HomeMy WebLinkAbout2013-257 DSS - Dispute Settlement Center in to Assist County with Safety and self-sufficience $10,000 Contract#68-1012
The Dispute Settlement Center,Inc.
Contract#�68-1012 Fiscal Year Begins_Julyl,2013 Ends June 30,2014
This contract is hereby entered into by and between the Orange County Department of Social Services(the"County")and The
Dispute Settlement Center, Inc. (the "Contractor") (referred to collectively as the "Parties"). The Contractor's federal tax
identification number or Social Security Number is
1. Contract Documents: This Contract consists of the following documents
(1) This contract
(2) The General Terms and Conditions(Attachment A)
(3) The Scope of Work,description of services,and rate(Attachment B)
(4) Federal Certification Regarding Drug-Free Workplace&Certification Regarding Nondiscrimination(Attachment C)
(5) Conflict of Interest(Attachment D)
(6) No Overdue Taxes(Attachment E)
(7) IRS Federal Tax Exempt Letter or 501(c)(3)(Attachment K)
(8) Outcomes and Reporting(Attachment N)
(9) Contract Determination Questionnaire
These documents constitute the entire agreement between the Parties and supersede all prior oral or written statements or
agreements.
2. Precedence Among Contract Documents: In the event of a conflict between or among the terms of the Contract
Documents, the terms in the Contract Document with the highest relative precedence shall prevail. The order of
precedence shall be the order of documents as listed in Paragraph 1, above, with the first-listed document having the
highest precedence and the last-listed document having the lowest precedence. If there are multiple Contract
Amendments,the most recent amendment shall have the highest precedence and the oldest amendment shall have the
lowest precedence.
3. Effective Period: This contract shall be effective on July 1,2013 and shall terminate on June 30, 2014.
This contract must be twelve months or less.
4. Contractor's Duties: The Contractor shall provide the services and in accordance with the approved rate as described in
Attachment B, Scope of Work,and shall meet the requirements set forth in Attachment N,Outcomes and Reporting.
5. County's Duties: The County shall pay the Contractor in the manner and in the amounts specified in the Contract
Documents. The total amount paid by the County to the Contractor under this contract shall not exceed$10,000. This
amount consists of$10,000 in Federal (CFDA # ), State and County funds, $0 (source of other funds if
applicable).
[X] a.There are no matching requirements from the Contractor.
[ ] b.The Contractor's matching requirement is$ ,which shall consist of:
[ ] In-kind [ ] Cash
[ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed$10,000.
6. Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22&23 and OMB Circular A-133.
7. Payment Provisions:
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Payment shall be made in accordance with the Contract Documents as described in the Scope of Work,
Attachment B.
8. Contract Administrators: All notices permitted or required to be given by one Party to the other and all questions about
the contract from one Party to the other shall be addressed and delivered to the other Party's Contract Administrator. The
name,post office address,street address,telephone number,fax number,and email address of the Parties'respective initial
Contract Administrators are set out below. Either Party may change the name, post office address, street address,
telephone number,fax number,or email address of its Contract Administrator by giving timely written notice to the other
Party.
For the County:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Sharron Hinton,Community Services Manager Sharron Hinton,Community Services Manager
Orange County Department of Social Services Orange County Department of Social Services
P.O. Box 8181 113 Mayo Street
Hillsborough,NC 27278 Hillsborough,NC 27278
(919)245-2840
shinton co.oran e.nc.us
Program Contact:
Robert Gilmore, Work First Manager
Orange County Department of Social Services
P.O. Box 8181
300 West Tryon Street
Hillsborough,NC 27278
(919)245-2847
rSilmore@co.qrgnge.nc.us
For the County:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Denise Shaffer, Social Work Program Director Denise Shaffer, Social Work Program Director
Orange County Department of Social Services Orange County Department of Social Services
P.O.Box 8181 2501 Homestead Road
Hillsborough,NC 27278 Chapel Hill,NC 27516
(919)245-2246
dshaffer co.oran e.nc.us
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Contract#68-1012
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Program Contact:
Duston Lowell,Program Manager
Orange County Department of Social Services
113 Mayo Street
Hillsborough,NC 27278
(919)245-2857
dIowell&oranMcopptync.gov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Frances Henderson Frances Henderson
The Dispute Settlement Center, Inc. The Dispute Settlement Center, Inc.
302 West Weaver Street 302 West Weaver Street
Carrboro,NC 27510 Carrboro,NC 27510
(919)929-8800
9. No Assignment or Sub-Contract: Contractor shall not sub-contract out any of the services provided for in this
Agreement or make any assignment of this Agreement(including rights to payments)without the prior written Consent of
the County as specified more fully in Attachment A,General Terms and Conditions.
10. Supplementation of Expenditure of Public Funds: The Contractor assures that funds received pursuant to this contract
shall be used only to supplement, not to supplant, the total amount of federal, state and local public funds that the
Contractor otherwise expends for contract services and related programs.Funds received under this contract shall be used
to provide additional public funding for such services; the funds shall not be used to reduce the Contractor's total
expenditure of other public funds for such services.
11. Disbursements: As a condition of this contract, the Contractor acknowledges and agrees to make disbursements in
accordance with the following requirements:
a. Implement adequate internal controls over disbursements;
b. Pre-audit all vouchers presented for payment to determine:
i. Validity and accuracy of payment
ii. Payment due date
iii. Adequacy of documentation supporting payment
iv. Legality of disbursement
c. Assure adequate control of signature stamps/plates;
d. Assure adequate control of negotiable instruments;and
e. Implement procedures to insure that account balance is solvent and reconcile the account monthly.
12. Outsourcing to Other Countries: The Contractor certifies that it has identified to the County all jobs related to the
contract that have been outsourced to other countries,if any. The Contractor further agrees that it will not outsource any
such jobs during the term of this contract without providing notice to the County.
13. Federal Certifications: Individuals and Organizations receiving federal funds must ensure compliance with certain
certifications required by federal laws and regulations. The contractor is hereby complying with Certifications regarding
Nondiscrimination, Drug-Free Workplace Requirements, Environmental Tobacco Smoke, Debarment, Suspension,
Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor's authorized representative.
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14. Relationship of the Parties: Contractor is an independent contractor of the County.Contractor represents that it has or
will secure,at its own expense,all personnel required in performing the services under this Agreement. Such personnel
shall not be employees of or have any contractual relationship with the County. All personnel engaged in work under this
Agreement shall be fully qualified and shall be authorized or permitted under state and local law to perform such services.
It is further agreed by Contractor that it shall obey all State and Federal statutes,rules and regulations which are applicable
to provisions of the services called for herein. Neither Contractor nor any employee of the Contractor shall be deemed an
officer, employee or agent of the County.
15. Signature Warranty:
The undersigned represent and warrant that they are authorized to bind their principals to the terms of this agreement.
The Contractor and the County have executed this contract in duplicate originals,with one original being retained by each
party.
THE DISPUTE SETTLEMENT CENTER,INC.
Sign ture Date
Fri(,e s 'D ior-cf --
Printed Name Title
ORANGE COUNTY
Frank W. Clifton,Jr.,County. snag Date
This instrument has been approved as to technical content.
6-)-1 5-13
Nancy Cost n,Depart1nent of Social Services Director Date
This instrument has been pre- udited in the manner required by the Local Government Budget and Fiscal Control Act.
Clarence G.Grier,Asst.County Manager/CFO ate
This con at as be roved as to form and legal sufficiency.
)3
Annet4l.Moore, S ff Attorn y,County Attorney's Office D to
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Contract#68-1012
The Dispute Settlement Center,Inc.
ATTACHMENT A
GENERAL TERMS AND CONDITIONS
Orange County Department of Social Services
Relationships of the Parties the County or the Contractor,receiving services or benefits
under this contract shall be deemed an incidental
Independent Contractor: The Contractor is and shall be beneficiary only.
deemed to be an independent contractor in the performance
of this contract and as such shall be wholly responsible for
the work to be performed and for the supervision of its Indemnity and Insurance
employees. The Contractor represents that it has, or shall
secure at its own expense, all personnel required in Indemnification: The Contractor agrees to indemnify and
performing the services under this agreement. Such hold harmless the County and any of their officers,agents
employees shall not be employees of, or have any and employees,from any claims of third parties arising out
individual contractual relationship with the County. or any act or omission of the Contractor in connection with
the performance of this contract.
Subcontracting: The Contractor shall not subcontract any
of the work contemplated under this contract without prior Insurance: During the term of the contract,the Contractor
written approval from the County. Any approved at its sole cost and expense shall provide commercial
subcontract shall be subject to all conditions of this insurance of such type and with such terms and limits as
contract.Only the subcontractors specified in the contract may be reasonably associated with the contract. As a
documents are to be considered approved upon award of minimum, the Contractor shall provide and maintain the
the contract. The County shall not be obligated to pay for following coverage and limits:
any work performed by any unapproved subcontractor. (a) Worker's Compensation - The contractor shall
The Contractor shall be responsible for the performance of provide and maintain Worker's Compensation
all of its subcontractors. Insurance as required by the laws of North
Carolina,as well as employer's liability coverage
Assignment: No assignment of the Contractor's with minimum limits of$500,000.00,covering all
obligations or the Contractor's right to receive payment of Contractor's employees who are engaged in any
hereunder shall be permitted. However, upon written work under the contract. If any work is sublet,the
request approved by the issuing purchasing authority,the Contractor shall require the subcontractor to
County may: provide the same coverage for any of his
(a) Forward the Contractor's payment check(s) employees engaged in any work under the
directly to any person or entity designated by the contract.
Contractor,or (b) Commercial General Liability - General
(b) Include any person or entity designated by Liability Coverage on a Comprehensive Broad
Contractor as a joint payee on the Contractor's Form on an occurrence basis in the minimum
payment check(s). amount of$1,000,000.00 Combined Single Limit.
In no event shall such approval and action obligate the (Defense cost shall be in excess of the limit of
County to anyone other than the Contractor and the liability.)
Contractor shall remain responsible for fulfillment of all (c)Automobile Liability Insurance: The Contractor
contract obligations. shall provide automobile liability insurance with a
combined single limit of$500,000.00 for bodily
Beneficiaries: Except as herein specifically provided injury and property damage; a limit of
otherwise,this contract shall inure to the benefit of and be $500,000.00 for uninsured/under insured motorist
binding upon the parties hereto and their respective coverage; and a limit of$25,000.00 for medical
successors. It is expressly understood and agreed that the payment coverage. The Contractor shall provide
enforcement of the terms and conditions of this contract, this insurance for all automobiles that are:
and all rights of action relating to such enforcement,shall (a) owned by the Contractor and used in the
be strictly reserved to the County and the named performance of this contract;
Contractor.Nothing contained in this document shall give (b) hired by the Contractor and used in the
or allow any claim or right of action whatsoever by any performance of this contract; and
other third person.It is the express intention of the County (c) Owned by Contractor's employees and
and Contractor that any such person or entity, other than used in performance of this contract("non-
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The Dispute Settlement Center,Inc.
owned vehicle insurance"). Non-owned
vehicle insurance protects employers when
employees use their personal vehicles for Default and Termination
work purposes. Non-owned vehicle
insurance supplements, but does not Termination Without Cause: The County may terminate
replace,the car-owner's liability insurance. this contract without cause by giving 30 days written
notice to the Contractor.
The Contractor is not required to provide and maintain
automobile liability insurance on any vehicle—owned, Termination for Cause: If, through any cause, the
hired,or non-owned--unless the vehicle is used in the Contractor shall fail to fulfill its obligations under this
performance of this contract. contract in a timely and proper manner,the County shall
(d) The insurance coverage minimums specified in have the right to terminate this contract by giving written
subparagraph(a)are exclusive of defense costs. notice to the Contractor and specifying the effective date
(e) The Contractor understands and agrees that the thereof. In that event,all finished or unfinished deliverable
insurance coverage minimums specified in items prepared by the Contractor under this contract shall,
subparagraph (a) are not limits, or caps, on the at the option of the County, become its property and the
Contractor's liability or obligations under this contract. Contractor shall be entitled to receive just and equitable
(f) The Contractor may obtain a waiver of any one or more compensation for any satisfactory work completed on such
of the requirements in subparagraph (a) by materials,minus any payment or compensation previously
demonstrating that it has insurance that provides made. Notwithstanding the foregoing provision, the
protection that is equal to or greater than the coverage Contractor shall not be relieved of liability to the County
and limits specified in subparagraph(a). The County for damages sustained by the County by virtue of the
shall be the sole judge of whether such a waiver Contractor's breach of this agreement,and the County may
should be granted. withhold any payment due the Contractor for the purpose
(g) The Contractor may obtain a waiver of any one or more of setoff until such time as the exact amount of damages
of the requirements in paragraph(a)by demonstrating due the County from such breach can be determined. In
that it is self-insured and that its self-insurance case of default by the Contractor, without limiting any
provides protection that is equal to or greater than the other remedies for breach available to it,the County may
coverage and limits specified in subparagraph(a). The procure the contract services from other sources and hold
County shall be the sole judge of whether such a the Contractor responsible for any excess cost occasioned
waiver should be granted. thereby. The filing of a petition for bankruptcy by the
(h) Providing and maintaining the types and amounts of Contractor shall be an act of default under this contract.
insurance or self-insurance specified in this paragraph
is a material obligation of the Contractor and is of the Waiver of Default: Waiver by the County of any default
essence of this contract. or breach in compliance with the terms of this contract by
(i) The Contractor shall only obtain insurance from the Provider shall not be deemed a waiver of any
companies that are authorized to provide such subsequent default or breach and shall not be construed to
coverage and that are authorized by the Commissioner be modification of the terms of this contract unless stated
of Insurance to do business in the State of North to be such in writing, signed by an authorized
Carolina.All such insurance shall meet all laws of the representative of the County and the Contractor and
State of North Carolina. attached to the contract.
0) The Contractor shall comply at all times with all lawful
terms and conditions of its insurance policies and all Availability of Funds: The parties to this contract agree
lawful requirements of its insurer. and understand that the payment of the sums specified in
(k) The Contractor shall require its subcontractors to this contract is dependent and contingent upon and subject
comply with the requirements of this paragraph. to the appropriation, allocation, and availability of funds
(1) The Contractor shall demonstrate its compliance with for this purpose to the County.
the requirements of this paragraph by submitting
certificates of insurance to the County before the Force Majeure: Neither party shall be deemed to be in
Contractor begins work under this contract. default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
Transportation of Clients by Contractor: war,hostile foreign action,nuclear explosion,riot,strikes,
The contractor will maintain Insurance requirements if civil insurrection,earthquake,hurricane,tornado,or other
required as noted under Article 7 Rule R2-36 of the North catastrophic natural event or act of God.
Carolina Utilities Commission.
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Survival of Promises: All promises,requirements,terms, The Contractor will comply with the requirements of
conditions, provisions, representations, guarantees, and Section 106(g)of the Trafficking Victims Protection Act
warranties contained herein shall survive the contract of 2000,as amended(22 U.S.C.7104)
expiration or termination date unless specifically provided
otherwise herein, or unless superseded by applicable Confidentiality
Federal or State statutes of limitation.
Confidentiality: Any information, data, instruments,
Intellectual Property Rights documents, studies or reports given to or prepared or
assembled by the Contractor under this agreement shall be
Copyrights and Ownership of Deliverables: All kept as confidential and not divulged or made available to
deliverable items produced pursuant to this contract are the any individual or organization without the prior written
exclusive property of the County. The Contractor shall not approval of the County.The Contractor acknowledges that
assert a claim of copyright or other property interest in in receiving,storing,processing or otherwise dealing with
such deliverables. any confidential information it will safeguard and not
further disclose the information except as otherwise
Federal Intellectual Property Bankruptcy Protection provided in this contract.
Act: The Parties agree that the County shall be entitled to
all rights and benefits of the Federal Intellectual Property Oversight
Bankruptcy Protection Act,Public Law 100-506,codified
at 11 U.S.C. 365(n)and any amendments thereto. Access to Persons and Records: The State Auditor shall
have access to persons and records as a result of all
Compliance with Applicable Laws contracts or grants entered into by State agencies or
political subdivisions in accordance with General Statute
Compliance with Laws: The Contractor shall comply 147-64.7. Additionally,as the State funding authority,the
with all laws, ordinances, codes, rules, regulations, and Department of Health and Human Services shall have
licensing requirements that are applicable to the conduct of access to persons and records as a result of all contracts or
its business, including those of federal, state, and local grants entered into by State agencies or political
agencies having jurisdiction and/or authority. subdivisions.
Title VI,Civil Rights Compliance: In accordance with Record Retention: Records shall not be destroyed,
Federal law and U.S.Department of Agriculture(USDA) purged or disposed of without the express written consent
and U.S. Department of Health and Human Services of the County. The North Carolina State basic records
(HHS) policy, this institution is prohibited from retention policy requires all grant records to be retained for
discriminating on the basis of race,color,national origin, a minimum of five years or until all audit exceptions have
sex, age or disability. Under the Food Stamp Act and been resolved, whichever is longer. If the contract is
USDA policy, discrimination is prohibited also on the subject to federal policy and regulations,record retention
basis of religion or political beliefs. may be longer than five years since records must be
retained for a period of three years following submission of
Equal Employment Opportunity: The Contractor shall the final Federal Financial Status Report,if applicable,or
comply with all federal and State laws relating to equal three years following the submission of a revised final
employment opportunity. Federal Financial Status Report. Also, if any litigation,
claim, negotiation, audit, disallowance action, or other
Health Insurance Portability and Accountability Act action involving this Contract has been started before
(HIPAA): The Contractor agrees that, if the County expiration of the five-year retention period described
determines that some or all of the activities within the above,the records must be retained until completion of the
scope of this contract are subject to the Health Insurance action and resolution of all issues which arise from it, or
Portability and Accountability Act of 1996,P.L. 104-91, until the end of the regular five-year period described
as amended("HIPAA"),or its implementing regulations, above,whichever is later.
it will comply with the HIPAA requirements and will
execute such agreements and practices as the County Warranties and Certifications
may require to ensure compliance.
Date and Time Warranty: The Contractor warrants that
Trafficking Victims Protection Act of 2000 : the product(s) and service(s) furnished pursuant to this
contract("product"includes,without limitation,any piece
of equipment,hardware,firmware,middleware,custom or
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commercial software,or internal components,subroutines,
and interfaces therein)that perform any date and/or time Time of the Essence: Time is of the essence in the
data recognition function,calculation,or sequencing will performance of this contract.
support a four digit year format and will provide accurate
date/time data and leap year calculations. This warranty Executive Order#24: It is unlawful for any vendor,
shall survive the termination or expiration of this contract. contractor, subcontractor or supplier of the state to make
gifts or to give favors to any state employee. For
Certification Regarding Collection of Taxes: G.S. 143- additional information regarding the specific
59.1 bars the Secretary of Administration from entering requirements and exemptions,contractors are
into contracts with vendors that meet one of the conditions encouraged to review Executive Order 24 and G.S. Sec.
of G.S. 105-164.8(b)and yet refuse to collect use taxes on 133-32.
sales of tangible personal property to purchasers in North
Carolina. The conditions include: (a) maintenance of a Key Personnel: The Contractor shall not replace any of
retail establishment or office; (b) presence of the key personnel assigned to the performance of this
representatives in the State that solicit sales or transact contract without the prior written approval of the County.
business on behalf of the vendor; and (c) systematic The term "key personnel" includes any and all persons
exploitation of the market by media-assisted, media- identified as such in the contract documents and any other
facilitated, or media-solicited means. The Contractor persons subsequently identified as key personnel by the
certifies that it and all of its affiliates (if any) collect all written agreement of the parties.
required taxes.
Care of Property: The Contractor agrees that it shall be
Miscellaneous responsible for the proper custody and care of any property
furnished to it for use in connection with the performance
Choice of Law: The validity of this contract and any of its of this contract and will reimburse the County for loss of,
terms or provisions, as well as the rights and duties of the or damage to, such property. At the termination of this
parties to this contract,are governed by the laws of North contract, the Contractor shall contact the County for
Carolina.The Contractor,by signing this contract,agrees instructions as to the disposition of such property and shall
and submits,solely for matters concerning this Contract,to comply with these instructions.
the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive Travel Expenses: Reimbursement, if provided in this
venue for any legal proceedings shall be Orange County, Agreement, to the Contractor for travel mileage, meals,
North Carolina. The place of this contract and all lodging and other travel expenses incurred in the
transactions and agreements relating to it, and their situs performance of this contract shall not exceed the rates
and forum,shall be Orange County,North Carolina,where established in County policy.
all matters,whether sounding in contract or tort,relating to
the validity,construction,interpretation,and enforcement Sales/Use Tax Refunds: If eligible,the Contractor and all
shall be determined. subcontractors shall: (a) ask the North Carolina
Department of Revenue for a refund of all sales and use
Amendment: This contract may not be amended orally or taxes paid by them in the performance of this contract,
by performance. Any amendment must be made in written pursuant to G.S. 105-164.14; and (b) exclude all
form and executed by duly authorized representatives of refundable sales and use taxes from all reportable
the County and the Contractor. expenditures before the expenses are entered in their
reimbursement reports.
Severability: In the event that a court of competent
jurisdiction holds that a provision or requirement of this Advertising: The Contractor shall not use the award of
contract violates any applicable law, each such provision this contract as a part of any news release or commercial
or requirement shall continue to be enforced to the extent it advertising.
is not in violation of law or is not otherwise unenforceable
and all other provisions and requirements of this contract Orange County Living Wage: Orange County is
shall remain in full force and effect. committed to providing its employees with a living wage
and encourages agencies to which it provides funding to
Headings: The Section and Paragraph headings in these pursue the same goal. The County's living wage hourly
General Terms and Conditions are not material parts of the standard, as adopted by the Orange County Board of
agreement and should not be used to construe the meaning County Commissioners annually, can be found in the
thereof. Orange County Budget Ordinance. To the extent possible,
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Orange County recommends that the Contractor and all
subcontractors provide a living wage,as defined in this
section,to their employees.
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ATTACHMENT B
SCOPE OF WORK
Orange County Department of Social Services
Federal Tax Id.or SSN
Contract# 68-1012
A. CONTRACTOR INFORMATION
1. Contractor Agency Name:_ The Dispute Settlement Center, Inc.
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: 119'g2-q- f-k0d Fax Number:lr(9J4 2--6V Email
A- addpn
we
3. Name of Program(s): Conflict Resolution diTp d+ese�/`�r
4. Status: ( )Public (X)Private,Not for Profit ( )Private,For Profit
5. Contractor's Financial Reporting Year July 1,2013 through June 30,2014
B. Explanation of Services to be provided and to whom(include SIS Service Code): The
Contractor will assist the County in meeting goals of family safety and self-sufficiency by
providing Job Readiness/Conflict Resolution classes and Team Building workshops to Work First
participants(SIS Code 547) Communication/Conflict Resolution classes to families involved in
Child Welfare Services,and Communication/Conflict Resolution/Team Building training and
training curriculum and materials to Department of Social Services staff. The Contractor is
required to meet all goals and outcomes listed in Attachment N
C. Rate per unit of Service(define the unit):
1. If Standard Fixed Rate,Maximum Allowable,(See Rates for Services Chart)
2.Negotiated County Rate.
$75.00/hour
D.Number of units to be provided:
E.Details of Billing process and Time Frames; The Counly will reimburse the Contractor for
services described in this contract up to the budgetga limits of the contract allotment The
County will reimburse the Contractor at a rate of$75 00/hour for aRproved services provided For
reimbursement,the Contractor must submit an original and two copies of an invoice by the fifth
of the month for the preceding month's expenditures to the designated County Administrators
The County will reimburse the Contractor monthly upon receipt of a complete and correctly filed
report.
F.Area to be served/Delivery site(s): Orange County
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Nancy Coston ocia Services Director (Signature of Contractor)
0 -15' 0 �7 -Rs"l3
(Date Submitted) (Date Submitted)
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Orange County Department of Social Services
1. 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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II. The site(s)for the performance of work done in connection with the specific agreement are listed
below:
1 -3 02- W e cL ve, r-
(-
(Street address)
l Gi�� to wy N C Z 7 S / a
(City,county,state,zip code)
2.
(Street address)
(City,county,state,zip code)
Contractor will inform the County of any additional sites for performance of work under this agreement.
False certification or violation of the certification shall be grounds for suspension of payment,suspension
or termination of grants,or government-wide Federal suspension or debarment(45 C.F.R. Section
82.510. Section 4 CFR Part 85, Section 85.615 and 86.620).
CERTIFICATION REGARDING NONDISCRIMINATION
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination. These
include but are not limited to: (a)Title VI of the Civil Rights Act of 1964(P.L. 88-352)which prohibits
discrimination on the basis of race, color or national origin;(b)Title IX of the Education Amendments of
1972,as amended(20 U.S.C. §§1681-1683,and 1685-1686),which prohibits discrimination on the basis
of sex; (c)Section 504 of the Rehabilitation Act of 1973,as amended(29 U.S.C. §794),which prohibits
discrimination on the basis of handicaps; (d)the Age Discrimination Act of 1975, as amended(42 U.S.C.
§§6101-6107),which prohibits discrimination on the basis of age;(e)the Drug Abuse Office and
Treatment Act of 1972(P.L.92-255),as amended,relating to nondiscrimination on the basis of drug
abuse;(f)the Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment and Rehabilitation
Act of 1970(P.L.91-616), as amended,relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g)Title VIII of the Civil Rights Act of 1968(42 U.S.C. §§3601 et seq.), as amended,
relating to nondiscrimination in the sale,rental or financing of housing; (h)the Food Stamp Act and
USDA policy,which prohibit discrimination on the basis of religion and political beliefs; and(i)the
requirements of any other nondiscrimination statutes which may apply to this Agreement.
_4A-6tA,11 - ?
Signature Title
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Federal Certification-Drug-Free Workplace(07/10) Page 2 of 2
Dispute Settlement Center, Inc.
Conflict of Interest Policy
A. Agency officers, directors, employees, and agents are obligated to always act in the best
interest of the organization. This obligation requires that any officer, director, employee, or
agent, in the performance of Agency duties, seek only the furtherance of the Agency mission.
B. The officers, directors, employees, or agents of the Agency should neither solicit nor accept
gratuities, favors, or anything of monetary value from contractors/vendors. This is not intended
to preclude bona-fide Agency fund-raising activities.
C. No officer, director, employee or agent of the Agency shall participate in the selection,
award, or administration of a purchase or contract with a vendor where, to his knowledge, any of
the following has a financial interest in that purchase or contract:
1. the officer, director, employee, or agent;
2. any member of their immediate family;
3. their partner;
4. an organization in which any of the above is an officer, director, or employee;
5. a person or organization with whom any of the above individuals is negotiating or
has any arrangement concerning prospective employment.
D. Disclosure — Any possible conflict of interest shall be disclosed by the person or persons
concerned.
E. Board Action — When a conflict of interest is relevant to a matter requiring action by the
Board, the interested person(s) shall call it to the attention of the Board and said person(s) shall
not vote on the matter. In addition, the person(s) shall not participate in the final deliberation or
decision regarding the matter under consideration and shall leave the room during the vote of the
Board. When there is doubt as to whether a conflict exists, the matter shall be resolved by vote of
the Board, excluding the person(s) concerning whose situation the doubt has arisen.
F. Record of Conflict — The official minutes of the Board shall reflect that the conflict of
interest was disclosed and the interested person(s) was (were) present during the final discussion
or vote and did not vote on the matter.
Adopted by the Dispute Settlement Center,Inc. Board of Directors, 10/27/04
Approved by:
D,s P,,,,k S e T((,c_.tie y,r C c�
Name o rganization
. 14
Signa re of rga ization Official
9 � 3
Date
Contract#68-1012
The Dispute Settlement Center,Inc.
NOTARIZED CONFLICT OF INTEREST POLICY
State of North Carolina
County of Orange
I, fe-n 0 Notary Public for said County and State,
certify that (a c2s 3n r,(Zr�c�n personally appeared before me this
day and acknowledged that he/she is L e cwf we A 7'e cl"'— of
1) S C , zvl C- 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 9:'? day of ® Gc?( Z004
Sworn to and subscribed before me this day of J UJu �3
(O`(2 1 Seal)
Notary Public
My Commission expires&► AA 3
BRENDA B YOUNG
NOTARY PUBLIC
ORANGE COUNTY,NC
Conflict of Interest Policy(06/04) Page 3 of 3
Tour community resource for mediation,facit'tation, and conflict resolution.
July 9, 2013
TO: Orange County Department of Social Services
Certification
We certify that the Dispute Settlement Center, Inc. has no overdue tax debts,
as defined by N.C.G.S. 105-243.1 , at the federal, state, or local level. We
further understand that any person who makes a false statement in violation of
N.C.G.S. 143-6.2(b2) is guilty of a criminal offense punishable as provided by
N.C.G.S. 143-34(b).
Sworn Statement
Lisa Wagner and Frances Henderson, being duly sworn, say that they are the
President and Executive Director, respectively, of the Dispute` Settlement
Center, Inc. in the State of North Carolina; and that the foregoing certification is
true, accurate, and complete to the best of their knowledge and was made and
subscribed to by them. They also acknowledge and understand that any misuse
of State funds will be reported to the appropriate authorities for further action.
�— — --------- ------- -- --
-----------
Lisa Wagner, President G date
flt,� r_.._ ------- 47 !3--------
-- -------- -------------
Frances Henderson, Executive Director dat
9
(Lisa Wagner) Sworn to and subscribed bef rye ft he & of the date of
said
certification.
� G s 9FS
orf°> 1 N
Notary Pu is
(Frances Henderson) Sworn to and subscribed before me on the day of the date
of said certification.
YGIMG
Notary Pu is NOTARY
NTY,NC
302 West Weaver St,'Carrboro NC 27510
(919) 929-8800
www.disputesettlement.org Fax: (919) 942-6931
Contract#68-1012
The Dispute Settlement Center,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: December 13, 2004 P. O. Box 2508
Cincinnati, OH 45201
DISPUTE SETTLEMENT CENTER INC Person to Contact:
302 W WEAVER ST Lois Parrott 31-07342
CARRBORO NC 27510-6004 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 December 13, 2004, regarding your organization's tax-
exempt status.
In June 1979 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(b)(1)(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,
Janna K. Skufca, Director, TE/GE
Customer Account Services
Contract#68-1012
The Dispute Settlement Center,Inc.
ATTACHMENT N
OUTCOMES AND REPORTING
Orange County Department of Social Services
By signing and submitting this document,the Contractor certifies that it agrees to the following:
1. The Contractor agrees to participate in program, fiscal and administrative monitoring and/or audits,
making records and staff time available to Federal, State and County staff.
2. The Contractor agrees to take necessary steps for corrective action, as negotiated within a corrective
action plan,for any items found to be out of compliance with Federal, State,and County laws,regulations,
standards and/or terms of the Contract.
3. The Contractor agrees that continuation of and/or renewal of this Contract is contingent on meeting the
following requirements. The Contractor agrees to:
A. Provide Job Readiness/Conflict Resolution Workshops to Work First clients referred by the
County.
a. The maximum number of billable hours per class is 33 and includes all prep time.
B. Provide Team Building Workshops to Work First clients referred by the County.
a. The maximum number of billable hours per class is 6 and includes all prep time.
C. Provide Communication/Conflict Resolution classes to families or individuals involved with
Child Welfare Services and referred by the County per year.
a. The maximum number of billable hours per class is 27 and includes all prep time.
D. Submit invoices to the appropriate administrator.
a. Work First and staff training invoices to Sharron Hinton
b. Child Welfare Services invoices to Denise Shaffer
E. Help to ensure that 80%of Work First clients enrolled in classes obtain employment within 3
months of completion and maintain employment for at least 6 months after the class ends.
F. Help to ensure that 80%of clients referred through child welfare will have no instances or no
repeat instances of child maltreatment.
G. Maintain client records that date and document the service delivered to the individual,a valid
authorization for service,program records,and documents and other evidence that reflect
program operations.
H. Furnish information to the County,as requested,to support provision of service(s)pursuant to
this Contract and the full cost of the service;and submit changes,as needed or required for
review and approval by the County.
I. Maintain books,records, documents and other evidence and accounting procedures that reflect
all direct and indirect costs expended under this Contract. A current, complete inventory of all
equipment purchased under the terms of this Contract must be kept.
J. Retain all financial and program records for a period of three years from the date of final
payment under this agreement or until all audits continued beyond this period are completed.
Federal auditors and any persons authorized by the Division of Social Services or the County
shall have
the'right to examine any of these materials. ,( j�
G(�•GI LP�t. /fC.(.t !/r1 X� �M t Z V
SigLture Title
M 5 pct t .Celt e L-4 t"
Agenc /Organization Date
(Certification signature should be same as Contract signature.)
Outcomes (06/04) Page 1 of 1