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HomeMy WebLinkAbout2013-482 Housing - Caterina Phillips Sign Language Interpretation $1,000 �v � -3 ORANGE COUNTY COUNTYWIDE AMERICAN SIGN LANGUAGE INTERPRETER CONTRACT $15,000 OR LESS NORTH CAROLINA THIS AGREEMENT, made and entered into this 4th day of November, 2013, ("Effective Date") by and between Orange County,North Carolina, a body politic and corporate organized under the laws of the State of North Carolina, (the"County"),and Caterina Phillips(the"Provider"); WITNESSETH: For the purpose and subject to the following terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the following Interpretation Services (hereinafter referred to as "Services") to the County in accordance with the terms of this Agreement,time being of the essence. 1. Contract. This Contract consists of this document and additional documents checked below: a. For Health Department: i. ® Health Department Additional Terms and Conditions ii. ® Business Associates Agreement iii. ® Condition of Contract Statement b. For Department of Social Services: i. ❑ The General Terms and Conditions (Attachment A); ii. ® The Scope of Work, description of services, and rate(Attachment B); iii. ® Federal Certification Regarding Drug-Free Workplace(Attachment C); iv. ® Conflict of Interest(Attachment D); v. ® No Overdue Taxes (Attachment E); vi. ❑ Outcomes and Reporting(Attachment N) These documents constitute the entire agreement between the Parties and supersede all prior oral or written statements or agreements. 2. Provider's Responsibilities: a. The Provider shall be qualified to interpret between English and American Sign Language with the client and County staff. b. Professional Conduct. The Provider shall adhere to the standards of professional conduct of an interpreter while conducting the services to include the following: i. The Provider shall relate to all County clients and staff in a respectful and professional manner. ii. The Provider will interpret the information being shared between client/family and staff as clearly as possible, without additional personal comments or biases on the topic being discussed. Revised November 2013 1 iii. The Provider will interpret the information to the best of his/her ability. iv. The Provider shall provide OCHD with documentation of a valid NC interpreting nd transliterating license and proof of certification through the Registry of Interpreters for the Deaf(RID). v. The Provider will follow the National Association of the Deaf — Registry of Interpreters for the Deaf (NAD-RID) Code of Professional Conduct which can be found at http://www.rid.org/lJserFiles/File/NAD RID ETHICS pdf and is hereby incorporated by reference. c. Client Confidentiality. i. The Provider acknowledges that she/he may have access to information that is confidential and provided by state and federal laws and agrees to comply with all privacy policies, regulations, and laws as well as the Health Insurance Portability and Accountability Act(HIPAA)of 1996 (P.L.104-191). ii. The Provider agrees to protect confidential information (e.g., client name, appointment type, telephone number, health information)that he/she may receive in doing business with County. The Provider should ensure proper, safe storage and protection of client information during use, and shredding/deletion of such information when it is no longer necessary for business purposes. iii. Breaches of client confidentiality will result in automatic termination of this Agreement. d. Scope of Services. i. Procedures and Guidelines Upon Acceptance of an Interpretation Assignment: 1. The Provider agrees to give at least 24 hour notice if he/she is unable to participate in a scheduled client contact. 2. The Provider will NOT be expected to make confirmation phone calls to clients in advance of an assigned appointment. Furthermore, it is not acceptable for the Provider to give out his/her home telephone number or cell phone number for later contact between the client and Provider. If asked, the Provider should generally instruct clients to call the Health Department front desk staff to schedule an appointment or to inquire about services. 3. County's Responsibilities. County will compensate Provider as provided in subsection 4 for interpretation services at the rate prescribed. The Provider will record start and finish time worked to the minute. After the first two hours of service, payment will be calculated and paid per minute. Per hour reimbursement will begin at the time the Provider meets with County staff for the appointment. There will be a minimum of two (2) hours of service for an appointment. County will reimburse the Provider for two (2) hours of interpretation service in the event of a same day cancelled appointment. That includes appointments for clients who do not show up for an appointment, and for those who cancel an appointment with less than 24 hour notice. The County will not reimburse the Provider if an appointment is cancelled with more than 24 hours of notice. Revised November 2013 2 4. Payment for Services: The County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. The amount to be paid by the County shall not exceed $1,000 ($35/hour for Interpretation Services). Payment shall be made within thirty(30) days of an invoice properly submitted to County. Should Provider fail to perform its duties under the terms of this Agreement, County may,without fault or penalty,withhold any payment associated with the work to be performed until such time as said work is completed. The procedures for payment of services rendered shall be as follows: a. The Provider. The Provider will complete and submit the County Invoice for Payment of Interpretation Services form to County staff at the time the service is rendered. County staff will verify the information, sign and forward the form for payment of services. b. For interpretation services: i. The Provider will record the start and finish time worked to the minute. After the first hour of service,payment will be calculated and paid per minute. ii. The Provider shall submit one invoice per client, unless there is a block of appointments without interruption. Without interruption means that there were no cancelled appointments and no lunch hour included. This is appropriate for a group of clients who are served for the same type of appointment, at the same location. For question,contact the departmental contact. iii. In the event of a cancelled appointment, the Provider is required to stay until relieved of duty by the individual in charge. County staff may require other interpreter-related services in place of the scheduled appointment. As stated above, the Provider may submit an invoice in the event of a broken appointment (with less than 24 hour notice). iv. If the Provider is assisting County staff with a large volume of phone calls outside of a scheduled appointment time, the Provider should complete a Call Log to submit along with an invoice describing the services performed. This type of service is paid by the minute,without a one hour minute requirement for payment. v. In the case of an unexpected closing or delayed opening(e.g., inclement weather) of the County Offices when providing interpretation services, the Provider shall not be paid for missed appointments. When in doubt,the Provider can call 732-8181 to see if county offices are open or are on a delayed schedule. When possible,the Provider is also asked to help call his/her scheduled clients to inform them of the delay or closing. 5. Term.. The term of this Agreement shall be from November 4,2013 to June 30, 2014. 6. Errors and Omissions. Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. Revised November 2013 3 7. Additional Terms and Condition. The County may have additional terms and condition that shall be provided as attachment 1, and shall be attached and are hereby incorporated by reference. 8. 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 this contract document having the highest precedence then the first listed document and the last-listed document having the lowest precedence. If there are multiple Contract Amendments, the most recent amendment shall have the highest precedence and the oldest amendment shall have the lowest precedence. 9. Non—waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same,nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non-Waiver Clause. 10. Independent Contractor: The Provider shall operate as an independent Provider, and the County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or workers' compensation purposes. The Provider understands that neither federal, nor state, nor shall payroll tax of any kind be withheld or paid by the County on behalf of the Provider or the employees of the Provider. 11. Insurance: Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by Owner's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at http://oran eg count goy/purchasina/contracts asp). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. 12. Indemnity: The Provider agrees to defend,indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider. 13. Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. 14. Entire Agreement: The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. Modifications may be evidenced by telefacsimile signature. 15. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Should either party initiate litigation to settle any dispute involving the Revised November 2013 4 terms of this Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws,rules, and regulations including but not limited to all anti-discrimination laws. Pursuant to the terms of North Carolina General Statute 153A-449(b) no county may enter into a contract with a contractor unless the contractor and the contractor's subcontractors comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the General Statutes constitutes Provider's breach of this Agreement. By executing this Agreement Provider affirms Provider is in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. 16. Non Appropriation: Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County's obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement, effective as of the day first written above. ORANGE O PROVIDER: Caterina Phillips li �i�"'`Q,Q��S By: By: ri o ty a ager Title: ASS ii:Ee� 200 S. Cameron St. P.O.Box 8181 Hillsborough,NC 27278 This i trument has been pp ved as to technical content. a L.Fik ,Housing,Housing and Community Development Department Director This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. Clarence G. Grier, Asst. County Manager/CFO &Ti has been approved as to form and legal sufficiency. AnVette M.Moore, ff Attorney Revised November 2013 5 Health Department(hereinafter referred to as"OCHD") Additional Terms and Conditions These are additional terms and conditions to the Agreement between Orange County and the (PROVIDER)to the Countywide Interpreter Translator Contract of$15,000 or less. The additional terms and conditions shall supersede any terms in the original contract and are hereby incorporated as follows: Add to Section 2.b. vi. The Provider is required to sign the OCHD Conditions of Contract Statement containing the confidentiality, Title X and public health activities in emergency situations information which is hereby incorporated by reference. Add to Section 2.d.i.3 the following sentence: The Provider should generally instruct clients to call the Health Department front desk staff or the Spanish voicemail line at 644-3350 (when language appropriate) to schedule an appointment or to inquire about services. Add Section 2.e. e. Medical Documentation. i. The Provider is required to provide proof of immunity to varicella, measles, mumps and rubella prior to inception of contract work. Proof of immunity must be one of the following: medical records diagnosing the disease, laboratory records confirming the disease, laboratory records documenting positive disease titers, or medical records documenting receipt of 2 doses of each vaccine. (Exception: If the Provider has documentation of only one dose of vaccine, the Provider must provide documentation of a second dose within 60 days of the first day of contract work.) The Provider is responsible for covering all costs associated with acquiring any necessary titers, medical diagnosis or laboratory confirmation of disease or vaccinations. ii.The Provider is required to get a TB screening and provide those results to OCHD prior to beginning contract work. The Provider is responsible for the costs associated with acquiring such screening. The screening can be one of the following: 1. Receipt of a TB skin test (TST) if the Provider has no history of TB infection/disease or of a positive TST(Note: If the Provider has not had an additional TST within the previous 12 months, a second TST will be required one week after the first to establish an accurate baseline.) Revised November 2013 6 2. Completion of a TB Screening Form by a medical provider if the Provider has a history of TB disease or of having a positive TST. Replace Section 3 with the following paragraph: 3. County's Responsibilities. County will compensate Provider as provided in subsection 4 for interpretation and translation services at the rate prescribed. Per hour reimbursement will begin at the time the Provider meets with County staff for the appointment and ends at the time the staff and interpreter contact is completed. There will be a minimum of one (1) hour of service for an appointment. OCHD will reimburse the Provider for one (1)hour of interpretation service in the event of a same day cancelled appointment. That includes appointments for clients who do not show up for an appointment, and for those who cancel an appointment with less than 24 hour notice. Exception: "Family"Refugee Health Assessment (communicable disease and/or physical exam) appointments with 3 or more family members will only be reimbursed for a total of two (2) hours in the case of same day cancelled appointments. OCHD will not reimburse the Provider if an appointment is cancelled with more than 24 hour notice. Add to Section 4.b.iii the following sentence: ii. In the event of a cancelled appointment,the Provider is required to stay until relieved of duty by the nurse supervisor or the individual in charge of clinical operations. OCHD staff may require other interpreter-related services in place of the scheduled appointment. As stated above, the Provider may submit an invoice in the event of a broken appointment (with less than 24 hour notice). Revised November 2013 7 BUSINESS ASSOCIATE AGREEMENT This Agreement is made effective the 4th of November, 2013, by and between Orange County on behalf of the Orange County Health Department, hereinafter referred to as "Covered Entity", and Caterina Phillips, hereinafter referred to as "Business Associate," (individually, a "Party" and collectively, the "Parties"). WITNESSETH: WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, known as "the Administrative Simplification provisions," direct the Department of Health and Human Services to develop standards to protect the security, confidentiality and integrity of health information; and WHEREAS, pursuant to the Administrative Simplification provisions, the Secretary of Health and Human Services has issued regulations modifying 45 CFR Parts 160 and 164 (the "HIPAA Security and Privacy Rule"); and WHEREAS, the Parties wish to enter into or have entered into an arrangement whereby Business Associate will provide certain services to Covered Entity, and, pursuant to such arrangement, Business Associate may be considered a "business associate" of Covered Entity as defined in the HIPAA Security and Privacy Rule (the agreement evidencing such arrangement is entitled Countywide American Sign Language Interpreter Contract ($15,000 or less) , dated November 4, 2013, and is hereby referred to as the "Arrangement Agreement"); and WHEREAS, Business Associate may have access to Protected Health Information (as defined below) in fulfilling its responsibilities under such arrangement; THEREFORE, in consideration of the Parties' continuing obligations under the Arrangement Agreement, the Parties agree to the provisions of this Agreement in order to address the requirements of the HIPAA Security and Privacy Rule and to protect the interests of both Parties. 1. DEFINITIONS Except as otherwise defined herein, terms used in this Agreement shall have the same meaning as those terms set forth in the HIPAA Security and Privacy Rule. II. CONFIDENTIALITY REQUIREMENTS (a) Business Associate shall: (i) use or disclose any protected health information solely as permitted or required by this Agreement, the Arrangement Agreement (if consistent with this Agreement and the HIPAA Security and Privacy Rule), or as required by law. (ii) ensure that its agents, including a subcontractor, to whom it provides protected health information received from or created by Business Associate on behalf of Covered Entity, agrees to the same restrictions and conditions that apply to Business Associate with respect to such 2 information. In addition, Business Associate agrees to take reasonable steps to ensure that its employees' actions or omissions do not cause Business Associate to breach the terms of this Agreement; (iii) implement appropriate safeguards to prevent use or disclosure of protected health information other than as permitted or required by this Agreement; (iv) permit the Secretary of Health and Human Services to audit Business Associate's records and practices related to use and disclosure of protected health information to ensure Covered Entity's compliance with the terms of the HIPAA Security and Privacy Rule; (v) report to Covered Entity any use or disclosure of protected health information which is not in compliance with the terms of this Agreement of which it becomes aware; (vi) report to Covered Entity any Security Incident of which it becomes aware. For purposes of this Agreement, "Security Incident" means the attempted or successful unauthorized access, use disclosure, modification, or destruction of information or interference with system operations in an information system; and (vii) mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of protected health information by Business Associate in violation of the requirements of this Agreement. (b) Notwithstanding the prohibitions set forth in this Agreement or the Arrangement Agreement, Business Associate may use and disclose protected health information as follows: (i) if necessary, for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided that as to any such disclosure, the following requirements are met: (A) the disclosure is required by law; or (B) Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will be held confidentially and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached; (ii) for data aggregation services, if such services are to be provided by Business Associate for the health care operations of Covered Entity pursuant to any agreements between the Parties evidencing their business relationship. III. AVAILABILITY OF PROTECTED HEALTH INFORMATION Business Associate shall: (a) at the request of Covered Entity, provide access to protected health information in a designated record set to Covered Entity or, as directed by Covered Entity, to an individual, in a time and manner sufficient to permit Covered Entity to comply with the requirements of 45 CFR 164.524. 3 (b) at the request of Covered Entity or an individual, make any amendment(s) to protected health information in a designated record set that are directed by or agreed to by Covered Entity, in a time and manner sufficient to permit Covered Entity to comply with the requirements of 45 CFR 164.526. (c) document disclosures of protected health information and information related to such disclosures in a manner sufficient to permit Covered Entity to respond to a request by an individual for an accounting of disclosures of protected health information in accordance with 45 CFR 164.528 and provide such documentation to Covered Entity or an individual as directed by Covered Entity. IV. TERMINATION (a) Term: This Agreement terminates when the Arrangement Agreement terminates or as provided in Paragraph IV.b. below (termination for cause). (b) Termination for cause: Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity shall either: (i) provide an opportunity for Business Associate to cure the breach or end the violation or, if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity, terminate this Agreement and the Arrangement Agreement; or (ii) immediately terminate this Agreement and the Arrangement Agreement if Business Associate has breached a material term of this Agreement and cure is not possible. (c) Return or destruction of protected health information: At termination of this Agreement, the Arrangement Agreement (or any similar documentation of the business relationship of the Parties), or upon request of Covered Entity, whichever occurs first, Business Associate shall: (i) if feasible, return or destroy all protected health information received from or created or received by Business Associate on behalf of Covered Entity that Business Associate still maintains in any form. Business Associate shall only destroy protected health information with the written approval of Covered Entity. After return or destruction, Business Associate shall retain no copies of such information. (ii) if return or destruction is not feasible, Business Associate will provide Covered Entity with documentation explaining the reason that it is not feasible. If the protected health information is not returned or destroyed, Business Associate will extend the protections of this Agreement to the information and limit further uses and disclosures to those purposes that make the return or destruction of the information not feasible. (d) Survival: The obligations of Business Associate under this Agreement shall survive the expiration, termination, or cancellation of this Agreement, the Arrangement Agreement and/or the business relationship of the parties, and shall continue to bind Business Associate, its agents, employees, contractors, successors, and assigns as set forth herein. V. MISCELLANEOUS 4 (a) All protected health information that is created or received by Covered Entity and disclosed or made available in any form, including paper record, oral communication, audio recording, and electronic display by Covered Entity or its operating units to Business Associate or is created or received by Business Associate on Covered Entity's behalf shall be subject to this Agreement. (b) A reference in this Agreement to a section in the HIPAA Security and Privacy Rule means the section as in effect or as amended. (c) In the event of an inconsistency between the provisions of this Agreement (including definitions) and mandatory provisions of the HIPAA Security and Privacy Rule, as amended, the HIPAA Security and Privacy Rule shall control. Where provisions of this Agreement are different than those mandated in the HIPAA Security and Privacy Rule, but are nonetheless permitted by the HIPAA Security and Privacy Rule, the provisions of this Agreement shall control. (d) Except as expressly stated herein or the HIPAA Security and Privacy Rule, the parties to this Agreement do not intend to create any rights in any third parties. (e) This Agreement may be amended or modified only in a writing signed by the Parties. No Party may assign its respective rights and obligations under this Agreement without the prior written consent of the other Party. None of the provisions of this Agreement are intended to create, nor will they be deemed to create any relationship between the Parties other than that of independent parties contracting with each other solely for the purposes of effecting the provisions of this Agreement and any other agreements between the Parties evidencing their business relationship. (f) This Agreement will be governed by the laws of the State of North Carolina. (g) No change, waiver or discharge of any liability or obligation hereunder on any one or more occasions shall be deemed a waiver of performance of any continuing or other obligation, or shall prohibit enforcement of any obligation, on any other occasion. (h) The parties agree that, in the event that any documentation of the arrangement pursuant to which Business Associate provides services to Covered Entity contains provisions relating to the use or disclosure of protected health information that are more restrictive than the provisions of this Agreement, the provisions of the more restrictive documentation will control. (i) In the event that any provision of this Agreement is held by a court of competent jurisdiction to be invalid or unenforceable, the remainder of the provisions of this Agreement will remain in full force and effect. (j) The headings in this Agreement are for convenience of reference only and shall not define or limit any of the terms or provisions hereof. 5 IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and year written above. COVERED TTY: BUSINESS ASSOCIATE: B : ey: Y Titl fij Title: Lj 6 ORANGE COUNTY HEALTH DEPARTMENT Contracted Interpreters Conditions of Contract Statement Confidentiality As a Contract Interpreter for Orange County Health Department(OCHD), I acknowledge that I may have access to information that is confidential as mandated by state and federal law, HIPAA regulation and/or Orange County policy. I recognize my legal obligation as a Contractor to maintain the confidentiality of information about former and current recipients of OCHD services. I understand that release of information determined to be confidential by law to unauthorized persons may result in criminal prosecution. I further understand that the failure to maintain legally required confidentiality of information constitutes "misconduct"within the meaning of the Orange County Personnel Ordinance and may lead to disciplinary action, including termination of contract. If a question arises regarding whether a release of information may be public record vs. confidential client information, I will seek assistance from an OCHD Clinic Manager. Title X Information Requirement OCHD provides services solely on a voluntary basis. A client's acceptance of service is not a prerequisite to eligibility or receipt of a non-Title X service (Family Planning). As an OCHD Contract Interpreter, you may be subject to prosecution under Federal law if you coerce or endeavor to coerce any person to undergo an abortion or a sterilization procedure. As an Interpreter, your responsibility is to convey the message from the provider to the client to the best of your ability,without prejudice or personal bias. If you are present when an OCHD employee attempts to coerce a person to undergo an abortion or a sterilization procedure, discontinue interpreting, and report this to the Clinic Manager. Public Health Activities in Emergency Situations In order to fulfill the responsibilities of the department in emergency situations or in training, and due to our limited number of bilingual staff, you may be asked to work at emergency shelters or other locations designated by the Health Director or emergency operations. You may also be asked to participate in emergency drills and exercises. As a Contractor, you do have the right to decline any of these special requests. I certify that I have read and understand the conditions stated above. I have had an opportunity to discuss the conditions and requirements of my contract with a designated agency representative. Contractor Name: OJ e 2.+V1 0, p h Id l I P 5 Date: Contractor Signature: I Date: l ` OCHD Representative: Date: \.."iVL4 Contract Catering Phillips ATTACHMENT B SCOPE OF WORK Orange County Department of Social Services Federal Tax Id. or SSN Contract# A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Catering,Phillips 2. If different from Contract Administrator Information in General Contract: Address Telephone Number: Fax Number: Email: 3. Name of Program (s): Interpreter Services 4. Status: ( ) Public ( )Private,Not for Profit (X) Private, For Profit 5. Contractor's Financial Reporting Year July 1, 2013 through June 30, 2014 B. Explanation of Services to be provided and to whom (include SIS Service Code): C. Rate per unit of Service (define the unit): 1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) 2. Negotiated County Rate. $35.00/hour - Interpretation D. Number of units to be provided: E. Details of Billing process and Time Frames; The County will reimburse the Contractor for services described in this contract up to the budgetary limits of the contract allotment The County will reimburse the Contractor at a rate of$35.00/hour for approved services provided and travel at the county rate. For reimbursement the Contractor must submit the Orange County Department of Social Services Invoice for Payment of Interpreting Services form to the County staff at the time services are rendered. County staff will verify the information, sign the form, and forward the form to the designated County Administrator. The County will reimburse the Contractor monthly upon receipt of a complete and correctly filed report. Contract-Scope of Work(06/04) Page I of 2 Contract Caterina Phillips Per hour reimbursement will begin at the time the Contractor meets with County staff for the appointment and ends when the County staff and Contractor contact is completed. There will be a minimum of 1 hour of service for an appointment. Mileage reimbursement will be for round trip from the Contractor's home or work site to the prearranged appointment site F. Area to be serve elivery site ): Orange Count ( ignature of my ut o ized erson) (Signature of Contractor) 3 (Date§u bmitte (Date Submitted) Contract-Scope of Work(06/04) Page 2of 2 ATTACHMENT C CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Orange County Department of Social Services I. By execution of this Agreement the Contractor certifies that it will provide a drug-free workplace by: A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing,possession or use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; B. Establishing a drug-free awareness program to inform employees about: (1) The dangers of drug abuse in the workplace; (2) The Contractor's policy of maintaining a drug-free workplace; (3)Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph(A); D. Notifying the employee in the statement required by paragraph(A)that, as a condition of employment under the agreement,the employee will: (1)Abide by the terms of the statement; and (2)Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; E. Notifying the County within ten days after receiving notice under subparagraph(D)(2) from an employee or otherwise receiving actual notice of such conviction; F. Taking one of the following actions, within 30 days of receiving notice under subparagraph(D)(2), with respect to any employee who is so convicted: (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (A), (B), (C), (D), (E), and(F). Federal Certification-Drug-Free Workplace(06/04) Pagel of 2 II. The site(s)for the performance of work done in connection with the specific agreement are listed below: 1. 113 Mayo Street (Street address) Hillsborough, Orange,NC, 27278 (City, county, state, zip code) 2. 2501 Homestead Road (Street address) _ Chapel Hill, Orange,NC, 27516 (City, county, state, zip code) Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment, suspension or termination of grants, or government-wide Federal suspension or debarment (Section 4 CFR Part 85, Section 85.615 and 86.620). cl Al—� Signature Title /- Agency/Organization Date (Certification signature should be same as Contract signature.) Federal Certification-Drug-Free Workplace(06/04) Page 2 of 2 ATTACHMENT D CONFLICT OF INTEREST POLICY Orange County Department of Social Services Conflict of Interest Defined: A conflict of interest is defined as an actual or perceived interest by a(Contractor/staff member/Board member) in an action that results in, or has the appearance of resulting in, personal, organizational, or professional gain. A conflict of interest occurs when an employee/Contractor/Board member has a direct or fiduciary interest in another relationship. A conflict of interest could include: ➢ Ownership with a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. ➢ Employment of or by a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. ➢ Contractual relationship with a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. ➢ Creditor or debtor to a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. ➢ Consultative or consumer relationship with a member of the Board of Directors/Trustees or an employee where one or the other has supervisory authority over the other or with a client who receives services. The definition of conflict of interest includes any bias or the appearance of bias in a decision-making process that would reflect a dual role played by a member of the organization or group. An example, for instance, might involve a person who is an employee and a Board member, or a person who is an employee and who hires family members as consultants. Employee/Contractor/Board Member Responsibilities: It is in the interest of the organization, individual staff, and Board members to strengthen trust and confidence in each other, to expedite resolution of problems,to mitigate the effect and to minimize organizational and individual stress that can be caused by a conflict of interest. Employees are to avoid any conflict of interest, even the appearance of a conflict of interest. This organization serves the community as a whole rather than only serving a special interest group. The appearance of a conflict of interest can cause embarrassment to the organization and jeopardize the credibility of the organization. Any conflict of interest, potential conflict of interest, or the appearance of a conflict of interest is to be reported to your supervisor immediately. Employees are to maintain independence and objectivity with clients,the community, and organization. Employees are called to Conflict of Interest Policy(06/04) Page 1 of 2 maintain a sense of fairness, civility,ethics and personal integrity even though law, regulation,or custom does not require them. Acceptance of Gifts: Employees,members of employee's immediate family,and members of the Board are prohibited from accepting gifts,money or gratuities from the following: a. Persons receiving benefits or services from the organization; b. Any person or organization performing or seeking to perform services under contract with the organization; and c. Persons who are otherwise in a position to benefit from the actions of any employee of the organization. Employees may, with the prior written approval of their supervisor,receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. If the employee is acting in any official capacity, honoraria received by an employee in connection with activities relating to employment with the organization are to be paid to the organization. NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of Orange I, (�out 212.1 h L'A /[I✓2 T , certify that I have read the forgoing information, understand it, and that no conflict of interest exists in the execution of this contract. Signature- Sworn to and subscribed before me on the day of_�CV, 2013. j 0�. My Commission Expires 17 (Notary Signature ano eal) Conflict of Interest Policy(06/04) Page 2 of 2 Exhibit E November 4, 2013 Caterina Phillips 1403 Woodburn Rd. Durham,NC 27705 To: Orange County Department of Social Services Certification: I certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1,at the federal, State, or local level. I further understand that any person who makes a false statement in violation of N.C.G.S. 143-6.2(b2) is guilty of a criminal offense punishable as provided by N.C.G.S. 143-34(b). Sworn Statement: I, being duly sworn, say that I am Caterina Phillips and that the foregoing certification is true, accurate and complete to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Signature Sworn to and subscribed before me on the day of 2013. My Commission Expires: Z.. 7 (Notary Signature Seal)