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2015-316-E DSS - The Dispute Settlement Center, Inc. to assist the County in meeting goals of family safety and self-sufficiency to OC DSS clients $10,000
DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract 468-1012 The Dispute Settlement Center, Inc. Contract#_68-1012 Fiscal Year Begins 3uiv�, i.?O15_ _Ends June-130—, 2016 This contract is hereby entered into by and between the Orange County Department of Social Services(the The contractor's ederal tax Dispute Settlement Center, Inc. (the "Contractor") (referred to collectively as ) 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) State Certifications(Attachment M) (9) Outcomes and Reporting(Attachment N) (10) 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 tlamendme document lhall have the highest p ecedence and the oldest amendment multiple recent hall have the Amendments, the most lowest precedence. 3. Effective Period: This contract shall be effective on July 1,2015 and shall terminate on June 30,2016. This contract must be twelve months or less. 4. Contractor's Duties: The Contractor shall meet the requirements rements setforth accordance with the N, outcomes rate nd Reporting.in Attachment B, Scope of Work, and shall e9 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 State and Courant act hall of exceed othe 00. T is if amount consists of$10,000 in Federal (CFDA # applicable). [X] a. There are no matching requirements from the Contractor. [ ] b. The Contractor's matching requirement is$ ,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. Reversion of Funds: to the County Department of Social Services upon termination of this contract. Any unexpended grant funds shall revert 7. Reporting Requirements: Page 1 of 5 Contract-General (07110) DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center,Inc. Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 &2') and OMB Circular—CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106. 8. Payment Provisions: Payment shall be made in accordance with the Contract Documents as described in the Scope of Work, Attachment B. 9. 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 ofthe 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 a,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 r ilmore�co.oran e.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 dshafferk.co.gran e.nc.us Contract-General (07/10) Page 2 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract 468-1012 The Dispute Settlement Center,Inc. Program Contact: Duston Lowell, Program Manager Orange County Department of Social Services 113 Mayo Street Hillsborough, NC 27278 (919)245-2857 dlowell&orangCeountvnc. ov 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 10. 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. 11. 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. 12. 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. 13. 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. Contract-General (07/10) Page 3 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center, Inc. 14. 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. 15. 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 b Contractor that it shall obey al l State and Federal statutes,rules and regulations which are applicable g Y 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. 16. 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. Contract-General (07110) Page 4 of 5 I DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#b8-1012 The Dispute Settlement Center, Inc. CA0�3LAG4Pt PS TE SETTLEMENT CENTER,INC. hu, VVu 7/1/2015 T r5 C12 Signature Date Frances Henderson Executive Director Printed Name Title ORANGE COUNTY DocuSigned by: �jOV�,l�t,tt. l�auhw�t,V'S� 7/6/2015 os�ss�Ba-�s Bonnie Hammersley, County Manager Date This i has:been approved as to technical content. Na" (hS 61& 7/2/2015 7BAE QQ4UP .. Nancy Coston, Department of Social Services Director Date This r r►�+rlas been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. �� haw 7/6/2015 Paul Laughton, Interim Finance Director Date This asbbeen approved as to form and legal sufficiency. 1�M,_ 7/6/2015 Annette M.Moore, Staff Attorney, County Attorney's Office Date Contract-General (07/10) Page 5 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract 468-1012 The Dispute Settlement Center, Inc. ATTACHMENT A GENERAL TERMS AND CONDITIONS Orange County Department of Social Services Relationships of the Parties and Contractor that any such person or entity, other than the County or the Contractor,receiving services or benefits Independent Contractor: The Contractor is and shall be under this contract shall be deemed an incidental deemed to be an independent contractor in the performance beneficiary only. 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 Iimits 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 i s 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 General Terms and Conditions—(06/15) Page 1 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center, Inc. (c) Owned by Contractor's employees and The contractor will maintain Insurance requirements if used in performance of this contract("non- required as noted under Article 7 Rule R2-36 of the North owned vehicle insurance"). Non-owned Carolina Utilities Commission. 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. {j) 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, General Terms and Conditions—(06115) Page 2 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract 968-1012 The Dispute Settlement Center, Inc. civil insurrection,earthquake,hurricane,tornado,or other catastrophic natural event or act of God. Health Insurance Portability and Accountability Act (HIPAA): The Contractor agrees that, if the County Survival of Promises: All promises,requirements,terms, determines that some or all of the activities within the conditions, provisions, representations, guarantees, and scope of this contract are subject to the Health Insurance warranties contained herein shall survive the contract Portability and Accountability Act of 1996,P.L. 104-91, expiration or termination date unless specifically provided as amended ("HIPAA"), or its implementing regulations, otherwise herein, or unless superseded by applicable it will comply with the HIPAA requirements and will Federal or State statutes of limitation. execute such agreements and practices as the County may require to ensure compliance. Intellectual Property Rights (a) Data Security: The Contractor shall adopt and Copyrights and Ownership of Deliverables: All apply data security standards and procedures deliverable items produced pursuant to this contract are the that comply with all applicable federal, state and exclusive property of the County. The Contractor shall not local laws, regulations, and rules. assert a claim of copyright or other property interest in such deliverables. (b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the Federal Intellectual Property Bankruptcy Protection local Department of Social Services Contract Act: The Parties agree that the County shall be entitled to Administrator within twenty-four(24)hours all rights and benefits of the Federal Intellectual Property after the breach is first discovered, provided that Bankruptcy Protection Act,Public Law 100-506,codified the Contractor shall report a breach involving at 11 U.S.C. 365 (n) and any amendments thereto. Social Security Administration data or Internal Revenue Service Data within one(1)hour after Compliance with Applicable Laws the breach is first discovered. Compliance with Laws: The Contractor shall comply (c) Cost Borne by Contractor: If any applicable with all laws, ordinances, codes, rules, regulations, and federal, state, or local law,regulation or rule licensing requirements that are applicable to the conduct of requires the Contractor give written notice of a its business, including those of federal, state, and local security breach to affected persons,the Contract agencies having jurisdiction and/or authority. Pursuant to shall bear the cost of the notice. the terms of North Carolina General Statute 153A-449(b) no County may enter into a contract with a contractor Trafficking Victims Protection Act of 2000 unless the contractor and the contractor's subcontractors The Contractor will comply with the requirements of comply with the requirements of Article 2 of Chapter 64 of Section 106(g) of the Trafficking Victims Protection Act the North Carolina General Statutes. Where applicable, of 2000,as amended(22 U.S.C. 7104) failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the General Statutes constitutes Executive Order#24: It is unlawful for any vendor, Provider"s breach of this Agreement. By executing this contractor, subcontractor or supplier of the state to make Agreement Provider affirms Provider is in compliance with gifts or to give favors to any state employee. For Article 2 of Chapter 64 of the North Carolina General additional information regarding the specific Statutes. requirements and exemptions, contractors are encouraged to review Executive Order 24 and G.S. Sec. Title VI, Civil Rights Compliance: In accordance with 133-32. Federal law and U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services Confidentiality (HHS) policy, this institution is prohibited from discriminating on the basis of race, color,national origin, Confidentiality: Any information, data, instruments, sex, age or disability. Under the Food Stamp Act and documents, studies or reports given to or prepared or USDA policy, discrimination is prohibited also on the assembled by the Contractor under this agreement shall be basis of religion or political beliefs, kept as confidential and not divulged or made available to any individual or organization without the prior written Equal Employment Opportunity: The Contractor shall approval of the County.The Contractor acknowledges that comply with all federal and State laws relating to equal in receiving,storing,processing or otherwise dealing with employment opportunity. any confidential information it will safeguard and not General Terms and Conditions—(46115) Page 3 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract 468-1012 The Dispute Settlement Center, Inc. further disclose the information except as otherwise sales of tangible personal property to purchasers in North provided in this contract. Carolina. The conditions include: (a) maintenance of a retail establishment or office; (b) presence of Oversight representatives in the State that solicit sales or transact business on behalf of the vendor; and (c) systematic Access to Persons and Records: The State Auditor shall exploitation of the market by media-assisted, media- have access to persons and records as a result of all facilitated, or media-solicited means. The Contractor contracts or grants entered into by State agencies or certifies that it and all of its affiliates (if any) collect all political subdivisions in accordance with General Statute required taxes. 147-64.7. Additionally,as the State funding authority,the Department of Health and Human Services shall have E-Verify access to persons and records as a result of all contracts or grants entered into by State agencies or political Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the subdivisions. undersigned hereby certifies that the Contractor named below,and the Contractor's subcontractors,complies with Record Retention: Records shall not be destroyed, the requirements of Article 2 of Chapter 64 of the NC purged or disposed of without the express written consent General Statutes, including the requirement for each of the Division. State basic records retention policy employer with more than 25 employees in North Carolina requires all grant records to be retained for a minimum of to verify the work authorization of its employees through five years or until all audit exceptions have been resolved, the federal E-Verify system." E-Verify System Link: whichever is longer. If the contract is subject to federal www.uscis.gov policy and regulations,record retention may be longer than five years since records must be retained for a period of Miscellaneous three years following submission of the final Federal Financial Status Report, if applicable, or three years Choice of Law: The validity of this contract and any of its following the submission of a revised final Federal terms or provisions, as well as the rights and duties of the Financial Status Report. Also, if any litigation, claim, parties to this contract, are governed by the laws of North negotiation, audit, disallowance action, or other action Carolina. The Contractor,by signing this contract, agrees involving this Contract has been started before expiration and submits,solely for matters concerning this Contract,to of the five-year retention period described above, the the exclusive jurisdiction of the courts of North Carolina records must be retained until completion of the action and and agrees, solely for such purpose, that the exclusive resolution of all issues which arise from it,or until the end venue for any legal proceedings shall be Orange County, of the regular five-year period described above,whichever North Carolina. The place of this contract and all is later. The record retention period for Temporary transactions and agreements relating to it, and their situs Assistance for Needy Families (TANF) and MEDICAID and forum,shall be Orange County,North Carolina,where and Medical Assistance grants and programs must be all matters,whether sounding in contract or tort,relating to retained for a minimum of ten years. the validity,construction, interpretation,and enforcement shall be determined. Warranties and Certifications Amendment: This contract may not be amended orally or Date and Time Warranty: The Contractor warrants that by performance. Any amendment must be made in written the product(s) and service(s) furnished pursuant to this form and executed by duly authorized representatives of contract("product"includes,without limitation,any piece the County and the Contractor. of equipment,hardware,firmware,middleware,custom or commercial software,or internal components,subroutines, Severability: In the event that a court of competent and interfaces therein)that perform any date and/or time jurisdiction holds that a provision or requirement of this data recognition function, calculation, or sequencing will contract violates any applicable law, each such provision support a four digit year format and will provide accurate or requirement shall continue to be enforced to the extent it date/time data and leap year calculations. This warranty is not in violation of law or is not otherwise unenforceable shall survive the termination or expiration of this contract. and all other provisions and requirements of this contract shall remain in full force and effect. Certification Regarding Collection of Taxes: G.S. 143- 59.1 bars the Secretary of Administration from entering Headings: The Section and Paragraph headings in these into contracts with vendors that meet one of the conditions General Terms and Conditions are not material parts of the of G.S. 105-164.8(b)and yet refuse to collect use taxes on General Terms and Conditions—(06115) Page 4 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#65-1012 The Dispute Settlement Center,Inc. agreement and should not be used to construe the meaning Department of Revenue for a refund of all sales and use thereof taxes paid by them in the performance of this contract, pursuant to G.S. 105-164.14; and (b) exclude all Time of the Essence: Time is of the essence in the refundable sales and use taxes from all reportable performance of this contract. expenditures before the expenses are entered in their reimbursement reports. Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this Advertising: The Contractor shall not use the award of contract without the prior written approval of the County. this contract as a part of any news release or commercial The term "key personnel" includes any and all persons advertising. identified as such in the contract documents and any other persons subsequently identified as key personnel by the Orange County Living Wage: Orange County is written agreement of the parties. committed to providing its employees with a living wage and encourages agencies to which it provides funding to Care of Property: The Contractor agrees that it shall be pursue the same goal. The County's living wage hourly responsible for the proper custody and care of any property standard, as adopted by the Orange County Board of furnished to it for use in connection with the performance County Commissioners annually, can be found in the of this contract and will reimburse the County for loss of, Orange County Budget Ordinance. To the extent possible, or damage to, such property. At the termination of this Orange County recommends that the Contractor and all contract, the Contractor shall contact the County for subcontractors provide a living wage, as defined in this instructions as to the disposition of such property and shall section,to their employees. comply with these instructions. Signatures: This Agreement together with any Travel Expenses: Reimbursement, if provided in this amendments or modifications may be executed Agreement, to the Contractor for travel mileage, meals, electronically. All electronic signatures affixed hereto lodging and other travel expenses incurred in the evidence the intent of the Parties to comply with Article performance of this contract shall not exceed the rates 1 IA and Article 40 of North Carolina General Statute established in County policy. Chapter 66. Sales/Use Tax Refunds: If eligible,the Contractor and all subcontractors shall: (a) ask the North Carolina General Terns and Conditions—(06115) Page 5 of 5 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center, Inc. 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: Fax Number: Email: 3. Name of Program (s): Conflict Resolution 4. Status: ( ) Public (X)Private,Not for Profit ( ) Private, For Profit 5. Contractor's.Financial Reporting Year July 1, 2015 through June 30, 2016 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 rovidin 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 County will reimburse the Contractor for services described in this contract up to the budgetaa limits of the contract allotment. The County will reimburse the Contractor at a rate of$75.0O/hour for approved services provided. For reimbursement the Contractor must submit an on inal and two copies of an invoice by the fift=h 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 Contract-Scope of Work(06/04) Page lof 2 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center,Inc. DocuSigned by: DocuSigned by: Nawcy �esfa�, �V'aln,Gt,s C�un,�Q,e,vsaw DAE1F]96Afl3.BG5S..�. vsrn�.Q.4B2G124S�... Nancy Coston,Social Services Director (Signature of Contractor) 7/2/2015 7/1/2015 (Date Submitted) (Date Submitted) Contract-Scope of Work(06/04) Page 2of 2 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center, Inc. 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). Federal Certification-Drug-Free Workplace(0 7/10) Pagel of 2 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center,Inc. II. The site(s) for the performance of work done in connection with the specific agreement are listed below: 1. (Street address) (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. ,icuSigned by: A1n,Gt S hln'AXSbVt, Executive Director c-o aazc19 8... Signature Title Dispute settlement Center, Inc. 7/1/2015 Agency/Organization Date (Certification signature should be same as Contract signature.) Federal Certification-Drug-Free Workplace(07/10) Page 2 of 2 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center,Inc. committees with governing board delegated powers considering the possible conflict of interest. After disclosure of all material facts, and after any discussion with the person, he/she shall leave the governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In addition,the person(s)shall not participate in the final deliberation or decision regarding the matter under consideration and shall leave the meeting during the discussion of and vote of the Board of Directors/Trustees or other governing body. F. Violations of the Conflicts of Interest Policy -- If the Board of Directors/Trustees or other governing body has reasonable cause to believe a member, officer, employee or agent has failed to disclose actual or possible conflicts of interest, it shall inform the person of the basis for such belief and afford the person an opportunity to explain the alleged failure to disclose. If, after hearing the person's response and after making further investigation as warranted by the circumstances, the Board of Directors/Trustees or other governing body determines the member, officer, employee or agent has failed to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action. G. Record of Conflict -- The minutes of the governing board and all committees with board delegated powers shall contain: 1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed. 2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. Approved by: Name of Organization ignature of Organization Official Date Conflict of Interest Policy(06104) Page 2 of 3 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center, Inc. NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of Orange I, Hg-:rL Notary Public for said County and State, certify that F cz+A ng.cg,� ):a;E a,g-9-S personally appeared before me this day and acknowledged that he/she is of a, �� s,� � L ••� c . +�"� cL 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 eGfvbt, Z o 0 V Sworn to and subscribed before me this \017=~ day of pHNINNN ` p ASS '00 (Official Sea]) E,9'�''�. Notary Public �`.�`�s 4,ot 01M?), `;y My Commission expires �� a�.r� _:� r , 20 \a/ :_ co; ; 4Cy,, pUBL� ;:a 'yi`hfgeM HC4Q N',�r, Conflict of Interest Policy(06/04) Page 3 of 3 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Dispute Settlement Center OF OPANOE COUNTY June 18, 2015 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. 143C-6-23 c is guilty of a criminal offense punishable as provided by N.C.G.S. 143C-1.01(b) Sworn Statement Neil Offen 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&arities for f r action. Neil Offen, President date Frances Henderson, Executive Director date P A S :'�+� (Neil Offen) Sworn tQ' s 'before me on the day of the date of said certification. 9 gin; A .s: U80 G t �''••,,�NGpu Notary Public (Frances Henderson) Sworpql0r;MY*,scribed before me on the of the date of said certification. r` V qy'a ; ��TAR/- D Notary Public x • AU800 -'Cj •� ��,a��. _tip., ,a,• 4 cotyki MA 9nlfed Way Hf u111 of the G—wwa" 302 West Weaver Street,Carrboro,N.C.2 7510 .(919) 929-8800 ■ lax: (919) 942-6931 r WWWAsputesettlement.org . DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center,Inc. ATTACHMENT D CONFLICT OF INTEREST POLICY Orange County Department of Social Services The Board of Directors/Trustees or other governing persons, officers, employees or agents are to avoid any conflict of interest, even the appearance of a conflict of interest. The Organization's Board of Directors/Trustees or other governing body, officers, staff and agents are obligated to always act in the best interest of the organization. This obligation requires that any Board member or other governing person, officer, employee or agent, in the performance of Organization duties, seek only the furtherance of the Organization mission. At all times, Board members or other governing persons, officers, employees or agents, are prohibited from using their job title, the Organization's name or property, for private profit or benefit. A. The Board members or other governing persons, officers, employees, or agents of the Organization should neither solicit nor accept gratuities, favors, or anything of monetary value from current or potential contractors/vendors, persons receiving benefits from the Organization or persons who may benefit from the actions of any Board member or other governing person, officer, employee or agent. This is not intended to preclude bona-fide Organization fund raising- activities. B. A Board or other governing body member may, with the approval of Board or other governing body, receive honoraria for lectures and other such activities while not acting in any official capacity for the Organization. Officers may, with the approval of the Board or other governing body, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. 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 a Board or other governing body member, officer, employee or agent is acting in any official capacity, honoraria received in connection with activities relating to the Organization are to be paid to the Organization. C. No Board member or other governing person, officer, employee, or agent of the Organization 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 Board member or other governing person, officer,employee, or agent; 2. Any member of their family by whole. or half blood, step or personal relationship or relative-in-law; 3. An organization in which any of the above is an officer, director, or employee; 4. A person or organization with whom any of the above individuals is negotiating or has any arrangement concerning prospective employment or contracts. D. Duty to Disclosure -- Any conflict of interest, potential conflict of interest, or the appearance of a conflict of interest is to be reported to the Board or other governing body or one's supervisor immediately. E. Board Action--When a conflict of interest is relevant to a matter requiring action by the Board of Directors/Trustees or other governing body,the Board member or other governing person, officer, employee, or agent(person(s))must disclose the existence of the conflict of interest and be given the opportunity to disclose all material facts to the Board and members of Conflict of Interest Policy(06/04) Page 1 of 3 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 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 FRS 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. DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Internal Revenue Service Department of"the Treasury Date: December 13, 2004 P. O', Box 2508 Cincinnati, OH 45201 DISPUTE SETTLEMENT CENTER tNC 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 Identifeation Number: $6-121 6584 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)(vl) of the Internal Revenue Code. Our records indicate that-contributions to your organization are deductible under section 174 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.telephony: number shown in the heading of this letter. Sincerely, Ax4-4,A1Ay&) Janna K. Skufca, Director, TEIGE Customer Account Services DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center, Inc. ATTACHMENT M STATE CERTIFICATION Contractor Certifications Required by North Carolina Law Orange County Department of Social Services Instructions The person who signs this document should read the text of the statutes listed below and consult with counsel and other knowledgeable persons before signing. • The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at: http://www.ncga.state.ne.us/EnactedLegislation/Statutes/PDF/ByArticle/'Chapter_64/Article__odf • The text of G.S. 105-164.8(b)can be found online at: h ://www.ne 7a.state.nc.us/EiiactedLe islation/Statutes/PDF/B Section/Cha ter 105/GS 105-164.8. df • The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d))can be found online at: http://www.nega.state.nc.us/Sessions/201.3/Bills/House/PDF/H786v6.pdf • The text of G.S. 143-59.1 can be found online at: http://www nc�za.state..nc.us/EnactedLe�islation/Statutes/PDF/BySection/Chapter 143/GS_143-59.1.pdf • The text of G.S. 143-59.2 can be found online at: http://www.DC,,a.state.ne.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59.2.pdf • The text of G.S. 147-3395(g)(S.L. 2013-418, s. 2. (e))can be found online at: http://www.ncga.state.ne.us/Sessions/2013/Bills/House/PDF/H786v6.pdf Certifications (1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(8), the undersigned hereby certifies that the Contractor named below, and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina General Statutes. However, local government is subject to and must comply with North Carolina General Statute §153A-99.1. which states in part as follows: Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the work authorization of new employees hired to work in the United States. (2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below is not an "ineligible Contractor"as set forth in G.S. 143-59.1(a)because: (a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or Contractor Certifications Required by North Carolina Law Page 1 of 2 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract#68-1012 The Dispute Settlement Center, Inc. more of the conditions of G.S. 105-164.8(b); and (b) [check one of the following boxes] ❑ Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax haven country"as set forth in G.S. 143-59.1(c)(2)after December 31, 2001; or ❑ The Contractor or one of its affiliates has incorporated or reincorporated in a"tax haven country" as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but the United States is not the principal market for the public trading of the stock of the corporation incorporated in the tax haven country. (3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor's officers, directors, or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. (4) The undersigned hereby certifies further that: (a) He or she is a duly authorized representative of the Contractor named below; (b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf of the Contractor; and (c) He or she understands that any person who knowingly submits a false certification in response to the requirements of G.S. 143-59.1 and-59.2 shall be guilty of a Class I felony. Dispute settlement Center, Inc. Co r,a/?$f ign%hme l IrA&ws Kln,A,V'wu 7/1/2015 Signature o rol n ractor's Authorized Agent Date Frances Henderson Executive Director Prin em9ontractor's Authorized Agent Title Mediation coordinator D-1�FD&C-&K4E450... Signature of Witness Title 7enifer Yarnelle 7/2/2015 Printed Name of Witness Date The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately thereafter. Contractor Certifications Required by North Carolina Law Page 2 of 2 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 Contract 968-1012 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. 1. 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. DI-w- Sign re Title ifs ��� .e�h✓ ( -[5-1 Agency/Organization Date (Certification signature should be same as Contract signature.) Outcomes (06/04) Page 1 of i DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 gCoRD CERTIFICATE OF LIABILITY INSURANCE r6/3/2015 TE(MMfDDfYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Crystal Ireland NAME: BL1S1rie33 Insurers of Carolinas PHONE (919) 969-4611 MC No:(919)968-8991 800 Eastowne Drive, Suite 208 ADDRESS:cireland @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURER A:HairdIton Mutual Insurance Co 14125 INSURED INSURER B Em to ers Mutual Casualty 21415 DISPUTE SETTLEMENT CENTER INC INSURER C: 302 W WEAVER ST STE A INSURER D: INSURER E: CARRBOR0 NC 27510-6004 1 INSURER F COVERAGES CERTIFICATE NUMBER:CL156313007 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MWDOYIYEYYY MMf�OYIYYrr LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED 300,000 A CLAIMS-MADE X OCCUR PREMISES 4Ea occurrence)$ 4W54487 6/17/2015 6/17/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY PRO- LOG PRODUCTS-COMP/OP AGG $ 2,000,000 X OTHER: Hired/bonvwed $ 1,000,000 AUTOMOBILE LIABILITY COa MBINED SINGLE LIMIT $ E Oxidant ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOPJPARTNEP)EXECUTIVE ❑ NIA F.L.EACH ACCIDENT $ 100,000 OFFICERlMEMBER EXCLUDED? B (Mandatory In NH) 41154487 6/17/2015 6/17/2016 E.L.DISEASE-EA EMPLOYE $ 100 000 r yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 181,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION jetholnpson @orangecountync. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 S. Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE C Treland/TREL01 � ►tQ ©1988-2014ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 ivowi) DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 SPECIFIED R FE I N PROFESSION BIL ERRORS& OMISSIONS COVE RA DECLARATIONS PLEASE READ YOUR POLICY CAREFULLY. THIS IS A CLAIMS MADE POLICY COVERAGE FORM AND UNLESS OTHERWISE PROVIDED HEREIN,THE COVERAGE OF THIS FORM IS LIMITED TO LIABILITY FOR CLAIMS FIRST MADE DURING THE POLICY PERIOD, OR THE EXTENSION PERIOD, IF APPLICABLE. DEFENSE COSTS SHALL BE APPLIED AGAINST THE DEDUCTIBLE. No. SP 1557590 Effective Date: 10/0222014 12:01 AM STANDARD TIME ITEM I. NAMED INSURED AND PRINCIPAL ADDRESS Dispute Settlement Center Inc. 302 Weaver Street Carrboro, NC 27510 ITEM II. POLICY PERIOD:(MMIDDIYYYY) From: 1 010212 0 1 4 To: 10!0212015 Specified Professions Professional Liability ITEM IT LIMITS OF LIABILITY $1,000,000 EACH CLAIM $1,004,000 ANNUAL AGGREGATE ITEM IV. DEDUCTIBLE: $5,000 EACH CLAIM ITEM V. PREMIUM: $756 ITEM Vl. RETROACTIVE DATE: 10/212014 ITEM VII. Coverage Form(s)IPart(s)and Endorsement(s)made a part of this policy at See Endorsement EOD(0 1195) ITEM Vlll. Solely in the performance of Professional Services as a(n) Mediator/Training Specialist for others for a fee. THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. SP 150(0911 1) Page 1 Of 1 DocuSign Envelope ID: 79C656D4-C9CC-4E83-86DC-2586ACE20052 EXTENSION OF DECLARATIONS Policy No. SP 1557590 Effective Date_ 1010212014 12:01 AM STANDARD TIME FORMS AND ENDORSEMENTS The following forms apply to the Specified Professions Professional Liability Errors And Omissions coverage part Endt# Revised Description of Endorsements CONSA (01108) Specified Professions Professional Liability Application PROF-001 06101 Absolute Pollution Exclusion-Professional PROF-002 06101 Mold, Fungus, Bacteria,Virus And Organic Pathogen Exclusion- Professional SP 07109 Specified Professions Professional Liability Coverage Form SP 210 07/09 Retroactive Date Endorsement SP 211 07109 Professional Services Exclusion Endorsement SP NC 07109 North Carolina State Amendatory Endorsement SP Jacket 09110 Specified Professions Professional Liabii'ty Policy Jacket EOD(01195) All other terms and condttionsremain unchanged_ Page 1 of 1