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HomeMy WebLinkAbout2015-459-E Housing - Deborah Leisey for ASL interpretation $1,000 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF ORANGE COUNTY COUNTYWIDE AMERICAN SIGN LANGUAGE INTERPRETER CONTRACT $15,000 OR LESS NORTH CAROLINA THIS AGREEMENT, made and entered into this 1 st day of July, 2.015, ("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 Deborah Leisey(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. ® Fcderal 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 06/15 1 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF 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 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 htt :I/vrwNv.rid.ora/UserFitesCFile/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 shiedding/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: I 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 one (1) hours of'seivice 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 f'or 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 06/15 2 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF 4 Payment f'or Services: the County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. a. Compensation. Compensation for Services shall include all compensation due the Provider fio-m. the County for all Services provided under this Agreement including Reimbursable Expenses as specified below.. i) Basic Services. The amount to be paid by the County shall not exceed One Thousand Dollars ($1,000), to be paid at a rate of $40/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 ii) Reimbursable Expenses. Reimbursable expenses are in addition to the fees for Services Mileage shall be a reimbursable expense for travel to and from the job site to the extent reasonable and actually incurred by the Provider with respect to the Services provided: b the Provider shall 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 Reimbursable expenses shall be compensated by the County along with invoices for Services provided by Provider Payment of Reimbursable Expenses shall be subject to Provider's timely submission of valid receipts for any such expenses and approval by the County.. Any additional charges not specified herein, must be mutually agreed to in advance by County and Provider and documented in writing with a letter signed by authorized representatives for County and Provider and, subject to budgeted funds.. c 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 f'or 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 Revised 06115 3 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF v) In the case of an unexpected closing or delayed opening (e g , inclement weather) of the County Offices when providing interpretation services, the Provider shall not be paid for missed appointments. When in doubt, the Provider can call 732-8181 to see if county offices are open or are on a delayed schedule When possible, the Provider is also asked to help call his/her scheduled clients to inform them of the delay or closing 5 Term. the term of'this Agreement shall be from July 1, 2015 to June 30, 2016. 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 ox omissions, in the performance of the Agreement Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. 7. Additional Terms and Condition. The County may have additional terms and condition that shall be provided as attachment 1, and shall be attached and are hereby incorporated by reference 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 arty 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-.//oi-angeco4nt3me.gov/puT-chasing/conti-acts.asp). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of N/A (if' no additional insurance required mark NIA 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. IndemnitX: 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 Revised 06/15 4 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF 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 patties unless and until modified in writing and signed by the parties. Modifications may be evidenced by telefaesimile signature This Agreement together with any amendments or modifications may be executed electronically All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article I IA and Article 40 of North Carolina General Statute Chapter 66 15. Governing Law: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Should either party initiate litigation to settle any dispute involving the terms of'this Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina 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 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 O giLlw"off/., ly 1 PR DNA&ZWboiah Leisey �Oln.ln,lt, t�AaMMtMt,V'Sl,t,� tBy'County�lanager B tle : or�a`Ti" enne y Lei sey 200 S Cameron St 60 Summersweet Lane P O Box 8181 Chapel Hill,NC 27516 Hillsborough,NC 27278 Revised 06/r5 5 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF 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 ASL Interpteter Translator Contract of$15,000 or less The additional terms and conditions shall supersede any terms in the original contract and are her eby 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 di 3 the following sentence: The Provider should generally instruct clients to call the Health Department front desk staff or the Spanish voicernail line at 644-3350 (when language appropriate) to schedule an appointment of to inquire about services Add Section 2 e e Medical Documentation. Prior to beginning work,the Provider is required to: i Provide proof of immunity to varicella, measles, mumps and rubella 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) ii Provide proof of a TB screening and results to OCHD The screening can be one of the following: 1 Receipt of a TB skin test(ISI)if the Provider has no history of TB infection/disease or of a positive IS I (Note: If the Provider has not had an additional IST within the previous 12 months, a second I S I will be required one week after the first to establish an accurate baseline) 2 Completion of a TB Screening Form by a medical provider if the Provider has a history of TB disease of of having a positive TST. iii Provide proof of Idap vaccine iv.Provide proof of current influenza(flu)vaccine Revised 06115 6 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF v Unless otherwise provided, proof of immunization must take the form of one of the following: Provider's immunization record or medical record signed by a representative of the Provider's healthcare practice In either case both the Provider's name and the date of immunization must be present, Only vaccines approved by the Centers for Disease Control and Prevention (www cdc gov/flu/protect/vaccine/vaccines htm) will be accepted The provider is responsible for the costs associated with acquiring the vaccination 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 (2) hour of service for an appointment. OCHD will reimburse the Provider for one (2)hour of interpretation service in the event of a same day cancelled appointment Ihat 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 Replace Section 4.b.iii with the following paragraph: iii. 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 2.4 hour notice). Revised 06/15 7 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ("Agreement") is made effective the First day of July, 2015,. by and between Orange County Government through its Orange County Health Department ("Covered Entity"), and Deborah Leisey, ("Business Associate"), Covered Entity and Business Associate may be referred herein individually as a"Party" or collectively as the "Parties". This Agreement supersedes any previously executed Business Associate Agreement between the Parties WITNESSETH: WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability and Accountability Act of 1996 ("HIPAA'), Public Law 104-191, as modified by the Health Information Technology for Economic and Clinical Health Act ("HIIECH"), Public Law 111-5, 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 ("Secretary") has issued regulations modifying the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Parts 160 and 164, as the same may be amended fiom time to time(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 arrangements, 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 detailed below and hereinafter referred to as the"Service Agreement(s)"); 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 Service Agreement, compliance with the HIPAA Security and Privacy Rule, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties agree to the provisions of this Agreement in order to address the requirements of the HIPAA Security and Privacy Rule and to protect the interests of both Parties I DEFINITIONS (a) Service Agreement. Agreements) for services affected by this HIPAA Business Associate Agreement, which this Business Associate Agreement shall be attached to, and is (are) hereby incorporated by reference, and which shall be taken and considered as a part of this document the same as if fully set out herein: COUNIYWIDE INTERPRETER CONTRACT ($15,000 OR LESS) (b) Catch-all Provision.. Except as otherwise defined herein, any and all capitalized terms in this Agreement shall have the definitions set forth in the HIPAA Security and Privacy Rule, 45 C,FR Parts 160 and 164, subparts A and E In the event of an inconsistency between the provisions of this Agreement 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. 1 October 2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF (c) Electronic Protected Health Information. Protected Health Information that is transmitted by or maintained in Electronic Media(as defined in the HIPAA Security and Privacy Rule).. (d) Protected Health Information "Protected Health Information" shall have the same meaning as the term in 45 CPR § 160 103, limited to the information created of received by Business Associate from or on behalf of Covered Entity and includes without limitation "Electronic Protected Health Information." Business Associate acknowledges and agrees that 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 (e) Required by Law "Required by Law" shall have the same meaning as the term in 45 CFR § 164.103. II OBLIGATIONS AND ACIIVITIES OF BUSINESS ASSOCIATE (a) Use and Disclosure Business Associate agrees to fully comply with the requirements under the HIPPA Security and Privacy Rule applicable to Business Associates and not to use or disclose Protected Health Information other than as permitted or required by this Agreement, the Service Agreement or as Required by Law, To the extent Business Associate carries out obligations of Covered Entity under the HIPAA Security and Privacy Rule, Business Associate shall comply with the applicable provisions of the HIPAA Security and Privacy Rule as if'such use or disclosure were made by Coveted Entity Business Associate agrees to comply with Covered Entity's policies regarding the minimum necessary use or disclosure of'Protected Health Information. (b) Appropriate Safeguards Business Associate agrees to use appropriate safeguards to prevent use or disclosure of Protected Health Information other than as provided for by this Service Agreement(s), this Agreement or as Required by Law Ihis includes the implementation physical, technical and administrative safeguards to prevent use or disclosure of Protected Health Information other than as permitted in this Agreement or Required by Law and reasonably and appropriately protect the confidentiality, integrity, and availability of any Electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of Covered Entity as required by the HIPAA Security and Privacy Rule. The Business Associate shall maintain appropriate documentation of its compliance with the HIPPA Security and Privacy Rule, including, but not limited to, its policies, procedures, records of training and sanctions of members in its workforce. (c) Assurances Business Associate agrees to provide Covered Entity with written assurances that any Protected Health Information placed on any type of mobile media, including, but by no means limited to, lap top computers, Ipads and mobile phones, is encrypted in accordance with guidance issued by the Secretary (d) Agents and Subcontractors. Business Associate shall require any agents, including any subcontractors, to whom it provides Protected Health Information from Covered Entity that is created, received, maintained or transmitted on behalf of Business Associate to agree by written contract with Business Associate to the same (oi greater) restrictions, conditions and requirements that apply to Business Associate with respect to such information, and to agree to implement reasonable and appropriate safeguards to protect any of'such information that is Electronic Protected Health 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 (e) Mitigation of Breach. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health 2 October 2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF Information by Business Associate in violation of the requirements of this Agreement, as well as to provide complete cooperation to Covered Entity should Covered Entity elect to review or investigate such noncompliance or Security Incident Business Associate shall cooperate in Covered Entity's breach analysis and/or risk assessment, if requested Furthermore, Business Associate shall cooperate with Covered Entity in the event that Covered Entity determines that any third parties must be notified of a Breach,provided that Business Associate shall not provide any such notification except at the direction of Covered Entity (f) Breach Reporting Business Associate shall report in writing to Covered Entity's Privacy Officer (see Exhibit A), any use or disclosure of Protected Health Information that is not in compliance with the terms of this Agreement, as well as any Security Incident and any actual or suspected Breach, of which it becomes aware, without unreasonable delay, and in no event later than forty-eight (48) hours of such discovery. 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 Such notification shall contain the elements required by 45 C F R § 164.410 (g) Compliance Io the extent applicable, Business Associate will comply with (i) Covered Entity's Notice of Privacy Practices; (ii) any limitations to which Covered Entity has agreed in regard to an Individual's permission to use or disclose his or her Protected Health Information; and (iii) any restrictions to the use or disclosure of Protected Health Information to which Covered Entity has agreed or is required to agree. (h) Government Access. Business Associate will make its internal practices, books and records available to the Secretary of the Department of Health and Human Services for purposes of determining compliance with the terms of the HIPAA Security and Privacy Rule, and, at the request of the Secretary, will comply with any investigations and compliance reviews, permit access to information, and cooperate with any complaints, as Required by Law Without unreasonable delay and, in any event, no more than 48 hours of receipt of the request or notification, Business Associate will notify Covered Entity in writing of any request by any governmental entity, or its designee, to review Business assessment of'any kind. G) Electronic Transactions If Business Associate conducts any Standard Transactions for or on behalf of Covered Entity, Business Associate shall comply with the requirements under the Electronic Transaction Rule 0) Audit Business Associate shall permit Covered Entity, in its discretion, to conduct an audit of Business Associate's compliance with this Agreement, HIPAA, and HITECH Such audit may consist of an onsite visit, a series of inquiries that require written responses, or both. Business Associate shall promptly and completely respond to Covered Entity's requests for information in support of the audit, which shall not be conducted more than once annually except in cases of an actual or reasonably suspected Security Incident or reasonably suspected noncompliance with this Agreement, HIPAA or HITECH Each Party shall bear its own costs associated with the audit (k) Identity Theft Business Associate shall implement Identity Theft Monitoring Policies and Procedures to protect any patient information that may be breached by the Business Associate to the extent applicable under the Federal Trade Commission's Red Flag Rules (1) HIIECH Compliance Business Associate shall: A. Not receive, directly or indirectly, any impermissible remuneration in exchange for Protected Health Information or Electronic Protected Health Information, except as permitted by HITECH § 13405(d) or the HIPPA Regulations; 3 October 2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF B Comply with the marketing and other restrictions applicable to Business Associates contained in HITECH § 13406 and the HIPPA Regulations; C. To the extent required under HITECH § 13404, fully comply with the applicable requirements of 45 CFR 164 502(c)(2) for each use and disclosure of Protected Health Information; D Io the extent required under HIIECH § 13401, fully comply with 45 CFR §§ 164 308, 164.310, 164 312,and 164 316; E To the extent required under HIIECH §§13401 and 13404, comply with the additional privacy and security requirements that apply to Covered Entities in the same manner and to the same extent as Covered Entity is required to do so; and F. Io the extent required under the HIPPA Regulations, comply with the privacy and security requirements that apply to Business Associates (m) State Privacy Laws. Business Associate shall understand and comply with state privacy laws to the extent that such privacy laws are not preempted by HIPPA or HITECH III PERMITIED USES AND DISCLOSURES BY BUSINESS ASSOCIATE (a) Use of Protected Health Information on Behalf of Covered Entity Except as otherwise limited in this Agreement, Business Associate may use or disclose Protected Health Information to perform functions, activities or services for, or on behalf of, Covered Entity described in the Service Agreement, provided that such use or disclosure would not violate the HIPPA Security and Privacy Rule if it were made by Covered Entity or would not violate the Covered Entities minimum necessary policies. (b) Other Uses of Protected Health Information Except as otherwise limited in this Agreement, Business Associate may use Protected Health Information within its workforce for the proper management and administration of Business Associate not to include Marketing or Commercial Use and to carry out the legal responsibilities of Business Associate; and (c) Third Party Confidentiality. Except as otherwise limited in this Agreement, Business Associate may disclose Protected Health Information for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided that if Business Associate discloses any Protected Health Information to a third party for such purpose, the Business Associate shall enter into a written agreement with such third party requiring the following: A Disclosure only as Required by Law; or B Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and will be 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, integrity, and or availability of the Protected Health Information has been breached immediately upon becoming aware. (d) Business Associate may provide data aggregation services relating to the health care operations of Covered Entity pursuant to any agreements between the Parties evidencing their business relationship as permitted by 45 CFR§ 164 504(e)(2)(i)(B). (e) Other Uses Strictly Limited. Nothing in this Agreement shall permit the Business Associate to share Protected Health Information with Business Associate's affiliates or contractors except 4 October 2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF for the purposes of the Service Agreement(s) between the Covered Entity and Business Associate(s) identified in Section I(a) of this Agreement (f) Covered Entity Authorization for Additional Uses Any use of Protected Health Information by Business Associate, its affiliate or Contractor, other than those purposes of this Agreement, shall require express written authorization by the Covered Entity, and a Business Associate Agreement or amendment as necessary Activities which are prohibited include, but are not limited to Marketing, as defined by 45 CFR § 164.503 ox the sharing for Commercial Use or any purpose construed by Coveted Entity as Marketing or Commercial Use, even if such sharing would be permitted by federal oi state laws. (g) Business Associate may de-identify Protected Health Infbrmation only at the specific direction of and only for the use of Covered Entity. Business Associate may not sell Protected Health Information except at the direction of Covered Entity and in compliance with the requirements of the HlPAA Security and Privacy Rule_ IV AVAILABILIIY OF PHI (a) Access to Protected Health Information Business Associate agrees, in the event the Business Associate maintains protected health information in a Designated Record Set,to make available, within ten (10) days of a request by Covered Entity in a time and manner designated by Coveted Entity, Protected Health Irdormation in a Designated Record Set, to Covered Entity or as directed by Covered Entity, to an individual in order to meet the requirements of 45 CFR § 164.524 of the HIPAA Security and Privacy Rule. (b) Amendments to Protected Health Information In the event that the Business Associate maintains Protected Health Information in a Designated Record Set, Business Associate agrees to make any amendment(s) to Protected Health Information in a designated record set that the Coveted Entity directs or agrees to pursuant to the HIPAA Security and Privacy Rule at the request of Covered Entity of an individual,within ten(10) days of receipt of a request fiom Covered Entity and in the time and manner designated by Covered Entity. (c) Accounting of Disclosures Business Associate agrees to maintain and make available the information required to provide an accounting of disclosures, as required by 45 CFR § 164 52.8 of the HIPAA Security and Privacy Rule Business Associate will comply with Covered Entity's policy regarding accounting of disclosures. (d) Document Disclosures In the event an Individual makes a request under this Section of the Agreement directly to Business Associate, Business Associate will notify Covered Entity of such request within three (3) business days and shall cooperate with, and act only at the direction of Covered Entity in responding to such request V OBLIGAIIONS OF COVERED ENIIIY (a) Notice of Privacy Practices Covered Entity shall provide Business Associate with the notice of privacy practice that Covered Entity produces in accordance with 45 CFR § 164.520, as well as any changes to that notice (b) Notice of Changes in Individual's Access or Protected Health Information Covered Entity shall provide Business Associate with any changes in, or revocation of; permission by an Individual to use or disclose Protected Health Infbrrnation, is such changes affect Business Associate's permitted or required uses. 5 October 2013. DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF (c) Notice of Restriction in Individual's Access to Protected Health Information. Covered Entity shall notify Business Associate of any restrictions to the use or disclosure of Protected Health Information that Covered Entity has agreed in accordance with 45 CFR § 164 522 to the extent that such restriction may affect Business Associate's use of Protected Health Information VI PERMISSABLE REQUESTS BY COVERED ENTITY Requests Permissible Under HIPAA. Covered Entity shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy or Security Rule VIL. IERMINATION (a) Ierm This Agreement shall be effective as of the date first set fbrth above and shall terminate upon the earlier of (i) the termination of all agreements between the parties, and (ii) the termination by Covered Entity for cause as provided her (b) Termination for Cause Notwithstanding anything in this Agreement to the contrary, Covered Entity shall have the right to terminate this Agreement and the Service Agreement immediately if Covered Entity determines that Business Associate has or will violated any material term of this Agreement. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity shall provide an opportunity for Business Associate to cure the breach or end the violation Covered Entity may terminate this Agreement if'Business Associate does not cure the breach or end the violation within the time period specified by Covered Entity. If termination, cure or end of the violation is not feasible, Cover ed Entity may report the violation to the Secretary (c) Obligation of Business Associate Upon Termination At termination of this Agreement, the Service Agreement (or any similar documentation of the business relationship of the Parties), or upon request of Covered Entity,whichever occurs first,Business Associate, shall: A if feasible, return(in a manner or process approved by the Covered Entity)or destroy all Protected Health Information, regardless of form, including but not limited to paper or electronic format, received from Covered Entity, or created, maintained or received by Business Associate on behalf of Covered Entity Business Associate shall retain no copies of the Protected Health Information Phis provision shall also apply to Protected Health Information and other confidential information in the possession of sub-contractors or agents of Business Associate. B If such return or destruction is not feasible, Business Associate shall (i) retain only that Protected Health Information necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; (ii) return or destroy the remaining Protected Health Information that the Business Associate still maintains in any form; (iii) extend the protections of this Agreement to the retained Protected Health Information; (iv) limit further uses and disclosures to those purposes that make the return or destruction of the Protected Health Information not feasible; and (v) return or destroy the retained Protected Health Information when it is no longer needed by Business Associate (d) Survival Ihis paragraph shall survive the termination of this Agreement and shall apply to Protected Health Information created, maintained, or received by Business Associate and any of its subcontractors VIII MISCELLANEOUS 6 October 2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF (a) Indemnification. Business Associate agrees to indemnify, defend, and hold harmless Covered Entity, its officers, agents, contractors and agents,against, and in respect of, any and all claims, losses, expenses, costs, damages, obligations, penalties, and liabilities which Covered Entity may incur by reason of Business Associate's breach of or failure to perform any its obligations pursuant to this Agreement, including but not limited to any injury or damages arising from any noncompliance with this Agreement or any Security Incident attributable to the negligence of Business Associate, including failure to execute the terms of this Agreement. Further,Business Associate agrees to indemnify, defend, and hold harmless Covered Entity, its officers, employees, contractors and agents, against all costs and expenses, including but not limited to, reasonable legal expenses, which are incurred by or on behalf of Business Associate in connection with the defense of such claims (b) Disclaimer. Covered Entity makes no warranty or representation that compliance by Business Associate with this Agreement,HIPAA, HIIECH' or the HIPAA Regulations will be adequate or satisfactory for Business Associate's own purposes Business Associate is solely responsible for all decisions made by Business Associate regarding the safeguarding of Protected Health Information (c) Assistance in Litigation or Administrative Proceedings. Business Associate shall make itself, and any subcontractors, employees, affiliates or agents assisting Business Associate in the performance of its obligations under this Agreement, available to Covered Entity, at no cost to Covered Entity,to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being commenced against Covered Entity, its directors, officers or employees based upon a claimed violation of HIPAA, HIIECH, the HIPAA Regulations, or other laws relating to security and privacy, except where Business Associate or its subcontractor, employee or agent is named adverse party.. (d) Survival. The obligations of Business Associate under this Agreement shall survive the expiration, termination, or cancellation of this Agreement, the Service Agreement and/or the business relationship of the parties, and shall continue to bind Business Associate, its agents, employees, conti actor s, successors, and assigns as set forth herein (e) Ownership of Information Covered Entity holds all right, title, and interest in and to the Protected Health Information and Business Associate does not hold and will not acquire by virtue of this Agreement or by virtue of providing goods or services to Covered Entity, any right, title, or interest in or to the PHI or any portion thereof (f) Right to Injunctive Relief. Business Associate expressly acknowledges and agrees that the breach, or tbzeatened breach,by it of any provision ofthis Agreement may cause Covered Entity to be irreparably harmed and that Covered Entity may not have an adequate remedy at law. Iherefore,Business Associate agrees that upon such breach, or threatened breach, Covered Entity will be entitled to seek injunctive relief to prevent Business Associate from commencing or continuing any action constituting such breach without having to post a bond or other security and without having to prove the inadequacy of any other available remedies Nothing in this paragraph will be deemed to limit or abridge any other remedy available to Covered Entity at law or in equity Except as expressly stated herein or in the HIPAA Security and Privacy Rule, the parties to this Agreement do not intend to create any rights in any third parties. (g) Amendment_ The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the HIPSS Regulations In addition, this Agreement may be amended or modified by the Parties only in writing (h) Assignment. No Party may assign its respective rights and obligations under this Agreement without the prior written consent of the other Party 7 October2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF (i) Independent Contractor. None of the provisions of this Agreement are intended to create, not 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 Ihis Agreement will be governed by the laws of the State of North Carolina No change, waiver or discharge of any liability or obligation hereunder on any one or move 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 (j) Regulatory References. A reference in this Agreement to a section in HIPAA, HITECH or the HIPAA Regulations means the section as it currently is in effect or as amended (k) Interpretation Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits Covered Entity to comply with the HIPAA Regulations 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 more restrictive provisions will control The provisions of this Agreement are intended to establish the minimum requirements regarding Business Associate's use and disclosure of'Protected Health Information (1) Severability In the event any part or parts of this Agreement are held to be unenforceable, the remainder of this Agreement will continue in effect In addition, in the event a party believes in good faith that any provision of this Agreement fails to comply with the then-current requirements of the HIPAA Security and Privacy Rule, such party shall notify the other party in writing. F or a period of up to (30) thirty days, the parties shall address in good faith such concern and amend the terms of this Agreement, if necessary to bring it into compliance If, after such thirty-day period, a party believes in good faith that the Agreement fails to comply with the HIPAA Security and Privacy Rule, then either party has the right to terminate upon written notice to the other party (m) Notices and Communications All instructions, notices, consents, demands, or other communications required or contemplated by this Agreement shall be in writing and shall be delivered to the Party at the address below: For Covered Entity: For Business Associate Orange County Housing,Human Rights & Community Development Deborah Leisey AT"TN: Marlyn Valeiko 60 Summersweet Lane 300 W Tryon Street Chapel Hill,NC.27516 Hillsborough NC,2 7278 (n) Strict compliance No failure by any Party to insist upon strict compliance with any terms or provisions of this Agreement, to exercise any option, to enforce any right, or to seek any remedy upon any default of any other Party shall affect, or constitute a waiver of; any Party's right to insist upon such strict compliance, exercise that option, enforce that right, or seek that remedy with respect to that default or any prior, or contemporaneous, or subsequent default. No custom or practice of the Parties at variance with any provisions of this Agreement shall affect, or constitute a waiver of, any Party's right to demand strict compliance with all provisions of this Agreement (o) Governing Law. Ihis Agreement shall be governed and construed in accordance with the laws of the State of North Carolina except to the extent that North Carolina laws have been pre-empted by HIPAA and without giving effect to principals of conflicts of law Jurisdiction shall be Orange County, North Carolina, for purposes of litigation resulting fiom disagreements of'the Parties for purposes of this Agreement and the Service Agreement(s) 8 October 2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF (p) E-Verify. Employers and their subcontractors with 25 or more employees as defined in Article 2 of Chapter 64 of the NC General Statutes must comply with E-Verify requirements to contract with governmental units E-Verify is a Federal program operated by the United States Department of Homeland Security and other federal agencies, or any successor or equivalent program used to verify the work authorization of newly hired employees pursuant to federal law Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes shall constitute breach of this Agreement If'applicable, by executing this Agreement, Business Associate affirms that they are in compliance with Article 3 of Chapter 64 if the North Carolina General Statutes IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and year written above CO � LN4:ITY: BU &,S, &I OCIATE: 11bl�In tt (�cuMwrt V S1 t �t�bV cu t, (,t tSc By' 3nM7-75 rr By' MaabAe°reaea -. Title: County Manager Title: Deborah Kennedy Leisey 9 October201,3 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF EXHIBII A COVERED ENTITY PRIVACY OFFICER CONTACT INFORMATION To report to Covered Entity any use or disclosure of Protected Health Information not in compliance with the terms of this Agreement that might be considered a privacy breach,Business Associate should contact the Privacy Officer at the applicable entity, To report to Covered Entity any Security Incident(as defined in the Agreement),Business Associate should contact Carla Julian (919)245-2434, or the Security Officer at The Orange County Health Department 10 October 2013 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF ORANGE COUNTY HEALTH DEPARTMENT Conti acted Intexpreters 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 foxxnei 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 ox 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. Asa 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: Deborah Lei sey Date: 8/17/2015 Contractor Signature: ���� S I Date: 8/17/2015 OCHD Representative: � Date: 8/19/2015 ,ter DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF ATTACHMENT B SCOPE. OF WORK Orange County Department of Social Services Federal Tax Id. or SSN__ _ Contract# A CONTRACTOR INFORMATION 1. Contractor Agency Name: 2 If different from Contract Administrator Information in General Contract: Address Telephone Number: _ Fax Number: Email: 3 Name of Program (s): Inter Teter Services _ 4. Status: ( )Public ( )Private,Not for Profit (X)Private,For Profit 5 Contractor's Financial Reporting Year July 1, 2015 through .tune 30 2016 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 $40,00/hour - Interpretation D Number,of units to be provided: E Details of'Billing process and Time Frames; The Countv will reimburse the Contractor for services described in this contr act up to the budgetary limits of the contract allotment. The County will reimburse the Contractor at a rate of$40.00/hour_fol' 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 Interpretin 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 wilt reimburse the Contractor monthly u on recei t of a complete and correctly fried report. Contract-Scope of Work(46104) Page I of 2 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF 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 foz_an appointment. Mileage reimbursement will be for round trip from the Contractor's home oY work site to the piearianged appointment site. _ F Area to be served/Delivery site(s): Orange County DocuSigned by: DocuSigned by: -G&37_9j4B7-&5E47-T­. Ev,8GAQ90AG4IQAE4II (Signature of County Authorized Person) (Signature of Contractor) 8/21/2015 8/17/2015 (Date Submitted) (Date Submitted) Contract-Scope of Work(06/04) Page 2of 2 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF 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 ofmaintaining 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 requitement 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).. F ederal Certification-Drug-Free Workplace(06104) Page 1 of 2 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF It 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, 2'7278 (City, county, state, zip code) 2. 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). L�bVcr , (,t tSc Deborah Kennedy Lei sey Signature Title 8/17/2015 Agency/Organization Date (Certification signature should be same as Contract signature ) Federal Certification- Drug-Free Workplace(06/04) Page 2 of 2 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF ATTACHMENT D CONFLICT OF INIERESI 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 Ditectors/'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 inter est, even the appear ante 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 ate to maintain independence and objectivity with clients, the community, and organization Employees are called to Conflict of Intezest Policy(06104) Page 1 of 2 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF 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 or ganization; 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 f6r lectures and other such activities while on personal days, compensator y 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 INTERESI POLICY State of Nina 9 County of O�ea ����aLt,- I, `�rCX_--k,_ kc_C , certify that I have read the forgoing information,understand it, and that no fl i eflof,interest exists in the execution of this contract I A;� Signature Sworn to and subscribed before me on the /S k day of 3 2015.. My Commission Expires: �sYI (No ary Signature d S al) CARS. JAMEY NOTARY PUBLIC COMMONWEALTH Of MASSACHUSMS MY COMMISSION EXPIRES MAY 25, 2018 Conflict of Interest Policy(06/04) Page 2 of 2 DocuSign Envelope ID:CD6526B8-31F8-4494-98D6-FFE6244E4DOF Attachment F Deborah Leisey 60 Surnmexsweet Lane Chapel Hill, NC 27516 To: Orange County Department of Social Services Certification: I certify that I do not have any overdue tax debts, as defined by N C G S 105-243.1, at the federal, State, or local level. I finther understand that any person who makes a false statement in violation of N..0 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: 1, being duly sworn, say that I am Deborah Leisey; 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 furthe ction. Signature Sworn to and subscribed before me on the_/,S­4k - day of , fc , 2015 My Commission Expires: OS 4/o ary Signature eal) CARS. JANE'Y ,} NOTARY PUBLIC COMMONWEALTH OF MASSAC#USETIS MY COMMISSION EXPIRES MAY 25, 2018