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HomeMy WebLinkAboutAgenda - 12-05-94 - VIII-F 1 ORANGE COUNTY BOARD OF COMMISSIONERS Action Agenda Item No.____ p ACTION AGENDA ITEM ABSTRACT Meeting Date: December 5, 1994 SUBJECT: On-The-Job Training Contract DEPARTMENT: Social Services PUBLIC HEARING YES: NO: X ATTACHMENT(S) : INFORMATION CONTACT: Marti Pryor-Cook, ext. 2802 Contract between Economic Ted Abernathy, ext. 2326 Development Commission (EDC) and Orange County DSS TELEPHONE NUMBER- Hillsborough - 732-8181 Chapel Hill - 968-4501 Mebane - 227-2031 Durham - 688-7331 PURPOSE: To consider continuing a Contract with EDC for On-the-Job Training services for participants in the DSS Job Opportunities and Basic Skills program. BACKGROUND: On-the-Job Training (OJT) is a subsidized employment opportunity in which a Job Opportunities and Basic Skills (JOBS) program participant is hired and provided skill training by an employer. OJT provides work experience to bring job skills to a competitive level in the marketplace. OJT also improves employability through more substantial supervision and directions than normally available in an unsubsidized work situation. Employers who participate in the program must provide training essential to work performance and compensate employees at a rate comparable to other employees performing a similar job. Employers will be reimbursed 1/2 of the wages paid to the employee, based on the number of work hours and up to a maximum of 12 months. Upon successful completion of OJT, the employer is expected to hire and retain the JOBS participant as a regular employee. EDC will be responsible for the overall development of the OJT program which includes recruiting employers, conducting job assessments, facilitating job placements, and monitoring placements, subcontracts and participant progress at the work site. RECOMMENDATION(S) : The Manager recommends approval of continuing the On-the-Job Training Contract with EDC and authorization for the Chair to sign. 2 Page 1 of 5 STATE OF NORTH CAROLINA DIVISION OF SOCIAL SERVICES • PURCHASE CONTRACT ID # M68179 • This Contract is entered into between the.Department and the Provider identified an Attachment A. This contract shall consist of form DSS-2497, Attachment A (DSS-1292) and Budget (DSS-6844) . The Department will purchase specific services from the Provider as set forth in the Contract in order to make optimal use of the facilities, staff ' and programs of the Provider. This Contract is su..ject to the provisions of all applicable Federal regulations and State policies . Subject to its other provisions , the terms of this contract shall be in effect to and from the dates specified on Attachment A. • SECTION I : RESPONSIBILITIES A. The Department will: 1. Determine client eligibility for service(s) in accordance with Federal and State regulations; and 2. Inform the Provider on Form DSS-1360 concerning the eligibility of each individual for the service, the period of time for • which services are authorized, and any changes in the individual s eligibility status; and 3. Reimburse the Provider for service(s) purchased as described in Attachment A of this Contract for eligible clients; and 4. Keep the Provider informed of any alterations in and/or to the regulations governing the service program; and 5. Accept fiscal responsibility for deviations from the terms of this Contract as a result of acts of the Department or any of its officers, employees, agents or representatives. B. The Provider will: 1. Provide service(s) as specified in Attachment A of this Contract in accordance with applicable standards for the service(s) ; and 2. Furnish information to the Department as required to support the full cost of service(s) provided pursuant to this Contract; and DSS-2497 (Rev. 4-87) Family Services 3 Page 2 of 5 3. Comply with all State licensing standards, all applicable accrediting standards and any other standards or criteria established by the Division of Social Services to assure quality of services; and 4. Restrict the use or disclosure of information obtained in connection with the administration of North Carolina's programs for the provision of services concerning applicants for and recipients of those services to purposes directly connected with the administration of the service program; and 5. Comply with the terms of Section 504 of the Rehabilitation Act of 1973 and all requirements imposed by or pursuant to the regulations of the Department of Health and Human Services issued pursuant to that Section, which prohibit discrimination against handicapped persons in employment and in the operation of programs and activities receiving Federal funds; and 6. Comply with Title VI and VII of the Civil Rights Act of 1964 and all ' requirements imposed by or pursuant to the regulations of the Department of Health 'and Human Services issued pursuant to that Title; and 7. Accept fiscal responsibility for deviations from the terms of this Contract as a result of acts of the Provider or any of its officers, employees, agents or representatives. SECTION II: RESPONSIBILITY FOR LIABILITIES Each party hereto agrees to be responsible for its own liabilities and that of its officers, employees, agents, or representatives arising out of this Contract. • SECTION III: TREATMENT OF ASSETS N/A No property or equipment will be purchased Treatment of assets acquired under this Contract shall be subject to the following: A. Ownership of property purchased by the Provider under the terms of this Contract for which reimbursement by the Department is based upon the actual purchase cost of the property shall immediately vest with the Department of Human Resources upon such reimbursement. B. The North Carolina Department of Human Resources shall •have no claim to property purchased by the Provider under the terms of this Contract for which reimbursement by the Department is based upon an approved' depreciation schedule or use allowance. C. The Provider shall maintain and administer in accordance with sound business practice a program for the maintenance, repair, protection and preservation of property purchased under the terms of this Contract to assure its continued availability. D. Property purchased under the terms of this Contract shall be used only for the performance of this Contract. • • 1 4 Page 3 of 5 SECTION IV: RECORDS AND REPORTS A. The Provider agrees to maintain client records which date and document, in accordance with established pol-icy, the service delivered for the individual, a valid authorization for service, program records, documents and other evidence which reflect program operations. B. The Provider agrees to furnish information to the Department, 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, in this contract, Attachment A or approved supporting information for review and approval by the Department. C. . The Provider agrees to maintain books, records, documents and other evidence and accounting procedures which 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. D. The Provider agrees to retain all books, records and other documents relevant to this Contract for three years after final payment or until all audits continued beyond this period are completed. Federal auditors and any persons authorized by the Division of Social Services or the Department shall have the right to examine any of these materials. In the event the Provider dissolves or otherwise goes out of existence, records produced under this Contract will be turned over to the Department. • SECTION V: SUBCONTRACTING • The Provider shall not subcontract any of the work contemplated under this Contract without obtaining prior written approval from the Department. Any approved subcontract shall be subject to all conditions of this Contract. The Provider shall be responsible for the performance of any subcontractor. SECTION VI : MAINTENANCE OF EFFORT The Provider certifies that the funds to be used under this Contract do not replace or supplant, in any way, Federal, State.or local funds for already existing services. SECTION VII : MONITORING AND EVALUATION • A. The Provider agrees to participate in program, fiscal and administrative monitoring or audits, making records and staff time available to federal, State, and county staff. B. The Provider 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 and State laws , regulations, standards and/or terms of. this contract. 5 Page 4 of 5 SECTION VIII: AMENDING THE CONTRACT This contract in whole or in any part may be amended at any time: A. By the Department in the event that such amendment is necessary to comply with applicable laws, regulations, .policies and standards; or by sutual consent of both parties. B. Each party to this contract will notify the other immediately in writing if an amendment becomes necessary due to alterations in the activities described in Attachment A or for any other reason. • SECTION IX: TERMINATION A. This Contract, in whole or in any part, may be cancelled at any time: I. By any party, with cause, upon at least 30 days notice, in writing, and delivered by registered mail with return receipt requested or in person, or 2. By the Department in the event reimbursement to the Department is not available and/or continued at an aggregate level sufficient to allow for the purchase of the indicated quantity of services. The obligations of each party shall be terminated to the extent specified in the notice of termination, immediately upon receipt of • the notice of termination from the Department, or 3. By the Department in the event that the Division of Social Services/Department determines that the Provider is in violation of any or all of the terms of this Contract. The obligations of each party shall be terminated to the extent specified in the notice of termination immediately upon receipt of the notice from the Department, or 4. By mutual consent of all parties. B. In the event of termination in part, all parties shall continue the performance of this Contract to the extent not terminated. C. If this Contract is terminated, in whole or,,in part, the Provider may be required to deliver and transfer Title or assignment of interest to the Division of Social Services or dispose of any property specifically produced or acquired for the performance of such part of this Contract as has been terminated, and the Provider shall, upon the direction of the Division of Social Services, protect and preserve property in the possession of the Provider in which the Division of Social Services has an interest. D. After receipt of a notice of termination, and except as otherwise directed by the Department, the Provider shall cease work under the Contract on the date, and to the extent specified, in the notice of termination. The Department shall pay the Provider the agreed upon amount for the delivery of services under the terms of this Contract up to the effective date of termination. Reimbursement shall not be 6 Page 5 of 5 made for equipment or supplies purchased after the notice of termination is received except as approved by the Department. E. Waiver of any default shall not be deemed to be a waiver of any subsequent default. Waiver or breach of any provision of the Contract shall not be deemed to be a waiver of any other subsequent breach and shall not be construed to be a modification of the terms of this Contract unless stated to be such in writing, signed by an authorzied representative of the Department and attached to the Contract. • ' r SECTION X: CONCLUSION It is expressly understood and agreed that the services provided to eligible clients pursuant to this Contract shall consist exclusively of those services specified in the attached program description incorporated into this Contract as Attachment A. It is further understood aad agreed that the provision of services pursuant to this Contract shall be subject to the limitations and conditions contained in the laws, regulations, guidelines and plans cited in this Contract, and that this Contract is subject to renegotiation or revision to meet any new or revised rules, regulations, or policies that may be issued by the Department of Health and Human Services, or the North Carolina Social Services Commission, or the Department of..Human Resources and that are communicated to the Provider. PROVIDER ' DE?AR=T Economic Develoement Common Orange County Department of Snnial Services By: By: ) -71'.76tfz12-1-') Title: EDC Director Title: DSnS Director Date: �7/97,/ Date: This Agreement has been preaudited in the manner required by the Local Government Budget and Fiscal Control Act. ATTEST: County: Orange County - Title: _Finance. Director Signature: - Date: 7 STATE OF NORTH CAROLINA DIVISION OF SOCIAL SERVICES COUNTY BOARD APPROVAL This is to certify that on /2.,,Lmbw�- /5 , 19 94- , the Oran e County Board of Social Services, in official session, approved the purchase of certain services from Economic Development Commission to be purchased under the terms of (provider agency) the Purchase Contract bearing the ID #_M68179_. ne_z_4_ ,c5r1 pas Date ChAirman or Secretary 8 STATE OF NORTH CAROLINA DIVISION OF SOCIAL SERVICES COUNTY BOARD APPROVAL This is to certify that on , 19 , the Orange County Board of County Commissioners, in official session, approved the purchase of certain services from Economic Development Commission to be purchased under the terms of (provider agency) the Purchase Contract bearing the ID #_M68179_. Date Chairman or Secretary 9 ATTACHMENT A • State of North Carolina Division of Social Services Contract Application Page 1 of 8 I . Contract Summary A. This agreement is between the Orange County Department of Social Services (heretofore and hereinafter referred to as the "Department") and the Economic Development Commission IEDC) (heretofore and hereinafter referred to as the "Provider") . B . This agreement shall be in effect from 12/1/94 to 6/30/95 C. Services to be Provided: (1) (2) (3) (4) (5) • Number of Number of Definition Service Persons Units of of Unit Service Code Served Service of Service Job Assessment 521 8 8 1 Participant OJT 544 ;8 A 1 Participant Any additional services should be listed in III. -Service Program Description D. Area to be Served: The participant must be employed at a minimum of 30 hours per week and a maximum of 40 hours per week. The length of the training period must be determined by utilizing the Dept. of Labor (DOL) Specific Vocational Preparation Manual. DSS-1292 (4/87) Family Services • 10 State of North Carolina Division of Social Services Contract Application Page 2 of 8 E. Contract Identification: I . Provider a. Name of Contract Administrator Ted Abernathy Tel. #: (919) 732-8181 Ext 2326 b. Name of Program Contact Person: Ted Abernathy Tel. U. c. Program Name, Location and Mailing Address: 110 E. King St. P.O. Box 1177, Hillsborough, NC 27278 d. Additional Service Delivery Sites: none e. Status: (x) Public ( ) Private, non-profit ( ) Private, for profit ( ) Individual f. Provider Contract ID U: M 68179 2. County Department of Social Services a. Name of Contract Administrator: Tel. U: (919) 732-8181 Ext 2802 Martha Pryor-Conk b. Name of Services Program Contact Person: Gwendolyn Price Tel. U: (919) 732-8181 Ext 2847 c. Address of County Department of Social Services: P.O. Box 8181 Hillsborough, NC 27278 DSS-1292 (4/87) Family Services 11 State of North Carolina -- Division of Social Services Contract Application Page 3 of 8 II. Fiscal Provisions A. Amount of Reimbursement: Reimbursement under the terms of this agreement will be limited to a maximum of: $ 155,072 TOTAL = $ SSBG + $ IV-B + $ RAP + $ 4,744 State + $ 837 County + $ 9,491 Other (identify) : Fed (Optional: County funds consist of $ for (funding source) and $ for . ) (funding source) B. Method of Reimbursement: 1. For Purchase Contract (DSS-2497) Total and Unit Cost: (x) a. Reimbursement will be made in accordance with the current budget approved by the Department and on file with both parties. The amount of reimbursement will be based on allowable expenditures made in behalf of eligible clients, determined in accordance with acceptable cost allocation methods. The Provider will report all expenditures made under the terms of the contract. ( ) b. Reimbursement will be made at a unit cost rate of $ per unit of reimbursement delivered to eligible clients for an estimated number of units. The Provider will document total expenditures made under the terms of the contract to the Department within thirty days after the termination of this contract, or as instructed by the Department. Reimbursement which exceeds actual allowable cost will be adjusted to actual allowable cost. 2. For Vendor Agreements (DSS-2252) Fixed Rate Reimbursement will be based on: • ( ) a. a standard fixed rate or ( ) b. an individual fixed rate. c. Reimbursement will be made at a fixed rate of $ per unit of (define) for an estimated number of units. Reimbursement will be based on the actual number of units delivered whether over or under the estimated number. If multiple components are being purchased, additional rates and units can be identified as follows: DSS-1292 (4/87) Family Services 12 State of North Carolina Division of Social Services _- Contract Application Page 4 of 8 C. Reimbursement Reporting: 1. Expenditures The Provider will report expenditures monthly in accordance with policy set forth by the Controller's Office, Division of Social Services, issued via the Fiscal Manual. Expenditures are to be reported on the DSS Administrative Costs Report (Form DSS-1571, Part III) . Reports are to be submitted to the Department by the fifth working day of the month following the month in which services were delivered. The Department will reimburse the Provider monthly, usually by check, upon receipt of a completed and correctly filed report. 2. Reporting for the Statewide Services Information System (SIS) In addition to the Administrative Cost Report (DSS-1571, Part III) , the Provider will submit to the Department the Monthly Report of Service Delivery (DSS Form 1571, Part IV) . This should be submitted along with the Administrative Cost Report by the fifth working day of the month following the month in which services were delivered. The units reported in Column 12 of the 1571 Part IV are the units of service defined in Column 5 of I. C. of this Attachment. Service definition and reporting instructions are found in Family Services Manual, Volume VI, Chapter IV. D. Audit Requirements The Provider shall be responsible for compliance with the audit requirements of Department of Health and Human Services federal regulation 45 CFR Part 74, Administration of Grants, or State Administrative Procedures Manual for Federal Block Grant Funds, whichever is applicable. These regulations stipulate that an annual audit be performed for the fiscal year in which contract funds were received. ( ) 1. NA Private, non-profit if amount of reimbursement received is under $1,000; private, for profit or individual ( ) 2. (Applicable to Private, Non-Profit Providers if reimb. $1,000 or over) An annual audit is to be performed in accordance with OMB Circular A-110 by an "independent auditor." "Independent auditor" means either: (a) a state government auditor from the Department of Human Resources or the Department of Administration, Office of the State Auditor; or (b) a certified public accountant. Upon completion of the audit, a copy of the audit report must be forwarded to the county department of social services. DSS-1292 (4/87) Family Services 13 State of North Carolina • Division of Social Services Contract Application Page 5 of g ( ) 3. (Applicable to Public Hospitals , Colleges , and Universities) The annual audit must be performed in accordance with 0M Circular A-110. It is not necessary for the institution to program audits performed separately from an all-inclusive single audit which entails all revenues and expenditures of the public agency. However, it is the responsibility of the contractor to insure that the contract program is included in the institution's single annual audit. A copy of the audit report must be provided to the County department of social services upon completion of the annual audit. ( x) 4. (Applicable to State or Local Government Agencies) An annual audit is to be performed in accordance with OMB Circular A-128 by an independent auditor. Upon completion of the audit, a copy of the audit report must be forwarded to the county department of social services . E. Client Fees for Service ( x) 1. No fees will be charged to individuals determined to be eligible for services by the department of social services. ( ) 2. The service(s) under contract with the Provider are services for which a client fee may be assessed. Policy regarding the assessment and collection of fees is contained in Family Services Manual, Volume VI, Chapter III . If a client is to be charged a fee, the department will inform the Provider of the amount of the fee to be charged and of any subsequent changes by way of the Purchase of Service Referral and Authorization (DSS Form 1360) . The Provider will establish a plan with the client for collecting the fee on at least a monthly basis; and when fees are not paid within ten days of the due date, will bill the client in writing and send a copy of the bill to the Department. NO OTHER FEES FOR SERVICES MAY BE CHARGED TO THE CLIENT. Client fees are to be reported on the Monthly Report of Service Delivery (DSS Form 1571, Part IV) . • F. Management of the Funding/Matching Share Requirement ( ) 1. A cash transfer of the matching share will be made to the county department of social services in accordance with the terms specifed in the Donation Agreement (DSS-1319) . DSS-1292 (4/87) Family Services • 14 State of North Carolina Division of Social Services - Contract Application Page 6 of 8 ( ) 2. The provider certifies through the contract budget attached to this contract that the matching share is available. Further, it is agreed that the provider will report all program costs incurred each month relating to this contract on the DSS-1571. However, reimbursement will be limited to the federal/state financial participation rate. (X) 3. The county department of social services is providing the match. G. Provider Fees (For Purchase Contracts Only) ( ) 1. The Provider agrees to pay the Department/Division up to $ Administrative Fee as payment in full for the administration of the contract. The amount of the fee is five percent of the matching share contributed by the Provider. ( ) 2. The Provider agrees to pay the Department up to $ Certifica- tion Fee as payment in full for the determination and certification of client eligibility. The amount of the fee is five percent of the matching share contributed by the Provider. Monitoring and Certification Fees, when applicable, will be deducted from the amount to be reimbursed. DSS-1292 (4/87) Family Services 15 State of North Carolina Page 7 of 8 Division of Social Services Contract Application III. Service Program Description On-the-Job Training (OJT) is a subsidized employment opportunity in which a Job Opportunities and Basic Skills (JOBS) Program partici- pant is hired and provided skill training by an employer. OJT will provide work experience to bring skills to a level that will be competitive in the marketplace and improve employability potential through more substantial supervision and directions than normally available in an unsubsidized work situation. OJT will be purchased by the Orange County Department of Social Services from Economic Development Commission (EDC) . The EDC will be responsible for the development of job sites, the placement of participants , monitoring participants activities and contract compliance. The provider, EDC, will enter into sub-contracts with employers for OJT. The length of the participant training period must depend on the Specific Vocational Preparation (SVP) level described by the Department of Labor (DOL) . Employers must provide training essential to the adequate performance of the job and compensate employees at a rate comparable to other employees performing the same or similar job. Upon successful completion of the training, the employer is expected to hire and retain the participant as a regular employee. The purchaser will pay 1/2 of the wages paid to the participant, based on the number of actual hours worked, by the employer upon billing by EDC. This reimbursement is to be used solely to compensate employers for training cost. The Development Specialist and Administrative Assistant report to the Director. The Director will be responsible for the overall development of the OJT program and the direct supervision of the Development Specialist and Administration Assistance. The Director and Development Specialist will inform the public of the OJT program and aid in developing employer interest. The JTPA director will monitor the subcontracts, review participant progress and request for reimbursement from the employer. The subcontractor will submit budget invoices and documentation of cost; including a detailed breakdown of OJT cost to EDC. The Administration Assistant will complete the DSS 1571 Part III and Part IV for reimbursement of expenses . JOBS participants will be assessed by JOBS staff and referred to OJT via a DSS-1360 (Attachment 1) , if determined a good candidate for OJT. The Development Specialist will assess the JOBS client for OJT 16 Page 8 of 8 participation and provide written feedback of participant status. If the participant is placed in an OJT slot, the provider must forward a copy of the sub-contract. The JOBS staff will maintain, at a minimum, monthly contacts with EDC to keep abreast of par- ticipant progress . The JOBS Program requires monthly reporting of hours of participation. The JOBS Time Card is due on the 5th day of the month following the month of participation. The Development Specialist will be responsible for obtaining the time card and forwarding to JOBS staff. The Development Specialist will develop job opportunities by contacting area employers, scheduling participant appointments and conducting job readiness sessions. At a minimum, the record maintained by EDC will contain: 1) the initial JOBS Referral Form and response; 2) documentation of OJT agent' s contacts with the participant and/or sub-contracts with the employer on behalf of the recip- ient and documentation of service provision; 3) invoices or bills documenting wages paid to the client by the employer. DSS-1292 STATE OF NORTH CAROLINA DIVISION OF SOCIAL SERVICES PURCHASE CONTRACT BUDGET 17 SUMMARY Effective Provider Economic Developrrnet • IDM M 68179 Period 12/1/94 _ through 6/30/95 Part I - Estimated Expenditures • Total Non-Matchable I Total Matchable Program Costs Costs Costs Object of Expenditure (1 ) (2) (3) A. Salaries 1,320 1,320 B. Fringe Benefits 319 319 C. Staff Development-Services D. Travel 1 I E. Equipment Purchases-Tangible Property F. Transportation-Recipient G. Medical Supplies and Expense H. Cost of Space-Non-Residential I. Room & Board-Residential Treatment J. Service Payments 11,272 11,272 K. Other L. Indirect Costs 2,161 2,161 M. Totals 15,072 15,072 Part II - Computation of Unit Cost or Individual Fixed Rate A. 1 . Total Matchable Costs $ 15,072 2. Less: Earned Income for Unit Cost Method $ -0- 3. Net Matchable Costs $ 15,072 8. 1 . Total Service Unit Capacity, or 2. Total Anticipated Utilization Capacity C. Method of Computation or Source of Data D. Estimated Unit Cost or Individual Fixed Rate: S _ per DSS-5844 (2/83) Family Services Part III - Distribution of Estimated Revenue for Total Cost Reimbursement Method 18 A. Estimated Eligible and Matchable Costs (a) (t Number Ratio 1 . Estimated Eligible Clients 8 100 2. Estimated Ineligible Clients 3. Total Clients j 8 100 B. Eligible Costs (1 ) Matchable (2) Less (3) Net (4-) �5� Costs Eligible � Costs Earned Matchable Estimated for Financial [Part I , Line M, Income Costs - of Eligibles Participation col . (3)] [B. (1 ) Less (2)] [A. 1 . (b)] [B. (3) x (4)l $ 15,072 1 $ -0- 5 15,072 100% S 15,072 • Part IV - Additional Revenue and Fees A. Program Costs Amount Source of =ands 1 . Federal/State Funds $ 14,235 JOBS 2. Local Matching Share $ 837 3. Other Budgeted Funds $ j 4. TOTAL REVENUE $ 15,072 B. Fees (If Applicable) 1 . Administrative Fee $ 2. Certification Fee $ 3. TOTAL FEES $ I Part V - Reimbursement Projections (For Title XX Providers Only) July-September October-June Annual Projection ! Projection Projection A. S --- ....._ B. S � C. S Signed: Date: Provider/Authorized Official — -- Date: County Director or Designee JSS-o341 (?/83) Family Services Purchase Contract Budget • Supporting Budget Schedules 19 A. Salary Schedule (1 ) (2) (3) (4) (5) (6) (7) Number Pay % of No. of Months Annual Total of Persons Position or Title Grade Time Employed Salary Cost • 1 Development Specialist 66 7% 7 32,315 1,320 12 X 7 months) IECM I Total - Salaries { 1,320 B. Fringe Benefi ..:) � ) 2 (3) Total Type Method of Computation Cost FICA 7.65% of 1,320 `) $101 Retirement i 4.93% of 1,320 I $ 65 Health Annual Expense 3,740.64 = 12 X 7 months X 7% $153 I r Total - Fringe Benefits [ $219 j 'MS-6844 (2/83) cAm+ 1v Corvir.ne / I I C. Staff Development - Service Funds Schedule 20 (1 ) (2) Item Total. tem — ---- - ----- Cost Total Staff Development - Service Funds D. Travel Schedule (1 ) (2) (3) _.(4) (5) Daily Subsistence (8) No. of No. of Rate per No. of (6) 1 (7) Total Persons Position or Title Miles/Days Mile Days Rate Days Cost Total - Travel E. Equipment - Tangible Property Schedule (1 ) (2) (3) (4) No. of Total Units Item Cost Gar Unit Cost fTotal Equipment - Tangiu,e .Property DSS-6844 (2/83) Family Services 21 F. Recipient Transportation Schedule (1 ) (2) (3) Total Item Method of Computation Cost • la. Salaries - # of Pay % of # of Months Annual Persons Position or Title Grade Time Employed Salary lb. Fringe Benefits Type • Method of Computation • • 1Totai Recipient Transportation i DSS-6844 (2/83) Family Services G. Medical Supplies and Expense Schedule 22 (1 ) - (2) Total Item Cost - i Total - Medical Supplies and Expense H. Cost of Space - Non-Residential Schedule _ (1 ) (2) f 'Total Item L Cost � f 1 i Total Cost of Space - Non-Residential I. Room and Board Costs - Residential Treatment (1 ) f (2) • (3) Total Item Method of Com.utation Cost I Total Room 2no Ecarri Costs - Residen'i:l T;eatmen: 1 DSS-6844 (2/83) Family Services , IJ. Service Payment Schedule 23 1 2 No. of (4) Units Item _ Cost •er Unit Total 8 OJT Contracts $1,409.00 $11,272 - I Total - Service Payment $11,272 K. Other Expense Schedule (1 ) (2) Item Total tem Cost Total - Other Expenses ' L. Indirect Cost Schedule ( 1 ) (2) (3) (4) Rate Rate Applied to: Amount Rate Applied to: Total 1 Director Salary 2% 63,977 = 12X7 = 37,320 1 Administrative Assistant 7% 746 24,702 : 12 X 7 = 14,410 1,009 Fringe Benefits Director: FICA 7.65% of 746 57 Retirement 4.93% of 746 37 Health Annual 2,789.04 . 12 X 7 X 2% 33 Administrative Asst: FICA 7.65% of 1,009 77 Retirement - 4.93% of 1,009 50 Health ' Annual 3,715.44 : 12 X 7 X 7% 152 Total - Indirect Cost — ; 2,161 ' DSS-6844 (2/83) Family Services • IY STATE OF NORTH CAROLINA COUNTY OF ORANGE AGREEMENT BETWEEN THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF DENTISTRY FOR ITS DEPARTMENT OF DENTAL ECOLOGY AND ORANGE COUNTY HEALTH DEPARTMENT AMBULATORY CARE DENTAL SERVICE AND THE UNIVERSITY OF NORTH CAROLINA HOSPITALS THIS AGREEMENT, made and entered into this the 1st day of July, 1994, by and between The University of North Carolina at Chapel Hill, School of Dentistry, hereinafter referred to as "The School of Dentistry", for its Department of Dental Ecology; and The Orange County Health Department hereinafter referred to as"The Health Department"for its Ambulatory Care Dental Service, and The University of North Carolina Hospitals, hereinafter referred to as "The University of North Carolina Hospitals". WITNESSETH WHEREAS,The Health Department desires the services of one resident at the postgraduate year one level in the Ambulatory Care Dental Service for the academic year 1994-95; WHEREAS, The Health Department desires to reimburse The School of Dentistry for the salary plus fringe of one resident at the postgraduate year one level; WHEREAS,The School of Dentistry and The University of North Carolina Hospitals wish to provide the services of one resident to The Health Department; NOW, THEREFORE, in consideration of the premises and of the following mutual promises, covenants, and conditions, The School of Dentistry, The University of North Carolina Hospitals and The Health Department agree as follows: 1. The Health Department will reimburse The School of Dentistry at the close of each quarter for Between The University of North Carolina School of Dentistry for its Department of Dental Ecology and OCHD and UNC Hospitals Page 2 of 3 1/4 the total salary ($29,000) and fringe benefits, Composite Benefits ($88.00), FICA ($2,220.00), Hospital Insurance ($2657.00), Parking ($210.00), Interns Permit ($75.00), Total Fringe ($5,250.00) of one postgraduate year one resident beginning July 1, 1994 (quarterly totals-salary$7,250.00 fringe$1,312.50 grand total quarterly reimbursement $8,562.50). 2. The School of Dentistry will provide the services of one postgraduate year one resident to The Health Department for the purpose of rendering comprehensive dental services of 4 1/2 days/wk. 3. School of Dentistry will bill The Health Department at the close of each quarter for the salary/fringe of one postgraduate year one resident. 4. The person whose services are to be provided pursuant to the Agreement is, for all purposes, an employee of The University of North Carolina Hospitals. 5. While the University of North Carolina Hospitals resident is on rotation at the Orange County Health Department, their professional liability insurance coverage will be provided by the School of Dentistry with coverage of at least $1 million, per incident, $3 million per year. 6. This Agreement shall run for a period of one year, from the 1st day of July, 1994 to the 30th day of June, 1995, and shall be renewable thereafter. 7. This Agreement or its renewals may be terminated at any time without penalty by either party provided that written notice of such termination is furnished to the other party at least 90 days prior to termination. In the event of such termination any payment due shall be prorated to the date of termination. 8. In compliance with 42 U.S.C. 1395x (v)(1)(I) and implementing regulations, The School of Dentistry and The Health Department agree, until the expiration of four years after the services are furnished under this contract,to allow the Secretary of the Department of Health and Human Services and the Comptroller General access to this contract and to the books, documents and records of The School of Dentistry and The Health Department necessary to verify the nature and extent of this contract. • Between The University of North Carolina School of Dentistry for its Department of Dental Ecology and OCHD and UNC Hospitals Page 3 of 3 The School of Dentistry and The Health Department further agree that if any of the duties of this contract are carried out by a subcontractor of The School of Dentistry or The Health Department such subcontract shall contain a clause to the effect that, until the expiration of four years after the services are furnished under such subcontract, the Secretary of the Department of Health and Human Services and the Comptroller General shall have access to such subcontract and to the books, documents and records of the subcontractor necessary to verify the nature and extent of the costs of such subcontract. 9. The Health Department and The University of North Carolina Hospitals hereby agree with The School of Dentistry that, in its educational and/or employment practices The Health Department will comply with such non-discrimination laws as may be applicable to it in the performance of this Agreement. 10. The Agreement contains the entire understanding of the parties and shall not be altered, amended or modified, except by an agreement in writing executed by the duly authorized officials of both parties. 11. The laws of North Carolina shall govern the validity and interpretation of the provisions, terms and conditions of this Agreement. IN WITNESS WHEREOF, the parties have hereunto signed this Agreement in their official capacities of the day and year listed below. FOR AND ON BEHALF OF: FOR AND ON BEHALF OF THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL Daniel B. Reimer (�„ Wayne Jones Health Director Vice Chancellor Date: JA 117 9,3I- Business a F nance Date: 61 q4-- This instrument has been preaudited in the jj manner required by the Local Government Budget and Fiscal Control Act r 7 Kenneth Chavious Director, Orange County Finance Date: FOR AND ON BEHALF O . Mr/ W . THE U,,#' RSIT jv. "TN CA"•LINA Chai"a', Orange County / HOSE/ Board of Commissioners �_� ✓% Eric B. Munson, Executive Dir.