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HomeMy WebLinkAbout2018-047-E DSS - InterFaith CouncilDocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Contract #68 -3010 Inter -Faith Council for Social Service, Inc. Contract # 68 -3010 Fiscal Year BeginsJulyl, 2017 Ends June 30, 2018 This contract is hereby entered into by and between the Orange County Department of Social Services (the "County ") and Inter - Faith Council for Social Service, Inc. (the "Contractor ") (referred to collectively as the "Parties "). The Contractor's federal tax identification number or Social Security Number is 59- 1224041. 1. Contract Documents: This Contract consists of the following documents (1) This contract (2) The General Terms and Conditions (Attachment A) (3) The Scope of Work, description of services, and rate (Attachment B) (4) Federal Certification Regarding Drug -Free Workplace & Certification Regarding Nondiscrimination (Attachment C) (5) Conflict of Interest (Attachment D) (6) No Overdue Taxes (Attacluuent E) (7) Certification Regarding Lobbying (Attachment G) (8) Certification Regarding Debarment (Attachment H) (9) IRS Federal Tax Exempt Letter or 501(c)(3) (Attachment K) (10) State and Local Certifications (Attachment M) (11) Outcomes and Reporting (Attachment N) (12) Contract Determination Questionnaire These documents constitute the entire agreement between the Parties and supersede all prior oral or written statements or agreements. 2. Precedence Among Contract Documents: In the event of a conflict between or among the terms of the Contract Documents and this Agreement, the terms of this Agreement shall control. In the event of a conflict between or among the terms of the Contract Documents, then the Contract Documents with the highest relative precedence shall prevail. The order of precedence shall be the order of documents as listed in Section 1, above, with Attachment A having precedence over Attachment B and so forth. If there are multiple Contract Amendments, the most recent amendment shall have the highest precedence and the oldest amendment shall have the lowest precedence. 3. Effective Period: This contract shall be effective on January 1, 2018 and shall terminate on December 31, 2018. This contract must be twelve months or less. 4. Contractor's Duties: The Contractor shall provide the services and in accordance with the approved rate as described in Attachment B, Scope of Work, and shall meet the requirements set forth in Attachment N, Outcomes and Reporting. 5. County's Duties: The County shall pay the Contractor in the manner and in the amounts specified in the Contract Documents. The total amount paid by the County to the Contractor under this contract shall not exceed $48,000. This amount consists of $48,000 in Federal (CFDA # ), State and County funds, $0 (source of other funds if applicable). [X] a. There are no matching requirements from the Contractor. [ ] b. The Contractor's matching requirement is $ , which shall consist of: [ ] In -kind [ ] Cash [ ] Cash and In -kind [ ] Cash and /or In -kind The contributions from the Contractor shall be sourced from non - federal funds. The total contract amount including any Contractor match shall not exceed $48,000. Contract - General (07 /10) Page 1 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Contract #68 -3010 Inter -Faith Council for Social Service, Inc, 6. Reporting Requirements: Contractor shall comply with audit requirements as described in N.C.G.S. § 143C -6 -22 & 23 and OMB Circular A -133 and shall disclose all information required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106. 7. Payment Provisions: Payment shall be inadc in accordance with the Contract Documents as described in the Scope of Work, Attachment B. 8. Contract Administrators: All notices permitted or required to be given by one Party to the other and all questions about the contract from one Party to the other shall be addressed and delivered to the other Party's Contract Administrator. The name, post office address, street address, telephone number, fax number, and email address of the Parties' respective initial Contract Administrators are set out below. Either Party may change the name, post office address, street address, telephone number, fax number, or email address of its Contract Administrator by giving timely written notice to the other Party. For the County: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Sharron Hinton, Human Services Manager Orange County Department of Social Services P.O. Box 8181 Hillsborough, NC 27278 (919) 245 -2840 shintoii@oranocouiityiie.gov Program Contact: Suzanne Hitt, Prevention Services Supervisor Orange County Department of Social Services P.O. Box 8181 113 Mayo Street Hillsborough, NC 27278 (919) 245 -2850 For the Contractor: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Jackie Jenks, Director 110 West Main Street Carrboro, NC 27510 (919) 929 -63 80 Ext. 14 jjenks(c�r,ifcmailbox.or Contract- General (07110) Page 2 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Contract #6& -3010 Inter-Faith Council for Social Service, Inc. 9. No Assignment or Sub- Contract: Contractor shall not sub- contract out any of the services provided for in this Agreement or make any assignment of this Agreement (including rights to payments) without the prior written Consent of the County as specified more fully in Attachment A, General Terms and Conditions. 10. Supplementation of Expenditure of Public Funds: The Contractor assures that funds received pursuant to this contract shall be used only to supplement, not to supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract services and related programs. Funds received under this contract shall be used to provide additional public funding for such services; the fiends shall not be used to reduce the Contractor's total expenditure of other public funds for such services. 11. Disbursements: As a condition of this contract, the Contractor acknowledges and agrees to make disbursements in accordance with the following requirements: a. Implement adequate internal controls over disbursements; b. Pre -audit all vouchers presented for payment to determine; i. Validity and accuracy of payment ii. Payment due date iii. Adequacy of documentation supporting payment iv. Legality of disbursement c. Assure adequate control of signature stamps /plates; d. Assure adequate control of negotiable instruments; and e. Implement procedures to insure that account balance is solvent and reconcile the account monthly. 12. Outsourcing to Other Countries: The Contractor certifies that it has identified to the County all jobs related to the contract that have been outsourced to other countries, if any. The Contractor further agrees that it will not outsource any such jobs during the term of this contract without providing notice to the County. 13. Federal Certifications: Individuals and Organizations receiving federal funds must ensure compliance with certain certifications required by federal laws and regulations. The contractor is hereby complying with Certifications regarding Nondiscrimination, Drug -Free Workplace Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and certifications are to be signed by the contractor's authorized representative. ld. Relationship of the Parties: Contractor is an independent contractor of the County. Contractor represents that it has or will secure, at its own expense, all personnel required in performing the services tinder this Agreement. Such personnel shall not be employees of or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized or permitted under state and local law to perform such services. It is further agreed by Contractor that it shall obey all State and Federal statutes, rules and regulations which are applicable to provisions of the services called for herein. Neither Contractor nor any employee of the Contractor shall be deemed an officer, employee or agent of the County. 15. Termination: This Agreement may be terminated as specified in Attachment A, General Terms And Conditions. lb. Insurance Requirements: Contractor shall obtain, at its sole expense, all insurance as required inAttachrnentA, General Terms And Conditions, 17, Indemnification: Contractor agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense ( including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by Contractor in accordance with Attachment A, General Terms And Conditions. It is the intent of this Section that Contractor indemnify County to the full extent permitted by law. 18. Entire Agreement: The parties have read this Agreement, including the Contract Documents, and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties. 19. Interpretation: When the context in which words are used in this Agreement indicates that such is the intent, words shall in the singular number shall include the plural and vice versa. The masculine gender shall include the feminine and neuter. Contract - General (07110) page 3 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Contract #b8 -3010 Inter -Faith Council for Social Service, Inc. IN WITNESS WHEREOF, the County and the Contractor have been first duly authorized, have executed and entered into this Agreement as of the day and year first above written. 'T o us g d bvmTT COUNCIL FOR SOCIAL SERVICE, INC. 13a&(I ,�C.'Ztt,�S 2/13/2018 B317305AEFF04Ag ... Si gnature Date 3ackie 3enks Executive Director Printed Name ORANGE COUNTY 1DocuSigned by, 6'Rawi&L rs t" 3799d8755E477... Bomiie Hammersley, County Manager Title 2/19/2018 Date Contract - General (07/10) Page 4 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMENT A GENERAL TERMS AND CONDITIONS Orange County Department of Social Services Relationships of the Parties Independent Contractor: The Contractor is and shall be deemed to be an independent contractor in the performance of this contract and as such shall be wholly responsible for the work to be performed and for the supervision of its employees. The Contractor represents that it has, or shall secure at its own expense, all personnel required in performing the services under this agreement. Such employees shall not be employees of, or have any individual contractual relationship with the County. Subcontracting: The Contractor shall not subcontract any of the work contemplated under this contract without prior written approval from the County. Any approved subcontract shall be subject to all conditions of this contract. Only the subcontractors specified in the contract documents are to be considered approved upon award of the contract. The County shall not be obligated to pay for any work performed by any unapproved subcontractor. The Contractor shall be responsible for the performance of all of its subcontractors. Assignment: No assignment of the Contractor's obligations or the Contractor's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, the County may: (a) Forward the Contractor's payment check(s) directly to any person or entity designated by the Contractor, or (b) Include any person or entity designated by Contractor as a joint payee on the Contractor's payment check(s). In no event shall such approval and action obligate the County to anyone other than the Contractor and the Contractor shall remain responsible for fulfillment of all contract obligations. Beneficiaries: Except as herein specifically provided otherwise, this contract shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this contract, and all rights of action relating to such enforcement, shall be strictly reserved to the County and the named Contractor. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any other third person. It is the express intention of the County and Contractor that any such person or entity, other than the County or the Contractor, receiving services or benefits under this contract shall be deemed an incidental beneficiary only. Indemnity and Insurance Indemnification: The Contractor agrees to indemnify and hold harmless the County and any of their officers, agents and employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the performance of this contract. Insurance: During the term ofthe contract, the Contractor at its sole cost and expense shall provide commercial insurance of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the Contractor shall provide and maintain the following coverage and limits: (a) Worker's Compensation - The contractor shall provide and maintain Worker's Compensation Insurance as required by the laws of North Carolina, as well as employer's liability coverage with minimum limits of $500,000.00, covering all of Contractor's employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall require the subcontractor to provide the same coverage for any of his employees engaged in any work under the contract. (b) Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.) (c) Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured /under insured motorist coverage; and a limit of $25,000.00 for medical payment coverage. The Contractor shall provide this insurance for all automobiles that are: (a) owned by the Contractor and used in the performance of this contract; (b) hired by the Contractor and used in the performance of this contract; and (c) Owned by Contractor's employees and used in performance of this contract ("non - owned vehicle insurance "). Non -owned General Terms and Conditions — (06/16) Page I of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C vehicle insurance protects employers when employees use their personal vehicles for work purposes. Non -owned vehicle insurance supplements, but does not replace, the car - owner's liability insurance. The Contractor is not required to provide and maintain automobile liability insurance on any vehicle -- owned, hired, or non -owned -- unless the vehicle is used in the performance of this contract. (d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs. (e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are not limits, or caps, on the Contractor's liability or obligations under this contract. (f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be granted. (g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating that it is self- insured and that its self - insurance provides protection that is equal to or greater than the coverage and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be granted. (h) Providing and maintaining the types and amounts of insurance or self- insurance specified in this paragraph is a material obligation of the Contractor and is of the essence of this contract. (i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such insurance shall meet all laws of the State of North Carolina. (j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all lawful requirements of its insurer. (k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph. (1) The Contractor shall dernonstrate its compliance with the requirements of this paragraph by submitting certificates of insurance to the County before the Contractor begins work under this contract. Transportation of Clients by Contractor: The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2 -36 of the North Carolina Utilities Commission. Default and Termination Termination Without Cause: The County may terminate this contract without cause by giving 30 days written notice to the Contractor. Termination for Cause: If, through any cause, the Contractor shall fail to fulfill its obligations under this contract in a timely and proper manner, the County shall have the right to terminate this contract by giving written notice to the Contractor and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Contractor under this contract shall, at the option of the County, become its property and the Contractor shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Contractor shall not be relieved of liability to the County for damages sustained by the County by virtue of the Contractor's breach of this agreement, and the County may withhold any payment due the Contractor for the purpose of setoff until such time as the exact arnount of darnages due the County from such breach can be determined. In case of default by the Contractor, without limiting any other remedies for breach available to it, the County may procure the contract services from other sources'and hold the Contractor responsible for any excess cost occasioned thereby. The filing of a petition for bankruptcy by the Contractor shall be an act of default under this contract. Waiver of Default: Waiver by the County of any default or breach in compliance with the terms of this contract by the Provider shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms of this contract unless stated to be such in writing, signed by an authorized representative of the County and the Contractor and attached to the contract. Availability of Funds: The parties to this contract agree and understand that the payment of the sums specified in this contract is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to the County. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the contract expiration or termination date unless specifically provided General Tenns and Conditions — (06116) Page 2 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C otherwise herein, or unless superseded by applicable Federal or State statutes of limitation. Intellectual Property Rights Copyrights and Ownership of Deliverables: All deliverable items produced pursuant to this contract are the exclusive property of the County. The Contractor shall not assert a claim of copyright or other property interest in such deliverables. Federal intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100 -506, codified at 11 U.S.C. 365 (n) and any amendments thereto. Compliance with Applicable Laws Compliance with Laws: The Contractor shall comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the conduct of its business, including those of federal, state, and local agencies having jurisdiction and /or authority. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147- 86.58. Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S. Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited also on the basis of religion or political beliefs. Equal Employment Opportunity: The Contractor shall comply with all federal and State laws relating to equal employment opportunity. Health Insurance Portability and Accountability Act ( HIPAA): The Contractor agrees that, if the County determines that some or all of the activities within the scope of this contract are subject to the Health Insurance Portability and Accountability Act of 1996, P.L. 104 -91, as amended ( "HIPAA "), or its implementing regulations, it will comply with the HIPAA requirements and will execute such agreements and practices as the County may require to ensure compliance. (a) Data Security: The Contractor shall adopt and apply data security standards and procedures that comply with all applicable federal, state and local Iaws, regulations, and rules. (b) Duty to-Report: The Contractor shall report a suspected or confirmed security breach to the local Department of Social Services Contract Administrator within twenty -four (24) hours after the breach is first discovered, provided that the Contractor shall report a breach involving Social Security Administration data or Internal Revenue Service Data within one (1) hour after the breach is first discovered. (c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation or rule requires the Contractor give written notice of a security breach to affected persons, the Contract shall bear the cost of the notice. Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104) Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors are encouraged to review Executive Order 24 and G.S. Sec. 133 -32. Confidentiality Confidentiality: Any information, data, instruments, documents, studies or reports given to or prepared or assembled by the Contractor under this agreement shall be kept as confidential and not divulged or made available to any individual or organization without the prior written approval of the County. The Contractor acknowledges that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not ftrrther disclose the information except as otherwise provided in this contract. Oversight Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions in accordance with General Statute 147 -64.7. Additionally, as the State funding authority, the Department of Health and Human Services shall have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions. General Terns and Conditions — (06116) Page 3 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record retention may be longer than five years since records must be retained for a period of three years following submission of the final Federal Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Contract has been started before expiration of the five -year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five -year period described above, whichever is later. The record retention period for Temporary Assistance for Needy Families (TANF) and MEDICAID and Medical Assistance grants and programs must be retained for a minimum of ten years. Warranties and Certifications Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract ( "product" includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial software, or internal components, subroutines, and interfaces therein) that perform any date and /or time data recognition function, calculation, or sequencing will support a four digit year format and will provide accurate date /time data and leap year calculations. This warranty shall survive the termination or expiration of this contract. Certification Regarding Collection of Taxes: G.S. 143- 59.1 bars the Secretary of Administration from entering into contracts with vendors that meet one of the conditions of G.S. 105- 164.8(b) and yet refuse to collect use taxes on sales of tangible personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c) systematic exploitation of the market by media- assisted, media - facilitated, or media- solicited means. The Contractor certifies that it and all of its affiliates (if any) collect all required taxes. E- Verify Pursuant to G.S. 143 -48.5, the undersigned hereby certifies that the Contractor named below, and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes. Miscellaneous Choice of Law: The validity of this contract and any of its terms or provisions, as well as the rights and duties of the parties to this contract, are governed by the laws of North Carolina. The Contractor, by signing this contract, agrees and submits, solely for matters concerning this Contract, to the exclusive jurisdiction of the courts of North Carolina and agrees, solely for such purpose, that the exclusive venue for any legal proceedings shall be Orange County, North Carolina. The place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be Orange County, North Carolina, where all matters, whether sounding in contract or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Amendment: This contract may not be amended orally or by performance. Any amendment must be made in written form and executed by duly authorized representatives of the County and the Contractor. Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this contract violates any applicable law, each such provision or requirement shall continue to be enforced to the extent it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this contract shall remain in full force and effect. Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the agreement and should not be used to construe the meaning thereof. Time of the Essence: Time is of the essence in the performance of this contract. Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract without the prior written approval of the County. The term "key personnel" includes any and all persons identified as such in the contract documents and any other persons subsequently identified as key personnel by the written agreement of the parties. Care of Property: The Contractor agrees that it shall be responsible for the proper custody and care of any property furnished to it for use in connection with the performance of this contract and will reimburse the County for loss of, or damage to, such property. At the termination of this contract, the Contractor shall contact the County for General Terms and Conditions (06/16) Page 4 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C instructions as to the disposition of such property and shall comply with these instructions. Travel Expenses: Reimbursement, if provided in this Agreement, to the Contractor for travel mileage, meals, lodging and other travel expenses incurred in the performance of this contract shall not exceed the rates established in County policy. Sales[Use Tax Refunds: If eligible, the Contractor and all subcontractors shall: (a) ask the North Carolina Department of Revenue for a refund of all sales and use taxes paid by them in the performance of this contract, pursuant to G.S. 105- 164.14; and (b) exclude all refundable sales and use taxes from all reportable expenditures before the expenses are entered in their reimbursement reports. Advertising: The Contractor shall not use the award of this contract as a part of any news release or commercial advertising. Orange County Living Wage: Orange County is committed to providing its employees with a living wage and encourages agencies to which it provides funding to pursue the same goal. The County's living wage hourly standard, as adopted by the Orange County Board of County Commissioners annually, can be found in the Orange County Budget Ordinance. To the extent possible, Orange County recommends that the Contractor and all subcontractors provide a living wage, as defined in this section, to their employees. Signatures: 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. General Terms and Conditions — (06/16) Page 5 of 5 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMIJNT B SCOPE OF WORK Orange County Department of Social Services Federal Tax Id. or SSN 59- 1224041 Contract # 68 -3010 A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Inter -Faith Council for Social Service, Inc. 2. If different from Contract Administrator Information in General Contract: Address Telephone Number: Fax Number: Email: 3. Name of Program (s):ESG Housing Grant Funds 4. Status: ( ) Public (X) Private, Not for Profit ( ) Private, For Profit 5. Contractor's Financial Reporting Year July 1, 2017 through June 30 2018 B. Explanation of Services to be provided and to whore (include SIS Service Code): The Contractor will assist homeless individuals to obtain and maintain permanent_ housing.througli individualized housing stabilization case management services as well as other supportive services as needed and as finds allow while linking households to other Federal State local and private assistance for which individuals are eligible. The Contractor will provide rapid rehousing services including housing search and placement services, housing stability _case management services short -term rental assistance medium -term rental assistance, security deposits, utility deposits and pgyments, rental applications fees arrears p4yments and payments of last month's rent at the levels and amounts specified below. The Contractor is required to meet all goals and outcomes listed in Attachment N. C. Funding reimbursement limits by category: Rental Application Fees $250.00 Security Deposits $2,200.00 Last Month's Rent $850.00 Utility Deposits $1,000.00 Utility Payments $1,800.00 Arrears $1,500.00 Short -Term Rental Assistance $4,254.00 Medium -Term Rental Assistance $12,000.00 Housing Search & Placement Housing Stability Case Management D. Number of units to be provided: E. Details of Billing process and Time Frames; The County will reimburse the Contractor for services described in this contract tip to the budgetar y limits of the contract allotment. The Contract -Scope of Work (06/04) Page 1 of 2 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C County will reimburse the Contractor for actual expenditures for approved services provided. For reimbursement, the Contractor mast submit copies of bills, checks, receipts and /or other proof of expenditures by the fifth of the mouth for the preceding month's ex enditures to the designated County Administrator. The Contractor must submit a completed time sheet and payment records for staff time reimbursement, The Coup will reimburse the Contractor monthl upon. receipt of a complete and correctly filed report. F. Area to be served /Delivery site(s): _Orange County DocuSigned by: Nam w6w DAE1E196A83 @455... Nancy Coston, Social Services Director 2/14/2018 (Date Submitted) DocuSigned by: @31730 SAE FF04A9... (Signature of Contractor) 2/13/2018 (Date Submitted) Contract -Scope of Work (06104) Page 2of 2 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMENT C CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS AND CERTIFICATION REGARDING NONDISCRIMINATION Orange County Department of Social Services I. By execution of this Agreement the Contractor certifies that it will provide a drug -free workplace by: A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; B. Establishing a drug -free awareness program to inform employees about: (1) The dangers of drug abuse in the workplace; (2) The Contractor's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph (A); D. Notifying the employee in the statement required by paragraph (A) that, as a condition of employment under the agreement, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; E. Notifying the County within ten days after receiving notice under subparagraph (D)(2) from an employee or otherwise receiving actual notice of such conviction; F. Taking one of the following actions, within 30 days of receiving notice under subparagraph (D)(2), with respect to any employee who is so convicted: (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and Malting a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (A), (B), (C), (D), (E), and (F). Federal Certification - Drug -Free Workplace & Nondiscrimination rev. 06 -2015 Page 1 of 2 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C II. The site(s) for the performance of work done in connection with the specific agreement are listed below: I. 01 (Street address) (City, county, state, zip code) (Street address) (City, county, state, zip code) Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment, suspension or termination of grants, or government -wide Federal suspension or debarment 45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620. CERTIFICATION REGARDING NONDISCRfMINATION The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. § §I681 -1683, and 1685- 1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. § §6101 - 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. § §3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this Agreement. I Docu5igned by: 3a&t, , t t s B317305AEFFNA9... Signature Executive Director Title Inter -Faith Council for Social Servic(2/13/2018 Agency /Organization Date (Certification signature should be same as Contract signature.) Federal Certification - Drug -Free Workplace & Nondiscrimination rev. 06 -2015 Page 2 of 2 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C CONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY State of N o i—k (= bAGL _ County Q . 1, - oom's Mww(L L 0 J Notary Public for said County and State, certify that .rck G I u e. 1,A er 3e it5 personally appeared before me this day and acknowledged that he /she is �,' rv' 6-;b r of 1" J-, f i )i So _ i c '�e rvl (iy [name of Organization] and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held on the /(2 - -- -- day of VC-0 er , ADO , Sworn to and subscribed before me this to „ day of b C-CD 6-e,r 1 dot 7 TOMAS MATkRIN Notary Public Wake Co., North Carolina (Official Seal) 0( �1 rEa:N My Commission Expires iXE-2M My Commission expires _ u {, 7 20 7-z- ■r1tY ■eRlltla rMr1111M ■ ■f tl6elRtllleeretlaefr 'erietrll ■ ■eYir tltlrre ■1[r ■ ■FAre ■ ■Ila ■i ■asetlrrrse■ Instruction for Organization: Sign and attach the following pages after adopted by the Board of DirectorsMustees or other governing body OR replace the following with the currant adopted conflict of Interest policy. Name of Organization V� L-^°'°'°' Signature of organization Official NCDHHS CO11 0 13 (Rev. 4/11) u DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C 2.3. Conflicts of Interest and Outside 'Vil'ork The policy applies to all persons working, paid or unpaid, on behalf of the IFC, whether they are employees or volunteers (for the purpose of this document, all paid and unpaid persons working on behalf of the IFC shall be referred to as "staff"). During their involvement with the TFC, staff shall abide by the following Conflict of Interest / Ethical Standards Policy: If the IFC has a contract, agreement or transaction with a third party, or if the IFC is contemplating entering into any contract, agreement or transaction with a third party, staff shall fully disclose in writing to the Executive Director any financial interest or relationship that staff has with the third party. -The President or Executive Director shall disclose this information to the Board of Directors, which may approve the contract, agreement or transaction in question by a majority vote. if a board member or the Executive Director is the interested staff member, that person may not participate in the vote. Staff shall not act as representatives of the iFC or claim to act on behalf of the 1FC to bolster, legitimize or benefit any other organization or individual, unless authorized by the Executive Director to do so. Staff shall not seek to personally employ, or provide services to, beyond those provided in the regular course of their work with the IFC, any individual who has received or is receiving services from the TFC without the approval of the Executive Director. The Executive Director shall keep a written :record of such approvals and inform. the ]Board of Directors of them. Staff shall maintain professional, ethical standards of conduct. Staff shall not engage in personal relationships of any nature with clients, guests or residents of the IFC, or with any person who has received or is receiving services from the IFC. This includes, but is not limited to the following examples, and any other type of relationship that extends beyond the professional boundaries of the normal IFC /client relationship: • Living or residential arrangements, for. any length of time, including room mate or landlord/tenant relationships, temporary housing, or any official or unofficial living arrangement • Personal, intimate, friendship and /or sexual relationships • Financial relationships where money is given, accepted, lent (loaned), borrowed or in any way exchanged between the staff and the recipient of IFC services, or in which items are bought and/or sold between an IFC staff member and a client, guest or president of the 1FC o Employment, including recruiting, hiring, employing or in any way paying for services provided, for any length of time ® Individual requests, including, but not limited to, doing favors, running errands, picking_ up or dropping off family members, friends or relatives, or any other type of personal requests P Sponsorship in Alcoholics Anonymous or Narcotics Anonymous: no staff member may sponsor a client, guest or resident of the IFC for participation in either of these, or any other, addiction - assistance groups. Staff should become knowledgeable about DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C To: State Agency Head and Chief Fiscal Officer Certification: We certify that the Inter - Faith Council for Social Service does not have any overdue tax debts, as defined by N.C.G.S.1q,_243.1, at the federal, State or local level. We further understand that any person who makes a false statement in violation. of N.C.G.S.143C -6 -23 (c) is guilty of a criminal offense punishable as provided by N.C,G.S.) 1430- 10-1b. Sworn Statement, Keith Taylor and Jackie Jenks being duly sworn, say that we are the Board Chair and Executive Director, respectively, of Inter -Faith Council for Social Service o£ Carrboro in the State of North Carolina; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of S ate funds w' be reported to the appropriate authorities for further action, Board Chair Executive Director Sworn to and subscribed before me on the day of the date of said certification, My Commission Expires: S, tY 2 7, z,-z.-L_ Notary Signature and Seal) "' pmA$n�:� TOMAS MATERIN Notary Public Wake Co., North Carolina My Commissions Expires July 27, 2o22 710 W. Main Street • Carrboro, NC 27510 -Phone 914 -929 -6380 -fax 919 -929 -3353 • www.lftweb.org F DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMENT G CERTIFICATION REGARDING LOBBYING Orange County Department of Social Services and Department on Aging Certification for Contracts, Grants, Loans and Cooperative Agreements The undersigned certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any Federal, state or local government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of a Member of the General Assembly in connection with the awarding of any Federal or state contract, the snaking of any Federal or state grant, the malting of any Federal or state loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal or state contract, grant, loan, or cooperative agreement. (2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any Federal, state or local government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of a Member of the General Assembly in connection with the awarding of any Federal or state contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly. (4) This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for malting or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Notwithstanding other provisions of federal OMB Circulars -CFR Title 2, Grants and Agreements, Part 200, costs associated with the following activities are unallowable: Paragraph A. (1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity; (2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political action committee, or other organization established for the purpose of influencing the outcomes of elections; (3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or modification of any pending Federal or State legislation through communication with any member or employee of the Congress or State legislature (including efforts to influence State or local Federal Certification = Lobbying (06115) Page I of 3 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C officials to engage in similar lobbying activity), or with any Government official or employee in connection with a decision to sign or veto enrolled legislation; (4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or modification of any pending Federal or State legislation by preparing, distributing or using publicity or propaganda, or by urging members of the general public or any segment thereof to contribute to or participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing or telephone campaign; or (5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering information regarding legislation, and analyzing the effect of legislation, when such activities are carried on in support of or in knowing preparation for an effort to engage in unallowable lobbying. The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A: Paragraph B. (1) Providing a technical and factual presentation of information on a topic directly related to the performance of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented request (including a Congressional Record notice requesting testimony or statements for the record at a regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant staff member thereof; provided such information is readily obtainable and can be readily put in deliverable form; and further provided that costs under this section for travel, lodging or meals are unallowable unless incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee conducting such hearing. (2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly reduce the cost, or to avoid material impairment of the organization's authority to perform the grant, contract, or other agreement. (3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other agreement. Paragraph C. (1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in accordance with the procedures of subparagraph B.(3). (2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the requirements and standards of this paragraph have been complied with. (3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being allowable or unallowable pursuant to this section complies with the requirements of this Circular. (4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with this paragraph during any particular calendar month when; (1) the employee engages in lobbying (as defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of employment during that calendar month, and (2) within the preceding five - year period, the organization has not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs. When conditions (1) and (2) are met, organizations are not required to establish records to support the allowability of claimed costs in addition to records already required or maintained. Also, when conditions (1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month. Federal Certification — Lobbying (06115) Page 2 of 3 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C (5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant questions or disagreements concerning the interpretation or application of this section. Any such advance resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant or contract for purposes of interpretation of this Circular; provided, however, that this shall not be construed to prevent a contractor or grantee from contesting the lawfulness of such a determination. Paragraph D. Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an employee or officer of the Executive Branch of the Federal Government to give consideration or to act regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter. Docu5igned by: B317305AEFFNA9... Signature Inter -Faith council for social service Agency /Organization Executive Director Title 2/13/2018 Date (Certification signature should be same as Contract signature.) Federal Certification --- Lobbying (06/15) Page 3 of 3 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMENT H CERTIFICATION REGARDING DEBARIN1ENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION -LOWER TIER COVERED TRANSACTIONS Orange County Department of Social Services and Department on Aging Instructions for Certification 1. By signing and submitting this proposal, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of the fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and /or debarment. I The prospective lower tier participant will provide immediate written notice to the person to which the proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is debarred, suspended, determined ineligible or voluntarily excluded from participation in this covered transaction unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this proposal that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency of which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List, 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. Federal Certification - Debarment (06115) Page I of 2 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C 9. Except for transactions authorized in paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedics available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension, and /or debarment. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. I 1�Docu5igned by: JatG GAS Executive Director B317305AEFF04A9... Signature Title Inter -Faith Council for social S(?{NiWC2018 Agency /Organization Date (Certification signature should be same as Contract signature.) Federal Certification - Debarment (05/15) Page 2 of 2 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMENT K 501(c)(3) and TAX EXEMPT STATUS Orange County Department of Social Services What is a Private Non Profit Agency? Ansiver A private non profit is an organization that is incorporated under State law and whose purpose is not to make a profit, but rather to further a charitable, civic, religious, scientific, or other lawful purpose. The Secretary of State's office grants corporate status to organizations in North Carolina. What is a 501(c)(3) designation? Answer: When the agency becomes a state private non profit corporation, it can then apply for 501(c)(3) designation through the IRS. Once the IRS grants 501(c)(3) status, the organization is exempt from certain taxes and any donations to the charitable organization are tax deductible. Many individuals and organizations prefer to make donations to 501(c)(3) private non profits. Who can obtain a 501(c)(3) designation? Ansiver: Any organization or group can apply for 501(c)(3) status, provided their charter or mission focuses on the non profit's objective. Another option is to apply for a 509(a)(1) status which falls under the 501(c)(3) umbrella. Being a 509(a)(1) designates an organization as a tax -free public charity that receives most of its support from a governmental unit or from the general public. Becoming a 509(a)(1) provides public recognition of tax - exempt status, advance assurance to donors of deductibility of contributions, exemption from certain State and federal taxes, and non profit mailing privileges. Organizations that typically qualify are churches, educational institutions, hospitals, and governmental units. To learn more about non profits, visit www.irs.gov, or call the tax - exempt helpline at 877.829- 4933. How does a Private Non Profit obtain Tax Exempt Status? A private non profit must apply to the IRS for tax exempt status. To qualify, applicants must complete and submit to the IRS Form 1023. Once federal tax exempt status is granted, the private non profit applies for State tax exempt status by completing Form CD -435 and submitting it to the N. C. Department of Revenue. Please attach proof of 501(c)(3) or IRS tax - exempt status to this page. DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMENT M STATE AND LOCAL CERTIFICATION Contractor Certifications Required by North Carolina Law Orange County Department of Social Services Instructions The person who signs this document should read the text of the statutes listed below and consult with counsel and other knowledgeable persons before signing. • The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at: http: / /www.ncga. state. nc. us /EnactedLegislation / Statutes /PDF/ByAiliele /Chaptera64 /Article 2.pdf • The text of G.S. 105- 164.8(b) can be found online at: http: / /www.ncga. state. ne. us /EnactedLegislation / Statutes /PDF/BySection/Chaptei- 105 /GS 105- 164.8.pdf • The text of G.S. 143 -48,5 (S,L. 2013 -418, s. 2.(d)) can be found online at: http: / /www.nega, state, nc.us/ Sessions /2013 /Bills /House /PDF /H786y6,pdf • The text of G.S. 143 -59.1 can be found online at: http: / /www.ncga.state.ne.us/ EnactedLegislation /Statutes/PDFBySection/Chapter 143 /GS 143 -59.1 .pdf • The text ofG,S. 143 -59.2 can be found online at: http: / /www.noga.state.ne.us/ EnactedLegislation / Statutes /PDF /BySection /Chapter_143 /GS_ 143- 59.2.12df • The text of G.S. 147 - 33.95(8) (S,L 2013 -418; s. 2. (e)) can be found online at: 7ttp: www.nci;a.state.nc.us Se, s,sions /20.1,3 /Bills /House /PDF /H786v6.pdf • The text of Orange County Living Wage Contractor Policy which is attached to this document. Certifications (1) Pursuant to G.S. 143 -48.5, the undersigned hereby certifies that the Contractor named below, and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its employees through the federal E- Vcrify system." E- Verify System Link: www.uscis,g_ov Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina General Statutes. However, local government is subject to and must comply with North Carolina General Statute § 153A- 99.1., which states in part as follows: Counties Must Use E- Verify. - Each county shall register and participate in E- Verify to verify the work authorization of new employees hired to work in the United States. (2) Pursuant to G.S. 143- 59.1(b), the undersigned hereby certifies that the Contractor named below is not an "ineligible Contractor" as set forth in G.S. 143- 59.1(a) because: (a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or Contractor Certifications Required by North Carolina Law Page I of 3 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C more of the conditions of G.S. 105- 164.8(b); and (b) [check one of the following boxes] ❑ Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a "tax haven country" as set forth in G.S. 143- 59.1(c) (2) after December 31, 2001; or ❑ The Contractor or one of its affiliates has incorporated or reincorporated in a "tax haven country" as set forth in G.S. 143- 59.1(c)(2) after December 31, 2001 but the United States is not the principal market for the public trading of the stock of the corporation incorporated in the tax haven country. (3) Pursuant to G.S. 143- 59.2(b), the undersigned hereby certifies that none of the Contractor's officers, directors, or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. (4) The undersigned hereby certifies further that: (a) He or she is a duly authorized representative of the Contractor named below; (b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf of the Contractor; and (c) He or she understands that any person who knowingly submits a false certification in response to the requirements of G.S. 143 -59.1 and -59.2 shall be guilty of a Class I felony. (5) Pursuant to the Orange County Living Wage Contractor's Policy: (a) The undersigned certifies that the Contractor pays the employees who perform services under this contract a living wage (in Orange County currently $13.75 per /hr.) Check here ❑ if contractor pays employees performing under this contract a living wage. If Contractor does not pay employees a living wage, what is the wage that employees performing services under this contract paid Inter -Faith Council for Social Service DocuSigned by: le @317305AEFF04A9 . signature or contractor's Authorized Agent 7ackie 7enks DocuSigned by: s� �y�& 93B45EA087'D426_. �irgnaturc of witness Stephani Kilpatrick Printed Name of Witness or's Authorized Agent 2/13/2018 Date Executive Director Title Residential Services Director Title 2/14/2018 Date The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately thereafter. Contractor Certifications Required by North Carolina Law Page 2 of 3 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Section I: General Government and Administration Policy 10.0: Living Wage Contractor Policy Reviewed by: County Attorney /County Manager Approved by: County Manager Original Effective Date: April 21, 2016 Revisions: Policy Statement It is the policy of Orange County to ensure its employees, and all individuals who provide services for Orange County, are paid a living wage. Purpose To encourage al I vendors and contractors to pay a living wage to all employees who perform work pursuant to a contract with Orange County. Apnlicabilify Applies to all Orange County contracts and purchases. Policy 10.1 Living Wage 10.1.1 Orange County is committed to providing its employees with a living wage and encourages all contractors and vendors doing business with Orange County to pursue the same goal. Orange County's living wage is $13.75 per hour. To the extent possible, Orange County recommends that contractors and vendors seeking to & business with Orange County provide a living wage to their employees. 10.1.2 Prior to final execution of a contract with Orange County all contractors and vendors seeking to do business with Orange County shall submit to the County's representative a statement indicating whether those employees who will perform work on the Orange County contract are paid at Ieast the living wage amount set out above. If such employees do not snake at least the living wage amount set out above the contractor or vendor shall indicate in the statement the actual amount paid to such employees. For bid projects this statement should be submitted as part of the bid packet. This policy may he reviewed annually and updated as needed by the Manager's Office Contractor Certifications Required by North Carolina Law Page 3 of 3 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ATTACHMENT N OUTCOMES AND REPORTING Orange Comity Department of Social Services By signing and submitting this document, the Contractor certifies that it agrees to the following: 1. The Contractor agrees to participate in program, fiscal and administrative monitoring and /or audits, making records and staff time available to Federal, State and County staff. 2. The Contractor agrees to take necessary steps for corrective action, as negotiated within a corrective action plan, for any items found to be out of compliance with Federal, State, and County laws, regulations, standards and /or terms of the Contract. 3. The Contractor agrees that continuation of and /or renewal of this Contract is contingent on meeting the following requirements: a. Training ESG project staff, including housing stability managers, case management supervisors, grant managers, Emergency Services case managers, and financial processors must attend all relevant ESG trainings provided during the program year. Trainings will be conducted via webinar and /or conference call when feasible. Some training may require face to face participation. b. Eligibility Screening and Intake For Housing Stability activities, the Contractor will document all federal and state eligibility criteria, including but not limited to housing and homeless status, income eligibility, financial supports, assets and social supports using State approved forms. Contractors must use an approved ESG Program Homeless Management System (HMIS) for entering client data. Data must be entered into the data system within 30 days of approval for ESG services. The State can request additional documentation as deemed necessary. The Contractor will only provide ESG funded activities to eligible participants. c. Case Management Housing Stability Case Management services should emphasize immediate access to safe, affordable housing that complies with HUD housing quality standards. Housing Stability services, including the number of months support is provided, should be personalized to meet the needs of each household. Case workers will be responsible for financial assistance eligibility determination as well as for assisting the program participant to develop and implement a Housing Stabilization Action PIan. Documentation: Documentation/Performance Requirements: Staff tirnesheets, participant file, housing status documents, HMIS reports, leases, invoices /bills, checks /bank statements /ledger, case notes, staff timesheets and Reimbursement Requests, The State has the right to request additional documentation as deemed necessary. Shelter providers must work within their CoC network to reduce the number of shelter stays until the goal is less than 30 days. d. Financial Assistance Documentation For Housing Stability activities, the Contractor will be responsible for providing assistance based on individual household need. Financial Assistance should be strategic and intentionally used to support long term housing stability. Participant file should provide rationale for how decisions about financial assistance amounts and types are determined. Outcomes (06/04) Page 1 of 6 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Documentation/Performance Standards: Participant file, HMIS records and Reimbursement Requests, all federal and state required documentation for financial assistance. Such documents include but are not limited to, leases, utility payment receipts, documentation of utility(ies) in the recipient's name, unit inspection report, assurances of tenancy and tracking of financial assistance (amounts and number of months) in a financial system and /or record that allows the Contractor to comply with 24 CFR Parts 84 or 85, as applicable. e. Housing Stabilization Policy and Procedures —Written Standards Contractors must adhere to housing stabilization polices established and approved by CoCs to ensure service provision targets are met by ESG providers. f. Ineligible Activities If the Contractor provides emergency response and /or housing stability activities to ineligible participants using ESG funds or ESG matching funds, the Contractor will reimburse the County for those funds from a non -ESG funding source. g. Recertification Contractors providing rapid rehousing activities will be responsible for recertification of any household that receives more than 12 months of services including financial assistance. Contractors providing prevention activities will be responsible for recertification of households every 3 months. Recertification will include all steps prescribed by HUD to verify that the household still meets the eligibility criteria, including, but not limited to social supports, income, asset certification and inspections. Documentation /Performance Standards: Participant file, HMIS records, income and asset verification forms, social supports assessment, housing status and other Federal or State required forms documenting annual recertification for rapid rehousing households, and quarterly (90 day) recertification(s) for prevention households. Contractor will stop providing ESG funded, or ESG match funded, assistance to ineligible households immediately upon determination of change in eligibility status. The ineligible households should be made aware of their right to appeal the decision. h. Homeless Management Information System (HMIS) The Contractor is responsible for ensuring that all staff involved in the approved Statewide Homeless Management Information System (HMIS) will ensure data entry or data quality monitoring and shall participate in HMIS trainings, Staff responsible for HMIS data entry or monitoring is expected to take advantage of available technical assistance in an assertive, proactive manner to ensure their ability to meet the requirements for accurate data entry. Documentation/Performance Measures: Participant files will be used to compare and document that the Contractors will input, regularly review, and correct, if necessary, 100% of required data fields into HMIS within two weeks of client contact and /or service. Data fields include, but are not limited to: Eligibility, demographic, risk factor and services data for participant households, as well as, Financial Assistance (dollar amounts per individual. Monthly data quality reports must be submitted to the NC ESG staff. i. For Housing Stability Programs (Rapid Rehousing) Rapid Rehousing: Individuals and families experiencing homelessness, meaning those who qualify under paragraph (1) of the homeless definition in 24 CFR 576.2 or who meet the criteria under Outcomes (06104) Page 2 of 6 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C paragraph (4) of the homeless definition and live in an emergency shelter or other place described in paragraph (1) of the homeless definition. i. Financial Assistance 1. Rental application fees 2. Security deposits 3. Last month's rent 4. Utility deposits 5, Utility payments 6. Rent Arrears (6 months only) 7. Utility Arrears (6 months only) ii. Services 1. Housing search and placement 2. Housing stability case management iii. Rent assistance The Contractor may only spend funds in categories that were applied for and awarded in the NC ESG application that was submitted to the State prior to the contracting period January 1, 2018 - December 31, 2018. j. Spending Rates Contractors must expend ESG fiends on monthly basis until the contracted amount is expended on or before December 31, 2018. Additionally, contractors must have at least one requisition leading to a disbursement of ESG funds per quarter. k. Monitoring The Contractor will participate in all monitoring activities, programmatic and /or fiscal, state and /or federal, field and /or desk monitoring (materials mailed /emailed in to the state offices). a. At a minimum, participant file monitoring will include review of households that were not enrolled into the program, households that are currently enrolled in the program, and households that have exited the program (unless no households have yet exited) i. Fiscal monitoring will include monitoring of fiscal processes, financial documentation of expenses, and eligibility documentation in client files. ii. Programmatic monitoring will also include review of HMIS data entry and monitoring practices. iii. For Housing Stability activities: Participant file monitoring will include, but is not limited to, eligibility determination and recertification, Housing Stabilization Action Plans, financial assistance determination, financial assistance documentation, referral and follow up documentation, and HMIS consent forms. iv. hispections: Shelter and Housing inspections must meet HUD's minimum emergency shelter and permanent housing standards. Documentation: Monitoring reports and participant files 1. Reporting Contractors will be responsible for accurate and complete statewide EMS data entry (comparable data for Domestic Violence programs) and submission of any state, federal, local HMIS administrators' request. All HMIS data entry for the quarter must be entered into the statewide system by the end of the third month of the quarter. Outcomes (06/04) Page 3 of 6 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C Contractors will be responsible for providing all other information required for federal, state and CoC reporting. in. Homeless Participation A homeless or formerly homeless person must participate to the fullest extent possible in the development of ESG- funded programs and policies set forth by the Department of Housing and Urban Development (HUD). Additionally, to the maximum extent practicable, the Contractor will involve, through employment, volunteer services, or otherwise, homeless individuals and families in maintaining and operating facilities assisted under ESG, and in providing services for occupants of facilities assisted under ESG. n. Accessibility of Spaces, Services and Activities Contractor shall operate each existing program or activity receiving federal financial assistance so that the program or activity, when viewed in its entirety, is equally accessible to and usable by individuals with disabilities as by persons without disabilities. o. Property Standards All dwelling units that are a part of an ESG - funded activity shall meet minimum habitability standards set by HUD. Shelters facilities are also required to meet state or local government safety and sanitation standards, as applicable, including energy - efficient appliances and materials. p. Lead -based Paint All shelters assisted under the ESG program and all housing occupied by program participants must adhere to the requirements of the Lcad -Based Paint Poisoning Prevention Act (42 U.S.C. 4821- 4846), the Residential Lead -Based Paint Hazard Reduction Act of 1992 (42 U.S.C. 4851- 4856), and implementing regulations in 24 CFR path 35, subparts A, B, H, J, K, M, and R. Such regulations pertain to all HUD - assisted housing and require that all owners, prospective owners, and tenants of properties constructed prior to 1978 be properly notified that such properties may include lead -based paint. Such notification shall point out the hazards of lead -based paint and explain the symptoms, treatment and precautions that should be taken when dealing with lead -based paint poisoning and the advisability and availability of blood lead -level screening for children under seven. The notice should also point out that if lead -based paint is found on the property, abatement measures may be undertaken. The regulations further require that, depending on the amount of Federal funds applied to a property, paint testing, risk assessment, treatment and /or abatement may be conducted. q. Termination of Services Contractor shall ensure that if a participant violates program requirements, services will be terminated in accordance with a formal written procedure established by the Contractor that recognizes the rights of the individual affected. This policy shall include the option for reinstatement, under proscribed circumstances, as dictated by the Interim Rule. r. Grievance Hearings The Contractor shall establish a formal, written procedure to address grievances and shall inform applicants and participants of their right to an appeal. The appeals policy must be posted in an area visible to program participants and must allow for appeals to be requested in writing and verbally. s. Fair Housing The Contractor hereby ensure theTurtherance of fair housing policies and procedures. Outcomes (06/04) Page 4 of 6 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C t. Procurement HUD procurement standards found at 24 CFR Parts 84 and 85, as applicable are hereby incorporated into this contract by reference. u. Faith -based activities The Contractor agrees that funds provided under this Agreement will not be utilized for inherently religious activities prohibited by 24 CFR §576.406. v. HMIS Reporting The Contractor shall report client -level data in a Homeless Management Information System (HMIS). w. Investigation of Noncompliant Activities The County may investigate any matter covered tinder this Contract and may withhold any payments until the results of the investigation have been revealed. Reimbursement to the Contractor will be determined upon resolution of the investigation by the County. x. Other Applicable Laws: Certifications and Compliance Requirements 1. _x_ 24 CFR Part 84 Uniform Administrative Requirements for Grants and Cooperative Agreements to Hospitals, Institutes of Higher Education and Non - profit Organizations, which sets forth rules for administering all federal grant funds. 2. X Title VI of the Civil Rights Act of 1964 (PL88 -352) and regulations issued pursuant thereto (24 CFR Part 1) on nondiscrimination in federally assisted programs. 3. X Section 109 of the Housing and Community Development Act of 1974 and regulations issued pursuant thereto (24 CFR Part 570.602 et seq., known as subpart K), which requires that no person in the United States shall, on the grounds of age, race, color, national origin, religion, disability or sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance 4. X Executive Order 11246 and the regulations issued pursuant thereto (41 CFR Chapter 60) on nondiscrimination in employment. 5. X Lead Based Paint Poisoning Prohibition (Public Law 91 -695), which requires that hazards posed by the presence of lead be addressed and made safe. 6. X Hatch Act (5 U.S.C. 1501 -1508) prohibiting federal, state and local government employees from benefiting from federal grants. 7. X Executive Order 11063 which addresses equal opportunity in housing and non- discrimination. 8. X Section 306 of the Clean Air Act (42 U.S.C. 1857(h)) which sets forth monitoring and reporting procedures for any program that affects air quality. 9. X Age Discrimination Act of 1967, as amended. 10. X The Rehabilitation Act of 1973, as amended, Sections 503 and 504, which prohibit discrimination against the handicapped. Outcomes (06104) Page 5 of 6 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C 11. X 24 CFR Part 84: Cost Principles for Non - Profit Organizations, which sets forth parameters for expenditures made with federal grant money. 12. X N. C. Fair Housing Law, which prohibits discrimination against any person for reasons of age, race, color, national origin, religion, disability or sex in all transactions relating to buying, selling, or renting housing units. 13. X 24 CFR Part 84 or 85, as applicable: Audits of States, Local Governments and Nonprofit Organizations, which sets forth requirements and methodologies for auditing programs funded in whole or in part with federal grant money. Docu5igned by: B317305AEFF04Ag... Signature Executive Director Title inter -Faith council for Social Service 2/13/2018 Agency /Organization Date (Certification signature should be same as Contract signature.) Outcomes (06104) Page 6 of 6 DocuSign Envelope ID: 4909266A- 4CCB- 4CD9- BDDF- F47C66COC89C ----Wr INTECOLI -01 MSLIMMERS f CERTIFICATE OF LIABILITY INSURANCE © THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE- OF INSURANCE DOES NOT CONSTITUTE_ A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,_ IMPORTANT. If the certificate holder Is an ADDITIONAL INSURED; the policy(Ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of.the policy, certain policies may require an endorsement. A statement on. this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Summers Thompson LOWry, Inc. 100 Europa Drive Suite 571 Chapel Hill, NC 27517 -2393 iJAM'`cT Megan Summers ZwCONNo, EXI) : (919) 539 -5318 FAX Noj:(919) 942 -4221 ADDRESS: Megan @STLinsure.com INSURER(S) AFFORDING COVERAGE NA.IC i- 1NSURERA : Alliance for Non - Profits for Insurance Risk Retention Group COMMERCIAL GENERAL LIABILITY - CLAMS -MADE [X] OCCUR Professional- $1M12M INSURED Inter -Faith Council for social Service Inc. 110 W. Main Street Carrboro, NC 27.510 INSURER B: Association Insurance Company OI O- 17838. INSURERC:Hartford Fire Insurance Company 19682 INSURERD:The Hanover Ins Co 22292 INSURER E: DAMAGE To RENTED PREMISES- Ea occurrence INSURER F X C011FRAr:FR r:FRTIRIrATF NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DDL INSD. SUBR WVO POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMiDD1YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY - CLAMS -MADE [X] OCCUR Professional- $1M12M X OI O- 17838. 07/01/2017 07101120'18 EACH OCCURRENCE 1j000.1000 DAMAGE To RENTED PREMISES- Ea occurrence 500,000 $ X MEDEXP An :one arson $ 20,000 X Sexual Abuse- $1 M12M PERSONAL &ADV INJURY 1,000,000 GENV AGGREGATE L IMIT APPLIES PER: X POLICY ❑.P1 ,of E].LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMPfOPAGG $ 2,000,000 $ -A AUTOMOBILE LIABILITY X ANY AUTO "M ONLY tA{U�T�O�S ONLY AUUT�OpSy�€E(} AUTOS ONLY MOP 2015 -17838 _ 07101/2017 07/0112018. COMBINEDSINGLELIMIT Ea a.,de"t $ 1,000,000 BODILY INJURY Per arson $ BODILY IN AJRY Peraccident $ P ra..deYr MAGE $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAltvls- hAADEx 017- 17838 -UMB 07/0112017 07101.12018 EACH OCCURRENCE 1,000;000 AGGREGATE $ 1,000,000 DED .X RETENTION $ '10,OOO $ - B WORKERS COMPENSATION AND EMPLOYVRS' LIABILITY ANYPROPRIIM�!PE'XCTNERf M-CUTIVE Y!N Wandatory in NH) II yes, dssaibe.under DESCRIPTION OF OPERATIONS below NIA _ C522- 000320 -115 07/01/2017 07101120E 8 x I STATUTE' ER E,L.EACHACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1x000,000 E.L. DISEASE - POLICY LIMIT 000000 $ 1 C D CrIme1ERISA D&O /Employment Pract 225PD HK5511 LH68785106 07101/2017 071011201.7 07/41/2018 07/0112018 100,000 1;000,000 DESCRIPTION OF OPERATIONS i LOCATIONS F VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) It is understood and agreed that the certificate holder is included as additional insured as respects General Liability as required by written contract, !`CRTE GIf`flTI= un1 r]PR CAAICEI_LATION ACORD 25 (2016103) O 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are rag ietered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count 9 y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) O 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are rag ietered marks of ACORD