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HomeMy WebLinkAbout2018-056-E DSS - Express Support Group In-home aide servicesDocuSign Envelope ID: OF933o0E -D182- 4824- AB97- AB4A8DFC99A5 Contract #68 -2017 Express Support Group, LLC CONTRACT # 68 -2017 Fiscal Year Begins December 5, 2017_ Ends June 30, 2018_ NORTH CAROLINA ORANGE COUNTY IN -HOME AIDE PROVIDER SERVICES AGREEMENT THIS AGREEMENT, is made and entered into this 5 day of December, 2017 by and between Orange County, North Carolina for and on behalf of the Orange County Department of Social Services and the Orange County Department of Aging (the "County"); and Express Support Group, LLC (the "Contractor ") whose federal tax identification number or Social Security Number is: _80- 0406469 WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Contractor, and the Contractor agrees to provide the services to the County in accordance with the terms of this Agreement. 1. Contract Documents: This Agreement consists of this document as well as each of the documents listed below as indicated (collectively referred to as the "Contract Documents "). If the word "Yes" appears beside the title of the contract document at the time both parties execute this Agreement, then that document is included as part of this Agreement. If the word "No" appears beside the title of the contract document at the time both parties execute this Agreement, then that document is not included as part of this Agreement. Each of the Contract Documents made part hereof are attached hereto and incorporated herein by reference to the same: TITLE OF CONTRACT DOCUMENT Rer. 6116 YES/NO (1) The General Terms and Conditions ( Attachment A) YES (2) The Scope of Work, services, and rate (Attachment B) YES (3) Federal Drug Free Workplace & Nondiscrimination Certification (Attachment C) YES (4) Conflict of Interest Policy (Attachment D) YES (5) No Overdue Taxes Certification (Attachment E) YES (6) Certification Regarding Lobbying (Attachment G) YES (7) Certification Regarding Debarment (Attachment H) YES (8) Certification Regarding Transportation (Attachment J) YES (9) State Certifications (Attachment M) YES (10) Outcomes & Reporting (Attachment N) YES DocuSign Envelope ID: OF933OOE -D182- 4824- AB97- AB4A8DFC99A5 Contract #68 -2017 Express Support Group, LLC (11) Contract Determination Questionnaire YES 2. Precedence Among Contract Documents: In the event of a conflict between or among the terms of the Contract Documents and this Agreement, the terns 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 Agreement shall be effective from December 5, 2017 through June 30, 2018, 4. Contractor's Duties: The Contractor shall provide the services to the County described in Attachment B 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. (a) The total amount paid by the County to the Contractor under this Agreement for the provision of services to the Department of Social Services shall not exceed: $415,647. This amount consists of $415,647 in Federal, State and County funds (CFDA # ), $0 (source of other funds if applicable). (b) The total amount paid by the County to the Contractor under this Agreement for the provision of services to the Department on Aging shall not exceed: $75,000. This arnount consists of $75,000 in Federal, State and County funds (CFDA # , $0 (source of other f rods if applicable). ® (c) There are no matching requirements from the Contractor. ❑ (d) 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 for matching requirements for the provision of services to the Department of Social Services shall be sourced from non - federal funds. 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 made 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 2 Rev. 6116 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 Contract #68 -2017 Express Support Group, LLC 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 Services Performed on Behalf of the Department of Social Services: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Kim Lassiter Fisher, Adult Services Supervisor I ,'im Lassiter Fisher, Adult Services Supervisor Orange County Department of Social Services Orange County Department of Social Services P.O. Box 8181 113 Mayo Street Hillsborough, NC 27278 Hillsborough, NC 27278 (919) 245 -2880 (919) 644 -3005 Lassiter c oran eeoun nc, gov For Services Performed on Behalf of the Department on A i� ng: IF DELIVERED BY US POSTAL, SERVICE IF DELIVERED BY ANY OTHER MEANS Janice Tyler, Director Janice Tyler, Director Orange County Department on Aging Orange County Department on Aging 2551 Homestead Road 2551 Homestead Road Chapel Hill, NC 27516 Chapel Hill, NC 27516 (919) 968 -2071 jtyler &o.orange_nc.us For the Contractor: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Patrick Ogbonna Express Support Group 1801 St Albans Dr # G Raleigh, NC 27609 info express- groups.com 919- 876 -4949 919- 649 -8368 Cell 919- 876 -4946 Fax 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 Rev. 6116 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 Contract #68 -2017 Express Support Group, LLC such services; the funds shall not be used to reduce the Contractor's total expenditure of other public funds for such services. 1 L 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: • Validity and accuracy of payment • Payment due date • Adequacy of documentation supporting payment • 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. 14. Relationship of the Parties: Contractor is an independent contractor of the County. Contractor represents that it has or will secure, at its own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees of or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized or permitted under state and local law to perform such services. It is further agreed 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. 16. Insurance Requirements: Contractor shall obtain, at its sole expense, all insurance as required in Attachment A, 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. 4 Rev. 6116 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 Contract #68 -2017 Express Support Group, LLC 18. Entire A reement: 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. 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. EXT—oacu5igned by: OUP, LL By' cu r �L� I�II�61n.In.A. 1 B38COA91A82B44B... Signature Patrick ogbonna Printed Name OR' Too u5ignedby, ry .T�.nmH CAROLINA By. O�a379946755E477... Bonnie B. 1- iammerstey, county Manager 5 Rev. 6116 1/29/2018 Date President / Managing Partni Title 2/19/2018 Date DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ATTACHMENT A GENERAL TERMS AND CONDITIONS Orange County Department of Social Services and Department on Aging 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 terra of the 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 wont 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 Temis and Conditions — (12117) Page I of 5 DocuSign Envelope ID: OF933OOE -D182- 4824- AB97- AB4A8DFC99A5 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. (c) 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 demonstrate 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 amount of damages 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, carthqualce, 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 `terms and Conditions — (12117) Page 2 of 5 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 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, Consultant certifies that Consultant has not been identified, and has not utilized the services of any agent or subcontractor identified, on the Iran divestment list created by the State Treasurer pursuant to G.S. 147 -86.58 or the Israel boycott list created pursuant to G.S. 147- 86.81. 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 laws, 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 9 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 aclmowledges that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not further 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 Terrm and Conditions — (12/17) Page 3 of 5 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 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, firinware, 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 rneet 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 Terns and Conditions -- (12117) Page 4 of 5 DocuSign Envelope ID: OF933OOE -D182- 4824- AB97- AB4A8DFC99A5 instnictions 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 11A and Article 40 of North Carolina General Statute Chapter 66. General Terms and Conditions — (12117) Page 5 of 5 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ATTACHMENT B SCOPE OF WORK- Orange County Department of Social Services and Orange County Department on Aging Federal Tax Id. or SSN #80- 0406469 Contract # 68 -2017 A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Express Support Group, LLC 2. If different from Contract Administrator Information in General Contract: Telephone Number: Fax Number: Email: 3. Name of Program (s): In -Home Services 4. Status: ( ) Public ( ) Private, Not for Profit (X) 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 whom (include SIS Service Code): The Contractor will provide em to ees to perform in -home services for the De artment of Social Services' clients and the De artment on A in 's clients at the level amount and fre uenc s ecified b the social worl�er in the In -Home Aide Services Plan. (SIS Code 042 The Contractor will provide Level II Home Management and Level III Personal Care. The Contractor is required to meet all goals and outcomes listed in Attachment N. C. Rate per unit of Service (define the unit): 1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) A maximum allowable rate of 21.95/hour, of which the Contractor must pqy the In Home Aide at least the County's Living Wage (currently $13.75 pe r/hr . The County has increased the standard fixed rate to coln ensate Contractor for an amount above Federal Minimum Wage. 2. Negotiated County Rate. D. Number of units to be provided: E. Details of Billing process and Time Frames; The Counly will reimburse the Contractor for services described in this contract u to the budgetqg limits of the contract allotment. The County will reimburse the Contractor at a rate of $21.95 /hour for approved services provided. For reimbursement the Contractor must submit an original and two copies of an invoice by the fifth of the month for the preceding month's ex enditures to the designated County Administrator. All invoices for the provision of services to the Department of Social Services shall be submitted to the Administrator for said Department. All invoices for the provision..of services to the Contract -Scope of Work (06104) Page lof 2 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 De artment on Aging shall be submitted to the Administrator for said Department. The County will reiinburse the Contractor monthly upon receipt of a com fete and correctl y filed re oiL F. Area to be served/Delivery site(s): Oran e Coun �ovcusign�rd by: ('h5 bt" nA= 1= 198An3Fi45d Nancy Coston, Social Service Director 1/31/2018 (Date Submitted) D s aped hy: R7 FF)F 7 n I R F,1 'A FA Janice Tyler, Dept. on Aging Director 2/6/2018 (Date Submitted) E S5ig ­d hy: vc uat1' l O -Ob A&a R34COA9'A82R44R (Signature of Contractor) 1/29/2018 (Date Submitted) Contract -Scope of Work (06/04) Page 2of 2 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ATTACHMENT C CERTIFICATION REGARDING DRUG -FREE WORKPLACE REQUIREMENTS AND CERTIFICATION REGARDING NONDISCRIMINATION Orange County Department of Social Services and Department on Aging I. By execution of this Agreement the Contractor certifies that it will provide a drug -free workplace by: A. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; B. Establishing a drug -free awareness program to inform employees about: (1) The dangers of drug abuse in the workplace; (2) The Contractor's policy of maintaining a drug -free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph (A); D. Notifying the employee in the statement required by paragraph (A) that, as a condition of employment under the agreement, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; E. Notifying the County within ten days after receiving notice under subparagraph (D)(2) from an employee or otherwise receiving actual notice of such conviction; F. Taking one of the following actions, within 30 days of receiving notice under subparagraph (D)(2), with respect to any employee who is so convicted: (1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and Making a good faith effort to continue to maintain a drug -free workplace through implementation of paragraphs (A), (B), (C), (D), (E), and (F). Federal Certification - Drug -Free Workplace & Nondiscrimination rev. 06 -2015 Page 1 of 2 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 II. The site(s) for the performance of work done in connection with the specific agreement are listed below: 1. 0 (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 NONDISCRIMINATION The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88 -352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. § §1681 -1683, and 1685- 1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. § §6101 - 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92 -255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91 -616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title V11I 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. oo. Sig —d by: R3RC0A9'A82R44R Signature Express Support Group, LLC Agency /Organization President / Managing Partner Title 1/29/2018 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: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 Conflict of Interest Policy Definition of Conflict of Interest: A conflict of interest involves an actual action, appearance or perceived interest by an agency, the agency's staff members or Board members, which would result in personal. organizational or professional gain. A conflict of interest occurs if Express Supp ort Home Care, its employee(s), or board member(s) have direct fiduciary interest in another relationship. Other situations that could result in conflict of interest include: Ownership with a member(s) of the Board of Directors or an employee(s) that could result in one or the other is having supervisory authority over the other or with any client that receives services. Employment of or by a member of the Board of Directors or an employee where one or the other has supervisory authority over the other or with a client who receives services. Contractual relationship with a member of the board of directors or an employee where one or the other is having supervisory authority over the other or with a client who receives services. Creditor or debtor to a member of the Board of Directors or an employee where one or the other has supervisory authority over the other or with a client who receives services. Consultative or consumer relationship with a member of the Board of Directors or an employee where one or the other has supervisory authority over the other or with a client who receives services. Conflict or interest also includes the existence of any bias or appearance of bias in a decision- making process that would result in a duel role played by.a member of the organization or group. Definition of the responsibilities of Employee /Contractor /Board Member: Defining the responsibilities of the employees, contractors and board members would fortify trust and confidence, expedite resolution of problems and strive to reduce organizational and individual stress that emanates from conflict of interest. Employees are to avoid any actual or appearance of conflict of interest. Employees should realize that the agency serves the totality of the community and not any particular special interest group. The appearance of a conflict of interest would not only bring embarrassment to the agency, but could jeopardize its credibility. Any trace of conflict of interest, potential conflict of interest or appearance of conflict of interest should be reported to any supervisor immediately. Employees are required to maintain independence and objectivity with clients, the community and organization. Employees are expected to maintain a sense of fairness, civility, ethics and personal integrity even when not required by law, regulation or custom. Acceptance of Gifts: Employee, members their immediate family and members of the Board of Directors are prohibited from accepting gifts, money or gratuities from the following: a. Persons receiving benefits or services from the agency. b, Any person or organization performing or seeking to perform services under contract with the agency; and c. Persons who are otherwise in a position to benefit from the actions of any employee of the agency. J DocuSign Envelope ID: OF933OOE -D182- 4824- AB97- AB4A8DFC99A5 With proper prior written authorization, employees may receive honoraria for lectures or other similar activities perfumed while on personal days, compensatory time, annual leave or leave without pay. When acting on any official capacity, any honoraria received by an employee in connection with the activities relating to employment with the agency are to be paid to the agency. NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of Orange I n Notary Public for said County and 1 { State, certify that t-' �n�_�� -' — personally appeared before me this day and acknowledged that he is the President of Express Support Home Care, and by that authority duly given and as the act of the corporation, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors in a meeting held on Monday the 20th of March 2017. Sworn to and subscribed before me this _.,,. day of �' f C s �, 2017. Yecenia Banegas NOTARY PUBLIC Wake County, NC �--- My Commission Expires March 11, 2020 Public My Commission Expires: 1 —2 0 2� Attached is the Conflict of Interest Policy for Express Support, LLC signature of Corporate Official DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 Over Due Tax Statement 1, Patrick Ogbonna, President of Express Support Home Care do hereby state that Express Support Group, LLC dba Express Support Home Care does not have any over due tax liability. State of North Carolina County of e lf�t.�as� 1, 15 h2,15 La � , Notary Public for said County and State, certify that n- �J� r1n0.. personally appeared before me this day and acknowledged that he is the President of Express Support Home Care, and by that authority duly given and as the act of the corporation, affirmed that the foregoing Overdue Tax Statement Policy was adopted by the Board of Directors in a meeting held on Monday the 20th of March 2017. Sworn to and subscribed before me this 23 day of � * -2 Notary Public M C ;—ion Expires- O�CM R '� � cc •, C6 P fiXF i3 202t , co��'��,. Y ommi 111 0% Attached is the Overdue Tax Statement Policy for Express Support, LLC Sign re of Corporate Official r� DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ATTACHMENT G CERTIFICATION REGARDING LOBBYING Orange County Department of Social Services and Department on Aging Certification for Contracts Grants Loans and Coo erative Agree 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 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. (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 malting 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: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 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: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 (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. E Dvcu5igned 6y: a{n(t 0-obv " R3RC.'OA9'A82R44R Signature Express Support Group, LLC Agency /Organization President / Managing Partner Title 1/29/2018 Date (Certification signature should be same as Contract signature.) Federal Certification — Lobbying (06115) Page 3 of 3 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ATTACHMENT H CERTIFICATION REGARDING DEBARMENT, 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. 3. 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. S. 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. b. 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 (06/15) Page 1 of 2 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 9. Except for transactions authorized in paragraph 5 of these instructions, if a participant in a covered transaction la -iowingly 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 remedies 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. ED— Sig —d by: afn(t 0-0ev t,E.a R3RC'OA9'A82R44R Signature Express Support Group, LLC Agency /Organization President / Managing Partner Title 1/29/2018 Date (Certification signature should be same as Contract signature.) Federal Certification - Debarment (06/15) Page 2 of 2 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ATTACHMENT J CERTIFICATION REGARDING TRANSPORTATION Orange County Department of Social Services and Orange County Department on Aging By execution of this Agreement the Contractor certifies that it will provide safe client transportation by: 1. Insuring that all drivers (including employees, contractors, contractor's employees, and volunteers) shall be at least 18 years of age; 2. Insuring that all drivers (including employees, contractors, contractor's employees, and volunteers) shall be licensed to operate the specific vehicle used in transporting clients in accordance with Chapter 20 -7 of the General Statutes of North Carolina and the Division of Motor Vehicle requirements; 3. Insuring that all vehicles transporting clients shall have at least the minimum level of liability insurance appropriate for the type of vehicle as defined by Article 7, Rule R2 -36 of the North Carolina Utilities Commission; 4. Insuring that the contractor shall have written policies and procedures regarding how drivers handle and report client emergencies and/or vehicle crashes involving clients to contractor and how contractor notifies the County Department of Social Services; 5. Insuring that no more than one quarter of one percent of all trips be missed by the contractor during the course of the contract period; (Medicaid only) 6. Insuring that that no more than five percent (5 %) of trips should be late for recipient drop off to their appointment per month; (Medicaid only) 7. Contractor will maintain records documenting the following (County may require contractor to provide): a. Valid current copies of Drivers License for all drivers; b. Current valid Vehicle Registration, for all vehicles transporting clients; c. Driving records for all drivers for the past three years and with annual updates; d. Criminal Background checks through North Carolina Law Enforcement or NCIC prior to employment and every three years thereafter; e. Alcohol and Drug Testing policy to meet the Federal Transit Authority guidelines. S. Disclosing, at the outset of the contract, upon renewal and upon request, any criminal convictions or other reasons for disqualifications from participation in Medicare, Medicaid or Title XX programs ( signature on this form confirms this statement). D.—Sig ned my: E afntt 0-06 President / Mana in Partner. R3RC0Ag1A32R44R Signature Title Express Support Group, LLC Agency /Organization 1/29/2018 Date (Certification signature should be same as Contract signature.) Transportation Certification (06/16) Page 1 of 1 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 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: htt :l /www.nc a.state.ne.us /EnactedLe islation/Statutes/PDF /B Article /Cha ter 64 /Article 2, df • The text of G.S. 105- 164.8(b) can be found online at: htt : / /,,ww,nc Ya.statc.ne.us /EnactedLe islation/Statutes /PDFB Section/Cha ter 105 /GS 105-164,8. pd • The text of G.S. 143 -48.5 (S.L. 2013 -418, s. 2.(d)) can be found online at: ht : / /www.nc a.state.ne.us /Sessions /2013Bills /House /PDF /H786v6. df • The text of G.S. 143 -59.1 can be found online at: htt : / /www.nc 7a.state.nc.us /EnactedLe islation /Statutes /PDFB Section/Cha ter 143 /GS 143 -59.1. df • The text of G.S. 143 -59.2 can be found online at: htt :I/wwrv.nc a.state.nc.usiEnactedLe islatian/Statutes/PDFIB SectionlCha ter 143/GS 143 -59.2. df • The text of G.S. 147- 33.95(g) (S.L. 2013 -418, s. 2. (c)) can be found online at: ht : / /w vw.nega.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pd f • 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- Verify system." E- Verify System Link: www,uscis:goy 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.l(a) because: (a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or Contractor Certifications Required by North Carolina Law Page 1 of 3 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 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. land -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 Express Support Group, LLC Dec uSig . 6I � Y Ca�nl0- Dv R 3 RC.'OAW A82F644F6 'S1 gnawre of �I omractor's Authorized Agent Patrick Ogbonna oocu5i9 -d by: ° " ontractor's Authorized Agent r. .... C."", ,irgnarure or witness Reggie Ogbonna Printed Name of Witness 1/29/2018 Date President / Managing Partner Title CFO Title 1/30/2018 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: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 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. Pur ose To encourage all vendors and contractors to pay a living wage to all employees who perform work pursuant to a contract with Orange County. Applicability Applies to all Orange County contracts and purchases. Policy 10.1 Living Wage 10.13 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 do 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 least the living wage amount set out above. If such employees do not make 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 be 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: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ATTACHMENT N OUTCOMES AND REPORTING Orange County Department of Social Services and Orange County Department on Aging 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, malting records and staff time available to Federal, State and County staff. 2. The Contractor agrees to take necessary steps for corrective action, as negotiated within a corrective action plan, for any items found to be out of compliance with Federal, State, and County laws, regulations, standards and/or terms of the Contract. 3. The Contractor agrees that continuation of and/or renewal of this Contract is contingent on meeting the following requirements. The Contractor agrees to: A. Allow the County to complete the assessment of each client. The County will complete an In- Home Aide Service Plan as part of the assessment. The County will provide the In -Home Aide Service Plan to the Contractor prior to the start of service. The County will update the In -Home Aide Service Plan as needed. B. Provide employees to perform in -home services for the County's clients, at the level, amount and frequency specified by the social worker in the In -Home Aide Service Plan. C. Assure that employees meet the competency requirements for the level(s) of service provided. The Contractor will provide verification, upon request, that the selected employee has been properly licensed and trained and is qualified to perform assigned tasks. D. Select and assign qualified employees to clients according to the clients' needs and the employees' abilities and experience. The Contractor agrees to honor requests made by the County for a change in assignment. E. Fulfill all employer financial obligations. F. In a timely manner, provide the County with information on significant changes in the clients' conditions or situations. G. Assure that the client is treated with dignity and respect, assist in protecting the client's assets and possessions, and assure confidentiality of client's circumstances. H. Allow aides to provide transportation, within reason, for both medical and personal reasons. I. Provide care at Level H as appropriate to the needs of the client. J. Complete, for employees serving Level II clients, at least a quarterly on site visit to the home of at least one client the employee is serving. K. Maintain all financial and program records for a period of three years from the date of final payment under this agreement for inspection by the County, the Area Agency on Aging and the Comptroller General of the United States, or any of their duly authorized representatives. If any claim, litigation, negotiation, audit or other action involving the Contractor's records has been started before the expiration of the three -year period, the records must be retained until completion of the action and resolution of all issues that arise from it. L. Monthly contact and annual on -site visits with the County. The Contractor agrees to client contact per Home and Community Care Block Grant guidelines. M. Protective Service In -Home Aide requests are to be staffed within 24 hours and the hours to be worked are to be strictly adhered to. Referral acceptance by the Contractor is conditional on worker availability. The Contractor will notify the County within two hours if the request cannot be honored. N. Provide backup service when a client's usual In -Home Aide is unavailable. Outcomes (06104) Page 1 of 2 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 O. High Risk In -Home Aide Service requests are to be staffed within five days. All other requests are to be filled within ten working days of the request. P. Changes in the service hours are to be made by the County. Requests for changes may be made by the Contractor, but are not finalized until notification is given by the County. Q. The Contractor will immediately notify the County when Protective Services Cases are not staffed, when In -Horne Aide workers are absent, and /or when any of the following occur: a. The client dies. b. The client enters a rest home, nursing home, or hospital. c. The client moves from the original address on the request. d. The client refuses to accept the services or to comply with care requirements. e. There are significant factors that affect the client or significant changes in a client's situation. C pD—Sig ­d 6y: atmi 0-obk .a R 3 RCOW A82R44R Signature Express Support Group, LLC Agency /Organization President / Managing Partner Title 1/29/2018 Date (Certification signature should be same as Contract signature.) Outcomes (06/04) Page 2 of 2 DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 T ® DATE (MMIDDNYYY{ AC" R" CERTIFICATE OF LIABILITY INSURANCE 05131!2017 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, SubjOCt 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). pRaoucER Piedmont Insurance Associates PO BOX 406, Huntersville, NC 28070 NAME IT Jennifer Goodman PHONE 887 -3901 ac No:_(888) 236.0940 Arc 0 Ext: ( 704 ) E -MAIL ADDRESS: jgoodman@pledmont-ins.com INSURER(S)AFFOROINGCOVERAGE NAICN INSURFRA: Colony Insurance Co. POLICY EXP MMIDDIYYYY INSURED Express Support Group LLC DBA Express Support Group Home Care 1801 St Albans Or Ste G Ra ei h NC 27609 INSURER B. Patriot National X INSURERC: INSURER D: AP515946 INSURERE - 0312712098 INSURER F: S 1,000,000 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MMIODNYYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY AP515946 03/27/2017 0312712098 EACH OCCURRENCE S 1,000,000 PREMISFa Eaoccunence $ 50,000 rA CLAIMS -MODE � OCCUR MED EXP (Any one person) $ 2,500 PERSONAL &ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; GENERALAGGREGATE S LL% 'OOO PRODUCTS- COMPFOPAGG $ i'000,000 X POLICYY IRI LOC S OTHER: EaaalldeDSlNGLE MIT S AUTOMOMLE LIABILITY BODILY INJURY(Perperson) S ANYAUTO BODILY INJURY (Per accident) $ OWNED SCHEDULED AUfOSONLY AUTOS HIRED NON - OWNED PROPERTY 1) AGE P!AGGREGATE reocldent AUTOS ONLY AUTOSONLY S UMBRELLA LIAB OCCUR HOCCURRBJCE $ $ EXCESS LIAB CLAIMS -MADE OED RETENTION$ _ STATUTE �RH S WCP102124601GIC 01/12/2017 01!1212018 E.L. EACHACCIDENT $ 100,000 AND EMPLOYERS LIARIOFY YIN ANY OFRCERIMEMBER EXCLUDED? PROPRIETOMPARTNEWEXECUTIVE NIA E.L. DISEASE - EA EMPLOYEE $ 100,000 (Mandatary €n NH) Ilyes, describe urxlar 5500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ A SexuallMolestation AP515946 03/27/2017 03/27/2018 $1,000,000 DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CA Mar! I A III VV C ER i FICA I C nV r -L1Gr% SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Social Services ACCORDANCE WITH THE POLICY PROVISIONS. 113 Mayo St AUIHOR€ZED REP ESENTATIVE JLG a Hillsborough, NC 27278 LJ'lyiSt7-LU'iO H�.VRN �JVRf VrVirrvr`1. nrr eryrrw reae,raa.. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Printed by JLG On May 31, 2017 at 01:03PM DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 � ARGO GROUP PO Box 469012 San Antonio, TX 78246 Email submissions to: am @colonyspecialty.com Quote No: 174130 -1 Allied Medical Binder Confirmation Date: 03/29/2017 TO; BURLS & WILCOX (CHARLOTTE), Charlotte, NC 28277 ATTN: Jacqueline P. Leslie FROM: LIZ STEPHENS, Istephens @colonyspecialty.com, 804 - 560 -4034 INSURED: EXPRESS SUPPORT GROUP LLC, Raleigh, NC 27609 Policy Number: AP516946 Effective Date: 0312712017 Expiration Date: 03/27/2018 Per terms and conditions listed herein. The terms and conditions of the bind on behalf of Colony Insurance Company are noted below: � TOTAL. PREMIUM (Including Excess Uability, if a $7,865 pplicable): Covers e Re ected Certified Acts of Terrorism (Not included in the total premium above): g 1$205 Inspection Fee (Not included in the total premium above): The continued coverage of terms bound is subject to a favorable inspection. x Plus taxes and fees Commercial General Liability Claims Made Coverage Form: 03/2712017 Retroactive Date: Insuring Agreement A - Bodily injury and Properly Damage Limit: $1,000,000 Included Products - Completed Operations Aggregate Limit: $50,000 Damage to Premises Rented to You Limit: $1,000,000 Insuring Agreement B - Personal and Advertising Injury Limit: Insuring Agreement C- Medical Payments: $2,500 Medical Expense Per Incident Limit: $10,000 Medical Expense Aggregate Limit: $2;000,000 General Liability Aggregate Limit: Professional Liability Claims Made Coverage Form: 03/27/2017 Retroactive Date: Insuring Agreement D - Professional Liability Limit: $1,000,000 $2,000,000 Professional Liability Aggregate Limit: Additional Coverages $100,0001300,000 Sexual Abuse or Molestation Sublimit: Separate Professiohal Liability Limits Included in CGL or Separate: Excluded Punitive Damages: Within the Limits Defense Expenses: $5,000 Deductible: Deductible applies per occurrence for Insuring Agreements A and B, and per claim for Insuring Agreement D. See coverage parts and endorsements which may have separate deductibles. DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 PO Box 469012 San Antonio, TX 78246 AR G O GROUP Email submissions to: am @colonyspecialty.com Quote No: 174130 -1 Allied Medical Binder Confirmation Date: 0312912017 Optional Endorsements (included in the total premium above) $2.500 Deductible: $50,00011 D0,000 Legal Media Endorsement SublimiE, $0 Premium: Sublimit: $50,000150,000 Privacy Wrongful Acts Premium: $0 Deductible: $1,000 Sublimit: $50,000150,000 Privacy Incident Response $0 Premium: Deductible: $1,000 Sublimit: $25,000125,000 Evacuation Coverage $0 Premium: Subjectivities Binder is subject to receipt, review and acceptance of the following, within (10) la has carried similar coverages binding: �- Currently valued loss runs for any and all time during the past 5 years the applicant (General Liability/Professianal Liability). Workers Compensation loss run is not acceptable- - All applications included in the submission must be signed and dated by the applicant within 30 days prior to bind. - Current State License. (All licenses provided are expired, except for facility located at 401 West Queen St) - Completed, signed and dated No Know Loss Letter on insureds own letterhead (Copy Attached) Business Description: ASSISTED LIVING FACILITY FOR THE ELDERLY AND HOME HEALTH CARE AGENCY. Audit Period: Annual Minimum Earned: 25% Minimum Premium and Deposit: 100 1/4 Forms • GUPL Access.or Disclosure of Confidential or Personal Info and Data - Related Liability (Ur-G2107-0916) - Blanket Additional Insureds) - Mortgagees, Lenders, Lessors and/or Landlords (AP073ALMS 07 0711) Certified Acts Of Terrorism -And Other Acts Of Terrorism Exclusion (AP041 LMS -0115) Certified Acts of Terrorism and Other Acts of Terrorism Exclusion .(UCG2175- 0115) Commercial General Liability Coverage part (LMSCGO002- 0912) Common Policy Provisions (LMSCPP -0912) Communicable Disease Exd (AP012LMS -0713) Exclusion - Health Care Services and Patient Client or Resident Injury (AP051 NP -0912) Exclusion - Recording and Distribution of Mat'l. or I nf. in Violation of Law (U983LM5- 0916) Legal Media Endorsement (AP083- 0912) Long Term Care Facilities - Common Dec, (LTCDEC -0713) Medical Facility Barber And Beautician Services Coverage Extension (U57OLMS -0912) Medical Facility Evacuation Coverage (AP097LMS -0912) OFAC Advisory Notice OLP001 -0104) Policyholder Disclosure - Notice of Terrorism Insurance Coverage (fRIANoticeA -0115) Privacy Incident Response Cov (AP061 -1115) Privacy Notice (PrivacyNodce -0415) Privacy Wrongful Acts Sublimit (AP062LMS -0912) Professional Liability Coverage Part (LMS0002.0912) Punitive, Exemplary Or Multiple Damages Exclusion (AP070LMS -0912) Risk Management Resource Center (RiskMgmtResCtr -0516) DocuSign Envelope ID: OF93300E -D182- 4824- AB97- AB4A8DFC99A5 ARGO GROUP PO Box 469 012 San Antonio, TX 78246 Email submissions to: am @colonyspecialty.com Quote No: 174130 -1 Allied Medical Binder Confirmation Date: 03/29f2017 Forms Schedule of Forms and Endorsements (U001 -1004) Schedule of Locations) Endt (AP075LMS -0911) Service of Suit (UG94 -0415) Sexual Abuse Or Molestation Sublimit (AP063 -0912) Signature Page (SIGCIC -1013) Supplementary Payments Within Limits Of insurance (U775LMS-0912) Unmanned Aircraft Exclusion (U961LMS -0616) Coverage is bound upon issuance of policy number by the Company. Extended Reporting option If Coverage applies on a Claims Made basis an Optional Extended. Reporting period may be available if this policy is terminated or not renewed; restrictions apply_ Maximum of five(5) years. Must be requested within sixty(69) days of termination or expiration. Refer to applicable sections($) of the policy for additional details. 3