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HomeMy WebLinkAbout2018-584-E DSS - FlairCare-Homewatch Caregivers in home aide services DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract#68-2034 Flaircare„Inc.dba Homewatch Caregivers of the Triangle CONTRACT#_68-2034 )Fiscal Year Begins_July 1,2018 Ends^June 30,2419 NORTH CAROLINA ORANGE COUNTY IN-HOME AIDE PROVIDER SERVICES AGREEMENT THIS AGREEMENT", is made and entered into this 1 day of July, 2018 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 Flaircare, Inc. dba Homewatch Caregivers of the Triangle (the "Contractor")whose federal tax identification number or Social Security Number is: 26- 00176244. 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 YES/NQ (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) Non-Discrimination,Clean Air Act,Clean Water Act(Attachment N) YES l Rev. 6116 DocuSign Envelope ID: D6A1OEDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract#68-2034 Flaircare,Inc.dba Homewatch Caregivers of the Triangle (11) Outcomes&Reporting(Attachment©) YES (12) 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 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 Agreement shall be effective from July 1,2018 through June 30,2019. 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: $75,0€10. This amount consists of $75,000 in Federal, State and County funds (CFDA # 3, $0 (source of other funds if applicable). ® (c) There are no matching requirements from the Contractor. [] (d) The Contractor's matching requirement is$ ,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. 2 Rev. 6116 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract#68-2034 Flaircare,Inc.dba Homewatch Caregivers of the Triangle 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 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 Kim 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 Lassiter@orangecountync.gov For Services Performed on Behalf of the Department on Affing: 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 jjyler@co.oran&e.nc.us For the Contractor: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Stephanie Wright or Anzor Gachechiladze Stephanie Wright or Anzor Gachechiladze Flaircare,Inc. dba Homewatch Caregivers of the Flaircare,Inc. dba Homewatch Caregivers of the Triangle Triangle 1210 SE Maynard Road 1210 SE Maynard Road Suite 202 Suite 202. Cary,NC 27511 Cary,NC 27511 9. No Assi nment 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. 3 Rev.6116 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract#68-2034 Flaircare,Inc.dba Homewatch Caregivers of the Triangle 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 funds 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: • 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. Outsourcine 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 terra 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 4 Rev. 6116 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract 468-2034 Flaireare,Inc.dba Homewatch Caregivers of the Triangle 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. 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. FL JNC DBA HOMEWATCH CAREGIVERS OF THE TRIANGLE By: aW'6r 8/29/2018 567 36,54F47242Ei.. Signature Date Anzor Gachechiladze President Printed Name Title ORPGE401QNTY,NORTH CAROLINA By:I J)j6la 6A A, t� MKAU s�t,I� 9/20/2018 Bonnie K ammersley, County Manager Datc 5 Rev. 6116 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 ATTACHMENT A GENERAL TERMS AND CONDITIONS Orange County Department of Social Services and Department on Aging Relationships of the Parties the County or the Contractor,receiving services or benefits under this contract shall be deemed an incidental Independent Contractor: The Contractor is and shall be beneficiary only. deemed to be an independent contractor in the performance of this contract.and as such shall be wholly responsible for Indemnity and Insurance the work to be performed and for the supervision of its employees. The Contractor represents that it has, or shall Indemnification: The Contractor agrees to indemnify and secure at its own expense, all personnel required in hold harmless the County and any of their officers,agents performing the services under this agreement. Such and employees,from any claims of third parties arising out employees shall not be employees of, or have any or any act or omission ofthe Contractor in connection with individual contractual relationship with the County. the performance of this contract. ,Subcontracting: The Contractor shall not subcontract any Insurance: During the term ofthe contract,the Contractor ofthe work contemplated under this contract without prior at its sole cost and expense shall provide commercial written approval from the County. Any approved insurance of such type and with such terms and limits as subcontract shall be subject to all conditions of this may be reasonably associated with the contract. As a contract.Only the subcontractors specified in the contract minimum, the Contractor shall provide and maintain the documents are to be considered approved upon award of following coverage and limits: the contract. The County shall not be obligated to pay for (a) Worker's Compensation- The contractor shall any work performed by any unapproved subcontractor. provide and maintain Worker's Compensation The Contractor shall be responsible for the performance of Insurance as required by the laws of North all of its subcontractors. Carolina,as well as employer's liability coverage with minimum limits of$500,000.00,covering all Assignment: No assignment of the Contractor's of Contractor's employees who are engaged in any obligations or the Contractor's right to receive payment work under the contract. If any work is sublet,the hereunder shall be permitted. However, upon written Contractor shall require the subcontractor to request approved by the issuing purchasing authority,the provide the same coverage for any of his County may: employees engaged in any work under the (a) Forward the Contractor's payment check(s) contract. directly to any person or entity designated by the (b) Commercial General Liability - General Contractor,or Liability Coverage on a Comprehensive Broad (b) Include any person or entity designated by Form on an occurrence basis in the minimum Contractor as a joint payee on the Contractor's amount of$1,000,000.00 Combined Single Limit. payment check(s). (Defense cost shall be in excess of the limit of In no event shall such approval and action obligate the liability.) County to anyone other than the Contractor and the (c)Automobile Liability Insurance: The Contractor Contractor shall remain responsible for fulfillment of all shall provide automobile liability insurance with a contract obligations. combined single limit of$500,000-00 for bodily injury and property damage; a limit of Beneficiaries: Except as herein specifically provided $500,000.00 for uninsured/under insured motorist otherwise,this contract shall inure to the benefit of and be coverage; and a limit of$25,000.00 for medical binding upon the parties hereto and their respective payment coverage. The Contractor shall provide successors. It is expressly understood and agreed that the this insurance for all automobiles that are: enforcement of the terms and conditions of this contract, (a) owned by the Contractor and used in the and all rights of action relating to such enforcement,shall performance of this contract; be strictly reserved to the County and the named (b) hired by the Contractor and used in the Contractor.Nothing contained in this document shall give performance of this contract; and or allow any claim or right of action whatsoever by any (c) Owned by Contractor's employees and other third person.It is the express intention ofthe County used in performance of this contract("non- and Contractor that any such person or entity, other than owned vehicle insurance"). Non-owned General Terms and Conditions—(06116) Page 1 of 5 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 vehicle insurance protects employers when employees use their personal vehicles for Termination Without Cause: The County may terminate work purposes_ Dion-owned vehicle this contract without cause by giving 36 days written insurance supplements, but does not notice to the Contractor. replace,the car-owner's liability insurance. Termination for Cause: If, through any cause, the The Contractor is not required to provide and maintain Contractor shall fail to fulfill its obligations under this automobile liability insurance on any vehicle—owned, contract in a timely and proper manner,the County shall hired,or non-owned--unless the vehicle is used in the have the right to terminate this contract by giving written performance of this contract. notice to the Contractor and specifying the effective date (d) The insurance coverage minimums specified in thereof. In that event,all finished or unfinished deliverable subparagraph(a)are exclusive of defense costs. items prepared by the Contractor under this contract shall, (e) The Contractor understands and agrees that the at the option of the County, become its property and the insurance coverage minimums specified in Contractor shall be entitled to receive just and equitable subparagraph (a) are not limits, or caps, on the compensation for any satisfactory work completed on such Contractor's liability or obligations under this contract. materials,minus any payment or compensation previously (f) The Contractor may obtain a waiver of any one or more made. Notwithstanding the foregoing provision, the of the requirements in subparagraph (a) by Contractor shall not be relieved of liability to the County demonstrating that it has insurance that provides for damages sustained by the County by virtue of the protection that is equal to or greater than the coverage Contractor's breach of this agreement,and the County may and limits specified in subparagraph(a). The County withhold any payment due the Contractor for the purpose shall be the sole judge of whether such a waiver of setoff until such time as the exact amount of damages should be granted. due the County from such breach can be determined. In (g) The Contractor may©btaitn a waiver of any one or more case of default by the Contractor, without limiting any of the requirements in paragraph(a)by demonstrating other remedies for breach available to it,the County may that it is self-insured and that its self-insurance procure the contract services from other sources and hold provides protection that is equal to or greater than the the Contractor responsible for any excess cost occasioned coverage and Iimits specified in subparagraph(a). The thereby. The filing of a petition for bankruptcy by the County shall be the sole judge of whether such a Contractor shall be an act of default under this contract. waiver should be granted. (h) Providing and maintaining the types and amounts of Waiver of Default: Waiver by the County of any default insurance or self-insurance specified in this paragraph or breach in compliance with the terms of this contract by is a material obligation of the Contractor and is of the the Provider shall not be deemed a waiver of any essence of this contract. subsequent default or breach and shall not be construed to (i) The Contractor shall only obtain insurance from be modification of the terms of this contract unless stated companies that are authorized to provide such to be such in writing, signed by an authorized coverage and that are authorized by the Commissioner representative of the County and the Contractor and of Insurance to do business in the State of North attached to the contract. Carolina.All such insurance shall meet all laws of the State of North Carolina. Availability of Funds: The parties to this contract agree (j) The Contractor shall comply at all titres with all lawful and understand that the payment of the sums specified in terms and conditions of its insurance policies and all this contract is dependent and contingent upon and subject lawful requirements of its insurer. to the appropriation, allocation, and availability of funds (k) The Contractor shall require its subcontractors to for this purpose to the County. comply with the requirements of this paragraph. (1) The Contractor shall demonstrate its compliance with Force Majeure: Neither party shall be deemed to be in the requirements of this paragraph by submitting default of its obligations hereunder if and so long as it is certificates of insurance to the County before the prevented from performing such obligations by any act of Contractor begins work under this contract. war,hostile foreign action,nuclear explosion,riot,strikes, civil insurrection,earthquake,hurricane,tornado,or other Transportation of Clients by Contractor:The contractor catastrophic natural event or act of God. will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina Utilities Survival of Promises: All promises,requirements,terms, Commission. conditions, provisions, representations, guarantees, and warranties contained herein shall survive the contract Default and Termination expiration or termination date unless specifically provided General Terms and Conditions—(45116) Page 2 of 5 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 otherwise herein, or unless superseded by applicable that comply with all applicable federal, state and Federal or State statutes of limitation. local laws,regulations, and rules. Intellectual Property Rights (b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the Copyrights and Ownership of Deliverables: All local Department of Social Services Contract deliverable items produced pursuant to this contract are the Administrator within twenty-four(24)hours exclusive property of the County. The Contractor shall not after the breach is first discovered, provided that assert a claim of copyright or other property interest in the Contractor shall report a breach involving such deliverables_ Social Security Administration data or Internal Revenue Service Data within one(1)hour after Federal Intellectual Property Bankruptcy Protection the breach is first discovered. Act:The Parties agree that the County shall be entitled to all rights and benefits of the Federal Intellectual Property (c) Cost Borne by Contractor: If any applicable Bankruptcy Protection Act,Public Law 100-506,codified federal, state,or local law,regulation or rule at 11 U.S.C. 365(n)and any amendments thereto. requires the Contractor give written notice of a security breach to affected persons,the Contract Compliance with Applicable Laws shall bear the cost of the notice. Compliance with Laws: The Contractor shall comply Trafficking Victims Protection Act of 2000: with all laws, ordinances, codes, rules, regulations, and The Contractor will comply with the requirements of licensing requirements that are applicable to the conduct of Section 106(g)of the Trafficking Victims Protection Act its business, including those of federal, state, and local of 2040,as amended(22 U.S.C. 7104) agencies having jurisdiction and/or authority. By executing this Agreement Provider certifies that Executive Order#24: It is unlawful for any vendor, Provider has not been identified,and has not utilized contractor, subcontractor or supplier of the state to make the services of any agent or subcontractor, on the list gifts or to give favors to any state employee. For created by the State Treasurer pursuant to G.S. 147- additional information regarding the specific 86.58. requirements and exemptions, contractors are encouraged to review Executive Order 24 and G.S. Sec. Title VI,Civil Rights Compliance: In accordance with 133-32. Federal law and U.S. Department of Agriculture(USDA) and U.S. Department of Health and Human Services Confidentiality (HHS) policy, this institution is prohibited from Confidentiality: Any information, data, instruments, discriminating on the basis of race,color,national origin, documents, studies or reports given to or prepared or sex, age or disability. Under the Food Stamp Act and assembled by the Contractor under this agreement shall be USDA policy, discrimination is prohibited also on the kept as confidential and not divulged or made available to basis of religion or political beliefs. any individual or organization without the prior written Equal Employment Opportunity The Contractor shall approval of the County.The Contractor acknowledges that comply with all federal and State laws relating to equal in receiving,storing,processing or otherwise dealing with any confidential information it will safeguard and not employment opportunity. further disclose the information except as otherwise Health Insurance Portability and Accountability Act Provided in this contract. (HIPAA): The Contractor agrees that, if the County Oversight determines that some or all of the activities within the scope of this contract are subject to the Health Insurance Access to Persons and Records:The State Auditor shall Portability and Accountability Act of 1996,P.L. 104-91, have access to persons and records as a result of all as amended("HIPAA"), or its implementing regulations, contracts or grants entered into by State agencies or it will comply with the HIPAA requirements and will political subdivisions in accordance with General Statute execute such agreements and practices as the County 147-64.7. Additionally,as the State funding authority,the may require to ensure compliance. Department of Health and Human Services shall have (a) Data Security: The Contractor shall adopt and access to persons and records as a result of all contracts or apply data security standards and procedures grants entered into by State agencies or political subdivisions. General Terms and Conditions—(06/16) Page 3 of 5 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 subcontractors,complies with the requirements ofArticle 2 Record Retention: Records shall not be destroyed, of Chapter+64 of the NC General Statutes. purged or disposed of without the express written consent of the Division. State basic records retention policy Miscellaneous requires all grant records to be retained for a minimum of five years or until all audit exceptions have been resolved, Choice of Law: The validity of this contract and any of its whichever is longer, If the contract is subject to federal terms or provisions,as well as the rights and duties of the policy and regulations,record retention may be longer than parties to this contract,are governed by the laws of North five years since records must be retained for a period of Carolina.The Contractor,by signing this contract,agrees three years following submission of the final Federal and submits,solely for matters concerning this Contract,to Financial 'Status Report, if applicable, or three years the exclusive jurisdiction of the courts of North Carolina following the submission of a revised final Federal and agrees, solely for such purpose, that the exclusive Financial Status Report. Also, if any litigation, claim, venue for any legal proceedings shall be Orange County, negotiation, audit, disallowance action, or other action North Carolina. The place of this contract and all involving this Contract has been started before expiration transactions and agreements relating to it, and their situs of the five-year retention period described above, the and forum,shall be Orange County,forth Carolina,where records must be retained until completion of the action and all matters,whether sounding in contract or tort,relating to resolution of all issues which arise from it,or until the end the validity,construction,interpretation,and enforcement of the regular five-year period described above,whichever shall be determined. is later. The record retention period for Temporary Assistance for Needy Families(TANF) and MEDICAID Amendment: This contract may not be amended orally or and Medical Assistance grants and programs must be by performance. Any amendment must be trade in written retained for a minimum of ten years. form and executed by duly authorized representatives of the County and the Contractor. Warranties and Certifications Severability: In the event that a court of competent Date and Time Warranty: The Contractor warrants that jurisdiction holds that a provision or requirement of this the product(s) and service(s) furnished pursuant to this contract violates any applicable law,each such provision contract("product"includes,without limitation,any piece or requirement shall continue to be enforced to the extent it of equipment,hardware,firmware,middleware,custom or is not in violation of law or is not otherwise unenforceable commercial software,or internal components,subroutines, and all other provisions and requirements of this contract and interfaces therein)that perform any date and/or time shall remain in full force and effect. data recognition function,calculation, or sequencing will support a four digit year format and will provide accurate Readings: The Section and Paragraph headings in these date/time data and leap year calculations. This warranty General Terms and Conditions are not material parts ofthe shall survive the termination or expiration of this contract. agreement and should not be used to construe the meaning thereof. Certification Regarding Collection of Taxes: G.S. 143- 59.1 bars the Secretary of Administration from entering Time of the Essence: Time is of the essence in the into contracts with vendors that meet one of the conditions performance of this contract. of G.S. 165-164.8(b)and yet refuse to collect use taxes on sales of tangible personal property to purchasers in North Key Personnel: The Contractor shall not replace any of Carolina. The conditions include: (a) maintenance of a the key personnel assigned to the performance of this retail establishment or office; (b) presence of contract without the prior written approval of the County. representatives in the State that solicit sales or transact The term "key personnel" includes any and all persons business on behalf of the vendor; and (c) systematic identified as such in the contract documents and any other exploitation of the market by media-assisted, media- persons subsequently identified as key personnel by the facilitated, or media-solicited means. The Contractor written agreement of the parties. certifies that it and all of its affiliates (if any) collect all required taxes. Care of Property: The Contractor agrees that it shall be responsible for the proper custody and care of any property E-Verify furnished to it for use in connection with the performance of this contract and will reimburse the County for loss of, Pursuant to G.S. 143-48.5,the undersigned hereby certifies or damage to, such property. At the termination of this that the Contractor named below, and the Contractor's contract, the Contractor shall contact the County for General Terms and Conditions—(06116) Page 4 of 5 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 instructions as to the disposition of such property and shall comply with these instructions. Orange County Living Wage: Orange County is committed to providing its employees with a living wage Travel Expenses: Reimbursement, if provided in this and encourages agencies to which it provides funding to Agreement, to the Contractor for travel mileage, meals, pursue the same goal. The County's living wage hourly lodging and other travel expenses incurred in the standard, as adopted by the Orange County Board of performance of this contract shall not exceed the rates County Commissioners annually, can be found in the established in County policy. Orange County Budget Ordinance. To the extent possible, Orange County recommends that the Contractor and all Sales[Use Tax Refunds: If eligible,the Contractor and all subcontractors provide a living wage, as defined in this subcontractors shall: (a) ask the North Carolina section,to their employees. Department of Revenue for a refund of all sales and use taxes paid by them in the performance of this contract, Signatures: This Agreement together with any pursuant to G.S. 105-164.14; and (b) exclude all amendments or modifications may be executed refundable sales and use taxes from all reportable electronically. All electronic signatures affixed hereto expenditures before the expenses are entered in their evidence the intent of the Parties to comply with Article reimbursement reports. I IA and Article 40 of North Carolina General Statute Chapter 66. Advertising: The Contractor shall not use the award of this contract as a part of any news release or commercial advertising. General Terms and Conditions—(06/16) Page 5 of 5 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 ATTACERUENT B SCOPE OF WORK Orange County Department of Social Services and Orange County Department on Aging Federal Tax Id. or SSN 26-0076244 Contract# 68-2034 A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Flaircare.Inc.dba Homewatch Caregivers of the Triangle 2. If decent from Contract Administrator Information in General Contract: Address 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 1.2018 through June 30,2019 B. Explanation of Services to be provided and to whom(include SIS Service Code): The Contractor will provide employees to perform in-home services for the Department of Social Services' clients and the Department on Aging's clients, at the level,amount and frequency specified by the social worker in the In-Horne Aide Services Plan (SIS Code 042). The Contractor will provide Level II Home Management and Level IT 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$22.741hour, of which the Contractor must pay the In Home Aide at least the County's Living Wage(currently$14.25 per/hr). The County has increased the standard fixed rate to compensate Contractor for any amount above Federal Minimum Waize. 2.Negotiated County Rate. 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 0 to the budaetary limits of the contract allotment. The County will reimburse the Contractor at a rate of$22.74/hour for approved services provided. For reimbursement,the Contractor must submit an original and two copies ofan invoice by the fifth of the month for the preceding month's expenditures 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 1 of 2 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Department on Aging shall be_submitted to the Administrator-for said Department. The County will reimburse the Contractor monthly upon receipt of complete and correctly filed report. F. Area to be served/Delivery site(s): _Orange County [�ocuSigned by: �"RIM55 u a (,6sf6v, Nancy Coston,Social Service Director 9/19/2018 (Date Submitted) DocuSigned by: Janice Tyler,Dept.on Aging Director 9/19/2018 (Date Submitted) DocuSigned by: (Signature of Contractor) 8/29/2018 (Date Submitted) Contract-Scope of Work(06/04) Page 2of 2 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 ATTACHMENT C CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS AND CERTIFICATION REGARDING NONDISCRIMINATION Orange County Department of Social Services and Department on Aging 1. By execution of this Agreement the Contractor certifies that it will provide a drug-free workplace by: A. Publishing a statement notifying employees that the unlawful manufacture,distribution, dispensing,possession or use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; B. Establishing a drug-free awareness program to inform employees about: (1)The dangers of drug abuse in the workplace; (2)The Contractor's policy of maintaining a drug-free workplace; (3)Any available drug counseling, rehabilitation,and employee assistance programs; and (4)The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph(A); D. Notifying the employee in the statement required by paragraph(A)that,as a condition of employment under the agreement,the employee will: (1)Abide by the terms of the statement;and (2)Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; E. Notifying the County within ten days after receiving notice under subparagraph(D)(2)from an employee or otherwise receiving actual notice of such conviction; F. Taking one of the following actions,within 30 days of receiving notice under subparagraph (D)(2),with respect to any employee who is so convicted: (1)Taking appropriate personnel action against such an employee, up to and including termination; or (2)Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State,or local health, law enforcement,or other appropriate agency;and Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs(A), (B),(C),(D),(E),and(F). Federal Certification-Drug-Free Workplace&Nondiscrimination rev.06-2015 Page 1 of 2 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 H. The site(s)for the performance of work done in connection with the specific agreement are listed below: 1. (Street address) (City, county,state,zip code) 2. (Street address) (City,county,state,zip code) Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,suspension or termination of grants,or government-wide Federal suspension or debarment 45 C.F.R.Section 82.510. Section 4 CFR.Part 85,Section 85.615 and 86.620. CERTIFICATION REGARDING NONDISCRIMINATION The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a)Title VI of the Civil Rights Act of 1964 (P.L. 88-352)which prohibits discrimination on the basis of race, color or national origin; (b)Title IX of the Education Amendments of 1972, as amended(20 U.S.C. §§1681-1683, and 1685-1686),which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794),which prohibits discrimination on the basis of handicaps; (d)the Age Discrimination Act of 1975, as amended(42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this Agreement. I 1DocuSigned by: /,� V,,j6r ���Ar^'JL President 6670366047242F_. Signature Title; F1airCare Inc. dba Homewatch Caregivers8/29/2018 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: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Homewatch Cdx1 e v rs- L.et our family care for yours.T" ATTACHMENT D CONFLICT OF INTEREST POLICY Orange County Department of Social Services The Board of Directors/Trustees or other governing,persons, officers, employees or agents are to avoid any conflict of interest, even the appearance of a conflict of interest. The Organization's Board of Directors/Trustees or other governing, body, officers, staff and agents are obligated to always act in the best interest of the organization.This obligation requires that any Board member or other governing person, officer, employee or agent, in the performance of Organization duties, seek only the furtherance of the Organization mission. At all times, Board members or other governing, persons, officers, employees or agents, are prohibited from using their job title, the Organization's name or property, for private profit or benefit. A. The Board members or other governing persons, officers, employees, or agents of the Organization should neither solicit nor accept gratuities, favors, or anything of monetary value from current or potential contractors/vendors, persons receiving benefits from the Organization or persons who may benefit from the actions of any Board member or other governing person, officer, employee or agent This is not intended to preclude bona-fide Organization fund raising- activities. B. A Board or other governing body member may,with the approval of Board or other governing body, receive honoraria for lectures and other such activities while not acting in any official capacity for the Organization. Officers may, with the approval of the Board or other governing body, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. Employees may, with the prior written approval of their supervisor, receive honoraria for lectures and other such activities while on personal days, compensatory time, annual leave, or leave without pay. if a Board or other governing body member, officer, employee or agent is acting in any official Capacity, honoraria received in connection with activities relating to the Organization are to be paid to the Organization. C. No Board member or other governing person, officer, employee, or agent of the Organization shall participate in the selection, award, or administration of a purchase or contract with a vendor where, to his knowledge, any of the following has a financial interest in that purchase or contract: 1. The Board member or other governing person,officer,employee, or agent; 2. Any member of their family by whole or half blood, step or personal relationship or relative-in-law; 3. An organization in which any of the above is an officer,director, or employee; 101 Cosgrove Ave,Ste 120 Chapel Hill NC 27514 1210 SE Maynard Rd,Ste 202 Cary NC 27511 919.960.6038 919.461.3741 hwcg.corn DocuSign Envelope ID: D6A1OEDE-9BO6-43F7-AB6A-BOCF29ADEBA4 4. A person or organization with whom any of the above individuals is negotiating; or has any arrangement concerning prospective employment or contracts. D, Duty to Disclosure-- Any conflict of interest, potential conflict of interest, or the appearance of a conflict of interest is to be reported to the Board or other governing body or one's supervisor immediately. E. Board Action--When a conflict of interest is relevant to a matter requiring action by the Board of Directors/Trustees or other governing body,the Board member or other governing person, officer, employee, or agent(person(s))must disclose the existence of the conflict of interest and be given the opportunity to disclose all material facts to the Board and members of corruTdttees with goventing board delegated powers considering the possible conflict of interest. After disclosure of all material facts,and after any discussion with the person, he/she shall leave the,governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if conflict of interest exists. In addition, the person(s)shall not participate in the final deliberation or decision regarding;the matter under consideration and shall leave the meeting;during the discussion of and vote of the Board of Directors/Trustees or other governing body, F. Violations of the Conflicts of Interest Policy If the Board of Directors/Trustees or other goverrringg body has reasonable cause to believe a member, officer, employee or agent has failed to disclose actual or possible conflicts of interest, it shall inform the person of the basis for such belief and afford the person an opportunity to explain the alleged failure to disclose. If, after hearing the person's response and after making further investigation as warranted by the circumstances, die Board of Directors/Trustees or other governing body determines the member, officer, employee or agent has faired to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action. G. Record of Conflict --- The minutes of the governing board and all committees with board delegated powers shall contain. 1. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committee's decision as to whether a conflict of interest in fact existed. 2. The names of the persons who were present for discussions and votes relating to the transaction or arrangement that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. Approved by: F'lairCare. Inc. d a Hornewatch CareGivcrs of the Triangle Name t)rg r Signatulf of Orgard"n6on Official I — Date 101 Cosgrove Ave,Ste 120 Chapel Hill NC 27514 1210 SE Maynard Rd,Ste 202 Cary NC 27511 919,960.6036 919,461.3741 hwcg.com DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of Orange I, fthlee—n � } ]+r} Notary Public for said County and State, certify that Anzor Gachechiladze personally appeared before me this day and acknowledged that he/she is President of FlairCare, Inc., dba Nomewatch CareGivers of the Triangle 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 DirectorsfTrustees or other governing body in a meeting held on the lath day of August,20 IS. Sworn to and subscribed before me this I day of US-k- (C)ff'icial Seal) N Notary Public 41?), My Conunission expires rLh l , 20� py C DIlN s �G 101 Cosgrove Ave,Ste 12D Chapel Hill NC 27514 1210 SE Maynard Rd,Ste 202 Cary NC 27511 919.960.6038 919,461.3741 hweg.com DocuSign Envelope ID: D6A10EDE-9B06-43F7-AB6A-BOCF29ADEBA4 Homewatch C dlk 1"A9311 L� Lot our family care for yours." August 13, 2018 To: Orange County Department of Social Services Certification: We certify that FlairCare, Inc., dba Hornewatch CareGivers of the Triangle,does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1{, at the federal,State,or local level. We Further understand that any person who makes a false statement in violation of N.C.G.S. 1430-6- 23(c)is guilty of criminal offense punishable as provided by N.C.G.S. 1430-10-1(b), Sworn Statement, Anzor Gachechiladze and Kimberly Flair being,duly sworn, say that we are the Board Chair and Secretary/Treasurer of the Board respectively, of F1airCare, Inc., dba Hornewatch CareGivers of the Triangle of Chapel Hill 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 State funds will he reported to the appropriate authorities for r action. Board h Secretatry/Treagurer of the Board Sworn to and subscribed'before me on the day of the date of said certification. EN • eR0 d3AR1! C I- ission Expires: (Notary Signature and Seal) PU13LIC y�+ ► c�U l G.S. 105-243.1 dcriincv.Overdue tax debt.—Any part of a tax debt dial remains unpaid 90 days or more after die notice of final assessment%vas mailed to the Wxpayer.The terra does not include a tax debt,hmYever,if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days aflcr the notice of final assessment%vas mailed and has not railed to make any payments due under the installment agreement." 101 Cosgrove Ave,Ste 120 Chapel Hill NC 27514 1210 SE Maynard Rd,Ste 202 Cary NC 27511 919.960.6038 919.461.3741 hweg.com DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 ATTACE MENT 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 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 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 making 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(06/15) Page 1 of 3 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 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: D6A1OEDE-9BO6-43F7-AB6A-BOCF29ADEBA4 (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. F 1DocuSigned by: V,1j6r President F_ Signature l itle Flaircare Inc. dba Homewatch Caregivers 8/29/2018 Agency/Organization Date (Certification signature should be same as Contract signature.) Federal Certification—Lobbying(06115) Page 3 of 3 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 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. 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 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: D6A1OEDE-9BO6-43F7-AB6A-BOCF29ADEBA4 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 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,proposer/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. DocuSigned by: aln/LjbV G"W yL President Signature Title Flaircare Inc. dba Homewatch caregivers8/29/2018 Agency/Organization Date (Certification signature should be same as Contract signature.) Federal Certification-Debarment(05115) Page 2 oft DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 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 hove drivers handle and report client emergencies and/or vehicle crashes involving clients to contractor and how contractor notifies the Orange 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 rewire 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. 8. Disclosing, at the outset of the contract,upon renewal and upon request, any criminal convictions or other reasons for disqualifications from participation in Medicare, DocuSi9W,dicaid or Title XX programs(signature on this form confirms this statement). v-1/ 6r ���A�^ 1L President Fa Signature Title Flaircare Inc. dba Homewatch caregivers8/29/2018 Agency/Organization Date (Certification signature should be same as Contract signature.) Transportation Certification(05116) Page I of 1 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 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/EnactedLei4islation/Statutes/PDF/ByArticle/Chapter 64/Article 2.ndf • The text of G.S. 105-164.8(b)can be found online at: htt ://www.nc a.state.nc.us/EnactedLe islation/Statutes/PDF/B 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: http•//www nega state.ne.tis/Sessions/2013/Bills/House/PDF/H786y6,pdf • The text of G.S. 143-59.1 can be found online at: htt ://www.nc a.state.ne.us[EnactedLe islation/Statutes/PDF/B Section/Cha ter 143/GS 143-59.1 df • The text of G.S. 143-59.2 can be found online at: http•//www ncga state nc us/EnactedL.egislatioti/Statutes/PDF/BySeetion/Chapter 143/GS 143-59.2.pdf • The text of G.S. 147-33.95(g)(S.L.2013-418,s.2.(e))can be found online at: htt //www.nc a.state.nc.us/Sessions/2613/Bills/House/PDF/H786v6. df • 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.ggvv 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 Contractor Certifications Required by North Carolina Law Page 1 of 3 revised May 30,2018 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and (b) [check one of the following boxes] n 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 $14.25 per/hr.) Check here Z if contractor pays employees performing under this contract a living wage. If Contractor does not pay employees a living wage,what is the wage that employees performing services under this contract paid Flail-Care Inc. dba Homewatch Caregivers nfrac$ce ' ' amp. (ae�t, 8/29/2018 Signatur of Contractor's Authorized Agent Bate Anzor Gachechiladze President r Sa �f Contractor's Authorized Agent Title �Vl Clinical Manager Signature of Witness Title Krista Flair 9/18/2018 Printed Name of Witness Date The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately thereafter. Contractor Certifications Required by North Carolina Law Page 2 of 3 revised May 30,2018 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Section 1: 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 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 10.1.1 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$14.25 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 revised May 30,2018 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract#68-2034 Flaircare-Homewatch ATTACHMENT N Orange County Department of Social Services/Human Services CERTIFICATION REGARDING NONDISCRIMINATION,CLEAN AIR ACT,CLEAN WATER ACT Certification Regarding Nondiscrimination The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101- 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g)Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended,relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs, and (i) the requirements of any other nondiscrimination statutes which may apply to this Agreement. The Contractor trust comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented by the Department of Labor Regulations (41 CFR Part 60): The Executive Order prohibits federal contractors and federally-assisted construction contractors and subcontractors who do over $10,000 in Government business in one year from discriminating in employment decisions on the basis of race, color, religion, sex, or national origin. The Executive Order also requires Government contractors to take affirmative action to ensure that equal opportunity is provided in all aspects of their employment. Meaningful Access for LEP Individuals: The Contractor that participate in the SNAP trust take reasonable steps to ensure that LEP persons have meaningful access to programs, services, and benefits. This includes the requirement to provide bilingual program information and certification materials and interpretation services to single language minorities in certain project areas. SNAP Contractors that do not provide meaningful access for LEP individuals risk violating prohibitions against discrimination based on National Origin in the Food and Nutrition Act of 2008, as amended, Title VI of the Civil Rights Act of 1964 (Title VI)and SNAP program regulations at 7 CFR 272A(b). They also risk noncompliance with the USDA policy guidance titled, "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against. National Origin Discrimination Affecting Limited English Proficient Persons", published in 79 FR 70771 -70784(November 28,2014). The Contractor should develop an implementing plan to address the language assistance needs of the LEP population served. This may include contracting for oral interpretation services, hiring bilingual staff, arranging telephone interpreters and/or language lines, coordinating community volunteers, translating vital documents, and providing written notice that language services are available in appropriate languages. Quality and accuracy of the language service is (Federal Certification-Non-Discrimination, Clean Air,Clean Water)(01/2018)Page 1 of 4 DocuSign Envelope ID: D6A1OEDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract#68-2034 Flaircare-Homewatch critical in order to avoid serious consequences to the LEP person and to the recipient.LEP needs should be considered in developing budgets and front line staff should understand how to obtain language assistance services. For additional assistance and information regarding LEP matters, please also visit http://www.tei2.yQv. Ensuring Equal C?pportunity Access for Persons with Disabilities: The Contractor must also ensure equal opportunity access for persons with disabilities. This includes ensuring that communications with applicants, participants, members of the public, and companions with disabilities are as effective as communications with people without disabilities. Contractors that do not provide persons with disabilities equal opportunity access to programs may risk violating prohibitions against disability discrimination in the Rehabilitation Act of 1978, the American with Disabilities Act(ADA)of 1990, as amended,and SNAP program regulations. DOJ published revised final regulations implementing Title H and Title III of the ADA on September 15, 2010, These regulations are codified at 28 CFR Part 35 "Nondiscrimination on the Basis of Disability in State and Local Government Services" and at 28 CFR Part 36 "Nondiscrimination on the Basis of Disability in Public Accommodations and Commercial Facilities". In accordance with the implementing regulations,Contractors must provide auxiliary aids and services where necessary to ensure effective communication and equal opportunity access to program benefits for individuals with disabilities. The type of auxiliary aids and services required will vary, but a Contractor may not require an individual with a disability to bring another individual to interpret, and may rely on a person accompanying a disabled individual only in limited circumstances. When a Contractor communicates with applicants and beneficiaries by telephone, it must provide text telephone services (ITY) or have access to an equally effective electronic telecommunications system to communicate with individuals who are deaf, hard of hearing, or hearing impaired. Contractors must also ensure that interested persons, including persons with impaired vision or hearing, can obtain information as to the existence and location of accessible services, activities, and facilities. For more information, please visit the ADA website: http://www.ada.gov. 1V.The Clean Air Act, Section 306; 42 U.S.C.§7401 et seq.(1970) a. No Federal agency may enter into any contract with any person who is convicted of any offense under section 113(c) for the procurement of goods, materials, and services to perform such contract at any facility at which the violation which gave rise to such conviction occurred if such facility is owned, leased, or supervised by such person. The prohibition in the preceding sentence shall continue until the Administrator certifies that the condition giving rise to such a conviction has been corrected. For convictions arising under section 113(c)(2), the condition giving rise to the conviction also shall be considered to include any substantive violation of this Act associated with the violation of 113(c)(2). The Administrator may extend this prohibition to other facilities owned or operated by the convicted person. b. The Administrator shall establish procedures to provide all Federal agencies with the notification necessary for the purposes of subsection(a). c. In order to implement the purposes and policy of this Act to protect and enhance the quality of the Nation's air,the President shall,not more than 180 days after enactment of the Clean Air Amendments of 1970 cause to be issued an order (1) requiring each Federal agency authorized to enter into contracts and each Federal agency which is empowered to extend Federal assistance by way of grant, loan, or contract to effectuate the purpose and policy of this Act in such contracting or assistance activities, and (2) (Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01/2018)Page 2 of 4 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract 968-2434 F1aircare-Homewatch setting forth procedures, sanctions, penalties, and such other provisions, as the President determines necessary to carry out such requirement. d. The President may exempt any contract, loan, or grant from all or part of the provisions of this section where he determines such exemption is necessary in the paramount interest of the United States and he shall notify the Congress of such exemption. e. The President shall annually report to the Congress on treasures taken toward implementing the purpose and intent of this section, including but not limited to the progress and problems associated with implementation of this section. [42 U.S.C. 7606] V.The Clean Water Act;33 U.S.C. §1251 et seq. (1972) a. No Federal agency may enter into any contract with any person who has been convicted of any offense under Section 309(c) of this Act for the procurement of goods, materials, and services if such contract is to be performed at any facility at which the violation which gave rise to such conviction occurred, and if such facility is owned, leased, or supervised by such person. The prohibition in preceding sentence shall continue until the Administrator certifies that the condition giving rise to such conviction has been corrected. b. The Administrator shall establish procedures to provide all Federal agencies with the notification necessary for the purposes of subsection(a)of this section. c. In order to implement the purposes and policy of this Act to protect and enhance the quality of the Nation's water, the President shall, not more than 180 days after the enactment of this Act,cause to be issued an order: (i) requiring each Federal agency authorized to enter into contracts and each Federal agency which is empowered to extend Federal assistance by way of grant, loan, or contract to effectuate the purpose and policy of this Act in such contracting or assistance activities,and (ii) setting forth procedures, sanctions, penalties, and such other provisions, as the President determines necessary to carry out such requirement. d. The President may exempt any contract, loan, or grant from all or part of the provisions of this section where he determines such exemption is necessary in the paramount interest of the United States and he shall notify the Congress of such exemption. e. The President shall annually report to the Congress on measures taken in compliance with the purpose and intent of this section, including, but not limited to,the progress and problems associated with such compliance. f. No certification by a contractor, and no contract clause, may be required in the case of a contract for the acquisition of commercial items in order to implement a prohibition or requirement of this section or a prohibition or requirement issued in the implementation of this section. g. In paragraph(1), the term"commercial item"has the meaning given such term in section 4(12)of the Office of Federal Procurement Policy Act(41 U.S.C.403(12)). (Federal Certification-Non-Discrimination, Clean Air, Clean Water)(0112018)Page 3 of DocuSign Envelope ID: D6A1OEDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Contract#68-2034 L D G S' d by: Ffaircare-Homewatch President S i"111 l u C Title F1airCare Inc. dba Homewatch Caregiver_,�/29/2018 Agency/Organization Date (Certification signature should be same as Contract signature.) (Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01f2018)Fage 4 of 4 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 ATTACHMENT U 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, 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 terns 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 It 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 for frequency of required aide supervision by RN,competency testing, and document provision including: a. A supervisory on site home visit by RN within the first calendar week of an aide assignment to observe the work of the aide. b. A supervisory on site home visit by RN within calendar weeks 2 through 4 of an aide assignment to observe the work of the aide.. Outcomes (06104) Page 1 of 3 DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 c. A quarterly on site home visit by RN made at least every 3 months and an annual visit. Aide must be observed in performance of duties. d. A telephone contact made with aide and client/designated person by RN during non- quarterly review month. e. The provider agency will assure that competency testing is appropriately administered. The aide will demonstrate the tasks before the RN and competency testing reflects the task and the knowledge required of the aide. A check list may be used.The date of competency testing is documented and signed off on by the RN and by the aide who is being competency tested. F. The provider agency will assure that the aide has sufficient training to pass a competency test for the level of service provision requested.The provider agency will have written documentation of the competencies completed,trainings completed,etc. All information will be dated and signed by RN. g. Provider agency will comply with all necessary documentation needed by Orange County Department of Social Services including but not limited to an assessment addressing the following areas: social,environmental,activities of daily living, instrumental activities of daily living,economic,physical,and mental. h. RN will document information regarding economic status at least quarterly. (For example: Client has sufficient income to meet current needs.) i. RN will participate in and sign Orange County DSS In-Home Aide Service Plan. j. RN will participate in and sign Orange County DSS Adult Services Functional Assessment. 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. 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-Home 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. DocuSigned by: /,� 1V,j6r G��a" JL President y7?4PF Signature Title Outcomes (06/04) Page 2 of 3 DocuSign Envelope ID: D6A1OEDE-9BO6-43F7-AB6A-BOCF29ADEBA4 Flaircare Inc. dba Homewatch Caregivers 8/29/2018 Agency/Organization Date (Certification signature should be same as Contract signature.) Outcomes (06/04) Page 3 of DocuSign Envelope ID: D6A10EDE-9BO6-43F7-AB6A-BOCF29ADEBA4 �r FLAIINC-01 DMASO ACt?RIJI" DATE{MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0812712018 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 INSURERS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)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 Ileu of such�andorsement(s). PRODUCER I CO Summers Thompson Lowry,Inc. A No,E:1 919 968-4472 AIC,Na)T_919 942-4221 100 Europa Drive M IL Suite 571 .info @STLinsure.com Chapel HIII,NC 27517-2393 IN AFFORDING COVERAGE NAIC# INSURER A;ACE American Insurance Co 22667 INSURED INSURER a:Alimerica Financial Benefit 41844 Flaircare,Inc DBA INSURER C:Accident Fund National Ins Co. 12305 Homewatch Caregivers 1210 SE Maynard Rd.Suite 202 INSURER Q: Cary,NC 27511 INSURERE: INSURER F COVERAGES CERTIFICATE 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE IN2512 WVO I POLICY NUMBER fly n=1 I LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 X CLAIMS-MADE F—]OCCUR MLP 627939594 003 0110112018 0110112D19 DAMAGE TO RENTED 100,000 MED EXP AnY one ersen PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 POLICY 1:1% F-1 LOG PRODUCTS COMPIOP AGG $ 1,000,000 OTHER; H&NO Auto 11000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Es accide ) ANY AUTO AW6D229198 04/18/2017 0411812D18 BODILY INJURY Per person) OWNED SCHEDULED AUTOS ONLY x AUUTO$$ BODILY INJURY Per accfdent $ AU OS ONLY All OS phiLOY PPorr aERfdent AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAS CLAIMS-MADE AGGREGATE DED I J RETENTION$ PE C WORKERS COMPENSATION _ STA[1TE._.,,f 0TH- AND EMPLOYERS' YIN LIABILITY WCV801303900 0110112018 01/0112019 500,000 ANY PROPRIETORIPARTNERIEXECUTIVE MCA E.L.EACH ACCIDENT $ OFFICERIMEMBE EXCLUDED? {Mandatory In N E.L.DISEASE-EA EMPLOYE 5'00'000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A AbuselSex Molestatio MLP 627939594 003 0110112018 0110112019 iPer Claim 1,000,000 A Prof Liability MLP 627939594 003 0110112018 01/0112019 Per Aggregate 3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 141,Additional Remarks Schedule,may he attached It more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Department of Social Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 tS P 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 registered marks of ACORD