Loading...
HomeMy WebLinkAbout2019-101 Aging - State of NC SHIIP Division grant DocuSign Envelope ID:3D67EE7B-C2CE-49B3-86AC-6C601CADD1FF STATE OF NORTH CAROLINA COUNTY OF WAKE Grant Name: Medicare Improvements for Patients and Providers Act Federal Awarding Agency: US Department of Health & Human services, Administration for community Living CFDA # 93.071 Cost Center: Fiscal Year: 2018-2019 Grant Award # 1801NCMISH-00 16001659g8 Award Amount $ 3,496.00 Performance Period: 10/1/2018 - 9/29/2019 Federal Award Date: 9/24/18 Account # 536405 Total Award Amount $ 3,496.00 Subreceipient: Contract Between Name: Orange County, North Carolina Recipient: � State of North Carolina County: orange Tax ID/FIN# Department of Insurance DUNS # - SHIIP Division This Contract and its attachments shall be completed and returned to the Recipient within 45 days of receiving the electronic document in order for the Recipient to process the award and provide funds to the Subrecipient. The Subrecipient shall provide the Recipient with progress reports and a final report detailing the Subrecipient's use of State funds. 1. Contract Documents: This Contract shall consist of the following documents, incorporated herein by reference: (1) This Contract; (2) General Terms and Conditions for Public Sector Contracts(Attachment A) ° f (3) Statement of Work(Attachment B) (4) Line Item Budget and Budget Narrative (Attachment C) (5) Certifications Regarding, Drug-Free Work-Place; Lobbying; and Debarment, Suspension and Other E Responsibility Matters (Attachment D) (6) Certification of Eligibility Under the Iran Divestment Act(Attachment E) These documents constitute the entire agreement between the Parties and supersede all prior statements or agreements. } 2. Precedence Among Contract Documents: In the event of a conflict between or among the terms of the Contract Documents,the terms in the Contract Document with the highest relative precedence shall prevail. E The order of precedence shall be the order of documents as listed in Paragraph 1, above,with the first-listed document having the highest precedence and the last-listed document having the lowest precedence. If there are multiple Contract Amendments, the most recent amendment shall have the highest precedence and the oldest amendment shall have the lowest precedence. 3. Subrecipient's Duties: The Subrecipient shall provide the services as described in Attachment B with the terms of this Contract and in accordance with the approved budget in Attachment C. The Subrecipient shall maintain and make available all records,papers,vouchers,books, correspondence or other documentation or evidence at reasonable times for review,inspection or audit by duly authorized officials of the Recipient, the North Carolina State Auditor, or applicable federal agencies. Upon termination of contract as a SHIIP DocuSign Envelope ID : 31D67EE713- = &49133 -86AC-6C601 CADD1 FF Coordinating Site , any equipment or property less than five ( 5 ) years old purchased by Subrecipient with grant funds to perform SHIIP functions shall be returned to the Recipient in good working order . The Subrecipient shall submit to the Recipient all plans , reports , documents or other products that the Recipient may require , in the form specified by the Recipient , including at the least following : A) A final budget report of expenses incurred during the contract period date , B ) A mid -year report of the contracted activities of the Subrecipient due by April 30 , C ) A final comprehensive report within sixty ( 60) days of project end date ; due on or before November 29 , 4 . Recipient ' s Duties : The Recipient shall reimburse the Subrecipient for the costs of services and activities The Recipient described in Attachment B and in accordance with the approved budget in Attachment C . e pP g P shall monitor the Subrecipient for compliance with the terms of this Contract ; and shall specify all reports and other deliverables required from the Subrecipient . The Recipient shall pay the Subrecipient in the manner and in the amounts specified in the Contract Documents . X . There are no matching requirements from the Subreci lent . [ ] a atc g q p [ ] b . The Subrecipient ' s matching requirement is $ n/a , which shall consist of. [ ] In - kind [ ] Cash [ ] Cash and In - kind [ ] Cash and/or In - kind The contributions from the Subrecipient shall be source from non -federal funds . 5 . Conflict of Interest Policy : The Recipient has determined that this Contract is not subject to NCGS 143C- 6 -22 & 23 . 6 . Reversion of Unexpended Funds : Any unexpended grant funds shall revert to the Recipient upon termination of this Contract . 7 . Grants : The Subrecipient has the responsibility to ensure that all sub - grantees , if any, provide all information necessary to permit the Subrecipient to comply with the terms and conditions set forth in this Contract . The grant award for the contract is not to be used for Research & Development (R&D) . 8 . Payment Provisions : As provided in NCGS 143C-6 -21 this Contract is an annual appropriation of $ 100 , 000 or less to or for the use of a non-profit corporation and payment shall be made in a single annual payment . 9 . 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 , address , telephone number and fax number of the Parties ' respective initial Contract Administrators are set out below . Either Party may change the name , address , telephone number and fax number of its Contract Administrator by giving timely written notice to the other Party. ° For the Receiplent : For the Subreceipient : Melinda Munden , Deputy commissioner 3eanne Chamberlin SHIIP Division Orange County , North Carolina 1201 Mail service Center 2551 Homestead Road Raleigh , NC 27699 - 1201 chapel Hill , NC 27516 Telephone : 919 - 814 - 9942 Telephone . 919 - 245 - 4240 10 . Supplementation of Expenditures of Public Funds : The Subrecipient assures that funds received under this Contract shall be used only to supplement , not to supplant, the total amount of federal , state and local Page 2of16 DocuSign Envelope ID : 3D67EUB- = E4% 3-86AC -6C601 CADD1 FF public funds the Subrecipient otherwise expends for MIPPA and SHIIP 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 Subrecipient' s total expenditure of other public funds for such services . 11 . Disbursements : As a condition of this Contract , the Subrecipient 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 ; and • Legality of disbursement ; c . Assure adequate control of signature stamps/plates ; d . Assure adequate control of negotiable instruments ; and e . Implement procedures to ensure that the account balance is solvent and reconcile the account monthly . 12 . Outsourcing : The Subrecipient certifies that it has identified to the Recipient all jobs related to the Contract that have been outsourced to other countries , if any. Subrecipient further agrees that it will not outsource any such jobs during the term of this Contract without providing notice to the Recipient . 13 . Executive Order # 249. NCGS 133 - 32 and Executive Order 24 prohibit the offer to , or acceptance by , any State Employee of any gift from anyone with a contract with the State , or from any person seeking to do business with the State . By execution of any response in this procurement, you attest, for your entire organization and its employees or agents , that you are not aware that any such gift has been offered, accepted, or promised by any employees of your organization , 14 . Audit : The Recipient reserves the right to conduct an audit through the NCSMP Program Director . The Subrecipient must permit access to records and financial statements by the audit staff of Recipient as necessary . 15 . Federal Certifications : The Subrecipient agrees to execute the following federal certifications that are attached to this agreement (applicable when receiving federal funds) . A . Certification Regarding Lobbying , Be Certification Regarding Department , C . Certification Regarding Drug-Free Workplace Requirements , Page 3 of 16 DocuSign Envelope ID : 31DUEUB- CKE49B3-86AC -6C601 CADD1 FF 16 . Signature Warranty : The undersigned represent and warrant that they are authorized to bind their principals to the terms of this agreement . Subrecipient : DocuSigned by : L blit.liUL �oUM �Mt,VS�,t� 2 / 15 / 19 BY . �477 DATE : Bonnie Hammersley County Manager Division of SHIIP ,DocuSigned by : JWUr ,'44V02 / 11/ 2019 BY ; r= D4F� DATE ; da Ili DocuSigned by: 02 / 15 / 2019 BY : DATE : Susan Nestor DocuSigned by: 2 / 18 / 19 BY ; CE4BBB5B379E9482. 1 . DATE ; Michelle Osborne Contract is not executed until last signature is obtained . D5 DS DS Reviewed by : DSn controller ' s office Review : V Page 4 of 16 DocuSign Envelope ID : 3D67EE7B- C2CE-49B3-86AC -6C601 CADD1 FF Attachment A General Terms and Conditions DEFINITIONS ( 8 ) "Financial Statement" means a report Unless indicated otherwise from the context , the providing financial statistics relative to a given following terms shall have the following meanings in this part of an organization ' s operations or status . Contract . Some definitions are from 9 NCAC 3M . 0102 ( 9) " Grant " means financial assistance provided by unless otherwise noted . If the rule or statute that is the an Recipient , Subrecipient , or subrecipient to source of the definition is changed by the adopting carry out activities whereby the grantor authority , the change shall be incorporated herein , anticipates no programmatic involvement with ( 1 ) " Recipient" (as used in the context of the the Subrecipient or subrecipient during the definitions below) shall mean and include performance of the grant , every public office , public officer or official ( 10 ) " Subrecipient" has the meaning in NCGS ( State or local , elected or appointed) , 143C- 6 -23 (a) (2) : a non- State entity that institution , board , commission , bureau , receives a grant of State funds from a State council , department , authority or other unit of agency, department, or institution but does not government of the State or of any county, unit, include any non- State entity subject to the audit special district or other political sub agency of and other reporting requirements of the Local government . For other purposes in this Government Commission . For other purposes Contract, " Recipient" shall mean the entity in this Contract , " Subrecipient" shall mean the identified as one of the parties hereto . entity identified as one of the parties hereto . ( 2 ) " Audit" means an examination of records or ( 11 ) " Grantor" means an entity that provides financial accounts to verify their accuracy , resources , generally financial , to another entity ( 3 ) " Certification of Compliance " means a report in order to achieve a specified goal or objective , provided by the Recipient to the Office of the ( 12 ) "Non - State Entity" has the meaning in NCGS State Auditor that states that the Subrecipient 143C - 1 - 1 ( d) ( 18 ) : Any of the following that is has met the reporting requirements established not a State agency : An individual , a firm, a by this Subchapter and included a statement of partnership , an association , a county, a certification by the Recipient and copies of the corporation, or any other organization acting as submitted Subrecipient reporting package , a unit . The term includes a unit of local (4 ) " Compliance Supplement" refers to the North government and public authority . Carolina State Compliance Supplement, ( 13 ) "Public Authority" has the meaning in NCGS maintained by the State and Local Government 143C4 4 ( d) (22 ) : A municipal corporation that Finance Agency within the North Carolina is not a unit of local government or a local Department of State Treasurer that has been governmental authority , board , commission , developed in cooperation with agencies to council , or agency that ( 1) is not a municipal assist the local auditor in identifying program corporation and (ii) operates on an area, compliance requirements and audit procedures regional , or multiunit basis , and the budgeting for testing those requirements , and accounting systems of which are not fully (5 ) " Contract" means a legal instrument that is a part of the budgeting and accounting systems used to reflect a relationship between the of a unit of local government . Recipient, Subrecipient, and subrecipient . ( 14 ) " Single Audit" means an audit that includes an ( 6 ) " Fiscal Year" means the annual operating year examination of an organization' s financial of the non- State entity , statements , internal controls , and compliance (7 ) "Financial Assistance " means assistance that with the requirements of Federal or State non- State entities receive or administer in the awards . form of grants , loans , loan guarantees , property ( 15 ) " Special Appropriation" means a legislative act ( including donated surplus property) , authorizing the expenditure of a designated cooperative agreements , interest subsidies , amount of public funds for a specific purpose . insurance , food commodities , direct ( 16 ) " State Funds " means any funds appropriated by appropriations , and other assistance . Financial the North Carolina General Assembly or assistance does not include amounts received as collected by the State of North Carolina . State reimbursement for services rendered to funds include federal financial assistance individuals for Medicare and Medicaid patient received by the State and transferred or services , disbursed to non- State entities . Both Federal Page 5 of 16 DocuSign Envelope ID : 3D67EE7B- C2CE-49B3-86AC-6C601 CADD1 FF and State funds maintain their identity as they Assignment : No assignment of the Subrecipient' s are subrecipient to other organizations , obligations or the Subrecipient' s right to receive payment Pursuant to NCGS 143C -6 -23 ( a) ( 1 ) , the terms hereunder shall be permitted . However , upon written " State grant funds " and " State grants " do not request approved by the issuing purchasing authority , the include any payment made by the Medicaid State may : program , the State Health Plan for Teachers ( a) Forward the Subrecipient' s payment check( s) and State Employees , or other similar medical directly to any person or entity designated by the programs . Subrecipient , or ( 17 ) " Subrecipient" has the meaning in NCGS (b) Include any person or entity designated by 143C - 6 -23 (a) ( 3 ) : a non- State entity that Subrecipient as a joint payee on the receives State funds as a grant from a grantee Subrecipient ' s payment check( s) , or from another subrecipient but does not In no event shall such approval and action obligate the include any non- State entity subject to the audit State to anyone other than the Subrecipient and the and other reporting requirements of the Local Subrecipient shall remain responsible for fulfillment of all Government Commission , contract obligations . ( 18 ) " Unit of Local Government " has the meaning in NCGS 143C - 1 - 1 (d) (29 ) : A municipal Beneficiaries : Except as herein specifically provided corporation that has the power to levy taxes , otherwise , this Contract shall inure to the benefit of and including a consolidated city- county as defined be binding upon the parties hereto and their respective by NCGS 16013 -2 ( 1 ) , and all boards , agencies , successors . It is expressly understood and agreed that the commissions , authorities , and institutions enforcement of the terms and conditions of this Contract , thereof that are not municipal corporations , and all rights of action relating to such enforcement, shall be strictly reserved to the Recipient and the named Relationships of the Parties Subrecipient . Nothing contained in this document shall give or allow any claim or right of action whatsoever by Independent Contractor : The Subrecipient is and shall any other third person . It is the express intention of the be deemed to be an independent contractor in the Recipient and Subrecipient that any such person or entity, performance of this Contract and as such shall be wholly other than the Recipient or the Subrecipient , receiving responsible for the work to be performed and for the services or benefits under this Contract shall be deemed supervision of its employees . The Subrecipient represents an incidental beneficiary only. that it has , or shall secure at its own expense , all personnel required in performing the services under this agreement . Ineligible Vendors : As provided in G . S . 147 - 86 . 59 and Such employees shall not be employees of, or have any G . S . 147 - 86 . 82 , the following companies are ineligible individual contractual relationship with, the Recipient , to contract with the State of North Carolina or any political subdivision of the State : a) any company Subcontracting : The Subrecipient shall not subcontract identified as engaging in investment activities in Iran , as any of the work contemplated under this Contract without determined by appearing on the Final Divestment List prior written approval from the Recipient . Any approved created by the State Treasurer pursuant to G . S . 147 - subcontract shall be subject to all conditions of this 86 . 58 , and b ) any company identified as engaged in a Contract . Only the subcontractors or subrecipients boycott of Israel as determined by appearing on the List specified in the contract documents are to be considered of restricted companies created by the State Treasurer approved upon award of the contract . The Recipient shall pursuant to G . S . 147 - 86 . 81 . A contract with the State or not be obligated to pay for any work performed by any any of its political subdivisions by any company unapproved subcontractor or subrecipient . The identified in a) or b) above shall be void ab initio . Subrecipient shall be responsible for the performance of all of its subrecipients and shall not be relieved of any of the duties and responsibilities of this Contract . Indemnity Subrecipients : The Subrecipient has the responsibility Indemnification : The Subrecipient agrees to indemnify to ensure that all subrecipients , if any , provide all and hold harmless the Recipient, the State of North information necessary to permit the Subrecipient to Carolina, and any of their officers , agents and employees , comply with the standards set forth in this Contract , from any claims of third parties arising out of any act or omission of the Subrecipient in connection with the Page 6of16 DocuSign Envelope ID : 31D67EE713 C= -4913MMC-6C601 CADD1 FF performance of this Contract to the extent permitted by law , Force Majeure : Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is Default and Termination prevented from performing such obligations by any act of war, hostile foreign action , nuclear explosion , riot , strikes , Termination by Mutual Consent : The Parties may civil insurrection , earthquake , hurricane , tornado , or other terminate this Contract by mutual consent with 60 days ' catastrophic natural event or act of God , notice to the other party , or as otherwise provided by law . Survival of Promises : All promises , requirements , Termination Without Cause : The Recipient may terms , conditions , provisions , representations , guarantees , terminate this contract without cause by giving 60 days and warranties contained herein shall survive the contract written notice to the Contractor . In that event , all finished expiration or termination date unless specifically or unfinished deliverable items prepared by the provided otherwise herein , or unless superseded by Contractor under this contract shall , at the option of the applicable federal or state statutes of limitation . Recipient , become its property and the Contractor shall be entitled to receive just and equitable compensation for any Health Insurance Portability and Accountability Act satisfactory work completed on such materials , minus any (HIPAA) : The Contractor agrees that , if the Recipient payment or compensation previously made , determines that some or all of the activities within the scope of this contract are subject to the Health Insurance Termination for Cause : If, through any cause , the Portability . and Accountability Act of 1996 , P . L . 104- 915 Subrecipient shall fail to fulfill its obligations under this as amended ("HIPAA ") , or its implementing regulations , Contract in a timely and proper manner , the Recipient it will comply with the HIPAA requirements and will shall have the right to terminate this Contract by giving execute such agreements and practices as the Recipient written notice to the Subrecipient and specifying the may require to ensure compliance , effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Subrecipient Executive Order # 24 : "By Executive Order 24 , issued under this Contract shall , at the option of the Recipient, by Governor Perdue , and NCGS 133 -32 , it is unlawful for become its property and the Subrecipient shall be entitled any vendor or contractor ( i . e . architect, bidder , to receive just and equitable compensation for any contractor, construction manager, design professional , satisfactory work completed on such materials , minus any engineer, landlord, offeror, seller, subcontractor , supplier, payment or compensation previously made . or vendor) , to make gifts or to give favors to any State Notwithstanding the foregoing provision, the employee of the Governor ' s Cabinet Agencies ( i . e . , Subrecipient shall not be relieved of liability to the Administration , Commerce , Correction , Crime Control Recipient for damages sustained by the Recipient by and Public Safety, Cultural Resources , Environment and virtue of the Subrecipient ' s breach of this agreement, and Natural Resources , Health and Human Services , Juvenile the Recipient may withhold any payment due the Justice and Delinquency Prevention , Revenue , Subrecipient for the purpose of setoff until such time as Transportation, and the Office of the Governor) . This the exact amount of damages due the Recipient from such prohibition covers those vendors and contractors who breach can be determined . have a contract with a governmental agency; or have performed under such a contract within the past year ; or Waiver of Default : Waiver by the Recipient of any anticipate bidding on such a contract in the future , default or breach in compliance with the terms of this Contract by the Subrecipient shall not be deemed a waiver For additional information regarding the specific of any subsequent default or breach and shall not be requirements and exemptions , vendors and contractors construed to be modification of the terms of this Contract are encouraged to review Executive Order 24 and NCGS unless stated to be such in writing, signed by an Sec . 133 -32 , authorized representative of the Recipient and the Subrecipient and attached to the contract . Executive Order 24 also encouraged and invited other State Agencies to implement the requirements and Availability of Funds : The parties to this Contract agree prohibitions of the Executive Order to their agencies , and understand that the payment of the sums specified in Vendors and contractors should contact other State this Contract is dependent and contingent upon and Agencies to determine if those agencies have adopted subject to the appropriation, allocation, and availability of Executive Order 24 . " funds for this purpose to the Recipient . Page 7of16 DocuSign Envelope ID : 31D67EUB-= &49133-86AC -6C601 CADD1 FF Intellectual Property Rights of three years following submission of the final Federal Financial Status Report, if applicable , or three years Copyrights and Ownership of Deliverables : All following the submission of a revised final Federal deliverable items produced pursuant to this Contract are Financial Status Report . Also , if any litigation , claim , the exclusive property of the Recipient . The Subrecipient negotiation , audit, disallowance action , or other action shall not assert a claim of copyright or other property involving this Contract has been started before expiration interest in such deliverables . of the five -year retention period described above , the records must be retained until completion of the action and resolution of all issues which arise from it , or until the Compliance with Applicable Laws end of the regular five -year period described above , whichever is later . Compliance with Laws : The Subrecipient shall comply with all laws , ordinances , codes , rules , regulations , and Miscellaneous licensing requirements that are applicable to the conduct of its business , including those of federal , state , and local Choice of Law : The validity of this Contract and any of agencies having jurisdiction and/or authority , its terms or provisions , as well as the rights and duties of the parties to this Contract , are governed by the laws of Equal Employment Opportunity : The Subrecipient North Carolina , The Subrecipient , by signing this shall comply with all federal and state laws relating to Contract, agrees and submits , solely for matters equal employment opportunity . concerning this Contract , to the exclusive jurisdiction of the courts of North Carolina and agrees , solely for such Confidentiality purpose , that the exclusive venue for any legal proceedings shall be Wake County, North Carolina . The Confidentiality : Any information , data , instruments , place of this Contract and all transactions and agreements documents , studies or reports given to or prepared or relating to it, and their situs and forum , shall be Wake assembled by the Subrecipient under this agreement shall County, North Carolina, where all matters , whether be kept as confidential and not divulged or made available sounding in contract or tort , relating to the validity, to any individual or organization without the prior written construction , interpretation , and enforcement shall be approval of the Recipient . The Subrecipient determined . acknowledges that in receiving , storing, processing or otherwise dealing with any confidential information it Amendment : This Contract may not be amended orally will safeguard and not further disclose the information or by performance . Any amendment must be made in except as otherwise provided in this Contract . written form and executed by duly authorized representatives of the Recipient and the Subrecipient . Oversight Severability : In the event that a court of competent Access to Persons and Records : The State Auditor shall jurisdiction holds that a provision or requirement of this have access to persons and records as a result of all Contract violates any applicable law , each such provision contracts or grants entered into by State agencies or or requirement shall continue to be enforced to the extent political subdivisions in accordance with NCGS 147 - it is not in violation of law or is not otherwise 64 . 7 . Additionally, as the State funding authority, the unenforceable and all other provisions and requirements Recipient and all applicable federal agencies or their of this Contract shall remain in full force and effect , agents shall have access to persons and records as a result of all contracts or grants entered into by State agencies or Headings : The Section and Paragraph headings in these political subdivisions . General Terms and Conditions are not material parts of the agreement and should not be used to construe the Record Retention : Records shall not be destroyed, meaning thereof. purged or disposed of without the express written consent of the Recipient . State basic records retention policy Time of the Essence : Time is of the essence in the requires all grant records to be retained for a minimum of performance of this Contract , five years or until all audit exceptions have been resolved, whichever is longer . If the contract is subject to federal Key Personnel : The Contractor shall not replace any of policy and regulations , record retention may be longer the key personnel assigned to the performance of this than five years since records must be retained for a period contract without the prior written approval of the Page 8 of 16 DocuSign Envelope ID : 31D67EE713 C= -49BMMC-6C601CADD1FF Recipient . The term " key personnel" includes any and all shall be reasonable and supported by documentation , persons identified as such in the contract documents and State rates should be used as guidelines . International any other persons subsequently identified as key travel shall not be reimbursed under this Contract , personnel by the written agreement of the parties . Sales/Use Tax Refunds : If eligible , the Subrecipient and Care of Property : The Subrecipient agrees that it shall all subrecipients shall : (a) ask the North Carolina be responsible for the proper custody and care of any Department of Revenue for a refund of all sales and use property furnished to it for use in connection with the taxes paid by them in the performance of this Contract , performance of this Contract and will reimburse the pursuant to NCGS 105 - 164 . 14 ; and (b) exclude all Recipient for loss of, or damage to , such property. At the refundable sales and use taxes from all reportable termination of this Contract, the Subrecipient shall expenditures before the expenses are entered in their contact the Recipient for instructions as to the disposition reimbursement reports , of such property and shall comply with these instructions . Advertising : The Subrecipient shall not use the award of Travel Expenses : Reimbursement to the Subrecipient this Contract as a part of any news release or commercial for travel mileage , meals , lodging and other travel advertising, except as allowed in Attachment B . expenses incurred in the performance of this Contract Page 9 of 16 DocuSign Envelope ID : 31D67EE713 C= -49BMMC-6C601 CADD1 FF Attachment B For the period 10 / 1/ 2018 - 9 / 29 / 2019 Statement of Work Orange County , North Carolina Subrecipient : This statement should be a short summary describing what the Subrecipient does and how the Subrecipient will use these funds . The terms of the contract between the SHIIP office and the agencies require local programs meet these goals for the contract period . The uses of these funds are not limited to but MUST include the following activities : 1 . Expand Low Income subsidy ( LIS ) outreach and enrollment in the county by conducting a minimum of four enrollment clinics during the period 10 / 1 / 2018 through 9 / 29 / 2019 , clinics are to be held in non - traditional locations , i . e . , library , church , senior housing complex , etc . , 2 . Display Monthly Prevention and wellness campaign Posters in your respective agency and at SHIIP outreach events during the reporting period , i . e . , health fairs , awareness events , etc . ; 3 . submit Client counseling Contact and Public & Media outreach ( NPR ) forms in a timely manner through the STARS website ; 4 . work with the Area Agency on Aging in your area to conduct outreach events in the county . Page 10 of 15 DocuSign Envelope ID : 3D67EE7B- C2CE-49B3-86AC -6C601 CADD1 FF Subrecipient Response to scope of work : The Orange County Department on Aging (DOA) partners with the North Carolina Department of Insurance to host Orange County ' s SHIIP program . A DOA staff person , Jeanne Chamberlin , is assigned responsibilities of coordinating SHIIP outreach and volunteer activities . During the grant period, Jeanne will work with other DOA staff, SHIIP volunteers , and other community leaders to accomplish the following activities . • Enrollment events focused on low- income seniors will be held during Open Enrollment at two community centers in Northern Orange County and Adelaide Walters Apartments in Chapel Hill . • Extra Help program information and Prevention Posters are posted at both Senior Centers throughout the year and enrollment sessions are held weekly at each center . • Articles and short informational items will be developed and included in the Department on Aging publications : Senior Times published quarterly and Endless Possibilities electronic newsletter published twice per month . Content will include preventive services covered by Medicare , low- income assistance programs , and cost savings on prescription drugs among other topics . • Extra Help program information will be distributed to residents receiving supplemental food benefits through programs such as food banks and Meals on Wheels . • Welcome to Medicare classes will be held monthly in both Chapel Hill and Hillsborough . Information on preventive services and Extra Help are included in each class . All outreach and media activities , as well as beneficiary contacts will be recorded in the STARS system as required for Federal SHIIP reporting . Page 11 of 15 DocuSign Envelope ID : 3D67EE7B-C2CE-49B3-86AC-6C601 CADD1 FF Attachment C For the period 10 / 1/ 2018 - 9 / 29 / 2019 Line Item Budget and Budget Narrative Provide a budget and short narrative on the use of the funding amount reflected on the contract . Please provide details of all expenses including routine charges . These expenditures may include telephone , postage , salary, equipment purchases , internet services etc . Upon termination of contract as a SHIIP Subrecipient , any equipment or property less than five ( 5 ) years old purchased by Subrecipient with grant funds to perform SHIIP functions shall be returned to the Recipient in good working order . All budgets must be approved by the Recipient . Subrecipient Name : orange County , North Carolina Award Amount : $ 3 , 496 . 00 All fields must be completed . zero is an acceptable answer . Budget Amount Contractual 0 Must agree to the award Construction 0 amotAnt . Is this required by your Supplies 0 local government ? pp This instrument has been Equipment 0 pre - audited in the manner Other 699 required by the Local Government Budget and Travel 0 Fiscal control Act . Personnel 2797 No Fringe 0 Total 3 , 496 . 00 Written description of planned expenditures : Personnel costs will cover wages for SHIIP Coordinator , 7eanne Chamberlin . other is Annual License Fee for Appointment Plus Software used to make appointment for SHIIP weekly counseling sessions at both senior Centers . Page 12 of 15 DocuSign Envelope ID : 31D67EE713 C= E49BMMC -6C601CADD1FF Attachment D Certifications Regarding, Drug-Free Work-Place ; Lobbying ; and Debarment, Suspension and Other Responsibility Matters 1 . Drug-Free Work-Place The undersigned ( authorized official ) certifies that it will provide a drug- free workplace in accordance with the Drug- Free Work-Place Act of 1988 , 45 CFR Part 76 , subpart F . The certification set out below is a material representation of fact upon which reliance will be placed when awarding the grant . False certification or violation of the certification shall be grounds for suspension of payments , suspensions or termination of grants or government wide suspension or debarment . The Subrecipient certifies that it will or will continue to 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 Subrecipient ' s workplace and specifying the actions that will be taken against employees for violation of such prohibition ; (b) Establishing an on -going drug-free awareness program to inform employees about ( 1 ) The dangers of drug abuse in the workplace ; (2 ) The Subrecipient' 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 to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a) ; above ; ( d) Notifying the employee in the statement required by paragraph ( a) that, as a condition of employment under the grant , the employee will— ( 1 ) Abide by the terms of the statements and (2 ) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction ; ( e) Notifying the Recipient , in writing, within 10 calendar days after receiving notice under subparagraph ( d) (2 ) , above , from an employee or otherwise receiving actual notice of such conviction . Employers of convicted employees must provide notice , including position title , to Recipient on whose grant activity the convicted employee was working . Notices shall include the identification number( s) of each affected grant ; (f) Taping one of the following actions , within 30 days of receiving notice under subparagraph (d) (2 ) , above , with respect to any employee who is so convicted— ( 1 ) Taking appropriate personnel action against such an employee , up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973 , as amended; 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 ; ( g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a) , (b ) , ( c) , (d) , ( e) , and ( f) . The Subrecipient certifies that , as a condition of the grant, it will not engage in the unlawful manufacture , distribution , dispensing, possession or use of a controlled substance in conducting any activity with the grant . Page 13 of 15 DocuSign Envelope ID : 31D67EE713 C= -4913MMC-K601CADD1FF 2 . Lobbying Title 31 of the United States Code , Section 1352 , entitled "Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions , " generally prohibits recipients of Federal grants and cooperative agreements from using Federal ( appropriated) funds for lobbying the Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative agreement . Section 1352 also requires that each person who request or received a Federal grants or cooperative agreement must disclose lobbying undertaking with non-Federal (non -appropriated) funds . These requirements apply to grants and cooperative agreements EXCEEDING $ 100 , 000 in total costs (45 CFR Part93 ) . The undersigned ( authorized official) certifies , to the best of his or her knowledge and belief, that : ( a) 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 agency, a member of Congress , any officer or employee of Congress , or an employee of a Member of Congress in connection with the awarding of any Federal contract , the making of any Federal grant , the making of any Federal loan , the entering into of any cooperative agreement, and the extension , continuation , renewal , amendment, or modification of any Federal grant, loan or cooperative agreement , (b) 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 agency, a Member of Congress , an officer or employee of Congress , or an employee of a Member of Congress in connection with this Federal contract , grant , loan or cooperative agreement, the undersigned shall complete and submit Standard Form - LLL , " Disclosure of Lobbying Activities , " in accordance with its instructions ; ( c ) 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 , contracts and contracts under grants , loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly . 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 . 3 . Debarment, Suspension and Other Responsibility Matters NOTE : In accordance with 45 CFR Part 76 , amended June 26 , 1995 , any debarment, suspension , proposed debarment or other government wide exclusion initiated under the Federal Acquisition Regulation (FAR) on or after August 25 , 1995 , shall be recognized by and effective for Executive Branch agencies and participants as an exclusion under 45 CFR Part 76 . (a) Primary Covered Transactions The undersigned ( authorized official) certifies to the best of his or her knowledge and belief, that the applicant, defined as the primary participant in accordance with 45 CFR Part 76 , and its principals : ( 1 ) are not presently debarred , suspended , proposed for debarment , declared ineligible , or voluntarily excluded by any Federal department or agency ; (2 ) have not within a 3 -year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain , or performing a public (Federal , State or local) transaction or contract under a public transaction ; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery , falsification or destruction of records , making false statements , or receiving stolen property ; Page 14 of 15 DocuSign Envelope ID : 31D67EE713 C= -4 % 3-86AC-6C601 CADD1 FF (3 ) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal , State , or local) with commission of any of the offenses enumerated in paragraph (a) (2) of this certification ; and (4) have not within a 3 -year period preceding this application/proposal had one or more public transactions (Federal , State , or local ) terminated for cause or default . Should the applicant not be able to provide this certification , an explanation as to why should be placed under the assurances page in the application package . (b) Lower Tier Covered Transactions The applicant agrees by submitting this proposal that it will include , without modification , the following clause titled " Certification Regarding Debarment, Suspension , Ineligibility, and Voluntary Exclusion -- Lower Tier Covered Transaction " (Appendix B to 45 CFR Part 76) in all lower tier covered transactions (i . e . , transactions with subrecipients and/or contractors ) and in all solicitations for lower tier covered transactions : Certification Regarding Debarment, Suspension , Ineligibility, and Voluntary Exclusion -- Lower Tier Covered Transactions ( 1 ) The prospective lower tier participant certifies by submission of this proposal , that neither it nor its principals is presently debarred , suspended , proposed for debarment , declared ineligible , or voluntarily excluded from participation in this transaction by any Federal department or agency . (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification , such prospective participant shall attach an explanation to this proposal . Signature of Authorized Certifying Official Title DocuSigned by : county Manager Subrecipient Name Date Submitted orange County , North Carolina 2 / 15 / 19 Page 15 of 15 DocuSign Envelope ID : 3D67EE7B- C2CE-49B3-86AC-6C601 CADD1 FF All Participants : Enter any necessary notes throughout the process in the comments box below . Comments are not part of the contract . Please do not enter anything below as it will only restart the process . Thank you . Please do not enter anything here as it will only restart the process . Thank you .