HomeMy WebLinkAbout2020-896-E Housing - NC Dept of Health and Human Services CARES Act funding DocuSign Envelope ID:BOFE06B7-70C7-44D2-A46C-D41 E904EED91B
Contract Number 00041659, Amendment Number 1 / Page 1 of 16
AMENDMENT
This Agreement amends the contract bearing the effective date of 3/1/2020 between the North Carolina
Department of Health and Human Services, Division of Aging and Adult Services, hereinafter referred to
as the "Division" and Orange County, hereinafter referred to as the "Contractor." This Amendment is
hereby effective on 11/1/2020.
As provided for under the terms of this contract, the Division and the Contractor agree to amend the
following contract provisions:
1. Reference "Effective Period": The termination date of 12/30/2020 has not changed
2. Reference "Contractor's Duties": The Contractor shall provide the amended services as
described in the scope of work.
3. Reference "Division's Duties": The total amount paid by the Division to the Contractor is being
increased by$100,000 from $195,000 to $295,000. This amended amount consists of$0 in
State funds, $0 in Local funds, $0 in Other funds and $100,000 in Federal funds.
The Contractor's matching requirement for this amendment is $0. The total contractor's matching amount
is $0.
The total amendment amount is $100,000.
The total contract amount is $295,000.
All other terms and conditions as set forth in the original contract document shall remain in effect for the
duration of this Agreement.
Signatures follow on next page
NCDHHS ACT2007 (Amendment Template) (Rev. 11.01.15)
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Contract Number 00041659, Amendment Number 1 / Page 2 of 16
In Witness Whereof, the Contractor and the Division have executed this contract in duplicate originals,
with one original being retained by each party.
Orange County
Docu igned by:
E
bin I�dL 11/11/2020
0637994B755E477...
Signature Date
Bonnie B. Hammersley County Manager
Printed Name Title
WITNESS
Signature Date
Printed Name Title
Division of Aging and Adult Services, North Carolina Department of Health and Human Services
Signature Date
Joyce Massey-Smith Director
Printed Name Title
NCDHHS ACT2007 (Amendment Template) (Rev. 11.01.15)
DocuSign Envelope ID:BOFE06B7-70C7-44D2-A46C-D41 E904EED91B
Contract Number 00041659, Amendment Number 1 / Page 3 of 16
SCOPE OF WORK
PURPOSE
Additional funds in Homelessness Prevention for Coronavirus Relief Funds (CRF)to use on
necessary expenses incurred due to the public health emergency with respect to the
Coronavirus Disease 2019 (COVID-19). Expenses incurred beginning March 1, 2020
directly related to coronavirus are eligible for reimbursement.
Scope of Work (Rev. 06/11)
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Contract Number 00041659, Amendment Number 1 / Page 4 of 16
PERFORMANCE MEASURES CHART
The Department of Health and Human Services uses performance measures rubrics as a tool to
determine the success of a project and how well services and products are being delivered.
Together they enable the Department to gauge efficiency, determine progress toward desired
results and assess whether the Department is on track with meeting its goals. The contractor
shall adhere to all of the performance requirements/standards in the scope of work, including
performance measures in the performance measures chart below.
Measure Output Reporting Monthly
Type Frequency
Measure All subrecipients must submit 1 requisition per month for reimbursement or must
submit requisition documentation that outlines the activities and amounts spent
toward their advance
Budget Year 1 Trend Maintain
Baseline amount of funds awarded or advanced
Value
Target Value 100% of the allocation by the end of the contract period
Data Source fiscal data monitoring and requests for reimbursement
Collection reimbursement submission
Process and
Calculation
Collection monthly
Frequency
Measure Outcome Reporting Monthly
Type Frequency
Measure Subrecipient will use CRF award to meet CARES Act and Department goals, as
described and approved in Subrecipient CRF request, to serve individuals
experiencing homelessness stay safe from COVID-19 within CRF timeframe.
Budget Year 1 Trend Maintain
Baseline eligibility verification
Value
Target Value 100%
Data Source electronic submission and file submission
Performance Measures (Rev. 4//12)
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Contract Number 00041659, Amendment Number 1 / Page 5 of 16
Collection onsite, virtual and/or desk monitoring
Process and
Calculation
Collection monthly and quarterly
Frequency
Performance Measures (Rev. 4//12)
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Contract Number 00041659, Amendment Number 1 / Page 6 of 16
LINE ITEM BUDGET
This begins the line item budget for year 1
Budget Detail -Year 1
Category Item Narrative Original Amount Change Amount Final Amount
Salary\Wages $0.00 $0.00 $0.00
Fringe Benefits $0.00 $0.00 $0.00
Other $0.00 $0.00 $0.00
Repair and Maintenance $0.00 $0.00 $0.00
Staff Development $0.00 $0.00 $0.00
Dues and Subscriptions $0.00 $0.00 $0.00
Operational Other Not $140,663.00 $0.00 $140,663.00
Otherwise
Classified
Operational Other Not Homelessness Prevention $0.00 $100,000.00 $100,000.00
Otherwise
Classified
Operational Other Not $5,000.00 $0.00 $5,000.00
Otherwise
Line Item Budget Detail (08/11)
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Contract Number 00041659, Amendment Number 1 / Page 7 of 16
Budget Detail -Year 1
Category Item Narrative Original Amount Change Amount Final Amount
Classified
Operational Other Not $49,337.00 $0.00 $49,337.00
Otherwise
Classified
Subcontracts and Grants $0.00 $0.00 $0.00
Match $0.00 $0.00 $0.00
Cost Per Service $0.00 $0.00 $0.00
Sub Total $195,000.00 $100,000.00 $295,000.00
Indirect Cost $0.00 $0.00 $0.00
Total Budget $195,000.00 $100,000.00 $295,000.00
Subcontracting and Grants Budget Detail -Year 1
Category Item Narrative Original Amount Change Amount Final Amount
$0.00 $0.00 $0.00
Sub Total $0.00 $0.00 $0.00
Line Item Budget Detail (08/11)
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Contract Number 00041659, Amendment Number 1 / Page 8 of 16
Salaries -Year 1
Persons Position or Title Annual Salary Hourly Months Work% Fringe Fringe Total
Rate Amount Total Percent Total
0 $0.00 0.0000 0 0% $0.00 $0.00 $0.00
Line Item Budget Detail (08/11)
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659, Amendment Number 1 / Page 9 of 16
FEDERAL CERTIFICATIONS
The undersigned states that:
a) He or she is the duly authorized representative of the Contractor named below;
b) He or she is authorized to make, and does hereby make, the following certifications on behalf of the
Contractor, as set out herein:
a. The Certification Regarding Nondiscrimination;
b. The Certification Regarding Drug-Free Workplace Requirements;
c. The Certification Regarding Environmental Tobacco Smoke;
d. The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions; and
a. The Certification Regarding Lobbying;
c) He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the
addresses at which the contract work will be performed;
d)` pp a:pplic�b.le stateiim,
[ ] He or she has completed the attached Disclosure Of Lobbying Activities because the Contractor has
made, or has an agreement to make, a payment to a lobbying entity for influencing or attempting to
influence an officer or employee of an agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with a covered Federal action;
OR
[X]He or she has not completed the attached Disclosure Of Lobbying Activities because the Contractor
has not made, and has no agreement to make, any payment to any lobbying entity for influencing or
attempting to influence any officer or employee of any agency, any Member of Congress, any officer or
employee of Congress, or any employee of a Member of Congress in connection with a covered Federal
action.
e) The Contractor shall require its subcontractors, if any, to make the same certifications and disclosure.
Signature _ TiEle
Prange`County overrirltent Cri6iin l Justice Resoutco pe artmer)t and i ouslrtg and Community Der/elopment
Department Augusts 2620,
Contractor Name Date
[This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page]
I. 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 Educatlon 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 Vill of the Civil Rights Act of 1968 (42
U.S,C. §§3601 at seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h)
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Contract Number 00041659, Amendment Number 1 / Page 10 of 16
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.
II. Certification Regarding Drug-Free Workplace Requirements
1. 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:
i. The dangers of drug abuse in the workplace;
ii. The Contractor's policy of maintaining a drug-free workplace;
iii. Any available drug counseling, rehabilitation, and employee assistance programs; and
iv. 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:
i. Abide by the terms of the statement; and
ii. 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 Department within ten days after receiving notice under subparagraph (d)(ii) 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)(ii), with
respect to any employee who is so convicted:
i. Taking appropriate personnel action against such an employee, up to and including
termination; or
ii. 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
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).
2. The sites for the performance of work done In connection with the specific agreement are listed below (list all
sites; add additional pages if necessary),
Addirer's
street. .
108„F,.M arg aref.Laris
Glty,;State,Zip Code
Hillsborough; NC 27278,
Street
25011Homestead Rd?
City, Mate,Zip Cody „
Chapel:Hill,,NC 27.66
Street
ado 1lV Tryon St. 3. fl
Gaty ` tate .Z�p Cade
Hill$f3orough, NC 27278
3. Contractor will inform the Department of any additional sites for performance of work under this agreement,
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Contract Number 00041659, Amendment Number 1 / Page 11 of 16
4. False certification or violation of the certification may be grounds for suspension of payment, suspension or
termination of grants, or government-wide Federal suspension or debarment. 45 C.F.R. 82.510.
Ill. Certification Regarding Environmental Tobacco Smoke
Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act),
requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an
entity and used routinely or regularly for the provision of health, day care, education, or library services to children
under the age of 18, if the services are funded by Federal programs either directly or through State or local
governments, by Federal grant, contract, loan, or loan guarantee. The law does not apply to children's services
provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities
used for inpatient drug or alcohol treatment, Failure to comply with the provisions of the law may result in the
imposition of a civil monetary penalty of up to $1,000.00 per day and/or the imposition of an administrative
compliance order on the responsible entity.
The Contractor certifies that it will comply with the requirements of the Act. The Contractor further agrees that it
will require the language of this certification be included in any subawards that contain provisions for children's
services and that all subgrantees shall certify accordingly.
IV. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions
Instructions
[The phrase"prospective lower tier participant" means the Contractor.]
1, By signing and submitting this document, 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 originate may pursue available remedies, including
suspension and/or debarment.
3. The prospective lower tier participant will provide immediate written notice to the person to whom this 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, 45 CFR Part 76. You may contact the person to whom 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.
b, The prospective lower tier participant further agrees by submitting this document that it will include the clause
titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--tower 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 by which it determines the eligibility of its principals. Each participant may, but is not required to,
check the Nonprocurement List,
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Contract Number 00041659, Amendment Number 1 / Page 12 of 16
8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order
to render in good faith the certification required by this clause. The knowledge and information of a participant
Is not required to exceed that which is normally possessed by a prudent person in the ordinary course of
business dealings.
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
1. The prospective lower tier participant certifies, by submission of this document, 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.
V. Certification Regarding Lobbying
The Contractor 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 agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress In connection with the
awarding of any Federal contract, continuation, renewal, amendment, or modification of any Federal 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 agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with this Federally funded
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form
SF-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the award document for
subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) who receive federal funds of $100,000.00 or more 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 falls to file the required
certification shall be subject to a civil penalty of not less than $10,000.00 and not more than $100,000,00 for
each such failure.
Vl. Disclosure Of Lobbying Activities
Instructions
This disclosure form shall be completed by the reporting.entity, whether subawardee or prime Federal recipient, at
the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31
U,S,C. section 1362. The filing of a form is required for each payment or agreement to make payment to any
lobbying entity 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 a
covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form
is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the
implementing guidance published by the Office of Management and Budget for additional information.
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Contract Number 00041659, Amendment Number 1 / Page 13 of 16
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence
the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to
the information previously reported, enter the year and quarter in which the change occurred. Enter the date
of the last previously submitted report by this reporting entity for this covered Federal action.
4. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if
known, Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a
prime or sub-award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime Is the
1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
5. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name, address, city,
state and zip code of the prime Federal recipient. Include Congressional District, if known.
6. Enter the name of the Federal agency making the award or loan commitment. Include at least one
organizational level below agency name, if known. For example, Department of Transportation, United States
Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
8. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1
(e.g., Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the
contract grant, or loan award number, the applicationlproposal control number assigned by the Federal
agency). Include prefixes, e.g., "RFP-DE-90-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
enter the Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity
identified in Item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a).
Enter Last Name, First Name and Middle Initial(MI).
11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Item 4) to
the lobbying entity (Item 10). Indicate whether the payment has been made (actual) or will be made
(planned). Check all boxes that apply, If this is a material change report, enter the cumulative amount of
payment made or planned to be made.
12, Check the appropriate boxes. Check all boxes that apply. If payment is made through an in-kind contribution,
specify the nature and value of the in-kind payment.
13. Check the appropriate boxes. Check all boxes that apply. If other, specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected
to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time
spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the
off icer(s), employee(s), or Member(s)of Congress that were contacted,
15, Check whether or not a SF-LLL A Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
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Public reporting burden for this collection of information is estimated to average 30 minutes per response, including
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding the burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management
and Budget, Paperwork Reduction Project(0348-0046),Washington, D. C. 20503
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Disclosure Of lobbying Activities
(Approved by OMB 0344-0046)
Complete this form to'disclose lobbying activitles: pursuant to 31 U.S.C. 1362
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
❑ a. contract ❑ a. Bid/offer/applicallon ❑ a. initial filing
❑ b. grant ❑ b. Initial Award ❑ b. material change
❑ c. cooperative agreement ❑ c. Post-Award
❑ d, loan For Material Change Only:
❑ e, loan guarantee
❑ f. loan Insurance Year Quarter
Date Of Last Report:
4. Name and Address of Reporting Entity: S. If Reporting Entity in No.4 is Subawardee, Enter Name and
Address of Prime:
❑ Prime
❑ Subawardee Tier (If known)
Congressional District(if known) Congressional District(if known)
6. Federal Department/Agency: 7. Federal Program NameiDescriptlow
CFDA Number(if applicable)
8. Federal Action Number(if known) 9. Award Amount(if known)$
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services(including address if different
(if individual, last name, first name, MO: from No. 10a.) (fast name, first name, MJ):
(attach Continuation Sheel(s)SF-LLL A,if necessary) (attach Continuation Sheet(s)SF-LLL-A,if necessary)
11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply):
$ actual planned ❑ a. retainer
❑ b. one-time fee
12. Form of Payment(check all that apply): ❑ c, commission
❑ d. contingent fee
❑ a. cash ❑ e. deferred
❑ b, In-klnd;specify: Nature ❑ f. other;specify:
Value
14. Brief Description of Services Performed or to be Performed and Date(s)of Services,Including officer(s),employee(s), or Member(s)
contacted,for Payment Indicated in Item 11(attach Continuation Sheet(s)SF-LLL-A,ifnecessary):
15, Continuation Sheet(s)SF-LLL-A attached: ❑ Yes ❑ No
16, Information requested through this form is authorized by Signature:
title 31 U. S.C, section 1362. This disclosure of lobbying
activities is a material representation of fact upon which Print Name:
reliance was placed by the tler above when this transaction
was made or entered into. This disclosure is required Title:
pursuant to 31 U. S. C. 1352. This information will be
reported to the Congress semi-annually and will be Telephone No: Date:
available for public inspection. Any person who fails to file
the required disclosure shall be subject to a civil penalty of
not less than$10,000 and not more than$100,000 for each
such failure,
Authorized for Local Reproduction
r Standard Form-LLL
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State Certifications
Contractor Certifications Required by North Carolina Laiv
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 each North Carolina General Statutes can be found online at;
• Article 2 of Chapter 64: htt ://www.nc a.state.ne.us/EnactedLe islatiorr/Statutes/PDF B Article/Clia ter 641Article 2. df
G.S. 105-164.8(b), h : www.nc a,state nc s/Enac edLe islation/St tutes/PDF/B Section/Chapter 105/GS 105-164.8,)df
• G.S. 143-48.5; h!W://www.nega.state.ne.us/Fn ctedLe istatiotVStatutes/HTML/B Section/Cha tBl' 143/GS 143-48.5,htinl
• G.S. 143-59.1: htt ://www.nc a.state,nc.us/EnactedLe islation/Statutes/PDF,/B Section/Clta ter 143/GS 143-59.1. df
• G.S. 143-59.2: htt :/www nc st e.nc us/EnactedLe rislation/Statutes/PDF/B Section/Cha ter 143/GS 143-59,2. df
• G.S. 147-33.95(g): h ;/ ww,nc a.state.nc s/En ctedLe islation/Statutes/H'1'ML/B Section Cha ter 147/GS 147-3395Atinl
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g),the undersigned hereby certifies that the Contractor named below,and
the Contractor's subcontractors, complies with the fequirements 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.go
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below is not an "ineligible
Contractor" as set forth in G.S. 143-59.1(a)because:
(a.) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter
105 of the General Statutes on its sales delivered to North Carolina when the sales met one or more of the
conditions of G.S. 105-164.8(b);and
(b)';; [chi ck pnc'of the fell¢wing boxed
® 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 matte,and does hereby make,the foregoing certifications on behalf of the Contractor;
and
c) He or she understands that any person who knowingly submits a false certification in response to the
requirements of G.S. 143-59.land-59.2 shall be guilty of a Class I felony.
The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and
date this document immediately thereafter.
Orange County overiiment Grrii mai Jrtstic: Resource De ai neirt aril Housing and°Coiriri tltltty Develop nerrt
CQi�ti'tictor's Mane
v4z 8/3/20
Slguature of Gon#[actor's Authoiized AgenjCj Date
CaitliilFcnl ag i __ Di'ector 'Criminal Justice Resource .�j artrMnt
Pk in#ed Name bf Cann @ctor's.Autlrorized,Agert t itl
8/4/20
St 40Ie of wit ness Date
Panted Natne:.4f Wtttress Tltle
The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document inmiediately
thereafter,
13
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D4lE904EED9B
ORANGE COUNTY—DEPARTMENT USE ONLY
Party/Vendor Name: OCHCD Party/Vendor Contact Person: E Sutton Contact Phone: 919-245-2490 Party/Vendor Address:
300 W Tryon St City Hillsborough State: NC Zip: 27278 Department: 4800 Amount: $195,000 Purpose: CARES (CRF)-
NCDHHS Budget Code(s): 32470620-782630-95051 Street Outreach$5000.00;32470620-782631-95051 Essential Move-In
$57,163; 32470620-782632-95051 Homelessness Prevention $30,000.00; 32470620-782633-95051 Unit Upfits $15,000.00;
32470620-782634-95051 Hotel Assistance$14,000.00;32470620-630315-95051 Landlord Incentives$50,000.00;32470620-
633300-95051 $4,500.00; 32470610-510000-95040 Permanent Salaries(RRH Case Manager) $19,337. Vendor#N/A(N/A
if new vendor) Vendor is a BOCC consultant? Yes X No❑ Contract Type: (Check one)New Renewal ❑ Amendment
X Effective Date 10/01/20 Approved by Board Yes X No❑ Agenda Date: 10/01/20
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this
project has not been initiated prior to execution of the agreement:
DocuSigned.b�yll
Department Director's SignatureFwtt� S bw Date: 11/11/2020
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement
have already begun or been completed please briefly describe the nature of the emergency condition that was addressed:
Information Technologies
(Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as
to information technology content and specifications:
Office of the Chief Information Officer Date:
Risk Management
This agreement is approved for sufficiency 1111% �'"'��fa'ndards,specifications,and requirements:
Q�1Sa rbvv�.t lTb 11/11/2020
Office of the Risk Management Officer 7FDCFs17s800as8... Date:
Financial Services
DocuSigned by:
This instrument has been pre-audited in the En4E5181ACC1409
er regeed the Local Government Budget and Fiscal Control Act:
O 11/11/2020
Office of the Chief Financial Officer ... Date:
Legal Services
DocuSigned by:
This agreement is approved as toEew1 form end suffi iency:
bi.Ak I�LU�IL �S(0 11/11/2020
Office of the County Attorney 079A4D525COF4FB... Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board Date:
Revised 07/20
DocuSign Envelope ID: B0FE06B7-7OC7-44D2-A46C-D41E904EED9B
DHHS Contract Approval Form Division DAAS PO# 2190041659
Effective 3/12/18
(revised 3.12.2020) OW Contract#41659
Contractor Name: Orange County ESSS#lClick or tap here to enter text
Contractor Type: local Government
Federal Tax ID or SSN #56-60000327 Contract Title.Coronavirus Relief Funds
Group#06 Service Name: CRF
DUNSM 91545191 Contracts Dates: 3/1/2020 to 12/31/2020
Contract Administrator: Caitlin Fenhagen Amended Contract Dates:(Click or tap to enter a date,;to 1click
Email: cfenhagen@orangecountync.gov Telephone: 919-245- or tap to enter a date;
2302 Contractor Signature Authority: Caitlin Fenhagen Contract Type: I®I FA or101 POS
Contract Purpose: CRF Funding to providers to strategically Status: New Amd#IClick or tap here to enter text.(
respond to COVID-19 and end homelessness in North
Sub Contract No HIPAA BAA: No
Carolina.
IT Contract No How Procured RFA
Rid#)Q ! pIAXQV�Is
Contract Total Value 9 ,f 00,
Joseph M. Breen X53435
Division Contract Administrator Telephone Amendment Amount: .
New Contract Total Value: �' 195,000
10/16/2020
Budget Officer Signature Date
UII` Ilpl41C [
f® Funds Budgeted ID1 Funds Proposed
[Ell Funds Proposed requires realignment BR#
_Joseph M. Breen
Section Chief Signature Date Budget&Analysis, if IT contract Date
r2rRet�'e �a<ycue$� fct`o�en 1g, 2020 PIO Signature, if required Date
Contract Manager/Office Signature Date
HR Director Signature (required for Services)Date
Division HR Signature, if required Date
DHHS ITD Signature, if required Date
Division ISO Signature, if required Date
0/20/20 OPCS Final Approval Signature Date
Diyl lon Ulxecfor S rlat a Date
................ OPCS Tracking#
EXBoutQa y
Revised 3.12.20
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
2020 ESG-CV Budget
Agency Name: Orange County
Contract#: 41659
Date: 10/1/2020
Information below details CRF Funding Activities:
Current FY
2019-20 Change Amount Revised Total
Funded Requested
Amount
Street outreach $5,000
Emergency Shelter
Rapid Re-Housing Financial Assist $49,337
Homeless Prevention
Other $140,663
Total $195,000
............
ESG Office: Chris Battle
DATE: 9/29/2020
Revised 3.12.20
DocuSign Envelope ID: BOFE06B7-70C7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 1 of 22
GENERAL_ CONTRACT COVER
This contract is hereby entered into by and between the North Carolina Department of Health and
Human Services, Division of Aging and Adult Services (the"Division") and Orange County (the
"Contractor") (referred to collectively as the "Parties").
1. Contract Documents:
This contract consists of the following documents, which are incorporated herein by reference:
(a) This contract cover
(b) The General Terms and Conditions
(c) Scope of Work
(d) Performance Measures Chart
(e) The Line Item Budget
(f) Federal Certifications
(g) State Certification
Incorporated By Reference
The following documents are reference materials and are available by going to the following
website, Open Window
(http://dhhsopenwindow.nc.gov/index.aspx?pid=doc ReferenceDocuments).
(a) Travel: Policies Governing Travel Related Expenses for Contractors
(b) General Statutes G.S.143C6 NonState Entities Receiving State Funds
(c) Subchapter 03M Uniform Administration of State Grants
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
2. Precedence Among Contract Documents:
In the event of a conflict between or among the terms of the Contract Documents, the terms in the
Contract Document with the highest relative precedence shall prevail. The order of precedence
shall be the order of documents as listed in the contract document section, 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. Effective Period:
This contract shall be effective on 3/1/2020 and shall terminate on 12/3012020, with the option to
extend, if mutually agreed upon, through a written amendment as provided for in the General
Terms and Conditions.
4. Contractor's Duties:
The Contractor shall provide the services as described in the scope of work and in accordance
with the approved budget.
5. Division's Duties:
The Division shall pay the Contractor in the manner and in the amounts specified in the contract
documents. The total amount paid by the Division to the Contractor under this contract shall not
exceed $195,000. This amount consists of$0 in State funds, $0 in Local funds, $0 in Other funds
and $195,000 in Federal funds.
The total contract amount is $195,000.
NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
DocuSign Envelope ID: BOFE06B7-70C7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 2 of 22
6. Conflict of Interest Policy:
The Division has determined that this contract is a financial assistance contract. The Contractor
shall file with the Division, a copy of the Contractor's policy addressing conflicts of interest that
may arise involving the Contractor's management employees and the members of its board of
directors or other governing body. The policy shall address situations in which any of these
individuals may directly or indirectly benefit, except as the Contractor's employees or members of
its board or other governing body, from the Contractor's disbursing of state funds and shall
include actions to be taken by the Contractor or the individual, or both to avoid conflicts of interest
and the appearance of impropriety. The policy shall be filed before the Division may disburse the
grant funds. (N.C.G.S. 143C-6-23(b)(2007))
7. Statement of No Overdue Tax Debts:
Contractor's sworn written statement pursuant to N.C.G.S. 143C-6-23(c), stating that the
Contractor does not have any overdue tax debts, as defined by G.S. 105-243.1, at the federal,
state, or local level. The Contractor acknowledges that the written statement must be filed before
Division may disburse the grant funds.
S. Reversion of Unexpended Funds:
Any unexpended grant funds shall revert to the Division upon termination of this contract.
9. Grants:
The Contractor/Grantee has the responsibility to ensure that all sub-grantees, if any, provide all
information necessary to permit the Contractor/Grantee to comply with the standards set forth in
this contract.
10. Reporting Requirements:
The Division has determined that this is a contract for financial assistance, and therefore is
subject to the reporting requirements in Uniform Administration of State Awards of Financial
Assistance at 09 NCAC 03M.0205
11. Payment Provisions:
Upon execution of this contract, the Contractor shall submit to the Division Contract
Administrator, a monthly reimbursement request for services rendered the previous month by the
10th of each month and, upon approval by the Division, receive payment within 30 days. Monthly
payment shall be made based on actual expenditures made in accordance with the approved
budget on file with both parties and reported on the monthly expenditure report submitted by the
Contractor. If this contract is terminated, the Contractor shall complete a final accounting report
and return any unearned funds to the Division within 30 days of the contract termination date. The
Division shall have no obligation for payments based on expenditure reports submitted later than
30 days after termination or expiration of the contract period.All payments are contingent upon
fund availability.
12. 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.
NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/Page 3 of 22
For the Division:
IF DELIVERED BY US POSTAL SERVICE. IF DELIVERED BY ANY OTHER MEANS
Lisa Worth, Homeless Programs Coordinator Lisa Worth, Homeless Programs Coordinator
Division of Aging and Adult Services Division of Aging and Adult Services
918 Tate Drive 918 Tate Drive
Raleigh, NC 27699 Raleigh, NC 27699
Telephone : (919)-855-4993
Fax: ()--
Email: lisa.worth@dhhs.nc.gov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Emila Sutton, Housing and Community Emila Sutton, Housing and Community
Development Director Development Director
Orange County Orange County
PO Sox 8181 PO Box 8181
Hillsborough, NC 27278 Hillsborough, NC 27278
Telephone: (919)-245-2490
Fax: ()--
Email: esutton@orangecountynr,.gov
13. 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.
14. 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.
15. Outsourcing to Other Countries
The Contractor certifies that it has identified to the Division all jobs related to the contract that
have been outsourced to other countries, if any. The Contractor further agrees that it will not
outsource any such jobs during the term of this contract without providing notice to the Division.
16. Federal Certifications:
NCDHHS GCT1007 (Contract) (General) (Rev. 11,01.15)
DocuSign Envelope ID: BOFE06B7-70C7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 4 of 22
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 accompanied by
a signature page and can be found in the Contractor's Managed Documents section of DHHS
Open Window. The signature page is to be signed by the contractor's authorized representative.
17. Signature Warranty:
The undersigned represent and warrant that they are authorized to bind their principals to the
terms of this agreement,
Signatures follow on next page
NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041669!Pago 5 of 22
i
In Witness Whereof, the Contractor and the Division have executed this contract in duplicate originals,with
one original being retained by each party. '
Orange County
i
C 10/20/20
Signature Date
Emila Sutton Housing and Community Development
Director
Printed Name Title
i
i
WITNESS
Cott 10/21/20
Signature Date
Printed Name Title
Division of Aging and Adult Services, North Carolina Department of Health and Human Services
1 oiz7izozo
Signature Date
__Joyce Massey-Smith Director
Printed Name Title
{
NCDHHS GCT1007(Contract) (General) (Rev. 11.01.16)
i
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 6 of 22
GENERAL TERMS AND CONDITIONS
Relationships of the Parties performance of this contract to the extent permitted by
law.
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the Default and Termination
performance of this contract and as such shall be wholly
responsible for the work to be performed and for the Termination Without Cause: The Division may
supervision of its employees. The Contractor represents terminate this contract without cause by giving 30 days
that it has, or shall secure at its own expense, all written notice to the Contractor.
personnel required in performing the services under this
agreement. Such employees shall not be employees of, Termination for Cause: If, through any cause, the
or have any individual contractual relationship with, the Contractor shall fail to fulfill its obligations under this
Division. contract in a timely and proper manner, the Division shall
have the right to terminate this contract by giving written
Subcontracting: The Contractor shall not subcontract notice to the Contractor and specifying the effective date
any of the work contemplated under this contract without thereof. In that event, all finished or unfinished deliverable
prior written approval from the Division. Any approved items prepared by the Contractor under this contract shall,
subcontract shall be subject to all conditions of this at the option of the Division, become its property and the
contract. Only the subcontractors specified in the contract Contractor shall be entitled to receive just and equitable
documents are to be considered approved upon award of compensation for any satisfactory work completed on
the contract. The Division shall not be obligated to pay for such materials, minus any payment or compensation
any work performed by any unapproved subcontractor. previously made. Notwithstanding the foregoing
The Contractor shall be responsible for the performance provision,the Contractor shall not be relieved of liability to
of all of its subcontractors. the Division for damages sustained by the Division by
virtue of the Contractor's breach of this agreement, and
Assignment: No assignment of the Contractor's the Division may withhold any payment due the
obligations or the Contractor's right to receive payment Contractor for the purpose of setoff until such time as the
hereunder shall be permitted. However, upon written exact amount of damages due the Division from such
request approved by the issuing purchasing authority,the breach can be determined. In case of default by the
State may: (a) Forward the Contractor's payment check Contractor,without limiting any other remedies for breach
directly to any person or entity designated by the available to it, the Division may procure the contract
Contractor, or(b) Include any person or entity designated services from other sources and hold the Contractor
by Contractor as a joint payee on the Contractor's responsible for any excess cost occasioned thereby. The
payment check. In no event shall such approval and filing of a petition for bankruptcy by the Contractor shall
action obligate the State to anyone other than the be an act of default under this contract.
Contractor and the Contractor shall remain responsible
for fulfillment of'all contract obligations. Waiver of Default: Waiver by the Division of any default
or breach in compliance with the terms of this contract by
Beneficiaries: Except as herein specifically provided the Contractor shall not be deemed a waiver of any
otherwise, this contract shall inure to the benefit of and be subsequent default or breach and shall not be construed
binding upon the parties hereto and their respective to be modification of the terms of this contract unless
successors. It is expressly understood and agreed that stated to be such in writing, signed by an authorized
the enforcement of the terms and conditions of this representative of the Department and the Contractor and
contract, and all rights of action relating to such attached to the contract.
enforcement, shall be strictly reserved to the Division and
the named Contractor. Nothing contained in this Availability of Funds: The parties to this contract agree
document shall give or allow any claim or right of action and understand that the payment of the sums specified in
whatsoever by any other third person. It is the express this contract is dependent and contingent upon and
intention of the Division and Contractor that any such subject to the appropriation, allocation, and availability of
person or entity, other than the Division or the Contractor, funds for this purpose to the Division.
receiving services or benefits under this contract shall be
deemed an incidental beneficiary only. Force Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
Indemnity and Insurance prevented from performing such obligations by any act of
war, hostile foreign action, nuclear explosion, riot, strikes,
Indemnification: The Contractor agrees to indemnify civil insurrection, earthquake, hurricane, tornado, or other
and hold harmless the Division, the State of North catastrophic natural event or act of God.
Carolina, and any of their officers, agents and employees,
from any claims of third parties arising out of any act or Survival of Promises: All promises, requirements,
omission of the Contractor in connection with the terms, conditions, provisions, representations,
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
DocuSign Envelope ID: BOFE06B7-70C7-44D2-A46C-D41E904EED9B
Contract Number 00041659/Page 7 of 22
guarantees, and warranties contained herein shall survive During the performance of this contract, the contractor is
the contract expiration or termination date unless to notify the Division contract administrator of any contact
specifically provided otherwise herein, or unless by the federal Office for Civil Rights (OCR) received by
superseded by applicable Federal or State statutes of the contractor.
limitation.
Cost Borne by Contractor: If any applicable federal,
Intellectual Property Rights state, or local law, regulation, or rule requires the Division
or the Contractor to give affected persons written notice
Copyrights and Ownership of Deliverables: All of a security breach arising out of the Contractor's
deliverable items produced pursuant to this contract are performance under this contract,the Contractor shall bear
the exclusive property of the Division. The Contractor the cost of the notice.
shall not assert a claim of copyright or other property
interest in such deliverables. Oversight
Compliance with Applicable Laws Access to Persons and Records: The State Auditor
shall have access to persons and records as a result of
Compliance with Laws: The Contractor shall comply all contracts or grants entered into by State agencies or
with all laws, ordinances, codes, rules, regulations, and political subdivisions in accordance with General Statute
licensing requirements that are applicable to the conduct 147-64.7. Additionally, as the State funding authority, the
of its business, including those of federal, state, and local Department of Health and Human Services shall have
agencies having jurisdiction and/or authority. access to persons and records as a result of all contracts
or grants entered into by State agencies or political
Equal Employment Opportunity: The Contractor shall subdivisions.
comply with all federal and State laws relating to equal
employment opportunity. Record Retention: Records shall not be destroyed,
purged or disposed of without the express written consent
Health Insurance Portability and Accountability Act of the Division. State basic records retention policy
(HIPAA): The Contractor agrees that, if the Division requires all grant records to be retained for a minimum of
determines that some or all of the activities within the five years or until all audit exceptions have been resolved,
scope of this contract are subject to the Health Insurance whichever is longer. If the contract is subject to Federal
Portability and Accountability Act of 1996, P.L. 104-91, as policy and regulations, record retention may be longer
amended("HIPAA"),or its implementing regulations, it will than five years. Records must be retained for a period of
comply with the HIPAA requirements and will execute three years following submission of the final Federal
such agreements and practices as the Division may Financial Status Report, if applicable, or three years
require to ensure compliance. following the submission of a revised final Federal
Financial Status Report. Also, if any litigation, claim,
Confidentiality negotiation, audit, disallowance action, or other action
involving this Contract has been started before expiration
Confidentiality: Any information, data, instruments, of the five-year retention period described above, the
documents, studies or reports given to or prepared or records must be retained until completion of the action
assembled by the Contractor under this agreement shall and resolution of all issues which arise from it, or until the
be kept as confidential and not divulged or made available end of the regular five-year period described above,
to any individual or organization without the prior written whichever is later. The record retention period for
approval of the Division. The Contractor acknowledges Temporary Assistance for Needy Families (TANF) and
that in receiving, storing, processing or otherwise dealing MEDICAID and Medical Assistance grants and programs
with any confidential information it will safeguard and not must be retained for a minimum of ten years.
further disclose the information except as otherwise
provided in this contract.
Data Security: The Contractor shall adopt and apply data
security standards and procedures that comply with all
applicable federal, state, and local laws, regulations, and
rules.
Duty to Report: The Contractor shall report a suspected
or confirmed security breach to the Division's Contract
Administrator within twenty-four (24) hours after the
breach is first discovered, provided that the Contractor
shall report a breach involving Social Security
Administration data or Internal Revenue Service data
within one (1) hour after the breach is first discovered.
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 8 of 22
Miscellaneous or phrase shall be read to include the plural and vice
versa.
Choice of Law: The validity of this contract and any of its
terms or provisions, as well as the rights and duties of the Time of the Essence: Time is of the essence in the
parties to this contract, are governed by the laws of North performance of this contract.
Carolina. The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract, Key Personnel: The Contractor shall not replace any of
to the exclusive jurisdiction of the courts of North Carolina the key personnel assigned to the performance of this
and agrees, solely for such purpose, that the exclusive contract without the prior written approval of the Division.
venue for any legal proceedings shall be Wake County, The term "key personnel" includes any and all persons
North Carolina. The place of this contract and all identified as such in the contract documents and any
transactions and agreements relating to it, and their sites other persons subsequently identified as key personnel
and forum, shall be Wake County, North Carolina, where by the written agreement of the parties.
all matters, whether sounding in contract or tort, relating
to the validity, construction, interpretation, and Care of Property: The Contractor agrees that it shall be
enforcement shall be determined. responsible for the proper custody and care of any
property furnished to it for use in connection with the
Amendment:This contract may not be amended orally or performance of this contract and will reimburse the
by performance. Any amendment must be made in Division for loss of, or damage to, such property. At the
written form and executed by duly authorized termination of this contract, the Contractor shall contact
representatives of the Division and the Contractor. The the Division for instructions as to the disposition of such
Purchase and Contract Divisions of the NC Department property and shall comply with these instructions.
of Administration and the NC Department of Health and
Human Services shall give prior approval to any Travel Expenses: Reimbursement to the Contractor for
amendment to a contract awarded through those offices. travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
Severability: In the event that a court of competent exceed the rates published in the applicable State rules
jurisdiction holds that a provision or requirement of this or approved local government travel policy. International
contract violates any applicable law, each such provision travel shall not be reimbursed under this contract.
or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise Sales/Use Tax Refunds: If eligible, the Contractor and
unenforceable and all other provisions and requirements all subcontractors shall: (a) ask the North Carolina
of this contract shall remain in full force and effect. Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
Headings: The Section and Paragraph headings in these pursuant to G.S. 105-164.14; and (b) exclude all
General Terms and Conditions are not material parts of refundable sales and use taxes from all reportable
the agreement and should not be used to construe the expenditures before the expenses are entered in their
meaning thereof. reimbursement reports.
Gender and Number: Masculine pronouns shall be read Advertising: The Contractor shall not use the award of
to include feminine pronouns and the singular of any word this contract as a part of any news release or commercial
advertising.
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 9 of 22
SCOPE OF WORK
PURPOSE
These Coronavirus Relief Funds (CRF) must be used on necessary expenses incurred due
to the public health emergency with respect to the Coronavirus Disease 2019 (COVID-19).
Expenses incurred beginning March 1, 2020 directly related to coronavirus are eligible for
reimbursement.
Street Outreach -$5,000
Rapid Rehousing -$49,337
Other- $140,663
Funds may be provided through advancements or reimbursement. If funds are received
through advancement,fifty percent (50%) of the total award may be advanced upon contract
execution. The remaining 50% may be advanced upon expenditure of 80% of the first
advance. Any unspent advanced funds must be returned to the Department of Health and
Human Services, Division of Aging and Adult Services by January 30, 2021.
Requisitions for reimbursement or reports of expenditure of the advancement must be
submitted at least monthly.
Scope of Work(Rev. 06111)
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 10 of 22
PERFORMANCE MEASURES CHART
The Department of Health and Human Services uses performance measures rubrics as a tool to
determine the success of a project and how well services and products are being delivered.
Together they enable the Department to gauge efficiency, determine progress toward desired
results and assess whether the Department is on track with meeting its goals. The contractor
shall adhere to all of the performance requirements/standards in the scope of work, including
performance measures in the performance measures chart below.
lsgC Output Monthly
�J1�� urP All subrecipients must submit 1 requisition per month for reimbursement or must
submit requisition documentation that outlines the activities and amounts spent
toward their advance
Maintain
M� � amount of funds awarded or advanced
r.
100% of the allocation by the end of the contract period
9C fiscal data monitoring and requests for reimbursement
lI� reimbursement submission
P1 h monthly
1U( y�e Outcome 1 Monthly
Subrecipient will use CRF award to meet CARES Act and Department goals, as
described and approved in Subrecipient CRF request, to serve individuals
experiencing homelessness stay safe from COVID-19 within CRF timeframe.
tff 1r1rf Maintain
r eligibility verification
y
100%
>t electronic submission and file submission
Performance Measures (Rev.41112)
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659 I Page 11 of 22
onsite, virtual and/or desk monitoring
s
] monthly and quarterly
Performance Measures (Rev. 4/112)
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DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/Page 15 of 22
FEDERAL CERTIFICATIONS
The undersigned states that:
a) He or she Is the duly authorized representative of the Contractor named below;
b) He or she Is authorized to make, and does hereby make, the following certifications on behalf of the
Contractor, as set out herein:
a. The Certification Regarding Nondiscrimination;
b. The Certification Regarding Drug-Free Workplace Requirements;
c, The Certification Regarding Environmental Tobacco Smoke;
d. The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions; and
a. The Certification Regarding Lobbying;
c) He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the
addresses at which the contract work will be performed;
[ 1 He or she has completed the attached Disclosure Of Lobbying Activities because the Contractor has
made, or has an agreement to make, a payment to a lobbying entity for Influencing or attempting to
Influence an officer or employee of an agency, a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress In connection with a covered Federal action;
OR
(X]He or she has not completed the attached Disclosure Of Lobbying Activities because the Contractor
has not made, and has no agreement to make, any payment to any lobbying entity for influencing or
attempting to Influence any officer or employee of any agency, any Member of Congress, any officer or
employee of Congress, or any employee of a Member of Congress In connection with a covered Federal
action.
e) The Contractor shall require its subcontractors, if any, to make the same certifications and disclosure.
:..
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IThis Certification Must be Signed by the Same Individual Who Signed the Proposa[ Execution Page]
I. 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 604 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 1976, as amended (42 U,S,C. §§6101-6107), which prohibits
discrimination on the basis of age; (a) the Drug Abuse Office and Treatment Act of 1972 (P1, 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 Vill of the Civil Rights Act of 1968 (42
U.S.C. §§3601 at seq,), as amended, relating to nondiscrimination In the sale, rental or financing of housing; (h)
fi
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/Page 16 of 22
the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs;
and (1) the requirements of any other nondiscrimination statutes which may apply to this Agreement.
II, Certification Regarding Drug-Free Workplace Requirements
1. 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 fvr.vlolation of such prohibition;
b. Establishing a drug-free awareness program to inform employees about:
1. The dangers of drug abuse In the workplace;
11. The Contractor's policy of maintaining a drug-free workplace;
Ill. Any available drug counseling, rehabilitation, and employee assistance programs; and
Iv. The penalties that may be Imposed upon employees for drug abuse violations occurring in the
workplace;
c. Making It a requirement that each employee he 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
11, Notify the employer of any criminal drug statute conviction for a violation occurring In the workplace
no later than five days after such conviction;
a. Notifying the Department within ten days after receiving notice under subparagraph (d)(11) from an
employee or otherwise receiving actual notice of such conviction;
f. Taking one of the following actions, within 36 days of receiving notice under subparagraph (d)(Il), with
respect to any employee who Is so convicted;
1. Taking appropriate personnel action against such an employee, up to and Including
termination; or
11, 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
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).
2. The sites for the performance of work done In connection with the specific agreement are listed below (list all
sites; add additional pages If necessary):
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3. Contractor will Inform the Department of any additional sites for performance of work under this agreement.
7 .
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Contract Number 00041659/ Page 17 of 22
4, False certification or violation of the certification may be grounds for suspension of payment, suspension or
termination of grants, or government-wide Federal suspension or debarment. 46 C,F.R. 82.610.
Ill. Certification Regarding Environmental Tobacco Smoke
Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act),
requires that smoking not be permitted In any portion of any indoor facility owned or leased or contracted for by an
Qr<tl.ty..and.uaedrputinply or regularly for,the provision of health,,day care, education, or library services to children
under the age of 18, If the services are funded by Federal programs either directly or through State or local
governments, by Federal grant, contract, loan, or loan guarantee. The law does not apply to children's services
provided In private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities
used for Inpatient drug or alcohol treatment, Failure to comply with the provisions of the law may result In the
imposition of a civil monetary penalty of up to $1,000,00 per day and/or the imposition of an administrative
compliance order on the responsible entity.
The Contractor certifies that It will comply with the requirements of the Act. The Contractor further agrees that It
will require the language of this certification be included in any subawards that contain provisions for children's
services and that all subgrantees shall certify accordingly.
IV. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions
Instructions
[The phrase"prospective lower tier participant" means the Contractor,]
I. By signing and submitting this document, 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 ogler remedies available to the Federal Government, the
department or agency with which this transaction originate may pursue available remedies, including
suspension and/or debarment.
3. The prospective lower tier participant will provide immediate written notice to the person to whom this 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 12649, 46 CFR Part 76, You may contact the person to whom this proposal Is submitted for
assistance in obtaining a copy of those regulations,
S. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered Into, It shall not knowingly enter any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily excluded from participation In this covered
transaction unless authorized by the department or agency with which this transaction originated.
b. The prospective lower tier participant further agrees by submitting this document that it will Include the clause
titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--tower 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 by which It determines the eligibility of Its principals. Each participant may, but Is not required to,
check the Nonprocurement Dist,
s .
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
Contract Number 00041659/ Page 18 of 22
8. Nothing contained In the foregoing shall be construed to require establishment of a system of records In order
to render in good faith the certification required by this clause, The knowledge and Information of a participant
Is not required to exceed that which Is normally possessed by a prudent person In the ordinary course of
business dealings,
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
voluntgrllypxcluded.trom participatlon.In this„transaction, In addition to other remedies available to the Federal
Government,the department or agency with which this transaction.originated may pursue avaflabie rerrledles,
Including suspension, and/or debarment.
Certification
1. The prospective lower tier participant certifies, by submission of this document, 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.
V. Certification Regarding Lobbying
The Contractor 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 agency, a Member of Congress,
an officer or employee of Congress, or an employee of a Member of Congress in connection with the
awarding of any Federal contract, continuation, renewal, amendment, or modification of any Federal 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 agency, a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection with this Federally funded
contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form
SF-LLL, "Disclosure of Lobbying Activities," in accordance with Its Instructions.
3. The undersigned shall require that the language of this certification be Included In the award document for
subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) who receive federal funds of $100,000.00 or more and that all subreciplents 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 1362, 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 $10,000.00 and not more than $100,000.00 for
each such failure.
VL Disclosure Of lobbying Activities
Instructions
This disclosure form shall be completed by the reporting-entity, whether subawardee or prime Federal recipient, at
the Initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31
U,S,C. section 1352, The filing of a form Is required for each payment or agreement to make payment to any
lobbying entity 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 a
covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form
Is Inadequate, Complete all Items that apply for both the initial filing and material change report. Refer to the
implementing guidance published by the Office of Management and Budget for additional Information.
a
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Contract Number 00041659 /Page 19 of 22
1, Identify the type of covered Federal action for which lobbying activity Is and/or has been secured to influence
the outcome of a covered Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to
the Information previously reported, enter the year and quarter in which the change occurred, Enter the date
of the last previously submitted report by this reporting entity for this covered Federal action.
g, Enter the full name, address, city, state and zip code of the reporting entity., Incfu'de Con gres616 ial District, if
known, Check the appropriate classification of the reporting entity that designates If It is, or expects to be, a
prime or sub-award recipient, Identify the tier of the subawardee, e,g., the first subawardee of the prime Is the
1st tier. 'Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
S. If the organization filing the report in Item 4 checks "subawardee", then enter the full name, address, city,
state and zip code of the prime Federal recipient, Include Congressional District, If known.
b, Enter the name of the Federal agency making the award or loan commitment. Include at least one
organizational level below agency name, If known, For example, Department of Transportation, United States
Coast Guard.
7, Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
8. Enter the most appropriate Federal Identifying number available for the Federal action identified in item 1
(e.g., Request for Proposal (RFP) number, Invitation for Bid (IFS) number, grant announcement number, the
contract grant, or loan award number, the appilcation/proposal control number assigned by the Federal
agency), Include prefixes, e,g., "RFP-DE-90-001,"
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
enter the Federal amount of the award/loan commitment for the prime entity Identified in Item 4 or 5.
10, (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity
Identified in Item 4 to Influence the covered Federal action.
(b) Enter the full names. of the Individual(s) performing services, and Include full address If different from 10(a).
Enter Last Name, First Name and Middle Initial(MI),
11, Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to
the lobbying entity (item 10), Indicate whether the payment has been made (actual) or will be made
(planned), Check all boxes that apply. If this Is a material change report, enter the cumulative amount of
payment made or planned to be made.
12, Check the appropriate boxes. Check all boxes that apply. If payment is made through an in-kind contribution,
specify the nature and value of the in-kind payment,
13, Check the appropriate boxes. Check all boxes that apply. If other, specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected
to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not Just time
spent In actual contact with Federal officials, Identify the Federal official(s) or employee(s) contacted or the
off leer(s), employee(s), or Member(s)of Congress that were contacted,
15, Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
10
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Contract Number 00041659 I Page 20 of 22
Public reporting burden for this collection of Information Is estimated to average 30 minutes per response, including
time for reviewing Instructions, searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of Information. Send comments regarding the burden estimate or any other
aspect of this collection of information, Including suggestions for reducing this burden, to the Office of Management
and Budget, Paperwork Reduction Project(0348-0046),Washington, D. C. 20503
91
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Contract Number 00041659/ Page 21 of 22
Disclosure Of Lobbying Activities
(Approvad by OMB 0344.0046)
Complete this form to tiisic.lia i3.lobbyirlg a EiVifi s pursuant to 31 U.S.C. 1362
1. Type of Federal Action: 2, Status of Federal Action: 3. Report Type:
❑ a. contract ❑ a, Bid/offer/applicallon a. Initial filing
❑ b. grant ❑ b. Initial Award H b. material change
❑ c, cooperative agreement ❑ c, Post-Award
For Materlal Chan a Onl
❑ d, loan.... 9 y;... ... .
❑ e. loan guarantee
❑ f, loan Insurance Year _Quarter
Date Of Las(Report:
4. Name and Address of Reporting Entity: S. If Reporting Entity In No.4 is Subawardee, Enter Name and
Address of Prime:
❑ Prime
❑ Subawardee Tier (if known)
Congressional District(if known) Congressional District(if known)
B. Federal Departmenl./Agency: 7. Federal Program NamelDescriptiow
CFDA Number(if applicable)
p. Federal Action Number(if known) 9. Award Amount(if known)$
10. a, Name and Address of Lobbying Entity b, Indlviduals performing Services(including address it different
(If Individual,last name, first name, M0, from No. 10a.) (last name, first name, MO:
(attach continuation Shoat(s)SF-UL A,if nacassaty) (attach Continuation Sheet(s)SF-LU-A,if necessary)
11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply):
$ actual planned ❑ a. retainer
❑ b. one-time fee
12, Form of Payment(chock all that apply): ❑ c, commission
❑ d• contingent fee
❑ a. cash ❑ e. deferred
❑ b. In-klnd; specify: Nature ❑ f. other;specify:
Vacua
14. Brief Description of Services Performed or to be Performed and Dates)of Services,Including offlcer(s),employee(s), or Member(s)
contacted,for Payment Indicated in Item 11(altach Continuation Shoel(s)SP-ILL-A,Ifnecossery):
16. Continuation Sheets)SF-LLL-A attached: ❑ Yes ❑ No
16, Information requested through(his form is authorized by Signature:
title 31 U. S.C. section 1362, This disclosure of lobbying
acllvl(les Is a material representation of fact upon which Print Name: _
reliance was placed by the(ter above when this transaction
was made or entered Into. This disclosure Is required Title:
pursuant to 31 U. S.C, 1362. This information will be
reported to the Congress semi-annually and will be Telephone No: Date:
available for publlc Inspection. Any person who falls to ilia
the required disclosure shall be subject to a civil penalty of
not less than$10,000 and not more than$100,000 for each
such failure.
r , �r _ Authorized for Local Reproduction
�;ad *' ` ,.,_ n Standard Form-•LLL
12
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Contract Number 00041659/Page 22 of 22
State Certifications
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes fisted below and consult with counsel and other
knowledgeable persons before signing, The text of cacti North Carolina General Statutes can be found online at:
• Article 2 of Chapter 64: h :/ e s to nc► Lin c edLe isl tt t/S u esl 13 Ar icle/Cha er b4/Article 2 df
• G,S, 105-164,8(b); h tr r s e rc sjElig9tedLegislation e' PDF B Sec io C r 105 GS I05-16 8 )df
•" G,S. 143-48.5 ft
... p
h. ' 11www nog aatot.c nc,itslEnac isle for S tr esl 1' 13 Section Ch a 1 3 GS 1 3= 8.5 htinl
'
03, I43-59.1; hit : s ten t s e Isl on St h to IPDr B Sac iorrlClr et 1 3 GS 143-59,1,pdf
G.S. 143-59.2; l 3 GS 143-59 2
G.S. 147-33.95(g): c s e nc t sl ctedLe •s r S to II B ion Ci a t t GS 1 -33.95 €rhrfi
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g),the undersigned hereby certifies that the Contractor named below,and
the Conhraetor's subcontractors, complies with the t'eclutretnents of Article 2 of Chapter 64 of the NC General Statutes,
including the requirement for each employer with ;pore than 25 employees in North Carolina to verify the work
authorization of its employees through the federal 13-Varify system."E-Verify System Link: www.uscis.rcov
(2) Pursuant to G.S. 143-59,1(b), the undersigned hereby certifies that the Contractor named below is not an "ineligible
Contractor" as set forth in G.S, 143-59,1(a)because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter
105 of the General Statutes on its sales delivered to North Carolina when tile, sales met one of more of the
conditions of G.S. 105-164.9(b), and
....:CQhsak..pn ' ft)ie.ftal4wghaxtsj
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 rnarlcet for the public
trading of the stock of the corporation incorporated in the tax haven country.
(3) Pursuant to G,S, 1.43-59.2(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 cortifras 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, 143-59.1and-59.2 shall be guilty of a Class I felony.
The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and
date this document immediately thereafter.
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therenfler.
13
DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
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CRF Award Scope of Work
This agreement is entered into the aforementioned Effective date, by and between NCDHHS
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and Subrecipient.
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Whereas, on March 13, 2020, the President of the United States issued a Proclamation on
Declaring a National Public Health Emergency as a result of the COVID-19 outbreak; and
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Whereas, on March 27, 2020, the Coronavirus Aid, Relief and Economic Security Act (the i
"CARES Act") (Public Law 116- 136), was signed Into law; and
Whereas, the CARES Act established the Coronavirus Relief Fund ("CRF"), which provides aid
to State and local governments to address necessary expenditures due to the COVID-19 Public
Health Emergency; and
Whereas, NCDHHS received CRF funding from the U.S. Department of Treasury by way of the
North Carolina General Assembly appropriation; and
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Whereas, Section 601(d) of the Social Security Act, as added by section 5001 of the CARES
Act requires that the CRF funds cover only those costs that are (1) are necessary expenditures
incurred due to the public health emergency with respect to the COVID-19; (2)were not
accounted for in the budget most recently approved as of March 27, 2020 (the date of the
enactment of the CARES Act)for the state or local government; and (3)were incurred during i
the period that begins on March 1, 2020, and ends on December 30, 2020.
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Whereas, NCDHHS is using the CRF funding source for the purpose of providing street
outreach, emergency shelter, rapid rehousing, homelessness prevention, or other services
and/or building community capacity to respond and recover from the COVID-19 pandemic and
serving individuals experiencing or at risk of experiencing homelessness and has selected the
Subrecipient to serve as a partner in effectuating the program.
Now, therefore, the Parties mutually agree as follows:
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Activities
1. The Agreement shall become effective on the date of execution and end on December
30, 2020. The Subrecipient hereby acknowledges that this Agreement is subject to the
availability of federal funds. 4
2. CRF awards will be used to serve individuals that are experiencing homelessness or at
risk of homelessness (by ESG-CV eligibility). E
3. CRF awards may be used for all ESG-CV eligible activities including Street Outreach,
Emergency Shelter, Rapid Rehousing and Homelessness Prevention. i
4. CRF awards may also be used for other eligible activities including hotel/motel, essential
move-in goods, unit upfits, landlord incentives, and other durable goods (see Appendix
A).
5. NCDHHS will reimburse and/or provide funding to Subrecipient for"Eligible Expenses"
as described in Appendix B. I
6. Agencies participating in Back@Home-CV for Rapid Rehousing and Homelessness
Prevention will use Back@Home infrastructure and workflows when using CRF funds.
Reporting and Billing
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DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
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7. Agencies that request advances will receive 50% of their allocation advanced once
contract has been executed. Once the agency has spent at least 80% of their advances,
they may request the second half of their award by emailing ncesg(7dhhs.nc.gov.
8. Agencies must account for advances or submit reimbursements according to NCDHHS
CRF Billing Guidance.
9. Any CRF funds that have not been spent by 12/30/20 on eligible activities must be
returned to Division of Aging and Adult Services,which will then revert funds back to
Treasury.
10.Any advanced funds not used for eligible services provided by December 30, 2020, will
need to be paid back to the Division of Aging and Adult Services. You will be required to
remit the unspent advance with your last reimbursement request, or by January 15, 1
2021, whichever date is earlier. Checks should be made payable to the NC Dept. of
Health and Human Resources and be mailed to: '
Division of Aging and Adult Service
ATTN., Budget Office
2101 Mail Service Center 9
Raleigh, NC 27699-2101 I
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11. Each month, organizations must complete Progress Report via Smartsheet according
to the below schedule. Progress Report can be found here:
https./tapp.smartsheet.com/blform/980c7aa3eOb343988b8b8fl cb62c270a
Progress Report Schedule
Reporting Period Due to NCDHHS
March 1 —September 30 October 31
October 1 --31 November 12
November 1 --30 December 11
December 1 --31 January 12
Audit and Treasury Requirements
12. Per new US Treasury requirements, the CARES Act sub-recipients and vendors are to
register with the System for Award Management(SAM)at SAM.gov 1
(https://sam.gov/SAM/) as soon as possible. For those of you that have already started �
work and are not already registered with SAM.gov, please do this immediately but no
later than ten (10) days post contract execution.
13.Audit: In addition, per 9 N.C.A.C. Subchapter 3M.0205A, a recipient or subrecipient that
receives, holds, uses, or expends State financial assistance in an amount to or greater
than five hundred thousand dollars($500,000)within its fiscal year shall have a single or
program-specific audit prepared and completed in accordance with Generally Accepted
Government Auditing Standards, also known as the Yellow Book. Audits must be 1
provided to NCGrants Repo rting@dhhs.nc.qo_v no later than nine-months after the end of
the recipient's fiscal year.
CRP and ESG-CV
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DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
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14. Duplication of Benefits: Subreciplent shall not carry out any of the activities under this
Agreement in a manner that results in a prohibited duplications of benefits as defined by
Section 312 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act(42
U.S.C. 5155) and in accordance with Section 1210 of the Disaster Recovery Reform Act
of 2018 (division D of Public Law 115-2541 132 Stat. 3442), which amended section 312
of the Robert T. Stafford Disaster Relief and Emergency Assistance act (42 U.S.C.
5155). Subrecipient must prevent duplication of benefits, consistent with CRF and ESG-
CV requirements.
15. Funding Priority Order: Agencies that were awarded CRF for activities for which they
were also funded through ESG-CV must spend CRF first with some exceptions (see
CRF for Rapid Rehousing section below). NC DHHS ESG Office anticipates that some !
Agencies that receive CRF funds will be delayed in spending ESG-CV awards. Agencies
will not be docked for this. However, Agencies should communicate proactively with NC
DHHS ESG Office if they have concerns with spending either CRF or ESG-CV awards in
the necessary timeline so those funds can be reallocated.
16. CRF for Street Outreach and/or Emergency Shelter: Once an Agency spends the full
CRF award and accounts for it through requisitions sent to NC DHHS ESG Office, the
Agency may begin submitting requisitions to ESG-CV. All requisitions to ESG-CV will be
reimbursement-based. If the Agency does not spend the full CRF award by December i
30, 2020, all remaining CRF funds must be returned to NC DHHS Division of Aging and
Adult Services which will revert the funding back to the Treasury. All Agencies will
submit requisitions to ESG-CV for any expenses starting December 31, 2020. l
17. CRF for Rapid Rehousing: Based on current HUD guidance, Agencies must not fully 1
spend their CRF before ESG-CV. To ensure that households served first with CRF funds
for Rapid Rehousing maintain eligibility to be served with ESG-CV funds, Agencies must
take the following steps. Agencies that do not take these steps may cause a household i
to lose ESG-CV eligibility and/or be required to pay back ESG-CV funds spent on these
households.
a. Rapid Rehousing, whether it starts with CRF or ESG-CV funding should be
treated as one HMIS program. Client level info should be entered in HMIS as
soon as the project begins regardless of the primary or secondary funding
source.
b. Current ESG-CV guidance states that for a household to be eligible for ESG-CV
funds, some portion of costs must be paid with ESG-CV expenses from the start
of their program enrollment and eligibility determination. Therefore, all agencies
that are using CRF to fund Rapid Rehousing must charge 20% of all household
services (i.e. case management, housing search and placement, etc) costs to
ESG-CV on a monthly basis. The remaining 80% of monthly household services
costs must be charged to CRF. The services costs charged to ESG CV and CRF
must reflect households enrolled in HMIS for Rapid Re-housing. 1
c. Below is an illustration to help plan for distributing these costs:
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October Invoice Remittance
Households Served 5 i
Total Services Cost $750
ESG CV Cost Share 20% $150
CRF Cost Share 80% $600
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DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
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d. All other costs should be charged to CRF until these funds are expended or
December 30, 2020, whichever comes first.
18. CRF for Homelessness Prevention: NCDHHS is still waiting for guidance on HUD on
how to reimburse for Homelessness Prevention and will send updated guidance shortly
on how to handle these requisitions.
Information and Guidance
19. December 30, 2020 Deadline: All CRF awards must be spent by December 30, 2020
and it is critical that all funds are expended in accordance with CARES Act guidance by
that time. All Agencies will receive regular emails to check in if they are able to spend i
the full award.Agencies must respond to those check-ins as soon as possible to let
NCDHHS know if they are: (1)on track to spend the full award, (2) are not on track and
need to return some of the award, (3) need to move the award to a different eligible
category, or(4) could use additional funds, if available. Agencies may also reach out
between check-in emails with this information by reaching out to Erika Ferguson
(Erika.Ferguson Ca-)dhhs.nc.gov). The deadline for these funds is final and will not be
extended.
20. CRF Guidance: More guidance on the Coronavirus Relief Fund (CRF) can be found:
a. htt s:l/home.treasu ov/s stem/files/136/Coronavirus-Relief-Fund-Gui ance-
for-State-Territorial-Local-and-Tribal-Governments, df
f. https://home.treasu[y.govlsystem/files/136/Coronavirus-Relief-Fund-Frequently-,
Asked-Questons.pdf
g. https://files.nc.gov/ncgov/documents/flles/ncpro/FAQ Nonprofit CRF June2520
20-1-converted-1. df I
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