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HomeMy WebLinkAbout2021-169-E Health-NC DHHS FY22 consolidated agreement DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 1 of 27 FY 2022 CONSOLIDATED AGREEMENT This Agreement is made between the North Carolina Department of Health and Human Services, Division of Public Health (hereinafter referred to as "DPH") and the Orange County Health Department(herein after referred to as "LHD") for the purposes of maintaining and promoting the advancement of public health in North Carolina. This Agreement shall cover a period from June 1, 2021 to May 31, 2022 and shall remain in force until the next Fiscal Year Agreement is signed except as provided for in Section J. Termination. Now, therefore, DPH and the LHD agree that the provisions and clauses herein set forth shall be incorporated in and constitute the terms and conditions applicable for activities involving State funding. (State funding or funds means State, federal, and/or special funding or funds throughout this Agreement.) A. LHD RESPONSIBILITIES a. Performance 1. The LHD shall perform activities in compliance with applicable program rules contained in the North Carolina Administrative Code, as well as all applicable federal and North Carolina laws and regulations. 2. The LHD shall perform the activities specified in the Agreement Addenda for State-funded budgets. The LHD must negotiate these Agreement Addenda in good faith to the satisfaction of DPH representatives as part of the Agreement execution. The LHD will meet or exceed the Agreement Addenda deliverables unless extenuating circumstances prevail and are explained in writing and subsequently approved by the DPH section,branch or program. 3. The LHD shall be committed to achieve health equity,promote inclusion of all populations affected by conditions contributing to health disparities (including race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location), and ensure all staff, clinical and non- clinical,participate in ongoing training focused on health equity, health disparities, and/or social determinants of health to support individual competencies and organizational capacity to promote health equity. The LHD shall administer and enforce all rules that have been adopted by the Commission for Public Health or adopted by the Local Board of Health, Consolidated Human Services Board, or Board of County Commissioners (hereinafter referred to as "LHD governing board"), and laws that have been enacted by the North Carolina General Assembly. 4. The LHD shall provide to DPH a copy of any rules adopted, amended or rescinded by the LHD governing board pursuant to NCGS § 130A-39 Powers and duties of a local board of health and Public Health Ordinances adopted by the County Commissioners, within 30 days of adoption or rescission. These rules and ordinances are to be sent to the Deputy Director of DPH or designee. 5. The LHD shall provide formal training/orientation for its LHD governing and/or advisory board members. 6. The LHD shall not require a client to present identification that includes a picture of the client for at least immunization,pregnancy prevention, sexually transmitted disease and communicable disease services. 7. LHDs shall provide or assure provision of Care Management for High-Risk Pregnancies (CMHRP), formerly known as Pregnancy Care Management(OBCM), and Care Management for At-Risk Children(CMARC), formerly known as Care Coordination for Children(CC4C). These services may be funded by Medicaid, state or federal funding through Agreement Addenda, private fenders or local funds. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 2 of 27 a) Per federal CAPTA (Child Abuse Prevention and Treatment Act) requirements, a notification to the county child welfare agency must occur upon identification of an infant as "substance- affected," as defined by NC DHHS, for the development of a Plan of Safe Care (POSC). The POSC requires that all substance-affected infants be referred by the local Child Welfare Agency to CMARC for care management and care coordination, regardless of insurance coverage. b) Medicaid requires that the LHD has the first right of refusal to provide CMHRP and CMARC services. c) The LHD shall use every resource including technical assistance from the regional consultants and Women's and Children's Health(WCH) Section to resolve issues to prevent care gaps and discontinuation of services. d) In the event that the LHD determines it cannot directly provide CMHRP and/or CMARC, the LHD shall: 1) Notify the DPH Director in writing of the LHD's intention to discontinue the service at least 90 days in advance of any planned action. 2) Cooperate with DPH in identifying another LHD that can provide these care management services. 3) Provide a written plan to the DPH Director outlining the agreed-upon terms for the transition. Discontinuation of CMHRP and CMARC without an approved transition plan may result in the withholding of all funds to the LHD at the discretion of the DPH Director. 8. The LHD shall notify the DPH Director if any of the following occurs: a) there is a legal name change to the LHD b) the LHD becomes part of a consolidated human services agency, a district or a public health authority c) there is any other governance change, or d) the LHD is not subject to the NC Human Resources Act. Notification should be in writing, within the next business day, and provide an organization chart and any relevant supporting documents reflecting the changes. 9. The LHD shall assure DPH that expenditures of locally appropriated funds (Maintenance of Effort, or MOE) is maintained for maternal health, child health, and family planning program activities equal to or greater than that reported on the Staff Time Activity Report for the period July 1, 1984 through June 30, 1985. This figure is increased annually based on a federally accepted inflation index. This revised baseline figure has been calculated and is provided as Attachment A to this Consolidated Agreement for the LHD's use in budget preparation. 10. The LHD shall retain financial and program records including electronic records in accordance with the North Carolina Department of Natural and Cultural Resources' Local Government Schedules records retention policy(https:Harchives.ncdcr.gov/government/retention-schedules/local- government-schedules) and in accordance with the retention of those records as described in Section D., Paragraph£ Records resulting from these services shall not be destroyed,purged or disposed of except in accordance with the records retention policy and in accordance with State and federal law. The State's basic records retention policy requires all grant records to be retained for a minimum of five years or until all audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record retention may be longer than five years since records must be retained for a period of three years following submission of the final Federal DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 3 of 27 Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Agreement has been started before expiration of the five-year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five-year period described above, whichever is later. b. Data/Reporting 1. The LHD shall report client, service, encounter, and other data as specified by applicable program rules, Agreement Addenda for State-funded budgets, and by North Carolina Administrative Code. Data shall be reported through North Carolina's centralized reporting system known as the LHD Health Services Analysis. To ensure that such data is accurately linked to the specific client served in a manner that results in a unique identifier from the DHHS Common Name Data Service except as allowed by NCGS § 130A-34.2, the LHD shall allow the State to submit(on its behalf) the Social Security Numbers of all clients to the Social Security Administration for verification. 2. The LHD shall submit monthly reports of On-Site Wastewater activities to the On-Site Water Protection Branch in the Environmental Health Section of DPH in the format provided by the Environmental Health Section. 3. The LHD shall provide access to patient records to authorized staff from DPH for technical consultation, program monitoring, and program evaluation, as specified by this Agreement, Agreement Addenda for State-funded budgets, statute, and North Carolina Administrative Code. 4. The LHD shall share data with DPH to support public health objectives. The data will be shared in a manner which respects the confidentiality and integrity of each party's data and protects the privacy of individual client health information. Sharing data includes providing client information allowed as permitted disclosures under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, HIPAA Administration Simplification Provisions Sections 261 through 264, 45 CFR 164.512. 5. The LHD shall provide Network and internet access at its facilities (or to the county network where desired) in order to: a) Connect with critical data and surveillance systems including, but not limited to, the North Carolina Health Alert Network(HAN),North Carolina Electronic Disease Surveillance System(NCEDSS),North Carolina Immunization Registry (NCIR), Local Health Department Health Services Analysis (LHD-HSA) and Electronic Birth Registration System (EBRS). b) Rapidly communicate email alerts to and from DPH regarding bioterrorism and public health topics (outbreaks, emergency alerts, etc.) c) Access DPH training material and information used for training staff, including access to webinars d) Maintain a secure infrastructure for remote data entry in the LHDs e) Report electronically all required Environmental Health Section inspection data in the format and frequency specified by DPH. 6. The LHD may utilize security products (i.e., firewalls) of its choosing to maintain network connectivity and security integrity. The LHD network configuration and security practices must allow communication with systems within the DPH network. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 4 of 27 7. LHDs shall be responsible to report all privacy and security breaches that may affect DPH data and surveillance systems to DPH as soon as possible but no later than 24 hours from discovery of the breach. This may include but is not limited to Ransomware attacks, malicious code execution, or network breaches. LHDs access to DPH data and surveillance systems may be limited or turned off until proof of remediation is supplied by the LHD. c. Assessments and Plans 1. The LHD shall provide to the Director of Community Health Assessment, State Center for Health Statistics or designee: a) A comprehensive community health assessment (CHA) at least every four years, for each county or health district. The CHA shall be a collaborative effort with local partners inclusive of hospitals,businesses, community partners, and the local community health coalitions and shall include the collection and analysis of primary data at the county and district level (if such exists), secondary data from the State Center for Health Statistics (SCHS) and other sources, and an assessment and analysis of community resources. The CHA shall identify a list of community health problems based on the assessment. Each identified problem shall be prioritized and described in the narrative. The CHA will include data analysis of those indicators listed in the Accreditation Self-Assessment Inventory, Benchmark 1, Activity 1.1. The CHA is due on the first Monday in March following the year of assessment. Community Health Improvement Plans (CHIPS), which shall be submitted no later than six months after the completion of the comprehensive community health assessment(CHA). CHIPs are due by the first Monday in September following the year of assessment. 1) The CHIP shall address a minimum of two priorities identified in the most recent community health assessment. 2) The CHIP shall be data driven and use results-based accountability to focus on both population and program accountability. Specifically, results, indicators, programs, and performance measures must be included. 3) The CHIP shall be aligned with the Healthy North Carolina 2030 indicators and use best evidence interventions targeting health behaviors, the physical environment, social and economic factors, and/or clinical care. 4) The CHIP shall be updated at least annually and monitor performance. 5) CHIPs can persist across CHA-CHIP cycles when: a. the health problem persists and continues to be a priority; b. new interventions are needed; and/or c. the interventions need to be expanded to a new target population. 6) The LHD shall use the web-based software Clear Impact Scorecard for submitting the CHIP for approval. a. The LHD shall provide a state of the county or district health report (SOTCH) during each interim year between community assessments. The SOTCH is due by the first Monday in March in years when a CHA is not submitted. 1. The LHD shall use Clear Impact Scorecard for the SOTCH. 2. The SOTCH shall include progress made on each performance measure in the CHIP. b) The LHD shall make a written request for any variances in submission of CHAs, CHIPs, and SOTCH documents in advance of the required date of submission. Emails may be sent to the Director, Community Health Assessment, State Center for Health Statistics at cha.sotch@dhhs.nc.gov. c) Refer to guidance: hM2s:Hschs.dph.ncdhhs.gov/units/ldas/cha.htm. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 5 of 27 B. DPH RESPONSIBILITIES a. Training, Consultation, and Support 1. DPH shall provide training to the LHD for the LHD's response to this Agreement and to the Agreement Addenda. Upon request, consultation will be provided by DPH to the LHD. 2. DPH shall provide coordination and support for the education and training for the public health workforce, including developing training opportunities to achieve health equity, promote inclusion of all populations affected by health disparities (including racial/ethnic minority groups and persons with disabilities), and ensure all staff, clinical and non-clinical, have opportunities for training focused on health equity, health disparities, and/or social determinants of health to support individual competencies and organizational capacity to promote health equity. 3. DPH shall conduct liaison activities with LHDs for general problem solving and technical support. 4. DPH shall provide high-level consultation, technical assistance, and advice to local health directors and teams via the Local and Community Support(LCS) Section. Contact the Deputy Director/Section Chief, LCS. Broad content areas include, but are not limited to: a) Board Relations b) Management Teams and Staffing c) Policy Development d) Program Planning and Implementation e) Quality and Performance Improvement f) General Administrative Consultation, including consultation and technical assistance in budgeting, fiscal, administrative and management support topic areas. 5. DPH shall provide technical assistance and consultant services, as required, for specific health program areas, including providing guidance and consultation about specific patient clinical issues, when requested. Contact the specific section or branch head. 6. DPH shall provide course coordination, consultation, and technical assistance on nursing practice and standards,policies and procedures that cross programs via LCS: Local Technical Assistance and Training Branch(LTATB). Contact the Chief Public Health Nurse/Branch Head LTATB. 7. DPH shall provide support and consultation to the public health workforce in LHDs, including regional public health consultants who offer technical assistance and training on professional development; program planning, program evaluation and quality assurance and data collection. Contact the Chief Public Health Nurse/Branch Head, LTATB. b. Performance 1. DPH shall act as the principal liaison between the public health system and the State's Medicaid agency on issues related to Medicaid reimbursed services provided by the State and the LHD and shall cooperate with the State Medicaid agency to provide technical assistance, guidance, and consultation to local health programs to ensure compliance with Medicaid policies and procedures. 2. For services of the State Laboratory of Public Health (SLPH), DPH shall: a) Provide free or at-cost mailers that meet the US Postal Service/DOT UN3373 Biologic substance shipping and packaging regulations for samples submitted to the SLPH only, when ordered via the SLPH's web-based mailroom ordering system; DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 6 of 27 b) Ensure qualified personnel to process, analyze and report test results; c) Ensure that the SLPH maintains CLIA certification; d) Submit invoices to the LHDs via electronic means; e) Collect interest(per NCGS § 147-86.23 Interest and penalties) and a l 0% late fee as appropriate; and f) Provide a qualified Laboratory Director and a Technical Consultant for LHDs' laboratories participating in the North Carolina SLPH CLIA Contract Program. Services provided by the oversight of this personnel include training and continuing education, CLIA inspection assistance, proficiency testing and enrollment, competency assessment, and models for laboratory forms, procedures and policies. 3. DPH will provide support and training for the LHD to comply with all applicable laws, regulations, and standards relating to the activities covered in this Agreement. 4. DPH shall conduct reviews, audits, and program monitoring to determine compliance with the terms of this Agreement and its associated Agreement Addenda. c. Data/Reporting 1. DPH shall provide the following automated data and surveillance systems to collect DPH program- related data from client, service, encounter and other data on behalf of the LHDs and other public health programs. DPH shall provide business and technical support to the users of these systems. DPH shall notify LHDs as opportunities and/or timelines for improved or emerging technology systems occur. a) LHD-Health Services Analysis: for automated reporting of clinical service data fields. b) Environmental Health Inspection Data System (EHIDS) (formerly NC BETS): for Food and Lodging inspection and billing data c) Electronic surveys for gathering statewide data for external funders, as required d) Aid-to-Counties System for reporting all local expenditures and claiming State funds e) North Carolina Health Alert Network(HAN) f) North Carolina Electronic Disease Surveillance System(NCEDSS) g) North Carolina Immunization Registry(NCIR) h) Electronic Birth Registration System (EBRS) i) COVID-19 Community Team Outreach Tool (CCTO) j) COVID-19 Vaccine Management System(CVMS) k) North Carolina Database Application for Vital Events (NC DAVE) for Electronic Death Registration Other automated data and surveillance systems may be added as they are developed. 2. DPH shall be responsible in its use of data received and reviewed in its various roles as a public health authority, health oversight agency, and business associate. Protected health information received by DPH in its capacity as a covered entity or business associate shall be protected as required by HIPAA (see Attachment B: Business Associate Addendum to this Consolidated Agreement). DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 7 of 27 3. DPH will coordinate with the North Carolina Association of Local Health Directors to support data collection, analysis, and publication. d. Fund Availability and Notification DPH shall provide to the LHD the Budgetary Estimates of Funding Allocations no later than February 14 of each year to use in preparation of their local budget proposals per current General Statute. 1. An exception is the Food and Lodging distributions required by NCGS § 130A-248(d). DPH shall provide the Food and Lodging funding allocation on the Distribution Spreadsheet which will accompany the Activity 874 Food and Lodging Agreement Addendum. 2. The Food and Lodging Local Health Department Request for Payment Form (DPH EH 2948)will accompany the Agreement Addendum for Activity 874 Food and Lodging and will be provided to the LHD no later than March 30 for the State Fiscal Year(SFY) in which payment will be made. DPH shall disperse Food and Lodging funds to the LHD upon receipt of the executed Agreement Addendum and the signed, completed, and approved Food and Lodging Local Health LHD Request for Payment Form. 3. DPH shall provide a Funding Authorization document to the LHD after the receipt of the Certified State Budget. 4. DPH shall make funds available to the LHD at the beginning of each fiscal year upon receipt of this executed Agreement, and the executed Agreement Addenda. Funds will be dispersed in accordance with the timely submissions of Expenditure Reports. Payment will be made to the LHD according to the DHHS Controller's Office Aid-to-Counties Expenditure Control Schedule issued December of each year for the following calendar year. C. FUNDING STIPULATIONS a. Use of Funds 1. Funding for this Agreement and all Agreement Addenda is subject to the availability of State, federal, and Special Funds for the purpose set forth in this Agreement and the Agreement Addenda. 2. During the period of this Agreement, the LHD shall not use State, federal or Special Project funds received under this Agreement or any Agreement Addenda to reduce locally appropriated funds as reflected in the Local Appropriations Budget(see Section D. Fiscal Control, Paragraph h. Local Appropriations Budget below). b. Compliance 1. To receive funding under this Agreement, the LHD shall comply with 10A NCAC 46, Section .0200 Standards for Local Health Departments. 2. The LHD shall maintain authenticated employee time records to document the actual work activity of each employee on a daily basis. The percentage of time each employee spends in each activity shall be converted to dollars based upon the employee's salary and benefits at least on a monthly basis. The computation shall support the charges for salaries and benefits to all federal and State grants (as required in 2 CFR Part 200) as well as provide the documentation of detailed labor cost per activity for preparation of Medicaid Cost Report. 3. LHD charges/billing. The LHD shall: a) Establish one charge per clinical/support service for all payors (including Medicaid)based on their related costs as permitted by NCGS § 130A-39(g). DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 8 of 27 b) Bill All Payors the established charge except when billing 340B Drug Pricing Program drugs or devices to Medicaid. All drugs or devices purchased using 340B Program must be billed to Medicaid at the acquisition cost. c) The LHD may accept negotiated or other agreed upon lower amounts (e.g., the Medicaid reimbursement rate) as payment in full. d) Make every reasonable effort to collect charges for services through public or private third- party payors. except where prohibited by federal regulations or State law; however, no one shall be refused services solely because of an inability to pay. e) All LHD fees, including environmental health fees shall be reviewed annually by the governing body in accordance with the North Carolina Local Health Department Accreditation Board guidance and local policies. 4. The LHD shall comply with the federal Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards ("Uniform Guidance"), codified at 2 CFR 200, when utilizing federal grant funds. a) When procuring goods and services with federal grant funds, the LHD shall apply the most restrictive rule when following federal, State, and local government procurement requirements. 5. When administering the Women, Infants, and Children's Program (WIC), the LHD must adhere to the requirements set forth in Section 361 of the Healthy Hunger-Free Kids Act of 2010 which amended Section 12(b) of the Richard B. Russell National School Lunch Act(NSLA), 42 USC 1760(b). This Act requires the LHD to support full use of the federal administrative funds provided for the WIC program. The federal administrative funds are specifically excluded from budget restrictions or limitations including, at a minimum, hiring freezes, work furloughs and travel restrictions. 6. The LHD agrees to execute the following consolidated Federal Certifications (Attachment C) as applicable when receiving federal funds: a) Certification regarding Nondiscrimination b) Certification regarding Drug-Free Workplace Requirements c) Certification regarding Environmental Tobacco Smoke d) Certification regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions e) Certification regarding Lobbying. 7. Pursuant to the Federal Funding Accountability and Transparency Act(FFATA), the LHD is required to submit to DPH information that is reportable by DPH for all qualified sub-awardees of federal funds. The LHD will complete and submit the Federal Funding Accountability and Transparency Act(FFATA) Data Reporting Requirement form provided by DPH to determine the eligibility as a sub-awardee for reporting purposes. Information provided by the LHD will be used by DPH to report subawards (funding authorizations) equal to or greater than $25,000 from each federal grant. 8. The LHD shall maintain an active registration in the federal government's System for Award Management(SAM). The SAM registration must be updated no less than annually in order to maintain an active status. To update the registration, the LHD must log in at the SAM home page, www.sam.gov, and follow the instructions found there. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 9 of 27 c. Training Reimbursement 1. Subject to the availability of funds and approval by the Office of the Chief Public Health Nurse, the LHD may request reimbursement for: a) Nursing service personnel participating in Principles and Practices of Public Health Nursing course. Reimbursement is $400 per participant upon successful completion of the course. Reimbursement requests must be filed by the LHD to the Public Health Nursing and Professional Development Unit within the same fiscal year the course is completed. b) LHD Management/Supervision level staff participating in the Management and Supervision for Public Health Professionals course. Reimbursement is $600 per participant upon successful completion of the course. Reimbursement requests must be filed by the LHD to the Public Health Nursing and Professional Development Unit within the same fiscal year the course is completed. The Training Funds Reimbursement Request Form can be found at https://publichealth.nc.-ovg /lhd/ under the General Information: Training Reimbursement section. (The training form can also be downloaded at https://publichealth.nc.gov/lhd/docs/Funds_Reimb_Form%20PPPHN M- S_v072020.xlsx) 2. Subject to the availability of funds and approval by the Environmental Health Section, the LHD may request reimbursement for Centralized Intern Training (CIT) and a one-time mileage allocation. Reimbursement requests must be filed by the LHD to the Environmental Health Section within the same fiscal year the training is completed. Reimbursement requires successful completion of the course and requests must be filed by the LHD within 60 days course completion. (Reimbursement Request Form DHHS 4125 Centralized Intern Training Funds Reimbursement Request is available at https:Hehs.ncpublichealth.com/oet/index.htm) a) For Interns attending CIT sessions, reimbursement amounts are based on the session attended: 1) Food Protection& Facilities Track $280 2) On-Site Water Protection Track $560 3) Tier 2 General EH Module $280 b) For Cross-training Registered Environmental Health Specialists (REHS) attending CIT sessions, reimbursement amounts are based on the session attended: 1) Food, Lodging, & Institutions—$170 2) Child Care & School Sanitation—$62 3) On-site Water Protection—$450 4) Private Drinking Water Wells—$62 5) Public Swimming Pools—$62 6) Tattoo—$62 c) A one-time mileage allocation per two REHSs from the same county per training session is based on one of the four geographical areas they are employed. 1) Area 1 —$57: Alamance, Caswell, Chatham, Cumberland, Duplin, Durham, Edgecombe, Franklin, Granville, Greene, Guilford, Halifax, Harnett, Hoke, Johnston, Lee, Lenoir, Montgomery, Moore,Nash, Orange, Person, Randolph, Sampson, Vance, Wake, Warren, Wayne, Wilson. 2) Area 2 $170: Alexander, Alleghany, Anson, Ashe, Beaufort, Bertie, Bladen, Brunswick, Cabarrus, Camden, Carteret, Catawba, Chowan, Columbus, Craven, Currituck, Dare, Davidson, Davie, Forsyth, Gaston, Gates, Hertford, Hyde, Iredell, DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 10 of 27 Jones, Lincoln, Martin, Mecklenburg,New Hanover,North Hampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Richmond, Robeson, Rockingham, Rowan, Scotland, Stanly, Stokes, Surry, Tyrrell, Union, Washington, Watauga, Wilkes, Yadkin. 3) Area 3 —$283: Avery, Buncombe, Burke, Caldwell, Cleveland, Haywood, Henderson, Jackson, Madison, McDowell, Mitchell, Polk, Rutherford, Transylvania, Yancey. 4) Area 4—$396: Cherokee, Clay, Graham, Macon, Swain. d. Purchases 1. Equipment is a type of fixed asset consisting of specific items of property that: (1) is tangible in nature; (2)has a life longer than one year; and(3) has a significant value. a) For Inventory Purposes 1) Equipment must be accounted for in accordance with guidance published by the Governmental Accounting Standards Board(GASB) for capital assets. 2) All equipment with an acquisition cost of$500 or more which was purchased with Women, Infants and Children (WIC) Program Funds,prior to January 1, 2018 will be inventoried with the Nutrition Services Branch. The Local Agency is responsible for assigning a fixed asset number and applying a fixed asset tag to equipment purchased by the Local Agency, using WIC funds, after January 1, 2018. Within 60 days of the purchase, the Local Agency will provide to the Nutrition Services Branch a written report of the purchase, including a description of the item purchased, serial number, fixed asset tag number, and a copy of the bill of sale. b) For Prior Approval Purposes 1) Except for WIC, all equipment purchased or leased with an acquisition cost exceeding $2,500, where there is an option to purchase with State/federal funds, the purchase or lease must receive prior written approval from the appropriate Section and Branch within DPH. [See Subparagraph 2 below for WIC requirements.] For those purchased with Public Health Preparedness and Response (PHP&R) Branch funds only, any purchase exceeding $2,500 per invoice shall be treated as a single purchase for prior approval purposes. [For example, on one invoice, the LHD purchases a computer, monitor, and printer totaling more than $2,500, or purchases six computers at $500 each.] 2) For WIC, all computer and medical equipment purchased or leased, must receive prior written approval from the Branch regardless of cost. In addition, all other tangible assets (non-computer/medical)with an acquisition cost exceeding $500 must receive prior approval. Computer accessories, such as keyboards and monitors, do not require approval. c) For Accounting Purposes 1) The LHD must utilize the depreciation schedule provided by the State for all assets with an acquisition cost of$5,000 or greater. The accumulated depreciation shall be recorded in the general fixed assets account group. 2. Prior approval required for purchases other than equipment: a) For PHP&R Branch funds, purchases for meals and refreshments must receive prior written approval from the PHP&R Branch. b) The use of Women's and Children's Health Medicaid fees for capital improvements requires prior written approval from the Women's and Children's Health Section. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 11 of 27 D. FISCAL CONTROL a. The LHD shall comply with the Local Government Budget and Fiscal Control Act, North Carolina General Statute Chapter 159, Article 3. 1. The LHD shall maintain a purchasing and procurement system in accordance with generally accepted accounting practices and procedures set forth by the Local Government Commission. b. The LHD shall execute written agreements with all parties who invoice the LHD for payment for the provision of services to patients. Exceptions may be permitted in cases where the patient has a preference for a non-contracted provider and that provider verbally agrees to abide by program requirements and to accept program payment as payment in full. c. The LHD, when subcontracting, must meet the following conditions: 1. The LHD is not relieved of any of the duties and responsibilities provided in this Agreement. 2. The LHD will not enter into a subcontractual financial assistance agreement with any entity on the current North Carolina Office of State Budget and Management (OSBM) "Suspension of Funding" list(SOFL) and shall withhold funds not yet disbursed until the entity has been removed from the SOFL. Updated SOFLs are released weekly and are available on the OSBM website (https://www.osbm.nc.gov/management/grants). 3. The subcontractor will agree to abide by the standards contained herein or to provide such information as to allow the LHD to comply with these standards. 4. The subcontractor shall be subject to all conditions of this Agreement and of any subsequent Agreement Addenda for which they perform work on behalf of the LHD. 5. The subcontractor will agree to allow State and federal authorized representatives' access to any records pertinent to its role as a subcontractor of the LHD. 6. Upon request, the LHD will make available to the State a copy of subcontracts supported with State or federal funds. d. The LHD must receive prior written approval from the State to subcontract when any of the following conditions exist: 1. The LHD proposes to subcontract to a single entity 50 percent or more of the total State and federal funds made available through this Agreement. 2. The LHD proposes to subcontract 50 percent or more, or$50,000, whichever is greater, of the total State and federal funds made available through this Agreement for any Agreement Addendum. 3. The LHD proposes to subcontract for services in the Women, Infants and Children(WIC) Program. e. The LHD shall mail a signed copy of all public health Funding Authorization documents to the DPH Budget Office, 1931 Mail Service Center, Raleigh,NC 27699-1931. £ The LHD shall retain a copy of all Funding Authorization documents, the monthly certified electronic printed screen of the Expenditure Reports with any amendments (via the Aid--to-Counties Database), Consolidated Agreement, Agreement Addenda, Agreement Addendum Revisions and other financial records in accordance with the current Records Disposition Schedule for Local Health Departments issued by the North Carolina Department of Natural and Cultural Resources and located on their website at: https://archives.ncdcr.gov/documents/local-health-departments-schedule g. Audits/Monitoring: The county or the LHD shall have an annual audit performed in accordance with the Single Audit Act of 1984 (with amendment in 1996) and 2 CFR Part 200. The audit report shall be DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 12 of 27 submitted to the Local Government Commission(LGC)by the County Administration(if single county LHD) or the District Health Department or Public Health Authority (if so organized) within six months following the close of the Agreement. Audit findings referred to the DHHS Internal Audit Office by LGC will be investigated and findings verified by the DHHS Controller's Office staff with assistance of DPH Program Staff. h. Local Appropriations Budget: The LHD shall prepare and maintain a Local Appropriations Budget (reflecting the plans to use local appropriations or earned fees) for each Agreement Addendum in a manner consistent with instructions provided in funding-specific budgetary guidance from DPH and the specific guidance from the respective programs. i. Local Earned Revenues Budgeting and Reporting: The LHD shall observe the following conditions when budgeting and reporting Local Earned Revenues: 1. Locally appropriated funds may not be withdrawn due to fee collection greater than projected in the budget or due to new grant funding except during the last two months of the fiscal year to allow the county to manage end of year budget close out. 2. All earned revenue (officially classified as local funds) must be budgeted and spent in the program that earned it except: a) Revenue generated by Women's and Children's Health (WCH) Section Programs may be budgeted and expended(consequently reported) in any WCH Section Program,unless a specific Agreement Addendum has a more restrictive requirement. b) Revenue generated by a local clinic or program that has no State-funded budget(no State or federal funds) shall be budgeted and associated expenditures reported in a State Program Activity that most closely matches the deliverables of the respective State program. This process will enable the collection of total expenditures in public health per program. 3. The LHD shall not use personal health program funds to support environmental health programs nor use environmental health program funds to support personal health programs. 4. Use of program income generated by the expenditure of federal categorical funds will be governed by applicable federal regulations, including,but not limited to, 2 CFR Part 200. 5. A local account shall be maintained for unexpended earned revenues (i.e., Title XIX fees,private insurance or private pay [cash]). Accounts shall be maintained in sufficient detail to identify the program source generating the fees. 6. The amount of Title XIX fees budgeted and expended in FY 2021-2022 must equal or exceed the amount of Title XIX revenues earned during FY 2019-2020. The State will not approve program activity budgets that do not include an amount of Title XIX fees sufficient to meet the requirements of this section. The State may waive this requirement if the LHD provides sufficient justification. j. Aid-to-Counties Database and Expenditure Reports: The LHD shall submit a monthly report of actual State, federal and local expenditures to the DHHS Controller's Office via the Aid-to-Counties Database (ATC). 1. Specific ATC instructions and training will be provided by LTATB to LHDs and will include guidance for reporting local programs (i.e., those programs that are not funded through DPH), examples include but are not limited to: Dental Clinic and Primary Care. 2. DPH shall produce an annual ATC report in order to provide information reported that summarizes LHD and statewide analysis and trending, including per capita analysis, when applicable. This report will be produced in collaboration with NCALHD and will be posted publicly on the DPH website. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 13 of 27 3. The LHD shall submit to the DHHS Controller's Office a monthly Expenditure Report of the pertinent month's actual expenditures for all programs via ATC. The Office of the Controller's Aid- to-Counties Expenditure Control Schedule,published annually in December for the next calendar year, provides the submission dates for these expenditures. This schedule allows the LHD at least seven days to enter the pertinent month's expenditures into the Aid-to-Counties Database. Failure to meet the reporting deadline will result in the exclusion of those expenditures for that month. The LHD must submit these monthly Expenditure Reports via the Aid-to-Counties Database consecutively throughout the Agreement period. The health director and the finance officer will approve the monthly Expenditure Report in the Aid- to-Counties Database and the system will alert the staff in the DHHS Controller's Office that expenditures have been approved and certified. The "Certification"verifies that the total State and federal expenditures reported are valid for the pertinent month's actual expenditures. Local expenditures are part of the Expenditure Report but are not included in the amount verified in the "Certification."Local appropriations must be reported monthly along with the State and federal expenditures. Funding is based on an allocation method, not a contract method, and counties receive reimbursement for services provided during one month in the following month. 4. The final Expenditure Report for the SFY, the last service month to be paid in the SFY, will be May services which are reported and paid in June. (Services provided in June and reported in July will be paid out of the next SFY.) 5. When Agreement Addenda are supported by federal funding or grants that do not coincide with the State fiscal year, care must be taken to be attentive to the service month and payment months for each grant as well as the ending liquidation date for each grant. Expenditures of federal funds must be reported according to the funding period for a grant. For each grant, the Budgetary Estimate document and the Funding Authorization document will have service and payment month dates listed. Failure to report expenditures after the payment period ends may result in non-payment. 6. The LHD shall have the opportunity to submit amended expenditure reports in the month following discovery of the error. The LHD shall not wait to submit all adjustments with the invoice submitted to the Office of the Controller at the end of May as that will not allow sufficient time for verification of the adjustments before the last payment in the State Fiscal Year. a) In accordance with Paragraph D J A above, the LHD must keep current on reporting adjustments against federal funds to ensure such adjustments are received in time to be paid within the grant's payment period. b) The LHD shall review their prior reimbursement claims against payments monthly. c) Amended expenditure reports must be submitted no later than the next reporting date after the grant period ends in order to be paid unless an exception is approved by the DPH Budget Office. d) Any overpayments identified by either the State or the LHD will be adjusted out of the next month's claim for reimbursement by the DHHS Controller's Office or by submitting a check to DHHS for payment if it is the last month of the fiscal year or the federal grant is closed. There is no provision to carry forward funds from one State Fiscal Year to another; therefore, any adjustment not included in the June payment (or earlier if the grant period expires during the State Fiscal Year) shall be paid from local funds. E. PERSONNEL POLICIES a. The LHD shall adhere to and fully comply with State and county personnel policies as applicable. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 14 of 27 b. Environmental Health Specialists employed by the LHD shall be delegated authority by the State to administer and enforce State environmental health rules and laws as directed by the State pursuant to NCGS § 130A-4 Administration. This delegation shall be done according to 15A NCAC 010 .0101 Scope of Delegated Authority. 1. The LHD is responsible for sending their newly employed environmental health specialists (interns) to centralized intern training within 180 days from date of employment. 2. Arrangements for centralized intern training for newly employed environmental health specialists will be handled by the DPH Education and Training Staff. 3. The LHD, when contracting with an environmental health specialist (EHS) employed by another entity, shall be responsible for ensuring that all original documents/public records (e.g.,permits, inspection reports, correspondence) generated by the contracted EHS be maintained by the LHD. All contracts covering this work shall stipulate that the contracted EHS shall be available for consultation with the public concerning work performed under the contract. c. The LHD shall comply with l0A NCAC 46 .0301 Minimum Standard Health Department Staffing and shall ensure that all nursing staff who provide public health services funded by this Agreement comply with this rule. d. The LHD shall complete the State Certifications (Attachment D) regarding its compliance with E-Verify, its eligibility status as a contractor, and that its officers have not violated any State or federal Securities Acts. F. CONFIDENTIALITY a. The LHD shall protect the confidentiality of all information, data, instruments, documents, studies, or reports received under this Agreement in accordance with the standards of the DHHS privacy and security policies, applicable local laws, State regulations, and federal regulations including: the Privacy Rule at 45 C.F.R. Parts 160 and 164, subparts A and E , Security Standards at 45 C.F.R. Parts 160, 162, and 164, subparts A and C ("the Security Rule"), and the applicable provisions of the Health Information Technology for Economic and Clinical Health Act(HITECH). b. All information obtained by LHD personnel in connection with the provision of services or other activity under this Agreement shall be confidential, except as may be required or allowed by law or otherwise permitted by this agreement. Information may be disclosed in summary, statistical, or other form which does not directly or indirectly identify particular individuals. Otherwise, information shall not be disclosed or made available to any individual or organization without the prior written consent of the client or responsible person, except as may be required or allowed by law or otherwise permitted by this agreement. c. LHD employees must sign confidentiality agreements documenting the knowledge of, and the agreement to maintain personal and medical confidentiality. G. CIVIL RIGHTS a. The LHD shall assure that no person, on the grounds of race, color, age, religion, sex, marital status, immigration status, national origin, or disability be excluded from participation in,be denied the benefits of, or be subjected to discrimination under any program or activity covered by this Agreement. b. The American with Disabilities Act 1990 (ADA) makes it unlawful to discriminate in employment against a qualified individual with a disability and outlaws discrimination against individuals with disabilities in State and local government services and public accommodations. The LHD certifies that it DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 15 of 27 and its principals and subcontractors will comply with regulations in ADA Title I(Employment), Title II (Public Services), and Title III (Public Accommodations) in fulfilling the obligations under this Agreement. c. As required by Title VI of the Civil Rights Act, the LHD, because it receives federal funds, must provide interpreter services at no charge to Limited English Proficiency clients in all programs and services offered by the LHD. H. LHD DISBURSEMENT OF FUNDS a. DPH shall disburse funds to the LHD on a monthly basis; monthly disbursements for each program Activity will be based on monthly expenditures reported. b. Total payment by program Activity is limited to the total amount listed on the Funding Authorization document and any Funding Authorization revision documents received after the initial notification. c. Final payments for the State Fiscal Year will be made based on the final monthly Expenditure Report which is due as delineated per the Controller's Office's Aid-to-Counties Payment Schedule. I. AMENDMENT OF AGREEMENT Amendments, modifications, or waivers of this Agreement may be made at any time by mutual consent of all parties. Amendments shall be in writing and signed by appropriate authorities. J. PROVISION OF TERMINATION a. Either party may terminate this Agreement for reasons other than non-compliance upon 60 days written notice. If termination occurs, the LHD shall receive payment only for allowable expenditures. b. In the event of termination, DPH may withhold payment to the LHD until DPH can determine whether the LHD is entitled to further payment or whether DPH is entitled to a refund. K. COMPLIANCE a. DPH shall respond to non-compliance with all terms of this Agreement as follows: I. Upon determination of non-compliance, DPH shall give the LHD 60 days written notice to come into compliance. If the deficiency is corrected, the LHD shall submit a written report to DPH that sets forth the corrective action taken. 2. If the above deficiency is not corrected to the satisfaction of DPH after the 60-day period, disbursement of funds for the particular activity may be temporarily suspended pending negotiation of a plan of corrective action. 3. If the deficiency is not corrected to the satisfaction of DPH within 90 days of the written notice in Section K.a.1, program funds may be permanently suspended until the LHD can provide evidence that the deficiency has been corrected. 4. In the event of the LHD's non-compliance with clauses of this Agreement, DPH may cancel, terminate, or suspend this Agreement in whole or in part and the LHD may be declared ineligible for further DPH contracts or agreements. Such terminations for non-compliance shall not occur until the provisions of Section K.a.I through K.a.3 have been followed, documented, and have failed to correct the deficiency. b. Monitoring—"Uniform Guidance" or"Omni-Circular"2 CFR Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F Audit Requirements requires that pass-through entities monitor the activities of their subcontractors as DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 16 of 27 necessary to ensure that federal awards are used for authorized purposes in compliance with laws, regulations and the provision of contracts or grant agreements and that performance goals are achieved. North Carolina establishes related monitoring requirements for State funds received by subrecipients in NCGS § 143C-6-23 State grant funds: administration; oversight and reporting requirements. Also, DPH must perform monitoring as required in the DHHS Policy and Procedure Manual entitled Monitoring of Programs dated August 1, 2002 and its DPH Subrecipient Monitoring Plan dated October 2016. Additionally, the LHD is required under 2 CFR, Part 200 Subpart F,NCGS § 143C-6-23, and NCGS § 159-34 Annual independent audit; rules and regulations, to perform monitoring of its subrecipients and to maintain records to support such monitoring activities and results. Accordingly, the LHD shall participate fully in monitoring by DPH and shall appropriately monitor its sub-recipients to the extent necessary based on the assessed level of risk. In witness whereof, the LHD and the Division of Public Health have executed this Agreement. Orange County Health Department North Carolina Department of Health and Human Services, DocuSi9ned by: Division of Public Health QUvUA.1n.A, S& vavt 3/16/2021 3C16F2D09E3445F... I ,1 an Services Director Date Division Director Date i✓lyk��ylc,t, 6tnalnkjt 3/15/2021 Finance O 0r Date N/A County Official Date (when locally required) DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 17 of 27 ATTACHMENT A LHD MAINTENANCE OF EFFORT SCHEDULE Local Health MOE Baseline Updated Baseline Local Health MOE Baseline Updated Baseline Department 1985 CPI * 2021-22 Department 1985 CPI *2021-22 Alamance 215,751 532,502 Jackson 11,822 29,178 Albemarle District 51,320 126,665 Johnston 196,475 484,926 Alexander 33,308 82,209 Jones 22,851 56,399 Anson 27,096 66,877 Lee 57,470 141,844 Appalachian District 56,663 139,852 Lenoir 120,667 297,822 Beaufort 63,029 155,564 Lincoln 78,475 193,687 Bladen 19,564 48,287 Macon 27,277 67,323 Brunswick 122,285 301,816 Madison 55,718 137,519 Buncombe 166,104 409,967 MTW District 97,748 241,255 Burke 83,689 206,556 Mecklenburg 375,712 927,307 Cabarrus 250,406 618,035 Montgomery 24,389 60,195 Caldwell 59,226 146,178 Moore 36,243 89,453 Carteret 16,843 41,571 Nash 124,412 307,065 Caswell 31,809 78,509 New Hanover 128,664 317,560 Catawba 127,542 314,791 Northampton 71,678 176,911 Chatham 50,121 123,705 Onslow 63,147 155,855 Cherokee 11,705 28,889 Orange 258,834 638,837 Clay 1,580 3,900 Pamlico 11,162 27,549 Cleveland 243,917 602,020 Pender 0 0 Columbus 85,858 211,909 Person_ 42,878 105,829 Craven 113,647 280,496 Pitt 164,404 405,771 Cumberland 458,294 1,131,131 Polk 6,189 15,275 Dare 22,597 55,772 Randolph 81,302 200,664 Davidson 100,199 247,304 Richmond 50,348 124,266 Davie 38,546 95,137 Robeson 225,422 556,371 Duplin 84,922 209,599 Rockingham 157,370 388,410 Durham 439,506 1,084,759 Rowan 178,268 439,989 Edgecombe 157,941 389,819 Sampson 37,229 91,886 Forsyth 508,138 1,254,152 Scotland 12,388 30,575 Foothills District 42,126 103,973 Stanly 23,625 58,310 Franklin 65,012 160,458 Stokes 41,687 102,889 Gaston 342,765 845,990 Surry 49,658 1221563 Graham 3,949 9,747 Swain 10,674 26,345 Granville-Vance 170,160 419,978 Toe River District 49,658 122,563 Greene 78,527 193,815 Transylvania 66,417 1631926 Guilford 1,605,509 3,962,610 Union 25,573 63,118 Halifax 118,024 291,299 Wake 758,321 1,871,637 Harnett 69,651 171,908 Warren 8,551 21,105 Haywood 82,684 204,075 Wayne 271,847 670,955 Henderson 109,750 270,878 Wilkes 73,909 182,417 Hoke 25,698 63,426 Wilson 59,617 147,143 Hyde 12,355 30,494 Yadkin 20,687 51,058 Iredell 36,698 90,576 TOTAL: $10,583,276 $26,120,943 Citation: 130A-4.1;Consolidated Agreement clause A.a.9. Notes: 'Adjusted for inflation,January 1985 through October 2020,based upon changes in Consumer Price Index(CPI).Adjustment factor equals 246.8133%.Reference for calculating CPI changes:https://www.bls.gov/data/inflation_calculator.htm DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 18 of 27 ATTACHMENT B BUSINESS ASSOCIATE ADDENDUM TO CONSOLIDATED AGREEMENT This Agreement is made effective July 1, 2021, by and between Orange County Health Department ("Covered Entity") and the North Carolina Department of Health and Human Services,Division of Public Health ("Business Associate") (collectively the "Parties"). 1. BACKGROUND a. Covered Entity and Business Associate are parties to a Memorandum of Understanding, entitled "FY 2022 Consolidated Agreement" (the "MOU"), whereby Business Associate agrees to perform certain services for or on behalf of Covered Entity. b. Covered Entity is an LHD in the State of North Carolina that has been designated in whole or in part by as a"covered entity" for purposes of the HIPAA Privacy Rule. c. The relationship between Covered Entity and Business Associate is such that the Parties believe Business Associate is or may be a"business associate"within the meaning of the HIPAA Privacy Rule. d. The Parties enter into this Business Associate Addendum to the MOU with the intention of complying with the HIPAA Privacy Rule provision that a covered entity may disclose protected health information to a business associate and may allow a business associate to create or receive protected heath information on its behalf, if the covered entity obtains satisfactory assurances that the business associate will appropriately safeguard the information. 2. DEFINITIONS Unless some other meaning is clearly indicated by the context, the following terms shall have the following meaning in this Agreement: a. "Electronic Protected Health Information" shall have the same meaning as the term"electronic protected health information" in 45 C.F.R. § 160.103. b. "HIPAA"means the Administrative Simplification Provisions, Sections 261 through 264, of the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as modified and amended by the Health Information Technology for Economic and Clinical Health ("HITECH") Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009, Public Law 111-5. c. "Individual" shall have the same meaning as the term "individual" in 45 C.F.R. § 160.103 and shall include a person who qualifies as a personal representative in accordance with 45 C.F.R. § 164.502(g). d. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 C.F.R. Part 160 and Part 164. e. "Protected Health Information" shall have the same meaning as the term "protected health information" in 45 C.F.R. § 160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity. f. "Required By Law" shall have the same meaning as the term"required by law" in 45 C.F.R. § 164.103. g. "Secretary" shall mean the Secretary of the United States Department of Health and Human Services or the person to whom the authority involved has been delegated. h. Unless otherwise defined in this Agreement, terms used herein shall have the same meaning as those terms have in the Privacy Rule. 3. OBLIGATIONS OF BUSINESS ASSOCIATE a. Business Associate agrees to not use or disclose Protected Health Information other than as permitted or required by this Agreement or as Required By Law. b. Business Associate agrees to use appropriate safeguards and comply, where applicable, with subpart C of 45 C.F.R. Part 164 with respect to electronic protected health information, to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 19 of 27 c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health Information by Business Associate in violation of the requirements of this Agreement. d. Business Associate agrees to report to Covered Entity any use or disclosure of the Protected Health Information not provided for by this Agreement of which it becomes aware, including breaches of unsecured protected health information as required by 45 C.F.R. § 164.410. e. Business Associate agrees, in accordance with 45 C.F.R. § 164.502(e)(1) and § 164.308(b)(2), to ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of Business Associate agree to the same restrictions and conditions that apply to Business Associate with respect to such information. f. Business Associate agrees to make available protected health information as necessary to satisfy Covered Entity's obligations in accordance with 45 C.F.R. § 164.524. g. Business Associate agrees to make available Protected Health Information for amendment and incorporate any amendment(s) to Protected Health Information in accordance with 45 C.F.R. § 164.526. h. Unless otherwise prohibited by law, Business Associate agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from or created or received by Business Associate on behalf of, Covered Entity available to the Secretary for purposes of the Secretary determining Covered Entity's compliance with the Privacy Rule. i. Business Associate agrees to make available the information required to provide an accounting of disclosures of Protected Health Information in accordance with 45 C.F.R. § 164.528. 4. PERMITTED USES AND DISCLOSURES a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the MOU permits, Business Associate may use or disclose Protected Health Information to perform functions, activities, or services for, or on behalf of, Covered Entity as specified in the MOU, provided that such use or disclosure: 1) would not violate the Privacy Rule if done by Covered Entity; or 2) would not violate the minimum necessary policies and procedures of the Covered Entity. b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the MOU permits, Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate,provided that: 1) the disclosures are Required By Law; or 2) Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and will be used or further disclosed only as Required By Law or for the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached. c. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the MOU permits, Business Associate may use Protected Health Information to provide data aggregation services to Covered Entity as permitted by 45 C.F.R. § 164.504(e)(2)(i)(B). d. Notwithstanding the foregoing provisions, Business Associate may not use or disclose Protected Health Information if the use or disclosure would violate any term of the MOU or other applicable law or agreements. 5. TERM AND TERMINATION a. Term. This Agreement shall be effective as of the effective date stated above and shall terminate when the MOU terminates. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 20 of 27 b. Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity may, at its option: 1) Provide an opportunity for Business Associate to cure the breach or end the violation, and terminate this Agreement and services provided by Business Associate, to the extent permissible by law, if Business Associate does not cure the breach or end the violation within the time specified by Covered Entity; 2) Immediately terminate this Agreement and services provided by Business Associate, to the extent permissible by law; or 3) If neither termination nor cure is feasible, report the violation to the Secretary as provided in the Privacy Rule. c. Effect of Termination. 1) Except as provided in paragraph(2) of this section or in the MOU or by other applicable law or agreements, upon termination of this Agreement and services provided by Business Associate, for any reason, Business Associate shall return or destroy all Protected Health Information received from Covered Entity or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information. 2) In the event that Business Associate determines that returning or destroying the Protected Health Information is not feasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction not feasible. Business Associate shall extend the protections of this Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information. 6. GENERAL TERMS AND CONDITIONS a. This Agreement amends and is part of the MOU. b. Except as provided in this Agreement, all terms and conditions of the MOU shall remain in force and shall apply to this Agreement as if set forth fully herein. c. In the event of a conflict in terms between this Agreement and the MOU, the interpretation that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then remains, the MOU terms shall prevail so long as they are in accordance with the Privacy Rule. d. A breach of this Agreement by Business Associate shall be considered sufficient basis for Covered Entity to terminate the MOU for cause. Orange County Health Department North Carolina Department of Health and Human Services, Division of Public Health DocuSigned by: ak11 A.I.A. S&Woy'f 3/16/2021 --------------- Health or Human Services Director Date Division Director Date DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 21 of 27 ATTACHMENT C FEDERAL CERTIFICATIONS The undersigned states that: 1. He or she is the duly authorized representative of the Contractor named below; 2. 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 e. The Certification Regarding Lobbying; 3. He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the addresses at which the contract work will be performed; 4. [Check the applicable statement] ❑ 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 © 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. 5. The Contractor shall require its subcontractors, if any, to make the same certifications and disclosure. DocuSigned by: Q 04A.�t.OI. 9w ayf orange county Health Director Signature Title Orange County Health Department 3/16/2021 Contractor [Organization] Legal Name Date [This Certification must be signed by a representative of the Contractor who is authorized to sign contracts.] 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 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended(42 U.S.C. §§6101-6107),which prohibits discrimination on the basis of age; (e)the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended,relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g)Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended,relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and(i) the requirements of any other nondiscrimination statutes which may apply to this Agreement. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 22 of 27 IL 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor's policy of maintaining a drug-free workplace; (3) Any available drug counseling,rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; c. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph (a); d. Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the agreement, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; e. Notifying the LHD within ten days after receiving notice under subparagraph (d)(2) from an employee or otherwise receiving actual notice of such conviction; f. Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2), with respect to any employee who is so convicted: (1) taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and 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): Street Address No. 1: 300 West Tryon Street City, State, Zip code: Hillsborough, NC 27278 Street Address No. 2: 2501 Homestead Road City, State,Zip Code: Chapel Hill, NC 27516 see final page for address#3 3. Contractor will inform the LHD of any additional sites for performance of work under this agreement. 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. III. 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 DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 23 of 27 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 LHD 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 LHD or agency with which this transaction originated. 6. 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--Lower Tier Covered Transaction,"without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may,but is not required to,check the Non-procurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 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 LHD or agency with which this transaction originated may pursue available remedies, including suspension, and/or debarment. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 24 of 27 Certification a. 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. b. 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 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. VI.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. 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 subaward 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. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 25 of 27 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 application/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 officer(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. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 26 of 27 Disclosure of Lobbying Activities (Approved by OMB 0348-0046) Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ❑ a. contract ❑ a. Bid/offer/application ❑ 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: 5. If Reporting Entity in No.4 is Subawardee, Enter Name ❑ Prime and Address of Prime: ❑ Subawardee Tier (if known) Congressional District if known Congressional District if known 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number(if applicable) 8. Federal Action Number(if known) 9. Award Amount(if known) : 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individual, last name, first name, Ml): different from No. 10a.)(last name, first name, Ml): attach Continuation Sheets SF-LLL-A, if necessary) attach Continuation Sheets SF-LLL-A, if necessary) 11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply): $ u actual a 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-kind; 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, if necessary): 15. Continuation Sheet(s)SF-LLL-A attached: ❑ Yes ❑ No 16. Information requested through this form is authorized by title 31 U. S. C. section 1352.This disclosure of lobbying Signature: activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Print Name: was made or entered into. This disclosure is required pursuant to 31 U. S. C. 1352.This information will be Title: reported to the Congress semi-annually and will be available for public inspection.Any person who fails to file Telephone No: Date: 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. Federal Use Only Authorized for Local Reproduction Standard Form -LLL 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 DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 Consolidated Agreement FY22 Page 27 of 27 ATTACHMENT D STATE CERTIFICATIONS Contractor Certifications Required by North Carolina Law Instructions:The person who signs this document should read the text of the statutes and Executive Order listed below and consult with counsel and other knowledgeable persons before signing.The text of each North Carolina General Statutes and of the Executive Order can be found online at: • Article 2 of Chapter 64: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFByArticle/Chapter_64/Article_2.pdf • G.S. 133-32: http://www.ncga.state.nc.us/gascripts/statutes/statutelookup.pl?statute=133-32 • Executive Order No.24(Perdue,Gov.,Oct. 1,2009): http://www.ethicscommission.nc.gov/library/Pdfs/Laws/E024.pdf • G.S. 105-164.8(b): http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chapter_105/GS_105-164.8.pdf • G.S. 143-48.5: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter 143/GS_143-48.5.html • G.S. 143-59.1: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chapter_143/GS_143-59.l.pdf • G.S. 143-59.2: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chapter_143/GS_143-59.2.pdf • G.S. 143-133.3: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter 143/GS_143-133.3.html • G.S. 143B-139.6C: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chapter_143B/GS_143B-139.6C.pdf Certifications (1) Pursuant to G.S. 133-32 and Executive Order No. 24 country"as set forth in G.S. 143-59.1(c)(2)after (Perdue, Gov., Oct. 1, 2009), the undersigned hereby December 31, 2001 but the United States is not certifies that the Contractor named below is in the principal market for the public trading of the compliance with, and has not violated,the provisions of stock of the corporation incorporated in the tax either said statute or Executive Order. haven country. (2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby undersigned hereby certifies that the Contractor named certifies that none of the Contractor's officers,directors, below, and the Contractor's subcontractors, complies or owners (if the Contractor is an unincorporated with the requirements of Article 2 of Chapter 64 of the business entity) has been convicted of any violation of NC General Statutes,including the requirement for each Chapter 78A of the General Statutes or the Securities Act employer with more than 25 employees in North of 1933 or the Securities Exchange Act of 1934 within Carolina to verify the work authorization of its 10 years immediately prior to the date of the bid employees through the federal E-Verify system." E- solicitation. Verify System Link: www.uscis.gov (5) Pursuant to G.S.143B-139.6C,the undersigned hereby (3) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor will not use a former certifies that the Contractor named below is not an employee,as defined by G.S. 143B-139.6C(d)(2), of the "ineligible Contractor" as set forth in G.S. 143-59.1(a) North Carolina Department of Health and Human because: Services in the administration of a contract with the (a) Neither the Contractor nor any of its affiliates has Department in violation of G.S. 143B-139.6C and that a refused to collect the use tax levied under Article 5 violation of that statute shall void the Agreement. of Chapter 105 of the General Statutes on its sales (6) The undersigned hereby certifies further that: delivered to North Carolina when the sales met one (a) He or she is a duly authorized representative of the or more of the conditions of G.S. 105-164.8(b);and Contractor named below; (b) [check one of the following boxes] (b) He or she is authorized to make, and does hereby ❑ Neither the Contractor nor any of its affiliates make, the foregoing certifications on behalf of the has incorporated or reincorporated in a "tax Contractor; and haven country" as set forth in G.S. 143- (c) He or she understands that any person who 59.1(c)(2)after December 31,2001; or knowingly submits a false certification in response ❑ The Contractor or one of its affiliates has to the requirements of G.S. 143-59.1and -59.2 shall incorporated or reincorporated in a"tax haven be guilty of a Class I felony. Contractor's Name: Orange County Health Department DocuSigned by: Contractor's 3/16/2 021 Authorized Agent: Signature Date 30uirita aFStewart Orange County Health Department Printed Name D-oe S-g'�Je-d-by Title Witness: Signature txi,�rw.t,, Date 3/15/2021 Kimberlee Quatrone BE77D91B9275412... Printed Name Title Business Officer The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately thereafter. DocuSign Envelope ID:B749018F-351A-4D6F-9FC5-C2EB21856524 II. Certification Regarding Drug-Free Workplace Requirements 2. The sites for the performance of work done in connection with the specific agreement are listed below: Street Address No. 3: 131 West Margaret Lane Hillsborough, NC 27278