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HomeMy WebLinkAbout2021-180-E Housing-NC DHHS Emergency Solutions Grant contract amendment DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 1 of 22 AMENDMENT This Agreement amends the contract bearing the effective date of 7/29/2020 between the North Carolina Department of Health and Human Services, Division of Aging and Adult Services, hereinafter referred to as the "Division" and Orange County, hereinafter referred to as the "Contractor." This Amendment is hereby effective on 2/17/2021. As provided for under the terms of this contract, the Division and the Contractor agree to amend the following contract provisions: 1. Reference "Effective Period": The termination date of 6/30/2022 has not changed 2. Reference "Contractor's Duties": The Contractor shall provide the amended services as described in the scope of work. 3. Reference "Division's Duties": The total amount paid by the Division to the Contractor is being increased by$303,365 from $341,633 to $644,998. This amended amount consists of$0 in State funds, $0 in Local funds, $0 in Other funds and $303,365 in Federal funds. The Contractor's matching requirement for this amendment is $0. The total contractor's matching amount is $0. The total amendment amount is $303,365. The total contract amount is $644,998. Other Requirements: The Emergency Solutions Grant program or ESG is a HUD funded program that the department has supported and administered for several years. ESG-CV funding is the result of funds made available to HUD and passed to the states for distribution to qualified sub-recipient organizations. Funds are reimbursed to the sub-recipient monthly upon receipt of a request for reimbursement and supporting documents describing how funds were used. Each contract is monitored by both on-site visit (20% of caseload each year) and by desk review (100% of the caseload each quarter) Sub-recipient- Orange County DUNS Number-091575191 Federal Award — E20DW37001 Award Date—9/2/2020 Performance Period —July 29, 2020 - June 30, 2022 Total Amount Obligated —$644,998 Sub-recipient Total —$644,998 Total Federal Award -$54,371,314 Project Description - HUD Emergency Solutions Grant Funding to address COVID-19 Funding Agency- US Department of Housing and Urban Development CFDA# 14.231 NCDHHS ACT2007 (Amendment Template) (Rev. 11.01.15) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 2 of 22 CFDA Emergency Solutions Grant R&D - No Federal Award Indirect Cost Rate -0% All other terms and conditions as set forth in the original contract document shall remain in effect for the duration of this Agreement. Signatures follow on next page NCDHHS ACT2007 (Amendment Template) (Rev. 11.01.15) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 3 of 22 In Witness Whereof, the Contractor and the Division have executed this contract in duplicate originals, with one original being retained by each party. Orange County F�b ocuSigned by: lA AAu (�A.t mtrsbj 3/22/2021 Signature Date Bonnie B. Hammersley County Manager Printed Name Title WITNESS DocuSigned by: 3/24/2021 FPGBG8A92GG124!! �^�a �wt,St,ln Signature Date Laura 3ensen Clerk to the Board Printed Name Title Division of Aging and Adult Services, North Carolina Department of Health and Human Services Signature Date Joyce Massey-Smith Director Printed Name Title NCDHHS ACT2007 (Amendment Template) (Rev. 11.01.15) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 4 of 22 SCOPE OF WORK BACKGROUND The NC ESG program is a reimbursable grant program established by the McKinney-Vento Homeless Assistance Act(Public Law 100-77, Public Law 100-628) as amended by the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (HEARTH Act). The HEARTH Act authorized the Emergency Solutions Grant (ESG) Program for providing assistance to persons and families who are homeless or at risk of homelessness. These programs and services are carried out by community organizations that apply for, and are awarded, NC ESG funds on an annual basis. These funds are a formula grant appropriated by Congress to the United States Department of Housing and Urban Development with the intention to: (1)engage homeless individuals and families living on the street; (2) improve the number and quality of emergency shelters for homeless individuals and families; (3) help operate these shelters; (4) provide essential services to shelter residents, (5) rapidly re-house homeless individuals and families, and (6) prevent families and individuals from becoming homeless. NC ESG funds are intended to be used as part of a crisis response system using a low barrier, housing-focused approach to ensure that homelessness is rare, brief, and non-recurring. PURPOSE The purpose of this is: • ESG funds are intended to be used as part of a crisis response system using a low barrier, housing-focused approach to ensure that homelessness is "rare, brief, and one time"; • Engage homeless individuals and families living on the street; • Improve the number and quality of emergency shelters for homeless individuals and families; • Help operate emergency shelters; • Provide essential services to emergency shelter residents; • Rapidly re-house homeless individuals and families; • Prevent families and individuals from becoming homeless. Services to be provided: • RRH Financial Assistance: Rapid Re-housing financial services are used to assist individuals with rental assistance along with the payment of allowable financial assistance to avoid homelessness. • RRH Services: Rapid Re-housing is a service provided to rapidly re-house individuals who are homeless or at risk of becoming homeless. Funds can be used both for financial services and case management. PERFORMANCE REQUIREMENTS Reimbursement submission must be accurate to ensure both timely service provision and reimbursement. Incorrect submissions delay and effect spending. All requisitions incorrect or incomplete will be returned for correction and will not be submitted for payment until corrects are received. Requisitions must be submitted monthly and within 45 days of the expenditure disbursing ESG funds per HUD regulation. Program compliance with both HUD Scope of Work (Rev. 06/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 5 of 22 and State regulation must be followed as a condition of continued funding. Failure to stay in compliance and/or to develop a corrective action plan as a result of findings deriving from a monitoring review may result in loss of funding PERFORMANCE STANDARDS Monitoring by the ESG office will yield 10% or less in the findings/categories in cumulative records reviewed. Actual compliance rate will be no less than 80% in all measure requirements. PERFORMANCE MONITORING/QUALITY ASSURANCE PLAN All programs are monitored once per quarter and receive a desk review. On-site or virtual monitoring will take place yearly with 20% of the caseload minimum receiving monitoring visits. Monitoring visits are also completed when sub-recipients are having continued concerns or receive a finding in the past year. REIMBURSEMENTS Sub-recipients complete the reimbursement request, the ESG staff checks the reimbursement for accuracy and that it includes all necessary back-up documentation. Reimbursements are then submitted to the DAAS budget office for further review and lastly, they are submitted to the Office of the Controller for request for payment from HUD. Sub- recipients receive payments directly. Scope of Work (Rev. 06/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 6 of 22 PERFORMANCE MEASURES CHART The Department of Health and Human Services uses performance measures rubrics as a tool to determine the success of a project and how well services and products are being delivered. Together they enable the Department to gauge efficiency, determine progress toward desired results and assess whether the Department is on track with meeting its goals. The contractor shall adhere to all of the performance requirements/standards in the scope of work, including performance measures in the performance measures chart below. Measure Input Reporting Quarterly Type Frequency Measure All subrecipients must submit 1 requisition per month within the 45-day submission period with a minimum of 1 requisition leading to a disbursement of CV funds. Budget Year 2 Trend Maintain Baseline $322,499 Value Target Value 100% of the allocation by the end of the contract period Data Source fiscal data monitoring and requests for reimbursement Collection reimbursement submission Process and Calculation Collection monthly Frequency Budget Year 1 Trend Maintain Baseline $322,499 Value Target Value 100% of the allocation by the end of the contract period Data Source fiscal data monitoring and requests for reimbursement Collection reimbursement submission Process and Calculation Collection monthly Frequency Performance Measures (Rev. 4//12) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 7 of 22 Measure Output Reporting Monthly Type Frequency Measure 80% of requisitions submitted were correctly submitted Budget Year 2 Trend Maintain Baseline 0 Value Target Value 80% of submissions Data Source fiscal data monitoring Collection reimbursement submission Process and Calculation Collection monthly Frequency Budget Year 1 Trend Maintain Baseline 0 Value Target Value 80% of submissions Data Source fiscal data monitoring Collection reimbursement submission Process and Calculation Collection monthly Frequency Measure Outcome Reporting Annual Type Frequency Measure Program Compliance-On-site or virtual desk monitoring by the ESG office yields 10% or less findings/concerns in cumulative records reviewed. Budget Year 2 Trend Increase Performance Measures (Rev. 4//12) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 8 of 22 Baseline 0 Value Target Value 100% Data Source electronic submission and file submission Collection onsite, virtual and/or desk monitoring Process and Calculation Collection Monthly and quarterly Frequency Budget Year 1 Trend Increase Baseline 0 Value Target Value 100% Data Source electronic submission and file submission Collection onsite, virtual and/or desk monitoring Process and Calculation Collection Monthly and quarterly Frequency Performance Measures (Rev. 4//12) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 9 of 22 LINE ITEM BUDGET This begins the line item budget for year 1 Budget Detail -Year 1 Category Item Narrative Original Amount Change Amount Final Amount Salary\Wages $0.00 $0.00 $0.00 Fringe Benefits $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 Repair and Maintenance $0.00 $0.00 $0.00 Staff Development $0.00 $0.00 $0.00 Dues and Subscriptions $0.00 $0.00 $0.00 Operational Other Not RRH Financial Assistance $0.00 $86,868.00 $86,868.00 Otherwise Classified Rapid Re-housing financial services are used to assist individuals with rental assistance along with the payment of allowable financial assistance to avoid homelessness. Operational Other Not $128,113.00 $0.00 $128,113.00 Otherwise Line Item Budget Detail (08/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 10 of 22 Budget Detail -Year 1 Category Item Narrative Original Amount Change Amount Final Amount Classified Operational Other Not $42,704.00 $51,025.00 $93,729.00 Otherwise Classified Operational Other Not Admin $0.00 $13,789.00 $13,789.00 Otherwise Classified Subcontracts and Grants $0.00 $0.00 $0.00 Match $0.00 $0.00 $0.00 Cost Per Service $0.00 $0.00 $0.00 Sub Total $170,817.00 $151,682.00 $322,499.00 Indirect Cost $0.00 $0.00 $0.00 Total Budget $170,817.00 $151,682.00 $322,499.00 Subcontracting and Grants Budget Detail -Year 1 Category Item Narrative Original Amount Change Amount Final Amount $0.00 $0.00 $0.00 Line Item Budget Detail (08/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 11 of 22 Subcontracting and Grants Budget Detail -Year 1 Category Item Narrative Original Amount Change Amount Final Amount Sub Total $0.00 $0.00 $0.00 Salaries -Year 1 Persons Position or Title Annual Salary Hourly Months Work% Fringe Fringe Total Rate Amount Total Percent Total 0 $0.00 0.0000 0 0% $0.00 $0.00 $0.00 Line Item Budget Detail (08/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 12 of 22 This begins the line item budget for year 2 Budget Detail -Year 2 Category Item Narrative Original Amount Change Amount Final Amount Salary\Wages $0.00 $0.00 $0.00 Fringe Benefits $0.00 $0.00 $0.00 Other $0.00 $0.00 $0.00 Repair and Maintenance $0.00 $0.00 $0.00 Staff Development $0.00 $0.00 $0.00 Dues and Subscriptions $0.00 $0.00 $0.00 Operational Other Not RRH Financial Assistance $0.00 $86,868.00 $86,868.00 Otherwise Classified Rapid Re-housing financial services are used to assist individuals with rental assistance along with the payment of allowable financial assistance to avoid homelessness. Operational Other Not Admin $0.00 $13,790.00 $13,790.00 Otherwise Classified Line Item Budget Detail (08/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 13 of 22 Budget Detail -Year 2 Category Item Narrative Original Amount Change Amount Final Amount Operational Other Not $42,704.00 $51,025.00 $93,729.00 Otherwise Classified Operational Other Not $128,112.00 $0.00 $128,112.00 Otherwise Classified Subcontracts and Grants $0.00 $0.00 $0.00 Match $0.00 $0.00 $0.00 Cost Per Service $0.00 $0.00 $0.00 Sub Total $170,816.00 $151,683.00 $322,499.00 Indirect Cost $0.00 $0.00 $0.00 Total Budget $170,816.00 $151,683.00 $322,499.00 Subcontracting and Grants Budget Detail -Year 2 Category Item Narrative Original Amount Change Amount Final Amount $0.00 $0.00 $0.00 Sub Total $0.00 $0.00 $0.00 Line Item Budget Detail (08/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 Contract Number 00041435, Amendment Number 1 / Page 14 of 22 Salaries -Year 2 Persons Position or Title Annual Salary Hourly Months Work% Fringe Fringe Total Rate Amount Total Percent Total 0 $0.00 0.0000 0 0% $0.00 $0.00 $0.00 Line Item Budget Detail (08/11) DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope ID:6663A826-96F2-42AC-9318-450ABE98CC55 Contract Number 00041435, Amendment Number 1 / Page 15 of 22 FEDERAL CERTIFICATIONS The undersigned states that: a) He or she is the duly authorized representative of the Contractor named below; b) He or she is authorized to make,and does hereby make,the following certifications on behalf of the Contractor, as set out herein: a. The Certification Regarding Nondiscrimination; b. The Certification Regarding Drug-Free Workplace Requirements; c. The Certification Regarding Environmental Tobacco Smoke; d. The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and e. The Certification Regarding Lobbying; c) He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the addresses at which the contract work will be performed; d) [Check the applicable state dent.] [ ] 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 lV1 He or she has not completed the attached Disclosure Of Lobbying Activities because the Contractor has not made, and has no agreement to make, any payment to any lobbying entity for influencing or attempting to influence any officer or employee of any agency, any Member of Congress, any officer or employee of Congress, or any employee of a Member of Congress in connection with a covered Federal action. e) The Contractor shall require its subcontractors, if any, to make the same certifications and disclosure. €aocusigned by: county Manager Slg n. 794.4605N77.. T Itle , ,ofihle �rn.mprs.ey`. .. Januar 4, 2021 Contrac#or Name Qat.` [This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page] I. Certification Regarding Nondiscrimination The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L, 88-352)which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 604 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794),which prohibits discrimination on the basis of handicaps, (d)the Age Discrimination Act of 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 Vlll 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. 5 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope ID:B663A826-96F2-42AC-9318-450A8E98CC55 Contract Number 00041435, Amendment Number 1 / Page 16 of 22 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: i. The dangers of drug abuse in the workplace; ii. The Contractor's policy of maintaining a drug-free workplace; iii. Any available drug counseling, rehabilitation, and employee assistance programs; and iv. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; c. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph (a); d. Notifying the employee in the statement required by paragraph(a)that, as a condition of employment under the agreement, the employee will: i. Abide by the terns of the statement; and ii. Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; e. Notifying the Department within ten days after receiving notice under subparagraph(d)(ii)from an employee or otherwise receiving actual notice of such conviction; f. Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(ii), with respect to any employee who is so convicted: i. Taking appropriate personnel action against such an employee, up to and including termination; or ii. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and g. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f). 2. The sites for the performance of work done in connection with the specific agreement are listed below (list all sites; add additional pages if necessary): Address Street City, State, zE .O. cl4 HlIIsdofgUBh,WG,27278 street City, State,dip Coda 3. Contractor will inform the Department 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. Ill. Certification Regarding Environmental Tobacco Smoke Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law does not apply to children's services 6 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope ID:B663A826-96F2-42AC-931B-450A8E98CC55 Contract Number 00041435, Amendment Number 1 / Page 17 of 22 provided in private residences,facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol treatment. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to$1,000,00 per day and/or the imposition of an administrative compliance order on the responsible entity. The Contractor certifies that it will comply with the requirements of the Act. The Contractor further agrees that it will require the language of this certification be included in any subawards that contain provisions for children`s services and that all subgrantees shall certify accordingly. IV. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions Instructions [The phrase "prospective lower tier participant"means the Contractor.] I. By signing and submitting this document, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of the fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originate may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant will provide immediate written notice to the person to whom this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,""person,""primary covered transaction,""principal,""proposal,"and"voluntarily excluded,"as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 CFR Part 76. You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those regulations. S. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is debarred, suspended,determined ineligible or voluntarily excluded from participation in this covered transaction unless authorized by the department or agency with which this transaction originated. 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 Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized in paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension, and/or debarment. 7 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope ID:B663A826-96F2-42AC-9318-45DA8E98CC55 Contract Number 00041435, Amendment Number 1 / Page 18 of 22 Certification 1. The prospective lower tier participant certifies, by submission of this document, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification,such prospective participant shall attach an explanation to this proposal. V. Certification Regarding Lobbying The Contractor certifies, to the best of his or her knowledge and belief,that: 1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress,or an employee of a Member of Congress in connection with this Federally funded contract,grant, loan,or cooperative agreement,the undersigned shall complete and submit Standard Form SF-LLL,"Disclosure of Lobbying Activities," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award document for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) who receive federal funds of $100,000.00 or more and that all subrecipients shall certify and disclose accordingly. 4. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who 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 8 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope ID:B663A826-96F2-42AC-9318-450A8E98CC55 Contract Number 00041435, Amendment Number 1 / Page 19 of 22 prime or sub-award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 5. If the organization filing the report in Item 4 checks"Subawardee", then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard. 7. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 8. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e.g., Request for Proposal(RFP)number, Invitation for Bid (IFB) number, grant announcement number,the contract grant, or loan award number,the 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. 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 9 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope ID:B663A826-96F2-42AC-9318-45oA8E98CC55 Contract Number 00041435, Amendment Number 1 / Page 20 of 22 Disclosure Of Lobbying Activities (Approved by OMB 0344-0046) Complete this form to diulose lobbying actiVitle0 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 and Address of Prime: ❑ 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 Entity b. Individuals Performing Services(including address if different (if individual, last name, first name, MI): from No. 1Oa.) (last name, first name, MI): (attach Continuation Sheet(s)SF-LLL-A,if necessary) (attach Continuation Sheet(s)SF-LLL-A,if necessary) 11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply): $ € actual€ planned ❑ a. retainer ❑ b, one-time fee 12. Form of Payment(check all that apply): ❑ c. commission ❑ d. contingent fee ❑ a. cash ❑ e. deferred ❑ b. In-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 Signature: title 31 U. S. C.section 1352. This disclosure of lobbying activities is a material representation of fact upon which Print Name: reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required Title: pursuant to 31 U. S. C. 1352. This information will be reported to the Congress semi-annually and will be Telephone No: Date: available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than$100,000 for each such failure. LIM pf1 4, t r Authorized for Local Reproduction Standard Form LLL 10 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope ID:B663A826-96F2-42AC-9318-450A8E98CC55 Contract Number 00041435, Amendment Number 1 / Page 21 of 22 State Certifications Contractor Certifications Required by North Carolina Law Instructions The person who signs this document should read the text of the statutes listed below and consult with counsel and other knowledgeable persons before signing.The text of each North Carolina General Statutes can be found online at: • Article 2 of Chapter 64: http://www.ncga.state.no.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article 2.pdf • G.S. 105-164.8(b): hitp://www.ncga.state.ne.us/EnactedLegislation/StatiitestPDF/BySection/Chapter 105/GS_105-164.8.pdf • G.S. 143-48.5: htt ://www.nc a.state.nc.us/EnactedLe islation/Statutes/HTMLB Section/Cho ter 143/GS 143-48.5.html • G.S. 143-59.1: http://www.ncga.state.tic.us/EnactedLegislation/Statutes/PDF/BySectioii/Chapter_143/GS_143-59.1.pdf • G.S. 143-59.2: ltttp://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59.2.pdf • G.S. 147-33.95(g): http://www.nega.state,ne,its/EnactedLegislation/Statutes/HTML/BySection/Chapter_147/GS_147-33.95.html Certifications (1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g),the undersigned hereby certifies that the Contractor named below,and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its employees through the federal E-Verify system."E-Verify System Link:www.uscis.gov (2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below is not an "ineligible Contractor"as set forth in G.S. 143-59.1(a)because: (a) Neither the Contractor not,any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b);and {�) jcYiecic nne 9£the following boxes] Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a"tax haven country" as set forth in G.S. 143-59.1(c)(2)after December 31,2001;or ❑ The Contractor or one of its affiliates has incorporated or reincorporated in a"tax haven country"as set forth in G.S. 143-59.1(e)(2)after December 31,2001 but the United States is not the principal market for the public trading of the stock of the corporation incorporated in the tax haven country. (3) Pursuant to G.S. 143-59.2(b),the undersigned hereby certifies that none of the Contractor's officers,directors,or owners(if the Contractor is an unincorporated business entity)has been convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. (4) The undersigned hereby certifies further that: a) He or she is a duly authorized representative of the Contractor named below; b) He or she is authorized to make, and does hereby make,the foregoing certifications on behalf of the Contractor; and c) He or she understands that any person who knowingly submits a false certification in response to the requirements of G.S. 143-59.land-59.2 shall be guilty of a Class I felony. The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately thereafter. Bonnie Hammersley Contractor s Nine DocuSigned by: 1/4/21 11/18/2020 Sig a ' a A.tt1horized Agent Date ©428075CF42E417... Emila Sutton Housing&Community Development Director to4` IIE'' P Contractor's Authorized Ag�n1 Title 11/20/2020 1/4/21 ftnittire'o;, .11=i Date Greg Wilder Erika Brandt Interim County Clerk Housing & Comm. Development Manager 1'r111ted.14aine o Wllness Tiff The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately therealier. 71 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 DocuSign Envelope 1D:6663A826-SSF2-42AC 9318 450A8E88CC56 Contract Number 00041435, Amendment Number 1 / Page 22 of 22 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: State ESQ Office Party/Vendor Contact Person: Lisa Worth Contact Phone: 919 855-4993 Party/Vendor Address: 2101 Mail Service Center City Raleigh State:NC Zip:27699 Department: OCHCD Amount:no buddizet implications-certifications needed for grant award Purpose: ESG F -2l B5i dget Code(s): NIA Vendor #N/A W/A if new Je dor) Vendor is a]BOCC consultant? Yes No&ontract Type heck one)New Renewal Amendment Effective Date 11/18/20 Approved by Board Yes No Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: DOcuSlgned by: '.. 11/18/2020 Department Director's Signature D42e0 76CF42E4D7... Date: Agreements for emergency services or repair are not subject to the above affirmation.If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologic (Applicable only to harclivare/sofnvare purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency ofz ' 11ARmt idards,specifications,and requirements: Office of the Risk Management Officer a "-ray" 11192020 Date: / / Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: L A.-I&Io r d by: Office of the Chief Financla1 Officer Date: 11/19/2020 Legal Services This agreement is approved as to legal form and sufficiency: Docusigned by: 11/19/2020 Office of the County Attorney Date: 070MP525COWB.- Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync•gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 07/20 9 DocuSign Envelope ID:6BA9D3D1-719B-42F7-A645-83C9267F2082 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: State ESG Office Party/Vendor Contact Person:Lisa Worth Contact Phone: (919)-855-4993 Party/Vendor Address: 2101 Mail Service Center City Raleigh State: NC Zip: 27699 Department: OCHCD Amount: $303,365 Purpose: Rapid Re-Housing (RRH) Financial Assistance;Housing Stability Case Manager 1 FTE and Coordinated Entry Prevention/Diversion.5 FTE Budget Code(s): 32470605-4412 -9$000 Vendor#_ (N/A if nevE3endor) aendor is a BOCC consultant? Yes No ContrE Tyge (Check one)New Renewal ®Amendment Effective Date 4/l/2021 Approved by Board Yes No Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: DocuSigned by: 1� `�Wtl�G1 SWlbv, 3/22/2021 Department Director's Signature D42B075CF42E4D7... Date: Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency ®mW!wecWnndards,specifications,and requirements: LaUS& rbvvu lib 3/22/2021 Office of the Risk Management Officer 7PQrPQ176AQWQQ Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: DocuSigned by: rq� �" `n 3/22/2021 Office of the Chief Financial Officer ,D4F51A1Arr.14M Date: Legal Services This agreement is approved as to sufficiency: Qkku� Auril, 'No 3/22/2021 Office of the County Attorney Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Revised 07/20 9