HomeMy WebLinkAbout2021-206-E- NC DEPT OF HEALTH & HUMAN SERVICES-To prevent teen pregency DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 1 of 26
GENERAL CONTRACT COVER
This contract is hereby entered into by and between the North Carolina Department of Health and
Human Services, Division of Public Health (the"Division")and Orange County Department of
Social Services (the"Contractor")(referred to collectively as the"Parties").
1. Contract Documents:
This contract consists of the following documents,which are incorporated herein by reference:
(a) This contract cover
(b) The General Terms and Conditions
(c) Scope of Work
(d) Performance Measures Chart
(e) The Line Item Budget
(f) State Certification
Incorporated By Reference
The following documents are reference materials and are available by going to the following
website, Open Window
(hftp://dhhsopenwindow.nc.aov/index.asr)x?pid=doc ReferenceDocuments).
(a) Travel: Policies Governing Travel Related Expenses for Contractors
(b) General Statutes G.S.143C6 NonState Entities Receiving State Funds
(c) Subchapter 03M Uniform Administration of State Grants
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
2. Precedence Among Contract Documents:
In the event of a conflict between or among the terms of the Contract Documents,the terms in the
Contract Document with the highest relative precedence shall prevail. The order of precedence
shall be the order of documents as listed in the contract document section,with the first-listed
document having the highest precedence and the last-listed document having the lowest
precedence. If there are multiple contract amendments,the most recent amendment shall have
the highest precedence and the oldest amendment shall have the lowest precedence.
3. Effective Period:
This contract shall be effective on 6/1/2021 and shall terminate on 5/31/2022,with the option to
extend, if mutually agreed upon, through a written amendment as provided for in the General
Terms and Conditions.
4. Contractor's Duties:
The Contractor shall provide the services as described in the scope of work and in accordance
with the approved budget.
5. Division's Duties:
The Division shall pay the Contractor in the manner and in the amounts specified in the contract
documents. The total amount paid by the Division to the Contractor under this contract shall not
exceed$75,000. This amount consists of$75,000 in State funds, $0 in Local funds, $0 in Other
funds and$0 in Federal funds.
The Contractor's matching requirement is$25,000.
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount is$100,000.
NCDHHS GCT1007 (Contract)(General) (Rev. 11.01.15)
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6. Conflict of Interest Policy:
The division has determined that this contract is not subject to N.C.G.S. 143C-6-22&23.
7. Reversion of Unexpended Funds:
Any unexpended grant funds shall revert to the Division upon termination of this contract.
8. Grants:
The Contractor/Grantee has the responsibility to ensure that all sub-grantees, if any, provide all
information necessary to permit the Contractor/Grantee to comply with the standards set forth in
this contract.
9. Reporting Requirements:
The Division has determined that this is a contract for financial assistance with a Public Entity.
Local governmental agencies subject to N.C.G.S. § 159-34, annual independent audit; rules and
regulations, OMB Uniform Guidance 2 CFR Part 200, and N.C.G.S. § 143C-6-22, use of state
funds by non state entities. If subgranting is allowable, a nongovernmental subgrantee is subject
to the reporting requirements described in Uniform Administration of State Awards of Financial
Assistance at 09 NCAC 03M.0205.
10. Payment Provisions:
Upon execution of this contract,the Contractor shall submit to the Division contract administrator,
a monthly reimbursement request for services rendered the previous month by the 10th of each
month and, upon approval by the Division, receive payment within 30 days.The Division must
make all payments to the Contractor by June 30.Therefore, the Contractor shall submit any
adjusted reimbursement request for services,the final request for reimbursement and return any
unearned funds, relating to this contract period,to the Division no later than June 10 of the
current state fiscal year. The Division shall have no obligation for payment of reimbursement
request received later than June 10. If this contract is terminated prior to the original end date,the
Contractor is required to submit a final reimbursement report and to return any unearned funds to
the Division within 30 days of the contract termination date or no later than June 10.All payments
are contingent upon fund availability.
11. Contract Administrators:
All notices permitted or required to be given by one Party to the other and all questions about the
contract from one Party to the other shall be addressed and delivered to the other Party's contract
administrator.The name, post office address, street address, telephone number,fax number, and
email address of the Parties'respective initial contract administrators are set out below. Either
Party may change the name, post office address, street address,telephone number,fax number,
or email address of its contract administrator by giving timely written notice to the other Party.
NCDHHS GCT1007(Contract)(General)(Rev. 11.01.15)
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Contract Number 00042091 /Page 3 of 26
For the Division:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Deborah Hamlin-Aggrey Deborah Hamlin-Aggrey
Division of Public Health Division of Public Health
1929 Mail Service Center, DPH Women's Six Forks Road, Building 2, 2nd floor, Room A-
Health Branch 11
Raleigh, NC 27699-1929 Raleigh, NC 27699-1929
Telephone : (919)-707-5720
Fax: (919)-870-4827
Email: Deborah.Hamlinaggrey@dhhs.nc.gov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Suzanne Hitt, Social Worker Supervisor II Suzanne Hitt,Social Worker Supervisor II
Orange County Department of Social Services Orange County Department of Social Services
PO Box 8181, 113 Mayo St. PO Box 8181, 113 Mayo St.
Hillsborough, NC 27278 Hillsborough, NC 27278
Telephone: (919)-245-2850
Fax: ()--
Email: hiftb_oranglecounlync.gov
12. Supplementation of Expenditure of Public Funds:
The Contractor assures that funds received pursuant to this contract shall be used only to
supplement, not to supplant,the total amount of federal, state and local public funds that the
Contractor otherwise expends for contract services and related programs. Funds received under
this contract shall be used to provide additional public funding for such services; the funds shall
not be used to reduce the Contractor's total expenditure of other public funds for such services.
13. Disbursements:
As a condition of this contract, the Contractor acknowledges and agrees to make disbursements
in accordance with the following requirements:
(a) Implement adequate internal controls over disbursements;
(b) Pre-audit all vouchers presented for payment to determine:
• Validity and accuracy of payment
• Payment due date
• Adequacy of documentation supporting payment
• Legality of disbursement
(c) Assure adequate control of signature stamps/plates;
(d) Assure adequate control of negotiable instruments; and
(e) Implement procedures to insure that account balance is solvent and reconcile the account
monthly.
14. Outsourcing to Other Countries:
The Contractor certifies that it has identified to the Division all jobs related to the contract that
have been outsourced to other countries, if any.The Contractor further agrees that it will not
outsource any such jobs during the term of this contract without providing notice to the Division.
NCDHHS GCT1007 (Contract)(General) (Rev. 11.01.15)
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Contract Number 00042091 /Page 4 of 26
15. Signature Warranty:
The undersigned represent and warrant that they are authorized to bind their principals to the
terms of this agreement.
Signatures follow on next page
NCDHHS GCT1007 (Contract)(General)(Rev. 11.01.15)
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Contract Number 00042091 /Page 5 of 26
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 Department of Social Services
FDocuSigned by:
'VavuS ' I� 4/28/2021
Signature Date
Travis Myren Deputy Manager
Printed Name Title
WITNESS
DocuSigned by:
ht'ussa awsbo, 4/28/2021
L�,8AA2RQCF-7j-
Signature Date
Melissa Allison Business Officer I
Printed Name Title
Division of Public Health, North Carolina Department of Health and Human Services
Signature Date
Mario T. Benton Assistant Secretary for Public Health
Printed Name Title
NCDHHS GCT1007(Contract)(General)(Rev. 11.01.15)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 6 of 26
GENERAL TERMS AND CONDITIONS
Relationships of the Parties performance of this contract to the extent permitted by
law.
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the Default and Termination
performance of this contract and as such shall be wholly
responsible for the work to be performed and for the Termination Without Cause: The Division may
supervision of its employees. The Contractor represents terminate this contract without cause by giving 30 days
that it has, or shall secure at its own expense, all written notice to the Contractor.
personnel required in performing the services under this
agreement Such employees shall not be employees of, Termination for Cause: If, through any cause, the
or have any individual contractual relationship with, the Contractor shall fail to fulfill its obligations under this
Division. contract in a timely and proper manner, the Division shall
have the right to terminate this contract by giving written
Subcontracting: The Contractor shall not subcontract notice to the Contractor and specifying the effective date
any of the work contemplated under this contract without thereof. In that event,all finished or unfinished deliverable
prior written approval from the Division. Any approved items prepared by the Contractor under this contract shall,
subcontract shall be subject to all conditions of this at the option of the Division, become its property and the
contract.Only the subcontractors specified in the contract Contractor shall be entitled to receive just and equitable
documents are to be considered approved upon award of compensation for any satisfactory work completed on
the contract.The Division shall not be obligated to pay for such materials, minus any payment or compensation
any work performed by any unapproved subcontractor. previously made. Notwithstanding the foregoing
The Contractor shall be responsible for the performance provision,the Contractor shall not be relieved of liability to
of all of its subcontractors. the Division for damages sustained by the Division by
virtue of the Contractor's breach of this agreement, and
Assignment: No assignment of the Contractor's the Division may withhold any payment due the
obligations or the Contractor's right to receive payment Contractor for the purpose of setoff until such time as the
hereunder shall be permitted. However, upon written exact amount of damages due the Division from such
request approved by the issuing purchasing authority,the breach can be determined. In case of default by the
State may: (a) Forward the Contractor's payment check Contractor,without limiting any other remedies for breach
directly to any person or entity designated by the available to it, the Division may procure the contract
Contractor, or(b) Include any person or entity designated services from other sources and hold the Contractor
by Contractor as a joint payee on the Contractor's responsible for any excess cost occasioned thereby.The
payment check. In no event shall such approval and filing of a petition for bankruptcy by the Contractor shall
action obligate the State to anyone other than the be an act of default under this contract.
Contractor and the Contractor shall remain responsible
for fulfillment of all contract obligations. Waiver of Default: Waiver by the Division of any default
or breach in compliance with the terms of this contract by
Beneficiaries: Except as herein specifically provided the Contractor shall not be deemed a waiver of any
otherwise,this contract shall inure to the benefit of and be subsequent default or breach and shall not be construed
binding upon the parties hereto and their respective to be modification of the terms of this contract unless
successors. It is expressly understood and agreed that stated to be such in writing, signed by an authorized
the enforcement of the terms and conditions of this representative of the Department and the Contractor and
contract, and all rights of action relating to such attached to the contract.
enforcement,shall be strictly reserved to the Division and
the named Contractor. Nothing contained in this Availability of Funds: The parties to this contract agree
document shall give or allow any claim or right of action and understand that the payment of the sums specified in
whatsoever by any other third person. It is the express this contract is dependent and contingent upon and
intention of the Division and Contractor that any such subject to the appropriation, allocation, and availability of
person or entity,other than the Division or the Contractor, funds for this purpose to the Division.
receiving services or benefits under this contract shall be
deemed an incidental beneficiary only. Force Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
Indemnity and Insurance prevented from performing such obligations by any act of
war, hostile foreign action, nuclear explosion, riot, strikes,
Indemnification: The Contractor agrees to indemnify civil insurrection, earthquake, hurricane,tornado,or other
and hold harmless the Division, the State of North catastrophic natural event or act of God.
Carolina,and any of their officers,agents and employees,
from any claims of third parties arising out of any act or Survival of Promises: All promises, requirements,
omission of the Contractor in connection with the terms, conditions, provisions, representations,
NCDHHS TC1010 (General Terms and Conditions)(Local Government)(Rev. 11.01.15)
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guarantees,and warranties contained herein shall survive During the performance of this contract, the contractor is
the contract expiration or termination date unless to notify the Division contract administrator of any contact
specifically provided otherwise herein, or unless by the federal Office for Civil Rights (OCR) received by
superseded by applicable Federal or State statutes of the contractor.
limitation.
Cost Borne by Contractor: If any applicable federal,
Intellectual Property Rights state,or local law, regulation,or rule requires the Division
or the Contractor to give affected persons written notice
Copyrights and Ownership of Deliverables: All of a security breach arising out of the Contractor's
deliverable items produced pursuant to this contract are performance under this contract,the Contractor shall bear
the exclusive property of the Division. The Contractor the cost of the notice.
shall not assert a claim of copyright or other property
interest in such deliverables. Oversight
Compliance with Applicable Laws Access to Persons and Records: The State Auditor
shall have access to persons and records as a result of
Compliance with Laws: The Contractor shall comply all contracts or grants entered into by State agencies or
with all laws, ordinances, codes, rules, regulations, and political subdivisions in accordance with General Statute
licensing requirements that are applicable to the conduct 147-64.7. Additionally, as the State funding authority, the
of its business, including those of federal, state, and local Department of Health and Human Services shall have
agencies having jurisdiction and/or authority. access to persons and records as a result of all contracts
or grants entered into by State agencies or political
Equal Employment Opportunity: The Contractor shall subdivisions.
comply with all federal and State laws relating to equal
employment opportunity. Record Retention: Records shall not be destroyed,
purged or disposed of without the express written consent
Health Insurance Portability and Accountability Act of the Division. State basic records retention policy
(HIPAA): The Contractor agrees that, if the Division requires all grant records to be retained for a minimum of
determines that some or all of the activities within the five years or until all audit exceptions have been resolved,
scope of this contract are subject to the Health Insurance whichever is longer. If the contract is subject to Federal
Portability and Accountability Act of 1996,P.L. 104-91,as policy and regulations, record retention may be longer
amended("HIPAA"),or its implementing regulations,it will than five years. Records must be retained for a period of
comply with the HIPAA requirements and will execute three years following submission of the final Federal
such agreements and practices as the Division may Financial Status Report, if applicable, or three years
require to ensure compliance. following the submission of a revised final Federal
Financial Status Report. Also, if any litigation, claim,
Confidentiality negotiation, audit, disallowance action, or other action
involving this Contract has been started before expiration
Confidentiality: Any information, data, instruments, of the five-year retention period described above, the
documents, studies or reports given to or prepared or records must be retained until completion of the action
assembled by the Contractor under this agreement shall and resolution of all issues which arise from it, or until the
be kept as confidential and not divulged or made available end of the regular five-year period described above,
to any individual or organization without the prior written whichever is later. The record retention period for
approval of the Division. The Contractor acknowledges Temporary Assistance for Needy Families (TANF) and
that in receiving, storing, processing or otherwise dealing MEDICAID and Medical Assistance grants and programs
with any confidential information it will safeguard and not must be retained for a minimum of ten years.
further disclose the information except as otherwise
provided in this contract.
Data Security:The Contractor shall adopt and apply data
security standards and procedures that comply with all
applicable federal, state, and local laws, regulations, and
rules.
Duty to Report: The Contractor shall report a suspected
or confirmed security breach to the Division's Contract
Administrator within twenty-four (24) hours after the
breach is first discovered, provided that the Contractor
shall report a breach involving Social Security
Administration data or Internal Revenue Service data
within one (1) hour after the breach is first discovered.
NCDHHS TC1010 (General Terms and Conditions) (Local Government)(Rev. 11.01.15)
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Miscellaneous or phrase shall be read to include the plural and vice
versa.
Choice of Law.The validity of this contract and any of its
terms or provisions,as well as the rights and duties of the Time of the Essence: Time is of the essence in the
parties to this contract,are governed by the laws of North performance of this contract.
Carolina.The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract, Key Personnel: The Contractor shall not replace any of
to the exclusive jurisdiction of the courts of North Carolina the key personnel assigned to the performance of this
and agrees, solely for such purpose, that the exclusive contract without the prior written approval of the Division.
venue for any legal proceedings shall be Wake County, The term "key personnel' includes any and all persons
North Carolina. The place of this contract and all identified as such in the contract documents and any
transactions and agreements relating to it, and their situs other persons subsequently identified as key personnel
and forum, shall be Wake County, North Carolina,where by the written agreement of the parties.
all matters, whether sounding in contract or tort, relating
to the validity, construction, interpretation, and Care of Property: The Contractor agrees that it shall be
enforcement shall be determined. responsible for the proper custody and care of any
property furnished to it for use in connection with the
Amendment:This contract may not be amended orally or performance of this contract and will reimburse the
by performance. Any amendment must be made in Division for loss of, or damage to, such property. At the
written form and executed by duly authorized termination of this contract, the Contractor shall contact
representatives of the Division and the Contractor. The the Division for instructions as to the disposition of such
Purchase and Contract Divisions of the NC Department property and shall comply with these instructions.
of Administration and the NC Department of Health and
Human Services shall give prior approval to any Travel Expenses: Reimbursement to the Contractor for
amendment to a contract awarded through those offices. travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
Severability: In the event that a court of competent exceed the rates published in the applicable State rules
jurisdiction holds that a provision or requirement of this or approved local government travel policy. International
contract violates any applicable law, each such provision travel shall not be reimbursed under this contract.
or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise Sales/Use Tax Refunds: If eligible, the Contractor and
unenforceable and all other provisions and requirements all subcontractors shall: (a) ask the North Carolina
of this contract shall remain in full force and effect. Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
Headings:The Section and Paragraph headings in these pursuant to G.S. 105-164.14; and (b) exclude all
General Terms and Conditions are not material parts of refundable sales and use taxes from all reportable
the agreement and should not be used to construe the expenditures before the expenses are entered in their
meaning thereof. reimbursement reports.
Gender and Number: Masculine pronouns shall be read Advertising: The Contractor shall not use the award of
to include feminine pronouns and the singular of any word this contract as a part of any news release or commercial
advertising.
NCDHHS TC1010 (General Terms and Conditions)(Local Government)(Rev. 11.01.15)
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N. C. Department of Health and Human Service
Division of Public Health
SCOPE OF WORK
BACKGROUND
Teen pregnancy is closely linked to critical social issues, including poverty, low birth weight, health issues,
school failure, and child abuse and neglect.The North Carolina Department of Health and Human
Services(DHHS)administers programs to prevent teen pregnancy through the Teen Pregnancy
Prevention Initiatives(TPPI). The Adolescent Parenting Program (APP)is a program of TPPI that
increases opportunities for pregnant and parenting adolescents and empowers them to make healthy
decisions. The primary goals of the program are to increase the self-sufficiency outcomes for APP
participants and improve the child welfare and school readiness outcomes for the children of APP
participants.
Comparison data:
2019 North Carolina Percent of Repeat Teen Pregnancy:21.5%
PURPOSE
To provide APP services to 15-25 pregnant or parenting teens who reside within the Contractor's
catchment area, are 19 years of age or younger at time of enrollment and enrolled in school or an
equivalent program.
COUNTIES
This contract serves the following North Carolina County(ies): Orange
PERFORMANCE REQUIREMENTS
The Contractor shall for 15-25 unduplicated participants:
1. Caseload: Maintain a caseload of 15 to 25 pregnant or parenting teens who reside within the
Contractor's catchment area.
a. Eligible participants must be 19 years of age or younger at the time of enrollment and are
enrolled in school or an equivalent program. The teens may be pregnant at the time of
enrollment. Participants can no longer remain in APP if they experience a subsequent
pregnancy while enrolled in the program.
2. Home Visits: Implement the Parents as Teachers curriculum for home visiting (either the
Curriculum Subscriber or the Model Affiliate level). All Contractor's staff implementing the home
visiting curriculum must be formally trained to use the curriculum.
a. Provide at least one(1)60-minute home visit per month with each program participant
using the Parents as Teachers home visiting curriculum.At least 33%of these meetings
shall take place in the home of the participant. Other home visits may take place in
school, the APP office, or another appropriate setting. The focus of the sessions shall be
directly related to the goals of APP. If a virtual implementation is needed, prior approval
from the TPPI Program Consultant must be received.
b. Develop an individualized goal plan with each APP participant using Motivational
Interviewing techniques.The goal plan of each participant shall be reviewed monthly
during the home visits. Goals should be updated and/or created based upon the needs of
the participant.The APP staff shall support the participants in achieving their goals by
connecting them with resources and referring them for services as appropriate to meet
the goals of the goal plan.
c. Participants should only be enrolled in one(1)home visiting program at a time within your
community.
3. Group Instruction: Implement with fidelity the Be Proud! Be Responsible! Be Protective!Third
Edition curriculum during group instruction with APP participants. Every participant must complete
the program during their enrollment in APP.
a. Provide at least quarterly group instruction to program participants. Group sessions shall
be primarily educational in nature and include opportunities for social interaction.Topics
DPH rev 08-12-13
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of the sessions shall be directly related to the goals of APP. If a virtual implementation is
needed,prior approval from the TPPI Program Consultant must be received.
b. Provide educational field trips to one(1)family planning clinic and a college tour(four(4)
year or community college)either as a group or during a home visit.
c. Count as participants only those who attend at least 75%of group instruction.
PERFORMANCE STANDARDS
The Contractor shall:
1. Assume responsibility for the activities of the APP in accordance with the TPPI legislative rules
(North Carolina Administrative Code,Title 10A—Health and Human Services, Chapter 43—
Personal Health, Section .0800—Teen Pregnancy Prevention).
2. Employ at least one(1)staff person with appropriate qualifications for the APP.
a. The caseload of one (1)full-time APP staff member shall not exceed 20 participants. If
more than 20 participants will be served,then the Contractor shall hire additional staff at
the rate of ten (10)hours per week for every five(5)additional participants.
b. Staff person(s)shall be formally trained to implement the Parents as Teachers curriculum
(either the Curriculum Subscriber or the Model Affiliate level)and group instruction
curriculum(Be Proud! Be Responsible! Be Protective!).
c. Notify the TPPI Program Consultant of any changes in staff included in this contract
within ten (10)days of the change.
d. Program staff shall receive 20 hours of professional development training including TPPI
networking meeting, conferences,trainings, and webinars relevant to teen pregnancy
prevention. Professional development training hours shall be prorated for part-time
employees.
e. Program staff shall receive an additional four(4)hours of training annually focused on
health equity, health disparities, or social determinants of health to support individual
competencies and organizational capacity to promote health equity. A list of resources to
meet this requirement is available at http://www.teenpregnancy.ncdhhs.gov/ap2proi-htm.
f. Supervisors of program staff shall be formally trained in the Parents as Teachers
curriculum(either the Curriculum Subscriber or the Model Affiliate level)and receive at
least six(6)hours of professional development training around supervision and
leadership.
g. All training certificates must be available for review upon request.
3. Ensure that services are provided in a caring, respectful manner in an effort to create an
environment where participants are comfortable sharing their values and beliefs and practicing
skills that will improve their health.
a. The program staff shall administer a Participant Feedback Survey to all participants
before May 31, 2022 and to any participant who exits the program prior to May 31, 2022.
b. A summary of the feedback survey results must be submitted to the TPPI Program
Consultant by June 30, 2022. The summary should include all the required information
detailed in the"TPPI Participant Feedback Survey Summary Guidance"(available at
httD:I/www.teenpregnancy.ncdhhs.gov/ap2proi.htm).
4. Ensure that at least two(2) home visits are observed and assessed by the Contractor's Program
Supervisor.
a. The Supervisor must utilize the observation form (available at
http://www.teenpregnancy.ncdhhs_gov/ap2proj_htm), sign it and email to the TPPI
Program Consultant no more than 30 days after the observation is completed.
5. Maintain a Community Advisory Council (CAC),which shall be responsible for advising and
assisting program staff to provide high quality services to participants, reviewing all educational
and promotional materials developed by the program to ensure appropriateness for the
community,and actively promoting and supporting the program in the community.
DPH rev 12/10/14
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a. The CAC shall meet at least quarterly and minutes with attendance are recorded for each
meeting and submitted electronically to the TPPI Program Consultant by the tenth (1001)
day of the month following the meeting.
b. The CAC shall consist of at least seven (7)members who are:
i. A representative of the following five(5)types of agencies,where one (1)of the five
(5)agencies must be either the local Children's Development Services Agency or
Partnership for Children: the local health department,the public-school system, the
department of social services, a Cooperative Extension,a mental health services
agency, local corporations and businesses, or local news outlet(such as newspaper
or radio station);
ii. An adolescent; and
iii. A current or former adolescent parent.
6. Gift cards may be provided to participants and parents as incentives for completing the program.
After purchase,gift cards shall be logged by serial number and maintained in a locked storage
cabinet. Recipients shall sign the log upon receipt of the gift card.
7. Submit Itemization and Financial Reports including Contract Expenditure Reports(CERs)on a
monthly basis to the TPPI Program Consultant, so it arrives by no later than the tenth (10th)day of
the following month. If the tenth (10th)day of the month falls on a weekend or a holiday,
Contractor shall submit report by the last business day before the tenth (10th)day. Submit
Itemization Reports via email to the TPPI Program Consultant.
8. The Contractor shall report all required data elements for program activities completed each
month to a secure,electronic system (such as EZTPPI)no later than the tenth (101h)day of the
following month. If the tenth (10th)day of the month falls on a weekend or holiday, the Contractor
shall report the data by the last business day before the tenth (10th). A list of required data
elements is available at hftp://www.teenpregnancy.nedhhs.gov/ap2proi.htrn.
PERFORMANCE MONITORING/QUALITY ASSURANCE PLAN
This contract will be monitored according to the following plan:
1. The TPPI Program Consultant shall verify that expenditures are in accordance with the approved
contract budget.
2. The TPPI Program Consultant shall monitor the completion of all outputs and all performance
standards specified in this contract by reviewing reported program data.
3. The TPPI Program Consultant shall conduct at least one(1)annual on-site visit,which shall
include a review of agency programmatic and fiscal policies and records, and an observation of a
program session. Compliance with this contract and fidelity to the APP model shall be assessed
during the site visit.
4. The TPPI Program Consultant shall conduct additional monitoring via ongoing communication by
phone and e-mail.
Deliverables shall be monitored by site visits and required reports.The Contractor agrees to participate in
periodic site visits as needed with a minimum of one(1)per year as determined by the TPPI Program
Consultant. If the Contractor is deemed out of compliance, program staff shall provide technical
assistance;and funds may be withheld until Contractor is back in compliance with deliverables. If
technical assistance does not prove beneficial,the contract may then be terminated.
REIMBURSEMENT
The Contractor must expend the required local matching funds in order to be reimbursed for the full
amount of state funds.
DPH rev 12/10/14
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 12 of 26
Original signed CERs must be submitted even when no expenses are incurred in a given month. CERs
must be signed by an approved organization representative. Failure to submit monthly sequential reports
may delay receipt of reimbursement.
The Contractor must use funding in a manner that is consistent with the Executed Contract. Contractor
shall get preapproval from the TPPI Program Consultant for any changes to the Line-Item Budget
("Budget Realignments")prior to the expenditure of funds. All requests must be submitted 30 days prior
to the expenditure of funds. The last realignment for the contract period must be submitted no later than
April 30.
DPH rev 12/10/14
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 13 of 26
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 Demand Reporting Annual
Type Frequency
Measure Percent of repeat teen pregnancies in Orange County, 2019.
Budget Year 1 Trend Decrease
Baseline 11.6
Value
Target Value 10.5
Data Source North Carolina State Center for Health Statistics (SCHS).
Collection Data is collected from birth certificates on second or higher order
Process and births and reported to SCHS.
Calculation
Collection Annual
Frequency
Measure Input Reporting Annual
Type Frequency
Measure Number of full-time equivalent positions
Budget Year 1 Trend Decrease
Baseline 1.56
Value
Target Value 1.43
Data Source Contractor budget and Contractor final itemized report.
Collection Contractor budget proposes the staff time spent on the contract.
Process and Monthly itemized reports and a final report are submitted that
Calculation reflect the staff time spent on the project.
Performance Measures(Rev.402)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 000420911 Page 14 of 26
Collection Annual
Frequency
Measure Input Reporting Annual
Type Frequency
Measure Contract not to exceed amount.
Budget Year 1 Trend Maintain
Baseline $100,000
Value
Target Value $100,000
Data Source Executed contract.
Collection Funds are appropriated and contracts are awarded.
Process and
Calculation
Collection Annual
Frequency
Measu Output Reporting Annual
Type Frequency
Measure Number of quarterly group education sessions provided to program participants.
Budget Year 1 Trend Maintain
Baseline 4
Value
Target Value 4
Data Source North Carolina Teen Pregnancy Prevention Initiatives Adolescent
Parenting Program Database.
Collection Contractor enters into the database the participant attendance at
Process and group education sessions.
Calculation
Collection Annual
Frequency
Performance Measures(Rev.402)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 15 of 26
Measure Output Reporting Annual
Type Frequency
Measure Percent of repeat pregnancies among participants, limited to or less than.
Budget Year 1 Trend Maintain
Baseline 30
Value
Target Value 3%
Data Source NC Teen Pregnancy Prevention Initiatives Adolescent Parenting
Program Database
Collection Contractor enters into the database the number of repeat
Process and pregnancies in the caseload
Calculation
Collection Annual
Frequency
Measure Output Reporting Annual
Type Frequency
Measure Number of quarterly Community Advisory Council meetings.
Budget Year 1 Trend Maintain
Baseline 4
Value
Target Value 4
Data Source NC Teen Pregnancy Prevention Initiatives Adolescent Parenting
Program Database.
Collection Contractor enters into the database the date of the Community
Process and Advisory Council meeting held each quarter.
Calculation
Collection Annual
Frequency
Performance Measures(Rev.41112)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 16 of 26
Measure Output Reporting Annual
Type Frequency
Measure Number of pregnant or parenting teens enrolled in the program (minimum)
Budget Year 1 Trend Maintain
Baseline 15
Value
Target Value 15
Data Source NC Teen Pregnancy Prevention Initiatives Adolescent Parenting
Program Database.
Collection Contractor enters into the database the number of participants
Process and enrolled in the program.
Calculation
Collection Annual
Frequency
Measure Outcome Reporting Annual
Type Frequency
Measure Percent of Adolescent Parenting Program participants who drop out of school,
limited to or less than.
Budget Year 1 Trend Maintain
Baseline 5%
Value
Target Value 5%
Data Source NC Teen Pregnancy Prevention Initiatives Adolescent Parenting
Program Database.
Collection Contractor enters into database the number of participants
Process and enrolled in school and whether they drop out.
Calculation
Collection Annual
Frequency
Performance Measures(Rev.4//12)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 !Page 17 of 26
Measure ,!' Outcome Reporting Annual
Type Frequency
Measure Percent of Adolescent Parenting Program participants whose children are the
subjects of child maltreatment, limited to or less than.
Budget Year 1 Trend Maintain
Baseline 3%
Value
Target Value 3%
Data Source Division of Social Services
Collection Division Social Services (DSS) Data managers will supply a data
Process and file from the Central Registry and North Carolina Families
Calculation Accessing Services through Technology (NC FAST) to the Teen
Pregnancy Prevention Initiatives Evaluation Consultant. The
Evaluation Consultant will determine whether any of the children of
Adolescent Parenting Program participants were the victim of child
abuse or neglect as reported to DSS. The data will then be de-
identified and summarized at the program level.
Collection Annual
Frequency
Measure Outcome Reporting Annual
Type Frequency
Measure Percent of graduates who enroll in post-secondary education or training.
Budget Year 1 Trend Maintain
Baseline 65%
Value
Target Value 65%
Data Source NC Teen Pregnancy Prevention Initiatives Adolescent Parenting
Program Database
Collection Contractor enters the number of participants that graduate high
Process and school, enroll in post-secondary education or training in the
Calculation database
Collection Annual
Frequency
Performance Measures(Rev.4l112)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 18 of 26
Measure Outcome Reporting Annual
Type Frequency
Measure Percent of participants who complete 75%of the home visits for which they are
eligible.
Budget Year 1 Trend Maintain
Baseline 75%
Value
Target Value 75%
Data Source NC Teen Pregnancy Prevention Initiatives Adolescent Parenting
Program Database
Collection Contractor enters into the database the number of 60 minute face
Process and to face visits for each participant.
Calculation
Collection Annual
Frequency
Measure Quality Reporting Annual
Type Frequency
Measure Percent of staff trained in Be Proud! Be Responsible! Be Protective! and Parents
as Teachers.
Budget Year 1 Trend Maintain
Baseline 100%
Value
Target Value 100%
Data Source Copies of training certificates.
Collection Copies of certificates are available to Teen Pregnancy Prevention
Process and Initiatives Staff during annual site visit.
Calculation
Collection Annual
Frequency
Performance Measures(Rev.402)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091 /Page 19 of 26
Measure Quality Reporting Annual
311fType I Frequency
Measure Number of Community Advisory Council members representing an adolescent and
a current or former adolescent parent.
Budget Year 1 Trend Maintain
Baseline 2
Value
Target Value 2
Data Source NC Teen Pregnancy Prevention Initiatives Adolescent Parenting
Program Database.
Collection Contractor enters Community Advisory Council membership and
Process and meeting attendance in the database.
Calculation
Collection Annual
Frequency
Measure Efficiency Reporting Annual
Type Frequency
Measure Cost per unduplicated participant(maximum cost based on minimum number of
participants).
Budget Year 1 Trend Maintain
Baseline $6,666.67
Value
Target Value $6,666.67
Data Source Total amount expended by Contractor is recorded by NCAS. Total
number of unduplicated participants enrolled in the program
complied using the data from NC TPPI database.
Collection $100,000/15 teen parents = $6,666.67. Contractor submits
Process and Contract Expenditure Reports and are recorded in NCAS. Total
Calculation number of unduplicated participants enrolled in the program
complied using the data from NC TPPI database.
Collection Annual
Frequency
Performance Measures (Rev.402)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091/Page 20 of 26
LINE ITEM BUDGET
This begins the line item budget for year 1
Budget Detail-Year 9
Category Item Narrative. Amount
SalarylWages APP Coordinator 1,Theresa Collosso($45,232;1.0 FTE). $58,820.00
APP Coordinator 2,Mikaela Morraco-Schelp($13,588;0.33 FTE).
APP Coordinators are responsible for providing case management
services to pregnant and parenting teens who are working toward
their high school diploma or equivalency.These services are
provided in traditional school settings and non traditional settings
such as Home School,or,GED.
Fringe Benefits No Fringe Benefits for the APP Coordinator positions charged to $0.00
this portion of the contract(claimed in Contractor Match).
Other $0.00
Supplies and Materials Other Yearly planners for APP Coordinators at$35 each x 2 staff=$70. $545.00
Office supplies including but not limited to binders,notebooks,ink
for printer,expo markers,etc,at an average of$25/month x 12
months=$300.
Beck Depression Inventory—II=$175.
Total supplies=$545
Travel Contractor Staff Overnight hotel for TPPI Networking Meeting in Greenville,NC for $451_00
2 APP Coordinators and Program Supervisor=2 nights x
$75.10/night x 3 staff=$450.60.
No monthly mileage costs charged to this contract as Orange
Line Item Budget Detail(08/11)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 000420911 Page 21 of 26
Budget Detail-Year I
Category Item Narrative Amount
County DSS provides vehicles and fuel for program coordinators
to make home visits or other program travel.
Repair and Maintenance $0.00
Staff Development Trainings such as:Mental Health,Healthy Birth Outcomes,Child $2,250.00
Development,Health Equity,Health Disparities,or Social
Determinants of Health to support individual competencies and
organizational capacity to promote health equity for 2 APP
Coordinators and Program Supervisor.$200/training x 2 trainings
x 3 staff=$1,200.
Registration for 2 APP Coordinators to attend the Parents as
Teachers Conference:$525 x 2 staff=$1,050. Total Staff
Development=$2,250.
Media/Communication Audiovisual Prime One Media,a local company,will record,edit and produce a $2,000.00
presentations/multimedialty 1-2 minute promotional video about the Adolescent Parenting
/radio presentations Program for$2,000. The video will help increase community
awareness,recruit participants,enlist volunteers and engage
partnering organizations.
Dues and Subscriptions Parents as Teachers Curriculum Subscribers annual renewal for 2 $1,505.00
APP Coordinators and Program Supervisor$265/person x 3 staff
_$795 and Foundation 2 Curriculum access for 2 APP
Coordinators:$55/person x 2 staff=$110.
Zoom Business renewal for 2 APP Coordinators and Program
Supervisor_$199.90/person x 3 staff=$599.70.
Total Dues and Subscriptions=$1,504.70_
Line Item Budget Detail(08/11)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091/Page 22 of 26
Budget Detail-Year 9
category. Item Narrative Amount
Operational Other Incentives and Participants Materials for home visits and group sessions: $9,429.00
Books for participants,$20/participant x 15 participants=$300.
Child proofing kits(participants with infants),$151participant x 8
participants=$120.Supplies for home visits activities(play dough,
color crayons,developmental toys,etc_)$25/participant x 15
participants=$375.Total Materials=$795.
Admissions and transportation for enrichment activities:
End of school enrichment activity,25 people(15 participants and
10 children)x$24/person=$600.
Educational zoo trip,20 people(15 participants and 5 chaperones)
x$15/person=$300 and 15 children x$11 =$165.Round trip
charter bus transportation for zoo trip Hillsborough to Asheboro,
NC=$1,000_
Enrichment Activities Total=$2,065.
Meals:
Peer group meetings,5 participants x$11.30 lunch x 8 meetings=
$452
Large group meeting,10 participants x$19.50 dinner x 1 meeting
_$195_ Holiday and Graduation Events for 30 people(15
participants and 15 additional guests)x$19.50 dinner x 2 events=
$1,170.
BPI BRI BPI Workshop,6 participants x$11.30 lunch x 2 Days=
$135.60.College Tour,5 participants x$11.30 lunch=$56.50.
End of school enrichment activity,25 people(15 participants and
10 children)x$11.30 lunch=$282.50.
Educational zoo trip,35 people(15 participants plus 15 children
and 5 chaperones)x$11.30 lunch=$395.50.Total Meals=
$2,687.10_
Line Item Budget Detail(08/11)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 000420911 Page 23 of 26
Budget Detail-Year 1
category Item Narrative Amount'
Gift cards:Gift card for BPI BRI BPI Workshop,6 participants x
$100/gift card=$600.Gift card for Clinic Tour,6 participants x
$25/gift card=$150.Gift card for College Tour,5 participants x
$30/gift card=$150.Total Gift Cards=$900.
Additional incentives:
Various items to meet participants needs,such as formula,pack
and plays,strollers,belly belts,car seat covers,high chair=
$40.47 x 15 participants=$607.05.Incentive gifts for high school
graduates such as luggage,memory books,photo frames,etc.5
participants x$100/participant=$500.Professional Photos Day,
15 participants x$125/participant=$1,875.
Total Additional Incentives=$2,982.05.
Not all APP participants are able to attend all group meetings or
the enrichment activities.For example,when purchasing child
proofing kits,not every participant has a child that will need that
item this year.Some participants have received them in past years
and other participants will receive once the child is older.Our
Holiday Event and Graduation Event have bigger turnouts of the
participant's families than other APP events.
Subcontracts and Grants $0.00
Match Fringe Benefits will be claimed as in--kind for this grant.Fringe $25,000.00
Benefits includes:Social Security,Medicare,Health Insurance for
the employee,Dental Insurance for the employee,the county
contribution for Life Insurance,County Retirement,and 401K
Theresa Collosso,APP Coordinator 1 ($18,98825):FICA 7.65%x
$45,232=$3,460.25;Health Insurance=$9,679;Dental
Insurance=$373;Life Insurance=$125;County Retirement=
Line Item Budget Detail(08/11)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091/Page 24 of 26
Budget Detail-Year 1
Category. Item Narrative Amount
$4,636;and 401K=$715.Total=$18,988.25
Mikaela MoraccoSchelp,APP Coordinator 2($4,916.57):FICA
7.65%x$41,177=$3,150.04,Health Insurance$9,679 prorated
at 8 months=$6,452.67;Dental Insurance=$373;Life Insurance
=$110;County Retirement=$4,098;and 401 K=$715.Total=
$14,898.71 x 33%=$4,916.57.
Suzanne Hitt,Program Supervisor($2,274.93):FICA 7.65%x
$66,710=$5,103.32,Health Insurance=$8,166 and HSA$1,416;
Dental Insurance=$373;Life Insurance=$138;County
Retirement=$6,838;and 401 K=$715.
Total=$22,749.32 x 10%=$2,274.93.
Total Fringe=$26,179.75
Local Match for volunteers include,but are not limited to:
CAC members:8 hours x$22.99 x 8 members=$1,471.36.
Group Meetings:10 hours x$22.99 x 1 guest speaker=$229.90.
MSW intern hours:30 hours x$22.99 x 1 intern=$689.70.Total
volunteer hours=$2,390.96
Total Local Match=$28,570.71 but only$25,000 will be applied
to Local Match_
Cost Per Service $0.00
Sub Total $100,000.00
Indirect Cost $0.00
Total Budget $100,000.00
Line Item Budget Detail(08111)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
Contract Number 00042091/Page 25 of 26
Subcontracting and Grants Budget Detail-Year 1
Category Item Narrative Amount
$0.00
Sub Total $0.00
Salaries -Year 1
Persons Position or Title Annual Salary Hourly Months Work% fringe Fringe Total
Rate Amount Total Percent Total
1 APP Coordinator 1,Theresa Collosso $45,232.00 0.0000 12 100.00 $0.00 $0.00 $45,232.00
1 APP Coordinator2,Mikaela Monaco-Schelp $41,177.00 0.0000 12 33.00% $0.00 $0.00 $13,588.00
Line Item Budget Detail(08/11)
DocuSign Envelope ID:502E262B-12B8-4E26-A3B9-A519026ACBC6
DocuSign Envelope ID:90846844-6A46-0456-9ABC-788993474441
State Certifications Contract Number 00042091 /Page 26 of 26
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: hap:f/www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFByArticle/Chapter_64/Articie_2.pdf.
G.S. 133-32: http:/hvww.ncga.state,nc.us/gaserip(s/statutes/statutelookup.Pi?statute=133-32
• Executive Order No.24(Perdue,Gov.,Oct. 1,2009): http://Www,othicscotnmission.nc.gov/library/Pdfs/LawsIE024,pdf
• G.S. 105-164.8(b): http://www,ncga.state,ne.us/EnactedLegislation/Statutes/Pl)F(3ySectiorl/Chapter IOS/GS_105-164.8.pdf
• G.S. 143-48.5: http://www.ncga.state.ne.us/P-nactedLegislation/Statutes/HTML/BySection/Chapter-143/GS_143-49.5.htrnl
• G.S, 143-59.1: htip://www.ncga_state.nc.us/EnnetedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59,1,pdf
• G.S, 143-59.2: http://www.ncga.state.nc,us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59.2.pdf
w
• G.S. 143-133.3: http://ww.nega.state.nc.us/EnactedLegislettion/Statutes/I-ThTL/BySection/Chapter_143/G5_143-133.3.htn11
• G.S. 143B-139.6C: http://www.ncga.state,ne.us/EnactedLegislation/Statttes/PDFBySection/Chapter_143B/GS_143B-139.6C.pdf
Certifications
(1) Pursuant to G.S.'1.33-32 and Executive Order No.24 after December 31, 2001 but the United States
(Perdue, Gov., Oct. 1, 2009), the undersigned hereby is not the principal market for the public trading
certifies that the Contractor named below is in of the stock of the corporation incorporated in
compliance with, and has not violated,the provisions of the tax haven country.
either said statute or Executive Order. (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby
(2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the certifies that none of the Contractor's officers,
undersigned hereby certifies that the Contractor named directors, or owners (if the Contractor is an
below, and the Contractor's subcontractors, complies unincorporated business entity) has been convicted of
with the requirements of Article 2 of Chapter 64 of the any violation of Chapter 78A of the General Statutes or
NC General Statutes, including the requirement for the Securities Act of 1933 or the Securities Exchange
each employer with more than 25 employees hi North Act of 1934 within 10 years immediately prior to the
Carolina to verify the work authorization of its date of the bid solicitation,
employees through the federal E-Verify system." E- (5) Pursuant to G.S. 143B-139.6C, the undersigned
Verify System Link: www.uscis.gov hereby certifies that the Contractor will not use a
(3) Pursuant to G.S. 143-59.1(b), the undersigned hereby former employee, as defined by G.S. 143B-
certifies that the Contractor named below is not an 139.6C(d)(2), of the North Carolina Department of
"ineligible Contractor" as set forth in G.S. 143-59.1(a) Health and Human Services in the administration of a
because: contract with the Department in violation of G.S.
(a) Neither the Contractor nor any of its affiliates has 143B-139.6C and that a violation of that statute shall
refused to collect the use tax levied under Article 5 void the Agreement.
of Chapter 105 of the General Statutes on its sales (6) The undersigned hereby certifies further that:
delivered to North Caroluia when the sales met (a) He or she is a duly authorized representative of the
one or more of the conditions of G.S. 105- Contractor named below;
164.8(b);and (b) He or she is authorized to make, and does hereby
(b) [check one of the following boxes] make, the foregoing certifications on behalf of the
9 Neither the Contractor nor any of its affiliates Contractor;and
has incorporated or reincorporated in a "tax (c) He or she understands that any person who
haven country" as set forth in G.S. 143- knowingly submits a false certification in response
59,1(c)(2)after December 31,2001; or to the requirements of G.S. 143-59.1and -59.2
❑ The Contractor or one of its affiliates has shall be guilty of a Class I felony.
incorporated or reincorporated in a "tax haven
country" as set forth in G.S. 143-59.1(c)(2)
Contractor's Name; Orange 2 IC*Qvpmment—Oran e County Department of Social Services
Contractor's L11:A3r',@1
1S Vt.Lt. 11/18/Z020
Authorized Agent: Signature Date.
Printed N 1) M-%"dlb4- ren Title Deputy County Manager
ht�SSa Q tSd1n 11/18/2020
Witness: Signature Date
setae ...
Printed Name Melissa Allison Title Executive Assistant
The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document luunediately thereafter.
Contractor Certifications Required by North Carolina Law(Rev.612016) Page I of t