HomeMy WebLinkAbout2021-287-Aging-Orange County Meals on Wheels-Meals on wheels1
[Departmental Use Only]
TITLE Aging
FY 2020-2021
NORTH CAROLINA
(FEDERAL FUNDING)
ORANGE COUNTY SERVICES AGREEMENT
This Services Agreement (hereinafter “Agreement”), made and entered into this 1st day of
June, 2021 (“Effective Date”) between the County of Orange, a local political subdivision of the
State of North Carolina (hereinafter “County”) and Meals on Wheels of Orange County
(hereinafter “Provider”) to provide Home Delivered Meals to persons age 60+.
WITNESSETH:
That the County and Provider, for the consideration herein named, do hereby
agree as follows:
1. Services
a. Scope of Work.
i) This Agreement is for services to be rendered by Provider to County with respect
to Home Delivered Meals for persons age 60 and over.
ii) By executing this Agreement, the Provider represents and agrees that Provider is
qualified to perform and fully capable of performing and providing the services
required or necessary under this Agreement in a fully competent, professional and
timely manner.
iii) Time is of the essence with respect to this Agreement.
iv) The services to be performed under this Agreement consist of Basic Services, as
described and designated in Section 3 hereof. Compensation to the Provider for
Basic Services under this Agreement shall be as set forth herein.
2. Responsibilities of the Provider
a. Services to be provided. The Provider shall provide the County with all services required
in Section 3 to satisfactorily complete the Project within the time limitations set forth
herein and in accordance with the highest professional standards.
b. Standard of Care.
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i) The Provider shall exercise reasonable care and diligence in performing services
under this Agreement in accordance with the highest generally accepted standards
of this type of Provider practice throughout the United States and in accordance
with applicable federal, state and local laws and regulations applicable to the
performance of these services. Provider is solely responsible for the professional
quality, accuracy and timely completion and/or submission of all work related to
the Basic Services.
ii) Provider shall be responsible for all errors or omissions of its agents, contractors,
employees, or assigns in the performance of the Agreement. Provider shall correct
any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at
no additional cost to the County.
iii) The Provider shall not, except as otherwise provided for in this Agreement,
subcontract the performance of any work under this Agreement without prior
written permission of the County. No permission for subcontracting shall create,
between the County and the subcontractor, any contract or any other relationship.
iv) Provider is an independent contractor of County. Any and all employees of the
Provider engaged by the Provider in the performance of any work or services
required of the Provider under this Agreement, shall be considered employees or
agents of the Provider only and not of the County, and any and all claims that may
or might arise under any workers compensation or other law or contract on behalf
of said employees while so engaged shall be the sole obligation and responsibility
of the Provider.
v) If activities related to the performance of this Agreement require specific licenses,
certifications, or related credentials Provider represents that it and/or its employees,
agents and subcontractors engaged in such activities possess such licenses,
certifications, or credentials and that such licenses certifications, or credentials are
current, active, and not in a state of suspension or revocation.
vi) In determining the Basic Services to be provided, should any documents be
referenced in this Agreement, the terms of this Agreement shall have priority in any
conflict between the terms of referenced documents and the terms of this
Agreement.
vii) Should this Agreement involve project designs, the construction or creation of
which is to be bid out and/or fulfilled by other contractors, and bidding or
negotiation with contractors produce prices which, when added to the other
elements of the approved total project cost, produce a cost that is in excess of the
approved total project cost, the Provider shall participate with the County in
negotiation and design adjustments to the extent such are necessary to obtain prices
within the approved total project cost. All activity of the Provider with respect to
these matters shall constitute Basic Services and shall be performed by the Provider
without additional compensation. If negotiation and design adjustments fail to
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bring costs within the total project cost the County may reject all bids and Provider
will redesign and/or reduce portions of the project in an effort to reduce the bid
prices to within the total project cost and rebid the project. One such redesign is
included within Basic Services. If this second letting for bids does not produce bids
that are within the approved total project cost initially or after negotiations with the
contractor the cost is not reduced to an amount within the total project cost, the
Provider is not obligated to engage in further redesign.
3. Basic Services
a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows:
Assessment, Client Registration Forms and Meal Tracking for Home Delivered Meals
A Client Registration Form (CRF) is required for each meal recipient. Completed registrations are
submitted to Orange County Department on Aging (OCDOA) to be entered in NC Division of Aging and
Adult Services ARMS system for reimbursement.
Meal tracking records of individuals receiving meals, date received and number of meals received will be
submitted each Friday to OCDOA.
Home Delivered Meal assessments and reassessments are to be documented when service begins and
updated every 6 months.
If a client is receiving weekly frozen meals it should be documented in the individual’s assessment they
have the means to reheat these meals and is physically and mentally able to do so.
Meals may be provided on a daily, weekly or bi-weekly basis (such as 5 frozen meals delivered once per
week) or multiple meals can be provided in a day to an eligible client.
Menus and meal components
Provider is encouraged to provide meals meeting the 1/3 RDA requirement. Meals must provide at a
minimum, one serving of meat or meat alternative, one serving of vegetable or fruit and two servings of
grain or starch. Eligibility for reimbursement of meals is based on meal components rather than nutrient
analysis. Documentation should be provided of meal components and serving size, number of meals
ordered; number of meals delivered, number of meals served and temperatures. All menu records of
meals are required to be submitted to OCDOA for TJCOG-AAA monitoring.
Consumer Contributions
Client must be offered an opportunity to contribute to the meal cost. Consumer contributions require
that two signatures receipt the contribution and that the individual making the bank deposit be different
from the person signing the receipts. Client contributions record should be submitted weekly with the
meals served documentation.
Funding must be spent by 9/30/21
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b. Equipment. Provider shall supply, at its sole expense, all equipment, tools, materials, and
or supplies required to provide Basic Services hereunder, unless otherwise agreed in
writing.
c. Health and Safety. Provider shall be responsible for complying with all safety precautions,
guidance, programs and rules required by federal or state law, regulation, local ordinance
or any other requirements applicable to the Basic Services provided while providing the
Services under this Agreement.
4. Duration of Services
a. Term. The term of this Agreement shall be from June 1, 2021 to September 20, 2021.
b. Scheduling of Services.
i) The Provider shall schedule and perform its activities in a timely manner.
ii) Should the County determine that the Provider is behind schedule, it may require
the Provider to expedite and accelerate its efforts, including providing additional
resources and working overtime, as necessary, to perform its services in accordance
with the approved project schedule at no additional cost to the County.
iii) The Commencement Date for the Provider's Basic Services shall be June1, 2021
5. Compensation
a. Compensation for Basic Services. Compensation for Basic Services shall include all
compensation due the Provider from the County for all services satisfactorily (as
determined by the County) performed pursuant to this Agreement. The maximum amount
payable for Basic Services shall not exceed $90,000 where per meal cost will be $8.02 .
Payment for satisfactorily performed Basic Services shall become due and payable within
thirty (30) days of Provider properly invoicing County. Payment shall be subject to
provisions of Section 5(b).
b. Disputes. In the event the amount stated on an invoice is disputed by the County, the
County may withhold payment of all or a portion of the amount stated on an invoice until
the parties resolve the dispute. Should Provider fail to perform its duties under the terms
of this Agreement, County may, without fault or penalty, withhold any payment associated
with the work to be performed until such time as said work is completed.
c. Additional Services. County shall not be responsible for costs related to any services in
addition to the Basic Services performed by Provider unless County requests such
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additional services in writing and such additional services are evidenced by a written
amendment to this Agreement.
6. Responsibilities of the County
Cooperation and Coordination. The County has designated Anshu Gupta and Janice Tyler to
act as the County's representatives with respect to the Project and shall have the authority to
render decisions within guidelines established by the County Manager and/or the County
Board of Commissioners and shall be available during working hours as often as may be
reasonably required to render decisions and to furnish information.
7. Insurance
General Requirements. Provider shall obtain, at its sole expense, Commercial General
Liability Insurance, Automobile Insurance, Workers’ Compensation Insurance, and any
additional insurance as may be required by County’s Risk Manager as such insurance
requirements are described in the Orange County Risk Transfer Policy and Orange County
Minimum Insurance Coverage Requirements (each document is incorporated herein by
reference and may be viewed at
http://www.orangecountync.gov/departments/purchasing_division/contracts.php). If County’s
Risk Manager determines additional insurance coverage is required such additional insurance
shall consist of N/A (if no additional insurance required mark N/A as being not applicable).
Provider shall not commence work until such insurance is in effect and certification thereof
has been received by the County's Risk Manager.
8. Indemnity
Indemnity. To the extent authorized by North Carolina law the Provider agrees, without
limitation, to defend, indemnify and hold harmless the County from all loss, liability, claims
or expense, including attorney's fees, arising out of or related to the Project and arising from
property damage or bodily injury including death to any person or persons caused in whole
or in part by the negligence or misconduct of the Provider except to the extent same are caused
by the negligence or willful misconduct of the County. It is the intent of this provision to
require the Provider to indemnify the County to the fullest extent permitted under North
Carolina law.
9. Amendments to the Agreement
Changes in Basic Services. Changes in the Basic Services and entitlement to additional
compensation or a change in duration of this Agreement shall be made by a written
Amendment to this Agreement executed by the County and the Provider. The Provider shall
proceed to perform the Services required by the Amendment only after receiving a fully
executed Amendment from the County.
10. Termination
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a. Termination for Convenience of the County. This Agreement may be terminated without
cause by the County and for its convenience upon seven (7) days’ prior written notice to
the Provider. Termination of this Contract, under Section 10, shall not form the basis of
any claim for anticipated profits by either party.
b. Other Termination. The Provider may terminate this Agreement based upon the County's
material breach of this Agreement, provided, the County has not taken all reasonable
actions to remedy the breach. The Provider shall give the County seven (7) days' prior
written notice of its intent to terminate this Agreement for cause.
c. Compensation after Termination.
i) In the event of termination, the Provider shall be paid that portion of the fees and
expenses that it has earned to the date of termination, less any costs or expenses
incurred or anticipated to be incurred by the County due to errors or omissions of
the Provider.
ii) Should this Agreement be terminated, the Provider shall deliver to the County
within seven (7) days, at no additional cost, all deliverables including any electronic
data or files relating to the Project.
d. Waiver. The payment of any sums by the County under this Agreement or the failure of
the County to require compliance by the Provider with any provisions of this Agreement
or the waiver by the County of any breach of this Agreement shall not constitute a waiver
of any claim for damages by the County for any breach of this Agreement or a waiver of
any other required compliance with this Agreement.
e. Suspension. County may suspend the Basic Services and this Agreement at any time for
County’s convenience and without penalty to County upon three (3) days’ not ice to
Provider. Upon any suspension by County, Provider shall discontinue work on the Basic
Services and shall not resume the Basic Services until notified to proceed by County.
11. Additional Provisions
a. Limitation and Assignment. The County and the Provider each bind themselves, their
successors, assigns and legal representatives to the terms of this Agreement. Neither the
County nor the Provider shall assign or transfer its interest in this Agreement without the
written consent of the other.
b. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of
respective parties hereunder shall be governed by the laws of the State of North Carolina.
By executing this Agreement Provider affirms that Provider and any subcontractors of
Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North
Carolina General Statutes. By executing this Agreement Provider certifies that Provider
has not been identified, and has not utilized the services of any agent or subcontractor
identified, on the list created by the State Treasurer pursuant to G.S. 147-86.58. By
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executing this Agreement Provider certifies that Provider has not been identified, and has
not utilized the services of any agent or subcontractor identified, on the list created by the
State Treasurer pursuant to G.S. 147-86.81.
c. Non-Discrimination. Provider shall at all times remain in compliance with all applicable
local, state, and federal laws, rules, and regulations including but not limited to all state
and federal non-discrimination laws, policies, rules, and regulations and the Orange
County Non-Discrimination Policy and Orange County Living Wage Policy (each policy
is incorporated herein by reference and may be viewed at
http://www.orangecountync.gov/departments/purchasing_division/contracts.php.) Any
violation of the Orange County Non-Discrimination Policy is a breach of this Agreement
and County may immediately terminate this Agreement without further obligation on the
part of the County. This paragraph is not intended to limit and does not limit the definition
of breach to discrimination.
d. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with
respect to any provision of, or the performance or non-performance of, this Agreement
shall be brought in the General Court of Justice of North Carolina sitting in Orange
County, North Carolina. It is agreed by the parties that no other court shall have
jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be
initiated by either Party, however, the Parties may agree to nonbinding mediation of any
dispute prior to the bringing of such suit or action.
e. Severability. If any provision of this Agreement is held as a matter of law to be
unenforceable, the remainder of this Agreement shall be valid and binding upon the
Parties.
f. Ownership of Work Product. Should Provider’s performance of this Agreement generate
documents, items or things that are specific to this Project such documents, items or things
shall become the property of the County and may be used on any other project without
additional compensation to the Provider. The use of the documents, items or things by the
County or by any person or entity for any purpose other than the Project as set forth in this
Agreement shall be at the full risk of the County.
g. Non-Appropriation. Provider acknowledges that County is a governmental entity, and the
validity of this Agreement is based upon the availability of public funding under the
authority of its statutory mandate.
In the event that public funds are unavailable and not appropriated for the performance of
County’s obligations under this Agreement, then this Agreement shall automatically expire
without penalty to County immediately upon written notice to Provider of the
unavailability and non-appropriation of public funds. It is expressly agreed that County
shall not activate this non-appropriation provision for its convenience or to circumvent the
requirements of this Agreement, but only as an emergency fiscal measure during a
substantial fiscal crisis.
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In the event of a change in the County’s statutory authority, mandate and/or mandated
functions, by state and/or federal legislative or regulatory action, which adversely affects
County’s authority to continue its obligations under this Agreement, then this Agreement
shall automatically terminate without penalty to County upon written notice to Provider of
such limitation or change in County’s legal authority.
h. Compliance With The Contract Work Hours And Safety Standard Act. (See 29 C.F.R.
§5.5)
i. Overtime requirements. No Provider or sub-Provider contracting for any part of the
contract work which may require or involve the employment of laborers or
mechanics shall require or permit any such laborer or mechanic in any workweek in
which he or she is employed on such work to work in excess of forty hours in such
workweek unless such laborer or mechanic receives compensation at a rate not less
than one and one-half times the basic rate of pay for all hours worked in excess of
forty hours in such workweek.
ii. Violation; liability for unpaid wages; liquidated damages. In the event of any
violation of the clause set forth in paragraph (b)(1) of 29 C.F.R.§5.5 the Provider
and any sub-Provider responsible therefor shall be liable for the unpaid wages. In
addition, such Provider and sub-Provider shall be liable to the United States (in
the case of work done under contract for the District of Columbia or a territory, to
such District or to such territory), for liquidated damages. Such liquidated damages
shall be computed with respect to each individual laborer or mechanic, including
watchmen and guards, employed in violation of the clause set forth in paragraph
(b)(1) of 29 C.F.R. §5.5, in the sum of $26 for each calendar day on which such
individual was required or permitted to work in excess of the standard workweek
of forty hours without payment of the overtime wages required by the clause set
forth in paragraph (b)(1) of 29 C.F.R.
§5.5.
iii. Withholding for unpaid wages and liquidated damages. The (write in the name of
the Federal agency or the loan or grant recipient) shall upon its own action or upon
written request of an authorized representative of the Department of Labor
withhold or cause to be withheld, from any moneys payable on account of work
performed by the Provider or sub-Provider under any such contract or any other
Federal contract with the same prime Provider, or any other federally- assisted
contract subject to the Contract Work Hours and Safety Standards Act, which is
held by the same prime Provider, such sums as may be determined to be necessary
to satisfy any liabilities of such Provider or sub-Provider for unpaid wages and
liquidated damages as provided in the clause set forth in paragraph (b)(2) of 29
C.F.R. §5.5.
iv. Subcontracts. The Provider or sub-Provider shall insert in any subcontracts the
clauses set forth in paragraph (b)(1) through (4) of 29 C.F.R. §5.5 and also a
clause requiring the sub-Providers to include these clauses in any lower tier
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subcontracts. The prime Provider shall be responsible for compliance by any sub-
Provider or lower tier sub-Provider with the clauses set forth in paragraphs (b)(1)
through (4) of 29 C.F.R. §5.5.
i. Byrd Anti-Lobbying Amendment, 31 U.S.C. § 1352 (as amended). Providers who apply
or bid for an award of $100,000 or more shall file the required certification. Each tier
certifies to the tier above that it will not and has not used Federal appropriated funds to
pay any person or organization for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, officer or employee of Congress, or an
employee of a Member of Congress in connection with obtaining any Federal contract,
grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any
lobbying with non-Federal funds that takes place in connection with obtaining any Federal
award. Such disclosures are forwarded from tier to tier up to the recipient who in turn
will forward the certification(s) to the awarding agency.
j. Clean Air And Federal Water Pollution Control Act (Applicable only if the contract is
more than $150,000)
i. Clean Air Act.
(a) The Provider agrees to comply with all applicable standards, orders, or
regulation issue pursuant to the Federal Water Pollution Control Act, as
amended, 33 U.S.C. 1251 et seq.
(b) The Provider agrees to include these requirements in each subcontract
exceeding $150,000 financed in whole or in part with Federal assistance
provided by FEMA.
ii. Federal Water Pollution Control Act.
(a) The Provider agrees to comply with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act, as amended, 42 U.S.C. §
7401 et seq.
(b) The Provider agrees to report each violation to the Orange County Department
on Aging and understands and agrees that the Orange County Department on
Aging will, in turn, report each violation as required to assure notification to
the Federal Emergency Management Agency, and the appropriate
Environmental Protection Agency Regional Office.
(c) The Provider agrees to include these requirements in each subcontract
exceeding $150,000 financed in whole or in part with Federal assistance
provided by FEMA.
k. Suspension And Debarment
i. This Agreement is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2
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C.F.R. pt. 3000. As such, the Provider is required to verify that none of the
Provider’s principals (defined at 2 C.F.R. § 180.995) or its affiliates (defined at
2 C.F.R. § 180.905) are excluded (defined at 2 C.F.R. § 180.940) or disqualified
(defined at 2 C.F.R. § 180.935).
ii. The Provider must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000,
subpart C, and must include a requirement to comply with these regulations in any
lower tier covered transaction it enters into.
iii. This certification is a material representation of fact relied upon by Orange County.
If it is later determined that the Provider did not comply with 2 C.F.R. pt. 180,
subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to
Orange County, the Federal Government may pursue available remedies, including
but not limited to suspension and/or debarment.
iv. The bidder or proposer agrees to comply with the requirements of 2 C.F.R. pt. 180,
subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout
the period of any contract that may arise from this offer. The bidder or proposer
further agrees to include a provision requiring such compliance in its lower tier.
l. Access to Records. The following access to records requirements apply to this contract:
i. The Provider agrees to provide State of North Carolina, the County, the FEMA
Administrator, the Comptroller General of the United States, or any of their
authorized representative access to any books, documents, papers, and records
of the Contractor, which are directly pertinent to this contract for the purposes
of making audits, examinations, excerpts, and transcriptions.
ii. The Provider agrees to permit any of the foregoing parties to reproduce by any
means whatsoever or to copy excerpts and transcriptions as reasonably needed.
iii. The Provider agrees to provide the FEMA Administrator or his authorized
representative access to construction or other work sites pertaining to the work
being completed under the contract.
iv. In compliance with the Disaster Recovery Act of 2018, the County and Provider
acknowledge and agree that no language in this contract is intended to prohibit
audits or internal reviews by the FEMA Administrator or the Comptroller
General of the United States.
m. DHS Seal, Logo, and Flags. The Provider shall not use the DHS seal(s), logos, crests,
or reproductions of flags or likenesses of DHS agency officials without specific FEMA
pre-approval.
n. Compliance with Federal Law, Regulations and Executive Orders. This is an
acknowledgement that FEMA financial assistance will be used to fund all or a portion of
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the Agreement. The Provider will comply with all applicable Federal law, regulations,
executive orders, FEMA policies, procedures, and directives.”
o. No Obligation by Federal Government. The Federal Government is not a party to this
Agreement and is not subject to any obligations or liabilities to the non-Federal entity,
Provider, or any other party pertaining to any matter resulting from this Agreement.
p. Program Fraud and False or Fraudulent Statements or Related Acts. The Provider
acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims
and Statements) applies to the Provider’s actions pertaining to this Agreement.
q. Entire Agreement. This Agreement represents the entire and integrated agreement between
the County and the Provider and supersedes all prior negotiations, representations or
agreements, either written or oral. This Agreement may be amended only by written
instrument signed by both parties. Facsimile signatures may evidence modifications.
r. Notices. Any notice required by this Agreement shall be in writing and delivered by
certified or registered mail, return receipt requested to the following:
Orange County Provider’s Name
Attention: Janice Tyler Meals on Wheels of Orange County
P.O. Box 8181
Hillsborough, NC 27278
s. Signatures. This Agreement together with any amendments or modifications may be
executed electronically. All electronic signatures affixed hereto evidence the consent of
the Parties to utilize electronic signatures and the intent of the Parties to comply with
Article 11A and Article 40 of North Carolina General Statute Chapter 66.
IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have
hereunder set their hands and seal, all as of the day and year first above written.
ORANGE COUNTY: PROVIDER:
By: _________________________________
Bonnie Hammersley, County Manager
By: __________________________________
Printed Name and Title
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ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Party/Vendor Name: Orange County Meals on Wheels Party/Vendor Contact Person: Rachel Sobel Bearman
Contact Phone: Party/Vendor Address: 632 Laurel Hill Road City Chapel Hill, State: NC Zip:
27514 Department: AGING Amount: $90,000 Purpose: Budget Code(s): 10430120-630000-95060 Vendor
# 65841 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New X
Renewal Amendment Effective Date Approved by Board Yes No Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affir matively state work on
this project has not been initiated prior to execution of the agreement:
Department Director’s Signature ________________________________________ 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 specifica tions:
Office of the Chief Information Officer___________________________________ Date: _______________
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _______________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _______________
Legal Services
This agreement is approved as to legal form and sufficiency:
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:_________
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6/1/2021
6/2/2021
6/2/2021
6/2/2021
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APPENDIX A, 44 C.F.R. PART 18 – CERTIFICATION REGARDING LOBBYING
Certification for Contracts, Grants, Loans, and Cooperative Agreements
The undersigned 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 an 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, the
making of any Federal grant, the making of any Federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any Federal 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 Federal contract, grant, loan, or
cooperative agreement, the undersigned shall complete and submit Standard Form-
LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.
3. The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts
under grants, loans, and cooperative agreements) and that all subrecipients shall certify
and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
The Provider, , certifies or affirms the truthfulness and accuracy of each statement of its
certification and disclosure, if any. In addition, the Provider understands and agrees that the
provisions of 31 U.S.C. Chap. 38, Administrative Remedies for False Claims and Statements,
apply to this certification and disclosure, if any.
Signature of Provider’s Authorized Official
_____________________________________________________ __________________
Printed Name and Title of Provider’s Authorized Official Date
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INSR ADDL SUBR
LTR INSR WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #:
INSURED INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER
POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY)
GENERAL LIABILITY
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
AUTHORIZED REPRESENTATIVE
INSURER(S) AFFORDING COVERAGE NAIC #
Y / N
N/A
(Mandatory in NH)
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
EACH OCCURRENCE $
DAMAGE TO RENTED
COMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence)
CLAIMS-MADE OCCUR MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $
$PRO-POLICY LOCJECT
COMBINED SINGLE LIMIT
(Ea accident)$
ANY AUTO BODILY INJURY (Per person)$
ALL OWNED AUTOS BODILY INJURY (Per accident)$
SCHEDULED AUTOS PROPERTY DAMAGE
(Per accident)$
HIRED AUTOS
$NON-OWNED AUTOS
$
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $$
WC STATU-OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
c
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09)
O
CERTIFICATE OF LIABILITY INSURANCEACORDTM 9/15/2020
The CIMA Companies, Inc.
2750 Killarney Dr, Suite 202
Woodbridge, VA 22192-4124
703 739-9300
Nayab Alam
703-778-7304 703-778-7354
nalam@cimaworld.com
Chapel Hill-Carrboro Meals on Wheels
dba Meals on Wheels Orange County, NC
PO Box 2102
Chapel Hill, NC 27515
Alliance of Nonprofits for Ins
Hartford Underwriters Insurance
Carolina Casualty Insurance Com
10023
30104
10510
A
X
X
202036882 07/01/2020 07/01/2021
2,000,000
2,000,000
1,000,000
1,000,000
500,000
20,000
A
X
X
202036882 07/01/2020 07/01/2021
1,000,000
B
N
6S60UB0G11045218 07/01/2020 07/01/2021 X
100,000
500,000
100,000
A
C
Liquor Liab
D&O
202036882
DCP1231894P8
07/01/2020
07/03/2020
07/01/2021
07/03/2021
1,000,000
1,000,000
The certificate holder is hereby listed as an additional insured.
Orange County Government
Attn: Risk Manager
P.O. Box 8181,
Hillsborough, NC 27278
1 of 1
#S391951/M389620
NCCHAP7Client#: 58358
NPA
1 of 1
#S391951/M389620
DocuSign Envelope ID: 1C0795C4-E5F5-4D2B-A734-9175427D7278