HomeMy WebLinkAbout2020-864-E Housing-NC ESG Office rapid rehousing grantNCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
GENERAL CONTRACT COVER
This contract is hereby entered into by and between the North Carolina Department of Health and
Human Services, Division of Aging and Adult Services (the "Division") and Orange County (the
"Contractor") (referred to collectively as the “Parties”).
1.Contract Documents:
This contract consists of the following documents, which are incorporated herein by reference:
(a)This contract cover
(b)The General Terms and Conditions
(c)Scope of Work
(d)Performance Measures Chart
(e)The Line Item Budget
(f)Federal Certifications
(g)State Certification
Incorporated By Reference
The following documents are reference materials and are available by going to the following
website, Open Window
(http://dhhsopenwindow.nc.gov/index.aspx?pid=doc_ReferenceDocuments).
(a)Travel: Policies Governing Travel Related Expenses for Contractors
(b)General Statutes G.S.143C6 NonState Entities Receiving State Funds
(c)Subchapter 03M Uniform Administration of State Grants
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
2.Precedence Among Contract Documents:
In the event of a conflict between or among the terms of the Contract Documents, the terms in the
Contract Document with the highest relative precedence shall prevail. The order of precedence
shall be the order of documents as listed in the contract document section, with the first-listed
document having the highest precedence and the last-listed document having the lowest
precedence. If there are multiple contract amendments, the most recent amendment shall have
the highest precedence and the oldest amendment shall have the lowest precedence.
3.Effective Period:
This contract shall be effective on 1/1/2021 and shall terminate on 12/31/2021, 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 $40,730. This amount consists of $0 in State funds, $0 in Local funds, $0 in Other funds
and $40,730 in Federal funds.
The total contract amount is $40,730.
Contract Number 00041822 / Page 1 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
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. Monthly
payment shall be made based on actual expenditures made in accordance with the approved
budget on file with both parties and reported on the monthly expenditure report submitted by the
Contractor. If this contract is terminated, the Contractor shall complete a final accounting report
and return any unearned funds to the Division within 30 days of the contract termination date. The
Division shall have no obligation for payments based on expenditure reports submitted later than
30 days after termination or expiration of the contract period. All payments are contingent upon
fund availability.
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.
Contract Number 00041822 / Page 2 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
For the Division:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Lisa Worth, Homeless Programs Coordinator Lisa Worth, Homeless Programs Coordinator
Division of Aging and Adult Services Division of Aging and Adult Services
918 Tate Drive 918 Tate Drive
Raleigh, NC 27699 Raleigh, NC 27699
Telephone : (919)-855-4993
Fax: ()--
Email: lisa.worth@dhhs.nc.gov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Emila Sutton, Housing and Community
Development Director
Emila Sutton, Housing and Community
Development Director
Orange County Orange County
PO Box 8181 PO Box 8181
Hillsborough, NC 27278 Hillsborough, NC 27278
Telephone: (919)-245-2490
Fax: ()--
Email: esutton@orangecountync.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.
15.Federal Certifications:
Contract Number 00041822 / Page 3 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
Individuals and Organizations receiving federal funds must ensure compliance with certain
certifications required by federal laws and regulations. The contractor is hereby complying with
Certifications regarding Nondiscrimination, Drug-Free Workplace Requirements, Environmental
Tobacco Smoke, Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier
Covered Transactions, and Lobbying. These assurances and certifications are accompanied by
a signature page and can be found in the Contractor’s Managed Documents section of DHHS
Open Window. The signature page is to be signed by the contractor’s authorized representative.
16.Other Requirements:
The Emergency Solutions Grant program or ESG is a HUD funded program that the
department has supported and administered for several years. ESG-CV funding is the
result of funds made available to HUD and passed to the states for distribution to
qualified sub-recipient organizations. Funds are reimbursed to the sub-recipient
monthly upon receipt of a request for reimbursement and supporting documents
describing how funds were used. Each contract is monitored by both on-site visit (20%
of caseload each year) and by desk review (100% of the caseload each quarter)
Sub-recipient - Orange County
DUNS Number -
Federal Award – E-20-DC-37-0001
Award Date – 9/2/2020
Performance Period – January 1, 2021 – December 31, 2021
Total Amount Obligated – $40,730
Sub-recipient Total – $40,730
Total Federal Award - $5,342,722
Project Description - HUD Emergency Solutions Grant Funding
Funding Agency - US Department of Housing and Urban Development
CFDA# 14.231
CFDA Emergency Solutions Grant
R&D - No
Federal Award Indirect Cost Rate - 0%
17.Signature Warranty:
The undersigned represent and warrant that they are authorized to bind their principals to the
terms of this agreement.
Signatures follow on next page
Contract Number 00041822 / Page 4 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15)
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
Signature Date
Bonnie B. Hammersley County Manager
Printed Name Title
WITNESS
Signature Date
Printed Name Title
Division of Aging and Adult Services, North Carolina Department of Health and Human Services
Signature Date
Joyce Massey-Smith Director
Printed Name Title
Contract Number 00041822 / Page 5 of 22
Greg Wilder Assistant to County Manager for Legislative Affairs
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
12/10/2020
12/10/2020
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
GENERAL TERMS AND CONDITIONS
Relationships of the Parties
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the
performance of this contract and as such shall be wholly
responsible for the work to be performed and for the
supervision of its employees. The Contractor represents
that it has, or shall secure at its own expense, all
personnel required in performing the services under this
agreement. Such employees shall not be employees of,
or have any individual contractual relationship with, the
Division.
Subcontracting: The Contractor shall not subcontract
any of the work contemplated under this contract without
prior written approval from the Division. Any approved
subcontract shall be subject to all conditions of this
contract. Only the subcontractors specified in the contract
documents are to be considered approved upon award of
the contract. The Division shall not be obligated to pay for
any work performed by any unapproved subcontractor.
The Contractor shall be responsible for the performance
of all of its subcontractors.
Assignment: No assignment of the Contractor's
obligations or the Contractor's right to receive payment
hereunder shall be permitted. However, upon written
request approved by the issuing purchasing authority, the
State may: (a) Forward the Contractor's payment check
directly to any person or entity designated by the
Contractor, or (b) Include any person or entity designated
by Contractor as a joint payee on the Contractor's
payment check. In no event shall such approval and
action obligate the State to anyone other than the
Contractor and the Contractor shall remain responsible
for fulfillment of all contract obligations.
Beneficiaries: Except as herein specifically provided
otherwise, this contract shall inure to the benefit of and be
binding upon the parties hereto and their respective
successors. It is expressly understood and agreed that
the enforcement of the terms and conditions of this
contract, and all rights of action relating to such
enforcement, shall be strictly reserved to the Division and
the named Contractor. Nothing contained in this
document shall give or allow any claim or right of action
whatsoever by any other third person. It is the express
intention of the Division and Contractor that any such
person or entity, other than the Division or the Contractor,
receiving services or benefits under this contract shall be
deemed an incidental beneficiary only.
Indemnity and Insurance
Indemnification: The Contractor agrees to indemnify
and hold harmless the Division, the State of North
Carolina, and any of their officers, agents and employees,
from any claims of third parties arising out of any act or
omission of the Contractor in connection with the
performance of this contract to the extent permitted by
law.
Default and Termination
Termination Without Cause: The Division may
terminate this contract without cause by giving 30 days
written notice to the Contractor.
Termination for Cause: If, through any cause, the
Contractor shall fail to fulfill its obligations under this
contract in a timely and proper manner, the Division shall
have the right to terminate this contract by giving written
notice to the Contractor and specifying the effective date
thereof. In that event, all finished or unfinished deliverable
items prepared by the Contractor under this contract shall,
at the option of the Division, become its property and the
Contractor shall be entitled to receive just and equitable
compensation for any satisfactory work completed on
such materials, minus any payment or compensation
previously made. Notwithstanding the foregoing
provision, the Contractor shall not be relieved of liability to
the Division for damages sustained by the Division by
virtue of the Contractor’s breach of this agreement, and
the Division may withhold any payment due the
Contractor for the purpose of setoff until such time as the
exact amount of damages due the Division from such
breach can be determined. In case of default by the
Contractor, without limiting any other remedies for breach
available to it, the Division may procure the contract
services from other sources and hold the Contractor
responsible for any excess cost occasioned thereby. The
filing of a petition for bankruptcy by the Contractor shall
be an act of default under this contract.
Waiver of Default: Waiver by the Division of any default
or breach in compliance with the terms of this contract by
the Contractor shall not be deemed a waiver of any
subsequent default or breach and shall not be construed
to be modification of the terms of this contract unless
stated to be such in writing, signed by an authorized
representative of the Department and the Contractor and
attached to the contract.
Availability of Funds: The parties to this contract agree
and understand that the payment of the sums specified in
this contract is dependent and contingent upon and
subject to the appropriation, allocation, and availability of
funds for this purpose to the Division.
Force Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
war, hostile foreign action, nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other
catastrophic natural event or act of God.
Survival of Promises: All promises, requirements,
terms, conditions, provisions, representations,
Contract Number 00041822 / Page 6 of 22
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NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
guarantees, and warranties contained herein shall survive
the contract expiration or termination date unless
specifically provided otherwise herein, or unless
superseded by applicable Federal or State statutes of
limitation.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract are
the exclusive property of the Division. The Contractor
shall not assert a claim of copyright or other property
interest in such deliverables.
Compliance with Applicable Laws
Compliance with Laws: The Contractor shall comply
with all laws, ordinances, codes, rules, regulations, and
licensing requirements that are applicable to the conduct
of its business, including those of federal, state, and local
agencies having jurisdiction and/or authority.
Equal Employment Opportunity: The Contractor shall
comply with all federal and State laws relating to equal
employment opportunity.
Health Insurance Portability and Accountability Act
(HIPAA): The Contractor agrees that, if the Division
determines that some or all of the activities within the
scope of this contract are subject to the Health Insurance
Portability and Accountability Act of 1996, P.L. 104-91, as
amended (“HIPAA”), or its implementing regulations, it will
comply with the HIPAA requirements and will execute
such agreements and practices as the Division may
require to ensure compliance.
Confidentiality
Confidentiality: Any information, data, instruments,
documents, studies or reports given to or prepared or
assembled by the Contractor under this agreement shall
be kept as confidential and not divulged or made available
to any individual or organization without the prior written
approval of the Division. The Contractor acknowledges
that in receiving, storing, processing or otherwise dealing
with any confidential information it will safeguard and not
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.
During the performance of this contract, the contractor is
to notify the Division contract administrator of any contact
by the federal Office for Civil Rights (OCR) received by
the contractor.
Cost Borne by Contractor: If any applicable federal,
state, or local law, regulation, or rule requires the Division
or the Contractor to give affected persons written notice
of a security breach arising out of the Contractor’s
performance under this contract, the Contractor shall bear
the cost of the notice.
Oversight
Access to Persons and Records: The State Auditor
shall have access to persons and records as a result of
all contracts or grants entered into by State agencies or
political subdivisions in accordance with General Statute
147-64.7. Additionally, as the State funding authority, the
Department of Health and Human Services shall have
access to persons and records as a result of all contracts
or grants entered into by State agencies or political
subdivisions.
Record Retention: Records shall not be destroyed,
purged or disposed of without the express written consent
of the Division. State basic records retention policy
requires all grant records to be retained for a minimum of
five years or until all audit exceptions have been resolved,
whichever is longer. If the contract is subject to Federal
policy and regulations, record retention may be longer
than five years. Records must be retained for a period of
three years following submission of the final Federal
Financial Status Report, if applicable, or three years
following the submission of a revised final Federal
Financial Status Report. Also, if any litigation, claim,
negotiation, audit, disallowance action, or other action
involving this Contract has been started before expiration
of the five-year retention period described above, the
records must be retained until completion of the action
and resolution of all issues which arise from it, or until the
end of the regular five-year period described above,
whichever is later. The record retention period for
Temporary Assistance for Needy Families (TANF) and
MEDICAID and Medical Assistance grants and programs
must be retained for a minimum of ten years.
Contract Number 00041822 / Page 7 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
Miscellaneous
Choice of Law: The validity of this contract and any of its
terms or provisions, as well as the rights and duties of the
parties to this contract, are governed by the laws of North
Carolina. The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract,
to the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Wake County,
North Carolina. The place of this contract and all
transactions and agreements relating to it, and their situs
and forum, shall be Wake County, North Carolina, where
all matters, whether sounding in contract or tort, relating
to the validity, construction, interpretation, and
enforcement shall be determined.
Amendment: This contract may not be amended orally or
by performance. Any amendment must be made in
written form and executed by duly authorized
representatives of the Division and the Contractor. The
Purchase and Contract Divisions of the NC Department
of Administration and the NC Department of Health and
Human Services shall give prior approval to any
amendment to a contract awarded through those offices.
Severability: In the event that a court of competent
jurisdiction holds that a provision or requirement of this
contract violates any applicable law, each such provision
or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise
unenforceable and all other provisions and requirements
of this contract shall remain in full force and effect.
Headings: The Section and Paragraph headings in these
General Terms and Conditions are not material parts of
the agreement and should not be used to construe the
meaning thereof.
Gender and Number: Masculine pronouns shall be read
to include feminine pronouns and the singular of any word
or phrase shall be read to include the plural and vice
versa.
Time of the Essence: Time is of the essence in the
performance of this contract.
Key Personnel: The Contractor shall not replace any of
the key personnel assigned to the performance of this
contract without the prior written approval of the Division.
The term “key personnel” includes any and all persons
identified as such in the contract documents and any
other persons subsequently identified as key personnel
by the written agreement of the parties.
Care of Property: The Contractor agrees that it shall be
responsible for the proper custody and care of any
property furnished to it for use in connection with the
performance of this contract and will reimburse the
Division for loss of, or damage to, such property. At the
termination of this contract, the Contractor shall contact
the Division for instructions as to the disposition of such
property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Contractor for
travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
exceed the rates published in the applicable State rules
or approved local government travel policy. International
travel shall not be reimbursed under this contract.
Sales/Use Tax Refunds: If eligible, the Contractor and
all subcontractors shall: (a) ask the North Carolina
Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
pursuant to G.S. 105-164.14; and (b) exclude all
refundable sales and use taxes from all reportable
expenditures before the expenses are entered in their
reimbursement reports.
Advertising: The Contractor shall not use the award of
this contract as a part of any news release or commercial
advertising.
Contract Number 00041822 / Page 8 of 22
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Scope of Work (Rev. 06/11)
SCOPE OF WORK
BACKGROUND
The NC ESG program is a reimbursable grant program established by the McKinney-Vento
Homeless Assistance Act (Public Law 100-77, Public Law 100-628) as amended by the
Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (HEARTH
Act). The HEARTH Act authorized the Emergency Solutions Grant (ESG) Program for
providing assistance to persons and families who are homeless or at risk of homelessness.
These programs and services are carried out by community organizations that apply for, and
are awarded, NC ESG funds on an annual basis. These funds are a formula grant
appropriated by Congress to the United States Department of Housing and Urban
Development with the intention to: (1) engage homeless individuals and families living on
the street; (2) improve the number and quality of emergency shelters for homeless
individuals and families; (3) help operate these shelters; (4) provide essential services to
shelter residents, (5) rapidly re-house homeless individuals and families, and (6) prevent
families and individuals from becoming homeless. NC ESG funds are intended to be used
as part of a crisis response system using a low barrier, housing-focused approach to ensure
that homelessness is rare, brief, and non-recurring.
PURPOSE
The purpose of this contact is:
• ESG funds are intended to be used as part of a crisis response system using a low barrier,
housing-focused approach to ensure that homelessness is “rare, brief, and one time”;
• Engage homeless individuals and families living on the street;
• Improve the number and quality of emergency shelters for homeless individuals and
families;
• Help operate emergency shelters;
• Provide essential services to emergency shelter residents;
• Rapidly re-house homeless individuals and families;
• Prevent families and individuals from becoming homeless.
Services to be provided:
RRH Financial Assistance: Rapid Re-housing financial services are used to assist
individuals with rental assistance along with the payment of allowable financial
assistance to avoid homelessness.
PERFORMANCE REQUIREMENTS
Reimbursement submission must be accurate to ensure both timely service provision and
reimbursement. Incorrect submissions delay and effect spending. All requisitions incorrect
or incomplete will be returned for correction and will not be submitted for payment until
corrects are received. Requisitions must be submitted monthly and within 45 days of the
expenditure disbursing ESG funds per HUD regulation. Program compliance with both HUD
and State regulation must be followed as a condition of continued funding. Failure to stay in
compliance and/or to develop a corrective action plan as a result of findings deriving from a
monitoring review may result in loss of funding
PERFORMANCE STANDARDS
Monitoring by the ESG office will yield 10% or less in the findings/categories in cumulative
records reviewed. Actual compliance rate will be no less than 80% in all measure
requirements.
Contract Number 00041822 / Page 9 of 22
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Scope of Work (Rev. 06/11)
PERFORMANCE MONITORING/QUALITY ASSURANCE PLAN
All programs are monitored once per quarter and receive a desk review. On-site or virtual
monitoring will take place yearly with 20% of the caseload minimum receiving monitoring
visits. Monitoring visits are also completed when sub-recipients are having continued
concerns or receive a finding in the past year.
REIMBURSEMENTS
Sub-recipients complete the reimbursement request, the ESG staff checks the
reimbursement for accuracy and that it includes all necessary back-up documentation.
Reimbursements are then submitted to the DAAS budget office for further review and lastly,
they are submitted to the Office of the Controller for request for payment from HUD. Sub-
recipients receive payments directly.
Contract Number 00041822 / Page 10 of 22
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Performance Measures (Rev. 4//12)
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
Type
Input Reporting
Frequency
Quarterly
Measure All subrecipients must submit 1 requisition per month within the 45-day submission
period with a minimum of 1 requisition leading to a disbursement of CV funds.
Budget Year 1 Trend Maintain
Baseline
Value
$40,730
Target Value 100% of the allocation by the end of the contract period
Data Source fiscal data monitoring and requests for reimbursement
Collection
Process and
Calculation
reimbursement submission
Collection
Frequency
monthly
Measure
Type
Output Reporting
Frequency
Monthly
Measure 80% of requisitions submitted were correctly submitted
Budget Year 1 Trend Maintain
Baseline
Value
0
Target Value 80% of submissions
Data Source fiscal data monitoring
Collection
Process and
Calculation
reimbursement submission
Contract Number 00041822 / Page 11 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
Performance Measures (Rev. 4//12)
Collection
Frequency
monthly
Measure
Type
Outcome Reporting
Frequency
Annual
Measure Program Compliance- On-site or virtual desk monitoring by the ESG office yields
10% or less findings/concerns in cumulative records reviewed.
Budget Year 1 Trend Increase
Baseline
Value
0
Target Value 100%
Data Source electronic submission and file submission
Collection
Process and
Calculation
onsite, virtual and/or desk monitoring
Collection
Frequency
Monthly and quarterly
Contract Number 00041822 / Page 12 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
Line Item Budget Detail (08/11)
LINE ITEM BUDGET
This begins the line item budget for year 1
Budget Detail - Year 1
Category Item Narrative Amount
Salary\Wages $0.00
Fringe Benefits $0.00
Other $0.00
Repair and Maintenance $0.00
Staff Development $0.00
Dues and Subscriptions $0.00
Operational Other Not Otherwise Classified RRH Financial Assistance
Rapid Re-housing financial services are used to assist individuals
with rental assistance along with the payment of allowable
financial assistance to avoid homelessness.
$40,730.00
Subcontracts and Grants $0.00
Contract Number 00041822 / Page 13 of 22
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
Line Item Budget Detail (08/11)
Budget Detail - Year 1
Category Item Narrative Amount
Match $0.00
Cost Per Service $0.00
Sub Total $40,730.00
Indirect Cost $0.00
Total Budget $40,730.00
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
Rate
Months Work %Fringe
Amount Total
Fringe
Percent Total
Total
0 $0.00 0.0000 0 0%$0.00 $0.00 $0.00
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Greg Wilder
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
Revised 07/20 9
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Party/Vendor Name: State ESG Office Party/Vendor Contact Person: Lisa Worth Contact Phone: (919)-855-4993
Party/Vendor Address: 2101 Mail Service Center City Raleigh State: NC Zip: 27699 Department: OCHCD
Amount: $40,730 Purpose: Rapid Re-Housing (RRH) Financial Assistance Budget Code(s): 32470605-442235-
71084 Vendor # (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type:
(Check one) New Renewal Amendment Effective Date 1/1/2021 Approved by Board Yes No
Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work
on this project has not been initiated prior to execution of the agreement:
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 specifications:
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:_________
DocuSign Envelope ID: 222DC9BE-6B82-4FBD-883D-4D642ACDA58E
12/9/2020
12/10/2020
12/10/2020
12/10/2020