HomeMy WebLinkAbout2021-579-E-Ashley Perez-Dental ServicesRevised 07/20
NORTH CAROLINA
CONTRACT AMENDMENT
ORANGE COUNTY
THIS CONTRACT AMENDMENT (“Amendment”) is made and entered into this twelfth day of October, 2021 by and
between ORANGE COUNTY (hereinafter referred to as “County”) and Ashley Perez (hereinafter referred to as
“Provider”).
WITNESSETH:
THAT WHEREAS, the County and Provider entered into a contract dated June 28, 2021, (hereinafter the “Original
Agreement”), for the provision of services for dental services and patient care; and
WHEREAS, the County and Provider desire to amend the Original Agreement while keeping in effect all terms and
conditions of the Original Agreement not inconsistent with the terms and conditions set forth below.
NOW THEREFORE, for and in consideration of the mutual covenants and agreements made herein, the parties agree to
amend the Original Agreement as follows:
1. Article 2, is amended to reflect a maximum payable not-to-exceed amount of $20,416.00.
2. Except for the changes made herein, the Original Agreement shall remain in full force and effect to the extent
it is not inconsistent with this Amendment. In the event there is a conflict between the terms of the Original
Agreement and the terms of this Amendment, this Amendment shall control.
IN TESTIMONY WHEREOF, this Amendment has been executed by the parties hereto, as of the date first above
written.
ORANGE COUNTY PROVIDER
______________________________ __________________________________
Bonnie Hammersley Ashley Perez
County Manager
DocuSign Envelope ID: 8820E63B-A189-4552-96CE-F9ADBC4DF87D
Revised 07/20
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Party/Vendor Name: Ashley Perez Party/Vendor Contact Person: Ashley Perez Contact Phone: 704-649-7876 Party/Vendor
Address: 202B Jay Street. City Chapel Hill State: NC Zip: 27514 Department: Health Amount: $4000 Purpose: Dental Services
Budget Code(s): 10410120-630000 Vendor # 67224 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract
Type: (Check one) New Renewal Amendment Effective Date 10-18-21 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, specifi cations, 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: 8820E63B-A189-4552-96CE-F9ADBC4DF87D
10/15/2021
10/15/2021
10/18/2021
10/18/2021
Revised 07/20
[Departmental Use Only]
TITLE A.Perez-Hygienist Svcs.
FY 2021-2022
NORTH CAROLINA
TEMPORARY SERVICES AGREEMENT
ORANGE COUNTY
THIS AGREEMENT, is made and entered into this 28th day of June, 2021 by and between Orange
County, North Carolina (the "County") party of the first part; and Ashley Perez (the "Provider"),
party of the second part;
W I T N E S S E T H:
For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby
contracts for the services of the Provider, and the Provider agrees to provide the services to the
County in accordance with the terms of this Agreement.
1. TERM
The term of this Agreement shall be July 1, 2021 through October 29, 2021. In no event shall this
Agreement extend more than 7 days beyond 10/29/21 unless a written agreement modifying this
Agreement is signed by both Parties as an amendment to this Agreement.
2. MAXIMUM AMOUNT PAYABLE
The contract amount shall not exceed $16,416.00.
3. SERVICES
Provider agrees to provide the following services: Provide dental hygienist services to patients of
Orange County Health Department dental clinic at a rate of $38 per hour, or $304 per full clinic
day..
4. PAYMENT
A form of invoice shall be provided to Provider by County. Provider shall submit this invoice for
services provided on or within a reasonable amount of time after the last day of each applicable
County payroll period. The invoice shall be signed and dated by the Provider or an officer or agent
of Provider. It shall detail all services provided in payment requests along with detailed
timekeeping of time spent in furtherance of the provision of services set out in this Agreement. The
County will endeavor to make payments to Provider within fifteen (15) days of receipt of and
approval of the invoice by the contracting department.
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.
5. RELATIONSHIP OF PARTIES
Provider is an independent contractor of the County. Provider represents that it has or will secure,
at its own expense, all personnel required in performing the services under this Agreement. Such
personnel shall not be employees of or have any contractual relationship with the County. All
personnel engaged in work under this Agreement shall be fully qualified and shall be authorized or
permitted under state and local law to perform such services. It is f urther agreed that the Provider
DocuSign Envelope ID: 7C92EBC6-C659-47CF-AB66-197597C1911BDocuSign Envelope ID: 8820E63B-A189-4552-96CE-F9ADBC4DF87D
Revised 07/20 2
will obey all State and Federal statutes, rules and regulations which are applicable to provisions of
the services called for herein. Neither Provider nor any employee of the Provider shall be deemed
an officer, employee or agent of the County.
6. WORKER’S COMPENSATION AND INSURANCE
Provider shall be provided Professional Liability Insurance for services as a dental hygienist
provided to County’s Health Department.
7. EXPENSE REIMBURSEMENT
Provider will be reimbursed for routine travel expenses incurred upon the County’s request and
approval, these routine expenses to be defined as mileage between dental sites. Travel
reimbursement shall not be made for travel between Provider’s place of residence and place of
business or for other routine travel.
Payment of Reimbursable Expenses shall be subject to Provider’s timely submission of valid
receipts for any such expenses and approval by the County. Any additional charges not specified
herein, must be mutually agreed to in advance by County and Provider and documented in writing
with a letter signed by authorized representatives for County and Provider and, subject to budgeted
funds.
8. TERMINATION
This Agreement may be terminated by Provider upon thirty (30) days' written notice to the County,
and the County may terminate this Agreement upon thirty (30) days' written notice to Provider.
County may suspend this Agreement upon five (5) days’ reasonable notice to Provider. Either
party may terminate this Agreement upon notice to the other party that obligations pursuant to this
Agreement are made impossible due to declarations of emergency by Orange County or by North
Carolina due to events directly impacting Orange County. Both parties shall remain responsible for
all payment and performance due up to the receipt of such notice, but shall have no further
obligation or responsibility beyond that date provided the terminating party has taken all
reasonable steps to complete the performance of its obligations.
9. INDEMNITY
Provider agrees to waive the right to file any claim, lien, action or suit of any kind against the
County relating to or connected with any injury whether physical, mental or other, or any loss of or
damages to the Provider’s property regardless of whether such injury, loss or damage occurred at
a time when Provider was carrying out duties or responsibilities in furtherance of the provision of
services set out in this Agreement. The Provider agrees to defend, indemnify, and hold harmless
Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses
(including reasonable attorney's fees) arising from bodily injury, including death, to any person or
persons or damage to or destruction of any property caused in whole or in part by any negligent or
intentional act or omission on the part of the Provider.
10. CONFIDENTIALITY
Provider may, during the course of providing services hereunder or in relation to this Agreement
have access to, and acquire knowledge regarding personnel, materials, data, systems, legal,
economic development, tax, or other information which may not be accessible or known to the
general public. Any such knowledge acquired by the Provider shall not be used, published or
divulged by the Provider to any person, firm or other entity without prior written approval of the
DocuSign Envelope ID: 7C92EBC6-C659-47CF-AB66-197597C1911BDocuSign Envelope ID: 8820E63B-A189-4552-96CE-F9ADBC4DF87D
Revised 07/20 3
County unless such use, publication or divulgence is in the direct furtherance of the provision of
services set out in this Agreement. Provider specifically agrees that the foregoing confidentiality
obligation applies to the terms of this Agreement and any information disclosed to the Provider in
any document provided to the Provider by the County. Provider agrees to be bound by the terms
of this section of this Agreement in perpetuity.
11. RECORD AND DOCUMENT RETENTION AND SECURITY
Provider agrees to maintain all records and documents of, or related to, the employment and
services set out in this Agreement on the property of the County, specifically, in the office of Dr.
Meng-Haggerty/Eaglesoft EMR. In the event the removal of such records and documents from the
property of the County is necessary for the furtherance of the employment and provision of
services set out in this Agreement the Provider agrees to maintain such records and doc uments in
a safe and secure location. Provider agrees that upon the conclusion of the provision of services
to the County it will leave all records and documents and things accumulated in the furtherance of
the provision of services set out in this Agreement in a safe and secure location upon the property
of the County, specifically, 300 West Tryon Street, Hillsborough, NC 27278.
12. NONAPPROPRIATION
Provider acknowledges that County is a governmental entity, and the contract validity 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 contract, then this contract shall automatically expire without penalty to
County thirty (30) days after 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 contract, but only as an emergency
fiscal measure during a substantial fiscal crisis.
In the event of a change in the County’s statutory authority, mandate and mandated functions, by
state and federal legislative or regulatory action, which adversely affects County’s authority to
continue its obligations under this contract, then this contract shall automatically terminate without
penalty to County upon written notice to Provider of such limitation or change in County’s legal
authority.
13. SEVERABILITY
Should any word, sentence, paragraph or clause of this Agreement be determined to be unlawful, it
shall have no bearing or impact on the remaining terms of the Agreement which shall remain fully
enforceable as if the unlawful word, sentence, paragraph, or clause had been absent from the
initial drafting of the Agreement.
14. 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.
15. ENTIRE AGREEMENT
DocuSign Envelope ID: 7C92EBC6-C659-47CF-AB66-197597C1911BDocuSign Envelope ID: 8820E63B-A189-4552-96CE-F9ADBC4DF87D
Revised 07/20 4
The parties have read this Agreement and agree to be bound by all of its terms, and further agree
that it constitutes the complete and exclusive statement of the Agreement between the Parties
unless and until modified by a written instrument signed by the Parties. Modifications may be
evidenced by telefacsimile signatures.
16. GOVERNING LAW AND NOTICES
Both parties agree that this Agreement shall be governed by the laws of the State of North
Carolina. Provider affirms it is in compliance with North Carolina E-Verify requirements and the
Iran Divestment Act, if applicable. Any notice required or related to this Agreement shall be in
writing.
ORANGE COUNTY, NORTH CAROLINA PROVIDER
By _________________________ By _________________________________
County Manager Ashley Perez
202B Jay Street
Chapel Hill, NC 27514
DocuSign Envelope ID: 7C92EBC6-C659-47CF-AB66-197597C1911BDocuSign Envelope ID: 8820E63B-A189-4552-96CE-F9ADBC4DF87D
Revised 07/20 5
ORANGE COUNTY—DEPARTMENT USE ONLY
______________________________________________________________________________
Party/Vendor Name: Ashley Perez Party/Vendor Contact Person: Ashley Perez Contact Phone: 704-649-7876
Party/Vendor Address: 202B Jay Street City Chapel Hill State: NC Zip: 27514 Department: Health Amount: $16,416
Purpose: Provide dental hygienist services Budget Code(s): 10410120-630000 Vendor # N/A (N/A if new vendor)
Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment
Effective Date 7-1-21 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 con dition 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: 7C92EBC6-C659-47CF-AB66-197597C1911B
6/29/2021
6/30/2021
7/1/2021
7/1/2021
DocuSign Envelope ID: 8820E63B-A189-4552-96CE-F9ADBC4DF87D