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Home My WebLink About2022-033-E-Social Svc-CNC Access INC All ways caring homecare-In home aides service DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Contract#68-2067 CNC/Access,Inc. dba All Ways Caring HomeCare Contract#68-2067 Fiscal Year Begins July 1,2021 Ends June 30, 2022 This contract is hereby entered into by and between the Orange County Department of Social Services (the "County")and CNC/Access, Inc. dba All Ways Caring HomeCare (the "Contractor") (referred to collectively as the "Parties"). The Contractor's federal tax identification number or Social Security Number is 05-0422187 and DUNS Number is 09-157-5191. 1. Contract Documents: This Contract consists of the following documents: (1) This contract (2) The General Terms and Conditions(Attachment A) (3) The Scope of Work, description of services, and rate(Attachment B) (4) Combined Federal Certifications(Attachment C) (5) Conflict of Interest(Attachment D) (6) No Overdue Taxes(Attachment E) (7) Certification Regarding Transportation(Attachment J) (8) State Certification(Attachment M) (9) Non-Discrimination, Clean Air, Clean Water(Attachment N) (10) Outcomes and Reporting(Attachment O) (11) Contract Determination Questionnaire(required on file) 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 Paragraph 1,above,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 July 1, 2021 and shall terminate on June 30,2022. This contract must be twelve months or less. 4. Contractor's Duties: The Contractor shall provide the services and in accordance with the approved rate as described in Attachment B,Scope of Work, and shall meet the requirements set for in Attachment O,Outcomes and Reporting. 5. County's Duties: The County shall pay the Contractor in the manner and in the amounts specified in the Contract Documents. The total amount paid by the County to the Contractor under this contract shall not exceed $89,400. This amount consists of $89,400 in Federal funds(CFDA# ), $ 0 in State Funds, $0 in County funds ® a. There are no matching requirements from the Contractor. ❑ b. The Contractor's matching requirement is $ ,which shall consist of: ❑ In-kind ❑ Cash ❑ Cash and In-kind ❑ Cash and/or In-kind The contributions from the Contractor shall be sourced from non-federal funds. The total contract amount including any Contractor match shall not exceed $89,400. 6. Reversion of Funds: Any unexpended grant funds shall revert to the County Department of Social Services/Human Services upon termination of this contract. Contract-General (06/19) Page 1 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Contract#68-2067 CNC/Access,Inc.dba All Ways Caring HomeCare 7. Reporting Requirements: Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 &23 and OMB Circular-CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106. 8. Payment Provisions: Payment shall be made in accordance with the Contract Documents as described in the Scope of Work, Attachment B. 9. 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. For Services Performed on Behalf of the Department of Social Services: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Kim Lassiter Fisher,Adult Services Supervisor Kim Lassiter Fisher,Adult Services Supervisor Orange County Department of Social Services Orange County Department of Social Services P.O.Box 8181 113 Mayo Street Hillsborough,NC 27278 Hillsborough,NC 27278 (919)245-2880 (919)245-2880 Lassiter@orangecounlync.gov Lassiter oran ecoun nc. ov For Services Performed on Behalf of the Department on Aging: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Janice Tyler,Director Janice Tyler,Director Orange County Department on Aging Orange County Department on Aging 2551 Homestead Road 2551 Homestead Road Chapel Hill,NC 27516 Chapel Hill,NC 27516 (919)968-2071 (919)968-2071 jjyler!korangecountync.gov ` ler oran ecount nc. ov For the Contractor: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Sherry Pemberton Sherry Pemberton CNC/Access, Inc. dba All Ways Caring HomeCare CNC/Access,Inc. dba All Ways Caring HomeCare 4011 University Drive 4011 University Drive Suite 203 Suite 203 Durham,NC 27707 Durham,NC 27707 919-493-7059 Office 919-493-7059 Office SPemberton CdBrightSpringHeaIth.com SPemberton Bri htS rim Health.com 10. Supplementation of Expenditure of Public Funds: Contract-General (06/19) Page 2 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Contract#68-2067 CNC/Access,Inc. dba All Ways Caring HomeCare 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. 11. 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. 12. Outsourcing to Other Countries: The Contractor certifies that it has identified to the County 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 County. 13. Federal Certifications: 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 to be signed by the contractor's authorized representative. 14. Specific Language Not Previously Addressed: (can be delted if not needed) 15. Signature Warranty: The undersigned represent and warrant that they are authorized to bind their principals to the terms of this agreement. Contract-General (06/19) Page 3 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Contract#68-2067 CNC/Access,Inc. dba All Ways Caring HomeCare The Contractor and the County have executed this contract in duplicate originals,with one original being retained by each party. CNC/ACCESS,INC.DBA ALL WAYS CARING HOMECARE rSDocuSigned by: LVY, Pt,".J' .Vt, 12/22/2021 Signature Date Sherry Pemberton VP HomeCare Contracts & Sale! Printed Name Title 9nld by: �jbin bUt, t�WMKALY'bj 1/24/2022 Signature Date Bonnie Hammersley County Manager Printed Name Title 'f;W` nt has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. Er�i 1/4/2022 Signature of County Finance Officer Date Contract-General (06/19) Page 4 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Contract#68-2067 CNC/Access,Inc. dba All Ways Caring HomeCare ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: CNC/Access, Inc. dba All Ways Caring HomeCare Party/Vendor Contact Person: Sherry Pemberton Contact Phone:(919)493-7059 Party/Vendor Address:4011 University Drive,Suite 203 City Durham State:NC Zip:27707 Department:Social Services/Aging Amount:$89,400 Purpose: In-home aides services Budget Code(s): 10400220-630000/10400220-680026/10400220- 761005/10432020-630100/10432020-630105 Vendor#58844 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New ❑ Renewal ® Amendment ❑ Effective Date July 1,2021 Approved by Board Yes®No❑ Agenda Date:May 7,2013 This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: DocuSigned by: 12/22/2021 Department Director's Signature NOUn.U1 C,b6in. 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�ri%fl cribe the nature of the emergency condition that was addressed: Department Director's Signature I �6UA u_ 1i b_r Date: 1/4/2022 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 sufficienc -,urgeystandards,specifications,and requirements: Quso, (hn ttb 12/21/2021 Office of the Risk Management Officer ;WRRF99 Date: Financial Services This instrument has been pre-audited h1441tecmawsw inquired by the Local Government Budget and Fiscal Control Act: +� 1/4/2022 Office of the Chief Financial Officer Date: Legal Services This agreement is approved as tTtugM4NMctMd sufficiency: Office of the County Attorney r 'T �b�VvV Date: 1/24/2022 096464 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: Contract-General (06/19) Page 5 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ATTACHMENT A GENERAL TERMS AND CONDITIONS Orange County Department of Social Services and Department on Aging Relationships of the Parties the County or the Contractor,receiving services or benefits under this contract shall be deemed an incidental Independent Contractor: The Contractor is and shall be beneficiary only. deemed to be an independent contractor in the performance of this contract and as such shall be wholly responsible for Indemnity and Insurance the work to be performed and for the supervision of its employees. The Contractor represents that it has, or shall Indemnification: The Contractor agrees to indemnify and secure at its own expense, all personnel required in hold harmless the County and any of their officers,agents performing the services under this agreement. Such and employees,from any claims of third parties arising out employees shall not be employees of, or have any or any act or omission of the Contractor in connection with individual contractual relationship with the County. the performance of this contract. Subcontracting: The Contractor shall not subcontract any Insurance: During the term of the contract,the Contractor of the work contemplated under this contract without prior at its sole cost and expense shall provide commercial written approval from the County. Any approved insurance of such type and with such terms and limits as subcontract shall be subject to all conditions of this may be reasonably associated with the contract. As a contract.Only the subcontractors specified in the contract minimum, the Contractor shall provide and maintain the documents are to be considered approved upon award of following coverage and limits: the contract. The County shall not be obligated to pay for (a) Worker's Compensation - The contractor shall any work performed by any unapproved subcontractor. provide and maintain Worker's Compensation The Contractor shall be responsible for the performance of Insurance as required by the laws of North all of its subcontractors. Carolina,as well as employer's liability coverage with minimum limits of$500,000.00,covering all Assignment: No assignment of the Contractor's of Contractor's employees who are engaged in any obligations or the Contractor's right to receive payment work under the contract. If any work is sublet,the hereunder shall be permitted. However, upon written Contractor shall require the subcontractor to request approved by the issuing purchasing authority,the provide the same coverage for any of his County may: employees engaged in any work under the (a) Forward the Contractor's payment check(s) contract. directly to any person or entity designated by the (b) Commercial General Liability - General Contractor, or Liability Coverage on a Comprehensive Broad (b) Include any person or entity designated by Form on an occurrence basis in the minimum Contractor as a joint payee on the Contractor's amount of$1,000,000.00 Combined Single Limit. payment check(s). (Defense cost shall be in excess of the limit of In no event shall such approval and action obligate the liability.) County to anyone other than the Contractor and the (c)Automobile Liability Insurance: The Contractor Contractor shall remain responsible for fulfillment of all shall provide automobile liability insurance with a contract obligations. combined single limit of$500,000.00 for bodily injury and property damage; a limit of Beneficiaries: Except as herein specifically provided $500,000.00 for uninsured/under insured motorist otherwise,this contract shall inure to the benefit of and be coverage; and a limit of$25,000.00 for medical binding upon the parties hereto and their respective payment coverage. The Contractor shall provide successors. It is expressly understood and agreed that the this insurance for all automobiles that are: enforcement of the terms and conditions of this contract, (a) owned by the Contractor and used in the and all rights of action relating to such enforcement, shall performance of this contract; be strictly reserved to the County and the named (b) hired by the Contractor and used in the Contractor.Nothing contained in this document shall give performance of this contract; and or allow any claim or right of action whatsoever by any (c) Owned by Contractor's employees and other third person.It is the express intention of the County used in performance of this contract("non- and Contractor that any such person or entity, other than owned vehicle insurance"). Non-owned General Terms and Conditions—(06/16) Page I of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E vehicle insurance protects employers when employees use their personal vehicles for Termination Without Cause: The County may terminate work purposes. Non-owned vehicle this contract without cause by giving 30 days written insurance supplements, but does not notice to the Contractor. replace,the car-owner's liability insurance. Termination for Cause: If, through any cause, the The Contractor is not required to provide and maintain Contractor shall fail to fulfill its obligations under this automobile liability insurance on any vehicle—owned, contract in a timely and proper manner,the County shall hired, or non-owned--unless the vehicle is used in the have the right to terminate this contract by giving written performance of this contract. notice to the Contractor and specifying the effective date (d) The insurance coverage minimums specified in thereof. In that event,all finished or unfinished deliverable subparagraph(a)are exclusive of defense costs. items prepared by the Contractor under this contract shall, (e) The Contractor understands and agrees that the at the option of the County, become its property and the insurance coverage minimums specified in Contractor shall be entitled to receive just and equitable subparagraph (a) are not limits, or caps, on the compensation for any satisfactory work completed on such Contractor's liability or obligations under this contract. materials,minus any payment or compensation previously (f) The Contractor may obtain a waiver of any one or more made. Notwithstanding the foregoing provision, the of the requirements in subparagraph (a) by Contractor shall not be relieved of liability to the County demonstrating that it has insurance that provides for damages sustained by the County by virtue of the protection that is equal to or greater than the coverage Contractor's breach of this agreement,and the County may and limits specified in subparagraph(a). The County withhold any payment due the Contractor for the purpose shall be the sole judge of whether such a waiver of setoff until such time as the exact amount of damages should be granted. due the County from such breach can be determined. In (g) The Contractor may obtain a waiver of any one or more case of default by the Contractor, without limiting any of the requirements in paragraph(a)by demonstrating other remedies for breach available to it,the County may that it is self-insured and that its self-insurance procure the contract services from other sources and hold provides protection that is equal to or greater than the the Contractor responsible for any excess cost occasioned coverage and limits specified in subparagraph(a). The thereby. The filing of a petition for bankruptcy by the County shall be the sole judge of whether such a Contractor shall be an act of default under this contract. waiver should be granted. (h) Providing and maintaining the types and amounts of Waiver of Default: Waiver by the County of any default insurance or self-insurance specified in this paragraph or breach in compliance with the terms of this contract by is a material obligation of the Contractor and is of the the Provider shall not be deemed a waiver of any essence of this contract. subsequent default or breach and shall not be construed to (i) The Contractor shall only obtain insurance from be modification of the terms of this contract unless stated companies that are authorized to provide such to be such in writing, signed by an authorized coverage and that are authorized by the Commissioner representative of the County and the Contractor and of Insurance to do business in the State of North attached to the contract. Carolina.All such insurance shall meet all laws of the State of North Carolina. Availability of Funds: The parties to this contract agree (j) The Contractor shall comply at all times with all lawful and understand that the payment of the sums specified in terms and conditions of its insurance policies and all this contract is dependent and contingent upon and subject lawful requirements of its insurer. to the appropriation, allocation, and availability of funds (k) The Contractor shall require its subcontractors to for this purpose to the County. comply with the requirements of this paragraph. (1) The Contractor shall demonstrate its compliance with Force Majeure: Neither party shall be deemed to be in the requirements of this paragraph by submitting default of its obligations hereunder if and so long as it is certificates of insurance to the County before the prevented from performing such obligations by any act of Contractor begins work under this contract. war,hostile foreign action,nuclear explosion,riot,strikes, civil insurrection,earthquake,hurricane,tornado,or other Transportation of Clients by Contractor:The contractor catastrophic natural event or act of God. will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina Utilities Survival of Promises: All promises,requirements,terms, Commission. conditions, provisions, representations, guarantees, and warranties contained herein shall survive the contract Default and Termination expiration or termination date unless specifically provided General Terms and Conditions—(06/16) Page 2 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E otherwise herein, or unless superseded by applicable that comply with all applicable federal, state and Federal or State statutes of limitation. local laws,regulations, and rules. Intellectual Property Rights (b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the Copyrights and Ownership of Deliverables: All local Department of Social Services Contract deliverable items produced pursuant to this contract are the Administrator within twenty-four(24)hours exclusive property of the County. The Contractor shall not after the breach is first discovered, provided that assert a claim of copyright or other property interest in the Contractor shall report a breach involving such deliverables. Social Security Administration data or Internal Revenue Service Data within one(1)hour after Federal Intellectual Property Bankruptcy Protection the breach is first discovered. Act: The Parties agree that the County shall be entitled to all rights and benefits of the Federal Intellectual Property (c) Cost Borne by Contractor: If any applicable Bankruptcy Protection Act,Public Law 100-506,codified federal, state, or local law,regulation or rule at 11 U.S.C. 365 (n)and any amendments thereto. requires the Contractor give written notice of a security breach to affected persons,the Contract Compliance with Applicable Laws shall bear the cost of the notice. Compliance with Laws: The Contractor shall comply Trafficking Victims Protection Act of 2000: with all laws, ordinances, codes, rules, regulations, and The Contractor will comply with the requirements of licensing requirements that are applicable to the conduct of Section 106(g)of the Trafficking Victims Protection Act its business, including those of federal, state, and local of 2000, as amended(22 U.S.C. 7104) agencies having jurisdiction and/or authority. By executing this Agreement Provider certifies that Executive Order#24: It is unlawful for any vendor, Provider has not been identified, and has not utilized contractor, subcontractor or supplier of the state to make the services of any agent or subcontractor, on the list gifts or to give favors to any state employee. For created by the State Treasurer pursuant to G.S. 147- additional information regarding the specific 86.58. requirements and exemptions, contractors are encouraged to review Executive Order 24 and G.S. Sec. Title VI, Civil Rights Compliance: In accordance with 133-32. Federal law and U.S.Department of Agriculture(USDA) and U.S. Department of Health and Human Services Confidentiality (HHS) policy, this institution is prohibited from Confidentiality: Any information, data, instruments, discriminating on the basis of race, color,national origin, documents, studies or reports given to or prepared or sex, age or disability. Under the Food Stamp Act and assembled by the Contractor under this agreement shall be USDA policy, discrimination is prohibited also on the kept as confidential and not divulged or made available to basis of religion or political beliefs. any individual or organization without the prior written Equal Employment Opportunity: The Contractor shall approval of the County.The Contractor acknowledges that comply with all federal and State laws relating to equal in receiving,storing,processing or otherwise dealing with employment opportunity. any confidential information it will safeguard and not further disclose the information. except as otherwise Health Insurance Portability and Accountability Act provided in this contract. (HIPAA): The Contractor agrees that, if the County Oversight determines that some or all of the activities within the scope of this contract are subject to the Health Insurance Access to Persons and Records: The State Auditor shall Portability and Accountability Act of 1996,P.L. 104-91, have access to persons and records as a result of all as amended("IRMA"), or its implementing regulations, contracts or grants entered into by State agencies or it will comply with the HIPAA requirements and will political subdivisions in accordance with General Statute execute such agreements and practices as the County 147-64.7. Additionally,as the State funding authority,the may require to ensure compliance. Department of Health and Human Services shall have (a) Data Security: The Contractor shall adopt and access to persons and records as a result of all contracts or apply data security standards and procedures grants entered into by State agencies or political subdivisions. General Terms and Conditions—(06/16) Page 3 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E subcontractors,complies with the requirements of Article 2 Record Retention: Records shall not be destroyed, of Chapter 64 of the NC General Statutes. purged or disposed of without the express written consent of the Division. State basic records retention policy Miscellaneous requires all grant records to be retained for a minimum of five years or until all audit exceptions have been resolved, Choice of Law: The validity of this contract and any of its whichever is longer. If the contract is subject to federal terms or provisions,as well as the rights and duties of the policy and regulations,record retention may be longer than parties to this contract,are governed by the laws of North five years since records must be retained for a period of Carolina.The Contractor,by signing this contract,agrees three years following submission of the final Federal and submits,solely for matters concerning this Contract,to Financial Status Report, if applicable, or three years the exclusive jurisdiction of the courts of North Carolina following the submission of a revised final Federal and agrees, solely for such purpose, that the exclusive Financial Status Report. Also, if any litigation, claim, venue for any legal proceedings shall be Orange County, negotiation, audit, disallowance action, or other action North Carolina. The place of this contract and all involving this Contract has been started before expiration transactions and agreements relating to it, and their situs of the five-year retention period described above, the and forum,shall be Orange County,North Carolina,where records must be retained until completion of the action and all matters,whether sounding in contract or tort,relating to resolution of all issues which arise from it,or until the end the validity,construction,interpretation,and enforcement ofthe regular five-year period described above,whichever shall be determined. is later. The record retention period for Temporary Assistance for Needy Families (TANF) and MEDICAID Amendment: This contract may not be amended orally or and Medical Assistance grants and programs must be by performance. Any amendment must be made in written retained for a minimum of ten years. form and executed by duly authorized representatives of the County and the Contractor. Warranties and Certifications Severability: In the event that a court of competent Date and Time Warranty: The Contractor warrants that jurisdiction holds that a provision or requirement of this the product(s) and service(s) furnished pursuant to this contract violates any applicable law, each such provision contract("product"includes,without limitation,any piece or requirement shall continue to be enforced to the extent it of equipment,hardware,firmware,middleware,custom or is not in violation of law or is not otherwise unenforceable commercial software,or internal components,subroutines, and all other provisions and requirements of this contract and interfaces therein)that perform any date and/or time shall remain in full force and effect. data recognition function, calculation, or sequencing will support a four digit year format and will provide accurate Headings: The Section and Paragraph headings in these date/time data and leap year calculations. This warranty General Terms and Conditions are not material parts of the shall survive the termination or expiration of this contract. agreement and should not be used to construe the meaning thereof. Certification Regarding Collection of Taxes: G.S. 143- 59.1 bars the Secretary of Administration from entering Time of the Essence: Time is of the essence in the into contracts with vendors that meet one of the conditions performance of this contract. of G.S. 105-164.8(b)and yet refuse to collect use taxes on sales of tangible personal property to purchasers in North Key Personnel: The Contractor shall not replace any of Carolina. The conditions include: (a) maintenance of a the key personnel assigned to the performance of this retail establishment or office; (b) presence of contract without the prior written approval of the County. representatives in the State that solicit sales or transact The term "key personnel" includes any and all persons business on behalf of the vendor; and (c) systematic identified as such in the contract documents and any other exploitation of the market by media-assisted, media- persons subsequently identified as key personnel by the facilitated, or media-solicited means. The Contractor written agreement of the parties. certifies that it and all of its affiliates (if any) collect all required taxes. Care of Property: The Contractor agrees that it shall be responsible for the proper custody and care of any property E-Verify furnished to it for use in connection with the performance of this contract and will reimburse the County for loss of, Pursuant to G.S. 143-48.5,the undersigned hereby certifies or damage to; such property. At the termination of this that the Contractor named below, and the Contractor's contract, the Contractor shall contact the County for General Terms and Conditions—(06/16) Page 4 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E instructions as to the disposition of such property and shall comply with these instructions. Orange County Living Wage: Orange County is committed to providing its employees with a living wage Travel Expenses: Reimbursement, if provided in this and encourages agencies to which it provides funding to Agreement, to the Contractor for travel mileage, meals, pursue the same goal. The County's living wage hourly lodging and other travel expenses incurred in the standard, as adopted by the Orange County Board of performance of this contract shall not exceed the rates County Commissioners annually, can be found in the established in County policy. Orange County Budget Ordinance. To the extent possible, Orange County recommends that the Contractor and all Sales[Use Tax Refunds: If eligible,the Contractor and all subcontractors provide a living wage, as defined in this subcontractors shall: (a) ask the North Carolina section,to their employees. Department of Revenue for a refund of all sales and use taxes paid by them in the performance of this contract, Signatures: This Agreement together with any pursuant to G.S. 105-164.14; and (b) exclude all amendments or modifications may be executed refundable sales and use taxes from all reportable electronically. All electronic signatures affixed hereto expenditures before the expenses are entered in their evidence the intent of the Parties to comply with Article reimbursement reports. 11A and Article 40 of North Carolina General Statute Chapter 66. Advertising: The Contractor shall not use the award of this contract as a part of any news release or commercial advertising. General Terms and Conditions—(06/16) Page 5 of 5 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ATTACHMENT B SCOPE OF WORK Orange County Department of Social Services and Orange County Department on Aging Federal Tax Id. or SSN 05-0422187 Contract# 68-2067 A. CONTRACTOR INFORMATION 1. Contractor Agency Name: CNC/Access,Inc. dba All Ways Caring HomeCare 2. If different from Contract Administrator Information in General Contract: Address Telephone Number: _ Fax Number: Email: 3. Name of Program(s): In-Home Aide Services 4. Status: ( )Public ( )Private,Not for Profit (X)Private,For Profit 5. Contractor's Financial Reporting Year July 1, 2021 through June 30,2022 B. Explanation of Services to be provided and to whom(include SIS Service Code):_The Contractor will provide employees to perform in-home services for the Department of Social Services' clients and the Department on Aging's clients, at the level, amount and frequency specified by the social worker in the In-Home Aide Services Plan (SIS Code 042). The Contractor will provide Level It Home Management and Level I1 Personal Care. The Contractor is required to meet all goals and outcomes listed in Attachment O. The Contractor may be asked to provide employees to perform personal care services during an emergency sheltering event. C. Rate per unit of Service(define the unit): 1. If Standard Fixed Rate,Maximum Allowable,(See Rates for Services Chart) A maximum allowable rate of$23.88/hour, of which the Contractor must pay the In Home Aide at least the Coun, 's Living Wage(currently$14.95 per/hr). The County has increased the standard fixed rate to compensate Contractor for any amount above Federal Minimum Wage. 2.Negotiated County Rate. D.Number of units to be provided: E.Details of Billing process and Time Frames: The County will reimburse the Contractor for services described in this contract up to the budgetary limits of the contract allotment. The County will reimburse the Contractor at a rate of$23.88/hour for approved services provided.For reimbursement,the Contractor must submit an original and two copies of an invoice by the fifth of the month for the preceding month's expenditures to the designated County Administrator. All invoices for the provision of services to the Department of Social Services shall be submitted to Contract-Scope of Work(06/04) Page lof 2 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E the Administrator for said Department. All invoices for the provision of services to the Department on Aging shall be submitted to the Administrator for said Department. The County will reimburse the Contractor monthly pon receipt of a complete and correctly filed report. F. Area to be served/Delivery site(s): _Orange County DocuSigned by: Naun,U� �esfbw Nancy Coston, Social Services Director 12/22/2021 (Date Submitted) DDocuSigned by: Janice Tyler,Dept. on Aging Director 1/4/2022 (Date Submitted) DocuSigned by: (Signature of Contractor) 12/22/2021 (Date Submitted) Contract-Scope of Work(06/04) Page 2of 2 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ATTACHMENT C FEDERAL CERTIFICATIONS The undersigned states that: 1. He or she is the duly authorized representative of the Contractor named below; 2. He or she is authorized to make, and does hereby make,the following certifications on behalf of the Contractor, as set out herein: a. The Certification Regarding Nondiscrimination; b. The Certification Regarding Drug-Free Workplace Requirements; c. The Certification Regarding Environmental Tobacco Smoke; d. The Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions; and e. The Certification Regarding Lobbying; 3. He or she has completed the Certification Regarding Drug-Free Workplace Requirements by providing the addresses at which the contract work will be performed; 4. [Check the applicable statement] [ ] He or she has completed the attached Disclosure Of Lobbying Activities because the Contractor has made, or has an agreement to make, a payment to a lobbying entity for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action; OR [ ] He or she has not completed the attached Disclosure Of Lobbying Activities because the Contractor has not made, and has no agreement to make, any payment to any lobbying entity for influencing or attempting to influence any officer or employee of any agency, any Member of Congress, any officer or employee of Congress, or any employee of a Member of Congress in connection with a covered Federal action. 5. The Contractor shall require its subcontractors, if any,to make the same certifications and disclosure. FSDocuSigned by: ' '1 LVY� � VP HomeCare Contracts & Sales Signature Title CNC/Access, INc. dba All ways Caring HomeCare 12/22/2021 Contractor Name Date [This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page] I. Certification Regarding Nondiscrimination The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended,relating to nondiscrimination on the basis of drug abuse; (f) DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and(i)the requirements of any other nondiscrimination statutes which may apply to this Agreement. H. Certification Regarding Drug-Free Workplace Requirements 1. The Contractor certifies that it will provide a drug-free workplace by: a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; b. Establishing a drug-free awareness program to inform employees about: i. The dangers of drug abuse in the workplace; ii. The Contractor's policy of maintaining a drug-free workplace; iii. Any available drug counseling,rehabilitation, and employee assistance programs; and iv. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; c. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph(a); d. Notifying the employee in the statement required by paragraph (a) that, as a condition of employment under the agreement,the employee will: i. Abide by the terms of the statement; and ii. Notify the employer of any criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; e. Notifying the Department within ten days after receiving notice under subparagraph (d)(ii) from an employee or otherwise receiving actual notice of such conviction; f. Taking one of the following actions,within 30 days of receiving notice under subparagraph(d)(ii), with respect to any employee who is so convicted: i. Taking appropriate personnel action against such an employee, up to and including termination; or ii. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and g. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a),(b), (c),(d),(e), and(f). 2. The sites for the performance of work done in connection with the specific agreement are listed below (list all sites; add additional pages if necessary): Address Street DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E City, State, Zip Code Street City, State,Zip Code 3. Contractor will inform the Department of any additional sites for performance of work under this agreement. 4. False certification or violation of the certification may be grounds for suspension of payment, suspension or termination of grants, or government-wide Federal suspension or debarment. 45 C.F.R. 82.510. III. Certification Regarding Environmental Tobacco Smoke Public Law 103-227, Part C-Environmental Tobacco Smoke, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, education, or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law does not apply to children's services provided in private residences, facilities funded solely by Medicare or Medicaid funds, and portions of facilities used for inpatient drug or alcohol treatment. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000.00 per day and/or the imposition of an administrative compliance order on the responsible entity. The Contractor certifies that it will comply with the requirements of the Act. The Contractor further agrees that it will require the language of this certification be included in any subawards that contain provisions for children's services and that all subgrantees shall certify accordingly. IV. Certification Regarding Debarment, Suspension,Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions Instructions [The phrase "prospective lower tier participant" means the Contractor.] 1. By signing and submitting this document, the prospective lower tier participant is providing the certification set out below. 2. The certification in this clause is a material representation of the fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originate may pursue available remedies, including suspension and/or debarment. 3. The prospective lower tier participant will provide immediate written notice to the person to whom this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 CFR Part 76. You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those regulations. 5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is debarred, DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E suspended, determined ineligible or voluntarily excluded from participation in this covered transaction unless authorized by the department or agency with which this transaction originated. 6. The prospective lower tier participant further agrees by submitting this document that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion--Lower Tier Covered Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 9. Except for transactions authorized in paragraph 5 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension, and/or debarment. Certification 1. The prospective lower tier participant certifies, by submission of this document, that neither it nor its principals is presently debarred, suspended,proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2. Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. V. Certification Regarding Lobbying The Contractor certifies,to the best of his or her knowledge and belief,that: 1. No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federally funded contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form SF-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. 3. The undersigned shall require that the language of this certification be included in the award document for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) who receive federal funds of$100,000.00 or more and that all subrecipients shall certify and disclose accordingly. 4. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000.00 and not more than$100,000.00 for each such failure. VI.Disclosure of Lobbying Activities Instructions This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action. 1. Identify the status of the covered Federal action. 2. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action. 3. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub- award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants. 4. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name, address, city, state and zip code of the prime Federal recipient. Include Congressional District, if known. 5. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example,Department of Transportation,United States Coast Guard. 6. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments. 7. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e.g., Request for Proposal(RFP)number, Invitation for Bid(IFB)number, grant announcement number, the contract grant, or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes, e.g., "RFP-DE-90-001." 8. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5. 9. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in Item 4 to influence the covered Federal action. (b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name,First Name and Middle Initial(MI). DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E 10. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Item 4) to the lobbying entity(Item 10). Indicate whether the payment has been made (actual)or will be made(planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made. H. Check the appropriate boxes. Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment. 12. Check the appropriate boxes. Check all boxes that apply. If other, specify nature. 13. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s)of Congress that were contacted. 14. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached. 15. The certifying official shall sign and date the form,print his/her name,title, and telephone number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project 0348-0046 , Washington,D. C. 20503 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Disclosure Of Lobbying Activities (Approved by OMB 0344-0046) Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ❑ a. contract ❑ a. Bid/offer/application ❑ a. initial filing ❑ b. grant ❑ b. Initial Award ❑ b. material change ❑ c. cooperative agreement ❑ c. Post-Award ❑ d. loan For Material Change Only: ❑ e. loan guarantee ❑ f. loan insurance Year Quarter Date Of Last Report: 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: ❑ Prime ❑ SubawardeeTier (if known) Congressional District(if known) Congressional District(if known) 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number(if applicable) 8. Federal Action Number(if known) 9. Award Amount(if known)$ 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services(including (if individual, last name,first name, MI): address if differentfrom No. IOa.) (last name, first name, 1111): (attach Continuation Sheet(s)SF-LLL-A, if necessary) (attach Continuation Sheet(s)SF-LLL-A, if necessary) 11. Amount of Payment(check all that apply): 13. Type of Payment(check all that apply): $ actual ❑ a. retainer planned ❑ b. one-time fee ❑ c. commission 12. Form of Payment(check all that apply): ❑ d. contingent fee ❑ e. deferred ❑ a. cash ❑ f. other; specify: ❑ b. In-kind; specify: Nature Value 14. Brief Description of Services Performed or to be Performed and Date(s)of Services, including officer(s), employee(s), or Member(s)contacted,for Payment Indicated in Item 11(attach Continuation Sheet(s) SF-LLL-A, if necessary): DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E 15. Continuation Sheet(s) SF-LLL-A attached: ❑ Yes ❑ No 16. Information requested through this form is authorized Signature: by title 31 U. S. C. section 1352. This disclosure of lobbying activities is a material representation of fact Print Name: upon which reliance was placed by the tier above when this transaction was made or entered into. This Title: disclosure is required pursuant to 31 U. S. C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required Telephone No: Date: disclosure shall be subject to a civil penalty of not less than$10,000 and not more than$100,000 for each such failure. Federal Use Only Authorized for Local Reproduction Standard Form-LLL DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E I , act ALLWAYS CARIN4 APRIL 15,2021 CONFLICTS OF INTEREST STATEMENT Employees shall not engage in any activities that conflict or might appear to conflict with the interests of CNC/Access, Inc. and shall bring to the attention of the Compliance Department any information about any actual or apparent conflicts of interest involving employees or others with respect to CNC/Access, Inc. A conflict of interest occurs when an employee's private interests interfere in any way with the interests of CNC / Access, Inc. A conflict of interest may also exist if the demands of any outside activities distract you from the performance of your job or cause you to use CNC / Access, Inc. resources for other than CNC /Access, Inc. purposes. An employee's obligation to conduct CNC / Access, Inc.'s business in an honest and ethical manner includes the ethical handling of actual or apparent conflicts of interest between personal and professional relationships. You must remain free of conflicts of interest for the proper performance of your responsibilities. Before making any investment, accepting any position or benefits, participating in any transaction or business arrangement or otherwise acting in a manner that creates or appears to create a conflict of interest, an employee must make full disclosure of all facts and circumstances to the Legal Department, and obtain the prior written approval of General Counsel. The disclosure obligations of employees extend to disclosure of changed circumstances relating to apparent or actual conflicts of interest. Signed: Sherry Pemberton, VP HomeCare Contracts & Sales Date: 4/15/2021 SUBSCRIBED AND SWORN TO before me by Sherry Pemberton, VP HomeCare Contracts & Sales of CNC/Access, Inc., on the day of April 2021. My Commission expires: 7/29/2023 F Z fSsY PV$'•0'L�': �zo Ios sue) t-i . COMMIS9(OK �� EXPIRES U r tl% :ti 7/28/2023 fir` GF- DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ALLWAYS HOMCCAOF Attachment E- NO OVERDUE TAX Debts April 15, 2021 To: Orange County Department of Social Services Certification: We certify that CNC/Access, Inc. dba All Ways Caring HomeCare does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1 b. Sworn Statement: Sherry Pemberton, Vice President of HomeCare Sales & Marketing being duly sworn, say that I am the Vice President of HomeCare Contracts & Sales of CNC/Access, Inc dba All Ways Caring HomeCare in the State of North Carolina: and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. Sherry Pemberton, VP HomeCare Contracts & Sales Sworn to and subscribed before me on the day of the date of said certification. r My Commission Expires: 7/29/2023 $a4?.�NEFi..••RY...lzt- in (Notary Signature and Seal) =Ca 625311 "% c-4 !, COMMISSION t EXPIRES .,,..0 s.41 aa.. G.S. 105-243.1 defines: Overdue tax debt.—Any part of a tax debt that remains unpaid 90 days or more after the notice of final assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement." DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ATTACHMENT J CERTIFICATION REGARDING TRANSPORTATION Orange County Department of Social Services and Orange County Department on Aging By execution of this Agreement the Contractor certifies that it will provide safe client transportation by: 1. Insuring that all drivers(including employees, contractors,contractor's employees, and volunteers)shall be at least 18 years of age; 2. Insuring that all drivers(including employees, contractors,contractor's employees, and volunteers) shall be licensed to operate the specific vehicle used in transporting clients in accordance with Chapter 20-7 of the General Statutes of North Carolina and the Division of Motor Vehicle requirements; 3. Insuring that all vehicles transporting clients shall have at least the minimum level of liability insurance appropriate for the type of vehicle as defined by Article 7,Rule R2-36 of the North Carolina Utilities Commission; 4. Insuring that the contractor shall have written policies and procedures regarding how drivers handle and report client emergencies and/or vehicle crashes involving clients to contractor and how contractor notifies the Orange County Department of Social Services; 5. Insuring that no more than one quarter of one percent of all trips be missed by the contractor during the course of the contract period; (Medicaid only) 6. Insuring that that no more than five percent(5%)of trips should be late for recipient drop off to their appointment per month; (Medicaid only) 7. Contractor will maintain records documenting the following(County may require contractor to provide): a.Valid current copies of Driver's License for all drivers; b. Current valid Vehicle Registration,for all vehicles transporting clients; c.Driving records for all drivers for the past three years and with annual updates; d. Criminal Background checks through North Carolina Law Enforcement or NCIC prior to employment and every three years thereafter; e.Alcohol and Drug Testing policy to meet the Federal Transit Authority guidelines. 8. Disclosing, at the outset of the contract,upon renewal and upon request, any criminal convictions or other reasons for disqualifications from participation in Medicare,Medicaid or Title XX Iw�DocuSiPWgrams(signature on this form confirms this statement). s t, rvmt ,V'fbvu VP Homecare Contracts & Sales Signature Title CNC/Access, INC. dba All ways caring Hord;E 42021 Agency/Organization Date (Certification signature should be same as Contract signature.) Transportation Certification(06/16) Page 1 of 1 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ATTACHMENT M STATE AND LOCAL CERTIFICATIONS Contractor Certifications Required by North Carolina Law Orange County Department of Social Services and Department on Aging 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: http://www.ncga.state.nc.us/EnactedLeizislation/Statutes/PDFByArticle/Chapter 64/Article 2.pdf • G.S. 133-32: http://www.ncga.state.nc.us/gaseripts/statutes/statutelookup.pl?statute=133-32 • Executive Order No. 24(Perdue,Gov.,Oct. 1,2009): http://www.ethicscommission.nc.gov/library/pdfs/Laws/E024.pdf • G.S. 105-164.8(b): http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chgpter 105/GS 105- 164.8.pdf • G.S. 143-48.5: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTMLBySection/ChWter 143/GS 143- 48.5.html • G.S. 143-59.1: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/Chapter 143/GS 143- 59.l.pdf • G.S. 143-59.2: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter 143/GS 143- 59.2.pdf • G.S. 143-133.3: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/fITMLBySection/Chapter 143/GS 143- 133.3.html • G.S. 143B-139.6C: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDFBySection/ChVter 143B/GS 143B-139.6C.pdf • The text of Orange County Living Wage Contractor Policy which is attached to this document. Certifications (1) Pursuant to G.S. 133-32 and Executive Order No.24 (Perdue, Gov., Oct. 1, 2009), the undersigned hereby (a) Neither the Contractor nor any of its affiliates has certifies that the Contractor named below is in refused to collect the use tax levied under Article 5 compliance with,and has not violated,the provisions of of Chapter 105 of the General Statutes on its sales either said statute or Executive Order. delivered to North Carolina when the sales met (2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the one or more of the conditions of G.S. 105- undersigned hereby certifies that the Contractor named 164.8(b); and below, and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the (b) [check one of the following boxes] NC General Statutes, including the requirement for ❑ Neither the Contractor nor any of its affiliates each employer with more than 25 employees in North has incorporated or reincorporated in a "tax Carolina to verify the work authorization of its haven country" as set forth in G.S. 143- employees through the federal E-Verify system." E- 59.1(c)(2)after December 31,2001;or Verify System Link: www.uscis.gov Local government is specifically exempt from Article 2 ❑x The Contractor or one of its affiliates has of Chapter 64 of the North Carolina General incorporated or reincorporated in a "tax haven Statutes. However,local government is subject to and country" as set forth in G.S. 143-59.1(c)(2) must comply with North Carolina General Statute after December 31, 2001 but the United States 153A-99.1,which states in part as follows: is not the principal market for the public trading Counties Must Use E-Verify-Each county shall of the stock of the corporation incorporated in register and participate in E-Verify to verify the work the tax haven country. authorization of new employees hired to work in the (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby United States. certifies that none of the Contractor's officers, (3) Pursuant to G.S. 143-59.1(b), the undersigned hereby directors, or owners (if the Contractor is an certifies that the Contractor named below is not an unincorporated business entity) has been convicted of "ineligible Contractor" as set forth in G.S. 143-59.1(a) any violation of Chapter 78A of the General Statutes or because: the Securities Act of 1933 or the Securities Exchange Contractor Certifications Required by North Carolina Law(Rev.8/2016) Page 1 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Act of 1934 within 10 years immediately prior to the (c) He or she understands that any person who date of the bid solicitation. knowingly submits a false certification in response (5) Pursuant to G.S. 143B-139.6C, the undersigned to the requirements of G.S. 143-59.1and -59.2 hereby certifies that the Contractor will not use a shall be guilty of a Class I felony. former employee, as defined by G.S. 14313- 139.6C(d)(2), of the North Carolina Department of (1) Pursuant to the Orange County Living Wage Health and Human Services in the administration of a Contract's Policy, the undersigned certifies that contract with the Department in violation of G.S. 14313- the Contractor pays the employees who perform 139.6C and that a violation of that statute shall void the services under this contract a living wage (in Agreement. Orange County currently $14.95 per/hr.) Check (6) The undersigned hereby certifies further that: here ❑ if contractor pays employees performing under this contract a living wage. If Contractor (a) He or she is a duly authorized representative of the does not pay employees a living wage, what is the Contractor named below; wage that employees performing services under this contract paid? (b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf of the Contractor; and Contractor's Name: CNC/Access, INc. dba All Ways Caring HomeCare Contractor's DocuSigned by: Authorized Esbv,� �1Agent: Signature � � ��1 Date 12/22/2021 Printed Sherry Pemberton VP HomeCare Contracts & Sales Name Docu'I _ wltSbV Signed by: Title f�C Witness: Signature Date 12/22/2021 e1s Printed Heather Wilson National Credentialing Manager Name Title The witness should be present when the Contractor's Authorized Agent signs this certificate and should sign and date the document immediately thereafter. Contractor Certifications Required by North Carolina Law(Rev.8/2016) Paae 2 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E Section I: General Government and Administration Policy 10.0: Living Wage Contractor Policy Reviewed by: County Attorney/County Manager Approved by: County Manager Original Effective Date: April 21, 2016 Revisions: Policy Statement It is the policy of Orange County to ensure its employees, and all individuals who provide services for Orange County, are paid a living wage. Purpose To encourage all vendors and contractors to pay a living wage to all employees who perform work pursuant to a contract with Orange County. Applicability Applies to all Orange County contracts and purchases. Policy 10.1 Living Wage 10.1.1 Orange County is committed to providing its employees with a living wage and encourages all contractors and vendors doing business with Orange County to pursue the same goal. Orange County's living wage is $14.95 per hour. To the extent possible, Orange County recommends that contractors and vendors seeking to do business with Orange County provide a living wage to their employees. 10.1.2 Prior to final execution of a contract with Orange County all contractors and vendors seeking to do business with Orange County shall submit to the County's representative a statement indicating whether those employees who will perform work on the Orange County contract are paid at least the living wage amount set out above. If such employees do not make at least the living wage amount set out above the contractor or vendor shall indicate in the statement the actual amount paid to such employees. For bid projects this statement should be submitted as part of the bid packet. This policy may be reviewed annually and updated as needed by the Manager's Office Contractor Certifications Required by Orange County and North Carolina Law Revised 6/19 Page 3 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ATTACHMENT N CERTIFICATION REGARDING NONDISCRIMINATION,CLEAN AIR ACT, CLEAN WATER ACT Orange County Department of Social Services/Human Services Certification Regarding Nondiscrimination The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101- 6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970(P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VHI of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy,which prohibit discrimination on the basis of religion and political beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this Agreement. The Contractor must comply with Executive Order 11246, entitled "Equal Employment Opportunity," as amended by Executive Order 11375, and as supplemented by the Department of Labor Regulations (41 CFR Part 60): The Executive Order prohibits federal contractors and federally-assisted construction contractors and subcontractors who do over $10,000 in Government business in one year from discriminating in employment decisions on the basis of race, color, religion, sex, or national origin. The Executive Order also requires Government contractors to take affirmative action to ensure that equal opportunity is provided in all aspects of their employment. Meaningful Access for LEP Individuals: The Contractor that participate in the SNAP must take reasonable steps to ensure that LEP persons have meaningful access to programs, services, and benefits. This includes the requirement to provide bilingual program information and certification materials and interpretation services to single language minorities in certain project areas. SNAP Contractors that do not provide meaningful access for LEP individuals risk violating prohibitions against discrimination based on National Origin in the Food and Nutrition Act of 2008, as amended, Title VI of the Civil Rights Act of 1964 (Title VI) and SNAP program regulations at 7 CFR 272A(b). They also risk noncompliance with the USDA policy guidance titled, "Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons", published in 79 FR 70771 -70784(November 28,2014). The Contractor should develop an implementing plan to address the language assistance needs of the LEP population served. This may include contracting for oral interpretation services, hiring bilingual staff, arranging telephone interpreters and/or language lines, coordinating community volunteers, translating vital documents, and providing written notice that language services are available in appropriate languages. Quality and accuracy of the language service is critical in order to avoid serious consequences to the LEP person and to the recipient. LEP needs should be considered in developing budgets and front line staff should understand how to obtain (Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01/2018)Page 1 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E language assistance services. For additional assistance and information regarding LEP matters, please also visit http://www.lep.gov. Ensuring Equal Opportunity Access for Persons with Disabilities: The Contractor must also ensure equal opportunity access for persons with disabilities. This includes ensuring that communications with applicants, participants, members of the public, and companions with disabilities are as effective as communications with people without disabilities. Contractors that do not provide persons with disabilities equal opportunity access to programs may risk violating prohibitions against disability discrimination in the Rehabilitation Act of 1978, the American with Disabilities Act(ADA)of 1990, as amended,and SNAP program regulations. DOJ published revised final regulations implementing Title II and Title III of the ADA on September 15,2010. These regulations are codified at 28 CFR Part 35 "Nondiscrimination on the Basis of Disability in State and Local Government Services" and at 28 CFR Part 36 "Nondiscrimination on the Basis of Disability in Public Accommodations and Commercial Facilities". In accordance with the implementing regulations, Contractors must provide auxiliary aids and services where necessary to ensure effective communication and equal opportunity access to program benefits for individuals with disabilities. The type of auxiliary aids and services required will vary, but a Contractor may not require an individual with a disability to bring another individual to interpret, and may rely on a person accompanying a disabled individual only in limited circumstances. When a Contractor communicates with applicants and beneficiaries by telephone, it must provide text telephone services (ITY) or have access to an equally effective electronic telecommunications system to communicate with individuals who are deaf, hard of hearing, or hearing impaired. Contractors must also ensure that interested persons, including persons with impaired vision or hearing, can obtain information as to the existence and location of accessible services, activities, and facilities. For more information, please visit the ADA website: http://www.ada.gov. IV.The Clean Air Act,Section 306; 42 U.S.C. §7401 et seq. (1970) a. No Federal agency may enter into any contract with any person who is convicted of any offense under section 113(c) for the procurement of goods, materials, and services to perform such contract at any facility at which the violation which gave rise to such conviction occurred if such facility is owned, leased, or supervised by such person. The prohibition in the preceding sentence shall continue until the Administrator certifies that the condition giving rise to such a conviction has been corrected. For convictions arising under section 113(c)(2), the condition giving rise to the conviction also shall be considered to include any substantive violation of this Act associated with the violation of 113(c)(2). The Administrator may extend this prohibition to other facilities owned or operated by the convicted person. b. The Administrator shall establish procedures to provide all Federal agencies with the notification necessary for the purposes of subsection(a). c. In order to implement the purposes and policy of this Act to protect and enhance the quality of the Nation's air,the President shall,not more than 180 days after enactment of the Clean Air Amendments of 1970 cause to be issued an order(1)requiring each Federal agency authorized to enter into contracts and each Federal agency which is empowered to extend Federal assistance by way of grant, loan, or contract to effectuate the purpose and policy of this Act in such contracting or assistance activities, and (2) setting forth procedures, sanctions, penalties, and such other provisions, as the President determines necessary to carry out such requirement. (Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01/2018)Page 2 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E d. The President may exempt any contract, loan, or grant from all or part of the provisions of this section where he determines such exemption is necessary in the paramount interest of the United States and he shall notify the Congress of such exemption. e. The President shall annually report to the Congress on measures taken toward implementing the purpose and intent of this section, including but not limited to the progress and problems associated with implementation of this section. [42 U.S.C. 7606] V.The Clean Water Act;33 U.S.C. §1251 et seq. (1972) a. No Federal agency may enter into any contract with any person who has been convicted of any offense under Section 309(c) of this Act for the procurement of goods, materials, and services if such contract is to be performed at any facility at which the violation which gave rise to such conviction occurred, and if such facility is owned, leased, or supervised by such person. The prohibition in preceding sentence shall continue until the Administrator certifies that the condition giving rise to such conviction has been corrected. b. The Administrator shall establish procedures to provide all Federal agencies with the notification necessary for the purposes of subsection(a)of this section. c. In order to implement the purposes and policy of this Act to protect and enhance the quality of the Nation's water, the President shall, not more than 180 days after the enactment of this Act,cause to be issued an order: (i) requiring each Federal agency authorized to enter into contracts and each Federal agency which is empowered to extend Federal assistance by way of grant, loan, or contract to effectuate the purpose and policy of this Act in such contracting or assistance activities, and (ii) setting forth procedures, sanctions, penalties, and such other provisions, as the President determines necessary to carry out such requirement. d. The President may exempt any contract, loan, or grant from all or part of the provisions of this section where he determines such exemption is necessary in the paramount interest of the United States and he shall notify the Congress of such exemption. e. The President shall annually report to the Congress on measures taken in compliance with the purpose and intent of this section, including, but not limited to, the progress and problems associated with such compliance. f. No certification by a contractor, and no contract clause, may be required in the case of a contract for the acquisition of commercial items in order to implement a prohibition or requirement of this section or a prohibition or requirement issued in the implementation of this section. In paragraph (1),the term"commercial item"has the meaning given such term in section Sig Alof the Office of Federal Procurement Policy Act(41 U.S.C. 403(12)). [j.u � �UM��V�blit VP HomeCare Contracts & Sales Signature Title CNC/Access, INc. dba All ways Caring HoVkWe2021 Agency/Organization Date (Certification signature should be same as Contract signature.) (Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01/2018)Page 3 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ATTACHMENT O OUTCOMES AND REPORTING Orange County Department of Social Services and Orange County Department on Aging By signing and submitting this document,the Contractor certifies that it agrees to the following: 1. The Contractor agrees to participate in program, fiscal and administrative monitoring and/or audits, making records and staff time available to Federal, State, and County staff. 2. The Contractor agrees to take necessary steps for corrective action,as negotiated within a corrective action plan,for any items found to be out of compliance with Federal, State, and County laws,regulations, standards and/or terms of the Contract. 3. The Contractor agrees that continuation of and/or renewal of this Contract is contingent on meeting the following requirements. The Contractor agrees to: A. Allow the County to complete the assessment of each client. The County will complete an In- Home Aide Service Plan as part of the assessment. The County will provide the In-Home Aide Service Plan to the Contractor prior to the start of service. The County will update the In-Home Aide Service Plan as needed. B. Provide employees to perform in-home services for the County's clients,at the level,amount and frequency specified by the social worker in the In-Home Aide Service Plan. C. Assure that employees meet the competency requirements for the level(s)of service provided. The Contractor will provide verification,upon request,that the selected employee has been properly licensed and trained and is qualified to perform assigned tasks. D. Select and assign qualified employees to clients according to the clients' needs and the employees' abilities and experience. The Contractor agrees to honor requests made by the County for a change in assignment. E. Fulfill all employer financial obligations. F. In a timely manner,provide the County with information on significant changes in the clients' conditions or situations. G. Assure that the client is treated with dignity and respect,assist in protecting the client's assets and possessions, and assure confidentiality of client's circumstances. H. Allow aides to provide transportation,within reason,for both medical and personal reasons. I. Provide care at Level H as appropriate to the needs of the client. J. Complete,for employees serving Level H clients, at least a quarterly on site visit to the home of at least one client the employee is serving. K. Maintain all financial and program records for a period of three years from the date of final payment under this agreement for inspection by the County,the Area Agency on Aging and the Comptroller General of the United States,or any of their duly authorized representatives. If any claim, litigation,negotiation, audit or other action involving the Contractor's records has been started before the expiration of the three-year period,the records must be retained until completion of the action and resolution of all issues that arise from it. L. Monthly contact and annual on-site visits with the County. The Contractor agrees to client contact per Home and Community Care Block Grant guidelines for frequency of required aide supervision by RN, competency testing, and document provision including: a. A supervisory on site home visit by RN within the first calendar week of an aide assignment to observe the work of the aide. Outcomes (06/04) Pagel of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E b. A supervisory on site home visit by RN within calendar weeks 2 through 4 of an aide assignment to observe the work of the aide. c. A quarterly on site home visit by RN made at least every 3 months and an annual visit. Aide must be observed in performance of duties. d. A telephone contact made with aide and client/designated person by RN during non- quarterly review month. e. The provider agency will assure that competency testing is appropriately administered. The aide will demonstrate the tasks before the RN and competency testing reflects the task and the knowledge required of the aide.A check list may be used. The date of competency testing is documented and signed off on by the RN and by the aide who is being competency tested. f. The provider agency will assure that the aide has sufficient training to pass a competency test for the level of service provision requested. The provider agency will have written documentation of the competencies completed,trainings completed,etc. All information will be dated and signed by RN. g. Provider agency will comply with all necessary documentation needed by Orange County Department of Social Services including but not limited to an assessment addressing the following areas: social,environmental,activities of daily living, instrumental activities of daily living,economic,physical,and mental. h. RN will document information regarding economic status at least quarterly. (For example: Client has sufficient income to meet current needs.) i. RN will participate in and sign Orange County DSS In-Home Aide Service Plan. j. RN will participate in and sign Orange County DSS Adult Services Functional Assessment. M. Protective Service In-Home Aide requests are to be staffed within 24 hours and the hours to be worked are to be strictly adhered to. Referral acceptance by the Contractor is conditional on worker availability. The Contractor will notify the County within two hours if the request cannot be honored. N. Provide backup service when a client's usual In-Home Aide is unavailable. O. High Risk In-Home Aide Service requests are to be staffed within five days. All other requests are to be filled within ten working days of the request. P. Changes in the service hours are to be made by the County. Requests for changes may be made by the Contractor,but are not finalized until notification is given by the County. Q. The Contractor will immediately notify the County when Protective Services Cases are not staffed,when In-Home Aide workers are absent,and/or when any of the following occur: a. The client dies. b. The client enters a rest home,nursing home,or hospital. c. The client moves from the original address on the request. d. The client refuses to accept the services or to comply with care requirements. e. There are significant factors that affect the client or significant changes in a client's situation. Outcomes (06/04) Page 2 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E rSDocuSigned by: LVY� �UM��V�bIiL VP HomeCare Contracts & Sales Signature Title CNC/Access, INc. dba All ways Caring HomeCarel2/22/2021 Agency/Organization Date (Certification signature should be same as Contract signature.) Outcomes (06/04) Page 3 of 3 DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E ACC DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/04/2021 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 have ADDITIONAL INSURED provisions or 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 LD certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT a NAME: Aon Risk Services central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 `y Philadelphia PA office INC.No.Ext): A/c.No.: a one Liberty Place E-MAIL e 1650 Market Street ADDRESS: _ Suite 1000 Philadelphia PA 19103 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Indian Harbor Insurance Company 36940 Res-Care, Inc. INSURERB: ACE American insurance company 22667 805 North Whittington Parkway STE 400 Louisville KY 40222 USA INSURERC: Indemnity Insurance Co of North America 43575 INSURERD: Endurance American insurance Company 10641 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570088340601 REVISION NUMBER: 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDD YYY MM/DD YYY POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY XSLG7248079A 1120Z2 EACH OCCURRENCE $4,000,000 X CLAIMS-MADE ❑OCCUR EXCeSS GL/Prof-Claims Md DAMAGE TO RENTED $4,000,000 SIR applies per policy terns & condi ions PREMISES Ea occurrence X Professional Liability Included MED EXP(Any one person) $10,000 X Sexual Abuse/Moleslatlon Included PERSONAL&ADV INJURY $4,000,000 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $6,000,000 a X POLICY ❑PRO LOC PRODUCTS-COMP/OPAGG $4,000,000 o 0 00 OTHER: B 11 07/01/20210710112022 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY ISA H255487 $2,000,000 E accident) „ X ANYAUTO BODILY INJURY(Per person) C Z OWNED SCHEDULED BODILY INJURY(Per accident) 4) AUTOS ONLY AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident 1: 01 D UMBRELLA LIAR X OCCUR XSc30000119105 07/01/2021 07/01/2022 EACH OCCURRENCE $3,000,000 U X EXCESS LIAB CLAIMS-MADE XS Auto & EL Only AGGREGATE $3,000,000 DED RETENTION C WORKERS COMPENSATION AND WLRC67822705 07/01/2021 07/01/2022 X I PER STATUTE I OTH- EMPLOYERS'LIABILITY Y/N ADS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $2,000,000 B OFFICERIMEMBEREXCLUDED? Y N/A WLRC67822663 07/01/2021 07/01/2022 (Mandatory In NH) CA E.L.DISEASE-EA EMPLOYEE $2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $2,000,000- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) ��.. Retroactive Date for Policy #XSLG7248079A is 7/1/01. CNC/Access, Inc. dba All Ways caring Homecare a subsidiary of Rescare, Inc. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ■ice.■ orange County AUTHORIZED REPRESENTATIVE 113 Mayo St. Hillsborough NC 27278 USA �. c.�:kYfG r5�i!84EIEd �hsfBGE�f �,idEl ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E AGENCY CUSTOMER ID: 570000032784 LOC#: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk Services Central, Inc. Res-Care, Inc. POLICY NUMBER see Certificate Number: 570088340601 CARRIER NAIC CODE See Certificate Number: 570088340601 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Additional Coverages Workers' Compensation Policies - 7/1/2021 - 7/1/2022 WLRC67822705 (All other States) - Indemnity insurance Co. of North America, NAIL #43575; WLRC67822663 (CA) - ACE American Insurance Co., NAIC #22667; SCFC67822742 (WI) - ACE Fire Underwriters Insurance Co., NAIC #20702; Cov. A - statutory COV. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Agg. (Disease) Ohio/Washington Excess workers' Compensation Pol # WCUC67822626 - ACE American Insurance Co., NAIL #22667; Cov. A - Statutory Cov. B - $2,000,000 Each Accident / $2,000,000 Each Employee (Disease) / $2,000,000 Annual Aggregate Retention: $1,100,000 ACORD 101(2008/01) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD