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Home My WebLink About2023-108-E-Housing Dept-OCHCD-Homelessness PreventionNCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15) GENERAL CONTRACT COVER This contract is hereby entered into by and between the North Carolina Department of Health and Human Services, Division of Aging and Adult Services (the "Division") and Orange County Dept. of Housing & Community Develop (the "Contractor") (referred to collectively as the “Parties”). 1.Contract Documents: This contract consists of the following documents, which are incorporated herein by reference: (a)This contract cover (b)The General Terms and Conditions (c)Scope of Work (d)Performance Measures Chart (e)The Line Item Budget (f)Federal Certifications (g)State Certification Incorporated By Reference The following documents are reference materials and are available by going to the following website, Open Window (https://openwindow.ncdhhs.gov/index.aspx?pid=doc_ReferenceDocuments ). (a)Travel: Policies Governing Travel Related Expenses for Contractors (b)General Statutes G.S.143C6 NonState Entities Receiving State Funds (c)Subchapter 03M Uniform Administration of State Grants These documents constitute the entire agreement between the Parties and supersede all prior oral or written statements or agreements. 2.Precedence Among Contract Documents: In the event of a conflict between or among the terms of the Contract Documents, the terms in the Contract Document with the highest relative precedence shall prevail. The order of precedence shall be the order of documents as listed in the contract document section, with the first-listed document having the highest precedence and the last-listed document having the lowest precedence. If there are multiple contract amendments, the most recent amendment shall have the highest precedence and the oldest amendment shall have the lowest precedence. 3.Effective Period: This contract shall be effective on 2/1/2023 and shall terminate on 9/30/2023, with the option to extend, if mutually agreed upon, through a written amendment as provided for in the General Terms and Conditions. 4.Contractor’s Duties: The Contractor shall provide the services as described in the scope of work and in accordance with the approved budget. 5.Division’s Duties: The Division shall pay the Contractor in the manner and in the amounts specified in the contract documents. The total amount paid by the Division to the Contractor under this contract shall not exceed $111,471. This amount consists of $0 in State funds, $0 in Local funds, $0 in Other funds and $111,471 in Federal funds. The total contract amount is $111,471. Contract Number 00045595 / Page 1 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15) 6.Conflict of Interest Policy: The division has determined that this contract is not subject to N.C.G.S. 143C-6-22 & 23. 7.Reversion of Unexpended Funds: Any unexpended grant funds shall revert to the Division upon termination of this contract. 8.Grants: The Contractor/Grantee has the responsibility to ensure that all sub-grantees, if any, provide all information necessary to permit the Contractor/Grantee to comply with the standards set forth in this contract. 9.Reporting Requirements: This is a subaward for financial assistance. Financial Assistance awards are subject to the Uniform Administration of State Awards, Oversight and Reporting Requirements for recipient and subrecipients described in N.C. General Statue § 143C-6-23(d) and in 09 NCAC 03M.205.and subject to the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance),promulgated by the United States Office of Management and Budget sections: 2 C.F.R. 200.303 regarding internal controls; 2 C.F.R. 200.330 through 200.332 regarding subrecipient monitoring and management; and subpart F regarding audit requirements, which implements the Single Audit Act (31 U.S.C. §§ 7501-7507) if federal funds are received. A non-governmental grantee who receives a combined $500,000 or more funds from all state agencies (including federal financial assistance received by the State and transferred or disbursed to a non-State entity) must continue to submit a single or program-specific audit prepared and completed in accordance with Generally Accepted Government Auditing Standards, also known as a Yellow Book audit, to Risk Mitigation and Audit Monitoring Risk Management, Compliance and Consulting and mail to: NCGrantsReporting@dhhs.nc.gov within 9 months of the grantee's fiscal year end. Per 09 NCAC 03M. 205: “Unless prohibited by law, the costs of audits made in accordance with the provisions of this Rule shall be allowable charges to State and Federal awards. The charges may be considered a direct cost or an allocated indirect cost, as determined in accordance with cost principles outlined in the Code of Federal Regulations, 2CFR Part 200. The cost of any audit not conducted in accordance with this Subchapter shall not be charged to State awards.” DHHS encourages all its non-governmental grantees that receive funds from other state agencies or DHHS divisions to contact their assigned contract monitor(s) to determine if year-end reports must be submitted for those particular grants/awards. 10.Payment Provisions: Contract Number 00045595 / Page 2 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15) Upon execution of this contract, the Contractor may request and, upon approval by the Division, receive an advance of no more than two months' operating expenses plus start-up expenses if approved by the Division. The advance for start up expenses is limited to the amount to be expended within the two-month period. Monthly payment shall be made based on actual expenditures made in accordance with the approved budget on file with both parties and reported on the monthly expenditure report submitted by the Contractor. The original expenditure report shall be submitted to the Division Contract Administrator. The Department of Health and Human Services’ Controller’s Office will analyze the cash needs of the Contractor no less often than every three months. If the Department determines that the advance exceeds the financial needs of the Contractor based on actual monthly expenditures, the excess advance will be reduced from a subsequent month’s expenditure report/reimbursement. Any State funds advanced to the Contractor must be returned or settled no later than June 10 of the year in which this contract terminates or the Contractor may request that the outstanding advance of State funds be deducted from the May expenditure report to be reimbursed during June. If the expenditure report is not sufficient in amount to cover the advance settlement, a check representing the difference must be attached to the report. The Division must receive this report no later than June 10. The Contractor shall have up to 30 days for close out of non-State funds, completion and submission of the final monthly expenditure report related to this contract period. The Division shall have no obligation for payments based on expenditure reports submitted later than 30 days after termination or expiration of the contract period. However, if federal funds have been approved for an advance, any excess or unearned federal funds advanced must be returned to the Division no later than the expiration date of the contract or settled with the submission of the final expenditure report. If this contract is terminated prior to the end of the contract period, the Contractor is required to settle or return any State funds advanced within 30 days of the termination date or June 10, whichever occurs first. If the contract extends beyond June 30, a settlement of state funds can be made during the subsequent month of July and settlement of these State funds must occur at the end of the contract period, or by June 10 of the following year, whichever occurs first. All payments are contingent upon fund availability. 11.Contract Administrators: All notices permitted or required to be given by one Party to the other and all questions about the contract from one Party to the other shall be addressed and delivered to the other Party’s contract administrator. The name, post office address, street address, telephone number, fax number, and email address of the Parties’ respective initial contract administrators are set out below. Either Party may change the name, post office address, street address, telephone number, fax number, or email address of its contract administrator by giving timely written notice to the other Party. Contract Number 00045595 / Page 3 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15) For the Division: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Lisa Worth, Homeless Programs Coordinator Lisa Worth, Homeless Programs Coordinator Division of Aging and Adult Services Division of Aging and Adult Services 918 Tate Drive 918 Tate Drive Raleigh, NC 27699 Raleigh, NC 27699 Telephone : (919)-855-4993 Fax: ()-- Email: lisa.worth@dhhs.nc.gov For the Contractor: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Kat Weis, Coordinator Kat Weis, Coordinator Orange County Dept. of Housing & Community Develop Orange County Dept. of Housing & Community Develop PO Box 8181 PO Box 8181 Hillsborough, NC 27278 Hillsborough, NC 27278 Telephone: (919)-245-2496 Fax: ()-- Email: sweis@orangecountync.gov 12.Supplementation of Expenditure of Public Funds: The Contractor assures that funds received pursuant to this contract shall be used only to supplement, not to supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract services and related programs. Funds received under this contract shall be used to provide additional public funding for such services; the funds shall not be used to reduce the Contractor’s total expenditure of other public funds for such services. 13.Disbursements: As a condition of this contract, the Contractor acknowledges and agrees to make disbursements in accordance with the following requirements: (a)Implement adequate internal controls over disbursements; (b)Pre-audit all vouchers presented for payment to determine: Validity and accuracy of payment Payment due date Adequacy of documentation supporting payment Legality of disbursement (c)Assure adequate control of signature stamps/plates; (d)Assure adequate control of negotiable instruments; and (e)Implement procedures to insure that account balance is solvent and reconcile the account monthly. 14.Outsourcing to Other Countries: The Contractor certifies that it has identified to the Division all jobs related to the contract that have been outsourced to other countries, if any. The Contractor further agrees that it will not outsource any such jobs during the term of this contract without providing notice to the Division. 15.Federal Certifications: Contract Number 00045595 / Page 4 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15) Individuals and Organizations receiving federal funds must ensure compliance with certain certifications required by federal laws and regulations. The contractor is hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and certifications are accompanied by a signature page and can be found in the Contractor’s Managed Documents section of DHHS Open Window. The signature page is to be signed by the contractor’s authorized representative. 16.Other Requirements: The Emergency Solutions Grant program or ESG is a HUD funded program. Funds are reimbursed to the sub-recipient monthly upon receipt of a request for reimbursement and supporting documents describing how funds were used. Each contract is monitored by both on-site visit (20% of caseload each year) and by desk review (100% of the caseload each quarter) Sub-recipient - Orange County UEI - GFFMCW9XDA53 Federal Award – E-21-DC-37-001 Award Date – 11/2/2022 Performance Period – January 1, 2023 – December 31,2023 Total Amount Obligated – $111,471 Sub-recipient Total – $111,471 Total Federal Award - $5,339,223 Project Description – HUD Emergency Solutions Grant Funding Agency - US Department of Housing and Urban Development CFDA# 14.231 CFDA Emergency Solutions Grant R&D - No Federal Award Indirect Cost Rate - 0% 17.Signature Warranty: The undersigned represent and warrant that they are authorized to bind their principals to the terms of this agreement. Signatures follow on next page Contract Number 00045595 / Page 5 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 NCDHHS GCT1007 (Contract) (General) (Rev. 11.01.15) In Witness Whereof, the Contractor and the Division have executed this contract in duplicate originals, with one original being retained by each party. Orange County Dept. of Housing & Community Develop Signature Date Bonnie Hammersley County Manager Printed Name Title Division of Aging and Adult Services, North Carolina Department of Health and Human Services Signature Date Joyce Massey-Smith Director Printed Name Title Contract Number 00045595 / Page 6 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 3/7/2023 NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15) GENERAL TERMS AND CONDITIONS Relationships of the Parties Independent Contractor: The Contractor is and shall be deemed to be an independent contractor in the performance of this contract and as such shall be wholly responsible for the work to be performed and for the supervision of its employees. The Contractor represents that it has, or shall secure at its own expense, all personnel required in performing the services under this agreement. Such employees shall not be employees of, or have any individual contractual relationship with, the Division. Subcontracting: The Contractor shall not subcontract any of the work contemplated under this contract without prior written approval from the Division. Any approved subcontract shall be subject to all conditions of this contract. Only the subcontractors specified in the contract documents are to be considered approved upon award of the contract. The Division shall not be obligated to pay for any work performed by any unapproved subcontractor. The Contractor shall be responsible for the performance of all of its subcontractors. Assignment: No assignment of the Contractor's obligations or the Contractor's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, the State may: (a) Forward the Contractor's payment check directly to any person or entity designated by the Contractor, or (b) Include any person or entity designated by Contractor as a joint payee on the Contractor's payment check. In no event shall such approval and action obligate the State to anyone other than the Contractor and the Contractor shall remain responsible for fulfillment of all contract obligations. Beneficiaries: Except as herein specifically provided otherwise, this contract shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this contract, and all rights of action relating to such enforcement, shall be strictly reserved to the Division and the named Contractor. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any other third person. It is the express intention of the Division and Contractor that any such person or entity, other than the Division or the Contractor, receiving services or benefits under this contract shall be deemed an incidental beneficiary only. Indemnity and Insurance Indemnification: The Contractor agrees to indemnify and hold harmless the Division, the State of North Carolina, and any of their officers, agents and employees, from any claims of third parties arising out of any act or omission of the Contractor in connection with the performance of this contract to the extent permitted by law. Default and Termination Termination Without Cause: The Division may terminate this contract without cause by giving 30 days written notice to the Contractor. Termination for Cause: If, through any cause, the Contractor shall fail to fulfill its obligations under this contract in a timely and proper manner, the Division shall have the right to terminate this contract by giving written notice to the Contractor and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Contractor under this contract shall, at the option of the Division, become its property and the Contractor shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Contractor shall not be relieved of liability to the Division for damages sustained by the Division by virtue of the Contractor’s breach of this agreement, and the Division may withhold any payment due the Contractor for the purpose of setoff until such time as the exact amount of damages due the Division from such breach can be determined. In case of default by the Contractor, without limiting any other remedies for breach available to it, the Division may procure the contract services from other sources and hold the Contractor responsible for any excess cost occasioned thereby. The filing of a petition for bankruptcy by the Contractor shall be an act of default under this contract. Waiver of Default: Waiver by the Division of any default or breach in compliance with the terms of this contract by the Contractor shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms of this contract unless stated to be such in writing, signed by an authorized representative of the Department and the Contractor and attached to the contract. Availability of Funds: The parties to this contract agree and understand that the payment of the sums specified in this contract is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to the Division. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, Contract Number 00045595 / Page 7 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15) guarantees, and warranties contained herein shall survive the contract expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation. Intellectual Property Rights Copyrights and Ownership of Deliverables: All deliverable items produced pursuant to this contract are the exclusive property of the Division. The Contractor shall not assert a claim of copyright or other property interest in such deliverables. Compliance with Applicable Laws Compliance with Laws: The Contractor shall comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the conduct of its business, including those of federal, state, and local agencies having jurisdiction and/or authority. Equal Employment Opportunity: The Contractor shall comply with all federal and State laws relating to equal employment opportunity. Health Insurance Portability and Accountability Act (HIPAA): The Contractor agrees that, if the Division determines that some or all of the activities within the scope of this contract are subject to the Health Insurance Portability and Accountability Act of 1996, P.L. 104-91, as amended (“HIPAA”), or its implementing regulations, it will comply with the HIPAA requirements and will execute such agreements and practices as the Division may require to ensure compliance. Confidentiality Confidentiality: Any information, data, instruments, documents, studies or reports given to or prepared or assembled by the Contractor under this agreement shall be kept as confidential and not divulged or made available to any individual or organization without the prior written approval of the Division. The Contractor acknowledges that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not further disclose the information except as otherwise provided in this contract. Data Security: The Contractor shall adopt and apply data security standards and procedures that comply with all applicable federal, state, and local laws, regulations, and rules. Duty to Report: The Contractor shall report a suspected or confirmed security breach to the Division’s Contract Administrator within twenty-four (24) hours after the breach is first discovered, provided that the Contractor shall report a breach involving Social Security Administration data or Internal Revenue Service data within one (1) hour after the breach is first discovered. During the performance of this contract, the contractor is to notify the Division contract administrator of any contact by the federal Office for Civil Rights (OCR) received by the contractor. Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Division or the Contractor to give affected persons written notice of a security breach arising out of the Contractor’s performance under this contract, the Contractor shall bear the cost of the notice. Oversight Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as the State funding authority, the Department of Health and Human Services shall have access to persons and records as a result of all contracts or grants entered into by State agencies or political subdivisions. Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all audit exceptions have been resolved, whichever is longer. If the contract is subject to Federal policy and regulations, record retention may be longer than five years. Records must be retained for a period of three years following submission of the final Federal Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Contract has been started before expiration of the five-year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five-year period described above, whichever is later. The record retention period for Temporary Assistance for Needy Families (TANF) and MEDICAID and Medical Assistance grants and programs must be retained for a minimum of ten years. Contract Number 00045595 / Page 8 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15) Miscellaneous Choice of Law: The validity of this contract and any of its terms or provisions, as well as the rights and duties of the parties to this contract, are governed by the laws of North Carolina. The Contractor, by signing this contract, agrees and submits, solely for matters concerning this Contract, to the exclusive jurisdiction of the courts of North Carolina and agrees, solely for such purpose, that the exclusive venue for any legal proceedings shall be Wake County, North Carolina. The place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all matters, whether sounding in contract or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Amendment: This contract may not be amended orally or by performance. Any amendment must be made in written form and executed by duly authorized representatives of the Division and the Contractor. The Purchase and Contract Divisions of the NC Department of Administration and the NC Department of Health and Human Services shall give prior approval to any amendment to a contract awarded through those offices. Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this contract violates any applicable law, each such provision or requirement shall continue to be enforced to the extent it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this contract shall remain in full force and effect. Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the agreement and should not be used to construe the meaning thereof. Gender and Number: Masculine pronouns shall be read to include feminine pronouns and the singular of any word or phrase shall be read to include the plural and vice versa. Time of the Essence: Time is of the essence in the performance of this contract. Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract without the prior written approval of the Division. The term “key personnel” includes any and all persons identified as such in the contract documents and any other persons subsequently identified as key personnel by the written agreement of the parties. Care of Property: The Contractor agrees that it shall be responsible for the proper custody and care of any property furnished to it for use in connection with the performance of this contract and will reimburse the Division for loss of, or damage to, such property. At the termination of this contract, the Contractor shall contact the Division for instructions as to the disposition of such property and shall comply with these instructions. Travel Expenses: Reimbursement to the Contractor for travel mileage, meals, lodging and other travel expenses incurred in the performance of this contract shall not exceed the rates published in the applicable State rules or approved local government travel policy. International travel shall not be reimbursed under this contract. Sales/Use Tax Refunds: If eligible, the Contractor and all subcontractors shall: (a) ask the North Carolina Department of Revenue for a refund of all sales and use taxes paid by them in the performance of this contract, pursuant to G.S. 105-164.14; and (b) exclude all refundable sales and use taxes from all reportable expenditures before the expenses are entered in their reimbursement reports. Advertising: The Contractor shall not use the award of this contract as a part of any news release or commercial advertising. Contract Number 00045595 / Page 9 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Scope of Work (Rev. 06/11) SCOPE OF WORK BACKGROUND The NC ESG program is a reimbursable grant program established by the McKinney-Vento Homeless Assistance Act (Public Law 100-77, Public Law 100-628) as amended by the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (HEARTH Act). The HEARTH Act authorized the Emergency Solutions Grant (ESG) Program for providing assistance to persons and families who are homeless or at risk of homelessness. These programs and services are carried out by community organizations that apply for, and are awarded, NC ESG funds on an annual basis. These funds are a formula grant appropriated by Congress to the United States Department of Housing and Urban Development with the intention to: (1) engage homeless individuals and families living on the street; (2) improve the number and quality of emergency shelters for homeless individuals and families; (3) help operate these shelters; (4) provide essential services to shelter residents, (5) rapidly re-house homeless individuals and families, and (6) prevent families and individuals from becoming homeless. NC ESG funds are intended to be used as part of a crisis response system using a low barrier, housing-focused approach to ensure that homelessness is rare, brief, and non-recurring. The funds under the CARES Act may only be used to prevent, prepare for, and respond to coronavirus, among individuals and families who are homeless or receiving homeless assistance, and to support additional homeless assistance and homelessness prevention activities to mitigate the impacts created by coronavirus. People experiencing homelessness shall not be required to receive treatment or perform any other prerequisite activities as a condition for receiving assistance. PURPOSE In order to address the COVID-19 pandemic, HUD is providing a supplemental allocation of ESG funds as authorized by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136. These special ESG-CV funds are to be used to prevent, prepare for, and respond to the coronavirus pandemic (COVID-19) among individuals and families who are homeless or receiving homeless assistance. The funds will also support additional homeless assistance and homelessness prevention activities to mitigate the impacts of COVID-19. This first allocation, totaling $1 billion, was based on HUD’s FY 2020 formula allocation. The North Carolina Department of Health and Human Services (DHHS) will administer North Carolina’s non-entitlement ESG funds. NCDHHS is seeking proposals for up to $16.58 million in Emergency Solutions Grant CARES Act (ESG-CV) funding for homeless services providers in North Carolina to assist with responding to the COVID-19 public health crisis, subject to the availability and appropriation of funds. The purpose of this contract is:  ESG funds are intended to be used as part of a crisis response system using a low barrier, housing-focused approach to ensure that homelessness is “rare, brief, and one time”;  Engage homeless individuals and families living on the street;  Improve the number and quality of emergency shelters for homeless individuals and families;  Help operate emergency shelters;  Provide essential services to emergency shelter residents;  Rapidly re-house homeless individuals and families;  Prevent families and individuals from becoming homeless. The funds under the CARES Act may only be used to prevent, prepare for, and respond to coronavirus, among individuals and families who are homeless or receiving homeless Contract Number 00045595 / Page 10 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Scope of Work (Rev. 06/11) assistance, and to support additional homeless assistance and homelessness prevention activities to mitigate the impacts created by coronavirus. People experiencing homelessness shall not be required to receive treatment or perform any other prerequisite activities as a condition for receiving assistance. Pre-award costs are eligible Services to be provided:  RRH Financial Assistance: Rapid Re-housing financial services are used to assist individuals with expenses associated with obtaining housing. This includes: on-going rental assistance, rental arrears, rental application fees, security and utility deposits, utility payments, last month's rent, and moving costs  RRH Services: Rapid Re-housing services include housing search and placement, housing stability case management, landlord-tenant mediation, tenant legal services, credit repair  Prevention Financial Assistance: Prevention FA provides financial assistance to persons at risk of becoming homeless. The costs of homelessness prevention are only eligible to the extent that the assistance is necessary to help the program participant regain stability in their current housing or move into other permanent housing and achieve stability in that housing. Eligible costs include rental assistance, rental arrear, rental application fees, security and utility deposits, utility payments, last month's rent, and moving costs.  Prevention Services: Services provide case management services to individuals who face the risk of becoming homeless. Eligible services include housing search and placement, housing stability case management, landlord-tenant mediation, tenant legal services, credit repair. PERFORMANCE REQUIREMENTS The ESG program operates on a reimbursement basis. Subrecipient is required to submit monthly reimbursement requests. These are requests for expenses already incurred by the subrecipient which must include documentation of the expense such as client logs, receipts, pay stubs, timesheets, and check copies. Requisitions must be submitted within 45 days of the last day of the month for which the subrecipient is requisitioning per HUD regulation. Incorrect submissions delay and effect spending. All requisitions incorrect or incomplete will be returned for correction and will not be submitted for payment until corrections are received. Program compliance with both HUD and State regulation must be followed as a condition of continued funding. Failure to stay in compliance and/or to develop a corrective action plan as a result of findings deriving from a monitoring review may result in loss of funding. Subrecipients are required to enter all client level data into the Homeless Management Information System (HMIS). HMIS data will be used to submit quarterly reports to HUD. Subrecipients will work the local system administrator and the ESG Office to meet quarterly reporting requirements and deadlines. Overall program compliance rate will be no less than 80% in all measure requirements. PERFORMANCE STANDARDS Subrecipient must remain in compliance with all HUD ESG federal regulations, requirements, and guidelines. The ESG Office will conduct monitoring to evaluate subrecipient compliance. It is expected that monitoring outcomes will yield 90% or more compliance with HUD regulations for client file reviews and fiscal reviews. PERFORMANCE MONITORING/QUALITY ASSURANCE PLAN All subrecipients are monitored once per quarter via desk review. On-site or virtual Contract Number 00045595 / Page 11 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Scope of Work (Rev. 06/11) monitoring will take place annually with a minimum of 20% of the subrecipients receiving monitoring visits/virtual monitoring. Monitoring visits/virtual monitoring may also be conducted when a subrecipient is having continued concerns or received a finding in the past year. Findings are issued when it is determined that a service recipient or incurred expense was ineligible under ESG regulations. Other monitoring outcomes include recommendations which are suggestions to improve a program and concerns which are issues that if not resolved could lead to a finding. Failure to stay in program compliance and/or to develop a corrective action plan as a result of findings from a monitoring review may result in loss of funding or other actions to recover ineligible costs. REIMBURSEMENTS Sub-recipients complete the reimbursement request by submitting a PDF of the complete reimbursement including client logs, invoices, time sheets, pay stubs, and check copies as applicable. Reimbursement requests are reviewed for accuracy and completeness of all back-up documentation. Reimbursements are then submitted to the DAAS budget office for further review and lastly, they are submitted to the Office of the Controller for request for payment from HUD. The Controller’s Office receives acceptance of the reimbursement from HUD and issues payment to the subrecipient. Contract Number 00045595 / Page 12 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Performance Measures (Rev. 4//12) PERFORMANCE MEASURES CHART The Department of Health and Human Services uses performance measures rubrics as a tool to determine the success of a project and how well services and products are being delivered. Together they enable the Department to gauge efficiency, determine progress toward desired results and assess whether the Department is on track with meeting its goals. The contractor shall adhere to all of the performance requirements/standards in the scope of work, including performance measures in the performance measures chart below. Measure Type Input Reporting Frequency Quarterly Measure All subrecipients must submit 1 requisition per month within the 45-day submission period with a minimum of 1 requisition per quarter leading to a disbursement of funds. Budget Year 1 Trend Increase Baseline Value $111,471 Target Value 100% of the allocation by the end of the contract period Data Source fiscal data monitoring and requests for reimbursement Collection Process and Calculation reimbursement submission Collection Frequency monthly Measure Type Output Reporting Frequency Monthly Measure 80% of requisitions submitted were correctly submitted Budget Year 1 Trend Maintain Baseline Value 0 Target Value 80% of submissions Data Source fiscal data monitoring Collection Process and reimbursement submission Contract Number 00045595 / Page 13 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Performance Measures (Rev. 4//12) Calculation Collection Frequency monthly Measure Type Outcome Reporting Frequency Annual Measure Program Compliance- On-site or virtual desk monitoring by the ESG office yields 10% or less findings/concerns in cumulative records reviewed. Budget Year 1 Trend Increase Baseline Value 0 Target Value 90% Data Source electronic submission and file submission Collection Process and Calculation onsite, virtual and/or desk monitoring Collection Frequency Monthly and quarterly Contract Number 00045595 / Page 14 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Line Item Budget Detail (08/11) LINE ITEM BUDGET This begins the line item budget for year 1 Budget Detail - Year 1 Category Item Narrative Amount Salary\Wages $0.00 Salary\Wages $0.00 Salary\Wages $0.00 Salary\Wages $0.00 Fringe Benefits $0.00 Fringe Benefits $0.00 Fringe Benefits $0.00 Fringe Benefits $0.00 Other $0.00 Contract Number 00045595 / Page 15 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Line Item Budget Detail (08/11) Budget Detail - Year 1 Category Item Narrative Amount Other $0.00 Other $0.00 Other $0.00 Repair and Maintenance $0.00 Repair and Maintenance $0.00 Repair and Maintenance $0.00 Repair and Maintenance $0.00 Staff Development $0.00 Staff Development $0.00 Staff Development $0.00 Contract Number 00045595 / Page 16 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Line Item Budget Detail (08/11) Budget Detail - Year 1 Category Item Narrative Amount Staff Development $0.00 Dues and Subscriptions $0.00 Dues and Subscriptions $0.00 Dues and Subscriptions $0.00 Dues and Subscriptions $0.00 Operational Other Not Otherwise Classified Rapid Rehousing •RRH Financial Assistance ($11,922): Rapid Re-housing financial services are used to assist individuals with expenses associated with obtaining housing. This includes: on-going rental assistance, rental arrears, rental application fees, security and utility deposits, utility payments, last month's rent, and moving costs •RRH Services ($20,111): Rapid Re-housing services include housing search and placement, housing stability case management, landlord-tenant mediation, tenant legal services, credit repair $32,033.00 Operational Other Not Otherwise Classified Homelessness Prevention •Prevention Financial Assistance ($39,964): Prevention FA provides financial assistance to persons at risk of becoming $79,438.00 Contract Number 00045595 / Page 17 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Line Item Budget Detail (08/11) Budget Detail - Year 1 Category Item Narrative Amount homeless. The costs of homelessness prevention are only eligible to the extent that the assistance is necessary to help the program participant regain stability in their current housing or move into other permanent housing and achieve stability in that housing. Eligible costs include rental assistance, rental arrear, rental application fees, security and utility deposits, utility payments, last month's rent, and moving costs. •Prevention Services ($39,474): Services provide case management services to individuals who face the risk of becoming homeless. Eligible services include housing search and placement, housing stability case management, landlord-tenant mediation, tenant legal services, credit repair. Subcontracts and Grants $0.00 Subcontracts and Grants $0.00 Subcontracts and Grants $0.00 Subcontracts and Grants $0.00 Match $0.00 Match $0.00 Contract Number 00045595 / Page 18 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Line Item Budget Detail (08/11) Budget Detail - Year 1 Category Item Narrative Amount Match $0.00 Match $0.00 Cost Per Service $0.00 Cost Per Service $0.00 Cost Per Service $0.00 Cost Per Service $0.00 Sub Total $111,471.00 Indirect Cost $0.00 Total Budget $111,471.00 Subcontracting and Grants Budget Detail - Year 1 Category Item Narrative Amount Contract Number 00045595 / Page 19 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Line Item Budget Detail (08/11) Subcontracting and Grants Budget Detail - Year 1 Category Item Narrative Amount $0.00 Sub Total $0.00 Salaries - Year 1 Persons Position or Title Annual Salary Hourly Rate Months Work %Fringe Amount Total Fringe Percent Total Total 0 $0.00 0.0000 0 0%$0.00 $0.00 $0.00 Contract Number 00045595 / Page 20 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 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 influen ce 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 [X ] 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. ________________________________________________________________________________________________ Signature Title ________________________________________________________________________________________________ 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) 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, re ntal 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. DocuSign Envelope ID: 9DDCE310-CD26-46F2-A88B-B5927F654D07 12/2/2022 County Manager Bonnie Hammersley Contract Number 00045595 / Page 21 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 II. 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 300 W Tryon St. ________________________________________________________________________________________________ City, State, Zip Code Hillsborough, NC, 27278 ________________________________________________________________________________________________ Street ________________________________________________________________________________________________ City, State, Zip Code ________________________________________________________________________________________________ DocuSign Envelope ID: 9DDCE310-CD26-46F2-A88B-B5927F654D07 Contract Number 00045595 / Page 22 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 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 car e, 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, suspended, determined ineligible or voluntarily exc luded 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 ti tled "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. DocuSign Envelope ID: 9DDCE310-CD26-46F2-A88B-B5927F654D07 Contract Number 00045595 / Page 23 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 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 exclu ded 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 age ncy, 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 whe n this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subj ect 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 Fe deral 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. sec tion 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. DocuSign Envelope ID: 9DDCE310-CD26-46F2-A88B-B5927F654D07 Contract Number 00045595 / Page 24 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 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). 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. 11. 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: 9DDCE310-CD26-46F2-A88B-B5927F654D07 Contract Number 00045595 / Page 25 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 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: a. contract b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance 2. Status of Federal Action: a. Bid/offer/application b. Initial Award c. Post-Award 3. Report Type: a. initial filing b. material change For Material Change Only: Year___________ Quarter____________ Date Of Last Report:_________________ 4. Name and Address of Reporting Entity: Prime Subawardee Tier (if known) ________________________ Congressional District (if known) _________________________ 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime: 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 (if individual, last name, first name, MI): (attach Continuation Sheet(s) SF-LLL-A, if necessary) b. Individuals Performing Services (including address if different from No. 10a.) (last name, first name, MI): (attach Continuation Sheet(s) SF-LLL-A, if necessary) 11. Amount of Payment (check all that apply): $ € actual € planned 13. Type of Payment (check all that apply): a. retainer b. one-time fee c. commission d. contingent fee e. deferred f. other; specify: _____________________________ 12. Form of Payment (check all that apply): a. cash 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): 15. Continuation Sheet(s) SF-LLL-A attached: Yes No 16. Information requested through this form is authorized by title 31 U. S. C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This 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 disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Signature: Print Name: Title: ______________________________________________ Telephone No: Date: Federal Use Only Authorized for Local Reproduction Standard Form - LLL DocuSign Envelope ID: 9DDCE310-CD26-46F2-A88B-B5927F654D07 Contract Number 00045595 / Page 26 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Contractor Certifications Required by North Carolina Law (Rev. 8/16;3/22) Page 1 of 1 State Certifications Contractor Certifications Required by North Carolina Law Instructions: The person who signs this document should read the text of the statutes and Executive Order listed below and consult with counsel and other knowledgeable persons before signing. The text of each North Carolina General Statutes and of the Executive Order can be found online at:  Article 2 of Chapter 64: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf  G.S. 133-32: http://www.ncga.state.nc.us/gascripts/statutes/statutelookup.pl?statute=133-32  Executive Order No. 24 (Perdue, Gov., Oct. 1, 2009): https://ethics.nc.gov/media/242/download?attachment  G.S. 105-164.8(b): http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-164.8.pdf  G.S. 143-48.5: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143-48.5.html  G.S. 143-59.1: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59.1.pdf  G.S. 143-59.2: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-59.2.pdf  G.S. 143-133.3: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter_143/GS_143-133.3.html  G.S. 143B-139.6C: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143B/GS_143B-139.6C.pdf Certifications (1) Pursuant to G.S. 133-32 and Executive Order No. 24 (Perdue, Gov., Oct. 1, 2009), the undersigned hereby certifies that the Contractor named below is in compliance with, and has not violated, the provisions of either said statute or Executive Order. (2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the undersigned hereby certifies that the Contractor named below, and the Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its employees through the federal E-Verify system." E- Verify System Link: www.uscis.gov (3) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because: (a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and (b) [check one of the following boxes] X Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a “tax haven country” as set forth in G.S. 143- 59.1(c)(2) after December 31, 2001; or ☐ The Contractor or one of its affiliates has incorporated or reincorporated in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but the United States is not the principal market for the public trading of the stock of the corporation incorporated in the tax haven country. (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s officers, directors, or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. (5) Pursuant to G.S. 143B-139.6C, the undersigned hereby certifies that the Contractor will not use a former employee, as defined by G.S. 143B-139.6C(d)(2), of the North Carolina Department of Health and Human Services in the administration of a contract with the Department in violation of G.S. 143B-139.6C and that a violation of that statute shall void the Agreement. (6) The undersigned hereby certifies further that: (a) He or she is a duly authorized representative of the Contractor named below; (b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf of the Contractor; and (c) He or she understands that any person who knowingly submits a false certification in response to the requirements of G.S. 143-59.1and -59.2 shall be guilty of a Class I felony. Contractor’s Name: Contractor’s Authorized Agent: Signature Date Printed Name Title Witness: Signature Date Printed Name Title The witness should be present when the Contractor’s Authorized Agent signs this certification and should sign and date this document immediately thereafter. DocuSign Envelope ID: 9DDCE310-CD26-46F2-A88B-B5927F654D07 County Manager Bonnie Hammersley 12/2/2022 Bonnie Hammersley Clerk to the BoardLaura Jensen 12/2/2022 Contract Number 00045595 / Page 27 of 27 DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 Revised 07/20 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Party/Vendor Name: OCHCD Party/Vendor Contact Person: Corey Root Contact Phone: 919-245-2492 Party/Vendor Address: 300 West Tryon St City Hillsborough State: NC Zip: 27278 Department: OCHCD Amount: $111,471 Purpose: Homelessness Prevention Budget Code(s): 32470605 442235 95040 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 3/1/2023 Approved by Board Yes No Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: Department Director’s Signature ________________________________________ Date: ________ Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board __________________________________________Date:_________ DocuSign Envelope ID: 38483A0E-2707-4763-8263-42C2F7C43A91 3/2/2023 3/3/2023 3/7/2023