HomeMy WebLinkAboutAgenda - 06-18-2024; 8-g - In-Home Aide Contract Awards for the Department of Social Services and Department on Aging 1
ORANGE COUNTY
BOARD OF COMMISSIONERS
ACTION AGENDA ITEM ABSTRACT
Meeting Date: June 18, 2024
Action Agenda
Item No. 8-g
SUBJECT: In-Home Aide Contract Awards for the Department of Social Services and
Department on Aging
DEPARTMENT: Social Services and Aging
ATTACHMENT(S): INFORMATION CONTACT:
FY 2024-25 Sample Contract Nancy Coston, 245-2800
Janice Tyler, 245-4255
Rebekah Rapoza, 245-2800
PURPOSE: To approve contracts to provide In-Home Aide Services with CNC/Access, Inc. dba
All Ways Caring Home Care, First-Watch Homecare, LLC, Ole Creek Health and Wellness, Inc.,
Premier Home Health Care Services, Inc., and Regional Home Care, Inc. for eligible adults using
a joint contract between the Department of Social Services and the Department on Aging and the
Contractor.
BACKGROUND: The Department of Social Services and Department on Aging provide In-Home
Aide Services to older and disabled adults. In-Home Aide involves the provision of
paraprofessional services that assist functionally impaired older and disabled adults and/or their
families with essential home management and personal care and/or supervision to enable the
adult to remain at home as long as possible. These services vary in terms of amount and duration
as indicated on an individualized case plan developed by County staff.
In February 2024, Orange County published a Request for Proposals (RFP). On March 7, 2024,
the County received six (6) sealed bids from in-home aide businesses. Of the six (6) bids that
were received, five (5) are being recommended for contracts. The sixth did not meet the
requirements of the RFP. In an effort to streamline the contracting and approval process, the
Department of Social Services and Department on Aging have developed a joint contract template
to use with In-Home Aide providers.
Contracts would be awarded to providers in the following amounts:
1. CNC/Access, Inc. dba All Ways Caring HomeCare — $115,000 ($90,000 from Social
Services, $25,000 from Aging);
2. First-Watch Homecare, LLC—$25,000 ($20,000 from Social Services, $5,000 from Aging);
3. Ole Creek Health and Wellness, Inc. dba Ole Creek Healthcare — $25,000 ($20,000 from
Social Services, $5,000 from Aging);
2
4. Premier Home Health Care Services, Inc. — $847,000 ($825,000 from Social Services,
$42,000 from Aging); and
5. Regional Home Care, Inc. — $25,000 ($20,000 from Social Services, $5,000 from Aging).
Each of the contracts is thirty (30) pages or longer. A sample contract is attached to demonstrate
the contract content, and staff will finalize each respective provider contract with the above award
amounts following Board approval.
FINANCIAL IMPACT: Social Services has requested $1,135,450 and Aging has requested
$91,000 for in-home aide services in the Manager's Recommended FY 2024-25 budget. These
contracts will be funded by a combination of Federal, State, and County dollars. It should be noted
that all providers have agreed to pay the County's living wage to all employees working under
these contracts.
These contracts do not guarantee that this amount of funds will be made available to the providers,
but rather assure availability of contracted providers when needed for individuals in Orange
County.
SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable
to this item:
• GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY
The creation and preservation of infrastructure, policies, programs and funding necessary
for residents to provide shelter, food, clothing, and medical care for themselves and their
dependents.
• GOAL: CREATE A SAFE COMMUNITY
The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang
activity, substance abuse and domestic violence.
ENVIRONMENTAL IMPACT: There is no Orange County Environmental Responsibility Goal
impact associated with this item.
RECOMMENDATION(S): The Manager recommends that the Board:
1. Approve the RFP contract awards using a joint contract with CNC/Access, Inc. dba All
Ways Caring Home Care, First-Watch Homecare, LLC, Ole Creek Health and Wellness,
Inc., Premier Home Health Care Services, Inc., and Regional Home Care, Inc. for FY 2024-
2025; and
2. Authorize the County Manager to sign these contracts, any future contract renewals, and
any amendments to these contracts subject to County Attorney review and contingent upon
approval of the annual County budget.
Contract#68-xxxx
Contractor Name
Contract#68-xxxx Fiscal Year Begins July 1,202x Ends June 30,202x
This contract is hereby entered into by and between the Orange County Department of Social Services and Orange County
Department on Aging (the "County") and Contractor Name (the "Contractor") (referred to collectively as the "Parties").
The Contractor's federal tax identification number or Social Security Number is xx-xxxxxxx.
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 1,202x and shall terminate on June 30,202x.
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 $xx,xxx. This amount consists of
$xx,xxx 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$xx,xxx.
6. Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services/Human Services and/or
Department on Aging upon termination of this contract.
Contract-General (04/23) Page 1 of 5
Contract#68-xxxx
Contractor Name
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
For Services Performed on Behalf of the Department on Aging:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
10. Supplementation of Expenditure of Public Funds:
Contract-General (04/23) Page 2 of 5
Contract#68-xxxx
Contractor Name
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 (04/23) Page 3 of 5
Contract#68-xxxx
Contra@tor Name
The Contractor and the County have executed this contract in duplicate originals, with one original being retained by each
party.
CONTRACTOR NAME
Signature Date
Printed Name Title
COUNTY
Signature Date
Printed Name Title
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
Signature of County Finance Officer Date
Contract-General (04/23) Page 4 of 5
Contract#68-xxxx
Contra7tor Name
ORANGE COUNTY—INTERNAL USE ONLY
Finance Information
Vendor Name: Vendor Contact Person: Phone: Address: City State: Zip:
Department: Amount: Purpose: Budget Code(s): Vendor#
Vendor Status with NCSOS: is a BOCC consultant: ❑Yes ❑No
Contract Details
Contract Type: ❑New ❑Amendment(Original Contract: )(Most Recent Amendment )
Effective Date End Date Notice Date (Notice Purpose )
Award
❑Approved by Board(Agenda Date: ❑Made or Administered by
Signature Authority
- ❑ BOCC Express Delegation(Agenda Date:
Policy 9.4: ❑Under$5,000; ❑ Service Under$90,000; ❑ Construction Under$250,000
❑ Budget Policy Section XV(Capital Improvement Project: )
Bidding
❑ Informal Bidding($30k-$90k); ❑ Formal RFP($90k+); ❑ Other(<$30k); ❑Exception(#____)
Department Affirmation
❑ 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.
❑ Services related to this agreement have already begun or been completed.Description of the nature of the emergency condition that
was addressed:
Department Director's Signature Date:
Information Technologies
This agreement has been reviewed and is approved as to information technology content and specifications:
Office of the Chief Information Officer Date:
❑Inapplicable because no hardware/software purchases or related services
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
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:
Received for record retention:
Office of the Clerk to the Board Date:
Contract-General (04/23) Page 5 of 5
8
ATTACHMENT A
GENERAL TERMS AND CONDITIONS
Orange County Department of Social Services and Orange County 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 beneficiary only.
be deemed to be an independent contractor in the
performance of this contract and as such shall be wholly Indemnity and Insurance
responsible for the work to be performed and for the
supervision of its employees. The Contractor represents Indemnification: The Contractor agrees to indemnify
that it has,or shall secure at its own expense,all personnel and hold harmless the County and any of their officers,
required in performing the services under this agreement. agents and employees, from any claims of third parties
Such employees shall not be employees of, or have any arising out or any act or omission of the Contractor in
individual contractual relationship with the County. connection with the performance of this contract.
Subcontracting: The Contractor shall not subcontract Insurance: During the term of the contract, the
any of the work contemplated under this contract without Contractor at its sole cost and expense shall provide
prior written approval from the County. Any approved commercial insurance of such type and with such terms
subcontract shall be subject to all conditions of this and limits as may be reasonably associated with the
contract.Only the subcontractors specified in the contract contract. As a minimum,the Contractor shall provide and
documents are to be considered approved upon award of maintain the 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 Insurance as required by the laws of North
of all of its subcontractors. Carolina,as well as employer's liability coverage
with minimum limits of $500,000.00, covering
Assignment: No assignment of the Contractor's all of Contractor's employees who are engaged in
obligations or the Contractor's right to receive payment any work under the contract. If any work is
hereunder shall be permitted. However, upon written sublet, the Contractor shall require the
request approved by the issuing purchasing authority,the subcontractor to provide the same coverage for
County may: any of his employees engaged in any work under
(a) Forward the Contractor's payment check(s) the 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
payment check(s). Limit.(Defense cost shall be in excess of the limit
In no event shall such approval and action obligate the of liability.)
County to anyone other than the Contractor and the (c) Automobile Liability Insurance: The
Contractor shall remain responsible for fulfillment of all Contractor shall provide automobile liability
contract obligations. insurance with a combined single limit of
$500,000.00 for bodily injury and property
Beneficiaries: Except as herein specifically provided damage; a limit of $500,000.00 for
otherwise,this contract shall inure to the benefit of and be uninsured/under insured motorist coverage;and a
binding upon the parties hereto and their respective limit of $25,000.00 for medical payment
successors. It is expressly understood and agreed that the coverage. The Contractor shall provide this
enforcement of the terms and conditions of this contract, insurance for all automobiles that are:
and all rights of action relating to such enforcement, shall (a) owned by the Contractor and used in the
be strictly reserved to the County and the named performance of this contract;
Contractor.Nothing contained in this document shall give (b) hired by the Contractor and used in the
or allow any claim or right of action whatsoever by any performance of this contract; and
other third person.It is the express intention of the County (c) Owned by Contractor's employees and
and Contractor that any such person or entity, other than used in performance of this contract("non-
General Terms and Conditions—(06/16) Page 1 of 5
9
owned vehicle insurance"). Non-owned
vehicle insurance protects employers Default and Termination
when employees use their personal
vehicles for work purposes. Non-owned Termination Without Cause: The County may
vehicle insurance supplements, but does terminate this contract without cause by giving 30 days
not replace, the car-owner's liability written notice to the Contractor.
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
subparagraph(a) are exclusive of defense costs. deliverable items prepared by the Contractor under this
(e) The Contractor understands and agrees that the contract shall, at the option of the County, become its
insurance coverage minimums specified in property and the Contractor shall be entitled to receive
subparagraph (a) are not limits, or caps, on the just and equitable compensation for any satisfactory work
Contractor's liability or obligations under this contract. completed on such materials, minus any payment or
(f) The Contractor may obtain a waiver of any one or more compensation previously made. Notwithstanding the
of the requirements in subparagraph (a) by foregoing provision, the Contractor shall not be relieved
demonstrating that it has insurance that provides of liability to the County for damages sustained by the
protection that is equal to or greater than the coverage County by virtue of the Contractor's breach of this
and limits specified in subparagraph(a). The County agreement, and the County may withhold any payment
shall be the sole judge of whether such a waiver due the Contractor for the purpose of setoff until such
should be granted. time as the exact amount of damages due the County from
(g) The Contractor may obtain a waiver of any one or more such breach can be determined. In case of default by the
of the requirements in paragraph(a)by demonstrating Contractor, without limiting any other remedies for
that it is self-insured and that its self-insurance breach available to it, the County may procure the
provides protection that is equal to or greater than the contract services from other sources and hold the
coverage and limits specified in subparagraph (a). Contractor responsible for any excess cost occasioned
The County shall be the sole judge of whether such a thereby. The filing of a petition for bankruptcy by the
waiver should be granted. Contractor shall be an act of default under this contract.
(h) Providing and maintaining the types and amounts of
insurance or self-insurance specified in this paragraph Waiver of Default: Waiver by the County of any default
is a material obligation of the Contractor and is of the or breach in compliance with the terms of this contract by
essence of this contract. the Provider shall not be deemed a waiver of any
(i) The Contractor shall only obtain insurance from subsequent default or breach and shall not be construed to
companies that are authorized to provide such be modification of the terms of this contract unless stated
coverage and that are authorized by the to be such in writing, signed by an authorized
Commissioner of Insurance to do business in the State representative of the County and the Contractor and
of North Carolina. All such insurance shall meet all attached to the contract.
laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all Availability of Funds: The parties to this contract agree
lawful terms and conditions of its insurance policies and understand that the payment of the sums specified in
and all lawful requirements of its insurer. this contract is dependent and contingent upon and subject
(k) The Contractor shall require its subcontractors to to the appropriation, allocation, and availability of funds
comply with the requirements of this paragraph. for this purpose to the County.
(1) The Contractor shall demonstrate its compliance with
the requirements of this paragraph by submitting Force Majeure: Neither party shall be deemed to be in
certificates of insurance to the County before the default of its obligations hereunder if and so long as it is
Contractor begins work under this contract. prevented from performing such obligations by any act of
war,hostile foreign action,nuclear explosion,riot,strikes,
Transportation of Clients by Contractor: The civil insurrection,earthquake,hurricane,tornado,or other
contractor will maintain Insurance requirements if catastrophic natural event or act of God.
required as noted under Article 7 Rule R2-36 of the North
Carolina Utilities Commission.
General Terms and Conditions—(06/16) Page 2 of 5
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Survival of Promises: All promises, requirements,
terms,conditions,provisions,representations,guarantees, (a) Data Security: The Contractor shall adopt and
and warranties contained herein shall survive the contract apply data security standards and procedures
expiration or termination date unless specifically that comply with all applicable federal, state and
provided otherwise herein, or unless superseded by local laws,regulations, and rules.
applicable Federal or State statutes of limitation.
(b) Duty to Report: The Contractor shall report a
Intellectual Property Rights suspected or confirmed security breach to the
local Department of Social Services Contract
Copyrights and Ownership of Deliverables: All Administrator within twenty-four(24)hours
deliverable items produced pursuant to this contract are after the breach is first discovered,provided that
the exclusive property of the County. The Contractor the Contractor shall report a breach involving
shall not assert a claim of copyright or other property Social Security Administration data or Internal
interest in such deliverables. Revenue Service Data within one(1)hour after
the breach is first discovered.
Federal Intellectual Property Bankruptcy Protection
Act: The Parties agree that the County shall be entitled to (c) Cost Borne by Contractor: If any applicable
all rights and benefits of the Federal Intellectual Property federal, state, or local law,regulation or rule
Bankruptcy Protection Act,Public Law 100-506,codified requires the Contractor give written notice of a
at 11 U.S.C. 365 (n)and any amendments thereto. security breach to affected persons,the Contract
shall bear the cost of the notice.
Compliance with Applicable Laws
Trafficking Victims Protection Act of 2000:
Compliance with Laws: The Contractor shall comply The Contractor will comply with the requirements of
with all laws, ordinances, codes, rules, regulations, and Section 106(g) of the Trafficking Victims Protection Act
licensing requirements that are applicable to the conduct of 2000, as amended(22 U.S.C. 7104)
of its business,including those of federal, state, and local
agencies having jurisdiction and/or authority. By Executive Order#24: It is unlawful for any vendor,
executing this Agreement Provider certifies that contractor, subcontractor or supplier of the state to make
Provider has not been identified, and has not utilized gifts or to give favors to any state employee. For
the services of any agent or subcontractor, on the list additional information regarding the specific
created by the State Treasurer pursuant to G.S. 147- requirements and exemptions, contractors are
86.58. encouraged to review Executive Order 24 and G.S. Sec.
133-32.
Title VI,Civil Rights Compliance: In accordance with Confidentiality
Federal law and U.S.Department of Agriculture(USDA)
and U.S. Department of Health and Human Services Confidentiality: Any information, data, instruments,
(HHS) policy, this institution is prohibited from documents, studies or reports given to or prepared or
discriminating on the basis of race,color,national origin, assembled by the Contractor under this agreement shall
sex, age or disability. Under the Food Stamp Act and be kept as confidential and not divulged or made available
USDA policy, discrimination is prohibited also on the to any individual or organization without the prior written
basis of religion or political beliefs. approval of the County. The Contractor acknowledges
Equal Employment Opportunity: The Contractor shall that in receiving, storing,processing or otherwise dealing
comply with all federal and State laws relating to equal with any confidential information it will safeguard and
not further disclose the information except as otherwise
employment opportunity. provided in this contract.
Health Insurance Portability and Accountability Act Oversight
(HIPAA): The Contractor agrees that, if the County
determines that some or all of the activities within the Access to Persons and Records: The State Auditor shall
scope of this contract are subject to the Health Insurance have access to persons and records as a result of all
Portability and Accountability Act of 1996,P.L. 104-91, contracts or grants entered into by State agencies or
as amended("HIPAA"), or its implementing regulations, political subdivisions in accordance with General Statute
it will comply with the HIPAA requirements and will 147-64.7. Additionally,as the State funding authority,the
execute such agreements and practices as the County Department of Health and Human Services shall have
may require to ensure compliance.
General Terms and Conditions—(06/16) Page 3 of 5
11
access to persons and records as a result of all contracts
or grants entered into by State agencies or political Pursuant to G.S. 143-48.5, the undersigned hereby
subdivisions. certifies that the Contractor named below, and the
Contractor's subcontractors, complies with the
Record Retention: Records shall not be destroyed, requirements of Article 2 of Chapter 64 of the NC General
purged or disposed of without the express written consent Statutes.
of the Division. State basic records retention policy
requires all grant records to be retained for a minimum of Miscellaneous
five years or until all audit exceptions have been resolved,
whichever is longer. If the contract is subject to federal Choice of Law: The validity of this contract and any of
policy and regulations, record retention may be longer its terms or provisions, as well as the rights and duties of
than five years since records must be retained for a period the parties to this contract, are governed by the laws of
of three years following submission of the final Federal North Carolina. The Contractor, by signing this contract,
Financial Status Report, if applicable, or three years agrees and submits, solely for matters concerning this
following the submission of a revised final Federal Contract, to the exclusive jurisdiction of the courts of
Financial Status Report. Also, if any litigation, claim, North Carolina and agrees, solely for such purpose, that
negotiation, audit, disallowance action, or other action the exclusive venue for any legal proceedings shall be
involving this Contract has been started before expiration Orange County,North Carolina.The place of this contract
of the five-year retention period described above, the and all transactions and agreements relating to it,and their
records must be retained until completion of the action situs and forum, shall be Orange County,North Carolina,
and resolution of all issues which arise from it,or until the where all matters, whether sounding in contract or tort,
end of the regular five-year period described above, relating to the validity, construction, interpretation, and
whichever is later. The record retention period for enforcement shall be determined.
Temporary Assistance for Needy Families (TANF) and
MEDICAID and Medical Assistance grants and programs Amendment: This contract may not be amended orally
must be retained for a minimum of ten years. or by performance. Any amendment must be made in
written form and executed by duly authorized
Warranties and Certifications representatives of the County and the Contractor.
Date and Time Warranty: The Contractor warrants that Severability: In the event that a court of competent
the product(s) and service(s) furnished pursuant to this jurisdiction holds that a provision or requirement of this
contract ("product" includes, without limitation, any contract violates any applicable law, each such provision
piece of equipment, hardware, firmware, middleware, or requirement shall continue to be enforced to the extent
custom or commercial software, or internal components, it is not in violation of law or is not otherwise
subroutines, and interfaces therein)that perform any date unenforceable and all other provisions and requirements
and/or time data recognition function, calculation, or of this contract shall remain in full force and effect.
sequencing will support a four digit year format and will
provide accurate date/time data and leap year Headings: The Section and Paragraph headings in these
calculations. This warranty shall survive the termination General Terms and Conditions are not material parts of
or expiration of this contract. the 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
E-Verify property furnished to it for use in connection with the
General Terms and Conditions—(06/16) Page 4 of 5
12
performance of this contract and will reimburse the Advertising: The Contractor shall not use the award of
County for loss of, or damage to, such property. At the this contract as a part of any news release or commercial
termination of this contract, the Contractor shall contact advertising.
the County for 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
Sales/Use Tax Refunds: If eligible, the Contractor and and all subcontractors provide a living wage, as defined
all subcontractors shall: (a) ask the North Carolina in this 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.
General Terms and Conditions—(06/16) Page 5 of 5
13
ATTACHMENT B— Scope of Work Federal Tax Id. or SSN
Contract#
A. CONTRACTOR INFORMATION
1. Contractor Agency Name:
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: Fax Number: Email:
3. Name of Program(s):
4. Status: ❑ Public ❑ Private,Not for Profit ❑ Private, For Profit
5. Contractor's Financial Reporting Year through
B. Explanation of Services to be provided and to whom(include SIS Service Code): The
Contractor will provide employ, e�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 Contract will provide Level 1I Home Management and Level 1I Personal Care.
The Contract is required to meet all goals and outcomes listed in Attachment O. The
Contractor may be asked to provide employ. e�perform personal care services during
an emergency shelteringevent.
vent.
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$31.42/hour, of which the Contractor must pay the
in-home aide at least the County's Living Wage ($17.65/hour effective 7/l/24).
2. Negotiated County Rate.
N/A
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$31.42/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. Invoices received after this date may not be processed.
All invoices for the provision of services to the Department of Social Services shall be
submitted to 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
Contract-Scope of Work (7-2008) Page 1 of 2
14
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
(Nancy Coston, Social Services Director) (Date Submitted)
(Janice Tyler,Dept. on Aging Director) (Date Submitted)
(Signature of Contractor) (Date Submitted)
Contract-Scope of Work (7-2008) Page 2of 2
15
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.
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
16
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.
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
17
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,suspended,
18
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 by
19
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 1 st 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).
20
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
21
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 different from No. IOa.) (last name,
first name, MI):
(attach Continuation Sheet(s)SF-LLL-A, if necessary)
attach Continuation Sheets 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 I I(attach Continuation Sheet(s) SF-LLL-A, if
necessary):
22
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 WAuthorized for Local Reproduction
Standard Form-LLL
23
CONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY
State of
County
I, Notary Public for said County and State, certify
that
personally appeared before me this day and
acknowledged
that he/she is of
[name of Organization]
and by that authority duly given and as the act of the Organization, affirmed that the foregoing Conflict of
Interest Policy was adopted by the Board of Directors/Trustees or other governing body in a meeting held
on the day of
Sworn to and subscribed before me this day of
(Official Seal) Notary Public
My Commission expires 20
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Instruction for Organization:
Sign and attach the following pages after adopted by the Board of Directors/Trustees or other
governing body OR replace the following with the current adopted conflict of interest policy.
Name of Organization
Signature of Organization Official
NCDHHS COT 10l 5 (Rev. 4/T T)
24
Conflict of Interest Policy Example
The Board of Directors/Trustees or other governing persons, officers, employees or agents are to avoid
any conflict of interest, even the appearance of a conflict of interest. The Organizations Board of
Directors/Trustees or other governing body, officers, staff and agents are obligated to always act in the best
interest of the organization. This obligation requires that any Board member or other governing person,
officer, employee or agent, in the performance of Organization duties, seek only the furtherance of the
Organization mission. At all times, Board members or other governing persons, officers, employees or
agents, are prohibited from using their job title, the Organization's name or property, for private profit or
benefit.
A. The Board members or other governing persons, officers, employees, or agents of the Organization
should neither solicit nor accept gratuities, favors, or anything of monetary value from current or potential
contractors/vendors, persons receiving benefits from the Organization or persons who may benefit from the
actions of any Board member or other governing person, officer, employee or agent. This is not intended
to preclude bona-fide Organization fund raising-activities.
B. A Board or other governing body member may, with the approval of Board or other governing body,
receive honoraria for lectures and other such activities while not acting in any official capacity for the
Organization. Officers may, with the approval of the Board or other governing body, receive honoraria for
lectures and other such activities while on personal days, compensatory time,annual leave,or leave without
pay. Employees may, with the prior written approval of their supervisor, receive honoraria for lectures and
other such activities while on personal days, compensatory time, annual leave, or leave without pay. If a
Board or other governing body member, officer, employee or agent is acting in any official capacity,
honoraria received in connection with activities relating to the Organization are to be paid to the
Organization.
C. No Board member or other governing person, officer, employee, or agent of the Organization shall
participate in the selection, award, or administration of a purchase or contract with a vendor where, to his
knowledge, any of the following has a financial interest in that purchase or contract:
1. The Board member or other governing person, officer, employee, or agent;
2. Any member of their family by whole or half blood, step or personal relationship or relative-in-law;
3. An organization in which any of the above is an officer, director, or employee;
4. A person or organization with whom any of the above individuals is negotiating or has any
arrangement concerning prospective employment or contracts.
D. Duty to Disclosure--Any conflict of interest, potential conflict of interest, or the appearance of a conflict
of interest is to be reported to the Board or other governing body or one's supervisor immediately.
E. Board Action -- When a conflict of interest is relevant to a matter requiring action by the Board of
Directors/Trustees or other governing body, the Board member or other governing person, officer,
employee, or agent (person(s)) must disclose the existence of the conflict of interest and be given the
opportunity to disclose all material facts to the Board and members of committees with governing board
delegated powers considering the possible conflict of interest.After disclosure of all material facts, and after
any discussion with the person, he/she shall leave the governing board or committee meeting while the
determination of a conflict of interest is discussed and voted upon. The remaining board or committee
members shall decide if a conflict of interest exists.
In addition, the person(s)shall not participate in the final deliberation or decision regarding the matter
under consideration and shall leave the meeting during the discussion of and vote of the Board of
Directors/Trustees or other governing body.
F. Violations of the Conflicts of Interest Policy -- If the Board of Directors/Trustees or other governing
body has reasonable cause to believe a member, officer, employee or agent has failed to disclose actual
or possible conflicts of interest, it shall inform the person of the basis for such belief and afford the person
an opportunity to explain the alleged failure to disclose. If, after hearing the person's response and after
making further investigation as warranted by the circumstances, the Board of Directors/Trustees or other
governing body determines the member, officer, employee or agent has failed to disclose an actual or
possible conflict of interest, it shall take appropriate disciplinary and corrective action.
NCDHHS COT T0T5 (Rev. 4/TT)
25
G. Record of Conflict -- The minutes of the governing board and all committees with board delegated
powers shall contain:
1. The names of the persons who disclosed or otherwise were found to have an actual or possible
conflict of interest, the nature of the conflict of interest, any action taken to determine whether a
conflict of interest was present, and the governing board's or committee's decision as to whether a
conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relating to the transaction
or arrangement that presents a possible conflict of interest, the content of the discussion, including
any alternatives to the transaction or arrangement, and a record of any votes taken in connection
with the proceedings.
Approved by:
##ContractorName##
Name of Organization
Signature of Organization Official
Date
NCDHHS COI 1015 (Rev. 4/11)
26
State Grant Certification — No Overdue Tax Debts
Instructions: Grantee/Contractor should complete this certification for all state funds received. Entity should
enter appropriate data in the yellow highlighted areas. The completed and signed form should be
provided to the state agency funding the grant to be attached to the contract for the grant funds. A
copy of this form, along with the completed contract, should be kept by the funding agency and
available for review by the Office of State Budget and Management.
Note: If you have a contract that extends more than one state fiscal year,you will need to obtain an updated certification for
each year of the contract.
Entity's Letterhead
[Date of Certification (mmddyyyy)]
To: Nancy Coston, Director, Orange County Department of Social Services
Certification:
We certify that the [insert organization's name] 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-10-1b.
Sworn Statement:
[Name of Board Chair] and [Name of Second Authorizing Official] being duly sworn, say that we are
the Board Chair and [Title of the Second Authorizing Official], respectively, of[insert name of
organization] of[City] in the State of[Name of State]; 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.
Board Chair
[Title of Second Authorizing Official]
Sworn to and subscribed before me on the day of the date of said certification.
My Commission Expires:
(Notary Signature and Seal)
If there are any questions, please contact the state agency that provided your grant. If needed,you may contact the North
Carolina Office of State Budget and Management:
NCGrants@osbm.nc.gov-(919)807-4795
' 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."
Page 1 of 1
MS&NCD Form 0008
Eff.July 1,2005
Revised July 18,2006,7/07,8/09,9/11
27
Contract#
(Contractor)
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 Orange County Department of Social Services and
Orange County Department on Aging;
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 Drivers 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 programs (signature on this form confirms this statement).
Signature Title
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Transportation Certification(06-2015) Page 1 of 1
ATTACHMENT M 28
STATE AND LOCAL CERTIFICATIONS
Contractor Certifications Required by North Carolina Law
Orange County Department of Social Services and Orange County 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/EnactedLegislation/Statutes/PDF/ByAnicle/Chapter_64/Article 2.pdf
• G.S. 133-32: http://www.ncga.state.nc.us/ ag scripts/statutes/statutelookup.pl?statute=133-32
• Executive Order No. 24(Perdue, Gov., Oct. 1,2009):
http://www.ethicscommission.nc.gov/librLry/pdfs/Laws/E024.pdf
• G.S. 105-164.8(b): hgp://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chgpter_105/GS_105-
164.8.pdf
• G.S. 143-48.5: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chgpter_143/GS_143-
48.5.html
• G.S. 143-59.1: http://www.ncga.state.nc.us/EnactedLe,gislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.l.pdf
• G.S. 143-59.2: http://www.ncga.state.nc.us/EnactedLe,gislation/Statutes/PDF/BySection/Chgpter_143/GS_143-
59.2.pdf
• G.S. 143-133.3: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chgpter_143/GS_143-
133.3.html
• G.S. 143B-139.6C:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chgpter_143B/GS_143B-13 9.6C.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 one
(2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the or more of the conditions of G.S. 105-164.8(b);and
undersigned hereby certifies that the Contractor named
below, and the Contractor's subcontractors, complies (b) [check one of the following boxes]
with the requirements of Article 2 of Chapter 64 of the ❑ Neither the Contractor nor any of its affiliates
NC General Statutes,including the requirement for each has incorporated or reincorporated in a "tax
employer with more than 25 employees in North haven country" as set forth in G.S. 143-
Carolina to verify the work authorization of its 59.1(c)(2)after December 31, 2001; or
employees through the federal E-Verify system." E-
Verify System Link: www.uscis.gov
❑ The Contractor or one of its affiliates has
Local government is specifically exempt from Article 2 incorporated or reincorporated in a "tax haven
of Chapter 64 of the North Carolina General country"as set forth in G.S. 143-5 9.1(c)(2)after
Statutes. However,local government is subject to and December 31, 2001 but the United States is not
must comply with North Carolina General Statute the principal market for the public trading of the
153A-99.1,which states in part as follows: stock of the corporation incorporated in the tax
Counties Must Use E-Verify-Each county shall haven country.
register and participate in E-Verify to verify the work (4) Pursuant to G.S. 143-59.2(b), the undersigned hereby
authorization of new employees hired to work in the certifies that none of the Contractor's officers,directors,
United States. or owners (if the Contractor is an unincorporated
(3) Pursuant to G.S. 143-59.1(b), the undersigned hereby business entity) has been convicted of any violation of
certifies that the Contractor named below is not an Chapter 78A of the General Statutes or the Securities Act
"ineligible Contractor" as set forth in G.S. 143-59.1(a) of 1933 or the Securities Exchange Act of 1934 within
because: 10 years immediately prior to the date of the bid
Contractor Certifications Required by North Carolina Law(Rev.8/2016) Pagel of 3
solicitation. (c) He or she understands that any person who
(5) Pursuant to G.S.143B-139.6C,the undersigned hereby knowingly submits a false certification in response
certifies that the Contractor will not use a former to the requirements of G.S. 143-59.land-59.2 shall
employee,as defined by G.S. 143B-139.6C(d)(2),of the be guilty of a Class I felony.
North Carolina Department of Health and Human
Services in the administration of a contract with the (1) Pursuant to the Orange County Living Wage
Department in violation of G.S. 14313-139.6C and that a Contract's Policy,the undersigned certifies that the
violation of that statute shall void the Agreement. Contractor pays the employees who perform
(6) The undersigned hereby certifies further that: services under this contract a living wage(in Orange
County currently $17.65 per/hr.) Check here ❑ if
(a) He or she is a duly authorized representative of the contractor pays employees performing under this
Contractor named below; contract a living wage. If Contractor does not pay
employees a living wage, what is the wage that
(b) He or she is authorized to make, and does hereby employees performing services under this contract
make, the foregoing certifications on behalf of the paid.
Contractor; and
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 certificate and should sign and
date the document immediately thereafter.
Contractor Certifications Required by North Carolina Law(Rev.8/2016) Page 2 of 3
30
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: August 1,2016
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 as
reflected in the adopted Orange County Budget and as that budget document is amended from time to time. 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
31
ATTACHMENT N
CERTIFICATION REGARDING NONDISCRIMINATION, CLEAN AIR ACT,CLEAN
WATER ACT
Orange County Department of Social Services and Orange County Department on Aging
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, 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 language
(Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01/2018) Page 1 of
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32
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
33
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.
£ 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.
g. In paragraph(1),the term"commercial item"has the meaning given such term in section
4(12)of the Office of Federal Procurement Policy Act(41 U.S.C. 403(12)).
Signature Title
Agency/Organization Date
(Certification signature should be same as Contract signature.)
(Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01/2018) Page 3 of
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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.
1. Provide care at Level II as appropriate to the needs of the client.
J. Complete, for employees serving Level II 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.
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.
Outcomes (06/18) Page 1 of 2
35
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.
Signature Title
Agency/Organization Date
(Certification signature should be same as Contract signature.)
Outcomes (06/18) Page 2 of 2