08-05-2024 Agenda Packet BOCPERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
MEETING AGENDA
304 South Morgan Street, Room 215
Roxboro, NC 27573-5245
336-597-1720
Fax 336-599-1609
August 5, 2024
6:00 p.m.
This meeting will convene in Room 215 of the County Office Building.
CALL TO ORDER…………………………………………………. Chairman Powell
INVOCATION
PLEDGE OF ALLEGIANCE
DISCUSSION/ADJUSTMENT/APPROVAL OF AGENDA
PUBLIC HEARING:
ITEM #1 (pgs.3-28)
Rezoning Map Amendment Application RZ-01-24 request
By the Applicant, the Person County Economic Development
Department, to rezone the ±1,347.34-acre Subject Property,
identified as the Person County Mega Park, from an RC
(Rural Conservation) to a G-I (General Industrial)
zoning designation………………………………………………….. Chris Bowley
CONSIDERATION TO GRANT OR DENY REQUEST
ITEM #2
Consideration to Grant or Deny Approval of request by
the Applicant, the Person County Economic Development
Department, to rezone the ±1,347.34-acre Subject Property,
identified as the Person County Mega Park, from an RC
(Rural Conservation) to a G-I (General Industrial)
zoning designation…………………………………………………… Chairman Powell
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INFORMAL COMMENTS
The Person County Board of Commissioners established a 10-minute segment
which is open for informal comments and/or questions from citizens of this
county on issues, other than those issues for which a public hearing has been
scheduled. The time will be divided equally among those wishing to comment.
It is requested that any person who wishes to address the Board, register with
the Clerk to the Board prior to the meeting.
ITEM #3
DISCUSSION/ADJUSTMENT/APPROVAL OF CONSENT AGENDA
A.Approval of Minutes of July 15, 2024 (pgs.29-80),
B.Budget Amendment #3 (pgs.81-82),
C.Personnel Policy Amendment (pgs.83-153),
D.Person County Health Department Fee Schedule Amendment (pgs.154-155),
E.Person Industries Record Destruction (pgs.156-158), and
F.Person County Department of Social Services Attorney Contracts (pgs.159-304)
NEW BUSINESS:
ITEM #4 (pgs.305-308)
2024-2025 Legislative Goals………………...………………………. Katherine Cathey
CHAIRMAN’S REPORT
MANAGER’S REPORT
COMMISSIONER REPORTS/COMMENTS
CLOSED SESSION #1
A motion to enter into Closed Session #1 per General Statute 143-318.11(a)(3) for
the purpose to consult with the county attorney in order to preserve the attorney-
client privilege with the following individuals permitted to attend: County Manager
Katherine Cathey, Clerk to the Board Michele Solomon, County Attorney T.C.
Morphis, Jr., and Attorney Bo Somers.
CLOSED SESSION #2
A motion to enter into Closed Session #2 per General Statute 143-318.11(a)(6) for
the purpose to discuss personnel with the following individuals permitted to attend:
County Manager Katherine Cathey, Clerk to the Board Michele Solomon, and
County Attorney T.C. Morphis, Jr.
Note: All Items on the Agenda are for Discussion and Action as deemed appropriate
by the Board.
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AGENDA ABSTRACT
Meeting Date: August 5, 2024
Agenda Title: Rezoning/Map Amendment Application RZ-01-24 is a request by the Applicant,
the Person County Economic Development Department, to rezone the ±1,347.34-acre Subject
Property, identified as the Person County Mega Park, from an RC (Rural Conservation) to a G-I
(General Industrial) zoning designation. Property ownership includes the Wagstaff family and the
Person County Business and Industrial Center. The Subject Property includes four (4) tracts), two
having addresses of 1950 and 2352 Country Club Rd., as well as with Tax Map Nos. 46 6, A46
10, A46 47, and A46 54. The Parcel Identification Nos. include 0909-00-01-1802.000, 0909-00-
31-9026.000, 0909-00-31-0271.000, and 0909-00-17-9298.000. The property is generally located
at the intersection of Country Club Rd. and Edwin Robertson Rd., with roadway frontage along
the east and west sides of Country Club Rd. and along the north side of Edwin Robertson Rd.
Summary of Information: The Subject Property includes an Industrial future land use
designation and an RC (Rural Conservation) zoning district. This amendment request is to change
the zoning designation on the four tracts listed above from RC to G-I (General Industrial) for future
industrial development within the proposed Person County Mega Park. The Mega Park is one of
the six EDPNC-identified megasites within North Carolina. For site selection of potential
advanced manufacturers, the Mega Park is ideally located near the Triangle, Triad, and Southern
Virginia regions, has large vacant tracts of land for potential assemblage, has a readily available
skilled workforce, has existing and potential infrastructure that can be expanded, and is within
close proximity to major Duke Energy plants. In short, it is well-positioned to attract advanced
manufacturers over comparable locations.
The Person County & City of Roxboro Joint Comprehensive Land Use Plan (Comp Plan) includes
the following Guiding Principles, with relation to this rezoning request (listed in italics):
Guiding Principle No. 2 – Facilitating Sustainable Economic Growth
Guiding Principle No. 2.1 – Designate sufficient developable land and sites to support
economic growth. The G-I zoning amendment will allow for future industrial development
on-site that appropriately uses City of Roxboro central utilities.
Guiding Principle No. 2.4 – Identify and recruit industry sectors that bring diversity to the
economic/employment base. The G-I zoning designation on the site will attract industrial
uses at this location and diversify the employment base of the County.
Guiding Principle No. 2.7 – Provide utility infrastructure to support economic growth. The
extension of City of Roxboro central water and sewer services into this site will support
future developments in this part of the County through line extensions and capacity at the
central plants.
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Recommended Action: Based on the above, Planning & Zoning Department staff recommends
approval of Rezoning/Zoning Map Application RZ-01-24 amendment. It is also recommended that
the Board of Commissioners adopt a statement describing whether their action is consistent or
inconsistent with the Comp Plan and why that action is reasonable and in the public’s interest, as
follows:
“I hereby move to approve Rezoning/Map Amendment Application RZ-01-24, for the Person
County Mega Park site to rezone the ±1,347.34-acre Subject Property from an RC (Rural
Conservation) to a G-I (General Industrial) zoning designation, and find it is consistent with
the adopted Person County & City of Roxboro Joint Comprehensive Land Use Plan;
specifically, in the public’s interest to designate sufficient developable land and sites to support
economic growth, to identify and recruit industry sectors that bring diversity to the
economic/employment base, and to provide utility infrastructure to support economic growth.”
Submitted By: Chris Bowley, AICP, Planning & Zoning Director
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PLANNING & ZONING DEPARTMENT
325 S. Morgan Street Suite B
Roxboro, NC 27573
July 12, 2024
NOTICE OF PUBLIC HEARING
The Person County Board of Commissioners will
conduct a public hearing on Monday, August 5, 2024,
at 6:00 PM, in Room 215 of the Person County Office
Building, located at 304 S. Morgan Street, Roxboro,
NC, to hear the following:
Petition RZ-01-24 – A request by the Applicant, the
Person County Economic Development Department,
to rezone the ±1,347.34-acre Subject Property,
identified as the Person County Mega Park, from an
RC (Rural Conservation) to a G-I (General Industrial)
zoning designation.
The public is invited to attend the meeting.
Substantial changes may occur to the request based
on comments from the public hearing. The Board
of Commissioners reserves the right to recess the
public hearing at another place and time. For further
information on the case listed above, please contact
the Person County Planning & Zoning Department at
(336) 597-1750.
7/25; 8/1/20245
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REZONING/ MAP AMENDMENT APPLICATION
Person County Planning & Zoning
325 S. Morgan Street, Suite B
Date Receiv ed Roxboro, NC 27573
(336) 597-1750 R..t -Ol -2..4
Application Number
APPLICANT INFORMATION
Name: Person County Economic Development Department Telephone: _3_3_6_-5_9_7_-_1_7_5_2 _____ _
Mailing Address : 303 S. Morgan St.
City: Roxboro State: NC Zip: 27573 --------
Email: blynch@personcountync.gov Fax: N/A
PROPERTY OWNER INFORMATION
Name: Lindsay T . Wagstaff & PCBIC Telephone: 336-599-1467
Mailing Address: 31 Reams Ave.
City: Roxboro State : NC Zip: 27573 --------
Email: N/A Fax: N/A -----------------------
SUBJECT PROPERTY INFORMATION
Property Location: 1950 & 2352 Country Club Rd. Roxboro, NC 27573
Tax Map & Parcel Number(s): A46 6, A46 10, A46 47, & A46 54
Total Acreage : 1,347 .34 Watershed: Roanoke Floodplain: Iii Yes □ No
Existing zoning : (RC) Rural Conservation Requested zoning: (G-1) General Industrial
Current Use of Land: Vacant land -------------------------------
Surrounding Land Uses: _V_a_c_a_n_t_la_n_d ________________________ _
comments: Request for a zoning amendment for economic development purposes for future
development of non-residential uses on an assembled Subject Property.
A SURVEY MAP OR A MAP DRAWN TO SCALE SHOWING THE EXTERIOR BOUNDARIES OF THE LOT(S) SHALL BE
ATTACHED TO THIS APPLICATION.
SIGNATURES AND ACKNOWLEDGEMENT
To the best of my knowledge, all of the information herein submitted on this application is complete and accurate.
Date
Signature of Property Owner Date
PA GE l
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ZONING PROPOSAL SIGNS
Applicants are required to post notice on the land subject to the application, one sign per each road frontage and no
more than 25' from the street right-of-way. Signs must be clearly visible fr~om ,h: •=~ ~~ /7,
Sign picked up: 06/26/2024 Signature:
Sign Returned: 08/06/2024 Signature: ______________ _
OFFICE USE ONLY ·
Completed Application Submitted On: _0_6_/_18'_2_4 ____ _ Received By: Chris Bowley
Date of Planning Board Hearing: _0_7_/_1_1_/2_4 _______ _ Receipt Number: __________ _
Public Hearing Notice Filed: Courier-Times --------------------------------
Name of Newspaper
Dates Notices Published: June 27, 2024 & July 3, 2024
Action of Planning Board :---------------------------------
Additional Comments :----------------------------------
Date of Board of Commissioners Hearing: _A_u_g;;_u_s_t_S_,_2_0_2_4 ____________________ _
Dates Notices Published: ::::r-<J-L.,-':f 25"\ 2.D Zt-\ ~ A-u..GLQ.ST \ 1 zo:?4:
Action of Board of Commissioners: ------------------------------
Additional Comments: ----------------------------------
PAGE2
Mega Park Zoning Map AmendmentREZONING/MAP AMENDMENT APPLICATIONRZ – 01 – 248
Mega Park Zoning Map Amendment (RZ-01-24)IntroductionThe Subject Property is ±1,347.34-acresGenerally located at the Country Club Rd./Edwin Robertson Rd. intersectionSite is vacant & adjacent uses are vacant (primarily) & residentialSite has an Industrial future land use designation & an RC (Rural Conservation) zoning classificationProposed zoning amendment to G-I (General Industrial) will be within Industrial-designated landsSite has been contemplated for future industrial uses in the County’s Mega Park for economic development purposesSite may need to be assembled & platted in the future prior to developmentProposed rezoning is consistent with County’s Comp Plan & Planning Ordinance9
Mega Park Zoning Map Amendment (RZ-01-24)Exhibit A: Aerial Photo10RZ-0.1-24 Exhibit A: Aerial Photo ~COUft'Y ..... •S.e --ualltyUte,-M
Mega Park Zoning Map Amendment (RZ-01-24)Exhibit B: Final Plat Sheet 111
Mega Park Zoning Map Amendment (RZ-01-24)Exhibit C: Final Plat Sheet 212--, 11· I ------------------------------------------------------------------------------------
Mega Park Zoning Map Amendment (RZ-01-24)Exhibit D: Future Land Use Map13RZ-01-24 Exhibit D: Future Land Use Map Future land Use --ti .... --tJt.lilR,~N'tnef't
Mega Park Zoning Map Amendment (RZ-01-24)Exhibit E: Zoning Map (Existing)14RZ-01-24 Exhibit E: Z.oning Map (Existing) _n,--,z......., •<-• ..,,. .. ~,e-nrwon ~ OtP'w1'P'arceb "'""~ --Ulllll-jC. .. ,,,..,, ~ Inch a 1,600.fee~ __ ,_
Mega Park Zoning Map Amendment (RZ-01-24)Exhibit F: Zoning Map (Proposed)15RZ-01-24 El(hibit F: Zoning Map (Proposed) -Zo .. GlCi<nolllllndl,11...i ---UdtrvlaW:.flll'nt --WcOl"ldilty•oed --Loaolllood ~ Ind, • 1.600 f••~ __ ,_ 0 Ol 0.2 0., o,
Mega Park Zoning Map Amendment (RZ-01-24)Comprehensive Plan Guiding PrinciplesThePerson County & City of Roxboro Joint Comprehensive Land Use Plan(Comp Plan) identifies theIndustrial future land use category to designate land for existing and future industrial development.The Subject Property anticipates future industrial development, with the following guiding principles:Guiding Principle No. 2 – Facilitating Sustainable Economic Growth•Guiding Principle No. 2.1 – Designate sufficient developable land and sites to support economicgrowth.The G-I zoning amendment will allow for future industrial development on-site thatappropriately uses City of Roxboro central utilities.•Guiding Principle No. 2.4 – Identify and recruit industry sectors that bring diversity to theeconomic/employment base.The G-I zoning designation on the site will attract industry sectors atthis location and diversify the employment base of the County.•Guiding Principle No. 2.7 – Provide utility infrastructure to support economic growth.The extensionof City of Roxboro central water and sewer services into this site will support future developments inthis part of the County through line extensions and capacity at the central plants.16
Mega Park Zoning Map Amendment (RZ-01-24)Staff Recommendation & Potential MotionBased on the above, Planning & Zoning Department staff recommends adoption ofRezoning/Zoning Map Application RZ-01-24 amendment. It is also recommended that the Boardof Commissioners adopt a statement describing whether their action is consistent orinconsistent with the Comp Plan and why that action is reasonable and in the public’s interest,as follows:“I hereby move to adopt Rezoning/Map Amendment Application RZ-01-24, for the Person CountyMega Park site, to rezone the ±1,347.34-acre Subject Property from an RC (Rural Conservation)to a G-I (General Industrial) zoning designation, and find it is consistent with the adopted PersonCounty & City of Roxboro Joint Comprehensive Land Use Plan; specifically, in the public’s interestto designate sufficient developable land and sites to support economic growth, to attractindustry sectors at this location and diversify the employment base of the County, and to provideutility infrastructure to support economic growth.”17
Mega Park Zoning Map Amendment (RZ-01-24)Thank You18
PERSON COUNTY PLANNING & ZONING DEPARTMENT STAFF REPORT
Rezoning/Map Amendment Application RZ-01-24 is for the Person County Mega Park site to rezone the
±1,347.34-acre Subject Property from an RC (Rural Conservation) to a G-I (General Industrial) zoning
designation.
Request
Rezoning/Map Amendment Application RZ-01-24 is a request by the Applicant, the Person County
Economic Development Department, to rezone the ±1,347.34-acre Subject Property, identified as the
Person County Mega Park, from an RC (Rural Conservation) to a G-I (General Industrial) zoning
designation. Property ownership includes the Wagstaff family and the Person County Business and
Industrial Center. The Subject Property includes four (4) tracts), two having addresses of 1950 and 2352
Country Club Rd., as well as with Tax Map Nos. 46 6, A46 10, A46 47, and A46 54. The Parcel
Identification Nos. include 0909-00-01-1802.000, 0909-00-31-9026.000, 0909-00-31-0271.000, and 0909-
00-17-9298.000. The property is generally located at the intersection of Country Club Rd. and Edwin
Robertson Rd., with roadway frontage along the east and west sides of Country Club Rd. and along the
north side of Edwin Robertson Rd. (see Exhibit A: Aerial Photo, Exhibit B: Final Plat Sheet 1, and Exhibit
C: Final Plat Sheet 2).
The Subject Property includes an Industrial future land use designation and an RC (Rural Conservation)
zoning district. This amendment request is to change the zoning designation on the four tracts listed above
from RC to G-I (General Industrial) for future industrial development within the proposed Mega Park.
Existing Land Use & Land Use Compatibility
The existing land use for the Subject Property is vacant. The existing land uses are consistent and
compatible with adjacent land uses, as follows:
North – vacant.
East – vacant and residential.
South – vacant and residential.
West – vacant and residential.
Comprehensive Plan & Zoning Consistency
Person County Planning Ordinance Section 152, Zoning Permits, as well as, North Carolina General Statues
(NCGS) § 160D-604 & § 160D-605 requires plan consistency and a recommendation from the Planning
Board and the Board of Commissioners. Zoning amendment review shall also follow specific criteria, as
listed in NCGS Article 7, § 160-701, as follows:
Article 7. Zoning Regulation. § 160D-701. Purposes. Zoning regulations shall be made in accordance with
a comprehensive plan and shall be designed to promote the public health, safety, and general welfare. To
that end, the regulations may address, among other things, the following public purposes: to provide
adequate light and air; to prevent the overcrowding of land; to avoid undue concentration of population;
to lessen congestion in the streets; to secure safety from fire, panic, and dangers; to facilitate the efficient
and adequate provision of transportation, water, sewerage, schools, parks, and other public requirements;
and to promote the health, safety, morals, or general welfare of the community. The regulations shall be
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RZ-01-24 Application Staff Report
Page 2 of 3
made with reasonable consideration, among other things, as to the character of the district and its peculiar
suitability for particular uses and with a view to conserving the value of buildings and encouraging the
most appropriate use of land throughout the local government's planning and development regulation
jurisdiction. The regulations may not include, as a basis for denying a zoning or rezoning request from a
school, the level of service of a road facility or facilities abutting the school or proximately located to the
school (2019-111, s. 2.4; 2020-3, s. 4.33(a); 2020-25, s. 51(a), (b), & (d).)
The Person County & City of Roxboro Joint Comprehensive Land Use Plan (Comp Plan) includes the
following Guiding Principles, with relation to this rezoning request (listed in italics):
Guiding Principle No. 2 – Facilitating Sustainable Economic Growth
Guiding Principle No. 2.1 – Designate sufficient developable land and sites to support economic
growth. The G-I zoning amendment will allow for future industrial development on-site that
appropriately uses City of Roxboro central utilities.
Guiding Principle No. 2.4 – Identify and recruit industry sectors that bring diversity to the
economic/employment base. The G-I zoning designation on the site will attract industry sectors at
this location and diversify the employment base of the County.
Guiding Principle No. 2.7 – Provide utility infrastructure to support economic growth. The
extension of City of Roxboro central water and sewer services into this site will support future
developments in this part of the County through line extensions and capacity at the central plants.
Amending the zoning designation for the Subject Property to G-I will be consistent and compatible with
the site’s Industrial future land use designation and Comp Plan that proposed future industrial development
on the site (see Exhibit D: Future Land Use Map, Exhibit E: Zoning Map (Existing), and Exhibit F: Zoning
Map (Proposed)). With a G-I zoning designation, development on the Subject Property will be able to
develop Permitted Uses by-right and have the potential for Special Use Permit approvals, per Appendix C,
Table of Permitted Uses of the Planning Ordinance.
Upon review of Application RZ-01-24, the Planning Board advised that the proposed action is consistent
with the County’s adopted Comp Plan and this “Statement of Reasonableness and Plan Consistency” was
approved in a single-statement for a motion. The Planning Board voted 7-0 at their July 11, 2024, public
hearing to recommend approval of RZ-01-24 to the Board of Commissioners. The Board of Commissioners
shall also adopt a statement describing whether their action is consistent or inconsistent with the Comp Plan
and why that action is reasonable and in the public’s interest.
Planning Staff Analysis & Recommendation
The State of North Carolina General Assembly identified the need for megasite development with a $1
million appropriation to create the Megasite Readiness Program that is operated by the Economic
Development Partnership of North Carolina (EDPNC). The EDPNC identified six (6) strategically located
sites within the state that, “…offers advanced manufacturers the perfect opportunity to grow with six
megasites along with the lowest corporate income tax in the US, an abundance of skilled workers, and
convenient access to major markets, consumers and suppliers.” The megasite concept identifies areas of
“significant landmass for industry (that) is in high demand, but in low supply, and that’s why the Economic
Development Partnership of North Carolina is forging new frontiers in megasite development.”
The Person County Mega Park is one of the six EDPNC-identified megasites within North Carolina. For
site selection of potential advanced manufacturers, the Mega Park is ideally located near the Triangle, Triad,
and Southern Virginia regions, has large vacant tracts of land for potential assemblage, has a readily
available skilled workforce, has existing and potential infrastructure that can be expanded, and is within
close proximity to major Duke Energy plants. In short, it is well-positioned to attract advanced
manufacturers over comparable locations.
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RZ-01-24 Application Staff Report
Page 3 of 3
Person County also recognized the development potential of the Mega Park early in the process of megasite
designation with the EDPNC. The County identified the Mega Park within the Comp Plan with an Industrial
future land use designation, as the only vacant site with this classification. The other Industrial-designed
sites in the County have existing development. The RC zoning designation for the site has limitations on
land uses that potentially could be developed on-site. A zoning amendment to G-I will expand the
permissible land use range of land uses that may be developed on-site. The Permitted Uses in the G-I zoning
district include industrial and non-industrial uses, as listed on the Permitted Use Table in Appendix C of
the Planning Ordinance. Special Use Permit-approved land uses may also be permitted in the G-I zoning
district, as listed on the Permitted Use Table.
Land uses on the Subject Property may require assemblage and platting to achieve unified development.
The uses will need adequate public facilities to serve it, such as a regional roadway network and central
water and sanitary sewer facilities. Country Club Rd. is State Route 1333 and Edwin Robertson Rd.
provides east-west access to US 501 (approximately 3.5-miles to the east). Norfolk-Southern also has an
existing rail line that is approximately 1.5-miles to the east. The City of Roxboro provides central water
service along Country Club Rd. adjacent to the site and the closest sanitary sewer connection is at the
wastewater treatment plant, approximately 3-miles to the southeast. Powerline easements bisect the Subject
Property at two locations, as the site is located between the Roxboro and Mayo Plants. Thus, the location
and physical attributes of the Subject Property for development potential for future industrial/manufacturing
development, along with the EDPNC’s identification as one of six megasites in the state, supports
Rezoning/Map Amendment Application RZ-01-24.
Based on the above, Planning & Zoning Department staff recommends adoption of Rezoning/Zoning Map
Application RZ-01-24 amendment. It is also recommended that the Board of Commissioners adopt a
statement describing whether their action is consistent or inconsistent with the Comp Plan and why that
action is reasonable and in the public’s interest, as follows:
“I hereby move to adopt Rezoning/Map Amendment Application RZ-01-24, for the Person County
Mega Park site, to rezone the ±1,347.34-acre Subject Property from an RC (Rural Conservation) to a
G-I (General Industrial) zoning designation, and find it is consistent with the adopted Person County
& City of Roxboro Joint Comprehensive Land Use Plan; specifically, in the public’s interest to
designate sufficient developable land and sites to support economic growth, to attract industry sectors
at this location and diversify the employment base of the County, and to provide utility infrastructure
to support economic growth.”
Attachments:
Exhibit A – Aerial Photo
Exhibit B – Final Plat Sheet 1
Exhibit C – Final Plat Sheet 2
Exhibit D – Future Land Use Map
Exhibit E – Zoning Map (Existing)
Exhibit F – Zoning Map (Proposed)
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A46 47A46 47
A47 44A47 44
A34 10A34 10
A35A35
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A47 56A47 56
A35 88A35 88
A34A34
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A34A34
109109
A35 87A35 87
A46 8A46 8
A46A46
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A35 96A35 96
A34 82A34 82
A35A35
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A46 51A46 51
A46 12A46 12
A34 75A34 75A34A34
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A46 1A46 1
A46 10A46 10
A46 46A46 46
A34 102A34 102
A34 7A34 7 A45 1A45 1
A46 5A46 5
A46 2A46 2
A35 85A35 85
A35 202A35 202
A35 169A35 169
A46 50A46 50
A35 67A35 67
A45 4A45 4
A46 49A46 49
A34 33A34 33
A45A45
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A46 45A46 45
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A46 47A46 47A47 44A47 44A34 10A34 10A35A35172172A47 56A47 56A35 88A35 88A34A348383A46 54A46 54A34A34109109A35 87A35 87A46 8A46 8A46A4699A34 3A34 3A35 96A35 96A34 82A34 82A35A358686A46 51A46 51A46 12A46 12A34 75A34 75A34A34107107A34 1A34 1A46 1A46 1A46 10A46 10A46 46A46 46A34 102A34 102A34 7A34 7A45 1A45 1A46 5A46 5A46 2A46 2A35 85A35 85A35 202A35 202A35 169A35 169A46 50A46 50A35 67A35 67A45 4A45 4A46 49A46 49A34 33A34 33A45A456565A46 6A46 6A46 45A46 45A34 42A34 42A47 60A47 60A45 22A45 22A35 170A35 170A34 8A34 8A35 54A35 54CCoouunnttrryyCClluubbRRddCChhaarrlliieeJJaayyRRddEdwi
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OOaakkGGrroovveeRRddEEddwwiinnRRoobbeerrttssoonnRRdd¯Future Land UseIndustrialRuralPerson County Mega SiteOther ParcelsAcces EasementUtility EasementSecondary RoadLocal Road1 inch = 1,600 feetZͲϬϭͲϮϰ džŚŝďŝƚ͗FƵƚƵƌĞ>ĂŶĚhƐĞDĂƉ0 0.1 0.2 0.3 0.4 0.5MilesNot Valid if Reproduced25
A46 47A46 47A47 44A47 44A34 10A34 10A35A35172172A47 56A47 56A35 88A35 88A34A348383A46 54A46 54A34A34109109A35 87A35 87A46 8A46 8A46A4699A34 3A34 3A35 96A35 96A34 82A34 82A35A358686A46 51A46 51A46 12A46 12A34 75A34 75A34A34107107A34 1A34 1A46 1A46 1A46 10A46 10A46 46A46 46A34 102A34 102A34 7A34 7A45 1A45 1A46 5A46 5A46 2A46 2A35 85A35 85A35 202A35 202A35 169A35 169A46 50A46 50A35 67A35 67A45 4A45 4A46 49A46 49A34 33A34 33A45A456565A46 6A46 6A46 45A46 45A34 42A34 42A47 60A47 60A45 22A45 22A35 170A35 170A34 8A34 8A35 54A35 54CCoouunnttrryyCClluubbRRddCChhaarrlliieeJJaayyRRddEdwi
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OOaakkGGrroovveeRRddEEddwwiinnRRoobbeerrttssoonnRRdd¯Person County ZoningR-C: Rural ConservationPerson County Mega SiteOther ParcelsAcces EasementUtility EasementSecondary RoadLocal Road1 inch = 1,600 feetZͲϬϭͲϮϰ džŚŝďŝƚ ͗Zoning Map; džŝƐƚŝŶŐͿ0 0.1 0.2 0.3 0.4 0.5MilesNot Valid if Reproduced26---.... -. -----------------:..: ,:'; ,:-.:. ,:-.:. ,:-; ,:-; ,:-;,:".:.=-.:.-::-.: ------------------------· -. ---. ---. -. -,:.-:-.:.-::-.:. ~ ..:.-:: ,:.-:::.:.=--=-=-·=::: ---------_ ... ----, ... _ ---________ ... llllllliit~ ..... llllllt--..... ------------.. .._....., -... _
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OOaakkGGrroovveeRRddEEddwwiinnRRoobbeerrttssoonnRRdd¯Rpoposed ZoningGI: General IndustrialR-C: Rural ConservationPerson County Mega SiteOther ParcelsAcces EasementUtility EasementSecondary RoadLocal Road1 inch = 1,600 feetZͲϬϭͲϮϰ džŚŝďŝƚ&͗Zoning Map;WƌŽƉŽƐĞĚͿ0 0.1 0.2 0.3 0.4 0.5MilesNot Valid if Reproduced27
AN ORDINANCE AMENDING THE PERSON COUNTY OFFICIAL ZONING MAP
FOR ZONING AMENDMENT APPLICATION RZ-01-24
WHEREAS, Person County received a verified and complete Zoning/Map Amendment
Application from the Applicant, Person County Economic Development Department, and the Property
Owners, Wagstaff family and Person County Person County Business and Industrial Center, to rezone
±1,347.34-acres of land, known as the Mega Park, located at Tax Map and Parcel Nos. 46 6, A46 10, A46
47, and A46 54; 0909-00-01-1802.000, 0909-00-31-9026.000, 0909-00-31-0271.000, and 0909-00-17-
9298.000, in Person County. The Applicant petitioned to change the zoning designation on the Subject
Property from Rural Conservation (“RC”) to General Industrial (“G-I”) (hereafter “Zoning Map
Amendment RZ-01-24”); and
WHEREAS, the Person County Board of Commissioners, voted ______ to adopt Zoning Map
Amendment RZ-01-24 amending and updating the Person County Official Zoning Map from Rural
Conservation (“RC”) to General Industrial (“G-I”); and
WHEREAS, the Person County Board of Commissioners finds that the proposed zoning/text
amendment is consistent with the Person County & City of Roxboro Joint Comprehensive Land Use Plan;
and
WHEREAS, the Person County Board of Commissioners, of the State of North Carolina, finds
that the proposed rezoning/text amendment is reasonable and in the public interest through Guiding
Principle No. 2, Facilitating Sustainable Economic Growth.
NOW THEREFORE, BE IT ORDAINED BY THE PERSON COUNTY BOARD OF
COMMISSIONERS THE FOLLOWING:
Section 1. Applicability. Zoning Amendment Application RZ-01-24 is hereby adopted and
approved Person County Board of Commissioners, of the State of North Carolina, and the Person County
Official Zoning Map is amended accordingly.
Section 2. Conflicts and Severability. All provisions of any County Ordinance or Resolution that
are in conflict with this Ordinance are hereby repealed.
Section 3. Effective Date. This Ordinance shall become immediately effective upon adoption. The
foregoing Ordinance, having been submitted to a vote, and received the following vote, was duly adopted
this 5th day of August 2024.
Ayes:
Noes:
Absent or Excused:
Dated: Gordon Powell, Chairman
Person County Board of Commissioners
Attest:
______________________________
Michele Solomon, Clerk to the Board
28
July 15, 2024
1
PERSON COUNTY BOARD OF COMMISSIONERS July 15, 2024
MEMBERS PRESENT OTHERS PRESENT
Gordon Powell Katherine M. Cathey, County Manager
C. Derrick Sims Michele Solomon, Clerk to the Board
Kyle W. Puryear T.C. Morphis, Jr., County Attorney
Charlie Palmer
Jason Thomas
The Board of Commissioners for the County of Person, North Carolina, met in
regular session on Monday, July 15, 2024 at 9:00 a.m. in the Commissioners’ Boardroom
215 in the Person County Office Building located at 304 S. Morgan Street, Roxboro, NC.
Chairman Powell called the meeting to order. Chairman Powell offered an
invocation, and Commissioner Puryear led the group in the Pledge of Allegiance.
DISCUSSION/ADJUSTMENT/APPROVAL OF AGENDA:
A motion was made by Commissioner Puryear and carried 5-0 to approve the
agenda with the removal of Item #2, as it is not needed due to Items # 3, and #4, and the
removal of Closed Session #1.
PUBLIC HEARING:
CONSIDERATION OF APPROVAL OF FINANCING OF 2024 PROJECTS
A motion was made by Vice Chairman Sims and carried 5-0 to open the duly
advertised public hearing for Consideration of Approval of Financing of 2024 Projects.
Chief Financial Officer Amy Wehrenberg stated that the purpose of the hearing is
to obtain feedback from the public on the County’s plans to finance, at an amount not to
exceed $22M, the acquisition of the Human Services Building, the Carolina Pride
Carwash Building for Piedmont Community College’s use, roof repairs at South
Elementary School, and improvements to the Person County Recycling Center in
connection with the consolidation of facilities for Person Industries and the Person County
Recycling Center. She stated that once the public hearing is closed, she will bring forth
other related documents for the Board’s consideration.
There were no individuals appearing before the Board to speak in favor of or in
opposition to the Consideration of Approval of Financing of 2024 Projects.
A motion was made by Vice Chairman Sims and carried 5-0 to close the public
hearing for Consideration of Approval of Financing of 2024 Projects.
29
July 15, 2024
2
APPROVING RESOLUTION 2024 LOB’S ISSUANCE
Chief Financial Officer Amy Wehrenberg stated that since the hearing has been
closed, she is now requesting the Board’s approval of the final resolution for the 2024
Limited Obligation Bonds (LOB’s) issuance in an amount not to exceed $22M for financing
the projects that were presented during the public hearing. She stated that as part of the
resolution, the Board is authorizing County staff to execute and deliver a related deed of
trust, a lease and agency agreement with the school board, and other underwriting
documents associated with the sale of these bonds. She stated that in addition, the resolution
designates certain County staff as representatives to execute the final documents and
perform certain duties with respect to the financing in its post-closing phase. She stated that
copies of all documents referenced in the resolution can be made available to any Board
member upon request.
A motion was made by Commissioner Palmer and carried 5-0 to adopt the
Approving Resolution for 2024 LOB’s Issuance.
30
l (XTRACTS FROM MINUTES OFTn E BOARD OF COMMlSSI ONll!l'<S
I\ regular m~ctlnF. t1(1ha Ooord of Commissioners or1hc Coun\y of rcrsoo, Nor1h CuoUna, was
OUl-1 held on Ju ly IS, 202'1 al 9:QO 0 1m , lo the Coo1 m isslo11crs· llo:.rdroom, Koom 1 15, PtBQ'n Coun1y
Off,te Bu ilding. 304 S. l\•fo rS,ai, S h ctt, Roxhoro, N<"H1h C11roll1111, Ch•innlln Ootdon Powell pruidiug,
C01mnissioncr moved that lhc following resolulion. copies of which having been
mo:ck avai lable 10 the Doard o(Comrnis!iionus, be adopted:
R&S0LU1"10N OY T IIF. 80AR0 Of COMMISSIONE;RS OF T H£ COUNTY OF' PERSON,
NORTU CAROLINA, APP1f:OVI J'IIG AN l N!.IALLMEftfT FINANCING CONTRACT /1,.i"'fD
Ot:1~1VCR.V TIIEREOf ANO PROVI OINO FOR CERTAI N 0 Tt-tt:R RELATED MATTERS
WHEREAS, the County of Pcrso,t, North C l!lrolinn (the "'C<wnry'') is a validly existing political
subdivision, existing Mi soch u nder and by vir1ue of the Constitulion, $latule! l\M laws of the State o r North
Carolin a (the "Stare");
WHEREAS, the County h as the power, pursuant to the Ocncrlll Statutes or North C1uolina to
(l) m t a into installment con1rac.1S in order to purchase, or fin ance or refinance the purch ase of,, real or
personal property and to finance or rt:finaocc the conslruction o r repa ir of fixtures or irnprovcme1lls on rcttl
property and (2) create. a security i1\tcrcst in soine or all of l hc property financed or refinanced to s~cure
rep1yn1e:nt of the purchase price;
WHEREA S, the Board hH previously dc1 ermh1cd that it is in th e best h1tcrcsl of the County to
(1) tntCf i mo no Instal lment Fi11a11cing Coutrflct (the .. Contract') with the Person County Fio.ancing
Corpor ation (the "Corporatlc11") to finance (a) the acquisitK>n of a portion of a buildirtC currently being
le41.$Cd by the Com\ty aod used by the County Hct1 lth Ocpn11ment 101d Social Services Depa1tmen1, (b) the
ecq1Jisi1ion of a buildint for use by Picd1nont Corn munily College. (c) roof repairs at SOuch Elementary
School and (d) improveincn1 s to 1he County's re,cycHng center i 11 connection with !he co11soli dation or
racilitiC$ for Person Industries and Person County Recycling (collectively, the "2024 Prajecrs") and
(2) tntcr into n deed or trust, security ;,grccmcnt and fixture flling (lhe "Dc¢d of 1l·u.1f} J'clued to lhe
July 15, 2024
3
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County's fee simple interest in the real property on which South Elementary School is located, together
with the improvements thereon (collectively, the "Mor/gaged Property"), that will provide security for the
County's obligations under the Contract;
WHEREAS, to enable the County to enter into the Contract, tl1e Person County Board of Education
(the "Board of Ed11cation") must first convey to the County ownership of the Mortgaged Property so that
the County may secure its obligations under the Contract pursuant to the Deed of Trust an d grant a lien on
the Mongaged Property, and the Board of Education has approved such conveyance at its meeting held on
June 25, 2024;
WHEREAS. pursuant to a Lease and Agency Agreement, to be dated on or about August l, 2024
(the"Lease and Agency Agreement"), between the Board of Education ru1d the County, (1) the Board of
Educat ion will lease the Mortgaged Property back from the County for a term of years, at the end of which
the County will convey ti tle to the Mortgaged Property back to the Board of Education, and (2) the County
will designate the Board of Education as its agent to carry out the construction and completion of the 2024
Projects;
WHEREAS, in furtherance of the above plan, the Corporation will execute and deliver its Limited
Obligation Bonds, Series 2024 (the "2024 Bonds") in an aggregate principal amount not to exceed
$22,000,000, evidencing proportionate undivided interests in rights to receive certain Revenues (as defined
in the Contract), under the terms of the lndellture of Trust between the Corporation and U.S. Bank Trust
Company, National Association, as trustee;
WHEREAS, in connection with the sale of the 2024 Bonds by the Corporation 10 PNC Capital
Markets LLC (the "Unde,,vriter"), the Corporation will ellter into a Contract of Purchase to be dated the
delivery date thereof (the "Contract of Purchase") between the Corporation and the Underwriter, and the
County will execute a Letter of Representation to the Underwriter with respect to the 2024 Bonds (the
"Lellerof Representation");
WHEREAS, there have been described to the Board the forms of the followillg documents
(collect ively, the "Instruments"), copies of which have beell made available to the Board, which the 0oard
proposes to approve, enter into and deliver, as applicable, to effectuate the proposed installment financing:
(I) the Contract;
(2) the Indenture;
(3) the Deed of Trust;
( 4) the Letter of Representation; and
(5) the Lease and Agency Agreement;
WHEREAS, to make an offering and sale of the 2024 Bonds, there will be prepared a Preliminary
Official Statement with respect to the 2024 Bonds (the "Preliminary Official Statement"). a draft thereof
having been presented to the Board, and a final Official Statement relating to the Preliminary Official
Statement (together with the Preliminary Official Statement, the "Official Swtemen/''), which Official
Statement will contain certain information regarding the County;
2
July 15, 2024
4
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WHEREAS, it appears that each of the Instruments and the Preli mi nary Official Statement is in an
appropriate form and is an appropriate instrument for the purposes intended;
WHEREAS, a public hearing 011 the Contract, Deed of Trust and the 2024 Projects to be financed
the~by, after publication of a notice with respect to such public hearing, must be held and the Board
conducted such public hearing at this meeting;
WHE REAS, the County has filed an application to the North Caroli na Loca l Government
Commission (the "LGC') for approval of the Contract;
WHEREAS, Parker Poe Adams & Bernstein Ll,P, as bond counsel, will render an opinion to the
effect that enterin g into the Contract and t he transactions contemplated th ereby are authorized by law;
NOW, THEREFORE BE 1T RESOLVED BY THE BOARD O F COMMISSIONERS OF THE
COUNTY OF PERSON, NORTH CAROLINA, AS FOLLOWS:
Section I . Ratijlcntio11 of I11strume11ts. All actions of the County, the Chairma n of the Board
(the"Chair111011"), the Clerk to the Board {the "Clerk"), the County Manager, the Chief Finan cial Officer,
the Deputy Chief Financial Officer, the County Attomcy, and their respective designees, incl ud ing anyo11e
serving as such in an interim capacity, whether prev iously or hereinafter taken, in effcctuati ng the proposed
financ ing, i11cluding the making of application to the LGC, are hereby approved, ratified! and authorized
pursuant to and in accordance w ith the transactions contemplated by the Instruments.
Section 2. A 11tl1orlzathm of the Offlc/11/ S tntem e11t. The fonn, tenns and content of the
Prelim inary Official Sta tement arc in all respects authorized, approved, and confirmed, and the use of th e
Prelim inary Official Statement and the final Official Statement by the Underwriter in connection with tl1e
sa le of the 2024 Bonds is hereby iu all respects authori zed, approved and confirmed. The Chairman, the
County Manager, the Chief Financial Officer, the Deputy Ch ief Financial Offi cer, and the Clerk
(collectively, the "Authorized Officers") are hereby authorized and directed, individually and co ll ectively,
to deliver, on behalf of the County, the Official Statement in substantia lly such form, wit'h such changes,
insert ions and omissions as he or she may approve ,
Section 3. A11tltoriwtio11 to Exec111e1/1e Co11trnct. The Co unty hereby approves the financing
of the 2024 Projects in accordance with the terms of the Contract, wh ich will be a valid, legal and binding
obligation of the County in accordance with its terms. The form and content of the Contract arc hereby in
all resp ects authorized, approved and con firmed, and the Authorized Officers and their respective des ignccs
are hereby authorized, empowered and directed, individua lly and collectively, to execute and deliver the
Coniract, including necessary counterparts, in substantially the form and content presented to the Board,
but 1vit h such changes, modifications, additi01iS or deletions therein as !hey may deem necessary, desirable
or appropriate, their execution thereof to constitute conclusive evidence of the County's .approval of any
and all changes, modifications, additions or deletions therei n from the form and content of the Contract
presented to the Board. From and after the execution and delivery of the Contract, the Authorized Officers
are he re by authorized, empowered and directed, individually and collectively, to do all such acts and things
and to execute all such documents as may be necessary to ca rry out and comply with the provisions of the
Cm~ract as executed.
Sectio n 4. A111lwrizatlo11 /(I Execute tlte Deed of Trust. The County approves the form and
content of the Deed of Trust, and the Deed of Trust is in all respects authorized, approved and confirmed.
The Au1horized Officers and the ir respective designees are hereby authorized, empowered and directed,
individually and collectively, to execute and deliver th e Deed of Trust, including necessary counterparts, in
3
July 15, 2024
5
33
substantially the form and content presented lo the Board, but with such changes, modifications, additions
or deletions therein as they deem necessary, desirable or appropriate. Execution by the Authorized Officers
or their respective designees, individually or collectively, constitutes conclus ive evidence of the County's
approval of any and all such changes, modifications, additions or deletions therein from the fonn and
content of the Deed of Trust presented to the Board, and from and after the execution ancl delivery of the
Deed of Trust, the Authorized Officers arc hereby authorized, empowered and directed, individually and
collectively, to do all such acts and things and to execute all such documents as may be necessary to carry
out and comply with the provisions of the Deed ofTnist as execu ted.
Section 5. Leifer of Represellfa//011. The form and content of the Letter of Representation
are hereby in all respects approved, and the Authorized Officers are authorized to cxecwte the Letter of
Representation for the purposes stated therein.
Section 6. A11//1orizatlo11 ft> Exec11te the Lease amt Age11cy Agreeme111. The County
approves the form and content ofthe Lease and Agency Agreement and the lease of the Montgaged Property
to the Board of Education as contemplated thereby, and the Lease and Agency Agreement is in all respects
authorized, approved and confirmed. The Authorized Officers and their respective designees arc hereby
authorized, empowered and directed, individually and collectively, to execute and deliver the Lease and
Agency Agreement, including necessary counterparts, in substantially the form and content presented to
the Board, but with such changes, modifications, additions or deletions therein as they deem necessary,
desirable or appropriate. Execution by the Authorized Officers or their respective designees, individually
or collective ly, constitutes conclusive evidence of the County's approval of any and all such changes,
modifications, additions or deletions therein from the form and content of the Lease and Agency Agreement
presented to the Board, and from and after the execution and delivery of the Lease and Agency Agreement,
the Authorized Officers are hereby authorized, empowered and directed, individually and collectively, to
do all such acts and things and to execute all such documents as may be necessary to carry out and comply
with the provisions of the Lease and Agency Agreement as executed.
Section 7. Co1111ty Represe,itallve. The Authorized Officers are hereby designated as the
County's representat ives to act on behalf of the County in connection with the transactions contemplated
by the Instruments and the Preliminary Official Statement, and the Authorized Officers are authorized to
proceed with financing the 2024 Projects in accordance with the Instruments and the Preliminary Official
Statement and to seek opinions as a matter of law from the County Attorney, which the County Attorney is
authorized to furnish on behalf of the County, and opinions of law from such other attorneys for all
documents contemplated hereby as required by law. The County Manager and the Chief Financial Officer
are hereby authorized, individually and collectively, to select a co-managing underwriter for the 2024
Bonlls if they determine such selection to be in the best interests of the County. The County's
representatives or their respective designees are hereby authorized, empowered and directed, individually
and collectively, to do any and all other acts and to execute any and all other documents, which they, in
their discretion, deem necessary and ap _propriate to consummate the transactions contemplated by the
Instruments and the Preliminary Official Statement or as they deem necessary or appropr iate to implement
and carry out the intent and purposes of this Resolution and to administer the transact ions contemplated by
this Resolution after the execution and delivery of the 2024 Bonds.
Section 8. Severnbilily. If any section, phrase or provision of this Resolution is for any reason
declare d to be invalid, such declaration shall not affect the validity oflhe remainder of the sections, phrases
or provisions of this Resolution .
Section 9.
are hereby re pealed.
Repealer. All motions, orders, resolutions and parts thereof, in conflict herewith
4
July 15, 2024
6
34
Section 10. Effective D"te. This Reso lution is effective on the date of its ado,ption.
Read, approved and adopted this I 5th day of July, 2024.
'"~ Chalrnanofthe8ollrdofCommlsners
APPROW.D AS TO FORM:
County Aifut{ey
5
July 15, 2024
7
2024 LOB’S CAPITAL PROJECT ORDINANCE
Chief Financial Officer Amy Wehrenberg stated that budget approval for these
projects allows for the creation of this project in the County's financial system. She stated
that expenditure categories include acquisition cost for the Human Services and Carolina
Pride Carwash Buildings, estimated costs related to the Person Industries and Recycling
Center merger, and roofing replacement construction at South Elementary School. She
stated that the County has set aside contingency funds in the Capital Improvement Project
Fund for FY25 to supplement the project, as necessary. She stated that the total budget for
this Project is $21,122,000, all of which is proposed to be sourced from LOB’s in FY25.
She stated that the Capital Project Ordinance also includes direction to the Chief Financial
Officer and Budget Officer for the advancement of funds prior to receiving bond proceeds
and direction for reporting the status of project expenditures to the Board of Commissioners.
A motion was made by Commissioner Puryear and carried 5-0 to approve the 2024
LOB’s Capital Project Ordinance.
35
PERSON COUNTY
PROPERTY ACQUI SITI ONS A N D O T HER I MPROVEMENTS
FUNDED BY L I MITED OBLIGATION BONDS
CAPITAL PROJECT ORDINANCE
BE IT OR.OAINEO by the Soard of Commissioners or P e reon County, North C1;1rolin a, t hat, pu.-suant to Section
13,2 of Chapter 159 of the General S tatutes of North Cerollna, the tolrow'lng c apital project ordinance Is hereby
adopted:
Section 1 The project aut horized ls t he acquisition of the currently leased Human Services Building,
aoqulslllon of the Car'Olina Pride Car Wash Building (225 Crown Boutevard. Timberl ake , N C 27583) for uso by
Pi&dmont Community College, construction and r-enovaUon Improvements (Phase I ) and equipment upgrades
(Phasa II) for the Pers on County Recycling Center associated with the m erging of Person fndustries, e:nd the
t(Hoofing of Sout h E le m ent:ery School (the '"Project"). The ProJe<:t la proposed to be ffnancod by an
lns t allmenl financing under G .S. 160A-20.
Soctfon 2 rha officers or Uils unit ore h e reby directed to proceed with t hO capilal project within the te rms of
tho financing resoluUon a nd the budget contained here in.
Section 3 The f ollowlng amounts an, approprfatod fOf' the p roject:
AC:qulsltlon of Human Servkcs Bulldlng..................................... S 8,000,000
Acquh:ltfon o f Col'c>llna Pride Carwash Bulld lng ......................... 7,000,000
PI/MRF M ctgertPhascs I & It)................................................... 4,480,706
Roof Replaceme nt-South Elemenuty School........... 639,838
Contlng~ncy .............. ,................................................................ 579,456
Issuance Costs ............................................................................ _ __c4::2c.:>,,0c,OO"'-
Total Expenditures................................... ..................... 21,1221000
Soction 4 Th e followlng revoniuo& a re ontlc ipated lo be ovallable to complete \hrs project
1,lmitod Obllgatlon 8qncfs of l024 ................................................ $2:1,122,000
Section 5 The Chief Flnan ciaD Office,. Is hereby directed to m3inleln within the Capital Project Fund sufflclent
specific delallad &ee0untlng r&cords to satisfy the ,.equlremonts of any and all applic.abro requirem e nts of N orth
Caroline Gene,-e1 Stotutes. T h e t e,.ms of the financing resolution also shall be met.
Sectlon 6 Funds may be advonced from t he General Fund, Capital Investment Fund. or Copltal t mprovement
Proj ect Fund f or the purpcse of moklng p a yments as due. Any such advances made prior l o the securing of
adoquate Mane.Ing Is lnlendod to be reimbursed from t he Llmitod Obllg eitlon Bonds of 2024 . Reimbursement
requests should be made to t ho ffnancing Inst itution In an orderly and tlmery manner.
Section 7 T h e Chlo f F in ancial Officer Is dlrectcd to ntport p erlodicalfy on t he llnancial stalus of each project
eloment in Section 3 ond on the totel ,.even u es received or c la imed.
Sectron 8 The Bvdget Officer ,Is d irected t o lnclu do a, det ailed anarysls or pust and future costs a n d revenues
on this capital project pe,.lodically to t he Board.
Seel/on 9 Coples of this capital project ordinance shall be furnlshed to the Clerk lo the Govemn:!Jll )O,!~ll!lllqilil
lo lhe 8udget Of11eer and t he Ch'8r Fl n anclol Officer fol' directron in carrying oul t hla project. ~ •
July 15, 2024
8
INFORMAL COMMENTS:
The following individuals appeared before the Board to make informal comments:
Andrea Childers of 270 Blackberry Lane, Rougemont stated that she has been a
resident of Person County for 31 years. She stated that Person County Government is not
willing to allow the NC Department of Environmental Quality (NCDEQ) Division of Air
Quality (DAQ) to hold its Public Hearing for a permit for Moriah Energy Center (MEC)
here in Person County because they would not sign the indemnity clause in the rental
agreement for rental of a Person County Government facility; therefore, they are having to
hold the hearing in Vance County. She stated that she believes the Board is uninformed and
uneducated about the facts that lead to them continually making horrible decisions. She
stated that this month we have had record-setting heat, yet the Board wants to fill Person
County with fossil fuels that continue to spew chemicals that contribute to climate change.
Katie Moore of 411 North Lamar Street, Roxboro voiced concerns about Person
County not hosting the Permit Hearing for the NCDEQ Division of Air Quality. She stated
that for most residents here, the location two counties away is not feasible. She stated that
over the course of the last eight to nine months, there has been a lot of concern about MEC.
She stated that she would have thought the Board would have worked something out with
the State to make sure that the location for the hearing was in Person County.
DISCUSSION/ADJUSTMENT/APPROVAL OF CONSENT AGENDA:
A motion was made by Vice Chairman Sims and carried 5-0 to approve the
Consent Agenda with the following items:
A. Approval of Minutes of June 17, 2024,
B. Budget Amendment #1,
C. Budget Amendment #2,
D. FY25 Budget Ordinance Correction,
E. Person County Schools Request for Distributions from the North Carolina
Education Lottery Public School Building Repair & Renovation Fund,
F. Contract for School Nursing Services between Person County and Person County
School System,
G. Home and Community Care Block Grant Funding for FY25,
H. Resolution Authorizing Execution of Opioid Settlements and Approving the
Second Supplement Agreement for Additional Funds, and
I. Tax Adjustments for June 2024
a. Tax Releases
b. NC Vehicle Tax System Pending Refunds
36
July 15, 2024
9
NEW BUSINESS:
FUNDING REQUEST FOR TAR RIVER LAND CONSERVANCY TO PURHASE
“MT. HARMONY TRACT” FOR PRESERVATION AND CONSERVATION
Recreation, Arts and Parks Director John Hill stated that he has been working on a
project with the Tar River Land Conservancy (TRLC) on possibly preserving an 85-acre
tract of land in the Mount Tirzah area in Person County for future environmental and
watershed quality purposes, and so that the land would forever remain rural and natural. He
stated that he has worked with the TRLC for 24 years, and they have helped Person County
gain millions of dollars in grant support. He turned the presentation over to Derek Halberg
and Michelle Mound with the TRLC who presented the following:
37
Funding Request to Person County Board of
Commissioners
Tar River Land Conservancy's Acquisition of
''Mount Harmony Tract"
r7A'J TAR RIVER L!!:J LANO CoNc;;fRVANCY
Derek Halberg, Executive .Director
Miche lle M o und, L a nd Con se 1·vation Specialist
Nola R eed Knouse, TRLC Board Member
July 15, 2024
10
38
rn-l TAR R 1VE R ~ LAND CONSERVANCY
•
•
•
•
•
•
•
•
501c(3) charitable, nonprofit organization
founded in September 2000
one of 22 land trusts working in local
cotnmunities across North Carolina
serves P erson , Granville, Vance, Franklin,
Warren, Halifax, Nash & Edgecombe Counties
headquartered in Louisburg (Franklin County)
s ince 2002
g uide d by an 10 -member Board of Director s
staffed by 5 full -time employees , 2 interns, and
many volunteers
accr e dite d by Land Trust Accreditation
Commission since 2 012
LAND CONSERVATION PRIORITIES
• Drinking Water
• Wildlife Habitat
• E ndange red Species
• Parks and Trails
• Working Farms & Forests
• C ultura l & Heritage Resources
July 15, 2024
11
39
■
■
■
■
■
■
■
Land Protected by TRLC
Land Protected (total across eight counties)
23 701 acres & 207 miles of trea1ns
Land Protected in F alls Lake Water s hed
■ Granville County = 5 935 acres
■ Per s on C ounty = 2 14 acres
TRLC Nature Preserves Open to Public
■ Ledge Creek Forest Conservation Area (5.0 miles of trails)
■ Horseshoe Road Nature Preserve (2.4 miles of trails)
■ Robertson Creek Nature Preserve (1.9 miles of trails)
■ Roberts Chapel Conservation Area ( 1. 5 miles of trails)
Proposed Acquisition:
"Mount Harmony I
Tract"
Tax Map & Parcel No:
A8620 I
85.10 acres
Mt. Tirza h Towns h ip,
Person County
Located on Mount
Harmony Chu rch Rd
Listed for sale in
October 2023
Owned by A llen family
since 1920s
Current owners: heirs
ofRach !A llen
Hornbuckle (Person
County residents) ,
July 15, 2024
12
40
Mount Harmony Tract:
Summary of Conditions
L o cation:
• Mt Harmony C h urch R d
• 1 mile t o M t. Tirzah Park
• 11 miles t o Roxbor o
Land Cover:
• 79 acr e s for e s tland
• 6 acres agricu ltural fie lds
Str eams:
• 7 ,300 f t t o t a l (with 2 ,230 f t
a long Rock Fork Branch )
Other:
• D umped tras h & t ire s
• A b and o n e d a uto & b oat s
July 15, 2024
13
41
MOUNT HARMONY TRACT -PRO.JECT BUDGET
A c quis iti on Cost s = $626,400
► Inc ludes p ayinent to sellers, due diligence, closing costs,
site c l eanup, and TRLC Stewardship EndoWinent and
TRLC Legal Defen se Fund d eposits
P r o_ject Fundrais ing
► Sec ured Fundi ng:
■ L andowner Bargain Sal e ($84 ,000) (1 4 %)
■ Raleigh W atershed Progra1n ($334,4 0 0 ) (53%)
■ D urha m Watershed P r ogram ($1 58,0 0 0) (25%)
► R e que ste d Funds:
■ Person County ($50~000) 8%)
July 15, 2024
14
42
MOUNT HARMONY TRACT -
WHY SHOULD PERSON COUN'IY INVEST ?
• The project offers credits towards P erson County's
stonnwater obligations .
• County funds will leverage significant funds fro1n outside
county to preserve land for benefit of county residents.
• Project honors the rural character and longbistory of land
stewardship in Person County.
• Conservation easement to be held by Person County will
ensure that land remains undeveloped in perpetuity.
• TRLC plans to create a nature preserve on this property-
a model that TRLC could be replicated elsewhere in
Person County.
MOUNT HARMONY TRACT PROPOSAL -
KEY POINTS & WRAP-UP
• TRLC has track record of securing :fimds to preserve land in
Falls Lake Watershed and opening land to corrununity.
• TRLC is excited to par1n r with Person County to acquire
Mt. Hannony Tract.
• Closing is targeted for Sep -Oct 2024.
• Thank you to the County Manager and her team for
guidance and feedback on this project.
• TRLC requests $50 000 :from Person County to leverag
$490,400 from Durham and Raleigh watershed programs.
July 15, 2024
15
Vice Chairman Sims asked if anyone has walked the property to which Hill
responded that he, Mound, and GIS Director Sallie Vaughan walked the property. He
stated that the property is nice, very rural, and one of those properties in Person County
that you would probably want to keep as nice countryside. He stated that this land is a
gem, is located in the middle of Mount Tirzah, and compliments the surrounding rural
area. Sims stated that looking at the pictures, he sees an old barn and inquired about the
possibility of restoring and keeping it, as he would hate to see it get torn down. Hill stated
that from a liability standpoint, the TRLC would probably want the barn off the property.
He stated that the County would like to work with neighboring organizations to keep the
barns that are on the property in Person County. Chairman Powell asked if approved by
the Board, looking long-term, how does the County tie in to the maintenance and upkeep.
Hill advised that it would be a nature preserve allowing public access to the property, and
would be controlled, operated, and maintained by the TRLC. He stated that it is a benefit
of having a land preserve in your ‘backyard” with the Parks and Rec Department not
operating it, as it could build partnerships through volunteers, Friends of the Park, and
other organizations in conjunction with TRLC. Halberg stated that Hill is absolutely
correct. He stated that in Granville County, the TRLC has designed these preserves with
minimal infrastructure, as the intention is not to create a place where you have lots of
buildings, yet their objective is to create a place where people can park their vehicles and
walk two to three miles of trail through the woods. Sims asked about ATV use. Hill
advised strictly hiking trails, similar to the County Farm Park. Commissioner Puryear
asked why this particular piece of property? Halberg replied that first off, the property was
listed for sale, and secondly, the TRLC had been looking at a number of tracts of land in
Person County. He stated that they get to work with landowners who want to work with
them to preserve the land. Puryear asked Halberg, what would be the anticipated timeline
to have the property cleaned? Halberg stated that approximately one to two months from
the closing date. He stated that they would be obtaining bids from contractors and would
be speaking with the property owner about vehicles and boats on the property that have
been abandoned. Puryear asked if the TRLC would be absorbing 100% of the cost for the
cleanup, to which Halberg replied yes, the cost has been budgeted and the City of Raleigh
has included the cleanup in their grant that was awarded to the TRLC. Powell asked if the
TRLC has a board of directors. Halberg stated that yes, they have a board of directors, and
that Nola Knouse owns land in Person County and is a board member that is present
today. Knouse stated that she resides in Winston-Salem, and owns approximately 100
acres of land along the Flat River and Highway 501 S in Timberlake. She stated that she is
a descendant of the JG Chambers family, and the land she owns has been in her family
since the late 19th Century. She stated that she and her sister did research and were
extremely impressed with the TRLC; therefore, they signed a conservation easement on
the property in 2021 that will prohibit further development in perpetuity. She stated that
she joined the TRLC Board in February 2023, and has found it to be a positive experience.
Commissioner Palmer stated that he would assume that the property would be posted as
no hunting. Halberg stated that there will be signage posted on the property such as, Open
to the Public, No Hunting, and No ATV Use, after acquisition of the property.
43
July 15, 2024
16
County Manager Katherine Cathey stated that within the County’s Stormwater
Fund, which is funded through the stormwater fees that are paid along with property taxes
each year, there is a balance of $575,194 in that account. She stated that out of that fund,
the County already has commitments, such as developing the County Farm Park property,
and work at the Sportsplex. She stated that beyond that, the County still has that fund
balance that exists; therefore, her recommendation is that the County appropriate $50K
from the Stormwater Fund fund balance towards the acquisition of this property.
A motion was made by Commissioner Palmer and carried 5-0 to approve the
resolution to contribute funding to Tar River Land Conservancy for the purchase of the
“Mt Harmony Tract” and a Stormwater Fund fund balance appropriation in the amount of
$50K.
44
R ESOLUTI ON TO C ONTRIB U TE F U NDIN G T O T A R R I V E R L AN D C O NSERVANC Y
FOR T H E PURC HAS E OF TII E "MT. HAR M O NY TRACT "
W H E R E A S, Person Cou nty hos been approM.:hed by Tar River Land Con servancy (the Conservancy'')
regarding partici pating TRLC's purchase ofn t ract of land sitwltcd on Mount Harmony Chu rch Road in Mt.
T irzah Tow ns hi p, Person County, North Carol ina;
W H E REAS, t he p roperty consists of approximatel y 85.10 acres and is known as the "Mt. Hnr1nony
T ract";
W H E REAS, the pJ"eservat ion of the property will benefit t he Falls Lake Watershed by reduc i ng and
filtering stor mwater runoff into R ock f"ork O rnnch nnd several t r ibuu,.-i cs;
W IIF.RF..A S , the acquisition o f t he property could allow t ho Conservancy to irn p rove o nd mon agc the
property for passi ve rucreational access for the benefit of the county's r esidents: nnd visitors;
W H E R E A S. t he Conservancy has recei ved (m1di ng comm i.t ments from t he City of Raleigh a nd C ity o f
Durham's watershed protect ion pro2rams to purchase and protect the property in perpetuity; and
W H EREAS, the County bel ieves that patti c i pat ior\ i n this purchase will advance its obligat ions to
protect water qual ity in the Falls Lnk e Watershed.
NOW, T H E H.E F'OR.£, U E JT RESO L V E D that the Person County Bourd of Commissioners (t he
uooard") suppon t he proposal by Tar R i ver Land Conservancy to parti ci pate in the p urchase of the Mt.
Harmony Tract us set forth below;
D E JT FURTH ER R ESOLVE D lhnt the Board hereby aut hor izes the f u nding comrnitmcnt of
$50,000.00 for th e Conservancy's purchase of the Mt. l-lnrmony Tn1ct to be t rans fer red to the closing
attorney upon confirm &t ion by t he County Attorney that all otl1cr funding has been obtnined ond closing o f
the pur c h ase is schcduh ... -d; und that Person C oun ty ugref.:ls to accept a conscrvution casement on the pr operty
10 ensu re lhnt it remains dedicated to envir onmental protect ion i n perpetuity. and t hat the County Attorney
is hereby authorized to ncgo1 iatc terms of said conser vation casement with the Conser vancy.
Adopted this, t he I Sl" day of Jul y. 2024.
Attest:
July 15, 2024
17
APPOINTMENT OF INTERIM CHIEF FINANCIAL OFFICER
County Manager Katherine Cathey stated that Chief Financial Officer Amy
Wehrenberg will be retiring at the end of the month. She stated that the County has a Deputy
Chief Financial Officer Tracy Clayton. She stated that Clayton is very experienced with
Person County and has agreed to assume the role as Interim Finance Officer while the
County continues to search for a permanent Chief Financial Officer. She stated that it is her
recommendation that the Board approve Clayton’s interim appointment and administer the
oath of office to be effective August 1, 2024, upon the retirement of Wehrenberg.
A motion was made by Vice Chairman Sims and carried 5-0 to adopt the Resolution
Appointing Tracy Clayton as Interim Finance Officer.
45
A RESOLUTION APPOINTING AN I NTER IM FINANCF. OFFICER
WHEREAS, N.C . Gen. Stat. § 159-24 rtqu ires each unit of North Carolina local
governmcn1 to have a Finance Officer, and this: office is currently held by Ms . Amy Wehrenberg,
the Person County Chief Financial Officer;
WHEREAS, Ms. Wehrenberg will rc1irc from her position effectivo August I, 2024;
WH EREAS, the Person County Manager is in the process of hiring a new Chief Financial
Office r, but until such person can be identified and appointed to serve as f inance Oflicer, the
Person Board ofCoun1y Commissioners intends to appoint Ms . Tracy Clayton, the Deputy Chief
Financial Officer, to serve as Interim Finance Officer:
NOW Tl-lEREFORE, BE IT RESOLVED BY TflE PERSON COUNTY BOARD OF
COM MI SS IONERS THE FOLLOW ING:
Section 1. Tracy Clayton is hereby appointed to scr.oe as the Interim Person Coun1y
Finance Officer until such 1imc as a permanent Finance Officer can be appoinlcd.
Section 2. All provisions of any County ordinance or resolut ion in conflic1 with this
resol ulion arc repealed.
Sect ion 3. This resolution sha ll become effective August I, 2024.
The foregoing resolu1ion1 having been subm itted to a vole, received 1hc following vote and
was duly adopted this 15" day of July 2024.
Ayes:_§____
Noes: I,
Absent or Excused: fl--
July 15, 2024
18
Clerk to the Board Michele Solomon administered the Oath of Office to Interim
Finance Officer Tracy Clayton.
46
PERSON COUNTY
B OARD OF COUNT Y COMMI SS I ON ER S
Person Coun ty O flicc Buil ding. Room 2 12
304 South M o rgon Sircct
Roxboro, North Camli11:1 27573-5245
(336) 597-1720
FAX (336) 599-1609
Oath of Office
Interim Chief Fi nancial Officer
I, Tracy Clayton, do solo,mnly and sincerely swear that I will support the Constitution and laws of the
United States; that I will be faithful and bear true allegiance to the State of North Carolina, and to the
constitutional powers and authorities which are or may be established for the government thereof;
that I will endeavor to support, maintain, and defend the Constitution and laws of said State, not
Inconsistent with the Constitution of the United States, to the best of my knowledge and ability; and
that I will faith fully discharge the duties of my office as Person County Interim Chief Financial Officer,
so help me God.
~ Interim Chief Financial Officer
Subscribed and sworn to before me this 15'" day of July 2024
e Board of Commissioners
July 15, 2024
19
TAX COLLECTOR SETTLEMENT
Tax Administrator Russell Jones presented the following:
47
Introduction:
Per N.C. General Statute 105-373
the Tax Collector must make a
report of settlement for the fiscal
Year 2023-2024 and prior years.
July 15, 2024
20
48
Total Billed
$29,911,814.66
Total Billed
$7,123,845.64
Total Billed
$3,435,126.53
Total Billed
$40,470, 786.83
2023 County Levy
Real/Personal Property
Actual Collections
$29, 700,453.50
Uncollected
$211,361.16
Public Service
Actual Collections Uncollected
$7,123,845.64 $.00
NCVTS-Motor Vehicles
Actual Collections
$3,432,622.42
Actual Collections
$40,256,921.56
Uncollected
$2,504.11
Uncollected
$213,865.27
% Collected
99.29%
% Collected
100.00%
% Collected
99.93%
% Collected
99.47%
Total 2023 County Levy-Adjusted
Total Billed
$40,461,255.08
Combined Collections
Actual Collections
$40,248,389.81
Uncollected
$204,333.52
% Collected
99.47%
July 15, 2024
21
49
5 Year Comparison By Category
Real/Personal Property
6/30/2024 6/30/2023 6/30/2022 6/30/2021 6/30/2020
99.29% 99.28% 98.15% 98.08% 98.53%
Public Service
6/30/2024 6/30/2023 6/30/2022 6/30/2021 6/30/2020
100.00% 100.00% 100.00% 100.00% 100.00%
Motor Vehicles
6/30/2024 6/30/2023 6/30/2022 6/30/2021 6/30/2020
99.93% 99.94% 99.96% 99.88% 99.83%
July 15, 2024
22
50
Collections Tools Used
DelinquentNotices
Advertising
Garnishments
Mailed out in January and May each year
Listed in newspaper early March
Instructs employerto withhold/submit 10% of gross
wages
Instructs bank to withdraw available funds to pay
taxes
Also known as NCCash
For debts over $SO/submitted against NC Tax Refunds
& Lottery Winnings
Payment Arrangements Many taxpayers, especially t hose with fixed income,
make payments even before bills are mailed
Results in the sale o f property at public action
Pre-Payment
$168,909.60
Prior Year Taxes
$228,128.47
County In terest
$131,281.43
Late Listing
$25,538.81
$52,820.65
Animal Taxes
$2.92
Gross Receipts
$22,195.80
ABC License
$2,835.00
$288,423.90
Fire Tax/Interest
$2,206,902.02
Copy Fees
City
$5,810,227.04
July 15, 2024
23
Chairman Powell expressed thanks to the citizens of Person County for paying their
tax bills and thanked the Tax Administrator and staff for their hard work and collection
efforts. Commissioner Palmer stated great job on the presentation and collection efforts.
51
Real Es tate/Other 99.96%
99.60%
Final Collection Rate Overall
$27,748,211.87
$1,268,598.37
$29,016,810.24
$10,820.00
$5,079.93
$15,899.93
2025 Reappraisal
Fo reclo sure
Draft checking accounts for both payment plans and pre-
payments for next y ear
Sales ratio current at 700/4
Created 3,379 new bills, county taxes due of $90,361.48,
collected $70,409.77, or 77.92%.
Added e-check as a payment option, with $1.50 fee to
taxpayer. Over 1,092 payments and $1.23M collected.
Collected $117,683.51 with no cost to county
July 15, 2024
24
A motion was made by Commissioner Puryear and carried 5-0 to accept the
settlement report.
ORDER TO COLLECT TAXES
Tax Administrator Russell Jones asked the board to approve the order to collect taxes
for 2024 and delinquent taxes from prior years.
A motion was made by Commissioner Palmer and carried 5-0 to direct the Tax
Collector to collect taxes for 2024 and delinquent taxes from prior years.
52
PERSON COUNTY
S1,ue ofNonh Cnrolina,, Coun1y of Person
To lhl1 Tax Collector or the Cm111ty of Person:
B OA RD O F CO UNTY COMM ISSION ERS
Pc,.,;on County Orricc B u ilding. Room 2 12
304 Sout h Morga n St reet
Roxboro, North Cmolinn 27573-524.'i
(3'.!6) 597.1720
P/\X (336) 599-1609
You rtre hcrcb)1 nu1horiz.cd, ctupowcrcd, und com111.111dcd to collect 1hc 1axcs set for1h in lhc tax records
filed in the oOice of Person County Tnx Office: ruid In the rnx 1-ccci pts tum,,vith delivered to you. in the ::,mounts and
from lhc taxpayers likewise therein .set fonh. Such wxes nrc hereby dee l ured 10 be n first lien upon o ll real property
of the respective taxpayers in the Coumy of Person, nnd this order ~hull be u full 1111d suOicfcn t muhorhy 10 di Net,
require, and enable you to levy on nnd sell nny real or 1>erso11nl nropcny of such 1nx1>nycrs. for und t>n acco11n1
1hcrcof. in accordance with law.
Witness my hnnd nnd 01fficial seal, this 15th dny of July, 2024.
Atu.-sl:
,J~8~
~c.lc.-6olo111on
Cle1·k to the Ptrson County Board ofConu11lssio11crs
July 15, 2024
25
STRYKER ALS360 FUNDING REQUEST
Director of Emergency Services Thomas Schwalenberg presented the following:
53
Stryker ALS 360
Asset Management Program
Person County Board of Comm i ssioners
July 15, 2024
What is the Stryker ALS 360 Asset
Management Program?
10 year asset management program that bundles all of
the emergency biomedical and patient movement
equipment into a single purchase and maintenance
plan which provides a significant long term cost savings
to Person County while ensuring that we have safe,
reliable and modern equipment to take care of the
residents and visitors of Person County.
July 15, 2024
26
54
Why is this needed and why now?
SAFETY
RISK REDUCTION
Why is this needed and why now?
• Biomedical equipment and patient movement equipment have
defined service lives in which that equipment is deemed safe to
operate. This is regulated by the FDA.
• Patient Movement Equipment - 7 Years
• Stretchers, Ambulance Load Systems, Stair Chairs
• Biomedical Equipment - 8 Years
• Cardiac Monitors, Defibrillators, Automatic External Defibrillators, CPR Chest
Compression Devices (LUCAS)
July 15, 2024
27
55
Person County Biomedical Fleet Age
• Cardiac Monitor/Defibrillators -Year 6 of their 8 year service life
• LUCAS Chest Compression Devices -Year 6 of their 8 year service life
• Automatic External Defibrillators (AED) -Year 10+ of their 8 year service
life
• Cardiac Monitors -Lifepak lS's versus Lifepak 35's
AED Chaos to Sta ndardization
July 15, 2024
28
56
Perso n County Patient Movement Fleet Age
• St r etc hers • Power Load System s
• Four at year 6 of 7 year service life • Five at year 6 of 7 year service life
• One at year 7 of 7 year service life • One at yea r 7 of 7 year service life
• One at year 8 of 7 year service life
Person County Patient Movement Fleet Age
• Sta i r Chairs
• One at year 9 of 7 year service life
• Four at year 12 of 7 year service life
• One at year 20 of 7 year service life
July 15, 2024
29
57
Risk Reduction
• Reducing Person County's risk and liability through proper asset
management
• Patient injury or death due to equipment failure or malfun ction
• Provider injury or death due to equipment failure or malfunction
Risk Reduction
EMS consistently ranks among America's ri skiest jobs ~ EMTs
have higher rates of work-related injuries then tne general
workforce and are three times more likely to ge t hurt and
experience lost work days than all private industry workers.
The No. 1 reason for first responders leaving t he profession is
having sustained soft tissue musculoskeletal injury (MSI) from
patient hand ling .
1. Centers for Dise_qse Cont,o/ an(i Prev~ntiofJ . Emerg_eflcy_ Medico/ Services Workers : How Employers Con Prevent Injuries and
Exposures, hrtps://www.cdc.gov/niosh/docs/201194/pdfs/2017194.pdf
July 15, 2024
30
58
Risk Reduction
• Economic cost of back injuries
• Annually in the U.S.-50 billion in direct medical costs and lost wages
• 2 0 billion i s related to the healthcare profess ion
• Thi s exce ed s the co st of back injuries in the profess ion s of mining, con struction and
manufacturing 2
• Each individual back sprain carries an anticipated d i rect medical cost of
$18,000 in physician and medical bills, lost income and emp loyer costs
• One quarter of EMS professionals experience a career -ending back
injury wit hin t he fi rst four years o f their career. 3
2 . EMS Bac;k Injury factf/WW myractic;aLcom
3. Cen ter s for Disease Control and,.revention , l;mer gency Medica l Services Workers-Injury and Ill ness Data ,
https :/ /www.cdc.gov/ni osh/topics ems/data .html .
Aside f ro m Safe t y and Risk Reduc ti o n ...
• Recruitment
• Retention
• Clinica l Rele v ance
• Fisc a lly sou n d bu d geting p ractic es an d co st sa v ings
July 15, 2024
31
59
Why now?
• To get ahead on technology cost increases and market forces that are
driving costs upward at alarmingly fast rates.
• Lifepak 15 -Gen IV versus Lifepak 35 costs
• Stryker Capita l Price I ncreases 2021 -2023
• Stryker ProCare Price Increases 2021 -2023
Stryker Capital Pr ice increases 2021-2023
U>lS ... "' ... _ ...
ZC21 ~· __J!!_ 2021
20Z1Q1 1ffllQ1 u~ 20~Q1_
20UQ4 llJUQ4 J ,_ ,on~
ZOZJ ZCl!J un Z02J
Not d Net
UJW .... ,.
20ll 16,190 .lllZ:t ZOU
l0l2Ql 17.323 ~ 20Z1Ql ZO.UQl
ZOl2Q4 18,W 9~ .!OiUQ4 lllllQ4
2112,1 20,IIUI 6~ 21111 10ll
Net 24" NM NI 2"'
July 15, 2024
32
60
Stryker Maintenance Pr ice Increases 2021-202 3
-•tot> ,au SUI.I
lOU Qt Jli SUID
20llQUll SUD
l013QlS1'. Sl.S9i
_,.__
ZOU sun
m.u:Q.t n, S1,1Sl
lOU0Oll Sl.01!1
lOllQlS" 52,110
Sta Chan ·-20no1nc .,.,
,on ••• ~ .,,
.ZOllQtS" S>t&
U'IS
,au S1JUIJ
2022Q17,C S1Sl6
.IOll0Oll Sl.100
20lJ Q1Stl. 52.l05
LUCAS)
,au SUOI
20ZZ Ql 7'C SI .SOI
JDllQtft SUD
atllQlSX S"l ,11.1
W hy c h oose St r yker?
July 15, 2024
33
61
Why ALS 360?
.. e Fleet management .. e On-site service and support
.... 0 Fixed annual payments .. (i Data and QA/QI tools
.... 0 Future t ec h made simple .. C) Operational effici encies
Why ALS 360?
10 years of level payments includes t he following:
• No increase in payments on equipment of any like kind and qual ity
Tec hnology Refresh'" after 36 mon th s, upon the lau nch of new tec hnology:
• New installation based on custome r specs
• May stagger n ew equipment
If n ew ge nerat ion is not la unched w ithin 60 months:
• We will refresh equipment of the same genera lion to main lain performance
Includes Power-LOAD insta ll, excl udes fl oor plat e and wiring installation
July 15, 2024
34
62
Maintenance Agreement
• ProCare Pit Cr ew
• On -site certified ma i ntenance
techn icians for all transp ort and
treatment devices
• Maintenance is coord inated to be
done simultaneously
• Reduced down time, greater
efficiency
• Si n gle maintenance contract
• Fixed payments for the life of the
p rogram
Who el se is using ALS 360?
Sp okane FD, WA
City of Tacoma, WA
Gaston FPD, OR
Forest Grove FR, OR
Las Vegas Fi re/Rescue, NV
Jackson County I L
Orem FD, UT -------:;:-...:..._
City of La M esa, CA
Murrietta Fire/Rescue,CA
City of El Cajon, CA
Rosev i l l e, CA
~·
,l'
Anchorage FD, AK • ;{
Viol et TWP, OH
Pla i n TWP, OH
Dryden EM S, NY
Wayne County, NY
City of Fai rbanks, AK Corpus Chri sti, FD, TX City of New Or l eans, LA
Grapevi ne FD, TX Birmi ngha m, AL
Cheatham County, TN
East Lansing, Ml
Grand Ledge, Ml
MEDIC·l, M l
Surry County, NC
Gaston County, NC
Cabarrus County, NC
Wil kes EMS, N. Wi lkesboro, NC
Yadkin County, NC
Warren County, NC•
Stokes County, NC *
Nelso n County, KY
Allen Co unty, KY
Gadsden EMS, FL
Sumter County, FL
Since 2020, @ 300 customers have adopted ALS 360. Th i s map represents j ust a sample of the types and si zes of agencies and
localities from across the United States that have adopted this program.
July 15, 2024
35
63
Stryker Emergency care
and
Person County Emergency Services
TOGETHER WE SAVE LIV S
'
.
>
.
Person County ALS 360 Proposal
EMS Version
Fire Version
.... " 360 -Person County EMS -July 2024 -EMS VERSION
Comprehensive Solution
capital product Qt)< Reh-esb Service/data solutions Qty.
it Power-LOAD• Fastener System 6 6 Wi-Fi•/Cellular gateway 12
•8c1Ntseooc,pl,ltMdwttift&Wi~
~ Power•PRO""XT Powered Kore data plan Included (12)
Ambulance Cot
~ Powcr,PR0"2 Powered 6 6 LIFEN~Aml lnciudod
Ambulance Cot
l Xpodltion Powered Stair Chair 6 6 LI FENET"C.re
LIFEPAK• 15 monitor/defibrillator 12 12 CODE-STAT" data review Included
software license e LUCAS-3, v3.1 ch est compressio n system 9 9 COOEPSTAT data review
annotation service
9 LIFE PAK 1000 AED s s CODE·STAT maintenance
subscripdon
,-,. LIFEPAK CR2 AEO 44 44 Trade-In Credits Applied ·"
~ McGRATH"MAC EMS No Accessories and independent Customer
video laryngoscope Upgrade disposables contract Loyalty Agreement
Procare• Services ALL Included
(all program products)
stryker
~
□
D
t
July 15, 2024
36
64
EMS VERSION
A sse t Ma n ageme nt Example
Example Prog ram Costs
?
1,000,000 ?
800,000
600,000
400,000
200,000
0
Remove cents
ALS 360 Total -$4,673,369
Cash Purchase Total· $5,995,900
Pay ment Structure
Projected Savings vs Cash
$1,322 ,532
•Tiibb.J.flleQmp!fMill,US36U f'tv~•odlf~
to ~age tw.d oa pruducu. tlomlQJ md ~mu. Stand•d
tr.ad~Ula'Nl:ktx.:11ppty.Al.fpridng~1Sddm~of~
~ C.'Ollt!QC'fflt \IJ)Oft CTfdi\ ,ippi"O'iil
stryker
I ALS 3('0 financial advantage over 10 year s -EMS VERSION
Equipment/services
and accessories
Capital equipment
Connectivity and Data Solutions
Service and support
Trade-in value
A&D: electrodes
A&D: filter line sets
A&D: all other
Technology Refresh
made simple
10-vear annual payment
Capital type purchase price
(purchase of cu rrent product x2
and price In crease)
$4,666,500
66,000
51,335,000
$(71,600)
Variable dis count
Requires new capital investment
$5 ,995,900
What you pay with ALS 360
(Technol ogy Refresh
Included)
$3,7 37 ,9 00
2 8,700
$922,30 0
$(121,500)
% d iscount at volume
% d isco u nt at volum e
% d iscount at volume
T echno l ogy u pgrade I nc lude d
$4,673 ,369
$467 ,3 3 7
TIils ls an uampleofan Al.S 360 FMV propos:,11la.nd ks subf«t todtange based on products, dmlng and terms.St1ncbrd trad~ln cred(tsapply.Alt prldngshown ls~xclust\·eofw:es aDd contingent upon
crtcUt~pprov.1t.
July 15, 2024
37
65
.stryker
• I:" tl' -Person County EMS -July 2024 -
Comprehensive Solution
FIRE VERSION
C.pltal product Qty, llefl'ffh Servltt/data solutlons
1i Power-LOAOC Fastener System Wi-Fi,./Cellula r gateway
•~ftoo,-pl-.-9~1~
~ Power-PRO-XT Powered Kore d.1t3 plan
Ambulance Cot
":d--Powl'r·PR0,.2 Powered LIFEN~Asset
Ambulance Cot
l XpedlUon Powered Sni ir Chair LIi' EN e,-. Care
LIFEPAK• JS monitor/defibrillator CODE·STArdata review
software license e UJCAS•3, v3.J chestcomprfflio n sy.ste.m 9 9 COOE·STAT data review
annotation seMce
9 LIFePAK lOOOAEO 16 16 CODE-STAT maintenance
subscription
,--. LIFEPAK CR2 AEO Trade-i n Cr edits _.,,
~ M«:RATH" MAC ms No Accessories and
video laryngoscope Upgrade disposables contract
Proc.are•Services
tall program products)
Thi.$ Is an ,c,xample ofan ,\LS 360 FMV proposal ;and l:SklbiN't 10 dl.lni,tt bakd on pr~u. (Im int and ltt'mS.
FI RE VERS ION
Asset Management Ex ample
Qty.
Included
Included
I ndependeot Customer
Loyalty Agreement
ALLlnduded
9
~
D
t
ALS 360 Total -$805,620
Cash Purchase Total -$1,146,500
Payment Srructure
Projected Savings vs Cash
$340 ,881
'lhbilantUnapl1tol~ALSJ60t""MYp,11pON!mdbs1.1btt('t
lO~~OI JM'O(tl;.ffl. uoo,-41nd '1l'ffllJ. Su,nd..vd
fn.l».lncn'dttt.tpply,Abrnctiu:~11kf\fiGmtp{g,,·f'4i
vMI CUftliJ'l&tllt upun n1.'W1 ;1pprvnl
July 15, 2024
38
66
EMS + FIRE = Total Savings
ALS 360 Total -$5 478,988
Example Program Costs Cas h Purchase Tota l - $7 ,142,400
? ?
1,500,000
1,000,000 Paytnenr Srn1ct ure
S00,000
Projected Savi ngs vs Cash
0 $1 663 412
2 3 4 5 6 7 8 9 10 "N.illtn.--...0,Mi'I.Sl.oPMV~aldta...-«t
ladulletla-.d•pnNMtn.tJmlaa-it,nn.Saaunt
ndl-illlc:rlNla.....,i,.Allpnc.clllawnUndusw.-,w.n
-~Ufll'ICT'fdcl,,..._-
t 7
ei
Will annual costs increase during the life of the program?
• No-Contract is specific that the annual cost is locked in for ten years from
entering into the program.
• Yes-If Person County decides to add more equipment due to increasing
fleet size, then that equipment could:
• Be added to the program and the cost (based on the product costs at that time)
divided out annually for the remainder of the program
• Be purchased outright and not added to the program but could incur a separate
maintenance agreement
• Enter into a separate lease agreement with Stryker for a specified term to purchase
the equipment. This could also incur a separate maintenance agreement.
July 15, 2024
39
67
Program Exit Options
At the end of ten years
• Option 1-FMV* at end of term:
• Sign a new agreement with the same structure, or a different one, and exchange the
equipment for new equipment and move into a new annual payment .
• Pay the fair market value of the equipment and take ownership of the capital/end
the agreement. {"Not to Exceed" clause in Equipment Schedule ).
• Continue to rent the current equipment (payment structure stays the same).
• Option 2-Have agreement written with a "cash out" option. This would
increase annual payment on agreement but we would take ownership of
equipment after last payment and the agreement ends .
Program Exit Options
Before the ten years has expired
• Purchase equipment at fair market value based on residual cost
formula. Factors to determine value would include age of equipment,
condition of eq uipment, market influences, etc.
• Required to give Stryker 90 day s notice
• If Stryker does not uphold their conditions of the contract then we
can exit the program
July 15, 2024
40
68
Summary
• 10 years of level payments which allows for better budgeting practices and
no increases in equipment or maintenance costs over that ten-year
period.
• Technology refresh after 36 months, and upon the launch of new
technology, allowing the system to stay current on EMS equipment and
take advantageof new technologies at current price points.
• If a new generation of equipment is not launched in sixty months, then
equipmentwill be replaced with current generation ensuringequipmentis
safe, reliable and meets FDA service life requirements
• Price includes all new Power Load installations for ambulance fleet to
include floor plates and wiring installation.
Summary (cont.)
• ProCare maintenance program consolidates all maintenance contracts into one
single contract, covers on-site maintenance to reduce equipment downtime,
includes asset tracking software, and maintenance costs are fixed (will not
increase) for the life of the program.
• Includes comprehensive patient data management software for optimized
tracking and sharing of patient biomedical data across the continuum of the
patient care experience in a HIPPA secure platform.
• Includes discounted pricing for consumable supplies and equipment used for
patient care associated with the biomedical and transportequipment
• Additional equipment that is purchased , due to fleet growth , can be added to
the program through an addendum at current market costs.
July 15, 2024
41
69
Fundin g Re qu es t
Fund Budget Line Amount
Ge oeraJ Fuod (I \l~l 1004370-443000 $467.337
Fire Tax Dist1ict -Speclal ReveoueFuod (FIRE) 2504377 -430000 $80.562
Total Aonual Request $547,899
• If fund i ng reql!est is approved, $109,000 can be reallocated from Genera l Fund
Lines 1004370-443000 and 1004370-444000 which are cu rrently a llocated for
Stryker Maintenance and Service contracts in the current budget to t he ALS
360 Program (EMS).
• Additional $358,337 dollars will need to be a l located for the initial annual
payme nt, potentially using ARP funding.
Thank You
Questions
July 15, 2024
42
Chairman Powell asked in reference to the Volunteer Fire Departments (VFD’s),
would part of their funding coincide with this. Schwalenberg stated yes it would, and that it
is two funding streams, with one purchase. County Manager Katherine Cathey stated that
originally this was included as a new line item within the Fire Tax District Budget, and
when the Board pulled this from the budget, prior to approval, it was moved into
unallocated, so it is still within their budget for this year. She stated that if approved by the
Board, it would be moved from unallocated into a line item specifically for this purchase.
Powell asked if the proposal is from ARP funds for the County’s share. Cathey replied yes,
from ARP funds, which he had mentioned during the budget work session. She stated that
the alternative is appropriating fund balance, because at this point, it is not included in the
budget and we do not have another funding mechanism for it at this time. She stated that
this would be for the first year of funding for this program, then the funding source will be
reconsidered. Powell asked what was the funding balance in the ARP fund. Cathey advised
that currently there is $1.5M that is not appropriated or designated yet in the ARP fund and
is reserved. She stated that there are many things that are reserved within the ARP fund, to
include broadband expansion and economic development. She stated that some of this
year’s CIP is funded through ARP funding. She stated that if you shift $358,337, that is
going to leave about $1,140,000 left to consider potential uses within the ARP fund. Powell
asked, if we do that this year out of the fund, then next year it becomes part of the budget,
to which Cathey replied yes. He asked, one penny in tax gives you how much money, to
which Cathey replied around $550K this year. He stated that you are looking at a penny
increase maybe next year to compensate for that and offset it. Cathey stated that it would all
be taken into account when creating the budget and looking at the revenue that is available
next year. Powell stated that he does not have a problem with the needs, and it was very
well explained much more in depth, and clearer than previously presented. He stated that he
does not like the ten-year lease, as no one knows what tomorrow brings, and that it is all
about the people we serve and that is a priority. Vice Chairman Sims had questions related
to the VFD’s. He asked if the County was taking $80K from the fire tax fund. Cathey replied,
yes to the amount, and stated that we are not pulling it out of their fund balance, the money
is available within the collections for this current fiscal year. She stated that their budget is
based on the amount that we anticipate collecting in the fire tax district. She stated that we
can fund everything that was previously included in the budget as well as the addition of
this item. Sims asked what about moving forward, where would the money come from and
how would it be budgeted. Cathey stated that this is adding to their budget within the amount
of revenues that we anticipate collecting. She stated that as long as we continue to collect
that amount of revenues or more that this can become a staple within their budget from year
to year. Sims asked about the number of Lifepaks to be purchased for the VFD’s, to which
Schwalenberg replied, under the fire contract, it would be a total of sixteen, which is two
per department. Sims asked Schwalenberg if he had discussed that with the VFD’s.
Schwalenberg stated that yes, he has presented it to the fire chiefs. Sims asked if they were
OK with it, and Schwalenberg replied that they did not present opposition. Sims asked what
happens to the current AED’s that the VFD’s currently have. Schwalenberg stated that is up
to the VFD’s as they own them not the County. He stated that a lot of them are past their
service life and probably need to be put out of service.
70
July 15, 2024
43
Sims asked Schwalenberg why is equipment so far out of compliance, past their
service life, and have not been replaced. Schwalenberg stated that was before his time, and
he is trying to fix the issue now. Commissioner Palmer asked Schwalenberg, based on his
professional experience, which would he prefer and recommend, the Lifepak 15 or 35.
Schwalenberg stated that he would recommend the continuance of the Lifepak 15 until the
35’s have a little bit more experience. He stated that the 35 is a great device, just has not
been out that long. Powell asked if there was any effort to make this device compatible with
other industries in the County. Schwalenberg stated that he works with the industries in the
county with their questions about AED’s; however, as a county entity he cannot recommend
one brand over another, yet he can give them his opinion. Sims asked, if we do not like the
lease, say two years down the road, can we cancel the contract, and what happens to the
equipment. Schwalenberg stated that the contract can be canceled at any time and the
County would have to buy the equipment at fair market value at the residual schedule that
Stryker produces. Sims asked how much is Stryker’s profit, to which a representative from
Stryker advised that it depends on when you would exit. Sims asked, what happens if a piece
of equipment breaks or is damaged. Schwalenberg replied that it is covered through
maintenance unless it is pure negligence on the County’s part. He stated that everyday
normal wear and tear is covered under the maintenance plan. A representative from Stryker
stated that as part of the maintenance, lithium batteries are replaced, and they recommend
replacement every three to four years. Sims stated that when the Board saw this in the
budget, it looked like a big increase from the year before, and anytime there is an increase
at that amount, it raises a red flag, which made them dig deeper into this and figure out what
we are getting into. He stated that is why the Board requested more information.
Commissioner Puryear stated that if the Board had heard this presentation before the budget
was adopted, they would have found a way for it to be included in the budget. County
Attorney T.C. Morphis, Jr. advised that a sample agreement was provided. He stated if the
Board decided to enter into the agreement, that would be the next step, and they would
authorize the County Manager to execute the agreement. He stated that he would review
and negotiate any terms, and if there is something substantive, it can certainly come back to
the Board.
Cathey advised that the $109K is already within the EMS budget to pay for existing
maintenance agreements and would be shifted into this line item through a budget transfer
within the department. She stated that would cover the General Fund EMS allocation
portion, then we would also need to move $80,562 from the unallocated line item within the
Fire Tax District Budget into Contract Services, and reduce unallocated by this amount to
fund this program this year. Sims asked how much is in the unallocated fund. Cathey advised
that there is currently $186,852 in the unallocated line item for FY25 for the Fire Tax
District.
A motion was made by Commissioner Palmer and carried 5-0 to approve Stryker
ALS360 funding request and to allocate ARP funding in the amount of $358,337 to fund
the first year of the program
71
July 15, 2024
44
ANIMAL SERVICES CITATION AND FEE SCHEDULE AMENDMENTS
Animal Services Director Kelli Lewis stated that at the request of the Board of
Commissioners (BOC) during their May meeting, she is here today to discuss Animal
Service’s Citation and Fee Schedule Amendments. She stated that the Animal Services
Advisory Committee met in June to discuss potential changes regarding the BOC’s request.
She stated that the Animal Services Advisory Committee is recommending the following
changes:
Edit the wording at the top of the Animal Control Citations from “Warning” to
“Written Warning” for the purpose of ensuring issuance of the citation for
documentation and public education purposes
Increase the fee amount on the citation from $100 to $250 in reference to leaving
a dangerous dog unattended
Commissioner Palmer stated that is a good move and that he is sure the County will
appreciate this change. He stated that Lewis did a good job and expressed thanks to the
Animal Services Advisory Committee.
A motion was made by Commissioner Palmer and carried 5-0 to approve the
recommended changes to the Animal Services Ordinance as presented.
PCBIC STRUCTURE
Chairman Powell stated as the BOC continues discussions on the future of
EDC/PCBIC, that he believes that there are two things Commissioners should remember:
BOC members are the stewards of taxpayer money and should be cautiously aware
of how tax money is spent.
Secondly, as Commissioners, a major emphasis should be placed on building the
County’s tax base.
He stated that PCBIC was first initiated as a non-profit arm of the County EDC
Department designed to assist in accomplishing that goal. He stated that the BOC
appointed members with faith and trust in their ability to carry out the goals and objectives
of the BOC, and must be a mirror image of the County’s long-range goals and objectives.
He stated that having a determined, thriving, self-motivated non-profit is critical to future
growth and as such is charged with raising funds to be a self-funded, self-perpetuating
organization, not one funded by a line item of taxpayer funds in the County budget.
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July 15, 2024
45
Powell provided the following options for changes in the structure of the EDC/PCBIC:
Elimination of the EDC Board - Within current County structure, the EDC has
three employees capable of carrying out the economic development business of the
County. This change eliminates back-to-back meetings and frequent duplication of
agenda items, streamlines the County’s economic development efforts, and
eliminates lengthy and unproductive meetings that can be a burden to the volunteer
members.
PCBIC would continue to operate with current membership as allowed by statute
and would be completely responsible for future removal or appointment of its
members.
PCBIC should review their vision and mission statements assuring that they
coincide with County economic goals to ensure a joint plan for economic growth
between both organizations.
PCBIC should establish fund raising guidelines that support economic goals and
objectives of the County without County budgeted funds. The EDC staff has
visited other counties, which have successful non-profits, that PCBIC could adopt
or incorporate into current operations, taking advantage of what others have done
without wasting time and effort.
PCBIC should establish guidelines for projects that require County support to
include an itemized, detailed list of projected costs, benefits, incentives, expected
outcomes, and submit to the Board of Commissioners 60 days prior to being
considered as an agenda item. Historically, the BOC has supported PCBIC
economic efforts, and he believes the BOC will continue to do so when viable
projects are presented to the BOC.
Research has found that there are some unknowns about where the funds to
purchase some of the land titled to the PCBIC came from and at minimum, PCBIC
should be required to re-title land paid for by taxpayers back to the County. To
whom property is titled, has been an unnecessary issue in recent negotiations, and
needs to be corrected.
He stated that economic development is a team sport, with the County citizens and
taxpayers being the winner. He stated that he is offering this as a recommendation to
go to the PCBIC at their meeting on July 23, 2024. PCBIC President Phillip Allen
advised that he had not received the most recent handout that Powell provided for the
BOC today. Commissioner Puryear stated he thinks this is a good start, but before the
BOC makes a recommendation, he feels the BOC needs feedback from the PCBIC.
Allen advised that he would discuss this with the PCBIC Board at their meeting
scheduled for July 23, 2024 and come back to the BOC at some point to discuss the
consensus of the PCBIC Board.
A motion was made by Commissioner Puryear and carried 5-0 to table this item
related to the structure of PCBIC.
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July 15, 2024
46
A motion was made by Commissioner Puryear and carried 5-0 to approve the FY25
Funding Agreement.
74
NORTH CAROLINA
PERSON COUNTY
PERSON COUNTY BUSINESS AND INDUSTRIAL CENTER (PC131C)
FUNDING AGREEMENT
This Agreement is made and entered into this .J.§__ day of JU-l<f1 . 2024, by and between
Person County, North Carolina, a political subdivision of the State of North Carolina, hereinafter
called "County," and Person County J3usiness and Industrial Center, a North Carolina nonprofit
corporation, hereina fter called "PCBIC.''
WI IERE/\S, the PCI3IC president and vice-president made a presentation to the Person County
Board of Commissioners at its budget work session on June 5, 2024 and requcslcd a FY25
special appropriation to support insurance, legal, professional, office, lease and property tax
expenses incurred as a result of PCBIC 's support of economic development projects and for park
maintenance and utility expenses at the PCBIC-owned industrial park on US-501; and
WHEREAS, PC131C is a 50 I (c)(3), non-profit economic development organization that was
fom1ed to promote the growth and expansion of new and existing business and industry in
Person County and works in close cooperation with other entities engaged in similar efforts; and
WHEREAS, PCBIC is actively engaged in an economic development project that will bring rail
services to existing and future industry in Person County; and
WHEREAS, the Person County Business and Industrial Park strengthens the local economy by
housing a solar farm, industrial facilities and Piedmont Community College's future Center for
Health, Advanced Technology & Trades; and
WHEREAS, PCBIC requested a total of$62,800 in fundin g for fY25 for maintenance, utility,
insurance, legal, professional, office, lease, and tax expenses; and
WHEREAS, the Board of Commissioners approved a special appropriation of$62,800 in the
FY25 Budget;
NOW, THEREFORE, the County agrees to provide a special appropriation of $62.800 to PCl3IC
from FY25 budgeted funds, subject to the following provisions:
I. PURPOSE. The funds may be used only to support expenses associated with economic
development projects and the Person County Business and Industrial Park, pursuant to
the attached J\ppendix I, that have been or will be paid by PCl3IC during the county's
current fiscal year ( ending June 30, 2025).
July 15, 2024
47
75
2. REPORTING. PCBIC shall send a conc ise written report to the Person County Manager
not later than August 15, 2025, detailing the use of county funds.
3. TERM AND TERM INATION OF AGREEMENT, POTENTIAL RETURN OF FUNDS.
This Agreement is effective immediately upon execution, and will terminate on June 30,
2025, unless terminated sooner by mutual agreement in writing. If the funding is used for
purposes not contained in the Paragraph I above, PCBIC agrees to repay the provided
funding to the County in full.
4. INSURANCE AND INDEMNI TY. PCB IC wi ll maintain adequate liability, workers
compensation and property insurance, and will provide certificates of insurance to the
County if requested . PCB IC agrees that it is acting as an independent contractor under
this Agreement, and that its members, employees and contractors are not County
employees. PCBIC agrees that the County has no ownership interest in or operational
responsibility for PCBIC. PCBIC will indemnify and hold harmless the County from any
and all liabilities and costs arising out of the acts or omissions or negligence of PCBIC to
the extent, and only to the extent, of the one-t ime appropriation identified above.
5. INSPECTION OF FINANCIA L RECORDS. PCBIC will provide a detailed report about
expenditu re of the funds or allow access to its financial records if requested by the
County.
6. COMPLIANCE WITH LAWS. PCBIC agrees to comply with all applicable state and
federal laws in its operations and to cooperate in a professional and productive manner
with the partner agencies listed above.
7. NO ASS IGN MENT. PCBIC agrees that this Agreement is not transferable or assignable,
and that the appropriated funds may not be transferred to other entities, except in
payment for expected expenses, without written consent of the County.
8. APPLICABLE LAW AND FORUM. This Agreement shall be construed under North
Carol in a law, and any action to enforce its provisions shall be filed in Person County in
the General Court of Justice of North Carolina.
9. ENTIRE AGREEMENT. The Agreement constitutes the entire understanding of the
parties. Any modification, amendment or rescission of this Agreement must be in writing
signed by both parties.
2
July 15, 2024
48
76
PERSON COUNTY:
CY-~ ,J,~t:4
Gordon Powell Date
Cha ir, Board of Commissioners
This instrument has been pre-audited i n the manner req uired by lhc Local Government
Budget and Fiscal Control Act.
Approved as to legal form: __ -;-'~-"~·~~~ ... ~~-~'-,} __ )~'~· ______ r~f/,~(.~(>,_.11~1_,_2._'1
T.C. Morphis, Jr., Cou nty Attorney Date
Person County Business and Industrial Cente r
Attestation and Seal if applicable:
3
July 15, 2024
49
77
APPENDIX I
Person County Busi ness and Industrial Center Inc
Budget
July 1, 2024 through June 30, 2025
Revenue Industrial park fees
Expenses Park maintenance
Utilities
Insurance
Legal/Project
Professiona l
Office
Lease
Tax
Total expense
Net-req uest for funding
$18,000
$15,000
1,500
3,000
50,000
600
1,000
3,200
6,500
$80,800
-$62,800
Details or above line item amounts:
lndust rla l park fee revenues-
Park Maintenance expenses-
Utilities
Insurance
legaVProject
Professional
Office expense
Amo unts are billed quarterly to occupant s of Ilic Industrial Park
Occupants presenly Include Carolina Pride Car Wash, US-Flue Cured Tobacco,
PCIP Solar LLC and the PCB IC
The monthly rate for each wil be $375
Expenses consist of grou nds upkeep(most ly mowing) and expenses of repa iring
the banks of t he road and entrance t o the park.
Monthly mowing amounts are at least $S00, bank repairs and maintenance
have been estimated at $4,500, PCBIC contribution to maintenance Is $4,500
Annual stree t lighting costs of Crown Blvd estimat ed at $1,500
Directors and officer policy paid In 2023 was $2,340
Commercial policy for PCBIC was $550
This year Is rounded to $3,000 tot al
Legal fees and other expenses of economic development projects,
Two projects presently exist, Project Log and Person County Mega Pa rk
This Is for services rendered regard ing annual prepara tion of the Form 990,
Income Tax Return for Organization Exempt From Income Tax
This Is the annual qulckbooks accounting software renewal cost
2023 cost was $915 •
July 15, 2024
50
DESIGNATION OF VOTING DELEGATE TO NC ASSOCIATION OF COUNTY
COMMISSIONERS ANNUAL CONFERENCE
Clerk to the Board Michele Solomon stated that the NC Association of County
Commissioners Annual Conference will take place August 8-10, 2024 in Forsyth County,
with the business meeting taking place on August 10, 2024 at 2:00 p.m. She stated that we
need a voting delegate to represent Person County. She stated that she is requesting the
Board to designate Vice Chairman Sims, who is attending the conference.
A motion was made by Commissioner Puryear and carried 5-0 to designate Vice
Chairman Sims who is attending the Conference, as Person County’s delegate.
78
Thls Is the annual o a sc.-n o nt for roll a c cess with with N o rfolk ond Southe rn
2 023 omount was $2 1 613
Pro p e rty t o x ,,old to P o r son C ountv1 2023 an,ount wns $6,342
July 15, 2024
51
County Manager Katherine Cathey advised the Board that since we are on the
topic of a voting delegate, she would like to call to the Board’s attention, that they should
have received an email on Friday from Abbey Thayer with the NCACC. She stated that
there will be a District 8 Caucus next Monday morning at 9:30 a.m. via Zoom. She stated
that Thayer sent a calendar invite to the meeting along with an explanation of what the
meeting is about, and the description of the role of District Director, which is a two-year
term. She stated that based on previous history of rotation, Person County is next in the
rotation to take on the District Director role. She stated that someone from Person County
would need to attend the meeting to vote or nominate a District Director. Vice Chairman
Sims stated that he would attend the Zoom meeting on behalf of Person County.
CHAIRMAN’S REPORT
Chairman Powell stated that he attended a very productive meeting with the Airport
Commission last week regarding future plans. He stated that he also attended the very
lengthy Planning Board meeting related to some projects, one of which was the Mega Park,
and the vote was unanimous by the Planning Board to proceed with actions to be taken for
the rezoning.
Chairman Powell stated that he wanted to speak on the comments made earlier
referencing Person County’s refusal to allow the DEQ hearing regarding MEC to take place
here in Person County. County Manager Katherine Cathey advised that she is not aware
there was a decision made for Person County not to host the Air Quality Permit Hearing.
She stated that she does know that the State inquired as to a place within the County to hold
the hearing. She stated that the County offered a few suggestions and the State reached out
regarding reservations. She stated that beyond that, she was not aware that there was any
type of challenge to them being able to reserve a facility in Person County. She advised that
she would check with their staff, as well as County staff to find out what conversations were
had, which would have happened at the reservation level. She stated that she was very
surprised to learn that the hearing was not being held in Person County. She stated that she
was not aware that it was a conscious decision for Person County to decide not to host the
hearing. Powell stated that he was not aware of any discussions along that line, that we knew
the hearing was coming, and talked about it several months ago. He stated that the County
offered to have the hearing in the auditorium, and the State made a suggestion to have it at
PCC, due to space limitations in the County Office Building Auditorium. He stated that
there was no opposition to holding the hearing in Person County, and the BOC never had
any discussions related to this matter. He stated that he is surprised at the comments that
were made earlier, and wanted to make it perfectly clear that Person County was not
opposed to holding the hearing here and had nothing to do with the decision-making process
of where the hearing would be held.
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July 15, 2024
52
MANAGER’S REPORT
County Manager Katherine Cathey stated that Chairman Powell referenced the
Airport Commission meeting. She stated at the meeting, there was a presentation about
terminal possibilities. She stated that she brought hard copies for the Board if they would
like to look at it while they are here today.
COMMISSIONER REPORTS/COMMENTS
Vice Chairman Sims expressed thanks to everyone for the well wishes he received
for his grandson. He indicated that he had a family medical emergency; therefore, he was
not in attendance at the last meeting.
Commissioner Palmer thanked department heads for the presentations today for the
betterment of Person County.
Commissioner Puryear stated that he is very happy but also sad that the Library
Director is moving on to a great opportunity with UNC-G. He stated that Kayli has done a
great job and he hates to lose her, and he hopes that the County can find another Director as
good as she was.
Commissioner Thomas had no report.
A motion was made by Vice Chairman Sims and carried 5-0 to enter into
Closed Session at 11:39 a.m.
CLOSED SESSION #1
A motion to enter into Closed Session #1 per General Statute 143-318.11(a)(6) for the
purpose to discuss personnel.
Chairman Powell called the Closed Sessions to order at 11:45 a.m.
A motion was made by Vice Chairman Sims and carried 5-0 to return to open
session at 12:00 p.m.
ADJOURN:
A motion was made by Vice Chairman Sims and carried 5-0 to adjourn the meeting
at 12:00 p.m.
_____________________________ ______________________________
Michele Solomon Gordon Powell
Clerk to the Board Chairman
(Draft Board minutes are subject to Board approval).
80
8/5/2024
Dept./Acct No.Department Name Amount
Incr / (Decr)
EXPENDITURES General Fund
General Government (188,439)
Public Safety 118,686
Transportation 42,992
Culture & Recreation 12,505
Human Services 26,767
Environmental Protection 754
Transfer to Other Funds 10,934
Contingency (15,110)
REVENUES General Fund
Transfer from Other Funds 8,800
Other Revenues 289
EXPENDITURES PI & MRF Fund
Community Rehab Program Services 10,934
REVENUES PI & MRF Fund
Transfers from Other Funds 10,934
EXPENDITURES Capital Investment Fund
Issuance Cost 200,000
REVENUES Capital Investment Fund
Transfer from Other Funds 200,000
EXPENDITURES 2024 LOBs Project Fund
Acquisition-HS Bldg (105,300)
Acquisition-CPCW Bldg (103,500)
Transfer to General Fund 208,800
Explanation:
Account Number Account Description
$Revenues
incr. (decr.)
(cr.) dr.
$Expenditures
incr. (decr.)
dr. (cr.)
BUDGET AMENDMENT #3
Distribute cost of vehicle insurance from the Human Resources Department (-$248,544) to various
County departments in the General Fund ($237,610) and the Person Industries Fund ($10,934);
recognize revenues from Recreation, Parks and Art classes ($289) to support instructor fees;
transferring funds from the 2024 LOBs Project Fund to the General Fund as a reimbursement for
related survey expenses incurred in the prior year ($8,800) as well as using undesignated
contingency funds (-$15,110) to cover unexpected costs for necessary upgrades to the Airport fuel
system’s spillage containment ($23,910) as required by NCDEQ and transfering from the 2024
LOBs Project Fund (-$200,000) to the Capital Investment Fund ($200,000) as a reimbursement for
related aquisition costs incurred in the prior year.
BUDGET ADJUSTMENT DETAIL
81
1004122-445000 Human Resources-Insurance (248,544)
1004121-445000 IT Insurance 1,885
1004140-445000 Tax Insurance 1,885
1004260-445000 General Services Insurance 12,821
1004310-445000 Sheriff Insurance 88,672
1004350-445000 Inspections Insurance 5,278
1004370-445000 EMS Insurance 19,683
1004375-445000 Fire Admin Insurance 2,262
1004380-445000 Animal Serv Insurance 2,791
1004520-445000 PATS Insurance 42,992
1004960-445000 Soil & Water Conservation 754
1006120-445000 P&R Insurance 6,636
1006121-445000 Mayo Insurance 3,695
1009820-400005 Transfer to Fleet Management Fund 19,604
1009820-400012 Transfer to Health Fund 11,687
1009820-400015 Transfer to Library Fund 1,885
1009820-400019 Transfer to DSS 15,080
1009821-401023 Transfer to PI 10,934
10570-390010 Transfer from General Fund 19,604
1054125-445000 Fleet Insurance 19,604
12070-390010 Transfer from General Fund 11,687
1205110-445000 Health Insurance 5,278
1205180-445000 Env Health Insurance 6,409
15070-390010 Transfer from General Fund 1,885
1506110-445000 Library Insurance 1,885
19070-390010 Transfer from General Fund 15,080
1905310-445000 DSS Insurance 15,080
23070-398010 Transfer from General Fund 10,934
2305280-445000 PI Insurance 10,934
10055-361414 P&R-Recreation Fees-Camps/Classes 289
1006120-419000 P&R-Professional Services 289
10070-398044 Transfer from 2024 LOBs 8,800
1009910-499100 Contingency-Undesignated (15,110)
1004530-435100 Airport-Maint & Repair/Bldg & Grounds 23,910
21070-398044 CIF-Transfer from 2024 LOBs 200,000
2109100-479900 CIF-Issuance Cost 200,000
4404260-458100 FY24 LOBs-Acquisition-HS Bldg (105,300)
4405921-458200 FY24 LOBs-Acquisition-CPCW Bldg (103,500)
4409821-401010 Transfer to General Fund 208,800
Totals 268,279 268,279
82
AGENDA ABSTRACT
Meeting Date: August 5, 2024
Agenda Title: Personnel Policy Amendments
Summary of Information: Human Resources has drafted personnel policy amendments
regarding the reasonable accommodations, Pregnant Workers Fairness Act, the Providing Urgent
Maternal Protection Act, and Longevity pay for part-time employees.
Article IV. Recruitment and Employment. Section 8. Reasonable Accommodations. On June 18,
2024, the Equal Employment Opportunity Commission issued a final rule on the Pregnant
Workers Fairness Act (PWFA) (42 U.S.C. § 2000gg). This act applies to reasonable
accommodations for known limitations related to pregnancy, childbirth, or related medical
condition of a job applicant or employee.
Article III. The Pay Plan. Section 21. The Providing Urgent Maternal Protection Act (PUMP
Act) (29 U.S.C. § 218d). As part of the Consolidated Appropriations Act, 2023, the Fair Labor
Standards Act (FLSA) was amended by the Providing Urgent Maternal Protections Act
(PUMP). This requires most employers to provide covered nursing workers reasonable break
time and a private space, other than a bathroom, to pump breast milk for one year after the
baby’s birth.
Article III. The Pay Plan. Section 19. Longevity. Eligible part-time employees will need to work
850 hours per fiscal year instead of a recurring schedule in order to qualify for longevity pay.
Updating the criteria enables the county to acknowledge part-time employees whose positions
and departmental requirements do not permit a fixed recurring schedule and yet contributes a
high number of hours in a part-time status. This hour count reflects a part-time position with
consistent hours maintained over a 12-month period.
Article VII. Section 5. Wellness Day. Updated “calendar” with “fiscal”
Recommended Action: Approve Personnel Policy amendments
Submitted By: Sonya Carver, Human Resources Director
83
PERSON COUNTY GOVERNMENT
PERSONNEL POLICY
Person County Human Resources
304 S. Morgan Street, Room 203
Roxboro, NC 27573
336-597-1725
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2
PERSON COUNTY GOVERNMENT
PERSONNEL POLICY
Amended 6/14/2024August 5, 2024
BE IT RESOLVED by the Board of County Commissioners for Person County that the
following policies apply to the appointment, classification, benefits, salary, promotion, demotion,
dismissal, and conditions of employment for the employees of the County.
Article Title Page
ARTICLE I. GENERAL PROVISIONS .......................................................................... 8
Section 1. Purpose of the Policy .......................................................................... 8
Section 2. Merit Principles .................................................................................... 8
Section 3. Responsibilities of the County Board of Commissioners………….…..8
Section 4. Responsibilities of the County Manager .............................................. 8
Section 5. Responsibilities of the Human Resources Director ............................. 9
Section 6. Application of Policies, Plan, Rules, and Regulations ....................... 10
Section 7. Departmental Rules and Regulations ............................................... 10
Section 8. Definitions .......................................................................................... 10
ARTICLE II. POSITION CLASSIFICATION PLAN ..................................................... 13
Section 1. Purpose ............................................................................................. 13
Section 2. Composition of the Position Classification Plan ................................ 13
Section 3. Use of the Position Classification Plan ............................................. 13
Section 4. Administration of the Position Classification Plan ............................. 14
Section 5. Authorization of New Positions and the Position Classification Plan..14
Section 6. Request for Reclassification .............................................................. 14
ARTICLE III. THE PAY PLAN ..................................................................................... 15
Section 1. Definition ............................................................................................ 15
Section 2. Administration and Maintenance ....................................................... 15
Section 3. Starting Salaries ................................................................................ 16
Section 4. Maximum of the Range ..................................................................... 17
Section 5. Trainee Designation and Provisions ................................................. 17
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3
Section 6. Education and Certification Increase ................................................ 17
Section 7. Pay Range Increases ........................................................................ 19
Section 8. Performance Review and Development System…………………..…19
Section 9. Salary Effect of Promotions, Demotions, Transfers and
Reclassifications ................................................................................ 19
Section 10. Salary Effect of Salary Range Revisions ........................................ 21
Section 11. Temporary or Permanent Additional Job Duties Assigned ............. 21
Section 12. Transition to a New Salary Plan ..................................................... 21
Section 13. Effective Date for Pay Changes ...................................................... 22
Section 14. Pay for "Acting" or Temporary Assignments in a Higher-Level
Class ................................................................................................ 22
Section 15. Overtime Pay Provisions ................................................................. 22
Section 16. On-Call and Call Back Compensation…………………………….… 24
Section 17. Payroll Schedule and Deductions ................................................... 25
Section 18. Hourly Rate of Pay for Full-time, Part- time and Temporary
Employees and for Work Weeks with Varying Hours………………25
Section 19. Longevity…………………………….………………………………… 26
Section 20. Overnight Supervision Incentive (DSS)……………….…………….26
Section 21. Providing Urgent Maternal Protection Act (PUMP Act)…………….27
ARTICLE IV. RECRUITMENT AND EMPLOYMENT ................................................ 287
Section 1. Equal Employment Opportunity Policy ........................................... 287
Section 2. Implementation of Equal Employment Opportunity Policy .............. 287
Section 3. Recruitment, Selection and Appointment ........................................ 287
Section 4. Probationary Period ....................................................................... 298
Section 5. Promotion ........................................................................................ 298
Section 6. Demotion ....................................................................................... 3029
Section 7. Transfer ......................................................................................... 3029
Section 8. Accommodations ........................................................................... 3029
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ARTICLE V. CONDITIONS OF EMPLOYMENT ........................................................ 330
Section 1. Work Schedule ................................................................................ 330
Section 2. Political Activity ................................................................................ 330
Section 3. Expectation of Ethical Conduct ....................................................... 330
Section 4. Outside Employment ....................................................................... 341
Section 5. Dual Employment ............................................................................ 341
Section 6. Employment of Relatives ................................................................ 341
Section 7. Harassment ..................................................................................... 352
Section 8. Use of County Time, Equipment, Supplies, and Vehicles ............... 352
Section 9. Performance Evaluation…………….………………..……….……….363
Section 10. Safety ............................................................................................ 363
Section 11. Immigration Law Requirements…………….….…………………....363
Section 12. Substance Abuse and Employee Assistance Program ................ 374
Section 13. Credentials and Certifications ....................................................... 374
Section 14. Travel Rules and Regulations ....................................................... 374
Section 15: Internet Access ............................................................................ 374
ARTICLE VI. EMPLOYEE BENEFITS………………………………………………… .... 385
Section 1. Eligibility ............................................................................................. 385
Section 2. Group Health and Hospitalization Insurance ..................................... 385
Section 3. Group Life Insurance ......................................................................... 385
Section 4. Other Optional Group Insurance Plans ............................................. 385
Section 5. Retirement ......................................................................................... 385
Section 6. Supplemental Retirement Benefits (401-K)………………………….4037
Section 7. Social Security…………………………………………………………4037
Section 8. Workers' Compensation………………………………………………4037
Section 9. Unemployment Compensation………………………………………..4037
Section 10. Tuition Assistance Program…………………………………………..4037
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5
Section 11. Credit Union………………………………………………………….4138
ARTICLE VII. HOLIDAYS AND LEAVES OF ABSENCE ........................................ 4239
Section 1. Policy……………………………………………………………………4239
Section 2. Holidays . …………………………………………………………….…4239
Section 3. Holidays: Effect on Other Types of Leave…………………………..4239
Section 4. Holidays: Compensation When Work is Required………….…..….4239
Section 5: Wellness Day…………………………………..……………………..4340
Section 6. Annual Leave ………………………………………….….….….…….4340
Section 7. Annual Leave: Accrual Rate……………………………...………..…4340
Section 8. Annual Leave: Maximum Accumulation………………….……..…...4441
Section 9. Annual Leave: Manner of Taking…………………….….….……..…4441
Section 10. Annual Leave: Payment Upon Separation………………….…..….4441
Section 11. Annual Leave: Payment Upon Death..……………………..…..…..452
Section 12. Sick Leave………………………………………………………...……452
Section 13. Sick Leave: Accrual Rate and Accumulation……………..…....……463
Section 14. Sick Leave: Medical Certification………………..……………………463
Section 15. Bereavement Leave……………………………….………………….463
Section 16. Extended Leave ……………………………………………………….474
Section 17. Parental Leave………………………………………….….………….474
Section 18. Family Medical Leave…………………………………….…………….485
Section 19. Family and Medical Leave: Medical Certification….…………….…5047
Section 20. Family Medical Leave and Leave Without Pay: Retention and
Continuation of Benefits …………………………..……….…..…….5047
Section 21. Workers' Compensation Leave……………………..…...…….....5047
Section 22. Military Leave………………………….……………………………..5148
Section 23. Reinstatement Following Military Service………………….....…5249
Section 24. Civil Leave………………………………………………………….…5249
Section 25. Parental School Leave………………………………………….…...5249
Section 26. Voluntary Shared Leave………………………………………….….5350
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ARTICLE VIII. SEPARATION AND REINSTATEMENT………………………………..5552
Section 1. Types of Separations……………………………………………….…5552
Section 2. Resignation………………………………………………….……….…5552
Section 3. Reduction in Force…………………………………………….………5552
Section 4. Disability………………………………………..………….……………5552
Section 5. Voluntary Retirement………………………………..….…..………….5653
Section 6. Death………………………………………………..….……..………....5653
Section 7. Dismissal…………………………………………….……….…………5653
Section 8. Reinstatement…………………………………………..…….………….5653
Section 9. Rehiring………………………….…………………………..…………..5653
ARTICLE IX. UNSATISFACTORY PERFORMANCE OF DUTIES, GROSSLY
INEFFICIENT JOB PERFORMANCE AND UNACCEPTABLE
PERSONAL CONDUCT………………………………………….……....5754
Section 1. Disciplinary Action for Unsatisfactory Performance of Duties….…5754
Section 2. Unsatisfactory Performance of Duties Defined……………….…….5754
Section 3. Communication and Warning Procedures Preceding Disciplinary
Action for Unsatisfactory Job Performance……………………...…5855
Section 4. Disciplinary Action for Unsatisfactory Performance of Duties …….5855
Section 5. Pre-Disciplinary Conference for Unsatisfactory Performance of
Duties …………………………………………………………….……5855
Section 6. Unacceptable Personal Conduct Defined ..................................... 5855
Section 7. Disciplinary Action for Unacceptable Personal Conduct ............... 6057
Section 8. Pre-disciplinary Conference for Unacceptable Personal Conduct . 6057
Section 9. Non-disciplinary Suspension ......................................................... 6057
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ARTICLE X. GRIEVANCE PROCEDURE AND ADVERSE ACTION APPEAL ...... 6259
Section 1. Policy ............................................................................................. 6259
Section 2. Grievance Defined ........................................................................ 6259
Section 3. Purposes of the Grievance Procedure .......................................... 6360
Section 4. Procedure ...................................................................................... 6461
Section 5. Role of the Human Resources Director ........................................ 6562
Section 6. Specific Grievance and Adverse Action Appeal Procedure for
Discrimination and/or Harassment ................................................ 6663
ARTICLE XI. PERSONNEL RECORDS AND REPORTS ....................................... 6764
Section 1. Public Information ........................................................................ 6764
Section 2. Access to Confidential Records ………………………...…………..6764
Section 3. Personnel Actions…………………………………………………..6865
Section 4. Records of Former Employees ..................................................... 6865
Section 5. Remedies of Employees Objecting to Material in File .................. 6865
Section 6. Penalties for Permitting Access to Confidential Records .............. 6865
Section 7. Examining and/or Copying Confidential Material without
Authorization.................................................................................. 6966
Section 8. Destruction of Records Regulated ............................................... 6966
ARTICLE XII. IMPLEMENTATION OF POLICIES ................................................... 7067
Section 1. Conflicting Policies Repealed ........................................................ 7067
Section 2. Severability .................................................................................... 7067
Section 3. Effective Date ................................................................................ 7067
Section 4. Amendments ................................................................................ 7067
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ARTICLE I. GENERAL PROVISIONS
Section 1. Purpose of the Policy
It is the purpose of this Personnel Policy, and the rules and regulations set forth to establish a fair
and uniform system of personnel management for all employees of the County under the
administration of the County Manager, elected officials, Elections Board and Board of Health. These
aforementioned entities are the official Hiring or Appointing authorities covered by this personnel
policy. State requirements will supersede these policies for positions subject to the State Human
Resources Act whenever there is a conflict. This policy is established under authority of G.S. 153A,
Article 5 and G.S. 126 of the General Statutes of North Carolina.
This Policy does not change the “at-will” status of any Person County employee who is considered
an “at-will” employee. For employees who are “at-will” (Probationary employees), their employment
may be ended at any time, and at any reason, and shall not be afforded the benefits protected
pursuant to the Disciplinary and Grievance policy, among other policies, described herein.
Section 2. Merit Principles
All appointments and personnel actions shall be made on the basis of merit. All positions requiring
the performance of the same duties and fulfillment of the same responsibilities shall be assigned to
the same class and salary grade. No applicant for County employment or employee shall be deprived
of employment opportunities or otherwise be adversely affected as an employee because of an
individual's race, color, religion, sex, national origin, qualified disability, age, genetic information
(including family medical history), marital status, political affiliation, sexual orientation, status as
parent, labor organization affiliation or non-affiliation, or any other non-merit-based factor.
Section 3. Responsibilities of the County Board of Commissioners
The County Board of Commissioners shall be responsible for establishing and approving human
resources policies, the position classification and pay plan, and it may change the policies and
benefits as necessary. The Board also shall make and confirm appointments when so specified by
the general statutes.
Section 4. Responsibilities of the County Manager
The County Manager shall be responsible to the County Board of Commissioners for the
administration and technical direction of the human resources program. The County Manager shall
appoint, suspend, and remove County officers and employees except those elected by the people
or whose appointment is otherwise provided for by law. The County Manager shall make
appointments, dismissals and suspensions in accordance with the state statutes and other policies
and procedures spelled out in other Articles in this Policy.
The County Manager may delegate human resources functions, as appropriate. The County
Manager or designee shall maintain the position classification plan and the pay plan and perform
such other duties in connection with a modern human resources program as the Board requires. All
matters dealing with human resources shall be routed through the office of the County Manager or
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designee who shall maintain a complete system of personnel files and records. The County Manager
shall:
a)recommend rules and revisions to the personnel system to the County Board of
Commissioners for consideration;
b)make changes as necessary to maintain an up to date and accurate position
classification plan;
c)recommend necessary revisions to the pay plan;
d)determine which employees shall be subject to the overtime provisions of FLSA;
f)develop and administer such recruiting programs as may be necessary to obtain an
adequate supply of competent applicants to meet the needs of the County; and
g)perform such other duties as may be assigned by the County Board of Commissioners
not inconsistent with this Policy.
Section 5. Responsibilities of the Human Resources Director
The responsibilities of the Human Resources Director are to make recommendations to the County
Manager on the following:
a)recommend rules and revisions to the personnel system to the County Manager for
consideration;
b)recommend changes as necessary to maintain an up to date and accurate position
classification plan;
c)recommend necessary revisions to the pay plan;
d)recommend which employees shall be subject to the overtime provisions of FLSA;
e)maintain a roster of all persons in the County service;
f)establish and maintain a list of authorized positions in the County service at the
beginning of each budget year which identifies each authorized position, class title of
position, salary range, any changes in class title and status, position number and
other such data as may be desirable or useful;
g)develop and administer such recruiting programs as may be necessary to obtain an
adequate supply of competent applicants to meet the needs of the County;
h)develop and coordinate training and educational programs for County employees;
i)investigate periodically the operation and effect of the personnel provisions of this
policy;
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j)perform such other duties as may be assigned by the County Manager not
inconsistent with this Policy; and
k)insure that all employees receive and sign for a copy of this personnel policy and
any revisions.
Section 6. Application of Policies, Plan, Rules, and Regulations
This personnel policy and all rules and regulations adopted pursuant thereto shall be binding on all
County employees. The County Manager, County Attorney, elected officials, appointed members of
the County Board and advisory boards and commissions will be exempted except in sections where
specifically included. An employee violating any of the provisions of this policy shall be subject to
appropriate disciplinary action, as well as prosecution under any civil or criminal laws which have
been violated.
Section 7. Departmental Rules and Regulations
Due to the particular personnel and operational requirements of the various departments of the
County, each department is authorized to establish supplemental rules and regulations applicable
only to the personnel of that department. All such rules and regulations shall be subject to the
approval of the County Manager or designee, and shall not in any way conflict with the provisions of
this Policy, but shall be considered as a supplement to this Chapter.
Section 8. Definitions
For the purpose of this chapter, the following words and phrases shall have the meanings
respectively ascribed to them by this section:
Adverse Action. An involuntary demotion, reduction in pay, suspension, reduction in force, or
separation from employment.
Anniversary Date. The employee’s most recent date of employment with the County in a permanent
position.
Appointing or Hiring Authority. The County Manager will be designated as the Appointing or Hiring
Authority with the following exceptions:
a)The Sheriff shall be the Appointing and Hiring Authority for positions in the Sheriff’s
Department;
b)The Register of Deeds shall be the Appointing and Hiring Authority for positions in the
Register of Deeds Department;
c)The Board of Elections shall be the Appointing and Hiring Authority for positions in the
Elections Department; and
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d)The Health Director shall be the Appointing and Hiring Authority for positions in the Health
Department.
Classification. A title of a single or group of positions which are sufficiently similar to require the same
set of knowledge, skills, abilities, education and experience qualifications.
Continuous Employment. Uninterrupted service to Person County as a Full-time employee.
Demotion. A demotion is the movement of an employee from one position to a position in a class
assigned to a lower salary range. Demotions may be voluntary or involuntary.
Full-time employee. An employee who is in a position for which an average work week equals at more
than 30 hours on average, and Continuous Employment of at least 12 months. Such employees
are eligible for benefits.
Grant-funded employee. An employee whose position is paid for with grant funds. Such employees are
not generally eligible for accrued leave benefits, probationary increases, longevity, merit pay, etc. unless
the grant program allows for such expenditures and they have been appropriately budgeted.
Immediate Family. Spouse, parent, guardian, children, sister, brother, grandparents, grandchildren plus
the various combinations of half, step, in-law, and adopted relationships that can be derived from those
named.
Part-time employee. An employee who is in a position requiring less than 30 hours of work on
average per week, and, less than 1,000 hours per year. Part-time employees may be designated as
permanent or temporary and do not typically qualify for benefits.
Probationary employee. An employee appointed to a Full-time or Part-time permanent position who has
not yet successfully completed the designated probationary period of nine months. Persons in trainee
appointments are a Probationary employee for the full duration of their appointment in that status.
Department Heads and sworn law enforcement shall serve a twelve- month probationary period. Any
employee serving a probationary period following initial appointment, may be dismissed without the
dismissal procedures stated herein, at any time during the probationary period. In addition, during
the probationary period, the employee will not have access to the grievance procedures found
herein. In other words, probationary employees are treated as “at will” employees.
Promotion. The movement of an employee from one position to a vacant position in a class assigned to a
higher salary range.
Recurring part-time employee. A part-time employee that works a consistent and routine schedule
each week. An employee in this status does not have the flexibility to self-direct their work schedule on
a regular basis.
Regular employee. An employee appointed to a full -time position who has successfully completed the
designated probationary period.
Trainee. An employee status when an applicant is hired (or employee promoted) who does not meet all of
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the requirements for the position. During the duration of a trainee appointment, the employee is on
probationary status.
Transfer. The movement of an employee from one position to a position in a class in the same salary range.
Work Against Appointment. In departments whose employees are subject to the Human Resources
Act, the Appointing or Hiring Authority may appoint an employee in a Work Against situation. When
qualified applicants are unavailable and there is no trainee provision for the classification of the
vacancy, the Hiring or Appointing Authority may appoint an employee below the level of the regular
classification in a "Work Against" appointment. This appointment is for the purpose of allowing the
employee to gain the qualifications needed for the full class through on the job experience. A Work
Against appointment may not be made when applicants are available who meet the training and
experience requirements for the full class in the position being recruited. During the duration of the Work
Against appointment, the employee is on probationary status.
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ARTICLE II. POSITION CLASSIFICATION PLAN
Section 1. Purpose.
The position classification plan provides a complete inventory of all authorized and permanent positions
in the County service, and an accurate description and specification for each class of employment. The
plan standardizes job titles, each of which is indicative of a definite range of duties and responsibilities.
All positions covered by the personnel policy are to be classified according to the assigned duties,
responsibilities, qualifications needed, and other required factors. In order to ensure its continuing value
as a personnel management tool, the positions classification plan will be maintained to reflect the current
work assignments and other conditions and requirements which are factors in proper classification and
allocation of regular positions.
Positions in the Department of Public Health will be classified by the NC Department of Health and Human
Services (DHHS) in compliance with the rules and regulations under the State Human Resources Act.
Section 2. Composition of the Position Classification Plan
The classification plan shall consist of:
a) A grouping of positions in classes which are approximately equal in difficulty and
responsibility which call for the same general qualifications, and which can be equitably
compensated within the same range of pay under similar working conditions;
b) class titles descriptive of the work of the class;
c) written specifications for each class of positions; and
d) an allocation list showing the class title of each position in the classified service.
Section 3. Use of the Position Classification Plan
The classification plan is to be used:
a) as a guide in recruiting and examining applicants for employment;
b) in determining lines of promotion and in developing employee training programs;
c) in determining salary to be paid for various types of work;
d) in determining personnel service items in departmental budgets; and
e) in providing uniform job terminology.
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Section 4. Administration of the Position Classification Plan
The County Manager, assisted by the Human Resources Director, shall allocate each position covered
by the classification plan to its appropriate class, and shall be responsible for the administration of the
position classification plan. The Human Resources Director shall periodically review portions of the
classification plan and recommend revisions to the County Manager to ensure that classifications
accurately reflect current job duties and responsibilities. The Human Resources Director shall also
periodically review the entire classification plan and, when needed, recommend major changes to the
County Manager. For Employees subject to the State Human Resources Act, both the Person County
Classification Plan, and the Office of State Human Resources Classification Plan should be considered.
Section 5. Authorization of New Positions and the Position Classification Plan
New positions shall be established upon recommendation of the County Manager and approval of the
Board of Commissioners. New positions shall be recommended to the Board of Commissioners with a
recommended class title. The position classification plan, along with any new positions or classifications
shall be approved by the Board of Commissioners and on file with the Human Resources Director. A
copy of the position classification plan will be posted on the County website under the Human Resources
Department for review by employees and the public.
Section 6. Request for Reclassification
Any employee or Department Head who considers the position in which classified to be improper shall
submit a request in writing for reclassification to such employee's immediate supervisor, who shall
immediately transmit the request to the Human Resources Director through the chain of command. Upon
receipt of such request, the Human Resources Director shall study the request, determine the merit of
the reclassification, and recommend any necessary changes to maintain a fair and accurate classification
plan, to the County Manager. The decision of the County Manager is final.
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ARTICLE III. THE PAY PLAN
Section 1. Definition
The pay plan includes the salary schedule and the assignment of classes to salary grades and
ranges adopted by the Board of Commissioners. The salary schedule may consist of a minimum,
midpoint, and maximum rates of pay for each job classification approved by the Board of
Commissioners. Salary increases within the pay range shall be based on criteria established by
the County Manager and approved by the Board of Commissioners.
In order to ensure proper pay, time worked must be entered on the employee’s timesheet pursuant
to current County practices, which currently require time entry in quarter hour increments. Please
note that some employees, particularly those subject to the Department of Transportation
Guidelines, may have different timekeeping requirements.
Section 2. Administration and Maintenance
The County Manager shall be responsible for the administration and maintenance of the pay plan.
All employees covered by the pay plan shall be paid at a rate within the salary range established
for the respective position classification, except for employees in trainee status or employees
whose existing salaries are above the established maximum rate following transition to a new pay
plan.
The pay plan is intended to provide equitable compensation for all positions, reflecting differences
in the duties and responsibilities, the comparable rates of pay for positions in public employment
in the area, changes in the cost of living, the financial conditions of the County, and other factors.
To this end, from time to time the County Manager, assisted by the Human Resources Director,
shall make comparative studies of all factors affecting the level of salary ranges and may make
minor adjustments in the allocation of positions to salary grades. When major adjustments
encompassing numerous positions are needed, or when a general adjustment is needed to the
pay plan, the County Manager shall recommend such changes in salary ranges as appear to be
warranted to the Board of Commissioners. The Board of Commissioners shall adopt the salary
schedule and assignment of job classes to salary grades, including any minor adjustments made
by the County Manager during the previous budget year, annually as part of the budget process.
The County Manager may approve in-range adjustments to employee salaries when necessary
to accommodate inequities, special performance, achievements, retention or other issues. The
Department Head will submit documentation to the Human Resources Director explaining the
reason for requesting an in-range adjustment. The Human Resources Director will make a
recommendation to the County Manager.
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Section 3. Starting Salaries
In order to establish the pay rate for new hires (or rehires), the following criteria will be used to
promote fairness and equity in pay.
a) The starting salary for a new employee who meets the minimum qualifications for the
position is typically the minimum of the salary range to which the job classification is
assigned.
b) The new hire starting salary for employees (or re-hires) may consider directly relevant
experience and/or experience that can be verified by the Human Resources Department.
Employees who have left the County and have been officially terminated will be re-hired
using this criteria and will not be rehired at the previous salary. Re-hires who have left the
County’s employ will be considered using the same criteria as new hires.
c) Internal Equity is an equally important consideration in filling a vacant position. Before a
salary offer is made, Human Resources will also consider the current salaries, level of
education, relevant licenses/certifications and length of service in the same/similar job
class or classes of current incumbents. It is the policy of the County to make every effort
to avoid inverted salary relationships which are created by bringing in newly hired
employees at a salary that exceeds the current salaries of comparably placed existing
employees in the same/similar job class.
d) The Human Resources Department may consider a higher salary offer if the open position
is determined to be a “hard to fill” position. “Hard to fill” positions will be determined by
the Human Resources Department and will be based on the length of time the position
has remained unfilled, the difficulty to recruit, the “mission critical” nature of the work and
the market conditions of the position, at the time of a vacancy.
e) The salary range is typically considered the span in salary between the minimum of the
range and the midpoint for most positions. For Directors or Assistant Director level
positions, the qualifications of the applicant and/or the needs of the County should include
the discretion to hire anywhere within the range. However, consideration should still be
given to existing salaries of other employees who are in directly comparable leadership
positions.
Elected officials, i.e. the Sheriff and Register of Deeds, shall be paid upon initial election or
appointment, at the starting salary for the office. The Board of Commissioners may adjust the
salary of the elected official by considering the years of service, performance and related
experience of the person.
Pay for part-time or temporary status will be based on the applicable hourly rate for the position.
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Section 4. Maximum of the Range
Ranges are established to reflect the market value of a given job profile and not an incumbent.
Once an employee reaches the maximum of his/her assigned range, the salary is frozen, and the
employee is not eligible for any additional compensation unless there is a range movement that
would result in a higher maximum.
Section 5. Trainee Designation and Provisions
Applicants being considered for employment or County employees who do not meet all of the
requirements for the position for which they are being considered may be hired, promoted,
demoted, or transferred by the County Manager to a "trainee" status or under the State Human
Resources Act job classes as a "Work Against.” In such cases, a plan for training and meeting
the minimum qualification for the job classification, including a time schedule, must be prepared by
the supervisor. An employee shall remain at the trainee or "Work Against" salary level until the
Department Head certifies that the employee is qualified to assume full responsibilities of the
position and the County Manager approves the certifications. The Department Head shall review
the progress of each employee in a trainee or "Work Against" status every six months or more
frequently as necessary to determine when the employee is qualified to assume full
responsibilities of the position. "Trainee" salaries may be one to two grades below the minimum
rate established for the position for which the person is being trained. Assignment two grades
below is appropriate when the traineeship is expected to last two years. Assignment one grade
below is appropriate when traineeship is expected to last one year. (Note: Positions subject to the
State Human Resources Act may be assigned no more than two grades below for trainee
purposes.) The actual assignment should be reviewed and approved by the Human Resources
Director. A new employee designated as "trainee" appointment shall be in a probationary status
until requirements for the full job class are met.
If the training is not successfully completed as planned, the employee shall be transferred,
demoted, or dismissed. If the training is successfully completed, the employee shall be paid at
least at the minimum rate established for the job class.
Section 6. Education and Certification Increase
To encourage growth and promote a learning atmosphere in local government, a full-time
employee of Person County Government may be eligible to receive a 1.5% salary increase for an
advanced certification or a 2.5% salary increase for a higher-level education if certain criteria are
met.
Education is defined as graduation from a community college or university where an individual
may receive an associate, bachelor’s, graduate, doctorate or professional degree.
A certification is an official document acknowledging that an individual has successfully passed a
professional class or training that has provided them with knowledge, experience and skills to
perform certain job tasks. Most certifications that pertain to this policy will include an individual
attending training for a considerable number of hours and/or passing an exam in order to receive
the certification.
Requests for certification or education approvals should be made before the fiscal year in which
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the certificate or diploma is attained to ensure accurate budgeting for the associated salary
increase.
The following criteria will be applied when an employee has requested an increase for additional
education or certification:
The certification or accreditation will be earned in their professional field furthering their ability
to perform the duties and responsibilities of their position. Approval from the Department
Head, Human Resources Director and County Manager may also be made for an employee
who is seeking a higher level of education to pursue a promotion within County services.
An education or certification increase will only be awarded during the fiscal year in which it
was obtained.
The County will pay for one certification school and up to two attempts at an exam for a single
certification level. Exceptions may be made if deemed appropriate by the County Manager.
College courses will usually be taken outside of regular work hours. Courses during work hours
are typically not permitted but may be considered by the County Manager on a case by case
basis if work time can be made-up with minor schedule adjustments. Employees will not be
paid for time spent in classes. Employees may be reimbursed for tuition, fees, laboratory fees,
and student fees up to a certain amount as outlined in the Personnel Policy, Article VI.
Employee Benefits, Section 10.
Pay increases for certifications should be submitted in a timely manner. The effective date of
the pay increase will be consistent with the next full pay period. There may be instances where
the delay is from a third party and no fault of the employee or supervisor. Certification
increases are not intended to be re-applied for position status change that includes but is
not limited to promotions, transfers, reclassifications, or demotions. No increases will be
awarded retroactively for certifications obtained prior to the adoption of this policy.
Re-certifications will not be eligible for an increase, but the County may pay for the renewal
of the required certification.
If the certification has been suspended, lapsed or is no longer being utilized, the pay
incentive may be removed.
If the employee has an active performance improvement plan due to not meeting work
standards, they will not be approved for a certification increase until the employee has
successfully resolved performance issues. The increase will not be retroactive but may be
effective the first day the employee has successfully completed the performance
improvement plan.
The employee may not receive more than two education or certification increases per fiscal
year.
A salary increase will not typically be awarded if the certification is included as a
requirement on the job description or formal acceptance letter of employment. Special
circumstances may be considered if deemed appropriate by the County Manager and
Human Resources Director.
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Section 7. Pay Range Increases
Upward movement within the established salary range for an employee is not automatic but rather
based upon specific criteria. Procedures for determining performance levels and performance
pay increases shall be established in procedures approved by the County Manager.
Section 8. Performance Review and Development System (separate policy)
The purpose is to establish and maintain a performance review and development system that
contributes to the organization achieving its mission and goals and focuses on continuous
performance improvement and recognition for all employees of the County. Reviews will
encompass one year and be conducted on or before the anniversary date of the employee’s initial
hire or rehire. Pay for performance or merit may vary or be funded at the discretion of the Board
of Commissioners. Grant funded positions may receive merit only if funds are available from the
grant program.
Section 9. Salary Effect of Promotions, Demotions, Transfers, and Reclassifications
Promotions. When an employee is promoted, as a result of a job change or job progression, to
a higher pay grade position, the salary placement within the new pay grade shall be determined
along with the above criteria as follows: apply a 5% increase to the previous salary for promotions
of one pay grade, and an additional 2.5% for each additional pay grade up to a maximum of 15%.
The resulting pay will be no less than the minimum of the new pay grade and no less than a 5%
salary increase, but not more than the maximum salary of the assigned pay grade. Any increase
of more than 5% requires documentation by the department or agency and a supporting
recommendation from the Human Resources Director. The County Manager will review the
documentation for approval. The effective date of the pay increase will be consistent with the next
full pay period.
The amount of the salary adjustment should also include consideration for the following:
a) the employee’s related education, training, and experience;
b) the nature and magnitude of the change in jobs;
c) budget availability;
d) consistency with similar situations in the past;
e) internal equity within the work unit; and
f) other relevant issues.
Employee (Employees subject to the State Human Resources Act are exempt) will serve a nine-
month probationary period.
There may be times when the uniqueness of an individual job and level or necessary skills
required by the County, and not just possessed by the incumbent, may require a higher salary
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schedule placement than stipulated in this section. Under such circumstances, the County
Manager may approve a higher salary placement within the assigned pay grade.
Cost of living (or market adjustment), and other in-range increases cannot take the place of a
promotional increase. The position of the employee’s adjusted salary within the new salary range
shall not exceed the position of the employee’s salary in the current range.
Demotion or Voluntary Reassignment. Demotion or reassignment is a change in status
resulting from an assignment to a position in a lower salary grade. If the change results from a
disciplinary action, the action is considered a demotion. If the change results from a mutual
agreement between the employee and employer, the action is considered a voluntary
reassignment.
The adjusted salary of the employee shall be within the range of the lower classification based on
salary grade with consideration of internal equity, decreased workload and responsibility level.
Lateral Transfers. A lateral transfer occurs when an employee is transferred from one job class
to another in the same pay grade. The salary will remain the same and employee must possess
the minimum qualifications for the new position.
Reclassifications. When a job has been reclassified to a higher pay grade, the employee’s
salary shall increase at least 5% but not exceed the maximum salary of the new pay grade.
If the reclassification results in an upgrade of one pay grade, the employee’s pay will be moved
upward by 5%. An upgrade of two or more pay grades will increase the employee’s pay by an
additional 2.5% for each additional pay grade, up to a maximum of 15%. Any increase of more
than 5% would require documentation by the department or agency and a supporting
recommendation from Human Resources Director. The County Manager will review the
documentation for approval.
For general reclassifications completed as a result of an internal or external compensation study,
or as a result of a normal budget process review, a pay increase for an employee who has been
in their position since on or before the first day of the fiscal year, will have an effective date of the
first day of the fiscal year, or the effective date of implementation as approved by the Board of
Commissioners.
Otherwise, for an individual reclassification, done outside the normal budget cycle, the effective
date of the pay increase will be consistent with the next full pay period.
Reclassification or changes in pay grade, whether resulting from an internal or external
compensation study or individual change in pay grade, shall not be retroactive with respect to
calculating the new salary.
When a job has been reclassified to a lower pay grade, the affected employee(s) shall have their
pay grade adjusted accordingly. The effective date will be the day following approval and the
change will be reflected in the next full pay period. If, after the pay grade adjustment, the
employee(s) salary is greater than the maximum salary of the new pay range, the employee will
continue to be paid at the higher rate of pay, the salary would be “frozen” and the employee is
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typically ineligible for any pay adjustment until the range “catches up” with the salary and allows
for movement.
Section 10. Salary Effect of Salary Range Revisions
When a class of positions is assigned to a higher salary range as a result of labor market
conditions (outside of a total county pay study), employees will be placed at minimum of pay grade
and equity of old grade will be considered during the reclassification. An implementation process
will be recommended by the Human Resources Director and approved by the County Manager.
Budgetary funding will also be considered. When a class of positions is assigned to a lower salary
range, the salaries of employees in that class will remain unchanged. If this assignment to a lower
salary range results in an employee being paid at a rate above the maximum established for the
new class, the salary of that employee shall be maintained at that level until such time as the
employee's salary range is increased above the employee's current salary.
Section 11. Temporary or Permanent Additional Job Duties Assigned
At times, employees may be temporarily assigned job duties that are outside of their normal job
requirements. Consideration for extra pay will be given if the employee’s assignment of extra
duties is from a higher-grade classification.
Permanent additional job duties that are assigned will result in a re-evaluation of the position to
determine if the position should be assigned a higher-grade classification.
For temporary and permanent additional job duties, department heads should submit
documentation to the Human Resources Director. The Human Resources Director will review
and make a recommendation to the County Manager.
Section 12. Transition to a New Salary Plan
The following principles shall govern the transition to a new salary plan:
a) No employee shall receive a salary reduction as a result of the transition to a new salary plan.
b) All employees being paid at a rate lower than the minimum rate established for their respective
classes shall have their salaries raised to the new minimum for their classes. A trainee, or
employee in a “Work Against” status will remain in their same relative pay status in the new salary
grade assigned.
c) All employees being paid at a rate above the minimum and below the maximum are considered
as being paid at a competitive rate for the job class and may receive any approved salary plan
implementation increases as authorized by the Board of Commissioners
d) All employees being paid at a rate above the maximum rate established for their respective
classes shall be maintained at that salary level with no increase in base pay until such time as
the employees' salary range is increased above the employees' current salary. This means no
performance/merit pay increases or market adjustment/cost of living increases or any other
increases to the base pay of the employee until the employee is within the appropriate salary
range.
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Section 13. Effective Date for Pay Changes
The effective date of the pay changes will be consistent with the next full pay period.
Section 14. Pay for “Acting” or Temporary Assignments in a Higher-Level Classification
(Interim duties)
“Acting” or temporary assignment(s) occurs when the County recognizes a critical job assignment
need that must be met and cannot be met through the normal recruitment process. This can occur
when an unexpected vacancy occurs; when a mission critical job cannot be filled in a timely
fashion; or when a mission objective changes abruptly and requires an immediate action.
Temporary or “acting” assignment(s) would be anticipated to last more than 30 days, but less than
6 months. A temporary or “acting” assignment is to fill a vacancy and not to assume the duties of
another employee who is on approved leave, i.e. vacation, holiday, medical, or other short-term
absence(s).
If the position assigned is lower in pay grade (or substantially equivalent pay range) this would
not result in a lower salary for the assigned employee even if the employee’s salary exceeded the
maximum of the new pay range.
If the position extends beyond 30 days, but less than 6 months, there should be a 5% “temporary
assignment” pay adjustment for the first pay grade and 2.5% for each additional pay grade to a
maximum of 15% or the minimum of the grade, whichever is higher. The employee’s salary shall
not exceed the maximum of the assigned range. Internal equity and expectation of fulfilling the
job requirements will be taken into consideration when establishing the temporary assignment
pay. Employees receiving temporary assignment pay shall sign an agreement acknowledging the
understanding that they are receiving “Temporary Assignment Pay” and also acknowledging that
when the temporary assignment ends, the “assignment pay” will also end.
Section 15. Overtime Pay Provisions
Employees of the County can be requested and may be required to work overtime hours as
necessitated by the needs of the County and determined by the supervisor. All overtime work
must be authorized in advance.
Supervisors shall attempt to arrange employee work and schedules so as to accomplish the
required work within the standard workweek and without incurring overtime.
To the extent required, the County will comply with the Fair Labor Standards Act (FLSA). The
County Manager/designee shall determine which jobs are "Non-Exempt" and are therefore
subject to the Act in areas such as hours of work and work periods, rates of overtime
compensation, and other provisions.
Non-Exempt Employees: Non-exempt employees will be paid at a straight time rate for hours up
to the FLSA established limit for their position (usually 40 hours in a 7-day period or alternative
FLSA approved full time schedule). Employees in law enforcement job classes may earn overtime
based on a 28-day time period. Hours worked beyond the FLSA established limit will be
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compensated in compensatory time or overtime pay at the appropriate overtime rate. In
determining eligibility for overtime in a work period, only hours actually worked shall be
considered; in no event will vacation, sick leave, or holidays be included in the computation of
hours worked for FLSA purposes.
Whenever practicable, departments will schedule time off on an hour-for-hour basis within the
applicable work period for non-exempt employees, instead of paying overtime. When time off
within the work period cannot be granted, overtime worked will be given in the form of
compensatory time off or paid in accordance with the FLSA. The County retains the right to
determine whether to compensate overtime as pay or as compensatory time off.
In the event the Governor declares a state of emergency where employees would be required to
work long and continuous hours, the County Manager may approve compensation at a rate up to
double time for those hours worked and/or grant time off with pay for rest and recuperation to
ensure safe working conditions.
Exempt employees: Employees in positions determined to be "exempt" from the FLSA (for
example, as Executive, Administrative, or Professional staff) will not receive pay for hours worked
in excess of their normal work periods. These employees may be granted compensatory leave
by their supervisor where the convenience of the department allows and in accordance with
procedures established by the County Manager. Such compensatory time is not guaranteed to
be taken and ends without compensation upon separation from the organization.
The County intends to make deductions from the pay of exempt employees for authorized reasons
and prohibits improper pay deductions. Exempt employees who wish to question deductions they
believe to be improper may use the County’s Grievance procedure, as explained in this policy. If
the deduction is found to be improper the County will reimburse the employee for lost pay.
Compensatory Time Off.
Compensatory time off for overtime hours worked may be provided in lieu of immediate overtime
pay in cash in accordance with appropriate current FLSA rules, at the option of the County
Manager, for covered non-exempt employees. Unless the law requires otherwise, compensatory
time shall be exhausted before annual leave is used.
Covered non-exempt employees may be granted compensatory time for hours worked in excess
of 40 in any one work week, at a rate of one and one-half hours for each hour of work in excess
of 40 hours in any one work week, subject to the following provisions:
- The maximum compensatory time which may be accrued by any affected employee shall
be eighty (80) hours. An employee who has accrued the maximum number of
compensatory hours shall be paid overtime compensation for any additional overtime
hours of work.
- Upon request by Employee to use accrued compensatory time, the Employer shall allow
Employee to use said time off within a reasonable period after the request, so long as
such use does not unduly disrupt the operations of Employer. This determination shall be
based on the facts and circumstances of each individual case. Compensatory time must
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be used within 26 pay periods (approximately 13 months) from the pay period in which
they earned it, otherwise, the employee shall be paid overtime compensation for any
additional overtime hours of work.
- Upon termination of employment for any reason, Employee shall be paid for accrued
compensatory time at a rate of compensation equal to: the average regular rate received
by Employee during the last three years of the Employee’s employment, or the final regular
rate received by the Employee, whichever amount is greater.
The County, at its option, shall be entitled to pay Employee for any portion of accrued
compensatory time. If Employer elects to make such election, payment shall be based
upon Employee’s rate of earnings at the time said payment is made.
- Any compensatory time employees may have accumulated up to the effective date of this
policy will remain in place and may be used pursuant federal and state wage laws. Once
employees use any accumulated compensatory time over eighty (80) hours, they will then
be subject to the maximum accrual of eighty (80) hours of compensatory time and will be
paid overtime pursuant to this policy. The County’s policy is stricter than the FLSA
provisions that allow non-exempt employees to accumulate up to 240 hours of
compensatory time.
- Nonexempt employees separating from employment shall be paid for their compensatory
time balances.
Section 16. On-Call and Call-Back Compensation
The County provides continuous twenty-four hours a day, seven days a week service to its
citizens. Therefore, it is necessary for certain employees to respond to any reasonable request
for duty at any hour of the day or night. One of the conditions of employment with the County is
the acceptance of a share of the responsibility for continuous service in accordance with the
nature of each job. If an employee fails to respond to reasonable calls, either special or routine,
the employee may be subject to disciplinary action up to and including dismissal by the Appointing
or Hiring Authority. Therefore, the County provides compensation for employees who are
required to be on-call. Compensation for time spent while on-call and for time spent when actually
called back to work shall be determined according to the following:
On-call. On-call time consists of scheduled non-work hours in excess of an employee’s standard
work period when an employee is required to be available to be called back to work on short
notice if the need arises. Each department may have more specific rules in light of the type of on-
call needs. However, generally speaking, on-call time will not be over-used (unless volunteered)
for any employee and will not be over-restrictive such that it interferes substantially with the
personal use of an employee’s time out-side of work. The general rule is that an on-call employee
should be able to respond to a call within a one-hour time frame. On-call schedules must be
approved by the Department Head. The Human Resources Office shall maintain a list of
employees who are approved for on-call compensation arrangements.
Non-exempt employees will be compensated for the inconvenience of on-call duty. Employees
required to be on “on-call” duty will be compensated $2.00 per hour for on-call time they serve
until they are called back to work or until the on-call time has expired. The on-call pay and call-
back pay shall not overlap. Employees will receive their regular rate of pay for all time the
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employee is “called-back” to work while on-call, unless the hours worked otherwise qualify for
overtime pay. Reciprocal time in exchange for working while on-call (or to minimize overtime) is
only allowed when such time is within the time off during the same work-week.
Call-back. Call-back time consists of actual time spent when called back to work to handle a
requested or emergency situation, regardless of whether the person is “on-call.” "Call-back"
provisions do not apply to previously scheduled overtime work (scheduled one or more days in
advance). Exempt employees will not be paid for being called back to work outside of normal
working hours. Non-exempt employees will receive their regular rate of pay for all time worked
while on-call, unless the hours worked otherwise qualify for overtime pay. The on-call stipend
of $2.00 per hour will cease once an employee has been called back to work. Reciprocal time in
exchange for working while on-call (or to minimize overtime) is only allowed when such time is
within the time off during the same work-week.
Time Keeping. In the event a non-exempt employee is needed to respond to a call while on-call,
or for call-back time, the employee must log all time beginning with the drive to the specific location
requested and ending with the time of returning home from the on-call location. Non-exempt
employees are guaranteed a minimum of 15 minutes call-back pay for any business-related
telephone calls, remote-in tasks, or text messages that occur while being on-call, as well as 2
hours call-back pay if travel is required as part of the call-back. If call-back occurs, the employee
will need to report any guaranteed time not worked in a separate pay code in the County’s time
keeping system in minimum quarter hour increments as defined in Article III, Section 1.
Guaranteed time that is not actually worked is not considering compensable time and is therefore
not subject to overtime pay. However, guaranteed time that is actually worked is considered
compensable time and is subject to overtime pay if other overtime requirements are met. Total
call-back time should not exceed 2 hours unless the time actually worked exceeds two hours, in
which event the employee is not entitled to any compensation beyond payment for the time
actually worked. In other words, if the employee actually works 2 hours or more, all time should
be entered as worked, compensable time. The employee is responsible for accurately logging
his or her time and turning it in to a Department Head and/or Human Resources as not all
employees have the ability to “clock in” remotely. Please note that certain departments may have
more specific rules based on the type of work completed.
Section 17. Payroll Schedule and Deductions
The payroll schedule shall be established by the County Manager and shall be administered by
the Finance Department. Each employee is responsible for entering their own time in the County’s
time keeping system based on the payroll schedule. Deductions shall be made from each
employee's salary, as required by law. Additional deductions may be made upon the request of
the employee on determination by the County Manager as to capability of payroll equipment and
appropriateness of the deduction.
Section 18. Hourly Rate of Pay for Full-time, Part- time and Temporary Employees and
for Work Weeks with Varying Hours
Employees working in a Part-time or temporary capacity with the same duties as Full-time
employees will work at a rate in the same salary range as the Full-time employees. The hourly
rate for employees working other than 40 hours per week, such as employees working 37.5 hours
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per week and law enforcement officers working an average 42 hours per week, will be determined by
dividing the average number of hours scheduled per year into the annual salary established for the
position.
Section 19. Longevity Pay
Full-time and eligible part-time employees are compensated for continuous employment with the County
by payment of a longevity supplement based on continuous years of service as of November 1st of
each year. Full-time and eligible part-time employees must be in active status as of November 1 of
the applicable year in order to receive longevity pay. Eligible part-time employees must
have worked at least 850 hours from November 1st of the previous year to
October 31st of the applicable year. Grant-funded positions may receive longevity pay, if
funds are available from the grant program.
Full-time and recurring part-time employees of the C ounty are compensated for continuous employment
with the County by payment of a longevity supplement based on continuous years of service as of
November 1st of each year. Full-time and recurring part-time employees must be in active status
as of November 1 of the applicable year in order to receive longevity pay. Grant-funded positions
may receive longevity pay, if funds are available from the grant program.
Longevity amounts shall be as follows:
Years of Service Percentage of Annual Salary
1 year, but less than 5 years .50%
5 years, but less than 10 years 1%
10 years, but less than 15 years 2%
15 years, but less than 20 years 3.25%
20 years, but less than 25 years 4.5%
25 year or more 5.75%
Longevity pay will be issued on the first regular pay period closest to the Thanksgiving Holiday or as
designated by the County Manager. The longevity pay benefit is a form of current compensation
that may be changed or eliminated at any time at the sole discretion of the Board of Commissioners.
The funding will be allocated on an annual basis during the budget adoption process.
Section 20. Overnight Supervision Incentive (DSS)
The County will provide a DSS overnight supervision shift incentive for 1st, 2nd and 3rd shifts as well
as holidays and weekends.
Shift Weekday Weekend
1st $25 $50
2nd $50 $75
3rd $75 $100
Weekday shifts (Monday-Friday) are 7:00 a.m-8:30 a.m., 5:00 p.m. -11:00 p.m. and 11:00 p.m.-7:00
a.m. Weekend shifts are 7:00 a.m.-3:00 p.m., 3:00 p.m.-11:00 p.m. and 11:00 p.m.-7:00 a.m. If the
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shift occurs on a County holiday, an additional $50 would be added to each shift covered by an
employee.
This additional incentive will not replace the employee’s ability to be paid for overnight supervision or
to earn compensatory time off if they are in overtime status.
Section 21. Providing Urgent Maternal Protection Act (PUMP Act)
Under the Fair Labor Standards Act, employees must be allowed the right to take reasonable break
time to express breast milk for their nursing child each time such employee has need to express the
milk. This right is available for up to one year after the child’s birth.
Covered employees must be provided with a place, other than a bathroom, that is shielded from view
and free from intrusion from coworkers and the public. This location must be functional as a space for
expressing break milk.
Under the FLSA, when an employee is using break time at work to express breast milk they either:
must be completely relieved of duty; or
must be paid for the break time.
Employees should inform their supervisor when they need to use this policy, so accommodations can
be arranged for a reasonable break time. Supervisors should clearly understand whether the
employee will be working during this break or will be completely relieved of duties to ensure accurate
pay for the employee.
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ARTICLE IV. RECRUITMENT AND EMPLOYMENT
Section 1. Equal Employment Opportunity Policy
It is the policy of the County to foster, maintain and promote equal employment opportunity. The
County shall select employees on the basis of the applicant's qualifications for the job and award
them, with respect to compensation and opportunity for training and advancement, including
upgrading and promotion, without regard to race, color, religion, sex, national origin,, qualified
disability, marital status, age, genetic information (including family medical history), marital status,
political affiliation, sexual orientation, status as parent, labor organization affiliation or non-affiliation,
or any other non-merit-based factor. Applicants with disabilities shall be given equal consideration
with other applicants for positions in which their disabilities do not represent an unreasonable barrier
to satisfactory performance of duties.
Section 2. Implementation of Equal Employment Opportunity Policy
All personnel responsible for recruitment and employment will continue to review regularly the
implementation of this policy and relevant practices to assure that equal employment opportunity
based on reasonable, job-related job requirements is being actively observed to the end that no
employee or applicant for employment shall suffer discrimination because of race, color, religion,
sex, national origin, qualified disability, marital status, age, genetic information (including family
medical history), marital status, political affiliation, sexual orientation, status as parent, labor
organization affiliation or non-affiliation, or any other non-merit-based factor. Notices with regard to
equal employment matters will be posted in conspicuous places on County premises in places
where notices are customarily posted.
Section 3. Recruitment, Selection and Appointment
Recruitment Sources. When position vacancies occur, the Human Resources Director shall
publicize these opportunities for employment, including applicable salary information and
employment qualifications. Information on job openings and hiring practices will be published in local
and/or other news media as necessary to inform the community and create a quality and diverse
pool of applicants. In addition, notice of vacancies shall be posted at designated conspicuous sites
within departments. Individuals shall be recruited from a geographic area as wide as necessary and
for a period of time sufficient to ensure that well-qualified applicants are obtained for County service.
In rare situations because of emergency conditions, high turnover, or other generally unavoidable
circumstances, the County, upon approval of the County Manager, may hire or promote without
advertising jobs. When hiring under these circumstances, however, the County shall continue to adhere
to the merit principles established in this Personnel Policy.
Job Advertisements. Employment advertisements shall contain assurances of equal employment
opportunity and shall comply with Federal and State statutes. Each applicant is notified of E-verify
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participation.
Application for Employment. All persons expressing interest in employment with the County shall
be given the opportunity to file an application for employment for positions which are currently
being recruited.
Selection. Department heads, with the assistance of the Human Resources Director, shall make
such investigations and conduct such examinations as necessary to assess accurately the
knowledge, skills, and experience qualifications required for the position. All selection devices
administered by the County shall be valid measures of job performance. Final candidates for
positions may be subject to a criminal background check, and if the position requires, a pre-
employment drug test. Pre-employment job function/fitness tests are required for some positions.
Appointment. Before any commitment is made to an applicant either internal or external, the
Department Head shall make recommendations to the Human Resources Director including the
position to be filled, the salary to be paid, and the reasons for selecting the candidate over other
candidates. The Human Resources Director and Department Head shall recommend approval of
appointments and the starting salary for all applicants to the Appointing or Hiring Authority. All
employment offers should be confirmed in writing. The Personnel Action Form, the original
application for employment, a copy of the employment offer letter, and any additional supporting
documents pertaining to the selected candidate should be submitted to the Human Resources office
prior to the beginning date of employment. The documents will become part of the new employee’s
personnel file.
Section 4. Probationary Period
An employee appointed or promoted to a regular position shall serve a probationary period.
Employees shall serve a nine-month probationary period, except that sworn law enforcement
personnel and department heads shall serve a twelve-month probationary period. Employees in
trainee or "Work Against" appointments will have specific time frames established for their
probationary period.
During the probationary period, supervisors shall monitor an employee's performance and
communicate with the employee concerning performance progress. Before the end of the
probationary period, the supervisor shall determine whether or not the employee is performing
satisfactory work and meeting job expectations. The employee's progress (accomplishments,
strengths, and areas for improvement) will be discussed with the employee and a summary of this
discussion should be documented in the employee's personnel file. The supervisor shall recommend
in writing whether the probationary period should be completed, extended, or the employee
transferred, demoted, or dismissed.
Disciplinary action, including demotion and dismissal, may be taken at any time during the
probationary period of a new hire without following the steps outlined in this Policy. In other words,
an employee in the probationary period is treated as an “at will” employee. A promoted or
transferred employee who does not successfully complete the probationary period in the employee’s
new position may be transferred or demoted to a position in which the employee shows promise of
success. If no such position is available, the employee shall be dismissed. Promoted or transferred
employees shall retain all other rights and benefits such as the right to use the grievance procedures,
provided the employee has completed the minimum probationary period for their initial position
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(typically 9-12 months).
Section 5. Promotion
Promotion is the movement of an employee from one position to a vacant position in a class
assigned to a higher salary range. It is the County's policy to create career opportunities for its
employees whenever possible. Therefore, when a current employee applying for a vacant position
is best suited of all applicants, that applicant shall be promoted to that position. The County will
balance three goals in the employment process:
a) the benefits to employees and the organization of promotion from within;
b) providing equal employment opportunity and a diversified workforce to the community; and
c) obtaining the best possible employee who will provide the most productivity in that position.
Therefore, except in rare situations where previous County experience is essential or exceptional
qualifications of an internal candidate so indicate, the County will consider external and internal
candidates rather than automatically promote from within. Candidates for promotion shall be chosen
on the basis of their qualifications and their work records. Internal candidates shall apply for
promotions using the same application process as external candidates.
Section 6. Demotion
Demotion is the movement of an employee from one position to a position in a class assigned to a
lower salary range. Demotions may be voluntary or involuntary. An employee whose work or conduct
in the current position is unsatisfactory may be involuntarily demoted provided that the employee
shows promise of becoming a satisfactory employee in the lower position. Such demotion shall follow
the disciplinary procedures outlined in this chapter. Demoted employees may appeal this decision
based on the Grievance Process outlined in this Personnel Policy.
An employee may request a voluntary demotion when a vacant position is available. Employees may
request voluntary demotions in order to accept a position with less complex duties and reduced
responsibilities, to change career paths, or for other reasons. A voluntary demotion is not a
disciplinary action and is made without using the above-reference disciplinary procedures.
Section 7. Transfer
Transfer is the movement of an employee from one position to a position in a class in the same salary
range. If a vacancy occurs and an employee in another department is eligible for a transfer, the
employee shall apply for the Transfer using the usual application process. The Department Head
wishing to Transfer an employee to a different department or classification shall make a
recommendation to the County Manager. Any employee transferred without requesting the action
may appeal the action in accordance with the grievance procedure outlined in this policy. Employees
who are transferred to a different department will serve a nine-month probationary period.
Section 8. AccommodationsReasonable Accommodation
The County is committed to complying with the Americans Disability Act (ADA), Pregnancy
Discrimination Act, the Americans with Disabilities Amendment Act (ADAA), and applicable State
laws, and maintains equal opportunity in employment for all qualified persons with disabilities and
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those who are pregnant. The County is committed to complying with the Americans with Disabilities
Act (“ADA”) and North Carolina law. Accordingly, the County will provide a reasonable
accommodation to qualified individuals with disabilities, unless it creates an undue hardship or poses
a direct threat to the health and safety of others. While many pregnant individuals and individuals
with disabilities can work without accommodations, other qualified applicants and employees face
barriers to employment without the accommodation process. You should make a request for a
reasonable accommodation to your Department Head. The request should be made in writing
This policy is to assist employees and applicants for employment in requesting and processing
reasonable accommodation requests. This policy also prohibits retaliation against employees.
The employee shall inform their supervisor and Human Resources Director or designee of the need
for an accommodation. Supervisors who have been notified by an employee of an accommodation
request should contact Human Resources for assistance.
Reasonable Accommodation (Disability)
An employer is required to make a reasonable accommodation to the known disability of a qualified
applicant or employee if requested and if it would not impose an “undue hardship” on the operation
of the employer’s business. For the purposes of this policy, (i) a “qualified applicant or employee” is
synonymous with a “qualified individual,” as that term is used in the Americans with Disabilities Act,
and (ii) “undue hardship” has the same meaning as used in the Americans with Disabilities Act.
Reasonable accommodation for a disability may include, but is not limited to:
Making existing facilities used by employees readily accessible to and usable by persons with
disabilities such as modifying existing office equipment for an employee in a wheelchair.
Job restructuring, modifying work schedules, reassignment to a vacant position such as
allowing an employee with diabetes regularly scheduled breaks during the workday to eat
properly, monitor blood sugar and insulin levels, or allowing an employee with cancer leave
to have radiation or chemotherapy treatments.
Acquiring or modifying equipment or devices, adjusting or modifying examinations, training
materials, or policies, and providing qualified readers or interpreters such as providing a deaf
applicant a sign language interpreter during the job interview or providing a blind employee
someone to read information posted on a bulletin board. Agencies may consider proposing
temporary accommodation(s) if the agreed upon accommodation cannot be provided
immediately.
Reasonable Accommodation (Pregnancy) – The Pregnant Workers Fairness Act
A covered employer is required to make a reasonable accommodation for known limitations related
to pregnancy, childbirth, or related medical conditions of a qualified applicant or employee if
requested and if it would not impose an “undue hardship” on the operation of the employer’s
business.
Reasonable accommodations for these known pregnancy-related limitations may include:
Redistributing marginal or nonessential functions (for example, occasional lifting) that a
pregnant worker cannot perform, or altering how a non-essential or marginal function is
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performed.
Redistributing an essential function of a job if:
o • any inability to perform an essential function is for a temporary period;
o • the essential function could be performed in the near future; and
o • the inability to perform the essential function can be reasonably accommodated.
Modifying workplace policies, such as allowing a pregnant worker more frequent breaks or
allowing her to keep a water bottle at a workstation even though keeping drinks at
workstations is generally prohibited.
Modifying a work schedule so that someone who experiences severe morning sickness can
arrive later than her usual start time and leave later to make up the time not eligible for FMLA
or other types of leave. Employers shall not require an employee to accept an
accommodation other than any reasonable accommodation arrived at through the interactive
process. Employers shall not require an employee to take leave, whether paid or unpaid, if
another reasonable accommodation can be provided. The employer shall not deny
employment opportunities to an applicant or employee if the denial is based on the need to
make reasonable accommodations to the known limitations related to pregnancy, childbirth,
or related medical conditions.
Applicants:
The job applicant shall inform the hiring official or Human Resources Director/designee of the
need for an accommodation. Hiring officials who have been notified by an applicant of a need
for accommodation should contact Human Resources for assistance. The Human Resources
Director/designee will discuss the needed accommodation and possible alternatives with the
applicant.
The County Manager and the Human Resources Director/designee will make a decision
regarding the request for accommodation and, if approved, take the necessary steps to see
that the accommodation in provided.
Time Frame for Processing Requests and Providing Reasonable Accommodations
Requests for a reasonable accommodation should be processed as soon as reasonably possible and
generally in no more than thirty (30) days from the date the request is made. Human Resources will
process requests and provide accommodations, where appropriate, in as short of a period as
possible. It is recommended that the employee work closely with their healthcare provider to
expedite their response. Human Resources may extend the deadline as necessary due to
unforeseen circumstances. Situations may warrant provision of a temporary or trial accommodation.
The County is also committed to providing a reasonable accommodation of an Employee’s sincerely
held religious belief, when required by law, unless doing so would create an undue hardship for the
Department. The employee shall inform their supervisor and Human Resources Director or designee
of the need for a religion accommodation. Supervisors who have been notified by an employee of
such accommodation request should contact Human Resources for assistance
You should make a request for a reasonable accommodation to your Department Head. The request should be
made in writing.
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ARTICLE V. CONDITIONS OF EMPLOYMENT
Section 1. Work Schedule
Department Heads shall establish work schedules, with the approval of the County Manager, which
meet the operational needs of the department in the most cost-effective manner possible.
Section 2. Political Activity
Each employee has a civic responsibility to support good government by every available means and
in every appropriate manner. Each employee may join or affiliate with civic organizations of a
partisan or political nature, may attend political meetings, may advocate and support the principles
or policies of civic or political organizations in accordance with the Constitution and laws of the State
of North Carolina and in accordance with the Constitution and laws of the United States. However,
no employee shall:
a) Engage in any political or partisan activity while on duty;
b) Use official authority of influence for the purpose of interfering with or affecting the result of
a nomination or an election for office;
c) Be required as a duty of employment or as condition for employment, promotion or tenure
of office to contribute funds for political or partisan purposes;
d) Coerce or compel contributions from another employee of the County for political or
partisan purposes;
e) Use any supplies or equipment of the County for political or partisan purposes; or
County employees in certain federally-funded programs are subject to the Hatch Act, as amended
in 1975. This federal act, in addition to prohibiting (b), (c), and (d) above, also prohibits candidacy
for elective office in a partisan election. This policy is not intended to intrude upon any First
Amendment or Fourteenth Amendment rights of County Employees.
Any violation of this section shall be deemed improper conduct and shall subject the employee to
disciplinary action under this Policy.
Section 3. Expectation of Ethical Conduct
The proper operation of County government requires that public officials and employees be
independent, impartial, and responsible to the people; that governmental decisions and policy be
made in the proper channels of the governmental structure; that public office not be used for personal
gain; and that the public have confidence in the integrity of its government.
As stewards of public resources and holders of the public trust, County employees are expected to
up hold the highest standards of ethical conduct while fulfilling their job duties and responsibilities.
No employee of the County shall accept any gift, favor, or thing of value (more than $50) from
organizations, business firms, or individuals with whom they have official relationships because of
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County business. These limitations do not prohibit the acceptance of articles of negligible value
which are distributed generally, nor prohibit employees from accepting social courtesies that provide
good public relations, not prohibit employees from obtaining loans from public lending institutions. It
is particularly important that inspectors, contracting officers, and law enforcement officers guard
against relationships that might be construed as evidence of favoritism, coercion, unfair advantage,
or collusion.
Section 4. Outside Employment
The work of the County shall have precedence over other occupational interests of employees. All
outside employment for salaries, wages, or commission and all self-employment must be reported
in advance to the employee's supervisor, who in turn will report it to the County Manager. The County
Manager will review such employment for possible conflict of interest and then approve or disapprove
the secondary employment. Documentation of the approval of outside employment will be placed in
the employee’s personnel file. Any employee who obtains outside employment but does not receive
approval for such employment under this policy shall be subject to disciplinary action up to and
including dismissal.
Examples of conflicts of interest in outside employment include but are not limited to:
a) employment with organizations or in capacities that are regulated by the employee or
employee’s department; or
b) employment with organizations or in capacities that negatively impact the employee’s
perceived integrity, neutrality, or reputation related to performance of the employee’s County
duties.
Off the job injuries: An employee who sustains an injury or illness in connection with outside
employment and is receiving Workers’ Compensation from that employer shall not be eligible to use
accrued sick leave.
Section 5. Dual Employment
The County does not typically allow employees to hold more than one position with the County. In
some cases, the County may make such an allowance, in its sole discretion. In the event the County
makes such an allowance, one job shall be designated the primary position, and one shall be
designated as the secondary position.
Section 6. Employment of Relatives
The County prohibits the hiring and employment of immediate family in permanent positions within
the same work unit. "Immediate Family" is defined herein. If there is a lack of qualified applicants
for a position in the same work unit and a qualified immediate family member applies, the supervisor
may request the County Manager for an exception. Outside of the same work unit, the County will
consider employing family members or related persons in the service of the County, provided that
such employment does not:
a) result in a relative supervising relatives;
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b) result in a relative auditing the work of a relative;
c) create a conflict of interest with either relative and the County; or
d) create the potential or perception of favoritism.
Section 7. Harassment
Harassment on the basis of race, color, religion, gender, national origin, age, disability, or any other
class protected by any applicable law, constitutes discrimination. The County opposes harassment
by supervisors and co-workers in any form. Harassment is verbal or physical conduct that denigrates
or shows hostility or aversion toward an individual because of his or her race, color, religion, sex,
national origin, qualified disability, marital status, age, genetic information (including family medical
history), marital status, political affiliation, sexual orientation, status as parent, or labor organization
affiliation or non-affiliation, or that of his or her relatives, friends, or associates.
Sexual harassment is defined as unwelcome sexual advances, requests for sexual favors, and other
verbal or physical conduct of a sexual nature when a) submission to such conduct is made either
explicitly or implicitly a term or condition of an individual's employment; b) submission to or rejection
of such conduct by an individual is used as the basis for employment decisions affecting such
individual; or c) such conduct has the purpose or effect of unreasonably interfering with an
individual's work performance or creating an intimidating, hostile, or offensive working environment.
Any employee who believes that he or she may have a complaint of harassment may follow the
Grievance Procedure described in this Policy or may file the complaint directly with the County
Manager, Human Resources Director, or any department head who will advise the Human
Resources Director of the complaint. The Human Resources Director will insureensure that an
investigation is conducted into any allegation of harassment and advise the employee and
appropriate management officials of the outcome of the investigation.
Employees witnessing harassment shall also report such conduct to an appropriate County official.
Employees who report or make a complaint of harassment will not be subject to retaliation for doing
so.
Section 8. Use of County Time, Equipment, Supplies, and Vehicles
County supplies and equipment are to be used exclusively for the County's business. During working
hours, an employee shall only conduct County business. Use of County time, supplies, or equipment
for personal or other purposes not related to the employee’s County duties and responsibilities is
prohibited and subjects the employee to disciplinary action, up to and including dismissal.
All employees, who use County vehicles are required to follow applicable motor vehicle and safety
requirements, may be subject to random drug tests and annual driver’s license checks. Family
members are not to be transported in County vehicles. Violation or misuse of County vehicles also
subjects the employee to disciplinary action, up to and including dismissal.
County equipment, materials, tool and supplies, shall not be available for personal use and are not
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to be removed from County property except in the conduct of official County business, unless
approved by the Board. No employee shall purchase for personal use any equipment or supplies
through County purchase accounts.
Separate policies covering the use of phones, email, computers, county cell phones and vehicles
are available in the HR office or on the County website.
Under North Carolina law, email sent or received by the County is generally considered a public
record and is subject to inspection upon request, and employees should therefore use caution with
email correspondence and follow all applicable laws and regulations in relation to the same
Surrender of Property. An employee who terminates employment shall be required to return all items
of equipment, including uniforms, ID badge, keys, credit cards, P-cards and other items owned by
the County. Pursuant to applicable law, if County owned property is not returned within established
timeframes, the County reserves the right to withhold portions of the employee’s final check until the
items are returned.
Section 9. Performance Evaluation
Supervisors and/or Department Heads shall conduct Performance Evaluation conferences with each
employee on or around their Anniversary Date. These performance evaluations shall be documented
in writing and placed in the employee's personnel file. The performance evaluation policy is available
in the HR office or on the County website.
Section 10. Safety
Safety is the responsibility of both the County and employees. It is the policy of the County to
establish a safe work environment for employees. The County shall establish a safety program
including policies and procedures regarding safety practices and precautions and training in safety
methods. Department Heads and supervisors are responsible for insuringensuring the safe work
procedures of all employees and providing necessary safety training programs. Employees shall follow
the safety policies and procedures and attend safety training programs. Employees who violate such
policies and procedures shall be subject to disciplinary action up to and including dismissal.
Additional detailed procedures regarding safety, worker's compensation, injury, and infection control
may be established by the County Manager.
Section 11. Immigration Law Requirements
All employees are required to furnish proof of citizenship or other required documents indicating a
legal right to work in the United States. Copies of the completed I-9 form shall be a permanent part
of their personnel file. The County uses E-verify which is an Internet-based system operated by the
U.S. Department of Homeland Security (DHS) in partnership with the Social Security Administration
(SSA) that allows participating employers to electronically verify the employment eligibility of their
newly hired employees. E-verify works by electronically comparing the information on an
employee’s Form I-9 with SSA and DHS records to verify the identity and employment eligibility of
each newly hired employee and/or employee assigned to a covered federal contract. All new,
temporary, and rehire employees must be entered into E-verify individually.
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Section 12. Substance Abuse and Employee Assistance Program
The County is firmly committed to maintaining a drug and alcohol-free work environment in order to
insureensure the safety and welfare of the general public and all County employees and to insureensure
an efficient and effective work force. The County also seeks to aid employees experiencing
substance abuse problems by offering rehabilitation opportunities. The County Manager has the
authority to establish, administer, and enforce substance abuse processes and procedures within the
County. A separate Substance Abuse Policy is available in the HR office or on the County
website. An Employee Assistance Program is available to County employees through the County’s
insurance. Contact the HR office for details or refer to your insurance card.
Section 13. Credentials and Certifications
Some duties assigned to positions in local government service may be performed only by persons
who are duly licensed, registered or certified as required by the relevant law, rule or regulation.
Employees in such classifications are responsible for maintaining current, valid credentials as
required by law, rule or regulation. Failure to obtain or maintain the required credentials may be a
basis for immediate dismissal without prior warning. An employee who is dismissed shall be given
a written statement of the reason for the action and his/her appeal rights.
Section 14. Travel rules and Regulations.
The policy of the County is to reimburse employees traveling on authorized County business for work
related expenses incurred as a result of the travel. Each department head is responsible for
authorization of employee travel and the reimbursement of travel expenses in accordance with
procedures issued periodically by the finance department. The County Manager shall authorize and
approve travel for department heads.
Section 15. Internet access.
The County provides Internet access via various computers throughout the county offices. Any
employee utilizing the Internet shall comply with the Acceptable Computer Use & Security Policy.
Violation of this policy represents grounds for dismissal.
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ARTICLE VI. EMPLOYEE BENEFITS
Section 1. Eligibility
All Full-time employees of the County who are in permanent positions are eligible for employee
benefits as provided for in this Article which are subject to change at any time at the County's
discretion. Temporary and Part-time employees are eligible only for workers' compensation and
social security.
Section 2. Group Health and Hospitalization Insurance
The County provides group health and hospitalization insurance programs for Full-time permanent
employees.
Employees may add dependents to the group health and hospitalization insurance at a cost paid by
the employee.
Information concerning cost and benefits shall be available to all employees from the Human
Resources Office.
Section 3. Group Life Insurance
The County provides paid life insurance to its employees. Information on costs, coverage, and
benefits are available from the Human Resources Office.
Section 4. Other Optional Group Insurance Plans
The County may make other group insurance plans available to employees upon authorization of
the County Manager or County Board. Information on costs, coverage, and benefits are available
from the Human Resources Office.
Section 5. Retirement
Each employee who is expected to work for the County more than 1,000 hours annually shall join
the North Carolina Local Governmental Employees' Retirement System when eligible as a condition
of employment. New hires who are current members of the NC Local or State Government
Employees’ Retirement System will likely be covered under the retirement system as of their first day
of employment.
Employees contribute, through payroll deduction, six percent of their gross salary to the system. The
County contributes an actuarially determined percentage of the gross payroll each month to the
system.
Provisions of this system are further outlined in the North Carolina Local Government Employees'
Retirement System handbook available from the Human Resource Office. Please note that the
specifics of this program may change from time to time and the provisions of LGERS, not this
Handbook, will apply.
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Please also note that law enforcement officers may be covered by the Law Enforcement Officer’s
Benefit and Retirement Fund, which applies different criteria. Information on the NCLEOBRF can be
found in the Human Resources Department.
Retiree Health Insurance
A Regular, Full-time employee of the County who applies for and receives full or reduced LGERS or
NCLEOBRF retirement may continue comparable individual coverage as is provided to active, full
time County employees. In the event the County requires its active Full-time employees to pay a
pro-rated share of his or her individual medical insurance costs, eligible retirees will also be required
to pay the same pro-rated share as active Full-time employees. The cost for the employee’s share
of the premiums, if any, will be determined on an annual basis.
Retiree health benefits are provided on the following pro-rated basis based on years of service with
Person County: If there is a break of service with the County, and the employee returns to work in
less than one year in a full-time status, the County will combine the first and second full-time
employment periods to qualify the employee for health insurance purposes. The second employment
period must total a minimum of 5 years.
a) The County will pay 50% of the cost of comparable individual coverage for an employee
retiring with 20 years of Continuous Employment with Person County;
b) The County will pay 75% of the cost of comparable individual coverage for an employee
retiring with 25 years of Continuous Employment with Person County;
c) The County will pay 100% of the cost of comparable individual coverage for an employee
retiring with 30 years of Continuous Employment with Person County.
Coverage will continue until the employee becomes eligible for Medicare, at which time the County
will no longer pay for comparable coverage.
In the event the eligible retiree chooses to cancel or elects not to participate in the retirement health
insurance benefit, or otherwise is disqualified for receipt of the retirement health insurance benefit,
the eligible retiree will not be allowed to reapply for the retirement health insurance benefit at a later
date.
The retirement health insurance benefit will be applied only to eligible retirees. Should an eligible
retiree wish to continue benefits for a dependent, the eligible retiree may do so at the same level
allowed for active, full time employees, and at his or her own personal expense. Dependent coverage
will terminate at the death of the retired employee.
Service time credit with the County will be calculated based on actual service time and any sick
leave time that is on balance with the County at the time of retirement.
The County has the sole discretion to change providers, determine the amount of pro-rated shares,
and to determine coverage or plan options for both active employees and eligible retirees.
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Section 6. Supplemental Retirement Benefits (401-K)
The County allows employees to defer a portion of their income before taxes into a 401-K tax
deferment plan. The County provides contributions of 5% to a 401-K plan for active law enforcement
personnel as required by the state, and an amount to be determined by the County Commissioners
to other full -time permanent employees.
The County also pays a monthly separation allowance to retired law enforcement officers as required
by General Statues.
The County may choose to offer other deferred compensation or supplemental programs.
Section 7. Social Security
The County, to the extent of its lawful authority and power, has extended Social Security benefits for
its eligible employees and eligible groups and classes of such employees.
Section 8. Workers' Compensation
All employees of the County (Full-time, Part-time, and temporary) are covered by the North Carolina
Workers' Compensation Act and are required to report all injuries arising out of and in the course of
employment to their immediate supervisors at the time of the injury in order that appropriate action
may be taken.
Employees may elect to use sick leave and/or vacation both during the waiting period before
Workers' compensation benefits begin, and afterward to supplement the remaining one-third of
salary, except that employee may not exceed the regular salary amount using this provision. This
provision also applies to reactions to small pox vaccinations administered to County employees
under Section 304 of the Homeland Security Act. Such reactions shall be treated the same as any
other workers compensation claim as regards leave and salary continuation.
Responsibility for claiming compensation under the Workers' Compensation Act is on the injured
employee. Supervisors and employees should place Human Resources on notice of any work-
related accident immediately after it occurs, if possible. The Human Resources department will
coordinate the filing of such claims.
Section 9. Unemployment Compensation
County employees are covered by unemployment insurance. County employees who are terminated
due to a reduction in force or released from County service may apply for benefits through the local
Employment Security Commission office, where a determination of eligibility will be made.
Section 10. Tuition Assistance Program
Full-time employees who have completed initial probation may apply for tuition reimbursement for
courses taken on their own time, which will improve their skills for their current job or prepare them
for promotional opportunities within the County service. Tuition, registration, fees, laboratory fees,
and student fees are eligible expenses. Employees may be reimbursed eligible expenses up to a
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total of $2,500 per fiscal year. Satisfactory completion of the courses will be required for
reimbursement. Requests for tuition assistance shall be submitted to the Department Head in writing
prior to course registration and are subject to the review and approval of Department Head, HR
Director and County Manager Requests for tuition reimbursements should be submitted prior to the
upcoming fiscal year to ensure funding is available. If an employee terminates within 3 years of tuition
reimbursement he/she will be required to reimburse the County a pro-rated amount.
Termination after tuition reimbursement Payback amount
Less than 1 year 100%
1 year, but less than 2 years 50%
2 years, but less than 3 years 25%
Section 11. Credit Union
Membership in the Local Government Employees' Credit Union is open to all County employees for
various loan services, checking, and savings accounts. Membership in the State Employees' Credit
Union is open to all employees under the State Human Resources Act and their family members for
various loan services, checking, and savings accounts.
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ARTICLE VII. HOLIDAYS AND LEAVES OF ABSENCE
Section 1. Policy
The policy of the County is to provide annual leave, sick leave, and holiday leave to all Full-time
employees in a permanent position with the County. Leave balances accrue with each payroll cycle
(excluding when a third check is issued in a month) when employees are working or are in a paid
leave status. Leave balances should be printed on payroll checks or provided to employees with
each paycheck, including net accrued sick leave, annual, holiday leave, and compensatory leave.
Section 2. Holidays
The policy of the County is to follow the holiday schedule as published by the State of North Carolina
each year. The schedule for the calendar year will be published by December 1 of the previous
calendar year for distribution to County employees. Public safety employees, regularly scheduled to
work 2,184 hours per year, will receive 8.4 hours of Holiday Pay for each holiday. Eemployees
regularly scheduled to work 2,080 hours per year will be entitled to receive 8 hours of Holiday Pay
for each holiday, and employees regularly scheduled to work 1,950 hours per year will be entitled
to receive 7.5 hours of Holiday Pay for each holiday.
Section 3. Holidays: Effect on Other Types of Leave
Regular holidays which occur during annual, sick or other leave period of any employee shall not be
considered as annual, sick, or other leave.
Section 4. Holidays: Compensation When Work is Required
Public Safety employees required to perform work on regularly scheduled holidays shall be entitled
to receive 8.4 hours pay for the holiday, regardless of the time spent working. In other words, if a Public
Safety Employee works 10 hours on a holiday, the employee will be paid their regular wage for the
actual time worked, plus 8.4 hours of holiday pay.
All other employees who are required to work on a holiday, or work longer hours on non-holidays
during the week of a holiday (for non-exempt employees only), will be entitled to receive either 7.5
or 8 hours of holiday pay depending on their work schedules as described above. Any earned holiday
pay which is in excess of the employee’s standard weekly pay will be “banked” as holiday time, and
shall be used before any annual leave or compensatory time is applied. For example, if a non-
exempt employee usually works 37.5 hours a week, works 32 hours Monday through Thursday,
and does not work on the Friday Holiday, 5.5 hours of holiday time will be used in order to ensure
the employee receives his or her regular weekly wage, and 2 hours of time will be “banked” for the
employees’ use in the future. In the event this same employee worked 30 hours Monday through
Thursday, the employee would be paid for all 7.5 hours of holiday pay. Any unused holiday hours
will be paid out. Payout will occur twice a year on the last paydays of June and December. This
enables employees to schedule time off during the year to use the banked holiday hours before
payout.
Upon termination, an employee will be paid for any unused holiday time that is available.
Departments with employees working a shift schedule will compensate those employees for working
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on the “true” holiday.
Section 5: Wellness Day
While prioritizing the well-being of employees, the county will provide regular full-time employees with
an annual accrual for a Wellness Day. This day can be utilized to support both mental and physical
well-being. The accrual rate will align with sick accruals. Any unused Wellness Day at the end of the
calendar fiscal year will not carry over and must be used in a one-day increment. Approval from the
supervisor is necessary for utilizing the Wellness Day. Although we recognize that the purpose of this
day may not always allow for advanced notice, employees are expected to provide as much notice as
possible.
Section 6. Annual Leave
Annual leave may be used for any purpose. Full-time Employees (including Probationary
employees) must request annual leave from their supervisor with as much advance notice as
possible, or as determined by the Department Head. Annual leave may also be used by employees
who wish to observe religious holidays other than those granted by the County, upon request in
advance. Supervisors are responsible for ensuring proper staff coverage and may refuse annual
requests when they create a hardship for the County
Section 7. Annual Leave: Accrual Rate
Full-time Employees (including probationary employees) of the County shall earn annual leave at
the following schedule:
Years of Service Days Accrued Per Year
0-2 years 12 days
3-4 years 15 days
5-9 years 17 days
10-14 years 20 days
15-19 years 22 days
20 plus years 25 days
Annual leave should be accrued in each payroll period on a pro-rated basis.
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Section 8. Annual Leave: Maximum Accumulation
Annual leave may be accumulated without any applicable maximum until December 31 of each year.
Effective the last payroll in the calendar year, any employee with more than 30 days of accumulated
leave shall have the excess accumulation converted to sick leave so that only 30 days are carried
forward to January 1 of the next calendar year.
Because the number of hours in employee work weeks vary, the number of hours in 30 days varies.
Hours Worked Accumulated Maximum
37.5-hour work week 225 hours
40-hour work week 240 hours
Sheriff’s Office, EMS, Communications 252 hours
Employees are cautioned not to retain excess accumulated annual leave until late in the year.
Because of the necessity to keep all functions in operation, large numbers of employees cannot be
granted annual leave at any one time. If an employee has excess leave accumulation during the
latter part of the year and is unable to take such leave because of staffing demands, the employee
shall receive no special consideration either in having annual leave scheduled or in receiving any
exception to the maximum accumulation. Employees may not receive pay for excess annual leave
time.
Section 9. Annual Leave: Manner of Taking
Employees shall be granted the use of earned annual leave upon request in advance at those times
designated by the Department Head which will least obstruct normal operations of the County.
Department heads are responsible for insuring that approved annual leave does not hinder
the effectiveness of service delivery. Annual leave will be taken in quarter hour units.
Section 10. Annual Leave: Payment upon Separation
An employee who has successfully completed their initial probationary period will normally be paid
for accumulated annual leave upon separation subject to the 30-day maximum, provided notice is
given to the supervisor at least two weeks in advance of the effective date of resignation. Department
Heads are required to give a 30-day notice. Any employee failing to give the notice required by this
section shall forfeit payment for accumulated leave. The notice requirement may be waived by the
County Manager when deemed to be in the best interest of the County.
Non-probationary employees who are involuntarily separated shall receive payment for accumulated
annual leave subject to the 30-day maximum.
Probationary Employees will not receive payment for any accumulated annual leave should their
employment end during or at the end of the Probationary Period.
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Section 11. Annual Leave: Payment upon Death
The estate of an employee who dies while employed by the County shall be entitled to payment of
all the accumulated annual leave credited to the employee's account not to exceed the 30-day
maximum.
Section 12. Sick Leave
Sick leave with pay is not a right which an employee may demand, but a privilege granted for the
benefit of an employee when sick. Sick leave may be granted to a Full-time employee (including
probationary employees) absent from work for any of the following reasons: sickness, bodily injury,
required physical or dental examinations or treatment, or exposure to a contagious disease, when
continuing work might jeopardize the health of others.
Sick leave may be used when an employee must care for a member of his or her immediate family
who is ill, but may not be used to care for healthy children when the regular care giver is sick.
Sick leave may also be used to supplement Workers' Compensation Disability Leave both during the
waiting period before Workers' Compensation benefits begin, and afterward to supplement the
remaining salary, except that employees may not exceed their regular salary amount using this
provision.
"Immediate family" is defined in the definitions section of this Policy.
Notification of the desire to take sick leave should be submitted to the employee's supervisor prior to
the leave when the need for leave is known. When unknown, the employee should notify his or her
supervisor no later than two hours prior to the beginning of the scheduled workday. Please note that
different departments may specifically require more than two (2) hours’ notice. Failure to do so
appropriately may result in disciplinary action.
In the event the employee needs to take more than three (3) consecutive days of sick leave, the
employee should inform his or her supervisor or Human Resources of the same so that the employee
can appropriately be considered for FMLA. Supervisors should ensure that Human Resources is
aware of any absence that exceeds three (3) consecutive days.
Employees who take an entire day of sick leave will be paid based on the hours scheduled to work
on that day. Payment for sick leave hours in excess of the employee's scheduled work hours shall
not be an option. Sick leave will generally be authorized only for the time off that would fall on a
scheduled workday.
In order to facilitate the recruitment of qualified persons with appropriate public-sector experience,
the County Manager may authorize the carry-over of all of the unused sick leave that has been
certified as accumulated during employment with a past state or local government employer under
the State or Local Government Employees Retirement System.
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Section 13. Sick Leave: Accrual Rate and Accumulation
Sick leave shall accrue at a rate of one day per month of service or twelve days per year for full time
employees. Sick leave will be cumulative for an indefinite period of time and may be converted upon
retirement for service credit consistent with the provisions of the North Carolina Local Government
Employees' Retirement System.
All sick leave accumulated by an employee shall end and terminate without compensation when the
employee resigns or is separated from the County, except as stated for employees retiring pursuant to
the terms of the North Carolina Local Government Retirement System. Sick leave will be kept on file
for five years with the County.
Section 14. Sick Leave: Medical Certification
The employee’s supervisor or Department Head may require a physician's certificate stating the
nature of the employee or immediate family member's illness and the employee's capacity to resume
duties, for each occasion on which an employee uses sick leave, whenever the supervisor observes a
"pattern of absenteeism,” or for other applicable reasons. The employee may be required to submit to
such medical examination or inquiry as the Department Head deems desirable. The Department Head
shall be responsible for the application of this provision to the end that:
a) Employees shall not be on duty when they might endanger their health or the health of
other employees; and
b) There will be no abuse of leave privileges.
Claiming sick leave under false pretense to obtain a day off with pay shall subject the employee to
disciplinary action.
Section 15. Bereavement Leave
Person County recognizes the importance of supporting employees as they grieve the loss of a
family member. Bereavement leave may be used for death in the full-time employee's immediate
family but may not exceed three consecutive days for any one occurrence. An employee may not
use more bereavement leave than what he or she is scheduled to work on the day being missed
and cannot use bereavement leave to be paid more than the employee’s scheduled work hours for
the week. Additional time off for the loss of a family member or to grieve the loss of an individual
outside the definition of an immediate family member may be requested. Such leave must be
approved by the supervisor. If approved, the time off must be charged to annual leave, holiday
leave, sick leave, or other accrued leave. Paid leave must be exhausted before leave without pay is
requested.
Documentation may be requested by the supervisor for the need for bereavement leave.
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Section 16. Extended Leave
A full -time permanent employee may be granted an extended leave of absence for a period of up to
six months by the County Manager. The leave should be used for reasons of personal disability,
sickness or disability of immediate family members, continuation of education, special work that will
permit the County to benefit by the experience gained or the work performed, or for other reasons
deemed justified by the County Manager.
The employee shall apply in writing to the Department Head for leave and the Department Head will
forward to the County Manager. The employee is obligated to return to duty within or at the end of
the time determined appropriate by the County Manager unless otherwise required by law. Upon
returning to duty after being on leave for up to six months the employee shall be entitled to return to
the same position held at the time leave was granted or to one of like classification, seniority, and
pay. After the six months of leave, the County will make all efforts to return the employee to the
same position held at the time leave was granted, or to a position of like classification, seniority, and
pay, but an employee is not entitled such reinstatement unless otherwise required by law. If the
employee decides not to return to work, the Department Head shall be notified immediately. Failure
to report at the expiration of a leave of absence, unless an extension or other type of accommodation
has been requested, shall be considered a resignation.
An employee on an extended leave of absence will be required to exhaust any unused holiday hours,
compensatory time, sick leave, annual leave, or other paid leave prior to going into a leave without
pay status. While in a paid leave status, all benefits and entitlements which would normally accrue
will continue to accrue. While in a leave without pay status, the employee may continue to be eligible
for benefits under the County’s Group insurance plans at his or her own expense, subject to any
regulation adopted by the County Commissioners, the regulations of the insurance carrier, and any
other federal, state or local la. At the time at which a triggering event occurs, an Employee will be
provided with a COBRA notice.
Leave for a permanent Part-time employee will be considered on a case by case basis, and will be
allowed in the sole discretion of the County.
Section 17. Parental Leave
After successful completion of the probationary period, regular full-time employees who are new
parents from the birth of a child or who legally adopt a child and who intend to return to work are
given 30 paid days of new parent leave. Requests for such leave should be made in writing at least
60 days before the start of the requested parental leave. Leave must be used concurrently with
Family Medical Leave (FMLA) and will begin on the first day out. A doctor’s note will be required to
begin the leave period and continue as approved by a doctor. Insurance benefits will continue during
parental leave as will accrual of paid vacation and sick leave. If both parents work for the County
and want to use parental leave, it cannot exceed 30 days combined.
Effective July 1, 2019
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Section 18. Family Medical Leave
The County will grant family and medical leave of up to 12 weeks and up to 26 weeks of military
caregiver leave, during any calendar year, to eligible employees in accordance with the Family and
Medical Leave Act.
Eligible employees will receive compensation for up to two weeks of paid time off at the beginning of
Family Medical Leave, which may be on a continuous or intermittent basis. (Employees who receive
parental leave do not receive additional paid Family Medical Leave.)
Paid leave will be based on the employee’s regular work schedule. During the FMLA period, eligible
employees are required to exhaust all available paid leave before going on a leave without pay, and
such paid time should be coordinated with the County’s annual, sick leave and compensatory time
off policies. Employees must also use any paid time off which is accrued while they are in a paid
leave status prior to going on a leave without pay. Once available paid leave has been exhausted,
the remaining FMLA leave period will be unpaid. Additional time away from the job beyond the 12-
week period may be approved in accordance with the County’s leave without pay policy.
To qualify for FMLA coverage, the employee must have been employed by the County for at least
12 months; which do not have to be consecutive. However, the employee must have worked 1,250
hours during the twelve-month period immediately before the date when the FMLA leave is
scheduled to begin.
Leave can be used for the following reasons:
a) For incapacity due to pregnancy, prenatal medical care or child birth;
b) For the birth of, and to care for, the employee’s child after birth;
c) For placement of a child with employee for adoption or for foster care;
d) To care for the employee’s spouse, son or daughter or parent, who has a serious health
condition;
e) For a serious health condition that makes the employee unable to perform the functions of
their job;
f) To care for the employee’s spouse, child, parent or next of kin who is a Covered Service
member with a Serious Injury or Illness incurred while on active duty (Military Caregiver
Leave); and/or
g) Because of a Qualifying Exigency of an employee’s spouse, child or parent who is either on
active duty or who has been called to active duty (Military Exigency Leave).
An employee who takes leave under this policy will be entitled to return to the same job or a job with
equivalent status, pay, benefits, and other employment terms. The position will be the same or one
which entails substantially equivalent skill, effort, responsibility, and authority.
If both spouses work for the County and each wish to take leave for the birth of a child, adoption or
placement of a child in foster care, or to care for a parent (not parent in-law) with a serious health
condition, the spouses together may only take a total of 12 weeks leave under FMLA.
An employee taking leave for the birth of a child may use paid sick leave for the period of actual
disability, based on medical certification. The employee shall then use all paid annual leave and
accrued compensatory time for the remainder of the 12-week period.
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An employee does not need to use FMLA leave in one block. Leave can be taken intermittently or on
a reduced leave schedule when medically necessary. Employees must make reasonable efforts to
schedule leave for planned medical treatment so as not to unduly disrupt the County’s operations.
The County reserves the right to request updated medical certifications every 30 days for intermittent
leave. The County will charge the employee’s FMLA for any leave taken for the purpose of the
FMLA qualifying health condition. Accordingly, it is the employee’s duty to notify his or her department
head so that it is clear that the need for unplanned leave is FMLA qualifying. If it is unclear, please be
aware that the department head may ask whether the need for the leave is for the employee’s FMLA
qualifying health condition.
Untruthful responses to County inquiries, untruthful statements on medical certifications, or working
for ones’ self or another entity while on FMLA leave will be considered abuse of the county’s leave
policies and may subject an employee to discipline.
A “Serious Health Condition” is defined as an injury, impairment, or physical or mental condition
which requires inpatient care at a hospital, hospice, or residential medical care facility, or a condition
which requires continuing care by a licensed health care provider, or continuing treatment by a health
care provider which includes any period of incapacity due to a chronic or long-term health condition
which results in a period of incapacity or more than three days. Pregnancy or prenatal care, a chronic,
serious health condition which continues over an extended period of time and requires periodic visits
to a health care provider, or permanent or long-term condition for which treatment may not be
effective, or any absences to receive multiple treatments for restorative surgery or for a condition
which would likely result in a period of incapacity of more than three (3) days if not treated, will all
likely qualify as a serious health condition.
“Military Exigency” is a qualifying exigency arising out of the fact that the employee’s spouse, son,
daughter, or parent is a military service member (reserve or national guard) under a call or order to
federal active duty in support of a contingency operation. Qualifying events are:
1. deployment of service member with seven or fewer days’ notice;
2. military ceremonies and events such as family-assistance or informational programs
related to the family member’s active duty or call to active duty;
3. urgent, immediate childcare or arranging for alternative childcare for the children of
service members;
4. attending school or daycare meetings relating to the child of service member;
5. making financial or legal arrangements related to a family member’s active duty status
or call to active duty; or
6. post-deployment activities for a period of ninety days after the termination of the service
member’s active duty status.
“Military Caregiver Leave” includes an employee whose spouse, son, daughter, parent or next of kin
is a current service member who is undergoing treatment, therapy, recuperation or outpatient
treatment or has temporary disability retirement for injury or illness sustained in the line of duty, is
eligible for 26 weeks of leave in a single 12-month period. During a single 12-month period, the
employee is eligible for a total of 26 weeks of all types of FMLA leave.
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Section 19. Family and Medical Leave: Medical Certification
In order to qualify for leave under this law, the County requires medical certification. This statement
from the employee's or the family member's physician should include the date when the condition
began, its expected duration, diagnosis, and brief statement of treatment. For the employee's own
health condition, it should state that the employee is unable to perform the essential functions of
his/her position. For a seriously ill family member, the certification must include a statement that the
patient requires assistance and the employee's presence would be beneficial or desirable.
This certification should be furnished at least 30 days prior to the needed leave unless the employee's
or family member's condition is a sudden one. The certification should be furnished as soon as
possible (no longer than 15 days from the date of the employee’s request under most scenarios).
The certification and request must be made to the department head and filed with the Human
Resources Director.
The employee is expected to return to work at the end of the time frame stated in the medical
certification, unless he/she has requested additional time off in writing under the County's Leave
Without Pay policy, or has requested some other type of accommodation.
Section 20. Family Medical Leave and Leave Without Pay: Retention and Continuation of
Benefits
When an employee is on leave under FMLA, the County will continue the employee's health benefits
during the leave period at the same level and under the same conditions as if the employee had
continued to work. In the event the Employee is required to pay a portion of his or her health care
premium, the Employee must make arrangements to do so with the Human Resources Director prior
to beginning FMLA leave. If an employee chooses not to return to work for reasons other than a
continued serious health condition, the County will require the reimbursement of the amount paid for
the employee's health insurance premiums during the FMLA leave period.
Other insurance and payroll deductions are the responsibility of the employee and the employee
must make those payments for continued coverage of that benefit.
During the time an employee uses paid leave, including but not limited to sick leave, annual leave or
holiday leave during FMLA leave, the employee will continue to accumulate sick and annual leave.
An employee ceases to accrue leave on the date leave without pay begins and service credit with
LGERS is not typically earned while in a leave without pay status.
Section 21. Workers' Compensation Leave
All injuries arising out of, and during, the course of employment should be reported by the injured
employee to the immediate supervisor as soon as possible. The supervisor or department head shall
file an injury report to the Human Resources department within twenty-four (24) hours of the time of
the accident.
An employee absent from duty because of sickness or disability covered by the North Carolina
Workers' Compensation Act may elect to use accrued sick leave, annual, or compensatory time
during the first waiting period. These days will be reimbursed only if the disability continues for more
than twenty-one (21) days. When workers’ compensation leave extends long enough for the waiting
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period to be reimbursed, the employee shall return the reimbursement check to the County and have
leave hours reinstated for all time covered by paid leave. In such cases, the County will pay the
employee for any unpaid time that is owed the employee. The employee may also elect to
supplement workers’ compensation payments after they begin with sick leave, annual, or
compensatory time, provided that the combination of leave supplement and workers’ compensation
payments do not exceed normal compensation. If an employee elects to supplement time,
employees will need to key their time into the timesheet under the workers’ compensation sick leave
pay type.
An employee on workers’ compensation leave may be permitted to continue to be eligible for benefits
under the County’s group insurance plans. The employee will continue to accrue leave, such as sick,
annual and holiday leave, while supplementing workers’ compensation leave, and will retain all
accumulated sick and annual leave. Service in LGERS, however, will not accrue during the period
of workers’ compensation leave. Employees are encouraged to contact LGERS for any questions
related to creditable service time.
a) Injured employees must notify their supervisor when they are placed out of work by the
attending physician. The department head will submit a personnel action form to Human
Resources to place the employee on workers’ compensation leave.
b) Before returning to work, a statement from the attending physician should be submitted to
the Human Resources department giving permission for the employee to resume regular or
modified duties.
c) Upon return to work, the employee’s department head will submit a personnel action form to
Human Resources to remove the employee from workers’ compensation and the employee’s
salary will be computed on the basis of the last salary plus any merit increment or other salary
increase to which the employee would have been entitled during the disability covered by
workers’ compensation.
This provision also applies to reactions to small pox vaccinations administered to County
employees under Section 304 of the Homeland Security Act. Such reactions shall be treated the
same as any other workers’ compensation claim as regards leave and salary continuation.
Section 22. Military Leave
The County will fully comply with the Uniformed Services Employment and Reemployment Rights
Act (USERRA) and any other federal, state or local law that requires protection or benefits service
members. Regular employees entitled to military leave pursuant to state or federal law will be eligible
to receive up to four weeks of paid leave in one year. However, if the employee receives military pay
during this time, the employee shall only receive partial compensation equal to the difference in the
base salary earned during this same period as a County employee. The effect will be to maintain the
employee's salary at the normal level during this period.
If time off is required beyond four weeks in a year, the employee shall be eligible to take accumulated
holiday leave, compensatory time, sick leave and annual leave or be placed in a leave without pay
status, and the provisions of that leave shall apply. Compensatory time should be used first.
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While taking protected military leave, the employee's leave credits and other benefits shall continue
to accrue as if the employee remained employed with the County. It is the responsibility of the
employee to pay for supplemental insurances. Employees who are eligible for military leave have all
job rights specified state and federal law.
Section 23. Reinstatement Following Military Service.
The County will fully comply with the requirements of USERRA and other applicable federal, state or
local laws. An employee called to extended active duty with the United States military forces, who
does not volunteer for service beyond the period for which called, shall be reinstated with full benefits
provided the employee:
a) Applies for reinstatement within ninety days after the release from military service; and
b) Is able to perform the duties of the former position or similar position; or
c) Is unable to perform the duties of the former position or a similar position due to disability
sustained as a result of military service, but is able to perform the duties of another position
in the service of the County. In this case the employee shall be employed in such other
position as will provide the nearest approximation of the seniority, status, and pay which the
employee otherwise would have been provided, if available.
Section 24. Civil Leave
A County employee called for jury duty, receives a subpoena or as a court witness for the federal or
state governments, or a subdivision thereof, shall receive leave with pay for such duty during the
required absence without charge to accumulated leave. The employee may keep fees and travel
allowances received for jury or witness duty in addition to regular compensation; except, that
employees must turn over to the County any witness fees or travel allowance awarded by that court
for court appearances in connection with official duties. While on civil leave, benefits and leave shall
accrue as though on regular duty. This Section is meant to apply to provide protected, unpaid leave
for Jury Duty, Domestic Violence leave, and Juvenile Court Order leave, as required by the North
Carolina General Statutes.
Section 25. Parental School Leave
Under NC General Statutes 95-28.3, a County employee who is a parent, guardian, or person
standing in loco parentis (in place of the parent) may take up to four hours of unpaid leave annually
to involve him or herself in school activities of his or her child(ren). This leave is subject to the three
following conditions:
1) The leave must be taken at a time mutually agreed upon by the employee and the County;
2) The County may require the employee to request the leave in writing at least 48 hours prior
to the time of the desired leave; and
3) The County may require written verification from the child’s school that the employee was
involved at the school during the leave time.
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Paid leave (annual time or earned compensatory time) taken by an employee to attend to school
activities of his or her child shall count toward the fulfillment of this provision by the County.
Section 26. Voluntary Shared Leave
Purpose
There are occurrences brought about by serious and prolonged medical conditions that cause
employees to exhaust all available leave and therefore be placed on leave without pay. It is
recognized that such employees forced to go on leave without pay could be without income at the
most critical point in their work life. It is also recognized that fellow employees may wish to voluntarily
donate some of their paid leave so as to provide assistance to a fellow employee. This policy would
provide an opportunity for employees to assist another affected by a medical condition that requires
absence from duty for a period of time resulting in possible loss of income due to lack of accumulated
leave.
This policy and program will provide the opportunity for one employee to help another on a one to
one, personal basis. It does not permit “banking” of leave.
Policy
In those cases of a medical condition an employee may apply for or be nominated to become a
recipient of leave transferred from the paid leave account of another employee. For purposes of this
policy, medical condition means medical condition of an employee or a family member of such
employee that is likely to require an employee’s absence from duty for a prolonged period of time
and to result in a substantial loss of income to the employee due to limited leave in the employee’s
leave account. The intent of this policy is to allow one employee to assist another in case of a crisis
involving a serious or prolonged medical condition. It is not the intent of this policy to apply to
incidental, normal, short-term medical conditions.
The use of paid leave on a shared basis for any purpose other than specified by this policy is
prohibited. An employee who has a medical condition and who receives benefits from the Disability
Income Plan of North Carolina (DIPNC) is not eligible to participate in the shared leave program.
Participation in this program is limited to six months, either continuously or, if for the same condition
on a recurring basis. However, management may grant employee continuation in the program,
month by month for a maximum of one year, if management would have otherwise granted leave
without pay.
An employee on workers’ compensation leave who is drawing temporary total disability
compensation may be eligible to participate in this program. Use of donated leave under the workers’
compensation program would be limited to use during the required waiting period.
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Administration
This program shall be administered through Human Resources under the following conditions:
I. Qualifying to Participate
a. Employee must be a full time permanent, probationary, Work Against or trainee
appointment status.
b. By letter of application to Human Resources, a recipient shall apply, or be
nominated by a fellow employee to participate in the program. Medical certification from a
physician is required.
c. Application for participation would include name, social security number, classification,
department and estimated length of time needed to participate in the program.
d. By submission of the application or nomination the employee is aware the HR
department will post the request to County departments.
e. The department head and Human Resources shall review the merits of the request and
approve or disapprove.
f. Establishment of a leave “bank” for use by unnamed employees is expressly prohibited.
II. Participation Requirements
a. A donor may contribute annual leave or sick leave.
b. The minimum amount to be donated is four hours.
c. An employee shall have exhausted all available annual, sick, and comp leave to become
eligible to use donated leave.
d. The maximum amount of leave allowed to be donated by one individual is to be no more than
the amount of the individual’s annual accrual rate. However, the amount donated is not to
reduce the donor’s annual leave balance below one-half of the annual leave accrual rate.
e. Leave donated to a recipient’s leave account is exempt from the maximum accumulation
carry over restrictions at calendar year end.
An employee may not directly, indirectly, intimidate, threaten, coerce, or attempt to
intimidate, threaten, or coerce, any other employee for the purpose of interfering with any right
which such employee may have with respect to donating, receiving, or using annual/sick
leave under this program. Such action by an employee shall be grounds for disciplinary
action up to and including dismissal on the basis of personal conduct. Individual leave
records are confidential and only individual employees may reveal their donation or receipt
of leave. The employee donating leave cannot receive remuneration for the leave donated.
III. Donor Leave Accounting and Usage Procedures
a. Donor forms will be returned to Human Resources. Each department shall maintain a
system of leave accountability which will accurately record leave donations and recipients
use. Such accounts shall provide a clear and accurate record for financial and
management audit purposes. Notes should be made on both recipient and donor
timesheets indicating participation in the program and amount of participation.
b. Withdrawals from recipient’s leave account will be charged to the recipient’s account
according to usual leave policies.
c. At the expiration of the medical condition, any unused donated leave will be returned to
the donors on a pro-rated basis. Each approved emergency medical condition shall
stand alone and donated leave not used in accordance with the above provisions shall
be considered as having served its purpose, shall lose its identity, and shall be deleted
and the account closed.
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ARTICLE VIII. SEPARATION AND REINSTATEMENT
Section 1. Types of Separations
All separations of employees from positions in the service of the County shall be designated as one
of the following types and shall be accomplished in the manner indicated: Resignation, reduction in
force, disability, voluntary retirement, dismissal, or death.
Section 2. Resignation
An employee may resign by submitting the reasons for resignation and the effective date in writing
to the immediate supervisor as far in advance as possible. In all instances, the minimum notice
requirement is two weeks. A thirty-day notice is required for department heads. Failure to provide
minimum notice shall result in forfeit of payment for accumulated annual leave unless the notice is
waived upon recommendation of the Department Head, Human Resource Director and approval by
the County Manager. When a resignation is submitted, the Appointing or Hiring Authority may in its
sole discretion, make the decision to release the employee at any time prior to the end of the notice
given. In this event, the employee shall not be entitled to receive wage payments after the last day
actually worked.
Three consecutive days of absence without contacting the immediate supervisor or Department
Head is generally considered to be a voluntary resignation.
Sick leave will only be approved during the final two weeks of a notice with a physician’s certification
of comparable documentation.
Section 3. Reduction in Force
In the event that a reduction in force becomes necessary, consideration shall be given to the quality
of each employee's performance, organizational needs, and seniority in determining those
employees to be retained. Employees who are separated because of a reduction in force shall be
given at least two weeks’ notice of the anticipated action. No Regular employee shall be separated
while there are temporary, emergency or probationary employees serving in the same class in the
department, unless the Regular employee is not willing to transfer to the position held by the
temporary or probationary employee.
Section 4. Disability
An employee who cannot perform the essential functions of their position with or without a reasonable
accommodation because of a disability may be separated for disability. Action may be initiated by
the employee or the County. In all cases, such action must be accompanied by medical evidence
acceptable to the Department Head Human Resource Director and County Manager. The County
may require an examination, at the County's expense, performed by a physician of the County's
choice.
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Section 5. Voluntary Retirement
An employee who meets the conditions set forth under the provision of the North Carolina Local
Government Employee's Retirement System may elect to retire and receive all benefits earned under
the retirement plan.
Section 6. Death
Separation shall be effective as of the date of death. All compensation due shall be paid to the estate
of the employee.
Section 7. Dismissal
An employee may be dismissed in accordance with the provisions and procedures of Article IX.
Section 8. Reinstatement
An employee who is separated because of reduction in force may be reinstated within five years of
the date of separation, upon recommendation of the supervisor and approval of the Human Resource
Director and the County Manager. An employee who is reinstated in this manner shall be re-credited
with his or her previously accrued sick leave.
Section 9. Rehiring
An employee who resigns while in good standing may be rehired with the approval of the Appointing
Hiring Authority, and shall be regarded as a new employee, subject to all of the provisions of rules
and regulations of this Chapter. However, the employee shall be credited with his or her previously
accrued sick leave if he or she is rehired within five years. If an employee is rehired within one year
of resigning, the annual leave accrual rate they previously had can be used.
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ARTICLE IX. UNSATISFACTORY PERFORMANCE OF DUTIES, GROSSLY INEFFICIENT JOB
PERFORMANCE, AND UNACCEPTABLE PERSONAL CONDUCT
Please note that this policy does not apply to employees in the probationary period. In addition, to
the extent that this policy conflicts with the State Human Resources Act, this policy shall not apply
to employees subject to said Act.
Section 1. Disciplinary Action for Unsatisfactory Performance of Duties
A Regular employee may be placed on disciplinary suspension (without pay), demoted, or dismissed
for unsatisfactory job performance, if after following the procedure outlined below, the employee's
job performance is still deemed to be unsatisfactory. All cases of disciplinary suspension, demotion,
or dismissal must be approved by the Human Resource Director and the County Manager,
Appointing or Hiring authority prior to giving final notice to the employee.
Section 2. Unsatisfactory Performance of Duties Defined
Unsatisfactory job performance includes any aspects of the employee's job which are not performed
as required to meet the standards set by the supervisor. Examples of unsatisfactory job performance
include, but are not limited to, the following:
a) Demonstrated inefficiency, negligence, or incompetence in the performance of duties;
b) Careless, negligent or improper use of County property or equipment;
c) Unsatisfactory performance of duties as defined in the Performance Evaluation Policy;
d) Discourteous treatment of the public or other employees;
e) Absence without approved leave;
f) Repeated improper use of leave privileges;
g) Pattern of failure to report for duty at the assigned time and place;
h) Failure to complete work within time frames established in work plan or work standards;
I) Failure to meet work standards over a period of time;
j) Failure to follow the chain of command to address work-related issues, unless authorized
byauthorized by the County’s policies;
the County’s policies;
k. Failure to comply with County policies;
l. Insubordination – the willful or refusal to carry out a reasonable order from an authorized
supervisor;
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m. Failure to meet work standards or perform critical tasks;
n. Poor work habits, such as chronic tardiness; or
o. Unsafe behavior at work.
Section 3. Communication and Warning Procedures Preceding Disciplinary Action for
Unsatisfactory Job Performance
When an employee's job performance is unsatisfactory, or when incidents or inappropriate actions
warrant, the supervisor should meet with the employee as soon as possible for a counseling session
and may issue a written warning to discuss specific performance problems. An employee whose job
performance is unsatisfactory over a period of time should receive at least two written warnings from
the supervisor, the last of which will notify the employee that failure to make the required performance
improvement may result in dismissal, before disciplinary action resulting in dismissal is taken by the
County Manager, Appointing or Hiring Authority. All written warnings will become a part of the
employee’s personnel file.
Section 4. Disciplinary Action for Unsatisfactory Performance of Duties
If the employee's performance continues to be unsatisfactory, and the employee has received at
least two written warnings as described above, then the supervisor should use the following
disciplinary steps:
a) A written recommendation from the Department Head should be sent to the Human
Resources Director, County Manager, Appointing or Hiring Authority for disciplinary action
such as suspension, demotion, or dismissal, and, if required, the employee should thereafter
be notified that a pre-disciplinary conference is being scheduled.
b) In the event the Department Head is the Appointing or Hiring Authority, a final written notice
should be from the Department Head to the employee to place them on notice that a pre-
disciplinary conference is being scheduled.
Section 5. Pre-Disciplinary Conference for Unsatisfactory Performance of Duties
Before disciplinary action is taken for unsatisfactory performance of duties, the County Manager,
Appointing or Hiring Authority, the Human Resources Director or a Department Head will conduct a
pre-disciplinary conference. At this conference, the employee may present any response to the
proposed disciplinary action to the County Manager, Appointing or Hiring Authority, Human Resource
Director or Department Head. This group will consider the employee’s response, if any, to the
proposed action, and will, no later than the end of the second business day following the pre-
disciplinary conference, notify the employee in writing of the final decision. If the employee is
dismissed, the notice shall contain a statement of the reasons for the action and the employee’s
appeal rights under the County’s grievance procedure.
Section 6. Unacceptable Personal Conduct Defined
Unacceptable personal conduct (previously and often referred to as “detrimental personal conduct”)
includes behavior of such a serious detrimental nature that the functioning of the County
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may be or has been impaired; the safety of persons or property may be or have been threatened; or
the laws of the government may be or have been violated. The Unacceptable Personal Conduct
category is intended to be used for actions and behaviors exhibited for which no reasonable person
could, or should, expect to receive prior warnings.
Examples of unacceptable personal conduct include, but are not limited to, the following:
a) Job related conduct which constitutes violation of state or federal law, including but not
limited to acts of fraud or theft; or
b) Conviction of a felony or an offense involving moral turpitude that is detrimental to or
impacts the employee's service to the agency; or
c) The willful violation of known or written work rules; or
d) Conduct unbecoming an employee that is detrimental to the agency's service; or
e) The abuse of client(s), patient(s), or a person(s) over whom the employee has charge or
to whom the employee has a responsibility, or of an animal owned or in the custody of
the agency; or
f) Falsification of an employment application or other employment documentation such as
falsification of any record for personal profit, or to grant special privileges; or
g) Insubordination which is the willful failure or refusal to carry out a reasonable order from
an authorized supervisor;
h) Absence from work after all authorized leave credits and benefits have been
exhausted; or
i) Grossly inefficient job performance.
For example only, willful violation of known or written work rules and conduct unbecoming an
employee that is detrimental to the agency's service may include:
1) Willful misuse or gross negligence in the handling of County funds; Willful or wanton damage
or destruction to property;
2) Willful or wanton acts that endanger the lives and property of others;
3) Possession of unauthorized firearms or other lethal weapons on the job;
4) Brutality in the performance of duties;
5) Reporting to work under the influence of alcohol or drugs or partaking of such while on duty.
Prescribed medication may be taken within the limits set by a physician as long as medically
necessary;
6) Engaging in incompatible employment or servicing a conflicting interest;
7) Request or acceptance of gifts in exchange for favors or influence;
8) Engaging in political activity prohibited by this policy; or
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9) Stated refusal to perform assigned duties or flagrant violation of work rules and regulations.
Grossly Inefficient Job Performance occurs in instances in which the employee fails to satisfactorily
perform job requirements as specified in the job description, work plan, or as directed by the
management of a County department or agency that results in:
A. The potential for death or serious harm to a client(s), employee(s), members of the
public, or to a person over whom the employee has responsibility, or
B. The loss of, or damage to, County property or funds that results in a serious impact
on the County or department, or on the employee’s ability to function effectively
thereafter, or
C. Any other instances of job performance deficiencies that may constitute a gross
oversight in performance of duties.
This category is intended to be used in addressing failure in the performance of duties for which no
reasonable person could, or should, expect to receive prior warnings.
Section 7. Disciplinary Action for Unacceptable Personal Conduct
With the approval of the Department Head, Human Resources Director, and County Manager,
Appointing or Hiring Authority, an employee may be placed on disciplinary suspension (without
pay), demoted, or Dismissed without prior warning for causes relating to personal conduct
detrimental to County service in order to:
a) avoid undue disruption of work;
b) to protect the safety of persons or property; or
c) for other serious reasons.
Employees may be disciplined based on one instance of grossly inefficient job performance. The
duration for suspensions will be reviewed case by case.
Section 8. Pre-Disciplinary Conference for Unacceptable Personal Conduct.
Before disciplinary action is taken for unacceptable personal conduct the County Manager,
Appointing or Hiring Authority, the Human Resource Director or a Department Head will conduct a
pre-disciplinary conference. At this conference, the employee may present any response to the
proposed action to the County Manager, Appointing or Hiring Authority, Human Resource Director
or Department Head. This group will consider the employee's response, if any, to the proposed
action, and will, no later than the end of the second business following the pre-disciplinary
conference, notify the employee in writing of the final decision. If the employee is dismissed, the
notice shall contain a statement of the reasons for the action and the employee's appeal rights under
the County's grievance procedure.
Section 9. Non-Disciplinary Suspension
During the investigation, hearing, or trial of an employee on any criminal charge, during an
investigation related to an alleged disciplinary, harassment or discrimination issue, during the course
of any civil action involving an employee, or for any other reason when suspension would,
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in the sole discretion of the County, be deemed in the best interest of the County, the Department
Head, with the approval of the Human Resource Director and the County Manager, Appointing or
Hiring Authority, may suspend the employee for the duration of the proceedings as a non- disciplinary
action. Such suspension may be paid or unpaid, in the sole discretion of the County. At the discretion
of the County, it may elect to allow the employee to use accrued paid leave during this suspension.
In such cases, the County may:
a) Temporarily relieve the employee of all duties and responsibilities and place the employee
on paid or unpaid leave for the duration of the suspension,
b) Assign the employee new duties and responsibilities and allow the employee to receive
such compensation as is in keeping with the new duties and responsibilities, or
c) Take any other actions necessary, as determined in the sole discretion of the County.
If the employee is reinstated following a suspension, such employee shall not lose any benefits to
which otherwise employee would have been entitled had the suspension not occurred. All benefits
with the exception of accrued annual leave and sick leave shall be maintained during the period of
suspension. However, it is in the sole discretion of the County as to whether the employee will receive
back-pay upon reinstatement after an un-paid non-disciplinary suspension. The duration for non-
disciplinary suspension may be up to 90 days at the discretion of the County Manager.
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ARTICLE X. GRIEVANCE PROCEDURE AND ADVERSE ACTION APPEAL
Section 1. Policy
It is the policy of the County to provide a just and prompt procedure for the presentation,
consideration, and disposition of employee grievances. The purpose of this article is to outline the
procedure and to assure all employees that a response to their complaints and grievances will be
prompt and fair.
Employees utilizing the grievance procedure shall not be subjected to retaliation or any form of
harassment from supervisors or employees for exercising their rights under the grievance procedure.
Supervisors or other employees who violate this policy shall be subject to disciplinary action up to
and including dismissal.
Please note that, this policy does not apply to employees in the probationary period. In addition, to
the extent that this policy conflicts with the State Human Resources Act, this policy shall not apply to
employees subject to said Act.
Section 2. Grievance Defined
Only issues specifically made grievable by this Article may be addressed through the grievance
procedure. Grievable issues are:
1. Serious disciplinary actions –Serious disciplinary actions covered by this policy are
demotion, disciplinary suspension without pay and dismissal. No other disciplinary
actions may be grieved through this policy. Please note that employees who wish to
present a grievance related to a dismissal are not required to undergo the informal
processes detailed in this policy and should submit their grievance directly to the
Human Resources Director, pursuant to Section 3, below.
2. Allegations of illegal discrimination – Allegations of illegal discrimination based on
race, color, religion, sex, national origin, qualified disability, marital status, age,
genetic information (including family medical history), marital status, political
affiliation, sexual orientation, status as parent, or labor organization affiliation or non-
affiliation, in promotion, discipline, termination or upon the terms and conditions of
employment may be grieved through this policy.
3. Allegations of unlawful workplace harassment – Allegations of harassment of any type
may be grieved and/or reported through this policy.
4. Allegations of violations of any applicable federal or state law - as applied to the
employee, including but not limited to
a. The Fair Labor Standards Act;
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b. The Age Discrimination in Employment Act;
c. The Family Medical Leave Act;
d. The Americans with Disabilities Act; and
e. Title VII of the Civil Rights Act of 1964
Any item, matter or issue not specifically listed above is not a grievable issue. Specifically, the
following matters are not covered by this policy and are not subject to the grievance policy:
1. Written warnings and placement on non-disciplinary suspension with or without
pay.
2. Matters of inherent management rights – These matters include, but are not limited
to, such areas as the programs and functions of Person County, budgetary
allocation, standards of service, utilization of technology, and the assignment and
re-assignment of staff to positions, duty stations, and shifts
Section 3. Purposes of the Grievance Procedure
The purposes of the grievance procedure include, but are not limited to:
1) Providing employees with a procedure by which their complaints can be considered
promptly, fairly, and without reprisal;
2) Encouraging employees to express themselves about the conditions of work which affect
them as employees;
3) Promoting better understanding of policies, practices, and procedures which affect
employees;
4) Increasing employees' confidence that personnel actions taken are in accordance with
established, fair, and uniform policies and procedures; and
5) Increasing the sense of responsibility exercised by supervisors in dealing with their
employees.
6) Encouraging conflicts to be resolved between employees and supervisors who
must maintain an effective future working relationship, and therefore,
encouraging conflicts to be resolved at the lowest level possible in the chain of command;
and
7) Creating a work environment free of continuing conflicts, disagreements, and negative
feelings about the County or its leaders, thus freeing up employee motivation, productivity,
and creativity.
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Section 4. Procedure
When an employee has a grievance, the following successive steps are to be taken unless otherwise
provided. The number of calendar days indicated for each step should be considered the maximum,
unless otherwise provided herein or required by the State Human Resources Act, and every effort
should be made to expedite the process. However, the time limits set forth may be extended by
mutual consent unless otherwise required by the State Human Resources Act. The last step initiated
by an employee shall be considered to be the step at which the grievance is resolved. A decision to
rescind a disciplinary suspension, demotion or dismissal must be approved by the Appointing or
Hiring Authority before the decision becomes effective.
Informal Resolution. Prior to the submission of a formal grievance, the employee and supervisor
should meet to discuss the problem and seek to resolve it informally. Either the employee or the
supervisor may involve the Human Resources Office as a resource to help resolve the grievance.
Unless otherwise required by the State Human Resources Act, mediation will not be a formal step
required during the informal resolution process.
Step 1. If no resolution to the grievance is reached informally, the employee who wishes to pursue
a grievance shall present the grievance to the supervisor in writing. The grievance must be presented
within fifteen calendar days of the event or within fifteen calendar days of learning of the event or
condition, or of written receipt of the notice of a disciplinary action, whichever occurs later. The
supervisor shall respond to the grievance within five work days after receipt of the grievance. The
supervisor should, and is encouraged to, consult with any employee of the County in order to reach
a correct, impartial, fair and equitable determination or decision concerning the grievance. Any
employee consulted by the supervisor is required to cooperate to the fullest extent possible.
The response from each supervisory level for each step in the formal grievance process shall be in
writing and signed and dated by the supervisor. In addition, the employee shall sign a copy to
acknowledge receipt thereof. The responder at each step shall send copies of the grievance and
response to the Human Resources Director.
Step 2. If the grievance is not resolved to the satisfaction of the employee by the supervisor, the
employee may appeal, in writing, to the Department Head within five work days after receipt of the
response from Step 1. The Department Head shall respond to the appeal, stating the determination
of decision within five work days after receipt of the appeal.
Step 3. (For general County employees only) If the grievance is not resolved to the satisfaction of
the employee by the Department Head, the employee may appeal, in writing, to the County Manager,
Appointing or Hiring Authority within five work days after receipt of the response from Step 2. The
Appointing or Hiring Authority shall respond to the appeal, may meet with the employee to discuss
the grievance fully, and will make a decision within ten calendar days. The Appointing or Hiring
Authority’s decision is final.
Special Note: The Sheriff and Register of Deeds, will carry out the responsibilities designated as
the County Manager in their respective departments.
Step 3. (For employees subject to the State Human Resources Act) If the grievance is not
resolved to the satisfaction of the employee by the Department Head, the employee may appeal the
decision to the North Carolina Office of Administrative Hearings (OAH) within thirty calendar days of
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the receipt of the Department Head's decision. The findings of the OAH will be forwarded to the
State Personnel Commission. The decision of the State Personnel Commission shall be advisory
only and the Department Head shall have the final decision.
In conjunction with the County’s grievance policy as listed above, employees subject to the State
Human Resources Act which have complaints related to unlawful workplace harassment must submit
those complaints/allegations in writing to the Department Head within 30 calendar days of the alleged
harassing action, and the Department will be given 60 calendar days in which to take remedial action
(by using the informal resolution process listed above), unless otherwise waived pursuant to the Act.
Employees subject to the Act may elect to proceed through this Grievance policy, or to proceed
directly to the State Human Resources Commission (SHRC) for a hearing by the Office of
Administrative Hearings (OAH) on any grievance related to unlawful discrimination that does not
involve unlawful workplace harassment. A direct appeal to the SHRC must be filed within 30 calendar
days of receipt of notice of the alleged discriminatory act.
Department Heads. In the case of department heads or other employees where the Appointing or
Hiring Authority has been significantly involved in determining disciplinary action, including dismissal,
the Hiring Authority may wish to obtain a neutral outside party to either:
(a) provide mediation between the grieving department head and the Appointing or Hiring
Authority (see definition of mediation in informal resolution above); or
(b) consider the appeal and make recommendations back to the Appointing or Hiring Authority
concerning the appeal. Such parties might consist of human resource professionals,
attorneys, mediators, or other parties appropriate to the situation.
Department heads may also request the application of these special provisions.
The Appointing or Hiring Authority’s decision regarding the disposition of the grievance shall be the
final decision. The County Manager would notify the Board of Commissioners of any impending
legal action.
Section 5. Role of the Human Resources Director
Throughout the grievance procedure, the roles of the Human Resources Director shall be as
follows:
a) To advise parties (including employee, supervisors, and County Manager) of their rights and
responsibilities under this policy, including interpreting the grievance and other policies for
consistency of application;
b) To be a clearinghouse for information and decisions in the matter including maintaining files
of all grievance documents.
c) To give notices to parties concerning timetables of the process, etc.;
d) To facilitate the resolution of conflicts in the procedures or of the grievance at any step in the
process; and
e) To help locate mediation or other resources as needed.
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The Human Resources Director shall also determine whether or not additional time shall be
allowed to either side in unusual circumstances if the parties cannot agree upon extensions when
needed or indicated.
Section 6. Specific Grievance and Adverse Action Appeal Procedure for Discrimination and/or
Harassment
When an employee, former employee, or applicant believes that any employment action
discriminates illegally (i.e. is based on age, sex, race, color, national origin, religion, creed, political
affiliation, disability or any other class protected by applicable law), or otherwise believes he or she
is subject to unlawful workplace harassment, he or she has the right to initiate a grievance pursuant
to this Policy. In the event the supervisor or department head is the subject of the employee’s
complaint, the employee has the right to bypass discussions with the alleged perpetrator, and may
appeal directly to the Human Resource Director and the County Manager. An employee or applicant
should appeal an alleged act of discrimination within thirty calendar days of the alleged discriminatory
action, but may appeal for up to six months following the action.
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ARTICLE XI. PERSONNEL RECORDS AND REPORTS
Section 1. Public Information
In compliance with GS 153A-98, the following information with respect to each County employee is
a matter of public record: name; age; date of original employment or appointment to the County
service; the terms of any contract by which the employee is employed whether written or oral, past
and current, to the extent that the county has the written contract or a record of the oral contract in
its possession; current position; title; current salary; date and amount of each increase or decrease
in salary with the County; date and type of each promotion, demotion, transfer, suspension,
separation, or other change in position classification with the County; date and general description
of the reasons for each promotion with the County; date and type of each dismissal, suspension, or
demotion for disciplinary reasons taken by the County. If the disciplinary action was a dismissal, a
copy of the written notice of the final decision of the County setting forth the specific acts or omissions
that are the basis of the dismissal; the office to which the employee is currently assigned. For the
purpose of this subsection, the term “salary” includes pay, benefits, incentives, bonuses, and
deferred and all other forms of compensation paid by the County. Any person may have access to
this information for the purposes of inspection, examination, and copying, during regular business
hours, subject only to such rules and regulations for the safekeeping of public records as the County
may adopt.
Section 2. Access to Confidential Records
All information contained in a County employee's personnel file, other than the information mentioned
above is confidential and shall be open to inspection only in the following instances:
a) The employee or his/her duly authorized agent may examine all portions of his/her personnel
file except letters of reference solicited prior to employment, and information concerning a
medical disability, mental or physical, that a prudent physician would not divulge to the
patient.
b) A licensed physician designated in writing by the employee may examine the employee's
medical record.
c) A County employee having supervisory authority over the employee may examine all material
in the employee's personnel file.
d) By order of a court of competent jurisdiction, any person may examine all material in the
employee's personnel file.
e) An official of an agency of the State or Federal Government, or any political subdivision of
the State, may inspect any portion of a personnel file when such inspection is deemed by the
County Manager to be necessary and essential to the pursuit of a proper function of the
inspecting agency, but no information shall be divulged for the purpose of assisting in a
criminal prosecution of the employee, or for the purpose of assisting in an investigation of the
employee's tax liability.
However, the official having custody of the personnel records may release the name,
address, and telephone number from a personnel file for the purpose of assisting in a
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criminal investigation.
f) An employee may sign a written release to be placed in his/her personnel file that permits
the record custodian to provide, either in person, by telephone, or by mail, information
specified in the release to prospective employers, educational institutions, or other persons
specified in the release.
g) The County Manager may inform any person of the employment, non-employment,
promotion, demotion, suspension or other disciplinary action, reinstatement, transfer, or
termination of a County employee, and the reasons for that action. Before releasing that
information, the County Manager shall determine that the release is essential to maintaining
the level and quality of County services. The written determination shall be retained in the
County Manager's office, is a record for public inspection, and shall become a part of the
employee's personnel file.
Section 3. Personnel Actions
The Human Resources Director, with the approval of the County Manager, will prescribe necessary
forms and reports for all personnel actions and will retain records necessary for the proper
administration of the personnel system. The official personnel files are those which are maintained
by the Human Resources Office. These files shall contain documents such as employment
applications and related materials, records of personnel actions, documentation of employee
warnings, disciplinary actions, performance evaluations, retirement and insurance records, letters of
recommendation, and other personnel-related documents.
Section 4. Records of Former Employees
The provisions for access to records apply to former employees as they apply to present employees.
Section 5. Remedies of Employees Objecting to Material in File
An employee who objects to material in his/her file may place a statement in the file relating to the
material considered to be inaccurate or misleading. The employee may seek removal of such
material in accordance with established grievance procedures.
Section 6. Penalties for Permitting Access to Confidential Records
Section 153A-98 of the General Statues provides that any public official or employee who knowingly
and willfully permits any person to have access to any confidential information contained in an
employee personnel file, except as expressly authorized by the designated custodian, is guilty of a
misdemeanor and upon conviction shall be fined in an amount consistent with the General Statutes.
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Section 7. Examining and/or Copying Confidential Material without Authorization
Section 153A-98 of the General Statutes of North Carolina provides that any person, not specifically
authorized to have access to a personnel file designated as confidential, who shall knowingly and
willfully examine in its official filing place, remove or copy any portion of a confidential personnel file
shall be guilty of a misdemeanor and upon conviction shall be fined consistent with the General
Statutes.
Section 8. Destruction of Records Regulated
No public official may destroy, sell, loan, or otherwise dispose of any public record, except in
accordance with GS 121.5 (b), without the consent of the State Department of Cultural Resources.
Whoever unlawfully removes a public record from the office where it is usually kept, or whoever,
alters, defaces, mutilates or destroys it will be guilty of a misdemeanor and upon conviction will be
fined in an amount provided in Chapter 132.3 of the General Statutes.
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ARTICLE XII. IMPLEMENTATION OF POLICIES
Section 1. Conflicting Policies Repealed
All policies, ordinances, or resolutions that conflict with the provisions of these policies are hereby
repealed.
Section 2. Severability
If any provision of these policies or any rule, regulation, or order thereunder of the application of such
provision to any person or circumstances is held invalid, the remainder of these policies and the
application of such remaining provisions of these policies of such rules, regulations, or orders to
persons or circumstances other than those held invalid will not be affected thereby.
Section 3. Effective Date
These policies shall become effective on a date as stated by the County Board of Commissioners.
Section 4. Amendments
This Policy or sections hereof may be amended by action of the County and by resolution
appropriately approved. Any revisions or amendments adopted in conformance with this procedure
shall become effective as of the date stated by the Commission.
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AGENDA ABSTRACT
Meeting Date: August 5, 2024
Agenda Title: Person County Health Department Fee Request
Summary of Information: The Person County Health Department’s proposed fee
schedule amendments are associated with the annual flu vaccinations and the new
children's RSV vaccine, Beyfortus. The proposed fees are for the administration of the
children’s RSV vaccine, the children’s RSV vaccine, and this year’s annual flu vaccine
which will be a trivalent vaccine instead of a quadrivalent vaccine.
The proposed fees will allow PCHD to receive reimbursement for the administration of
the children’s RSV vaccine-Beyfortus, the vaccine, and the annual flu vaccine.
The Board of Health approved the Fee Schedule Amendments on Monday, July 15,
2024, and in accordance with the North Carolina General Statute 130A-39(g), the Board
of Health requests the approval of the Board of Commissioners to implement the
proposed fees, which are attached.
Recommended Action: Approve recommended fees.
Submitted By: Janet Clayton, Health Director
154
Person County Health DepartmentFee Schedule Amendment Request 08.05.24DescriptionCPT Code Medicaid RateProposed Updated NotesFluMist trivalent90660 25.00$Fee set according to current fee setting procedureFluarix/Fluzone trivalent9065625.00$Fee set according to current fee setting procedureFlublok trivalent9067377.00$Fee set according to current fee setting procedureChildren's RSV vaccine-Beyfortus (1mL)90381566.00$ Fee set according to current fee setting procedureAdministration code for Beyfortus9638135.00$Fee matches current administration fee155
AGENDA ABSTRACT
Meeting Date: August 5, 2024
Agenda Title: Person Industries Record Destruction
Summary of Information: Person Industries must obtain permission from the Board
of Commissioners for destruction of records over 11 years old for routine record maintenance.
Shredding of files will occur at Person Industries for 2010 client archive files.
Recommended Action: Approve record destruction.
Submitted By: Amanda Doss, Director
156
AGENCY NAME: __Person Industries__ DATE OF DESTRUCTION:__________________ METHOD OF DESTRUCTION: ShreddingThe purpose for the destruction is due to the following: Routine record maintenance (Records over 11 years old)Permission for the destruction of the records was obtained from: ___________________________________________________________(Attache all supporting documentation) (Name, Title and Date)RECORD NO.DOBRecordMH or EmplMediaN/A11/5/1963PaperMH# 032013 5/11/1950PaperMH# 044436 1/10/1985PaperN/A5/15/1990PaperN/A10/5/1990PaperN/A5/22/1992PaperMH# 045718 12/18/1990PaperN/A4/29/1966PaperMH# 041863 4/7/1951PaperN/A6/8/1985PaperN/A3/29/1963PaperN/A3/20/1960PaperHamilton, TamaraN/A2/21/1988PaperN/A7/9/1982PaperMH# 047660 6/10/1980PaperN/A7/30/1985PaperMH# 042567 5/13/1963PaperMH# 042620 11/16/1953PaperN/A3/5/1991PaperN/A7/30/1975PaperN/A3/28/1992PaperN/A9/27/1989PaperClayton, AdelaideVR# 2907941Dawkins, ChrisFrazier, BeverlyGravitte, SheliaHerrington, JoshuaJames, Latara10/7/2010-12/6/2010Bacnik, Robert9/10/2009-12/10/2010Chandler, ChaseVR# 28430928/13/2009-6/10/2010Lofton, RodneyVR# 28628179/15/2009-10/26/2010 1/4"Kendall, BrianVR# 27160916/13/2003-6/30/2010 1/2"Lea, ShantiegaVR# 28663129/13/2010-10/29/2010 1/4"1/2"Jordan, Maurice12/1/1982-1/9/2010 2 1/2"Jones, Leon1/29/2010-6/15/2010N/AVR# 28431895 1/2"N/A7/5/2005-8/9/2010 3 1/2"Johnson, MarcusVR# 28986962/11/2010-6/7/2010 1/2"VR# 292059411/1/2010-12/16/2010 1/4"Jones, ErnestN/A7/29/1981-1/4/2010RECORD DESTRUCTION LOGCONSUMER NAME/RECORD TYPERECORD NO.TIMEFRAME VOLUMEIN INCHES1/4"3/18/2010-3/18/2010 1/4"1/4"Black, Crenessa2/28/2005-9/29/2010 1 1/2"Booze, Matthew VR# 2840633 1/20/2010-5/21/2010 3/4"OF SERVICES (dates)VR # N/AVR# 029524N/ABowes, Kyle12/15/2009-1/13/20103/4"Baldwin, Kennis1/31/1994-1/04/2010 12"1/4"Work First 6/14/2010-7/2/2010 1/4"VR# 2912162 6/17/2010-6/17/2010 1/4"N/A 9/4/1975-1/4/2010 2 1/2"4/26/2010-4/30/2010 1/2"1"VR# 2898083VR# 2904997Carver, CoraVR# 2909406 5/7/2010-5/7/2010Chappell, Glenn Jr. VR# 2912156157
RECORD NO.DOBRecordMH or EmplMediaN/A12/24/1991PaperN/A4/1/1992PaperN/A9/17/1984PaperN/A4/16/1990PaperN/A6/1/1963PaperN/A2/4/1960PaperN/A5/24/1985PaperN/A6/6/1956PaperN/A7/6/1966PaperN/A8/9/1978PaperN/A4/14/1964PaperMH# 041865 10/3/1950PaperMH# 888186 2/3/1990PaperN/A3/7/1963PaperN/A8/22/1982PaperTicket# 594-30-3921 3/29/1984PaperPaperPaperPaperPaperPaperPaperPaperPaperPaperPaperPaperPaperPaperPaperPaperPaperWilliams, NormanWilson, LaTonyaVillines, EstherN/AWhitlow, KyleN/AZelth, GarieMorton, JonnaSmith, AnthonySommers, SarahSowers, JanetVR# 2894919Work First6/14/2010-7/2/2010 1/4"1/9/2010-3/24/2010 1/2"Spiller, SandraStanton, LucianThomas, CrystalTicket-to-Work1/8/2010-8/31/2010 1/4"VR# 29068357/1/2010-7/1/2010 1/4"1/4"VR# 29173559/3/2010-9/7/2010 1/4"2/11/2010-3/4/2010 1/4"VR# 29141068/5/1010-8/5/201012/1/1977-1/4/2010 3 1/4"1/25/2010-6/12/2010 1/2"VR# 2896424VR# 29174369/22/2010-9/22/2010 1/4"Moore, ValinkaVR# 291437310/7/2010-12/2/2010 1/4"VR# 28684652/11/2010-3/4/2010 1/4"Martin, JalisaVR# 29150677/22/2010-7/26/2010 1/4"Martinez, AnnieVR# 28884885/3/2010-7/8/2010 1/2"VR# 28662999/15/2010-10/15/2010 1/4"Lunsford, WillieVR# 28661659/15/2010-11/15/2010 1/4"CONSUMER NAME/RECORD TYPERECORD NO.TIMEFRAME VOLUMEIN INCHESVR # OF SERVICES (dates)158
AGENDA ABSTRACT
Meeting Date: August 5, 2024
Agenda Title: Person County Department of Social Services Attorney Contracts
Summary of Information: Provided are the required contracts for legal services to be paid at an
hourly rate to the Person County Department of Social Services primary attorney, Tom
Fitzgerald, and secondary attorneys, Julie Ramsey, and James Tolin, III. There are separate
contracts for Child Support Services; therefore, there are two contracts for Attorneys Fitzgerald
and Tolin, and only one for Attorney Ramsey.
Recommended Action: Approval of Person County Department of Social Services Attorney
Contracts and Authorize Contracts to be Signed.
Submitted By: Carlton B. Paylor, Sr., MBA, Director, Person County Department of Social
Services
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160
Contract# 20241 Fisca l Yea r Begi ns July 1, 2024 Ends June 30 , 2025
This contract is hereby entered into by and between the Person County Department of Social Services (the "County") and
Thomas L. Fitzgerald (the "Contractor") (referred to coll ectively as the "Parties"). The Contractor's federal tax identification
number or Social Security Number is 20-2272 781 and DUNS Number (required if funding from a federal funding source).
1. Con tract Documents : This Contract consists of the following documents:
( 1) This contract
(2) The General Terms and Co nditions (Attachment A)
(3) The Scope of Work, description of services, and rate (Attachment B)
(4) Combined Federal Certifications (Attachment C)
(5) Conflict of Interest Policy (Attachment D)
(6) No Overdue Taxes (Attachment E)
(7) If applicable, HIPAA Bus iness Associate Addendum (checklist and forms) (Attachment I)
(8) Certification of Transportation (Attachment J )
(9) If applicable, IRS federal tax exempt letter or 501 (c)3 (Attachment K) http://www.irs .gov/pub/irs-fill/k1023.pdf
(10)Certain Reporting and Auditing Requirements (Attachment L)
(11 )State Certification (Attachment M)
(12)Attachment N -Non-D iscrimination, Clean Air , Clean Water
(16) Contract Determination Questionnaire (required)
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. T he 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 Co ntract
Amendments, the most rece nt 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, 2024 and shall termi nate on June 30, 2025,
Th is contract must be twelve months or less.
4 . Contractor's Duties : The Co nt ractor shall provide the services and in accordance with the approved rate as described in
Attachment B, Scope of Work.
5. County 's Du t ies : The Cou nty shall pay the Contractor in the manne r 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 1,150 hours
collectively for all attorneys under contract. Rate of compensation for Primary Attorney Thomas L. Fitzgerald is $14 7 per
hour.
[gj a. There are no matching requirements from the Contractor.
0 b. The Contractor's matching requirement is $ , wh ich shal l consist of:
0 In-kind O Cash
0 Cash and In-kind O Cash and/or In-kind
The contributions from the Co ntractor shall be sou rced from non-federal funds.
6. Reversion of Funds :
Any unexpended grant fu nds shall revert to the County Department of Social Services/Human Services upon
termination of this contract.
7 . Report i ng Requirements :
Contractor shall comply with aud it requ irements as described in N.C.G .S. § 143C-6-22 & 23 and 0MB 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 .
Contract-General (06/15 ) Page 1 of 3
161
8. Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope of Work,
Attachment 8.
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 the County:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name & Title Wendy McKinney, Business Officer Name & Title Wendy McKinney, Business Officer
County Person County County Person County
Mailing Address P.O. Box 770 Street Address 355-B S. Madison Blvd
City, State, Zip Roxboro, NC 27573 City, State, Zip Roxboro, NC 27573
Telephone 336-503-1158
Fax 336-599-397 4
Email wmckinnev@.personcountvnc.Qov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name& Title Thomas L. Fitzgerald, Attorney Name & Title Thomas L. Fitzgerald, Attorney
Company Name FitzLaw Company Name Fitzlaw
Mailing Address P.O. Box 1519 Street Address 22 Court Street
City State Zip Roxboro, NC 27573 City State Zip Roxboro, NC 27573
Telephone 336-599-2567
Fax
Email
10. Supplementation of Expenditure of Public Funds:
The Contractor assures that funds received pursuant to this contract shall be used only to supplement, not to
supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract
services and related programs. Funds received under this contract shall be used to provide additional public funding
for such services; the funds shall not be used to reduce the Contractor's total expenditure of other public funds for
such services.
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:
Contract-General (06/15} Page 2 of 3
162
The Contractor certifies that it has identified to the County all j obs 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. Fede ral Certificatio ns:
Individuals and Organizations receiving federa l funds must ensure compliance w ith certain certifications required by
federal laws and regulations. The contractor is hereby comply ing 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 a re to
be signed by the contractor's authorized representative.
14. Spec if ic Lang uage Not Previously Addressed :
15. Signat ure Warranty: The undersigned represent and warrant that they are au thorized to bind the ir principals to the
terms of th is agreement.
The Contractor and the County have executed this contract in duplicate originals , with one original bei ng retained by each
party .
1 1~ 7 -(-24
Signature Date
I~ L . Ot,vµr
Printed Name Title
COUNTY
Signature (must be legally authorized to sign contracts for County DSS) 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 Fi nance Officer Date
Contract-General (06/15) Page 3 of 3
163
GENERAL TE:RMS AND CONDITIONS
Relationships of the Parties
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the
performance of this contract and as such shall be wholly
responsible for the work to be performed and for the
supervision of its employees . The Contractor represents
that it has, or shall secure at its own expense, all
personnel required in performing the services under this
agreement. Such employees shall not be employees c>f,
or have any individual contractual relationship with, the
County.
Subcontracting: The Contractor shall not sybcontract
any of the work contemplated under this contract without
prior written approval from the County. Any approved
subcontract shall be subject to all conditions of this
contract. Only the subcontractors specified in the contract
documents are to be considered approved upon award of
the contract. The County shall not be obligated to pay for
any work performed by any unapproved subcontractor.
The· Contractor shall be responsible for the performance
of all of its subcontractors.
Assignment: No assignment of the Contractor's
obligations or the Contractor's right to receive payment
hereunder shall be permitted. However, upon writtem
request approved by the issuing purchasing authority, the
County may: (a) Forward the Contractor's payment check
directly to any person or entity designated by the
Contractor, or (b) Include any person or entity designated
by Contractor as a joint payee on the Contractor's
payment check. In no event shall such approval and
action obligate the County to anyone other than the
Contractor and the Contractor shall remain responsible
for fulfillment of all contract obligations.
Beneficiaries: Except as herein specifically provided
otherwise, this contract shall inure to the benefit of and t,e
binding upon the parties hereto and their respective
successors. tt is expressly understood and agreed th ,3t
the enforcement of the terms and conditions of this
contract, and all rights of action relating to suc:h
enforcement, shall be strictly reserved to the County and
the named Contractor. Nothing contained in this
document shall give or allow any claim or right of acticIn
whatsoever by any other third person . It is the express
intention of the County and Contractor that any suc:h
person or entity, other than the Gounty or the Contractor,
receiving services or benefits under this contract shall be
deemed an incidental beneficiary only.
Indemnity and Insurance
Indemnification: The Contractor agrees to indemnify and
hold harmless th e County, the State of North Carolin;3,
and any of their officers, agents and employees, and
Federal Government from any claims of third partiei s
arising out of any act or omission of the Contractor in
connection with the
performance of this contract to the extent permitted by
law.
Default and Termination
Termination Without Cause: The County may terminate
this contract without cause by giving 30 days written
notice to the Contractor.
Termination for Cause: If, through any cause, the
Contractor shall fail to fulfill its obligations under this
contract in a timely and proper manner, the County shall
have the right to terminate this contract by giving written
notice to the ContraQtor and specifying the effective date
thereof. In that event, all finished or unfinished deliverable
items prepared by the Contractor under this contract shall,
at the option of the County, become its property and the
Contractor shall be entitled to receive just and equitable
compensation for any satisfactory work completed on
such materials, minus any payment or compensation
previously made. Notwithstanding the foregoing
provision, the Contractor shall not be relieved of liability to
the County for damages sustained by the County by virtue
of the Contractor's breach of this agreement, and the
County may withhold any payment due the Contractor for
the purpose of setoff until such time as the exact amount
of damages due the County from such breach can be
determined. ln case of default by the Contractor, without
limiting any other remedies for breach available to it, the
County may procure the contract services from other
sources and hold the Contractor responsible for any
excess cost occasioned thereby. The filing of a petition for
bankruptcy by the Contractor shall be an act of default
under this contract.
Waiver of Default: Waiver by the County of any default
or breach in compliance with the terms of this contract by
the Contractor shall not be deemed a waiver of any
subsequent default or breach and shall not be construed
to be modification of the terms of this contract unless
stated to be such in writing, signed by an authorized
representative of the County and the Contractor and
attached to the contract.
Availability of Funds: The parties to this contract agree
and understan_d that the payment of. the sums specified in
this contract is dependent and contingent upon and
subject to the appropriation, allocation, and availability of
funds for this purpose to the County.
Force Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
war, hostile foreign action, nuclear explosion , riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other
catastrophic natural event or act of God.
Survival of Promises : All promises, requirements,
terms , conditions, provisions, representations,
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11 .01 .15)
164
guarantees, and warranties contained herein shall survive
the contract expiration or termination date unless
specifically provided otherwise herein, or unless
superseded by applicable Federal or State statutes of
limitation.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract are
t he exclusive property of the County. The Contractor shall
not assert a claim of copyright or other property interest in
such deliverables.
Compliance with Applicable Laws
Compliance with Laws: The Contractor shall comply
with all laws, ordinances, codes, rules, regulations, and
licensing requirements that are applicable to the conduct
of its business, including those of federal, state, and local
agencies having jurisdiction and/or authority.
Equal Employment Opportunity: The Contractor shall
comply with all federal and State laws relating to equal
employment opportunity.
Health Insurance Portability and Accountability Act
(HIPAA): The Contractor agrees that, if the County
determines that some or all of the activities within the
scope of this contract are subject to the Health Insurance
Portability and Accountability Act of 1996, P.L. 104-91, as
amended ("HIPAA"), or its implementing regulations, it will
comply with the HIPAA requirements and will execute
such agreements and practices as the County may
require to ensure compliance.
Confidentiality
Confidentiality: Any information, data, instruments,
documents, studies or reports given to or prepared or
assembled by the Contractor under this agreement shall
be kept as confidential and not divulged or made available
to any individual or organization without the prior written
approval 0f the County. The Contractor acknowledges
that in receiving, storing, processing or otherwise dealing
with any confidential information it will safeguard and not
further disclose the information except as otherwise
provided in this contract.
Data Security: The Contractor shall adopt and apply data
security standards and procedures that comply with all
applicable federal, state, and local laws, regulations, and
rules.
Duty to Report: The Contractor shall report a suspected
or confirmed security breach to the County's Contract
Administrator within twenty-four (24) hours after the
breach is first discovered, provided that the Contractor
shall report a breach involving Social Security
Administration data or Internal Revenue Service data
with in one ( 1) hour after the breach is first discovered.
During the performance of this contract, the contractor is
to notify the County contract administrator of any ?ontact
by the federal Office for Civil Rights (OCR) received by
the contractor.
Cost Borne by Contractor: If any applicable federal,
state or local law, regulation, or rule requires the County
or th~ Contractor to give affected persons written notice
of a security breach arising out of the Contractor's
performance under this contract, the Contractor shall bear
the cost of the notice.
Oversight
Access to Persons and Records: The State Auditor
shall have access to persons and records as a result of
all contracts or grants entered into by State agencies or
political subdivisions in accordance with General Statute
147-64.7. Additionally, as the State funding authority, the
Department of Health and Human Services shall have
access to persons and records as a result of all contracts
or grants entered into by State agencies or political
subdivisions .
Record Retention: Records shall not be destroyed,
purged or disposed of without the express written consent
of the County. State basic records retention policy
requires all grant records to be retained for a minimum of
five years or until all audit exceptions have been resolved,
whichever is longer. If the contract is subject to Federal
policy and regulations, record retention may be longer
than five years. Records must be retained for a period of
three years following submission of the final Federal
Financial Status Report, if applicable, or three years
following the submission of a revised final Federal
Financial Status Report. Also, if any litigation, claim,
negotiation, audit, disallowance action, or other action
involving this Contract has been started before expiration
of the five-year retention period described above, the
records must be retained until completion of the action
and resolution of all issues which arise from it, or until the
end of the regular five-year period described above ,
whichever is later. The record retention period for
Temporary Assistance for Needy Families (TANF) and
MEDICAID and Medical Assistance grants and programs
must be retained for a minimum of ten years.
NCDHHS TC101 o (General Terms and Conditions) (Local Government) (Rev. 11 .01 .15)
165
Miscellaneous
Choice of Law: The validity of this contract and any of its
terms or provisions, as well as the rights and duties of the
parties to this contract, are governed by the laws of North
Carolina. The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract,
to the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Wake County,
North Carolina. The place of this contract and all
transactions and agreements relating to it, and their situs
and forum, shall be Wake County, North Carolina, where
all matters, whether sounding in contract or_ tort, relating
to the validity, construction, interpretation, and
enforcement shall be determined.
Amendment: This contract may not be amended orally or
by performance. Any amendment must be made in written
form and executed by duly authorized representatives of
the County and the Contractor.
Severability: In the event that a court of competent
jurisdiction holds that a provision or requirement of this
contract violates any applicable law, each such provision
or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise
unenforceable and all other provisions and requirements
of this contract shall remain in full force and effect.
Headings: The Section and Paragraph headings in these
General Terms and Conditions are not material parts of
the agreement and should not be used to construe the
meaning thereof.
Gender and Number: Masculine pronouns shall be read
to include feminine pronouns and the singular of any word
or phrase shall be read to include the plural and vice
versa.
Time of the Essence: Time is of the essence in the
performance of this contract.
Key Personnel: The Contractor shall not replace any ?f
the key personnel assigned to the performance of this
contract without the prior written approval of the County.
The term "key personnel" includes any and all persons
identified as such in the contract documents and any
other persons subsequently identified as key personnel
by the written agreement of the parties.
Care of Property: The Contractor agrees that it shall be
responsible for the proper custody and care of any
property furnished to it for use in connection with the
performance of this contract and will reimburse the
County for loss of, or damage to, such property. At the
termination of this contract, the Contractor shall contact
the County for instructions as to the disposition of such
property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Contractor for
travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
exceed the rates published in the applicable State rules
or approved local government travel policy. International
travel shall not be reimbursed under this contract.
Sales/Use Tax Refunds: If eligible, the Contractor and
all subcontractors shall: (a) ask the North Carolina
Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
pursuant to G.S. 105-164.14; and (b) exclude all
refundable sales and use taxes from all reportable
expenditures before the expenses are entered in their
reimbursement reports.
Advertising: The Contractor shall not use the award of
this contract as a part of any news release or commercial
advertising.
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
166
ATTACHMENT B -Scope of Work Federal Tax Id. or SSN 20-2272781
Contract # 20241
A. CONTRACTOR INFORMATION
l. Contractor Agency Name: Thomas L. Fitzgerald
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: 336-599-2567 Fax Number: Email:
3. Name of Program (s):Child Welfare, Poster Care & Adoptions, Child Protective
Services, Adult Protective Services & Guardianship
4. Status: ~ Public D Private, Not for Profit D Private, For Profit
5. Contractor's Financial Reporting Year January through December
B. Explanation of Services to be provided and to whom (include SIS Service Code):
Legal services to the Agency in the nature of consultations, interpretation of social
services laws and regulations and drafting of legal documents when necessary.
C. Rate per unit of Service (define the unit):
1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart)
One hundred forty dollars ($147.00) per hour for out of court time and one
hundred forty dollars ($147.00) per hour for in court time for each hour of legal services
performed. Such hourly rates shall encompass all expenses, including, but not limited to,
those for salary, supplies, office space, heating and maintenance for office space,
telephone service, long-distance telephone calls, postage and travel.
2. Negotiated County Rate.
D. Number of units to be provided: no more than 1, 150 hours collectively
E. Details of Billing process and Time Frames;
Payable on or before the 10th of each month upon due submission by the Attorney of a
statement of work detailing the hours of work performed and the nature of such legal
work.
F. Area to be served/Delivery site(s): Person County Courthouse, FitzLaw, Person
County Department of Social Services
(Signature of County Authorized Person) ( f Contractor)
--UZ<{
(Date Submitted) (Date Submitted)
Contract-Scope of Work (7-2008) Page lof 1
167
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 appl!cable 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% ~f any, to make the same certification~n::I~
Signature Title
Contractor Na~e 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 l:>asis 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.
168
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
termination; or
against such an employee, up to and including
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
___ .22 Court Street
City, State, Zip Code
___ Roxboro, NC 27573 ______________________________ _
Street
City, State, Zip Code
169
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.
Ill. 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.]
l. By signing and submitting this document, the prospective lower tier participant is providing the certification set out
below.
2. The certification in this clause is a material representation of the fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an
erroneous certification, in addition to other remedies available to the Federal Government, the department or agency
with which this transaction originate may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant will provide immediate written notice to the person to whom this proposal is
submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted
or has become erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"
"person," "primary covered transaction," "principal," "proposal/' and "voluntarily excluded," as used in this clause, have
the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 CFR
Part 76. You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those
regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily 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.
170
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:
I. 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
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.
171
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.
I. Identify the status of the covered Federal action.
2. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last
previously submitted report by this reporting entity for this covered Federal action.
3. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known.
Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub-
award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards
include but are not limited to subcontracts, subgrants and contract awards under grants.
4. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name, address, city, state and
zip code of the prime Federal recipient. Include Congressional District, if known.
5. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
6. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
7. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e.g.,
Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant,
or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes,
e.g., "RFP-DE-90-001."
8. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the
Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5.
9. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity
identified in Item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 1 0(a). Enter Last
Name , First Name and Middle Initial (Ml).
IO. 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 certi in official shall si n and date the form, rint his/her name, title, and tele hone 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
Bud et, Pa erwork Reduction Pro·ect 0348-0046 , Washin ton, D. C. 20503
172
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□
□
4 .
M
□
Disclosure Of Lobbying Activities
(Approved by 0MB 0344-0046)
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract □ a. Bid/offer/application Mt 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:
Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name
and Address of Prime:
Prime
Suba'wardee Tier (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 address if
(if individual, last name, first name, MF): different from No. 10a.) (last name, first name, MF):
(attach Continuation Sheet(s) SF-LLL-A, if necessary) (attach Continuation Sheet(s) SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply):
$ actual planned □ a. retainer
□ b. one-time fee
12. Form of Payment (check all that apply): □ .c . commission
□ d . contingent fee
□ a. cash □ e. deferred
L,1,.~~ (A~t-J □ b. In-kind; specify: Nature ti'J f. other; specify:
Value
14. Brief Description of Services Performed or to be Performed and Date(s) of Services, including officer(s), employee(s), or
Member(s) contacted, for Payment Indicated in Item 11 (attach Continuation Sheet(s) SF-LLL-A, if necessary):
A/Olv~
15. Continuation Sheet(s) SF-LLL-A attached: □ Yes ~ □ No
16. Information requested through this form is authorized by Signature: ~ ~ 74'---
title 31 U. S . C. section 1352. This disclosure of l obbying I ,-l
activities is a material representation of fact upon which Print Name: T L.onv.-s L . f: th~ I I
reliance was placed by the tier above when this transaction &}~~ was made or entered into. This disclosure is required Title:
pursuant to 31 U.S. C. 1352. This information will be
Telephone No: •n, -{"~q,1,¢7Date: 1->--2&-Zf-reported to the Congress semi-annually and will be
available for public inspection. Any person who fails to fHe
the required disclosure shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each
such failure.
Federal Use Only Authorized for Local Reproduction
Standard Form -LLL . ... . . .
173
~ONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY
State of __ A4J"--"o'-"-1,,....:.(1,_=----..;;;;.~-=-tfL.:........;h....:.~-c;. __ _
County ___ -+~_..;;.e"'"'>i._.,t,..c;..._ _____ _
I, w h -~ e fft-irra.lJ . Notary Public for said County and State, certify
that
TktN-s L ft J. 'l';r1 .-. d. personally appeared before me this day and
acknowledged
that he/she is O w~r of
1:ie:li-Y L r.-Ji ""-"' fib "f z,.,... [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 le~ day of )k, {,, ' )u,,q .
Sworn to and subscribed before me this
Instruction for Organization:
Sign and attach the following pages after adopted by the Board of Directorsnrustees or other
governing body OR replace the following with the current adopted conflict of interest policy.
NCDHHS COI1015 (Rev. 4 /1 I)
174
Conflict of Interest Policy
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 Organization's 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. lf, 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 CO11015 (Rev. 4/11)
175
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:
T/r, ~ L. F, ns.e~ II 4f~,_,J.~,.
Name of Or anization
Sig ion Official
Jd~ {, ~"llf
Date
NCDHHS COI1015 (Rev. 4/11)
176
ATTACHMENTE-OVERD UETAXES
Thomas L. Fitzgerald
--------------------------------------ATTORN EY AT LAW-------------------------------·-,-
22 Co urt Street , S uite 2 0 0
P .O. Box 15 19
Ro xbo ro, NC 27573
July I , 2024
To: Person Coun ty Department of Social Services
Certification :
336-599-2567 -Tele ph o n e
3 36-599-5782 --Fax
I, Thomas L. Fitzgerald, certify that I d o not have any overdue tax debts, as d efined by N.C.G.S. 105-243.1, at
the federal, State, or lo cal le vel. I furth er understand that any person w ho makes a fal se state me nt in violati o n
ofN.C.G.S. l43C-6-23 (c) is g uil ty of a cri mi nal offense punis hable as provided by .C.G.S.) I 43C-I0-1 b.
Sworn Statement:
I, Thomas L. Fitzgerald , be in g duly sworn, say t hat the foregoing certifi cation is true, accurate and complete to
the bes t of my knowledge and was made an d s ub scribed by me. I a lso acknowledge and u nderstand t hat any
mi s us e of State funds will be reported to the appropriate authorities for further act ion.
Thom?h
Signature
NORTH CAROLI A
PERSO C<) l . 'TY
Sworn to and subscrib • ' • _ day or
W~~
Date
I-->\~'Wt, ,, ~-.,, ,,'~~ <4(', ....... ~ «::',
,202~
Notary Public §~-~OT,4 ~~ 3 ... ,9 )-1'.-::
My Commission expires: Q_l.9 -\ -L<Yl..') ~-o ,() O ~
~~ uauG r, ~ ~~~ ~'V~
1 G.S. 105-243.1 defi nes: Overdue tax debt. -Any part of a tax debt that rem~aid_~~Ld~ Q~~ore after the notice of fin al
assessment was mailed to the taxpayer. The te rm does not inclu de a tax debt, hcf~£~~•\'er entered i nto an installment
agre ement for the tax debt under G.S. 105-237 within 90 days after the notice of final ~~~~hh' was mailed and has not failed to
make any payments due under the installment ag reement."
177
This document will be used to detennine if you have a business associate relationship with a contractor. This form should be
completed on all contracts that have a HIPAA covered health care component. This would include all health related infonnation.
Contractor: Thomas L. Fitzgerald Contract Number: 20242 Date: 7/01/2024
HIP AA ASSESSMENT FORM
Questions
1. Has a relationship been initiated Select
allows the contractor to perform a -
function or activity for, or on behalf of,
County Department of Social Services
HIP AA covered health care component?
2. Is the function or service to be Select
rendered by the contractor on an activity
other than treatment of clients?
3. Does the function or service to Select
be rendered by the contractor involve the
use or disclosure of the County
Department of Social Services
individually identifiable health
information?
4. Aie the services rendered by Select
staff from the contractor performed on the
premises of the covered health care
component, using the component's
resources and following the component's
policies and procedures?
5. Is the contractor performing a Select
type(s) of function/activity for or on the
behalf of the County Department of
Social Services HIP AA covered health
Notes
NOTE: The sharing of
Individually identifiable
health information with
another treatment contractor
for treatment purposes only
does not require a business
associate agreement. See 45
CFR §164.502(e)(l)(ii)(A)
NOTE: Data that does not
contain A County
Department of Social
Services individually
identifiable health
information is not covered by
HIP AA and thus does not
have to be protected through
a business associate
agreement.
NOTES: Whenever a service
is rendered on the premises
of a covered component,
utilizing the component's
resources and following the
component's policies and
procedures, the person
rendering such services is
considered a member of the
component's workforce, and
is required to comply with
the component's privacy
policies and procedures. No
business associate agreement
is required.
Check appropriate service(s):
D Attorney Representing
Agency
D Benefits Management
Steps
YES-Go to Question 2.
1@--Stop. There is no business
associate relationship.
YES-Go to Question 3.
NO-Stop. There is no business
associate relationship.
YES--Go to Question 4.
NO-Stop. Tb.ere is no business
associate relationship.
NO-Got Question 5.
YES-Stop. There is not business
associate relationship.
YES-You have identified a business
associate relationship. The specified
function/activity, which involves the
sharing of individually identifiable
1
178
component that is directly related to the D Patient Accounts Billing health information, is provided by the
covered health component's continued D Claims Processing contractor. This constitutes a business
operation? D Claims Administration associate relationship as such
D Bill Collections information must be protected the same
D Professional Services as required of the HIP AA covered
D Special Population health care component. There are two
Assessments types of business associate relationships:
D Data Analysis External Business Associate
D Data Processing relationships: You have indenti:fied an
D Data Administration External business associate relationship
0JCAHO if you are contracting with any enti'ty
D Council on Accreditation outside city, county or state government.
D Re-pricing A Business Associate Addendum must
D Rate Setting be signed and included with the .
D Practice Management contract. If you are completing a
D Software Support Memorandum of Agreement (MOA)
D Utilization Review with a governmental entity the
D Quality Assurance Government Associate Addendum must
Contract Analysis be utilized.
D Central Office NO-STOP. There is no business
Supervision
D Security
associate relationship.
0 Dietary
D Machine Maintenance
D Facility Maintenance
D Landscaping
D Housekeeping
D Hardware Support
D Audits/Surveys
D Purchasing
ADDITIONAL REQUIRMENTS
NOTE: Make sure all county
requirements are met for internally
notifying the correct parties for External
and Internal Business Associates
Rev: 7-1-2013
2
179
State Certification s
Contracto r Ce rtificati ons Required by o rth Caro lin a Law
In stru ction s: The person who s igns th is document s ho uld read the text of the statutes and Executi ve Order li sted below and co ns ul t
wjth counsel and other kn owledgeable perso ns before signi ng. The text of each orth Carolina General Statutes and of th e Ex ec uti ve
Order can be found online at:
• Article 2 of Chapter 64: http://www .ncga.state .nc.us/EnactedLegi slation/ tatutes/P DF/ByAn icle/Chapter 64/Article 2.pdf
• G .S. 13 3-32: http://www .ncga.:;tate.nc.uslgascrip1s/s1aru1es/s1a1y1elookuo.p}?sta1u1e l 33-32
• Execut ive Order o. 24 (Perdue, Gov., Oct. I , 2009): http ://www.ethicscommission.nc.gov/libra.rv/pdfs/Laws/E024.pd f
• G .S . I 05-164.S(b): http://www.ncga.sta.te.nc. us/EnactedLegislation/Sta.tutes/PDF/BySecrion/Chapter I 05 /GS I 05-164.8 .pd f
• G .S . 143 -48 .5: http:f/www.ncga.state .nc.us/EnactedLe gislation/Statytes/HTML/BySec1ion/Chapter 143 /GS 143-48 .5 .html
• G.S. 143-59 .1: http://www.ncga.stute.nc.ys/EnactedLegislation/Statutes/PDF/BySection/Chapter 143/GS 143-59 .1,odf
• G.S. 143-59 .2 : hnp ://www.ncga.state.nc.us/EnactedLeg islation/Statutes/PDFIBySection/Chapter 143/G 143-59,2.pdf
• G .S. 143-1 33 .3: http://www.ncga.state.nc.us/EnactedLeg islation lS1atvtes/HTMUBySection/Chapter 143/GS 143-13 3.3.html
• G.S. 143 8-139.GC : hup ://www.ncga.state,nc.us/EnactedLegislatiool tatutcslPDF/BySection/Chapter 1438/GS I 43B-139 .6C.pdf
(1)
Ce rtificatio ns
Pu rs uant to G.S. 13 3 -32 an d Executive O rder N o. 24
(Perdu e, Gov., Oct. 1, 2009), the unders igned hereby
country'' as set forth in G .S . 143-59.J(c)(2) after
December 31 , 200 l but t he United States is not
the principal market for the public trading of the
stock of the corporation incorporated in the tax
haven country.
certifies that the Contracto r named below is in
compl iance with, and has not violated. the provisions of
either sa id statute o r Executive Order.
(2) Purs uant to G.S, 143-48.5 and G.S. 143 -133.3 , the
undersigned hereby ce rtifies that the Contractor named
below, and the Contractor's s ubcontractors, complies
with the requirements of Article 2 of Chapter 64 of t he
C General Statutes. incl uding the requirement for each
employer with more than 25 employees in orth
Carolina to verify t he work authorization of its
employees through the federal £-Verify system." E-
Verify System Link: www.uscis .gov
(3) Purs uant to G.S. 143 -59.l (b), the unders igned hereby
certifies that the Contractor named below is not an
•'ineligible Contractor'· as set forth in G .. 143-59.1 (a)
because:
(a) Neither the Contractor no r any of its affil iates has
refused to collect the use tax l evied under Arti c le 5
of Chapter 105 of the General Statutes on its sales
del ivered to North Carolina w he n the sa les met one
or more of the conditions ofG.S. 105-164.S(b); a nd
(b) [check one of the following boxes]
~ Neither the Contractor nor any of its affi li ates
has incorporated or reincorporated in a "tax
haven country" as set forth in G.S. 143 -
59.1 (c)(2) after December 31, 2001 ; or
D The Contractor or one of its affi liates has
incorporated or rei ncorpo rated in a "tax haven
(4) Pursuant to G.S . 143-59.2{b), t he undersigned hereby
certifies that non e of the Contractor's officers, directors,
o r owners (if the Contractor is an unincorporated
business entity) has been convicte d of any v iolation of
C hapter 78A of the General Statutes or the Securities Act
of 1933 or the Securities Exchange Act of 1934 within
10 years immediately prior to the date of the bid
so li c itation.
(5) P urs uant to G.S.143B-13 9.6C, the undersigned hereby
certifies that the Contractor w i ll not use a fom1er
emp loyee, as defined by G .S. 143B-139.6C(d)(2), of
the orth Carolina Department of Health and Human
Services in t he admin istratio n of a contract w ith the
Department in violation of G.S. I 43B-139.6C and t hat
a violation of that statute sh a ll void the Agreement.
(6) The undersigned hereby certifies further that:
(a) He or s he is a duly authorized representative of t he
Contractor named below·
(b)
(c)
He or she is authorized ro make, and does hereby
make, the foregoi ng certifications o n beh a lf of t he
Cont ractor; and
He or she understands that any per&on who
knowin gly s ubmits a false certification i n res ponse
to the requirements ofG.S. 143-59.land -59.2 s hall
be guilty ofa Class l fe lony.
Co ntractor's Name: T ~ orw>., L . F, hc.,t-... l , ft t ~ J ~w
Con tractor 's ~ ~ -l 2 Authorized Agent: Signature ~ _::: Date _ __,_ /_--=-f--__ O_l _..f ___ _
Pnmed Name -~ ~c;(k;., [Jrn1e __ O...::.....;~:........!,...___---'------------
Witness: 1gnature w~~ ~~ Date ') -\ l ~ 101..4
Printed Name V\) \-\ ~ ~ [.~4 tJ T11le___:$g=---.,,,,.....,(...!-'f():........1.j-c~l{-=-¼1------
The witness s ho uld be present when the Contractor's Autho~nt signs thi s certification an~hould s ign and date this
document immediately thereafter.
Contractor Certifications Required by orth Carolina Law (Rev 8/2016 ) Page I of I
180
ATTACHME T
Contract #20242
Thomas L. Fitzgerald
Pe rson Co un ty Department of S ocial Services/Human Services
CERTIFICATION REGARDING NONDISCRIMINATION. CLEAN AIR ACT,
CLEAN WATER ACT
Certificatio n Regarding Nondiscrimination
The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination .
These inclu de but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P. L. 88-352) wh ich
prohibits discrimination on the basis of race , color or national origin; (b) T itl e IX of the Education
Amendments of 1972 , as amended (20 U.S .C. §§1681-1683, and 1685-1686), which proh ibits
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
Discri mination Act of 1975, as amended (42 U.S.C. §§6101-6107), which proh ibits discrimination
on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P .L. 92-255), as
amended, relating to nondiscrim ination 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, re lating to nondiscrimi nation 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 basi s of religion and political beliefs; and (i) the
requirements of any other nond iscrimination statutes which may apply to this Agreement.
Th e Con t rac tor must comply with Executive Order 11246, entitled "Equal Employment
Opportun ity," as amended by Executiv e Order 11375, and as supplemented by the Department of
Labor Regulations (41 CFR Part 60): The Executive Order proh ibits federal contractors and
federally-ass isted 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, re ligion , sex, or nation al origin . The Executive Order also requires Government
contractors to take affirmative action to ensure that equal opportunity is provided in all aspects of
the ir employment.
Meaningful Access for LEP Individuals: The Con tra ctor that participate in the SNAP must take
reasonable steps to ensure that LEP persons have meaningful access to programs, services, and
benefits. This incl udes the requirement to provide bil i ngual program informatio n and certification
materials and interpretation services to single language minorities in certain project areas. SNAP
Contractors that do not provid e meaningful access for LEP individuals risk violating prohibitions
against d isc r imination based on National Origin in the Food and Nutrition Act of 2008 , as
amended, Title VI of the Civil Rig hts Act of 1964 (T itle VI) and SNAP program regulat ions at 7
CFR 272A(b). T hey also risk noncompliance with the USDA pol icy gu idance titled , "Guidance to
Federal Fi nancial Assistance Re ci pients Regard ing T itle VI Prohibition Aga inst Nat ional Origin
Discri mination Affecting Limited English Proficient Persons''. published in 79 FR 70771 -70784
(November 28 , 2014).
The Contra ctor should develop an implementing plan to address the language assistance needs
of the LEP population served . This may include contracting for oral interpretation services , hiri ng
bilingual staff, arranging telephone in terpreters a nd/or language lines, coord in ating community
volunteers , translating vital documents, and providing written notice that language services are
availab le 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 shou ld understand how to obtain
language assistance serv ices. For additional assistance and information regarding LEP matters,
please also visit http ://www.lep.gov .
(Federal Ce rtification-No n-Di scriminati o n Clean Air , C lean Water) (01 /2018)Page l of 4
181
Contract #20242
Thomas L. Fitzgerald
Ensuri ng Equal Opportunity Access for Persons with Disabilities: The Contractor must also
ensure equal opportunity access for persons with disabilit ies . This includes ensuring that
communications with appl icants, participants, members of the public, and companions with
disabilities are as effective as communications w ith people without disabilities . Contractors that
do not provide persons with disabilities equal opportunity access to programs may risk vio lating
prohibitions against disability discrimination in the Rehabi litation Act of 1978, the American w ith
Disabilities Act (ADA) of 1990, as amended, and SNAP program regu lations .
DOJ published revised final regulations i mplementi ng Title II and Title Ill of the ADA on
September 15 , 2010. These regulations are codified at 28 CFR Part 35 "Nond iscrimination on
the Basis of Disability in State and Loca l Government Services" and at 28 CFR Part 36
"Nondiscrimination on the Basis of Disability in Public Accommodations and Commercia l
Facil ities". In accordance w ith the implementing regu lations, Contracto rs must provide au x ili ary
aids and services where necessary to ensure effective commun ication 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 applican ts and beneficiaries by
telephone , it must provide text telephone services (ITY) or have access to an equally effectiv e
electron ic 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 i nformation 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 wh ic h the violation which gave rise to such
conviction occurred if such facility is owned, leased , or supervised by such person. The
proh ibitio n in the preceding sentence shall conti nue until the Administrator certifies that
the condition giving rise to such a convi ctio n has been corrected . For convictions aris in g
under section 113(c)(2), the condition giving rise to the conviction also shall be
conside red to include any substantive violation of th is Act associated w ith 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 w ith the
notification necessary for the purposes of subsection (a).
c. In order to implement the purposes and policy of this Act to protect a nd enhance the
q uality of the Nation's air, the Pres ident sha ll, not more than 180 days after enactment of
the C lean Air Amendments of 1970 cause to be issued an order (1) requ iring each
Federal agency authorized to enter into contracts and each Federal agency wh ich is
empowered to extend Federal assista nce by way of grant, loan , or contract to effectuate
the purpose and policy of this Act in such contracting or ass istance activities, and (2)
setting forth procedures, sanctions, penalties, and such other provisions , as the President
determines necessary to carry out such requ irement
d . The President may exempt any contract , loan , or grant from a ll 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 .
(Federal Certification-Non-Discrimination C lean Air , C lean Water) (0 1/20 l 8)Page 2 of 4
182
Contract #20242
Thoma s L . Fitzgerald
e . The Pre sident sha ll ann ually re poirt to the Congress on measures taken toward
imp lementin g the purpose and i ntt:nt of th is section , including but not limited to the
progress and problems associated w ith i mplemen tation of this section . (42 U.S.C. 7606)
V . The Clean Water J!,ct ; 33 U.S.C. §1251 et seq. (1972)
a . No Federal agency may enter intoi 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 facili ty at which t he violation wh ich
gave rise to such conviction occurred, and if such facility is owned , leased , or supervised
by such person . T he prohi bit ion in pre ced ing sentence shall continue un til the
Administrator certifies that th e conid ition giving rise to such conviction has bee n
corre cted .
b. The Administrator shall establish procedures to provide all Federal agencies with the
notification ne cessary 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 o f th e Nation 's water, the President shall, not mo re than 180 days afte r the
enactment of this Act, cause to be, issued an order:
(i) requiring ea ch Federal agency authoriz ed 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 th is Act in such con tracting or assistance
act ivit ies , and
(ii) setting forth procedures, sanctions, penalt ies, 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 Un ited States and he sha ll notify the Congress of such exemption.
e . The President shall an nually repoI1 to the Congress o n measures taken in compliance
with the purpose and intent of th is section , includin g , but not lim ited to , the progress and
problems associated with such compliance .
f . No certificati on by a contractor, and no contract clause, may be requi re d in the case of a
contra ct for the acquisition of commercial items in o rde r to implement a prohibition or
requirement of this section or a pr,o hibition or requ irement issued in the implementation of
this section .
g . In paragraph (1 ), the term "commHrcial item" has the meaning given such te rm in section
4 (12) of the Office of Federal Procu rement Policy Act (41 U.S .C . 403(12)).
SigM}J!LJ5= Title
/k~ L_ F, t1 c;~ (J, [)Jt,,.,
A ge nc y/Organjzatjon Da te
(Federal Certification-o n-Di scriminatjon, C lean Air, Clean Water) (01/2 018)Page 3 of 4
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(Certificatio n signlre e same as Contract signature.)
Contract #20242
Thomas L. Fitzgerald
(Federal Ce rtification-Non-Discrimination, C lean Air, C lean Water) (01/20 18)Page 4 of 4
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CONTRACT PROVIDER NAME: _ Thomas Fitzgerald
CONTRACT NUMBER: ____ 20242
CONTRACT PERIOD: _____ July 1, 2024-June 30, 2025
PROVIDER'S FISCAL YEAR: __ January-December
CONTRACT DETERMINATION QUESTIONNAIRE
(PURCHASE OF SERVICE VS. FINANCIAL ASSISTANCE)
Instructions: Enter 5 points for each factor in either the yes or no column. Once the entire list has been completed
tally the points in each column. The column with the most points should be a good indicator of the designation of
the organization--either Financial Assistance (Grant) or Vendor (Purchase of Service).
Determination Factors
Does the provider determine eligibility?
Does the provider provide administrative functions such as Develop program standards
procedures and rules?
Does the provider provide administrative functions such as Program Planning?
Does the provider provide administrative functions such as Monitoring?
Does the provider provide administrative functions such as Program Evaluation?
Does the provider provide administrative functions such as Program Compliance?
Is provider performance measured against whether specific objectives are met?
Does the provided have responsibilitv for programmatic decision making?
Is the provider obiective to carry out a public purpose to support an overall program objective?
Does the provider have to submit a cost report to satisfy a cost reimbursement arrangement?
Does the provider have any obligation to the funding authority other than the delivery of the
specified goods/services?
Does the provider operate in a noncompetitive environment?
Does the orovider provide these or similar goods and/or services only to the funding agency?
Does the provide these or similar ooods and/or services outside normal business operations?
ITOTAL
Note: The authorized individual(s) must place an X in one of the boxes below to indicate
the type of contractual arrangement for this contract , then sign and date where indicated.
5 points
Financial
Assistance
YES
X
X
10
...__ _ __.I FINANCIAL ASSISTANCE I PURCHASE SERVICE ----X
Signature of Authorize rammatic Individual
Signature of Authorized Administrative Individual
Revised effective 7-1-2013
page 1
DATE
DATE
5 points
Purchase
of Service
NO
X
X
X
X
X
X
X
X
X
X
X
X
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Contract # 20242
Thomas L. Fitzgerald
Person County Department of Social Services/Human Services
GOVERNMENT BUSINESS ASSOCIATE ADDENDUM TO MEMORANDUM OF
UNDERSTANDING
This Agreement is made effective the 1st day of July 2024, by and between Person County
Department of Social Services (name County Department of Social Services) ("Covered
Entity'') and Thomas L. Fitzgerald (name of contractor) ("Business Associate"
"Governmental Agency'') (collectively the "Parties"),
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a Memorandum of
Understanding ("entitled" or "dated" identify contract) contract# 20242(the
"MOU'), whereby Business Associate agrees to perform certain services for or on
behalf of Covered Entity.
b. Covered Entity is an organizational unit of Person County as the Person County
Department of Social Services as a health care component for purposes of the
HIPAA Privacy Rule.
c. The relationship between Covered Entity and Business Associate is such that the
Parties believe Business Associate is or may be a "business associate" within the
meaning of the HIP AA Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the MOU with the
intention of complying with the HIPAA Privacy Rule provision that a covered entity
may disclose protected health information to a business associate, and may allow a
business associate to create or receive protected heath information on its behalf, if
the covered entity obtains satisfactory assurances that the business associate will
appropriately safeguard the information.
2. DEFINITIONS.
Unless some other meaning is clearly indicated by the context, the following terms shall
have the following meaning in this Agreement:
a. "HIPAA'' means the Administrative Simplification Provisions, Sections 261 through
264, of the federal Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191.
b. "Individuar' shall have the same meaning as the term "individual" in 45 CFR
160.103 and shall include a person who qualifies as a personal representative in
accordance with 45 CFR 164.502(g).
c. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable
Health Information at 45 CFR part 160 and part 164, subparts A and E.
d. "Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 160.103, limited to the information created or
received by Business Associate from or on behalf of Covered Entity.
e. "Required By Law" shall have the same meaning as the term "required by law" in 45
CFR 164.103.
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Contract # 20242
Thomas L. Fitzgerald
f. "Secretary'' shall mean the Secretary of the United States Department of Health and
Human Services or his designee.
g. Unless otherwise defined in this Agreement, terms used herein shall have the same
meaning as those terms have in the Privacy Rule.
3. OBLIGATIONS OF BUSINESS ASSOCIATE
a. Business Associate agrees to not use or disclose Protected Health Information other
than as permitted or required by this Agreement or as Required By Law.
b. Business Associate agrees to use appropriate safeguards to prevent use or disclosure
of the Protected Health Information other than as provided for by this Agreement.
c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect
that is known to Business Associate of a use or disclosure of Protected Health
Information by Business Associate in violation of the requirements of this
Agreement.
d. Business Associate agrees to report to Covered Entity any use or disclosure of the
Protected Health Information :not provided for by this Agreement of which it
becomes aware.
e. Business Associate agrees to ensure that any agent, including a subcontractor, to
whom it provides Protected Health Information received from, or created or received
by Business Associate on behalf of Covered Entity agrees to the same restrictions
and conditions that apply through this Agreement to Business Associate with
respect to such information.
f. Business Associate agrees to provide access, at the request of Covered Entity, to
Protected Health Information in. a Designated Record Set to Covered Entity or, as
directed by Covered Entity; to an Individual in order to meet the requirements
under 45 CFR 164.524.
g. Business Associate agrees, at the request of the Covered Entity, to make any
amendment(s) to Protected Health Information in a Designated Record Set that the
Covered Entity directs or agrees to pursuant to 45 CFR 164.526.
h . Unless otherwise prohibited by law, Business Associate agrees to make internal
practices, books, and records, including policies and procedures and Protected
Health Information, relating 1to the use and disclosure of Protected Health
Information received from, or created or received by Business Associate on behalf of,
Covered Entity available to the Covered Entity, or to the Secretary, in a time and
manner designated by the Sec1~etary, for purposes of the Secretary determining
Covered Entity's compliance with the Privacy .Rule.
1. Business Associate agrees to document such disclosures of Protected Health
Information and information related to such disclosures as would be required for
Cove red Entity to respond to a request by an Individual for an accounting of
disclosures of Protected Health Information in accordance with 45 CFR 164.528, and
to provide this information to Covered Entity or an Individual to permit such a
response.
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4. PERMITTED USES AND DISCLOSURES
Contract# 20242
Thomas L. Fitzgerald
a. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use or disclose Protected
Health Information to perform functions, activities, or services for, or on behalf of,
Covered Entity as specified in the MOU, provided that such use or disclosure:
I) would not violate the Privacy Rule if done by Covered Entity; or
2) would not violate the minimum necessary policies and procedures of the
Covered Entity.
b. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information as necessary for the proper management and administration of the
Business Associate or to carry out the legal responsibilities of the Business
Associate.
c. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may disclose Protected Health
Information for the proper management and administration of the Business
Associate, provided that: •
1) disclosures are Required By Law; or
2) Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and will be used or
further disclosed only as Required By Law or for the purpose for which it was
disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information
has been breached.
d. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information to provide data aggregation services to Covered Entity as permitted by
45 CFR 164.504(e)(2)(i)(B).
e. Notwithstanding the foregoing provisions, Business Associate may not use or
disclose Protected Health Information if the use or disclosure would violate any term
of the MOU or by other applicable law or agreements.
5. TERM AND TERMINATION
a. Term. This Agreement shall be effective as of the effective date stated above and
shall terminate when the MOU terminates.
b . Termination for Cause. Upon Covered Entity's knowledge of a material breach by
Business Associate, Covered Entity may, at its option:
1) Provide an opportunity for Business Associate to cure the breach or end the
violation, and terminate this Agreement and services provided by Business
Associate, to the extent permissible by law, if Business Associate does not cure
the breach or end the violation within the time specified by Covered Entity;
2) Immediately terminate this Agreement and services provided by Business
Associate, to the extent permissible by law; or
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Contract# 20242
Thomas L. Fitzgerald
3) If neither termination nor cure is feasible, report the violation to the Secretary
as provided in the Privacy Rule.
c. Effect of Termination.
1) Except as provided in paragraph (2) of this section or in the MOU or by other
applicable law or agreements, upon termination of this Agreement and services
provided by Business Associate, for any reason, Business Associate shall return
or destroy all Protected Health Information received from Covered Entity, or
created or received by Business Associate on behalf of Covered Entity. This
provision shall apply to Protected Health Information that is in the possession
of subcontractors or agents of Business Associate. Business Associate shall
retain no copies of the Protected Health Information.
2) In the event that Business Associate determines that returning or destroying
the Protected Health Information is not feasible, Business Associate shall
provide to Covered Entity notification of the conditions that make return or
destruction not feasible. Business Associate shall extend the protections of this
Agreement to such Protected Health Information and limit further uses and
disclosures of such Protected Health Information to those purposes that make
the return or destruction infeasible, for so long as Business Associate maintains
such Protected Health Information.
6. GENERAL TERMS AND CONDITIONS
a. This Agreement amends and is part of the MOU.
b. Except as provided in this Agreement, all terms and conditions of the MOU shall
remain in force and shall apply to this Agreement as if set forth fully herein.
c. In the event of a conflict in terms between this Agreement and the MOU, the
interpretation that is in accordance with the Privacy Rule shall prevail. In the event
that a conflict then remains, the MOU terms shall prevail so long as they are in
accordance with the Privacy Rule.
d. A breach of this Agreement by Business Associate shall be considered sufficient
basis for Covered Entity to terminate the MOU for cause.
SIGNATURES:
Date: 7-J~ ~1/t
Rev: 6-7-2015
4
189
Contract# 20242 Fiscal Year Begins July 1 , 2024 Ends June 30, 2025
Th is contract is hereby entered into by and between the Person County Department of Social Services (the "County") and
Thomas L. Fitzgerald (the "Contractor") (referred to collective ly as the "Parties"). T he Contractor's federal tax identification
number or Social Security Number is 20-2272781 and DUNS Number (required if funding from a federal funding source).
1. Contract Documents: This Contract consists of the follow ing 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 Policy (Attachment D)
(6) No Overdue Taxes (Attachment E)
(7) If applicable, HIPAA Business Associate Addendum (checkli st and forms) (Attachment I)
(8) Certification of T ransportation (Attachment J)
(9) If applicable, IRS federal tax exempt letter or 501(c)3 (Attachment K) http://www .irs.gov/pub/irs-fill/k1023 .pdf
(10)Certain Reporting and Auditing Requirements (Attachment L)
(11)State Certification (Attachment M)
(12)Attachment N -Non-Discrimination , Clean Air, Clean Water
(16) Contract Determination Questionnaire (required)
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-liste d document having the lowest precedence. If there are multiple Contract
Amendments , the most rece nt amendment shall have the highest precedence and the oldest amendment shall have the
lowest precedence.
3. Effective Period : Th is contract shall be effective on July 1, 2024 and sha ll terminate on June 30 , 2025 ,
Th is contract must be twelve months or less.
4. Contractor's Duties : The Contra ctor shall provide the services and in accordance with the approved rate as described in
Attachment B, Scope of Work.
s. County's Duties : The County shall pay the Contractor in the manner and in the amounts specified in the Contract
Doc uments . The total amount paid by the County to the Contra ctor under this con t ract shall not exceed 1 ,150 hours
collectively for all attorneys under contract. Rate of compensation for Primary Attorney Thomas L. Fitzgerald is $147 per
hour.
l8] a . There are no match ing requirements from the Contract or.
0 b. The Contractor's matching requ i rement is $
0 In-kind
0 Cash and In-kind
. w hich shall consist of:
□cash
0 Cash and /or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
6 . Reversion of Funds:
Any unexpended grant funds shall rev ert to the County Department of Social Serv ices/Human Services upon
term ination of this contract.
7 . Reporting Requirements:
Contractor shall comply with aud it requ irements as described in N.C .G.S. § 143C-6-22 & 23 and 0MB Circu lar-CFR Title
2 G rants and Agreements, Part 200, and shall disclose al l information required by 42 USC 455 .104, or 42 USC 455 .105,
or 42 USC 455.106 .
Contract-General (06/15 ) Page 1 of 3
190
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 the County:
IF DELIVERED BY US POSTAL SERVICE lF DELIVERED BY ANY OTHER MEANS
Name & Title Wendy McKinney, Business Officer Name & Title Wendy McKinney, Business Officer
County Person County County Person County
Mailing Address P.O. Box 770 Street Address 355-B S. Madison Blvd
City, State, Zip Roxboro, NC 27573 City, State, Zip Roxboro, NC 27573
Telephone 336-503-1158
Fax 336-599-397 4
Email wmckinney@personcountync.Q0V
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name & Title Thomas L. Fitzgerald, Attorney Name & Title Thomas L. Fitzgerald, Attorney
Company Name FitzLaw Company Name FitzLaw
Mailing Address P.O. Box 1519 Street Address 22 Court Street
City State Zip Roxboro, NC 27573 City State Zip Roxboro, NC 27573
Telephone 336-599-2567
Fax
Email
10. Supplementation of Expenditure of Public Funds:
The Contractor assures that funds received pursuant to this contract shall be used only to supplement, not to
supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract
services and related programs. Funds received under this contract shall be used to provide additional public funding
for such services; the funds shall not be used to reduce the Contractor's total expenditure of other public funds for
such services.
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:
Contract-General (06/15) Page 2 of3
191
The Contractor certifies that it has identified to the Coun ty al l j obs re lated to the contract that have been outsourced
to other countries, if a ny. The Contractor further agrees that it w ill not outsource any such jobs during the term of
thi s contract w ithout providing notice to the County .
13 . Federal Certifications:
Individuals and Organizations receivi ng federa l funds must ensure com pli ance w ith certain certifications requi red by
federal laws and regulations. The contractor is hereby complying with Certifications regarding Nondiscrimi nation ,
Drug-Free Workplace Requ irements , Environmental Tobacco Smoke , Debarment, Suspension, Inelig ibility and
Vo l untary Excl usion Lower Tier Covered Transactions, and Lobby ing . These assurances and certifications are to
be signed by the contractor's authorized representative .
14. Specific language Not Previously Addressed :
15. Signature Warranty: The undersigned rep resent and warrant that they are authorized to bind their principals to th e
terms of this agreement.
T he Contractor and the County have executed this co ntract in duplicate or iginals, w ith one orig in al be ing reta ined by each
party .
Signature Date
Printed Name Title
COUNTY
Signature (must be legally authorized to sign contracts for County DSS) Date
Printed Name T itle
Th is instrument has been pre-audi ted in the manner req uired by the Local Government Budget and Fiscal Control Act.
Si gnature of County Finance Officer Date
Contract-Genera l (06/15) Page 3 of 3
192
GENERAL TERMS AND CONDITIONS
Relationships of the Parties
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the
performance of this contract and as such shall be wholly
responsible for the work to be performed and for the
supervision of its employees. The Contractor represents
that it has, or shall secure at its own expense, all
personnel required in performing the services under this
agreement. Such employees shall not be employees of,
or have any individual contractual relationship with , the
County.
Subcontracting: The Contractor ·shall not subcontract
any of the work contemplated under this contract without
prior written approval from the County. Any approved
subcontract shall be subject to all conditions of this
contract. Only the subcontractors specified in the contract
documents are to be considered approved upon award of
the contract. The County shall not be obligated to pay for
any work performed by any unapproved subcontractor.
The Contractor shall be responsible for the performance
of all of its subcontractors .
Assignment: No assignment of the Contractor's
obligations or the Contractor's right to receive payment
hereunder shall be permitted. However, upon written
request approved by the issuing purchasing authority, the
County may: (a) Forward the Contractor's payment check
directly to any person or entity designated by the
Contractor, or(b) Include any person or entity designated
by Contractor as a joint payee on the Contractor's
payment check. In no event shall such approval and
action obligate the County to anyone other than the
Contractor and the Contractor shall remain responsible
for fulfillment of all contract obligations.
Beneficiaries: Except as herein specifically provided
otherwise, this contract shall inure to the benefit of and be
binding upon the parties hereto and their respective
successors. It is expressly understood and agreed that
the enforcement of the terms and conditions of this
contract, and all rights of action relating to such
enforcement, shall be strictly reserved to the County and
the named Contractor. Nothing contained in this
document shall give or allow any claim or right of action
whatsoever by any other third person . It is the express
intention of the County and Contractor that any such
person or entity, other than the County or the Contractor,
receiving services or benefits under this contract shall be
deemed an incidental beneficiary only.
Indemnity and Insurance
Indemnification: The Contractor agrees to indemnify and
hold harmless the County, the State of North Carolina,
and any of their office rs , agents and employees, and
Federal Government from any claims of third parties
arising out of any act or omission of the Contractor in
connection with the
performance of this contract to the extent permitted by
law.
Default and Termination
Termination Without Cause: The County may terminate
this contract without cause by giving 30 days written
notice to the Contractor.
Termination for Cause: If, through any cause , the
Contractor shall fail to fulfill its obligations under this
contract in a timely and proper manner, the County shall
have the right to terminate this.contract by giving written
notice to the Contrac;tor and specifying the effective date
thereof. In that event, all finished or unfinished deliverable
items prepared by the Contractor under this contract shall,
at the option of the County, become its property and the
Contractor shall be entitled to receive just and equitable
compensation for any satisfactory work completed on
such materials, minus any payment or compensation
previously made. Notwithstanding the foregoing
provision, the Contractor shall not be relieved of liability to
the County for damages sustained by the County by virtue
of the Contractor's breach of this agreement, and th e
County may withhold any payment due the Contractor for
the purpose of setoff until such time as t he exact amount
of damages due the County from such breach can be
determined . In case of default by the Contractor, without
limiting any other remedies for breach available to it, the
County may procure the contract services from other
sources and hold the Contractor responsible for any
excess cost occasioned thereby. The filing of a petition for
bankruptcy by the Contractor shall be an act of default
under this contract.
Waiver of Default: Waiver by the County of any default
or breach in compliance with the terms of this contract by
the Contractor shall not be deemed a waiver of any
subsequent default or breach and shall not be construed
to be modification of the terms of this contra ct unless
stated to be such in writing, signed by an authorized
representative of the County and the Contractor and
attached to the contract.
Availability of Funds: The parties to this contract agree
and understand that the payme nt of the sums specified in
this contract is dependent and contingent upon an d
subject to th e appropriation, allocation , and availability of
funds for this purpose to the County.
Force Majeure : Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
war, hostile foreign action, nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other
catastrophic natural event or act of God:
Survival of Promises: All promises, requirements,
terms, conditions, provisio ns, repres entations,
NCDHHS TC1010 (General Term s and Conditions) (Local Government) (Rev. 11.01 .15)
193
guarantees, and warranties contained herein shall survive
the contract expiration or termination date unless
specifically provided otherwise herein, or unless
superseded by applicable Federal or State statutes of
limitation.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract are
the exclusive property of the County. The Contractor shall
not assert a claim of copyright or other property interest in
such deliverables.
Compliance with Applicable Laws.
Compliance with Laws: The Contractor shall comply
with all laws, ordinances, codes, rules, regulations, and
licensing requirements that are applicable to the conduct
of its business, including those of federal, state, and local
agencies having jurisdiction and/or authority.
Equal Employment Opportunity: The Contractor shall
comply with all federal and State laws relating to equal
employment opportunity.
Health Insurance Portability and Accountability Act
(HIPAA): The Contractor agrees that, if the County
determines that some or all of the activities within the
scope of this contract are subject to the Health Insurance
Portability and Accountability Act of 1996, P.L. 104-91, as
amended ("HIPAA"), or its implementing regulations , it will
comply with the HIPAA requirements and will execute
such agreements and practices as the County may
require to ensure compliance.
Confidentiality
Confidentiality: Any information, data, instruments,
documents, studies or reports given to or prepared or
assembled by the Contractor under this agreement shall
be kept as confidential and not divulged or made available
to any individual or organization without the -prior written
approval of the County. The Contractor acknowledges
that in receiving, storing, processing or otherwise dealing
with any confidential information it will safeguard and not
further disclose the information except as otherwise
provided in this contract.
Data Security: The Contractor shall adopt and apply data
security standards and procedures that comply with all
applicable federal, state, and local laws, regulations, and
rules.
Duty to Report: The Contractor shall report a suspected
or confirmed security breach to the County's Contract
Administrator within twenty-four (24) hours after the
breach is first discovered, provided that the Contractor
shall report a breach involving Social Security
Administration data or Internal Revenue Service data
within one (1) hour after the breach is first discovered.
During the performance of this contract, the contractor is
to notify the County contract administrator of any contact
by the federal Office for Civil Rights (OCR) received by
the contractor.
Cost Borne by Contractor: If any applicable federal,
state or local law, regulation, or rule requires the County
or th~ Contractor to give affected persons written notice
of a security breach arising out of the Contractor's
performance under this contract, the Contractor shall bear
the cost of the notice.
Oversight
Access to Persons and Records: The State Auditor
shall have access to persons and records as a result of
all contracts or grants entered into by State agencies or
political subdivisions in accordance with General Statute
147-64.7. Additionally, as the State funding authority, the
Department of Health and Human Services shall have
access to persons and records as a result of all contracts
or grants entered into by State agencies or political
subdivisions.
Record Retention: Records shall not be destroyed,
purged or disposed of without the express written consent
of the County. State basic records retention policy
requires all grant records to be retained for a minimum of
five years or until all audit exceptions have been resolved ,
whichever is longer. If the contract is subject to Federal
policy and regulations, record retention may be longer
than five years. Records must be retained for a period of
three years following submission of the final Federal
Financial Status Report, if applicable, or three years
following the submission of a revised final Federal
Financial Status Report. Also, if any litigation, claim,
·negotiation, audit, disallowance action, or other ~ct~on
involving this Contract has been started before expiration
of the five-year retention period described above, the
records must be retained until completion of the action
and resolution of all issues which arise from it, or until the
end of the regular five~year period described above,
whichever is later. The record retention period for
Temporary Assistance for Needy Families (TANF) and
MEDICAID and Medical Assistance grants and programs
must be retained for a minimum of ten years .
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11 .01 .15)
194
Miscellaneous
Choice of Law: The validity of this contract and any of its
terms or provisions, as well as the rights and duties of the
parties to this contract, are governed by the laws of North
Carolina. The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract,
to the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive
venue for any legal pro~eedings shall be Wake County,
North Carolina. The place of this contract and all
transactions and agreements relating to it, and their situs
and forum, shall be Wake County, North Carolina, where
all matters, whether sounding in contract or tort, relating
to the validity, construction, interpretation, and
enforcement shall be determined.
Amendment: This contract may not be amended orally or
by performance. Any amendment must be made in written
form and executed by duly authorized representatives of
the County and the Contractor.
Severability: ln the event that a court of competent
jurisdiction holds that a provision or requirement of this
contract violates any applicable law, each such provision
or requirement shall continue to be enforced to the extent
it is not in violation of • law or is not otherwise
unenforceable and all other provisions and requirements
of this contract shall remain in full force and effect.
Headings: The Section and Paragraph headings in these
General Terms and Conditions are not material parts of
the agreement and should not be used to construe the
meaning thereof.
Gender and Number: Masculine pronouns shall be read
to include feminine pronouns and the singular of any word
or phrase shall be read to include the plural and vice
versa.
Time of the Essence: Time is of the essence in the
performance of this contract.
Key Personnel: The Contractor shall not replace any ?f
the key personnel assigned to the performance of this
contract without the prior written approval of the County.
The term "key personner includes any and all persons
identified as such in the contract documents and any
other persons subsequently identified as key personnel
by the written agreement of the parties.
Care of Property: The Contractor agrees that it shall be
responsible for the proper custody and ~are <:>f any
property furnished to it for use in connection with the
performance of this contract and will reimburse the
County for loss of, or damage to, such property. At the
termination of this contract, the Contractor shall contact
the County for instructions as to the disposition of such
property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Contractor for
travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
exceed the rates published in the applicable State rules
or approved local government travel policy. International
travel shall not be reimbursed under this contract.
Sales/Use Tax Refunds: If eligible, the Contractor and
all subcontractors shall: (a) ask the North Carolina
Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
pursuant to G.S. 105-164.14; and (b) exclude all
refundable sales and use taxes from all reportab le
expenditures before the expenses are entered in their
reimbursement reports.
Advertising: The Contractor shall not use the award of
this contract as a part of any news release orcommercial
advertising .
NCDHHS TC1010 (General T erms and Conditions) (Local Government) (Rev. 11.01.15)
195
ATTACHMENT B-Scope of Work Federal Tax Id. or SSN 20-2272781
Contract # 20242
A. CONTRACTOR INFORMATION
1. Contractor Agency Name: Thomas L. Fitzgerald
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: 336-599-2567 Fax Number: Iv /t
3. Name of Program (s): Child Support
4. Status: IZ! Public D Private, Not for Profit
Email: f o~ ,-qt,~c,ro • Clt'(
f1tiJa...w(§? r-~~'tc ,,,J/
D Private, For Profit
5. Contractor's Financial Reporting Year January through December
B. Explanation of Services to be provided and to whom(include SIS Service Code):
To be available for consultation, legal advice and for representation as requested by the
Child Support Enforcement Agency on all legal matters arising from the duties of the
party of the first part under Sections 128 through 140 of Chapter 110 of the North
Carolina General Statutes and Title 42 of the United States Code, Sections 651 through
660 and the federal regulations lawfully promulgated pursuant thereto.
For their services under this contract, the agency agrees to pay the contractor one hundred
forty dollars ($14 7.00) per hour for out of court time and one hundred forty dollars
($147.00) per hour for in court time for each hour spent by the contractor providing legal
services under the Child Support Enforcement Program. Such hourly rate shall
encompass all expenses, including, but not limited to, those for salary, supplies, office
space, heating and maintenance for office space, telephone service, long-distance
telephone calls, postage, and travel ( other than travel to attend the Child Support
Enforcement Training). The contractor is not to be reimbursed for any extraordinary
expense incident to performing the services included under this agreement; except, that
the agency agrees to pay all court costs and filing fees which are required to be paid in
conjunction with services provided by the attorney under this agreement.
The contractor further agrees to attend at least one training session on Child Support
Enforcement per year conducted by the Child Support Enforcement Agency. Further, the
~gency agrees to compensate the contractor at the hourly rate of fifty-five dollars
($55.00) for each hour that the party· of the second part spends in training up to but not to
exceed the amount of four hundred forty dollars ($440.00) per day. Travel and meal
reimbursement shall be made at the same rates that are applicable to county DSS
employees (see Budget Addendum). However, the attorney may not be paid an hourly
rate for time spent traveling. Failure to attend one approved workshop per year shall be
construed as an indication that the contractor does not wish to continue providing
services under this agreement.
Contract-Scope of Work (7-2008) Page lof2
196
Person County Department of Social Services will pay standard costs for ACTS training
with consideration being given to Person County Department of Social Services paying
for Mr. Fitzgerald's ACTS computer software should such acquisition be necessary.
C. Rate per unit of Service ( define the unit):
1. If Standard fixed Rate, Maximum Allowable, (See Rates for Services Chart)
One hundred forty dollars ($14 7 .00) per hour for out of court time and one
hundred forty dollars ($147.00) per hour for in court time for each hour oflegal services
performed. Such hourly rates shall encompass all expenses, including, but not limited to,
those for salary, supplies, office space, heating and maintenance for office space,
telephone service, long-distance telephone calls, postage and travel.
2. Negotiated County Rate.
D. Number of units to be provided: no more than 1, 150 hours collectively
E. Details of Billing process and Time Frames;
Payable on or before the 10th of each month upon due submission by the Attorney of a
statement of work detailing the hours of work performed and the nature of such legal
work.
F. Area to be served/Delivery site(s): Person County Courthouse, FitzLaw, Person
County Department of Social Services .
(Signature of County Authorized Person) (Signature of Contractor)
l-\ ,LJ1t L{
(Date Submitted) (Date Submitted)
Contract-Scope of Work (7-2008) Page2of2
197
FEDERAIL CERTIFICATIONS
The undersigned states that:
1. He or she is the duly authorized representative of t:he 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 Toloacco 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 Discllosure 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 cov,ered Federal action;
OR
D( He or she has not completed the attached Dlisclosure 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 ~~<ti& ( Title
Contractor Name Date
[This Certification Must be Signed by the S,1me 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 19164 (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 amend1ed, 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.
198
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
___ 22 Court Street
City, State, Zip Code
___ Roxboro, NC 27573, ______________________________ _
Street
City , State, Zip Code
199
3. Contractor will inform the Department of any additional sites for performance of work under th is agreement.
4. False certification or violation of the. certificatio,n 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.
Ill. 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 c;:ire, 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
Covured Transactions
Instructions
[The phrase "prospective lower tier participant" means the Contractor.]
l. 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 ciircumstances.
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 knowingrly enter any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily excluded from participation in this covered transaction
unless authorized by the department or agency with which this transaction originated.
6. The prospective lower tier participant further agrees by submitting this document that it will include the clause titled
"Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered
Transaction," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered
transactions.
7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered
transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from covered transaction, unless it
knows that the certification is erroneous. A participant may decide the method and frequency by which it determines
the eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List.
200
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 deallngs.
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 parti_cipant 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 shalt 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
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.
201
Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome
of a covered Federal action.
1. Identify the status of the covered Federal action.
2. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
information previously reported , enter the year and quarter in which the change occurred . Enter the date of the last
previously submitted report by this reporting entity for this covered Federal action .
3. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known.
Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub-
award recipient. Identify the tier of the subawardee, e .g., the first subawardee of the prime is the 1st tier. Subawards
include but are not limited to subcontracts, subgrants and contract awards under grants.
4. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name, address, city, state and
zip code of the prime Federal recipient. Include Congressional District, if known.
5. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
level below agency name, if known . For example , Department of Transportation, United States Coast Guard .
6. Enter the Federal program name or description for the covered Federal action (Item 1 ). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, !pans, 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 i nclude full address if different from 1 0(a). Enter Last
Name, First Name and Middle Initial (Ml).
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 certi in official shall si n and date the form , rint his/her name, title, and tele hone number.
Pu b lic 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 i nformation, in cluding suggestions for reducing this burden , to the Office of Management and
Bud et. Pa erwork Reduction Pro·ect 0348-0046 , Washin ton, D. C. 20503
202
1 .
Disclosure Of Lobbying Activities
(Approved by 0MB 0344-0046)
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
Type of Federal Action: 2. Status of Federal Action: 3 . Report T ype:
IE-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, Ent er Name
and Address of Prime:
~ Prime
Subawardee Tier (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 address if
(if individual, la st name, first name, Ml): different from No. 10a.) (la st name, first name, Ml):
(atta ch Continuation Sheet(s) SF-LLL-A, if necessary) (attach Continuation Sheet(s) SF-LLL-A, if necessa,y)
11 . Amount of Payment (che ck all that apply): 13. Type of Payment (check all that apply):
$ actual planned □ a. retainer
□ b . one-time fee
12. Form of Payment (check afl that apply): □ c. commission
□ d. contingent fee
□ a. cash □ e. deferred
□ b. In-kind;· specify: Nature □ f. other; specify:
Value
14. Brief Description of Services Performed or to be Perfo rmed and Date(s) of Services, including office r(s), employee(s), or
Member(s) contacted, for Payment Indicated in Item 11 (attach Continuation Sheet(s) SF-LLL-A, if necessary):
15. Continuation Sheet(s) SF-LLL-A attached: □ Yes □ No
16. Information requested through this form is authorized by Signature: ~7~ VJ
title 31 U .. S. C. section 1352. This disclosure of lobbying ,-J.e.,..,, y__ ft t--i ~wl activities is a material representation of fact upon which Print Name:
reliance was placed by the tier above when this transaction &lk~
.
was made or entered into. This disclosure is required Title:
pursuant to 31 U.S. C. 1352. This information will be
Telephone No : ?J~ --{'e,~--2-r.17Date: ,,~-~l v reported to the Congress semi-annually and will be
available for public inspection. Any person who fails to file
the required disclosure shall be subject t o a civil penalty of
nottess than $10,000 and not more than $100,000 for each
such failure.
Federal Use Only Autho rized for Local Reproduction
Standard Form -LLL
203
CONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY
State of Nor:tb C..aro l ~I\J:\.
County Pl Cf 6 I\
. Notary Public for said County and State, certify ,.
1
~h;¼ E. ~en:Jd
___ (,__~_IM __ L_..:..f_,;~h-~_1c._. _l_! ___ personally appeared before me this day and
acknowledged
that he/she isOk."-b fir._., 4'-of TJ.M L fl-~ · .fff',_L<~
[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 ____ _, ___ _
My Commission expires ---"O~lo=----'---'3::;__-_~ __ L-_____;'7'---' 20 _
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
Instruction for Organization:
Sign and attach the following pages after adopted by the Board of Directorsffrustees or other
governing body OR replace the following with the current adopted conflict of interest policy.
Name of Organization
Signature of Organization Official
NCDHHS COII015 (Rev.4/11)
204
Conflict of Interest Policy
The Board of Directorsrrrustees or other governing persons, officers, employees or agents are to avoid
any conflict of interest, even the appearance of a conflict of interest. The Organization's Board of
Directorsffrustees 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
DirectorsfTrustees 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 djscussed 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
Directorsffrustees or other governing body.
F. Violations of the Conflicts of Interest Policy --If the Board of Directorsffrustees 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 Directorsrrrustees 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 COIJ0l5 (Rev. 4/11)
205
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:
Sign a Official
7-'/--'U l cf
Date
NCDHHS COI1015 (Rev. 4/11)
206
ATTACHMENT E-OVE RD UE TAXE S
Thomas L. Fitzgerald
--------------------------------------ATTORNEY AT LAW----------------------------------
22 Co urt Street, Suite 200
P.O. Box 1519
Ro x boro , NC 27573
July I , 2024
To: Person Coun ty Department of Social Services
Certification :
336-599-2567 -Telephone
336-599-5782 --Fax
1, Thomas L. Fitzgerald, certify that l do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1 , at
the federal , State, or local level. l further understand that any person wh o ma kes a fa lse statement in violation
ofN.C.G .S. l 43C-6-23(c) is g uil ty of a criminal offense punish able as provided by N.C.G.S.) I 43C-l 0-1 b.
Sworn Sta teme nt:
1, Thomas L. Fi tzgerald , being duly swo rn , say that the foregoing certification is true. accurate and complete to
the best of my knowledge and was made and subscribed by me. 1 also acknowledge and understand that an y
mi suse of State funds w ill be reported to the appropriate authoritie s fo r further action.
Signaru Date
My Commission expires:
-:. --0
1 G .S. 105-243.1 defines: Overdue tax debt. -Any part of a tax debt that rem"~
assessment was mailed to the taxpayer. The term does not include a tax debt, s
agreement for the tax debt under G.S. 105-237 within 90 days after the notice of 1
make any payments due under the installment agreement.•
, 202a/
'°u , 0 off
npaid Ja kys or ~ after the notice of final
r, if the taxl>rier,-e'r'ltered i nto an installment
1 ~~l'\,~mailed and has not fa iled to ,,,,,,,,,111''
207
This document will be used to detennine if you have a business associate relationship with a contractor. This fonn should be
completed on all contracts that have a HIPAA covered health care component. This would include all health related information.
Contractor: Thomas L. Fitzgerald Contract Number: 20241 Date: 7/01/2024
HIP AA ASSESSMENT FORM
Questions
1. Has a relationship been initiated Select
allows the contractor to perform a
function or activity for, or on behalf of,
County Department of Social Services
HIP AA covered health care component?
2. Is the function or service to be Select
rendered by the contractor on an activity
other than treatment of clients?
3. Does the function or service to Select
be rendered by the contractor involve the
use or disclosure of the County
Department of Social Services
individually identifiable health
information?
4. Are the services rendered by Select
staff from the contractor performed on the
premises of the covered health care
component, using the component's
resources and following the component's
policies and procedures?
5. Is the contractor performing a Select
type(s) of function/activity for or on the
behalf of the County Department of
Social Services HIP AA covered health
Notes
NOTE: The sharing of
Individually identifiable
health information with
another treatment contractor
for treatment purposes only
does not require a business
associate agreement. See 45
CFR &164.502(e)(l)(ii)(A)
NOTE: Data that does not
contain A County
Department of Social
Services individually
identifiable health
information is not covered by
HIPAA and thus does not
have to be protected through
a business associate
agreement.
NOTES: Whenever a service
is rendered on the premises
of a covered component,
utilizing the component's
resources and following the
component's policies and
procedures, the person
rendering such services is
considered a member of the
component's workforce, and
is required to comply with
the component's privacy
policies and procedures. No
business associate agreement
is reauired.
Check appropriate service(s):
D Attorney Representing
Agency
D Benefits Management
Steps
-Go to Question 2.
top. There is no business
te relationship.
YES-Go to Question 3.
NO-Stop. There is no business
associate relationship.
YES --Go to Question 4 .
NO-Stop. There is no business
associate relationship.
NO-Got Question 5.
YES-Stop. There is not business
associate relationship.
YES-You have identified a business
associate relationship. The specified
function/activity, which involves the
sharing of individually identifiable
1
208
component that is directly related to the D Patient Accounts Billing health information, is provided by the
covered health component's continued D Claims Processing contractor. This constitutes a business
operation? D Claims Administration associate relationship as such
D Bill Collections information must be protected t he same
D Professional Services as required of the HIP AA covered
D Special Population health care component. There are two
Assessments types of business associate relationships:
D Data Analysis External Business Associate
D Data Processing relationships: You have indentified an
D Data Administration External business associate relationship
0JCAHO if you are contracting with any entity
D Council on Accreditation outside city, county or state government.
D Re-pricing A Business Associate Addendum must
D Rate Setting be signed and included with the
D Practice Management contract. If you are completing a
D Software Support Memorandum of Agreement (MOA) •
D Utilization Review with a governmental entity the
D Quality Assurance Government Associate Addendum must
Contract Analysis be utilized.
D Central Office NO-STOP. There is no business
Supervision
D Security
associate relationship.
0 Dietary
D Machine Maintenance
D Facility Maintenance
D Landscaping
D Housekeeping
D Hardware Support
D Audits/Surveys
D Purchasing
ADDITIONAL REQUIRMENTS
NOTE: Make sure all county
requirements are met for internally
notifying the correct parties for External
and Internal Business Associates
Rev: 7-1-2013
2
209
State Certifications
Contractor Certifications Required by orth Carolina Law
lnstruction s : The person who signs this document s hould read the text of the statutes and Executive Order listed belo w and consult
with coun sel and other knowledgeab le persons before signing. The text of each North Carolina General Statutes and of the Executive
Order can be fo und online at:
• Article 2 of C hapter 64: http://www.ncga .state.nc.us/Enac1edLcg1slatton Statutes/PDF/ByArticle/Chapter 64/Artic lc 2 .pdf
• G .S. 133-32: hnp://www.nc ga .statc.nc.us/gascrip1s/statutes/sta1u1elookup.pl?stanne=l 33-32
• Executi ve Order No . 24 (Perdue, Gov., Oct. 1, 2009): http ://www.ethicscommission.nc.gov/library/pdfs/Laws/E024 .pdf
• G.S. I 05-l 64.8(b ): http ://www .ncga.state.nc.us/EnactedLegi slation/Sumnes/PDF/BySection/Chapter I 05/GS I 05-164.8.pdf
• G.S. 143-48.5: hnp://www.ncga.state.nc.us/EnactedLegis lati on/Statutes/HTMUBySec1ion/Chapter 143/GS 143-48.5.html
• G .S . 143-59.1 : http://www.ncga.state .nc.us/Enac1edLeg1sla tion/Statutes/PDF/BySection/Chapter 143 GS 143 -59. J.pdf
• G .S . 143-59.2: http ://www.ncga.state.nc .us/EnactedLeg1slatton/Starutes/POF/ByScction/Chapter 143,GS 143-59.2.pdf
• G.S. 143 -1 33.3: http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTM L/BySection/Chapter 143/GS 143 -133.3 .html
• G .S . 143 B -139 .6C: http://www.ncga.staLe.nc.us/EnactedLcgislation/Statutes/PDF/BySection/Chapter 143B/GS l43B-J 39.6C.pdf
Certifications
Pursuant to G.S. 133-32 and Executive Order No . 24
(Perdue, Gov., Oct. I, 2009), the undersigned hereby
country" as set fo rth in G.S. 14 3-59.1 (c)(2) after
December 31, 200 I but the United States is not
the principa l market for the public trading of the
stock of the corporation incorporated in the tax
haven country.
certifies that the Co ntractor named below is in
compliance w ith , and ha s not violated, the provis ions of
e ither sajd statute or Executive Order.
(2) Pursuant to G.S . 143-48.5 and G.S. 143-133.3 , the
undersigned hereby certifies that th e Contractor named
below, and the Contractor's su bcontractors, compli es
with the requirements of Artic le 2 of Chapter 64 of the
C Genera l Statute . includi ng th e requirement for each
employer with more than 25 employees in North
Carol ina to verify the work authorization of its
employees through the federa l E-Yerify system ." E-
Verify System Link: www.uscis.gov
(3) Pursuant to G.S. 143-59.1 (b), the undersigned hereby
certifies that the Contractor named be low is not an
"ineligible Contractor" as set forth in G.S. 143-59. l(a)
because:
(a) Neither the Contractor nor any of its affiliates h as
refused to co ll ect the use tax levied under Article 5
of Chapter I 05 of the Genera l Statutes on its sa les
delivered to orth Caro lina when the sa les met one
or more oft.he cond itions of G.S. 105-164 .S(b); and
(b) [ check one of the fo ll owin g boxes]
D Neither the Contractor nor any of its affiliates
has incorporated or reincorporated in a "tax
hav en country" as set forth in G.S. 143-
59 . l(c)(2) after D ecemb er 31 , 2001 ; or
□ T he Contractor or one of its affi li ates ha s
incorporated or
Contractor's Name:
Contrac ror 's
Authorized Agent :
Witness:
The witness should be present when tbe Contra
document immediately thereafter.
Contractor C'ertitiClltinns Rea 11ired hv nn-h C'Mn liM I .aw (Rev R/2011\1
(4) Pursuant to G.S. 143-59.2(b), the undersigned hereby
certifies that none of the Contractor's officers, d irectors,
or owners (if the Contractor is an unincorporated
business entity) has been convicted of any vio lation of
Chapter 78A of the General Statutes or the Securities Act
of 1933 or th e Securities Exchange Act of I 93 4 within
10 year s immediately p1ior to the date of the bid
sol icitation .
(5) Purs uant to G.S . 143 B-139.6C , the undersigned hereby
certifies that the Contractor will not use a former
employee, as defined by G.S. 143B-L 39.6C(d)(2), of
the North Carolin a Department of Health and Human
Services in the administration of a contract with the
Department in vio lation ofG.S. 1438-139.6C and that
a violation of that statute shall v oid the Agreement.
(6) The unders igned hereby certifies further t hat:
(a) He or she is a dul y auth orized representative of th e
Contractor named below;
(b) He or she is authorized to make , and does hereby
make, the foregoing certifications on behalf of the
Contractor; and
(c) He or she understands that any person who
knowingly submits a false certification in res pon se
to the requirements of G.S. 143-59. land -59 .2 shall
be guil ty of a Class I fe lony.
fr k './k i,-1 14-tir
Pa 11e I n f I
210
ATTACHME T
Contract #20241
Thomas L. Fitzgerald
Person County Department of Social Services/Human Services
CERTIFICATION REGARDING NOND ISCRIMINATIO , CLEAN AIR ACT,
CLEAN WATER ACT
Certification Regarding Nondiscrimination
The Contractor certifies that it w ill comply w ith all Federa l statutes relating to nondiscrimination.
These include but are not limited to: (a ) T itle VI of the Civil Rights Act of 1964 (P.L. 88-352) which
prohibits discrimination on the bas is of ra ce , color or national origin ; (b) Title IX of the Ed ucat ion
Amendments of 1972, as amended (20 U.S.C . §§1681-1683, and 1685-1686), which prohib its
discrimination on the basis of sex; (c ) Section 504 of the Rehabil itation Act of 1973, as amended
(29 U.S.C. §794), which proh ibits discrimination on the basis of handicaps; (d) the Age
Discrim ination 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 nondiscri min ation on the basi s of drug abuse; (f) the Comprehensiv e
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 alcoho li sm ; (g )
Title V II I of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq .), as amended , relating to
nond iscrimin ation in the sa le, 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
Opportun ity ," as amended by Executive Order 11375, and as supp lemen ted by the De partmen t of
Labor Regulations (41 CFR Part 60): The Executive Order prohibits federal contractors a nd
federally-assisted construction contractors and subcontracto rs who do over $10,000 i n
Government business in one year from discriminating in employment decisions on the basis of
race , color, religion, sex, or national origi n. The Executive Order also requ ires Government
contractors to take affirmative action to ensure tha t equal opportunity is provided in all aspects of
the ir employment.
Mean ingful Access for LEP Individuals : The Contractor that participate in the SNAP must take
reasonable steps to ensure that LEP persons have meaningful access to p rograms , services, and
benefits. This i ncludes the requirement to provi de bilingual program information and certification
material s and interpretation services to sing le language mi nori ties in certain proj ect areas. SNAP
Contractors that do not provide meaningful access for LEP individua ls risk violating prohibitions
against d iscrimination based on National Orig in in the Food and Nutrition Act of 2008, as
amended , Title VI of the Civil Rights Act of 1964 (Title VI ) and SNAP program regu lations at 7
CFR 272A(b). They also r isk noncompliance with the USDA policy g uidance t itled , "Guidance to
Federal Financial Assistance Re cip ients Regarding Tit le VI Prohibition Against National Origin
Discrimina tion Affecting Limited Engl ish Profi c ient 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
bil ingual staff, arranging telepho ne interpreters and/or language li nes, coordinating community
volunteers , translating vital doc uments, and providing w ritten notice that language services are
ava ilab le in appropriate languages. Quality and accu racy of the language service is critical in
order to avoid serious consequences to the LEP person and to the recipient. LEP needs shou ld
be considered in developing budgets and front line staff should understand how to obtain
language assistance services. For additional ass istance and information regarding LEP matters,
please also visit http ://www.lep.gov.
(Federal Certification -Non-Disc riminatio n, Clean Ai r , Clean Water) (0 1/20 18 )Page 1 of 4
211
Contract #20241
Thomas L. Fitzgerald
Ensuring Equa l Opportun ity Access for Persons w ith Disabili ties: The Contractor must a lso
ensure equal opportunity access for persons with disabilities . Th is includes ensuring that
communications with applicants , participants, members of the publ ic, and companions with
disabilities are as effective as communications with people without disabilities. Contractors that
do not provi de persons with disabilities equal opportunity access to programs may risk violat ing
prohibition s against disability di scrimination in the Re habilitation Act of 1978, the American with
Disabilit ies Act (ADA) of 1990, as amended , and SNAP prog ram regulations.
DOJ published revised final regulations implementing T itle II and T itle Il l of the ADA on
September 15 , 2010. These regulations are codified at 28 CFR Part 35 "Nondiscriminatio n on
the Basis of Disability in State and Local Government Services" and at 28 CFR Part 36
"Nondiscrimination o n the Basis of Disability i n Pub lic Accommodation s and Commercial
Facil ities". In accordance with the implementing regulations , Contractors must provide auxili ary
aids and services where necessary to ensure effective commu nication and equal opportunity
access to program benefits for individuals with disabiliti es. 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 in dividual only in
limited circum stances. When a Contractor communicates with applicants and benefici aries 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 facili ties . For more information , please vi sit 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 o f goods, materi als , and services to
perform such contract at any facility at which the violation which gave rise to such
conviction occurred if su ch facility is owned , leased, or supervised by such person . The
prohibition in the precedin g sentence sha ll contin ue until the Ad ministrator certifies that
the condition g iving rise to such a conviction has been corrected . For convictions arising
under section 113(c)(2), the condition givi ng ri se to the conviction also shall be
considered to include any substantive violation of this Act associated with the violation of
113(c)(2). The Admin istrator may extend this prohibition to other facilities owned or
operated by the convicted person .
b. T he Administrator shall establish procedures to provi de all Federal agencies with the
notification necessary for the purposes of subsection (a).
c . In order to implement the purposes and pol icy of this Act to protect and enhance the
quality of the Nation's a ir, t he President sha ll , no t more than 180 days after enactment of
the C lean 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 Presid ent
determines necessary to carry o ut such requ irement.
d. The President may e xempt any contract, loan , or grant from all or part of th e provisions of
thi s section where he determines such e xemption is necessary in the paramount interest
of the Un ited States and he shall notify the Congress of such exemption.
(Fed eral Certifi cation-Non-Discrimin ati o n, C lean Ai r, C lea n Water) (01 /20 l 8)Page 2 of 4
212
Conn-act #2024 1
Thomas L. Fitzgerald
e . The President shall annu al ly report to the Congress on measures taken toward
implementing the purpose and intE,mt of this section , i nclud ing but not li mited to the
progress and problems associated with impl ementation of this section. [42 U.S .C . 7606]
V . The Clean Water )!~ct ; 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, materia ls,
and services if such contract is to be performed at any facility at wh ich 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 givin g rise to such conviction has been
corrected .
b. The Adm inistrator shall establish procedures to provide all Federal agencies with the
notificat ion necessary for the pu rposes of subsection (a) of th is section.
c . In order to implement the purposes and policy of this Act to protect and enhance the
qua lity 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 pol icy of this Act in such contracting or assistance
activities, and
(ii ) setting forth procedures, sanctions, penalt ies, and su c h other provisions , as the
President determines necessary to carry o ut such requirement.
d. The President may exempt any contract, lo an, or grant from all or part of the provisions of
th is section where he determines such exemptio n is necessary in the paramoun t interest
of t he United States and he shall notify the Congress of such exemption .
e . The President shall annually report to the Congress on measures taken in compliance
with the purpose and intent of this section , including , but not limited to , the progress and
problems associated with such compliance.
f . No certification by a co ntractor, 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
req uirement of this section or a prohibition or requiremen t issued in the implementation of
this section.
g. In paragraph (1 ), the term "commi~rcial 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)).
Titl e
Agency/Organization Date
(Fede ral Certifi cation-No n-Di scrimina ti o n, C lean Air, Clean Water) (0 l /20 18 )Page 3 of 4
213
(Certification signatur1u~)t Contract signature.)
Contract #20241
Thomas L. Fitzgera ld
(Federal Certification-Non-Discrimination, Clean Air, Clean Water) (01/2018 )Page 4 of 4
214
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CONTRACT PROVIDER NAME: _ Thomas L. Fitzgerald
CONTRACT NUMBER: 20241
CONTRACT PERIOD: __ July 1, 2024-June 30, 2025
PROVIDER'S FISCAL YEAR: __ July 1, 2024-June 30,2025
CONTRACT DETERMINATION QUESTIONNAIRE
(PURCHASE OF SERVICE VS. FINANCIAL ASSISTANCE)
Instructions: Enter 5 points for each factor in either the yes or no column. Once the entire list has been completed
tally the points in each column. The column with the most points should be a good indicator of the designation of
the organization-either Financial Assistance (Grant) or Vendor (Purchase of Service).
Determination Factors
Does the provider determine eligibility?
Does the provider provide administrative functions such as Develop program standards
procedures and rules?
Does the provider provide administrative functions such as Program Planning?
Does the provider provide administrative functions such as Monitoring?
Does the provider provide administrative functions such as Program Evaluation?
Does the provider provide administrative functions such as Program Compliance?
Is orovider performance measured against whether specific objectives are met?
Does the provided have responsibility for programmatic decision making?
Is the provider objective to carry out a public purpose to support an overall program objective?
Does the provider have to submit a cost report to satisfy a cost reimbursement arrangement?
Does the provider have any obligation to the funding authority other than the delivery of the
specified goods/services?
Does the provider operate in a noncompetitive environment?
Does the provider provide these or similar goods and/or services only to the funding agency?
Does the provide these or similar goods and/or services outside normal business operations?
ITOTAL
Note: The authorized individual(s) must place an X in one of the boxes below to indicate
the type of contractual arrangement for this contract , then sign and date where indicated.
5 points
Financial
Assistance
YES
5
5
10
.__ __ _,I FINANCIAL ASSISTANCE ,___x_· ___.I PURCHASE sERv1cE
Signature of Authorized Administrative Individual
Revised effective 7-1-2013
page 1
DATE
DATE
5 points
Purchase
of Service
NO
5
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5
5
5
5
5
5
60
215
Contract# 20241
Thomas L. Fitzgerald
Person County Department of Social Services/Human Services
GOVERNMENT BUSINESS ASSOCIATE ADDENDUM TO MEMORANDUM OF
UNDERSTANDING
This Agreement is made effective the 1st day of July 2024, by and between Person County
Department of Social Services (name County Department of Social Services) ("Covered
Entity'') and Thomas L. Fitzgerald (name of contractor) ("Business Associate"
"Governmental Agency") (collectively the "Parties").
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a Memorandum of
Understanding ("entitled" or "dated" identify contract) contract# 20241 (the
"MOU'), whereby Business Associate agrees to perform certain services for or on
behalf of Covered Entity.
b. Covered Entity is an organizational unit of Person County as the Person County
Department of Social Services as a health care component for purposes of the
HIP AA Privacy Rule.
c. The relationship between Covered Entity and Business Associate is such that the
Parties believe Business Associate is or may be a "business associate" within the
meaning of the HIP AA Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the MOU with the
intention of complying with the HIP AA Privacy Rule provision that a covered entity
may disclose protected health information to a business associate, and may allow a
business associate to create or receive protected heath information on its behalf, if
the covered entity obtains satisfactory assurances that the business associate will
appropriately safeguard the information.
2. DEFINITIONS.
Unless some other meaning is clearly indicated by the context, the following terms shall
have the following meaning in this Agreement:
a. "HIPAA'' means the Administrative Simplification Provisions, Sections 261 through
264, of the federal Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191.
b . "Individual" shall have the same meaning as the term "individual" in 45 CFR
160.103 and shall include a person who qualifies as a personal representative in
accordance with 45 CFR 164.502(g).
c. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable
Health Information at 45 CFR part 160 and part 164, subparts A and E.
d. "Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 160.103, limited to the information created or
received by Business_ Associate from or on behalf of Covered Entity.
e. "Required By Law" shall have the same meaning as the term "required by law" in 45
CFR 164.103.
1
216
Contract# 20241
Thomas L. Fitzgerald
f. ''Secretary'' shall mean the Secretary of the United States Department of Health and
Human Services or his designee.
g. Unless otherwise defined in this Agreement, terms used herein shall have the same
meaning as those terms have in the Privacy Rule.
3. OBLIGATIONS OF BUSINESS ASSOCIATE
a. Business Associate agrees to not use or disclose Protected Health Information othe1·
than as permitted or required by this Agreement or as Required By Law.
b. Business Associate agrees to use appropriate safeguards to prevent use or disclosure
of the Protected Health Information other than as provided for by this Agreement.
c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect
that is known to Business Associate of a use or disclosure of Protected Health
Information by Business Associate in violation of the requirements of this
Agreement.
d. Business Associate agrees to report to Covered Entity any use or disclosure of the
Protected Health Information :not provided for by this Agreement of which it
becomes aware.
e. Business Associate agrees to ensure that any agent, including a subcontractor, to
whom it provides Protected Health Information received from, or created or received
by Business Associate on behalf of Covered Entity agrees to the same restrictions
and conditions that apply through this Agreement to Business Associate with
respect to such information.
f. Business Associate agrees to provide access, at the request of Covered Entity, to
Protected Health Information in a Designated Record Set to Covered Entity or, as
directed by Covered Entity, to an Individual in order to meet the requirements
under 45 CFR 164. 524.
g. Business Associate agrees, at the request of the Covered Entity, to make any
amendment(s) to Protected Health Information iri a Designated Record Set that the
Covered Entity directs or agrees to pursuant to 45 CFR 164.526.
h. Unless otherwise prohibited by law, Business Associate agrees to make internal
practices, books, and records, including policies and procedures and Protected
Health Information, relating to the use and disclosure of Protected Health
Information received from, or created or received by Business Associate on behalf of,
Covered Entity available to the Covered Entity, or to the Secretary, in a time and
manner designated by the Sec1~etary, for purposes of the Secretary determining
Covered Entity's compliance with the Privacy Rule.
l. Business Associate agrees to document such disclosures of Protected Health
Information and information related to such disclosures as would be required for
Covered Entity to respond to a request by an Individual for an accounting of
disclosures of Protected Health Information in accordance with 45 CFR 164.528, and
to provide this information to Covered Entity or an Individual to permit such a
response.
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4. PERMITTED USES AND DISCLOSURES
Contract# 20241
Thomas L. Fitzgerald
a. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use or disclose Protected
Health Information to perform functions, activities, or services for, or on behalf of,
Covered Entity as specified in the MOU, provided that such use or disclosure:
1) would not violate the Privacy Rule if done by Covered Entity; or
2) would not violate the minimum necessary policies and procedures of the
Covered Entity.
b. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information as necessary for the proper management and administration of the
Business Associate or to carry out the legal responsibilities of the Business
Associate.
c. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may disclose Protected Health
Information for the proper management and administration of the Business
Associate, provided that:
1) disclosures are Required By Law; or
2) Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and will be used or
further disclosed only as Required By Law or for the purpose for which it was
disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information
has been breached.
d. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information to provide data aggregation services to Covered Entity as permitted by
45 CFR 164.504(e)(2)(i)(B).
e . Notwithstanding the foregoing provisions, Business Associate may not use or
disclose Protected Health Information if the use or disclosure would violate any term
of the MOU or by other applicable law or agreements.
5. TERM AND TERMINATION
a. Term. This Agreement shall be effective as of the effective date stated above and
shall terminate when the MOU terminates.
b . Termination for Cause. Upon Covered Entity's knowledge of a material breach by
Business Associate, Covered Entity may, at its option:
1) Provide an opportunity for Business Associate to cure the bre ach or end the
violation, and terminate this Agreement and services provided by Business
Associate, to the extent permissible by law, if Business Associate does not cure
the breach or end the violation within the time specified by Covered Entity;
2) Immediately terminate this Agreement and services provided by Business
Associate, to the extent permissible by law; or
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Contract# 20241
Thomas L. Fitzgerald
3) If neither termination nor cure is feasible, report the violation to the Secretary
as provided in the Privacy Rule.
c. Effect of Termination.
1) Except as provided in paragraph (2) of this section or in the MOU or by other
applicable law or agreements, upon termination of this Agreement and services
provided by Business Associate, for any reason, Business Associate shall return
or destroy all Protected He·alth Information received from Covered Entity, or
created or received by Business Associate on behalf of Covered Entity. This
provision shall apply to Protected Health Information that is in the possession
of subcontractors or agents of Business Associate. Business Associate shall
retain no copies of the Protected Health Information.
2) In the event that Business Associate determines that returning or destroying
the Protected Health Info1rmation is not feasible, Business Associate shall
provide to Covered Entity notification of the conditions that make return or
destruction not feasible. Business Associate shall extend the protections of this
Agreement to such Protect,ed Health Information and limit further uses and
disclosures of such Protected Health Information to those purposes that make
the return 01· destruction infeasible, for so long as Business Associate maintains
such Protected Health Information.
6. GENERAL TERMS AND CONDITIONS
a. This Agreement amends and is part of the MOU.
b. Except as provided in this Agreement, all terms and conditions of the MOU shall
remain in force and shall apply to this Agreement as if set forth fully herein.
c. In the event of a conflict in tEirms between this Agreement and the MOU, the
interpretation that is in accordance with the Privacy Rule shall prevail. In the event
that a conflict then remains, the MOU terms shall prevail so long as they are in
accordance with the Privacy Rule.
d. A breach of this Agreement by Business Associate shall be considered sufficient
basis for Covered Entity to terminate the MOU for cause.
Date: )-t-Uz-l '/
Rev: 6-7-2015
4
219
Contrac t # 20244 Fiscal Year Begins July 1 , 2024 Ends June 30 , 2025
This contract is hereby entered into by and between the Person County Department of Social Services (the "County") and
James Tolin , Il l (the "Con tractor") (referred to collectively as the "Parties "). The Contractor's federal tax id entification number
or Social Security Number is 27-432882 0 and DUNS Number (required if fund ing from a federal funding so urce).
1. Contract Docume nts : This Contract consists of the follow ing documents :
(1) Th is contract
(2) The General Term s and Cond itions (Attachment A)
(3) T he Scope of Work, description of services, a nd rate (Attachment B)
(4 ) Combined Federa l Certifications (Attachment C)
(5) Conflict of Interest Policy (Attachment D)
(6) No Overdue Taxes (Attachment E)
(7) If applicable, HIPAA Business Associate Adden d um (checklist and forms) (Attachment I)
(8) Certification of Transportation (Attachment J)
(9) If applicable, IRS federal tax exempt letter or 501 (c)3 (Attachment K) http://www.irs.gov/pub/irs-fill/k1023 .pdf
(1 0)Certai n Reporting an d Auditing Requ irements (Attachment L)
(11 )State Certification (Attachment M)
(12 )Attachment N -Non-Discriminatio n, Clean A ir, C lean Water
(16) Con tract Determi nation Questionnaire (requ i red )
These documents constitute t he enti re agreement between the Parties and supersede a ll prior o ral or written statements
or ag reements .
2. Precedence among Contract Documents: In the event of a conflict between o r among the terms of the Contract
Documents, the terms in the Contract Document with the highest rela tive precedence sha ll p reva il. The order of
precedence sha ll be the order of documents as listed in Paragraph 1, above, with the firs t-listed document having the
highest precedence and the last-liste d document having t he lowest precede nce . If there are mult iple Cont ract
Amendments , the most recent amendment shall have the hi ghest precedence and the oldest amendment shall have the
lowest precedence.
3. Effective Period : T his contract shall be effective on July 1, 2024 and shall termi nate on June 30 , 2025,
This contract must be twelve months or less .
4. Contractor's Dut ies : T he Contractor shall provide the services and in accordance with the approved rate as described in
Attachment B, Scope o f Work.
5. County 's Duties : The County shal l pay the Cont racto r in the manner and in the amounts spe cified i n the Contrac t
Documents. The tota l a mo un t pa id by the County to the Contractor under th is contract shall not exceed 1,150 hours
coll ectively for all attorneys under contract. Rate of compensa tion for Secondary Attorney James Tolin , Ill is $125 per
hour.
[gl a. There are no matching requirement s from the Contractor.
D b. T he Contractor's matching requ irement is $
0 In-kind
D Cash and In -kin d
, which shall cons ist of:
□cash
D Cash and/or In-kind
The contributions from the Contractor sha ll be sourced from non -federal funds .
6 . Revers ion of Funds:
Any unexpended grant funds shall re vert to the County Departme nt of Social Services/Human Services upon
t ermination of this co ntract.
7 . Reporting Requ irements :
Contractor shall comply with audit requ i rements as described i n N.C .G.S. § 143C -6-22 & 23 and 0MB Circular-CFR Title
2 Grants a nd Agreements , Part 200, and shall disclose all inform ation required by 42 USC 455.104, or 42 USC 455 .105,
or 42 USC 455 .106.
Contract-General (06/15) Page 1 of 3
220
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 the County:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name & Title Wendy McKinney, Business Officer Name & Title Wendy McKinney, Business Officer
County Person County County Person County
Mailing Address P.O. Box 770 Street Address 355-B S. Madison Blvd
City, State, Zip Roxboro, NC 27573 City, State, Zip Roxboro, NC 27573
Telephone 336-503-1158
Fax 336-599-397 4
Email wmckinney(.a)personcountvnc.gov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name & Title James Tolin, Ill Name & Title James Tolin , Ill
Company Name Tolin & Tolin, PLLC Company Name Tolin & Tolin, PLLC
Mailing Address 112 South Main Street Street Address 112 South Main Street
City State Zip Roxboro, NC 27573 City State Zip Roxboro, NC 27573
Telephone 336-592-7077
Fax 336-599-0242
Email itolin@tolinlaw.com
10. Supplementation of Expenditure of Public Funds:
The Contractor assures that funds received pursuant to this contract shall be used only to supplement, not to
supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract
services and related programs. Funds received under this contract shall be used to provide additional public funding
for such services; the funds shall not be used to reduce the Contractor's total expenditure of other public funds for
such services.
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:
Contract-General (06/15) Page 2 of 3
221
The Contractor c ertifies that it has identified to the County all j obs related to t he 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 cont ract w ithout providing notic e to the County .
13. Federal Certifica ti ons:
Individuals and Organizations receiving federal funds must ensure compliance with certain certifications required by
federal laws and regu lations. 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 . T hese assurances and certifications are to
be signed by the contractor's authorized representat ive .
14. Specific Lang uage Not Previously Addressed:
15. Signature Warra nty: The undersigned represent and warrant that they are authorized to b ind their principals to th e
terms of th is agreement.
The Contractor and the County have executed this contract in duplicate orig inals, w ith one original being retai ned by each
party .
Signature Date
Pri nted Name T itl e
COUNTY
Signature (must be legally authorized to sign contracts for County DSS) 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 Cou nty Fin ance Officer Date
Contract-General (06/15) Page 3 of 3
222
GENERAL TERMS AND CONDITIONS
Relationships of the Parties
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the
performance of this contract and as such shall be wholly
responsible for the work to be performed and for the
supervision of its employees. The Contractor represents
that it has, or shall secure at its own expense, all
personnel required in performing the services under this
agreement. Such employees shall not be employees of,
or have any individual contractual relationship with, the,
County.
Subcontracting: The Contractor shall not subcontract
any of the work contemplated under this contract without
prior written approval from the County. Any approved
subcontract shall be subject to all conditions of this
contract. Only the subcontractors specified in the contract
documents are to be considered approved upon award of
the contract. The County shall not be obligated to pay for
any work performed by any unapproved subcontractor.
The Contractor shall be responsible for the performance
of all of its subcontractors.
Assignment: No assignment of the Contractor's
obligations or the Contractor's right to receive payment
hereunder shall be permitted. However, upon written
request approved by the issuing purchasing authority, the
County may: (a) Forward the Contractor's payment check
directly to any person or entity designated by the
Contractor, or (b) Include any person or entity designated
by Contractor as a joint payee on the Contractor's
payment check. In no event shall such approval and
action obligate the County to anyone other than the
Contractor and the Contractor shall remain responsible
far fulfillment of all contract obligations.
Beneficiaries: Except as herein specifically provided
otherwise, this contract shall inure to the benefit of and be
binding upon the parties • hereto and their respective
successors. It is expressly understood and agreed that
the enforcement of the terms and conditions of this
contract, and all rights of action relating to such
enforcement, shall be strictly reserved to the County and
the named Contractor. Nothing contained in this
document shall give or allow any claim or right of action
whatsoever by any other third person. It is the express
intention of the County and Contractor that any such
person or entity, other than the County or the Contractor,
receiving services or benefits under this contract shall be
deemed an incidental beneficiary only.
Indemnity and Insurance
Indemnification: The Contractor agrees to indemnify and
hold harmless the County, the State of North Carolina,
and any of their officers, agents and employees, and
Federal Government from any claims of third par:ties
arising out of any act or omission of the Contractor in
connection with the
performance of this contract to the extent permitted by
law.
Default and Termination
Termination Without Cause: The County may terminate
this contract without cause by giving 30 days written
notice to the Contractor.
Termination for Cause: If, through any cause, the
Contractor shall fail to fulfill its obligations under this
contract in a timely and proper manner, the County shall
have the right to terminate this contract by giving written
notice to the Contractor and specifying the effective date
thereof. In that event, all finished or unfinished deliverable
items prepared by the Contractor under this contract shall,
at the option of the County, become its property and the
Contractor shall be entitled to receive just and equitable
compensation for any satisfactory work completed on
such materials, minus any payment or compensation
previously made. Notwithstanding the foregoing
provision, the Contractor shall not be relieved of liability to
the County for damages sustained by the County by virtue
of the Contractor's breach of this agreement, and the
County may withhold any payment due the Contractor for
the purpose of setoff until such time as the exact amount
of damages due the County from such breach can be
determined. In case of default by the Contractor, without
limiting any other remedies for breach available to it, the
County may procure the contract services from other
sources and hold the Contractor responsible for any
excess cost occasioned thereby. The filing of a petition for
bankruptcy by the Contractor shall be an act of default
under this contract.
Waiver of Default: Waiver by the County of any default
or breach in compliance with the terms of this contract by
the Contractor shall not be deemed a waiver of any
subsequent default or breach and shall not be construed
to be modification of the terms of this contract unless
stated to be such in writing, signed by an authorized
representative of the County and the Contractor and
attached to the contract.
Availability of Funds: The parties to this contract agree
and understand that the payment of the sums specified in
this contract is dependent and contingent upon and
subject to the appropriation, allocation, and availability of
funds for this purpose to the County.
Force Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
war, hostile foreign action, nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other
catastrophic natural event or act of God.
Survival of Promises: All promises, requirements,
terms, conditions, provisions, representations,
NCDHHS TC101 O (General Terms and Conditions) (Local Government) (Rev. 11.01 .15)
223
guarantees, and warranties contained herein shall survive
the contract expiration or termination date unless
specifically provided otherwise herein, or unless
superseded by applicable Federal or State statutes of
limitation.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract are
the exclusive property of the County. The Contractor shall
not assert a claim of copyright or other property interest in
such deliverables.
Compliance with Applicable Laws
Compliance with Laws: The Contractor shall comply
with all laws, ordinances, codes, rules, regulations, and
licensing requirements that are applicable to the conduct
of its business, including those of federal, state, and local
agencies having jurisdiction and/or authority.
l:qual Employment Opportunity: The Contractor shall
comply with all federal and State laws relating to equal
employment opportunity.
Health Insurance Portability and Accountability Act
(HIPAA): The Contractor agrees that, if the County
determines that some or all of the activities within the
scope of this contract are subject to the Health Insurance
Portability and Accountability Act of 1996, P .L. 104-91, as
amended ("HIPAA"), or its implementing regulations, it will
comply with the HIPAA requirements and will execute
such agreements and practices as the County may
require to ensure compliance.
Confidentiality
Confidentiality: Any information, data, instruments,
documents, studies or reports given to or prepared or
assembled by the Contractor under this agreement shall
be kept as confidential and not divulged or made available
to any individual or organization without the prior written
approval of the County. The Contractor acknowledges
that in receiving, storing, processing or otherwise dealing
with any confidential information it will safeguard and not
further disclose the information except as otherwise
provided in this contract.
Data Security: The Contractor shall adopt and apply data
security standards and procedures that comply with all
applicable federal, state, and local laws, regulations, and
rules.
Duty to Report: The Contractor shall report a suspected
or confirmed security breach to the County's Contract
Administrator within twenty-four (24) hours after the
breach is first discovered, provided that the Contractor
shall report a breach involving Social Security
Administration data or Internal Revenue Service data
within one (1) hour after the breach is first discovered.
During the performance of this contract, the contractor is
to notify the County contract administrator of any ~ontact
by the federal Office for Civil Rights (OCR) received by
the contractor.
Cost Borne by Contractor: If any applicable federal,
state, or local law, regulation, or rule requires the Cou~ty
or the Contractor to give affected persons written notice
of a security breach arising out of the Contractor's
performance under this contract, the Contractor shall bear
the cost of the notice. •
Oversight
Access to Persons and . Records: The State Auditor
shall have access to persons and records as a result of
all contracts or grants entered into by State agencies or
political subdivisions in accordance with General Statute
147-64.7. Additionally, as the State funding authority, the
Department of Health and Human Services shall have
access to persons and records as a result of all contracts
or grants entered into by State agencies or political
subdivisions .
Record Retention: Records shall not be destroyed,
purged or disposed of without the express written consent
of the County. State basic records retention policy
requires all grant records to be retained for a minimum of
five years or until all audit exceptions have been resolved,
whichever is longer. If the contract is subject to Federal
policy and regulations, record retention may be longer
than five years. Records must be retained for a period of
three years following submission of the final Federal
Financial Status Report, if applicable, or three years
following the submission of a revised final Federal
Financial Status Report. Also , if any litigation, claim,
negotiation, audit, disallowance action, or other action
involving this Contract has been started before expiration
of the five-year retention period described above, the
records must be retained until completion of the action
and resolution of all issues which arise from it, or until the
end of the regular five-year period described above,
whichever is later. The record retention period for
Temporary Assistance for Needy Families (TANF) and
MEDICAID and Medical Assistance grants and programs
must be retained for a minimum of ten years.
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01 .15)
224
Miscellaneous
Choice of Law: The validity of this contract and any of its
terms or provisions, as well as the rights and duties of the
parties to this contract, are governed by the laws of North
Carolina. The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract,
to the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Wake County,
North Carolina. The place of this contract and all
transactions and agreements relating to it, and their situs
and forum, shall be Wake County, North Carolina, where
all matters whether sounding in contract or tort, relating
to the ~alidity, construction, interpretation, and
enforcement shall be determined.
Amendment: This contract may not be amended orally or
by performance. Any amendment must be made in written
form and executed by duly authorized representatives of
the County and the Contractor.
Severability: In the event that a court of competent
jurisdiction holds that a provision or requirement of this
contract violates any applicable law, each such provision
or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise
unenforceable and all other provisions and requirements
of this contract shall remain in full force and effect.
Headings: The Section and Paragraph headings in these
General Terms and Conditions are not material parts of
the agreement and should not be used to construe the
meaning thereof.
Gender and Number: Masculine pronouns shall be read
to include feminine pronouns and the singular of any word
or phrase shall be read to include the plural and Vice
versa.
Time of the Essence: Time is of the essence in the
performance of this contract.
Key Personnel: The Contractor shall not replace any ?f
the key personnel assigned to the performance of this
contract without the prior written approval of the County.
The term "key personnel" includes any and all persons
identified as such in the contract documents and any
other persons subsequently identified as key personnel
by the written agreement of the parties.
Care of Property: The Contractor agrees that it shall be
responsible for the proper custody and ~are ~f any
property furnished to it for use in connection with the
performance of this contract and will reimburse the
County for loss of, or damage to, such property. At the
termination of this contract, the Contractor shall contact
the County for instructions as to the disposition of such
property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Contractor for
travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
exceed the rates published in the applicable State rules
or approved local government travel policy. International
travel shall not be reimbursed under this contract.
Sales/Use Tax Refunds: If eligible, the Contractor and
all subcontractors shall: {a) ask the North Carolina
Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
pursuant to G.S. 105-164.14; and (b) exclude all
refundable sales and use taxes from all reportable
expenditures before the expenses are entered in their
reimbursement reports.
Advertising: The Contractor shall not use the award of
this contract as a part of any news release orcommercial
advertising.
NCDHHS TC101 o (General Terms and Conditions) (Local Government) (Rev. 11.01 .15)
225
ATTACHMENT B-Scope of Work Federal Tax Id.: 27-4328820 Contract# 20244
A. CONTRACTOR INFORMATION
1. Contractor Agency Name: James Tolin, III
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: 336-592-7077 Fax Number:336-599-0242
Email: jtolin@tolinlaw.com
3. Name of Program (s): Child Support
4. Status: r8J Public D Private, Not for Profit D Private, For Profit
5. Contractor's Financial Reporting Year January through December
B. Explanation of Services to be provided and to whom (include SIS Service Code):
To be available for consultation, legal advice and for representation as requested by the
Child Support Enforcement Agency on all legal matters arising from the duties of the
party of the first part under Sections 128 through 140 of Chapter 110 of the North
Carolina General Statutes and Title 42 of the United States Code, Sections 651 through
660 and the federal regulations lawfully promulgated pursuant thereto.
For their services under this contract, the agency agrees to pay the contractor one hundred
twenty-five dollars ($125.00) per hour for out of court time and one hundred twenty-five
dollars ($125 .00) per hour for in court time for each hour spent by the contractor
providing legal services under the Child Support Enforcement Program. Such hourly rate
shall encompass all expenses, including, but not limited to, those for salary, supplies,
office space, heating and maintenance for office space, telephone service, long-distance
telephone calls, postage, and travel ( other than travel to attend the Child Support
Enforcement Training). The contractor is not to be reimbursed for any extraordinary
expense incident to performing the services included under this agreement; except, that
the agency agrees to pay all court costs and filing fees which are required to be paid in
conjunction with services provided by the attorney under this agreement.
The contractor further agrees to attend at least one training session on Child Support
Enforcement per year conducted by the Child Support Enforcement Agency. Further, the
agency agrees to compensate the contractor at the hourly rate of fifty-five dollars
($55.00) for each hour that the party of the second part spends in training up to but not to
exceed the amount of four hundred forty dollars ($440.00) per day. Travel and meal
reimbursement shall be made at the same rates that are applicable to county DSS
employees (see Budget Addendum). However, the attorney may not be paid an hourly
rate for time spent traveling. Failure to attend one approved workshop per year shall be
construed as an indication that the contractor does not wish to continue providing
services under this agreement.
Contract-Scope of Work (7-2008) Page lof 1
226
Person County Department of Social Services will pay standard costs for ACTS training
with consideration being given to Person County Department of Social Services paying
for Mr. Tolin 's ACTS computer software should s uch acqui sition be n ecessary.
C. Rate per unit of Service (define the unit):
1. If Standard Fixed Rate, Max imum Allowab le, (See Rates for Services Chart)
On e hundred twenty-five dollars ($125.00) per hour for out of court time and one
hundred twenty-five dollars ($125.00) per hour for in co urt time for each hour of legal
services performed. Such hourly rates shall encompass all expenses, including, but not
limi ted to those for sa lary, supplies, office space, heating and maintenance for office
space, telephone service, long-distance te lephone call s , postage and travel.
2. egotiated County Rate.
D. Num ber of units to be prov ided: no more than 1, 150 hours co ll ectively
E. Details of Billing process and T ime Frames;
Payable on or before the I 0th of each month upon due submission by the Attorney of a
statement of work detai Ii ng the hours of wo rk perfo rm ed and the nature of such legal
work.
F. Area to be served/Deli very site(s): Perso n County Courthouse, To lin & Tolin, PLLC,
Person Coun ty Department of Social Services
~R:~~
(Signature of County Authorized Person) (Signature of Contractor)
(Date S ubmitted ) (Date Submitted)
Contract-Scope of Wo rk (7-2008) P age 2of I
227
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
ou t herein:
a. The Certification Regarding Nondiscrimination ;
b. The Certification Regarding Drug-Free Workplace Requirements;
c. The Certification Regarding Environmental Tobacco Smoke;
d. The Certification Regard ing Deba rment, 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 Requ i rements by providing the addresses
at which the contract work w ill 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 ag reem ent to make, a payment to a lobby i ng 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 Disc losure 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.
S ignat ure ' Tit le 7
Contractor Name Date
[This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page]
I. Certi fi cation Regarding Nond iscrimination
The Contractor certifies that it will comply with all Federal statutes re lating to nondiscrimination. These include but are
not limited to : (a) T itle 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 di scri mination 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 bas is of drug abuse; (f) the
Comprehensive Alcohol Abuse and A lcoholism Prevention , Treatment a nd Rehabi litation Act of 1970 (P.L. 91 -6 16), as
ame nded, relating to nondisc rimination on the basis of alcohol abuse or alcoholism; (g) T itle V III of the Civil Rights Act of
1968 (42 U.S.C. §§3601 et seq .), as amended , re lating to nondiscrim ination in the sale , rental or financi ng of housing; (h)
the Food Stamp Act and USDA policy, wh ich prohibit discrimi nation on the basis of rel igion and pol itical beliefs ; and (i)
the requirements of any other nondiscrim ination statutes which may apply to this Agreement.
228
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
___ 112 South Main Street. ______________________________ _
City, State, Zip Code
___ Roxboro, NC 27573. ______________________________ ~
Street
___ 105 South Main Street. ______________________________ _
City, State, Zip Code
___ Roxboro, NC 27573. _______________________________ :
229
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.
Ill. 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.]
I. 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 towe r tier participant will provide immediate written notice to the person to whom this proposal is
submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted
or has become erroneous by reason of changed circumstances .
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"
"person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have
the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 CFR
Part 76 . You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those
regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter any lower tier covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily 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 tie r 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.
230
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:
l. 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
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.
VJ. 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.
231
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 .
l . Identify the status of the covered Federal action.
2. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
information previously reported , enter the year and quarter in which the change occurred. Enter the date of the last
previously submitted report by this reporting entity for this covered Federal action .
3. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known.
Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub-
award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards
include but are not limited to subcontracts, subgrants and contract awards under grants.
4. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name, address, city, state and
zip code of the prime Federal recipient. Include Congressional District, if known.
5. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
level below agency name, if known. For example, Department of Transportation , United States Coast Guard.
6. Enter the Federal program name or description for the covered Federal action (Item 1 ). If known , enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
7. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e.g .,
Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant,
or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes,
e.g., "RFP-DE-90-001."
8. For a covered Federal action where there has been an award or loan commitment by the Federal agency , enter the
Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5 .
9. (a) Enter the full name, address, ·city, state and zip code of the lobbying entity engaged by the reporting entity
identified in Item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last
Name, First Name and Middle Initial (Ml).
10. Enter the amount of compensation paid or reasonably ex pected 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 certi in official shall si n and date the form, rint his/her name, title, and tele hone 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
Bud et, Pa erwork Reduction Pro·ect 0348-0046 Washin ton, D. C. 20503
232
1.
□
□
□
□
□
□
4.
□
□
Disclosure Of Lobbying Activities
(Approved by 0MB 0344-0046)
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
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:
Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name
and Address of Prime:
Prime
Subawardee Tier (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 address if
(if individual, last name, first name, Ml): different from No. 10a.} (last name, first name, Ml):
(attach Continuation Sheet(s) SF-LLL-A, if necessary) (attach Continuation Sheet(s) SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply):
$ actual planned □ a. retainer
□ b. one-time fee
12. Form of Payment (check all that apply): □ C . commission
□ d . contingent fee
□ a. cash □ e. deferred
□ b. In-kind; specify: Nature □ f . other; specify:
Value
14. Brief Description of Services Performed or to be Performed and Date(s) of Services, including officer(s), employee(s), or
Member(s) contacted, for Payment Indicated· in Item 11 (attach Continuation Shaet(s) SF-LLL-A, if necessary):
15. Continuation Sheet(s) SF-LLL-A attached: □ Yes □ No
16. Information requested through this form is authorized by Signature:
title 31 U.S. C. section 1352. This disclosure of lobbying
activities is a material representation of fact upon which Print Name:
reliance was placed by the tier above when this transaction
was made or entered into. This disclosure is required Title:
pursuant to 31 U.S. C. 1352. This information will be
reported to the Congress semi-annually and will be Telephone No: Date:
available for public inspection. Any person who fails to file
the required disclosure shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each
such failure.
Federal Use Only Authorized for Local Reproduction
-.. . -Standard Form -LLL
233
CONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY
State of fo.Lo e.:f A CA i!Dl:rv it
County _ ___,£..., .. ~ll-,51,,40-'-'N......_ ______ _
I, _..,.,D::;......,o.c...lY~L ..... H:'-'--J L...h .... ) ..... , ........... /f ........... A-.;_ZZ='-';;.,..•'_5..__ ____ , Notary P ubli c for sa id County and State, certify
that
y Am 'fl s lv . 7a 1 ~ o . T persona ll y appeared before me th is day and
ack nowledged 7
that he/s he is...-----~-----~--of To h s11 ::\:: Tc2ht1r fl). LC
/ [name of Organ ization]
and by that au t hority du ly g iven an d as the act of t he Organization , affirm ed th at the foregoing Conflict of
Interest Policy was adopted by the Board of Directors/Trustees or other govern ing body in a meeting hel d
on the I 'j-fi'-day of )r 14! , ,;J.CQ i.J
I ~ay of_------........ \ ~vj~L -~,~tj
,,11 111111 .._,.
# w ' ,,, ~,,.. • 1-fA .,, ........... __ ,. ~ ..... ._.--..A ~,.
Sworn to and subscribed before me th is
~ o" .... •,;~ .. ~ CA.Ah ) L\) ~~ /0 /~oT-4R,,~~\
(Official Seal ) \ 13 \. ~tJi~~lic i j
~~·•. #I
"""5 -... ,. Ct -:.,~ ....... ~· My Co mmission expires l) ~ {.J,,e . 20 d: { ',,,,?~C OU~~;♦• ,,,, ~.-•
........................................................................... :~~v~ ....... .
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.
Na me of Organi~ation
~~~~--
si?nature of Org aniza tion Official
NC DHH S CO il 0 15 (Rev.4/1 I )
234
Conflict of Interest Policy
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 Organization's 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
offic;ial capacity, honoraria received in connection with activities re lating 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 purch~se or contract with a vendor whe·re, 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
member? 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 h·as 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 COI1015 (Rev. 4/l I)
235
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 we re found to have an actua l or possible
conflict of i nterest, the nature of the confl ict of i nterest, any action taken to determine whether a
conflict of i nterest was present , and the governing board 's or comm ittee'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 in terest, the content of the d iscussion ,
includ i ng any alternatives to the transaction or arrangement, and a record of any votes taken in
connection with the proceedings .
Approved by :
lo I / A ~ /ol./,,,, Jl?iU!-(
Name of Organization
~4((?~'~
Signature of Organization Officia l
Date
NCOHHS COll 0 15 (Rev . 4/1 I)
236
State Grant Certification -No Overdue Tax Debts
Instructions : Grantee/Contractor should complete this certification for all state funds received . En tity should
enter appropriate data in t he yellow high lighted 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 com pleted contract, should be kept by the fu nding agency and
available for revi ew by the Office of St ate Budget and Ma nagem ent.
Note : ff you have a contract that extends more than one state fiscal year. you will need to obtain an updated certification/or
each year of the contract.
Tolin & Tolin, PLLC
112 South Main Street
Roxboro, NC 27573
Ph: (336) 585-6930
Fax: (336)599-0242
07/01/2024
To : State Agency Head and Chief Fiscal Officer
Certification:
We certify that the Tolin & Tolin , PLCC 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 w ho makes a
false statement in viol ati on of N.C .G.S. 143C-6-23(c) is guilty o f a c rim inal offe nse pun ishable as
provid ed by N.C.G .S.) 143C-10-1b.
Sworn Statement:
James T olin , Ill being duly sworn , respectively , of Tolin & T olin , PL LC of Roxboro in the State of North
C arolin a; and that the foregoing certificatio n is true , accurate and complete to the best of ,9'Wh"'!'-.
knowledge and w as made and subscribed by us . We also acknowledge and underst~~;p~n~,
misuse of State funds w ill be reported to the appropriate authorities for further act~~-~ .,, ... -... "'f~';,,, _ .r~o., , ~ ~
/4?w4P, mk·~ f ~/~OTA.Ft ►ifp~?.
Tames Tolin, Ill § i -•-: §
:-o• /:) • = ~~\ uauc lug
~-;.~n '• •" ~f Sworn to and subscri bed before me n the day of the date of said certification . ;, "O; •••-... -:..t ,.,, ~ ;,,, "'' ~ ... "~,, cou~ "',,•
''~'A.ur~"'
My Commission Expires: of""~ -,;Jo;;;) 7
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-(9 19)807-4 795
1 G .S. 105-243.1 defines : Overdue tax debt. -A ny 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 ma il ed and has not failed to make any payments due under the installment
agreement."
MS&NCD Form 0008
Eff. J uly 1, 2005
Revised July 18, 2006, 7/07, 8/09 , 9/11
Page 1 of 1
237
This document will be used to determine if you have a business associate relationship with a contractor. This form should be
completed on all contracts that have a HIP AA covered health care component. This would include all health related infonnation.
Contractor: James Tolin, III Contract Number: 20244 Date: 07/01/2024
HIP AA ASSESSMENT FORM
Questions
1. Has a relationship been initiated Select
allows the contractor to perform a
function or activity for, or on behalf of,
County Department of Social Services
HIP AA covered health care component?
2. Is the function or service to be Select
rendered by the contractor on an activity
other than treatment of clients?
3. Does the function or service to Select
be rendered by the contractor involve the
use or disclosure of the County
Department of Social Services
individually identifiable health
information?
4. Are the services rendered by Select
staff from the contractor performed on the
premises of the covered health care
component, using the component's
resources and following the component's
policies and procedures?
5. Is the contractor performing a Select
type(s) of function/activity for or on the
behalf of the County Department of
Social Services HIP AA covered health
Notes
NOTE: The sharing of
Individually identifiable
health information with
another treatment contractor
for treatment purposes only
does not require a business
associate agreement. See 45
CFR §164.502(e)(l)(ii)(A)
NOTE: Data that does not
contain A County
Department of Social
Services individually
identifiable health
information is not covered by
HIP AA and thus does not
have to be protected through
a business associate
agreement.
Steps
YES-Go to Question 2.
NO-Stop. There is no business
associate relationship.
YES-Go to Question 3.
NO-Stop. There is no business
associate relationship.
YES--Go to Question 4.
NO-Stop. There is no business
associate relationship.
NOTES: Whenever a service NO-Got Question 5.
is rendered on the premises YES-Stop. There is not business
of a covered component, associate relationship.
utilizing the component's
resources and following the
component's policies and
procedures, the person
rendering such services is
considered a member of the
component's workforce, and
is required to comply with
the component's privacy
policies and procedures. No
business associate agreement
is required.
Check appropriate service(s):
D Attorney Representing
Agency n Benefits Management
YES-You have identified a business
associate relationship. The specified
function/activity, which involves the
sharing of individually identifiable
1
238
component that is directly related to the D Patient Accounts Billing health information, is provided by the
covered health component's continued D Claims Processing contractor. This constitutes a business
operation? D Claims Administration associate relationship as such
D Bill Collections information must be protected th~ same
D Professional Services as required of the HIPAA covered
D Special Population health care component. There are two
Assessments types of business associate relationships:
D Data Analysis External Business Associate
D Data Processing relationships: You have indentified an
D Data Administration External business associate relationship
0JCAHO if you are contracting with any entity
D Council on Accreditation outside city, county or state government.
D Re-pricing A Business Associate Addendum must
D Rate Setting be signed and included with the
D Practice Management contract. If you are completing a
D Software Support Memorandum of Agreement (MOA)
D Utilization Review with a governmental entity the
D Quality Assurance Government Associate Addendum must
Contract Analysis be utilized.
D Central Office NO-STOP. There is no business
Supervision associate relationship.
D Security
D Dietary
D Machine Maintenance
D Facility Maintenance
D Landscaping
D Housekeeping
D Hardware Support
D Audits/Surveys
D Purchasing
ADDITIONAL REQUIRMENTS
NOTE: Make sure all county
requirements are met for internally
notifying the correct parties for External
and Internal Business Associates
Rev: 7-1-2013
2
239
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4
5
6
7
8
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10
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CONTRACT PROVIDER NAME : _ James Tolin , 11 1
CONTRACT NUMBER: ____ 20244
CONTRACT PERIOD : _____ July 1, 2024-June 30 , 2025
PROVIDER'S FISCAL YEAR : __ January-December
CONTRACT DETERMINATION QUESTIONNAIRE
(PURCHASE OF SERVICE VS. FINANCIAL ASS ISTANCE)
Instructions : Enter 5 points for each factor in either the yes or no column. Once the entire list has been completed
tally the points in each column . The column w ith the most points should be a good indicator of the designation of
the orqanization--either Financial Assistance (Grant) or Vendor (Purchase of Service).
Determination Factors
Does the provider determine eligibility?
Does the provider provide administrative functions s uch as Develop program standards
procedures and rules?
Does the provider provide administrative functions such as Program Planning?
Does the p rovider provide administrat ive functions such as Monitoring?
Does the provider provide administrative functions such as Program Evaluation?
Does the provider provide administrative functions such as Program Compliance?
Is provider performance measured against whether specific objectives are met?
Does the provided have responsib ility for programmatic decision makin g?
Is the provider objective to carrv out a public pu r pose to support an overall program objective?
Does the provider hav e to submit a cost report to satisfy a cost rei mbursement arrangement?
Does the provider have any obligation to the fund i ng authority other than the delivery of the
specified goods/services?
Does the provider operate in a noncompetitive environment?
Does the provider provide these or sim il ar goods and /or services only to the funding agency?
Does the p rovide these or similar qoods and/or services outside normal business operations?
!TOTAL
Note: T he authorized individual(s) must place an X in one of the boxes below to indicate
the type of contractual arrangement for th is contract , then sign and date where ind icated .
5 points
Financial
Assistance
YES
X
X
10
~-_ ..... I FINANCIAL ASS ISTA NC E ,___x_ ..... l PURCHASE SERVICE
Signature of Authori zed Pro grammatic Individual
Signature of Authorized Admi nistrative Individual
Revi sed effective 7-1-2013
page 1
DATE
DAT E
5 points
Purchase
of Service
NO
X
X
X
X
X
X
X
X
X
X
X
X
60
240
AITACHME TN
Contr act #20244
James Tolin , Ill
Person Coun ty De partment of Social Serv ices/Human Services
CERTIFI CATION REGARDrNG NOND ISCRIMJNATIO , CLEAN AJR ACT ,
C LEA WATER ACT
Certification Regarding Nondiscrimination
The Contractor certifies that it w ill comply with all Federal statutes relating to nond iscrimination .
These include but are not limited to: (a) Title VI of the Civi l Rights Act of 1964 (P. L. 88-352 ) which
prohibits discrimination on the basis of race , color or national orig in; (b) Title IX of the Ed ucation
Amendmen ts of 1972, as amended (20 U.S .C. §§1681-1683, and 1685-1686), wh ich 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 di scrimination on the bas is o f handicaps ; (d) the Age
Discri min a tion 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 nondiscrimin ation on the bas is of drug abuse; (f) the Comprehensive
Alcohol A b use and Alcohol ism Prev entio n, Treatme nt and Rehabilitat ion Act of 1970 (P.L. 91-
616 ), as amended , relating to nondi scrimination 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 , relat in g to
nond iscrim ination in the sale , re nta l or financing of housing ; (h) the Food Stamp Act and USDA
policy, wh ich prohibit discrimin ation on the basis of relig ion and political beliefs; and (i) the
requirements of an y other nond iscri mination statutes which may apply to this Agreement.
The Contractor must comply with Exec utive Order 11246, entitled "Eq ual Employment
Opportuni ty / as amended by Exec utive Order 11375 , and as supp lemented by the Departme nt of
Labor Regu lations (41 CFR Part 60): The Executive Order prohibits federal con tractors and
federally-assisted construction contractors and subcontractors who do over $10,000 in
Government business in one yea r from discrimi nati ng in employment decisions on the bas is of
race , color, re ligion , se x, or national origin. The Ex ecutive Order a lso requ ires Government
contractors to take affirmative action to ensure that equal opportunity is provided in all aspects of
their employm ent.
Meanin gfu l Access for LEP Ind ividuals : The Contractor that participate in the SNAP must take
reasonable steps to ensure that LEP persons have mean ingful access to programs, services, and
benefit s. Th is i ncludes the requirement to provide bilingual program information and certification
materia ls and interpretation services to single language minorities in certain project areas . SNAP
Contractors that do not provide mean ingful access for LEP ind ividuals risk vio lating prohibitions
against discrimination based on National Origin in th e Food and Nutrition Act of 2008, as
amended , Title V I of the Civil Rights Act of 1964 (T itle VI) and SNAP program regulations at 7
CFR 27 2A (b). They also risk noncom pliance with the USDA policy gu idance titled , "Gu id ance to
Federa l Financial Assistance Re cipients Regarding T it le VI Prohibition Against National Orig in
Discrim in ation Affecting Limited Eng li sh Proficient Persons", published in 79 FR 70771 -70784
(November28,2014).
The Contractor should develo p an implementing plan to address the language assistance needs
of the LEP population served . T his may include contracting for oral interpretation services, h irin g
bi lin gual staff, arranging te lephone interpreters and/or language lines, coord inating comm un ity
voluntee r s, translating vital documents , and prov iding written notice that language services are
available in appropriate languages. Quality and accuracy of the language service is critical in
order to avo id seri ou s consequences to the LEP person and to the recip ien t. LEP needs shou ld
be co nsid ered i n developing budgets and fron t line staff should understand how to obta in
la nguage assistance services . For additional assistance and informatio n regarding LEP matters,
please a lso visi t http://www.lep.gov .
(Fed eral Certifi cation-Non -Di scrimination. C lean A ir, Clean Water) (0l/20 18)P age 1 of3
241
Contract #20244
Jame s Tolin, Jll
Ensuring Equal Opportunity Access for Persons with Disabilities : The Contractor must a lso
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
prohibit ions against disability discrimination in the Rehabilitation Act of 1978, the American w ith
Disabilities Act (ADA) of 1990, as amended, and SNAP program regulations.
DOJ publ ished revised final regulations implementing T itle II and Title Ill of the ADA on
September 15 , 2010. These regulations are codified at 28 C FR Part 35 "Nondiscrimination on
the Basis of Disability in State and Local Government Services" and at 28 CFR Part 36
"Nondiscri mination on the Bas is of Disability in Public Accommodati ons 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 fo r ind ividuals with d isabilities. The type of auxi liary aids and services
required will vary, but a Contractor may not requ ire an i ndividual with a disability to bring another
individual to interpret, and may rely on a person accompanying a disabled individual only in
lim ited circumstances . When a Contractor communicates w ith applicants and beneficiaries by
telephone , it must provide te xt telephone services (ITY) or have access to an equally effective
electron ic 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 vis ion or hearing , can obtain information as to the ex istence and location of
accessible services, activities, and facil ities. 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 v iolation which gave ri se to such
conviction occurred if such facility is owned , leased , or supervised by such person . The
prohibition in th e preceding sentence shall continue until the Administrator certifies that
the condition giving ri se to such a conviction has been corrected . For convictions arising
under section 113(c}(2), the condition g iving ri se to the conviction a lso shall be
considered to include any substantive violation of this Act associated with the violation of
113(c)(2). The Admin istrator may extend this prohibition to other facilities owned or
operated by the conv icted person .
b. The Administrator shall establish procedures to provide all Federal agencies with the
notifica tion 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)
setti ng forth procedures, sanctions, penalties, and such other provis ions, 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
th is section where he determines such exemption is necessary in the paramount in terest
of the United States and he sha ll notify the Co ngress of such exemption .
e. The President shall annually report to the Con gress on measures taken toward
implementi ng the purpose and intent of th is section , includ ing but not limited to the
progress and problems associated with i mplementation of this section . [42 U.S.C . 7606]
(Fed eral Certification-N on-Discrimination C lean Air, C lean Wa ter) (0 l /2018)Page 2 of 3
242
V . The Clean Wate r Act ; 33 U.S.C. §1251 et seq . (1972)
Contract #20244
James Tolin. Ill
a. No Federal ag ency may enter into any contract with any person who has been convict ed
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 conv iction occu r red , and if such faci lity is owned , leased, or supervised
by such person . T he proh ibition in preceding sentence shall con tinue unti l t he
Admin istrator certifies that the condition giving rise to such conviction has been
corrected .
b. The Administrator shall establish procedures to provide all Federa l agencies w ith the
notification necessary for the purposes of subsection (a ) of th i s section.
c . In order to implement the purposes and policy of this Act to protect and en hance the
quality of the Nation's water, the Pres ident shall , not more than 180 days after the
enactment o f th is Act, cause to be issued an order:
(i) requiring each Federa l 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 t he purpose and policy of this Act in such contracting or assistance
activities , and
(ii) setting fo rth procedures, sanctions, penalties , and such other provisions, as the
President determines necessary to carry out such requirement.
d. The President may exempt any contract, lo an , or grant from all or part of the prov isions of
t his section where he determines such exemption is necessary in the paramount interest
of the United States and he shal l notify the Congress of such exemption.
e . The President shall annually report to the Congress on measures taken in compliance
w ith the purpose and intent of thi s section , including, bu t not limited to, the prog ress and
problems associated w ith such compliance.
f. No certification by a contractor, a nd no contract clause , may be required in the case of a
contract for th e acq uisition of commercial items in order to implement a prohibition or
requireme nt of this section or a proh ibition or requirement issued in the implementation of
th is section .
g . In parag raph (1 ), the term "commercial item'' has the meaning given such term in sec tio n
4(1 2) of the Office of Federal Procurement Po licy Act (41 U.S.C. 403(1 2 )).
Signature T itl e
Agency/Organization Date
(Certificati o n signature sho uld be sam e as Contract sig nature.)
(Federa l Certification -No n-Di scriminati o~ C lean A ir, C lean Water) (01/20 l 8)P age 3 of 3
243
State Certifications
Contractor Certification s Required by North Carolina Law
Instruction s : T he person who s igns th is document s hould read the text of the statutes and Executi ve Order li s ted below and consult
with counsel and other kno wledgeable persons b e fore s igning. The text o f each orth Caro lina General Statutes and oftbe Exec utive
Order can be found online at:
• Arricle 2 of Chapter 64: http ://www.nc ga.state.nc.us/Enac tcdLegislation Statutes/PDF/ByAnicle/Chaptcr 64 /Anicle 2.pd f
• G .S . 133-32: hnp://www.ncga.s1ate.11c.us/gascri p1 s/s1aru1es/s1atu1elookup .pl '?s1anne=l33-32
• Executive Order o . 24 (Perdue , Gov., Oct. I , 2009): http ://www .ethicscommission.nc.gov/library/pdfs/Laws1E024.pdf
• G .S . I 05-l 64 .8(b): hnp:l/www.ncga.state.nc.us/EnactedLegislarion/Statutes/PD F/BySec1ion/Chapter 105/GS I 05 -164.8.pdf
• G .S. 143-48.5 : http://www.ncga.state.nc .us/EnactedLegislation/Statutes/1 ITMl/BySection/Chapter I 43 /GS 143-4 8.5.html
• G.S . 143-59. I : http ://www .ncga.state.nc.us/EnactedLegis lation/Statutes/PDF/BySection/ChapLer I 431GS 143-59.1.pdf
• G .S . 143-59 .2: hnp://www.ncga.state.nc.us/EnactedLegis lation/Starutes/PDF/BySection/Chapter 143 GS 143-59.2.pd f
• G.S. 143-133.3: http://www.ncga.state.nc.us/EnactedLegislation/Stanues/HTMUBySec tion/Chapter 143/GS 143-1 33.3 .html
• G.S. 143 B-l 39 .6C: http://www.ncga .state.nc.us /EnactedLcgislauoo/Statute s/PDF/BySec tion/Chapter 143 8 /GS I 438-l 39.6C pdf
Certifications
( 1) Purs uant to G.S. 133-32 and Exec utive Ord er No . 24 country" as et fort h in G.S . 143-59.1 (c)(2) after
December 3 l, 200 I but th e United States is not
the principal market for the public trading of th e
stock of the corporation in corporated in the tax
haven country.
(Perdue, Gov., Oct. J, 2009) the undersigned hereby
certifies th at the Con tractor named be low is in
compliance with , and has not violated, the p rovis ions of
eithe r said statute or Executive Order.
(2 ) Pursuant to G.S. 143-48.5 and G.S. 143-133.3 , the
undersigned hereby certifies that the Contractor named
below, and the Contractor 's subcontractors, co mplies
with th e requirements of Article 2 of Chapter 64 of the
NC Gene ra l Statutes, including the requi rement for each
employer with more than 25 employees in orth
Caro lina to verify the work authorization of it s
employees through the federal E-Verify system." E-
Verify System Link: www.uscis.gov
(3) Pursuant to G.S. 143-59.l(b), the undersigned hereby
certifies that the Contractor named below is not an
'ineligible Co ntractor" as set forth in G .S. 143-59. I (a)
because:
(a) Neither the Contractor nor any of its affiliates has
refused to collect the use tax le vied under Article 5
of C hapter l 05 of the General Statute on its sa les
delivered to 1orth Carolina when the sales met one
or more of the conditions ofG.S. 105 -l 64.8(b); and
(b) [check one of the fo ll owing boxes]
D Neither the Contractor nor any of its affi liates
ha s incorporated or reincorporated in a "tax
ha ven country" as set forth in G.S. 143-
59. l(c)(2) after Dece mber 31, 2001 • or
D The Contrac tor or one of its affiliates has
incorporated or reincorporated in a "tax ha ven
Contrac to r's Name:
(4) Purs uant to G.S. 143-59.2(b), the undersigned hereby
certifies that none of the Con tractor s officers, directors,
or owners (if the Co ntractor is an unincorporated
business entity) has been convicted of any vio la ti on of
Chapter 78A oftbe General Statutes or the Securities Act
of 1933 or th e Securities Exchange Act of 1934 within
10 years immediately prior to the date of the bid
sol icitation.
(6)
Pursuant to G.S. 143B-139.6C, the undersigned hereby
certifi es that the Contractor wi ll not use a former
employee, as defined by G.S. l43B-139.6C(d)(2), of
the North Caro lina Departn1ent of Health and Human
Services in the administratio n of a contract with the
Department in violation ofG.S. 143B-l39.6C and that
a violation of that statute s hall void th e Agreement.
The undersigned hereby certi fies further that:
(a) He or she is a duly authorized representative oftbe
Co ntractor named below;
(b) He or she is authorized to make, and does hereby
make, the foregoing certification on behalf of the
Contractor; and
(c) He or she understand th at any person who
knowingly submits a false certification in res ponse
to the requirements ofG.S. 143-59.land-59.2 sha ll
be guil ty of a Class 1 felony.
Contractor's
Authorized Agen t: Signature \/~ P • M.J ~ Da te _________ _
Witness: Signature Da te 7 -rs--o?:OJ t./
Primed Nam e ]b{'{ptt) Y\ 2' /2 4£.L~ s Title ;Jot(-} (J.-'-./
The witness should be present when the Co ntractor's A uthorized Agent signs this certifi cation anlshould sign and date th.is
document immediate ly thereafter.
1ontrac 1nr ,er1 ifi c a1i on,~ Reouired t,v No n h 1nrn li na I.a w (Rev ll/2 0 Io) PaP e l n f l
244
Contract# 20244
James Tolin, III
Person County Department of Social Services/Human Services
GOVERNMENT BUSINESS ASSOCIATE ADDENDUM TO MEMORANDUM OF
UNDERSTANDING
This Agreement is made effective the 1st day of July 2024, by and between Person County
Department of Social Services (name County Department of Social Services) ("Covered
Entity") and James Tolin, III (name of contractor) ("Business Associate" "Governmental
Agency'') (collectively the "Parties").
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a Memorandum of
Understanding ("entitled" or "dated" identify contract) contract# 20244(the
"MOU''), whereby Business Associate agrees to perform certain services for or on
behalf of Covered Entity.
b. Covered Entity is an organizational unit of Person County as the Person County
Department of Social Services as a health care component for purposes of the
HIP AA Privacy Rule.
c. The relationship between Covered Entity and Business Associate is such that the
Parties believe Business Associate is or may be a "business associate" within the
meaning of the HIP AA Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the MOU with the
intention of complying with the HIP AA Privacy Rule provision that a covered entity
may disclose protected health information to a business associate, and may allow a
business associate to create or receive protected heath information on its behalf, if
the covered entity obtains satisfactory assurances that the business associate will
appropriately safeguard the information.
2. DEFINITIONS.
Unless some other meaning is clearly indicated by the context, the following terms shall
have the following meaning in this Agreement:
a. "HIPAA'' means the Administrative Simplification Provisions, Sections 261 through
264, of the federal Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191.
b. "Individual" shall have the same meaning as the term "individual" in 45 CFR
160.103 and shall include a person who qualifies as a personal representative in
accordance with 45 CFR 164.502(g).
c. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable
Health Information at 45 CFR part 160 and part 164, subparts A and E.
d. -"Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 160.103, limited to the information created or
received by Business Associate from or on behalf of Covered Entity.
1
245
Contract# 20244
James Tolin, III
e . "Required By Law" shall have the same meaning as the term "required by law" in 45
CFR 164.103.
f. "Secretary" shall mean the Secretary of the United States Department of Health and
Human Services or his designee.
g. Unless otherwise defined in this Agreement, terms used herein shall have the same
meaning as those terms have in the Privacy Rule.
3. OBLIGATIONS OF BUSINESS ASSOCIATE
a. Business Associate agrees to not use or disclose Protected Health Information other
than as permitted or required by this.Agreement or as Required-By Law.
b. Business Associate agrees to use appropriate safeguards to prevent use or disclosure
of the Protected Health Information other than as provided for by this Agreement.
c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect
that is known to Business Associate of a use or disclosure of Protected Health
Information by Business Associate in violation of the requirements of this
Agreement.
I
d. Business Associate agrees to report to Covered Entity any use or disclosure of the
Protected Health Information not provided for by this Agreement of which it
becomes aware.
e. Business Associate agrees to ensure that any agent, including a subcontractor, to
whom it provides Protected Health Information received from, or created or received
by Business Associate on behalf of Covered Entity agrees to the same restrictions
and conditions that apply through this Agreement to Business Associate with
respect to such information.
f. Business Associate agrees to provide access, at the request of Covered Entity, to
Protected Health Information in a Designated Record Set to Covere d Entity or, as
directed by Covered Entity, to an Individual in order to meet the requirements
under 45 CFR 164.524.
g. Business Associate agrees, at the request of the Covered Entity, to make any
amendment(s) to Protected Health Information in a Designated Record Set that the
Covered Entity directs or agrees to pursuant to 45 CFR 164.526.
h . Unless otherwi se prohibited by l aw, Business Associate agrees to make internal
practices, books, and records, including policies and procedures and Protected
Health Information, relating to the use and disclosure of Protected Health
Information received from, or created or received by Business Associate on behalf of,
Covered Entity available to the Covered Entity, or to the Secretary, in a time and
manner designate d by the Secretary, for purposes of the Secretary determining
Covered Entity's compliance with the Privacy Rule.
i. Business Associate agrees to document such disclosures of Protected Health
Information and information related to such disclosures as would be required for
Covered Entity to respond to a request by an Individual for an accounting of
disclosures of Protected Health Information in accordance with 45 CFR 164.528, and
to provide this informa tion to Covered Entity or an Individual to permit such a
response.
2
246
4. PERMITTED USES AND DISCLOSURES
Contract # 20244
J runes Tolin, III
a. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use or disclose Protected
Health Information to perform functions, activities, or services for, or on behalf of,
Covered Entity as specified in the MOU, provided that such use or disclosure:
1) would not violate the Privacy Rule if done by Covered Entity; or
2) would not violate the minimum necessary policies and procedures of the
Covered Entity.
b. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information as necessary for the proper management and administration of the
Business Associate or to carry out the legal responsibilities of the Business
Associate.
c. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may disclose Protected Health
Information for the proper management and administration of the Business
Associate, provided that:
1) disclosures are Required By Law; or
2) Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and will be used or
further disclosed only as Required By Law or for the purpose for which it was
disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information
has been breached.
d. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information to provide data aggregation services to Covered Entity as permitted by
45 CFR 164.504(e)(2)(i)(B).
e. Notwithstanding the foregoing provisions, Business Associate may not use or
disclose Protected Health Information if the use or disclosure would violate any term
of the MOU or by other applicable law or agreements.
5. TERM AND TERMINATION
a. Term. This Agreement shall be effective as of the effective date stated above and
shall terminate when the MOU terminates.
b. Termination for Cause. Upon Covered Entity's knowledge of a material breach by
Business Associate, Covered Entity may, at its option:
1) Provide an opportunity for Business Associate to cure the breach or end the
violation, and terminate this Agreement and services provided by Business
Associate, to the extent permissible by law, if Business Associate does not cure
the breach or end the violation within the time specified by Covered Entity;
2) Immediately terminate this Agreement and services provided by Business
Associate, to the extent permissible by law; or
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Contract# 20244
James Tolin, III
3) If ne ithe r termination n or c ure is feasib l e, r eport the violation t o the Secretary
as provided in the Privacy Rule .
c. Effect of Termination.
1) Except as provided in pa ragra ph (2) of this section or in the MOU or by oth e r
a pplicable law or agreements, up on termination of this Agreement and ser vi ces
provided by Busin ess Associate, for a ny r eason , Bus iness Associate shall r eturn
or destroy all Protected H e alth Informat i on r eceived from Cove r ed Entity, or
cr eated or r eceived by Bus iness Associate on behalf of Covered Entity. This
provision s h a ll appl y t o Protected Health Information that i s in the possession
of s ubcontractors or agents of Bus iness Associate. Business Associate s h a ll
r etain n o cop i es of the Protected Health Information.
2) In the event t hat Business Associ a t e determines that r eturning or destr oyin g
the Protect e d H ealth Informatio n is n ot feasible, Business Associate s hall
provide to Cove r e d Entity n otifica tio n of the co nditions that m ake r eturn or
destruction not feasibl e. Business Associate shall extend the protection s of this
Agreement to s u ch Prot ected H ealth Information a nd limit furth er u ses and
dis clos ures of s uch Protected H ealth Information to t h ose purposes t h at make
t h e r e turn or destructi on infeas ible , for so long as Business Associate maintains
s u ch Protecte d H ealth Inform ation.
6. GENERAL TERMS AND CONDITIONS
a. This Agreemen t amends and is part of the MOU.
b. Except as provide d in this Agreement, all terms and co ndit i on s of the MOU s hall
r e m a in in force and s h a ll a pply to this Agr eem e nt as if set forth fully h e r ein.
c. In the event of a co nflict in terms between this Agreement and the MOU, the
interpretation t h at i s in acco rdance wit h the Privacy Rule sh all prevail. In t h e event
t hat a co nflict t h en r e m ains, the MOU terms s hall prevail so l ong as they are in
accordance with the Privacy Rule.
d. A breach of t his Agreement by Business Associate shall be co n sider ed suffici e nt
basis for Cover ed Entity to terminate the MOU for cau se.
SIGNATURES:
D ate:
Rev: 6-7-2015
4
248
Contract# 20245 Fiscal Year Begins July 1, 2024 E nds June 30, 2025
This contract is hereby entered into by and between the Person County Departm ent of Social Services (t he "County") and
James Tolin, 111 (the "Contractor'') (referred to collective ly as the "Parties"). The Contractor's federal tax identification number
or Social Security Number is 27-4328820 and DUNS Number (required if funding from a federa l fun d ing source).
1. Contract Documents : This Contract consists of th e 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 Policy (Attachment D)
(6) No Overdue Tax es (Attachment E)
(7) If applicable, HIPAA Business Associate Addendum (checklist and forms) (Attachment I)
(8) Certification of Transportation (Attachment J)
(9) If applicable, I RS federal ta x exempt letter or 501 ( c)3 (Attachment K) http://www. irs.qov/pub/irs-fill/k1023. pdf
(1 0)Certain Reporting and Auditing Requirements (Attachment L)
(11 )State Certification (Attachment M)
(12)Attachment N -Non-Discrimination, Clean Ai r, Clean Water
(16) Contract Determination Questionnaire (required )
These documents constitute the entire agreement between the Parties and s upersede all pr ior oral or written state ments
or agreements.
2 . Precedence among Contract Documents: In the event of a con flict between or among the terms o f the Contract
Documents, the terms in the Contract Document with the highest relative precedence shall p re vail. The o rder of
precedence shall be the order of documents as listed in Paragraph 1, above , wit h the first-listed document havin g the
highest precedence and the last-listed document having the lowest precedence. If th ere are multiple Contract
Amendments, the most recent amendment shall have the h ighest precedence a nd the oldest amendment shall ha ve the
lowest precedence.
3. Effective Period : This con tract shall be effective o n July 1, 2024 and sh all terminate on June 30, 2025,
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.
5. County's Duties : The County shall pay the Contractor in the manner and In th e amounts s pecified in the Contra ct
Documents. The total amount paid by the County to the Con tra ctor under th is con tract shall not exceed 1, 150 hours
collective ly for all attorneys under contract. Rate of compensation for Secondary Attorney James To lin , Ill is $125 per
hour.
[8] a. There are no matching requirements from the Contractor.
D b . The Contractor's matching requ irement is $
0 In -k ind
D Cash and In-kind
, wh ich shall co nsist of:
D Cash
D Cas h and /or In-kind
The contributions from the Contractor shall be sourced fro m non-federal fu nd s .
6. Reversion of Funds :
Any unexpended grant funds shall revert to the County Departmen t of Social Services/Human Services upon
termination of this contract.
7. Reporting Requirements :
Contractor shall comply with audit requ irements as described in N.C .G .S. § 143C-6-22 & 23 a nd 0MB Circular-CFR Title
2 Grants and Agreements, Part 200, and shall disclose all information re qu ired by 42 USC 4 55.104 , or 42 USC 455.105,
or 42 USC 455 .106.
Contract-General (06/15) Page 1 of 3
249
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 the County:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name & Title Wendy McKinney, Business Officer Name & Title Wendy McKinney, Business Officer
County Person County County Person County
Mailing Address P.O. Box 770 Street Address 355-8 S. Madison Blvd
City, State, Zip Roxboro, NC 27573 City, State, Zip Roxboro, NC 27573
Telephone 336-503-1158
Fax 336-599-397 4
Email wmckinney@personcountync.gov 1,
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name & Title James Tolin, Ill Name & Title James Tolin , Ill
Company Name Tolin & Tolin, PLLC Company Name Tolin & Tolin, PLLC
Mailing Address 112 South Main Street Street Address 112 South Main Street
City State Zip Roxboro, NC 27573 City State Zip Roxboro, NC 27573
Telephone 336-592-7077
Fax 336-599-0242
Email itolin@tolinlaw.com
10. Supplementation of Expenditure of Public Funds:
The Contractor assures that funds received pursuant to this contract shall be used only to supplement, not to
supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract
services and related programs. Funds received under this contract shall be used to provide additional public funding
for such services; the funds shall not be used to reduce the Contractor's total expenditure of other public funds for
such services.
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:
Contract-General (06/15) Page 2 of3
250
The Contractor certifies that it has identified to the County all jobs related to the contract that have been ou tsourced
to other countries, if any . The Contractor further agrees that it will not outsou rce any suc h 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 wit h certain certifications required by
federal laws and regulations . The contractor is hereby complying with Certifi cations regarding Nondiscrimination ,
Drug-Free Workplace Requirements, Environmental Tobacco Smoke, Debarment , Suspension, Ineligibility a nd
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying . These assu rances and certifications are to
be signed by the contractor's authorized representative .
14. Specific Language Not Previously Addressed:
15. Signature Warranty: The undersigned represent and warrant that they are authorized to b ind their principals to the
terms of this agreement.
The Contractor and the County have executed this contract in duplicate originals , with one original being retained by each
party .
Signature Date
Printed Name T itle
COUNTY
Signature (must be legally authorized to sign contracts for County DSS) Date
Printed Name Title
This instrument has been pre-audited in the manner required by the Local Government Budg et and Fiscal Con trol Act.
Signature of County F inance Officer Date
Contract-General (06/15) Page 3 of3
251
GENERAL TERMS AND CONDITIONS
Relationships of the Parties
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the
performance of this contract and as such shall be wholly
responsible far the work ta be performed and far the
supervision of its employees. The Contractor represents
that it has, or shall secure at its own expense, all
personnel required in performing the services under this
agreement. Such employees shall not be employees of,
or have any individual contractual relationship with, the
County.
Subcontracting: The Contractor shall not subcontract
any of the work contemplated under this contract without
prior written approval from the County. Any approved
subcontract shall be subject to all conditions of this
contract. Only the subcontractors specified in the contract
documents are to be considered approved upon award of
the contract. The County shall not be obligated to pay far
any work performed by any unapproved subcontractor.
The Contractor shall be responsible for the performance
of all of its subcontractors.
Assignme.nt: No assignment of the Contractor's
obligations or the Contractor's right to receive payment
hereunder shall be permitted. However, upon written
request approved by the issuing purchasing authority, the
County may: (a) Forward the Contractor's payment check
directly to any person or entity designated by the
Contractor, or (b) Include any person or entity designated
by Contractor as a joint payee on the Contractor's
payment check. In no event shall such approval and
action obligate the County to anyone other than the
Contractor and the Contractor shall remain responsible
for fulfillment of all contract obligations.
Beneficiaries: Except as herein specifically provided
otherwise, this contract shall inure to the benefit of and be
binding upon the parties hereto and their respective
successors. It is expressly understood and agreed that
the enforcement of the terms and conditions of this
contract, and all rights of action relating to such
enforcement, shall be strictly reserved to the County and
the named Contractor. Nothing contained in this
document shall give or allow any claim or right of action
whatsoever by any other third person. It is the express
intention of the County and Contractor that any such
person or entity, other than the County or the Contractor,
receiving services or benefits under this contract shall be
deemed ,an incidental beneficiary only.
Indemnity and Insurance
Indemnification: The Contractor agrees to indemnify and
hold harmles~ the County, the State of North Carolina,
and any of their officers, agents and employees, and
Federal Government from any claims of third parties
arising out of any act or omission of the Contractor in
connection with the
performance of this contract to the extent permitted by
law.
Default and Termination
Termination Without Cause: The County may terminate
this contract without cause by giving 30 days written
notice to the Contractor.
Termination for Cause: lf, through any cause, the
Contractor shall fail to fulfill its obligations under this
contract in a timely and proper manner, the County shall
have the right to terminate this contract by giving writtei:i
notice to the Contractor and specifying the effective date
thereof. In that event, all finished or unfinished deliverable
items prepared by the Contractor under this contract shall,
at the option of the County, become its property and the
Contractor shall be entitled to receive just and equitable
compensation for any satisfactory work completed on
such materials, minus any payment or compensation
previously made. Notwithstanding the foregoing
provision , the Contractor shall not be relieved of liability to
the County for damages sustained by the County by virtue
of the Contractor's breach of this agreement, and the
County may withhold any payment due the Contractor for
the purpose of setoff until such time as the exact amount
of damages due the County from such breach can be
determined. In case of default by the Contractor, without
limiting any other remedies for breach available to it, the
County may procure the contract services from other
sources and hold the Contractor responsible for any
excess cost occasioned thereby . The filing of a petition for
bankruptcy by the Contractor shall be an act of default
under this contract.
Waiver of Default: Waiver by the County of any default
or breach in compliance with the terms of this contract by
the Contractor shall not be deemed a waiver of any
subsequent default or breach and shall not be construed
to be modification of the terms of this contract unless
stated to. be such in writing, signed by an authorized
representative of the County and the Contractor and
attached to the contract.
Availability of Funds: The parties to this contract agree
and understand that the payment of the sums specified in
this contract is dependent and contingent upon and
subject to the appropriation, allocation, and availability of
funds for this purpose to the County.
Foree Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
war, hostile foreign action , nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other
catastrophic natural event or act of God.
Survival of Promises: All promises, requirements,
terms, conditions , provisions, representations,
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
252
guarantees, and warranties contained herein shall survive
the contract expiration or termination date unless
specifically provided otherwise herein, or unless
superseded by applicable Federal or State statutes of
limitation.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract are
the exclusive property of the County. The Contractor shall
not assert a claim of copyright or other property interest in
such deliverables.
Compliance with Applicable Laws
Compliance with Laws: The Contractor shall comply
with all laws, ordinances, codes, rules, regulations, and
. licensing requirements that are applicable to the conduct
of its business, including those of federal, state, and local
agencies having jurisdiction and/or authority.
Equal Employment Opportunity: The Contractor shall
comply with all federal and State laws relating to equal
employment opportunity.
Health Insurance Portability and Accountability Act
(HIPAA): The Contractor agrees that, if the County
determines that some or all of the activities within the
scope of this contract are subject to the Health Insurance
Portability and Accountability Act of_1996,-P.L. 104-91, as
amended ("H IPAA"), or its implementing regulations, it will
comply with the HIPAA requirements and will execute
such agreements and practices as the County may
require to ensure compliance.
Confidentiality
Confidentiality: Any information, data, instruments,
documents, studies or reports given to or prepared or
assembled by the Contractor under this agreement shall
be kept as confidential and not divulged or made available
to any individual or organization without the prior written
approval of the County. The Contractor acknowledges
that in receiving, storing, processing or otherwise dealing
with any confidential information it will safeguard and not
further disclose the information except as otherwise
provided in this contract.
Data Security: The Contractor shall adopt and apply data
security standards and procedures that comply with all
applicable federal, state, and local laws, regulations, and
rules.
Duty to Report: The Contractor shall report a suspected
or confirmed security breach to the County's Contract
Administrator within twenty-four (24) hours after the
breach is first discovered, provided that the Contractor
shall report a breach involving Social Security
Administration data or Internal Revenue Service data
within one (1) hour after the breach is first discovered.
During the performance of this contract, the con tractor is
to notify the County contract administrator of any contact
by the federal Office for Civil Rights (OCR) rece ived by
the contractor.
Cost Borne by Contractor: If any applicable federal,
state, or local law, regulation , or rule requires the County
or the Contractor to give affected persons written notice
of a security breach arising out of the Contracto r's
performance under this contract, t he Contractor sha ll bear
the cost of the notice.
Oversight
Access to Persons and Records : The State Auditor
shall have access to persons and records as a result of
all contracts or grants entered into by State agencies or
political subdivisions in accordance with Gene ral Statute
147-64.7. Additionally, as the State funding autho rity, the
Department of Health and Human Services shall have
access to persons and records as a result of all contracts
or grants entered into by State agencies or political
subdivisions .
Record Retention: Records shall not be destroyed ,
pu rged or disposed of without t he express written consent
of the County. State basic records retention policy
requ ires all grant records to be retained for a minimum of
five years or until all audit exceptions have been reso lved ,
whichever is longer. If the contract is subject to Federal
policy and regulations, record retention may be longer
than five years. Records must be retained for a period of
three years following submission of the final Federal
Financial Status Report, if app licable, or three yea rs
following the submission of a revised final Federal
Financial Status Report. Also , if any litigation, cla im,
negotiation, audit, disallowance action, or other action
involving this Contract has been started before expiration
of the five-year retention period described above, the
records must be retained until completion of the action
and resolution of all issues which arise from it, or until the
end of t he regular five-year period described above,
whichever is later. The record reten t ion period for
Temporary Assistance for Needy Families (TANF) and
MEDICAID and Medical Ass istance grants and prog rams
must be retained for a minimum of ten years.
NCDHHS TC1010 (General Terms and Conditions) (Local Government} (Rev. 11.01 .15)
253
Miscellaneous
Choice of Law: The validity of this contract and ariy of its
terms or provisions, as well as the rights and duties of the
parties to this contract, are governed by the laws of North
Carolina. The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract,
to the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Wake County,
North Carolina. The place of this contract and all
transactions and agreements relating to it, and their situs
and forum, shall be Wake County, North Carolina, where
all matters, whether sounding_in contract or tort, relating
to the validity, construction, interpretation, and
enforcement shall be determined.
Amendment: This contract may not be amended orally or
by performance. Any amendment must be made in written
form and executed by duly authorized representatives of
the County and the Contractor.
Severability: In the event that a court of competent
jurisdiction holds that a provision or requirement of this
contract violates any applicable law, each such provision
or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise
unenforceable and all other provisions and requirements
of this contract shall remain in full force and effect.
Headings: The Section and Paragraph headings in these
General Terms and Conditions are not material parts of
the agreement and should not be used to construe the
meaning thereof.
Gender and Number: Masculine pronouns shall be read
to include feminine pronouns and the singular-of any word
or phrase shall be read to include the plural and vice
versa.
Time of the Essence: Time is of the essence in the
performance of this contract.
Key Personnel: The Contractor shall not replace any ?f
the key personnel assigned to the performance of this
contract without the prior written approval of the County.
The term "key personnel" includes any and all persons
identified as such in the contract documents and any
other persons subsequently identified as key personnel
by the written agreement of the parties .
Care of Property: The Contractor agrees that it shall be
responsible for the proper custody and care of any
property furnished to it for use in connection with the
performance of this contract and will reimburse the
County for loss of, or damage to, such property. At the
termination of this contract, the Contractor shall contact
the County for instructions as to the disposition of such
property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Contractor for .
travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
exceed the rates published in the applicable State rules
or approved local government travel policy. International
travel shall not be reimbursed under this contract.
Sales/Use Tax Refunds: If eligible, the Contractor and
all subcontractors shall: (a) ask the North Carolina
Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
pursuant to G.S. 105-164.14; and (b) exclude all
refundable sales and use taxes from all reportable
expenditures before the expenses are entered in their
reimbursement reports.
Advertising: The Contractor shall not use the award of
this contract as a part of any news release orcommercial
advertising.
NCDHHS TC1010 {General Terms and Conditions) (Local Government) (Rev. 11.01 .15)
254
ATTACHMENT B-Scope of Work Federal Tax Id. or SSN 27-4328820
Contract # 20245
A. CO TRACTOR INFORMA TIO
I. Contractor Agency Name: James To lin , III
2. If different from Contract Admjnistrator Info rm a tion in General Contract:
Address
Telephone Number: 336-592-7077 Fax Number: 336-599 -024 2
Email: j to lin@ tolinlaw .com
3. a.m e of Program (s):Child Welfare, Foster Care & Adopti ons, Child Protecti ve
Services, Adult Protective Services, & Guardianshi p
4. Status: ~ Public D Private, ot for Profit D Pri vate, For Profit
5. Contractor's Financial Rep ortin g Year January through December
B. Explan ation of Serv ices to be provided and to whom (include S IS Service Code):
Legal serv ices to the Agency in the nature of consultations, interpretation of social
services laws and regulations and drafting of legal doc uments when necessary.
C . Rate per unit of Service (de fine the unit):
1. If Standard F ix ed Rate, Maximum Allowable, (See Rates fo r Services Chart)
One hundred twenty-fi ve dollars ($125.00) per ho ur fo r o ut of court time and one
hundred Twenty-Five dollars ($125.0 0) per hour for in court time fo r each hour of legal
services perform ed. Such hourl y rates shall e ncompass all expenses, including, but not
limited to, those for salary , suppli es , office space , heatin g and mai ntenance for office
space, telephone service, long -distance te lephone call s , po st age and tra vel.
2. Nego tiated County Rate .
D. umber of units to be provided: no more than 1, 150 hours co llecti vely
E. Details of Billing process and Time Frames;
Payabl e o n or before the 10th o f each month upon due submission by the Attorney of a
statement of wo rk detailin g th e hours of work performed and the nature of such legal
work.
F. Area to be served/Delivery site(s): Person Co unty Courthouse, Tolin & Tolin, PLLC,
Person Co unty Department of Social Services
(Signature of County Authorized Person) ignature of Contractor)
(Date S ubmitted) (Date Submitted)
Contract-Scope of Work (7-2008) Page lof 1
255
FEDERAL CERTIFICATIONS
The undersigned states that:
1. He or she is the duly authorized represen tative of the Contractor named be low;
2 . He or she is authorized to make, and does hereby make , the followi ng certifications on behalf of the Contractor, as set
out herein:
a. The Certification Regarding Nondiscrimi nation;
b. The Certification Regarding Drug-Free Workplace Requ irements ;
c. The Certification Regarding Environmental Tobacco Smoke;
d. The Certification Regarding Debarment. Suspens ion, Ineligi bility and Voluntary Excl usion Lower T ie r Covered
Transactions ; and
e. The Certification Regarding Lobby ing ;
3. He or she has completed the Certification Regarding Drug-Free Workplace Requ irements by providing the addresses
at which the contract work will be performed;
4. [Check the applicable statement]
[ ] He or she has completed the atta ch ed Disclosure Of Lobbying Activities because the Contractor has made,
or has an agreement to make, a payment to a lobby in g entity for influencing or attempting to influence an officer
or employee of an agency , a Member of Congress, an officer or employ ee of Congre ss, or an employee of a
Member of Cong ress in connection with a covered Federal action ;
OR
[ J He or she has not completed the attached Disclosure Of Lobbying Activiti es because the Contractor has not
made, and has no agreement to make, any pa yment to any lobby ing entity for influencing or attempting to
influence an y officer or employee of any agen cy , any Member of Cong ress, any offic er or em ployee of Cong ress,
or any employee of a Member of Cong ress in connection with a covered Federal action.
5. The Contractor shall requ ire its sub contracto rs , if an y , to make the same certificatio ns and disclosure.
Signature
Contractor Name Date
[This Certification Must be Signed by the Same Individual Who Signed th e Proposal Execution Page]
I. Certification Regarding Nondiscrimination
The Contractor certifies that it will comply with all Federal statutes relating to nond is cri mination . These includ e but are
not limited to : (a) Title VI of th e Civi l Rights Act of 1964 (P .L. 88-352) which pro hibit s di sc rimination on the basis of race,
color or national origin ; (b) Title IX of the Ed ucation Amendments of 1972, as a me nded (20 U.S.C. §§168 1-1683, 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), w hich prohibits discrimination on th e basis of hand icap s; (d) the Age Discrimination Act of
1975 , as amended (42 U.S.C. §§6101 -6 107), which prohibits discrimination on th e ba sis 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 Alcoho l Abuse and Alcoh olism Prevention , Treatment and Reha bilitatio n Act of 1970 (P .L. 91 -616), as
amended , relat in g to nondiscrimination on the basis of alcohol abuse or alcoholism ; (g) Title VI II of t he Civil Rights Act of
1968 (42 U.S.C. §§360 1 et seq .), as amended , re latin g to nond iscriminatio n in th e sale , re nta l or financing of ho using ; (h)
the Food Stamp Act and USDA policy , wh ich prohibit disc rimi nation on the basi s of relig ion and pol it ica l beliefs, and (i )
the requirements of any other nondiscrim ination statutes which may apply to th is Agree men t.
256
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 ag reement 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 t he
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 loca l 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
___ 112 South Main Street ______________________________ _
City, State, Zip Code
___ Roxboro, NC 27573, ______________________________ _
Street
___ 105 South Main Street ______________________________ _
City, State, Zip Code
___ .Roxboro, NC 27573 _____________ ~~---~------------
257
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.
Ill. 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 t he 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 pena lty 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 t hat 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
IThe 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 w hen this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendere d 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 debarmen t.
3. The prospective lower tier participant will provide immediate written notice to the person to w hom this proposal is
submitted if at any time the prospective lower tier participant learns that its certification was erroneous when subm itted
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 "vo luntarily 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 , susper,ded, 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.
258
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:
L 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
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 tiling, pursuant to title 31 U.S.C. section
1352. The tiling 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.
259
Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome
of a covered Federal action.
1. Identify the status of the covered Federal action .
2. Identify the appropriate classification of this report If this is a follow-up report caused by a material change to the
information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last
previously submitted report by this reporting entity for this covered Federal action .
3. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known .
Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub-
award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards
include but are not limited to subcontracts, subgrants and contract awards under grants.
4. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name, address, city, state and
zip code of the prime Federal recipient. Include Congressional District, if known .
5. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
6. Enter the Federal program name or description for the covered Federal action (Item 1 ). If known, enter the full
Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
commitments.
7. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e.g.,
Request for Proposal (RFP) number, Invitation for Bid (IFB) number, grant announcement number, the contract grant,
or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes,
e.g., "RFP-DE-90-001."
8. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the
Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5.
9. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity
identified in Item 4 to influence the covered Federal action.
(b) Enter the full names of the individual(s) performing services, and include full address if different from 1 0(a). Enter Last
Name, First Name and Middle Initial (Ml).
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. lf 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 certi in official shall si n and date the form, rint his/her name, title, and tele hone 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
Bud et, Pa erwork Reduction Pro·ect 0348-0046 , Washin ton, D. C. 20503
260
1.
□
□
□
□
□
□
4.
□
□
Disclosure Of Lobbying Activities
(Approved by 0MB 0344-0046)
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
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 ch ange
C. cooperative agreement □ C. Post-Award
d. loan For Material Change Only :
e. loan guarantee
f . loan insurance Year Quarter
Date Of Last Report:
Name and Address of Reporting Entity: 5 . If Reporting Entity in No. 4 is Subawardee, Enter Name
and Address of Prime:
Prime
Subawardee Tier (if known)
Congressional Dis~rict (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 address if
(if individual, last name, first name, Mf): different from No. 10a.) (last name, first name, Mf):
(attach Continuation Sheet(s) SF-LLL-A , if necessary) (attach Continuation Sheet(s) SF-LLL-A, if necessary)
11. Amount of Payment (check afl that apply): 13. Type of Payment (check af/ that apply):
$ actual planned □ a. retainer
□ b. one-time fee
12. Form of Payment (check all that apply}: □ C. commission
□ d. contingent fee
□ a . cash □ e. deferred
□ b. In-kind; specify: Nature □ f. other; specify:
Value
14. Brief Description of Services Performed or to be Performed and Date(s) of Service s, including officer(s), employee(s), or
Member(s) contacted, for Payment Indicated in Item 11 (attach Continuation Sheet(s) SF-LLL-A, If necessary):
15. Continuation Sheet(s) SF-LLL-A attached: □ Yes □ No
16. Information requested through this fonn is authorized by Signature:.
title 3 1 U . S. C. section 1352. This disclosure of lobbying
activities is a material representation of fact upon which Print Name:
reliance was placed by the tier above when this transaction
was made or entered into. This disclosure is required Title:
pursuant to 31 U.S. C. 1352. This information will be
reported lo the Congress semi-annually and will be Telephone No: Date:
available for public inspection. Any person who fails to file
the required disclosure shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each
such failure.
Federal Use Only Authorized fo r Local Reproductio n
Standard Form -LLL
261
CONFLICT OF INTEREST ACKNOWLE DGEMENT A ND POLIC Y
::~::t t:~C /J eo/tu d
I, T}oc,1 f\f t1 /A), i--) ,4 ~'2 .' 5 . Notary Public for said County and State, certify
that
.JA IY) ::e .s k ) Toh (II ·w perso nally appeared before me th is day and
acknowledged 1
that he/she is ---=----=---r----,..----,--,----of Toh ,11 «l Toi ~ ,,1 ,?J...L G
[name of Organizat ion ]
and by that authority duly given and as the act of the Organization , affirmed th at t he fore going Co nflict of
Interest Policy was adopted by the Board of Directorsrrrustees or other g overning body in a meeti ng held
o n the L.£-/ l'l day of )c,r . d(OJL/
-1.vt. ---~ ,I Sworn to and subscribed before me th is /j day o f __ J_c ~2 ~ __ / ____ , dQd'-1
..... u ... --_
, ... ,, ..i. .. W . ~ "'~ .,, ~,,r '7~ ,,
""' ~v # • ,..~ ~ J ~. ~
1;J ~-n'--.,.. ..... -. ""fA\ ,..
-i o,• ",.-~ ~
C/V\,A • Ck./\., ~ i ,1 ~ 0 TA Fl 1, • <fl :
(Official Seal) i 1• N~Pllbl\ ;
~ I) • = ~1, uauc ; g
/ ~ ~~~ ,,•_:f)~ My Commission expires LJS:: -Ora . 2 ~ij>~ •• .. -~ "" .. ~ ... ~v+ . "' ..... ............................................................... :~9AU ~~~~:., .,., ........... -
Instruction for Organization:
Sign and attach the following pages after adopted by the Board o f Directors/Trustees or other
governing body OR replace the following with the current adopted conflict of interest policy.
Name of Orga nizat ion
(/~g~~
Signature of Organization Official
N CDHHS COi i O 15 (Re v. 4/11 )
262
Co~flict of Interest Policy
The Board of DirectorsfTrustees or other governing persons, officers, employees or agents are to avoid
any conflict of interest, even the appearance of a conflict of interest. The Organization's Board of
DirectorsfTrustees 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
DirectorsfTrustees 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
DirectorsfTrustees or other governing body.
F. Violations of the Conflicts of Interest Policy -If the Board of DirectorsfTrustees 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 DirectorsfTrustees 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 COI1015 (Rev. 4/11)
263
G . Record of Conflict -The minutes of the governing board and all comm ittees with board delegated
powers shall contain :
1. The names of the persons who disclosed or otherwise were found to have a n 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 com mittee's dec ision as to whether
a conflict of interest in fact existed.
2. The names of the persons who were present for discussions and votes relati ng to the transaction
or arrangement that presents a possi ble 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 proceed ings .
Approved by :
7;;, t-:. l ~//~ ~e-
Name of Organization
tkR.~~
Signature of Organization Official
Date
N CDHHS CO 1101 5 (Rev. 4/1 I )
264
State Grant Certification -No Overdu e T ax Debts
Instructi ons : Grantee/Contractor should complete this certification for all state fund s received. Entity should
enter appropriate d ata in the yellow highlighted areas. The completed and signed form should be
provided t o the state agency fun ding the grant to be attached to the contract fo r the grant funds . A
copy of this form , along with the completed contract, sho ul d be kept by the funding agency and
ava ilable for review by the Office of State Budget and Management.
Note : ff you have a contra ct that extends more than one state fiscal year. you will need to obtain ,111 11J1du1ed cerlijicu.Jum /or
each year of the coniract.
Tolin & Tol in, PLLC
112 South Main Street
Roxboro, NC 27573
Ph: (336) 585-6930
Fax : (336 )599-0242
07/01 /2024
To: State Agency Head and Chief Fiscal Officer
Certification:
We certify th at the Tolin & Tolin , PLCC does not have any overdue tax debts, a s 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
fa lse statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as
provide d by N.C .G.S.) 14 3C-10-1b.
Sworn Statement:
James T olin , Ill being duly sworn, respectively , of Toli n & Tolin , PLLC of Roxbo ro in the State of North
Caroli na ; a nd that t he foregoing certification is true , accurate and complete to the best¢',ourn--.. ,, LlU 4,
knowledge and was made and subscribed by us . We also acknowledge and undec.st~r!U{.a~ "'"',,
misuse of State fu nds wi ll be reported to the app ropria te authorities for furth e r acj!bo~ , .......... ~-?""'';,._
'<) • '\ .,.. -
~~p~(£" f /t\OTA11;,~\
James Tolin, Ill ; i -•-: ~ ; i '. ,Qu eue ; i
~~.... . ✓.:f>f ~ ...... .,.. """"'"''
n the d ay of the date of said certification. ~,,;,, 0~ • .. --:,-0 . ,,~'
t,,lll cou I" ,,,,.,,.
lu111m,u"'"
----::......L.-=--..::=,,:::.,,._.'---"'--=-~Ot--~ My Commission Ex pir es: 0 5--o b ~ ~c;:;;l 1
(Notary Signature and Seal)
If there are any questions, please contact the state agency that provided your grant. If needed. you may conta ct the North
Carolin a Office of State Budget and Management:
N CGrants@osbm .nc. gov-(919)807 -4 795
1 G.S. 105-243 .1 defin es: Overdue tax debt. -Any part of a tax debt that remains unp aid 90 day s 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 withi n 90 days after the
notice of final assessment was mailed and has not failed to make any payments due u nder the inst allment
ag reement.·
MS&NCD Form 00 08
Eff. July 1, 2005
Revised July 18, 2006, 7/07, 8/09, 9/11
Page 1 of 1
265
This document will be used to detennine if you have a business associate relationship with a contractor. This form should be
completed on all contracts that have a HIP AA covered health care component. This would include all health related infonnation.
Contractor: James Tolin, III Contract Number: 20245 Date: 07/01/2024
HIP AA ASSESSMENT FORM
Questions
1. Has a relationship been initiated Select
allows the contractor to perform a
.function or activity for, or on behalf of,
County Department of Social Services
HIP AA covered health care component?
2. Is the function or service to be Select
rendered by the contractor on an activity
other than treatment of clients?
3. Does the function or service to Select
be rendered by the contractor involve the
use or disclosure of the County
Department of Social Services
individually identifiable health
information?
4. Are the services rendered by Select
staff from the contractor performed on the
premises of the covered health care
component, using the component's
resources and following the component's
policies and procedures?
5. Is the contractor performing a Select
type(s) of function/activity for or on the
behalf of the County Department of
Social Services HIP AA covered health
Notes
NOTE: The sharing of
Individually identifiable
health information with
another treatment contractor
for treatment purposes only
does not require a business
associate agreement. See 45
CFR §164.502(e)(l)(ii)(A)
NOTE: Data that does not
contain A County
Department of Social
Services individually
identifiable health
information is not covered by
HIP AA and thus does not
have to be protected through
a business associate
agreement.
Steps
YES-Go to Question 2.
NO-Stop. There is no business
associate relationship .
YES-Go to Question 3.
NO-Stop. There is no business
associate relationship.
YES--Go to Question 4.
NO-Stop. There is no business
associate relationship.
NOTES : Whenever a service NO-Got Question 5.
is rendered on the premises YES-Stop. There is not business
of a covered component, associate relationship.
utilizing the component's
resources and following the
component's policies and
procedures, the person
rendering such services is
considered a member of the
component's workforce, and
is required to comply with
the component's privacy
policies and procedures. No
business associate agreement
is required.
Check appropriate service(s):
D Attorney Representing
Agency
D Benefits Management
YES-You have identified a business
associate relationship. The specified
function/activity, which involves the
sharing of individually identifiable
1
266
component that is directly related to the D Patient Accounts Billing health information, is provided by the
covered health component's continued D Claims J>rocessing contractor. This constitutes a business
operation? D Claims Administration associate relationship as such
D Bill Collections information must be protected the same
D Professional Services as required of the HIP AA covered
D Special Population health care component. There are two
Assessments types of business associate relationships:
D Data Analysis External Business Associate
D Data Processing relationships: You have indentified an
D Data Administration External business associate relationship
0JCAHO if you are contracting with any entity
D Council on Accreditation outside city, county or state government.
D Re-pricing A Business Associate Addendum must
D Rate Setting be signed and included with the
D Practice Management contract. If you are completing a
D Software Support Memorandum of Agreement (MOA)
D Utilization Review with a governmental entity the
D Quality Assurance Government Associate Addendum must
Contract Analysis be utilized.
D Central Office NO-STOP. There is no business
Supervision associate relationship.
D Security
D Dietary
D Machine Maintenance
D Facility Maintenance
D Landscaping
D Housekeeping
D Hardware Support
D Audits/Surveys
D Purchasing
ADDITIONAL REOUIRl\tlENTS
NOTE: Make sure all county
requirements are met for internally
notifying the correct parties for External
and Internal Business Associates
Rev: 7-1-2013
2
267
State Certification s
Contractor Certifications Required by orth Carolina Law
J_nstructions : The person who signs thi s document should read th e text of tb e statutes and Exec uti ve Order li sted below a nd consult
with counse l and other knowledgeable persons before signing . The text of each Nort h Caro lina General Statutes and of the Exec uti ve
Order can be found online at:
• Article 2 of Chapter 64: http ://www.ncga .state.nc.us/EnactedLegislation Stat utes/PDF/ByArticle/Chapter 64/Articlc 2.pdf
• G.S. 13 3-32: http ://www.nc ga.state.nc.us/gascripts/statutcs/statutelookup.pl?statute= 133-32
• Executive Order No. 24 (Pe rdu e, Gov., Oct. I, 2009): http ://www.e th1cs commission.nc.gov/1ibrary/pdfs/Law s/E024.pdf
• G .S. I 05-l 64.8(b ): http://www.ncga.state.nc.us/EnacledLcgislation/Statules/PDF/8ySection /Chaplcr 105/0S I 05-164.8.p<lf
• G .S. 143-48 .5: htcp://www.ncga.state.nc.us/EnactedLegislation/Statutcs/HTMUBySeclion/Chaplcr 143 /GS 143-48.5 .htrnl
• G.S. 143-59. I: http://www.ncga.state.nc.us /EnacledLeg1slalion/Statutes/PDF/8ySection /Chapler 143 GS 143-59.1.pdf
• G. S. 14 3-5 9. 2: http://www.ncga.st ate.nc. us/EnactedLeg1slation/Statutes/PDF /BySection/Chapter 143 GS 14 3-59 .2.pd f
• G.S . l 43-1 33.3: http ://www.nc ga .state.nc.us/EnactedLegislation/StalUles/l lTMUBySecuon Chapter 143/GS L43-133.3 .htrnl
• G.S. 143B-l 39.6C: h1tp .//www.ncga.stale.nc.us/EnactedLegislat1on/Statutes/PDF/BySection/Chapter 143B /GS 143B-139.6C.pdf
Certifications
(1) Pursuant to G.S. 133-32 and Executive Order No. 24
(Perdue, Gov., Oct. 1, 2009), the undersigned hereby
certifies that the Contractor named below is in
compl iance with and has not violated, the provi sions of
either sa id statute or Executive Order.
(2) Pursuant to G.S. 143-48.5 and G.S. 143-133.3, the
undersigned hereby certifies that the Contractor named
be lo w, and the Contractor's subcontractors, comp lies
with the requirements of Article 2 of Chapter 64 of the
NC General Statutes , including the requirement for eac h
employer wi th more than 25 employees in North
Carolina to verify the work authorization of its
emp lo yees through the fede ral E-Verify system." E-
Verify System Link: www.uscis.gov
(3) Pursuant to G.S. 143-59.l(b), the undersigned hereby
certifies that the Contractor named below is not an
"ineligibl e Contractor" as set forth in G.S. l43-59 . l(a)
because:
(a) Neither the Contractor nor an y of its affiliates has
refused to collect the use tax levied under Article 5
of Chapter 105 of the General Statutes on its sales
delivered to North Carolina when the sales met one
or more of the conditions of G.S. 105-164 .8(6 ); and
(b) [ check one of the following boxes]
D Neither the Contractor nor any of its affiliates
has incorporated or reincorporated in a "tax
haven country" as set forth in G.S . 143 -
59. l(c)(2) after December 31, 2001 ; or
D The Contractor or one of its a:ffiliate s has
incorporated or reincorporated in a "tax haven
Contractor's Name: Ua.Ae5 tJ. /olill ~
country" as set forth in G .S. 143-59 .1 ( c )(2) after
December 3 1, 200 I but the United St.ate s is not
the pri nc ipal market for the public trading of th e
stock of th e corporation incorporated in the tax
haven country .
(4) Pursuant to G.S . 143 -59.2(b), the undersign ed hereb y
certifies that none of the Contractor's officer s, directors,
or owners (if the Contractor is an unincorporat ed
business entity} has been convicted of any vio lation of
Chapter 78A of th e Genera l Statutes or the Sec urities Act
of 193 3 or the Securities Exchange Act of J 934 within
IO years immedia te ly prior to th e date of the bid
so licitation.
(5) Pursuant to G.S. 143B-139.6C, the undersigned hereb y
certifies that the C o ntra tor will not us e a former
employee, as defined by G .S. 143B-139 .6C( d)(2 ), o f
the North Caro lina Depanment of Hea lth and Human
Services in the ad.ministration of a contract with the
Department in vio lation of G.S. 143B-139.6C and that
a vio lation of that statute shall void the Agreement.
( 6) The undersigned hereby certifies further that:
(a) He or she is a duly authori zed representative of the
Co ntractor named below;
(b) He or she is autho rized to make, and docs here by
make, the for egoing certifi cations on behalf of the
Contractor; and
(c) He or she understands that an y person who
knowingly submits a fal se certification in response
to the requirements of G.S . 143-59. land -59.2 shall
be guilty o f a Class J fe lon y.
Contractor 's
Authorized Agent: ( --c --~/4~,4 • 45,,c._ Signa ture ___ .L~:..w:::c...:......=._:....P'--"0 :.....L._ ... ~e...=:.=..__:Je-=,.o.._----------Dale _________ _
Z mAe:{Z E:::
Printed N ame Uc> d f\ ,tJ µ.) &I iLJ-Jt.,Q. L? Title--J~~=-'=-i+-----------
Witness:
The witness should be present when the Contractor 's Authorized Agent signs thi s certifi cat' n an d should s ign and date thi s
document immediate ly thereafter.
C:ontrac tnr (;erfificntions Reouired hv North C'amlina t .a w /Rev R/2 0 11\) Pave I nf I
268
ATTAC HME T
Contract #2024 5
James Tolin, Ill
Pe rson Coun ty D epartment of S ocial Services/Human Se rvi ce s
CERT IFICAT IO N R EGARDING NON DIS CRIMINATION , CLEAN AIR ACT.
CLEA WATERACT
Certification Regarding Nondisc rimination
The Contractor certifies that it w ill comply wit h all Federal statutes relat ing to nondiscri mination .
These i ncl ude but are not li m ited to: (a) T itle VI of the Civil Rights Act of 1964 (P.L. 88-352) which
proh i bits d iscrim ination on the basi s of race, color or national orig in; (b) T itle 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 prohib its 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, re lating to nondiscrimination on the bas is of drug abuse; (f) the Comprehensive
Alcohol Abuse and Alcoholism Prevention , Treatment and Rehabilitation Act of 1970 (P.L. 91-
616), as amended, re lating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g)
Title VIII of the Civil Rig hts Act of 1968 (42 U.S.C. §§3601 et seq .), as amended , re lating to
nond iscrimination in the sa le, rental or finan ci ng o f housing ; (h) the Food Stamp Act and USDA
po licy , which prohibit discrimi nation on the basis of re li gion and politi cal beliefs; and (i) the
requ irements of any other nond iscrimination statutes which may apply to th is Agreement.
The Contractor must comply w ith Executive Order 1 1246 , entitled "Equal Employment
Opportunity ," as amended by Executive Order 11375 , and as supplemented by the Department of
Labor Regu lations (41 CFR Part 60): The Executive Order pro hibits federa l contractors a nd
federally-ass isted construct ion contractors and subcontractors who do over $10,000 in
Government business in one year from discriminating in employment decis ions on th e basis of
race , color, re ligion , sex, or national origin. The Exec utive Order also requ ires Government
contrac tors to take affirmative action to ensure that equa l opportun ity is provided in all aspects of
their emp lo yment.
Meaningful Access for LEP Ind ividua ls : The Contractor that participate i n the SNAP must take
reasonable steps to ensure that LEP persons have meaningful a ccess to programs, services , and
benefits. This i ncludes the requ irement to prov ide bi lingual program information and certification
materials and i nterpretation services to sing le language minorities in certain project areas. SNAP
Contractors that do not prov ide meani ngful access fo r LEP individuals risk violating prohib itions
against discrimination based on National Origin i n the Food and Nutrition Act of 2008 , as
amended , Title VI of th e Civil Rights Act of 1964 (Title V I) and SNAP program regulations at 7
CFR 272A(b). They also risk noncompliance with the USDA policy guidance titled , "Guidance to
Federal Fi nan cial Assistance Re ci pients Regarding T itle VI Prohibition Aga inst National Origin
Discrimination Affecting Limited Eng lish 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 . Th is may include contracting for oral interpretation services, hiring
bilingual staff, arranging te lephone interpreters and/or language lines, coord inating commun ity
volunteers , t ranslating vita l documents, and prov id ing written notice that language services are
ava il able in appropriate languages . Quality and accuracy of the lang uage service is c ritica l i n
order to avoid serious conseq uences to the LEP person and to the recip ient. LEP needs sh o uld
be considered in developing budgets and front line staff shou ld understand how to obtain
language assistance services. Fo r additional assista nce and information regard ing LEP matters,
please also v is it http://www.lep.gov.
(Federal Certification-N on-Di sc riminati o n, C lean Ai r , Clean Wa t er) (01 /2018)Page l o f 3
269
Contract #20245
James Tolin, 111
Ensuring Equal Opportunity Access for Persons with Disabilities: The Contractor must a lso
ensure equal opportunity access for persons with d isabilities. This includ es ensuring that
communications with applicants, participants, members of the public, and companions with
disabilities are as effective as communications w ith 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 w ith
Disabilities Act (ADA) of 1990, as amended , and SNAP program regu l ation s.
DOJ published revised final regulations implementing Title II and T itle Ill 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
Facil it ies". In accordance with the i mplementing regulations , Contractors must provide au xiliary
aids and services where necessary to ensure effective commu nication and equal opportun ity
access to program benefits for in dividuals w ith disabilities. The type of auxiliary aids and services
required will vary , but a Contractor may not requ ire an i ndividual 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 appl icants 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 i nformation as to the existence and location of
accessible services, activities, and facilities. For more information , please v i sit the ADA websi te:
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 precedi ng sentence shall continue until the Administrator certifies that
the condition giving rise to such a conviction has been corrected. For convictions arisin g
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 th is prohibition to other fa cil ities 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 a ir, the President shall, not more than 180 days after enactment of
the C lean Air Amendments of 1970 cause to be issued an order (1) requi ring 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 Pre sident
determin es necessary to carry out such requ irement.
d . The President may exempt any co ntract, loan, or grant from all or part of the provisions of
this section where he determines such exemption is necessary i n 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 th is section, including but not limited to the
progress and problems associated with implementation of this section . [42 U.S.C . 7606]
(Federal Certification-No n-Discrimination, C lean Air, C lean Water) (0 1/20 l 8)Page 2 of 3
270
V . The Clean Water Act; 33 U.S.C. §1251 et seq . (1972)
Contract #20245
James Tolin, Ill
a. No Federal agency may enter into any con tract with any person who has been convicted
o f any offense under Section 309(c) of th is Act for the procuremen t of goods, materials,
and services if such contract is to be performed at any facility at wh ich the violation which
gave rise to such conviction occu rred , 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 cond ition 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 th is 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 th is 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 pol icy of this Act i n such contracting or assistance
activities, and
(ii) setting forth procedures, sanctions, penalties, and such other provisions , as the
Pres ident determines necessary to carry out such req uirement.
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 complian ce
with the purpose and intent of this section, including, but not limited to , the progress and
problems associated with such compliance.
f. No certification by a contractor, and no contract clause, may be required in the case of a
contract for the acquisition of commercia l items in order to implement a prohibition or
requirement of this section or a prohibition or requ i rement 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 Po licy Act (41 U.S.C . 403(1 2)).
Title
Agency/Organization Date
(Certification s ig nature should be same as Co ntract sig nature.)
(Federal Ce rtificat ion-on-Discriminati o n, C lean Air , C lean Water) (0l/20 18 )P age 3 of3
271
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CONTRACT PROVIDER NAME: _James Tolin , 11 1
CONTRACT NUMBER: ____ 20245
CONTRACT PERIOD: _____ July 1, 2024 -June 3 0, 2 025
PROVIDER'S FISCAL YEAR: __ January-December
CONTRACT DETERMINATION QUESTIONNAIRE
(PURCHASE OF SERVICE VS. FINANCIAL ASSISTANCE)
Instructions: Enter 5 points for each factor in either the yes or no column . Once t he entire list has been completed
tally the points in each column. The column with the most points should be a goo d ind icator of the designat ion of
the organization--either Financial Assistance (Grant) or Vendor (Purchase of Service)
Determination Factors
Does the provider determine ·eligibility?
Does the provider provide administrative functions such as Develop program standards
procedures and rules?
Does the provider provide administrative functions such as Program Planning ?
Does the provider provide administrative functions such as Monitorinq ?
Does the provider provi de administrative functions such as Program Evaluation ?
Does the provider provide administrative functio ns such as Proqram Compliance?
Is provider performance measured aqainst whether specific objectives are met?
Does the provided have responsibility for programmatic decision makino ?
Is the provider objective to carry out a public puroose to support an overall proo ram ob jective?
Does the provider have to submit a cost report to satisfy a cost reimbursement arranaement?
Does the provider have any obligation to the funding authority other than the delivery o f t he
specified goods/services?
Does the provider operate in a noncompetitive environment?
Does the provider provide these or similar goods and/or services only to t he fundrna aaencv?
Does the provide these or similar goods a nd/or services ou tside normal business operations?
IT0TAL
Note: The authorized individual(s) must place an X in one of the boxes below to indicate
the type of contractual arrang ement for this contract , then sign and date where indica ted .
5 points
Fi na ncia l
Assistance
Y ES
X
X
10
,__ __ _,I Fl NANCIAL ASSIST ANGE L..-_x _ __,I P URCHASE SERVICE
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Signatu re of Authorized Programmatic Individual
Signature of Authorized Administrative Individual
Revised effective 7-1-2013
page 1
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DATE
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Pu rc hase
of Service
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Contract # 20245
James Tolin, III
Person County Department of Social Services/Human Services
GOVERNMENT BUSINESS ASSOCIATE ADDENDUM TO MEMORANDUM OF
UNDERSTANDING
This Agreement is made effective the 1st day of July 2024, by and between Person County
Department of Social Services (name County Department of Social Services) ("Covered
Entity") and James Tolin, III (name of contractor) ("Business Associate" "Governmental
Agency") (collectively the "Parties").
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a Memorandum of
Understanding ("entitled" or "dated" identify contract) contract# 20245 (the
"MOU'), whereby Business Associate agrees to perform certain services for or on '
behalf of Covered Entity.
b. Covered Entity is an organizational unit of Person County as the Person County
Department of Social Services as a health care component for purposes of the
HIP AA Privacy Rule.
c. The relationship between Covered Entity and Business Associate is such that the
Parties believe Business Associate is or may be a "business associate" within the
meaning of the HIP AA Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the MOU with the
. intention of complying with the HIP AA Privacy Rule provision that a covered entity
may disclose protected health information to a business associate, and may allow a
business associate to create or receive protected heath information on its behalf, if
the covered entity obtains satisfactory assurances that the business associate will
appropriately safeguard the information.
2. DEFINITIONS.
Unless some other meaning is clearly indicated by the context, the following terms shall
have the following meaning in this Agreement:
a. "HIPAA'' means the Administrative Simplification Provisions, Sections 261 through
264, of the federal Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191.
b. "Individual" shall have the same meaning as the term "individual" in 45 CFR
160.103 and shall include a person who qualifies as a personal representative in
accordance with 45 CFR 164.502(g).
c. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable
Health Information at 45 CFR part 160 and part 164, subparts A and E.
d. "Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 160.103, limited to the information created or
received by Business Associate from or on behalf of Covered Ent ity.
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Contract# 20245
James Tolin, III
e. "Required By Law" shall have the same meaning as the term "required by law" in 45
CFR 164.103.
f. "Secretary'' shall mean the Secretary of the United States Department of Health and
Human Services or his designee.
g. Unless otherwise defined in this Agreement, terms used herein shall have the same
meaning as those terms have in the Privacy Rule.
3. OBLIGATIONS OF BUSINESS ASSOCIATE
a . Business Associate agrees to not use or disclose Protected Health Information other
than as permitted or required by this Agreement or as Required By Law.
b. Business Associate agrees to use appropriate safeguards to prevent use or disclosure
of the Protected Health Information other than as provided for by this Agreement.
c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect
that is known to Business Associate of a use or disclosure of Protected Health
Information by Business Associate in violation of the requirements of this
Agreement.
d. Business Associate agrees to report to Covered Entity any use or disclosure of the
Protected Health Information not provided for by this Agreement of which it
becomes aware.
e. Business Associate agrees to ensure that any agent, including a subcontractor, to
whom it provides Protected Health Information received from, or created or received
by Business Associate on behalf of Covered Entity agrees to the same restrictions
and conditions that apply through this Agreement to Business Associate with
respect to such information.
f. Business Associate agrees to provide access, at the request of Covered Entity, to
Protected Health Information in a Designated Record Set to Covered Entity or, as
directed by Covered Entity, to an Individual in order to meet the requirements
under 45 CFR 164.524.
g. Business Associate agrees, at the request of the Covered Entity, to make any
amendment(s) to Protected Health Information in a Designated Record Set that the
Covered Entity directs or agrees to pursuant to 45 CFR 164.526.
h. Unless otherwise prohibited by law, Business Associate agrees to make internal
practices, books, and records, including policies and procedures and Protected
Health Information, relating to the use and disclosure of Protected Health
Information received from, or created or received by Business Associate on behalf of,
Covered Entity available to the Covered Entity, or to the Secretary, in a time and
manner designated by the Secretary, for purposes of the Secretary determining
Covered Entity's compliance with the Privacy Rule.
1. Business Associate agrees to document such disclosures of Protected Health
Information and information related to such disclosures as would be required for
Covered Entity to respond to a request by an Individual for an accounting of
disclosures of Protected Health Information in accordance with 45 CFR 164.528, and
to provide this information to Covered Entity or an Individual to permit such a
response.
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4. PERMITTED USES AND DISCLOSURES
Contract# 20245
James Tolin, III
a. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Assopiate may use or disclose Protected
Health Information to perform functions, activities, or services for, or on behalf of,
Covered Entity as specified in the MOU, provided that such use or disclosure:
1) would not violate the Privacy Rule if done by Covered Entity; or
2) would not violate the minimum necessary policies and procedures of the
Covered Entity.
b. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information as necessary for the proper management and administration of the
Business Associate or to carry out the legal responsibilities of the Business
Associate.
c. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may disclose Protected Health
Information for the proper management and administration of the Business
Associate, provided that:
1) disclosures are Required By Law; or
2) Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that it will remain confidential and will be used or
further disclosed only as Required By Law or for the purpose for which it was
disclosed to the person, and the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information
has been breached.
d. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information to provide data aggregation services to Covered Entity as permitted by
45 CFR 164.504(e)(2)(i)(B).
e. Notwithstanding the foregoing provisions, Business Associate may not use or
disclose Protected Health Information if the use or disclosure would violate any term
of the MOU or by other applicable law or agreements.
5; TERM AND TERMINATION
a. Term. This Agreement shall be effective as of the effective date stated above and
shall terminate when the MOU terminates.
b. Termination for Cause. Upon Covered Entity1s knowledge of a material breach by
Business Associate, Covered Entity may, at its option:
1) Provide an opportunity for Business Associate to cure the breach or end the
violation, and terminate this Agreement and services provided by Business
Associate, to the extent permissible by law, if Business Associate does not cure
the breach or end the violation within the time specified by Covered Entity;
2) Immediately terminate this Agreement and services provided by Business
Associate, to the extent permissible by law; or
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Contract # 20245
James Tolin, III
3) If n e ither t e rmination nor cure i s fe a sible , report the violation to the Secretary
as provided in t h e Privacy Rule.
c. Effect of Termin ation.
1) Except as provide d in paragraph (2) of this secti on or in the MOU or by oth e r
applicable l a w or agr eeme nts , upon termination of this Agreeme n t a nd services
provide d by Bus iness Associate, for any reason, Business Associate shall r eturn
or destroy all Protected H e alth Information r eceiv ed from Covered Entity, or
created or r ecei ved by Bus iness Associate on behalf of Cover ed Entity. This
provision shall apply to Protecte d H ealth Informa tion that is in the possession
of s ubco ntractors or agents of Business Associate. Business Associate shall
r etain n o copies of t h e Prot ected Health Information.
2) In t h e e vent that Business Associate determines t hat r e turning or des troying
the Protected H e alth Information is not fe a sible , Business Associate shall
provid e to Cove r ed Entity n otifica tion of the co ndition s that make return or
d estruction not feasible. Business Associate shall extend the protections of this
Agreement to such Protecte d H e alth Information and limit furth e r uses and
disclosures of s uch Protected Health Information t o those purposes that make
the return or destruction infeas ible, for so long a s Busin ess Associate maintains
s u ch Protecte d H e alth Information.
6. GENERAL TERMS AND CONDITI ONS
a. This Agr eeme nt amends and is part of the MOU.
b. Except as provide d in this Agreement, all terms and conditions of the MOU s hall
r e main in force and s hall apply to this Agreement a s if set forth fully herein.
c. In the event of a conflict in terms between this Agreement and the MOU, the
interpretation that is in accordance with the Privacy Rule s hall prevail. In the eve nt
that a co nflict then r e m ains , the MOU terms shall prevail so l on g as they are in
accordance with the Privacy Rule.
d. A breach of t his Agreement by Business Associate s h a ll be co nsider ed s ufficie nt
basi s for Covered Ent ity to terminate the MOU for cause.
SIGNATURES: ~/;' ~~
Date:
Re v: 6-7-2015
4
276
Contract# 20246 Fiscal Year Begins July 1, 2024 Ends June 30, 2025
Th is contract is hereby entered in to by and between the Person County Department of Social Services (the "County") and
Julie Ramsey . (the "Contractor") (refe rred to collectively as the "Parties"). The Contractor's federal tax identification number or
Socia l Security Number is 56-199 9585.
1. Contract Documents: This Contract consists of the following documents :
( 1) Th is contract
(2) The General Terms and Cond itions (Attachment A)
(3) The Scope of Work, description of services, and rate (Attachment B)
(4) Combined Federal Certifications (Attachment C)
(5) Conflict of Interest Policy (Attachme nt D)
(6) No Overdue Taxes (Attachment E)
(7) HIPAA Busin ess Associate Addendum {checklist and forms ) (Attachment I)
(8) State Certification (Attachment M)
(9) Attachment N -Non-Discrim in ation, Clean Air , Clean Water
(10) Contract Determination Questionnaire (required )
These documents constitute the entire agreement between the Parti es and supersede a ll prior oral or written statements
or agreements.
2. Precedence among Contract Documents: In th e event of a conflict between or among th e terms of the Contract
Documents, the terms in the Contract Document with the hig hest relative precedence shall prevail. The order of
precedence s hall be the order of documents as liste d in Paragraph 1, above, with the first-listed document having the
highest precedence and the last-l isted document having the lowest precedence. If there are multiple Contract
Amen dmen ts, the most recent a mendment shall have the highest precedence and the oldest amendment shall have the
lowest precedence.
3. Effective Period: This contra ct sh all be effective on July 1, 2024 and shall terminate on June 30 , 2025.
Th is contract must be twelve mont hs 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.
5. County 's Duties: The County shall pay the Contractor i n the manner and in the amounts specified in the Contract
Documents .
[gJ a. T here are no matchi ng requ irements from the Contractor.
D b . The Contractor's matchin g requirement is $
□ In-kind
D Cash and In-kind
, which shall consist of:
□cash
D Cash and/or In-kind
The contributions from the Contractor shall be sourced from non -federal funds . T he tota l contract amount inc ludin g
an y Contractor match shall not exceed 1,150 hours co llectively for all attorneys under contra ct. Rate o f compensation
for Secon dary Attorney , Julie Ramsey is $75 pe r hour.
6 . Reversion of Funds:
Any unexpended grant fun ds shall revert to the County Department of Social Services/Human Services upon
termi nation of this contract.
7 . Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C .G.S. § 143C-6-22 & 23 and 0MB Ci rcular-CFR nt1e
2 Gra nts and Agreemen ts , 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 :
Pa yment shall be made in accordance with the Contract Documents as described in the Scope of Work,
Attachme nt B.
Contract-General (06/15) Page 1 of 3
277
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 the County:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS
Name & Title Wendy McKinney, Business Officer Name & Title Wendy McKinney, Business Officer
County Person County Person
Mailing Address P .0. Box 770 Street Address 3558 South Madison Blvd
City, State, Zip Roxboro, NC 27573 City, State, Zip Roxboro, NC 27573
Telephone (336)503-1158
Fax (336)599-397 4
Email wmckinney@personcountvnc.gov
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE JF DELIVERED BY ANY OTHER MEANS
Name & Title Julie Ramsey, Attorney Name & Title Julie Ramsey, Attorney
Company Name Julie A. Ramsey Attorney At Law Company Name Julie A. Ramsey Attorney At Law
Mailing Address P.O. Box 3130 Street Address 22 Court Street, Suite 200
City State Zip Roxboro, NC 27573 City State Zip Roxboro, NC 27573
Telephone (336) 599-5004
Fax
Email
10. Supplementation of Expenditure of Public Funds:
The Contractor assures that funds received pursuant to this contract shall be used only to supplement, not to
supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract"
services and related programs. Funds received under this contract shall be used to provide additional public funding
for such services; the funds shall not be used to reduce the Contractor's total expenditure of other public funds for
such services.
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:
Contract-General (06/15} Page 2 of 3
278
Individuals and Organizations receiving federal funds must ensure compl iance 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, Deba rment, Suspension , Ineligibility and
Voluntary Exclusion Lower Tier Covered Transact ions , and Lobbying . These assurances and certificat ions are to
be signed by the contractor's authorized representative.
14. Signature Warranty: The undersigned represent and warrant that they are authorized to bind their principals to the
terms of this agreement.
The Contractor and the County have execute this contract in duplicate originals , with one original being retained by each
party.
COUNTY
Signature (must be legally authorized to sign contracts for County DSS) Date
Printed Name Title
This instrume nt has been pre-audited in the manner required by the Loca l Government Budget and Fisca l Control Act.
Signature of County Finance Officer Date
Contract-General (06/15) Page 3 of 3
279
GENERAL TERMS AND CONDITIONS
Relationships of the Parties
Independent Contractor: The Contractor is and shall be
deemed to be an independent contractor in the
performance of this contract and as such shall be wholly
responsible for the work to be performed and for the
supervision of its employees. The Contractor represents
that it has, or shall secure at its own expense, all
personnel required in performing the services under this
agreement. Such employees shall not be employees of,
or have any individual contractual relationship with, the
County.
Subcontracting: The Contractor shall not subcontract
any of the work contemplated under this contract without
prior written approval from the County. Any approved
subcontract shall be subject to all conditions of this
contract. Only the subcontractors specified in the contract
documents are to be considered approved upon award of
the contract. The County shall not be obligated to pay for
any work performed by any unapproved subcontractor.
The Contractor shall be responsible for the performance
of all of its subcontractors.
Assignment: No assignment of the Contractor's
obligations or the Contractor's right to receive payment
hereunder shall be permitted. However, upon written
request approved by the issuing purchasing authority, the
County may: (a) Forward the Contractor's payment check
directly to any person or entity designated by the
Contractor, or (b) Include any person or entity designated
by Contractor as a joint payee on the Contractor's
payment check. In no event shall such approval and
action obligate the County to anyone other than the
Contractor and the Contractor shall remain responsible
for fulfillment of all contract obligations.
Beneficiaries: Except as herein specifically provided
otherwise, this contract shall inure to the benefit of and be
binding upon the parties hereto and their respective
successors. It is expressly understood and agreed that
the enforcement of the terms and conditions of this
contract, and all rights of action relating to such
enforcement, shall be strictly reserved to the County and
the named Contractor. Nothing contained in this
document shall give or allow any claim or right of action
whatsoever by any other third person. It is the express
intention of the County and Contractor that any such
person or entity, other than the County or the Contractor,
receiving services or benefits under this contract shall be
deemed an incidental beneficiary only.
Indemnity and Insurance
Indemnification: The Contractor agrees to indemnify and
hold harmless the County, the State of North Carolina,
and any of their officers, agents and employees, and
Federal Government from any claims of third parties
arising out of any act or omission of the Contractor in
connection with the
performance of this contract to the extent permitted by
law.
Default and Termination
Termination Without Cause: The County may terminate
this contract without cause by giving 30 days written
notice to the Contractor.
Termination for Cause: If, through any cause, the
Contractor shall fail to fulfill its obligations under this
contract in a timely and proper manner, the County shall
have the right to terminate this contract by giving written
notice to the Contractor and specifying the effective date
thereof. In that event, all finished or unfinished deliverable
items prepared by the Contractor under this contract shall ,
at the option of the County, become its property and the
Contractor shall be entitled to receive just and equitable
compensation for any satisfactory work completed on
such materials, minus any payment or compensation
previously made. Notwithstandi ng the foregoing
provision, the Contractor shall not be relieved of liability to
the County for damages sustained by the County by virtue
of the Contractor's breach of this agreement, and the
County may withhold any payment due the Contractor for
the purpose of setoff until such time as the exact amount
of damages due the County from such breach can be
determined. In case of default by the Contractor, withou t
limiting any other remed ies for breach available to it, the
County may procure the contract services from other
sources and hold the Contractor responsible for any
excess cost occasioned thereby. The filing of a petition for
bankruptcy by the Contractor shall be an act of default
under this contract.
Waiver of Default: Waiver by the County of any default
or breach in compliance with the terms of this contract by
the Contractor shall not be deemed a waiver of any
subsequent default or breach and shall not be construed
to be modification of the te rms of this contract unless
stated to . be such in writing , signed by an authorized
representative of the County and the Contractor and
attached to the contract.
Availability of Funds: The parties to this contract agree
and understand that the payment of the sums specified in
this contract is dependent and contingent upon and
subject to the appropriation , allocation, and availability of
funds for this purpose to the County.
Force Majeure: Neither party shall be deemed to be in
default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of
war, hostile foreign action , nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other
catastrophic natural event or act of God.
Survival of Promises: All promises, requirements,
terms, conditions , provisions, representations,
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11 .01 . 15)
280
guarantees, and warranties contained herein shall survive
the contract expiration or termination date unless
specifically provided otherwise herein, or unless
superseded by applicable Federal or State statutes of
limitation.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: All
deliverable items produced pursuant to this contract are
the exclusive property of the County. The Contractor shall
not assert a claim of copyright or other property interest in
such deliverables.
Compliance with Applicable Laws
Compliance with Laws: The Contractor shall comply
with all laws, ordinances, codes, rules, regulations, and
licensing requirements that are applicable to the conduct
of its business, including those of federal, state, and local
agencies having jurisdiction and/or authority .
Equal Employment Opportunity: The Contractor shall
comply with all federal and State laws relating to equal
employment opportunity.
Health Insurance Portability and Accountability Act
(HIPAA): The Contractor agrees that, if the County
determines that some or all of the activities within the
scope of this contract are subject to the Health Insurance
P.ortability and Accountability Act of 1996, P.L. 104-91, as
amended ("HIPAA"), or its implementing regulations, it will
comply with the HIPAA requirements and will execute
such agreements and practices as the County may
require to ensure compliance.
Confidentiality
Confidentiality: Any information, data, instruments,
documents, studies or reports given to or prepared or
assembled by the Contractor under this agreement shall
be kept as confidential and not divulged or made available
to any individual or organization without the prior written
approval of the County. The Contractor acknowledges
that in receiving, storing, processing or otherwise dealing
with any confidential information it will safeguard and hat
further disclose the information except as otherwise
provided in this contract.
Data Security: The Contractor shall adopt and apply data
security standards and procedures that comply with all
applicable federal, state, and local laws, regulations, and
rules.
Duty to Report: The Contractor shall report a suspected
or confirmed security breach to the County's Contract
Administrator within twenty~four (24) hours after the
breach is first discovered, provided that the Contractor
shall report a breach involving Social Security
Administration data or Internal Revenue Service data
within one (1) hour after the breach is first discovered.
During the performance of this contract, the contractor is
to notify the County contract administrator of any contact
by the federal Office for Civil Rights (OCR) received by
the contractor.
Cost Borne by Contractor: If any applicable federal,
state, or local law, regulation, or rule requires the County
or the Contractor to give affected persons written notice
of a security breach arising out of the Contractor's
performance under this contract, the Contractor shall bear
the cost of the notice.
Oversight
Access to Persons and Records: The State Auditor
shall have access to persons and records as a result of
all contracts or grants entered into by State agencies or
political subdivisions in accordance with General Statute
147·64.7. Additionally, as the State funding authority, the
Department of Health and Human Services shall have
access to persons and records as a result of all contracts
or grants entered into by State agencies or political
subdivisions.
Record Retention: Records shall not be destroyed,
purged or disposed of without the express written consent
of the County. State basic records retention policy
requires all grant records to be. retained for a minimum of
five years or until all audit exceptions have been resolved,
whichever is longer. If the contract is subject to Federal
policy and regulations, record retention may be longer
than five years . Records must be retained for a period of
three years following submission of the final Federal
Financial Status Report, if applicable, or three years
following the submission of a revised final Federal
Financial Status Report. Also, if any litigation, claim,
negotiation, audit, disallowance action, or other action
involving this Contract has been started before expiration
of the five-year retention period described above, the
records must be retained until completion of the action
and resolution of all issues which arise from it, or until the
end of the regular five-year period described above,
whichever is later. The record retention period for
Temporary Assistance for Needy Families (TANF) and
MEDICAID and Medical Assistance grants and programs
must be retained for a minimum of ten years.
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
281
Miscellaneous
Choice of Law: The validity of this contract and any of its
terms or provisions, as well as the rights and duties of the
parties to this contract, are governed by the laws of North
Carolina. The Contractor, by signing this contract, agrees
and submits, solely for matters concerning this Contract,
to the exclusive jurisdiction of the courts of North Carolina
and agrees, solely for such purpose, that the exclusive
venue for any legal proceedings shall be Wake County,
North Carolina. The place of this contract and all
transactions and agreements relating to it, and their situs
and forum, shall be Wake County, North Carolina, where
all matters, whether sounding in contract or tort, relating
to the validity, construction , interpretation, and
enforcement shall be determined.
Amendment: This contract may not be amended orally or
by performance. Any amendment must be made in written
form and executed by duly authorized representatives . of
the County and the Contractor.
Severability: In the event that a court of competent
jurisdiction holds that a provision or requirement of this
contract violates any applicable law, each such provision
or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise
unenforceable and all other provisions and requirements
of this contract shalt remain in full force and effect.
Headings: The Section and Paragraph headings in these
General Terms and Conditions are not material parts of
the agreement and should not be used to construe the
meaning thereof.
Gender and Number: Masculine pronouns shall be read
to include feminine pronouns and the singular of any word
or phrase shall be read to include the plural and vice
versa .
Time of the Essence: Time is of the essence in the
performance of this contract.
Key Personnel: The Contractor shall not replace any ?f
the key personnel assigned to the performance of this
contract without the prior written approval of the County.
The term "key personnel " includes any and all persons
identified as such in the contract documents and any
other persons subsequently identified as key personnel
by the written agreement of the parties.
Care of Property: The Contractor agrees that it shall be
responsible for the proper custody and care of any
property furnished to it for use in connection with the
performance of this contract and will reimburse the
County for loss of, or damage to, such property. At the
termination of this contract, the Contractor shall contact
the County for instructions as to the disposition of such
property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Contractor for
travel mileage, meals, lodging and other travel expenses
incurred in the performance of this contract shall not
exceed the rates published in the applicable State rules
or approved local government travel policy. International
travel shall not be reimbursed under this contract.
Sales/Use Tax Refunds: If eligible, the Contractor and
all subcontractors shall: (a) ask the North Carolina
Department of Revenue for a refund of all sales and use
taxes paid by them in the performance of this contract,
pursuant to G.S. 105~164.14; and (b) exclude all
refundable sales and use taxes from all reportable
expenditures before the expenses are entered in their
reimbursement reports.
Advertising: The Contractor shall not use the award of
this contract as a part of any news release orcommercial
advertising.
NCDHHS TC1010 (General Terms and Conditions) (Local Government) (Rev. 11.01.15)
282
ATTACHMENT B -Scope of Work Federal Tax Id. or SSN 56-1999585
Contract# 20246
A. CONTRACTOR INFORMATION
1. Contractor Agency Name: Julie Ramsey, Attorney at Law
2. If different from Contract Administrator Information in General Contract:
Address
Telephone Number: 336-599-5004 Fax Number: Email:
3. Name of Program (s): Child Support
4. Status: i:gj Public D Private, Not for Profit D Private, For Profit
5. Contractor's Financial Reporting Year January through December
B. Explanation of Services to be provided and to whom (include SIS Service Code):
To be available for consultation, legal advice and for representation as requested by the
Child Support Enforcement Agency on all legal matters arising from the duties of the
party of the first part under Sections 128 through 140 of Chapter 110 of the North
Carolina General Statutes and Title 42 of the United States Code, Sections 651 through
660 and the fed'eral regulations lawfully promulgated pursuant thereto.
For their services under this contract, the agency agrees to pay the contractor seventy-five
dollars ($75) per hour for out of court time and seventy-five dollars ($75.00) per hour for
in court time for each hour spent by the contractor providing legal services under the
Child Support Enforcement Program. Such hourly rate shall encompass all expenses,
including, but not limited to, those for salary, supplies, office space, heating and
maintenance for office space, telephone service, long-distance telephone calls, postage,
and travel ( other than travel to attend the Child Support Enforcement Training). The
contractor is not to be reimbursed for any extraordinary expense incident to performing
the services included under this agreement; except, that the agency agrees to pay all court
costs and filing fees which are required to be paid in conjunction with services provided
by the attorney under this agreement.
The contractor further agrees to attend at least one training session on Child Support
Enforcement per year conducted by the Child Support Enforcement Agency. Further, the
agency agrees to compensate the contractor at the hourly rate of fifty-five dollars
($55.00) for each hour that the party of the second part spends in training up to but not to
exceed the amount of four hundred forty dollars ($440.00) per day. Travel and meal
reimbursement shall be made at the same rates that are applicable to county DSS
employees (see Budget Addendum). However, the attorney may not be paid an hourly
rate for time spent traveling. Failure to attend one approved workshop per year shall be
construed as an indication that the contractor does not wish to continue providing
services under this agreement.
Contract-Scope of Work (7-2008) Page lof 1
283
Person County Department of Social Services will pay standard costs for ACTS training
with consideration being given to Person County Department of Social Services paying
for Ms. Ramsey's ACTS computer software should such acquisition be necessary.
C. Rate per unit of Service (define the unit):
1. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chari)
Seventy-five dollars ($75 .00) per hour for out of court time and seventy-five
dollars ($75.00) per hour for in court time for each how-oflegal services performed.
Such hourly rates shall encompass all expenses, including, but not limited to, those for
salary, supplies, office space, heating and maintenance for office space, telephone
service, long-distance telephone calls, postage and travel.
2. Negotiated County Rate.
D. Number of units to be provided: no more than 1, i50 hours collectively
E. Details of Billing process and Time Frames;
Payable on or before the I 0th of each month upon due submission by the Attorney of a
• stat~ment of work detailing the hours of work performed and the nature of such legal
work.
F. Area to be served/Delivery site(s): Person County Courthouse, Julie Ramsey,
Attorney at Law, Person County Department of Social Services
(Signature of County Authorized Person)
(Date Submitted)
Contract-Scope of Work (7-2008) Page2ofl
284
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 be half 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}
5.
[ ] He or she has completed the attached Disclosure Of Lobbying Activities because t he Contractor has made,
or has an agreement to make, a payment to a lobbying entity for influencing or attempting to influence an offi cer
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
9( 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.
·ts subcontractors, if any, to make the same certifications and disclosure.
Contractor Name
[This Certification Must be Signed by the Same Individual Who Signed the Proposal Execution Page]
I. Certification Regarding Nondiscrimination
The Contractor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are
not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race,
color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C . §§1681-1683 , and
1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps ; (d) the Age Discrimination Act of
1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office
and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as
amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of
1968 (42 U.S.C. §§3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or fi nancing of housing; (h)
the Food Stamp Act and USDA pol icy, 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.
285
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
-~22 Court Street Suite 200
City, State, Zip Code
___ .Roxboro, NC 27573 _____________________________ _
Street
City, State, Zip Code
286
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. 82.51 O.
Ill. 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.]
I. By signing and submitting this document, the prospective lower tier participant is providing the certification set out
below.
2. The certification in this clause is a material representation of the fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an
erroneous certification, in addition to other remedies available to the Federal Government, the department or agency
with which this transaction originate may pursue available remedies, including suspension and/or debarment.
3. The prospective lower tier participant will provide immediate written notice to the person to whom this proposal is
submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted
or has become erroneous by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"
"person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have
the meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549, 45 CFR
Part 76. You may contact the person to whom this proposal is submitted for assistance in obtaining a copy of those
regulations.
5. The prospective lower tier participant agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter any lower tier .covered transaction with a person who is
debarred, suspended, determined ineligible or voluntarily 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.
287
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
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.
288
Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome
of a covered Federal action.
1. Identify the status of the covered Federal action.
2. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last
previously submitted report by this reporting entity for this covered Federal action.
3. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known.
Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub-
award recipient. Identify the tier of the subawardee, e.g ., the first subawardee of the prime is the 1st tier. Subawards
include but are not limited t9 subcontracts, subgrants and contract awards under grants.
4. lf 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, i f 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) n1,1mber, Invitation for Bid (IFB) number, grant announcement number, the contract gr;mt,
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 1 0(a). Enter Last
Name, First Name and Middle Initial (Ml).
10. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Item 4) to t he
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 certi in official shall si n and date the form, rint his/her name, title, and tele hone 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
Bud et, Pa erwork Reduction Pro·ect 0348-0046 , Washin ton, D. C. 20503
289
1.
□
□
□
□
□
□
4.
□
□
Disclosure Of Lobbying Activities
(Approved by 0MB 0344-0046)
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
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:
Name and Address of Reporting ·Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name
and Address of Prime:
Prime
Subawardee Tier (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 address if
(if individual, last name, first name, Mf): different from No. 10a.) (last name, first name, Mf):
(attach Continuation Sheet(s) SF-LLL-A, if necessary) (attach Continuation Sheet(s) SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply):
$ actual planned □ a. retainer
□ b. one-time fee
12. Form of Payment (check all that apply): □ C. commission
□ d. conting~nt fee
□ a . cash □ e . deferred
□ b. In-kind; specify: Nature □ f. other; specify:
Value
14. Brief Description of Services Performed or to be Performed and Date(s) of Services, including officer(s), employee(s), or
Member(s) contacted, for Payment Indicated in Item 11 (attach Continuation Sheet(s) SF-LLL-A, if necessary):
15. Continuation Sheet(s) SF-LLL-A attached: □ Yes □ No
16. Information requested through this form Is authorized by Signature:
title 31 U. S. C. section 1352. This disclosure of lobbying
activities is a material representation of fact upon which Print Name:
reliance was placed by the tier above when this transaction
was made or entered into. This disclosure is required Title:
pursuant to 31 U.S. C. 1352. This information will be
reported to the Congress semi-annually and will be Telephone No: Date:
available for public inspection. Any person who fails to file
the required disclosure shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each
such failure.
Federal Use Only Authorized for Local Reproduction
' -. ~-. --. Standard Form -LLL
290
CONFLICT OF INTEREST ACKNOWLEDGEMENT AND POLICY
State of N t.
County ~-Q..A~O Y"'\
C..01.s~\
I, _ __.,="-"n"""· .... , \..;..'"'"'"""":t) __ _.,_~_,_,'C_."'-o,..;"""'Y"\...,(\....._ ____ _,, Notary Public for~ County and State, certify
that ~
_~ __ v-..._~_,_<..._"""-P\_,_~_\'--"-'~a.=.,..a..=~---e.-u~----personally appeared before me this day and
acknowledged ~
that he/she is Ow b ~v of
J\,1J·, r A.~ A±mr"",..~ A-1· Lc\._L,,.)
'' . [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 Directorsrrrustees or other governing body in a meeting held
on the .::R5' day of :S-Lt..i--.e ~o~4
Sworn to and subscribed before me this ~ S
~fficial Seal) •
Instruction for Organization:
Sign and attach the following pages after adopted by the Board of Directorsffrustees or other
governing body OR replace the following with the current adopted conflict of interest policy.
NCDHHS CO11015 (Rev. 4/11)
291
Conflict of Interest Policy
The Board of Directorsrrrustees or other governing persons, officers, employees or agents are to avoid
any conflict of interest, even the appearance of a conflict of interest. The Organization's Board of
Directorsrrrustees 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 wl)o 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 fqllowing 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
Directorsrrrustees or other governing body, the Board member or other governing person, officE!r,
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 interestexists.
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
Directorsrrrustees or other governing body.
F. Violations of the Conflicts of Interest Policy --If the Board of Directorsrrrustees 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 Directorsrrrustees 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 COI1015 (Rev. 4/11)
292
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.
1gnature of Organizatio
le/a~&J-4
Date 1
NCDHHS COI1015 (Rev. 4/11)
293
ATTACHMENT E -OVERDUE TAXES
Julie A. Ramsey
--------------------------------------ATTORNEY AT LAW------------------------------------
22 Court Street, Suite 200
P.O. Box 3130
Roxboro, NC 27573
July 1, 2024
To: Pers on County Department of Social Services
Certification :
336-599-5004 -Telephone
I, Juli e Ramsey , certify that I do not have any overdue tax debts, as defined by N.C .G.S. 105-243.1 , at the
federa l, State, or local level. l further understand that an y person who makes a fal s e statement in v io lati o n of
N.C.G.S. 143C-6-23(c) is g uilty ofa crim inaJ offense puni shable as provided by N.C.G.S.) 143C-10-1 b.
Sworn Statem ent:
I , J ul ie Ram sey, being duly sworn, say that the foregoing certification is true, accurate and complete to the best
of my knowledge and was made and s ub scribed by me. 1 also acknowledge and understand that any misuse of
State funds will be reported to the appropriate authorities for further action.
NORTH CAROLI 1A
PER.SO CO U TY
Date
Swo rn to and s ubscribed before me this A~--day ~~~ .... ~-, _____ , 202~
. ~ ~~'4-~ ,-... _. ... eo • .., ,.,
" ~ /1........ ~ ........,.. ... '-'
""-'· \O"'\~ [ ~ l ~:'< "'\ v \
Notaty Publi~ ; ~ f ~t-, <., \~_ ~
:-=. 0 ."' :>=
M y Commiss io n expires:
~ UJ \ ~ , ~v : ,.___ §
~ ~ c,\) ~~; ~ . ,.. ·~ ... ~ ..._ ··~ ~ ....a........... c,'-J ...... ~
' ~SWE\.'-,,,~
1 G.S. 105-243.1 defines : Overdue tax debt. -Any part of a tax debt t~~.~aid 90 days or more after the not ice of fina l
assessment was ma il ed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment
agreement for the ta x debt under G.S. 105-237 within 90 days after the notice of final assessment was ma iled and has not failed to
make any payments due under the installment agreement."
294
This document will be used to detennine if you have a business associate relati onship with a contractor. This form should be
completed on all contracts that have a HIP AA covered health care component. This would include all health related faformation.
Contractor: Julie Ramsey Contract Number: 20246 Date: 7/01/2024
HIPAA ASSESSMENT FORM
Questions
1. Has a relationship been initiated Se~b
allows the contractor to perform a \ol
function or activity for, or on behalf of,
County Department of Social Services
HIP AA covered health care component?
2. Is the function or service to be Select
rendered by the contractor on an activity
other than treatment of clients?
3. Does the function or service to Select
be rendered by the contractor involve the
use or disclosure of the County
Department of Social Services
individually identifiable health
information?
4. Are the services rendered by Select
staff from the contractor performed on the
premises of the covered health care
component, using the component's
resources and following the component's
policies and procedures?
5. Is the contractor performing a Select
type(s) of function/activity for or on the
behalf of the County Department of
Social Services HIP AA covered health
Notes
NOTE : The sharing of
Individually identifiable
health information with
another treatment contractor
for treatment purposes only
does not require a business
associate agreement. See 45
CFR ~164.502(e)(l)(ii)(A)
NOTE: Data that does not
contain A County
Department of Social
Services individually
identifiable health
information is not covered by
HIP AA and thus does not
have to be protected through
a business associate
agreement.
NOTES : Whenever a service
is rendered on the premises
of a covered component,
utilizing the component's
resources and following the
component's policies and
procedures, the person
rendering such services is
considered a member of the
component's workforce, and
is required to comply with
the component's privacy
policies and procedures. No
business associate agreement
is required .
Check appropriate service(s):
D Attorney Representing
Agency
D Benefits Management
Steps
YES-Go to Question 2.
NO-Stop. There is no business
associate relationship.
YES-Go to Question 3.
NO-Stop. There is no business
associate relationship.
YES--Go to Question 4.
NO-Stop. There is no business
associate relationship.
NO-Got Question 5.
YES-Stop. There is not business
associate relationship.
YES-You have identified a business
associate relationship. The specified
functi on/activity, which involves the
sharing of individually identifiable
1
295
component that is directly related to the D Patient Accounts Billing health information, is provided by the
covered health component's continued D Claims Processing contractor. This constitutes a business
operation? D Claims Administration associate relationship as such
D Bill Collections information must be protected the same
D Professional Services as required of the HIP AA covered
D Special Population health care component. There are two
Assessments types of business associate relationships:
D Data Analysis External Business Associate
'
D Data Processing relationships: You have indentified an
D Data Administration External business associate relationship
0JCAHO if you are contracting with any entity
D Council on Accreditation outside city, county or state government.
D Re-pricing A Business Associate Addendum must
D Rate Setting be signed and included with the
D Practice Management contract. If you are completing a
D Software Support Memorandum of Agreement (MOA)
D Utilization Review with a governmental entity the
D Quality Assurance Government Associate Addendum must
Contract Analysis be utilized.
D Central Office NO-STOP. There is no business
Supervision associate relationship.
D Security
□ Dietary
D Machine Maintenance
D Facility Maintenance
D Landscaping
D Housekeeping
D Hardware Support
D Audits/Surveys
D Purchasing
ADDITIONAL REQUIRMENTS
NOTE: Make sure all county
requirements are met for internally
notifying the correct parties for External
and Internal Business Associates
Rev: 7-1-2013
2
296
State Certifications
Contract or Certification s Required. by North Ca rolin a L aw
Instruction s : Tbe person who s igns this d ocument hould read the text o f the statutes and Exec u tive Order Ii ted below aod consu lt
with counsel and other knowledgeable persons before signing . The text o f each N orth Carolina General S tatutes and of the Executive
Order can be found o nline at:
• Article 2 of Ch apter 64: http ://ww-.v.ncga.state.nc.us/EnactedLegislation Statutes/PDF/ByArticlc/Chapler 64/Article 2.pdf
• G .S. 13 3 -32: http ://www.ncga.state.nc .us/gascripts/statutes/statutelookup.pl?stan1te= 133-32
• Executi ve Order No. 24 (P e rdue , Gov ., Oct. 1, 2 009): http://www .ethicscommission.nc.gov/1ibrary/pdfs/Laws /E024.pdf
• G. S . l 0 5-164. 8(b): http ://www. ncga.state. nc. us/EnactedLegislation/Statutes/P DF /ByS ection/Chaptcr I 05 /GS I 05-164 .8 .pdf
• G.S. 143 -48.5: http://www .ncga.state.nc .us/EnactcdLcg1slation/Statutes/HTML/BySecti on/Chap1er 143/GS 143-48.5.hcml
• G.S . 143-59.1 : http://www.ncga.s1ate.nc.us/Ena ctedLegis la1ion/S1arutes/PDF/BvSection/ChapLer 143 GS l43-59. I .pdf
• G .S. 143-59.2: http://www.ncga.s1ate .nc.u /Enac tedLegi slation/Starutes/PDF/BySection/Chapter 143 GS 143-59.2.pdf
• G .S . 143-133 .3 : http ://www.ncga.state.nc.us/EnactedLegislation/Stanttes/HTM U BySection/Chapter 143/GS 143 -1 33 .3 .html
• G .S. 14 3 8-l 39.6C: http://www.ncga .stale.nc.u EnactedLeg1slation/Statutes/PDF/BySection/Cbapter 143B/GS 1438-1 39.6C.pd(
Certificati o ns
(I ) Pu rs uant to G.S . 13 3 -32 and Execu tive Orde r No. 24
(Perdu e, Gov., Oct. 1, 2009), the unders igned hereby
certifies th at the Co ntractor named below is in
compliance with , and has not v io lated, the prov is ions of
e ither sai d statute or Execut1ve Order.
(2) Pursuant to G.S. 143-48.5 and G.S. 14 3-1 33.3 . the
undersigned hereby certifies th at the Contra ctor named
below, and t he Contractor's s ub contrac tors. comp lie s
with the requirements of Artic le 2 of C hapter 64 of the
C Genera l Statutes, including the requirement for eacb
employer with more than 25 employees in No rth
Caro lina to ve rify the wo r k authorization of its
employees through the fe deral E-Yerify system." E-
Veri fy System Link: www.uscis .gov
(3) Pursuant to G.S . 143-59.l(b), the undersigned hereby
certifies that the Contractor named below is not an
'•ineligible Contractor" as set forth in G.S. 143-59.1 (a)
because:
(a) e ither the Contractor nor any of its affiliates ha s
refused to coll ect the use tax l evied under Art1cle 5
of Chapter 105 of th e Genera l Statutes on its sales
de li ve red to orth Caro li na w hen the sales met one
or more of th e conditions of G.S . 105 -164.S(b); and
(b) [check o ne of the foUow ing boxes]
D Neither the Co ntractor nor any of its affiliates
has incorporated or reincorporated in a "tax
haven country" as set fo rth in G.S. 143-
59. l(c)(2) aft er December 31 , 2001; or
□ The Contractor or one of it s affiliates ha s
incorporate d or rei ncorporated in a "tax ha ven
Contractor's Nam e :
Contractor's
Authorized Ageni:
country" as set forth in G.S. 14 3 -59 .1 (c)(2) after
Decembe r 31, 200 I but the United States is not
the principal market for the pu b l ic trading of the
stock of the corporation incorporated in the tax
haven country.
(4) Pursuant to G .S. 143-59.2 (b), the unders igned hereby
c ertifies that none of the Contrac tor 's officers, d irectors ,
or own ers (if the Contractor is an unincorporated
bus iness entity) has been co nv icted of any vio lation of
Chapter 78A of the General Statu tes or the Securities Act
of J 933 or the Securities Exchange Act of 1934 within
10 years immediate ly prio r to the date of the bid
solicitati on .
(5)
(6)
Pursuant to G.S. 143B-139.6C, t he undersigned hereby
certifies that the Contractor will not u e a former
e mployee, a s defi ned by G .S. 143 B-139.6C(d)(2), of
the North Carolina Department of Health and Hu man
Serv ices in the administration of a contra ct with the
D epartment in vi olation of G .S . l 43B-139 .6C and that
a v io lation of tha t statute shall void the Agreement.
T h e und ersigned hereby certifies further that:
(a) He or s he is a duly au th o rized representative ofthe
Contrac tor named below;
(b) He or she is authorized to make, and does hereby
make, the foregoing certifi cation s on behalf of the
Contractor; and
( c) He or she understands that any person who
knowingly submits a fa lse certification in response
to th e req uire m ents of G.S . 14 3-5 9 . l and -59 .2 shall
be guil ty of a C lass l fe lon y.
Date (o / [:25 I {)_ c./ . ,
--'---='--""'=i.::..,:::__,_...L___._--"1-<~c...:....c~...=....,=+-Tit le _ _,M:tor.___._-=-~,lu~'-'-"t-,---------
s. tu C ' (L c:--... n -" · Da te 1 --d\.S -d-0 ~' 1
1gna re C..N"½--6 . \s.:>')vu:n 6o-LJ1 ~
P ri nted rune E:, en\\ I • :1) . i C O\.. l:YX'\. Title _ __,_N-=-.,.,___+'--=Q_y-=-_,__.,__._"""""-=-'--'--''-""..__ __ _
Witnes s:
The witness shoul d be present when the c;;J,tractor 's A uthorized Agent s igns th is certification an
document imme diately th ere a fter.
C ,,nt.ra c1nr C e r1 i fica1 ions Rem,irerl hv 10 11h <:aro lina l.nw fR e.v R/201 /i ) Pa1:1e I of I
297
ATTACHME T
Contract #20246
Julie Ram sey
Pe rson County Department of Socia] Services/Hwnan Services
CERTIFICA TrON REGARDING NONDISCRJMINA TTO N , CLEAN AIR ACT,
C LE A WATERACT
Certification Regarding Nondiscrimination
The Contractor certifies that it wi ll 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 discrimi nation 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
discrimi nation on the bas is 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 prohibi ts discrimin ation
on the basis of age; (e ) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as
amended , relating to nond iscrim ination on the bas is 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
nondiscrimin ation in the sale, renta l or financing of housing; (h) the Food Stamp Act and USDA
policy, which proh ibit discrimination on the basis of rel igi on 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 Regu lations ( 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 Execu tive Order also requires Government
contractors to take affirmative act ion to ensure that equal opportunity i s provi ded in all aspects of
the ir empl oym ent.
Mean ingfu l Access for LEP Ind ivi duals: 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 inclu des the requirement to provide bil ingual program information and certification
materials and interpretation services to single language mi norities in certain project areas . SNAP
Contractors that do not provide mean ingful access for LEP individuals ri sk vi olating 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 ). T hey also risk noncompliance with the USDA pol icy guidance titled , "Guidance to
Federal Fi nancial Assistance Recipients Regarding Tit le VI Proh ibition Against National Orig in
Discrimi nation Affecting Lim ited Eng li sh Proficie nt Persons", pub lished in 79 FR 70771 -70784
(November 28 , 2014).
The Contractor should develop an implementing plan to address the lang uage assistance needs
of the LEP population served . This may include con tracting for oral interpretation services, hiring
bilingual staff, arranging telephone interprete rs and/or language li nes, coord i nating commun ity
volunteers , translating vital documents, and providing written notice that language services are
available in appropriate languages. Quality and accu racy of the language serv ice is critical in
order to avoid serious consequences to the LEP person and to the re ci pie nt. LEP needs should
be conside red in developing budgets and front line staff should understand how to obtain
language assistance services. For additional assistance and i nformation regarding LEP matters,
please also visit http://www .lep.gov.
(Federal Certification-Non-Discrimination. C lean Air, Clean Water) (0 l /20 I &)Page 1 of 3
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Ensuring Equal Opportunity Access for Persons w ith Disabil ities : The Contractor must a lso
ensure equal opportunity access for persons w ith disabilit ies. Th is includes ensuring that
commun ications with appl icants , participants, members of the public, and compan ions w ith
disabilities are as effective as communications w ith people without d isab ilities. Contractors that
do not provide persons with disabilities equal opportunity access to programs may risk vio lating
prohibitions against disability discri mination in the Rehabilitation Act of 1978, the American w ith
Disabilities Act (ADA) of 1990, as amended , and SNAP program regulations .
DOJ publ ished rev ised fin a l reg ulati ons implementi ng Title II and Title Ill of the ADA on
September 15 , 2010. These regu lations 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
"Nond iscrimination on the Basis of Disability in Public Accommodations and Commercia l
Facil ities". In accordance with the implementing regulations , Contractors must provide auxiliary
aids and services wh ere necessary to ensure effective communication and equal opportunity
access to program benefits for individuals with disabilities . The type of auxiliary a ids and services
required w ill 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 o nly in
limited circumstances . When a Contractor communicates with applicants and beneficiaries by
telephone . it must provide text te lephone services (ITY) or have access to an equally effective
electronic telecommunications system to communicate w ith individuals who are deaf, hard of
hearing , or hearing impaired. Contractors must also ensure that interested persons, including
persons with im paired vision or hearing, can obtain information as to the existence and location of
accessible services , activities. and facilities. For more i nformation , 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 faci li ty is owned, leased , or supervised by such person. The
prohibition in the preceding sentence shall continue unti l the Administrator certifies that
the condition giving rise to such a conviction has been corrected . For convictions aris ing
under section 113(c )(2), the condition g iving rise to the conviction a lso shall be
considered to include any substantive violation of this Act associated with the v iolation of
113(c)(2). The Administrator may extend th is prohibition to other facilities owned or
operated by the convicted person .
b. The Administrator shall establish procedures to provide all Federal agencies w ith the
notification necessa ry 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 C lean 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 cont ract to effectuate
the pu rpose and policy of this Act in such contracti ng or assistance activities , and (2)
setting forth procedures, sanctions , penalties, and such other provisions , as t he President
determines necessary to ca rry 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 annuall y report to the Congress on measures taken toward
i mplementing the purpose and intent of this section , including but not limi ted to the
progress and problems associated with implementation of th is section . (42 U.S.C. 7606]
(Federal Certification-Non-Discriminati o n , Clean Air, C lean Water) (01 /2018)Page 2 of 3
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V . The Clean Water Act; 33 U.S.C. §1251 et seq. (1972)
Contract #20246
Ju lie Ramsey
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 wh ich the violation wh ich
gave rise to such conv iction occurred , and if such facility is owned , leased , or supervised
by such person . T he prohi bition in preceding sentence shall continue unti l the
Administrator certifies that the condition giving rise to such conviction has been
corrected .
b. The Administ rator shall establish procedures to provide all Federal agencies w ith t he
notification necessary for the purposes of subsection (a) of th is 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 Federa l assistance by way of grant, loan, or
contract to effectuate the purpose a nd 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 require ment.
d . The President may exempt any contract, loan , or grant from all or part of the provis ions of
this section where he determines such exemption is necessary in the param o unt i nterest
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 th is section , including , but not lim ited to , the progress and
problems associated with such compl iance.
f . No certification by a contractor, and no contract clause, may be required in the ca se of a
con tract for the acquisition of commercial items in order to implement a prohibition or
requ i rement of this section or a prohibition or requirement issued in the implementation of
th is section .
g. In paragraph (1 ), the term "commercial item" has the meaning given such term in section
4 12) of the Office of Fed eral Procurement Policy Act (41 U.S.C . 403(12)).
Agency/Organization /\-t+D r--~
A-t-Wtlv)
T itle~
Da te
(Certificatio n sig nature sh ould be same as Co ntract signature .)
(Federal Certification -N on-Disc1imination, C lean Air, C lean Water) (0 l /2018 )Page 3 of 3
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CONTRACT PROVIDER NAME: _ Julie Ramsey
CONTRACT NUMBER: 20246
CONTRACT PERIOD: __ July 1, 2024-June 30, 2025
PROVIDER'S FISCAL YEAR: __ July 1, 2024-June 30,2025
CONTRACT DETERMINATION QUESTIONNAIRE
(PURCHASE OF SERVICE VS. FINANCIAL ASSISTANCE)
Instructions: Enter 5 points for each factor in either the yes or no column . Once the entire list has been completed
tally the points in each column . The column with the most points should be a good indicator of the designation of
the organization-either Financial Assistance (Grant) or Vendor (Purchase of Service).
Determination Factors
Does the provider determine eligibility?
Does the provider provide administrative functions such as Develop program standards
procedures and rules?
Does the provider provide admin istrative functions such as Program Planning?
Does the provider provide administrative functions such as Monitoring?
Does the provider provide administrative functions such as Program Evaluation?
Does the provider provide administrative functions such as Program Compliance?
Is provider performance measured against whether specific objectives are met?
Does the provided have responsibility for programmatic decision making?
Is the provider objective to carry out a public purpose to support an overall program objective?
Does the provider have to submit a cost report to satisfy a cost reimbursement arrangement?
Does the provider have any obligation to the funding authority other than the delivery of the
specified goods/services?
Does the provider operate in a noncompetitive environment?
Does the provider provide these or similar goods and/or services only to the funding agency?
Does the provide these or similar goods and/or services outside normal business operations?
!TOTAL
Note: The authorized individual(s) must place an X in one of the boxes below to indicate
the type of contractual arrangement for this contract , then sign and date where indicated.
5 points
Financial
Assistance
YES
5
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,_ __ _.I FINANCIAL ASSISTANCE X !PURCHASE SERVICE
Revised effective 7-1-2013
page 1
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I DA
5 points
Purchase
of Service
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Person County Department of Social Services
Contract # 20246
Julie Ramsey
GOVERNMENT BUSINESS ASSOCIATE ADDENDUM TO MEMORANDUM OF
UNDERSTANDING
This Agreement is made effective the 1st day of July 2024, by and between Person County
Department of Social Services (name County Department of Social Services) ("Covered
Entity") and Julie Ramsey (name of contractor) ("Business Associate" ''Governmental
Agency") (collectively the "Parties").
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a Memorandum of
Understanding ("entitled" or "dated" identify contract) contract# 20246 (the
"MOU'), whereby Business Associate agrees to perform certain services for or on
behalf of Covered Entity.
b. Covered Entity is an organizational unit of Person County as the Person County
Department of Social Services as a health care component for purposes of the
HIP AA Privacy Rule.
c. The relationship between Covered Entity and Business Associate is such that the
Parties believe Business Associate is or may be a "business associate" within the
meaning of the HIP AA Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the MOU with the
intention of complying with the HIP AA Privacy Rule provision that a covered entity
may disclose protected health information to a business associate, and may allow a
business associate to create or receive protected heath information on its behalf, if
the covered entity obtains satisfactory assurances that the business associate will
app:ropriately safeguard the information.
2. DEFINITIONS.
Unless some other meaning is clearly indicated by the context, the following terms shall
have the following meaning in this Agreement:
a. "HIPAA'.' means the Administrative Simplification Provisions, Sections 261 through
264, of the federal Health Insurance Portability and Accountability Act of 1996,
Public Law 104-191.
b. "Individual" shall have the same meaning as the term "individual" in 45 CFR
160.103 and shall include a person who qualifies as a personal representative in
accordance with 45 CFR 164.502(g).
c. "Privacy Rule" shall mean the Standards for Privacy of Individually Identifiable
Health Information at 45 CFR part 160 and part 164, subparts A and E.
d. "Protected Health Information" shall have the same meaning as the term "protected
health information" in 45 CFR 160.103, limited to the information created or
received by Business Associate from or on behalf of Covered Entity.
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Julie Ramsey
e. "Required By Law" shall have the same meaning as the term "required by law" in 45
CFR 164.103.
f. "Secretary" shall mean the Secretary of the United States Department of Health and
Human Services or his designee.
g. Unless otherwise defined in this Agreement, terms used herein shall have the same
meaning as those terms have in the Privacy Rule.
3. OBLIGATIONS OF BUSINESS ASSOCIATE
a. Business Associate agrees to not use or disclose Protected Health Information other
than as permitted or required by this Agreement or as Required By Law.
b. Business Associate agrees to use appropriate safeguards to prevent use or disclosure
of the Protected Health Information other than as provided for by this Agreement.
c. Business Associate agrees to mitigate, to the extent practicable, any harmful effect
that is known to Business Associate of a use or disclosure of Protected Health
Information by Business Associate in violation of the requirements of this
Agreement.
d. Business Associate agrees to report to Covered Entity any use or disclosure of the
Protected Health Information not provided for by this Agreement of which it
becomes aware.
e. Business Associate agrees to ensure that any agent, including a subcontractor, to
whom it provides Protected Health Information received from, or created or received
by Business Associate on behalf of Covered Entity agrees to the same restrictions
and conditions that apply through this Agreement to Business Associate with
respect to such information.
f. Business Associate agrees to provide access, at the request of Covered Entity, to
Protected Health Information in a Designated Record Set to Covered Entity or, as
directed by Covered Entity, to an Individual in order to meet the requirements
under 45 CFR 164.524.
g. 'Business Associate agrees, at the request of the Covered Entity, to make any
amendment(s) to Protected Health Information in a Designated Record Set that the
Covered Entity directs or agrees to pursuant to 45 CFR 164.526.
h. Unless otherwise prohibited by law, Business Associate agrees to make internal
practices, books, and records, including policies and procedures and Protected
Health Information, relating to the use and disclosure of Protected Health
Information received from, or created or received by Business Associate on behalf of,
Covered Entity available to the Covered Entity, or to the Secretary, in a time and
manner designated by the Secretary, for purposes of the Secretary determining
Covered Entity's compliance with the Privacy Rule.
1. Business Associate agrees to document such disclosures of Protected Health
Information and information related to such disclosures as would be required for
Covered Entity to respond to a request by an Individual for an accounting of
disclosures of Protected Health Information in accordance with 45 CFR 164.528, and
to provide this information to Covered Entity or an Individual to permit such a
response.
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4. PERMITTED USES AND DISCLOSURES
Contract # 20246
Julie Ramsey
a . Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use or disclose Protected
Health Information to perform functions, activities, or services for, or on behalf of,
Covered Entity as specified in the MOU, provided that such use or disclosure:
1) would not violate the Privacy Rule if done by Covered Entity; or
2) would not violate the minimum necessary policies and procedures of the
Covered Entity.
b. Except as oth~rwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information as necessary for the proper management and administration of the
Business Associate or to carry out the legal responsibilities of the Business
Associate.
c. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may disclose Protected Health
Information for the proper management and administration of the Business
Associate, provided that:
1) disclosures are Required By Law; or
2) Business Associate obtains reasonable assurances from the person to whom the
information ' is disclosed that it will remain confidential and will be used or
further disclosed only as Required By Law or for the purpose for which it was
disclosed to the person, and the person notifies the Business Associate of any
instances of which it _is aware in which the confidentiality of the information
has been breached.
d. Except as otherwise limited in this Agreement or by other applicable law or
agreements, if the MOU permits, Business Associate may use Protected Health
Information to provide data aggregation services to Covered Entity as permitted by
45 CFR 164.504(e)(2)(i)(B).
e . Notwithstanding the foregoing provisions, Business Associate may not use or
disclose Protected Health Information if the use or disclosure would violate any term
of the MOU or by other applicable law or agreements.
5. TERM AND TERMINATION .
a. Term. This Agreement shall be effective as of the effective date stated above and
shall terminate when the MOU terminates.
b. Termination for Cause. Upon Covered Entity's knowledge of a material breach by
Business Associate, Covered Entity may, at its option:
1) Provide an opportunity for Business Associate to cure the breach or end the
violation, and terminate this Agreement and services provided by Business
Associate, to the extent permissible by law, if Business Associate does not cure
the breach or end the violation within the time specified by Covered Entity;
2) Immediately terminate this Agreement and services provided by Business
Associate, to the extent permissible by law; or
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Julie Ramsey
3) If neither termination nor cure is feasible, report the violation to the Secretary
as provided in the Privacy Rule.
c. Effect of Termination.
1) Except as provided in paragraph (2) of this section or in the MOU or by other
applicable law or agreements, upon termination of this Agreement and services
provided by Business Associate, for any reason, Business Associate shall return
or destroy all Protected Health Information received from Covered Entity, or
created or received by Business Associate on behalf of Covered Entity. This
provision shall apply to Protected Health Information that is in the possession
of subcontractors or agents of Business Associate. Business Associate shall
retain no copies of the Protected Health Information.
2) In the event that Business Associate determines that returning or destroying
the Protected Health Information is not feasible, Business Associate shall
provide to Covered Entity notification of the conditions that make return or
destruction not feasible. Business Associate shall extend the protections of this
Agreement to such Protected Health Information and limit further uses and
disclosures of such Protected Health Information to those purposes that make
the return or destruction infeasible, for so long as Business Associate maintains
such Protected Health Information.
6. GENERAL TERMS AND CONDITIONS
a. This Agreement amends and is part of the MOU.
b. Except as provided .in this Agreement, all terms and conditions of the MOU shall
remain in force and shall apply to this Agreement as if set forth fully herein.
c. In the event of a conflict in terms between this Agreement and the MOU, the
interpretation that is in accordance with the Privacy Rule shall prevail. In the event
that a conflict then remains, the MOU terms shall prevail so long as they are in
accordance with the Privacy Rule.
d. A breach of this Agreement by Business Associate shall be considered sufficient
basis for Covered Entity to terminate the MOU for cause.
Rev: 6-7-2015
4
AGENDA ABSTRACT
Meeting Date: August 5, 2024
Agenda Title: North Carolina Association of County Commissioners (NCACC) 2024-2025
Legislative Goal Proposals
Summary of Information: Every two years, counties are invited to submit proposals to the
NCACC for legislative goals that the association should seek in the best interest of counties. The
NCACC goal-setting process takes place each even-numbered year and consists of five stages,
beginning with the solicitation of proposals from counties and ending with the adoption of the
legislative agenda at the Legislative Goals Conference. Proposed 2024-2025 legislative goals must
be received by the Association on or before Aug. 23, 2024. The proposals are then sent through
steering committees, a legislative goals committee, and on to the NCACC Board of Directors before
being adopted in November at the Legislative Goals Conference.
For reference, the NCACC Legislative Agenda for the 2023-2024 Biennium is attached. Goals that
are still relevant must be re-adopted. Goal proposals should be in the form of a policy statement and
include background information on the impetus of the proposal.
Recommended Action: Discuss any legislative goals the board would like to consider and provide
direction to staff.
Submitted By: Katherine M. Cathey, County Manager
305
NCACC Legislative Agenda
2023-2024 Biennium
Top Priority Goals
Legislative Priorities
• Seek legislation, funding, and other efforts to expand digital infrastructure/broadband capability to the
unserved and under-served areas and residents of the state.
• Seek additional revenue sources to address statewide public school and community college capital needs
and ensure methods used to distribute school capital funding considers the needs of both low-wealth and
growing counties. Revisions to the Needs-Based Public School Capital Fund that will allow for more access to
counties and allow for faster school construction to include allowing projects that have not previously been
awarded a grant to commence and remain eligible for future grant application periods.
• Support expansion of Medicaid as well as related funding and operational flexibility for counties to expand
county workforce and necessary infrastructure.
• Seek legislation to provide additional resources for preventative storm damage maintenance, such as stream
clearing, and increase recurring funding to the state’s Coastal Storm Damage Mitigation Fund.
• Seek legislation for clean water funds throughout the state and to hold chemical manufacturers producing emerging
contaminants such as PFOA, PFOS, and other PFAS chemicals, and coal ash producers financially responsible for
cleanup and mitigation of pollutants.
• Seek legislation to grow North Carolina’s statewide economy through state investments, including technical
assistance, public infrastructure funding, increased competitive incentives, state economic development grant
programs and coordinated efforts with county economic development services.
• Seek legislation to increase the amount paid to county jails by the state to the full cost reimbursement for housing
sentenced inmates.
• Seek legislation that preserves existing local revenue by providing just compensation to counties for property
acquired by the state and removed from the ad valorem tax base.
• Seek legislation which will repeal NCGS 105-275(45) which mandates that counties must exclude eighty percent
(80%) of the appraised value of a solar energy electric system from property taxation. If repeal of NCGS 105-
275(45) is not feasible, then seek legislation which will require that the State of North Carolina provide funding
to any county which is forced to lose tax revenue due to NCGS 105-275(45) in an amount equal to the lost tax
revenue to said county.
• Seek legislation allowing counties to include specific language on the sales tax referendum ballot designating how
the proposed proceeds will be spent and to spend the proceeds of any newly enacted article 43 transit tax for all
types of transportation expenditures.
• Seek legislation to give counties flexibility with use of occupancy taxes.
• Seek additional funding and preserve block grant allocations to increase access to high quality childcare, early
childhood education, child welfare services, adult protective services and guardianship, including:
• Women’s and Children’s Health Services Block Grant funding to local health departments for critical services like
maternal health, child health and women’s health services to address unfavorable infant mortality rates;
• Home & Community Care Block Grant; Senior Center General Purpose Funds; Social Services and Human Services
Block Grants; TANF; and emergency childcare funding to ensure the safety and stability of our childcare system.
• Seek legislation that restores State Funding of Accreditation of Local Health Departments.
Environment
General Government
Justice and Public Safety
Tax and Finance
Health and Human Services
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• Support efforts to change grants and loan award criteria to more closely match the USDA Rural Development aid
requirements.
• Support legislation to protect farming operations from frivolous nuisance lawsuits.
• Support regulations and economic policies that promote small family farms.
• Support funding for a comprehensive approach to mitigate harmful and invasive species.
• Support additional funding to assist local governments in managing recycling and solid waste including: scrap tires,
manufactured homes, and electronics.
• Support legislation amending NCGS §90A-53 to shorten the work experience in the field of environmental health
practice necessary to receive a certificate as a Registered Environmental Health Specialists from two years to one
year.
• Support legislation that promotes recruitment and retention of both first responders and detention officers in jails,
including but not limited to workforce development, pay scale adjustments and/ or studies, and appropriate levels of
training and certification standards for these increasingly hard to staff positions.
• Support legislation to streamline and expedite the state response to emergency recovery.
• Support legislation treating all misdemeanor charges uniformly by removing statutorily imposed compliance defenses
to local ordinance violations.
• Support efforts to provide greater flexibility to local governments in expenditures of 911 surcharge funds and ensure
adequate funding for next-gen technology.
• Support expansion of Medicaid as well as related funding and operational flexibility for counties to expand county
workforce and necessary infrastructure.
• Support Medicaid reimbursement for Community Paramedic services and transport services to mental health and
substance abuse facilities.
• Support legislation to increase the number of state funded county Veteran Services Officers to at least one per county.
• Support legislation for hold harmless provisions and staggered payment plans to control/cap the liability to counties
under the Medicaid and NCHC overpayment recoupment plan, which holds counties financially responsible for the
erroneous issuance of Medicaid benefits and Medicaid claim payments resulting when the county DSS takes any
action that requires payment of Medicaid claims for an ineligible individual.
• Support legislation to expand the Good Samaritan protection of covered offenses in NCGS §90-96.2(c3) to include all
opioid and drug offenses to encourage reporting of drug overdoses and reduce overdose deaths and work to create
required treatment options for overdose victims covered by limited immunity.
• Support legislation that promotes opioid and other substance use prevention, intervention, harm reduction, treatment
and recovery initiatives.
• Support increased state funding and additional funding streams for existing and new transportation construction and
maintenance needs (including roads, rails, and multi-modal transportation, secondary roads and litter pickup), and
support legislation to ensure that the Strategic Transportation Investments (STI) funding formula recognizes that one
size does not fit all and that projects in both rural and urban areas are prioritized and funded.
• Support legislation allowing public bodies to provide emergency meeting notices by electronic means in addition to
notice through newspaper with general circulation within the county.
• Support legislation allowing counties flexibility in holding remote board meetings, allowing contemporaneous, virtual
public hearings, in order to expeditiously conduct county business during locally declared emergencies.
Agriculture
Environment
Justice and Public Safety
Health and Human Services
General Government
Additional County Advocacy Goals
NCACC Legislative Agenda
2023-2024 Biennium
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307
• Support legislation to provide exceptions to the K-3 class size mandate including but not limited to lack of school
facility space and availability of qualified teachers.
• Support legislation that promotes education attainment and career and college readiness by increasing funding
for apprenticeship and internship programs, trade certification, and workforce development programs, as well as
increased student support services in public schools with a focus on dropout prevention and an increase in the
dropout age.
• Support increased funding to aid counties in implementing school security measures.
• Support school calendar policy that promotes optimal student outcomes and best meets the needs of local
communities.
• Support funding to provide all public school students with an excellent education, including investments to assist
communities in eliminating achievement disparities including:
• Expanding teaching assistant allotments to fund assistants in all K-3 classrooms.
• Provide full state funding for state mandated exceptional student services.
Justice and Public Safety (Continued)
Public Education
Additional County Advocacy Goals (Continued)
Federal Goals
NCACC Legislative Agenda
2023-2024 Biennium
• Support legislation to restore state funding to cover the cost of facilities and utilities for state justice employees who
manage and operate state probation and parole juvenile services, and provide funding for public defender offices in
county-owned or leased facilities.
• Support additional flexibility and an extension in the deadline for spending American Rescue Plan (ARP) State and
Local Fiscal Recovery Funds (SLFRF).
• Support efforts to promote food system resiliency, such as ways to strengthen North Carolina’s Food System and
increase access to affordable, healthy food options.
• Support increased funding for disaster preparation, assistance and mitigation; legislation or policy changes that
expedite and expand county use of federal disaster assistance funds; legislation or policy changes to streamline and
expedite the FEMA individual assistance process; and legislation to review and update flood maps more frequently in
counties experiencing high rates of population growth and counties prone to flooding.
• Support funding for behavioral health programs and services to address the opioid and substance abuse epidemic and
support flexibility for counties to use funds for prevention and recovery.
• Support funding and legislation to expand high-speed broadband access.
• Support measures to reduce the number of people with mental illness in county jails and legislation that would allow
individuals in custody to continue receiving Medicaid and other federal health benefits until they are convicted,
sentenced, and incarcerated.
• Support funds for health, human and economic services programs including Temporary Assistance for Needy Families,
Food and Nutrition Services and federal block grants.
• Support increased funding and flexibility in services for older Americans and veterans.
• Support additional funding for Payment In Lieu of Taxes (PILT), agricultural, conservation, workforce, economic
development, and Infrastructure programs that help counties meet public needs.
• Support strong regulations and enforcement along with funding assistance or reimbursement to state and local
governments when a federal agency, such as the EPA, regulates emerging contaminants and other discharges into
drinking water sources.
• Oppose unfunded mandates and changes in eligibility for federal programs that shift costs to counties.
• Reauthorize the Workforce Innovation and Opportunity Act (WIOA) and increase funding for Title I programs.
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