Agenda Packet June 19 2017PERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
MEETING AGENDA
304 South Morgan Street, Room 215
Roxboro, NC 27573-5245
336-597-1720
Fax 336-599-1609
June 19, 2017
9:00am
CALL TO ORDER………………………………………………. Chairman Kendrick
INVOCATION
PLEDGE OF ALLEGIANCE
DISCUSSION/ADJUSTMENT/APPROVAL OF AGENDA
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 #1
DISCUSSION/ADJUSTMENT/APPROVAL OF CONSENT AGENDA
A. Approval of Minutes of June 5, 2017,
B. Approval of Minutes of June 7, 2017,
C. Budget Amendment #22,
D. NC Education Lottery Application for Northern Middle School for
renovations for $500,000,
E. Person Area Transportation System Safety Plan, and
F. FY 2017-2018 DSS Attorney Contracts for legal services
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NEW BUSINESS:
ITEM #2
Fiscal Year 2017-2018 Annual Budget Ordinance ………………………. Heidi York
& Amy Wehrenberg
ITEM #3
Appointments to Boards and Committees ……………………………. Brenda Reaves
ITEM #4
Designate NACo Voting Delegate for the 2017 Annual Conf. …. Chairman Kendrick
CHAIRMAN’S REPORT
MANAGER’S REPORT
COMMISSIONER REPORTS/COMMENTS
CLOSED SESSION #1
A motion to enter into Closed Session per General Statute 143-318.11(a)(5) to
establish, or to instruct the public body's staff or negotiating agents concerning the
position to be taken by or on behalf of the public body in negotiating (i) the price and
other material terms of a contract or proposed contract for the acquisition of real
property by purchase, option, exchange, or lease and to allow the following
individuals to attend: County Manager, Heidi York, Clerk to the Board, Brenda
Reaves, County Attorney, Ron Aycock, Assistant County Manager, Sybil Tate,
Interim IT Director, Chris Puryear and 911 Communications Manager, Brett Wrenn.
Note: All Items on the Agenda are for Discussion and Action as deemed appropriate
by the Board.
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June 5, 2017
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PERSON COUNTY BOARD OF COMMISSIONERS JUNE 5, 2017
MEMBERS PRESENT OTHERS PRESENT
Tracey L. Kendrick Heidi York, County Manager
Gordon Powell C. Ronald Aycock, County Attorney
Jimmy B. Clayton Brenda B. Reaves, Clerk to the Board
Kyle W. Puryear
B. Ray Jeffers
The Board of Commissioners for the County of Person, North Carolina, met in
regular session on Monday, June 5, 2017 at 7:00pm in the Person County Office Building
Auditorium.
Chairman Kendrick called the meeting to order. Vice Chairman Powell gave an
invocation and Commissioner Puryear led the group in the Pledge of Allegiance.
DISCUSSION/ADJUSTMENT/APPROVAL OF AGENDA:
Chairman Kendrick asked the Board to remove an item from the agenda related to
the Sale of Surplus Property noting it would be taken up at a future Board meeting.
A motion was made by Commissioner Puryear and carried 5-0 to remove an item
from the agenda for the Sale of Surplus Property.
A motion was made by Chairman Kendrick and carried 5-0 to approve the agenda
as adjusted.
RECOGNITION:
RESOLUTION OF APPRECIATION:
Chairman Kendrick read and presented a Resolution of Appreciation to Person
County Retiree, Douglas Dickerson.
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PUBLIC HEARING:
FISCAL YEAR 2017-2018 RECOMMENDED BUDGET:
A motion was made by Commissioner Puryear and carried 5-0 to open the duly
advertised public hearing for public comments related to the County Manager’s
Recommended Budget for Fiscal Year 2017-2018.
Chairman Kendrick asked the audience to be respectful to the public comments and
for speakers to hold their comments to two minutes each.
There were no individuals appearing before the Board to speak in favor of the
Manager’s Recommended Budget for Fiscal Year 2017-2018.
Speaking in opposition to the Manager’s Recommended Budget for Fiscal Year
2017-2018 were the following:
Ms. Celestine Bradsher of 870 Old Allensville Road, Roxboro addressed the
importance of the senior center, recounting her success with the exercise programs, but
also for others to have the ability to get a meal and to communicate socially with others.
Ms. Susan Naylor of 481 Valhalla Drive, Timberlake told the group that she had
presented to the Clerk to the Board a petition to restore operations funding and Home &
Community Care Block Grant match funding for the Person County Senior Center, a 501c
non-profit that was signed by 200 seniors concerned with losing the needed funding. She
said the Senior Center had tripled its participants with the new facility and urged the Board
to continue its funding so the doors would not close.
Mr. Don Shotwell of 81 Cavel Chub Lake Road, Roxboro stated with the County’s
aging population, it did not make sense to spend money on a new facility and then not to
fund the services. He asked the Board to check out what other counties were doing for their
senior centers, most of which are county departments.
Mr. Curtis Bradsher of PO Box 1183 Roxboro advocated for the $100,000 to be
placed in the budget citing that more than 50% of the property taxes paid in Person County
are paid by senior citizens.
Ms. Tammie Kirkland of 2312 Cunningham Road, Semora asked the Board to fund
the request of the Senior Center noting she would be fine with an increase to the tax rate to
secure such funding.
Mr. Nelson Johnson of 225 Charles Circle, Roxboro and a recent user of the Senior
Center stated his disbelief to buy a new building and not budget any funds to continue the
programming. He urged the Board to reconsider funding the request.
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Mr. Robert Allen of 549 Old City Lake Road, Roxboro requested the Board to fund
the $100,000 for operations of the Senior Center, some of which would be used to match
grant funds for the senior programming.
Mr. Bruce Whitfield of 5968 Gordonton Road, Hurdle Mills and Chairman of the
Agricultural Advisory Board advocated for a County funded positon, an Agricultural
Development Officer to work with the Economic Development Commission and
participating in its ex-officio seat.
Mr. Lawrence Upperman of 114 Clayton Street, Roxboro asked for the Board to
support funding the operational expenses and to continue to support the seniors of Person
County.
Ms. Marji Stehle of 59 Possum Trot Lane, Semora stated her frustration at the lack
of communication with the budgeting issues for the Senior Center. She noted the senior
population continued to increase in the County and further noted her support for the Board
to increase taxes to assist with the requested funding.
Ms. Betty Blalock of 144 Tirzah Ridge, Rougemont suggested that entities as well
as individuals pay a use fee at the senior center and added she did not mind if her taxes
were raised by or one or two cents to pay for things like the center.
Commissioner Jeffers noted the majority of the public comments spoke on behalf
of the Senior Center funding indicating this topic to be addressed at the budget work
session.
Commissioner Puryear corrected a rumor that the Board had voted to defund the
Senior Center, noting the budget as it stands, at this time was the County Manager’s
Recommended Budget and the Board had not held any work sessions to make adjustments
to the Recommended Budget. He said the public hearing set to hear citizen comments was
the first step in the Board’s work. Commissioner Puryear confirmed the Board had not
taken any action related to the Senior Center funding.
Commissioner Jeffers stated that when the Board had done away with non-profit
funding, the only non-profits that continued to be funded were related to economic
development which included the Senior Center, Volunteer Fire Departments, Roxboro
Development Group and the Chamber of Commerce.
Commissioner Puryear asked the County Manager about additional funding
requests. County Manager, Heidi York noted she had three additional requests for funding:
1) the Chamber of Commerce submitted a formal request for the Personality festival, 2)
the City of Roxboro submitted a formal request for an appropriation toward the July 4th
Fireworks display, and 3) the Director’s Roundtable submitted a funding request for the
County’s 225th Anniversary events.
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Commissioner Puryear thanked the Chamber of Commerce’s decision to withdraw
the membership fee for Person County in light that the County owns the facility and does
the up-keep on the facility.
A motion was made by Commissioner Puryear and carried 5-0 to close the public
hearing for the Manager’s Recommended Budget for Fiscal Year 2017-2018.
INFORMAL COMMENTS:
The following individual appeared before the Board to make informal comments:
Mr. Kenneth Perry, of 1363 Semora Road, Roxboro, and Chairman of the
Economic Development Commission provided a copy of the Economic Development
Commission’s adopted Resolution of Support for the Person County Agricultural Advisory
Board and the Farmland Preservation Plan of 2016 that requested the Board of
Commissioners to continue support of the Person County Agricultural Advisory Board
recommendation for a dedicated position with the County for further advancement of
agricultural development.
DISCUSSION/ADJUSTMENT/APPROVAL OF CONSENT AGENDA:
A motion was made by Commissioner Puryear and carried 5-0 to approve the
Consent Agenda with the following items:
A. Approval of Minutes of May 15, 2017,
B. Budget Amendment #21,
C. Audit Contract for Fiscal Year 2017,
D. NC Education Lottery Application for $100,000 for Northern Middle School
Contracted Interior School Painting,
E. Contract for School Nursing Services between Person County and Person County
School System, and
F. Memorandum of Agreement between Person County United Way and Person
County for $8,000 grant for GREAT summer camp
NEW BUSINESS:
PRESENTATION OF FIRE AND RESCUE AUDIT RESULTS:
Finance Director, Amy Wehrenberg stated as a part of the contractual requirements,
the Fire and Rescue agencies participate in a full financial audit process every other year
for review in accordance with generally accepted accounting principles and auditing
standards. For Fiscal Year 2016 audit reports, Ms. Wehrenberg noted that the County bid
out and awarded Winston, Williams, Creech Evans & Co, LLP as the primary contract
audit firm to complete the audit work for the Fire and Rescue agencies. Ms. Wehrenberg
introduced Mr. James P. Winston II, CPA of Winston, Williams, Creech, Evans &
Company, LLP to share with the Board a summary of audit results as they near completion
of the audit reports.
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Mr. Winston presented the following Fire and Rescue agencies summary noting
there were four volunteer fire departments that were in the process of being finished.
Mr. Winston confirmed a management letter with auditor recommendations for all
fire and rescue agencies will be sent to Ms. Wehrenberg.
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HOME & COMMUNITY CARE BLOCK GRANT FUNDING 2017-2018:
Person County Senior Center Aging Services Director, Maynell Harper requested
Board approval of the Home & Community Care Block Grant (HCCBG) funding allocation
as recommended by the HCCBG Committee for Fiscal Year 2017-2018.
Ms. Harper stated the Person County HCCBG Committee elected funding to
proceed as follows for county funding:
Person County Senior Center with a total of $292,914 allocated between
Congregate and Home Delivered Nutrition, Transportation, In-Home Aide II and III, Home
Care CDS and Operations; and
Person County Department of Social Services (DSS) receiving a total of $32,413
allocated for In-Home Aide services Level II, III.
Ms. Harper noted the total HCCBG funding for Person County for Fiscal Year
2017-2018 was $325,327.
County Manager, Heidi York clarified that the $3,601 in required local matching
funds for the DSS program was already in the Recommended Budget. The required local
match of $32,545 for the Senior Center’s programs was not currently budgeted. Ms. York
noted that approval by the Board would require $32,545 to be in next year’s budget and
would address the petition presented to the County for those funds to be restored.
A motion was made by Commissioner Puryear and carried 5-0 to approve the
Home & Community Care Block Grant County Funding Plan and to appropriate $32,545
in the required local match for the Senior Center.
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ONE-YEAR EXTENSION OF SOLID WASTE CONTRACT WITH REPUBLIC:
County Attorney, Ron Aycock presented the First Amendment to an Amended and
Restated Agreement for Continued Development, Use, and Operation of Upper Piedmont
Regional Landfill to the existing contract with Republic thereby extending that contract for
one-year.
Mr. Aycock stated the Board authorized and enacted a two-year Franchise for the
County’s Solid Waste. He added that Board action included authorization of moving
forward with an one-year contract extension. Mr. Aycock said the existing contract for
Solid Waste authorizes additional years at the same rate. Mr. Aycock noted the language
contained in the proposed one-year contract extension was agreed upon between himself
and the attorney for Republic, and also preserved the right of the parties to extend the
contract for an additional one-year under the existing Franchise Agreement, if so desired.
Pursuant to previous direction of the Board, Mr. Aycock requested the Board to
authorize the Chair to execute the Contract.
A motion was made by Commissioner Puryear and carried 5-0 to approve the one-
year extension of the Solid Waste Contract with Republic as presented.
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RECONVEYANCE OF SCHOOL PROPERTY TO SCHOOL BOARD:
County Attorney, Ron Aycock stated that in June of 1999 and March of 2007, the
Person County Board of Education conveyed to the County title to several school properties
for the sole purpose of allowing the County to use those properties to secure the debt of a
financing to construct, repair, renovate and improve those properties and other county
properties. In connection with those financings the County and the School board entered
into agreements which inter alia required the County to reconvey those properties to the
school board once the debt secured by those properties was paid and satisfied. Mr. Aycock
confirmed those debts have been paid in full.
Mr. Aycock presented to the Board the deed reconveying the following properties
to the School Board:
North Elementary School
Stories Creek Elementary School
South Elementary School
Helena Elementary School
The School Bus Garage
Mr. Aycock requested the Board to authorize the chairman to execute the deed for
delivery to the School Board.
A motion was made by Commissioner Clayton and carried 5-0 to approve
Reconveyance of School Property to the School Board as presented.
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CHAIRMAN’S REPORT:
Chairman Kendrick reported on the following:
A) Congratulated David Bradsher and Roxboro’s hometown local radio station, for
obtaining the number 1 slot across the board in every category from the Nielsen Radio
Ratings. Ms. Margaret Bradsher, present in the audience, stated this was the first time for
the Roxboro Radio Station, who has been operating for 70 years. She thanked the loyal
listeners. The categories of awards were:
-Number 1 in cumulative number of persons listening,
-Number 1 in percentage of cumulative listeners,
-Number one in average quarter hour persons,
-Number one in Average quarter Share (percentage) of listeners, and
-Number 1 in every category and beating out big powerful 100,000 watt stations in
Durham, Raleigh, and Danville.
B) Announced that on behalf of Bayard Crumpton, Chairman of the Piedmont
Community College (PCC) Board of Trustees, Pamela Gibson Senegal was selected as the
next president of PCC, starting on July 1, 2017.
MANAGER’S REPORT:
County Manager, Heidi York reminded the Board of its first budget work session
which will be held on June 7, 2017 at 9:00am, with subsequent work session(s) to be
announced at the end of the first work session.
COMMISSIONER REPORT/COMMENTS:
Commissioner Jeffers reported as the commissioner rep on the Environmental
Issues Advisory Committee noted support of Helena Elementary School Environmental
Club who are currently raising funds for solar panels in conjunction with an application of
a NC Green Power Solar School Grant that was awarded to five schools, one being Helena.
Commissioner Clayton reported he addressed the Helena Environmental Club
consisting of fourth and fifth graders.
Commissioner Puryear had no report.
Vice Chairman Powell reported he addressed the Helena Environmental Club as
well noting that he discussed with the students what a water bottle and a Fruit of the Loom
underwear waist band have in common. The waistbands are made from recycled water
bottles.
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RECESS:
A motion was made by Commissioner Puryear and carried 5-0 to recess the
meeting at 8:08pm until 9:00am on June 7, 2017.
_____________________________ ______________________________
Brenda B. Reaves Tracey L. Kendrick
Clerk to the Board Chairman
(Draft Board minutes are subject to Board approval).
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June 7, 2017
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PERSON COUNTY BOARD OF COMMISSIONERS JUNE 7, 2017
MEMBERS PRESENT OTHERS PRESENT
Tracey L. Kendrick Heidi York, County Manager
Gordon Powell
Jimmy B. Clayton Brenda B. Reaves, Clerk to the Board
Kyle W. Puryear
B. Ray Jeffers
The Board of Commissioners for the County of Person, North Carolina, met in
recessed session on Wednesday, June 7, 2017 at 9:00am in the Commissioners’ meeting
room in the Person County Office Building for the purpose of a budget work session.
Chairman Kendrick called the meeting to order.
DISCUSSION/ADJUSTMENT/APPROVAL OF AGENDA:
It was the consensus of the Board to approve the agenda, as presented.
ITEMS FOR DISCUSSION:
ADJUSTMENTS FROM RECOMMENDED BUDGET:
County Manager, Heidi York asked the Assistant Finance Director and Budget
Manager, Laura Jensen to update the Board on the following technical budget adjustments.
Ms. Jensen presented the following noted revenues and expenditures which offset for a
surplus of $21,540.
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As the group discussed electronics recycling fees for the upcoming fiscal year ($10
fee for disposal of televisions and $5 fee for monitor disposal), Commissioner Jeffers
asked Ms. York about implementing a residential false fire alarm fee. Ms. York stated
staff would have to bring an ordinance to the Board for approval to assess a faulty or
false fire alarm fee. Chairman Kendrick asked if a nuisance false alarm that are
responded by the Sheriff’s Office should also be included. Ms. York stated she would
review and bring back to the Board.
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June 7, 2017
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EDUCATION BUDGETS OVERVIEW AND Q&A:
PIEDMONT COMMUNITY COLLEGE:
Piedmont Community College President, Dr. Walter Bartlett presented the
following FY 2017-2018 budget request to the Board:
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PERSON COUNTY SCHOOLS:
Person County Schools Superintendent, Dr. Rodney Peterson shared the following
presentation for the FY 2017-2018 budget request to the Board:
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EMERGENCY SERVICES BUDGETS- EMS & 911:
Director of Emergency Services, Douglas Young told the Board the personnel
status of County’s Emergency Medical Services (EMS) was critical and requested the
Board consideration in the upcoming budget to assure the citizens of required services. Mr.
Young noted his staff would present the FY 2017-2018 budget requests.
911 Communications Manager, Brett Wrenn provided an overview of the
following:
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EMS Operations Director, Greg White provided an overview of the following:
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PERSONNEL POSITIONS:
County Manager, Heidi York presented to the Board the following chart illustrating
the 18 requested positions noting she recommended 9 positons that were all related to
public safety.
Vice Chairman Powell spoke favorably for the Ag Economic Development Officer
suggesting consideration on a part-time status. Ms. York noted she had not included a
salary/benefits with the Ag Economic Development Officer positon as she was not
recommending due to the Economic Development Commission’s restructure.
Commissioner Clayton advocated for the Environmental Health position that was
not recommended by the Manager. Ms. York stated she did not include in the budget as
they were implementing advanced technology. Ms. York noted the turnaround time was
three to four weeks for well and septic system evaluations.
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VOLUNTEER FIRE DEPARTMENT FUNDING:
County Manager, Heidi York provided the following chart for the Volunteer Fire
and Rescue agencies that included a 2% increase. Commissioner Jeffers added that this
group had agreed to the 2% increase along with a one-year contract with the condition to
work with the Board for a new plan for the next fiscal year.
SENIOR CENTER BUDGET:
County Manager, Heidi York presented the following chart to the Board related to
the Manager’s Recommended Budget for the Senior Center:
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Ms. York stated Ms. Diane Cox of the Kerr Tar Council of Government was not
available to attend the Board’s work session but had submitted a written request of local
funding of $100,000 for required local matches and to supplement operational costs. Ms.
York stated by action of the Board of June 5, 2017, the Board approved an additional
$32,545 in funding to cover the required match for the Home & Community Care Block
Grant.
Ms. York presented the following chart of other considerations related to the Senior
Center:
Ms. York noted, per the City Manager, they had not received a request from the
Senior Center non-profit; when asked to participate through mowing and snow removal by
the County, the City declined.
County Manager, Heidi York presented the following slide that illustrated the
additional requests made to Person County following her recommended budget
presentation:
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Commissioner Jeffers stated support to commit to the Person County Schools
salary/benefits request of $150,000 and offered to place the committed amount in the
Contingency Fund for the final amount from the state.
Commissioner Clayton advocated for the full funding request for the Senior Center.
Chairman Kendrick shared his preference to fund the emergency services and VFDs
illustrating a mandated services over non-mandated.
As an option, Commissioner Jeffers proposed a one-cent tax increase that could
cover the requested funding for the Senior Center, emergency services, Person County
Schools, Piedmont Community College, Fireworks, Personality and the 225th Anniversary
requests.
Commissioner Puryear stated opposition to a tax increase. Chairman Kendrick
added that he felt there were non-mandated areas within the budget that could be cut to
fund the priority services.
The Board made no formal motions for adjustments to the Recommended Budget
and it was the consensus to take more time for review and come back for another budget
work session.
RECESS:
A motion was made by Vice Chairman Powell and carried 5-0 to recess the
meeting at 10:20am until June 15, 2017 at 11:00am for the Board to conduct its second
budget work session.
_____________________________ ______________________________
Brenda B. Reaves Tracey L. Kendrick
Clerk to the Board Chairman
(Draft Board minutes are subject to Board approval).
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Dept./Acct No.Department Name Amount
Incr / (Decr)
EXPENDITURES General Fund
General Government 4,000
Public Safety (6,508)
Contingency (4,000)
REVENUES General Fund
Intergovernmental 34,554
Other Revenues 4,492
Fund Balance Appropriation (45,554)
EXPENDITURES Person Industries & MRF Fund
Person Industries 928,647
Material Recovery Facility 61,566
REVENUES Person Industries & MRF Fund
Intergovernmental 51,684
Charges for Services 936,227
Investment Earnings 2,302
Explanation:
BUDGET AMENDMENT
Transfer contingency - property and liability insurance (-$4,000) to Human Resources for insurance deductible
payments ($4,000); reduce JCPC grant (-$5,500) based on changes to grant expenditures and increase fund
balance appropriation ($5,500); receipt of vehicle insurance claim for Sheriff's department ($1,992); receipt of
United Way grant for Sheriff's GREAT program ($2,500); reduce Tier II Fee Grant (-$1,000) and Emergency
Management Training Grant (-$10,000); transfer funds from Fleet Management Fund (-$688) for vehicle tax and
tag costs for Tax department ($688); receipt of Medicaid Hold Harmless payment ($51,054), allowing for a
reduction in DSS fund balance appropriation (-$51,054); adjustments to Person Industries fund due to increased
revenues ($990,213).
BA‐22 47
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Person Area Transportation
System (PATS)
System Safety
Plan
(SSP)
(Plan Revised March 2017)
PERSON AREA TRANSPORTATION SYSTEM
341 South Madison Blvd
Phone (336) 597-1771 • Fax (336) 330-2311
Email: pats@personcounty.net
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PROCEDURES
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Table of Content Page
INTRODUCTION……………………………………………………………………………...................1
A. System Safety Plan General Description……….......…………………………………........….1
B. Mission / Vision Statement……………………………………………………….....................3
C. Safety Policies.....………………………………………………………………………..............4
D. Goals……………………………………………………………………………........................4
E. System Description…………………………………………………………………..................5
F. Employee Handbook……………………………………………………………………............6
G. Organizational Structure……………………………………………………………..................6
H. SSP Outline………………..……………………………………………………………............7
I. Annual Review……………………………………………………………………………..........9
J. Governing Board Adoption………………………………………………………………..........9
SECTION 1: DRIVER AND EMPLOYEE SELECTION……………………………………...........10
A. Review of Job Descriptions for Drivers and Safety Sensitive Personnel …………….........…10
B. Process for Selecting Drivers and Other Safety Sensitive Employees…………………..........11
C. System for Monitoring Drivers’ Licenses, Certifications, and Other Qualifications…............23
SECTION 2: DRIVER/EMPLOYEE TRAINING……………………………………………............27
A. Training Program for Drivers and Other Safety Sensitive Employees………………….........27
B. Training Materials……………………………………………………………………..............30
C. Refresher Training …………………………………………………………………….............32
D. Records of Training Performed……………………………………………………….............33
E. Evaluating Driver Performance………………………………………………………..............33
F. Remedial Training…………………………………………………………………….............34
G. Training Curriculums and Schedules………………………………………………….............34
H. Process to Identify Trainers……………………………………………………………...........42
I. Standards for On-The-job Training Education…………………………………………............42
J. Safety Meetings and Incentives…………………………………………………………..........42
K. Maintenance Training…………………………………………………………………............43
SECTION 3: SAFETY DATA ACQUISITION/ANALYSIS…………………………………...........44
A. Purpose…………………………………………………………………………………..........44
B. Safety Objectives………………………………………………………………………...........45
C. NCDOT Safety Philosophy Statements………………………………………………............45
D. Safety Terms and Definitions…………………………………………………………............45
E. Safety Awareness Program……………………………………………………………............47
F. Analysis of Accidents and Incidents……………………………………………………..........47
G. Personnel Policy Regarding Safety, Performance, and Discipline Procedures……….............48
H. Procedure to Communicate Safety Information during Business Hours………………...........50
I. Safety Equipment on Vehicles…………………………………………………………............50
J. Office Safety………………………………………………………………………...................50
K. Tracking and Analysis Incident Reports……………………………………………….....…..52
L. Exposure Control Plan…………………………………………………………………..........52
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M. Risk Management/Hazard Identification……………………………………………….....….58
SECTION 4: DRUG AND ALCOHOL ABUSE PROGRAMS……………………………….....…..62
A. Purpose……………………………………………………………………………………......62
B. Policy……………………………………………………………………………………….....62
SECTION 5: VEHICLE MAINTENANCE………………………………………………………......64
A. Maintenance Policy……………………………………………………………………….......64
B. Maintenance Plan………………………………………………………………………….......64
C. Preventative Maintenance Standards…………………………………………………….........64
D. Maintenance Records Standards ….………………………………………………………......65
E. Annual PTMS Inspection………………………………………………………………….......66
F. Vehicle Safety/Emergency Equipment …………………………………………………….....67
SECTION 6: SECURITY…………………………………………………………………………........68
A. Security Policy…………………………………………………………………………….......68
B. Security Program………………………………………………………………………….......70
C. Security Plan………………………………………………………………………………......70
D. Accident / Incident Packet – Vehicles .....................................................................................92
Appendix A: Resolution for Approval of Requirement for Community Transportation Systems
to Implement System Safety Program Plans………………………………………….......93
Appendix B: Employment Process Checklist………………………………………………………….......94
Appendix C: Motor Vehicle Report (MVR) ...............................................................................................96
Appendix D: Background Check.....................................……………………………………………......100
Appendix E: Federal Exclusion List Check (OIG)....................................................................................102
Appendix F: Job Function Test...................………………………………………………………….......103
Appendix G: New Hire and Annual Refresher Training Logs .................................................................107
Appendix H: Ride Check – Evaluation and Behind the Wheel Training .................................................110
Appendix I: Training Curriculums...............…………………………………………………………......115
Appendix J: Qualifying Trainers/Instructors..............……………………………………………….......133
Appendix K: Monthly Safety Meeting Report……………………………………………………….......134
Appendix L: Person County Government Safety Policy……………………………………………........135
Appendix M: PATS Drug and Alcohol Testing Policy...................………………………………….......143
Administration Covered Classification.........................................................................................170
Alcohol Fact Sheet........................................................................................................................171
Minimum Thresholds....................................................................................................................173
Affidavit of Correction..................................................................................................................174
Good Faith Effort Documentation.................................................................................................176
Order for Testing...........................................................................................................................178
Post-Accident testing Decision Report..........................................................................................179
Post-Accident Decision Tree.........................................................................................................180
Acknowledgement of Employer’s Drug and Alcohol Testing Policy...........................................182
Positive Drug and Alcohol Testing Log........................................................................................183
Post-Accident Testing Log............................................................................................................184
Pre-Employment Drug Testing Acknowledgement......................................................................185
Pre-Employment Testing Log.......................................................................................................186
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Random Testing Log.....................................................................................................................187
Reasonable Suspicion Testing Log................................................................................................188
Authorization for Release of Information from Previous Employer on US DOT
Drug and Alcohol Testing.............................................................................................................189
Reasonable Suspicion Incident Checklist......................................................................................190
Return To Duty / Follow Up Testing Log.....................................................................................192
Safety Sensitive Employee Application Supplement....................................................................193
Safety Sensitive Function Determination Worksheet....................................................................194
Substance Abuse Professional Referral Employee not present.....................................................195
Substance Abuse Professional Referral........................................................................................196
Vendor Oversite Inspection Master Log.......................................................................................197
Collection Site Checklist...............................................................................................................198
Appendix N: Maintenance Plan.......................................……………………………………..…............200
Policy Guidance for Vehicle Identification Markings..................................................................220
Vehicle Maintenance Software Package...................................................................................... 222
In House Maintenance Request Form...........................................................................................223
Pre-Trip Safety Inspection.............................................................................................................224
Post Trip Safety Inspection............................................................................................................225
Forms in the Accident Packet on each vehicle..............................................................................226
o The Seven Steps of Crisis Management..................................................................................226
o Code 300..................................................................................................................................227
o Bomb Threat Check List..........................................................................................................228
o Accident / Incident Form.........................................................................................................229
o Safety/Security Situation Form...............................................................................................230
o Person Involved Statement Form............................................................................................231
o Employment Statement Form..................................................................................................232
o Bloodborne Pathogen Form.....................................................................................................233
o Seating Chart...........................................................................................................................235
o Courtesy Card and Exoneration Card.....................................................................................236
Appendix O: Policies and Procedures ......................................................................................................237
Person County Government Emergency – Evacuation Policy and procedures............................237
PATS Distracted Driving Policy...................................................................................................241
PATS Seatbelt Policy....................................................................................................................242
PATS Service Policy.....................................................................................................................243
PATS Passenger Policy.................................................................................................................253
PATS Video Camera Policy..........................................................................................................255
PATS Disposition Policy...............................................................................................................256
PATS School Transportation Service Policy.................................................................................259
TAB Conflict of Interest Statement...............................................................................................261
PATS Title VI................................................................................................................................262
Person County Substance Abuse Policy........................................................................................300
Person County Personnel Policy....................................................................................................314
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1
Introduction
A. System Safety Plan General Description
1. POLICY STATEMENT AND AUTHORITY FOR SYSTEM SAFETY PLAN
A. Effective October 2012, Moving Ahead for Progress in the 21st Century (MAP-
21) mandated requirements for all public transportation to develop and implement
a safety plan. As defined by MAP-21 public transportation is regular, continuing
shared-ride surface transportation services that are open to the general public or
open to a segment of the general public defined by age, disability, or low income.
B. North Carolina Board of Transportation 2003 Resolution established the
requirement for each transit system to develop and implement a System Safety
Plan (SSP).
C. Establish the SSP as an operating document that has been prepared for and
approved by the transit system top management, chief executive officer or the
governing board.
D. The authority statement in the SSP should define, as clearly as possible, the
following:
1. The authority for establishment and implementation of the SSP
2. How that authority has been delegated through the organization
E. The SSP must adequately address the SIX CORE ELEMENTS.
2. DESCRIPTION OF PURPOSE FOR SYSTEM SAFETY PLAN
A. Address the intent of the SSP and define why it is being written.
B. Establish the safety philosophy of the whole organization and provide a means of
implementation.
C. A SSP could be implemented for the following reasons:
To establish a safety plan on a system wide basis.
To provide a medium through which a system can display its commitment
to safety.
To provide a framework for the implementation of safety policies and the
achievement of related goals and objectives.
To satisfy federal and state requirements.
To meet accepted industry standards and audit provisions.
To satisfy self-insurance or insurance carrier provisions.
D. The relationship of system safety to system operations should be defined.
E. All departments involved must have a clear definition of their individual
responsibilities relative to the scope of the SSP.
F. This section should also contain system safety definitions applicable to the
operating systems.
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3. CLEARLY STATED GOALS FOR VEHICLE SAFETY MANAGEMENT
PROGRAM
A. The overall goal of a SSP is to identify, eliminate, minimize and control safety
hazards and their attendant risks by establishing requirements, lines of authority,
levels of responsibility and accountability, along with methods of documentation
for the organization.
B. These goals should be system-specific, tailored to the individual needs of the
system, as well as being:
1. Long term - the goal must have broad and continuing relevance.
2. Meaningful - they must not be so broad as to be meaningless;
desired results must be identified.
3. Realizable - any goal that meets the first two criteria but cannot be
attained is meaningless.
C. Example:
1. A goal might be to establish a high level of safety comparable to
other transit systems in the U.S.
2. Identify, eliminate, minimize, and/or control all safety hazards
3. Provide appropriate action and measures to obtain necessary
safety-related agreements, permits and approvals from outside
agencies, where applicable.
4. IDENTIFIABLE AND ATTAINABLE OBJECTIVES
A. Objectives are the working elements of the SSP, the means by which the
identified goals are achieved.
1. Must be quantifiable and meaningful.
2. Met through the implementation of policies.
B. Policies are central to the SSP and must be established by top management.
1. They set the framework for guiding the safety program, on a
relatively long-term basis.
2. Policies are measurable.
3. Policies are methods for reaching a specified objective.
C. Example:
The establishment of a safety plan incorporating public, patron, employee,
and property safety including fire protection, loss prevention and life safety
requirements.
Policies depend on the goals defined by the transit system and its safety
philosophy.
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5. SYSTEM DESCRIPTION/ORGANIZATIONAL STRUCTURE
A. System Description
1. Briefly describes the system’s characteristics. The information
should be sufficient to allow non-technical person and those not
employed in transit to understand the system and its basic
operation.
2. Components that should be included in the system description:
a. History
b. Scope of service
c. Physical features
d. Operations
e. Maintenance
f. System Modifications
B. Organizational Structure
1. Organizational diagrams showing the title of each position.
2. Diagram showing the structure of the system safety unit
identifying the key position
3. Diagrams showing the relationships and lines of communication
between the system safety unit and other departments in the
organization.
4. Describe the relationship of the transit system to local political
jurisdictions.
B. Mission Statement:
We are a community partner in shaping a livable community that provides access and
mobility.
Vision Statement:
We plan to maintain and manage an effective and safe transportation system.
Values:
1. Safety – continuously improve the efficient and effective delivery of passengers
to their destinations.
2. Courtesy – Provide exceptional customer service; enhance our customer focus.
3. On-Time – Enhance system adoptability and flexibility.
4. Reliability – Maintain a competent workforce in an environment of technological
and demographic change.
5. Excellent – Enhance community awareness and support of Person Area
Transportation System
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C. Safety Policies
Safety is the number one priority of Person Area Transportation System (PATS). In
support of that goal, the primary importance of the SSPP policies and procedures is the
reduction of accidents and injuries to transit customers, employees and the general public.
Safety is a shared responsibility between system management and employees.
It is the policy of PATS to provide a place of employment that is free from recognized
hazards that could result in death or serious injury to employees, customers or the general
public.
It is the responsibility of each employee to report all incidents or unsafe conditions to
their Transit Manager. The Transit Manager must immediately take necessary corrective
action to prevent unsafe conditions.
It is also the policy of PATS to require that safety training and the use of safe protective
equipment and procedures are adhered to at all times. Individual employees are expected
to perform their duties in a safe and responsible manner, as safe work behavior is a
condition of employment.
Prohibited behaviors are behaviors that are in violation of the SSPP. Such behaviors
include behaviors that threaten the safety of employees, customers and the general public.
Other unacceptable behaviors include those that result in damage to system, employee or
public property.
An employee who intentionally violates safety policy and procedures will be subject to
appropriate disciplinary action, as determined by the findings of an investigation. Such
discipline may include warnings, demotion, suspension or immediate dismissal. In
addition, such actions may cause the employee to be held legally liable under State or
Federal Law.
PATS also developed this SSPP in part to fulfill the requirement by the North Carolina
Board of Transportation that each transit system develop and implement a SSPP. See
Appendix A for the North Carolina Board of Transportation’s 2003 Resolution.
D. Goals:
As a public transportation provider in North Carolina, PATS aims to meet statewide
safety goals, which include:
Instilling a safety attitude and a safe work place/customer service environment
Establishing a commitment to safety
Developing and maintaining a comprehensive, structured safety program
Developing and maintaining safety standards and procedures
Providing formalized safety training
Reducing accident and injury rates
Selecting equipment that promotes and enhances safety
Safeguarding hazards
Making necessary changes in the system to uphold safety
Establishing an incentive/reward program that rewards safe employee
practices
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Increasing employee safety awareness
E. System Description
Person Area Transportation System (PATS) is a consolidated transportation system
operating in Person County, North Carolina. As a public transportation system, PATS
offers an uptown shuttle (fixed route). Subscription routes and demand-response routes
and transportation by contractual agreement with the following human service
organizations:
Piedmont Community College
Person County Council on Aging
Person County Department of Social Services
Person County Health Department
Roxboro DaVita
Person Industries
Vocational Rehabilitation
Roxboro Nursing Center
Safety Sensitive Positions:
Transit Specialist (Full Time and Part Time)
Clerk / Dispatcher (Full Time and Part Time)
Senior Administrative Support Assistant /Safety/Training Officer
Transit Manager /Title VI Coordinator
Rural General Public (RGP) service is available on all of our subscription, demand-
response and fixed route. All service is accessible to persons with disabilities.
The PATS fleet consists of the following vehicles:
Five – Ford Lift 22’ LTV (10 passengers and 2 wheelchairs or 14 passengers without
wheelchairs)
Three – Ford Passenger Vans (13 passengers)
Two – Ford Lift 20’ LTV (6 passengers with 2 wheelchairs or 8 passengers without
wheelchairs)
Five –Ford Back lift vans (3 passengers and 2 wheelchairs or 8 passengers without
wheelchairs)
One – Dodge caravan (5-passengers)
Service Area
PATS serve all of Person County. Person County is a rural county located near the center of
North Carolina encompassing 404 square miles. The ridership of PATS is comprised mainly of
the clients and consumers of human service agencies in Person County that contract with PATS.
However, PATS services are open to the general public, and include transportation for work,
recreation, medical services, and shopping. Aside from local trips, PATS also serves some
destinations outside of Person County, specifically out-of-town medical appointments going to
Durham NC, Chapel Hill NC, and Prospect Hill NC, for contracted services and the general
public.
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Days and Hours of Service
PATS operate under Person County guidelines;
PATS Office hours are: Monday - Friday from 8:30 a.m. to 5:00 p.m.
PATS Vehicle Operational hours are: Monday - Friday, from 6:00 a.m. to 6:00 p.m.
PATS will be closed for the following holidays:
New Year’s Day Independence Day
Martin Luther King Jr. Birthday Labor Day
Presidents’ Day Veterans Day
Good Friday Thanksgiving
Memorial Day Christmas
F. Employee Handbook
Each PATS employee is required to read and keep a copy of the Person Area
Transportation Systems Employee Handbook they receive upon hire. Upon completion
of reading the handbook, each employee is required to sign a signature page that
acknowledges their understanding of relevant policies and procedures. The signature
page will be retained by the Transit Manager as record that each employee has read and
understood the handbook.
G. Organizational Structure
ORGANIZATIONAL STRUCTURE
FISCAL YEAR 2017
DEPARTMENT NUMBER 4520 DEPARTMENT NAME PATS
County Manager
PATS Transportation
Advisory Board
Transit Manager
Title VI Coordinator
Senior Administrative
Support Assistant
Safety/ Training Officer
Clerk/Dispatcher
Transit
Specialist
General Services Director
Scheduler/Dispatcher
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H. SSP Outline
This SSP consists of and addresses the six core elements required by the North Carolina
Department of Transportation, Public Transportation Division (NCDOT-PTD):
1. Driver/Employee Selection
2. Driver/Employee Training
3. Safety Data Acquisition/Analysis
4. Drug and Alcohol Abuse Program
5. Vehicle Maintenance
6. Security
All of the elements listed are equal in importance, and PATS must follow all the policies and
procedures described in this SSP. Such compliance will ensure that we meet all Federal
Transportation Administration (FTA) and NCDOT-PTD policies and regulations.
The following provides a brief summary of each element in the SSP:
1. Driver/Employee Selection:
Fair hiring practices are used to select employees. Each potential employee will
complete a written application. The Human Resource Director, Transit Manager, and
Senior Administrative Support Assistant shall interview each potential employee.
Employment Process Checklist - Appendix B
2. Driver/Employee Training:
The Minimum Training Standards for Community and Human Service Transportation
System Vehicle Operators are:
1. Defensive Driving
2. Americans with Disabilities Act (ADA) (49 CFR part 37.173)
3. Bloodborne Pathogens (29 CFR 1910.1030(g)(2)
4. Illegal Drug Use (49 CFR 655.14)
5. Emergency Procedures for Vehicle Operators
6. Ride Check – Driver Evaluations
In addition to the minimum requirements the following actions must be completed:
The training must be completed upon hire and annually
The training material must be on file for review by NCDOT-PTD
Records of each individual trained must be retained on file for five years
Each driver must have an annual driver’s ride check evaluation to provide
refresher training, assess skills, techniques, knowledge, etc.
New Hire Training Log and Annual Training Log - Appendix G
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3. Safety Data Acquisition/Analysis:
The goal of the SSP is the reduction of accidents and injuries to transit customers,
employees and the general public. Safety is a shared responsibility between system
management and employees. It is the policy of PATS to provide a place of employment
that is free from recognized hazards that could result in death or serious injury to
employees, customers or the general public. It is the responsibility of each employee to
report all incidents or unsafe conditions to their Safety/Training Officer. Your
Safety/Training Officer will report to your Transit Manager who must immediately take
necessary corrective action to prevent unsafe conditions.
Prohibited behaviors are behaviors that are in violation of the System’s Safety Policy.
Such behaviors include behaviors that threaten the safety of employees, customers and
the general public. Other unacceptable behaviors include those that result in damage to
system, employee and public and/or private property. An employee who intentionally
violates the safety policy and procedures will be subject to appropriate disciplinary
action, as determined by the findings of an investigation. Such discipline may include a
warning, demotion, suspension or immediate dismissal. In addition, such actions may
cause the employee to be held legally liable under State or Federal Law.
4. Drug Alcohol and Abuse Program:
The goal is to provide a safe, healthy and productive drug-free work environment for all
employees. A person being under the influence of a drug or alcohol while on the job
poses serious safety and health risk to the user, co-workers as-well-as passengers. PATS’
has established a policy of a drug-free work environment. A standard of zero tolerance
for use of alcohol, illegal substances, or the misuse of prescription medications during
work hours or the presence of these substances in the body during work hours regardless
of when consumed. Random drug test will be administered. See Drug and Alcohol
Testing Policy for further details. Appendix M
5. Vehicle Maintenance:
The goal is to ensure each vehicle, wheelchair lift and installed equipment is properly
maintained to maximize the service life, maintain reliability, mitigate high maintenance
costs and sustain proper safety and mechanical condition. To accomplish this goal we
will at a minimum adhere to the manufacturer’s maintenance/service manuals. See
Maintenance Plan Appendix N
6. Security Element:
The overall purpose of the Security Program is to optimize -- within the constraints of
time, cost, and operational effectiveness -- the level of protection afforded to vehicles,
equipment, facilities, passengers, employees, volunteers and contractors, and any other
individuals who come into contact with the system both during normal operations and
under emergency conditions.
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The security of passengers and employees is paramount to promoting the objectives of
FTA and NCDOT. We will take all reasonable and prudent actions to minimize the risk
associated with intentional acts against passengers, employees and equipment/facilities.
To further this objective, we have developed security plans and procedures and
emergency response plans and procedures. The plans have been coordinated with local
law enforcement, emergency services and with other regional transit providers, which
addresses the conduct of exercises in support of their emergency plans, and assessment of
critical assets and measures to protect these assets.
I. Annual Review
The SSP will be updated as changes occur. PATS will review the SSP at least annually to
ensure all information is current. The annual review and updates must be adopted by the
board and certified by NCDOT/PTD.
J. Governing Board Adoption
The operational policies and procedures outlined in the SSP were adopted by the PATS
governing board, the Person County Board of Commissioners. In adopting the SSP, the
PATS governing board provides the PATS Transit Manager with the authority to implement
the SSP, with the assistance of PATS employees as he or she sees fit.
Date of Original Adoption_____________________________________
Transit Manager (Signature) _______________________
Governing Board Chairman (Signature) ___________________
Dates of Governing
Board Adoption of
Changes to SSPP
Transit Manager
Signature
Governing Board
Chairman Signature
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Driver and Employee Selection
A. Review of Job Descriptions for Drivers and Safety Sensitive
Personnel
Job descriptions should be reviewed by the Transit Manager annually. New or updated job
descriptions should be approved by the governing board as required by County hiring procedures.
The following table documents the review dates and approvals received as necessary.
Annual Reviews of Job Descriptions for Drivers and
Other Safety Sensitive Personnel
Date of
Annual
Review
Signature of Reviewer Changes Made to
Job Descriptions
(Y/N)
Date of
Governing Board
Approval for
Changes
Section 1
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B. Process for Selecting Drivers and Other Safety Sensitive Employees
Each potential employee shall complete a written application, and then undergo an interview
with the Human Resource Director, PATS Transit Manager and Senior Support
Administrative Assistant.
PATS require that candidates possess the following qualifications for each job description
they are applying for:
Transit Specialist (Driver)
Physical Requirements
Each applicant must meet the requirements defined in 49 CFR Part 391.41 of the Federal
Motor Carrier Safety Regulations, in addition to the following requirements:
Eyesight – Drivers must have vision in both eyes, normal depth perception, normal
peripheral vision and be free of any disease or condition that could impair vision. Drivers
must have 20/40 vision in each eye with or without corrections, and 140 degrees or better
horizontal vision. Drivers must be able to distinguish between green, red and yellow. Drivers
who cannot meet the 20/40 acuity standard for the state of North Carolina are referred to an
eye care Specialist.
Hearing – Drivers shall have adequate hearing to assure safe response to vehicle horns,
emergency vehicle sirens, and train signals.
Physical Ability – Drivers must have the physical strength to assist wheelchair passenger and
other ADA passengers when loading and unloading the vehicle. Therefore they must consent
to participate in a Job Function Test that requires the exertion of potentially strenuous effort.
Age – Drivers shall be at least twenty-one (21) years of age.
Knowledge of English
Drivers can read and speak the English language sufficiently to converse with the general public,
to understand highway traffic signs and signals in the English language, to respond to official
inquiries, and to make entries on reports and records
Driver Requirements
Drivers transporting people shall hold a valid NC Driver’s License or Commercial Driver’s
License (CDL) as appropriate. In order to be considered for employment all potential
employees must provide a printout of the Bureau of Motor Vehicle (DMV) report issued within
the past ten (10) days. In no case will an individual be placed in training, or allowed to
operate an agency vehicle without a DMV check that is in compliance with this policy
and has been approved by the Transit Manager.
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The criteria include:
Good driving record with no Driving While Intoxicated (DWI), Driving Under the
Influence (DUI) or similar charges, reckless driving, railroad crossing violations or
leaving the scene of an accident offenses.
No more than a total of two moving violations or accidents within the last three years.
No suspended or revoked licenses within the past five years for moving violations or
violations of criminal laws.
Any combination of violations, unfavorable road observations or accidents that indicates
a pattern of unsafe vehicle operation behavior, whether on or off the job.
Minimum of two years driving experience.
Ability to perform simple math.
Reasonable knowledge of the service area and ability to read basic maps.
Operating Skills
Drivers shall have experience in safely driving some type of motor vehicle (including private
automobile) for not less than five years, including experience throughout the four seasons.
The Transit Manager completes an Employment Process checklist, attached as Appendix B,
per candidate interviewed.
The procedures for selecting a safe driver involve having driver candidates undergo the
following:
A background investigation and fingerprints (five years)
Office of Inspector General check (OIG)
NCDOT Division of Motor Vehicles Check (MVR)
Submission of driving record (five years)
No positive drug or alcohol test results within the last two years
Pre-employment drug testing
Clerk/Dispatcher: (Scheduler/Dispatcher)
Dispatchers and schedulers are the communications hub of PATS. Drivers and others in the field
expect you to know what is happening in and near our transit system. They also rely on you for
direction and assistance. Under normal circumstances this is a demanding position. When
unexpected incidents arise, the importance of your critical role is heightened and you must be
prepared to rise to the challenge.
Scheduler Responsibilities
Although your specific responsibilities as a scheduler will be determined by the Transit Manager,
they may include:
■ Entering and updating customer data
■ Scheduling trips using paper and pencil, computer software, or an automated
scheduling system
■ Producing driver schedules and/or manifests
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Assigning drivers to vehicles and making sure the driver has the right key to the
vehicle they will be assigned to for that day.
Being accountable for the keys to be returned to the office when drivers are
switched to other vehicles or not working the following day.
■ Changing or canceling trips
■ Resolving scheduling issues, service requests, and complaints
■ Preparing data or reports when needed
■ Working with service contractors
■Money in-take and receipts
Money In-take and Receipt Procedures (receiving money from driver)
When drivers bring money in to the office:
Receive Money from Driver
Count money in front of driver
verify amount
Match amount of money with amount of money on the receipts,
Put the driver’s receipts in order
Write driver a receipt – document on the receipt:
o Date you write the receipt
o Driver’s name
o List the driver’s receipt numbers in order:
Receipt number
client’s first initial and last name
amount of money they paid,
if they paid by check include check number.
Total amount of money received
Document in the money in-take notebook under client’s name and include:
o amount paid
o receipt number
o check number if paid by check
o Note what they are paying for (No Shows, dates they are riding)
Money In-take and Receipt Procedures (receiving money from client)
When Clients come in the office to pay:
Look in the Money in-take notebook for client’s name (add form if it’s not
there)
See if they owe or have a credit
Receive the money and verify amount
Write client a receipt and include:
o Date they paid
o Client’s full name
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o include check number if paid by check
o dates they are paying for (or what days they owed for)
Document in the money in-take notebook under client’s name and include:
o amount paid
o receipt number
o check number if paid by check
o Note what they are paying for (No Shows, dates they are riding)
Performs other duties assigned
Dispatching Responsibilities
The responsibilities you cover all aspects of service. On any given day, you look at the “big
picture” of service and know where the vehicles are and where to send them. You have contact
with the drivers, customers, internal PATS staff, and the community. You will also be
responsible for tracking data and reports. Your responsibilities can be grouped into these
categories:
■ System Coordination
■ Communications
■ Recordkeeping
Using the Appropriate Decision Making Strategy
When you make a decision, it has to “match” the problem. For example, if a driver calls in with a
flat tire, an appropriate decision would be at the operational level. You would call for assistance.
It is not the time for a tactical decision such as “improve emergency procedures”, or a strategic
decision like “provide safe and reliable service.” If you find that you are always “fighting fi res,”
it may show the need for more tactical and strategic decision making.
Decision Making Guidelines
When thinking about the decisions you need to make, keep in mind these tips:
■ Make decisions as you go along. If you let issues pile up, it may make it harder to
decide what to do.
■ Consider how your decisions impact all the levels.
■ Make sure that the people affected by your decision have a way to respond to it. For
customers, it may just be giving them the ability to speak to the agency about the
decisions.
■ Make your decision based on what is right, not who is right.
■ Indecision is the same as deciding not to take action.
By following the problem solving process, and understanding the type of decisions to make, you
will be well equipped to carry out your job responsibilities.
Communicating
Developing an appreciation of others, working on team skills, and becoming a good problem
solver and decision maker require the ability to communicate effectively.
Stop and think for a moment.
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How many times do you interact with someone at the agency, on the radio, on the phone?
You probably spend quite a bit of your day talking to customers, drivers, and other staff. Your
work is communication intensive!
Communication is about understanding each other, and communicating well will help reduce
conflicts and problems that arise from misunderstanding.
Projecting a Professional Image
What you say and how you say it influences how customers react and how they treat you.
Projecting a positive image will tell customers that you are professional and capable.
Energy Level
Your energy level translates through your voice. When you sound confident and energetic, your
customer will hear that.
Listening Ability
Your listening ability means making sure you hear and understand the customer’s questions and
comments. If you give an answer before hearing all of the information, your answer may not be
correct and the customer won’t get the information they need.
Tone of Voice
HOW you say something comes across more clearly than WHAT you say. Try to avoid
sarcasm, belittling tones or grumpiness.
Speaking Rate/Volume
Make sure the message is communicated correctly the first time. Speak slowly, clearly, and loud
enough for a person to hear and understand what you are saying.
Choice of Words
Company jargon is understandable to you, but may not translate to someone else. State the
message in simple, easy to understand terms. Avoid acronyms.
Voice Clarity
Avoid turning away from the receiver, holding your hand over the receiver or tucking the phone
under your chin while you are talking on the phone. In addition, avoid chewing gum and eating
while talking.
Professional Telephone Skills
When you interact with customers over the phone, it is especially important to treat them
well and ensure that information is communicated properly.
Placing a Call
Introduce yourself and your agency, and then ask to speak with the person
■ Before delivering your message, verify you are speaking to the correct person
■ Establish whether it is a convenient time for the call
■ Speak clearly and state your message concisely
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■ If the call involves some kind of action, recap what you have agreed to do
Receiving a Call
Answer the telephone promptly, within three rings
■ Start the call by stating your agency name, your name, and “How may I help you?”
■ Ask for the caller’s name, write it down, and use it frequently
■Demonstrate that you are listening by making “continuity noises” such as “yes” and
“really”
■ Make notes and read back key points so that the caller knows you are being attentive
■ If an incoming call is not convenient, explain why and take the name and number of the
caller and offer to call back as soon as possible-- then do it!
Taking Customer Information
When fielding a customer call for service, be sure you know, or be sure to get:
■ First and last name (write down pronunciation hints)
■ Phone number
■ Pick up time requested
■ Pick up location
■ Destination
■ Information about the return trip
■ Assistance equipment (walkers, wheelchairs, service animals)
■ Seat requirement for companions or Personal Care Attendant
(This is not a complete list, you will want to find out the exact customer information your agency
requires.)
If you have to write something down or look something up, explain your silence to the
caller.
Before ending the call, it is a good practice to verify that the information is correct by
repeating the information back to the customer.
Placing a Caller on Hold
■ Ask the caller “Will you please hold?” and ALWAYS WAIT FOR A REPLY!!!
■ Never leave a caller on hold longer than 60 seconds. If you are tied up on another call
or task, place the current call on hold and get information to call back.
■ When returning to the caller, say: “Thank you for holding.” NOT “Sorry.”
■ If available, USE THE HOLD FEATURE. If you place the receiver on the desk, callers
can hear you!
Transferring a Call
If you need to transfer a call:
■ First ask the customer if he/she wants to talk to someone else
■ Give the name and extension of the department/ person you are transferring to
■ When you have the new person on the line, briefly explain the call details
■ If you have a “Release” button, use it—it is quieter than hanging up.
Taking Messages
■ Use a sheet of paper, not the back of an envelope or a scrap of paper
■ Print clearly
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■ Take down the caller’s first AND last name. Ask the caller to spell his/her name, then
repeat it back. Jot down how to pronounce the name; “Arun pronounced Uh-roon”
■ Take down the phone number with area code
■ Take a brief message
■ Find out the best time to return the call
■ Repeat the information back to the caller
■ Thank the caller, and hang up
■ Write down the date and time the message was taken
■ Place it where the recipient can find it!
Knowledge, Skill, and Abilities
Has General knowledge of secretarial practices and procedures; spelling, grammar,
punctuation, proofreading, vocabulary, and language usage to compose correspondence
and reports.
Has the ability to understand and use computers for word processing and accounting
practices, as well as to compile data for reports.
Has the ability to maintain effective working relationships with public officials, agency
directors, department heads, Transportation Specialists, and the general public.
Ability to summarize, compile, and tabulate material; analyze and record information;
and to organize and effectively process and maintain agency records and files, both
manually and computerized, as required. Responsible for money in-take and writing
receipts for drivers and clients (documentation of who owes what).
Has Considerable knowledge (or ability to acquire considerable knowledge) of
governmental accounting principles and practices; and the ability to understand and
interpret the various laws and regulation governing the maintenance of financial records.
Excellent communication and customer service skills are needed as there is direct contact
with clients both in person and by phone.
Desirable Experience and Training:
Graduation from high school with some college (preferably in computer science, data
processing,) in business administration; or graduation from a two-year technical or business
college and a minimum of one-year experience, or four years of progressively responsible
experience in bookkeeping and accounting clerical work. Computer skills and ability to multitask
is a must. Patience and a high stress tolerance level are important. Promptness, accuracy, and
flexibility are other essential attributes in this position.
Senior Administrative Support Assistant / Safety/Training Officer:
A safety officer monitors workplace activities to ensure that workers comply with company
policies and government safety regulations. The duties of this job vary by employer, but safety
officer typically have responsibilities pertaining to policy development, safety inspections, safety
training and compliance with the Federal Occupational Safety & Health Administration,
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commonly known as OSHA and Minimum Training Standards for Community and Human
Service Transportation System Vehicle Operators – NCDOT.
Safety Policies
Developing and implementing safety policies helps employers reduce accident-related costs and
prevent losses due to a decline in productivity. The safety officer determines what policies are
needed and solicits input from managers and workers. Once a policy has been finalized, the
safety officer alerts workers about the change and monitors compliance. He may also ask each
employee to sign a statement acknowledging receipt of the information.
Workplace/ Vehicle Inspections
Safety officers inspect interior and exterior work areas to determine if there are any safety
hazards. During these inspections, a safety officer looks for broken equipment and damaged
equipment, slip-and-fall hazards and other potential hazards. Monthly General Safety Inspection
for the PATS vehicle the safety officer is checking to make sure all vehicles are equipped with
the required emergency equipment and it is serviceable and accessible: the pre-trip safety
inspection sheet is complete, back up alarm is working, the rear door busser is working, the fire
extinguisher is in place, charged, secure and inspected-signed off on monthly and county
inspected annually, three (3)reflective triangles, web cutter assessable to driver while seated,
First aid kit in place and stocked, Bloodborne pathogen kit in place and stocked, panic button-
light solid green, and cameras clean. The safety officer also observes workers to ensure that they
are wearing required personal protective equipment (Reflective vest will be worn by drivers
when performing job functions) and following company safety policies.
Accident/Incident Investigations
When a workplace accident/incident occurs, a safety officer conducts an investigation to
determine why the accident/incident happened, and to determine if it was avoidable or
unavoidable. The officer may question witnesses, inspect the accident/incident scene and take
pictures of any property damage. Once the officer determines the cause of the accident/incident,
he/she writes a report detailing the cause and provides recommendations that can help prevent
future accidents/incidents. Collects all the information and contacts Person County Government,
NCDOT and sends them copies of the information collected within a certain time frame.
NCDOT Training
The Safety/ Training officer follows the Policy Guidance for Minimum Training Standards for
Community and Human Service Transportation System Vehicle Operators. These topics include:
Defensive Driving, Americans with Disabilities Act (ADA), Bloodborne Pathogens, Emergency
Procedures, Ride Check-Driver Evaluation, Illegal Drug Use. Safety officer identifies and
implements training needs, develop appropriate training programs and deliver training to
employees to meet those requirements. All new hires must complete all of the minimum training
requirements before operating a transit vehicle unsupervised in revenue service. Drivers that are
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not meeting proficiency, expert performance level, must be given remedial training until they are
proficient. Refresher (annual) training must be completed annually (within 1-year of last training
date). They may also solicit feedback from workers and use that feedback to improve existing
programs or create new ones.
Regulatory Compliance
Employers must comply with regulations published by OSHA and NCDOT and County
Government. This involves reviewing standards, implementing plans to meet those standards and
following all record-keeping requirements. Safety officer completes the accident/ injuries
information record on the required OSHA documents (300 log, 300 – A Summary of Work-
Related Injuries/Illnesses and 301 Incident Report Log).This information must be properly
maintained. They also ensure that the entitled “Job Safety and Health: It’s the Law” is displayed
in a conspicuous place in the workplace, as required by OSHA.
Safety officers identify training needs, develop appropriate training programs and deliver
training to employees. All of the training materials and documentation must be on file for review
by the NCDOT/PTD. Materials shall include but not be limited to course outline (may be
included in instructor’s manual), instructor’s manual, sample student manual (if one is used),
handouts and copy of Power Point slides if used in lieu of instructor’s manual. Records of
qualifications and training performed (for each individual trained) must be kept on file for a
minimum of five (5) years. Records shall include proof of attendance (roster or certificate of
completion, if provided), date of the course, and type of instruction delivery (instructor led, self-
instruction, etc.) name and certification (if applicable) of instructor. They may also solicit
feedback from workers and use that feedback to improve existing programs or create new ones.
Minimum Training Standards Reporting Procedures
Grantees must submit the following information to the Safety and Security Unit: Number of
employees who received training by category/type. A spreadsheet will be provided by Safety and
Security Unit for the purposes of reporting training. The report must be submitted no later than
the fifteenth (15) day of the month following the end of the quarterly (Dates due: January 15,
April 15, July 15, and October 15). Submit reports by e-mail to the Safety and Security Specialist
assigned to your area and courtesy copy to safetyptd@ncdot.gov.
Administrative Duties
Developing and implementing policies, procedures and regulations for Person Area
Transportation System. Designs and develops brochures, pamphlets and advertisements
containing PATS information for the general public. Responsible for keeping the PATS webpage
updated, and developing documents and forms to be used to ensure appropriate documentation
by the PATS office staff and drivers. Assist the Transit Manager in performing administrative
and technical work. Responsible for policy development, safety inspections, safety training and
compliance with NCDOT and Person County Government procedures, program development
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and planning, training, individual agency and system reporting developing and evaluating
transportation service provisions. Researches and gathers information as required for planning
purposes. Researches and gathers information required to assist the Transit Manager in the
preparation of grant applications.
Keeps Federally-funded equipment and facilities in good operating order by making sure
preventive and safety inspections on all vehicles on a regular basis is being performed. Must
keep records showing when periodic maintenance inspections have been conducted on vehicles
and equipment. Performs in house maintenance checks and arranges for repairs on vehicles and
sees that maintenance is completed in a timely manner on all vehicles; maintains maintenance
records
Performs ride checks - Performance evaluations on Transit Specialist annually
Responsible for vehicle cameras – each vehicle is equipped with 4 cameras (front view, driver
view, step view, wheelchair view) spot check each vehicle and transit specialist monthly.
Maintenance on the cameras is performed every 6 months by Michael Everhart.
Responsible for monitoring employees’ current drivers’ licenses, and at least annually, review
the drivers’ MVR records and determine if they have any convictions or violations that would
disqualify them from driving PATS vehicles. Fill out a driver evaluation form based on drivers’
MVR.
Responsible for monthly checks being performed on Transit Specialist and all safety sensitive
positions thru the Office of Inspector General (OIG) database.
Additional reordered keeping includes: Refresher Training – Monthly, Safety Meeting Report –
Monthly, Building and vehicle inspections – monthly.
Performs other duties assigned
Desirable Knowledge, Skills, and Abilities Preferred:
You will need considerable knowledge of public transportation system’s programs, services and
the ability to keep the documentation, reporting and recordkeeping associated with the
requirements that are mandated for compliance by the state, federal, and county government.
Ability to use personal computer with multiple screens and the different many software programs
related and associated to public transportation.
Be familiar with Safety Terms and Definitions
Accident – An unforeseen event or occurrence that results in death, injury, or
property damage
Hazard – Any real or potential condition that can cause injury, death or damage to
or loss of equipment or property.
Incident – An unforeseen event or occurrence which does not necessarily result in
death, injury, contact or property damage.
Risk – Probability of an accident multiplied by the consequences of an accident
Safety – Freedom from those conditions that can cause death, injury, occupational
illness, damage to or loss of equipment or property, or damage to
the environment
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Security – Precautions taken to guard against crime, attack, sabotage, espionage,
etc.
System Security – All activities associated with providing security to transit
patrons and securing transit property.
You will need considerable knowledge about OSHA, NCDOT/PTD, and Person County
Government’s rules, regulations, their practices, policies and procedures to stay in compliance.
Understanding of OSHA requirements –
o 29 CFR 1910.1030(g)(2) – Bloodborne Pathogens (Information and
training)
o 49 CFR 655.14, – Prevention of Alcohol Misuse and Prohibited Drug Use
in Transit Operations-Education and Training Programs
o 49 CFR 37.173 – Americans with Disabilities Act (ADA) – Training
requirements
Knowledge of preventive maintenance schedules and necessary repairs for vehicles and
willing to learn AssetWorks computer program that goes along with recordkeeping and
reports for NCDOT.
Have a working knowledge and understanding of the operation of the SEON camera
system, vMax computer program, equipment and maintenance for the program and
cameras.
Have the ability to establish and maintain an effective working relationship with the
employees, general public, human service agencies and diverse interest groups.
Need to be able to exercise customer service, and discretion when in contact with the
elderly, disabled, and general public.
Ability to organized and prioritize, when working on several projects at one time.
General knowledge of writing policies and procedures
Thorough knowledge of methods and techniques of employee training and development
and principles of course development.
Have the ability to establish and maintain effective working relationships as necessitated
by work assignments.
Ability to develop and present visual aids and other instructional materials on a variety of
subjects to meet specific training needs.
Considerable knowledge in video/media production procedures and practices.
Ability to design, organize and conduct safety and training programs to meet employee
development needs and effectively evaluate program results.
Ability to communicate clearly and concisely, orally and in writing
Be willing to work flexible and irregular schedules.
Desirable Training, Education and Experience:
Associate’s degree in from an accredited four-year college or university with major course work
in education, personnel, business, public administration, communications or a related field.
Considerable experience in organizational and instructional phases of employee development,
safety, and training programs.
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Must have considerable knowledge and experience in the operation of computers; dealing with
software and programs that are associated and related to this job.
Have the ability to do research for training, policies, rules, and procedures to stay in compliance
with OSHA, NCDOT/PTD, NCMMIS and Person County Government.
Considerable experience/knowledge in public transportation system (rules and regulations)
Certificate in Drug and Alcohol Reasonable Suspicion Training conducted in accordance with 49
CFR Part 655.14.
Special requirement: must possess and maintain a valid North Carolina driver’s license,
preferably a North Carolina commercial driver’s license (CDL), and must have a clean driving
record.
Transit Manager / Title VI Coordinator / Accountable Executive
General Statement of Duties:
Responsible for grant administration, program development and planning, training, individual
agency and system reporting, and motor fleet management and maintenance for transportation
system. Responsible for personnel issues and resolving complaints.
Major Responsibilities:
Manages and administers the human service agency, subscription routes, demand response
routes, and fixed route (Uptown shuttle) transportation programs. Manages and approves the
Scheduling of passengers, routes and drivers.
Completes and sends in designated state and/or federal monthly, quarterly statistical reports.
Orders vehicles from NCDOT contracted agency with the specifications and/or equipment
requirements in conjunction with appropriate state agency.
Prepares and updates annual administrative capital and budgets.
Prepares Community Transportation Program (CTP) and ROAP grant applications annually.
Monitors budget expenditures and recommends appropriate actions to assure that established
budgets are followed.
Monitors vehicle utilization through a uniform reporting process.
Provides technical assistance to participating agencies with respect to route and schedule
development.
Maintains active working relationship with local service providers (public or private) to ensure
coordination among participating agencies.
Communicates with participating agencies on a regular basis as the Person Area Transportation,
liaison to the Transportation Advisory Board.
Attend training workshops that are required by NCDOT.
Advertises for, interviews, and recommends employment of qualified personnel.
Supervises and evaluates personnel employees of Person Area Transportation System.
Responsible for billing and collection of fees for services.
Responsible for turning in reimbursements to NCDOT.
Monitors policies and procedures for the drivers to follow regarding transportation for clients
and vehicle emergencies that meet all applicable federal, state, local, and program standards and
guidelines.
Prepares Transportation Board agendas and board information package/reports.
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Is the Accountable Executive for PATS
Is the Title VI Coordinator for PATS
Performs other duties assigned.
Knowledge, Skills, and Abilities:
General knowledge of office practice and procedure.
Ability to plan, direct, coordinates, and supervises.
Ability to use judgment in organizing and establishing format.
Ability to gather and draft materials from a variety of sources.
Ability to understand federal, state, and county policies and procedures, rules and
regulations concerning transportation and general county operations.
General knowledge of budgeting concepts and grant writing.
Working knowledge of computers and spreadsheet programs.
Understanding of OSHA requirements.
Typing is desirable.
Must possess a valid NC driver’s license, preferably a NC Commercial Driver’s license (CDL)
clean driving record, defensive driving training
Certified in CPR, and first-aid
Drug and Alcohol Reasonable suspicion training certificate in accordance with 49 CFR Part
655.14
Education and Experience:
Associate’s degree in business administration, social work or human services, or a related field
with at least two years’ experience in planning, management, or supervisory work and a
demonstrated knowledge of the required duties of the position; or an equivalent combination of
related course work, experience and training.
C. System for Monitoring Employees’ Current Employment Status, Driver
Licenses, Certifications, and other driver qualifications (Reference: 49 CFR,
Parts 383 and 391 Records Retention and Disposition Schedule, Standrd-15-Perssonnel
Records, Item 29 and 29 CFR 162.3)
The Transit Manager performs background checks on all potential employees through Safety-
WORKS who go through the National Crime Information Center (NCIC) upon hiring and must be
completed every 5 years in order to maintain compliance with state requirements. Person County
requirements for background checks are annually and PATS must maintain compliance with all
county contracts. PATS perform background checks annually.
Criminal Background Checks
(Reference: NCGS 114-19.6 Criminal History Record check, 49 CFR, Part 391 and TSA/FTA Security
and Emergency Management Action Items for Transit Agencies; Management and Accountability)
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Upon hiring the employee, background checks must be completed every 5 years in order
to maintain compliance with state requirements. (County requirements for background
checks are annually and Person Area Transportation System must maintain compliance
with all county contracts.)
North Carolina requires Person Area Transportation System to perform background
checks on all potential employees through the National Crime Information Center
(NCIC)
In addition to a standard background check, North Carolina requires Person Area
Transportation System to perform fingerprint-based criminal background checks on all
employee candidates who have resided in North Carolina for less than 5 years prior to the
application submission date.
Conviction, quality plea, or plea of no contest to any of the crimes listed in
Transportation Policy within the 10-year period preceding the date of the background
check is grounds for disqualification from employment.
o Murder
o Rape or aggravated sexual abuse
o Kidnapping or hostage taking
o Assault inflicting serious bodily injury
o A federal crime of terrorism
o Unlawful possession, use, sale, distribution, or manufacture of an
explosive device
o Unlawful possession, use, sale, distribution, or manufacture of a weapon
o Elder abuse/exploitation
o Child abuse/neglect
o Illegal sale or possession of a Schedule I or II controlled substance
o Conspiracy to commit any of the above.
The Safety/Training Officer is responsible for monitoring employees’ current employment status,
Employee driver licenses, certifications, and other relevant qualifications. All documentation will be
securely filed in the Employees File, located in the Safety/ Training Officer’s office.
Annually the NC Motor Vehicle Record (MVR) is reviewed, printed and filed. It is
determined if they have any convictions or violations that would disqualify them from
driving a PATS’ vehicle. The driver evaluation form based on drivers’ motor vehicle record
is attached in Appendix C.
Annually the employee’s driver license will be copied, dated and filed
Monthly A Federal Exclusion List Check will be checked, printed and filed
Federal Exclusion List Checks: The Office of Inspector General (OIG)
Person Area Transportation System is required to run an OIG check upon hiring an
employee. Because the exclusion list is updated monthly, Person Area Transportation
System is required to run OIG checks on all employees monthly.
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Annual Motor Vehicle Record Review(s) are conducted on all drives
North Carolina Department of Transportation Division of Motor Vehicles (MVR)
(Reference: 49 CFR, Part 391 and TSA/FTA Security and Emergency Management Action Item
for Transit Agencies; Management and Accountability)
Disclosure Form: In addition to having a valid driver license or commercial driver license
the driver must sign a disclosure form before they can be added to the system. When
signed, this form gives PATS permission to view the driver’s record.
Person Area Transportation System is required to run a MVR check upon hire and
annually.
Annually review an employee’s driver license history to monitor occurrences of
convictions, suspensions, disqualifications or cancellations a driver may receive.
Transit Manager will receive a correspondence when a conviction has been posted to an
employee’s record.
License Check: Annually (April 1st) the Safety/Training Officer verifies the driver’s driver license
(Reference: Minimum Training Standards for community and Human Service Transportation Vehicle Operators)
A dated copy of the driver’s driver license will be placed in their employee’s file in
the Safety/Training Officer’s office
Check license for correct information: NC, Name, Address, class, restrictions,
endorsements, DOB and expiration date
The following constitute grounds for disqualification of a driver:
1. A driver is disqualified and will be terminated for the loss of his / her North Carolina
Driver’s License for any reason.
2. Disqualification for criminal offences, including:
A. Operating a motor vehicle under the influence of alcohol, or a controlled substance
such as an amphetamine, a narcotic drug, a derivative of a narcotic drug or any
impairing substance anytime on or off duty.
B. Transportation, possession, or unlawful use of a controlled substance,
amphetamines, narcotic drugs, formulations of an amphetamine, derivative of
narcotic drugs or any impairing substance at anytime on or off duty.
C. Leaving the scene of an accident.
D. Conviction of a felony.
*If any of the above occurs to any PATS employee, they must inform Transit Manager
immediately.
Safety/Training Officer
Employee Files include:
MVR Disclosure Form – upon hire
Current Motor Vehicle Report (MVR) – upon hire and annually
Copy of driver’s license – upon hire and annually
Copy of Office of the Inspector General monthly exclusion list check (OIG) –upon hire
and monthly
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Behind the Wheel – during training
Ride Check Evaluations – must be completed upon hire and annually
(Reference: Minimum training Standards for Community and Human Service
Transportation Vehicle Operators)
The Safety/Training Officer tracks employees’ current employment status and the expiration
dates of their drivers’ licenses in the table below. The Safety/Training Officer maintains
documentation that all drivers and dispatcher have valid operator’s licenses in their employee file
in the Safety/Training Officer’s office.
Drivers’ Employment Status and License Expiration Dates
Employee Name / ID #
Employment Status
(Full or Part Time)
License Expiration
Date
Katherine Coates Adcock/ #2543 F/T Transit Manager 12/25/2020
Joy Catrett Bell / # 620 P/T Transit Specialist 8/11/2024
Tasha Drumwright Bradsher / 627 P/T Transit Specialist 03/02/2025
Chandler Franklin Clayton / 288 F/T Transit Specialist 08/14/2017
Matthew Donald Crane / #114 F/T Transit Specialist 03/04/2021
Douglas Elbert Dickerson / #2530 F/T Transit Specialist 12/17/2019
Karen Harris Dixon / #217 F/T Transit Specialist 11/10/2018
Robert Wilson Dunn / #2784 P/T Transit Specialist 01/16/2019
Gregory Mark Ellis / #1648 F/T Transit Specialist 07/30/2017
Tina Bryant Haden / #621 P/T Transit Specialist 10/31/2021
Patricia Holmes / #628 P/T Transit Specialist 4/22/2018
Bradley Scott Isackson / #622 P/T Transit Specialist 07/08/2023
Henry Ephraim Johnson / #287 P/T Transit Specialist 11/04/2019
Mona Lisa Johnson / #360 P/T Transit Specialist 11/01/2021
Rhonda Satterfield Long / #1524 F/T Senior Admin Support Assist 11/21/2024
Thomas John McCormick / #2628 F/T Transit Specialist 7/27/2019
Coy Bernard Obie / #2521 P/T Transit Specialist 10/31/2020
Edwin Sims Outlaw / #1832 F/T Transit Specialist 12/31/2018
John Ervin Pulliam / #359 P/T Transit Specialist 02/24/2018
Valerie Varnette Thorpe / #551 P/T Transit Specialist 12/21/2022
Elizabeth Louise Willamson / 358 P/T Clerk/Dispatcher 7/18/2019
Luella Harrison Winstead / #554 P/T Transit Specialist 06/23/2023
...See the next section for training procedures once drivers are hired
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Driver/Employee Training
A. Training Program for Drivers and Other Safety Sensitive Employees
The mission of the North Carolina Department of Transportation is “Connecting people and
places in North Carolina – safely and efficiently, with accountability and environmental
sensitivity.” Person Area Transportation System will meet all federal and state guidelines,
regulations and laws regarding the safe transportation of our passengers. Pats will follow
NCDOT-PTD’s Policy Guidance for Minimum Training Standards for Community and
Human Service Transportation System Vehicle Operators (effective May 23, 2014), which
are outlined below.
The Safety/Training Officer should contact the NCDOT-PTD regional safety and security
specialist with any questions concerning this policy.
Source Documents:
1. Federal Transit Administration (FTA) Circular 9040.1F “Non-Urbanized Area Formula
Program Guidance and Grant Application Instructions: effective April 1, 2007, Section X
(see 49 U.S.C. Chapter 53-Section 5329: Investigation of Safety Hazards)
2. 29 CFR 1910.1030(g)(2)-Bloodborne pathogens-Information and Training
3. 49 CFR 655.14-Prevention of Alcohol Misuse and Prohibited Drug Use in Transit
Operations-Education and Training Programs
4. 49 CFR 37.173-Americans with Disabilities Act-Training requirements
5. NCGS Statute 95 and Department of Labor Guidance
1. Defensive Driving
Shall include all vehicle operators, including any employees that operate the
vehicles in revenue service or carry passengers for any other trip purpose;
Initial training must be a certified program, or curriculum must be equal to an
existing certified program.
Training must be completed upon hire and annually.
Section 2
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2. Americans with Disabilities Act (ADA)
Shall include at a minimum the following training ( for further guidance refer to
49 CFR Part 37—Transportation Services for Individuals with Disabilities (ADA)
Sensitivity training
Passenger assistance
Wheelchair handling
Wheelchair securement ( passenger and mobility)
Wheelchair lift inspection
Wheelchair lift operation ( normal and emergency)
ADA requires training all personnel to “proficiency,” which is defined as expert
performance.
Training must be completed upon hire and annually.
3. Bloodborne Pathogens
Shall follow the Occupational Safety and Health Administration guidelines for the
training as listed in Standard 29 CFR 1910.1030(g)(2)
The OSHA Standard spells out the content of the training.
Training must be completed upon hire and annually.
4. Emergency Procedures
Shall include all procedures required to report or react to an emergency by transit
system staff:
Communication and notification procedures
Accident/Incident reporting procedures
Passenger handling procedures
Vehicle and facility evacuation procedures
Driver and passenger security training
Emergency evacuation procedures and training
Emergency equipment usage
First aid – drivers must be trained in first aid to include use of kit;
Bloodborne Pathogens – drivers must be trained in bloodborne
pathogens to include use of kit and transit system specific
engineering controls to minimize driver exposure, cleanup
procedures and waste disposal;
Emergency triangles – drivers must be trained to properly setup
equipment;
Fire extinguishers – drivers must be trained to properly inspect
and use equipment;
Web cutter – drivers must be trained to properly use equipment;
Reflective vest will be worn by drivers when performing job
functions.
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Participation in local or regional Emergency Management drills is strongly
encouraged.
Training must be completed upon hire and annually.
5. Ride Check – Driver Evaluations
Newly hired drivers must have a Ride Check – Driver Evaluation before being
allowed to operate a transit vehicle unsupervised in revenue service.
All drivers must have an annual evaluation to assess the driver’s performance of
techniques, skills and knowledge gained through training of each of the above
categories.
Remedial training will be provided as needed in addition to the required annual
training.
Training must be completed upon hire and annually.
6. Illegal Drug Use
Shall include all training on the effects and consequences of prohibited drug use
on personal health, safety, and the work environment, and on the signs and
symptoms that may indicate prohibited drug use.
This shall be done upon hire. (Required under 49 CFR 655.14)
7. General
All new hires must complete all of the minimum training requirements
before operating a transit vehicle unsupervised in revenue service.
Reflective vest will be worn by drivers when performing job functions.
Drivers that are not meeting proficiency, expert performance level, must be given
remedial training until they are proficient.
Refresher (annual) training must be completed annually (within 1 year of last
training date).
All of the training materials and documentation must be on file for review by the
NCDOT-PTD. Materials shall include but not be limited to course outline ( may
be included in instructor’s manual), instructor’s manual, sample student manual
(if one is used), handouts and copy of Power Point slides if used in lieu of
instructor’s manual.
Records of qualifications and training performed (for each individual trained)
must be kept on file for a minimum of five (5) years. Records shall include proof
of attendance (roster or certificate of completion, if provided), date of the course
and type of instruction delivery (instructor led, self-instruction, etc.), name and
certification (if applicable) of instructor.
8. Minimum Training Standards Reporting Procedures
Grantees must submit the following to the Safety and Training Unit:
Number of employees who received training by category/type
A spreadsheet will be provided by the Safety and Security Unit for the purposes of
reporting training.
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The report must be submitted no later than the fifteenth (15th) day of the month
following the end of the quarter (Dates due: January 15, April 15, July 15 and
October 15).
Submit reports by e-mail to the Safety and Security Specialist assigned to your
area and courtesy copy to safetyptd@ncdot.gov
All new hires must have all of the minimum training requirements completed as soon as
possible, but no later than 90 days of hire. New hires must complete Defensive Driving and
ADA training prior to starting revenue service.
B. Training Materials
PATS will provide comprehensive driver’s training through various mediums, including training
manuals, DVDs, and on-the-road sessions. All of the training materials must be on file for
review by the NCDOT-PTD.
Training materials shall include, but not be limited to:
Course outline (may be included in instructor’s manual),
Instructor’s manual,
Sample student manual (if one is used),
Handouts, and
Copy of Power Point slides, if used in lieu of instructor’s manual.
Initial Training Procedures:
The following subjects will be covered and trainees will demonstrate expertise in:
Agency Policies and Procedures
Policy and Procedures Manual
Personnel Policy Manual
Scheduling
Radio Procedures
Office and Paperwork Requirements
Federal and State Guidelines and Regulations:
Drug and Alcohol Program
Bloodborne Pathogens
ADA Requirements
Other Federal and State Requirements
Pre and Post Trip Safety Inspection
Training will be conducted on proper pre and post trip safety inspections as shown later in this manual.
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Vehicle Familiarization:
New employees will be given a complete familiarization of the vehicle including engine compartment, all
driver controls, emergency equipment and passenger safety devices.
Basic Operations and Maneuvering
Training will include starting, stopping, left and right turns, and parking.
Special Driving Conditions:
Interstate –
Proper procedures for entering and exiting Interstate or other limited access highways will be
covered.
Intersections –
Procedures for safety negotiating intersections of all types will be covered.
Railroad Crossing –
Person Area Transportation System’s vehicles will stop at all railroad crossing, the front door will
be opened (if they are in a van windows must be down) and both directions will be carefully
checked for trains. In the case of multiple tracks, vehicles will not proceed until all tracks can be
verified as clear. Special caution will be exercised at unguarded crossings.
Backing –
Backing is prohibited unless absolutely necessary. When backing is necessary, it is only to be done
with a spotter or guide.
Bad Weather –
New employees will be trained in operating in adverse weather conditions as shown in the
Emergency Driving Procedures section.
Boarding and Alighting Passengers –
Proper procedures for boarding and alighting passengers’ safety will be covered. This includes
stopping, starting, bus stops, special situations and hazardous conditions on steps or outside the
vehicle.
Defensive Driving –
Person Area Transportation System drivers spend the majority of their work time on the road,
which places them at a high risk of being involved in an accident. New Hires will be trained in the
best defense from being involved in an accident, and to drive defensively.
Passenger Assistance –
All New Hires will be trained on how to operate wheelchair lift, ramps, assisting disabled persons.
They will receive specialized training and on safe and proper techniques prior to offering such
assistance. The drivers will also be trained to be prepared to deal with mechanical failures of lifts
or other emergencies that may arise.
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Behind the Wheel Training –
All trainees shall complete an on the road training program that shall cover all aspects of driving
duties. Due to varying levels of expertise and experience, the program will be adapted to the
training needs of the trainee. After initial training, the new driver will be assigned to an
experienced driver for continued orientation and observation. Only when the driver is deemed to
be fully trained will he or she be permitted to operate a vehicle in regular service. Appendix F.
C. Refresher Training
Refresher training must be done annually for most of the topics listed in the Training Program,
except for First Aid, the refresher training for which may be completed every two years. PATS
will generally provide refresher training on different topics monthly, and will send employees to
attend additional trainings provided by NCDOT or other certified programs as needed. PATS
will have an ongoing refresher training program to:
1. Improve employees’ skills, attitudes, and apply methods to increase existing
performance standards.
2. Assist employees in becoming familiar with new equipment, technology, and
operations to be introduced into the system.
3. Provide an ongoing safety training reports monthly and through employee staff
meetings, which are mandatory. Employees who have unexcused absences from
staff meetings may face disciplinary action. Any employee who is absent from a
staff meeting must provide the Transit Manager or safety/training officers with a
written statement detailing why he or she was absent.
4. Supply employees with adequate training to perform the job of Transit Specialist.
5. Ensure that all drivers are trained in accordance with NCDOT PTD guidelines.
2 The Point Training (START – Safety Training & Rural Transit) is used for refresher training
monthly; employees will review applicable policies and training materials and are quizzed on
their knowledge of each topic.
July – ADA and Sensitivity (Issue: One – Five)
August – Bloodborne Pathogens (Issue: One – Five)
September – Customer Service (Issue: One – Six)
October – Defensive Driving (Issue: One – Four)
November – Defensive Driving (Issue: Five – Ten)
December – Defensive Driving (Issue: Eleven – Thirteen)
January – Distractive Driving (Issue: One – Three)
February – Safety and Security (Issue: One – Ten)
March – Drugs and Alcohol (Issue: One – Seven)
April – Emergency Management (Issue: One – Seven)
May – Transporting Non-Ambulatory Passengers (Issue: One – Seven)
June – Passenger Safety (Issue: One – Three)
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D. Records of Training Performed
Records of qualifications and training performed (for each individual trained) must be kept on
file for a minimum of five (5) years.
Records shall include:
Proof of attendance (roster or certificate of completion, if provided),
Date of the course,
Type of instruction delivery (instructor led, self-instruction, one-on-one coaching,
etc.), and
Name and certification (if applicable) of instructor.
As shown in Appendix D, a New Hire Training Log and an Annual Refresher Training Log will
be recorded for each employee and filed in the Driver’s training records located in the
Safety/training officer’s office.
In addition, the Safety/Training Officer should maintain an annual spreadsheet matrix of all
employees and the trainings they have undergone, in order to track the required refresher trainings.
A perennial Fiscal year Refresher Training At A Glance Calendar will be maintain with training
topics and drivers name and dates they completed the topic to submit quarterly to the Transit
Manager.
E. Evaluating Driver Performance
The Safety/Training Officer or Lead Driver will periodically (at least annually) evaluate each
driver’s performance of the techniques, skills, and knowledge required under each of the training
topics.
1. A Ride Check Evaluation due not less than annually.
2. Behind the Wheel Training is the first evaluation and is due before the driver operates a
vehicle unsupervised in revenue service
3. A ride check Evaluation is the second evaluation and should be accomplished on or near
their hiring date which will serve as their annual evaluation.
New employees require three evaluations within the first year of employment. Periodic or
special performance evaluations are subject to determination by competent authority, such as the
Transit Manager.
The Transit Manager will periodically do a Performance Review and Development System
evaluation on each PATS employee. The Transit Manager will complete a Performance Review
and Development System evaluation on each PATS employee on their anniversary date
(annually). The Transit Manager and the employee will sign and date the Performance Review
and Development System evaluation in the appropriate places after personally reviewing it with
him/her. The employee may attach comments to explain or clarify any points made in the
review. It will then be sent to Human Resources and a copy will be filed in the employee’s
personnel record in a confidential manner.
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Performance Review and Development System evaluation results may be used as the basis for
promotion, salary actions, demotions, suspensions, dismissals, and other actions. All
performance appraisals are maintained in a secure manner.
F. Remedial Training
The Safety/Training officer that conducts the driver ride check evaluations will note areas where
the driver has not achieved “proficiency”, which is defined as expert performance. The
Safety/Training Officer will discuss the evaluation results with the Transit Manager. They will
then discuss findings with the employee, and together they will plan out a course of action to
address areas for improvement. Remedial training will be provided as needed, in addition to
scheduled trainings.
The PATS office, utilizing various mediums including training manuals, DVDs, on-the-road
sessions, and videos (1 day training)
Vehicle Safety Training – 2.5 hours
Driver Safety Training – 2.5 hours
Passenger Safety Training – 3 hours
After the driver has completed the necessary remedial training, the Safety/Training Officer will
perform another driver ride check evaluation to determine if the driver has achieved proficiency
in the techniques, skills, and knowledge required under the training topics. If the Transit
Manager deems it necessary, the driver may or may not be required to undergo additional
remedial training.
As with any other training, records of remedial training will be filed in the employee’s training
record in a confidential manner.
G. Training Curriculums and Schedules
All employees will undergo the required NCDOT-PTD trainings upon hire. The Safety/Training
Officer will manage training curriculums / lessons plans to support in-house training courses, and
update the curriculums as necessary. Both visual and audio materials (i.e., presentations,
handouts, training videotapes) may be utilized to carry out curriculums. Training will also
include one-on-one coaching and hands on to ensure that drivers are proficient in the use of
safety equipment and safe practices, and to develop uniformity in operating practices among
drivers and dispatcher. Individual coaching may also be used to improve driving skills.
Safety/Training officer Training records include:
Training Log
o New Hire Training Log
o Annual Refresher Training Log
Training
o New Hire test/quiz and certificates
o Annual test/quiz and certificates
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This section describes the topics that should be addressed but not limited to the training
curriculums to meet NCDOT-PTD’s Minimum Training Standards for Community and Human
Service Transportation System Vehicle Operators.
The content of the training curriculums is:
Vehicle Safety
The transit driver alone is responsible for assessing the safety of their vehicle before, during, and
after regular service. The Transit driver must carefully pre-trip (safety inspect) their vehicle
before beginning service, carefully monitor the vehicle once in service, and post-trip (safety
inspect) the vehicle at the end of the service.
Vehicle safety outlines procedures for the important pre-trip, en route, and post-trip vehicle
safety inspections. While PATS vehicles or lift equipment may vary from those shown in the
materials, the inspection procedures are not product-specific and should complement our
manufactures’ training materials.
Source: (START) Safety Training & Rural Transit- (Learners guide and powerpoint)
Driver Safety
As a professional, transit drivers are expected to drive in a defensive manner every moment of
every day. They are expected to “prevent accidents” regardless of the actions of other drivers,
pedestrians, passengers, distractions, weather, or road conditions.
Driver safety covers the basics of safe driving, including: everyday hazards, standard safety
practices, coping with adverse driving conditions, and other important aspects of driver safety.
Source: (START) Safety Training & Rural Transit (Learners guide and powerpoint)
Passenger Safety
As a community transit professional, drivers must be aware of the safety of the passenger when
boarding, riding, and unloading – in normal and emergency situation. This includes ambulatory
passengers and special needs passengers such as the elderly, children, and the mobility impaired.
Passenger safety reviews procedures for safely picking up and dropping off ambulatory and non-
ambulatory passengers, securing mobility devices such as scooters and wheelchairs, handling
difficult and dangerous passengers, security awareness, vehicle evacuation and other emergency
situations, and skill for interacting with passengers to make every trip easier, safer and more
secure.
Source: (START) Safety Training & Rural Transit (Learners guide and powerpoint)
Defensive Driving
The job of a transit driver is primarily that of driving safely and courteously. Driving defensively
to prevent accidents reduces insurance and claim cost and ensures on-time delivery of
transportation services to the public.
Defensive driving is being constantly alert to accident hazards and a voiding those hazards. The
most important factor in defensive driving is YOU!!! Your defensive driving tools are:
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1. Your physical ability to spot a hazard, maneuvers the vehicle away from it, and warns others
of it.
2. Your knowledge of driving hazards and how to spot them
A. Your knowledge of the safety zone and how to maintain it.
B. Your knowledge of the rules of the road
C. Your knowledge of the vehicle’s equipment
D. Your skill maneuvering the vehicle.
3. Drivers with good defensive driving attitudes:
a. Leave personal problems at home.
b. Are Rested and alert.
c. Avoid the use of alcohol and drugs
d. Are physically and mentally healthy.
Source: Appendix G- (Training Curriculum, Powerpoint: Defensive Driver Overview North
Carolina Association of County Commissioners)
Pedestrian Awareness –
Key Learning Points
According to research, there are four situations that account for the majority of all
bus and pedestrian collisions. They include, turning right at intersections, turning left
at intersections, pulling into a stop and pulling away from a stop.
You will learn who’s at risk, what goes wrong and what you can do to prevent
pedestrian collisions.
It’s important to always Rock and Roll in your seat when making turns, so you can
detect pedestrians in your blind spots.
Source: TAPTCO Transit and Paratransit Company (Operator Study Guide, DVD)
Distractive Driving
The Growing Epidemic of cell phone use while driving introduces National Safety Council
recommendations on distracted driving, with an emphasis on cell phones, PDAs and other wireless
mobile devices. Specific topics include the concept of distracted driving, the dangers of using a cell
phone while driving, how cell phone-related distractions affect drivers and safety tips to prevent
distracted driving. During the training, participants also will have an opportunity to take a short
assessment to determine their own exposure to distractions.
Source: National Safety Council – Making our World Safer– (The Growing Epidemic of Cell
phone use while Driving-participant guide, power point)
Americans with Disabilities Act (49 CFR 37.173)
ADA requires training all personnel to “proficiency”, which is defined as expert performance.
This type of training shall include at a minimum the following training:
Sensitivity Training
Passenger assistance
Wheelchair handling
Wheelchair securement (passenger and mobility)
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Wheelchair lift inspections
Wheelchair lift operation (normal and emergency)
The goal of any transportation system is to transport their passengers from the pick-up point to
the drop-off point in the safest and most efficient manner possible. Our goal for this training is to
ensure that drivers thoroughly understand the principles of correct wheelchair and occupant
securement and are able to demonstrate their knowledge and ability in an effort to meet the
overall transportation goal.
Source:
1. Your Rights Under Title VI of the Civil Rights Act of 1964 (brochure)
2. ADA Guide for Rural Demand-Response Transportation Service Providers (Easter Seals)
3. Doing It Right – A guide to the proper use of Sure-Lok Wheelchair Securement and
Occupant Restraint systems (Workbook for Trainees and DVD)
4. The QRTMAX – To assist you to safely and properly use the Q’Straint wheelchair and
occupant securement system. (Workbook for trainees and DVD)
5. Video – Oxygen Securement
6. The Braun Corporation “Providing Access to the World.” Public use wheelchair lift
operational video
7. Hands on training using a wheelchair and wheelchair securement and occupant restraint
systems on the PATS vehicles.
Training must be completed upon hire and annually.
Bloodborne Pathogens
Person Area Transportation System will follow the Occupational Safety and Health
Administration guidelines for the training as listed in Standard 29 CFR 1910.1030(g)(2)(vii)
Source:
OSHA’s Bloodborne Pathogens Standard – AFSCME Health & Safety Fact Sheet
Bloodborne Pathogen Awareness For Transit Professionals – Your Ticket to Safety
(Handbook and video). This handbook and video tape provides a personal and ready
reference regarding Bloodborne pathogens for public transit system personnel, including
managers, drivers, mechanics, other employees and service providers.
Hands on training – How to clean up a spill properly, and remove gloves without
spreading germs or getting liquid on bare skin.(Hand-Outs: Removing Disposable Gloves
and Preventing the spread of Bloodborne Pathogens -National Red Cross)
Bloodborne Pathogens: Questions & Answers (Questions are provided to check how well
you understand the information presented during this training.)
Training must be completed upon hire and annually
Illegal Drug Use
This training follows the requirements of FTA’s drug and alcohol regulations, rules, and notices,
found at 49 CFR Parts 655 (Prevention of Alcohol Misuse and Prohibited Drug Use in Transit
Operations) and 40 (Procedures for Transportation Workplace Drug and Alcohol Testing
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Programs).1 PATS’ illegal drug use training reviews the effects and consequences of prohibited
drug use on personal health, safety, and the work environment, as well as the signs and
symptoms that may indicate prohibited drug use.
Source:
Office of Drug & Alcohol Policy & Compliance – What Employees Need To Know
About DOT Drug & Alcohol Testing (Handbook)
CD – Alcohol & Drug Testing Driver Awareness Training
The Truth About Drugs – Real People-Real Stories-A Documentary
o Handbook-covers drug facts and figures about the drug problem and
culture, what drugs do to the mind and body, why people take drugs, the
truth about specific drugs and drug prevention activities anyone can do.
o DVD-The Truth About Drugs Documentary Film
o drugfreeworld.org
Sign off sheet confirming that they viewed all videos listed and in compliance with 49
CFR 655.14(b)(1)
Training shall be done upon hire
Customer Driven Service
Focuses on how providing excellent customer service, it teaches transit employees how
customers come to form opinions of their organization, to know what constitutes excellent
customer service and to be aware of the unique needs and expectations of different riders.
The four core units of this training are:
The Keys to Customer Service: The Big Picture
Customer Service in Action: Creating a Culture of Customer Service
Taking Care of Your Customers
Customer Service Breakdowns
Source: National RTAP (Learner’s Guide and PowerPoint)
Problem Passengers Challenging Situations –
Managing Problem Passengers & Difficult Situations
(Workbook and Video)
Customer Management Techniques
Managing Angry Behavior
Handling Refusals
Dealing With Threats
Dealing With Human Needs Situations
Source: National RTAP
1 These regulations may be reviewed in their entirety at the FTA website, http://transit-
safety.fta.dot.gov/DrugAndAlcohol/Regulations/Regulations/default.asp.
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System Security Awareness
The goal of this training is to provide drivers with the skills and knowledge to:
Define their role and responsibility in system security.
Recognize suspicious people, activities, packages, devices and substances
Observe and report relevant information
Minimize harm to themselves and others
Course Outline
What is System Security?
What is Your Role in Reducing Vulnerability?
What do You Look For?
What about Anthrax and Other Suspicious Substances?
What is Your to Priority?
System Security Awareness for Transit Employees Warning Signs
(DVD and Student Guide)
The Mark – DVD – National Transit Institute
Source: National Transit Institute- Workplace Safety and Security program
Emergency Procedures for Rural Transit Drivers
Transit drivers must understand how to respond to emergency situations so they are able to take
action to save lives and personal property during times of crisis.
This training program is to help you anticipate, prepare for and respond to emergency situations.
As a professional driver, you should be prepared for all emergency situations including:
Vehicle collisions (accidents)
Passenger falls and illnesses (incidents)
Severe Weather conditions (acts of nature)
Chemical spills inside or outside your vehicle (hazardous materials)
Mechanical breakdowns (critical infrastructure)
Unruly passengers (can escalate to criminal activity)
A bombing or bomb threat (terrorism)
Emergency Equipment that must be on-board the vehicle includes:
First Aid Kit (stocked) – Drivers must be trained in first aid to include use of kit
Biohazard Kit (stocked) –Drivers must be trained in bloodborne pathogens to include use
of kit
Fire Extinguisher (Charged and secure) – Drivers must be trained to properly inspect and
use equipment (County provides on hands training to new hires)
Three emergency triangles – Drivers must be trained to properly setup equipment
Seatbelt cutter within reach of the driver while seated – Drivers must be trained to
properly use equipment
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Tips Regarding On-board Illness
Motion Sickness & Heart Attack
Seizures
Signs of possible stroke
Seven Steps of Crisis Management
Passenger Triage – Triage is a process of prioritizing care for passenger based on the severity of
their condition. It is a means of taking inventory of who needs attention immediately and who
can wait. Just like other emergencies, you can follow the Seven Steps of Crisis Management to
assist in triage situations.
1. Protect Yourself
2. Assess the Situation
3. Notify Dispatcher/Request Aid
4. Protect Others
5. Secure the vehicle
6. Gather Incident Information
7. Complete Post-Incident Reports
Source: RTAP (Powerpoint and Learner’s guide)
Scheduling and Dispatching – Training Package for Rural Transit Systems (RTP)
The training package includes a CD and a participant workbook, and is designed to be self-paced
and completed on an individual basis. The training program can also be integrated into a
Learning Management System or into classroom instruction. The self-paced training program
will result in approximately three (3) hours of instruction. Tracking features allow the
Safety/Training officer to track employee training program status, including completed modules
and successful completion of the final assessment.
This training program provides an introduction to the roles and responsibilities of a scheduler or
dispatcher in a rural transit agency while recognizing that every agency has policies and
procedures to guide scheduling and dispatching. Schedulers and dispatchers will need to become
familiar with the particulars of their transit agency. This program, along with comprehensive
understanding of the individual agency, will provide schedulers and dispatchers the knowledge
framework for success.
The training consists of seven modules, each focusing on a specific topic:
The Role of the Scheduler describes the scheduler’s role and responsibilities within the
transit system, introduces the basic concepts of both fixed route and demand-response
scheduling, explores factors that influence scheduling, and provides general knowledge
concerning customer information, reservations, scheduling, and cancellations.
The Role of the Dispatcher describes the dispatcher’s role and responsibilities within
the transit system related to system coordination, communications, and recording data,
explores factors that influence dispatching, and provides guidelines on professional radio
use and message transmission.
The Role of ITS Technologies in Scheduling and Dispatching introduces core
technologies that enhance rural transit scheduling and dispatching, describes the impact
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that ITS technologies have on rural transit operations, identifies factors to consider when
implementing new technology, and details the keys for successful implementation of new
technologies.
Working in a Transit Environment explores concepts critical for effective
communicate on, coordination and cooperation among agency employees. It provides a
definition of diversity and explores common barriers to valuing diversity, identifies
strategies for creating a friendly work environment, explains actions that build a team
environment, describes the process of problem solving and decision making, and
examines the cycle of communication.
Providing Quality Customer Service focuses on the professional skills necessary to
meet the customer’s service expectations. It discusses the customer’s service
expectations, explains the eight “C’s” of customer service, demonstrates techniques to
project a positive image and communicate positive messages, details professional
telephone skills, identifies appropriate methods for resolving complaints, and describes
strategies for dealing with difficult customers.
Responding to Transit Incidents prepares the scheduler and dispatcher for the
challenges that arise during an incident. The module lists key players and their roles in
managing an incident, identifies immediate actions that can be taken to control an
incident and discusses procedures to aid in the response to incidents that occur.
Maintaining Your Energy through Healthy Habits focuses on the essential health
topics that promote physical and mental well-being. It teaches how to recognize
symptoms of stress and fatigue, provides guidelines to reduce the impact of stressors,
provides techniques to develop healthy sleep, nutrition, and exercise patterns, and
discusses how an action plan can encourage long-term lifestyle changes.
PATS Operations Policies
In addition to NCDOT-PTD’s minimum training requirements, all PATS employees will also
receive training regarding PATS operations policies. This training will help employees
understand their roles in daily operations and the procedures for specific circumstances.
Training on PATS operations policies may include, but are not limited to:
Organizational structure
Customer relations techniques (i.e., answering phones, being friendly)
Proper operation of communication equipment (i.e., cell phones)
Scheduling and dispatch functions
Cash management (i.e., fare collection and verification with driver manifests)
Personnel issues
Maintenance
Continuity of operations
Planning
Coordination
Title VI.
Key Control
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PATS have policies and/or procedures for all these operational topics, which will be reviewed in
the training for employees.
H. Process to Identify Trainers
The PATS Transit Manager or Senior Administrative Support Assistant will work with NCDOT-
PTD to identify trainers. The trainer must be knowledgeable about the training topics and have
access to training materials; trainers should be certified as required by FTA or NCDOT-PTD.2
In many instances, the Transit Manager or Senior Administrative Support Assistant may act as
the trainer, or NCDOT-PTD may provide a trainer or organize a training session to review
relevant updates to training topics. PATS may also choose to send drivers to trainings held by
third parties, such as the Institute for Transportation Research and Education (ITRE) at North
Carolina State University. Appendix H includes a list of current qualified trainers or instructors
that PATS may use for trainings.
I. Standards for On-The-Job Training Evaluation
PATS Transit Manager implements standards and policies pertaining to the conduct of on-the-
job training (OJT). Personnel who are designated by the Transit Manager and are trained in the
particular topic and appropriate instructional techniques peculiar to OJT conduct and evaluate
OJT. OJT is conducted using valid methods (training objectives), approved training materials,
and a planned and logical instructional sequence. The Transit Manager may conduct OJT, or
designate particular staff who will become specialized OJT trainers in particular areas, learning
to use available course materials and evaluation standards.
Completion of OJT and task qualification is by actual task performance whenever possible.
When the task cannot be performed, but is simulated or walked-through, the conditions of task
performance, references, tools, and equipment reflect actual performance of the task to the extent
feasible (for example dealing with an emergency situation). Task performance evaluation is
conducted using valid methods and consists of evaluating trainee performance using established
standards prior to task or job qualification. The evaluation factors are defined appropriate to the
topic, but in general are based on the training topics specified in Appendix G.
J. Staff Meetings
PATS conduct quarterly staff meetings and promote safety awareness among the drivers and
other safety sensitive personnel. All PATS employees are required to attend the quarterly staff
meetings, which are planned by the Transit Manager.
2 Center for Urban Transportation Research, presentation on Developing a Compliant Drug and Alcohol Training
Program,
http://www3.cutr.usf.edu/byrnessamsite/section%202/Developing%20a%20Compliant%20Drug%20and%20Alcohol
%20Training%20Program.ppt.
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Safety Meetings
PATS’ promotes safety awareness at the quarterly staff meetings.
A long with promoting safety awareness at the quarterly Staff meetings; the Safety/Training
Officer distributes a monthly safety report with handouts that go along with the topic of the
month to all PATS employees. (Refresher Training Topics)
July – ADA and Sensitivity
August – Bloodborne Pathogens
September – Customer Service
October – Defensive Driving
November – Defensive Driving
December – Defensive Driving
January – Distractive Driving
February – Safety and Security
March – Drugs and Alcohol
April – Emergency Management
May – Transporting Non-Ambulatory Passengers
June – Passenger Safety
K. Maintenance Training
PATS contracts out its vehicle maintenance, so it does not provide in-house training of
maintenance personnel in the use of specialized tools, heavy equipment operation, etc.
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Safety Data Acquisition/Analysis
A. Purpose
According to the NCDOT-PTD Standard Operating Procedure (SOP) for the review of the SSP:
Understanding safety data is an important step toward allocating important (and often scarce)
resources to implement safety program elements. Safety data relative to transit provider
operations can be used to determine safety trends in system operation. The data include
information gathered from within the system on safety-related events such as passenger injuries
or claims, employee injuries, accidents, incidents, and preventability.
Driver reports (sometimes called Safety Inspections and/or manifest) can be an important
resource to help identify safety problems, such as dangerous stop locations, problems with
vehicle equipment, safety problems with the route, and other issues. The data is useful in a
formal hazard identification and resolution process to help identify hazards before they cause
accidents. The data may also help improve system performance, not only in respect to safety,
but also in overall delivery of service to the riding public. In addition, trend analyses of safety
data can help determine the effectiveness of safety initiatives that have been implemented.
Vehicle Camera Procedures:
The system activates upon vehicle ignition, and continues recording twenty minutes after
the vehicle is shut down.
The recorder will store 4 to 6 weeks of data (under normal use, after this period the
system will start recording over the oldest data).
The hard drives are easily accessed by two supplied keys. One key opens the outer cover
which restricts access to the DVR, and the second key is used to remove the hard drive.
Hard drives can be removed and brought to any computer with viewing software installed
and opened for review.
Recorders can be accessed wirelessly when vehicles are in the lot where the download
access point is setup.
Video recordings of significance can be saved in SEON or Windows Media Player
format.
Section 3
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B. Safety Objectives: Ensures Safety is addressed during System Planning,
Design and Construction
Provide analysis tools and methodologies to promote safe system operation through the
identification of safety hazards and the implementation of technology, procedures,
training, and safety devices to resolve these hazards
Create a proactive transit safety culture that supports employee safety and safe system
operation through motivated compliance with agency rules and procedures and the
appropriate use and operation of equipment.
C. NCDOT Safety Philosophy Statements
A Safety Philosophy is part of the NCDOT mission. As a North Carolina public transit
system, PATS upholds this mission by acknowledging and implementing the NCDOT
safety philosophy statements shown below:
All accidents and injuries can be prevented.
Management/supervisors are responsible, and will be held accountable, for
preventing injuries and occupational illnesses.
Occupational safety and health is part of every employee's total job performance.
Working safely is a condition of employment.
All workplace hazards can be safeguarded.
Training employees to work safely is essential and is the responsibility of
management/supervision.
Preventing personal injuries and accidents is good business.
D. Safety Terms and Definitions
Accident
An unforeseen event or occurrence that results in death, injury, or property damage – System
Safety Program Training Participant’s Guide.
An incident involving a moving vehicle. Includes collisions with another vehicle, object, or
person (except suicides) and derailment/left roadway. This also includes Personal Casualties
incidents on the vehicle and entering/exiting the vehicle. – Federal Transit Administration (FTA)
- Safety Management Information Statistics (1999 SAMIS Annual Report) (2000)
http://transit-safety.volpe.dot.gov/publications/default.asp
Occurrence in a sequence of events that produces unintended injury, death or property damage.
Accident refers to the event, not the result of the event. – National Safety Council (NSC),
National Safety Council Statistics Glossary [online] (Research & Statistics, 25 July 2000[15
March 2002]); http://www.nsc.org/lrs/glossary.htm
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Hazard
Any real or potential condition that can cause injury, death or damage to or loss of equipment or
property
- theoretical condition
- identified before an incident actually occurs
- FTA - Implementation Guidelines for State Safety Oversight of Rail Fixed Guideway
Systems (1996) http://transit-safety.volpe.dot.gov/publications/default.asp
Incident
An unforeseen event or occurrence which does not necessarily result in death, injury, contact or
property damage - FTA - Implementation Guidelines for State Safety Oversight of Rail Fixed
Guideway Systems (1996)
http://transit-safety.volpe.dot.gov/publications/default.asp
Collisions, personal casualties, derailments/left roadway, fires, and property damage greater than
$1,000 associated with transit agency revenue vehicles and all transit facilities - FTA - Safety
Management Information Statistics (1993 SAMIS Annual Report) (1995) http://transit-
safety.volpe.dot.gov/publications/default.asp
Risk
Probability of an accident multiplied by the consequences of an accident (often in $) - System
Safety Program Training Participant’s Guide.
Exposure or probable likelihood of a hazard (accident, crisis, emergency or disaster) occurring at
a system. Risk is measured in terms of impact and vulnerability - FTA - Critical Incident
Management Guidelines (1998)
http://transit-safety.volpe.dot.gov/publications/default.asp
Safety
Freedom from those conditions that can cause death, injury, occupational illness, damage to or
loss of equipment or property, or damage to the environment – Military Standard 882-D.
Freedom from danger - FTA - Implementation Guidelines for State Safety Oversight of Rail
Fixed Guideway Systems (1996).
http://transit-safety.volpe.dot.gov/publications/default.asp
Security
Precautions taken to guard against crime, attack, sabotage, espionage, etc. – The Learning
Network, Inc., A-Z Dictionary [online] (2000-2002[15 March 2002]) http://www.infoplease.com
Freedom from intentional danger - FTA - Implementation Guidelines for State Safety Oversight
of Rail Fixed Guideway Systems (1996)
http://transit-safety.volpe.dot.gov/publications/default.asp
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System Security
All activities associated with providing security to transit patrons and securing transit property
including supervision and clerical support. Includes patrolling revenue vehicles and passenger
facilities during revenue operations; patrolling and controlling access to yards, buildings and
structures; monitoring security devices; and, reporting security breaches – US Department of
Transportation, Bureau of Transportation Statistics, Transportation Expressions
[online](1996[15 March 2002]) http://www.bts.gov/btsprod/expr/expsearch.html
E. Safety Awareness Program
The acquisition of safety data relies heavily on the participation of drivers, who are on the
roads every day and are often the first responders in accidents or incidents. PATS conduct an
ongoing safety awareness program for its drivers and other staff members with two purposes
in mind: to help prevent accidents and injuries, and to collect safety data for incidents that do
occur. The Transit Manager or Senior Administrative Support Assistant is responsible for
managing the Safety Awareness Program.
The Safety Awareness Program includes training and educational components. The various
trainings were described in Section 2 of this plan. The educational component involves
notifying employees of PATS’ safety goals, policies, and procedures; updates to applicable
safety regulations; explanations of accidents or incidents that occur; upcoming trainings; and
other safety issues. This safety awareness is implemented through various means, including
but not limited to:
Hanging posters in the PATS office
Posting notices to employees in the PATS office
Mailing hard copy letters to employees
Emailing employees
Calling employees
Attaching letters to employees monthly calendar
Discussions at PATS safety/staff meetings
F. Analysis of Accidents and Incidents
When an accident or incident occurs, the driver should notify dispatch / the PATS office
immediately. The Transit Manager or Senior Administrative Support Assistant responds
to the scene immediately, and after making sure that all injuries are being treated,
conducts an investigation of the accident or incident. After speaking with the PATS
driver, other parties involved, witnesses, and the police (where applicable), the Transit
Manager or Senior Administrative Support Assistant determines if the accident or
incident was “avoidable” or “unavoidable.”
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G. Personnel Policy Regarding Safety, Performance, and Discipline
Procedures
In pursuing “safety awareness”, employees are expected to:
Abide by the safety rules and regulations of the organization.
Regard the safety of fellow workers at all times.
Report any unsafe condition to the Transit Manager.
Contribute ideas and suggestions for improving the safety of conditions or
procedures to the Safety/Training Officer.
Use individual knowledge and influence to prevent accidents.
Attend safety training sessions.
Report accidents and injuries immediately.
It is the responsibility of each employee of Person Area Transportation System to abide by all
rules and regulations and to comply with all laws pertaining to safety and health in the
workplace. This includes reporting all violations that he or she may incur on his or her driver’s
license. A vehicle driver’s license is a privilege granted to the driver by the state. It is also a
prerequisite to a driver’s employment at Person Area Transportation System. Accidents, moving
violations, vehicle equipment violations, etc., whether in a PATS vehicle or a personal vehicle,
must be reported to the Transit Manager at PATS.
It is the responsibility of the Transit Manager and the Safety/Training Officer to provide explicit
instructional and procedural safety training for each employee. Safety becomes a shared
responsibility between management and the employee, and working safely is a condition of
employment.
Employees are required to identify, report, and correct unsafe conduct and conditions. Under
(OSHA) 29 CFR part 1910; employees have the right to report any unsafe working conditions
without being subjected to any retaliation whatsoever. Each employee must be an integral part
of the System Safety Program.
All transit employees are required to attend quarterly safety/staff meeting and read their monthly
safety report and handouts. Safety handouts are very useful ways of training employees and
promoting safety awareness. Safety reports, handouts and safety/staff meetings are used to
present information, discuss problems and new ideas, and discuss recent accidents and injuries.
The Safety/Training Officer completes a Monthly Safety Report, shown in Appendix I, to
document the requisite monthly safety handouts and training. Copies of these reports are stored
in the Safety/Training Officer’s office.
The safety commitments of PATS drivers and safety sensitive positions shall include, but shall
not be limited to, the following:
1. Wearing the reflective vests and closed toe shoes as required.
2. Reporting promptly and in writing, to your clerk/dispatcher, all injuries and illnesses
associated with the jobs.
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3. Reporting, no matter how slight, all fires, accidental damage to property, hazardous
material spills and other emergency occurrences to your Clerk/dispatcher.
4. Disposing of all hazardous materials in an acceptable and lawful manner.
5. Working under the influence of alcohol or illegal drugs is specifically forbidden. Use of
prescription drugs, which may affect your alertness or work abilities, shall be reported to
your Transit Manager (49 CFR parts 40 and 655)
6. Taking care not to abuse vehicles and equipment, so these items will be in usable
condition for as long as possible, as well as ensure they are in the best possible condition
while being used.
Preventable Accidents/Injuries
Where PATS employees are deemed to have performed negligent acts, which result in
preventable injuries to employees, passengers or the general public; or preventable vehicle
accidents, then the minimum disciplinary action will be automatic suspension for three (3) days.
In addition, the employee at fault will be required to attend a defensive diving course or undergo
remedial training prior to operating a PATS vehicle again. The Transit Manager may decide to
apply further disciplinary action.
If the same employee is involved in a second accident that is deemed his or her fault, the Transit
Manager will apply further, more serious disciplinary measures, including possible termination
of employment with PATS.
All employees will sign a statement acknowledging their receipt and understanding of this
policy; a copy of the signed acknowledgement will be stored in the employee’s personnel file in
the Transit Manager’s office.
Grievance Procedure
An employee shall not be disciplined or dismissed from service, nor shall entry be made in the
employee’s record, without just cause. He/she shall receive a written statement of the charges.
Under ordinary circumstances, PATS will administer discipline within ten working days (not
counting Saturdays, Sundays, and holidays) from the date of knowledge of a violation. If an
investigation is necessary, the discipline will be administered within ten working days of
completion of the investigation.
If an employee objects to a disciplinary action taken by PATS, he/she must file a written
statement of the grievance with the Transit Manager within five working days of being informed
of the disciplinary action. The statement must be signed by the employee.
Within five working days, the employee will be accorded a hearing with the Transit Manager or
other representative of PATS. A written decision will be issued within five working days of the
hearing.
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H. Procedures to Communicate Safety Information During Business Hours
Where safety-related issues arise during the course of a day’s business, staff in the PATS
office will notify drivers as necessary by calling their cell phones.
If drivers encounter safety-related problems while in service, they must notify the PATS
office immediately. The Transit Manager, Senior Administrative Support Assistant or
Clerk/Dispatcher will provide guidance to the driver, or report to the scene to assist the
driver when necessary.
I. Safety Equipment on Vehicles
All vehicles are outfitted with a bloodborne pathogen kit, a first aid kit, a fire
extinguisher, 3 bi-directional reflective triangles, and a web cutter. The drivers will
check all this equipment during their pre- and post-trip inspections (see the Maintenance
Plan in Section 5 of this plan for more details). The Transit Manager or Safety/Training
Officer spot checks the vehicles at least once a month to ensure the safety equipment is
operable, accessible, and secure.
J. Office Safety
The Safety/Training Officer performs a monthly audit of all premises, equipment, and,
materials to ensure that PATS is a safe and healthful work place. Office staff is also
encouraged to adhere to the following safety procedures:
Computer Data Entry Safety Procedures
The following actions can help to reduce muscle fatigue and tension while enabling
maximum performance:
Adjust seat height and backrest angle to fit the user in a seated position. Adjust
footrest for proper height and angle.
Screens should have adjustable height and tilt; screens should be arranged so that they
are never higher than eye level for the users.
Position documents roughly perpendicular to the line of sight using a document
holder.
Adjust keyboard to fit the operator. Keyboards should be detached in order to allow
for positioning.
Always use anti-glare screens.
Users should maintain correct hand and wrist posture when entering data. Repetitive
motion illness develops over an extended period of time. Learn work habits that
reduce risks and be aware of early symptoms of the illness.
A footstool may be used as a footrest for petite operators.
Frequent work breaks should be taken after continuous work periods requiring more
than five hours of screen viewing time, constant rapid muscular action, fixed
positions on jobs that are highly repetitive.
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Office Safety Procedures
The following suggestions can help to make your office environment a safe one:
Don't place computers, calculators, or adding machines too close to the edge of
the desk or other surfaces.
Machines that tend to move during operation should be fastened down or secured
with rubber feet or mats.
Electric office machines should be equipped with three-prong electrical cords.
Avoid stretching cords between desks or across aisles.
Never store combustible office materials in HVAC closets or electrical rooms.
Do not permit floor coverings to become tripping hazards.
Keep floors clean. Clean up all spills on floors immediately. Pick up papers,
pencils, clips and any objects that will cause tripping hazards.
Place wastebaskets where they will not present a tripping hazard.
Never stack anything so high as to obstruct vision. Make sure that stacks are not
within 18 inches of ceiling sprinkler heads.
Electrical cords and phone lines should be secured to prevent tripping hazards.
Know where building emergency exits are located. These areas should not be
used for storage.
File drawers should be closed immediately after use so no one can run into or trip
over them. Only one drawer should be opened at a time to prevent the cabinet
from falling forward.
Entryway steps should be marked with contrasting colors.
Be sure all electrical equipment is grounded and the cord is in good condition. If a
machine is shocking or smoking, unplug it and immediately report the defect.
The use of portable electric, gas or other heating devices is prohibited.
Be cautious as you approach doors that open in your direction.
Slow your pace when approaching a blind corner in a hallway.
Do not run in corridors.
Office tables, chairs, and desks must be maintained in good condition and remain
free from sharp corners, projecting edges wobbly legs, etc.
Never use chairs, desks or other furniture as a makeshift ladder. Use a stepladder
for climbing but do not use the top two steps.
Do not lean forward in a roller chair to pick up an object.
Keep the blades of paper cutters closed when not in use.
Never run power cords under carpet or chair pads.
In addition to the safety policies described above, PATS employees must also follow the
Person County Safety Policy, attached as Appendix L, where applicable.
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K. Tracking and Analyzing Accident/Incident Reports
As described in Appendix I, the training curriculum for after accident reporting, drivers
should contact the PATS Clerk/dispatcher immediately to notify them when an accident
or incident has occurred. The Transit Manager or Senior Administrative Support
Assistant will respond to the accident/incident, conduct an investigation, and with the
assistance of the driver, make sure that an Accident/Incident Report is completed as soon
as possible.
The Senior Administrative Support Assistant will keep copies of all Accident/Incident
Reports and track accidents and incidents that occur in a master spreadsheet.
Characteristics of each accident/incident that may be tracked include:
Type of accident/incident
Time of day accident/incident occurred
Employees involved
Other persons involved
Vehicles involved
Resolution
Timeframe for implementing resolution
At least quarterly, the Transit Manager or Senior Administrative Support Assistant will
review the master spreadsheet to determine any trends among the accidents or incidents.
The Transit Manager or Senior Administrative Support Assistant will compile and
monitor monthly and annual totals for accident and incidents, vandalism, and crimes. If
trends are identified, the Transit Manager or Senior Administrative Support Assistant will
take actions, where feasible, to prevent similar future accidents or incidents from
occurring, including training and outreach. The Transit Manager or Senior
Administrative Support Assistant may also seek assistance from NCDOT-PTD to resolve
recurring problems.
Any passenger complaints related to safety and security that the PATS office receives
will also be documented in a written complaint log and tracked to determine any
necessary remedies. The complaint log will be located in the Transit Manager’s office.
L. Exposure Control Plan
Consistent with OSHA 1920.1030, PATS has adopted the following exposure control plan to
eliminate or minimize employees’ exposure to bloodborne pathogens:
Purpose
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Bloodborne pathogens are infectious microorganisms that are present in the blood stream of
an infected person and can be transmitted from one person to another through direct or
indirect contact. These pathogens include, but are not limited to Hepatitis B Virus (HBV)
and Human Immunodeficiency Virus (HIV).
Due to the nature of the service provided by PATS, there are certain events that may present
a risk of exposure to our employees to certain body fluids and other potentially infectious
materials. It is the intent of PATS to provide the proper training, information and protective
equipment so each employee might recognize when they may be at risk and to protect
themselves accordingly.
PATS is committed to providing a safe and healthy work environment for its employees. It is
up to each employee to follow these policies and procedures to ensure that these goals are
achieved. The policies and procedures of PATS are reviewed regularly and input from
employees is welcomed.
Goals
1. To provide training for each employee concerning the risks of potentially
infectious materials, body fluids and HBV.
2. To provide employees with the proper equipment to protect themselves from
potential infections.
3. To train each employee how to use the biohazard kits.
4. To provide all employees who may be at risk an opportunity to be inoculated for
HBV.
5. To provide a safe work environment for all employees.
Procedures
In an effort to protect the safety of employees and passengers, the following procedures
will be followed.
1. All body fluids are to be treated as contaminated. Follow all precautions.
2. Rubber gloves shall be worn at all times when handling body fluids or secretions.
3. All body fluids will be absorbed and removed using an approved absorbent
material and placed within RED BAGS clearly marked for biohazard materials.
4. All contaminated or damaged personal protective equipment shall be placed in
RED BAGS.
5. All contaminated areas of the vehicle shall be sanitized with the approved
germicide solution provided in each biohazard kit.
6. Thoroughly wash hands following contact with body fluids.
7. Used contaminated bags shall be properly marked, sealed, and contained until
proper disposal of the bags can be conducted at an approved disposal site.
8. Report, in writing to your Transit Manager, all contacts with potentially
hazardous situations and all contact with hazardous spills.
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General Information
The most common way exposure to HIV and HBV can occur is when an employee has an open
sore or injury and is in contact with infectious materials, or when an employee is not wearing the
proper Personal Protective Equipment to protect against contact with infectious material such as
blood and other body fluids.
The types of exposure with the highest likelihood of causing infections are open cuts and contact
with bodily fluids through open and non-protected facial features (i.e. eyes, mouth and nose).
When proper controls or other practices are not sufficient to eliminate exposure to blood or other
potentially infectious materials, Personal Protective Equipment shall be used. Personal
Protective Equipment shall be provided for employees at no cost to the employee.
All employees shall receive training in the use of Personal Protective Equipment, how to clean-
up hazardous spills, proper disposal and how to protect themselves from possible contact with
infectious materials. Additionally, employees will receive refresher training at least annually.
HIV Modes of Transmission, Symptoms, and Prevention
HIV is an incurable virus which will lead to Acquired Immunodeficiency Syndrome, better
known as AIDS. The virus itself does not kill, but weakens the immune system so that other
diseases can exist inside the body. It is these other diseases that eventually cause death.
HIV is transmitted through blood and certain other body fluids. The most common modes of
transmission are sexually and through sharing needles.
HIV is a fairly weak virus that cannot live long outside the human body. In the body, HIV has
low concentrations in the cells, so it is unlikely to be transmitted unless there is an actual mixing
of body fluids or other direct routes. There have been no known transmissions of HIV from
contact with environmental surfaces.
Once a person has contacted the HIV virus, there is no cure, so knowing how to prevent
transmission is very important. Other than sexual transmission, injection of the virus by a
needle, or an open cut or other break in the skin, the HIV can be transmitted through the open
facial feature (i.e. nose, eye, mouth). Another way that the virus has been transmitted is through
blood transfusions, if the donor’s blood is HIV positive.
Once a person has been exposed to HIV, they will usually have an episode known as an Acute
Retroviral Syndrome (ARS), within 12 weeks of the exposure. Although this usually happens,
there have been cases when it does not. An ARS episode usually resembles flu-like symptoms,
such as abdominal cramps, nausea, etc., and usually does not last more than a few days. A
person can transmit HIV to others even before an ARS episode, has occurred.
Before the ARS episode, the individual may test negative for HIV, but seroconversion usually
occurs with the onset of the ARS, and the individual will usually test positive afterwards. That is
why it is very important, if you think you may have been exposed to blood or body fluids, that
you report any fever or flu-like illnesses up to 12 weeks after a possible exposure.
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After acquiring AIDS, the most common types of illnesses encountered are pneumonia-like
illnesses, other respiratory problems, and certain types of cancers.
Although very few cases of occupationally-acquired HIV transmission have been reported, most
have occurred after accidental needle sticks or splashing of blood into the eyes or open cuts.
The best way to prevent transmission of HIV on the job is to regard ALL blood, body fluids, or
other potentially infectious materials as contaminated, and take all necessary precautions.
Hepatitis B – Transmission, Symptoms, and Prevention
Hepatitis B is a very dangerous virus, which infects thousands of individuals each year.
Annually, hundreds of deaths can be attributed to occupationally acquired infections. Hepatitis
B can be prevented.
Hepatitis B can be acquired through sexual transmission, mixing of blood or body fluids, or
contact with the virus in dried form on environmental surfaces through cuts, openings in the skin,
or contact with open facial feature such as the nose, eyes, mouth.
HBV can be found in very high concentrations in blood and body fluids, and the virus can live in
dried form on environmental surfaces for at least seven days. It is an extremely potent virus, and
can cause death or long-term illness.
The best way to protect against Hepatitis B infection is by getting the vaccine which is available.
If you are at risk of exposure on your job, the vaccine will be provided at no cost to you. If you
do not get the vaccine, you should know that you may be at increased risk.
People who are infected with Hepatitis B may show no symptoms at all, and may not look or feel
sick. However, they are able to give the disease to others. When present, symptoms may
include enlargement of the liver, jaundice, fatigue, nausea, abdominal pain, and sometimes, joint
pain, rash, and fever.
The best ways to avoid Hepatitis B are to:
a) get the vaccine
b) treat ALL blood and other body fluids as contaminated
c) take precautions to avoid cuts, splashes to skin and mucous membranes
Gloves and other protective equipment can protect your skin and open facial feature (i.e. nose,
eyes, mouth), and should always be worn when there is a risk of exposure.
If, on your job, you have a risk of exposure to Hepatitis B, you will be offered the HBV vaccine
at no cost to you, and you will be provided with personal protective equipment to reduce your
risk of exposure.
Remember, the best way to prevent HBV is by getting the vaccine. Even if you have the
vaccine, you should also use all personal protective equipment according to policy, and consider
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ALL blood, body fluids, and other potentially infectious materials as contaminated and capable
of transmitting the virus.
If you think that you may have been exposed to the HBV, it is important that you follow PATS’
policy and report any incidents, as well as any illnesses you may experience following the
possible exposure to your supervisor.
Post-Exposure Procedures
The following procedures are to be followed after employee or passenger exposure to blood or
other potentially infectious materials. If it is uncertain whether an exposure has taken place,
proceed with this set of instructions until a determination can be made.
An exposure is defined as a splash to an open facial feature (i.e. nose, eyes, mouth), or other
contact with blood or other potentially infectious materials or non-intact skin (open sore or cut)
etc., that is a result of carrying out your duties at PATS.
After a mucous membrane splash or non-intact skin exposure:
1. Immediately flush mucous membrane or skin surface with a soapy water solution or
approved disinfectant solution.
After all exposures, and after the above measures have been taken:
1. The object or substance causing the exposure shall be identified, if possible.
2. Immediate or designated supervisor shall be notified as soon as possible.
3. If possible, the source passenger shall be identified and notified of the incident. The
source passenger shall be tested for the HIV and HBV, after consent has been obtained.
4. If the source passenger cannot be identified, or if the source passenger tests positive, or if
source passenger consent for testing cannot be obtained, the exposed employee will have
the opportunity for an evaluation and appropriate counseling regarding exposure to
pathogens. Evaluation and counseling will be at no cost to the employee.
5. Exposed employees will have the opportunity, at no cost, to have baseline blood drawn
and stored for up to 90 days after an exposure. The employee, during that 90 day time
period, has their baseline blood levels tested for HIV or HBV. This will be done at no
cost to the employee. The employer is only obligated to store untested baseline blood
samples for 90 days.
6. The employee will be made aware of the results of source passenger testing, if available.
7. Results of employee medical evaluations will be confidential and not made available to
the employer or others. Medical evaluations will be conducted by a licensed physician or
other appropriate healthcare professional. It will be at no cost to the employee and will
be conducted as per recommendations of the United State Public Health Service at the
time of exposure.
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All PATS employees will undergo blood-borne pathogen training, including review of the
Exposure Control Plan, annually. At the initial training, employees are asked to sign the
statement below acknowledging that they have reviewed the Exposure Control Plan and agree to
comply with the procedures. Copies of this statement are maintained with the other training
files.
PERSON AREA TRANSPORTATION SYSTEM
Statement of Acknowledgement
I hereby acknowledge the Person Area Transportation System has reviewed with me its
Exposure Control Plan for Bloodborne Pathogens.
I further acknowledge that I have been provided a copy of PATS’ Exposure Control Plan and
written instructions on procedures to follow should I have an incident of exposure to blood or
other potentially infectious materials, and hereby agree to comply with PATS’ policies on
Exposure Control.
__________________________________ _____________________
Signature of Employee Date
__________________________________ _____________________
Signature of Supervisor Date
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M. Risk Management/Hazard Identification
Policy on Potential Work Site Hazards Identification
The Transit Manager or Senior Administrative Support Assistant shall identify at least annually
any potential Occupational Safety or Health Hazards at PATS facilities.
Hazards Identification
Any time a new substance, process, procedure, or piece of equipment is introduced and presents
a potential hazard or a hazard is identified during a Safety Inspection, an updated Hazards
Identification worksheet (see below) must be completed immediately.
A copy of the completed Hazards Identification worksheet shall be posted at the PATS facility
and must be reviewed with any new employee before the new employee begins to work; this will
be recorded in the employee’s training record.
A copy of the completed Hazards Identification worksheet must also be forwarded to the Safety
Committee for review and follow-up inspections.
HAZARDS IDENTIFICATION
Work Site Name (Center/Office)
Location
Potential Hazards Employee Action to be Followed
1.
2.
3.
4.
5.
Completed by:
Work Site Supervisor Date
Hazards Analysis
After identifying potential hazards, the Safety Committee will use a Hazard Assessment Matrix
to analyze and measure specific risks. The Matrix condenses “hazard assessment” into a chart
and prioritizes those hazards that are evaluated. Two hazard severity categories are used to
designate the magnitude of the “worst case” potential effects of the hazard are as follows:
Category I – Critical
Hazard can result in severe injuries or death to passengers, employees, or others who
encounter the Transportation System and/or cause major property damage.
Category II – Marginal
Hazard can result in minor injury or negligible property damage.
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After hazards are assessed for their potential severity, the Safety Committee will examine them
to determine the probability that they may lead to an accident. Two frequency categories are
used:
A. Frequent
The hazard is likely to cause an accident on a recurrent basis.
B. Remote
An accident is unlikely but possible during the life of the hazard.
As an increase in knowledge about safety is established through the course of the System Safety
Program, prior accident information will be factored into the probability analysis if it is
appropriate to do so.
For each potential hazard identified, the Safety Committee will complete the Hazard Analysis
worksheet (see below), rating the potential hazards using the Hazard Assessment Matrix
categories and the Hazard Risk Index, shown below.
HAZARD ASSESSMENT MATRIX
Frequency of Hazard Categories
Occurrence Critical I Marginal II
A Frequent I A II A
B Remote I B II B
Hazard Risk Index
I A Unacceptable or Undesirable (Management Decision
Necessary)
II A, I B Acceptable with Management Review
II B Acceptable without Management Review
HAZARD ANALYSIS
Potential Hazard Identified:
______________________________________________________________________________
______________________________________________________________________________
Circle the appropriate analysis:
Hazard Risk Index Criteria
I A Unacceptable or Undesirable
(Management Decision Necessary)
II A, I B Acceptable with Management Review
II B Acceptable without Management Review
Prepared By: Date:
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Next, the Safety Committee will complete the Review Action worksheet (see below) for the
potential hazards that have now been analyzed. Potential hazards where no remediation action is
possible should be documented in one Review Action worksheet, while those that are possible to
remedy should be documented in another Review action worksheet. The remedial or abatement
actions, where applicable, will be identified along with the schedule and designated Safety
Committee member or other PATS employee, who is responsible for the abatement action.
REVIEW ACTION
A. No remediation action possible
B. Remediation to be done
Hazard Action Schedule Responsibility
1.
2.
3.
4.
5.
C. Comments:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
By:
Program Manager/Director Date
Safety Committee Chair Date
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The PATS employee(s) responsible for the abatement action(s) will complete the Follow-up
Abatement Action worksheet, shown below, to document completion of the hazards
identification and remediation process.
FOLLOW-UP ABATEMENT ACTION
Hazard Abatement Action
Completed
Date Completed By
1.
2.
3.
Submitted by:
Position Date
Reviewed by:
Position Date
Safety Officer Date
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Drug and Alcohol Abuse Programs
A. Purpose
To establish guidelines that ensures a safe, healthy, and productive drug-free work environment
for the employees of Person Area Transportation System.
B. Policy
Person Area Transportation System employees are our most valuable resource and it is our goal
to provide a healthy, satisfying working environment which promotes personal opportunities for
growth. To meet this goal, we have developed the following objectives:
1. Assure that employees are not impaired in their ability to perform assigned duties in a
safe, productive, and healthy manner;
2. Create a workplace environment free from the adverse effects of drug abuse and alcohol
misuse;
3. Prohibit the unlawful manufacture, distribution, dispensing, possession, or use of
controlled substances; and
4. Encourage employees to seek professional assistance anytime personal problems,
including alcohol or drug dependency, adversely affect their ability to perform their
assigned duties.
All Person Area Transportation System employees must abide by the following policies:
Drug use and alcohol misuse is prohibited by PATS employees.
Possession of illicit drugs or alcohol on or in Person Area Transportation System
property is prohibited.
Employees must complete drug and alcohol training sessions.
PATS must implement and maintain an approved drug and alcohol testing program that is
consistent with FTA regulations as amended.
Drug and alcohol testing must be administered to all safety sensitive employees. PATS
must comply with all federal regulations pertaining to drug and alcohol testing
requirements. Employees must pass the drug and alcohol tests. Employees who do not
pass the drug and alcohol tests will be dismissed.
Section 4
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Person Area Transportation System employees are governed by the formally established Drug
and Alcohol Testing Policy of Person Area Transportation System, included in Appendix M.
County employees are governed by the formally established Substance Abuse Policy.
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Vehicle Maintenance
A. Maintenance Policy
PATS will provide proper maintenance of vehicles and equipment, which is critical to the
continued safe operation of the transit system. Unsafe vehicles present unnecessary hazards to
the driver, passengers, and other vehicles on the road. PATS will engage in vehicle maintenance
practices that regularly address safety-related vehicle equipment, to ensure unsafe vehicles are
not dispatched for service.
B. Maintenance Plan
PATS has a written Maintenance Plan to help implement its maintenance policy. Included in
Appendix L, the Maintenance Plan addresses vehicle and wheelchair lift maintenance, which
meets the manufacturer’s requirements, and describes an oversight process to ensure pre- and
post-trip inspections are performed and documented, among other topics.
C. Preventative Maintenance Standards
All vehicles, wheelchair lifts and associated equipment, system owned or operating under
contract with the system, is placed on a comprehensive preventive maintenance program for the
purpose of increasing safety and reducing operational costs.
The Preventive Maintenance Plan should consist of:
Making preventive maintenance arrangements
Conducting a Pre/Post-Trip Inspection course for driver
Completing a corresponding inspection checklist
Utilizing AssetWORKS Fleet Management Program to document, schedule and track
equipment maintenance
Maintaining maintenance record on file for each vehicle
Completing statistical reporting
Reporting common problems
Utilizing manufacturers Preventive Maintenance Guidelines Manual
Keeping all maintenance records for the life of the vehicle to include three (3) years
after disposition
*Note: The Preventive Maintenance Program has been developed for the purpose of safety,
reliability and vehicle use longevity. The guidelines are not designed to interfere with or
violate the Manufacturer’s Warranty Maintenance Schedule.
Section 5
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D. Maintenance Records Standards
PATS will retain all records pertaining to maintenance, service, warranty and other documents as
required for vehicles, wheelchair lifts and associated equipment. The records will be maintained
for at least the life of the vehicle which includes three (3) years after the vehicle’s disposal.
Maintenance Records Include:
AssetWORKS Fleet Management Program documentation
Documents showing vehicle identity
Documents showing vehicle, wheelchair lift and associated equipment completed
maintenance and inspection dates
Documents showing mileage
Documents identifying the contractor that provides non-owned vehicles
Documents showing maintenance contractors' names and addresses
Vehicle Accident Reports
A copy of the document notifying NCDOT of a fatal accident by the close of business or
the end of the working day
A copy of the document notifying NCDOT within 24 hours of a fatal death that occurs
within 30 days as a result of an accident
Documents that report to NCDOT within 48 hours all accidents/incidents
Documents showing completion of the driver's daily Pre/Post-Trip Inspection Checklists*
* maintain the previous (5) years (Ref: 49 CFR 18.42)
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E. Annual PTMS Inspection
ANNUAL PTMS INSPECTION
Form must be completed and maintained with vehicle maintenance records.
Date: ____________________________________________
Vehicle: __________________________________________
Wheelchair Lift Cycle Reading: _______________________
Odometer Reading: _________________________________
Inspector: _________________________________________
Inspection Key
For Each Item
OK =OK
"X" = Adjusted
"0"= Repairs Are Necessary
For Each "0" Give an Explanation
Body
___ Check windshield and other glass for cracks/damage
___ Check wheels for cracks/damage
___ Interior and exterior decals, signs, numbers (ex: railroad crossing, no turn on red, etc…)
___ Body damage
___ Destination signs for proper operation (Front, Rear, Back)
___ General physical condition of the vehicle
___ System name completely spelled out and condition
___ Sign identifying the vehicle as “Available for Public Use” if required
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F. Vehicle Safety/Emergency Equipment
The following items have been placed in all vehicles:
Seat Belts - An adjustable driver's restraining belt that complies with FMVSS 209 (Seat Belt
Assemblies) and FMVSS 210 (Seat Belt Anchorages) regulations
Each securement station has four securement straps, a lap belt and a shoulder belt.
Fire Extinguisher - Include a fully-charged dry chemical or carbon dioxide fire extinguisher
that has at least a 1A:BC rating and bears the Underwriter's Laboratory, Inc. label. The
extinguisher should be accessible and must be securely mounted in a visible place or a clearly
marked compartment.
Emergency Triangles - Vehicles are equipped with three (3) portable red reflector warning
devices in compliance with North Carolina Statutes. The triangle case must be mounted to the
vehicle.
Web Cutter – Must be visible and easily accessible by the vehicle driver while sitting in the
driver seat.
Bloodborne Pathogens Kit – The kit must be maintained, fully stocked. Any items are required
to be replaced as soon as possible.
First Aid Kit – The kit must be maintained, fully stocked. Any items are required to be replaced
as soon as possible.
Reflective Vest - Class 2 Orange with reflective material horizontally around torso and in an X
pattern on back. Vehicle operators (drivers) must wear reflective vests while performing job
functions.
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Security
A. Security Policy
As transit employees we need to be vigilant in protecting our systems, our community and
ourselves.
B. Security Program
Purpose
We play a critical role in system security. Our presence alone deters criminal acts and reassures
passengers. We can effectively monitor what is going on. We are often the first to notice
suspicious people, activities, packages, devices or substance. We are best positioned to recognize
and diagnose trouble. We are truly the first responder to any incident and are the most reliable
source of information in the first moments of an incident. We must lead passengers to safety,
guide emergency responders to the problem and help to restore operations.
The security of passengers and employees is paramount to promoting the objectives of FTA,
NCDOT, and their partner organizations in developing a Security Program. PATS will take all
reasonable and prudent actions to minimize the risk associated with intentional acts against
passengers, employees, and equipment/facilities. To further this objective, PATS has developed
security plans and procedures and follows Person County’s emergency response plans and
procedures. The plans have been coordinated with local law enforcement, emergency services,
and with other regional transit providers. PATS coordinates with these partners to conduct
exercises in emergency preparedness and to assess critical assets, including measures to protect
these assets.
Goals
The Security Program provides us with the skills and knowledge to:
Define our role and responsibility in system security
Recognize suspicious people, activities, packages, devices and substances
Observe and report relevant information
Minimize harm to ourselves and others.
Section 6
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Objectives
In this new environment, every threat cannot be identified and resolved, but PATS can take steps
to be more aware, to better protect passengers, employees, facilities and equipment, and to stand
ready to support community needs in response to a major event. To this end, our Security
Program has five objectives:
1. Achieve a level of security performance and emergency readiness that meets or exceeds
our requirements.
2. Increase and strengthen community involvement and participation in the safety and
security of our system.
3. Develop and implement a vulnerability assessment program, and based on the results of
this program, establish a course of action for improving physical security measures and
emergency response capabilities.
4. Expand our training program for employees, volunteers, and contractors to address
security awareness and emergency management issues.
5. Enhance our coordination with NCDOT PTD regarding security and emergency
preparedness issues.
Program Guidelines
Listed below are the actions taken to ensure that PATS is in compliant with all FTA and NCDOT
mandated regulatory requirements and polices.
1. The Security Plan will be reviewed annually and signed by the Transit Manager (SSPP-
001, 6.3).
2. Distribute Security Plan to key staff members (SSPP-001, 6.4).
3. Post Security Plan on bulletin board so that all employees can read.
4. Conduct monthly briefings with employees to discuss security awareness (SSPP-001,
6.5).
5. Establish a plan to monitor facilities and vehicles on a regular basis (SSPP-001, 6.6).
6. Delegate and assign security responsibilities (SSPP-001, 6.7).
7. The Transit Manager will be made aware of all security issues and will work with
management to develop possible solutions (SSPP-001, 6.8).
8. Establish procedures to control access to secure areas and vehicle operations (SSPP-001,
6.9).
9. Facilities and vehicles are monitored by local law enforcement by the use of random
patrols (SSPP-001, 6.10).
10. After normal hours of operation the facility and vehicles are secured and all external
lights are turned on (SSPP-001, 6.11).
11. Brief all employees on required reporting procedures for reporting suspicious people,
activities, packages, devices or vehicles (SSPP-001, 6.13).
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12. Brief all employees on required actions to take to protect themselves and passengers in
case of an explosion or evacuation when a suspicious package is identified (SSPP-001,
6.14).
13. Train all managers and supervisors in security incident management (SSPP-001, 6.15).
14. Develop procedures to respond to bomb threats or similar threats to include evacuation
procedures, search procedures and notification of local authorities (SSPP-001, 6.16).
15. Develop safety and emergency response policies, and brief all personnel (SSPP-001,
6.17).
16. Develop a policy on responding to passenger, vehicle or traffic emergencies (SSPP-001,
6.18).
17. Devise procedures to show appropriate degree of supportiveness for drivers when
emergency situations occur (SSPP-001, 6.20).
18. Inform law enforcement and emergency response personnel of planned changes to system
facilities, operations, etc., (SSPP-001, 6.21).
19. Establish policy and procedures to coordinate training exercises with law enforcement
and emergency service personnel (SSPP-001, 6.22).
20. Follow Person County’s Emergency Operations Plan, which is integrated with regional
emergency management plans as feasible (SSPP-001, 6.23).
21. Establish Mutual Aid Agreement with regional public agencies such as local government,
Fire and Police, etc. to coordinate actions during natural or other disasters (SSPP-001,
6.24).
22. Assign and brief roles/responsibilities employees have during various emergencies
(SSPP-001, 6.25).
C. Security Plan
The PATS Security Plan outlines the steps that agency employees should follow to meet the
goals and objectives of the PATS Security Program. Security Plan components include:
What is System Security?
What is Your Role in Reducing Vulnerability?
What do You Look For?
What about Anthrax and Other Suspicious Substances?
What is Your Top Priority?
Security Awareness Program
WHAT IS SYSTEM SECURITY?
TRANSIT SYSTEM SECURITY
A transit system is made up of four components: people, procedures, facilities and
equipment, and the environment. A System Security Plan is the use of operating principles
to reduce the security vulnerabilities of a transit system to the lowest practical level. The
plan emphasizes prevention of crime and vandalism, uses data collection and analysis and
focuses on customers, employees and property. The components of the plan are:
Risk: The probability that a security incident will occur
Threat: Any real or potential condition that can result in a security incident
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Vulnerability: Any condition or act that endangers human life and property
TERRORISM DEFINED
The Federal Bureau of Investigation defines terrorism as:
“The threat or use of force or violence to coerce a government or civilian population, in
pursuit of political or social objectives.”
According to the definition, the intent is to coerce more than just an individual or small
group, and the motivation is for something larger than personal gain or revenge. This course
applies a broader concept of terrorism that includes groups and individuals, who also could
be acting out of revenge, hatred or an emotional disorder, i.e., the Seattle bus hijacker or the
LIRR gunman.
THE EFFECTS OF TERRORISM ON TRANSIT
Injuries and casualties
Interruption of operations
Panic and confusion
Evacuations
Loss of riders
Service disruptions, delays, cancellations and safety concerns related to terrorist threats and
incidents will quickly begin to erode the public’s confidence in the system. Efficient and
effective response to these situations is critical to maintaining the economic stability of the
system and its employees.
TERRORIST WEAPONS
IMPROVISED EXPLOSIVE DEVICES
Improvised explosive devices (pipe bomb, car bomb, shoe bomb) are designed to conceal and
deliver quantities of explosives to a target. Explosives have been the most widely used
terrorist devices against transit systems for more than 80 years. Explosives by themselves
may be less catastrophic than chemical, biological or radiological weapons. They are also
easier to build or acquire, plant and detonate than more sophisticated weapons, and they
accomplish the terrorist’s primary goal: to cause death and damage and instill fear to
terrorize society.
CHEMICAL AGENTS
Chemical agents are used to poison victims. Toxic and incapacitating chemical substances
are intended to kill, seriously injure or incapacitate humans through physiological effects.
These agents, if properly dispersed, can cause immediate or short-term mass casualties and
fatalities. Non-fatal agents such as pepper spray can still cause panic and hysteria in a crowd
because of their inherent irritant properties.
BIOLOGICAL AGENTS
Biological agents are germs that will cause disease in people. Some of these are deadly to
animals as well, though they are not the primary targets. Unlike chemical agents, biological
agents may not produce visible symptoms in victims for hours or days after exposure.
RADIOLOGICAL AGENTS
Radiological materials can pose both an acute and long-term hazard to humans. In many
ways, they behave like some chemical agents in that they cause cell damage. A major
difference is that the radiological agents do not necessarily have to be inhaled or come in
contact with the skin to do damage. Some types of radiation, like X-rays, can penetrate
several layers of protective material.
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SECURITY MEASURES
OBSERVE AND REPORT SYSTEM SECURITY WEAKNESSES
You are the eyes and ears of your organization. Cultivate a sense about what is ordinary and
extraordinary in your operating environment. Many communities throughout the country
have implemented a Neighborhood Watch program. The concept is that residents in the
neighborhood are much more familiar with the area than anyone else. This effort does not
replace traditional police departments, it simply extends their reach through the eyes and ears
of the residents. This program extends that concept to be used in the work environment by
recognizing the critical role employees play in enhancing but NOT replacing other security
efforts. You know your environment, you know your surroundings; therefore, you know best
when something just does not seem right.
Aside being the eyes and ears (observing), you need to be the mouth (reporting) as well.
Noticing something without follow-up or reporting will not help avoid or prevent an incident.
YOU need to report these observations to your supervisor, Security or other appropriate
personnel.
FOLLOW PROCEDURES
Policies and procedures are established and enforced for a reason. The use of uniforms,
identification tags or badges and other systems is to reduce the likelihood that someone
unauthorized will gain access to restricted areas or operations. Many times, agencies become
very vulnerable by relaxing the enforcement of their policies. This enforcement
responsibility lies with all employees. If an unidentified or unfamiliar person is observed in
or around the facilities and vehicles, that person should be questioned or reported. Similarly,
if unattended objects or packages are out of place, they should be identified or reported.
PRACTICE GOOD HOUSEKEEPING
Good housekeeping means keeping a clean and organized environment where materials and
items are stored appropriately. It enhances the overall security and safety of a system by:
Making it easier to locate unusual objects or items that are out of place
Making it tougher for a terrorist to hide something
Aiding First Responders by making it easier to search for suspected devices
Enabling quicker rescue efforts
Facilitating recovery from an incident
SECURITY SWEEPS
Incorporate into your daily routine spot checks of vehicles and facilities for suspicious
packages, devices and substances. These sweeps will enable you to monitor potentially
vulnerable areas and help prevent threats and incidents.
BUS SYSTEMS
BUS OPERATIONS
Be alert to things that are suspicious or out of place at garages, depots, transfer stations and
shelters. Also be observant of activity, people and vehicles along bus routes.
BUS OPERATORS
Make quick and efficient vehicle inspections part of your normal routine. The few minutes
you spend doing it may save lives. During pre-trip inspections, layovers or when your bus
has been unattended, look for suspicious packages, devices, wires, substances and signs of
tampering.
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BUS MAINTENANCE
When receiving or releasing vehicles look for suspicious packages, devices, wires,
substances and signs of tampering. Quite often, if something is intentionally “planted” on a
vehicle or in a facility, the mechanic or maintenance person will be the first to notice. If
something seems out of the ordinary during an inspection, report it to your supervisor. In
particular, check the engine compartment for foreign objects or a false compartment in the air
filter area, additional wires from the battery and unusually clean components and devices.
Inspect the fuel and air tanks for inconsistent and missing connections.
SIGNS OF VEHICLE TAMPERING
Scratches or marks made by tools
Unusually clean or dirty compartments
Items attached to vehicles or objects with magnets or duct tape
Open or disturbed compartments and cabinets
SECURITY SWEEP CHECK LIST
INTERIOR
Floors
Above, on and below seats
Operator’s area
Steps
Internal lift mechanism
Compartments
Lights
EXTERIOR
Wheel wells
Engine compartments
Bus frame and underbody
Exhaust system
External lift mechanism
Fuel and air tanks
Rooftop area of CNG buses
SUSPICIOUS PEOPLE
Keep an eye out for people in the wrong place and wandering aimlessly around agency
property. Remember that terrorists shadow their targets before they attack. Be leery of
individuals expressing an unusual level of interest in aspects of agency operations. Quite
often people casing an area are looking for system vulnerabilities that they could exploit.
Often times these suspicious individuals pose as newspaper reporters. Never submit to
interviews or photographs.
A SUSPICIOUS PERSON IS SOMEONE WHO IS:
In an unauthorized area
In the wrong place or appears lost
Overdressed for the weather conditions
Loitering and/or watching customers and employees
Pacing, nervous or jumpy
Acting in a disorderly manner that alarms or disturbs others
A repair, utility or delivery person or other “trusted employee” who is out of place
Expressing an unusual level of interest in operations, personnel, equipment or facilities
On agency property without proper identification, uniform or safety gear
If you see people wandering around and you are not sure who they are, call security or the
police if you think they look dangerous. If they don’t look particularly dangerous, simply
approach them and offer help. Avoid profiling and observe where people are, when they are
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there and what they are doing.
APPROACHING PEOPLE
Avoid approaching people who are threatening or dangerous. Do not become
confrontational, abusive or offensive. Do not try to detain or hold a person by any means. If
you have observed an unfamiliar person in a restricted or unauthorized area or engaged in
suspicious activity, check the areas in which they were seen for signs of tampering or
suspicious packages, devices or substances.
When approaching an unfamiliar person in a restricted area, calmly ask if you can help.
Request identification, ask what the person’s business is or whom he or she is there to see,
and offer to escort the person out of the area. Notify security, police or your supervisor if
there is no explanation for the person’s presence. While doing so try to keep the person in
sight at all times and observe and report his or her location, activity, behavior and physical
characteristics.
PHYSICAL CHARACTERISTICS
When you observe someone who is suspicious, based upon his or her location and/or activity,
you need to make a mental note of certain characteristics. These characteristics will help
security or police officers identify the person should he or she leave the area. Aside from this
list also note the person’s gender and speech or accent.
Eyes: Color, shape, eyelashes and eyebrows
Ears: Size, shape
Mouth/Nose: Size of lips, shape and nostrils
Hair/Facial Hair: Color, length, texture, hairline, clean-shaven, bearded or mustache
Forehead: Skin texture, height
Cheeks/Chin: Flesh texture, bone structure, shape, type (cleft, dimpled)
Neck: Adam’s apple, hanging jowls, length, width
Complexion: Skin, color, texture, pores, pockmarks, acne, rashes, scars, birthmarks, bumps
Body Shape/Size: Height, weight, build
Hat: Color, style, how it is worn
Jewelry: Rings, watches, bracelets, earrings, necklaces, body piercing
Shirt/Blouse/Dress: Color, pattern, design, sleeves, collar
Coat: Color, style, length
Pants/Skirt: Color, pattern, design, length, cuffs
Socks/Shoes: Color, pattern, style, clean/dirty
Oddities/Tattoos: Shape, size, color, location on body
General Appearance: Neat, sloppy, clean, dirty
Accessories: Purses, briefcases, backpacks, packages
SUSPICIOUS ACTIVITIES
Suspicious activities include any activity that seems strange, wrong or out of place. You
know your operating environment and will know a suspicious activity when you see it.
Some clues may include trucks, vans, cars or bicycles parked in strange locations or which
are out of place in the surroundings; people abandoning packages; or people photographing
transit equipment and facilities. Do not be afraid to report something even if you are not 100
percent sure there is a problem. Better safe than sorry.
SUSPICIOUS PACKAGES
Transit systems deal with thousands of items left unattended or left in stations and on trains
and buses each year. These unattended packages impose a tremendous burden on security.
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Although unattended packages are rarely linked to explosive devices, they all represent a
potential threat and need to be examined systematically. To minimize potential confusion,
threats and incidents, do not allow anyone to leave any unattended parcels, packages or bags
with you or in your work area. Continually remind passengers and employees to take their
belongings with them.
AN UNATTENDED PACKAGE IS ONE THAT IS LEFT…
On or next to a seat in a vehicle or waiting area
Next to a phone booth or vending machine
In a rest room
On a station platform
A SUSPICIOUS PACKAGE IS AN UNATTENDED PACKAGE THAT…
Is left or placed in an out-of-the-way area (under or behind a seat or trash container)
Is an out-of-place or abandoned container (fire extinguisher, propane canister, Thermos)
Matches something described in a threat
Has a threatening message attached
SUSPICIOUS DEVICES
Although these devices come in all shapes and sizes, common characteristics include:
Unusual wires and batteries
Some sort of visible tank, bottle or bag
A clock or timer attached to the object
IMPROVISED EXPLOSIVE DEVICES (IEDs)
These are common devices used by terrorists. Most bombs assembled by terrorists and other
disgruntled or mentally ill individuals are improvised. The raw material required for the
explosives is stolen or misappropriated from military or commercial blasting supplies or is
made from fertilizer and other readily available household ingredients.
Almost all IEDs, no matter how big or small, consist of four basic components: a power
supply, some type of switch or timer, a detonator/initiator and the main explosive charge.
The effects of an IED are sometimes worsened by the addition of material, such as scrap iron
or ball bearings. Sometimes the switch/timer is not the only component that activates the
detonator; there is also an anti-handling device that triggers the device when the IED is
handled or moved. The purpose of most IEDs is to kill or maim. Some IEDs, known as
incendiaries, are intended to cause damage or destruction by fire.
PIPE BOMB
This is the most common type of terrorist bomb and usually consists of low-velocity
explosives inside a tightly capped piece of pipe. Pipe bombs are very easily made using
gunpowder and iron, steel, PVC, aluminum or copper pipes. They are sometimes wrapped
with nails to cause even more harm.
MOLOTOV COCKTAIL
This improvised weapon – first used by the Russian resistance against German tanks in
World War II – is used by terrorists worldwide. Molotov cocktails are extremely simple to
make and can cause considerable damage. They are usually made from materials like
gasoline, diesel fuel, kerosene, ethyl or methyl alcohol, lighter fluid and turpentine, all of
which are easily obtained. The explosive material is placed in a glass bottle, which breaks
upon impact. A piece of cotton serves as a fuse, which is ignited before the bottle is thrown
at the target.
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SUSPICIOUS SUBSTANCES
CHEMICAL, BIOLOGICAL AND RADIOLOGICAL AGENTS
The psychological impact of CBR weapons will extend far beyond their actual effect. The
mere thought of imminent exposure to a chemical or biological agent, or radiation, causes
fear in people. The most important things to remember regarding CBR weapons are the
symptoms of an attack that will be displayed in victims.
Chemical agent symptoms are generally immediate and widespread.
Biological and radiological agent effects are generally delayed.
Quite often the observation of two or more people with the same symptoms will be the first
indication of an attack or exposure. ALWAYS remember to protect yourself. If you become
a victim, you cannot help others, and you add to the problem.
CBR AGENTS CAN…
Be difficult to identify
Have a tremendous effect in small quantities
Be spread throughout large areas by natural convection or air-currents
Remain in the air as vapor or aerosols or settle on surfaces. In many cases, a hazard can
remain for hours, days or weeks if untreated. This requires that facilities be monitored
and decontaminated before being returned to service.
Be ingested, inhaled, injected or absorbed into the body
SIGNS OF CBR AGENT RELEASES
An unexplainable pungent odor
A suspicious package emitting a vapor or odor
Abandoned, out-of-place aerosol or manual spray devices, i.e., fire extinguisher or garden
sprayer
A cloud, mist, fine powder, dust, liquid or fog with no identifiable or suspected source
SYMPTOMS OF CBR AGENT EXPOSURES
You observe two or more people suddenly…
Experience difficulty breathing or cough uncontrollably
Suffer a collapse or seizure
Complain of nausea
Complain of blurred vision
CBR EXPOSURE PROTECTION
The severity of CBR agent exposure depends on three factors: time, distance and shielding.
TIME
How long you are exposed to the agent will often determine the extent of your injuries and
long-term adverse health effects. In most cases the faster you can get away from an agent
once you are exposed, the better your chances of survival.
DISTANCE
The farther you are from a source, the better. In many cases, unless you are inhaling or
coming in direct contact with an agent, you will not be exposed to it. By avoiding contact or
moving away from the suspicious package or substance, you will greatly limit your chances
of exposure.
SHIELDING
Many CBR agents can be blocked or partially blocked by various materials depending on the
type of agent being emitted. A sheet of paper or layer of skin stops some agents, some are
inhibited by clothing, and others require special protective clothing and respiratory apparatus.
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In some cases, if there is a release in a station, it may be best to shelter people in-place within
a train and shut down the ventilation system instead of allowing people out into the
contaminated area.
CBR DISPERSAL METHODS
The ability to identify a potential threat by recognizing the tools of a CBR terrorist is key to
the prevention or mitigation of an attack. Dissemination devices are one such tool and can be
categorized based on how they disseminate the agent or material.
BREAKING/IMPACT DEVICES
These are weapons that encapsulate the agent and release it when broken. They are optimally
constructed from common items, such as light bulbs, balloons or insulated bottles, by
inserting the agent and sealing the device. Some of the devices are deployed by throwing
them at the intended victims. Others can be placed in a light socket and will break when the
light is turned on. The device used in the Tokyo subway attack was a breaking device that
was intentionally punctured by an umbrella, thereby releasing the agent – Sarin gas.
EXPLOSIVE DISPERSAL
This method uses an explosive to break the container and disseminate the agent. The device
will look similar to an IED with the addition of a bottle, bag or other form of container.
These weapons are usually configured with the explosive at one end of a tube so the
explosion forces the agent out the other end, or with the explosive surrounded by the agent.
SPRAYING DEVICES
These devices also contain an agent reservoir, but rather than an explosive charge, they
employ pressure to disseminate the agent. They can be point-dissemination weapons, such as
an aerosol can, or a line source-generating weapon, such as a device incorporated into an
automobile exhaust system. Examples of spraying devices include aerosol spray containers,
garden sprayers or any kind of spray bottle.
RADIOLOGICAL AGENT DISPERSAL
Weapons are often developed to involve whole-body exposure to radioactive material
(inhalation, ingestion) or contamination by radioactive material. This can be achieved by
placing into a public place a radioactive metallic object that is emitting harmful radiation.
Incidents involving either an explosion or fire will elevate the potential for the ingestion or
contamination by spreading the radioactive material in the form of small fragments (dust) or
smoke. “Dirty bombs” are intended to release radioactive material in this way.
THREAT AND INCIDENT PRIORITIES
1. LIFE SAFETY
Protect yourself and others against exposure and injury
Think! Don’t just react
2. INCIDENT STABILIZATION
Gather and report information
Await further direction
3. PROPERTY CONSERVATION
Primarily a role for emergency responders
Conducted under the direction of the Incident Commander
THREAT AND INCIDENT MANAGEMENT
Remain calm
Do not touch, cover or move a suspicious package, device or substance
At incidents involving IEDs, If possible, refrain from using cellular phones or radios
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closer than 300 feet from the area
Don’t take risks that could harm yourself or others
Implement agency protocols
Gather and report information
Await direction from supervisor or controller
Maintain communications with customers, Dispatch/Control Center, other employees
and First Responders
Be aware of secondary attacks or devices
EVACUATION PROCEDURES FOR EXPLOSIVE OR CBR THREATS
Stay calm
If in a vehicle, find a safe location and park
Evacuate people from the vehicle or facility, ensuring that they remove ALL of their
possessions
In a CBR incident, direct people to move upwind, away from the hazard
When dealing with an IED, move away the appropriate distance, notify
Dispatch/Control Center of your location and status.
IED EVACUATION RANGES
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INCIDENT MANAGEMENT
INFORMATION GATHERING
Aside from protecting yourself and others from danger, your most important activity is to
accurately gather information. The more detail regarding victims, circumstances and
indicators, the more effective ALL response actions will be. Important information includes:
Your exact location and condition
Type of injuries and/or symptoms
Victim locations and positions
Indicators of suspicious people, activities, packages, devices and substances
Wind direction and weather on scene
Witness statements or observations
Safe access route
INFORMATION REPORTING
Staying calm and clearly communicating information is CRITICAL to the safety of everyone
and the eventual outcome of the situation. Follow procedures and answer questions as they
are asked. At the conclusion of the conversation, be sure to verify that help is on the way.
TRANSIT/EMERGENCY SERVICES INTERFACE
In many cases a supervisor will either be en route or on-scene at an emergency. Prior to
his/her arrival, you may need to take appropriate actions. The primary mission is to protect
yourself and your customers. If the situation appears imminently dangerous to life,
evacuation should be conducted quickly. Following a safe evacuation, you should find a
means to notify Dispatch or the Control Center (cell phone).
If there is not an immediate threat to life safety, notify Dispatch or the Control Center and
await further direction.
In either case, your primary objective is to protect human life. Avoid contamination
whenever possible, and limit exposure to the greatest extent. If a supervisor does not arrive
prior to local emergency responders, you should identify yourself to the responders and
provide a brief summary of the situation. Let the responders know where you will be in case
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they need further information. Police, fire and Emergency Medical Services (EMS) all have
distinct roles at an emergency, and the lead response agency will often be determined by the
nature of the incident.
INCIDENT COMMAND
The primary duties of emergency responders at an incident are to gain control of the situation
by gathering information, assessing the conditions and activities and developing a plan. This
is done through the Incident Management System. As the chart above illustrates, transit
representatives should work within the system to assist in the overall efforts of controlling
and mitigating the incident. Emergency responders have specific responsibilities at a scene.
Depending upon the local structure of the response agencies, these responsibilities may vary.
In most cases they are:
LAW ENFORCEMENT
Interview you – your actions and observations are very important
Evidence preservation – credible threats and incidents are crime scenes
Crowd and scene control
Seek out passengers or witnesses who may have critical information
FIRE DEPARTMENT
Rescue any victims who are contaminated or trapped
Decontaminate anyone who may have been exposed to an agent
Detect and monitor the CBR agent
EMERGENCY MEDICAL SERVICES
Treat those with best chance of survival – Triage
Record condition and destination of all victims who are transported
Transit/Incident Command Interface
Incident
Commander
Safety
Public
Information
Liaison Transit
Supervisor
Operator
Customers
Operations Planning Logistics Finance
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ALWAYS REMEMBER
DON’T BECOME A VICTIM YOURSELF
There will be too many victims already if an IED or CBR incident occurs.
DON’T ASSUME ANYTHING
Given that this is a terrorist event, booby traps, secondary devices and perpetrators may also
be present.
DON’T TEST
Taste, eat, smell, and touch nothing. Any one of these actions may make you a casualty.
DON’T RUSH IN
Always assess the situation before doing anything. Avoid contamination. People and
equipment that do not get contaminated do not have to be decontaminated. This minimizes
risk, saves time and saves resources. Always minimize exposure. Move away from the
hazard and relocate upwind. Establish an outer perimeter early in the incident. Control
crowds, and do not let people pass by or through the affected area.
Security Responsibilities
Each PATS employee has security-related responsibilities to fulfill, which depend on the severity
of the security incident or emergency.
Types of Incidents
Incidents can range from a minor event delaying a single vehicle, to an emergency that poses a
threat to life safety, property, or the environment. Emergencies require an immediate
response.
Sometimes minor incidents are compounded by circumstances, such as weather, equipment
failures, or human error (such as lack of proper notification, mismanaged priorities, or failure to
follow procedures) and turn into major incidents. Your ability to determine the severity of an
incident and react appropriately will make a difference in its ultimate impact. It is critical that
you are prepared to assess situations that may arise.
Key Response Players
An effective and timely response requires coordination among the key players involved with
the incident. The key response players are the driver, the dispatcher, the 911 call taker, and the
emergency responders. The effectiveness of the interactive communications between these key
players involved in an emergency response effort will determine the overall impact of an
incident.
Transit Priorities:
When handling transit priorities:
Life safety will always be the first priority in responding to an incident or emergency
Controlling property and environment conservation
Service Restoration and minimizing service disruptions
Driver:
The driver must assess personal injuries and the impact on passengers, contact dispatch, and
secure the immediate vicinity of the incident.
Dispatcher:
The transit system dispatcher serves as the communications and information hub for managing
the system’s role in incident response. He/she determines the proper response and coordinates
the transportation resources needed.
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911 Call Taker:
The 911 call taker is the initial connection between the transit agency and emergency
responders. He/she is the main point of contact with emergency responders until units arrive
and take control of the scene.
Emergency Responders:
Each emergency responder has a role:
■ Police secure the scene and investigate
■ Fire handles fi re suppression, hazard mitigation, and rescue
■ Emergency Medical Services assist with health problems and injuries
Dispatcher
Response Cycle
The response cycle shows the general sequence for responding to any incident. After the
incident has occurred and Dispatch has been notified, it is imperative that information is
gathered and the situation is assessed in order to make informed decisions regarding the best
response actions.
Be Prepared
Directing drivers and others in what to do during any incident requires you to draw on your job
knowledge, situational awareness, and available resources. During an emergency, it is even
more imperative that you stay calm and support your co‐workers in the field. In order to be
confident in your actions, prepare yourself to meet these challenges:
■ Know your organization’s policies and emergency procedures
■ Frequently review protocols for reporting emergency situations and keep lists of key
resource agencies at your fingertips
■ Rehearse the steps you would take in different emergency situations in your mind
Use Effective Communication Practices Every Day
Asking questions, gathering and analyzing information, and making detailed reports to various
entities are things you must do everyday. If you are conscientious in using effective
communication practices in your routine activities, you will be prepared to use those same
approaches during high‐stress emergency situations.
Informed of
Incident
Gather
Information
Assess
Situation
Determine
Actions
Direct
Employees
Make
Notifications
Communicate with
Responders
Evaluate
Priorities
Modify
Plan
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Clear Communication
Whether communicating with front‐line personnel or emergency responders, it is critical that
you keep your communication timely, clear, concise, accurate, and delivered with poise. They
are often looking to you for confidence and direction and they need to hear that in your voice
as well as your words.
■ Listen carefully and repeat the message if necessary
■ Take time to formulate your response and seek acknowledgement of the message
■ Keep communication in simple and concise terms to avoid misinterpretations
Key Information
Your main objective is to obtain and relay the key information needed to effectively respond to
an incident. This includes:
■ The people and vehicles involved
■ The location (note special circumstances such as elevated roadway, highway
entrance ramp, etc.)
■ A detailed description of the incident unfolding
■ The condition, injuries, and location of people involved
■ A description of the surrounding physical environment (traffic accidents, weather)
Supporting Front‐line Employees
When communicating with front‐line employees during an incident:
■ Remain patient and calm
■ Have them repeat back instructions you have given them
■ Give them frequent feedback as to what is transpiring
■ Direct them to give factual updates to their passengers
■ Explain that they will need to update the emergency responders who first arrive on‐
scene
Communicating with Emergency Responders
When speaking with the 911 Call Taker or responders:
■ Avoid transit jargon and acronyms
■ Keep communications in simple and concise terms
■ Stay accessible to them
■ Provide the following information:
■ Your name and organization
■ Your call back number
■ Location of the incident
■ Vehicle type and direction of travel
■ Description of what happened
■ Status of passengers, number and nature of injuries
■ Existing on‐scene hazards
■ Aid currently being provided
■ Any other pertinent information
Until Help Arrives
It is critical that front‐line personnel take the necessary steps to respond to incidents that may
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arise. In most instances they will be looking to you for guidance and direction. There are
generally two categories of incidents you will face: safety‐related incidents and security related
incidents.
Safety‐Related Incidents
Safety‐related incidents are unintentional acts or uncontrollable circumstances that result in
emergency situations. Safety‐related incidents can include:
■ Vehicle accidents
■ Severe weather
■ Hazardous materials release on route
■ Fire on vehicle
■ Medical issue on vehicle
Security Related Incidents
Security‐related incidents are intentional acts that result in threats or emergency situations.
Security‐related incidents can include:
■ Threats associated with suspicious activity or objects
■ Presence of an Improvised Explosive Device (IED)
■ Chemical, Biological and Radiological substance release (CBRs)
Responding to Vehicle Accidents
Accidents can range from minor incidents to more serious situations. In all instances:
■ Work with the driver to identify and address safety hazards at scene, such as
potential fires, fluid leaks, broken glass or moving traffic
■ Direct the driver to render aid and assistance to the best of his/her ability and
training without endangering his/her own safety
■ Gather important details about location and nature of the accident that need to be
communicated to emergency responders
■ Call 911 or the appropriate emergency responders in accordance with your agency’s
policies
■ Advise employees not to talk to the media
■ Stay in contact with and support employees at the scene
Responding to Severe Weather Incidents
Severe weather can come in many forms depending on your geographic area. Whether your
system suffers from blizzard conditions or hurricanes, it is important to be prepared and able to
respond to the severe weather conditions that can hinder your agency operations. Stay
attentive to current weather and the progress of approaching storms, review emergency
policies, procedures and communications plans, and investigate possible alternative routes that
may need to be utilized.
■ Keep communications open and know the status of all vehicles on the road
■ Inform, update, and remind drivers of:
■ Weather conditions
■ Route changes
■ Additional hazards created by the storm
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■ Direct drivers to keep customers inside and turn vehicle hazard lights on when
stopped on the side of a road
■ Request emergency assistance as needed
Responding to a Hazardous Materials Release on Route
If there is a hazardous materials release on or near one of your routes:
■ Follow the advice of local emergency officials
■ Reroute vehicles uphill, and upwind of the release to minimize exposure
■ Direct the drivers to shield themselves and their passengers from the contamination
by:
■ Closing vehicle windows and doors
■ Minimizing air movement
■ Being patient and remain calm
■ Keep communications open and know the status of all employees and vehicles in the
area
Responding to a Fire on a Vehicle
Fires can spread rapidly. The fi re itself is not the only deadly hazard. Asphyxiation from heat
and smoke is actually the leading cause of fi re deaths. The primary response measure is to
move passengers and employees well away from the fire.
■ Order a safe evacuation of the vehicle
■ Direct the driver to distance himself/herself and passengers from the vehicle and
stay uphill and upwind if possible
■ Collect appropriate information about the incident and request emergency
assistance
■ Direct employees to follow the instructions of emergency responders on‐scene
Responding to a Medical Issue on a Vehicle
If a person suffers a medical condition either on board a vehicle or at a stop, it is important that
the emergency medical responders obtain the proper information to respond appropriately.
■ Gather general information about the incident, including the location of the vehicle
■ Gather specific information about the person experiencing a medical issue
■ What is the problem?
■ Is the person conscious or unconscious?
■ Is the person breathing?
■ What is his/her age, gender, and known medical condition?
■ Has any first‐aid been administered by the driver or other passengers?
■ Relay information quickly to emergency personnel
■ Keep communications open with the driver
Responding to a Security Threat
Security threats are indications of potentially dangerous activity or objects that could inflict
harm. When a driver calls to report a security threat, take the following actions:
■ Calm the driver down and do not dismiss his/ her concerns
■ Collect as much information as possible
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■ Assess the situation based on your agency’s procedures and your knowledge and
experience
■ Dispatch a supervisor and/or emergency personnel to the scene if warranted
Suspicious Activity
Suspicious activity includes people exhibiting behaviors that are unusual or out‐of‐the‐
ordinary for your operating environment. This can include:
■A person loitering or acting in a disorderly manner on your vehicles or agency
property
■ Someone abandoning a package and quickly leaving an area
■ A person observing your operations and/or expressing an unusual level of
interest in your operations, facilities, personnel, or equipment
■ A vehicle that is parked in an unusual location, shows signs of tampering, or
is visibly overloaded
■ A vehicle that appears to be following one of your agency’s vehicles
Suspicious Objects
Suspicious objects are items, devices, or substances that are abnormal or out‐of‐the‐
ordinary for the surrounding environment. This can include objects with a threatening
note attached or that:
■ Have been hidden
■ Are unclaimed by people in the surrounding area
■ Are abandoned by someone quickly leaving the area
Use common sense in determining if an object is truly suspicious
Responding to the Presence of an Improvised Explosive Device (IED)
IED’s are typically simple in design and construction and can be deployed and detonated
in a number of ways. An IED is made up of four components:
■ Switch/timer mechanism
■ Detonator initiator
■ Explosive charge
■ Power supply
A suspicious object is elevated to the level of a dangerous object when it has an
indication of some of the four components, which include:
■ Visible wires, batteries, or tanks
■ Clocks, timers, or cell phones attached
■ Sounds emanating from it, such as ticking or buzzing
Immediate Actions for Suspicious and Dangerous Objects
If after conferring with a driver, you believe an item is suspicious or dangerous:
■ Instruct employees not to handle, touch, open, or cover the object
■ Direct employees to evacuate the immediate area and keep people safely
away from it
■ Gather information regarding the location and description of the object
■ Notify emergency responders providing as many details as possible about the
object
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If the object could be an IED:
■ Instruct employees not to use cell phones or radios in the vicinity of the
object
■ Stop or redirect vehicles entering the area and expedite vehicle departures
from the area
■ Conduct security sweeps of all other vehicles and facilities in your system
Responding to a Chemical, Biological, or Radiological Release
It is very important to be able to recognize the signs of a chemical, biological, or
radiological release, which include:
■ Abandoned aerosol or manual spray devices
■ A cloud, mist, fi ne powder, liquid, fog, or odor with no identifiable or
suspected source
■ TWO or more people who are:
■ Experiencing difficulty breathing or coughing uncontrollably
■ Suffering a collapse or seizure
■ Complaining of nausea or blurred vision
Immediate Actions for a Chemical, Biological, or Radiological Release
If based on the reports you are receiving, you suspect a dangerous release on a vehicle:
■ Direct the front‐line employee not to handle, touch, open, or cover the
substance
■ Stop and evacuate the vehicle immediately at a safe location
■ Gather information about location of the vehicle and status of the driver and
passengers
■ Request assistance from emergency responders
■ Direct employees to get passengers together and wait for decontamination
Summary of Response Techniques
In any type of emergency situation you ultimately have two choices for dealing with employees
and passengers while help is on the way: shelter‐in‐place or evacuate.
Shelter‐in‐place
In many situations it may be most prudent to have employees and passengers remain where
they are and let the rescue workers come to them. A transit vehicle or facility can provide
protection. Where there is smoke or other contaminants outside
the vehicle or facility direct employees to:
■ Turn off the HVAC systems
■ Close windows and doors
■ Keep the vehicle moving out of the contaminated area if possible
■ Stay away from flammable liquids or gases
Maintain communications with those sheltered in place and keep them updated on what is
being done to assist them.
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Evacuate
A vehicle or facility must be evacuated if there is an imminent threat or immediate danger to
employee and customer safety. In directing an evacuation, make sure that the on‐scene
employee:
■ Has a specific destination and route for evacuating passengers
■ Does not move seriously injured people unless they will be exposed to greater harm
where they are
■ Enlists assistance with elderly and disabled passengers
■ Maintains communications with employees executing the evacuation and keep them
updated on what is being done to assist them.
When Help Arrives
When emergency responders arrive on the scene they will assess the situation and implement
the Incident Command System (ICS), their standardized process for managing incidents. While
this will place fi re or police at the scene in charge, the on‐scene employees as well as dispatch
will still be an important part of the response eff ort. Coordination, cooperation, and
communication within your transit agency and with emergency responders are critical to
effectively managing all emergency situations.
Your role in the ongoing management of an incident is to support on‐scene employees and
emergency responders by:
■ Providing agency resources upon request
■ Coordinating activities within the transit agency related to the incident
■ Communicating with agency management regarding the status of the situation
Coordination, Communication and Cooperation within your transit agency and with emergency
responders are critical to effectively managing all emergency situations.
Coordination
Communication Cooperation
Others will Count on You
During any type of incidents your co‐workers and customers will count on you to do your best
to respond effectively. In order to react appropriately, be confident and rely on your:
■ Experience
■ Workplace preparation
■ Procedural knowledge
■ Training
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Take advantage of opportunities to drill, practice, and mentally rehearse potential situations so
when you encounter real incidents you will not be approaching them cold.
Identification of Security Problems
At least annually, the Transit Manager or designated security supervisor will assess the PATS
facilities and determine if any security problems or potential security threats exist, and then take
actions to resolve any issues. The Transit Manager or security supervisor will use the following
form to identify security problems:
Workplace Security Assessment Form
Facility (Worksite):
Location:
Date:
Inspection No.:
Describe the physical layout of the establishment. Indicate its location to other businesses or residences in
the area and access to the street.
Number/gender of employees on-site between 10:00 p.m. and 5:00 a.m.
Describe nature and frequency of client/customer/passenger/other contact:
Yes No
Are cash transactions conducted with the public during working
hours? If yes, how much cash is kept in the cash register or in another place accessible to
a robber?
Yes No
Is there safe or lock-box on the premises into which cash is deposited?
What is the security history of the establishment and environs?
What physical security measures are present?
____________________________________________________
Yes No
Has security training been provided to employees? If so, has the
training been effective?
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Procedures
The PATS Security Plan includes written procedures for PATS employees to follow in various
types of security incidents. While emergencies may be related to security incidents, PATS
employees should also refer to the emergency procedures included in Appendix G for additional
protocol to follow in emergency situations. Regardless of whether a security incident or
emergency arises, PATS employees should notify dispatch immediately, and call local
authorities when appropriate.
Vehicle and Facility Security
The PATS office is located at 341 South Madison Blvd, and PATS vehicles are located in the
Human Services parking lot across from the building. There is no fence around the perimeter of
the building or vehicle area, but the parking lot is gated and well illuminated and monitored by
PATS staff as well as the Roxboro Police Department through random patrols. The following
procedures will guide PATS employees in implementing security measures related to the
agency’s facilities and vehicles:
General Awareness
A. Be aware of suspicious activity or behavior by patrons, or others in proximity to or in
public transportation vehicles or facilities.
B. Notice unusual conditions of vehicles, both those belonging to the system and others,
which may be enter into parking lots or facilities.
C. Be vigilant with respect to strange packages, items or substance, which are brought into
or left in facilities or vehicles.
Vehicle Inspection
A. Inspect the interior of the vehicle: floors, seats, under seats, and interior compartments for
unknown objects or tampering.
B. Inspect under the vehicle for items taped or attached to the frame.
C. Inspect the interior lights to make sure they are operational and have not been tampered
with.
D. Inspect the exterior of the vehicle for unusual scratches or marks by tools, signs of
tampering, unusually clean or dirty compartments, or items attached using magnets or
duct tape.
E. Inspect engine compartments, and other areas, for foreign objects.
Transit Vehicle Being Commandeered
A. When approaching a stop or pick up point, survey the area for suspicious people or
activities.
B. If suspicious people or activities are present report concerns to dispatch/authorities and
drive the vehicle out of the area.
C. If suspicious people are aroused after the vehicle has stopped, do not open the doors but
communicate with individuals through the window until determining proper action.
D. Avoid boarding individuals carrying what might be a weapon or looks like a suspicious
package.
E. If the vehicle is commandeered follow all instructions and avoid confrontation.
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F. If the vehicle is commandeered while in park, open or keep open all doors and allow
opportunity for all to exit.
G. If the vehicle is commandeered and in motion, drive past locations where someone might
react and report.
H. Employ methodologies to alert the authorities but take no actions that will increase risk.
I. Stay calm, use common sense, follow instruction of perpetrator, wait for emergency
response or find a way to escape.
Office Security
A. Only PATS office staff and General Services have keys to the main entry door to the
PATS office. The first office employee to arrive at the office during business hours will
unlock the main entry door, while the last office employee to leave each day will be
responsible for locking the main entry door.
B. During normal business hours the main entry door will remain open to allow customers
entry to the reception area. All guests and staff must enter through the main entry door.
C. Office visitors who do not have a scheduled appointment may not be let in past the
reception area without a chaperone.
Security Incident Reporting
Any security issues will be reported to the PATS office immediately, and the following form
should be filled out within 24 hours of the reported incident:
SECURITY INCIDENT REPORTING FORM
Prepared By: Date:
Title: Phone #:
Description of Incident: Attach Law Enforcement Report(s) if Available
Transit Agency:
Security Contact Person:
Area Code and Phone #:
Date of Incident: Time of Incident:AM/PMCounty:
Location:
# of Fatalities: # of Injuries:Property Damage Estimate:$
Type of Security Incident(s) – Check all that apply
Homicide Burglary Bombing
Forcible Rape Motor Vehicle Theft Chemical or Biological Release
Robbery Arson Hijacking
Aggravated Assault Bomb Threat Kidnapping
Other ________________________________________________________________
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D. Accident/Incident Packet – Vehicles
The Seven Steps of Crisis Management
Drivers Severe Measures Code 300
Accident Incident Statement Form
Safety and Security Situation Form
Safety Situation Form
Employee Statement Form
Bloodborne Pathogens form
Vehicle Accident report
Bomb Threat Check List
Seating Chart
Courtesy Cards
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APPENDIX A
RESOLUTION FOR APPROVAL OF REQUIREMENT FOR COMMUNITY
TRANSPORTATION SYSTEMS TO IMPLEMENT SYSTEM SAFETY PLANS
WHEREAS, the Federal Transit Administration’s strategic safety goal is to promote the public
health and safety by working toward the elimination of transportation related deaths, injuries and
property damage;
WHEREAS, the Federal Transit Administration and the National Transportation Safety Board
require the reporting of certain transportation related accidents;
WHEREAS, the vision for public transportation services in North Carolina includes the
provision of safe, affordable transportation choices, statewide to those who have travel options
and to those whose options are limited;
WHEREAS, the development and implementation of System Safety Plans by Community
Transportation systems is a fundamental step toward these goals;
WHEREAS, the North Carolina Department of Transportation, Public Transportation Division
recognizes the safety implications of the development of System Safety Plans and provides
training and technical assistance to transit systems to assist in the development and
implementation of their System Safety Plans;
WHEREAS, rural transit systems receiving federal and state funds are not currently required to
have a System Safety Plan;
WHEREAS, the Public Transportation Division, in an effort to promote safe public
transportation services recommends requiring that each rural transit system in the state that
receives federal and/or state funds must have an approved System Safety Plan which includes
provision for local system safety data collection and reporting;
WHEREAS, the Transit, Rail and Ferry Committee has concurred in this recommendation.
THEREFORE BE IT RESOLVED AS FOLLOWS:
That the North Carolina Board of Transportation approves the recommended requirement that
each Community Transportation System that receives federal and/or state funds must have an
approved System Safety Plan which includes provision for local system safety data collection
and reporting.
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APPENDIX B
Employment Process Checklist
Driver Name:
Employment Phases Responsible Party Complete Notes
Phase I: Source of Applicants
Word of mouth
Newspaper advertisement
On-site advertisement
Walk in
Other
Phase II: Initial Review Responsible Party Complete Notes
Review Application materials
Employment history
Skills assessment
Experience
Other
Set up Interview
Phase III: In-depth Interview Responsible Party Complete Notes
Transit Manager
HR Director
Safety/Training Officer
Other
Phase IV: Candidate Evaluation Responsible Party Complete Notes
Preliminary background check
Criminal history
OIG (Office of Inspector General)
Federal Exclusion List Check
MVR (License, endorsements, violation history)
Accident history
(Physical work abilities) Job Function test
Controlled substances (Drug Screen)
Other
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Phase V: Conditional Employment Offer Responsible Party Complete Notes
Ensure compliance with minimum eligibility criteria
Skills and abilities
Character and job attitude
Other
Phase VI: Initial Training and Skills Classification Responsible Party Complete Notes
New Hire Classroom training program
Behind The Wheel
(Select appropriate level)
: Inexperienced
: Mid-level experienced
: Extensive experience
Other
Phase VII: Probationary Employment Period Responsible Party Complete Notes
Length of initial probationary employment period
(90 days)
Unacceptable behavior/actions
Required testing/evaluations
Duty restrictions
Other
Phase VIII: Permanent Employment
Testing and Evaluation
Responsible Party Complete Notes
Ride Check: Driver Evaluation
Assign Route (Full-Time)
Other
Driver’s Name: ________________________________
Transit Manager’s Name: _________________
Transit Manager’s Signature: ____________________
Date: _________________
I certify that all phases of the hiring process were completed in connection with the above named driver.
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Appendix C
The North Carolina Transportation Notification System is a sub-system of the State
Automated Driver License System (SADLS). The Transportation Notification System
allows its registered users to do the following:
Add drivers to their system database.
Record the termination of employment for drivers.
Review an employee’s driver license history as frequently as warranted to
determine whether the license status is in good standing.
o Person Area Transportation System requires driving record to be
reviewed every 12 months
Review a driver’s driver history to monitor occurrences of convictions,
suspensions, disqualifications or cancellations a driver may receive.
Receive correspondence when a conviction has been posted to an employee’s
record.
Purge the employment history of unused data as needed.
The North Carolina transportation Notification System puts in hand a tool that allows
transportation companies to be pro-active in improving and promoting highway safety.
General Information
Company Contact Person:
Rhonda Long from Person Area Transportation System has been designated as your
company’s contact person. The designated contact person is the only person from your
company with the authority to request adding and deleting users from the system and
changing company information.
Disclosure Form:
In addition to having a valid commercial driver license the driver must sign a disclosure
form before they can be added to the system. When signed, this form gives your
company permission to view the driver’s records.
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Person Area Transportation System
MVR Driver’s Disclosure Form
North Carolina Department Of Transportation
Division Of Motor Vehicles
Traffic Records Section
3105 Mail Service Center
Raleigh, NC 27699‐3105
*************************************************************************************
Effective September 13, 1997, all motor vehicle records are subject to the Federal Driver’s
Privacy Protection Act (FDPPA) and General Statute 20‐43.1. The FDPPA and GS 20‐43.1
requires that personal information in this Division of Motor Vehicles records be closed to the
public. Personal information from these records may be released to individuals or organizations
that qualify under one of the fourteen (14) exceptions listed on the back of this form. These
exceptions are summarized statements of permissible user.
Name of Driver: ________________________________________________________________
Driver License#: ___________________________ State of Driver License: __________________
Address: ______________________________________________________________________
City: _________________________ State: ______________________ Zip Code: ____________
By signing this form, you are granting the company access to your personal information under
exception number 13 of the FDPPA and GS 20‐43.1
Name of Company/Agency: Person Area Transportation System
Signature of Driver: _____________________________________________________________
Date Signed: ___________________________________________________________________
My signature on this document acknowledges that I understand that improper release of
information and/or false representation to gain information from the DMV’s records is
prohibited and is subject to civil action.
Company/Agency: Person Area Transportation System
Name of Requester/Contact: Rhonda S. Long
Requester’s Signature: ___________________________________ Date: ___________________
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Federal Driver’s Privacy Protection Act
Enacted by Congress August 24, 1994
Chapter 123, Section 2721 requires that personal information Division of Motor Vehicles’ records be closed to the public. This
refers to photos, social security numbers, drivers license numbers, names, addresses, telephone numbers and medical
information.
General Purpose: Division of motor vehicles, and any officer, employee or contractor, therefore shall not knowingly disclose or
otherwise make available to any person or entity personal information about any personal information about any individual
obtained by the division in connection with a motor vehicle record.
Permissible Users: Personal information SHALL be disclosed for use in connection with matter of:
A. Motor vehicle or driver safety and theft
B. Motor vehicle emissions
C. Motor vehicle product alterations, recall or advisories
D. Performance monitoring of motor vehicles and dealers by motor vehicle manufactures
E. Removal of non‐owner records from the original owners if motor vehicle manufactures to carry out purpose of the
Automobile information Act, the Motor Vehicle information and Cost Saving Act. The National Traffic and Motor
Safety Act of 1966. The Anti‐Car Theft Act of 1992 and the Clean Air Act.
Exceptions:
Personal Information MAY be released for the following reason: (List qualifying number on reverse)
1. For use by any government agency, or any private person or entity acting on behalf of a Federal, State, or local agency
in carrying out its functions.
2. For use in matters of motor vehicle or driver safety and theft, motor vehicle emissions, motor vehicle produce
alterations, recalls or advisories, performance monitoring of motor vehicles, motor vehicle parts and dealers, motor
vehicle market research activities, including survey research, and removal of non‐owner records from the original
owner records of motor vehicle manufactures
3. For use in the normal course of business by a legitimate business but only:
a. To verify accuracy of personal information
b. To obtain correct information, but only for purposes of
1. Preventing fraud by the individual
2. Pursuing legal remedies against the individual
3. Recovering on a debt or security interest against the individual
4. For use in connection with any civil, criminal, administrative, or arbitrate proceeding in any Federal, State or local
court or agency (includes the execution or enforcement of judgments and orders or court orders)
5. For use in research activities and statistical reports:
a. Personal information must not be:
1. Published
2. Redisclosed
3. Used to contact individuals
6. For use by insurance companies in connection with claims investigation, anti‐fraud activities, rating or underwriting.
7. For use in providing notice to owners of towed or impounded vehicles
8. For use by private investigators or licensed security service
9. For use by employer to verify information regarding CDL
10. For use in connection with private toll facilities
11. For any other use if person has opportunity to refuse disclosure on DMV forms
(Prohibited by N.C. General Statue 10‐43.1)
12. For bulk surveys, marketing or solicitations (Disclosure must be in accordance with N.C. General Statue 10‐43.1)
13. For use by any requester that has obtained written consent of the individual to whom the information pertains.
14. For any use specifically authorized under the law of the State that holds the record, if such use is related to the
operation of a motor vehicle or public safety.
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Driver Evaluation Form
Driver Name____________________ Date _____________________
Review the employee’s MVR and assign appropriate points for each violation in the score box.
Number of Accidents (within last 3 years)
Quantity Description Points Score
None 0 ___
1 1 ___
2 2 ___
3 5 ___
Major Moving Violations
Quantity Description Points Score
___ Hit and Run; leaving scene of accident 4 ea. ___
___ Driving under influence, alcohol/drugs 12 ea. ___
___ Felony, homicide, manslaughter involving use of motor
vehicle
12 ea. ___
___ Racing or excessive speeds (20 MPH over limits) 10 ea. ___
___ Reckless, negligent or careless driving 4 ea. ___
___ Implied consent refusal (Blood alcohol test) 12 ea. ___
___ License suspension or revocation 8 ea. ___
___ Speeding 2 ea. ___
Other Moving Violations
Quantity Description Points Score
None 0 ___
1 or 2 1 ___
3 and over 2 ___
Total Points _____________
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Appendix D
Background Checks:
North Carolina requires organizations to perform background checks on all potential
employees through the National Crime Information Center (NCIC)
Upon hiring the employee, background checks must be completed every 5 years in
order to maintain compliance with state requirements. (Person County requirements for
background checks are annually and Person Area Transportation System must maintain
compliance with Person County.
In addition to a standard background check, North Carolina requires organizations to
perform fingerprint-based criminal background checks on all employee candidates who
have resided in North Carolina for less than 5 Years prior to the application submission
date.
Conviction, guilty plea, or plea of no contest to any of the crimes listed in Transportation
Policy MA 2910 or MA 3550 of the NC Medicaid Manual within the 10-year period
preceding the date of the background check is grounds for disqualification from
employment or volunteer services.
1. Murder
2. Rape or aggravated sexual abuse
3. Kidnapping or hostage taking
4. Assault inflicting serious bodily injury
5. A federal crime of terrorism
6. Unlawful possession, use, sale, distribution, or manufacture of an explosive
device
7. Unlawful possession, use, sale, distribution, or manufacture of a weapon
8. Elder abuse / exploitation
9. Child abuse / neglect
10. Illegal sale or possession of a Schedule I or II controlled substance
11. Conspiracy to commit any of the above.
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SAFE-T-WORKS, INC.
Drug & Alcohol Testing and DOT Compliance Services
1029 Sunset Avenue, Asheboro, NC 27203
Phone: 336-736-8038 Fax: 336-736-8042
Background Investigation
Please perform a background investigation on the following (please PRINT all information):
Last Name: __________________ First Name: ____________________ Middle Name: ___________________
Maiden Name: ___________________
Current Street Address: ______________________________________________________________________
City: _______________________________________ State: _________________ Zip: ___________________
Prior Street Address: ________________________________________________________________________
City: ______________________________________ State: _________________ Zip: ____________________
Gender: M F Race: ___________________
Full Date of Birth: ____________________________ Social Security Number: _______________________
Signature of Authorization FCRA: 1) Signing this authorizes a background investigation. 2) You
may not be hired or your employment continued based on our report. 3) You will be told if that is the intent. 4) You can view the
report and dispute items you feel are erroneous with us or the source.
I hereby authorize the release to Safe-T-Works, Inc., any information held by any parties regarding my prior employment, criminal,
credit, driving, workers comp. and educational history as well as information regarding my general character and reputation.
I release any providers of such information from any liability for providing same. I understand the information may be reviewed
initially and periodically by Safe-T-Works and reported to my prospective/actual employer. I agree falsification may make
me ineligible for employment or subject to immediate dismissal, if hired. I further acknowledge that Safe-T-Works is relying on third
party information and I therefore release Safe-T-Works, my prospective employer, and their respective owners, officers, agents and
employees from any and all liability arising out of errors or omissions. If not hired, I understand I do have certain rights under FCRA
laws.
Please check the appropriate box below:
Multi-State with Identitrace (National) State ______________________
Other ___________________________________________ Federal Courthouse Search
Driver’s License Check ____________________________ Credit History
Driver’s License Number & State
Requested by: ___________________________________ County: _______________________
Phone Number: _________________________________ Today’s Date: __________________
Please fax to Safe-T-Works, Inc at 336-736-8042
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Appendix E
Federal Exclusion List Check:
All NEMT (Non-Emergency Medical Transportation) organizations are required to run
federal exclusion list checks before hiring an employee. Because the exclusion list is
updated monthly, the NCDHHS Provider Administrative Participation Agreement and
Transportation Policy MA-2910 and MA-3550 of the NC Medicaid Manual require the
provider to run OIG checks on all employees monthly.
Person Area Transportation System being a NEMT is required to run a federal exclusion
list check before hiring an employee. Because the exclusion list is updated monthly,
Person Area Transportation System is required to run OIG checks on all employees
monthly.
General Information
The Office of Inspector General (OIG) is required to exclude all individuals and entities
convicted of the following criminal offenses from participating in federal health care
programs: Medicare or Medicaid fraud, or any other offenses related to the delivery of
items or services under Medicare, Medicaid, SCHIP, or another state health care
program. The OIG is also responsible for citing these individuals and entities on the
exclusion list.
Website: https://exclusions.oig.hhs.gov/
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Appendix F
Person Area Transportation System: Job Function Test for New Hires
Job Function Test
Person County Transit Specialist
Date: ___________________
Name: _______________________
I hereby give my consent to participate in a Job Function Test that requires the exertion of potentially
strenuous effort. I understand that this test is based on the physical demands of this position. I attest
that I have no current medical limitations or conditions that may pose a risk of potential injury during
this test.
Signature: _____________________
Resting HR: __________ BP: ____________
Does this person safely pass a musculoskeletal screening evaluation? ___________
Potential Contraindications: ______________________________________________________________
Job Task/
Essential Function
Test
requirements
Applicant
Performance
Able to
perform
Essential
Function
1 Lifting up to 20#
from floor to
shoulder level
Lift up to 10#
frequently
Lifting up to 20# from
14” to 48” 10# x 20
reps
_________
20# x 5 reps _____
Max lift to
shoulder height
Yes / No
2 Climbing up to 12
step to enter vehicle
Step onto 12 inch
platform 10x
Able _______
Unable _____
3 Grip Strength to
operate vehicle
Grip bilateral more
than 25#
R ____ ____
L ____ ____
Max grip
R ____
L ____
4 Balance Required Demonstrate normal
unilateral stance on R
and L of 20 seconds
Able ____
Unable ____
5 Employee may sit for
extended periods,
driving up to 8 hours
Able to sit without
limitation
Able ____
Unable ____
6 Squat and bend for
vehicle inspection
Forward bend at waist
Squat to ground level
Able ____
Unable ____
7 Demonstrate proper
visual acuity for
operation a vehicle
Complete standard
eye test
With 20/40 vision*
Able ____
Unable ____
*Drivers who cannot meet the 20/40 acuity standard for the state of North Carolina are referred to an
eye care specialist.
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Comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Signature of Evaluator: _____________________________________
Date: ___________________________________________________
Job Function Description
General Information
Job name: Transit Specialist
Employer: Person County Government
Brief Description: Provide transportation services to a variety of county citizens including the elderly,
transportation deprived and emotionally, mentally and physically disabled of all ages.
Product: n/a
Job Number/Department: Person Area Transportation
# of job operators/associates: 1
Associate contacted: ___________________________________
Shift work: no
Length of work day: 7.5 hours
Days worked per week: 5
Detailed Description: The employee drives a van or bus to provide transportation to county citizens to
and from school, medical appointments, grocery/drug store, etc. Transportation may be subscription or
“on demand” and occurs both within and outside the County. Work includes driving an assigned route
schedule that vary on a daily basis, assisting passengers, collecting funds and writing receipts,
maintaining records, and maintaining the vehicles. Work involves a special understanding of the needs
and behavior of clients served. The work subjects the employee to inside and outside environmental
conditions, fumes and gases. Duties may expose the employee to human body fluids thus the work is
subject to OSHA requirements on Bloodborne pathogens.
Assessor: James Turner PT DPT OCS ___________________
Date of Analysis: ___________________________
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Specific Task Description/Essential Functions
# Job Function Force
Demands
Movement/Positional
Demands
Specific
Requirements
Frequency*
1 Perform duties of
operation and
inspecting a
commercial vehicle
Lift, carry,
push or pull
up to 20#
Bend
Reach
Squat
Climb
Balance
Stand
Walk
Fingering/Handling
Lift up to 20#
in a range of
body positions
occasionally or
up to 10#
frequently
Occasionally
2 Assist clients on and
off vehicles which
includes assistance
with scooters,
walkers and wheel
chairs (Mobile Units)
Lift carry,
push or pull
up to 20#
Bend
Reach
Squat
Climb
Balance
Stand
Walk
Fingering/Handling
Lift up to 20#
in a range of
body positions
occasionally
Occasionally
3 Clean the interior of
the vehicles and the
pre and post
inspections
Lift, carry,
push or pull
up to 20#
Bend
Reach
Squat
Climb
Balance
Stand
Walk
Fingering/Handling
Push/pull
broom/mop to
clean inside of
vehicle. Squat,
bend and
reach to pick
up trash when
necessary.
Carry up to
10# trash bags
when cleaning.
Occasionally
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Physical Demands Summary
Physical demands Never or Rarely Occasional Frequent Constant
Stand X
Sit X
Walk X
Climb X
Lift floor to waist X10# X10#
Lift waist to
overhead
X10#
X10#
Lift/carry X10# X10#
Push X10# X10#
Pull X
Grip X
Pinch X
Reach overhead X
Reach at
chest/shoulder
X
Low level work X
Bend X
Bend/reach X
Balance X
*Frequency is defined as the amount of time during a given work day that the activity occurs. Occasional
is defined by U.S. Dept. of Labor guidelines as activity that occurs up to 1/3 of the work day, frequent as
activity that occurs up to 2/3 of the work day and constant as activity that occurs for more than 2/3 of
the work day. All frequencies reported here occur on a daily basis during the given season in which that
work activity exits.
The above information is a statement of the physical demands of the position as observed through job
site analysis and interview with employees in the above position. It is intended to represent the range of
physical requirements associated with the essential functions of the job, as presented at the time of the
assessment. The employer reserves the right to assign or require other job duties as necessary.
I have reviewed the above information and attest that it is a fair and accurate depiction of the physical
requirements of the job as currently performed.
Signed: __________________
Date: ____________________
Position/Job Title: Transit Specialist
Assessor: James Turner PT DPT OCS
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APPENDIX G
Training Logs: New Hire and Annual
PATS New Hire Training Schedule Log
Description:
New Hire Training Schedule
New
Employees
Training Materials Time
Orientation to Job:
Responsibilities: Time Sheets, Emergency Information,
Policies and Procedures,
Initial
Transit Manager
Vehicle Safety
Pre-Trip Safety Inspection (Approach, Under the Hood,
Walk Around, On-Board, En-Route, Post Trip Safety
Inspection, Vehicle Familiarization
Initial
START Learner’s
Manual and Power
Point
2.5 hours
Driver Safety
Physical and Emotional Conditions, Vehicle control,
Following Distance, Important Considerations, Adverse
Weather, Night Driving, Other Considerations
Initial
START Learner’s
manual and Power
Point
2.5
Hours
Passenger Safety
Boarding and Alighting Passengers, Boarding
Ambulatory Passengers, Boarding Non-ambulatory
Passengers, On-Board Emergencies, BOLO, Different,
Difficult, Dangerous Passengers, Crisis Management,
Passenger Relations
Initial
START Learner’s
Manual, Power
Point, DVD
3 Hours
Defensive Driving
Basic Operations and Maneuvering, Starting and
Stopping, Maintaining Safe Following Distance,
Changing Lanes, Intersection Operation, Passing and
being Passed, Passing School Buses and Emergency
Vehicles, Making Turns, Standard Curbing Procedures,
Leaving a Service Stop, Backing a vehicle, Special
Operation situations,
Within 90
days of hire
*5.1 Defensive
Driving, DVD,
*Pedestrian
Awareness Trainer’s
Guide and DVD
(Stuart
Darden)
?
20
minutes
Distracted Driving
(Avoid Distractions) The Growing Epidemic of cell
phone use while driving. What is a Distraction?, Get the
Facts, Working to be Distraction Free
Within 90
days of hire
The Growing
Epidemic of Cell
Phone Use While
Driving manual,
Power point
1 Hour
American with Disabilities Act
(ADA) 49 CFR 37.173
Title VI, ADA Guide, Doing it Right (SURE-LOK),
QRTMAX (Q-STRAINT), Oxygen Securement, Hands
on Training, Passenger Assistance, Proficiency
Within 90 day
of hire prior
to starting
revenue
service
*ADA Guide,
*Doing it right
manual, DVD, *The
QRT manual, DVD,
*Title VI Brochure
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Note: New employees will receive all trainings upon hire; specific time frames reflect NCDOT PTD requirements or PATS policy.
Bloodborne Pathogen
29 CFR 1910.1030(g)(2)
OSHA’s Bloodborne Pathogens Standard, Awareness
for Transit Professionals, Your Ticket to Safety, Hands
on Training
First Aid-
Within 90
days of hire
Initial and
every 2 years
*OSHA’s
Bloodborne
Pathogens
Standards, *Your
Ticket to Safety,
DVD,
30
minutes
Prevention of Alcohol Misuse and
Prohibited Drug Use
49 CFR 655.14
Alcohol & Drug Testing (Driver Awareness Training),
The Truth About Drugs:
(Real People Real Stories) A Documentary
Effects and consequences of prohibited drug use on
personal health, safety, and the work environment, signs
and symptoms that may indicate prohibited drug use
Within 90
days of hire
*Illegal Drug Use:
The Truth About
Drugs manual,
DVD,
*What Employees
need to know about
DOT Drug and
Alcohol Testing,
DVD
1:42.56
27:19
Customer Driven Service
Who is the Customer?, The Keys to Customer Service:
The Big Picture, Customer service in action: Creating a
culture of customer service, Taking care of your
customers, Customer service breakdowns.
Initial
Learner’s Guide,
Power Point, DVD
Problem Passengers Challenging Situations
Customer Management Techniques, Managing Angry
behavior, handling refusals, dealing with threats, dealing
with human needs situations, stress management
Initial
Video, workbook
26:57
System Security Awareness
What is System Security?, What is your role in reducing
vulnerability?, What do you look for?:, What about
anthrax and other suspicious substances?, What is your
top priority?
Initial
System Security
Awareness Student
Guide, DVD, Mask
DVD
18:45
20:55
Emergency Procedures and Emergency
Equipment:
Report and react to an emergency, Preparedness,
Hazards and Threats, Emergency Procedures,
Emergency Equipment on vehicle
Within 90
days of hire
Learner’s Guide,
Power Point, DVD
Behind The Wheel Training
Newly hired drivers must have Behind the wheel
training before being allowed to operate a transit vehicle
unsupervised in revenue service (On Road Training)
After Initial
Training
1st week: riding with
drivers
2nd week: driving
with drivers
Driver Evaluation / Ride Check
All drivers must have an annual evaluation to assess the
driver’s performance of techniques, skills and knowledge
Within 3
months of
hire and
Annually
Scheduling, Radio Procedures, Office and Paperwork
Requirements
Initial
Transportation
Clerk/Dispatcher
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Employee Annual Refresher Training
Refresher Training
2 The Point Training
(START)
July
2017
June
2018
July
2018
June
2019
July
2019
June
2020
July
2020
June
2021
July
2021
June
2022
July
2022
June
2023
July
2023
June
2024
July
2024
June
2025
July
2025
June
2026
ADA and Sensitivity
Issue: One-Five
July
Bloodborne Pathogens
Issue: One-Five
August
Customer Service
Issue: One-Six
September
Defensive Driving
Issue: One-Four
October
Defensive Driving
Issue: Five - Ten
November
Defensive Driving
Issue: Eleven-Thirteen
December
Distractive Driving
Issue: One - Three
January
Safety and Security
Issue: One-Ten
February
Drugs and Alcohol
Issue: One-Seven
March
Emergency Management
Issue: One-Seven
April
Transporting Non
Ambulatory Passengers
Issue: One-Seven
May
Passenger Safety
Issue: One-Three
June
Employee’s Name: __________________________________ Employee #: ___________
Hire Date: ________________________________________ Ending Date: ___________
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APPENDIX H
Ride Check: Driver Evaluation
Date of Evaluation: ___________________
Driver’s Name : ______________________
Evaluator’s Name/Position: __________________________
Passenger Reception
Confirms identity/destination of passenger
Present at entry door while boarding
Greets passenger in a friendly manner
Uses proper assistance techniques (What are the driver’s responsibilities?)
Assists passengers to and from the vehicle door if needed
Stops proper distance from curb
Avoids use of AM/FM radio
Uses correct ADA language at all times
Vehicle Condition
Daily pre-trip inspection complete/documented
Web cutter and emergency triangles are available
Registration and insurance card in vehicle
Driver’s license/logs with driver
Vehicle exterior clean
Vehicle interior clean
Dashboard/windshield area clear of all objects
Tie downs properly employed
Tie downs clean/ stowed in box
Seat belts in good working condition
Fire extinguisher is available, serviceable, properly mounted/tagged
First Aid/Blood-borne pathogen kit available in vehicle
Flash light working (if applicable)
Communications system operable
Child seat used/stowed properly
Daily defect report filled out
Lift operational check
Keeps logs up to date
Performance While En-Route
Driver uses correct posture when driving
Both hands on steering wheel
Appropriate uniform/footwear
Driver and passengers use seatbelts
Driver gets out of vehicle and looks before backing
Adjust mirrors before moving vehicle. Keeps eyes moving
Signals entry into traffic every time. Leaves himself an out
Moves vehicle smoothly while slowing braking and stopping. Make sure they see you
Telegraphs use of brake or flashers when stopping
Squares corners when turning
Moves at appropriate speeds for current road conditions
Maintains following distance safety zone (4 seconds)
Uses proper caution at intersections
Anticipates stale green lights (slows down)
Seats passengers properly
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Stops at all railroad crossings
Comes to a complete stop, leaving private property
Uses proper lane changing procedure
Stops behind line or plane at intersections
Observes proper communication procedures
Uses turn signals properly
Maintains order in vehicle
Maintains scheduled stops and pick-ups
Avoids unauthorized stops
Uses four second distance rule, adds seconds to following distance when driving conditions
change – keeps safety cushion
Passenger Discharge
Uses parking brake when de-boarding passengers
Stops proper distance from curb. Assist passengers off vehicle (when needed or when
passengers request help)
Renders adequate assistance to wheelchair passengers
Advises Base when leaving vehicle and upon return to vehicle
Makes sure passenger is safely inside of destination before leaving property
Follows passengers instruction for assistance when needed
Comments
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Course of Action (required/taken)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Driver’s Signature ________________________ Date________________
Supervisor’s Signature ____________________ Date ________________
Driver’s Comments
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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Ride Check
Driver Performance Evaluation Explanation
PASSENGER RECEPTION
The Driver…
1. Asks the name of the passenger and the destination before boarding, unless the passenger
is a subscription rider.
2. Is available at the door to assist the passenger on or off the vehicle (if needed).
3. Acts courteously, offers help by asking, “May I help” or “How may I help you?”
4. Follows guidance from the passenger, if help is needed.
5. Uses the passenger’s instructions to assist in boarding and exiting the vehicle, if needed.
6. Stops the vehicle six inches or four feet from curb to keep passengers from falling off
the vehicle as they load and unload. (This depends on the stopping or parking situation.)
7. Uses AM or FM radio only when passengers are not aboard, then only for the news and
weather forecast.
8. Uses correct language under ADA guidelines. (Refer to the ADA handout given to
drivers who have taken the SNAAP training.)
VEHICLE CONDITION
The Driver . . .
1. Performs a pre-trip inspection and completely fills out the pre-trip inspection form before
starting the first run of the day.
2. Ensure registration and insurance cards are current and available.
3. Has driver license in possession and current route logs on person at all times.
4. Vehicle is clean on exterior.
5. Vehicle is kept clean inside at all times.
6. Nothing is on the dashboard, rear view mirror, or sun visors that could create a hazardous
situation.
7. Safely attaches tie down straps into floor tracks, and use the four-point tie down on
wheelchairs.
8. Removes tie downs from floor after each use. Stores tie down straps in their proper
place.
9. Seat belts/tie down straps are not tangled, missing or broken.
10. Checks fire extinguisher for serviceability and expiration date.
11. Checks the first aid and Blood-borne Pathogen Kits regularly (PPE) and re-supplies when
needed.
12. Ensures web cutter and emergency triangles are available.
13. Checks batteries daily to make sure flashlight is usable. (If applicable)
14. Tests the two-way radio and/or other communication device for operability.
15. Child seats are placed in vehicle properly and stowed when not in use.
16. Fills out daily defect report correctly.
17. Keeps logs up to date as trip is completed for each passenger.
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PERFORMANCE ENROUTE
The Driver…
1. Does not slouch in the seat while driving. Arms are not on or out of the window frame.
2. Both hands are on the steering wheel at the 9 and 3 or the 10 and 2 position. Gets the big
picture.
3. Clothing should be appropriate for job.
4. Uses seat belt correctly and requires correct use of seat belt for all passengers.
5. Gets out and looks behind vehicle, for obstacles, before backing.
6. Adjusts mirrors before leaving base (for safety and visibility). Keeps eyes moving.
7. Uses signals for all maneuvers in traffic. Leaves an out.
8. Does not jerk the vehicle when stopping and starting. Uses the brakes without stomping
or slamming (stops vehicle smoothly).
9. Presses the brakes slightly to warn tailgaters to slow down or uses flashers when coming
to a quick stop.
10. Does not whip around corners. Slows down to 2 to 5 miles per hour when turning
corners. Positions vehicle for proper safe turns. (Squares the corner.)
11. Does not travel too slow or too fast for conditions on the road or for the posted speed
limit.
12. Does not enter intersection without proper caution, uses the four second rule. Keeps
safety cushion under control.
13. Slows down when green light has been green for some time at a distance.
14. Checks mirrors, looks over shoulder, signals, and moves into passing lane, signals and
returns to proper lane. Leaves (himself/herself) an out.
15. Signals at proper distance for an intended turn. Cancels signal when maneuver is
completed.
16. Does not allow profanity or misbehavior in the vehicle.
17. Keeps on schedule safely but does not jeopardize safety for schedule.
18. Only transports passenger on route schedule. No unauthorized passengers or stops.
19. Maintains a safe distance when following someone in all weather conditions.
PASSENGER DISCHARGE
The Driver…
1. Uses parking brake when loading or unloading passengers.
2. Stops the vehicle 6 inches to 4 feet from curb to discharge passengers. Assists passenger
off vehicle.
3. Assists all passengers as required.
4. Advises dispatcher of absence from vehicle and advises dispatcher of return to vehicle.
5. Does not leave elderly and disabled passengers unattended. Makes sure they are in the
hands of caretakers or inside their homes/destinations before driver leaves the property
(case by case judgment).
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TITLE: BEHIND THE WHEEL TRAINING
DRIVER TRAINER: ___________________________
TRAINEE: ________________________________
DATE: __________________________
SUMMARY: THIS DOCUMENT FROM THE NORTH CAROLINA DEPARTMENT OF
TRANSPORTATION ADDRESSES THIRTEEN CONSIDERATIONS FOR
DRIVER SAFETY, BOTH BEFORE AND DURING DRIVING.
BEHIND THE WHEEL TRAINING
1. Always make sure the trainee can comprehend essential basic instructions or
commands of the [Driver Trainer] before beginning the road test.
2. Perform pre-operational checks on equipment making sure engine is off before
beginning inspection.
3. Do not stand directly in front of or behind the bus during the inspection.
4. Use proper lifting techniques when opening hood of vehicle.
5. When looking under the bus, crouch with one knee down rather than bending at the
waist.
6. Prior to testing, give clear preliminary instructions. Stand out of the direct line of the
bus. Establish eye contact with the driver before approaching the vehicle.
7. Observe trainee closely and constantly monitor traffic around the bus. Be alert for
inattentive drivers.
8. Remain in area where the traffic complexity is within the ability of the driver. Be sure
to consider his experience and confidence, moving to more demanding or
dangerous area only when driver is fully prepared.
9. If the [Driver Trainer] observes a trainee action that could result in an auto accident,
the Trainer will immediately provide corrective commands to the trainee.
10. Use handrail when getting on or off the bus. (Use 3 pt. Mount/dismount)
11. Sit at left edge of seat at angle to driver with both feet on floor.
12. Remove key from unattended vehicle.
13. All personnel to vacate bus when refueling. Do not over fill fuel tank.
Driver Trainer: _______________________________ Date: ______________
Trainee: ____________________________________ Date: _______________
Transportation Manager: _______________________ Date: ______________
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APPENDIX I
Training Curriculums
Defensive Driving
PATS drivers spend the majority of their work time on the road, which places them at a high risk
of being involved in an accident. As a PATS driver, your best defense from being involved in an
accident is to drive defensively.
1. Vehicle – You can control the conditions of your vehicle by doing a proper pre-trip
inspection and reporting any problems to the appropriate supervisor.
2. Anticipate potential accidents and take defensive action to avoid the hazards.
3. Stay Alert at all times.
4. Do not take any unnecessary risks.
5. If personal stress is affecting your ability to concentrate, alert the dispatcher so a
replacement can be called in to take over your route.
Defensive driving is being constantly alert to accident hazards and avoiding those hazards. The
most important factor in defensive driving is YOU!!! Your defensive driving tools are:
1. Your physical ability to spot a hazard, maneuvers the vehicle away from it, and warn
others of it.
2. Your knowledge of driving hazards and how to spot them.
a. Your knowledge of the safety zone and how to maintain it.
b. Your knowledge of the rules of the road.
c. Your knowledge of the vehicle’s equipment.
d. Your skill maneuvering the vehicle.
3. Drivers with good defensive driving attitudes:
a. Leave personal problems at home.
b. Are rested and alert.
c. Avoid the use of alcohol and drugs.
d. Are physically and mentally healthy.
Safety Zone
The safety zone consists of the area around the vehicle, which is determined by proper following
distance, road hazards, and weather conditions. The length of the safety zone is affected by the
speed of the vehicle, road hazards, and weather conditions.
Following Distance
Remember the four-second rule of following distance between your vehicle and the vehicle
ahead of you. You can check this by watching the vehicle ahead pass a stationary object and
then count off four seconds prior to reaching the same fixed object. Exercise caution to allow
sufficient stopping distance under varied conditions such as wet roads, passengers on the vehicle,
ice, snow, gravel, set leaves, fatigue or illness of the driver, and impairment.
Stoplights or Signs Regulate Intersections
When passing through an intersection a driver should do the following things:
1. Slow down.
2. Obey traffic lights and signs.
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3. Check pedestrian and vehicular traffic before entering.
4. Pull up to corner to see traffic. Make a traffic check to the front, then to the left, and to
the right, and left again before entering the intersection.
5. Stop or yield if necessary.
6. Keep foot on the brake.
7. At 4-way stops the vehicle, which enters the intersection, first goes first. The vehicle to
the right goes next. Be prepared to yield the right-of-way to vehicles, which may go out
of turn.
Testing the Brakes
Test the brakes for malfunctions within the first block or two after starting a trip.
Report immediately to the Maintenance Coordinator any problems with the brakes. A driver
must not operate any vehicle once he or she is aware that there is any problem with the vehicle’s
brakes.
1. Report immediately to the Dispatcher, Maintenance Coordinator or Director any
problems with the brakes. A driver must not operate a vehicle once he or she has
determined that it is unsafe to do so because of malfunctioning brakes.
2. Keep foot brake applied when passengers are boarding or leaving and when doors are
open.
3. Use the parking brake to hold the vehicle for parking or whenever the driver leaves the
driver’s seat.
4. Do not fan or pump a brake which cause excessive wear, and reduces braking capability.
5. Brakes should be applied in a manner that avoids skids, especially in inclement weather.
Dealing with Brake Failure Procedures
The guidelines below can assist you in safely maneuvering your vehicle during brake failure:
Do not force the brake to the floor; you will destroy any chance of rebuilding pressure.
Gently pump the brake pedal to see if you can restore pressure.
Sound your horn and flash your lights to alert other drivers.
Shift to the lowest gear possible.
Remain calm and guide your vehicle into an environment where you can slow the vehicle
and bring it to a natural stop.
Look for an outlet. Can you use a natural upgrade to slow the vehicle? Is there a large
open parking lot that you can coast across?
Do not pull the parking brake – you could put the vehicle in a tailspin. As an exception
in vans or small buses, it may be necessary to use emergency brake but you should
control the release with your hand to prevent the brake from locking.
Do not permit the wheels to lock until the vehicle has stopped.
Mirrors
1. Mirrors are to be adjusted before starting a trip.
2. Outside left and right mirrors are to be used for turning maneuvers when pulling out from
the side of the road and in addition, the right side mirror is to be used to observe loading
and offloading passengers.
3. When making traffic lane changes or entering traffic from a stop, be sure to check the
blind spot in both mirrors.
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4. Mirrors are very important defensive driving tools and are to be scanned every 8 – 10
seconds.
Backing Procedures
Vehicle backing is strongly discouraged unless it is absolutely necessary. The following
procedures are suggested in the event that an operator is required to use the reverse gear:
Except for backing out of a parking stall, drivers should only back a vehicle when it is
absolutely necessary. If it becomes necessary to back the vehicle while the vehicle is in
service, a driver should use an adult as a spotter. The spotter should not be asked to exit
the vehicle because that can cause the spotter to be vulnerable to injury. Use of a spotter
does not relieve the driver of the responsibility to back the vehicle safely.
Before backing, check carefully in all directions including the rear of the vehicle.
Turn on the four-way flashers.
Begin honking the horn (if the vehicle does not have a working ‘backing-up’ alarm) and
continue to give short continuous beeps on the horn while in motion.
As a rule when stopping in traffic, stop far enough back to see the rear tires on the vehicle
ahead. This allows a driver the ability to go around a stalled vehicle on the left or right if
necessary without the need to reverse direction. This procedure does not always work
but it is another good example of how to avoid backing.
Be sure to stay out of intersections and crosswalks until they are free to traffic. Do not
get into positions where backing a large vehicle becomes necessary.
If the view is obstructed and the driver is in doubt, he or she should exit the vehicle (if it
is reasonable safe to do so) to check behind and around it.
Turning
1. Signal 150 feet or 3 seconds prior to turn.
2. Check the mirror for other vehicles.
3. Be sure intersection is clear of cars and pedestrians before turning.
4. Check traffic in all directions.
5. Turn at speed appropriate to road, weather, and traffic conditions.
6. Follow vehicle through the turn using the mirrors.
Stopping for Passengers at Designated Stops
The following procedures should be followed by all drivers when stopping at designated stops to
load and offload passengers:
1. Turn on four way flasher lights to caution motorists.
2. Slow down gradually.
3. Pull as far to the right as safety allows, not hitting a curb or other stationary objects.
4. Make a full complete stop.
5. Place transmission in park.
6. Set the parking brake.
7. Open the door. (Never open the door while vehicle is in motion when stopping at a bus
stop).
8. Load / offload passengers
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9. Always wait for loading passengers to get seated and fasten their seat belt before moving
the vehicle.
Seat Belts
Drivers are required to use seat belts at all times.
Vehicle security
Drivers are responsible for their assigned vehicle and when temporarily leaving the vehicle, the
driver should turn on the hazard lights, set the parking brake, cut off the engine and shut the
door.
Crossing Railroad Tracks
To insure that everyone arrives safely at their destination, consistently utilize the following
procedures when approaching and crossing railroad tracks:
Upon approaching the railroad crossing, proceed into the far right lane.
Turn on the four-way flashers 100 feet before reaching the tracks the vehicle must stop
behind the white line (if a line is present) and not in the path of the crossing barrier.
Turn off heaters, fans, radios, etc. so that you can hear a train. If necessary, ask
passengers to remain silent during the crossing.
Open the door completely and listen for an approaching train or (if driving a van) open
the window completely and listen.
Look in both track directions as you listen for an approaching train.
When you can conclude that no train is approaching, close the door (watching the door
while it is closing) or window.
Check your left mirror for traffic.
Proceed slowly over the tracks to avoid damage to the vehicle.
Turn off the four-way flashers after the vehicle is past the tracks.
En-Route Procedures
Depart on time and stay on schedule, but never at the expense of passenger safety.
Drive safely and smoothly. Operate at all times on compliance with applicable traffic
regulations, ordinances, and laws of the jurisdiction in which the vehicle is being
operated.
Avoid lengthy conversations with passengers, since conversations can distract a driver
from safely operating the vehicle.
A vehicle with passenger doors in the open position should not be operated with
passengers aboard. The doors should not be opened until the vehicle is stopped or at a
railroad crossing. A vehicle with inoperable doors should not be operated with
passengers aboard.
During darkness, interior lighting and lighting of step-wells on vehicles should be
sufficient for passengers to enter and exit safely.
Passengers should not be permitted in the step-wells of the vehicle nor occupy an area
forward of the standee line when the vehicle is in motion.
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Standee passengers should not be permitted on vehicles that are not designed to
accommodate standing passengers.
Fueling the vehicle when passengers are being transported should be avoided unless it is
necessary.
When passengers are aboard, the transit system requires the driver to be secured to the
driver’s seat with a restraining belt at all times while the vehicle is in motion.
Vehicles should not be left unattended at any time when passengers are aboard.
When transporting passengers, drivers should stop at all railroad crossings in compliance
with North Carolina Statues.
School Zones
Drivers will use extreme caution near schools and observe the School Zone Speed Limit.
Drivers will also obey the signals of school crossing guards, school patrons, and the flashing
lights of school buses.
Night Time Driving Procedures
Several hazards associated with night driving are list below:
Reduced visibility
Glare
The need for increased reaction time
An increased number of tired and intoxicated drivers
Procedures for driving at night:
Inspect and clean your headlights, taillights, windshield, clearance lights, reflectors and
turn signals.
Increase your space cushion by driving a slightly slower speed than you usually would
during the day.
Turn your lights on early and avoid the glare of oncoming bright lights by watching the
right edge of the roadway. If someone is needlessly using bright light, do not turn your
bright lights on in response to their lights.
Make sure that your speed does not overdrive your headlight visibility.
Do not break more than necessary. Use engine and lower gears to help you to slow down
the vehicle when traction is poor.
Keep the fuel tank at least half full.
Slippery Road Surfaces
It takes longer to stop and it is harder to turn without skidding when the road is slippery.
Reduce speed by 1/3 (i.e., from 55 mph to 35 mph). Below are some signs that a road is wet and
caution should be taken:
a. Shaded areas – these will remain icy after other areas have melted.
b. Bridges – bridges freeze before the road.
c. Melting ice – melting ice is very slippery.
d. Black ice – thin layer of ice makes road look wet.
e. Vehicle icing – if vehicle is icy, generally so is the road.
f. Just after rain begins – oil left on the road by vehicles will mix and make road slippery.
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Driving Through Water
If a driver has to drive through water he or she should follow the following procedures:
1. Slow down.
2. Do not speed up while traveling through the water.
3. If the vehicle starts to hydroplane do not apply the brakes.
4. Take your foot off of the gas pedal and try to steer the vehicle to safety.
5. After you get out of the water, maintain light pressure on the brakes for a short distance
to heat them up and dry them out.
6. Make a test stop when safe to do so.
7. Check behind to make sure no one is following, and then apply the brakes to be sure they
work correctly.
Winter Driving
1. Snow produces a glare that can affect vision. Keep sunglasses and use them.
2. Fog requires you to slow down and maintain a longer following distance. Drive with
lights on in rain and fog.
3. Know when and how to use your brakes. If you must brake, tap and release them using
them in a pumping motion. Don’t brake in the middle of a curve. If your vehicle goes
into a skid, take your foot off the brake.
4. In a skid, you should not panic, over steer, or immediately apply brakes. Remove your
foot from the accelerator and turn the vehicle in the direction of the skid. When you
regain steering control, you may resume braking by using the pumping motion.
5. Loss of traction, let up on accelerator until traction is returned.
6. Before going up a hill, increase speed to build up momentum to help you climb.
7. Before going down a hill, slow down by shifting into a lower gear.
8. Use brakes only with extreme caution when going down a slippery hill.
9. If you are stuck in snow, alert dispatch so help can be sent.
Driving in Hot Weather
During heat, pay special attention to the daily inspection of:
1. Tires
2. Engine oil gauge
3. Engine coolant gauge
4. Engine belts
5. Hoses
Hurricane
Hurricanes are large powerful storms that can suddenly change direction. Check frequently on
the storm’s progress until all watches and warnings for your area from the National Weather
Service are cancelled. If needed bus and van drivers will be contacted by their dispatcher to
inform them to transport people from their homes to various shelters for safety. Everyone will
be on call for such weather. Watch strong wind, water pockets, power lines, flooded streets,
and heavy rain.
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Americans with Disabilities Act
Helping Passengers with Personal Assistance Devices
Use the Assisting Passengers who are Using Canes or Critters:
Always ask the disabled passenger if you can assist her/him prior to assisting the
passenger
Assist from the opposite side of the cane.
Canes, walkers and other personal assistance devices should be stored so that they do not
interfere with movement in the vehicle.
Amputees should be seated in cool areas during hot weather.
Assisting Developmentally Disabled Passengers:
Treat the passengers with respect.
Be patient and repeat instructions when necessary.
Be firm if they insist on doing something that will endanger you, them or the other
passengers.
Assisting Hearing-Impaired Passengers:
Look directly at them so they can see your lips.
Talk normally (do not shout) and do not exaggerate your speech.
Be prepared to repeat yourself.
Get another person to talk to them if the passenger has trouble reading your lips.
Use a pad and pencil when
Assisting Speech-Impaired Passengers:
Do not hesitate to ask speech-impaired persons to repeat anything that you do not
understand.
Be patient; the passenger’s speech condition may become more difficult to understand if
the passenger is under stress.
Assisting Passengers with Visual Impairments:
Don’t touch the passenger until you tell them who you are and what you intend to do.
Do not shout at the passenger.
Before boarding the passenger, take their hand and show them the door openings as well
as the seat and mention any hazards.
When escorting the passenger, remain on the opposite side of their cane and have them
hold your arm. Advise the passenger of any changes in ground texture or elevation level.
When walking with a passenger, call out turns and maneuvers at least five (5) steps in
advance.
If the passenger uses a service animal, it may be helpful to lean the name of the animal
for future reference. Avoid any abrupt movements toward the animal or the passengers.
Seat visually impaired passengers against vehicle walls when possible or seat the
passengers in seats with arm rests in order to assist them in keeping their balance.
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Transporting Elderly Passengers Procedures
Use special care in serving elderly passengers:
Dispatcher needs to be especially patient when giving elderly passengers information
regarding vehicle routes and schedules.
Give elderly passengers more time to get on or off the vehicle.
Ask the elderly passengers if they would like your assistance before assisting them.
If the elderly passenger refuses assistance, stay close to prevent them from tripping or
falling.
When assisting elderly passengers, do not put too much pressure on the passenger’s arm.
When letting elderly passengers on or off a vehicle, pull the vehicle close to the curb so
the passenger won’t have to step very far.
Be sure elderly passengers do not sit too close to heaters or other such hazards.
Elderly passengers may need to be reminded where to get off of the vehicle.
Keep temperature controls warm in the winter and cool in summer.
In cases of emergencies, drivers should notify dispatchers about possible health problems
of elderly passengers.
Wheelchair Boarding Methods
Your customers' safety will depend on more than just safely transporting them to their
destination, their safety will also depend on how well you board and secure their wheelchairs.
Several wheelchair boarding guidelines are indicated below:
Roll the wheelchair onto the lift, making sure that the front wheels are inside the platform
roll stop while the roll stop is in the upright position.
Lock the brakes.
If the passenger has the capability to do so, ask the passenger to hold on to the hand rails
provided on the lift. If the passenger does not have the capability to hold onto the
handrails, ask the passenger to hold his/her hands in his/her lap.
Before operating the lift for boarding, ask the passenger if he/she is ready. Keep one
hand on the lift controls. Ask the passenger if it is okay for you to rest your other hand
lightly on the armrest of the wheelchair as the lift goes up while you stand on the ground;
this will keep you alert to the stability of the chair while also providing the passenger
with psychological comfort.
Make sure that the lift is level with the floor before stopping. Be sure that there is a
smooth surface created by the vehicle transition plate so that the wheelchair rolls
smoothly over it and into the vehicle.
From inside the vehicle, hold the wheelchair handle as you unlock the brakes. (Turn the
power back on or engage the clutches of a motorized wheelchair if needed.)
Make sure the passenger's head does not hit the ceiling upon entering the doorway.
The ADA states that wheelchairs should always be secured facing the front of the
vehicle, with the exception given to some older vehicles that are not yet appropriately
equipped.
The driver should never stand on the lift.
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Wheelchair Lift and Securement Procedures
Always follow the guidelines below to ensure safe lift operation and passenger safety:
Always inspect a lift prior to each use (look for loose nuts, bolts,)
Before deploying a lift for use, safely park the vehicle on level ground, turn the engine
off (unless otherwise specified by the manufacturer) and check for obstacles to avoid in
area where lift is to be deployed. Make sure that hands, feet and clothing are away from
folding parts of the lift.
Only passengers and their mobility devices should ride the lift.
When operating a lift with a passenger on it, allow the lift to go all the way up to floor
level or down to the ground without stopping.
Have the passenger use the handrails and never leave a passenger unattended on a lift.
Assisting Wheelchair Users on the Lift:
Wheelchair users can choose to ride a lift either facing away from the vehicle or facing
the vehicle. The preferred method is to have the passenger facing away from the vehicle
because it positions the bulk of the weight where there is more structural support and
allows the driver to pull the wheelchair into the vehicle or push the wheelchair onto the
lift by the handgrips.
In the preferred positions, the small front wheels of the wheelchair are less likely than the
large back wheels of the wheelchair to roll over the platform roll stop.
The preferred position also reduces the possibility of the passenger’s feet or toes getting
caught between the lift platform and the vehicle when the passenger is riding upward.
Securing an Occupied Wheelchair
To insure the safety of your passengers, consistently use good practices in handling wheelchairs:
Always use a four point tie-down to the floor of vehicle.
Tie-downs should be attached to the strongest part of the device which is the frame.
Lap boards or metal and plastic trays attached to the chairs should be removed and
secured.
Liquid oxygen being transported should be securely mounted/fastened to prevent damage
Aspirators, ventilators/other equipment must be securely mounted to wheelchair or
vehicle.
Never restrain a child’s head separately such as with a headband attached to the back of
the seat. Restraining a child’s head separately can cause excessive strain on the child’s
neck. Many children now have special neck braces to support their head during transport.
Bloodborne Pathogens
Content of Blood-borne Pathogen Training as Described in the Occupational Safety and Health
Administration (OSHA) Standard 29 CFR 1910.1030(g)(2)
1910.1030(g)(2)(i)
The employer shall train each employee with occupational exposure in accordance with the
requirements of this section. Such training must be provided at no cost to the employee and
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during working hours. The employer shall institute a training program and ensure employee
participation in the program.
1910.1030(g)(2)(ii)
Training shall be provided as follows:
At the time of initial assignment to tasks where occupational exposure may take place;
At least annually thereafter.
1910.1030(g)(2)(iii)
[Reserved]
1910.1030(g)(2)(iv)
Annual training for all employees shall be provided within one year of their previous training.
1910.1030(g)(2)(v)
Employers shall provide additional training when changes such as modification of tasks or
procedures or institution of new tasks or procedures affect the employee's occupational exposure.
The additional training may be limited to addressing the new exposures created.
1910.1030(g)(2)(vi)
Material appropriate in content and vocabulary to educational level, literacy, and language of
employees shall be used.
1910.1030(g)(2)(vii)
The training program shall contain at a minimum the following elements:
An accessible copy of the regulatory text of this standard and an explanation of its
contents;
A general explanation of the epidemiology and symptoms of blood-borne diseases;
An explanation of the modes of transmission of bloodborne pathogens;
An explanation of the employer's exposure control plan and the means by which the
employee can obtain a copy of the written plan;
An explanation of the appropriate methods for recognizing tasks and other activities that
may involve exposure to blood and other potentially infectious materials;
An explanation of the use and limitations of methods that will prevent or reduce exposure
including appropriate engineering controls, work practices, and personal protective
equipment;
Information on the types, proper use, location, removal, handling, decontamination and
disposal of personal protective equipment;
An explanation of the basis for selection of personal protective equipment;
Information on the hepatitis B vaccine, including information on its efficacy, safety,
method of administration, the benefits of being vaccinated, and that the vaccine and
vaccination will be offered free of charge;
Information on the appropriate actions to take and persons to contact in an emergency
involving blood or other potentially infectious materials;
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An explanation of the procedure to follow if an exposure incident occurs, including the
method of reporting the incident and the medical follow-up that will be made available;
Information on the post-exposure evaluation and follow-up that the employer is required
to provide for the employee following an exposure incident;
An explanation of the signs and labels and/or color coding required by paragraph (g)(1);
and
An opportunity for interactive questions and answers with the person conducting the
training session.
1910.1030(g)(2)(viii)
The person conducting the training shall be knowledgeable in the subject matter covered by the
elements contained in the training program as it relates to the workplace that the training will
address.
Source: OSHA website http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=standards&p_id=10051 (accessed
August, 2010).
Emergency Procedures for Vehicle Operators
Immediately notify dispatch of any emergency situations, and then follow the applicable
procedures as described below.
Procedures (communication and notification, passenger handling, vehicle evacuation, etc.)
Emergency Preparedness
When there is an emergency on your vehicle, you alone are responsible for handling the situation
in a way that lessens the risk of injury or danger to your customers, yourself and your vehicle.
These are tremendous responsibilities that you alone must initially meet. You are the primary
person that customers look to for help and protection in an emergency.
When faced with an emergency you may be just as frightened as your customers. This is why it
is very important for you to have learned and practiced the four basic accident and emergency
handling procedures.
1. Remain calm.
2. Protect your customers, yourself, your vehicle.
3. Contact your dispatcher.
4. Complete the required reports.
Evacuation
You must be prepared to provide evacuation assistance to customers who are elderly and/or
customers with disabilities who use your transportation vehicle. As a professional transit
operator, you have an important responsibility for the welfare and safety of your customers.
Training helps you to fulfill these responsibilities. Evacuation should be considered hazardous
under the best of conditions. Hazards increase if the evacuation must be done hurriedly or if it
involves customers who are severely disabled.
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The Evacuation Decision
When fire is present, there is leaking fuel, and/or the vehicle is in danger, then the need to
evacuate is clearly indicated. Assessing a possible emergency in other situations may be less
clear, for example, a tornado sighting or heavy flooding.
Weather conditions, traffic, road conditions, availability of assistance, response time of public
safety services, customer characteristics and operator’s experience will enter into the decision to
evacuate.
Vehicle Location
Once you become aware of a possible emergency and the vehicle has stopped, its location should
be noted. You should be aware of the vehicle’s position relative to the nearest cross street, road
or widely recognized landmark.
Another aspect of vehicle location, which affects evacuation, will be the terrain characteristics of
where you are stopped. The following must be considered when deciding what to do.
1. Are you stopped on a hill, facing uphill or facing downhill?
2. Are you stopped on the shoulder?
Is the shoulder wide enough for your vehicle?
Is the shoulder flat or on an incline?
Is the shoulder grassy, rocky, and/or has a ditch on the side?
3. Are you on a curve and can oncoming traffic sees you clearly and in sufficient time?
4. Does the road have a crown?
5. Are you on
A divided highway?
Multi-lane undivided?
Two lane road?
6. Is your vehicle off the road and if so, is it
On the shoulder?
In a ditch?
In a driveway?
The above conditions must be considered in conjunction with the vehicle’s position,
e.g., level, front end down front end up, tilted on its side to some degree, resting on its side or
resting on its top.
Evacuating Wheelchair Customers
Customers in wheelchairs present two elements for assessment. The first is whether conditions
permit operation of the lift. Cold weather will cost significant loss of time to get the lift
deployed. If the emergency was caused by a collision the impact may have caused short circuits
in the lift’s wiring. These shorts can cause ignition of leaking fuel and/or possible injury to you
due to the high amperage of the electrical current required to operate the lift. The lift may be
damaged preventing manual deployment.
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Second, is the decision of whether or not to evacuate the customers in their chairs. If the vehicle
impact forces were high, then the wheelchair may have sustained damage that may not be readily
apparent. Do not waste time removing seat belts and tie-downs only to find the wheelchair
cannot be moved.
Customers will be reluctant to leave their wheelchair behind because without it they become
totally immobile. However, saving the customer’s life is of first priority. If time and conditions
permit, the wheelchair can be recovered later.
Communicating with Customers and Helpers
In an emergency, customers will look to you the operator for direction and leadership.
You represent authority and must take initial control and take the lead. Being well trained in
evacuation emergencies will make it easier for you to remain calm.
Remaining Calm is Crucial
Time and conditions permitting, tell customers in a calm, clear and concise manner that there is
an emergency. An explanation of what they are required to do will help to prevent customer
hysteria. Customers should be advised that help is on the way, but for their safety it is best they
leave and/or be assisted from the vehicle. Continued reassurance while performing your duties
will also be helpful in forestalling any panic.
The use of able-bodied customers or passersby must be done with great care. The ability to
remain calm and give clear and concise instructions to helpers will prevent unnecessary injuries.
Placement of hands and feet and body position can be done by example. Make it clear what
commands will be used to start whatever you will be doing. If you use 3 on a count of 3, your
helper is better able to synchronize his or her actions with you, rather than just using “go” or
some other single command.
Remember - as a professional transit operator, you are responsible for directing customers and
passers-by in giving assistance. Once public safety personnel arrive on the scene they will
assume command and control of the emergency. At that point, your responsibility is seeing to the
needs of the customers.
Emergency Evacuation Lifting Techniques
Bending & Lifting
Face the object (customer) with your feet apart and one foot forward
Get as close as possible
Bend your hips and knees to lower you to the customer. Avoid bending forward at the
waist
Reach with both hands for the customer. Get a good grip to bring the customer in close
to you
Straighten your knees and hips as you come to a standing position. Do not jerk as you
lift
Avoid twisting as you lift
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You may vary this lifting technique - according to your size and the size of the
customer you intend to lift - by spreading your feet farther apart, bending down so
that one knee touches the ground, lifting the customer to an intermediate height
before lifting him/her the rest of the way
Use this technique even if you are not lifting anything, but only bending to unlock a
wheelchair securement or unbuckle a belt.
Stooping or Squatting
The techniques are really the same as bending; spread your feet apart, get close to the customer,
lower yourself with your leg muscles, and do not bend at the waist.
Stooping usually means bending over at the waist, so that position should be avoided.
It is often more comfortable to have one knee on the floor and one knee up rather than a
deep squat with both knees off the floor.
Use a chair, vehicle seat or other sturdy object to push against with your hand to help get
yourself in and out of a squat position.
Basic Principles of Lifting
Keep it close.
Don’t lift and twist.
Lift smoothly, don’t jerk.
Keep your back erect.
Kneeling
Use your legs to get in and out of a kneeling position. Avoid waist bending.
Stay close to the customer you are going to move
A half-kneel position (with one knee up) is usually easier to maintain than a full kneel
position.
Carrying
Keep the customer close to your body
Keep the object centered in the middle of your body rather than off to one side (or,
balance by carrying part of the load in each arm)
Carry the object at waist level, with your elbow tucked in close to your sides
Try to push or pull the object rather than carry if you have a choice
Twisting
See if you can avoid twisting altogether by moving your feet to turn your whole body. Take
little steps instead of twisting. If you need to perform a twisting motion:
Position yourself so that you have the best possible leverage
Avoid waist-bending
Use your arms and legs to do the work, not your back
Pushing
Face the customer
Position your feet shoulder distance apart, with one foot slightly forward
Tuck your chin
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Bend at your knees and hips to move the customer
Keep your elbows in at your sides while pushing
Do not lean forward at the waist
Use a rocking motion to get the load started
If you have a choice, push instead of pull (you can push twice as much as you can pull
without strain)
Pulling and Drawing
Clear your path of things you might trip over
Face the customer
Position your feet, shoulder distance apart, with one foot slightly forward
Tuck your chin
Bend at your knees and hips to pull the customer
Keep your elbows in at your sides while pulling or dragging
Use a rocking motion to get the load started
Use both arms
Procedures to Follow in The Event of a Fire
1. Immediately notify dispatch that you have a fire.
2. Activate the four-way flashers.
3. Pull safely off the road. Try to pull into an open area where other surroundings will not
catch fire. DO NOT PULL INTO A SERVICE STATION!
4. Place the vehicle in park and cut off the engine.
5. Evacuate the vehicle, moving passengers away from vehicle.
6. Only try to extinguish a fire if you know what you are doing and it is safe to do so. Only
use the fire extinguisher.
7. Set up emergency warning equipment.
8. Do not re-board the vehicle unless the Fire Department deems it safe to do so.
Use of Equipment (web cutters, fire extinguishers, etc.)
Fire Extinguishers
A fire extinguisher is an essential piece of emergency equipment, and all vehicles should be
equipped with one. In order for a fire extinguisher to be effective, it must be used properly. All
operators must be familiar with fire extinguishers. The vehicle must be evacuated if a fire
or threat of fire exists.
Characteristics of Fires
All fires need three components in order to burn: Fuel, Oxygen and Heat. The removal of any
one of these three components will cause a fire to stop burning.
Fires are classified by the type of combustible fuel source that is feeding them. These fire
classifications dictate what type of fire extinguisher should be used to put out a fire.
Class “A” Fires - These fires have ordinary combustibles such as wood, paper products, cloth,
rubber and many plastics.
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Class “B” Fires - These fires result from burning flammable or combustible liquids such as
gasoline, paint varnishes and other petroleum-based liquids.
Class “C” Fires - These are energized electrical fires that are fueled by the flow of electricity.
Once the electricity is cut off from this type of fire it will revert to a lower class fire, most likely
a Class “A” Fire.
Class “D” Fires - Flammable or combustible metals fuel these fires. This type of fire is
extremely rare and generally is seen in industrial settings.
Types of Fire Extinguishers
Fire extinguishers are classified according to the types of fires they are designed to put out. A
fire extinguisher will be clearly marked to indicate what types of fires it should be used on.
Common extinguishing agents used include:
Water - Water is the most common and most readily available extinguishing agent.
Water should only be used on a Class “A” Fire.
Dry Chemicals - Generally, dry chemical extinguishers use a powdered substance similar to
baking powder. The chemicals will inhibit or stop the chain reaction of combustion. Dry
chemical extinguishers are multi-purpose in that they combat more than one class of fires.
Carbon Dioxide - This type of extinguisher is used predominately for Class “C”
Fires, but they can also be used on Class “B” Fires. These extinguishers work by displacing the
oxygen supply with carbon monoxide, which will not support combustion.
Halon - Halon is stored as a liquid but turns into a gas as soon as it is released from the
extinguisher. Halon can be used on Class “A”, “B” and “C” fires. The main advantage of this
extinguisher is it leaves no residue. Halon is the primary choice for use on electronic equipment,
such as computers.
Dry Powder - These are special extinguishing agents that are primarily designed to combat a
specific hazard, such as a specific combustible metal used in an industrial setting.
Operation of Fire Extinguishers
When operating a fire extinguisher you should remember the P.A.S.S. sequence:
Pull the Pin - Every fire extinguisher should be equipped with a pin that prevents accidental
discharge. This pin should be attached with a plastic seal that indicates that it has not been used
since its last recharging. The pin must be pulled out before the extinguisher can be operated.
Aim Nozzle Toward Fire - Depending on the type of extinguisher you are using, it may have a
flexible tube, a fixed nozzle, or a cone shaped nozzle that swivels. Aim his nozzle toward the
base of the fire.
Squeeze Handle of Extinguisher to Discharge - Discharge the fire extinguisher by squeezing
the handle.
Sweep at the Base of the Fire - The discharge of the fire extinguisher would be aimed at the
base of the fire. Use a regular sweeping motion on the base, covering that part of the fire
closest to you and then moving forward. If the fire flashes back on you begin again, maintaining
the sweeping motion.
Special Considerations for Fires
Fire extinguishers are an extremely valuable tool but you must always remember that they are
small and have a limited capacity. When confronted with a fire, you must make judgment as
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whether you should “fight” or “flee”. You must decide whether the fire is small enough to fight
and put out with the limited resources a fire extinguisher offers or whether it would be safer to
just get away from the fire and let it burn until fire fighters arrive. As always, your primary
concern should be in protecting the safety of your customers and yourself. You should never put
yourself in a life-threatening situation in an attempt to put out a fire.
Protocols (radio communication, after accident reporting, etc.)
After Accident Reporting
The driver should contact the PATS dispatcher immediately to notify them when an accident has
occurred. The Transit Director or safety supervisor will respond to the accident notification
immediately, and conduct an investigation. In the case of an injury, the Transit Director, safety
supervisor, or driver (while he or she is waiting for senior management to arrive) should:
1) Determine if the severity of the injury necessitates calling an ambulance. When in doubt,
call an ambulance.
2) If an ambulance is needed, have someone call 911 (someone who can provide clear
directions).
3) When the injury has occurred at the PATS office or facility, post someone at the nearest
entrance of the facility to direct EMS personnel to the scene.
4) The driver or safety supervisor should complete the Accident/Incident Report as soon as
possible (see sample below). This form should not be held while gathering additional
information. If necessary, turn in a preliminary report, and file a more complete copy at a
later time. If necessary, turn in a preliminary report, and file a more complete copy to the
Transit Director on the same day of the incident.
5) Client accident reports are required and must be forwarded to the Finance Department on
all client injuries on PATS premises or vehicles.
Late reported or questionable cases:
Any injury or illness that an employee alleges to be work-related should be documented
using the Accident/Incident Report form and forwarded to the Transit Director
immediately. This also includes claims that were not reported in a timely manner by the
employee.
Information regarding a disputable incident should also be forwarded to the Transit
Director immediately, regardless of whether it appears to be legitimate or not.
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Accident/Incident Report Form
Date of incident: Time of incident: Vehicle ID:
Location of incident:
Name of Driver:
Persons Involved
Name: Phone: Injury: yes no
If yes, type of injury: Treatment
Required?
Where treated?
Name: Phone: Injury: yes no
If yes, type of injury: Treatment
Required?
Where treated?
Name: Phone: Injury: yes no
If yes, type of injury: Treatment
Required?
Where treated?
Details of incident/accident:
Another vehicle involved? Yes No If yes, fill out accident packet
and attach.
Did vehicle require towing? Yes No If yes, where to?
Attach trip sheet indicating which passengers were aboard at time of incident.
Persons listed in the gray section above should read this report and sign below in the appropriate
section.
NO MEDICAL ATTENTION WAS DESIRED AND/OR REQUIRED.
Signature Of
Person Involved:
Signature Of
Person Involved:
MEDICAL ATTENTION WAS RECEIVED.
Signature Of
Person Involved:
Signature Of
Person Involved:
Return this form to the Transit Director or safety supervisor within 24 hours of the accident/incident
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APPENDIX J
Qualifying Trainers / Instructors
Safety/Training Officer: Rhonda Long
Lead Driver: Tom McCormick
Fire Training: Fire Department
Defensive Driving: Stewart Darden
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APPENDIX K
Monthly Safety Meeting Report
Date:
Address:
Meeting Chairman:
Where feasible attendance should be documented.
Other Persons Present:
______
Formal Presentation (Name of presenter and topic):
Other Subjects Discussed:
Reports on Weekly Meetings:
______
Employees’ Comments/Suggestions:
Chairman’s Signature ______________________
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APPENDIX L
Person County
Government
Safety
Policy
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I. Introduction
The management of the Person County Government has a sincere concern for the safety
and welfare of all employees and the public they serve. With the goal of eliminating
suffering and the cost of avoidable personal injury and vehicle accidents, the county safety
committee has implemented the Safety Policy for Person County Government.
It is the County’s policy to provide safe working conditions for all employees.
Comprehensive instructions covering safe work practices and special equipment to protect
employees against particular hazards will be addressed by department heads according to the
type of hazards in their areas. Most accidents are preventable. All county employees are
responsible for promoting accident prevention by actively supporting the safety policy and
observing the safety regulations.
Employees are expected to cooperate fully by observing the rules of safety and taking active
part in protecting themselves, their fellow workers and county facilities.
The joint effort of employees and management toward observance of this policy will provide
safe working conditions to the mutual advantage of all.
II. Safety Policy Statement
It is the objective of Person County Government to conduct all operations as safely and
efficiently as possible.
To accomplish this, we are assigning the responsibility, authority, and accountability for
safety to all department heads and supervisory personnel within their individual areas of
operations.
Each department may want to appoint an individual as their safety coordinator/officer. This
individual would be responsible for the administration and coordination of the department’s
safety program to ensure the safety standards are met throughout the department.
All employees will have the responsibility of performing their own work in a safe and
efficient manner and to report unsafe conditions to their department head or supervisor for
prompt corrections.
In addition to this General Policy, it is the responsibility of each department to develop and
maintain any specific policies and procedures to ensure a safe work environment.
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III. General Rules
Safety means efficient performance. Safety must, therefore be a part of the planning for
every job, equal in importance to all operational considerations. Observing safety
procedures will make all Person County operations safer, for all employees must be on the
alert to the possibility of improvement. Employee suggestions for improvement of work
conditions and work procedures are welcomed, in fact, invited.
Unsafe conditions and unsafe procedures must be identified before they can be corrected.
Consequently, it is the responsibility of every employee to report these conditions
immediately. All accidents should be reported, whether personal injury or property damage
is involved or not. Remember, the “near misses” are danger signals. The accident you
prevent could be the incident that injured you!
The following general safety procedures apply:
Report all personal injuries, no matter how minor, to your immediate supervisor soon as
possible. This must be done whether the injury resulted in lost time from work or
required medical attention or not. Prompt reporting of accidents is a requirement under
the Workers’ Compensation Law.
This organization does not expect you to take any unnecessary chances. Learn the right
way to do your job. That will be the safe way. If you are not sure you thoroughly
understand the job, ask your supervisor for further instructions.
Avoid horseplay and practical jokes on the job. Any employee participating in such
activities will be subject to disciplinary action.
Abuse of any substance (alcohol, medication, etc) during working hours is prohibited.
Any employee reporting to work under the influence of any substance during working
hours shall be subject to disciplinary action.
Work at a speed consistent with Safety. “Foolish Hurry” such as running in passageways
or on stairs is dangerous.
Keep yourself in good physical condition to do a days work.
Use the hand rails on stairs or on elevated places.
Jumping from an elevation such as a table, bench, or platform can result in Injury.
“DON’T DO IT”.
Always inspect tools and equipment before use. Report defects to supervisors and other
potential users. Do not use tools and equipment that are defective to an unsafe degree.
Remove splinters from work benches, tables, bins, shelves, or chairs before someone is
injured.
Remove, cut off, or hammer down protruding nails, staples, or steel straps.
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Work clear of suspended loads; if a load is moved above where you are working, stand
aside until it has passed by.
Obey warning tags and signs. They are posted to point out hazards.
Operate only the machinery or equipment you have been authorized and trained to
operate safely.
Remove jewelry such as rings, identification bracelets, etc., in works involving climbing,
materials handling, or operating mechanical equipment.
Never reach over moving parts of machinery or equipment.
Never operate machinery or equipment with guards removed.
Report to work in appropriate clothing suitable for the type of work you perform.
This includes footwear. Avoid wearing loose clothing or personal equipment near
machinery or equipment with moving parts.
Wear protective equipment as required. Its use should be enforced.
Common sense, along with health and sanitation rules, must be observed for the welfare
and consideration of other employees.
Repeat violators of safety rules and procedures may be subject to disciplinary action
and/or dismissal.
IV. Roles and Responsibilities
A. County Manager
The County Manager is responsible for the general oversight of the Safety
Program by setting policy and making strategic planning decisions.
Under the direction of the County Manager there is:
An active Safety Committee, consisting of department heads or their designees,
meeting on a regularly scheduled basis.
A thorough and effective Accident Investigation to include reporting and
recording procedures, and a written report on actions taken to prevent
recurrence of accidents, including actions taken against individual violators of
safety rules and practices.
A training program for employees and supervisory personnel directly related to
avoiding a possible injury or illness in the area of designated operations.
A periodic audit of all premises, equipment, and materials so that
recommendations can be developed to obtain compliance with established
standards.
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A communications system established and maintained to ensure that all
personnel responsible for safety matters are kept abreast of new standards or
procedures published by the Department of Labor.
Specific goals established for the safety program, with progress toward those
goals measured on a quarterly basis.
B. Department Heads
Department Heads are responsible to the County Manager for complying with the
County’s Safety Program and for maintaining safe and healthful working
conditions and practices for the benefit of all personnel under their supervision.
Department Heads will demonstrate support for the safety program through every
visible means, including:
Providing a safe and healthful workplace.
Providing personal protective equipment as well as machine guards and safety
devices commensurate with the state of the art.
Demonstrated support of the program through personal participation and
through approval of necessary expenditures for such items as personal protective
equipment, mechanical guards, good lighting, good ventilation, and other
physical improvements to the working environment, as well as expenditures for
safety training materials.
Reviewing accident records and accomplishments of the safety program with the
Safety Committee.
Evaluating the effectiveness of the safety program.
Participating directly and/or indirectly in safety activities as may be required to
maintain the enthusiasm and interest of all concerned.
Abiding by safety rules and regulations when exposed to conditions governed by
the rules.
Directing that any flagrant disregard of safety rules and regulations by employees
be grounds for discipline or dismissal as outlined in the Personnel Policy.
C. Supervisor
Supervisors are charged with the responsibilities of quality and quantity of
production with the department, and therefore are responsible for the work conduct
of the same. Supervisors should be afforded the necessary knowledge to carry out
their duties with efficiency and safety.
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Because of the close relationship with the employees and intimate knowledge of
operating procedures, Supervisors are key persons in the scheme of loss control.
Supervisors should:
Have a thorough knowledge of the safety policy.
Provide instruction and training to workers so that they may fulfill their job in a
safe manner.
Make daily inspection of the department to ensure that no unsafe conditions or
unsafe practices exist.
Initiate immediate corrective action where unsafe conditions or practices are
found.
Properly complete the Form 19 and investigate all accidents to determine what
must be done to prevent recurrence of a similar accident. This should be
completed and submitted to the Human Resources Technician in time that
she/he can submit within three working days to the proper insurance company.
Be familiar with all procedures that must be followed in the event of an
emergency.
Enforce safety rules and regulations of the County and each respective
department.
Provide good example by safe work habits.
D. Employees
To assist the employees in developing a keen “safety awareness”, the following
responsibilities are assigned:
To abide by the safety rules and regulations of the County and their respective
departmental policies and procedures.
To regard the safety of fellow workers at all times.
To report any unsafe conditions to the supervisor.
To contribute ideas and suggestions for improving the safety of conditions or
procedures to the Supervisor.
To use individual knowledge and influence to prevent accidents.
To attend safety training sessions.
To report accidents and injuries immediately.
E. Safety Committee Members
The committee team will help improve decision making in vital areas of
employee safety and well-being, public safety, and property protection. This
committee will develop and implement county safety policies, determine goals/
objectives, promote employee safety communication, increase employee safety
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awareness, ensure safety activities are completed, and keep up with governmental
regulations. The safety committee will report to the county manager.
The Committee shall meet every other month. Its primary purpose is to assist the
Safety Committee Chair in the formulation and implementation of the safety
program. To accomplish this, the Committee shall:
Draft safety rules and regulations and recommend approval for adoption by
management.
Devise methods of promoting safety among employees.
Review accident records to discover trends and to gauge effectiveness of the
safety program.
Discuss difficult accident problems and make suggestions for preventive
measures.
The following activities are the Committee’s responsibility and require periodic
attention:
Departmental self – inspection
Maintenance of fire prevention and suppression equipment.
Seasonal promotional activities.
Safety regulations.
Employee training program
Written reports of all Committee meetings approved by the Safety Committee
Chair and signed by the Safety Committee Secretary.
F. Safety Committee Chair
The Safety Committee Chair sets meeting dates, distribute meeting materials,
conduct meeting, establish sub-committees when necessary and determine
committee action on items discussed.
Further responsibilities of the Safety Committee Chair shall include:
Make periodic inspections of all county buildings/operations to ensure
compliance with safety regulations.
Promote a “safety awareness” in all employees through educational and training
programs.
Maintain contact with available sources of topical safety information such as
National Safety Council, NC Department of Labor, NC Industrial Commission,
and OSHA.
Maintain minutes of all Safety Meetings.
Safety Program status reports.
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V. Reporting Requirements
The purpose of recordkeeping is to discover patterns and trends of occurring accidents to
direct risk control efforts in the right directions. The following recordkeeping procedures
will be used:
All accidents shall be reported immediately to the supervisor or department
representative. A Form 19 should be filled out completely and sent to the
Human Resources Technician as soon as possible or within three working days.
The accident should be investigated to determine what corrective action should
be taken to prevent future similar accidents. This accident investigation can be
done by safety committee members or the employee’s supervisor. If the
investigation needs to be done by safety committee member, contact the Public
Works Safety Officer/Safety Committee Chair. If the investigation is done by
the supervisor the results should be reported to the Safety Committee Chair.
It shall be the responsibility of the County Safety Committee Chair to maintain
records as necessary to comply with laws and objectives of the safety program.
These records should include:
o Copy of the Form 19
o Person County Accident Investigation Report
o Required OSHA forms
VI. Examples of Forms
Examples of the following forms are attached:
Form 19
Facility Safety Inspection Report
Person County Accident Investigation Report
OSHA 300 Log
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APPENDIX M
197
144
198
145
199
146
200
147
201
148
202
149
203
150
204
151
205
152
206
153
207
154
208
155
209
156
210
157
211
158
212
159
213
160
214
161
215
162
216
163
217
164
218
165
219
166
220
167
221
168
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SYSTEM CONTACTS
Any questions regarding this policy or any other aspect of the substance abuse
policy should be directed to the following individual(s).
Person Area Transportation System (PATS) Drug and Alcohol Program Manager
Name: Kathy Adcock
Title: Transportation Manager
Address: 341 South Madison Blvd., Roxboro, NC 27573
Telephone Number: (336) 597-1771
Medical Review Officer
Name: John G. Camestas, MD
Title: MD (Pembrooke Occ Health)
Address: Richmond, Va.
Telephone Number: (804) 364-1010
Substance Abuse Professional
Name: Safe-T-Works
Title: Drug & Alcohol Testing & Employment Services
Address: 624 S. Fayetteville St., Asheboro, NC 27203
Telephone Number: (336) 736-8038
HHS Certified Laboratory Primary Specimen
Name: MedTox Labs
Address: 402 W. Country Rd., St. Paul, Mn
Telephone Number: (800) 832-3244
HHS Certified Laboratory Split Specimen
Name: MedTox Labs
Address: 402 W. Country Rd., St. Paul, Mn.
Telephone Number: (804) 346-1010
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Attachment A
Administration Covered Classifications
Director
Assistant Director
Grant Writer / Safety and Training Officer
Administrative Assistant
Part-time Secretary
Title Testing Authority
Safety and Training Officer
Job Classifications
Dispatcher
Part-time Dispatcher/ Scheduler
Part-time Scheduler / Driver
Drivers
Title Testing Authority
Safety and Training Officer
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Attachment B
Alcohol Fact Sheet
Alcohol is a socially acceptable drug that has been consumed throughout the world for
centuries. It is considered a recreational beverage when consumed in moderation for
enjoyment and relaxation during social gatherings. However, when consumed primarily for its
physical and mood-altering effects, it is a substance of abuse. As a depressant, it slows down
physical responses and progressively impairs mental functions.
Signs and Symptoms of Use
Dulled mental processes
Lack of coordination
Odor of alcohol on breath
Possible constricted pupils
Sleepy or stuporous condition
Slowed reaction rate
Slurred speech
(Note: Except for the odor, these are general signs and symptoms of any
depressant substance.)
Health Effects
The chronic consumption of alcohol (average of three servings per day of beer
[12 ounces], whiskey [1 ounce], or wine [6 ounce glass]) over time may result
in the following health hazards:
Decreased sexual functioning
Dependency (up to 10 percent of all people who drink alcohol become
physically and/or mentally dependent on alcohol and can be termed
“alcoholic”)
Fatal liver diseases
Increased cancers of the mouth, tongue, pharynx, esophagus, rectum,
breast, and malignant melanoma
Kidney disease
Pancreatitis
Spontaneous abortion and neonatal mortality
Ulcers
Birth defects (up to 54 percent of all birth defects are alcohol related)
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Social Issues
Two-thirds of all homicides are committed by people who drink prior to
the crime.
Two to three percent of the driving population is legally drunk at any
one time. This rate is doubled at night and on weekends.
Two-thirds of all Americans will be involved in an alcohol-related
vehicle accident during their lifetimes.
The rate of separation and divorce in families with alcohol dependency
problems is 7 times the average.
Forty percent of family court cases are alcohol problem related.
Alcoholics are 15 times more likely to commit suicide than are other
segments of the population.
More than 60 percent of burns, 40 percent of falls, 69 percent of boating
accidents, and 76 percent of private aircraft accidents are alcohol
related.
The Annual Toll
24,000 people will die on the highway due to the legally impaired
driver.
12,000 more will die on the highway due to the alcohol-affected driver.
15,800 will die in non-highway accidents.
30,000 will die due to alcohol-caused liver disease.
10,000 will die due to alcohol-induced brain disease or suicide.
Up to another 125,000 will die due to alcohol-related conditions or
accidents.
Workplace Issues
It takes one hour for the average person (150 pounds) to process one
serving of an alcoholic beverage from the body.
Impairment in coordination and judgment can be objectively measured
with as little as two drinks in the body.
A person who is legally intoxicated is 6 times more likely to have an
accident than a sober person.
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Attachment C
Minimum Thresholds
Initial Test Cutoff Levels (ng/ml)
Marijuana metabolites 50
Cocaine metabolites 300
Opiate metabolites 2,000
Phencyclidine 25
Amphetamines 1,000
Confirmatory Test Cut/Off Levels (ng/ml)
Marijuana metabolites 15
Cocaine metabolites 150
Morphine 2,000
Codeine 2,000
Phencyclidine 25
Amphetamines 500
Methamphetamine 500
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Attachment D
AFFIDAVIT OF CORRECTION
According to 49 CFR Part 40, as amended, the collector of the drug test referenced below
must take all practicable action to correct errors on the Federal Drug Testing Custody and
Control Form so that the test is not cancelled.
Transit System Name: ______________________Date of Test: __________________________
Test Category: _________________________Specimen ID#:____________________________
Donor Name: ____________________________Collector Name: ________________________
Date Collector Was Notified of Error: __________________________
This affidavit addresses the following errors that were not performed in accordance with 49 CFR
Part 40, as amended:
Step 1 Requirements (§40.63) (check all that apply)
___ A. Missing/Incorrect Employer Name, Address
___ B. Missing/Incorrect MRO Name, Address, Phone and Fax No.
___ C. Missing Donor SSN or Employee I.D. No.
___ D. Missing/Incorrect Testing Authority
___ E. Missing/Incorrect Reason for Test
___ F. Missing/Incorrect Drug Tests to be Performed
___ G. Missing/Incorrect Collection Site Name, Address, Phone and Fax No.
Step 2 Requirements (§40.65-70)(check all that apply)
___ Collector failed to indicate if the specimen was within the acceptable temperature range
___ Collector failed to mark ‘Split’
___ Collector arbitrarily marked ‘Observed’
___ Collector failed to mark ‘Observed’
___ Missing explanation within ‘Remarks’ section. (i.e. any unusual circumstances that occur
during collection)
Step 3 Requirements (§40.71)(check all that apply)
___ Bottle seals were filled out while still affixed to the CCF
Step 4 Requirements (§40.73)(check all that apply)
___ Missing collector’s signature
___ Missing collector’s printed name (First, MI, Last)
___ Missing/Incorrect Date of Collection
___ Missing/Incorrect Time of Collection
___ Missing Courier Name
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Step 5 Requirements (§40.73)(check all that apply)
___ Missing donor’s signature
___ Missing donor’s printed name (First, MI, Last)
___ Missing/Incorrect Date of Collection
___ Missing donor’s Daytime and/or Evening Phone No.
___ Missing/Incorrect donor’s Date of Birth
Collector Remarks:
1. Description of error:
____________________________________________________________
2. Description of action:
___________________________________________________________
3. Measures taken to ensure the same error(s) do not reoccur:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
By signing below, in accordance with 49 CFR Part 40.209, I certify that the aforementioned
errors occurred on the referenced drug test and that appropriate measures have been taken to
ensure the same errors will not reoccur.
_________________________________________ ___________________________
Collector Signature / Title Date
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Attachment E
GOOD FAITH EFFORT’ DOCUMENTATION
Release of Information from Previous Employer on DOT Drug and Alcohol Testing
1. ______________________________’s first attempt at acquiring information from previous
Agency Name
employer on DOT drug and alcohol testing, for ______________________________________,
Employee’s Full Name
was performed on __________________, ______________________________________sent an
Date Agency Name
‘authorization for release’ form, through certified mail, to the following DOT Employer:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Previous Employer’s Address (add additional sheets for additional employers)
2. ______________________’s second attempt at acquiring information from previous employer
Agency Name
on DOT drug and alcohol testing, for the aforementioned employee, was performed
on_____________.
Date
_____________________________attempted to call the previous employer at the following
Agency Name
telephone numbers:
______________________________________________________________________________
Employer’s Name and Telephone Number (add additional sheets for additional employers)
Left Voice-Mail Message Successfully Reached Company Representative
(Check appropriate box)
3. ________________________’s third attempt at acquiring information from previous employer
Agency Name
on DOT drug and alcohol testing, for the aforementioned employee, was performed
on_____________.
Date
_____________________________attempted to call the previous employer at the following
Agency Name
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telephone numbers:
______________________________________________________________________________
Employer’s Name and Telephone Number (add additional sheets for additional employers)
Left Voice-Mail Message Successfully reached Company Representative
(Check appropriate box)
5. Description of action:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. Measures taken to ensure the same error(s) do not reoccur:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
By signing below, in accordance with 49 CFR Part 40.209, I certify that the aforementioned
errors occurred on the referenced drug test and that appropriate measures have been taken to
ensure the same errors will not reoccur,
______________________________________ ___________________
Collector Signature / Title Date
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Attachment F
ORDER FOR TESTING
The Federal Transit Administration issued regulations (49 CFR Part 655)
that require all safety-sensitive employees/applicants to submit to drug
and alcohol testing as a condition of employment in a safety-sensitive
position. Refusing to submit to testing; providing false information in
connection with said testing; adulterating, substituting, or tampering with the specimen; or
failing to cooperate with any part of the collection process is a violation of the regulations and of
company policy.
Testing is to be accomplished on the date, time and location indicated below. You must present
this form at the collection site.
Print Full Name:______________________________ ID # __________________________
Collection Site Location: ______________________________________________________
You must report no later than ______________ am/pm, on ______________________ (date)
Failure to complete a drug and/or alcohol test will be considered a test refusal.
* Pre-employment tests = New applicants, transfer from a non-safety-sensitive position, return to active status.
** Return-to-Duty tests = Only performed following a positive/refusal to test and successful completion of SAP
counseling.
Type of Test: Drug Alcohol Both
Test Authority: DOT-FTA Non-DOT DOT- Other ________
Test Category: Pre-employment* Random
Post-accident Reasonable Suspicion
Return-to-duty** Follow-up
Retest, Specify: __________________________________
Observed Collection: Yes No
Transported: Yes, By Whom: ________________________________________ No
Picture ID: Yes No
Other Special Instructions: _______________________________________________________
Supervisor Authorizing Test: _________________________ ____________ ________________
Print Name Date Time Notified
Designated Employer Representative / DAPM: _________________________ ______________
Print Name Phone Number
To be completed by collection site personnel
upon arrival at site and returned to employer
with Employer’s copy of Chain of Custody
Form.
__________ ________ ____________
Time Date Collection Site
Personnel Initials
_________________________________
Print Collection Site Personnel Name
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POST ACCIDENT TESTING DECISION REPORT
**A separate sheet must be filled out for each covered employee that contributed to the accident**
System Name: _______________________Date of Accident: ___________________________
Time of Accident: ________________ Time Employer was notified: _____________________
Location of Accident: ___________________________________________________________
Safety-Sensitive Employee_____________________ ID# and Position_____________________
i.e. Driver, Dispatcher, etc.
1. Did the accident involve a revenue service vehicle? Yes No
2. Did the accident involve the operation of the vehicle? Yes No
3. Was there loss of life as a result of the accident? Yes No
4. Did an individual suffer a bodily injury and immediately Yes No
receive medical treatment away from the scene?
5. Was there disabling damage to any of the involved vehicles? Yes No
6. a) Did you perform a drug and/or alcohol test? Yes Yes No
(Use Decision Tree on back of this form) FTA Authority Company Authority
b) If no, why not? _______________________________________________________________
7. a) Was an alcohol test performed within 2 hours? N/A Yes No
b) If no, why: __________________________________________________________________
8. If no alcohol test occurred, and more than 8 hours elapsed from the time of the accident, please explain:
_______________________________________________________________
______________________________________________________________________________
9. a) Was a drug test performed within 32 hours? N/A Yes No
b) If no, why: __________________________________________________________________
______________________________________________________________________________
10.a) Did the employee leave the scene of the accident without a reasonable explanation? Yes No
b) If Yes, please explain: ________________________________________________________________
Test Determination:
Name of supervisor making determination: __________________________________________________
Time employee was informed of determination: ______________________________________________
________________________________________ __________________________
Signature & Title Date
For your files: attach test results summary, order to test, Custody and Control Form (USDOT) and alcohol testing form (USDOT)
Attachment G
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Post-Accident Decision Tree
* Disabling Damage:
Is damage that precludes departure of a motor vehicle from the scene of the accident in its usual
manner in daylight after simple repairs:
(1) Inclusion: Damage to a motor vehicle, where the vehicle could have been driven, but
would have been further damaged if so driven.
(2) Exclusions:
A. Damage that can be remedied temporarily at the scene of the accident without
special tools or parts.
B. Tire replacement without other damage even if no spare tire is available.
C. Headlamp or tail light damage.
D. Damage to turn signals, horn, or windshield wiper, which makes the vehicle
Inoperable.
ACCIDENT
Did the accident involve a revenue service
vehicle, whether in or out of revenue service? No No test required;
document
Was the occurrence associated with the
manner of operation?
No
Was there a fatality?
Yes
Test ASAPYes
Any other SS employee who could have contributed
Driver
Was anyone immediately
transported to a medical
treatment facility?
Can SS employee’s
performance be completely
discounted as a contributing
factor? **
No test required;
document
Test ASAP
Could any other SS employee
have contributed to the
accident?
Was there disabling
damage to any
vehicle*?
No test required;
document
No
No
No
Yes
Yes
Yes
Yes No
Operator
Other
SS Employee
No
Attachment H
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** Contributing Factor:
The determination of whether or not a safety-sensitive employee’s performance was a
contributing factor should be the decision of the company official investigating the accident; not
based on the police officer’s accident fault determination. This decision should not be made
hastily. The company official’s determination must be based on the best available information at
the time of the accident.
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Attachment I
ACKNOWLEDGEMENT
OF
EMPLOYER’S DRUG AND ALCOHOL TESTING POLICY
I, _____________________________________________, the undersigned, hereby
Print Full Name
acknowledge that I have received a copy of the anti-drug and alcohol misuse program policy
mandated by the U.S. Department of Transportation, Federal Transit Administration for all
covered employees who perform a safety-sensitive function. I understand this policy is required
by 49 CFR Part 655, as amended, and has been duly adopted by the governing board of the
employer. Any provisions contained herein which are not required by 49 CFR Part 655, as
amended, that have been imposed solely on the authority of the employer are designated as such
in the policy document.
I further understand that receipt of this policy constitutes a legal notification of the contents, and
that it is my responsibility to become familiar with and adhere to all provisions contained therein.
I will seek and get clarification for any compliance with all provisions contained in the policy. I
also understand that compliance with all provisions contained in the policy is a condition of
employment.
I further understand that the information contained in the approved policy dated
________________________, is subject to change, and that any such changes, or addendum,
shall be disseminated in a manner consistent with the provision of 49 CFR Part 655, as amended.
__________________________________ ______________
Signature of Employee Date
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183
Attachment J
POSITIVE DRUG AND ALCOHOL TESTING LOG
Employee
Date/Time
Of Positive
Result
Type of
Violation
SAP
Referral
Outcome
Transferred all
documentation to
this folder?
Positive
Refusal
Other:
Termination
Counseling
Other:
Yes
No
Other:
Initial
Positive
Refusal
Other:
Termination
Counseling
Other:
Yes
No
Other:
Initial
Positive
Refusal
Other:
Termination
Counseling
Other:
Yes
No
Other:
Initial
Positive
Refusal
Other:
Termination
Counseling
Other:
Yes
No
Other:
Initial
Positive
Refusal
Other:
Termination
Counseling
Other:
Yes
No
Other:
Initial
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184
Attachment K
POST-ACCIDENT TESTING LOG
Employee
Date/Time
of Accident
Accident Result
Date/Time
of Test
Date/Time
of Test
Result
Transferred all
documentation to folder?
Fatality
Immediate Transport to
Medical Facility
Disabling Damage
Other:
Yes
No
Other:
Initial
Fatality
Immediate Transport to
Medical Facility
Disabling Damage
Other:
Yes
No
Other:
Initial
Fatality
Immediate Transport to
Medical Facility
Disabling Damage
Other:
Yes
No
Other:
Initial
Fatality
Immediate Transport to
Medical Facility
Disabling Damage
Other:
Yes
No
Other:
Initial
Fatality
Immediate Transport to
Medical Facility
Disabling Damage
Other:
Yes
No
Other:
Initial
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185
Attachment L
PRE-EMPLOYMENT DRUG TESTING
ACKNOWLEDGEMENT
I, hereby acknowledge and understand that, as part of my application for employment for a
position which involves the performance of safety-sensitive functions as defined by 49 CFR Part
655, as amended, I must submit to a urine drug test under the authority of the U.S. Department of
Transportation, Federal Transit Administration. I acknowledge and understand that my
employment is contingent on the passing of the aforementioned drug test, and I will not be
assigned to perform a safety-sensitive function unless my urine drug test has a verified negative
result.
______________________________ ____________________
Signature of Applicant Date
______________________________ ____________________
Print Name Date
(Your application will not be considered for employment of a covered safety-sensitive position unless this acknowledgment is
completed and signed.)
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186
Attachment M
PRE-EMPLOYMENT TESTING LOG
Employee
Testing
Acknowledgement
Safety-
Sensitive
Application
Supplement
Previous
Employer
Record
Check
Policy
Acknowledge
ment
Order for
Test
Date/
Time
Of Test
Date/
Time
Of Result
Hire
Date
Date
Began
Safety-
Sensitive
Functions
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
Complete
Pending:
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187
Attachment N
RANDOM TESTING LOG
Employee
Random
Selection Sheet
Order For Test
Date/Time of
Test
Test Day
Date/Time
of
Result
Transferred all
documentation to
folder?
Yes
No
Other:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Yes
No
Other:
Initial
Yes
No
Other:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Yes
No
Other:
Initial
Yes
No
Other:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Yes
No
Other:
Initial
Yes
No
Other:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Yes
No
Other:
Initial
Yes
No
Other:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Yes
No
Other:
Initial
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188
Attachment O
REASONABLE SUSPICION TESTING LOG
Employee
Date/Time
of Suspicion
Date/Time
of Test
Date/Time
Of Test
Result
Reasonable
Suspicion Incident
Check List?
Transferred all
Documentation to
this folder?
Yes
No
Other:
Yes
No
Other:
Initial
Yes
No
Other:
Yes
No
Other:
Initial
Yes
No
Other:
Yes
No
Other:
Initial
Yes
No
Other:
Yes
No
Other:
Initial
Yes
No
Other:
Yes
No
Other:
Initial
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189
Attachment P
CONFIDENTIAL
AUTHORIZATION FOR RELEASE OF INFORMATION FROM PREVIOUS EMPLOYER ON
US DOT DRUG AND ALCOHOL TESTING
(A separate form must be filled out for each US DOT-regulated employer who employed the applicant during the two-year period preceding the
date of the employee’s application or transfer)
I, ___________________________________________ _____________________________, authorize that:
Print First Name, Middle Initial, Last Name Last 4 digits of Social Security Number
Contact Person: ________________________________________________________________
Previous Employer: ________________________________________________________________
________________________________________________________________
Street Address or
P.O. Box: __________________________________________ Telephone:______________________
City, State, Zip __________________________________________ Fax: ___________________________
may release the information requested below concerning my US DOT drug and alcohol testing records to:
Contact Person: ____________________________________________________________
Prospective Employer: ____________________________________________________________
Street Address or
P.O. Box: _________________________________________ Telephone:________________________
City, State, Zip _________________________________________ Fax: _____________________________
______________________________________________________ __________________
Applicant’s Signature Date
This information will be used solely for the purpose of ascertaining whether I am eligible to perform safety-sensitive
functions for the ______________________________________________________. This authorization for release
of information is valid for one year from the date of signature.
COMPLETED BY PREVIOUS EMPLOYER
Check here if this employee did not participate in US DOT-regulated drug and alcohol testing while under your employment. Then sign
below and return this form;
OR, respond to the following questions regarding this employee’s US DOT-regulated drug and alcohol testing history while employed with your
agency/firm.
1. Has this employee tested positive (0.04 or greater) for alcohol in the last two years? Y ___ N ___
2. Has this employee had a verified positive drug test result in the last two years? Y ___ N ___
3. Has this employee refused a required drug or alcohol test in the last two years? Y ___ N ___
4. Has this employee violated any other US DOT drug or alcohol testing regulation within the last two years? Y ___ N ___
5. Has a previous employer reported a drug and alcohol rule violation to you? Y ___ N ___
6. If you answered yes to any of the above items, did the employee complete the return to duty process? Y ___ N ___
Note: If you answered “yes” to item 5, you must provide the previous employer’s report. If you answered “yes” to item 6, you must also transmit
the appropriate return-to-duty documentation (e.g. SAP report(s), follow-up testing record).
___________________________________________________________ _____________________________
Previous Employer’s Signature Date
Please return this form to the prospective employer at the address listed above.
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190
Attachment Q
CONFIDENTIAL
REASONABLE SUSPICION INCIDENT CHECKLIST
________________________________________ ________________________________________
Employee’s Full Name Date / Time of Observation
_____________________________________________________________________________________
Supervisor’s Full Name & Telephone
_____________________________________________________________________________________
Date of Supervisor’s Reasonable Suspicion Decision Training
_____________________________________________________________________________________
This checklist is to be completed when a supervisor – trained in accordance with 49 CFR Part 655.14(b) –
determines that an incident has occurred which provides reasonable suspicion that an employee is exhibiting
behaviors consistent with the symptoms of drug use and / or alcohol misuse. Mark each applicable item on this form
and add any additional facts or circumstances which you have observed.
_____________________________________________________________________________________
A. Nature of Incident / Cause for Suspicion__________________
___1. Observed/reported possession or use of a prohibited substance (including passenger complaint).
___2. Apparent drug or alcohol intoxication.
___3. Observed drug or alcohol intoxication.
___4. Arrest for drug-related offense
___5. Other (e.g. flagrant violation of safety or serious misconduct, accident or ‘near miss,’ fighting or
argumentative/abusive language, refusal of supervisor instruction, unauthorized absence on the job) Please
specify:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
B. Behavioral Indicators__________________________________
___1. Verbal abusiveness
___2. Physical abusiveness
___3. Extreme aggressiveness or agitation
___4. Withdrawal, depression, tearfulness, or responsiveness
___5. Inappropriate verbal responses to questioning or instruction
___6. Other erratic or inappropriate behavior (e.g. hallucinations, disoriented, confused) Please specify:
_____________________________________________________________________________________
_____________________________________________________________________________________
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191
CONFIDENTIAL
C. Physical Signs and Symptoms___________________________
___1. Possession, dispensing, or using prohibited substance
___2. Slurred or incoherent speech
___3. Unsteady gait or other loss of physical control, poor conditioning
___4. Dilated or constricted pupils or unusual eye movement
___5. Bloodshot or watery eyes
___6. Extreme aggressiveness or agitation
___7. Excessive sweating or clamminess of skin
___8. Flushed or very pale face
___9. Highly excited or nervous
___10. Nausea or vomiting
___11. Disheveled appearance or out of uniform
___12. Odor of alcohol
___13. Odor of Marijuana
___14. Dry mouth (frequent swallowing/lip wetting)
___15. Shaking hands or body tremors/twitching
___16. Dizziness or fainting
___17. Breathing irregularity or difficulty breathing
___18. Runny nose or sores around nostrils
___19. Inappropriate wearing of sunglasses
___20. Puncture marks or “tracks”
___21. Other (Specify)__________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
D. Written Summary_____________________________________
Please summarize the facts and circumstances surrounding the incident. The observations must be specific,
contemporaneous, and articulable regarding the appearance, behavior, speech, or body odors of the safety-sensitive
employee. Attach additional sheets as needed.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
The above document of physical, behavioral, and performance indicators of the named employee were observed by:
________________________________ ______________________________ __________________________
Supervisor’s Full Name Signature Date
Forward this document to the drug and alcohol program manager 2 of 2
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192
Attachment R
RETURN-TO-DUTY / FOLLOW-UP TESTING LOG
Employee
Name
Order
For
Test
Return
to Duty
Release
Follow-
up
Test Plan
Date/Time
of Test
Consistent
with SAP’s
Follow up
Plan?
Test
Result
& Date
Notes
Return to Duty
Test
Yes
No
Yes
No
Yes
No
Follow-up
Test*
N/A
N/A
Yes
No
Follow-up
Test*
N/A
N/A
Yes
No
Follow-up
Test*
N/A
N/A
Yes
No
Follow-up
Test*
N/A
N/A
Yes
No
Follow-up
Test*
N/A
N/A
Yes
No
Follow-up
Test*
N/A
N/A
Yes
No
* The SAP determines the number of Follow-up tests (minimum of 6 tests in the first 12 months). This information will be included in the
Follow-up testing plan.
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193
Attachment S
CONFIDENTIAL
SAFETY-SENSITIVE EMPLOYEE APPLICATION
SUPPLEMENT
Previous US Department of Transportation Drug and Alcohol Testing
I, _____________________________________________ _________________________,
Print First Name, Middle Initial, Last Name Social Security Number
Attest that:
I have participated in DOT-regulated drug and alcohol testing with previous employers.
1. Have you tested positive (0.04 or greater) for alcohol in the last two years?
Yes_____ No_____
2. Have you had a verified positive drug test result in the last two years?
Yes_____ No_____
3. Have you refused a required drug or alcohol test in the last two years (or had a verified adulterated or
substituted drug test result)?
Yes_____ No_____
4. Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered
by an employer to which you applied for, but did not obtain, safety-sensitive transportation work
covered by DOT agency drug and alcohol testing rules in the last two years?
Yes____ No_____
5. Have you violated any other DOT drug or alcohol testing regulation within the last two years?
Yes_____ No_____
If you responded “YES” to any of the above questions, please provide documentation or your successful
completion of DOT return-to-duty requirements. If you do not have this information, please explain
why: ________________________________________________________________________________
_____________________________________________________________________________________
(Use additional pages as necessary)
“I certify that the facts contained in this form are true and complete to the best of my knowledge and
understand that, if employed, falsified statements on this form shall be grounds for dismissal.”
___________________________________________ __________________________
Signed Date
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194
Attachment T
SAFETY-SENSITIVE FUNCTIONS DETERMINATION WORKSHEET
1
Do you receive any funding as a recipient, subrecipient, or contractor under:
A)49 U.S.C. 5307, 5309, or 5311; or
B)24 U.S.C. 103 (e) (4)
Yes _____ No _____
If yes, continue to #2
If no, contact Caltrans
2
Regardless of job title or department, do you directly employ any personnel that perform any of the
Following functions for the transit system:
A
Operate a transit vehicle?
Yes _____ No _____
B
Operate a transit vehicle, when required to be operated by a holder of a CDL?
Yes _____ No _____
C
Control dispatch or movement of a transit vehicle?
Yes _____ No _____
D
Provide maintenance for transit vehicles?
-Preventative maintenance
-Repairs
-Overhaul
-Rebuilding
Yes _____ No _____
E Carry a firearm for security purposes?Yes _____ No _____
3
Do you contract out any services for the transit system?
Yes _____ No _____
If yes, continue to #4
If no, skip to #5
4
Regardless of job title or department, do you directly employ any personnel,
outside of the contracted services, that could be expected to perform any of the
functions listed in #2 above for the transit system?
Yes _____ No _____
5
If you answered YES to any question in #2 or #4:
-You employ personnel that are considered safety sensitive and are subject to testing under
49 CFR Parts 655 and 40; and
-You are required to establish an anti-drug use and alcohol misuse program consistent with
49 CFR Parts 655 and 40.
N
O
T
E
S
-Volunteers are considered safety-sensitive, and subject to testing, only if they are required to hold a
CDL, or receive remuneration for service in excess of actual expenses.
-Supervisors are safety-sensitive if they may perform one of the above functions.
-The maintenance section does not apply to the following:
A)An employer:
-Receiving funds under 49 U.S.C. 5307 or 5309 AND
-In an area less than 200,000 in population AND
-Contracts out such maintenance service
B)An employer:
-Receiving funds under 49 U.S.C. 5311 AND
-Contracts out such maintenance services
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195
Attachment U
CONFIDENTIAL
SUBSTANCE ABUSE PROFESSIONAL REFERRAL
EMPLOYEE NOT PRESENT
If the employee is not present to sign the Substance Abuse Professional Referral letter, send this form to the
employee utilizing certified mail.
Employee/Applicant Full Name:__________________________________________________________
Employee/Applicant Identification Number: ________________________________________________
This letter serves to notify that the aforementioned individual was in violation of DOT drug and alcohol
regulations (49 CFR Part 655 and/or 40) on __________________________________. In accordance
Date
with 49 CFR Part 655.62, this agency is required to advise the individual of the resources available for
evaluating and resolving problems associated with prohibited drug use and/or alcohol misuse.
The following Substance Abuse Professional(s) is available for the individual:
Name: ________________________________________________________________________
Address: ______________________________________________________________________
City/State: _____________________________________________________________________
Phone: ________________________________________________________________________
Alternate Substance Abuse Professional Referral:
Name: ________________________________________________________________________
Address: ______________________________________________________________________
City/State: _____________________________________________________________________
Phone: ________________________________________________________________________
_______________________________________________ _________________________________
Agency Representative Full Name, Title Telephone Number
_______________________________________________
Agency Name
_______________________________________________ _________________________________
Agency Representative Signature Date
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196
Attachment V
CONFIDENTIAL
SUBSTANCE ABUSE PROFESSIONAL REFERRAL
I acknowledge that I have received a referral to a Substance Abuse Professional in accordance with 49 CFR Part
655.62.
The cost of this service will be paid by: ____________________________________________________.
Substance Abuse Professional Referral:
Name: ________________________________________________________________________
Address: ______________________________________________________________________
City/State: _____________________________________________________________________
Phone: ________________________________________________________________________
Alternate Substance Abuse Professional Referral:
Name: ________________________________________________________________________
Address: ______________________________________________________________________
City/State: _____________________________________________________________________
Phone: ________________________________________________________________________
I, _____________________________________________, have received a copy of this referral.
Employee/Applicant Full Name
_______________________________________________ _________________________________
Employee/Applicant Signature Date
_______________________________________________ _________________________________
Agency Representative Full Name, Title Telephone Number
_______________________________________________
Agency Name
_______________________________________________ _________________________________
Agency Representative Signature Date
If the employee refuses to sign this form, please document why
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197
Attachment W
VENDOR OVERSIGHT INSPECTION MASTER LOG
Site Name
Date of
Interview
Compliant?
Follow up for
non-compliant
area(s)
Date of
error(s)
correction
Comments
Initials
Yes
No
Yes
No
N/A
Yes
No
Yes
No
N/A
Yes
No
Yes
No
N/A
Yes
No
Yes
No
N/A
Yes
No
Yes
No
N/A
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198
Attachment X
COLLECTION SITE CHECKLIST
Name of Collection Site: _________________________________ Date of Review: _________________________
Name of Collector: _________________________Name of Reviewer: ___________________________________
UNEVENTFUL BREATH ALCOHOL
TEST (result less than 0.02) - Did the
Breath Alcohol Technician (BAT)...
Perform the Alcohol test before the drug test, if
applicable
Explain testing procedures on back of Alcohol
Testing Form (ATF) (40.241(e))
Complete Step 1 of ATF (40.241(f))
− Employee Name, ID Number
− Employer Name and Contact information
− DER Name and Telephone Number
− Reason for Test
Have the employee complete Step 2 of the ATF
(40.241 ( g )).
Open individually sealed mouthpiece and attach
to EBT (40.243(b))
Instruct employee to blow forcefully until EBT
indicates that an adequate amount of breath has
been obtained (40.243(c))
Show employee the result displayed on EBT
(40.243(d))
If EBT prints result on paper strip: Did the BAT
affix the strip to the ATF using tamper evident
tape (40.243(f))
If EBT does not print results on paper strip: Did
the BAT complete the following information on
Step 3 of the ATF (40.243(g)):
− Identification of the machine
− Time
− Sequential Test Number
− Test Outcome
Complete Step 3 of the ATF by dating and
signing the certification (40.247( a ))
Distribute the ATF copies to appropriate
individuals (40.247(a)):
− Copy 1 to Employer
− Copy 2 to Employee
− Retain Copy 3
After the Breath Alcohol Test is completed,
review the following items:
Was consent - giving the collection site or its
personnel indemnification-required for testing?
(40.355( a ))
− Collection sites cannot require an employee to sign
a consent, release, waiver of liability, or
indemnification agreement with respect to any
part of the alcohol or drug testing process
covered by 49 CFR Part 40. No one may do so
on behalf of a service agent
Is the EBT on the National Highway Traffic
Safety Administration (NHTSA) conforming
products list?
Was the correct ATF used? (40.225(a))
− The DOT ATF must be used for every DOT
alcohol test. The ATF must be a three-part
carbonless manifold form. The ATF is found in
Appendix G of
49 CFR Part 40. You may view this form on the
ODAPC website (www.dot.gov/ost/dapc)
Were all necessary equipment, personnel, and
materials for breath testing provided at the
location where testing occurred? (40.221(d))
Did the breath alcohol testing location afford
visual and aural privacy to prevent unauthorized
persons from seeing or hearing test results?
(40.221(c))
Did the BAT remain with the employee for the
entire duration of the alcohol testing procedure?
(40.223(e)(3))
Does the BAT have a copy of the quality
assurance plan (QAP) for the EBT? (40.233(c))
Ask to see the external calibration checks for the
EBT (40.233(c))
Have the BATs completed the required training
and acquired the proper credentials? (40.213(g))
Ask to see the credentials of the BAT
Does the BAT have a current copy of 49 CFR
Part 40? (40.213)
UNEVENTFUL URINE COLLECTION -
Did the Collector…
Require employee to provide positive
identification (Part 40.61(c)).
Direct the employee to remove outer clothing
(jacket, hat) and to leave these garments and
other personal items (briefcase, purse, etc.) in a
mutually agreeable location (Part 40.61(f)).
- Advises employee that failure to comply
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199
constitutes a refusal to test.
- Allows employee to keep wallet (40.61(f)(2)).
Direct employee to empty pockets and display
items in them (Part 40.61(f)(4)).
- If no potential adulterants are found, allow
employee to return items to pockets.
Complete Step 1 of CCF (Part 40.63(a)).
- Ensures that the name and address of the drug
testing laboratory appears at the top of the
CCF.
- Ensures that the Specimen ID at the top of the
CCF matches the Specimen ID on labels/seals.
- Checks the Reason for Test box (Pre-
Employment, Random, Post-Accident, etc.).
- Checks the DOT and the FTA box (Testing
Authority)
- Checks the Drug Tests to Be Performed box
(THC, COC, PCP, OPI, AMP for DOT).
Instruct employee to wash/dry hands and not to
wash hands again until delivering specimen to
collector (Part 40.63(b)).
Ensure collection container is selected and
unwrapped in presence of employee (Part
40.63(c)).
Secure urination facility before the collection (If
single-toilet room with a full-length privacy
door)
(Parts 40.41 & 43).
- Secures any water sources or make them
unavailable to employees (e.g., turn off water
inlet, tape handles to prevent opening faucets).
- Ensures that the water in the toilet tank contains
bluing agent.
- Ensures that soap, disinfectants, cleaning
agents, or other possible adulterants are not
present.
- Inspects the site to ensure that no foreign or
unauthorized substances are present.
- Tapes or otherwise securely shuts any movable
toilet tank or puts bluing agent in the tank.
- Ensures that undetected access (e.g., through a
door not in your view) is not possible.
- Secures areas and items (e.g., ledges, trash
receptacles, paper-towel holders, under-sink
areas, drop-down ceiling panels) that appear
suitable for concealing contaminants.
Direct employee to go into room used for
urination and instruct employee to:
- Provide at least 45 ml of urine.
- Not flush the toilet.
- Return specimen to the collector as soon as the
void is complete.
- Set a reasonable time limit for voiding (Part
40.63(d)(2)).
- Allow only the employee into the room used
for urination (40.41(d)(1)).
Check that the specimen:
- Contains at least 45 ml of urine. If not, follow
shy bladder procedure (Part 40.65(a)).
- Reads temperature strip within 4 minutes (Part
40.65(b)).
Mark appropriate box in Step 2 of CCF (Yes =
between 90 and 100 degrees).
Check specimen for signs of tampering (Part
40.65).
Check specimen for unusual color, foreign
objects/material, or other signs of tampering
(odor).
Mark box in Step 2 of the CCF indicating a split
specimen collection (Part 40.71(b)(1)).
Pour at least 30 ml of urine into the primary
specimen bottle (Part 40.71(b)(2)).
Pour at least 15 ml of urine into the secondary
specimen bottle (Part 40.71(b)(2)).
Secure the lids or caps on the specimen bottles
(Part 40.71(b)(4)).
Place the tamper-evident seals on the specimen
bottles (Part 40.71(b)(5)).
- Dates the specimen bottle seals (Part
40.71(b)(6)).
- Ensures that the employee initials specimen
bottle seals (Part 40.71(b)(7)).
Direct employee to read and sign certification
statement on Copy 2, Step 5 of CCF and to
provide date of birth, printed name, day and
evening contact telephone numbers (Part
40.71(a)(1)).
Print collector name in Copy 1, Step 4 of CCF;
record the date and time of collection; sign
statement; enter actual name of delivery service
transferring the specimen to laboratory (Part
40.73(a)(2)).
Ensure that all copies of the CCF are legible and
complete (Part 40.73(a)(3)).
Remove Copy 5 of the CCF and give it to the
employee (Part 40.73(a)(4)).
Place specimen bottles and Copy 1 of CCF in
plastic bag and secure both pouches of plastic
bag (Part 40.73(a)(5)-(a)(6)).
Advise employee that he/she may leave the site
(Part 40.73(a)(7)).
Recheck the urination facility, performing all
steps as was done prior to the collection to
ensure the site’s continued integrity
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200
APPENDIX N
Maintenance Plan
PERSON AREA TRANSPORTATION SYSTEM (PATS)
TRANSIT SYSTEM MAINTENANCE PLAN
April 17, 2007
TO: Community Transportation Systems
FROM: NCDOT/PTD
SUBJECT: Maintenance Plan
Recipients must keep Federally-funded equipment and facilities in good operating order.
Recipients must have a written maintenance plan. The maintenance plan should identify the
goals and objectives of a maintenance program, which may include vehicle life, frequency of
road calls, maintenance costs compared to total operating costs, etc. The maintenance program
should also establish the means by which such goals and objectives will be obtained.
At a minimum, the plan should designate the specific goals and objectives of the program for
preventive maintenance inspections, servicing, washing, defect reporting, maintenance-related
mechanical failures, warranty recovery, vehicle service life, and vehicle records. The program
must address the particular maintenance cycles for each capital item.
Recipients must have records showing when periodic maintenance inspections have been
conducted on vehicles and equipment. Include information showing that the periodic
maintenance program meets at least minimum requirements of the manufacturer.
Maintenance of ADA elements may be incorporated in the regular maintenance plan or
addressed separately. At a minimum, the grantee must demonstrate that such features as lifts,
elevators, ramps, securement devices, signage, and communications equipment are maintained
and operational. The recipient is required to develop a system of maintenance checks for lifts on
non-rail vehicles to ensure proper operation. Additionally, a recipient is required to remove an
accessible van with an inoperable lift from service before the next day, unless no spare vehicles
are available to replace that vehicle. When a vehicle with an inoperable lift is operated, the
vehicle must not be in service for more than five days.
Recipients must keep written maintenance plans and checklist systems, as well as maintenance
records for accessible equipment.
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Recipients are required to maintain systems for recording warranty claims and enforcement of
such claims. Recipients should have written warranty recovery procedures. The warranty
recovery system should include warranty records and annual summaries of warranty claims
submitted.
Federally funded equipment needs to be maintained whether operated directly by a recipient or
by a third-party contractor. When a recipient has contracted out a portion of its operation, a
maintenance plan for Federally-funded equipment should be in existence and be treated similarly
to a recipient-operated service. In those cases, the third-party contractor must have in place a
system to monitor the maintenance of federally funded equipment.
POLICY STATEMENT
It is the policy of PATS that all vehicles be maintained to ensure safe, reliable,
comfortable, accessible, and cost-effective public transportation services to meet all service
commitments. The following preventive maintenance (PM) policies and procedures are adopted
and issued to ensure that appropriate, necessary, and required vehicle maintenance takes place.
RESPONSIBLE PARTIES
Transit Manager
The Transit Manager is responsible for ensuring that the vendors perform the required
maintenance.
Senior Administrative Support Assistant
The Senior Administrative Support Assistant is responsible for documenting all work performed
and charged, keep records, and provide work orders to the transit system documenting all work
performed, by vehicle, by date, including a complete breakdown of labor, parts, subcontracted
work, and any other costs. All work will be covered by work orders for; needed maintenance or
repairs. If, in the future, the role of maintenance supervisor is delegated to another staff member,
this policy will need to be revised.
Maintenance Vendors
All vehicles operated by Person County Public Transit are maintained by vendors to the
County on a work order basis.
Vehicle Operators
Vehicle operators (drivers) will be required to perform a daily pre-trip and post-trip
safety inspection of their vehicle (see below). If a vehicle is designed to carry 16 or more
passengers including the driver, all vehicle operators of that vehicle are required to possess a
valid Commercial Driver’s License (CDL).
Mechanics that test-drive the vehicle are also required to possess a valid CDL. As PATS
purchases its maintenance, this provision is a requirement of the vendors who service vehicles
requiring a CDL.
Mechanics and their supervisors are among the safety-sensitive positions subject to
Federal Transit Administration (FTA) Drug and Alcohol testing requirements (described in the
Drug and Alcohol policy).
PATS seeks to have its Section 5311 vehicles maintained by ASE-certified technicians.
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REQUIRED ACTIVITIES
Pre-Trip and Post-Trip Safety Inspections:
Vehicle operators will perform a daily pre-trip safety inspection, including cycling the
wheelchair lift (if so equipped). This pre-trip safety inspection will be recorded on the Pre-Trip
safety inspection form daily -- dated and signed, and these forms will be provided to the Senior
Administrative Support Assistant’s office (daily, if possible, but no less often than weekly for
vehicles that are garaged away from the office).
At the end of the service day, the operator will also perform the post-trip safety
inspection noting any vehicle deficiencies or damage. The post-trip safety inspection, if it notes
any conditions that could affect the safety of operation or cause the vehicle not to be available
for service in the morning, should be immediately provided to the Transit Dispatcher and the
Transit Manager.
If the pre- or post-trip safety inspections identify problems potentially affecting the
immediate usability of the vehicle (failure to start and operate normally, brake problems, critical
levels of fluids, tire problems, damage to glass or doors, lift failure, etc.), the Transit Manager
and/or Dispatcher will be notified immediately, a work order developed, and the vehicle taken to
the appropriate maintenance vendor for diagnosis and repair. If repair cannot be made to allow
the vehicle to meet its schedule, the Transit Manager or Dispatcher will take steps as needed to
reschedule trips in the immediate short term, and then assign another vehicle. Items that can wait
for scheduled maintenance should be noted on the inspection form as well, and added to the
developing work order for future repair.
PREVENTIVE MAINTENANCE SERVICE
All vehicles will have scheduled preventive maintenance performed as called for by FTA,
NCDOT/PTD and County policy. Person County will follow the recommended NCDOT/PTD
maintenance policy of basing the maintenance schedule on the manufacturer’s recommended
schedule, to be sure of meeting warranty requirements.
Maintenance priorities should first be focused on any repairs needed to keep vehicles in
service, address safety issues, and provide for complete safe operation of wheelchair lifts. The
second priority is scheduled preventive maintenance. As the Senior Administrative Support
Assistant keeps vehicle maintenance records, the Senior Administrative Support Assistant will
notify the drivers of upcoming scheduled preventive maintenance based on the mileages/cycles
of the vehicles as compared to the schedule of required maintenance activities. To further ensure
that maintenance takes place as scheduled, the Vendor will place mileage/time reminder stickers
on the vehicle windshield, and it is responsibility of the driver to note approaching scheduled
maintenance the pre- trip safety inspection form and contact the Senior Administrative Support
Assistant to schedule it, if the Senior Administrative Support Assistant has not already notified
the driver. Based on NCDOT/PTD policy, it is the goal of PATS that 80% of maintenance
actions will take place within plus or minus 10% of the recommended mileage interval. The
Transit Manager will be responsible for monitoring this measure.
The Senior Administrative Support Assistant will notify the Clerk/Dispatcher when
maintenance is needed and the Clerk/Dispatch will contact the Maintenance Vendor to schedule
any maintenance service. The Maintenance Vendor will communicate will an estimate for any
additional activities for approval. Please note that all fluids needed for topping off, reservoirs or
oil changes shall be included in the quoted price of the preventive maintenance service on the
contract.
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Periodically, the Transit Manager will meet with the Maintenance Vendor to review
procedures for monitoring performance. In general, the Maintenance Vendor shall anticipate that
the Transit Manager will use standard industry rate publications for cost and performance time
guidelines, obtain second opinions of service work at random, and schedule on-site visits with
shop management to review service performance. It should be noted that the scheduling of
preventive maintenance is the responsibility of the transit system, and timely performance of
maintenance actions and repairs is the responsibility of the vendor.
Required turn around time for routine PM Service shall be one a maximum of (1)
business day from the time of vehicle receipt, as mutually agreed.
Chassis Maintenance
The description of preventive maintenance activities for the vehicle chassis follows.
The Senior Administrative Support Assistant will provide the vendor with a pre-schedule
of the PM Services that are approaching their mileages. The Clerk/Dispatcher and
Maintenance Vendor will mutually agree on a schedule for the week to accomplish the
maintenance.
1. PM Description
Preventive maintenance (PM) service is scheduled at 5000 miles or six months,
whichever comes first. The preventive maintenance schedule matches the Original
Equipment Manufacturer’s (OEM’s) recommendations.
The majority of vehicles receive an “A” or “B” service on an alternating basis. For
example: the vehicles receive an “A service” at 5,000 miles, “B service” at 10,000
miles, then “A service” again at 15,000 miles, etc.
Class Code
PATS-PM-Vehicle with Lift
PATS-PM-VAN, A
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
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PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PMBL750-00 **** BRAUN WHEELCHAIR LIFT 750 CYCLE INSPECTION ****
PMBL750-01 APPLY LIGHT OIL OUTER BARRIER HINGE PILOT POINTS - 2
PMBL750-02 APPLY LIGHT OIL OUTER BARRIER LATCH - PIVOT / SLIDE POINTS
PMBL750-03 APPLY LIGHT OIL OUTER BARRIER LATCH LEVER PIVOT POINTS
PMBL750-04 APPLY LIGHT OIL LIFT-TITE LATCHES - TOWER PIVOT POINTS - 2
PMBL750-05 LIGHT OIL; LIFT-TITE LATCH GAS DAMPENING SPRING PIVOT PTS
PMBL750-06 INSPECT-REPAIR LIFT-TITE LATCHES AND GAS SPRINGS
PMBL750-07 INSPECT OUTER BARRIER FOR PROPER OPERATION
PMBL750-08 INSPECT OUTER BARRIER LATCH FOR PROPER OPERATION
PMBL750-09 INSPECT AND CORRECT LIFT FOR WEAR DAMAGE OR ABNORMAL COND
PMBL750-10 INSPECT AND CORRECT LIFT FOR RATTLES
PATS-PM-VAN, ANNUAL
PM Task Description
PM-ANU-01 MIL INDICATOR BULB
PM-ANU-02 DLC (DIAGNOSTIC LINK CONNECTOR)
PM-ANU-03 COMMUNICATION ESTABLISHED
PM-ANU-04 MIL COMMAND ON
PM-ANU-05 MIL INDICATOR BULB
PM-ANU-06 HEADLIGHT
PM-ANU-07 PARKING LIGHT
PM-ANU-08 TAIL LIGHTS
PM-ANU-09 BEAM INDICATOR LIGHT/SWITCH
PM-ANU-10 LICENSE PLATE
PM-ANU-11 STOP LIGHTS
PM-ANU-12 DIRECTIONAL SIGNALS
PM-ANU-13 HORN
PM-ANU-14 WINDSHIELD WIPER
PM-ANU-15 REAR VIEW MIRROR
PM-ANU-16 FOOT BRAKE
PM-ANU-17 EMERGENCY BRAKE
PM-ANU-18 STEERING MECHANISM
PM-ANU-19 TIRES
PM-ANU-20 EXHAUST SYSTEM
PM-ANU-21 CLEARANCE LIGHTS (BUSES; TRUCKS; TRAILERS)
PM-ANU-22 REFLECTORS
PM-ANU-23 WINDOW TINTING VISBLE LIGHT TRANSMISSIOM. 35% TOLARANCE
PM-ANU-24 CATALYTIC CONVERTER
PM-ANU-25 AIR INJECTION SYSTEM (AIS)
PM-ANU-26 PCV VALVE
PM-ANU-27 UNLEADED GAS RESTRICTOR
PM-ANU-28 EXHAUST GAS REGULATOR (EGR)
PM-ANU-29 THERMOSTATIC AIR CONTROL (TAC)
PM-ANU-30 FUEL EVAPORATON CONROL
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PM-ANU-31 OXYGEN (02) SENSOR
PATS-PM-VAN, B
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PMBL750-00 **** BRAUN WHEELCHAIR LIFT 750 CYCLE INSPECTION ****
PMBL750-01 APPLY LIGHT OIL OUTER BARRIER HINGE PILOT POINTS - 2
PMBL750-02 APPLY LIGHT OIL OUTER BARRIER LATCH - PIVOT / SLIDE POINTS
PMBL750-03 APPLY LIGHT OIL OUTER BARRIER LATCH LEVER PIVOT POINTS
PMBL750-04 APPLY LIGHT OIL LIFT-TITE LATCHES - TOWER PIVOT POINTS - 2
PMBL750-05 LIGHT OIL; LIFT-TITE LATCH GAS DAMPENING SPRING PIVOT PTS
PMBL750-06 INSPECT-REPAIR LIFT-TITE LATCHES AND GAS SPRINGS
PMBL750-07 INSPECT OUTER BARRIER FOR PROPER OPERATION
PMBL750-08 INSPECT OUTER BARRIER LATCH FOR PROPER OPERATION
PMBL750-09 INSPECT AND CORRECT LIFT FOR WEAR DAMAGE OR ABNORMAL COND
PMBL750-10 INSPECT AND CORRECT LIFT FOR RATTLES
PATS-PM-VAN, C
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
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PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC51 CHANGE TRANSMISSION FLUID AND REPLACE FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PMBL750-00 **** BRAUN WHEELCHAIR LIFT 750 CYCLE INSPECTION ****
PMBL750-01 APPLY LIGHT OIL OUTER BARRIER HINGE PILOT POINTS - 2
PMBL750-02 APPLY LIGHT OIL OUTER BARRIER LATCH - PIVOT / SLIDE POINTS
PMBL750-03 APPLY LIGHT OIL OUTER BARRIER LATCH LEVER PIVOT POINTS
PMBL750-04 APPLY LIGHT OIL LIFT-TITE LATCHES - TOWER PIVOT POINTS - 2
PMBL750-05 LIGHT OIL; LIFT-TITE LATCH GAS DAMPENING SPRING PIVOT PTS
PMBL750-06 INSPECT-REPAIR LIFT-TITE LATCHES AND GAS SPRINGS
PMBL750-07 INSPECT OUTER BARRIER FOR PROPER OPERATION
PMBL750-08 INSPECT OUTER BARRIER LATCH FOR PROPER OPERATION
PMBL750-09 INSPECT AND CORRECT LIFT FOR WEAR DAMAGE OR ABNORMAL COND
PMBL750-10 INSPECT AND CORRECT LIFT FOR RATTLES
PATS-PM-VAN, CAMERA
PM Task Description
PM-CAM-00P ***** PERFORM 6 MONTH CAMERA INSPECTION *****
PMSEON-1 CHECK OPERATION; ADJUSTMENT AND CONDITION OF ALL CAMERAS
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PMSEON-2 CHECK CAMERA SYSTEM DVR RECORDING PROPERLY; LIGHTS ON ETC
PMSEON-3 CLEAN BACK OF CAMERA DVR WITH COMPRESSED AIR
PATS-PM-VAN, D
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC51 CHANGE TRANSMISSION FLUID AND REPLACE FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
PMSFW61 REPLACE CLIMATE-CONTROLLED SEAT FILTER (IF EQUIPPED)
PMSAC57 REPLACE SPARK PLUGS
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PMBL750-00 **** BRAUN WHEELCHAIR LIFT 750 CYCLE INSPECTION ****
PMBL750-01 APPLY LIGHT OIL OUTER BARRIER HINGE PILOT POINTS - 2
PMBL750-02 APPLY LIGHT OIL OUTER BARRIER LATCH - PIVOT / SLIDE POINTS
PMBL750-03 APPLY LIGHT OIL OUTER BARRIER LATCH LEVER PIVOT POINTS
PMBL750-04 APPLY LIGHT OIL LIFT-TITE LATCHES - TOWER PIVOT POINTS - 2
PMBL750-05 LIGHT OIL; LIFT-TITE LATCH GAS DAMPENING SPRING PIVOT PTS
PMBL750-06 INSPECT-REPAIR LIFT-TITE LATCHES AND GAS SPRINGS
PMBL750-07 INSPECT OUTER BARRIER FOR PROPER OPERATION
PMBL750-08 INSPECT OUTER BARRIER LATCH FOR PROPER OPERATION
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PMBL750-09 INSPECT AND CORRECT LIFT FOR WEAR DAMAGE OR ABNORMAL COND
PMBL750-10 INSPECT AND CORRECT LIFT FOR RATTLES
PATS-PM-VAN, E
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
PMSFW61 REPLACE CLIMATE-CONTROLLED SEAT FILTER (IF EQUIPPED)
PMSAC57 REPLACE SPARK PLUGS
PMUHI62 REPLACE PCV VALVE ALL UNDER 6000 LBS GVW; NOT 3V ENGINES
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PMBL750-00 **** BRAUN WHEELCHAIR LIFT 750 CYCLE INSPECTION ****
PMSAC68 REPLACE REAR AXLE FLUID ON DANA AXLES; SYNTHETIC LUBRICANT
PMBL750-01 APPLY LIGHT OIL OUTER BARRIER HINGE PILOT POINTS - 2
PMSAC63 CHANGE MOTORCRAFT PREMIUM GOLD ENGINE COOLANT
PMBL750-02 APPLY LIGHT OIL OUTER BARRIER LATCH - PIVOT / SLIDE POINTS
PMBL750-03 APPLY LIGHT OIL OUTER BARRIER LATCH LEVER PIVOT POINTS
PMBL750-04 APPLY LIGHT OIL LIFT-TITE LATCHES - TOWER PIVOT POINTS - 2
PMBL750-05 LIGHT OIL; LIFT-TITE LATCH GAS DAMPENING SPRING PIVOT PTS
PMBL750-06 INSPECT-REPAIR LIFT-TITE LATCHES AND GAS SPRINGS
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PMBL750-07 INSPECT OUTER BARRIER FOR PROPER OPERATION
PMBL750-08 INSPECT OUTER BARRIER LATCH FOR PROPER OPERATION
PMBL750-09 INSPECT AND CORRECT LIFT FOR WEAR DAMAGE OR ABNORMAL COND
PMBL750-10 INSPECT AND CORRECT LIFT FOR RATTLES
PATS-PM-VAN, F
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC51 CHANGE TRANSMISSION FLUID AND REPLACE FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
PMSFW61 REPLACE CLIMATE-CONTROLLED SEAT FILTER (IF EQUIPPED)
PMSAC57 REPLACE SPARK PLUGS
PMUHI62 REPLACE PCV VALVE ALL UNDER 6000 LBS GVW; NOT 3V ENGINES
PMSAC68 REPLACE REAR AXLE FLUID ON DANA AXLES; SYNTHETIC LUBRICANT
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PMBL750-00 **** BRAUN WHEELCHAIR LIFT 750 CYCLE INSPECTION ****
PMSAC63 CHANGE MOTORCRAFT PREMIUM GOLD ENGINE COOLANT
PMBL750-01 APPLY LIGHT OIL OUTER BARRIER HINGE PILOT POINTS - 2
PMBL750-02 APPLY LIGHT OIL OUTER BARRIER LATCH - PIVOT / SLIDE POINTS
PMBL750-03 APPLY LIGHT OIL OUTER BARRIER LATCH LEVER PIVOT POINTS
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PMBL750-04 APPLY LIGHT OIL LIFT-TITE LATCHES - TOWER PIVOT POINTS - 2
PMBL750-05 LIGHT OIL; LIFT-TITE LATCH GAS DAMPENING SPRING PIVOT PTS
PMBL750-06 INSPECT-REPAIR LIFT-TITE LATCHES AND GAS SPRINGS
PMBL750-07 INSPECT OUTER BARRIER FOR PROPER OPERATION
PMBL750-08 INSPECT OUTER BARRIER LATCH FOR PROPER OPERATION
PMBL750-09 INSPECT AND CORRECT LIFT FOR WEAR DAMAGE OR ABNORMAL COND
PMBL750-10 INSPECT AND CORRECT LIFT FOR RATTLES
PATS-PM-VAN, FIRE-EXT
PM Task Description
PMFE-01 CONFIRM EXT IS VISIBLE; UNOBSTRUCTED; AND IN ASSIGNED LOC
PMFE-02 VERIFY THE LOCKING PIN IS INTACT; TAMPER SEAL IS UNBROKEN
PMFE-03 EXAMINE EXT FOR OBVIOUS DAMAGE; CORROSION; LEAKS OR CLOGGED
PMFE-04 CONFIRM PRES GAUGE/INDICATOR IS IN OP RANGE OR POSITION
PMFE-05 LIFT THE EXTINGUISHER TO ENSURE IT IS STILL FULL
PMFE-06 MAKE SURE OPERATING INSTRUCTIONS ON NAMEPLATE ARE LEGIBLE
PMFE-07 CHECK LAST PROFESSIONAL SERVICE DATE ON TAG IS WN 12 MONTHS
PMFE-09 MAKE SURE POWDER IS LIGHT BY HITTING BOTTOM OF FIRE EXTINGUI
PMFE-08 INITIAL AND DATE THE BACK OF THE TAG
CLASS CODE = PATS-PM
Vehicle without Lift
PATS-PM-VAN NO LIFT, A
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
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PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PATS-PM-VAN NO LIFT, ANNUAL
PM Task Description
PM-ANU-01 MIL INDICATOR BULB
PM-ANU-02 DLC (DIAGNOSTIC LINK CONNECTOR)
PM-ANU-03 COMMUNICATION ESTABLISHED
PM-ANU-04 MIL COMMAND ON
PM-ANU-05 MIL INDICATOR BULB
PM-ANU-06 HEADLIGHT
PM-ANU-07 PARKING LIGHT
PM-ANU-08 TAIL LIGHTS
PM-ANU-09 BEAM INDICATOR LIGHT/SWITCH
PM-ANU-10 LICENSE PLATE
PM-ANU-11 STOP LIGHTS
PM-ANU-12 DIRECTIONAL SIGNALS
PM-ANU-13 HORN
PM-ANU-14 WINDSHIELD WIPER
PM-ANU-15 REAR VIEW MIRROR
PM-ANU-16 FOOT BRAKE
PM-ANU-17 EMERGENCY BRAKE
PM-ANU-18 STEERING MECHANISM
PM-ANU-19 TIRES
PM-ANU-20 EXHAUST SYSTEM
PM-ANU-21 CLEARANCE LIGHTS (BUSES; TRUCKS; TRAILERS)
PM-ANU-22 REFLECTORS
PM-ANU-23 WINDOW TINTING VISBLE LIGHT TRANSMISSIOM. 35% TOLARANCE
PM-ANU-24 CATALYTIC CONVERTER
PM-ANU-25 AIR INJECTION SYSTEM (AIS)
PM-ANU-26 PCV VALVE
PM-ANU-27 UNLEADED GAS RESTRICTOR
PM-ANU-28 EXHAUST GAS REGULATOR (EGR)
PM-ANU-29 THERMOSTATIC AIR CONTROL (TAC)
PM-ANU-30 FUEL EVAPORATON CONROL
PM-ANU-31 OXYGEN (02) SENSOR
PATS-PM-VAN NO LIFT, B
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
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212
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PATS-PM-VAN NO LIFT, C
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
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PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC51 CHANGE TRANSMISSION FLUID AND REPLACE FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PATS-PM-VAN NO LIFT, CAMERA
PM Task Description
PM-CAM-00P ***** PERFORM 6 MONTH CAMERA INSPECTION *****
PMSEON-1 CHECK OPERATION; ADJUSTMENT AND CONDITION OF ALL CAMERAS
PMSEON-2 CHECK CAMERA SYSTEM DVR RECORDING PROPERLY; LIGHTS ON ETC
PMSEON-3 CLEAN BACK OF CAMERA DVR WITH COMPRESSED AIR
PATS-PM-VAN NO LIFT, D
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC51 CHANGE TRANSMISSION FLUID AND REPLACE FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
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PMSFW61 REPLACE CLIMATE-CONTROLLED SEAT FILTER (IF EQUIPPED)
PMSAC57 REPLACE SPARK PLUGS
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PATS-PM-VAN NO LIFT, E
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
PMSFW61 REPLACE CLIMATE-CONTROLLED SEAT FILTER (IF EQUIPPED)
PMSAC57 REPLACE SPARK PLUGS
PMUHI62 REPLACE PCV VALVE ALL UNDER 6000 LBS GVW; NOT 3V ENGINES
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PMSAC68 REPLACE REAR AXLE FLUID ON DANA AXLES; SYNTHETIC LUBRICANT
PMSAC63 CHANGE MOTORCRAFT PREMIUM GOLD ENGINE COOLANT
PATS-PM-VAN NO LIFT, F
PM Task Description
PMSAC28 CHANGE OIL; REPLACE OIL FILTER
PMUHI01 TRANSMISSION FLUID FULL / NO LEAKS
PMUHI02 COOLANT LEVEL IS FULL / NO LEAKS
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PMUHI04 STEERING FLUID FULL / NO LEAKS
PMUHI05 BRAKE MASTER CYLINDER FULL / NO LEAKS
PMHBI93 ROTATE TIRES; INSPECT FOR WEAR AND TEAR
PMDSV93 MEASURE TREAD DEPTH; INSIDE / OUTSIDE WHEN DUAL REAR WHEELS
PMDSV02 TREAD DEPTH L/F ______/32 PRESSURE ________
PMDSV04 TREAD DEPTH L/R OUTSIDE ______/32 PRESSURE _______
PMDSV05 TREAD DEPTH L/R INSIDE ______/32 PRESSURE __________
PMRSV02 TREAD DEPTH R/F _______/32 PRESSURE ______
PMRSV04 TREAD DEPTH R/R OUTSIDE _______/32 PRESSURE ______
PMRSV05 TREAD DEPTH R/R INSIDE _______/32 PRESSURE _______
PMSAC95 INSPECT EXHAUST SYSTEM; LEAKS; DAMAGE; LOOSE/FOREIGN OBJECTS
PMUHI93 CHECK BATTERY PERFORMANCE; CABLES; TERMINALS; FLUID LEVELS
PMDSC93 CHECK HORN; EXTERIOR LAMPS; TURN SIGNALS; HAZARD LIGHTS
PMWDE91 CHECK ENGINE COOLING SYSTEM; HOSES; RADIATOR; COOLERS
PMWDE96 CHECK HEATER AND AIR CONDITIONING HOSES
PMWDE01 HEATER AND DEFROSTER WORK PROPERLY
PMWDE06 AIR CONDITIONER WORKING PROPERLY APRIL - OCT
PMSAC99 CHECK FOR OIL AND FLUID LEAKS
PMFOV09 WASHER FLUID FULL AND WIPERS WORK PROPERLY ON LOW/MED/HIGH
PMFOV08 WINDSHIELD IN GOOD CONDITION
PMUHI20 CHECK AIR FILTER CONDITION
PMSAC97 INSPECT HALF SHAFT DUST BOOTS; IF EQUIPPED
PMSAC94 CHECK FOR LEAKS/DAMAGE SHOCKS;STRUTS;SUSPENSION COMPONENTS
PMSAC91 INSPECT STEERING LINKAGE; DRIVE SHAFT; BALL AND U-JOINTS
PMUHI98 INSPECT ACCESSORY DRIVE BELT(S)
PMSAC93 INSPECT WHEELS FOR END PAY AND NOISE
PMWDE81 REPLACE CABIN AIR FILTER (IF EQUIPPED)
PMSAC86 LUBRICATE BALL JOINTS; U-JOINTS-IF HAVE ZERK FITTINGS
PMHBI81 INSPECT BRAKE PADS; SHOES; ROTORS; DRUMS; BRAKE LINES; HOSES
PMHBI82 INSPECT PARKING BRAKE SYSTEM
PMSAC52 CHANGE FUEL FILTER
PMSAC51 CHANGE TRANSMISSION FLUID AND REPLACE FILTER
PMSAC79 REPLACE WHEEL BEARING GREASE; GREASE 4X2 WHEEL BEARING SEALS
PMSFW61 REPLACE CLIMATE-CONTROLLED SEAT FILTER (IF EQUIPPED)
PMSAC57 REPLACE SPARK PLUGS
PMUHI62 REPLACE PCV VALVE ALL UNDER 6000 LBS GVW; NOT 3V ENGINES
PMSAC68 REPLACE REAR AXLE FLUID ON DANA AXLES; SYNTHETIC LUBRICANT
PMSAC63 CHANGE MOTORCRAFT PREMIUM GOLD ENGINE COOLANT
PM-QT12 CHECK OPERATION OF ALL EMERGENCY EXITS; HATCH/WINDOWS/DOORS
PATS-PM-VAN NO LIFT, FIRE-EXT
PM Task Description
PMFE-01 CONFIRM EXT IS VISIBLE; UNOBSTRUCTED; AND IN ASSIGNED LOC
PMFE-02 VERIFY THE LOCKING PIN IS INTACT; TAMPER SEAL IS UNBROKEN
PMFE-03 EXAMINE EXT FOR OBVIOUS DAMAGE; CORROSION; LEAKS OR CLOGGED
PMFE-04 CONFIRM PRES GAUGE/INDICATOR IS IN OP RANGE OR POSITION
PMFE-05 LIFT THE EXTINGUISHER TO ENSURE IT IS STILL FULL
PMFE-06 MAKE SURE OPERATING INSTRUCTIONS ON NAMEPLATE ARE LEGIBLE
PMFE-07 CHECK LAST PROFESSIONAL SERVICE DATE ON TAG IS WN 12 MONTHS
PMFE-09 MAKE SURE POWDER IS LIGHT BY HITTING BOTTOM OF FIRE EXTINGUI
PMFE-08 INITIAL AND DATE THE BACK OF THE TAG
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Body Maintenance
All vehicles will be kept clean and sanitary, through regular interior cleaning and
washing. Vehicles should be swept and trash disposed of at the end of each service day or driver
shift. Each vehicle should be completely washed once a month. A general inspection of the
body should be conducted on the post trip safety inspection form and any defects or issued
identified and reported. These could include body damage, cracked glass, window and door
operation, functioning of escape hatches, heating and air conditioning, seat tears or vandalism,
seat-belts (if available), mirrors/brackets, steps/treads, fire extinguisher mounting and charge,
and handholds and racks (loose or broken). Vehicles with Goshen bodies have additional body-
related maintenance performed at the “A” check, at 12,000 miles, and at the “C” check. Of
particular importance is the 3,000 mile check of exterior caulk and seams for damage. If
cracking, separation, or leaks are noted, the affected areas should be re-caulked to maintain the
warranty. If the inspection by the driver or the garage finds any of these conditions, the Transit
Manager should be notified to initiate a work order for body-related repairs.
Accessibility Equipment
If during a pre-trip or other inspection the lift is found to be inoperable, the vehicle is
ordered out-of-service as soon as a lift-equipped replacement vehicle is available and it remains
out-of-service until repairs are made and the vehicle is re-inspected. If an accessible replacement
vehicle is not available, PATS may use the vehicle with the inoperable lift until an accessible
replacement vehicle is available, up to five days, as allowed by FTA regulations.
On lift-equipped vehicles, the FMVSS 404 form covering the installed accessibility
equipment should be on the bus at all times. The Senior Administrative Support Assistant will
also keep a copy of this form in the vehicle maintenance file of each vehicle.
Emergency Equipment
To prepare for potential emergency situations, each PATS vehicle is equipped with:
Communications equipment (a cell phone or 2-way radio)
Three roadside reflectors (safety triangles)
A dry chemical ABC type fire extinguisher with a minimum 5 pound capacity
A first aid kit
A blood-born pathogens bodily fluid clean-up kit
A seatbelt cutter
Instructions for opening emergency exits, at each exit.
A sign informing all riders (passengers and driver) that seat belt usage is required
A no-smoking sign.
The presence and condition of emergency equipment, as well as the condition of the
vehicle’s emergency exits, should be included in the daily pre-trip inspection by the operator.
Inspection and servicing of emergency exits will be included as part of regular preventive
maintenance. Drivers will be trained in use of all emergency equipment as part of emergency
response training (new hire as well as periodic refresher training).
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REPAIRS
Scheduling and Priority of Repairs
Maintenance priorities should first be focused on any repairs needed to keep vehicles in
service, address safety issues, and provide for complete safe operation of wheelchair lifts. The
second priority is scheduled preventive maintenance. However, it is anticipated that as a result of
PM Service, the Maintenance Vendor may make recommendations for repair service.
Maintenance Vendors shall support their recommendations for repair work by using diagnostic
statistics, accepted performance standards, vehicle history records, mileage, etc. The
Maintenance Vendor shall obtain prior authorization before completing any work that is the
result of PM Service. All repair service, other than emergencies, will be scheduled by the
Clerk/Dispatcher.
The required turn around time for PM Service plus routine repair services done as a result
of the PM shall not exceed two business days or a mutually agreed time frame.
Warranty Service
It is the policy of Person County to have all repairs that are covered by vehicle and
equipment warranties paid under the warranty coverage provided. The Transit Manager will
ensure that the maintenance vendors identify all work potentially covered by warranty, and that it
follows procedures to obtain repairs under the warranties. NCDOT/PTD’s vendors are the first
contact regarding any potential warranty work. Warranty claims always require documentation
of the vehicle history, including preventive maintenance, which is another incentive for
performing all the recommended maintenance functions on schedule. If a vendor (or the Transit
Director) identifies a potential warranty claim, the Transit Manager will obtain copies of the
vehicle maintenance and repair history, and contact the manufacturer’s representative. Once the
manufacturer’s representative has directed the Transit Manager to the appropriate repair site, that
vendor (often a local dealer) will call the manufacturer’s representative with their diagnosis and
an estimate. This call is made to the manufacturer’s Warranty Administrator, who must
authorize the repair, designating which warranty will cover the repair, and how much they will
pay.
Completion of warranty work revealed as a result of PM Service shall not exceed five (5)
business days from the date the vehicle is received by the warranty dealer. If special
circumstances require extended down times, the specific schedule will be mutually determined
between the Transit Manager and the Maintenance Vendor / Warranty Dealer.
Vendor service facilities shall be familiar with all manufacture and after-market
warranties. It is the responsibility of the Maintenance Vendor to identify and notify the Transit
Manager of service that is covered by any warranty. The Transit Manager will make the final
determination to exercise the warranty or not based on costs, nature of the work to be done,
convenience, and customer service.
The Transit Manager shall be responsible for coordinating all warranty work with the
Maintenance Vendor.
EMERGENCY SERVICE-ROAD CALLS/INCIDENTS
Should a vehicle fail while in service, the vehicle operator should ensure that the vehicle
and passengers are safely situated, and attempt to contact the Transit Manager who will contact
an appropriate vendor. Depending on the situation and the possible causes, the vendor may send
a service vehicle and technician to make repairs on site, or may send a tow vehicle. The Transit
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Director or clerk/dispatcher must be contacted to make arrangements to pickup the passengers
and transport them to their destinations. Generally, the driver should not leave the vehicle and/or
passengers unattended, unless it is required as the only way to summon assistance. If a vehicle
has a breakdown or is involved in an accident after hours and cannot be driven, the Transit
Manager shall have the vehicle towed to either the transit's parking lot or the Maintenance
Vendor’s facility.
SERVICE PROCEDURES
Communications
Transit Manager will assign a contact person to coordinate services including: daily
scheduling of vehicle drop-off and pick up, authorization of any service as a result of PM work,
update of vehicle work status, review of invoices, etc.
The Maintenance Vendor will provide contact information for a primary and secondary
contact, as provided on the Maintenance Vendor form.
The Clerk/Dispatcher will call the vendor on a daily basis when vehicles have been
delivered for services. The Maintenance Vendor shall anticipate the calls and be prepared to
provide accurate and timely information to the Clerk/Dispatcher on vehicle status including but
not limited to:
Vehicle status.
Which vehicles are ready by vehicle number.
Which vehicles are being serviced and/or require authorization for repair.
Which vehicles require warranty service.
Estimated completion date of vehicles under repair.
Description of repairs.
The Senior Administrative Support Assistant and Maintenance Vendor will discuss the
following information at a minimum:
Vehicles coming in for service including arrival time.
Type of PM Service to be done.
Significant mechanical problems vehicle is having – as relayed by driver.
Service work Authorization.
Billing Requirements
A detailed work order / invoice will be provided when the vehicle is returned. This
document should minimally include:
Vehicle #, Work Order #, Work Order Date, Work Order Costs, Sales Tax, Tire Fee,
Hours, Hours Cost, Total Cost
Each summary invoice will contain the following statement, a signature of person
preparing the invoice and be dated:
o This information is true and accurate to the best of my knowledge and ability.
Record-Keeping
In addition to any maintenance records kept by the Maintenance Vendor, the Senior
Administrative Support Assistant will maintain all vehicle records. Currently these include a
paper file containing all work orders and other documentation of maintenance, previous repairs,
and all warranty work. AssetWorks is a computerized maintenance records program used to
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track vehicle maintenance, work orders and is maintained by the Senior Administrative Support
Assistant.
Maintenance Analysis
The Transit Director will perform an annual analysis of maintenance costs, repairs, and
road calls/breakdowns by vehicle and for the system in order to identify problem areas,
determine trends, support replacement or overhaul decisions, or identify any opportunities for
cost savings. This analysis will include development of maintenance costs per mile, repair cost
per mile, and mileage between road calls/breakdowns.
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Attachment A
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In House Maintenance Request Form
Vehicle#________ Mileage: ___________________ Lift Cycle _______________
What Maintenance repair needs to be done?
Lights / Bulbs: _________________________________________________
Fluids (Top off oil): _____________________________________________
Radiator: (Add water or Antifreeze): _______________________________
Other:
1. ______________
2. ______________
3. ______________
4. ______________
5. ______________
Driver who requested repair: ___________________________ Date: ______________
Date Rhonda Long Received Request: _________________________
Date Tom McCormick Received Request: _______________________
Date Fixed: ________________________________________
Who fixed request: ____________________________________
Notes;
______________________________________________________________________________
______________________________________________________________________________
……………………………………………………………………………………………..
PATS office use only approved by: ________________
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Person Area Transportation System – Pre-Trip Safety Inspection Form
Date:__________Vehicle No.____ ___Mileage:____________ No. of Lift Cycles: _______
Next Oil Change: _____________
Inspect and OK or PROBLEM -- Use Note to clarify Problem (i.e. left rear turn signal)
OK Problem UNDERHOOD:
Oil Level
Radiator Level
Windshield Washer Level
Battery
Hoses/Belts
Coolant Leaks
Notes
OK Problem EXTERIOR:
Tires
Turn Signals
Head Lights
Tail/Brake Lights
Marker Lights
Windshield/Wipers
Body Damage
Mirrors
Doors
Cleanliness
Notes
OK Problem INTERIOR:
Brakes & Parking Brake
Steering
Transmission
Mirrors
Gauges (incl. Fuel)
Cleanliness
Heater/AC
Radio
Horn
Step-well & Dome Lights
Emergency Exit
Panic Button Light (green)
Wipe off cameras
Notes
OK Problem SAFETY EQUIPEMENT:
Accident Kit
Fire Ext. Charged / Secured
Flares/Triangle secured
First Aid/Blood borne Kit
Back-Up Alarm
Rear Door Buzzer
Seat Belt Cutter
Safety Vest (orange)
Notes
OK Problem WHEELCHAIR LIFT &
SECUREMENT:
Cycle Lift
Lift Mechanism
Lift Belt & Safety Plate
Manual Pump Arm
Shoulder/Lap Belts & Extensions
Floor Securement Belts
Trans. Interlock
Notes
PLACE AN X TO INDICATE BODY DAMAGE
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Person Area Transportation System Post-Trip Safety Inspection Form
Date: ___________ Vehicle No. _______ Mileage: ____________No. of Lift Cycles: _______
No. of clients lift was used for_________
Inspect and OK ADJUSTMENT NEEDED (AN) OR REPAIR NEEDED (RN)
Use Note to clarify Problem (i.e. left rear turn signal)
OK AN RN TIRES:
Pressure
Tread
Wear
Rim
Notes
OK AN RN FLUIDS
(Low and/or Leaks):
Oil
Water
Steering
Windshield
Transmission
Notes
OK AN RN SYSTEMS:
Driver Fan
Fan Switch
Turn Signals
Four Way
Horn
Dash Heat
Floor Heat
A/C
Seat Belt
Wipe off cameras
Notes
OK AN RN STEERING:
Pull
Play
Vibration
Notes
OK AN RN LIGHTS:
Exterior
Interior
Low Beam
High Beam
Notes
OK AN RN ENGINE:
Belts
Hoses
Radiator
Transmission
Notes
OK AN RN BRAKES:
Pull
Play
Vibration
Noise
Notes
OK AN RN WHEELCHAIR LIFT:
Access Door
Hydraulic Fluid Leaks
Electrical Controls
Lift Operation Smooth
Tie-Down Straps
Manual Controls
Notes
OK AN RN BODY DAMAGE:
Front
Driver
Rear
Door
Notes
Vehicle Locked and Secure
Place an X to indicate body damage.
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Accident /Incident Packet on Vehicles
THE SEVEN STEPS OF CRISIS MANAGEMENT
1. Assess the situation
2. Notify Dispatch / Request Aid
3. Protect Yourself
4. Protect Others
5. Secure the Vehicle
6. Gather Incident Information
7. Complete Post-Incident Reports
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CODE 300 – Severe Measures
Alert Code:
Person Area Transportation System has a pre-established alert code
using route location, direction and time
Example:
(Driver) Run 300 to Dispatch.
(Dispatch) Go ahead run 300 what is your location?
(Driver) I’m Southbound on Main Street at near Library
(Dispatcher) What time will you arrive at your next
destination?
(Driver) 10:42 at Peebles
(Dispatch) I’m transferring Smith to your route, pick up at
Peebles going home to 1502 Pine Ridge
(Driver) 10-4
(Dispatch will give you further instruction as appropriate)
If trained and practiced, this can be used to alert dispatch to on-board
threats without alerting the perpetrator.
*Other Drivers stay calm!!!!!!!!!!!!!
Don’t do anything out of the ordinary.
And DO NOT COME OVER THE RADIO
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Bomb Threat Checklist
Questions to Ask Caller: Caller’s Voice:
1. When is the bomb going to explode? _____Calm _____Nasal
_____Angry _____Stutter
2. Where is it right now? _____Excited _____Lisp
_____Slow _____Rasp
3. What does it look like? _____Rapid _____Deep
_____Soft _____Ragged
4. What kind of bomb is it? _____Loud _____Clearing Throat
_____Laughter _____Deep Breathing
5. What will cause it to explode? _____Crying _____Cracking Voice
_____Normal _____Disguised
6. Did you (the caller) place the bomb? _____District _____Accent
_____Slurred _____Familiar
7. Why?
If voice is familiar, whom did it sound like?
8. What is your address?
9. What is your name? Background Sounds:
_____Street noises _____Factory machinery
Exact Wording of the Threat: _____Television _____Animal noises
_____Voices _____Clear
_____PA System _____Static
_____Music _____Local
_____House noises _____Long Distance
_____Motor _____Booth
_____Office Machinery _____Other
Sex of Caller: M or F Race: Threat Language:
Age: Length of Call: _____Well Spoken _____Incoherent
(Educated) _____Taped
Number at which call is received: _____Foul _____Message read
_____Irrational by threat maker
Time: Date:
Report Call Immediately to: Remarks:
Contact Number
Contact Name or Title
Contact Organization _______________________________________
Secondary Contact Info
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Accident / Incident Statement Form
In the area below described in detail the circumstances leading up to, during and after
the Accident / Incident:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
All of the information submitted is true, accurate and complete as it relates to the:
Employee Name and # ________________________________________________________
Route #: ____________ Time: __________________ Bus # __________________________
Accident / Incident on (Date): ________________
at or near (location) _______________________________________
I understand any false or misleading statements; misrepresentations or concealment of a material fact; and
fabrication, altering, concealing or destroying a document will be considered fraudulent and will be dealt with in a
disciplinary manner up to and including discharge.
Employee Signature: _________________________________Date:_____________________
Transit Manager: ______________________________ Date: ______________________
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Safety / Security Situation Form
In the area below described in detail the circumstances leading up to, during and after
the Safety/Security Situation:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
All of the information submitted is true, accurate and complete as it relates to the:
Employee Name and # ________________________________________________________
Route #: ____________ Time: __________________ Bus # __________________________
Safety/Security situation on (Date): ________________
at or near (location) _______________________________________
I understand any false or misleading statements; misrepresentations or concealment of a material fact; and
fabrication, altering, concealing or destroying a document will be considered fraudulent and will be dealt with in a
disciplinary manner up to and including discharge.
Employee Signature: _________________________________Date:_____________________
Transit Manager: __________________________ Date: ____________________
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Person Involved Statement Form
Person Involved should use area below to describe in detail the circumstances leading up to, during and
after the Accident / Incident / Injury or Liability situation. Record everything you can remember while it
is fresh in your mind. Remember, the more you can tell us now, the less we will have to ask later.
All of the information submitted is true, accurate and complete as it relates to the:
Name: ______________________ Phone #: _________________ Time: ________________
Vehicle # Involved: ____________ Driver’s Name: __________________________________
Accident / Incident / Injury or liability situation on (Date) ______________ at or near (location)
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I understand any false or misleading statements; misrepresentations or concealment of a material
fact; and fabrication, altering, concealing or destroying a document will be considered fraudulent and
will be reported to law enforcement and charges may be filed.
Signature: ____________________________________ Date: _______________
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Employee Statement Form
Employee should use area below to describe in detail the circumstances leading up to, during and after
the Accident / Incident / Injury or Liability situation. Record everything you can remember while it is
fresh in your mind. Remember, the more you can tell us now, the less we will have to ask later.
All of the information submitted is true, accurate and complete as it relates to the:
Employee Name: __________________________________________________________
Route #: __________ Time: ________ Bus #: _____
Accident / Incident / Injury or liability situation on (Date) ______________ at or near (location)
I understand any false or misleading statements; misrepresentations or concealment of a material
fact; and fabrication, altering, concealing or destroying a document will be considered fraudulent and
will be dealt with in a disciplinary manner up to and including discharge.
Employee Signature: ____________________________________ Date: _______________
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Bloodborne Pathogen Incident / Injury Report Form
Date Report Completed ______________ Report No._________
Time Report Completed: ______________ AM _______ PM _______
Date of Incident / Injury: ________________ Time: ___________ AM _____ PM ____
Vehicle No.: _________ Route: __________
Location:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name of Injured: _____________________________________________
Age: ____________ Date of Birth: ______________ Occupation: ______________________
Address: ____________________________ City: _______________ State: _____ Zip: _____
Home Phone Number: ______________ Cell Phone Number: ______________
Phone Number to be reached / Day – During office hours: ______________________
Was Incident / Injury Reported To:
Driver
Dispatcher
Manager
Police
Medical
Other: _____________________
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Description of Incident:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Injuries:
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Did Injured Person Require Hospital Treatment? __________________________________
Yes (If yes, Name of Hospital) ____________________________________________
No
How was Injured Transported? ________________________
If Hospital Treatment was not necessary, did injured receive medical treatment at
doctor’s office?
Yes
No
Name of Person filling out Report: ______________________________________________
(PRINT)
Signature of Person filling out Report: ___________________________________________
(SIGNED)
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Courtesy Card
EXONERATION CARD
Courtesy Card
(Tarjeta de Courtesia)
Please complete this card and return to the driver
(Por favor de linear esta terjeta y devuelva al conductor.)
Your Name (Nombre): ______________________________________________________________
Address (Direccion): ________________________________________________________________
Home # (Numero de telephono de casa) ___________________________________
Work# (Numero de telephono de trabajo) __________________________________
Bus # (#de bus) __________ Route (Ruta) _____________ Time (Hora) ___________________
Where were you on the bus at the time of the accident? ________________________________________________________________________
(En que sitio del bus se encontraba cuando ocurrio el accidente?)
How did the accident happen? ___________________________________________________________________________________________
(Como occurio el accidente?)
Who do you think was responsible? _______________________________________________________________________________________
(Quien pensa usted fue responsible?)
Thank You / Gracias
Signature: ________________________________________________________________ Date: ______________________________
(Firma) (Fecha)
To Whom It May Concern:
I hereby exonerate and free from all negligence or blame driver, __________________
and his employer in connection with an accident involving the undersigned which
occurred at ___________ AM or PM on this date _________________.
Location: _____________________________________________________________________
Name: _______________________________________________________________________
Signature: ________________________________________ Date: ______________________
Address: _____________________________________________________________________
Witnessed By: ____________________________________ Date: ______________________
Signature: ________________________________________ Date: ______________________
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APPENDIX O
Person County Government
PERSON AREA TRANSPORTATION SYSTEM (PATS)
Emergency Evacuation Policy and Procedures
General Policy and Information
This policy was written and implemented to insure the safety of employees, patrons, and visitors.
The PATS office will be evacuated in the event of fire, explosion and bomb threat unless
instructed otherwise by law enforcement. In case of inclement weather conditions such as
hurricanes, tornadoes and high winds, employees and visitors will be assisted to a designated
area of safety. In the event of other catastrophic emergency condition, please follow these
policies unless otherwise instructed by law enforcement personnel.
The policy will be readily available to all employees. The Transportation Manager will review
the policy with all new employees on the first day or as soon as possible after employment. This
plan will be reviewed by a member of the administration staff and county safety committee chair
at least annually. If at any time, it is necessary to revise the policy, all employees will be
notified.
All employees should familiarize themselves with the location of fire extinguishers, and
evacuation plans in their area. Fire extinguisher training will be offered annually.
Staff should assist patrons and visitors in the evacuation of the building or designated area of
safety depending on the type of emergency.
Staff should close and unlock all doors as they leave rooms or areas.
A staff member should check meeting rooms, restrooms, etc.
All personnel, patrons and visitors should exit out the building using the route (s) specified in the
EVACUATION PLANS posted in the PATS reception area or report to the designated area of
safety depending on type of emergency.
Procedure for Evacuation of the PATS Facility - Fire
PATS is not equipped with a fire alarm system. If an employee spots a fire that employee has
the responsibility to contact staff by using the all call on the telephone system or by word of
mouth.
The employee in the Clerks/Dispatchers office will call 911.
Staff will be responsible for their assigned task.
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Notification by the fire department indicates that all is clear and that it is safe to resume normal
activities.
Fire/Evacuation Drill
Fire Drills will be conducted at least once a year at the PATS facility.
The staff will be alerted to the fire drill by the County Fire Inspector or Roxboro Fire
Department Personnel.
Evacuation of the PATS facility should be conducted according to the evacuation policy and
procedures.
Announcement by the county fire inspector and/or fire department indicates completion of the
drill and resumption of normal activities may then take place.
Inclement Weather Procedures for the Person County PATS
Tornadoes/Hurricanes/High Winds
When the weather is severe, all staff will listen for weather reports issued by Communications on
the paging system through the county telephones. If a tornado warning is issued or any other
weather conditions, all employees should be notified immediately through the county ALL
CALL system initiated by Communications (911). If a tornado warning is issued in your area
employees and visitors should take shelter in inner offices and hallways away from windows and
outside exposed walls. Protect your head and make yourself as small a target as possible by
crouching down.
(Conference room, bathroom off of staff lounge, training room, PATS managers
office, and the Clerk/Dispatcher’s office)
Preparations for the hazard are to be made within each area to protect employees from injury and
to safeguard building & property. Preparations may include: backing up computers, storing
critical documents, removing equipment/paper from areas that may get wet, etc.
If an injury occurs, emergency response will be addressed immediately by dialing 911. If
property damage has been sustained, appropriate safety measures should be addressed to ensure
the other employees are not injured by debris or other potential hazards. The damage should be
reported to the County Manager or General Services Director.
Earthquakes
If you feel the ground shake, take the following precautions immediately!
1. DUCK – When the shaking first starts: DUCK or drop to the floor.
2. COVER – Take COVER under a sturdy desk, table or other furniture. If there is
nothing available to take cover under, crouch against an interior wall and protect your
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head and neck with your arms. Stay away from windows, hanging objects, mirrors or
anything that might fall over.
3. HOLD – if seeking cover under a piece of furniture, HOLD onto it and be prepared to
move with it during the quake.
Use these tips if you find yourself in any of the following places when an earthquake strikes:
*High-rise building – Stay near an interior wall. Do not use the elevators
*Outdoors – Move to a clear area, away from trees, signs, buildings or downed electrical
wires and poles.
*Walking along the street – Duck into a doorway to protect yourself from falling bricks,
glass, plaster and other debris.
*In your car – Pull over to the side of the road and stop. Avoid overpasses, power lines,
and other hazards. STAY INSIDE THE VEHICLE UNTIL THE SHAKING IS OVER.
*In a public place – Do not rush for the exits. DO NOT PANIC. Move away from
anything that might fall.
Duties of PATS Emergency Action Plan Committee
Develop and implement an Emergency Action Plan.
Review and if necessary, revise plan annually at a minimum.
Discuss within one week after an evacuation to review problems and if necessary, revise the
Emergency Action Plan.
The group’s membership consist of: one representative from Administration and the County
Safety Officer.
Duties of Transportation Manager
The transportation manager or their designee is responsible for informing their employees of the
location of the emergency action plan, its contents and escape routes. This individual is
responsible for informing new employees on their first day or as soon as possible. This
information will be discussed by the County Safety Officer in New Employee Safety Orientation.
Duties of Staff Members
Check your areas (conference room, restrooms, training room, etc). to be sure all personnel,
patrons and visitors are alerted and have exited to a designated area of safety.
Close and unlock all doors in your area when exiting.
Exit building assigned outside area(s).
Attempt to insure that no one enters the building during the emergency.
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Upon notification by the Fire Department, communicate to evacuees that all is clear and the
normal activities may resume.
Report any problem with evacuation to the General Services Director.
Post-Incident Procedures
The PATS Manager will assess damage in the building and inform the Director of General
Services of any necessary repairs and/or actions required to restore departmental functioning.
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PATS EMPLOYER POLICY ON
DISTRACTED DRIVING
PATS Distracted Driving Policy
Please read the Distracted Driving Policy, sign and return to your supervisor.
In order to increase employee safety and eliminate unnecessary risks behind the wheel, PATS has
enacted a Distracted Driving Policy, effective [Date]. We are committed to ending the epidemic of
distracted driving, and have created the following rules, which apply to any employee operating a PATS
vehicle:
PATS employees may not use a hand-held cell phone while operating a vehicle – whether the
vehicle is in motion or stopped at a traffic light. This includes, but is not limited to, answering or
making phone calls, engaging in phone conversations, and reading or responding to emails,
instant messages, and text messages.
If PATS employees need to use their phones, they must pull over safely to the side of the road or
another safe location.
Additionally, PATS employees are required to:
o Turn cell phones off or put them on silent or vibrate before starting the vehicle.
o Consider modifying voice mail greetings to indicate that you are unavailable to answer
calls or return messages while driving.
o Inform clients, associates and family members of this policy as an explanation of why
calls may not be returned immediately.
PATS consequences for failing to follow policy:
I acknowledge that I have received a written copy of the Distracted Driving Policy, that I fully understand
the terms of this policy, that I agree to abide by these terms, and that I am willing to accept the
consequences of failing to follow the policy.
_________________________________________ ______________________
Employee Signature Date
_________________________________________
Employee Name (printed)
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Person Area Transportation
Systems
Seat Belt Policy
Person Area Transportation System recognizes that seat belts are extremely
effective in preventing injuries and loss of life. We care about our employees,
and want to make sure that no one is injured or killed in a tragedy that could
have been prevented by the use of seat belts. Therefore, all employees of
Person Area Transportation System must wear seat belts when operating a
PATS vehicle, or any vehicle pertaining to PATS business. In addition, all
occupants (customers) are to wear seat belts or, child restraints when riding in a
PATS vehicle at any time, or in a personal vehicle being used for PATS
business. All employees and their families are strongly encouraged to always
use seat belts and the proper child restraints whenever they are driving or riding
in any vehicle. If you have a doctor’s note preventing you to wear a seat belt for
medical reason, the Transportation Manager needs a copy of the doctor’s note
to keep on file and the note should be carried with you at all times while
operating a PATS vehicle.
Employees signature: _________________________________ Date:_______________
Transportation Manager’s signature: ___________________ Date: _____________
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PERSON AREA TRANSPORTATION SYSTEM
“PATS”
SERVICE POLICY
Definition of Services
Passenger is defined as an individual who is being transported by our agency. Each
passenger must read and follow all of PATS’ rules in order to use our service.
Attendants are defined as an individual who is authorized to ride with and provide
assistance to a passenger.
General Public/Private Pay refers to those individuals whose trip will not be paid by an
agency or Medicaid. Payments will be collected when you board the vehicle.
Subscription Trip is defined as daily, weekly and or monthly. Subscription trips may be
assigned to one route or rotated route for an extended period of time.
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Demand Response Trip is defined as daily, weekly and or monthly schedule
appointments, shared use transportation service operation in response to calls from
passengers or their agents to the transportation clerk/dispatchers, who schedules a
vehicle pick up the passengers to transport them to their destinations. Transportation
service may also be used as a ride sharing arrangement that is open to the public.
No-Show is defined as no passenger transported after going to the destination.
Passenger did not call in to cancel trip; the rest of the trip that day is automatically
canceled.
Cancelation a trip called in 2 hours ahead of time to cancel out the trip.
Description of Service
1) PATS operates a subscription route, demand response and general public
transportation service. Passengers needing transportation for medical
appointment, to pay bills, buy grocers, shopping, social and recreation
functions, etc., must call the PATS office at (336) 597-1771 at least 24
hours in advance to schedule transportation. All grocery shopping trips
must limit their bags due to limited space on vehicles. Medicaid is for
medical trips to medical facilities only; the number to call for Medicaid trips
is (336) 599-8361 (transportation).
2) Service is burb to curb and will not be provided for passengers from their
door to vehicle. Passengers must arrange for assistance, if needed, from
house to vehicle. This includes wheelchair users/disabled persons.
3) PATS provides non-emergency transportation only. If passenger is unable
to sit up, has severe pain, or other debilitating problems, we are unable to
transport. Please explain your disability at the time of the scheduling
request.
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4) PATS’ vehicles are accessible. All vehicles are properly maintained for
safety and cost efficiency.
Service and Service Area
1) The service area for transportation service includes all of Person County. Service
is provided into Durham, Chapel Hill, and Prospect Hill Tuesday, Wednesday and
Thursday. Return out of town trips must leave no later than 2:00pm.
2) Service is provided daily Monday – Friday unless there is a standard holiday. The
staff and drivers operate under the Person County Government Holiday
schedule.
3) No transportation will be provided on icy or snowy days or when unsafe road
conditions exist. Passengers should listen to the local radio station or call the
weather line (336) 597-1700 to obtain the delay or closing for the day.
4) General Public fares are based on location/zone for a one-way trip/round-trip
anywhere within Person County. To obtain the cost for a trip you may call the
PATS office during office hours 8:30am-5:00pm at (336) 597-1771.
5) Cash payment for General Public trips must be made upon boarding the vehicle.
Please have correct change; drivers are not required to issue change.
Passenger Assistance
1) It is the policy of this agency that passengers unable to access the system on
their own (wheelchair, walker, blind, etc.) be accompanied by an attendant. The
passenger is responsible for finishing his/her own attendant. An attendant must
be physically able to provide assistance to the passenger. An attendant must be
physically able to assist themselves on and off the vehicle. Passengers in
wheelchairs must be secured in the wheelchair with a safe restraint, such as a
belt, harness, etc. before boarding the vehicle. PATS will not transport anyone in
a wheelchair that is missing parts or is deemed unsafe.
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2) This agency does not transport children unaccompanied under the age of 16 to
medical appointments. An adult must accompany all children below that age.
3) Limited assistance will be provided to elderly passengers and person with
disabilities, as requested. Passengers and attendants must be able to handle all
equipment, carry-on bags and shopping bags. Drivers will not carry bags from or
into a residence. Drivers will assist passengers in boarding and exiting from the
vehicle when or if needed only.
4) Passengers scheduled for appointments will not be transported if the following
symptoms are evident”
a. Chest pains
b. Shortness of breath
c. Severe nausea
d. Vomiting or Diarrhea
e. Abdominal pain
f. Labor pain
If the driver finds the passenger in distress upon arriving at the passenger’s
home the driver will notify (911) for emergency medical services and then contact
the PATS office.
5) All return trips will only be made from the location of the drop off. If you travel to a
new location without using the PATS vehicle you will not be picked up from the
new location unless prior assignments have been made with the PATS office.
Reservations, Scheduling and Cancellations
1) Office hours are 8:30am – 5:00pm Monday – Friday. Appointments can be
scheduled by call the PATS office at (336) 597-1771. To cancel is the same
number, leave a message and someone will get back with you if needed.
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2) All calls for transportation must be made 24 hours in advance to ensure
service. All Medicaid recipients must be approved by the Department of
Social Services therefore, please call (336) 599-8361 (transportation line).
3) PATS request that passengers be ready one hour in advance of pick-up time.
Actual pickup time will be adjusted based on the system needs. Passengers
traveling on out of town trips will receive a phone call from the office the day
before to inform the passenger of leave time for the next morning. Out of town
return time is 2:00pm.
4) Drivers will wait no longer than 5 minutes for passengers to board the vehicle.
Passengers should be ready at pick up time. Extra time will be granted to
persons for wheelchair and disabilities as needed.
5) Failure to cancel an appointment in a timely manner on 3 occasions could
result in suspension from PATS vehicle from 1 to 3 months. No shows over a
time period are very costly.
Passenger Conduct and Responsibilities
Person Area Transportation System requests that all passengers conduct themselves
with courtesy and consideration to the driver and other passengers. The driver is
responsible for on vehicle behavior. Inappropriate behavior of a passenger is to be
reported to the PATS office. PATS reserve the right to refuse service based on violation
of agency rules and regulations.
Inappropriate Behavior on Vehicle:
A passenger’s right to transportation can be terminated by the transportation manager
due to misconduct of the passenger. Disruptive or abusive behavior to other passengers
will not be tolerated by the driver.
1) No tobacco products are to be used in the vehicles this includes smoking,
chewing, and or dipping.
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2) Passengers are not permitted to eat, or drink in vehicles.
3) No abusive, foul language, profanity or vulgarity is allowed while on a
transportation vehicle.
4) Lack of personal hygiene is offensive to others. Passengers should be clean
before boarding the vehicle.
5) No horseplay of any kind allowed. No annoyance to other passengers. This can
distract the driver and can be very unsafe.
6) Possessions of alcohol and or illegal drugs are not allowed. Prior uses of
alcoholic beverages or illegal drugs before boarding the vehicle will result in
denial of transportation. THE DRIVER HAS THE RIGHT TO REFUSE
TRANSPORTATION IF PASSENGER APPEARS INTOXICATED.
7) Passengers are required to buckle up, (that’s the law) seat belts are provided.
Passengers will be denied transportation services if they choose not to abide by
the seat belt policy.
8) Passengers must secure any carry-on or personal items.
9) No weapons (knives or firearms) will be allowed on a transit vehicle.
10) No inappropriate display of affection or sexual activity on the vehicles.
11) No release of human waste, including spitting, on the vehicle.
No Show Policy
1) When vehicle arrives at passenger’s home and there is no response, the driver
will attempt to get a response by using the horn. After the 5 minute time wait the
driver will report to dispatch and leave to continue the route.
2) Driver will notify dispatch/PATS office of the no show and the rest of the trip will
be cancelled for that day.
3) PATS will contact the agency to make them aware of the no-show if this is a
subscription rider.
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4) Passengers will be suspended service after 3 no-shows for up to 1 to 3 months
5) Passengers will be charged full price for no-shows.
Person Area Transportation will make every attempt to transport each person
scheduled. At no time can or will we force a passenger to ride the vehicle. All pick-
ups and cancellations should be called into the PATS office to be dispatched out to
the drivers.
Safety
1) The PATS transportation system maintains a Drug and Alcohol Testing
program to ensure safety sensitive personnel are drug and alcohol free when
providing safety sensitive services.
2) The PATS system requires drivers to be trained in Bloodborne Pathogen in
order to provide safe transportation services.
3) All drivers receive Defensive Driving/Distracted Driving Training when hired
and refresher training when required.
4) All drivers must have proper licenses.
5) All passengers are to be seated and wear seat belts. All passengers in
wheelchairs are to be safely secured when vehicle is in motion.
6) The PATS system has standard on vehicle safety equipment on all vehicles.
7) All drivers conduct a pre-trip and post-trip inspection on the vehicle daily.
8) The PATS system is committed to the safe operation of its vehicles, including
the safe boarding and exiting of the passengers.
9) PATS system will not operate if weather conditions make it unsafe to operate
vehicles on the roadways.
Inclement Weather Policy
The transportation system is responsible for the safe operation and management of the
transportation service. In order to carry out this responsibility with the assistance of
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other agencies, the following procedures will be used in the event of inclement weather.
The transportation manager will contact the Director for recommendations on the safety
of operating for the day. As a general guideline, if the county schools are closed, rural
transportation routes and out of town trips will not operate. If the road condition permits
medical and dialysis trips may be provided. The cancellation or delay is for the safety of
passengers and PATS system personnel.
The transportation manager will telephone the local radio station (WRXO) and the
Person County Government weather line with any inclement weather announcements.
These announcements may involve complete cancellation of service, delay of the start
of service, or cancellation of specific routes.
If inclement weather occurs in midday, the same procedures will apply. Transportation
take-home procedures may have to be modified and will be determined by the
transportation manager.
Emergency Procedures
In case of an accident or other emergencies the passenger should:
1) Follow the driver’s instructions
2) Remain calm
3) Maintain orderly evacuation of the vehicle, if warranted
4) Stay off roadway and stand in a safe location
5) Do not smoke anywhere near the vehicle
6) Driver will be responsible for calling 911
7) Driver will provide detailed and accurate reports of all accidents/incidents, using
the PATS system’s standard report form.
Passenger Comment and Complaint Procedures
Person Area Transportation System is committed to being responsive to passenger
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perceptions about their transportation services and welcomes feedback from
passengers. Any comments/complaints may be addressed by calling the PATS office
(336) 597-1771.
Complaint procedures are as followed:
1) Transportation Manager will discuss complaint with the passenger. If the
complaint is valid, immediate changes will be made, if possible.
2) If the complaint is against a driver, the manager will discuss the problem with the
driver involved within two (2) working days. If it is determined that the driver is at
fault, corrective measures will be taken immediately.
3) Passenger making the complaint will be notified within five (5) working days of
the status of the complaint.
Transit System Responsibilities
1) PATS is responsible for providing clean, on-time, reliable, safe, and efficient
service.
2) PAT is not responsible for passenger’s items left on vehicles.
3) PATS is responsible for abiding by the policies detailed in other sections of the
service policy.
4) PATS’ insurance coverage exceeding legally mandated minimums.
5) PATS abides by all applicable Federal, State and Local regulations.
6) PATS is committed to keeping all vehicles and other equipment properly
maintained and in safe working order.
Statement of Non-Discrimination
Person Area Transportation does not discriminate in the provision of service to any
individual based on race, creed, color, sex, age, or national origin. All persons will be
treated equally with respect and dignity.
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This agency is an equal opportunity employer and will not discriminate in the
employment of persons because of race, creed, color, sex, age, or national origin.
Any and all information regarding any individual person served by Person Area
Transportation System is strictly confidential.
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Effective June 1, 2001 / revised November 1, 2016
Transporting With a Purpose
For your safety, comfort and enjoyment, we ask that each of our passengers sign, date and
observe the following policy when using Person Area Transportation System (PATS)
1. Appointments must be called in no later than 11:00am the working day before the
scheduled appointments. Cancellations must be called into the PATS office 2 hours prior
to pick-up time in order not to be charged full price for a No-Show. When you are a no
show in the morning the rest of your trip will automatically be cancelled for the rest of
that day when riding under the grant (RGP). If you are a no show in the afternoon you are
still responsible for the full price of that no show and also the morning price converts to
full price too. Grant money will not pay for a one way trip. Pick up time is 1 hour before
scheduled appointment time.
2. Please be ready at least 1 hour prior to your scheduled appointment time. Once the
vehicle has arrived, wait time is no more than 5 minutes for passengers to board. When
the vehicle leaves, it will not be allowed to come back.
3. PATS drivers will assist passengers on and off the PATS vehicles safely. The PATS
vehicle has to be in driver’s sight at all times. The drivers are not to enter homes,
business, etc. for clients.
4. PATS drivers are not permitted to stop en-route unless confirmed by the PATS office
prior to time of pick up. Passengers are expected to be responsible for their own
personalitems (belongings) when getting on, during the ride and getting offthe PATS
vehicles. If things are left they will be disposed of. Passengers are only allowed to carry
items on the PATS vehicle which can fit on their laps and / or between their feet. (If you
take up other seats, additional fees may apply).
5. When paying PATS fares:
If you are paying with cash please have the correct fare, drivers can’t give change.
If you are paying by check, please make check payable to:
Person Area Transportation System or PATS.
*Please have fare ready when boarding the PATS vehicles.
You cannot ride if you do not pay before / when boarding.
6. All passengers are required:
a. To use seatbelts while riding in a PATS vehicle (wearing seatbelts is the
law in North Carolina). They must remain hooked until vehicle comes to
a complete stop.
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b. Children under the age of 8 years old or weighing less than 80 pounds
must be properly secured in an approved child restraint seat provided by
the adult passenger.
c. Passengers in wheelchairs or other mobility devices must be secured with
4-point tie downs (two front, two rear), and with the lap belt and shoulder
harness provided as part of the securement system on the PATS vehicles
(a mobility assessment application may be required).
7. Please limit conversation with the drivers, this is a big distraction and is not safe.
Conversations between passengers should be held in a normal tone so as not to disrupt
other passengers and distract the driver. The use of profanity is prohibited.
8. Physical contact with the driver or other passengers is not permitted. Passengers are
asked to refrain from public displays of affection while on board the PATS vehicle.
Passengers are asked to stay seated and seat belts remain hooked until the vehicle has
come to a complete stop. Passengers are asked not to rest their feet on or in the seats, and
to keep their hands and arms inside their seating area. Please keep aisles clear.
Destruction of PATS property will result in legal action.
9. The use of or possession of drug and / or alcohol is not permitted on the PATS vehicles.
PATS drivers have the authority to deny service to any person thought to be under the
influence of drugs or alcohol.
10. Carrying a concealed weapon is not permitted on the PATS vehicles. PATS drivers have
the authority to deny service to any persons carrying a weapon (knife, gun, etc.)
11. Smoking, eating, and / or drinking are not permitted on the PATS vehicles. The use of
cellphones should not be used unless it’s an emergency; they are very distracting to the
other passengers and the driver.
12. We go to Durham/Chapel Hill on Tuesday, Wednesday and Thursday, for medical
appointments only. We leave the lot at 6:00 am and return to the lot by 1:00 pm. Your
appointment should be made early in order to be finished by 12: pm (That’s the latest we
will be staying in Durham/Chapel Hill).
These policies are in effect in order to protect the passengers and the employees of Person Area
Transportation System (PATS). All passengers have the right to a safe and efficient ride on our
transportation system. Failure to observe these policies could result in temporary or permanent
suspension of PATS privileges. PATS will report all illegal actions to the proper authorities.
Sign: _____________________________________ Date: ________________________
(If not same as above; person responsible for payments and appointments)
Sign _________________________________________ Date: ________________________
*We will keep this original on file in the PATS office and give you a copy to keep for your
records.
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Video Camera Policy
A. PURPOSE
After careful consideration, Person Area Transportation System and NCDOT have determined that the use of video
cameras is necessary to ensure the safety and security of both passengers and employees.
Uses of the cameras and video:
complaint investigations
Driver Ride-A Longs
Accident Reporting and Review
Training
Discipline
Improve safety and security by deterring acts of theft, violence and other criminal activity, and increasing the
likelihood that perpetrators of these acts will be identified.
Person Area Transportation System has created this video policy in furtherance of these purposes and to assist
in complying with federal and provincial privacy laws governing the collection of personal information.
B. CAMERA LOCATIONS AND TIME OF OPERATIONS
Person Area Transportation System has installed video cameras on all our vehicles.
The system activates upon vehicle ignition, and continues recording twenty minutes after the vehicle is shut down.
The recorder will store 4 to 6 weeks of data under normal use, after this period the system will start recording over the
oldest data.
The hard drives are easily accessed by two supplied keys. One key opens the outer cover which restricts access to
the DVR, and the second key is used to remove the hard drive.
Hard drives can be removed and brought to any computer with viewing software installed and opened for review.
Recorders can be accessed wirelessly when vehicles are in the lot where the download access point is setup.
Video recordings of significance can be saved in SEON or Windows Media Player format.
C. USE AND RETENTION OF FOOTAGE
1. Video cameras shall be used for deterring theft, violence and complaint investigations.
2. In the event of a reported or observed incident, the recorded footage may be used to assist in the investigation of
the incident and may be turned over to law enforcement personnel, if appropriate.
3. At no time will persons other than those designated by the Transportation Manager have access to the footage
made in the course of the video. Personal information contained on the footage shall not be used or disclosed for
purposes other than those for which it was collected, except with the consent of the individual or as required by law.
4. Footage from the video cameras will be kept for a maximum of two (2) weeks unless required for the purposes
outlined in this policy. If footage has been used to investigate an incident, that footage will be retained for one year
after a final decision is reached concerning the incident.
5. Old footage that isn’t used after a period of 4 to 6 weeks will start recording over the oldest data.
D. SANCTIONS
Individuals who fail to follow this policy or who use video camera footage inappropriately will be subject to disciplinary
sanctions, up to and including termination.
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Disposition Policy
Vehicles
Disposition of vehicle(s) takes place when the vehicle meets the required mileage (“useful
service life”) criteria and is identified on the PTD Vehicle Inventory List (Public Transportation
Management System), the project’s grant application, and / or the CTSP implementation
schedule for replacement.
Important to Note:
Minimum mileage on October 1 prior to application submittal date.
The useful service life standards apply to federal and state funded vehicles.
Reaching the useful service life does not guarantee replacement of the vehicle.
Replacement will be recommended if the system service volume and vehicle needs
warrant vehicle replacement.
When new replacement vehicles are received and placed into service, the old vehicles
must be disposed. The disposition process for the replaced vehicle should be started
within 60 days after delivery of the new vehicle.
See the Disposition Methods (all equipment) section of this policy for the process of
vehicle and equipment disposal.
The PTD requires all Certificates of Title of vehicles purchased with federal and state
funds to have a first lien to PTD recorded on the titles. All titles are kept in the PTD
office files.
Titles will be released when the service life for the replaced vehicle has been reached and
the inspection / acceptance form for the new vehicle has been completed and submitted to
the Public Transportation Division.
The Public Transportation Division’s Mobility Development Specialist (MDS) will review
any changes in the vehicle replacement that differs from the vehicle approved in the funded
application. The PTD Vehicle Inventory List must be kept current to reflect the same
vehicle(s) that are requested for disposition as the ones replaced under the current FY
application or changes approved by the MDS.
The PTD will release titles for replaced vehicles to the owner (grant recipient). Once the title
is received, the project may proceed with local disposition of vehicle. Vehicle(s) may be sold
by advertising for sealed bids or through public auction method, or transferred, with PTD
approval, to another agency.
PTD will retain a lien on such vehicles as long as useful life remains and PTD will oversee
the disposition of these vehicles as identified in the approved guidelines.
Disposition Methods (All Equipment)
General Service Director is responsible for all Person Area Transportation System’s
vehicle dispositions.
Advertising for Sealed Bids
This method may be used by both public and private nonprofit transit systems
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A minimum of two(2) written appraisals of the current fair market value of the
vehicle will be required to establish a minimum bid price
A Fair Market Value form is included in the Inspection / Disposition Workbook
Packet to assist in getting appraisals from dealers
Estimates may be averaged to establish the minimum bid
An advertisement in local paper or paper with a large circulation shall be placed at
least once allowing for not less than 7 days between the advertisement date and sealed
bid opening
Ad must include minimum bid, place and time of bid opening
Sealed bids must be submitted and award shall be made to the highest bid over the
minimum established bid
The current grant recipient named in the CTSP may keep 100% of the proceeds
Local Public Auction
This method may be used by both public and private nonprofit transit systems
The vehicle(s) may be sold through an advertised public auction
Award shall be made to the highest bid
The current grant recipient named in the CTSP may keep 100% of the proceeds
State Surplus
This method is only available to public entities.
Private nonprofit systems may find that their county procurement or finance offices may
be able to process dispositions on their behalf.
Once the subrecipient receives the title, the State Surplus Property Agency can be
contacted to arrange the disposition of the vehicle on the Surplus Bid sheet. Contact at
State Surplus is 919-854-2160, or www.doa.state.nc.us/ssp/
Subrecipient will receive authorization and instructions to submit information
electronically.
o Select review by State Surplus Property Agency
o A “Power of Attorney” form completed for each title.
o Do not complete the back of the title.
o Complete the form, sign, and have it notarized.
o MVR 180 – A, Odometer and Damage Disclosure form must be completed for
each vehicle.
o The “Power of Attorney” form, Certificate of Title, and MVR 180 – A form must
be forwarded to:
State Surplus Property Agency
1310 Mail Service Center
Raleigh, NC 27669-1310
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The vehicle may be transported to the Department of Administration Surplus Property lot
on Highway 54 (near State Fairgrounds) or may remain at the project’s designated
location.
If vehicle is retained at the project site, a street address must be provided to State Surplus
Property Agency.
The vehicle will appear first in the “Classified Ads” section of the web site.
If the vehicle is not sold, State surplus Property Agency will forward the proceeds to the
project, less a 5% service charge for processing the vehicle.
Vehicle – Total Loss
Met useful Life – Vehicles that have been totaled and have met the useful life requirements
must be disposed of and the insurance proceeds retained by the grantee:
Minivans; standard vans; center aisle vans; conversion vans; and lift equipped vans
with 15 passengers or less must have at minimum of 115,000 miles.
Light transit vehicles (20’-25’) (formerly cutaway buses) must have a minimum of
145,000 miles.
Ten-year transit buses (30’-35’) must be a t least 10 years or have a minimum of
350,000 miles.
Twelve – year transit buses (30’-35’) must be at least 12 years or have a minimum of
500,000 miles.
Not-Met Useful Life –Vehicles that have been totaled, but have not met the useful life criteria
may be disposed of and the insurance proceeds applied as follows:
Return within 14 days to PTD either the Federal and / or State interest of the unamortized
value of the vehicle based on straight line deprecation of the original purchase price or
the Federal and / or State Interest of proceeds, whichever is greater.
Apply 100% of net proceeds to the acquisition of a new like-kind vehicle. Any additional
costs (if more than the proceeds) are to be met by the grantee. Excess proceeds are to be
returned to PTD, with the grantee retaining the pro rata local share.
Once all the required documentation is received by PTD, a letter along with the title will be
forwarded to the grantee.
If the vehicle has met or exceed the “Casualty loss criteria” the grantee may use the
proceeds for transportation related need.
If the vehicle has not met the “Casualty loss criteria”, the grantee will receive instructions
in the letter from PTS.
o Return the Federal and / or State share to PTD within 30 days.
o Provide in writing that they will purchase a “like-kind” vehicle within 60 days.
Proceeds received from vehicles that are sold or due to casualty loss, originally purchased with
State or Federal funds, must be used for transportation related needs of the transit system
specified in the grant with NCDOT.
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Person Area Transportation System
In accordance with TAB policy and related legislation, no employee, officer, agent,
immediate family member, or TAB member of the agency shall participate in the selection,
award, or administration of a contract supported by Federal and / or State funds if a conflict of
interest, real or apparent, would be involved. Such a conflict would arise when any of the
following has a financial or other interest in the firm selected for award:
The employee, officer, agent, or Board member,
Any member of his / her immediate family,
His or her partner, or
An organization that employs, or is about to employ, any of the above.
The agency’s officers, employees, agents, or Board members will neither solicit
nor accept gifts, gratuities, favors, or anything of monetary value from contractors, potential
contractors, or parties to sub-agreements.
Violation of this policy shall result in removal from the PATS TAB. As a TAB member I
acknowledge my understanding of and agreement to abide by the Conflict of Interest Policy by
signing this copy of the policy.
SIGNED BY:
__________________________________________________ ________________
Name: (Signature) Date:
__________________________________________________
Name: (Printed)
Transportation Advisory Board
Conflict of Interest Statement
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Person Area Transportation System
Title VI Program Plan
Date Adopted
Month/Day/2017
PLAN REVIEW AND APPROVAL
On behalf of the Person County Board of Commissioners for Person Area Transportation System (PATS), I hereby
acknowledge receipt of the Title VI Nondiscrimination Plan. We, the Person County Board of Commissioners, have
reviewed and hereby approve this Plan. We are committed to ensuring that all decisions are made in accordance with
the nondiscrimination guidelines of this Plan, to the end the no person is excluded from participation in, denied the benefits
of, or otherwise subjected to discrimination under any PATS transportation services and activities on the basis of race,
color, national origin, sex, age, religion, or disability, as protected by Title VI of the Civil Rights Act of 1964 and the
nondiscrimination provisions of the Federal Transit Administration.
____________________________________________ ___________________________
Signature of Authorizing Official DATE
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Table of Contents
Title VI Nondiscrimination Agreement..........................................................................................................5
1.0 Introduction..........................................................................................................................................6
2.0 Description of Programs and Services....................................................................................................6
2.1 Program(s) and Services Administered......................................................................................................6
2.2 Funding Sources / Tables...........................................................................................................................6
2.3 Decision‐Making Process...........................................................................................................................7
2.4 Title VI Coordinator...................................................................................................................................8
2.5 Change of Title VI Coordinator and/or Transit Manager..........................................................................8
2.6 Organizational Chart.................................................................................................................................8
2.7 Subrecipients 8
3.0 Title VI Nondiscrimination Policy Statement.......................................................................................9
4.0 Notice of Nondiscrimination...............................................................................................................10
5.0 Procedures to Ensure Nondiscriminatory Administration of Programs and Services............................11
6.0 Contract Administration......................................................................................................................12
6.1 Contract Language...................................................................................................................................12
6.2 Nondiscrimination Notice to Prospective Bidders...................................................................................13
7.0 External Discrimination Complaint Procedures..................................................................................14
Discrimination Complaint Form.....................................................................................................................16
Discrimination Complaints Log......................................................................................................................18
InvestigativeGuidance....................................................................................................................................19
8.0 Service Area Population Characteristics.............................................................................................20
8.1 Race and Ethnicity...................................................................................................................................20
8.2 Age & Sex.................................................................................................................................................20
8.3 Poverty.....................................................................................................................................................21
8.4 Household Income...................................................................................................................................22
8.5 Population Locations...............................................................................................................................22
9.0 Title VI Equity Analyses (and Environmental Justice Assessments).....................................................22
10.0 Public Involvement..........................................................................................................................23
10.1 Introduction..........................................................................................................................................23
10.2 Public Notification.................................................................................................................................23
10.3 Dissemination of Information................................................................................................................23
10.4 Meetings and Outreach.........................................................................................................................23
10.5 Summary of the Language Assistance Plan Components.................................................................24
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Table of Contents
Title VI Nondiscrimination Agreement......................................................................................................5
1.0 Introduction......................................................................................................................................6
2.0 Description of Programs and Services................................................................................................6
2.1 Program(s) and Services Administered....................................................................................................6
2.2 Funding Sources / Tables.........................................................................................................................6
2.3 Decision‐Making Process.........................................................................................................................7
2.4 Title VI Coordinator.................................................................................................................................8
2.5 Change of Title VI Coordinator and/or Transit Manager.........................................................................8
2.6 Organizational Chart................................................................................................................................8
2.7 Subrecipients...........................................................................................................................................8
3.0 Title VI Nondiscrimination Policy Statement......................................................................................9
4.0 Notice of Nondiscrimination.............................................................................................................10
5.0 Procedures to Ensure Nondiscriminatory Administration of Programs and Services..........................11
6.0 Contract Administration....................................................................................................................12
6.1 Contract Language..................................................................................................................................12
6.2 Nondiscrimination Notice to Prospective Bidders..................................................................................13
7.0 External Discrimination Complaint Procedures..................................................................................14
Discrimination Complaint Form.....................................................................................................................16
Discrimination Complaints Log......................................................................................................................18
Investigative Guidance..................................................................................................................................19
8.0 Service Area Population Characteristics............................................................................................20
8.1 Race and Ethnicity..................................................................................................................................20
8.2 Age & Sex...............................................................................................................................................20
8.3 Poverty...................................................................................................................................................21
8.4 Household Income.................................................................................................................................22
8.5 Population Locations..............................................................................................................................22
9.0 Title VI Equity Analyses (and Environmental Justice Assessments)...................................................22
10.0 Public Involvement........................................................................................................................23
10.1 Introduction........................................................................................................................................23
10.2 Public Notification...............................................................................................................................23
10.3 Dissemination of Information..............................................................................................................23
10.4 Meetings and Outreach.......................................................................................................................23
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10.5 Summary of the Language Assistance Plan Components...................................................................24
10.6 Demographic Request.........................................................................................................................30
10.7 Key Community Contacts....................................................................................................................31
10.8 Summary of Outreach Efforts Since the Last Title VI Program Submission.........................................31
11.0 Staff Training..................................................................................................................................31
12.0 Nonelected Boards and Committees – By Race and Gender............................................................31
13.0 Record‐Keeping and Reports...........................................................................................................32
Appendices..............................................................................................................................................33
Appendix A – Applicable Nondiscrimination Authorities
Appendix B – Organizational Chart
Appendix C– NCDOT’s Transit Review Checklist
Appendix D – Annual Education and Acknowledgement Form
Appendix E – Demographic Request
Appendix F – Minority Representation Data Collection Form
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TITLE VI NONDISCRIMINATION AGREEMENT
BETWEEN
THE NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
AND
PERSON AREA TRANSPORTATION SYSTEM
In accordance with DOT Order 1050.2A, Person Area Transportation System (PATS) assures the North Carolina
Department of Transportation (NCDOT) that no person shall, on the ground of race, color, national origin, sex, religion,
age, or disability, as provided by Title VI of the Civil Rights Act of 1964, the Civil Rights Restoration Act of 1987 and
related nondiscrimination authorities, be excluded from participation in, be denied the benefits of, or be otherwise
subjected to discrimination or retaliation under any program or activity undertaken by Person Area Transportation System.
Further, Person Area Transportation System hereby agrees to:
1. Designate a Title VI Coordinator that has a responsible position within the organization and easy access to the
Transit Manager of the organization.
2. Issue a policy statement, signed by the Transit Manager of the organization, which expresses a commitment to
the nondiscrimination provisions of Title VI and related applicable statutes. The signed policy statement shall be
posted and circulated throughout the organization and to the general public, and published where appropriate in
languages other than English. The policy statement will be re-signed when there is a change of the Transit
Manager.
3. Insert the clauses of the contract language from Section 6.1 in every contract awarded by the organization.
Ensure that every contract awarded by the organization’s contractors or consultants also includes the contract
language.
4. Process all and, when required, investigate complaints of discrimination consistent with the procedures contained
within this Plan. Log all complaints for the administrative record.
5. Collect statistical data (race, color, national origin, sex, age, disability) on participants in, and beneficiaries of,
programs and activities carried out by the organization.
6. Participate in training offered on Title VI and other nondiscrimination requirements. Conduct or request training
for employees or the organization’s subrecipients.
7. Take affirmative action, if reviewed or investigated by NCDOT, to correct any deficiencies found within a
reasonable time period, not to exceed 90 calendar days, unless reasonable provisions are granted by NCDOT.
8. Document all Title VI nondiscrimination-related activities as evidence of compliance. Submit information and
reports to NCDOT on a schedule outlined by NCDOT.
THIS AGREEMENT is given in consideration of, and for the purpose of obtaining, any and all federal funds, grants, loans,
contracts, properties, discounts or other federal financial assistance under all programs and activities and is binding.
Authorized Signature
Date
Print Name
Official Title
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1.0 INTRODUCTION
Title VI of the 1964 Civil Rights Act, 42 U.S.C. 2000d provides that: “No person in the United States shall, on the ground of
race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination
under any program or activity receiving Federal financial assistance.” The broader application of nondiscrimination law is
found in other statutes, executive orders, and regulations, which provide additional protections based on age, sex, religion,
and disability, including the 1987 Civil Rights Restoration Act, which extended nondiscrimination coverage to all programs
and activities of federal-aid recipients, subrecipients, and contractors, including those that are not federally-funded (see
Appendix A – Applicable Nondiscrimination Authorities).
Person Area Transportation System (PATS) is a recipient of Federal financial assistance from the North Carolina
Department of Transportation (NCDOT) and the United States Department of Transportation (USDOT), receiving Federal
Transit Administration (FTA) funds through the NCDOT. As the primary recipient of USDOT funds in North Carolina, the
NCDOT’s comprehensive Title VI Nondiscrimination Program includes compliance oversight and technical assistance
responsibilities towards its subrecipients and those subrecipients must use federal and state funds in a nondiscriminatory
manner.
Person Area Transportation System establishes this Title VI Nondiscrimination Plan for the purpose of complying with Title
VI of the Civil Rights Act of 1964, as required by FTA Circular 4702.1B, and related requirements outlined under Group
01.D, “Nondiscrimination Assurance,” of the FTA Certifications and Assurances. This document details the
nondiscrimination program, policies, and practices administered by this organization, and will be updated periodically to
incorporate changes and additional responsibilities as they are made.
2.0 DESCRIPTION OF PROGRAMS AND SERVICES
2.1 PROGRAM(S) AND SERVICES ADMINISTERED
Person Area Transportation System provides public transportation options to its customers within Roxboro of Person
County, North Carolina. Our service operates Monday through Friday from 6:00am to 6:00pm. We transport out of town to
Durham and Chapel Hill Tuesday, Wednesday and Thursday for medical appointments. To schedule a ride it must be
called in by 11:00am the business day before. Our fares are by zones starting with zone 1 to zone 6. Cost starting $6.00
to $12.00. We also operate an Uptown Shuttle that cost a dollar a ride.
Our office hours are 8:30am to 5:00pm. With the Administrative staff of (1) Transit Manager, (1) Senior Administrative
Assistant and (1) Dispatch/Clerk. We have (7) full time Transit Drivers and (13) part time Transit Driver
2.2 FUNDING SOURCES / TABLES
For the purpose of federally-assisted programs, "federal assistance" shall include:
1. grants and loans of Federal funds;
2. the grant or donation of Federal property and interest in property;
3. the detail of Federal personnel;
4. the sale and lease of, and the permission to use (on other than a casual or transient basis), Federal property or
any interest in such property without consideration or at a nominal consideration, or at a consideration which is
reduced for the purpose of assisting the recipient, or in recognition of the public interest to be served by such sale
or lease to the recipient; and
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5. any Federal agreement, arrangement, or other contract which has, as one of its purposes, the provision of
assistance.
Each FTA Formula Grant received by our system during the past year, and whether the funds were received through
NCDOT or directly from FTA, is checked below. Additional details are provided on how often each of the grants is received
(annually, first time, etc.) and the amount.
Grant Title NCDOT FTA Details
(i.e., purpose, frequency, and duration of receipt)
5310 (Transportation for Elderly Persons and Persons
with Disabilities) EDTAP-$63,165.-annually
5311 (b)(3) (Rural Transit Assistance) RGP-$72,666-annually
2.3 DECISION-MAKING PROCESS
The Person County Board of Commissioners (BOC) is the governing board for Person Area Transportation System. They
make the final decision on adopting documents, policies, and plans. The Transit manager makes the request to be on the
agenda at one of the monthly regular board meetings. The documents, policies or plans are then voted on by the Board of
Commissioners for approval and adopted.
Documents that do not need approval from Person County Board of Commissioners (BOC) are carried before the Transit
Advisory Board (TAB). The Transit Advisory Board (TAB) meets quarterly on the first Wednesday at 4:00pm.
Board or Committee Name Appointed Elected # of Members
Transit Advisory Board (TAB) 10
Board of Commissioners (BOC) 5
2.4 TITLE VI COORDINATOR
The individual below has been designated as the Title VI Coordinator for Person Area Transportation System, and is
empowered with sufficient authority and responsibility to implement the Title VI Nondiscrimination Program:
Name: Kathy Adcock
Official Title: Transit Manager
Address: 341 South Madison Blvd, Roxboro NC 27573
Phone: 336-330-2207
Email: kadcock@personcounty.net
Key responsibilities of the Coordinator include:
Maintaining knowledge of Title VI and related requirements.
Attending civil rights training when offered by NCDOT or any other regulatory agency.
Administering the Title VI Nondiscrimination Program and coordinating implementation of this Plan.
Making sure internal staff and officials are familiarized and complying with their Title VI nondiscrimination obligations.
Disseminating Title VI information internally and to the general public, including in languages other than English.
Presenting Title VI-related information to decision-making bodies for input and approval.
Ensuring Title VI-related posters are prominently and publicly displayed.
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Developing a process to collect data related to race, national origin, sex, age, and disability to ensure minority, low-
income, and other underserved groups are included and not discriminated against.
Ensuring that non-elected boards and committees reflect the service area and minorities are represented.
Implementing procedures for prompt processing (receiving, logging, investigating and/or forwarding) of discrimination
complaints.
Coordinating with, and providing information to, NCDOT and other regulatory agencies during compliance reviews or
complaint investigations.
Promptly resolving areas of deficiency to ensure compliance with Title VI nondiscrimination requirements.
2.5 CHANGE OF TITLE VI COORDINATOR AND/OR TRANSIT MANAGER
If Title VI Coordinator or Transit Manager changes, this document and all other documents that name the Coordinator, will
immediately be updated, and an updated policy statement and assurance will be signed by the new Transit Manager.
2.6 ORGANIZATIONAL CHART
An organizational chart showing the Title VI Coordinator’s place within the organization is located in Appendix B.
2.7 SUBRECIPIENTS
Person Area Transportation System does not have pass through funds to any other organizations and, therefore, does not
have any subrecipients.
3.0 TITLE VI NONDISCRIMINATION POLICY STATEMENT
It is the policy of Person Area Transportation System (PATS), as a federal-aid
recipient, to ensure that no person shall, on the ground of race, color, national
origin, sex, religion, age or disability, be excluded from participation in, be denied
the benefits of, or be otherwise subjected to discrimination under any of our
programs and activities, as provided by Title VI of the Civil Rights Act of 1964, the
Civil Rights Restoration Act of 1987, and all other related nondiscrimination laws
and requirements.
Signature
Kathy Adcock, Transit Manager
Date
Title VI and Related Authorities
Title VI of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d) provides that, “No person in the United
States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any program or activity receiving federal financial
assistance.” The 1987 Civil Rights Restoration Act (P.L. 100-259) clarified and restored the original intent of
Title VI by expanding the definition of “programs and activities” to include all programs and activities of
federal-aid recipients (such as, Person Area Transportation System), subrecipients, and contractors, whether
such programs and activities are federally-assisted or not.
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Related nondiscrimination authorities include, but are not limited to: U.S. DOT regulation, 49 CFR part 21,
“Nondiscrimination in Federally-assisted Programs of the Department of Transportation–Effectuation of Title
VI of the Civil Rights Act”; 49 U.S.C. 5332, “Nondiscrimination (Public Transportation)”; FTA Circular
4702.1B - Title VI Requirements and Guidelines for Federal Transit Administration Recipients; DOT Order
5610.2a, “Actions to Address Environmental Justice in Minority Populations and Low-Income Populations”;
FTA C 4703.1 - Environmental Justice Policy Guidance For Federal Transit Administration Recipients; Policy
Guidance Concerning (DOT) Recipient's Responsibilities to Limited English Proficient (LEP) Persons, 74 FR
74087; The Americans with Disabilities Act of 1990, as amended, P.L. 101-336; Section 504 of the
Rehabilitation Act of 1973, 29 U.S.C. 790; Age Discrimination Act of 1975, as amended 42 U.S.C. 6101; Title
IX of the Education Amendments of 1972, 20 U.S.C. 1681; Uniform Relocation Assistance and Real Property
Acquisition Policies Act of 1970, 42 U.S.C. 4601; Section 508 of the Rehabilitation Act of 1973, 29 U.S.C.
794d.
Implementation
This statement will be signed by the Transit Manager of Person Area Transportation System, and re-signed
whenever a new person assumes that position.
The signed statement will be posted on office bulletin boards, near the receptionist’s desk, in meeting rooms,
inside vehicles, and disseminated within brochures and other written materials.
The core of the statement (signature excluded) will circulate internally within annual acknowledgement forms.
The statement will be posted or provided in languages other than English, when appropriate.
4.0 NOTICE OF NONDISCRIMINATION
Person Area Transportation System operates its programs and services without regard to race, color, national
origin, sex, religion, age, and disability in accordance with Title VI of the Civil Rights Act and related statutes.
Any person who believes she or he has been aggrieved by any unlawful discriminatory practice may file a
complaint with Person Area Transportation System.
For more information on Person Area Transportation System’s civil rights program, and the procedures to file a
complaint, contact 336-597-1771, (TTD 1-800-735-2962); email Transit Manager, Kathy Adcock at
kadcock@personcounty.net; or visit our administrative office at 341 South Madison Blvd., Roxboro, NC 27573.
For more information, visit www.personcounty.net
If information is needed in another language, contact 336-599-8361
A complainant may file a complaint directly with the North Carolina Department of Transportation by filing with
the Office of Civil Rights, External Civil Rights Section, 1511 Mail Service Center, Raleigh, NC 27699-1511,
Attention: Title VI Nondiscrimination Program; phone: 919-508-1808 or 800-522-0453, or TDD/TTY: 800-735-
2962.
A complainant may file a complaint directly with the Federal Transit Administration by filing a complaint with the
Office of Civil Rights, Attention: Title VI Program Coordinator, East Building, 5th Floor-TCR,1200 New Jersey
Ave., SE, Washington, DC 20590.
Implementation
The notice will be posted in its entirety on our website and in any documents and reports we distribute.
Ads in newspapers and other publications shall include the first three (3) bullets.
The statement will be posted or provided in languages other than English, when appropriate.
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5.0 PROCEDURES TO ENSURE NONDISCRIMINATORY ADMINISTRATION OF PROGRAMS AND SERVICES
We are committed to the nondiscriminatory administration of our programs and services. As with the implementation of our
programs in general, organization-wide compliance is required. Thus, employees and staff will periodically be reminded of
our Title VI nondiscrimination obligations through staff training and use of the Annual Education and Acknowledgment
Form below. The Title VI Coordinator will periodically assess program operations to ensure that this policy is being
followed. A single copy of the form is located in Appendix D
Annual Education and Acknowledgement Form
Title VI Nondiscrimination Policy
(Title VI and related nondiscrimination authorities)
No person shall, on the grounds of race, color, national origin, sex, age, or disability, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or
activity of a Federal-aid recipient.
All employees and representatives of Person Area Transportation System are expected to consider,
respect, and observe this policy in their daily work and duties. If any person approaches you with a
civil rights-related question or complaint, please direct him or her to Kathy Adcock, Transit Manager
at 336-330-2207.
In all dealings with the public, use courtesy titles (e.g., Mr., Mrs., Miss, Dr.) to address or refer to them
without regard to their race, color, national origin, sex, age or disability.
Acknowledgement of Receipt of Title VI Program
I hereby acknowledge receipt of Person Area Transportation System’s Title VI Program and other
nondiscrimination guidelines. I have read the Title VI Program and I am committed to ensuring that no
person is excluded from participation in or denied the benefits of Person Area Transportation System’s
programs, policies, services and activities on the basis of race, color, national origin, sex, age, or
disability, as provided by Title VI of the Civil Rights Act of 1964 and related nondiscrimination
statutes.
__________________________________________ ____________________
Signature Date
Implementation
Periodically, but not more than once a year, employees and representatives will receive, review and certify
commitment to the Title VI Program.
New employees shall be informed of Title VI provisions and expectations to perform their duties accordingly,
asked to review the Title VI Program, and required to sign the acknowledgement form.
Periodic review of operational practices and guidelines by the Title VI Coordinator to verify compliance with the
Title VI Program.
Signed acknowledgement forms and records of internal assessments will remain on file for at least three years.
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6.0 CONTRACT ADMINISTRATION
Person Area Transportation System ensures all contractors will fulfill their contracts in a nondiscriminatory manner. While
contractors are not required to prepare a Title VI Program, they must comply with the nondiscrimination requirements of
the organization to which they are contracted. PATS and its contractors will not discriminate in the selection and retention
of contractors (at any level) or discriminate in employment practices in connection with any of our projects.
6.1 CONTRACT LANGUAGE
During the performance of this contract, the contractor, for itself, its assignees and successors in interest (hereinafter referred to as the
“contractor”) agrees as follows:
(1) Compliance with Regulations: The contractor shall
comply with the Regulation relative to nondiscrimination in
Federally-assisted programs of the Department of
Transportation (hereinafter, "DOT") Title 49, Code of Federal
Regulations, Part 21, as they may be amended from time to
time, (hereinafter referred to as the Regulations), which are
herein incorporated by reference and made a part of this
contract.
(2) Nondiscrimination: The contractor, with regard to the
work performed by it during the contract, shall not discriminate
on the grounds of race, color, national origin, sex, religion,
age, or disability in the selection and retention of
subcontractors, including procurements of materials and
leases of equipment. The contractor shall not participate either
directly or indirectly in the discrimination prohibited by section
21.5 of the Regulations, including employment practices when
the contract covers a program set forth in Appendix B of the
Regulations.
(3) Solicitations for Subcontractors, Including
Procurements of Materials and Equipment: In all
solicitations either by competitive bidding or negotiation made
by the contractor for work to be performed under a
subcontract, including procurements of materials or leases of
equipment, each potential subcontractor or supplier shall be
notified by the contractor of the contractor's obligations under
this contract and the Regulations relative to nondiscrimination
on the grounds of race, color, or national origin.
(4) Information and Reports: The contractor shall
provide all information and reports required by the Regulations
or directives issued pursuant thereto, and shall permit access
to its books, records, accounts, other sources of information,
and its facilities as may be determined by the Person Area
Transportation System (PATS) or the North Carolina
Department of Transportation (NCDOT), the Federal Highway
Administration (FHWA) and/or Federal Transit Administration
(FTA) to be pertinent to ascertain compliance with such
Regulations, orders and instructions. Where any information
required of a contractor is in the exclusive possession of
another who fails or refuses to furnish this information the
contractor shall so certify to PATS, or the NCDOT, FHWA
and/or FTA as appropriate, and shall set forth what efforts it
has made to obtain the information.
(5) Sanctions for Noncompliance: In the event of the
contractor's noncompliance with the nondiscrimination
provisions of this contract, PATS shall impose such contract
sanctions as it or the NCDOT, FHWA and/or FTA may
determine to be appropriate, including, but not limited to:
(a) withholding of payments to the contractor
under the contract until the contractor complies, and/or
(b) cancellation, termination or suspension of the
contract, in whole or in part.
(6) Incorporation of Provisions: The contractor shall
include the provisions of paragraphs (1) through (6) in every
subcontract, including procurements of materials and leases
of equipment, unless exempt by the Regulations, or directives
issued pursuant thereto. The contractor shall take such action
with respect to any subcontract or procurement as PATS or
the NCDOT, FHWA and/or FTA may direct as a means of
enforcing such provisions including sanctions for
noncompliance: Provided, however, that, in the event a
contractor becomes involved in, or is threatened with, litigation
with a subcontractor or supplier as a result of such direction,
the contractor may request PATS to enter into such litigation
to protect the interests of PATS, and, in addition, the
contractor may request the United States to enter into such
litigation to protect the interests of the United States.
*The Contractor has read and is familiar with the terms above:
_________________
Contractor’s Initials
_________________
Date
Implementation
The nondiscrimination language above (with initials line) will be appended to any existing contracts, purchase
orders, and agreements that do not include it, and initialed by the responsible official of the other organization.
The nondiscrimination language above (without initials line) will be incorporated as standard language before the
signature page of our standard contracts, purchase orders, and agreements.
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The Title VI Coordinator will review existing contracts to ensure the language has been added.
6.2 NONDISCRIMINATION NOTICE TO PROSPECTIVE BIDDERS
Person Area Transportation System, in accordance with Title VI of the Civil Rights Act of 1964 and related
nondiscrimination authorities, and Title 49 Code of Federal Regulations, Parts 21 and 26, hereby notifies all bidders
that it will affirmatively insure that in any contact entered into pursuant to this advertisement, minority and women
business enterprises will be afforded full opportunity to submit bids in response to this invitation and will not be
discriminated against on the grounds of race, color, national origin, or sex in consideration for an award.
Implementation
The nondiscrimination language above will be included in all solicitations for bids for work or material and proposals
for negotiated agreements to assure interested firms that we provide equal opportunity and do not discriminate.
Outreach efforts will be made to minority and women-owned firms that work in requested fields, and documented.
Unless specifically required under Disadvantaged Business Enterprise (DBE) or Affirmative Action programs, all
contractors will be selected without regard to their race, color, national origin, or sex.
7.0 EXTERNAL DISCRIMINATION COMPLAINT PROCEDURES
These discrimination complaint procedures describe the process used by Person Area Transportation System (PATS) to
process and investigate complaints of alleged discrimination filed under Title VI of the Civil Rights Act of 1964 and related
nondiscrimination laws that are applicable to programs, services, and activities carried out by Person Area Transportation
System.
Complaints will be investigated by the appropriate authority. Upon completion of every investigation, PATS will inform the
complainant of all avenues of appeal. PATS will make every effort to obtain early resolution of complaints at the lowest
level possible. The option of informal mediation between the affected parties and PATS staff may be utilized for resolution.
FILING OF COMPLAINTS
1. Applicability – The complaint procedures apply to the beneficiaries of PATS programs, activities, and services, such
as the members of the public and any consultants/contractors hired by PATS.
2. Eligibility – Any person or class of persons who believes that he/she has been subjected to discrimination or
retaliation prohibited by any of the Civil Rights authorities based upon race, color, sex, age, national origin, or
disability, may file a written complaint with PATS. The law prohibits intimidation or retaliation of any sort. The
complaint may be filed by the affected individual or a representative, and must be in writing.
3. Time Limits and Filing Options – A complaint must be filed no later than 180 calendar days after the following:
The date of the alleged act of discrimination; or
The date when the person(s) became aware of the alleged discrimination; or
Where there has been a continuing course of conduct, the date on which that conduct was discontinued or the
latest instance of the conduct.
Complaints may be submitted to the following entities:
Person Area Transportation System, Public Transportation System, 341 South Madison Blvd., Roxboro, NC
27573, Office: 336-597-1771, Fax: 336-330-2311
North Carolina Department of Transportation, Office of Civil Rights, External Civil Rights Section, 1511 Mail
Service Center, Raleigh, NC 27699-1511; 919-508-1830 or toll free 800-522-0453
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US Department of Transportation, Departmental Office of Civil Rights, External Civil Rights Programs Division,
1200 New Jersey Avenue, SE, Washington, DC 20590; 202-366-4070
Federal Transit Administration, Office of Civil Rights, ATTN: Title VI Program Coordinator, East Bldg. 5th Floor
– TCR, 1200 New Jersey Avenue, SE, Washington, DC 20590
Federal Highway Administration, Office of Civil Rights, 1200 New Jersey Avenue, SE, 8th Floor, E81-314,
Washington, DC 20590, 202-366-0693 / 366-0752
Federal Highway Administration, North Carolina Division Office, 310 New Bern Avenue, Suite 410, Raleigh,
NC 27601, 919-747-7010
Federal Aviation Administration, Office of Civil Rights, 800 Independence Avenue, SW, Washington, DC
20591, 202-267-3258
US Department of Justice, Special Litigation Section, Civil Rights Division, 950 Pennsylvania Avenue, NW,
Washington, DC 20530, 202-514-6255 or toll free 877-218-5228
4. Format for Complaints – Complaints shall be in writing and signed by the complainant(s) or a representative and
include the complainant’s name, address, and telephone number. Complaints received by fax or e-mail will be
acknowledged and processed. Allegations received by telephone or in person will be reduced to writing, may be
recorded and will be provided to the complainant for confirmation or revision before processing. Complaints will be
accepted in other languages, including Braille.
5. Discrimination Complaint Form – The Discrimination Complaint Form is consistent with the Nondiscrimination
Assurance in Group 01.D of the FTA Certifications & Assurances.
6. Complaint Basis – Allegations must be based on issues involving race, color, national origin, sex, age, or
disability. The term “basis” refers to the complainant’s membership in a protected group category
Protected
Categories
Definition Examples Applicable Statutes and
Regulations
FHWA FTA
Race An individual belonging to one of the accepted
racial groups; or the perception, based usually on
physical characteristics that a person is a member
of a racial group
Black/African American,
Hispanic/Latino, Asian,
American Indian/Alaska
Native, Native
Hawaiian/Pacific Islander,
White
Title VI of the
Civil Rights Act
of 1964;
49 CFR Part
21;
23 CFR 200
Title VI of the
Civil Rights Act
of 1964;
49 CFR Part
21;
Circular
4702.1B Color Color of skin, including shade of skin within a
racial group
Black, White, brown, yellow,
etc.
National
Origin
Place of birth. Citizenship is not a factor.
Discrimination based on language or a person’s
accent is also covered.
Mexican, Cuban, Japanese,
Vietnamese, Chinese
Sex Gender Women and Men 1973 Federal-
Aid Highway
Act
Title IX of the
Education
Amendments of
1972
Age Persons of any age 21 year old person Age Discrimination Act of 1975
Disability Physical or mental impairment, permanent or
temporary, or perceived.
Blind, alcoholic, para-
amputee, epileptic, diabetic,
arthritic
Section 504 of the Rehabilitation
Act of 1973; Americans with
Disabilities Act of 1990
Complaint Processing
1. When a complaint is received by PATS, a written acknowledgment and a Consent Release form will be
mailed to the complainant within ten (10) business days by registered mail.
2. PATS cannot investigate Title VI complaints filed against itself, but can investigate ADA complaints
against itself. PATS will consult with the NCDOT External Civil Rights Section to determine the acceptability
and jurisdiction of all complaints received. (Note: If NCDOT has jurisdiction, the External Civil Rights Section
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will be responsible for the remainder of this process. PATS will record the transfer of responsibility in its
complaints log).
3. Additional information will be requested if the complaint is incomplete. The complainant will be provided 15
business days to submit any requested information and the signed Consent Release form. Failure to do so
may be considered good cause for a determination of no investigative merit.
4. Upon receipt of the requested information and determination of jurisdiction, PATS will notify the complainant
and respondent of whether the complaint has sufficient merit to warrant investigation.
5. If the complaint is investigated, the notification shall state the grounds of PATS’ jurisdiction, while informing
the parties that their full cooperation will be required in gathering additional information and assisting the
investigator.
6. If the complaint does not warrant investigation, the notification to the complainant shall specifically state the
reason for the decision.
Complaint Log
1. When a complaint is received by PATS, the complaint will be entered into the Discrimination Complaints Log
with other pertinent information, and assigned a Case Number. (Note: All complaints must be logged).
2. The complaints log will be submitted to the NCDOT’s Civil Rights office during Title VI compliance reviews.
(Note: NCDOT may also be request the complaints log during pre-grant approval processes).
3. The Log Year(s) since the last submittal will be entered (e.g., 2012-2015, 2014-2015, FFY 2015, or 2015)
and the complaints log will be signed before submitting the log to NCDOT.
4. When reporting no complaints, check the No Complaints or Lawsuits box and sign the log.
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Person Area Transportation System (PATS)
DISCRIMINATION COMPLAINT FORM
Any person who believes that he/she has been subjected to discrimination based upon race, color, religion, sex, age, national origin, or
disability may file a written complaint with Person Area Transportation System (PATS), within 180 days after the discrimination occurred.
Last Name: First Name: Male
Female
Mailing Address: City State Zip
Home Telephone: Work Telephone: E-mail Address
Identify the Category of Discrimination:
RACE COLOR NATIONAL ORIGIN AGE
RELIGION DISABILITY SEX
*NOTE: Title VI bases are race, color, national origin. All other bases are found in the “Nondiscrimination Assurance” of the FTA Certifications & Assurances.
Identify the Race of the Complainant
Black White Hispanic Asian American
American Indian Alaskan Native Pacific Islander Other _________________
Date and place of alleged discriminatory action(s). Please include earliest date of discrimination and most recent date of discrimination.
Names of individuals responsible for the discriminatory action(s):
How were you discriminated against? Describe the nature of the action, decision, or conditions of the alleged discrimination. Explain as clearly
as possible what happened and why you believe your protected status (basis) was a factor in the discrimination. Include how other persons
were treated differently from you. (Attach additional page(s), if necessary).
The law prohibits intimidation or retaliation against anyone because he/she has either taken action, or participated in action, to secure rights
protected by these laws. If you feel that you have been retaliated against, separate from the discrimination alleged above, please explain the
circumstances below. Explain what action you took which you believe was the cause for the alleged retaliation.
Names of persons (witnesses, fellow employees, supervisors, or others) whom we may contact for additional information to support or clarify
your complaint: (Attached additional page(s), if necessary).
Name Address Telephone
1.
2.
3.
4.
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DISCRIMINATION COMPLAINT FORM
Have you filed, or intend to file, a complaint regarding the matter raised with any of the following? If yes, please provide the filing dates. Check
all that apply.
NC Department of Transportation
Federal Transit Administration
Federal Highway Administration
US Department of Transportation
Federal or State Court
Other
Have you discussed the complaint with any Person Area Transportation System (PATS) representative? If yes, provide the name, position,
and date of discussion.
Please provide any additional information that you believe would assist with an investigation.
Briefly explain what remedy, or action, are you seeking for the alleged discrimination.
**WE CANNOT ACCEPT AN UNSIGNED COMPLAINT. PLEASE SIGN AND DATE THE COMPLAINT FORM BELOW.
_________________________________________________________________
COMPLAINANT’S SIGNATURE
__________________________________
DATE
MAIL COMPLAINT FORM TO:
Person Area Transportation System
Attention: Kathy Adcock
Transit Manager
341 South Madison Blvd.
Roxboro, North Carolina 27573
336-597-1771 or 336-330-2207
FOR OFFICE USE ONLY
Date Complaint Received:
Processed by:
Case #:
Referred to: NCDOT FTA Date Referred:
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DISCRIMINATION COMPLAINTS LOG
CAS
E
NO.
COMPLAI
NANT
NAME
RACE
/
GEND
ER
RESPON
DENT
NAME
BASI
S
DATE
FILED
DATE
RECEI
VED
ACTION TAKEN DATE
INVESTI
G.
COMPLE
TED
DISPOSITION
No Complaints or Lawsuits
I certify that to the best of my knowledge, the above described complaints or lawsuits alleging discrimination, or
no complaints or lawsuits alleging discrimination, have been filed with or against Person Area Transportation
System since the previous Title VI Program submission to NCDOT.
_______________________________________________________________ ____________________
Signature of Title VI Coordinator or Other Authorized Official Date
_______________________________________________________________
Print Name and Title of Authorized Official
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INVESTIGATIVE GUIDANCE
A. Scope of Investigation – An investigation should be confined to the issues and facts relevant to the allegations in the
complaint, unless evidence shows the need to extend the issues.
B. Developing an Investigative Plan – It is recommended that the investigator prepares an Investigative Plan (IP) to
define the issues and lay out the blueprint to complete the investigation. The IP should follow the outline below:
1. Complainant(s) Name and Address (Attorney name and address if applicable)
2. Respondent(s) Name and Address (Attorney for the Respondent(s) name and address)
3. Applicable Law(s)
4. Basis/(es)
5. Allegation(s)/Issue(s)
6. Background
7. Name of Persons to be interviewed
a. Questions for the complainant(s)
b. Questions for the respondent(s)
c. Questions for witness(es)
8. Evidence to be obtained during the investigation
a. Issue – Complainant allege that there are only six African American contractors participating in the
highway construction industry in the State and their contract awards are very small.
i. Documents needed: documents which show all DBE firms which currently have contracts and must
include the following 1) name and race of DBE firm; 2) Date of initial certification into the DBE
program; 3) type of business; 4) contracts awarded anytime during the period to the present; 5) dollar
value of contract.
C. Request for Information – The investigator should gather data and information pertinent to the issues raised in the
complaint.
D. Interviews – Interviews should be conducted with the complainant, respondent, and appropriate witnesses during the
investigative process. Interviews are conducted to gain a better understanding of the situation outlined in the
complaint of discrimination. The main objective during the interview is to obtain information that will either support or
refute the allegations.
E. Developing an Investigative Report – The investigator should prepare an investigative report setting forth all
relevant facts obtained during the investigation. The report should include a finding for each issue. A sample
investigative report is provided below.
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8.0 SERVICE AREA POPULATION CHARACTERISTICS
To ensure that Title VI reporting requirements are met, Person Area Transportation System will collect and maintain
population data on potential and actual beneficiaries of our programs and services. This section is intended as a
compilation of relevant population characteristics from our overall service area. This data will provide context to the Title VI
Nondiscrimination Program and be used to ensure nondiscrimination and improve public outreach initiatives and delivery
of ongoing programs.
8.1 RACE AND ETHNICITY
The following table was completed using data from Census Table QT-P3, Race and Hispanic or Latino Origin: 2010:
Race and Ethnicity Number Percent
Total Population 15,284 100
White 8,427 98.2
Black or African American 5,918 38.7
American Indian or Alaska Native 83 0.5
Asian 59 0.4
Native Hawaiian and Other Pacific Islander 3 0.0
Some other Race 518 3.4
Two or More Races 55 0.4
HISPANIC OR LATINO (of any race) 15,284 100
Mexican 754 4.9
Puerto Rican 44 0.3
Cuban 12 0.1
Other Hispanic or Latino 149 1.0
8.2 AGE & SEX
The following table was completed using data from Census Table QT-P1, Age Groups and Sex: 2010:
Age
Number Percent
Both sexes Male Female Both sexes Male Female
Total Population 39,464 19,137 20,327 100%100% 100%
Under 5 years 2,369 1,186 1,183 6.0 6.2 5.8
Under 18 years 9,114 4,662 4,452 23.1 24.4 21.9
18 to 64 years 24,357 11,946 12,411 61.7 62.4 61.1
65 years and over 5,993 2,529 3,464 15.2 13.2 17.0
Median Age 41.4 40.1 42.8
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8.3 POVERTY
The following table was completed using data from Census Table S1701, Poverty Status in the Past 12 Months:
Subject
Total Below poverty level Percent below poverty
level
Estimate
Margin of
Error +/- Estimate
Margin of
Error +/- Estimate
Margin of
Error +/-
Population for whom poverty status is
determined 38,780 +/-203 7,708 +/‐1,013 19.9% +/‐2.6
AGE
Under 18 8,632 +/-94 2,347 +/-418 27.2% +/-4.8
18 to 64 8,475 +/-170 2,190 +/-439 25.8% +/-5.0
65 years and over 23,818 +/-108 4,592 +/-673 19.3% +/-2.8
SEX
Male 18,874 +/-119 3,574 +/-537 18.9% +/-2.8
Female 19,906 +/-154 4,134 +/-594 20.8% +/-3.0
RACE AND HISPANIC OR LATINO ORIGIN
White alone 26,674 +/-308 3,742 +/-708 14.0% +/-2.6
Black or African American alone 10,634 +/-162 3,534 +/‐603 33.2% +/‐5.6
American Indian and Alaska Native alone 372 +/-104 110 +/-105 29.6% +/-21.9
Asian alone 158 +/-35 0 +/-25 0.0% +/-18.5
Native American and Other Pacific Islander
alone 0 +/-25 0 +/-25 - **
Some other Race alone 597 +/-255 234 +/-110 39.2% +/-19.4
Two or more races 345 +/-153 88 +/-82 25.5% +/-19.2
Hispanic or Latino Origin (of any race) 1,630 +/-30 549 +/-260 33.7% +/-16.0
RACE AND HISPANIC OR LATINO ORIGIN
All individuals below:
50 percent of poverty level 3,280 +/-544 (X) (X) (X) (X)
125 percent of poverty level 10,084 +/-1,077 (X) (X) (X) (X)
150 percent of poverty level 11,943 +/-1,008 (X) (X) (X) (X)
185 percent of poverty level 15,081 +/-999 (X) (X) (X) (X)
200 percent of poverty level 16,198 +/-972 (X) (X) (X) (X)
300 percent of poverty level 23,828 +/-1,022 (X) (X) (X) (X)
400 percent of poverty level 29,589 +/-792 (X) (X) (X) (X)
500 percent of poverty level 33,159 +/-686 (X) (X) (X) (X)
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8.4 HOUSEHOLD INCOME
The following table was completed using data from Census Table S1901, Income in the Past 12 Months (In 2013 Inflation-
Adjusted Dollars):
Subject
Households
Estimate Margin of Error +/-
Total 3,039 +/-220
Less than $10,000 17.1% +/-5.0
$10,000 to $14,999 14.9% +/-5.4
$15,000 to $24,999 27.3% +/-5.9
$25,000 to $34,999 12.5% +/-4.7
$35,000 to $49,999 12.8% +/-3.8
$50,000 to $74,999 7.8% +/-2.8
$75,000 to $99,999 4.5% +/-2.3
$100,000 to $149,999 2.2% +/-3.5%
$150,000 to $199,999 1.0% +/-0.7
$200,000 or more 0.0% +/-1.1
Median income (dollars) 21,076 +/-3,440
Mean income (dollars) 30,320 +/-2,887
8.5 POPULATION LOCATIONS
Federal-aid recipients are required to know the characteristics and locations of populations they serve, particularly by
race/ethnicity, poverty and limited English proficiency. This can be accomplished through maps that overlay boundaries
and demographic features on specific communities.
9.0 TITLE VI EQUITY ANALYSES (AND ENVIRONMENTAL JUSTICE ASSESSMENTS)
As required under FTA C 4702.1B and 4703.1, Title VI equity and environmental justice (EJ) analyses will be
conducted whenever we plan to construct (or modify) a facility, such as a vehicle storage facility, maintenance
facility, operation center, etc., or when there will be a change in fares. These studies will be conducted to see if
the change could result in either a disparate impact based on race, color or national origin (Title VI) or a
disproportionately high and adverse impact to minority and/or low-income populations (EJ). Thus, they will look
at various alternatives before selecting a site for the facility. Project-specific demographic data will be collected
on potentially affected communities and their involvement in associated decision-making activities will be
documented. Specific studies will be made available to oversight agencies during compliance reviews or to
evidence our due diligence should a complaint be filed in relation to the location and effect of a proposed facility
or fare increases. Project-related equity and EJ studies will remain on file indefinitely.
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10.0 PUBLIC INVOLVEMENT
10.1 INTRODUCTION
Person Area Transportation (PATS) involves the public in addressing Title VI in decision-making. Recipients engaged in
planning and other decision-making must have a documented public participation process. Adequate notice of public
participation is needed for the public review and comments are a key decision point. Person Area Transportation (PATS) is
commitment to determining the most effective outreach methods for our public by having open meetings to the public and
accessible facilities and sign language interpreter for hearing impairments.
This Public Participation Plan describes how Person Area Transportation System (PATS) will disseminate vital agency
information and engage the public by seeking out and considering the needs and input of interested parties and those
traditionally underserved, such as minority and limited English proficient persons, who may face challenges accessing
programs and other services. General public involvement practices will include:
Scheduling meetings at times and locations that are convenient and accessible for minority and LEP communities.
Employing different meeting sizes, groups and formats.
Coordinating with community- and faith-based organizations, educational institutions, and other entities to implement
public engagement strategies that reach out specifically to members of affected minority and/or LEP communities.
Providing opportunities for public participation through means other than written communication.
Considering radio, television, or newspaper ads on stations and in publications that serve LEP populations
10.2 PUBLIC NOTIFICATION
Passengers and other interested persons will be informed of their rights under Title VI and related authorities with regard to
our program. The primary means of achieving this will be posting and disseminating the policy statement and notice as
stipulated in Sections 3.0 and 4.0, respectively. Additional measures may include openly stating our obligations and the
public’s rights at meetings, placing flyers at places frequented by targeted populations.
10.3 DISSEMINATION OF INFORMATION
Information on Title VI and other programs will be crafted and disseminated to employees, and the general public. Public
dissemination efforts may vary depending on factors present, but will generally include: posting public statements setting
forth our nondiscrimination policy in eye-catching designs and locations; placing brochures in public places, such as
government offices, transit facilities, and libraries; having nondiscrimination language within contracts; including
nondiscrimination notices in meeting announcements and handouts; and displaying our Notice of Nondiscrimination in our
PATS vehicles.
At a minimum, nondiscrimination information will be disseminated on our website and on posters in conspicuous areas at
our office.
10.4 MEETINGS AND OUTREACH
There are many ways to approach the public involvement. We try to reach out and engage the public participation and
audiences, including traditionally underserved and excluded populations (i.e., minorities, youth, low-income, the disabled,
etc.) will include the following:
Public Relations and Outreach
Public relations and outreach (PRO) strategies aim to conduct well-planned, inclusive and meaningful public
participation events that bring good relations and mutual trust through shared decision-making with the
communities we serve.
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We will seek out and facilitate the involvement of those potentially affected.
Public events will aim to be fun, and educational for all, rather than confrontational and prescriptive.
Media plans will typically involve multiple channels of communication like mailings, radio, TV, and newspaper ads.
Abstract objectives will be avoided in meeting announcements.
Efforts will be made to show how the input of participants can, or did, influence final decisions.
We will do our best to form decision-making committees that relate to the populations we serve.
We will seek out and identify community contacts and partner with local community- and faith-based organizations
that can represent, and help us disseminate information to, target constituencies.
Demographic data will be requested during public meetings, surveys, and from community contacts and committee
members.
Public Meetings
“Public meeting” refers to any meeting open to the public, such as hearings, charrettes, open house and board meetings.
Public meetings will be conducted at times, locations, and facilities that are convenient and accessible.
Meeting materials will be available in a variety of predetermined formats to serve diverse audiences.
An assortment of advertising means may be employed to inform the community of public meetings.
Assistance to persons with disabilities or limited English proficiency will be provided, as required.
Small Group Meetings
A small group meeting is a targeted measure where a meeting is held with a specific group, usually at their request or
consent. These are often closed meetings, as they will typically occur on private property at the owner’s request.
If it is determined that a targeted group has not been afforded adequate opportunities to participate, the group will be
contacted to inquire about possible participation methods, including a group meeting with them individually.
Unless unusual circumstances or safety concerns exist, hold the meeting at a location of the target group’s choosing.
Share facilitation duties or relinquish them to members of the target group.
Small group discussion formats may be integrated into larger group public meetings and workshops. When this
occurs, the smaller groups will be as diverse as the participants in the room.
Community Surveying
Opinion surveys will occasionally be used to obtain input from targeted groups or the general public on their
transportation needs, the quality or costs of our services, and feedback on our public outreach efforts.
Surveys may be conducted by using the drivers to distribute on the PATS vehicles, and/or with assistance from other
local agencies like social services.
10.5 SUMMARY OF THE LANGUAGE ASSISTANCE PLAN COMPONENTS
Limited English Proficient (LEP) persons refers to persons for whom English is not their primary language who have a
limited ability to read, write, speak, or understand English. It includes people who reported to the U.S. Census that they
speak English less than very well, not well, or not at all.
In an effort to comply with DOT’s LEP policy guidance and Executive Order 13166, this section of our public participation
plan outlines the steps we will take to ensure meaningful access to all benefits, services, information, and other important
portions of our programs and activities by individuals who are limited-English proficient. Accordingly, a four factor analysis
was conducted to determine the specific language services appropriate to provide, and to whom, to inform language
assistance planning and determine if our communication with LEP persons is effective.
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Four Factor Analysis
This Four Factor Analysis is an individualized assessment that balances the following four factors:
(1) The number or proportion of LEP persons eligible to be served or likely to be encountered by a program, activity,
or service of the recipient or grantee;
(2) The frequency with which LEP individuals come in contact with the program;
(3) The nature and importance of the program, activity, or service provided by the recipient to people’s lives; and
(4) The resources available to the recipient and costs.
Item #1 – Results of the Four Factor Analysis (including a description of the LEP population(s)
served)
LANGUAGE SPOKEN AT HOME Estimate Margin of Error Percent of
Population Margin of Error
Total (population 5 years and over): 37,092 +/- 9 100% (X)
Speak only English 35,389 +/- 251 % +/- %
Spanish or Spanish Creole: 1,447 +/- 221 % +/- %
Speak English "very well" 824 +/- 203 % +/- %
Speak English less than "very well" 623 +/- 196 % +/- %
Factor 1 – Demography
Person Area Transportation System contracts with Human Services Organizations to help
provide transportation for the residents in Person County.
The US Census Bureau – American Fact Finder (2008‐2012) reports there are numerous
languages spoken in Person County. Some of these languages include Spanish, Asian, Chinese,
Korean, Filipino, and Vietnamese. After English, the second largest language group is Spanish.
The Safe Harbor Threshold is calculated by dividing the population estimate for a language
group that “speaks English less then very well” by the total population of the county. The LEP
Safe Harbor Threshold provision stipulates that for each LEP group that meets the LEP language
threshold (5% or 1,000 individuals, whichever is less), Person Area Transportation System must
provide translation of vital documents in written format for non‐English speaking persons.
In Person County, with a population estimate of 39,409, 1812 persons have identified
themselves as Spanish speaking and “speaks English less than well”. This language group is less
than 1% and below the 5% or 1,000 person threshold. This means Person Area Transportation
System is not required to provide written translation of vital documents. All of the other
language groups listed above are also below the safe harbor threshold. This means, at this time,
Person Area Transportation System is also not required to provide written translation of vital
documents in these languages.
In the future, if Person Area Transportation System meets the Safe Harbor Threshold for any
language group, it will provide written translation of vital documents in such languages and also
consider measures needed for oral interpretation.
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Factor 2 – Frequency
Person Area Transportation System will be trained on what to do when they encounter a
person that speaks English less than well. Person Area Transportation System will track the
number of encounters and consider making adjustments as needed to its outreach efforts to
ensure meaningful access to all persons and specifically to LEP and minority populations of
Person Area Transportation System’s programs and services.
Person Area Transportation System Annually distributes a simple survey card with two
questions in English and in Spanish:
1. What purpose do you often use our services? (examples: medical, employment,
shopping, recreation, and college)
2. How often a week are you using our services?
Person Area Transportation System has encountered (4) four LEP persons using the service
within the last six months.
Person Area Transportation System has an open door policy and will provide rides to any
person who requests a ride. If an individual has speech limitations, the dispatcher or driver will
work with the Transportation Manager, if needed to ensure the individual receives access to
the transportation service.
Factor 3 – Importance
Person Area Transportation System understands an LEP person with language barrier
challenges also faces difficulties obtaining health care, education or access to employment. A
transportation system is a key link to connecting LEP persons to these essential services.
Person Area Transportation System has identified activities and services which would have
serious consequences to individuals if language barriers prevented access to information or the
benefits of those programs. The activities and services include providing emergency evacuation
instructions in our facilities, stations and vehicles and providing information to the public on
security awareness or emergency preparedness. Twice a year we sent out Complementary
Service Surveys.
1. Would you recommend Person Area Transportation System services to your family and
friends?
2. Would you recommend the Roxboro Uptown Shuttle to your family and friends?
3. Have you been satisfied with either/both services on a scale from 1 to 5, with 1 being
the lowest (not satisfied) and 5 being the highest (very satisfied).
Person Area Transportation System’s assessment of what programs, activities and services that
are most critical included contact with community organization(s) that serve LEP persons, as
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well as contact with LEP persons themselves to obtain information on the importance of the
modes or the types of services that are provided to the LEP populations.
Factor 4 – Resources and Costs
Even though Person Area Transportation System does not have a separate budget for LEP
outreach, the county has worked with us to implement low cost methods of reaching LEP
persons. For example, the Person Area Transportation System has a Spanish speaking person on
staff at Department of Social Services that handles Medicaid Transportation. This has ensured
Person Area Transportation System can provide assistance to LEP Spanish‐speaking persons, if
needed. In addition, Person Area Transportation System works with local advocacy groups to
reach LEP populations.
Item # 2 ‐Description of how Language Assistance Services are Provided, by Language
Person Area Transportation System works with our Department of Social Services to ensure
mechanisms are in place to reach LEP persons in the service area. For example, the Person Area
Transportation System has a special brochure printed and is available to assist LEP populations
in understanding the transportation service.
Item # 3 ‐ Description of how LEP Persons are Informed of the Availability of Language
Assistance Service
Person Area Transportation System does the following to inform LEP persons of the availability
of language assistance services: publishing flyers telling how the system works in languages
other than English. Staff works with Health Department and Social Services to provide
information to LEP persons.
Person Area Transportation System will continue to reach out to LEP populations by visiting
local elder housing sites with concentrations of Latinos as well as local non‐English speaking
churches.
Item # 4 – Description of how the Language Assistance Plan is Monitored and Updated
Person Area Transportation System reviews its plan on an annual basis and meet with their
contract people at the Health Department and Department of Social Services. In particular,
Person Area Transportation System will evaluate the information collected on encounters with
LEP persons as well as public outreach efforts to determine if adjustments should be made to
the delivering of programs and services to ensure meaningful access to minority and LEP
persons.
Item # 5 ‐ Description of the procedures PATS uses to ensure nondiscriminatory
administration of programs and services needs to be provided
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Person Area Transportation System employees are oriented on the principles of Title VI and
Person Area Transportation System’s Language Assistance Plan. New employees will be
provided guidance on the needs of clients served and how best to meet their needs. Person
Area Transportation System will also educate its staff on Title VI requirements, and specifically
LEP provisions. An annual acknowledge form will be disseminated for evidence of
understanding.
An important discussion point is that of language assistance. If a driver, dispatcher or employee
needs further assistance related to LEP program participants, her/she will work with Person
Area Transportation System’s Transportation Manager to identify strategies to meet the
language needs of the participants of the program or service.
As part of our annual meeting, if relevant, Person Area Transportation System will meet with its
staff to discuss updates on Person Area Transportation System’s Language Assistance Plan.
Language Assistance Plan
As a result of the above four factor analysis, a Language Assistance Plan (LAP) was not required. However, reasonable
attempts will be made to accommodate any persons encountered who require written translation or oral interpretation
services.
Plan Components
As a recipient of federal US DOT funding, Person Area Transportation System is required to take
reasonable steps to ensure meaningful access to our programs and activities by limited‐English
proficient (LEP) persons.
Limited English Proficient (LEP): Refers to persons for whom English is not their primary
language and who have a limited ability to read, write, speak or understand English. This
includes those who have reported to the U.S. Census that they speak English less than very well,
not well, or not at all.
Person Area Transportation System’s Language Assistance Plan includes the following
elements:
1. The results of the Four Factor Analysis, including a description of the LEP population(s),
served.
2. A description of how language assistance services are provided by language
3. A description of how LEP persons are informed of the availability of language assistance
service
4. A description of how the language assistance plan is monitored and updated
5. A description of how employees are trained to provide language assistance to LEP
persons
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6. Additional information deemed necessary
Additional Required Elements
In addition to the Four Factor Analysis (listed below as item #1), the Person Area Transportation
System will address the following elements:
Item #2: A description of how language assistance services are provided by
language
Item #3: A description of how LEP persons are informed of the availability of
language assistance service
Item #4: A description of how the language assistance plan is monitored and
updated
Item #5: A description of how employees are trained to provide language
assistance to LEP persons
And, any additional information deemed necessary.
10.6 Demographic Request
The following form was used to collect required data on Key Community Contacts and nonelected committee members. A
single copy of the “Demographic Request” form is located in Appendix E
Person Area Transportation System is required by Title VI of the Civil Rights Act of 1964 and related authorities to
record demographic information on members of its boards and committees. Please provide the following
information:
Race/Ethnicity:
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Hispanic/Latino
Other (please specify): __________________
National Origin: (if born outside the U.S.)
Mexican
Central American: _____________________
South American: ____________________
Puerto Rican
Chinese
Vietnamese
Korean
Other (please specify): __________________
Gender: Male Female Age:
Less than 18 45-64
18-29 65 and older
30-44 Disability: Yes No
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I choose not to provide any of the information requested above:
Completed forms will remain on file as part of the public record. For more information regarding Title VI or this
request, please contact the Person Area Transportation System at 336-597-1771 or by Fax: 336-330-2311
Please sign below acknowledging that you have completed this form.
Thank you for your participation!
Name (print): _________________________________________________________
Signature: ___________________________________________________________
Implementation
Forms will be completed prior to triennial Title VI compliance reviews and remain on file for three years.
All new and existing members of appointed decision-making boards or committees will be required to complete
this form for reporting purposes.
If a member, for whatever reason, selects “I choose not to provide any of the information requested above,” they
will have also completed the form.
If a member chooses not to provide any of the information on the form, the Title VI Coordinator will be permitted to
indicate that member’s race and gender, based on the Coordinator’s best guess.
Data from these forms will be used to complete the Demographic Request Table in Appendix E
Once a new member submits this form, the Demographic Request Table for the associated committee will be
updated.
10.7 KEY COMMUNITY CONTACTS
Contact Name Community Name Interest or Affiliation Also a Committee
Member? (Y/N)
Maynell Harper Senior Center Aging Y
John Hill Parks and Recreation Community Programs Y
Ronnie Dunevant Roots and Wings Youth N
Lee Thomas Kiwan’s Community Projects N
Contact information for key community contacts is not public information and is maintained outside of this document. Any
staff member who wishes to contact anyone listed above must request that information from the Title VI Coordinator.
10.8 SUMMARY OF OUTREACH EFFORTS MADE SINCE THE LAST TITLE VI PROGRAM SUBMISSION
The following format will be used to report all outreach efforts made since our last NCDOT Title VI Compliance Review. All
meetings and disseminations of information shall enable collection of information for the table below:
Meeting
Date Meeting Time Event
Target
Audience
Meeting
Purpose
Information
Disseminated
11/21/2016 6:00pm – 7:00pm Kiwanis Public Focus Group Projects
1/5/2017 3:00 pm – 5:00pm SC Aging Plan Elderly Planning Schedules /
Routes
1/13/2017 9:00am – 11:00am Roots & Wings Youth Focus Group Transit Routes
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11.0 STAFF TRAINING
All employees will receive basic Title VI training at least once every three years. New hires will receive this training within
15 days of their start date. Basic training will cover all sections of this Plan and our overall Title VI obligations. Staff may
receive specialized training on the application of Title VI in their specific work areas. Those who routinely encounter the
public, such as office personnel, call center staff, and vehicle drivers, will receive annual refresher training. Trainings will
be provided or organized by the Title VI Coordinator, and will often coincide with updates to our nondiscrimination policies
and procedures. Records of staff trainings will be remain on file for at least three years (and in personnel files), and will
include agendas, sign-in sheets, copies of calendars, and any certificates issued
12.0 NONELECTED BOARDS AND COMMITTEES – BY RACE AND GENDER
The table below depicts race and gender compositions for each of our nonelected (appointed) decision-making bodies.
Refer to Appendix F Minority Representation Information Form for member names and full demographics for each
committee.
Body
Male % Female
%
Caucasian
%
African
American
%
Asian
American
%
Native
American
%
Other % Hispanic
%
Service Area Population
Transit Advisory Board 50% 50% 80% 10% 10%
Strategies for Representative Committees
We will seek minority participation and strive for committees that are representative of our constituencies by:
Openly asking public and small group meeting participants if they would be interested in serving on a
committee.
Seeking referrals from local organizations and key community contacts that serve or represent minorities.
Exploring different types of committees, such as ad hoc minority- or youth-only Citizen Advisory
Committees.
Outreach efforts and responses (or lack thereof from those asked to serve or refer others) will be
documented.
13.0. RECORD-KEEPING AND REPORTS
Records will be kept to document compliance with the requirements of the Title VI Program. Unless otherwise specified,
Title VI-related records shall be retained indefinitely. These records will made available for inspection by authorized
officials of the NCDOT and/or FTA. As a subrecipient of FTA funds through NCDOT, we are required to submit a Title VI
Program update to NCDOT every three years, the next of which is due in 2020. Reports on Title VI-related activities and
progress to address findings identified in civil rights compliance reviews and assessments may also be submitted on an
as-requested basis. It will occasionally be necessary to update this program plan and its component parts (e.g.,
complaints, Public Involvement, and LEP), applicable documents, and responsible officials. Updates will be submitted to
NCDOT for review and approval.
In addition to other items throughout this plan, records and reports due at the time of compliance reviews or
investigations will include:
Compliance Reviews Title VI Program Plan 291
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List of civil rights trainings provided or received
Summaries from any internal reviews conducted
Ads and notices for specific meetings
Findings from reviews by any other external
agencies
Title VI equity analyses and EJ assessments
Discrimination Complaints Log
Complaint Investigations
Investigative Reports
Discrimination complaint, as filed
List of interviewees (names and affiliations)
Supporting Documentation (e.g., requested items,
photos taken, dates and methods of contact, etc.)
[Any PTD reporting expectations, such as related quarterly or annual reports, public outreach or actual LEP expenses,
etc…]
Appendix A
Applicable Nondiscrimination Authorities 292
346
During the implementation of this Title VI Program, the organization, for itself, its assignees and successors in interest, is
reminded that it has agreed to comply with the following non-discrimination statutes and authorities, including but not
limited to:
Title VI of the Civil Rights Act of 1964 (42 U.S.C. § 2000d et seq., 78 stat. 252), (prohibits discrimination on the
basis of race, color, national origin); and 49 CFR Part 21.
The Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, (42 U.S.C. § 4601),
(prohibits unfair treatment of persons displaced or whose property has been acquired because of Federal or
Federal-aid programs and projects);
Section 504 of the Rehabilitation Act of 1973, (29 U.S.C. § 794 et seq.), as amended, (prohibits discrimination on
the basis of disability); and 49 CFR Part 27;
The Age Discrimination Act of 1975, as amended, (42 U.S.C. § 6101 et seq.), (prohibits discrimination on the
basis of age);
The Civil Rights Restoration Act of 1987, (PL 100-209), (Broadened the scope, coverage and applicability of Title
VI of the Civil Rights Act of 1964, The Age Discrimination Act of 1975 and Section 504 of the Rehabilitation Act of
1973, by expanding the definition of the terms "programs or activities" to include all of the programs or activities
of the Federal-aid recipients, sub-recipients and contractors, whether such programs or activities are Federally
funded or not);
Titles II and III of the Americans with Disabilities Act, which prohibit discrimination on the basis of disability in the
operation of public entities, public and private transportation systems, places of public accommodation, and
certain testing entities (42 U.S.C. §§ 12131-12189) as implemented by Department of Transportation regulations
at 49 C.P.R. parts 37 and 38;
Title IX of the Education Amendments of 1972, as amended, which prohibits you from discriminating because of
sex in education programs or activities (20 U.S.C. 1681 et seq).
Title VII of the Civil Rights Act of 1964 (42 U.S.C. § 2000e et seq., Pub. L. 88-352), (prohibits employment
discrimination on the basis of race, color, religion, sex, or national origin);
49 CFR Part 26, regulation to ensure nondiscrimination in the award and administration of DOT-assisted
contracts in the Department's highway, transit, and airport financial assistance programs;
Executive Order 12898, Federal Actions to Address Environmental Justice in Minority Populations and Low-
Income Populations, which ensures discrimination against minority populations by discouraging programs,
policies, and activities with disproportionately high and adverse human health or environmental effects on
minority and low-income populations;
Executive Order 13166, Improving Access to Services for Persons with Limited English Proficiency, and resulting
agency guidance, national origin discrimination includes discrimination because of limited English proficiency
(LEP). To ensure compliance with Title VI, you must take reasonable steps to ensure that LEP persons have
meaningful access to your programs (70 Fed. Reg. at 74087 to 74100);
Federal-Aid Highway Act of 1973, (23 U.S.C. § 324 et seq.), (prohibits discrimination on the basis of sex);
Airport and Airway Improvement Act of 1982, (49 USC § 4 71, Section 4 7123), as amended, (prohibits
discrimination based on race, creed, color, national origin, or sex);
The Federal Aviation Administration's Non-discrimination statute (49 U.S.C. § 47123) (prohibits discrimination on
the basis of race, color, national origin, and sex).
Appendix B
Organizational Chart 293
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ORGANIZATIONAL STRUCTURE
Fiscal Year __________
County Manager
Transportation Advisory Board
General Services Director
Transit Manager
Title VI Coordinator
Senior Administrative Clerk / Dispatcher Dispatcher Transit Specialist
Support Assistant
Appendix C
NCDOT’s Compliance Review Checklist for Transit
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I. Program Administration (General Requirements)
Requirement: FTA C 4702.1B – Title VI Requirements and Guidelines for FTA Recipients, Chapter III – General Requirements and Guidelines.
Note: Every NCDOT subrecipient receiving any of the FTA Formula Grants listed above must complete this section.
Requested Items
(Please attach electronic documents (.pdf, .doc, etc.) or provide links to online versions) Completed
1. A copy of the recipient’s signed NCDOT’s Title VI Nondiscrimination Agreement
2. Title VI Policy Statement (signed)
3. Title VI Notice to the Public, including a list of locations where the notice is posted
4. Type the name and title of your Title VI Coordinator and attach a list of their Title VI duties
Kathy Adcock/Transit Manager:
5. Title VI Complaint Procedures (i.e., instructions to the public regarding how to file a Title VI
discrimination complaint)
6. Title VI Complaint Form
7. List of transit-related Title VI investigations, complaints, and lawsuits (i.e., discrimination
complaints log)
8. Public Participation Plan, including information about outreach methods to engage traditionally
underserved constituencies (e.g., minorities, limited English proficient populations (LEP), low-
income, disabled), as well as a summary of outreach efforts made since the last Title VI Program
submission
9. Language Assistance Plan for providing language assistance to persons with limited English
proficiency (LEP), based on the DOT LEP Guidance, which requires conducting four-factor
analyses
10. A table depicting the membership of non-elected committees and councils, the membership of
which is selected by the recipient, broken down by race, and a description of the process the
agency uses to encourage the participation of minorities on such committees
11. A copy of board meeting minutes, resolution, or other appropriate documentation showing the
board of directors or appropriate governing entity or official(s) responsible for policy decisions
reviewed and approved the Title VI Program
12. A description of the procedures the agency uses to ensure nondiscriminatory administration of
programs and services
13. If you pass through FTA funds to other organizations, include a description of how you
monitor your subrecipients for compliance with Title VI, and a schedule for your subrecipients’
Title VI Program submissions.
No Subrecipients
14. A Title VI equity analysis if you have constructed or conducted planning for a facility, such
as a vehicle storage facility, maintenance facility, operation center, etc.
No Facilities Planned or Constructed
15. Copies of environmental justice assessments conducted for any construction projects during
the past three years and, if needed based on the results, a description of the program or other
measures used or planned to mitigate any identified adverse impact on the minority or low-
income communities
No Construction Projects
16. If the recipient has undergone a Title VI Compliance Review in the last 3 years, please indicate
the year of the last review and who conducted it. Year/Agency: 295
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II. Transit Providers
Requirement: FTA C 4702.1B, Chapter IV – Requirements and Guidelines for Fixed Route Transit Providers.
Note: All NCDOT subrecipients that provide fixed route public transportation services (e.g., local, express or commuter bus; bus rapid
transit; commuter rail; passenger ferry) must complete this section.
Not Applicable (Check this box if you do not provide fixed route services, and skip questions 17 and 18. This section
does not apply to you if you only provide demand response services.)
Requested Items
(Please attach electronic documents (.pdf, .doc, etc.) or provide links to online versions) Completed
17. Service standards (quantitative measures) developed for each specific fixed route mode that the
recipient provides (standards may vary by mode) must be submitted for each of the following
indicators:
Vehicle load for each mode (Can be expressed as the ratio of passengers to the total number of seats on a
vehicle. For example, on a 40-seat bus, a vehicle load of 1.3 means all seats are filled and there are approximately 12
standees.)
Vehicle headway for each mode (Measured in minutes (e.g., every 15 minutes), headway refers to the
amount of time between two vehicles traveling in the same direction on a given line or combination of lines. A shorter
headway corresponds to more frequent service. Service frequency is measured in vehicles per hour (e.g., 4 buses per
hour).)
On time performance for each mode (Expressed as a percentage, this is a measure of runs completed as
scheduled. The recipient must define what is considered to be “on time.” Performance can be measured against route
origins and destinations only, or against origins and destinations as well as specified time points along a route.)
Service availability for each mode (Refers to a general measure of the distribution of routes within a transit
provider’s service area, such as setting the maximum distance between bus stops or train stations, or requiring that a
percentage of all residents in the service area be within a one-quarter mile walk of bus service. )
18. Service policies (system-wide policies) adopted to ensure that service design and operations
practices do not result in discrimination on the basis of race, color or national origin, must be
submitted for each of the following:
Transit amenities for each mode (e.g., benches, shelters/canopies, printed materials, escalators/elevators,
and waste receptacles. NOTE: Attach this information only if you have decision-making authority over siting transit
amenities or you set policies to determine the siting of amenities.)
Vehicle assignment for each mode (Refers to the process by which transit vehicles are placed into service
throughout a system. Policies for vehicle assignment may be based on the type or age of the vehicle, where age
would be a proxy for condition, or on the type of service offered.)
Appendix D
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Annual Education and Acknowledgement Form
Title VI Nondiscrimination Policy
(Title VI and related nondiscrimination authorities)
No person shall, on the grounds of race, color, national origin, sex, age, or disability, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or activity
of a Federal-aid recipient.
All employees and representatives of Person Area Transportation System are expected to consider,
respect, and observe this policy in their daily work and duties. If any person approaches you with a civil
rights-related question or complaint, please direct him or her to Kathy Adcock at (336) 330-2207.
In all dealings with the public, use courtesy titles (e.g., Mr., Mrs., Miss, Dr.) to address or refer to them
without regard to their race, color, national origin, sex, age or disability.
Acknowledgement of Receipt of Title VI Program
I hereby acknowledge receipt of Person Area Transportation System’s Title VI Program and other
nondiscrimination guidelines. I have read the Title VI Program and I am committed to ensuring that no
person is excluded from participation in or denied the benefits of Person Area Transportation System
programs, policies, services and activities on the basis of race, color, national origin, sex, age, or
disability, as provided by Title VI of the Civil Rights Act of 1964 and related nondiscrimination statutes.
__________________________________________ ____________________
Signature Date
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Appendix E
DEMOGRAPHIC REQUEST
Person Area Transportation System is required by Title VI of the Civil Rights Act of 1964 and related authorities to
record demographic information on members of its boards and committees. Please provide the following information:
Race/Ethnicity:
White
Black/African American
Asian
American Indian/Alaskan Native
Native Hawaiian/Pacific Islander
Hispanic/Latino
Other (please specify): ____________________
National Origin: (if born outside the U.S.)
Mexican
Central American: ____________________
South American: ____________________
Puerto Rican
Chinese
Vietnamese
Korean
Other (please specify): ____________________
Gender: Male Female Age:
Less than 18 45-64
18-29 65 and older
30-44 Disability: Yes No
I choose not to provide any of the information requested above:
Completed forms will remain on file as part of the public record. For more information regarding Title VI or this
request, please contact the Person Area Transportation System at (336) 597-1771 or by email at
kadcock@personcounty.net.
Please sign below acknowledging that you have completed this form.
Thank you for your participation!
Name (print): _________________________________________________________
Signature: ___________________________________________________________
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Appendix F
Minority Representation Data Collection Form
Name of board, commission, council, etc.
Date:
Dear Member,
Person Area Transportation System is a recipient of federal funds, we are required under Title
VI of the Civil Rights statue to ascertain the racial/ethnic make‐up of our Transportation
Advisory board.
Data from this section is used for statistical and reporting purposes. The information may be
subject to disclosure under federal or state law or rule.
Anti‐Discrimination Notice
It is unlawful for Person Area Transportation System to fail or refuse to provide services, access
to services or activities, or otherwise discriminate against an individual because of an
individual’s race, color, religion, sex, national origin, disability or veteran status.
As a member of advisory board of Person Area Transportation System, we invite board
members to voluntarily self‐identify their race/ethnicity in order for us to comply with FTA Title
VI regulations. This information will be used according to the provisions of applicable federal
and state laws, executive orders and regulations, including those requiring the information to
be summarized and reported to the federal government for civil rights enforcement purposes.
Race/Ethnicity
If you choose to self‐identify, please mark the one box describing the race/ethnicity category
with which you primarily identify:
___ Asian or other Pacific Islander: All persons having origins in any of the peoples of the Far
East, Southeast Asia, the Indian subcontinent, or the Pacific Islands. This area includes,
for example, China, Japan, Korea, Philippine Islands and Samoa.
___ Black and/or African American (not of Hispanic origin): All persons having origins in any of
the Black racial groups of Africa.
___ Hispanic or Latino: All persons of Mexican, Puerto Rican, Cuban, Central or South
American, or other Spanish culture or origin, regardless of race.
___ American Indian or Alaskan Native: All persons having origins in any of the original peoples
of North America, and who maintain cultural identification through tribal affiliation or
community recognition.
___ White or Caucasian (not of Hispanic origin): All persons having origins in any of the original
peoples of Europe, North Africa or the Middle East.
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Person County Government Substance Abuse Policy
Policy Overview:
Person County Government has a responsibility to all employees to provide a workplace that is
free of controlled substances and alcohol as well as a responsibility to the public to insure that its
safety and trust in the County is upheld. Therefore, Person County has adopted a policy that
prohibits the following behaviors by employees:
The use or possession of alcohol or any controlled substance, including the abuse of
medications, while on work time or work premises, or in county vehicles.
The sale, distribution, or provision of alcohol or any controlled substance while on work
time or work premises, or in county vehicles.
Reporting to work or working while intoxicated or otherwise impaired.
This is a zero tolerance policy due to the magnitude of potential adverse consequences of
controlled substances abuse and alcohol misuse which can range from personal injury or
equipment damage to death of co-workers or the public. Any violations of this policy will
subject the employee to disciplinary action, up to and including dismissal.
Purpose:
The purpose of the drug and alcohol policy is to:
1. Identify all requirements and actions necessary to eliminate controlled substance abuse
and alcohol misuse with Person County Government.
2. Ensure full compliance with federal requirements for establishing a drug-free workplace.
3. Identify when, and under what conditions, County employees are subject to drug and
alcohol testing.
Scope/Coverage:
All employees (full time; part time; temporary; contract) of Person County Government are
subject to the following types of tests:
reasonable suspicion
post-accident
return to duty
follow-up
Pre-employment testing will be conducted on safety sensitive positions.
Safety Sensitive Employees of Person County Government are subject to the following types of
tests:
random, unannounced testing
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Compliance with Law
1. Information regarding the testing and referral of employees and applicants under the
policy will be treated as confidential in accordance with the requirements of North
Carolina laws governing the privacy of employee personnel records.
2. Searches and seizures are to be conducted in a legal manner. Person County
Government reserves the right to conduct searches or inspections of property assigned
to an employee whenever a department head or his or her designee determines that
the search is reasonable under all circumstances.
Definitions
Alcohol test means a test for the presence of alcohol in the body as determined through the use
of a breath alcohol test, evidential breathalyzer test, or blood screening.
Approved laboratory means a laboratory approved and certified by the North Carolina
Department of Human Resources or the U. S. Department of Health and Human Services
(DHHS), the College of American Pathology, the American Association for Clinical Chemistry,
or the equivalent to conduct drug testing. Only laboratories certified by DHHS will be used for
tests required by Federal Transit Administration (FTA) and Federal Highway Administration
(FHWA).
Canceled Test with respect to the results of a drug test, means a test result in which the medical
review officer finds insufficient information or inconsistent procedures with which to make a
determination.
Confirmation test for alcohol means a second test, following a screening test with a result of
0.02 or greater that provides quantitative data of alcohol concentration. Confirmation test for
controlled substances means a second analytical procedure to identify the presence of a specific
drug or metabolite that is independent of the screen test and that uses a different technique and
chemical principle from that of the screen test in order to ensure reliability and accuracy. Gas
chromatography/mass spectrometry (GC/MS) is the only authorized confirmation method for the
five SAMHSA drugs.
Conviction means a finding of guilt (including a plea of nolo contendere) or imposition of
sentence, or both, by any judicial body charged with the responsibility to determine violations of
federal or state criminal drug statutes.
Criminal drug statute means a criminal statute relating to the manufacture, distribution,
dispensation, use or possession of any drug.
Drug means a controlled substance as listed in Schedules I through VI of Section 202 of the
Controlled Substances Act (21 USC 812) or Chapter 90, Section 87(5) of the North Carolina
General Statutes or a metabolite thereof.
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Drug test and drug screening means a test, including providing the necessary sample of body
fluid by the employee to be tested, for the presence of any of the following drugs or drug
metabolites in the urine or blood of an employee:
a. amphetamines
b. barbiturates
c. benzodiazepines
d. cannabinoids
e. cocaine
f. methaqualone
g. opiates
h. phencyclidine
i. propoxyphene
j. other drugs that may be determined to reduce work efficiency
Medical review officer (MRO) is a North Carolina-licensed physician with specific training in
the area of substance abuse. The medical review officer not only has knowledge of substance-
abuse disorders, but also has been trained to interpret and evaluate laboratory test results in
conjunction with an employee’s medical history. The medical review officer verifies a positive
drug test result by reviewing a laboratory report and an employee’s unique medical history to
determine whether the result was caused by the use of prohibited drugs or by an employee’s
medical condition.
Negative, with respect to the results of a drug test, means a test result that does not show
presence of drugs at a level specified to be a positive test.
Negative, with respect to the results of an alcohol test, means a test that indicates a breath
alcohol concentration of less than 0.02.
On call means being subject to a call to report immediately to work for Person County
Government.
On duty means when an employee is at the workplace, performing job duties, on call, or during
any other period of time for which he or she is entitled to receive pay from Person County
Government.
Other substance means any substance that has the potential to impair appreciably the mental or
physical function of a person who does not have an unusual or extraordinary reaction to such
substance.
Pass a drug test means that the result of a drug test is negative. The test either:
a. showed no evidence or insufficient evidence of a prohibited drug or drug metabolite,
or
b. showed evidence of a prohibited drug or drug metabolite but there was a legitimate
medical explanation for the result as determined by a certified medical review officer.
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Pass an alcohol test is a negative alcohol test. The test showed no evidence or insufficient
evidence of a prohibited level of alcohol.
Positive, with respect to the results of a drug test, means a laboratory finding of the presence of a
drug or a drug metabolite in the urine or blood of an employee at the levels identified by the
Substance Abuse and Mental Health Services Administration (SAMHSA), or for drugs not
subject to SAMHSA guidelines, at the levels identified by Person County Government; all
positive tests will be confirmed using a different technology than was used for the first test, such
as the gas chromatography/mass spectrometry (GC/MS) process.
Positive, with respect to the results of an alcohol test, means the presence of alcohol in an
employee’s system at the 0.04 level or greater.
Pre-placement testing is testing conducted on a current County employee prior to his or her
being promoted, transferred, or demoted into a safety-sensitive position.
Qualified negative, with respect to the results of a drug test, means a test in which the lab result
is consistent with legal drug use.
Random testing is testing conducted on an employee assigned to a safety-sensitive position and
is chosen by a method that provides an equal probability that any employee from a group of
employees will be selected.
Reasonable suspicion exists when a supervisor, utilizing the guidelines for determining
“Reasonable Suspicion” as shown in attachment “B”, to substantiate specific contemporaneous,
articulable observations concerning appearance, behavior, speech, or body odor or other physical
indicators of probable drug or alcohol use. By way of example and not limitation, any one or a
combination of the following may constitute reasonable suspicion:
a. slurred speech
b. the odor of marijuana or alcohol about the person
c. inability to walk a straight line
d. an accident resulting in damage to property or personal injury
e. physical altercation
f. verbal altercation
g. behavior that is so unusual that it warrants summoning a supervisor or anyone
else in authority (i.e., confusion, disorientation, lack of coordination, marked
personality changes, irrational behavior)
h. possession of drugs
i. verifiable information obtained from other employees based on their observations
j. arrests, citations, and deferred prosecutions associated with drugs or alcohol
Refuse to submit means that an employee (1) fails to provide adequate breath for testing without
a valid medical explanation after he or she has received notice of the requirement for breath
testing, (2) fails to provide adequate urine for controlled substances testing without a valid
medical explanation after he or she has received notice of the requirement for urine testing, (3)
refuses to sign the breath alcohol confirmation test certification, or (4) engages in conduct that
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clearly obstructs the testing process. An employee subject to the post-accident testing
requirements of the DOT who unnecessarily leaves the scene of an accident before a required
test is administered or fails to remain readily available for testing may be deemed to have refused
to submit to testing.
Safety-sensitive position means a position will be designated safety sensitive only where Person
County Government has a compelling need, on the basis of safety concerns, to ascertain on-the-
job impairment on the part of employees who hold the position. Such a compelling need may
arise where the duties of a position create, or are accompanied by, such a great risk of injury to
other persons or to property of such magnitude that even a momentary lapse of attention,
judgment, or dexterity could have disastrous consequences. Examples of these positions include:
a. Positions (full time; part time; temporary; or contract) requiring the use of weapons
(or potential use of weapons) or the operation of vehicles, machinery, or equipment as
a primary task (does not include routine office equipment) and other public safety
personnel.
b. Positions requiring the handling of hazardous materials, the mishandling of which
may place the employee, fellow employees, or the general public at risk of serious
injury, or the nature of which would create a security risk in the workplace.
c. Positions where the incumbent’s mental fitness is required to prevent immediate
injury to the public or to fellow employees, or to himself or herself.
d. Positions working with youth/children and/or are required to drive clients.
e. Other positions as determined on a case-by-case basis by the County Manager.
Federally Required Position Coverage (FTA Safety Sensitive): Federal drug and alcohol testing
regulations apply to an employee who: a) Operates a commercial motor vehicle and is subject
to the commercial driver’s license (CDL) requirement. b) Performs or supervises the
performance of certain functions related to mass transit.
Substance abuse professional means a licensed physician (medical doctor or doctor of
osteopathy), or a licensed or certified psychologist, social worker, employee assistance
professional, or addiction counselor (certified by the National Association of Alcoholism and
Drug Abuse Counselors Certification Commission) with knowledge of and clinical experience in
the diagnosis and treatment of both drug- and alcohol-related disorders.
Supervisor, in general, means any employee who has the authority to direct the job activities of
one or more other employees. With respect to a particular employee, the term means such
employee’s immediate supervisor and all persons having indirect supervisory authority over such
employee.
Unannounced follow-up testing is testing conducted on an employee on a periodic,
unannounced basis, following his or her return to work from an approved drug or alcohol
rehabilitation program.
Workplace means the location or facility where an employee may be expected to perform any
task related to the requirements of his or her job. This includes break rooms and restrooms,
outdoor worksites, or personal vehicles (while personal vehicle is being used for Person County
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Government business), computer work stations, conference rooms, hallways, private offices,
open/partitioned work areas, public contact/customer service/medical services areas, and parking
lots.
Reasonable Suspicion Testing (All Employees)
Reasonable suspicion testing is performed when supervisors, department heads, or County
officials have reasonable suspicion to believe that an employee’s behavior or appearance may
indicate he/she may be under the influence of or has recently used alcohol or controlled
substances. The determination to test for reasonable suspicion must be based on the following:
first hand observations seen or heard by supervisors or department heads
specific, clearly stated observations concerning the appearance, behavior, speech or body
odor of the employee (See Attachment B)
observations made just before, during or just after the performance of job duties
Supervisors, department heads, or County officials have the right and responsibility to require an
employee to submit to controlled substances or alcohol testing when reasonable suspicion is
present.
Reasonable suspicion alcohol testing should be done within 2 hours of the observed behavior or
appearance. If a test cannot be done within 8 hours, it should not be done. A reasonable
suspicion controlled substance test should be done no later than 32 hours from the observed
behavior or appearance. If a reasonable suspicion test cannot be conducted within the specified
time frame, the reasons for the failure to test should be documented by the supervisor and given
to the Human Resources Director. Further observation is required.
An employee who is asked to submit to reasonable suspicion testing will be driven to the testing
site and will be placed on a non-disciplinary suspension without pay pending the test results. An
employee who refuses to submit to reasonable suspicion testing or avoids meeting the time
requirements identified will be subject to dismissal.
Post Accident Testing (All Employees)
Post-accident testing is conducted following any accident involving an employee if any one of
the following conditions is met:
Estimated property damage of $500.00 or more.
An individual suffers bodily injury and receives medical treatment away from the
scene.
When the driver is issued a citation by law enforcement officers or is at fault.
A workers compensation report must be filed
If an alcohol and/or controlled substance test is administered by law enforcement, Person County
will not duplicate testing.
Post-accident alcohol testing should be done within 2 hours of the accident. If the test cannot be
performed within 8 hours, it should not be done. Post-accident controlled substances testing
must be performed within 32 hours of the accident, or it should not be done. If the tests cannot
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be performed in the specified time frame, the reasons for the failure to test should be documented
by the supervisor and given to the Human Resources Director.
As soon as practical after an accident, the employee will be driven to the specimen collection
location. Transportation will be provided. An employee who is required to submit to post-
accident controlled substances or alcohol testing will be placed on administrative leave with pay
pending test results.
An employee who refuses to be tested or avoids meeting the specified time limits will be subject
to dismissal. If unable to meet specified timelines due to circumstances beyond the employee’s
control, such circumstances must be documented and validated to the Human Resources Director
and the County Manager.
Pre-employment Testing
After an offer of employment has been made to the final candidate, the Human Resources
Director directs the applicant to the drug testing collection site and receives notification of the
test result. Applicants are not eligible to begin work until the Human Resources Director
receives the negative test result. If someone is already employed by the County, he/she is
required to submit to a pre-employment test only if he/she is moving into a safety sensitive
position from a position that is not safety sensitive.
Return-to-Duty and Follow-Up Testing
Return-to-duty and Follow-up testing is required for any employee who has violated this policy
and is returning to work on the recommendation of the substance abuse professional. Return-to-
duty testing must be conducted prior to the employee returning to work. Follow-up testing is
required for any employee who has violated this policy and has successfully completed a return-
to-duty test. Employees who fall into either one of these situations will be subject to at least 6
unannounced follow-up tests within the first year back on the job. Follow-up testing can be
performed for up to 5 years after return to work. Any employee who tests positive on a return to
duty or follow-up test shall be dismissed.
Controlled Substances Testing Information
Alcohol Tests
A breath alcohol level of 0.04 or higher on a breathalyzer administered by a certified Breath
Alcohol Technician is considered a positive alcohol test. A positive test result while on work
time or work premises, or in county vehicles, will result in disciplinary action up to and
including dismissal.
A breath alcohol level of 0.02 or greater requires a confirmation test. Confirmation test are
completed no sooner than 15 minutes after the initial screening test, but no later than 20 minutes
of that test. If the screening and confirmation tests are not the same, the confirmation test is
deemed to be the final result. If the BAT reading is between 0.02 and 0.039 the employee must
be removed from the work place for a 24-hour period (8 hours of work time).
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Drug Tests
All drug tests require an employee to provide a urine specimen for urinalysis at an approved
medical facility or for randoms the location will be advised at that time. The collection, analysis
and reporting processes are strictly controlled to ensure accuracy of test results and maximum
confidentiality.
Every urine specimen undergoes an initial screen followed by a confirmation test for all positive
screen results. Any confirmed positive test result is reviewed and interpreted by a Medical
Review Officer (MRO). The MRO will contact the employee to ensure no factors exist that may
have influenced the outcome of the testing process prior to transmission of the results to the
County. The MRO is responsible for confirming test results. Test results will be provided to the
Human Resource Director and test results will be revealed only to those persons authorized as
having an established need for the information. A confirmed positive test result will subject the
employee to disciplinary action, up to and including dismissal. The employee cannot return to
job duties until he/she has been evaluated by a substance abuse professional, completed the
treatment recommendations, and produced a negative return to duty test.
The employee will be notified in writing of a confirmed positive test result.
All cost of testing, with the exception of return to work or follow-up testing, will be the
responsibility of Person County Government. Cost of Return to work or follow-up testing will
be the responsibility of the employee.
Refusal to Test
An employee’s refusal to consent to testing as authorized under this policy will result in
immediate termination.
Impairment or other behavior off the job
Any employee whose job duties require operation of a motorized vehicle, hazardous machinery
or use of hazardous materials who is CHARGED with a controlled substances or alcohol related
offense (including DWI) must notify the appropriate supervisor or department head within one
work day of arrest, arraignment or indictment. Any employee who is required to have a driver’s
license for the performance of their job duties will be placed in disciplinary suspension without
pay status until their license is returned after the automatic ten-day revocation. An employee’s
failure to notify his/her supervisor or department head may result in disciplinary action, up to and
including dismissal. Under no circumstances will an employee operate a county vehicle or
equipment without a valid operator’s license.
Any employee CONVICTED or who is granted deferred prosecution of a controlled substances
or alcohol related offense must notify the appropriate supervisor or department head within one
work day of conviction. Failure to notify management may result in disciplinary action, up to
and including dismissal. If an employee’s job functions require an operator’s license and the
employee’s operator’s license is revoked, the employee shall be subject to disciplinary action, up
to and including dismissal. Failure to notify the supervisor or department head of any revocation
shall result in disciplinary action, up to and including dismissal.
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Any employee convicted of an off the job controlled substances or alcohol related offense which
could directly, or indirectly, affect his/her credibility or ability to carry out effectively the duties
and responsibilities of his/her position with Person County Government , shall be subject to
review by the County Manager and possible disciplinary action, up to and including dismissal.
Voluntary Referrals for Assistance
An employee who has a drug or alcohol problem is encouraged to seek assistance from the
County’s Employee Assistance Program (EAP). EAP visits are provided as a County benefit and
are confidential. Any permanent employee who seeks voluntary assistance and requires leave
time to participate in a treatment program will be granted sick leave, leave without pay or Family
Medical Leave.
Mandatory Referrals for Assistance
An employee who has tested positive for drugs or alcohol and is not dismissed may be required
as a condition of continued employment to undergo a drug and alcohol assessment and
participate in a treatment program as recommended by the assessing agency.
Person County Government respects the right of any employee to refuse assistance for a drug or
alcohol problem. However, the County maintains the right and responsibility for taking
disciplinary action regarding inadequate job performance and for protecting the public’s safety.
Attachment A
Safety Sensitive Positions
General Policy
Unannounced random testing will be completed on a certain percentage of employees whose
positions have been deemed safety sensitive. Employees in safety sensitive positions have a
special responsibility to maintain physical and mental fitness for duty at all times while on the
job. The simple random sample method is used and all names of the employees holding safety
sensitive positions are entered into the pool for random selection. Employees whose names are
randomly selected from the pool must be tested just before, during or just after performing job
responsibilities. Person County Government contracts with a third party administrator to
generate the random test list and the Human Resources Director coordinates the random tests.
The following positions are considered safety sensitive and thus subject to random drug testing.
Any County position is subject to reasonable suspicion testing. Other positions may be added to
this list of safety sensitive positions at any time due to the nature of job assignments or deleted
because the assignments of a particular position within a job title that do not fit the safety
sensitive criteria.
Under County policy, positions defined as safety-sensitive are:
Safety-sensitive position means a position will be designated safety sensitive only where Person
County Government has a compelling need, on the basis of safety concerns, to ascertain on-the-
job impairment on the part of employees who hold the position. Such a compelling need may
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arise where the duties of a position create, or are accompanied by, such a great risk of injury to
other persons or to property of such magnitude that even a momentary lapse of attention,
judgment, or dexterity could have disastrous consequences. Examples of these positions include:
a. Positions (full time; part time; temporary; or contract) requiring the use of weapons
(or potential use of weapons) or the operation of vehicles, machinery, or equipment as
a primary task (does not include routine office equipment).
b. Positions requiring the handling of hazardous materials, the mishandling of which
may place the employee, fellow employees, or the general public at risk of serious
injury, or the nature of which would create a security risk in the workplace.
f. Positions where the incumbent’s mental fitness is required to prevent immediate
injury to the public or to fellow employees, or to himself or herself.
c. Positions working with youth/children and/or to required to drive clients
d. Other positions as determined on a case-by-case basis.
Safety-Sensitive Positions:
County Engineer Animal Control Officer
Information Technology Director Transit Specialist
Network Administrator Transportation Director
Web and User Support Tech GIS Analyst
Webmaster/PC Consultant District Technician
Tax Administrator Recreation Program Supervisor
Public Works Director Building/Parks Maint. Mechanic
Public Works Safety Officer Parks and Recreation Director
Custodian Park Supervisor
Building Supervisor Cultural Arts Program Supervisor
Building Maintenance Technician Athletic Supervisor
Building Maintenance Mechanic Park Ranger
Grounds Maintenance Worker Athletics Adm. Support Spec.
Grounds Supervisor Athletic Recreation Specialist
Sheriff Community Health Technician
Chief Deputy Sheriff Social Worker I, II, III
Deputy Sheriff Commander Public Health Nurse Supervisor I
Detention Center Administrator Public Health Nurse I,II,III
Deputy Sheriff Unit Supervisor Social Work Supervisor II
Deputy Sheriff Special Assignment Processing Asst. IV
Deputy Sheriff Division Supervisor Office Assistant III
Deputy Sheriff Processing Assistant III
Senior Detention Officer Accounting Tech. II
Administrative Services Supervisor Public Health Educator II
Telecommunicator Physical Therapist Asst. II
Detention Administrative Officer Health Director
Detention Center Operations Manager PHN III/PHPR Coordinator
Detention Shift Supervisor Nutritionist III and II
Detention Officer Foreign Language Inter. II
Fire Marshal/Telecommunications Director Med. Lab. Tech II and I
Fire Inspector Clinical Chaplain
Telecommunications Supervisor Environmental Health Specialist
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Telecommunications Technology Specialist Environmental Health Prog. Spec.
Telecommunicator/EMD Environmental Health Supvr I
Building Codes Administrator Library Director
Senior Code Enforcement Officer Assistant to Library Director
Code Enforcement Officer Librarian
Emergency Management & Medical Services Director Library Tech
Emergency Medical Services Manager Library Associate
EMT-Paramedic Shift Supervisor Library Associate/Outreach Coor.
EMT-Paramedic Training Officer Income Maint. Investigator I
EMT-Paramedic Assistant Shift Supervisor Social Worker IAT
EMT-Paramedic,Intermediate & Basic Community SS Asst.
Animal Control Manager Prod/Maint Tech
Animal Shelter Assistant Job Coach
Program Manager Work Adj. Coord.
Program Specialist Field Supervisor
Habilitation Assistant Person Industries Director
Production Manager Van Driver
Truck Driver Forklift Operator
Senior Appraisal Technician Property Revaluation Manager
Contract employees who work with children
Attachment B
Guidelines for Determining “Reasonable Suspicion”
“Reasonable suspicion” is defined as the belief, based on the totality of the circumstances, that
an employee or applicant is using or has used drugs or alcohol in violation of the County’s
policy. This belief will be based upon specific and objective facts and reasonable inferences.
By themselves, the factors below may not be indicative of a problem with drugs or alcohol;
however, with strong individual evidence or in combination of several factors, the following may
be considered in determining the presence of reasonable suspicion:
1. Direct observation of drug use and/or the physical symptoms or manifestations of being
under the influence of a drug (e.g., slurred speech, odor of alcohol beverage on body or
breath, incoherence, loss of coordination, etc.) while at work.
2. Abnormal conduct or erratic behavior while at work such as deterioration in work
performance, or participation in physical or verbal altercation, under suspicious
conditions (as in 1, above).
3. Information from a reliable and credible source or evidence that an employee may be or
have been impaired in the performance of his or her duties by recent abuse of alcohol or
illegal drugs, whether on or off the job. Attempts should be made to independently
corroborate this information. (The Police Department should be contacted in these
circumstances, to determine whether there are state or federal legal implications.)
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4. Evidence that an employee or applicant has tampered with his/her alcohol or drug test or
has attempted to compromise the test sample or the testing process. (Evidence of
tampering with or attempting to compromise the test will be considered a positive test
and will be grounds for termination.)
Supervisors should be alert to the conduct and job performance of an employee based on the
supervisor’s long-term knowledge of the employee. In combination with observations of
current/contemporaneous conditions, the following may alert the supervisor to be watching for
signs of substance abuse:
A prior history of confirmed substance abuse by the employee during the period of
County employment, such as recent convictions of driving while impaired. (Prior history
shall not be considered sufficient on its own to constitute reasonable suspicion or present
violation of the County’s policies.)
A pattern of excessive absenteeism, tardiness, or deterioration in work performance.
A pattern of unexplained and unusual vehicle or personal accidents or injuries on or off
the job.
Random Drug Testing
STANDARD PROCEDURE
PERSON COUNTY GOVERNMENT ADMINISTRATIVE MANUAL
Purpose:
To provide a standard procedure for supervisors and employees to follow for the random drug
testing.
Policy:
This standard procedure falls under the Drug and Alcohol Policy effective upon adoption.
General Procedure:
1. The Human Resources Director will receive the list of employees selected for random testing
from Safe-T-Works, Inc.
2. The Human Resources Director will notify the department heads of effected employees who
are chosen for random testing. Department heads will notify employees.
3. Generally, testing will be conducted at the Person County Office Building 2nd floor. The
employee proceeds to the collection site immediately upon being notified. Failure to complete
the test as scheduled will result in disciplinary action, up to and including dismissal, unless there
is a certified medical reason for not completing the test. Any attempt to alter or manipulate the
specimen, control forms, or the testing process will be treated as if a positive test result was
obtained.
4. Safe-T-Works, Inc. will contact the Human Resources Director to provide the test results.
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5. If the test results are positive, the Human Resources Director will contact the department head
and County Manager to inform them of the results and initiate disciplinary action. Test results
are not official until received from the Human Resources Director. If the test results are
negative, the Human Resources Director will document the results. If the alcohol test result is
.02 through .0399, the Human Resources Director will document the result and will notify the
department head and County Manager. The employee will be placed on disciplinary suspension
without pay for 24 hours (8 work hours). Other disciplinary action may result depending on the
history and circumstances of the test and employee.
6. The Human Resources Director will compile and maintain all required records.
Reasonable Suspicion – Drug Testing
STANDARD PROCEDURE
PERSON COUNTY GOVERNMENT ADMINISTRATIVE MANUAL
Purpose:
To provide a standard procedure for supervisors to follow when they have reasonable suspicion
that a department employee may be under the influence of drugs or alcohol.
Policy:
This standard procedure falls under the Drug and Alcohol Policy effective upon adoption.
General Procedure:
1. The supervisor, department head, or County official will, upon reasonable suspicion of
controlled substances abuse or alcohol misuse, talk with the employee about his/her behavior and
advise him/her that he/she does not appear to be “ready for duty”. Point out the behaviors that
concern you. Do not accuse him/her of controlled substances abuse or alcohol misuse. It is
advisable to have a “third party” (Human Resources Director, department head, or County
Manager) as a witness to the conference. Utilize behavioral indicators which consist of what the
witness sees the employee do, hears the employee say, or any changes in the employee’s
appearance or body odor. Personnel should feel free to seek guidance from the Human Resources
Director and the EAP.
2. The supervisor, department head, or County official will transport the employee to a collection
site to have the appropriate testing completed.
3. The supervisor, department head, or County official will assist the employee in making
arrangements to have someone else drive him/her home following the testing. A suspected
controlled substance user or alcohol abuser should not drive him/herself home. If he/she refuses
to allow someone else to drive, explain that you will notify the proper authorities that he/she is
possibly impaired and should not be driving.
4. The supervisor, department head, or County official should document the incident. The
documentation shall be done immediately and no later than 24 hours after the events leading up
to and including action taken by the supervisor, department head or County official. Include
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date, time and specific behaviors observed. Forward this documentation to the Human
Resources Director in a sealed envelope marked confidential.
5. The collection site will contact the Human Resources Director to provide the test results.
While the County is awaiting test results, the employee will be placed on non-disciplinary
suspension without pay.
6. If the test results are positive, the Human Resources Director will contact the department head
and County Manager to inform them of the results and initiate disciplinary action. Test results
are not official until received from the Human Resources Director.
If the test results are negative, the Human Resources Director will document the test results and
immediately contact the department head who will notify the employee to return to work
immediately. Upon employees return to work following non-disciplinary suspension, pay will be
reinstated at that time. The successful completion of a controlled substance and alcohol test does
not bar any other disciplinary or administrative actions deemed appropriate by the supervisor or
department in relation to the incident. The Human Resources Director will compile and maintain
all required records.
Adopted by Person County Board of County Commissioners
January 19, 2010
Amended April 22, 2010
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PERSONNEL POLICY
Adopted by Person County Board of Commissioners on
December 18, 2006
Policy effective January 1, 2007
Revised and adopted by Person County Board of Commissioners on
November 19, 2007; Effective January 1, 2008
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PERSON COUNTY GOVERNMENT
PERSONNEL POLICY
Adopted on December 18, 2006 by the Board of Commissioners;Policy effective January 1,
2007.
Revisions adopted 11/19/07 by Board of County Commissioners for Person County. Revised
policy effective January 1, 2008.
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 ...................................................................................5
Section 1. Purpose of the Policy ............................................................................................ 5
Section 2. Merit Principles ...................................................................................................... 5
Section 3. Responsibilities of the County Board of Commissioners……………………….…...5
Section 4. Responsibilities of the County Manager ................................................................ 5
Section 5. Responsibilities of the Human Resources Director ............................................... 6
Section 6. Application of Policies, Plan, Rules, and Regulations ........................................... 7
Section 7. Departmental Rules and Regulations ................................................................... 7
Section 8. Definitions ............................................................................................................. 7
ARTICLE II. POSITION CLASSIFICATION PLAN ............................................................... 9
Section 1. Purpose ................................................................................................................ 9
Section 2. Composition of the Position Classification Plan .................................................... 9
Section 3. Use of the Position Classification Plan .................................................................. 9
Section 4. Administration of the Position Classification Plan ................................................. 9
Section 5. Authorization of New Positions and the Position Classification Plan................... 10
Section 6. Request for Reclassification ................................................................................ 10
ARTICLE III. THE PAY PLAN .............................................................................................. 11
Section 1. Definition ............................................................................................................. 11
Section 2. Administration and Maintenance ......................................................................... 11
Section 3. Starting Salaries .................................................................................................. 11
Section 4. Trainee Designation and Provisions ................................................................... 12
Section 5. Probationary Pay Increases ................................................................................ 12
Section 6. Pay Range Increases .......................................................................................... 12
Section 7. Performance Pay Bonus ..................................................................................... 12
Section 8. Salary Effect of Promotions, Demotions, Transfers, and Reclassifications......... 13
Section 9. Salary Effect of Salary Range Revisions ........................................................... 14
Section 10. Transition to a New Salary Plan ........................................................................ 14
Section 11. Effective Date of Salary Changes ..................................................................... 14
Section 12. Overtime Pay Provisions ................................................................................... 15
Section 13. On-Call and Call-Back Compensation .............................................................. 16
Section 14. Payroll Schedule and Deductions ..................................................................... 16
Section 15. Hourly Rate of Pay ............................................................................................ 17
Section 16. Longevity Pay.....................................................................................................17
Section 17. Pay for Interim Assignment in a Higher Level Classification..............................17
ARTICLE IV. RECRUITMENT AND EMPLOYMENT .......................................................... 18
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Section 1. Equal Employment Opportunity Policy ................................................................ 18
Section 2. Implementation of Equal Employment Opportunity Policy .................................. 18
Section 3. Recruitment, Selection and Appointment ............................................................ 18
Section 4. Probationary Period ............................................................................................ 19
Section 5. Promotion ............................................................................................................ 19
Section 6. Demotion ............................................................................................................. 20
Section 7. Transfer ............................................................................................................... 20
ARTICLE V. CONDITIONS OF EMPLOYMENT .................................................................. 21
Section 1. Work Schedule .................................................................................................... 21
Section 2. Political Activity ................................................................................................... 21
Section 3. Expectation of Ethical Conduct ........................................................................... 21
Section 4. Outside Employment ........................................................................................... 22
Section 5. Dual Employment ................................................................................................ 22
Section 6. Employment of Relatives .................................................................................... 22
Section 7. Harassment ......................................................................................................... 23
Section 8. Use of County Time, Equipment, Supplies, and Vehicles ................................... 23
Section 9. Performance Evaluation ...................................................................................... 24
Section 10. Safety..................................................................................................................24
Section 11. Immigration Law Requirements ........................................................................ 24
Section 12. Substance Abuse .............................................................................................. 24
Section 13. Credentials and Certifications ......................................................................... ..24
ARTICLE VI. EMPLOYEE BENEFITS ................................................................................. 25
Section 1. Eligibility .............................................................................................................. 25
Section 2. Group Health and Hospitalization Insurance ....................................................... 25
Section 3. Group Life Insurance ........................................................................................... 25
Section 4. Other Optional Group Insurance Plans ............................................................... 25
Section 5. Retirement ........................................................................................................... 25
Section 6. Supplemental Retirement Benefits (401-K) ......................................................... 26
Section 7. Social Security .................................................................................................... 26
Section 8. Workers' Compensation ...................................................................................... 26
Section 9. Unemployment Compensation ............................................................................ 27
Section 10. Tuition Assistance Program .............................................................................. 27
Section 11. Credit Union ...................................................................................................... 27
ARTICLE VII. HOLIDAYS AND LEAVES OF ABSENCE ................................................... 28
Section 1. Policy ................................................................................................................... 28
Section 2. Holidays .............................................................................................................. 28
Section 3. Holidays: Effect on Other Types of Leave ........................................................... 28
Section 4. Holidays: Compensation When Work is Required .............................................. 28
Section 5. Vacation Leave.....................................................................................................28
Section 6. Vacation Leave: Use by Probationary Employees................................................29
Section 7. Vacation Leave: Accrual Rate ............................................................................. 29
Section 8. Vacation Leave: Maximum Accumulation ........................................................... 29
Section 9. Vacation Leave: Manner of Taking ..................................................................... 29
Section 10. Vacation Leave: Payment upon Separation ...................................................... 30
Section 11. Vacation Leave: Payment Upon Death ............................................................ 30
Section 12. Sick Leave.........................................................................................................30 316
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Section 13. Sick Leave: Accrual Rate and Accumulation .................................................... 31
Section 14. Sick Leave: Medical Certification ...................................................................... 31
Section 15. Leave Pro-Rated .............................................................................................. 31
Section 16 Leave Without Pay…………………………………………………………………....32
Section 17. Family Medical Leave ....................................................................................... 32
Section 18. Family and Medical Leave: Medical Certification ............................................. 33
Section 19. Family Medical Leave and Leave Without Pay: Retention
And Continuation of Benefit.................................................................................................. 33
Section 20. Workers' Compensation Leave...............................………………………………34
Section 21. Military Leave……………………………………………………………………..….. 34
Section 22. Reinstatement Following Military Service .......................................................... 35
Section 23. Civil Leave ......................................................................................................... 35
Section 24. Parental School Leave ...................................................................................... 35
Section 25.Voluntary Shared Leave ..................................................................................... 36
ARTICLE VIII. SEPARATION AND REINSTATEMENT ..................................................... 39
Section 1. Types of Separations .......................................................................................... 39
Section 2. Resignation ......................................................................................................... 39
Section 3. Reduction in Force .............................................................................................. 39
Section 4. Disability .............................................................................................................. 39
Section 5. Voluntary Retirement .......................................................................................... 39
Section 6. Death ................................................................................................................... 39
Section 7. Dismissal..............................................................................................................40
Section 8. Reinstatement ..................................................................................................... 40
Section 9. Rehiring ............................................................................................................... 40
ARTICLE IX. UNSATISFACTORY JOB PERFORMANCE AND DETRIMENTAL PERSONAL
CONDUCT ............................................................................................................................ 41
Section 1. Disciplinary Action for Unsatisfactory Job Performance ...................................... 41
Section 2. Unsatisfactory Job Performance Defined ............................................................. 41
Section 3. Communication and Warning Procedures Preceding
Disciplinary Action for Unsatisfactory Job Performance ....................................................... 41
Section 4. Disciplinary Action for Detrimental Personal Conduct ..........................................42
Section 5. Detrimental Personal Conduct Defined ................................................................ 42
Section 6. Pre-Dismissal Conference ................................................................................... 43
Section 7. Non-Disciplinary Suspension ............................................................................... 43
ARTICLE X. GRIEVANCE PROCEDURE AND ADVERSE ACTION APPEAL .................. 44
Section 1. Policy ................................................................................................................... 44
Section 2. Grievance Defined ............................................................................................... 44
Section 3. Purposes of the Grievance Procedure ................................................................ 44
Section 4. Procedure ............................................................................................................ 45
Section 5. Role of the Human Resources Director ............................................................... 46
Section 6. Grievance and Adverse Action Appeal Procedure for Discrimination ................. 47
ARTICLE XI. PERSONNEL RECORDS AND REPORTS ........................................................ 47
Section 1. Public Information .................................................................................................... 47
Section 2. Access to Confidential Records...................................................................……….. 47
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Section 3. Personnel Actions .................................................................................................... 48
Section 4. Records of Former Employees ................................................................................ 48
Section 5. Remedies of Employees Objecting to Material in File ............................................. 48
Section 6. Penalties for Permitting Access to Confidential Records ........................................ 49
Section 7. Examining and/or Copying Confidential Material without ........................................ 49
Section 8. Destruction of Records Regulated .......................................................................... 49
ARTICLE XII. IMPLEMENTATION OF POLICIES .................................................................. 50
Section 1. Conflicting Policies Repealed .................................................................................. 50
Section 2. Separability .............................................................................................................. 50
Section 3. Effective Date .......................................................................................................... 50
Section 4. Amendments ............................................................................................................................50
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ARTICLE I. GENERAL PROVISIONS
Section 1. Purpose of the Policy
It is the purpose of this 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, Board of Health, and
Social Services Board. These aforementioned entities are the official appointing authorities
covered by this personnel policy. State requirements will supersede these policies for positions
subject to the State Personnel 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.
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, political affiliation,
qualified disability, or age.
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 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;
e) develop and administer such recruiting programs as may be necessary to obtain an
In the event there is no Human Resources Office, these duties will be assumed by the County
Manager or his/her designee.
f) adequate supply of competent applicants to meet the needs of the County;
g) perform such other duties as may be assigned by the County Board of
Commissioners not inconsistent with this Policy; and
h) appoint an employee to the role of Human Resources Director or serve in that role
for the County.
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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;
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.
In the event there is no Human Resources Office, these duties will be assumed by the County
Manager or his/her designee.
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 purposes 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.
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Anniversary Date. The employee’s most recent date of employment with the county service in
a permanent position.
Appointing Authority. The County Manager will be designated as the Appointing Authority with
the following exceptions:
a) The Sheriff shall be the appointing authority for positions in the Sheriff’s Department;;
b) The Register of Deeds shall be the appointing authority for positions in the Register of
Deeds Department;
c) The Board of Elections shall be the appointing authority for positions in the Elections
Department;
d) The Social Services Director shall be the appointing authority for positions in the Social
Services Department; and
e) The Health Director shall be the appointing 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.
Client/Employee. Employees who work for Person Industries in a structured environment for
the purposes of vocational rehabilitation. Such employees are not in permanent positions and
are not eligible for benefits.
Full-time employee. An employee who is in a position for which an average work week equals
at least 37.5 hours, and continuous employment of at least 12 months, is required by the
County. Such employees are eligible for benefits.
Part-time employee. An employee who is in a position for which an average work week of at
least 22.5 hours and less than 37.5 hours and continuous employment of at least 12 months are
required by the County. Such a position is eligible for benefits.
Permanent position. A position authorized for the budget year for a full twelve months and
budgeted for 22.5 or more hours per week. All County positions are subject to budget review
and approval each year by the Board of Commissioners and all employees' work and conduct
must meet County standards. Therefore, reference to "permanent” positions or employment
should not be construed as a contract or right to perpetual funding or employment.
Probationary employee. An employee appointed to a full or part-time regular 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.
Production/Employee. Employees who work for Person Industries in a structured environment
for the purposes of production demand. Such employees are not in permanent positions and are
not eligible for benefits.
Regular employee. An employee appointed to a full or part-time position who has successfully
completed the designated probationary period.
Temporary employee. An employee appointed to a position for which either the average work
week required by the County over the course of a year is 20 hours or less ( or 1000 hours per
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year), or continuous employment required by the County is less than 12 months. Such
employees are not eligible for benefits.
Trainee. An employee status when an applicant is hired (or employee promoted) who does not
meet all of the requirements for the position. During the duration of a trainee appointment, the
employee is on probationary status.
Work Against Appointment. In departments whose employees are subject to the State
Personnel Act, the appointing 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 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 without
clear justification.
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 insure 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 Departments of Social Services and Public Health will be classified by the NC
Office of State Personnel in compliance with the rules and regulations under the State
Personnel 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. The Office of State
Personnel shall administer the classification plan for employees who are subject to the State
Personnel Act.
Section 5. Authorization of New Positions and the Position Classification Plan
New positions shall be established upon recommendation of the 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. Copies will be available to all employees for review upon request.
Section 6. Request for Reclassification
Any employee 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 make the necessary changes to
maintain a fair and accurate classification plan.
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 County Commissioners. The salary schedule may consist
of a Hiring, Minimum, Midpoint, and Maximum rates of pay for each job classification approved
by the Board of County Commissioners. Salary increases within the pay range shall be based
on criteria established by the County Manager and approved by the Board of County
Commissioners.
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. The Board shall adopt the Salary
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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 not to exceed ten
percent when necessary to accommodate inequities, special performance or achievements, or
other issues.
Section 3. Starting Salaries
All persons employed in positions approved in the position classification plan normally shall be
employed at the Hiring Rate for the classification in which they are employed; however, on the
recommendation of the department head, with the approval of the County Manager, employee
salaries may be approved above the Hiring Rate. Reasons for hiring above the Hiring Rate
include exceptional education and experience qualifications of the applicant, a shortage of
qualified applicants, and/or the refusal of qualified applicants to accept employment at the Hiring
Rate. Department Heads shall consider internal equity of other employees in the department
when making a recommendation for employment above the Hiring Rate.
Elected officials, i.e. the Sheriff and Register of Deeds, shall be paid upon initial election or
appointment, at the entry rate of pay for the position because there is no appointing authority to
make decisions concerning their qualifications for placement above the hiring rate.
Section 4. 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
Personnel 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 three grades below the Hiring
rate established for the position for which the person is being trained. Assignment three grades
below is appropriate when the traineeship is expected to last two years. Assignment two grades
below is appropriate for more than six months but less than two years. (Note: Positions subject
to the State Personnel Act may be assigned no more than two grades below as 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 Hiring rate established for the job class.
Section 5. Probationary Pay Increases
Employees hired or promoted into the Hiring Rate of the pay range shall receive a salary
increase within the salary range of approximately 5% upon successful completion of the
probationary period. Employees serving a twelve-month probationary period are eligible for
consideration for this pay increase after nine months of successful employment. Employees
hired or promoted above the hiring rate may also be considered for an increase when removed
from probationary status, based upon performance level.
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Section 6. 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 7. Performance Pay Bonus
If the County implements a performance pay system, employees who are at the maximum of the
salary range for their position classification will be eligible to be considered for a performance
(merit) bonus at their regular performance evaluation time. Performance (merit) bonuses shall
be awarded based upon the performance of the employee as described in the performance
evaluation and shall be the same percentage of annual salary as employees within the salary
range with the same performance level. Performance (merit) bonuses do not become part of
base pay and shall be awarded in a lump sum payment. Employees above the maximum of the
range are not eligible for this increase.
Section 8. Salary Effect of Promotions, Demotions, Transfers, and Reclassifications
(See Article IV for definitions of these terms)
Promotions. When an employee is promoted to a position with a higher salary grade, the
employee's salary shall normally be advanced to the Hiring Rate of the new position, or to a
salary which provides an increase of at least approximately 5% over the employee's salary
before the promotion, provided, however, that the new salary may not exceed the Maximum rate
of the new salary range. The purpose of the promotional pay increase is to recognize and
compensate the employee for assuming increased responsibility. The amount of the salary
adjustment should be based on:
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.
Cost of living (or market adjustment), probationary increases for a previous job, 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.
Demotions. When an employee is demoted to a position for which qualified, the salary shall be
set at the rate in the lower pay range which provides a salary commensurate with the
employees’ qualifications to perform the job when the demotion is not the result of discipline. If
the current salary is within the new range, the employee's salary may be retained at the
previous rate, if appropriate. Consideration should be given to whether the employee is
receiving the same pay for decreased workload or responsibility level and action should be
appropriate to this consideration along with internal equity consideration of the pay rate of other
employees in the same classification. If the demotion is the result of disciplinary action, the
salary shall be decreased at least approximately 5%, but may be no greater than the maximum
of the new range.
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Transfers. The salary of an employee reassigned to a position in the same class or to a
position in a different class within the same salary grade shall not be changed by the
reassignment.
Reclassifications. An employee whose position is reclassified to a class having a higher salary
range shall receive a pay increase of approximately 5% or an increase to the Minimum Rate of
the new pay range, whichever is higher. If the position is reclassified to a lower pay range, the
employee's salary shall remain the same. If the employee's salary is above the maximum
established for the new range, the salary of that employee shall be maintained at the current
level until the range is increased above the employee's salary.
Section 9. 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, employees in that class shall receive a 5% increase for each salary grade increase,
if such increases do not exceed the midpoint of the new range. The employee shall receive a
minimum of 5% for the range revision, even if such increases takes the employee above the
midpoint of the new range. 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 10. Transition to a New Salary Plan
The following principles shall govern the transition to a new salary plan:
1) No employee shall receive a salary reduction as a result of the transition to a new salary
plan.
2) 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.
The only exception will be those employees in probationary status and currently being
paid at the Hiring, a trainee rate, or in a "work against" status. These employees will
remain in their same relative pay status in the new salary grade assigned.
3) 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.
4) 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.
Section 11. Effective Date of Salary Changes
Salary changes approved after the first working day of a month shall become effective at the
beginning of the next month, or at such specific date as may be provided by procedures
approved by the County Manager. This applies to probationary pay increases and certification
increases. Section 8: Promotions, Demotions, Transfers and Reclassifications salary changes
will be effective on the day it occurs.
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Section 12. 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.
The County will comply with the Fair Labor Standards Act (FLSA). The County Manager 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 compensated in time or 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.
Earned compensatory time may be granted whenever feasible and determined by the County
Manager, based on recommendations from the Department Head. Accumulation of more than
eighty hours of compensatory time is discouraged and must have the approval of the County
Manager. However, under FLSA provisions, non-exempt employees may accumulate up to 240
hours of compensatory time (sworn law enforcement officers may accumulate up to 480 hours).
Nonexempt employees separating from employment shall be paid for their compensatory time
balances.
In declared disaster or emergency situations such as a FEMA declared emergency where
employees are 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 (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.
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In declared disaster or emergency situations requiring long and continuous hours of work,
exempt employees may be compensated at a rate of up to double time for the duration of the
emergency period, at the approval of the County Manager. employees cannot count as part of
the 12 weeks of eligible Family and Medical Leave (FMLA).
Section 13. 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 for emergency service,
either special or routine, the employee may be subject to disciplinary action up to and including
dismissal by the appointing authority.
On-call. On-call (standby) time consists of scheduled non-work hours in excess of the standard
work period when an employee is required to be available to be called back to work on a
regularly scheduled or emergency basis and must respond within a reasonable period of time
and must be sober and able to work. On-call /standby 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.
An employee is required by FLSA to be compensated regular pay for on-call time if he or she
must remain near an established telephone or otherwise substantially restrict personal activities
in order to be ready to respond when called. The County chooses to compensate employees at
a rate less than regular pay for the inconvenience of on-call pay when a pager is used and time
is not substantially restricted. Non-exempt employees required to be on "stand-by" duty will be
paid for five hours of work for each week (approximately 128 hours, excluding work time) of
stand-by time they serve. Stand-by compensation for less than one full week shall be
determined by the ratio of .04 hours of pay per one hour of stand-by time. Hours actually worked
while on stand-by are calculated beginning when the employee reports to the work site and are
added to the regular total of hours worked for the week
Call-back. Call-back time consists of actual time spent when called back to work to handle an
emergency situation. Non-exempt employees will be guaranteed a minimum payment of two
hours of wages for being called back to work outside of normal working hours when not on
stand-by. "Call-back" provisions do not apply to previously scheduled overtime work (scheduled
one or more days in advance).
Section 14. Payroll Schedule and Deductions
The payroll schedule shall be established by the County Manager and shall be administered by
the Finance Department. 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.
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Section 15. 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 per
week and law enforcement officers working an average of 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 16. Longevity Pay
Full and part-time permanent employees of the County are compensated for continuous years of service
with the County by payment of a longevity supplement based on continuous years of service as of
November 1st of each year. Continuous service is continuous employment including any approved leave
or involuntary reduction in force.
Longevity amounts shall be as follows:
Years of Service Amount
5 years, but less than 10 years 1% of annual salary
10 years, but less than 15 years 2% of annual salary
15 years, but less than 20 years 3.25% of annual salary
20 years, but less than 25 years 4.5% of annual salary
25 years or more 5.75% of annual salary
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 County Commissioners. The funding will be allocated on an
annual basis during the budget adoption process.
*Employees hired on or after July 1, 2011 will not be eligible for longevity pay until they have completed
five years of continuous service. Those employees hired prior to July 1, 2011 shall be entitled to the
longevity benefits in effect on January 1, 2011.
(Amended March 21, 2011 by Person County Board of County Commissioners)
Section 17. Pay for “Interim” Assignment in a Higher Level Classification
An employee who is formally designated for a period of a least one month to perform the duties of a
Job that is assigned to a higher salary grade than that of the employee’s regular classification shall
Receive an increase for the duration of the “interim” assignment. The employee shall receive a
Salary adjustment to the entry level (Hiring rate) of the job in which the employee is acting or an
increase of 10%. Criteria involved in determining the amount of compensation shall include
a) the difference between the existing job and that being filled on a temporary basis, and
b) The degree to which the employee is expected to fulfill all the duties of the temporary
assignment.
The salary increase shall be temporary and the employee shall go back to the salary he or she would have
had in not assigned to the “acting” role upon completion of the assignment.
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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,
political affiliation, qualified disability, marital status, or age. 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, political affiliation, qualified disability, marital status, or age.
Notices with regard to equal employment matters shall 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. The North Carolina Employment Security Commission shall
normally be used as a recruitment source. In rare situations because of emergency conditions,
high turnover, etc., the County may hire or promote without advertising jobs, upon approval of
the County Manager.
Job Advertisements. Employment advertisements shall contain assurances of equal
employment opportunity and shall comply with Federal and State statutes.
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.
Application Reserve File. Applications shall be kept in an inactive reserve file for a period of
two years, in accordance with Equal Employment Opportunity Commission guidelines.
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.
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 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
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documents pertaining to the selected candidate should be submitted to the County Manager’s
office prior to the beginning date of employment. The documents will become part of the new
employees 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 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. A promoted
employee who does not successfully complete the probationary period 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 employees shall retain all other rights
and benefits such as the right to use of the grievance procedures.
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
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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 six
month probationary period.
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.
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
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organizations, business firms, or individuals with whom they have official relationships because
of 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.
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
A full or part-time employee of the County may simultaneously hold another position with the
County if the temporary position is in a different department or agency and substantially different
capacity and occupational area from that of the full or part-time position. The work must also be
performed on an occasional or sporadic basis. Any other situation requires weighted average
pay scales and/or overtime pay. However, the work of the full or part-time position shall take
precedence over the temporary 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 in Article VII, Section 12. If there is a
lack of qualified applicants for a position in the same unit and a qualified immediate family
member applies, the supervisor may appeal to the County Manager for consideration.
Otherwise, 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;
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 or disability
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, gender, national origin,
age, or disability, or that of his or her relatives, friends, or associates.
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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 insure 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.
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. 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 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. The County shall develop and distribute to
employees a separate policy covering the use of phones, email, computers, and county cell
phones.
Under North Carolina law, email sent or received by the County is considered a public records
and is subject to inspection upon request.
Surrender of Property. An employee who terminates employment shall be required to return all
items of equipment, including uniforms, owned by the County.
Section 9. Performance Evaluation
Supervisors and/or Department Heads shall conduct Performance Evaluation conferences with
each employee at least once a year. These performance evaluations shall be documented in
writing and placed in the employee's personnel file. Procedures for the performance evaluation
program shall be published by the County Manager.
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 insuring 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.
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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.
Section 12. Substance Abuse
The County is firmly committed to maintaining a drug and alcohol free work environment in
order to insure the safety and welfare of the general public and all County employees and to
insure 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.
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 is 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.
ARTICLE VI. EMPLOYEE BENEFITS
Section 1. Eligibility
All part-time and 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 the County's
discretion. Temporary 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 and
parttime 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 Director.
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.
Section 5. Retirement
Each employee in a permanent position 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.
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Employees contribute, through payroll deduction, six per cent 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.
Retiree Health Insurance
The County provides health insurance for retirees according to the following guidelines:
a) The County will pay 50% of the cost of the premiums for an employee retiring with 20
years of service with Person County;
b) The County will pay 75% of the cost of the premiums for an employee retiring with 25
years of service with Person County;
c) Then County will pay 100% of the cost of the premiums for an employee retiring with
30 years of service with Person County.
Coverage will continue until the employee becomes eligible for Medicare, at which time the
County will no longer pay any of the premium cost. The cost for the employee’s share of the
premiums, if any, will be determined on an annual basis. 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.
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 and part-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 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 vacations 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 and the supervisor and such claims must be filed by the employee with the North
Carolina Industrial Commission within two years from date of injury. The Human Resources
Director or designee will coordinate the filing of such claims.
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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 total of eight hundred dollars ($800) per fiscal year. Satisfactory completion of
the courses will be required for reimbursement. Requests for tuition assistance shall be
submitted to the Human Resources Office prior to course registration and are subject to the
review and approval of Department Head and County Manager, subject to availability of funds.
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 Personnel Act and their family members
for various loan services, checking, and savings accounts.
ARTICLE VII. HOLIDAYS AND LEAVES OF ABSENCE
Section 1. Policy
The policy of the County is to provide vacation leave, sick leave, and holiday leave to all full-
time and part-time employees in a permanent position with the County. . Leave balances should
accrue with each payroll when employees work or are on a paid leave status. Leave balances
should be printed on payroll checks or provided to employees with each paycheck, including net
accrued sick leave, vacation, 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.
The number of holiday hours earned by employees shall be determined in accordance with the
formula set forth in Section 15 of this article.
Departments which have staff working during holidays may designate which days of the week
are to be observed using the actual legal holidays when appropriate.
Section 3. Holidays: Effect on Other Types of Leave
Regular holidays which occur during a vacation, sick or other leave period of any employee
shall not be considered as vacation, sick, or other leave.
Section 4. Holidays: Compensation When Work is Required /Shift Work
Employees required to perform work on regularly scheduled holidays shall receive the
proportionally equivalent amount off for the holiday or receive pay in lieu of time off as described
in Section 15 of this Article.
If a holiday falls on a regularly scheduled off-duty day for shift personnel, the employee shall
receive pay for the proportionately equivalent holiday leave hours. Departments with employees
working a shift schedule may elect to compensate those employees for working on the “true”
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holiday rather than the designated holiday.
Section 5. Vacation Leave
Vacation leave may be used for rest and relaxation, school appointments, medical
appointments, and other personal needs. Employees must request vacation leave from their
supervisor in advance. Vacation 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 insuring proper staff coverage and may refuse vacation
requests when they create a hardship for the County.
Section 6. Vacation Leave: Use by Probationary Employees
Employees serving a probationary period following initial employment may accumulate vacation
leave but shall not be permitted to take vacation leave during the probationary period.
Employees serving a twelve month probationary period shall be allowed to take accumulated
vacation leave after nine months of service.
Section 7. Vacation Leave: Accrual Rate
Each full time permanent employee of the County shall earn vacation at the following schedule,
Years of Service Days Accrued Per Year
0 - 4 12
5 - 9 15
10 - 14 18
15 - 19 20
20 plus 21
Part-time permanent employees of the County shall earn vacation at a pro-rated amount. See
Section 15 Leave Pro-Rated.
Vacation should be accrued in each payroll period
Section 8. Vacation Leave: Maximum Accumulation
Vacation 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 removed so that only 30 days are
carried forward to January 1 of the next calendar year. Employees may have the entire excess
amount converted to sick leave provided that the employee has taken a minimum of five
consecutive days of vacation during the calendar year. Holidays may not be counted for this
purpose. It must be five consecutive work days.
Because the number of hours in employee work weeks vary, the number of hours in 30 days
varies. See Section 15 of this Article for formula to calculate the number of hours in 30 days.
Employees are cautioned not to retain excess accumulated vacation leave until late in the year.
Because of the necessity to keep all functions in operation, large numbers of employees cannot
be granted vacation 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 vacation leave scheduled
or in receiving any exception to the maximum accumulation. Employees may not receive pay for
excess vacation time.
Section 9. Vacation Leave: Manner of Taking
Employees shall be granted the use of earned vacation 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 vacation leave does not
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hinder the effectiveness of service delivery. Vacation leave will be taken in quarter hour units.
Section 10. Vacation Leave: Payment upon Separation
An employee who has successfully completed nine months of the 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. 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.
Employees who are involuntarily separated shall receive payment for accumulated annual leave
subject to the 30-day maximum.
Section 11. Vacation 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 vacation 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 an employee 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 for death in the employee's immediate family, but may not exceed
three days for any one occurrence.
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" shall be defined as 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.
Notification of the desire to take sick leave should be submitted to the employee's supervisor
prior to the leave or not later than two hours after the beginning of the scheduled workday.
Failure to do so appropriately may result in disciplinary action.
In order to facilitate the recruitment of qualified persons with appropriate public sector
experience, the County Manager may authorize the carry-over of all or a portion 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.
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. Part-time permanent employees see Section 15. Leave Pro-Rated. 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.
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All sick leave accumulated by an employee shall end and terminate without compensation
whenthe employee resigns or is separated from the County, except as stated for employees
retiring or terminated due to reduction in force.
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 or whenever the
supervisor observes a "pattern of absenteeism." 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. Leave Pro-Rated
Holiday, annual, and sick leave earned by part-time permanent employees with fewer hours
than the basic work week shall be determined by the following formula:
1) The number of hours worked by such employees shall be divided by the number
of hours in the basic work week (usually 40 hours).
2) The proportion obtained in step 1 shall be multiplied by the number of hours of
leave earned annually by employees working the basic work week.
3) The number of hours in step 2 divided by 12 shall be the number of hours of
leave earned monthly by the employees concerned; the number of hours in step
2 divided by 26 is the number of hours earned per bi-weekly payroll period.
Example:
step 1) working hours 22.50/37.50 basic work week=.60
step 2) 7.50 x 12 = 90.00 hours annual x .60 (step 1) = 54.00 earned
step 3) 54.00/12=4.50 per month
Section 16. Leave Without Pay
A full or part-time permanent employee may be granted a leave of absence without pay for a
period of up to six months by the County Manager. The leave shall be used for reasons of
personal disability after both sick leave and desired amount of annual leave have been
exhausted, 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. The employee is
obligated to return to duty within or at the end of the time determined appropriate by the County
Manager. Upon returning to duty after being on leave without pay, 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. 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 has been requested, shall be considered a resignation.
Section 17. Family Medical Leave
The County will grant up to 12 weeks of family and medical leave to eligible employees in
accordance with the Family and Medical Leave Act of 1993 (FMLA) during any 12-month period
beginning on the date paid leave is exhausted. Eligible employees must have regular status and
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must have been employed at least twelve months and worked at least 1,250 hours during the
previous twelve months. The leave will be unpaid. Additional time away from the job beyond the
12-week period may be considered in accordance with the County's Leave Without Pay policy.
Employees will be required to exhaust eligible paid leave before going on a leave without pay
status.
FMLA leave may be taken for the following reasons:
(a) to care for the employee's child after birth or placement for adoption or foster care;
(b) to care for the employee's spouse, child or parent who has a serious health condition;
or
(c) for a serious health condition that makes the employee unable to perform the
employee's job.
Use of earned compensatory leave may not count toward FMLA leave.
A serious health condition is defined as a 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. This policy covers illness of a serious and long-term nature
resulting in recurring or lengthy absences. Generally, a chronic or long term health condition
which results in a period of incapacity for more than three days would be considered a serious
health condition.
If a husband and wife both work for the County and each wishes 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 husband and wife together may only take a total of 12 weeks
leave under FMLA.
The request for the use of leave must be made in writing by the employee and approved by the
department head or County Manager.
An employee who takes leave under this policy will 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.
Section 18. 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). 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 in writing under the County's Leave
Without Pay policy
Section 19. 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. 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.
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Other insurance and payroll deductions are the responsibility of the employee and the employee
must make those payments for continued coverage of that benefit.
An employee ceases to earn leave credits on the date leave without pay begins. 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 and the
regulations of the insurance carrier.
Section 20. Workers' Compensation Leave
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, vacation, or compensatory
time during the first waiting period. The employee may also elect to supplement workers'
compensation payments after they begin with sick leave, vacation, or compensatory time,
provided that the combination of leave supplement and workers' compensation payments does
not exceed normal compensation. An employee on workers' compensation leave may be
permitted to continue to be eligible for benefits under the County 's group insurance plans.
When workers' compensation leave extends long enough for the waiting 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.
a) 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
Director within twenty-four (24) hours of the time of the accident. The employee
must use sick leave or annual leave for the first seven (7) days of disability.
These days will be reimbursed only if the disability continued for more than
twenty-one (21) days.
b) Before returning to work, a statement from the attending physician should be
submitted to the Human Resources Director giving permission for the employee
to resume regular duties.
c) Upon return to work, 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. While receiving workers' compensation benefits, an employee
continues to earn sick and annual leave and will retain all accumulated sick and
annual leave.
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 21. Military Leave
Regular employees who are members of an Armed Forces Reserve organization or National
Guard shall be granted ten workdays per year for military leave without pay. On rare occasions
due to annual training being scheduled on a federal fiscal year basis, an employee may be
required to attend two periods of training in one calendar year. For this purpose only, an
employee shall be granted an additional ten days of military leave during the same calendar
year. If the compensation received while on military leave is less than the salary that would have
been earned during this same period as a County employee, the employee shall receive partial
compensation equal to the difference in the base salary earned during this same period as a
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County employee. The effect will be to maintain the employee's salary at the normal level during
this period.
If such duty is required beyond this ten workdays, the employee shall be eligible to take
accumulated vacation leave or be placed in a leave without pay status, and the provisions of
that leave shall apply.
While taking military leave without pay or with partial pay, the employee's leave credits and
other benefits shall continue to accrue as if the employee physically remained with the County
during this period. Employees who are eligible for military leave have all job rights specified by
the Vietnam Veterans Readjustment Act, including members of the National Guard or a reserve
unit.
Employees who volunteer for additional duty may use vacation, compensatory time or leave
without pay. If there is a compensatory balance, it should be used first for nonexempt
employees.
Section 22. Reinstatement Following Military Service .
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 23. Civil Leave
A County employee called for jury duty 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.
Section 24. 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.
Paid leave (vacation 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.
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Section 25. Voluntary Shared Leave
Purpose
There are occurrences brought about my 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 annual 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 annual 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 annual 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 975 hours, 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 1,950 hours, 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.
Administration
This program shall be administered within the department of the recipient employee under the
following conditions:
I. Qualifying to Participate
A. Employee must be permanent, probationary, work against or trainee
appointment status.
B. By letter of application to the department head, a recipient shall apply, or be
nominated by a fellow employee to participate in the program.
C. Application for participation would include name, social security number,
classification, department, description of the medical condition and
estimated length of time needed to participate in the program.
D. Prior to making the employee’s status public for purpose of receiving
shared leave, the employee must sign a release to allow the status to be
known.
E. The department head shall review the merits of the request and approve or
disapprove. Department heads may choose to delegate the responsibility
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for reviewing the validity of requests to an existing peer group or establish
a committee for this purpose. Such a committee may also be used in an
advisory capacity to the department head.
F. Establishment of a leave “bank” for use by unnamed employees is expressly
prohibited.
G. For program evaluation purposes during the two (2) year trial period, each
department shall forward a copy of each application received for receipts,
indicating approval or disapproval, to the personnel office. Other
summary information including number of requests, approvals,
disapprovals, amount of leave donated and used will be
requested to develop recommendations for the future of the program.
II. Participation Requirements
A. A donor may contribute only annual 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.
F. 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 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 can not
receive remuneration for the leave donated.
III. Donor Leave Accounting and Usage Procedures
A. 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 donor’s 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. 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.
Three consecutive days of absence without contacting the immediate supervisor or Department
Head is 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
Consistent with State and Federal Laws
An employee who cannot perform the required duties because of a physical or mental
impairment 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.
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 one year
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.
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Section 9. Rehiring
An employee who resigns while in good standing may be rehired with the approval of the
appointing 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. An employee in good
standing who is separated due to a reduction in force shall be given the first opportunity to be
rehired in the same or a similar position.
ARTICLE IX. UNSATISFACTORY JOB PERFORMANCE AND DETRIMENTAL PERSONAL
CONDUCT
Section 1. Disciplinary Action for Unsatisfactory Job Performance
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 or hiring authority prior to giving final notice to the employee.
Section 2. Unsatisfactory Job Performance 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) Physical or mental incapacity to perform duties;
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; or
i) Failure to meet work standards over a period of time.
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 in one or
more counseling sessions to discuss specific performance problems. A brief summary of these
counseling sessions should be noted in the employee's file by the supervisor. An employee
whose job performance is unsatisfactory over a period of time should normally receive at least
two warnings from the supervisor before disciplinary action resulting in dismissal is taken by the
County Manager or appointing authority. In each case, the supervisor should record the dates of
discussions with the employee, the performance deficiencies discussed, the corrective actions
recommended, and the time limits set. If the employee's performance continues to be
unsatisfactory, then the supervisor should use the following disciplinary steps:
a) A final written warning from the supervisor serving notice upon the employee that
corrected performance must take place immediately in order to avoid
suspension, demotion, or dismissal.
b) If performance does not improve, a written recommendation should be sent to the
Department Head, Human Resource Director, and County Manager or Hiring
Authority for disciplinary action such as suspension, demotion, or dismissal.
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Suspensions should not normally exceed three days for nonexempt employees. For exempt
employees, suspensions should normally be for one week to retain the exempt status of the
employee.
Section 4. Disciplinary Action for Detrimental Personal Conduct
With the approval of the Department Head, Human Resource Director, and County Manager 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.
Disciplinary suspension should not normally exceed three days for nonexempt employees and
should be one full week for exempt employees as prescribed by the FLSA.
Section 5. Detrimental Personal Conduct Defined
Detrimental personal conduct includes behavior of such a serious detrimental nature that the
functioning of the County 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.
Examples of detrimental personal conduct include, but are not limited to, the following:
a) Fraud or theft;
b) Commission of a felony or the entry of a plea of nolo contendere thereto;
c) Falsification of records for personal profit, to grant special privileges, or to obtain
employment;
d) Willful misuse or gross negligence in the handling of County funds;
e) Willful or wanton damage or destruction to property;
f) Willful or wanton acts that endanger the lives and property of others;
g) Possession of unauthorized firearms or other lethal weapons on the job;
h) Brutality in the performance of duties;
i) 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;
j) Engaging in incompatible employment or servicing a conflicting interest;
k) Request or acceptance of gifts in exchange for favors or influence;
l) Engaging in political activity prohibited by this policy; or
m) Stated refusal to perform assigned duties or flagrant violation of work rules and
regulations.
Section 6. Pre-Dismissal Conference .
Before dismissal action is taken, whether for detrimental personal conduct or unsatisfactory job
performance, the County Manager or Hiring authority, the Human Resource Director or a
Department Head will conduct a pre-dismissal conference. At this conference, the employee
may present any response to the proposed dismissal to the County Manager or Hiring Authority,
Human Resource Director or Department Head. The County Manager or Hiring Authority,
Human Resource Director or Department Head will consider the employee's response, if any, to
the proposed dismissal, and will, within three working days following the pre-dismissal
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 7. Non-Disciplinary Suspension
During the investigation, hearing, or trial of an employee on any criminal charge, or during an
investigation related to alleged detrimental personal conduct, or during the course of any civil
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action involving an employee, when suspension would, in the opinion of the supervisor, be in
the best interest of the County, the Department Head, with the approval of the Human Resource
Director and the County Manager or Hiring Authority, may suspend the employee for the
duration of the proceedings as a non-disciplinary action. 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, or
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.
If the employee is reinstated following the suspension such employee shall not lose any benefits
to which otherwise employee would have been entitled had the suspension not occurred. If the
employee is terminated following suspension, the employee shall not be eligible for any pay
from the date of suspension; provided, however, all other benefits with the exception of accrued
annual leave and sick leave shall be maintained during the period of suspension.
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.
Section 2. Grievance Defined
A grievance is a claim or complaint by an employee based upon an event or condition, which
affects the circumstances under which an employee works, allegedly caused by
misinterpretation, unfair application, or lack of established policy pertaining to employment
conditions. Former employees may appeal their termination from County employment within
required time frames.
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
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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.
Section 4. Procedure
When an employee or group of employees 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, and every effort should be
made to expedite the process. However, the time limits set forth may be extended by mutual
consent. 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 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. Mediation may be used at any step in the process and is encouraged.
Mediation is the neutral facilitation of the conflict between or among parties where the facilitator
helps the parties find a mutually agreeable outcome.
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. 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 or Hiring Authority within five work days after receipt of the response from
Step 2. The 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 Hiring
Authority’s decision is final. However, the County Manager should inform the County Board of
Commissioners of any possible legal actions. Any appeal of this decision must be made through
the North Carolina Court System.
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 only in the Health and Social Services Departments) 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 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. Discrimination cases may be appealed directly to the OAH.
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Department Heads. In the case of department heads or other employees where the 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 Hiring Authority
(see definition of mediation in informal resolution above); or
b) consider the appeal and make recommendations back to the 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 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 assist employees and supervisors in drafting statements; and
e) To facilitate the resolution of conflicts in the procedures or of the grievance at any
step in the process; and
f) To help locate mediation or other resources as needed.
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. Grievance and Adverse Action Appeal Procedure for Discrimination
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, or disability) he or she has the right to appeal such action using the grievance
procedure outlined in this policy. While such persons are encouraged to use the grievance
procedure, they shall have the right to 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.
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 service; current position title; current salary; date and amount of the most recent increase
or decrease in salary; date of the most recent promotion, demotion, transfer, suspension,
separation, or other change in position classification; and the office to which the employee is
currently assigned. Any person may have access to this information for the purpose 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.
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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 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, with the concurrence of the County Board, 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.
The County Board shall establish procedures for all personnel files containing information other
than the public information mentioned above whereby an employee who objects to material may
seek to have the material removed from the file or may place in the file a statement relating to
the material.
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. Any documents
not contained in these files or maintained as designated by the Human Resources Director are
not an official part of the personnel file.
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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.
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.
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. Separability
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 approved by the County Board of
Commissioners.
Section 4. Amendments
This policy may be amended by action of the Board of Commissioners and by resolution
appropriately approved. Notice of any suggested amendment to the policy, or any portion
thereof, shall be provided to employees and opportunities for employee comment and reaction
shall be made available prior to the amendments going to the Commissioners for action.
Proposed amendments should be posted on bulletin boards in all employee work locations
and/or in employee newsletters. Any revisions or amendments adopted in conformance with this
procedure shall become effective as of the date of such adoption.
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Meeting Date: June 19, 2017
Agenda Title: DSS Attorney Contracts for FY 2017-2018
Summary of Information: Contracts for legal services to be paid at an hourly rate to
agency’s primary attorney, Tom Fitzgerald, and secondary attorneys, Walter Cates, Julie
Ramsey, and Joe Weinberger. There are separate contracts for Child Support services
therefore two contracts per attorney are attached.
There are no proposed changes to the contracts.
Recommended Action: Approval
Submitted By: Carlton B. Paylor, Sr., MBA
Director, Person County Department of Social Services
408
Contract # 1006
Joe Weinberger, Jr.
Page 1
Contract # 1006 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
This contract is hereby entered into by and between the Person County Department of Social
Services (the "County") and Joseph Weinberger, Jr. (the "Contractor") (referred to collectively
as the “Parties”). The Contractor’s federal tax identification number is 56-153 8949.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Secondary Attorney
Joseph Weinberger, Jr. is $75 per hour.
409
Contract # 1006
Joe Weinberger, Jr.
Page 2
Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Joseph Weinberger, Jr., Attorney
P.O. Box 770 P.O. Box 1215
355B South Madison Boulevard 114 North Main Street
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 599-4959
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 56-153 8949
NORTH CAROLINA
DUPLICATE ORIGINAL
PERSON COUNTY
LEGAL SERVICES AGREEMENT
THIS Agreement, made and entered into this the 1st day of July, 2017, by and between
the PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES, hereinafter referred to as
Agency, and Joseph Weinberger, Jr., Attorney at Law, hereinafter referred to as Attorney.
W I T N E S S E T H :
THAT WHEREAS, the Agency has determined that it has need for legal services and
consultation beyond those presently being provided by the county attorney;
AND WHEREAS, the Attorney is a member in a reputable law firm with an office in
Person County, North Carolina, and has expertise in the field of social services law, rules and
regulations, and the Agency is desirous of obtaining such legal services from said Attorney on a
continuing basis;
NOW, THEREFORE, it is hereby agreed that the Attorney shall provide legal services to
the Agency in the nature of consultations, interpretation of social services laws and regulations
and drafting of legal documents when necessary on the following terms and conditions:
1
The Attorney shall make himself available and on call to the Agency on a prompt basis
for the purposes herein above described until June 30, 2018. At the end of said period, the
arrangement herein described will be analyzed by the parties hereto to determine if same is
effective and fair to all parties concerned and revised or terminated accordingly as deemed
necessary.
2
The Agency shall pay for such legal services to the Attorney the sum of 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 hour of legal services performed, same to be due and 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.
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3
The Attorney will assist the Agency in maintaining records of the legal services provided
as same are necessary for the agency in filing its reports and funding statements.
4
It is understood and agreed that the legal services provided pursuant to this contract will
be in addition to those provided by the county attorney and not in substitution nor duplication of
such services by the county attorney.
5
It is specifically agreed that Attorney is an independent contractor and shall perform the
legal services herein provided according to his own judgment and method and shall not be
subject to control of the Agency except as to the result of his work.
6
The Attorney shall not under any circumstance be considered an employee of the
Agency. The Agency shall not withhold federal or state taxes from sums paid to the Attorney
pursuant to this agreement.
IN WITNESS WHEREOF, the parties have executed this agreement in duplicate
originals, one of which is retained by each of the parties hereto, on the day and year first above
written.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
114 North Main Street, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Joseph Weinberger, Jr., Attorney At Law
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Joseph Weinberger,
Jr., Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
Joe Weinberger, Jr.
Attorney and Counselor at Law
ll4 NORTH MAIN STREET
P.O. BOX l2l5
ROXBORO, NORTH CAROLINA 27573
JOE WEINBERGER, JR. TELEPHONE
336-599-2239
FAX 336-599-2239
E-MAIL wein@osinc.net
______________, 2017
To: Person County Department of Social Services
Certification:
I, Joseph Weinberger, Jr., certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1,
at the federal, State, or local level. I further understand that any person who makes a false statement in
violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.)
143C-10-1b.
Sworn Statement:
I, Joseph Weinberger, Jr., being duly sworn, say that the foregoing certification is true, accurate and complete
to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment
agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Joseph Weinberger, Jr., Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Joseph Weinberger, Jr.
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Joseph Weinberger, Jr.
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Attachment N
CERTIFICATION OF
ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Joseph Weinberger, Jr., Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Joseph Weinberger, Jr., Attorney At Law, shall not utilize on any contract with
the State agency any subcontractor that is identified on the Final Divestment List;
and
3. that Joseph Weinberger, Jr., Attorney At Law, is authorized to make this Certification.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
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Contract # 1007 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
This contract is hereby entered into by and between the Person County Department of Social
Services (the "County") and Joseph Weinberger, Jr. (the "Contractor") (referred to collectively
as the “Parties”). The Contractor’s federal tax identification number is 56-153 8949.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Secondary Attorney
Joseph Weinberger, Jr. is $75 per hour.
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Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Joseph Weinberger, Jr., Attorney
P.O. Box 770 P.O. Box 1215
355B South Madison Boulevard 114 North Main Street
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 599-4959
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 56-153 8949
STATE OF NORTH CAROLINA )
)
) CONTRACT FOR LEGAL SERVICES
)
COUNTY OF Person )
THIS CONTRACT made and entered into this the 1st day of July, 2017, by and
between the Person County Commissioners, party of the first part, and Joseph
Weinberger, Jr., Attorney, party of the second part;
W I T N E S S E T H :
The parties hereby agree that the party of the second part shall provide legal
services to the party of the first part pursuant to the following mutual covenants:
1. This Contract shall begin July 1, 2017, and unless sooner terminated by 30
days’ notice of either party shall exist and continue through June 30, 2018.
2. Said party of the second part, upon reasonable notice, is 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.
3. Said party of the second part, agrees to comply with all the requirements of
Sections 128 through 140 of Chapter 110 of the North Carolina General Statutes, Title
42 of the United States Code, Sections 651 through 660, and the regulations
promulgated pursuant thereto relating to the performance of program legal services
including, but not limited to, maintaining such records as are required by the party of the
first part, to make said records available for federal or state audit if required, and to
make financial, statistical, and program progress reports as are required.
4. For his services under this contract, the party of the first part agrees to pay
the party of the second part 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 hour spent by the
party of the second part 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, and travel. The party of the second
part is not to be reimbursed for any extraordinary expense incident to performing the
services included under this agreement; except, that the party of the first part 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.
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5. It is specifically agreed that the party of the second part is an independent
contractor and the party of the second part shall perform the services herein provided
according to his own judgment and method and shall not be subject to the control of the
party of the first part except as to the result of his work.
6. The party of the second part shall not under any circumstance be considered
an employee of the party of the first part. The party of the first part shall not withhold
federal or state taxes from sums to be paid to the party of the second part pursuant to
this agreement.
IN TESTIMONY WHEREOF, said parties have executed this contract in triplicate
originals, one of which is to be retained by the party of the first part, one of which is to
be retained by the parties of the second part, and one of which is to be filed with Child
Support Enforcement Section, Division of Social Services of the Department of Human
Resources, Raleigh, North Carolina.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
114 North Main Street, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Joseph Weinberger, Jr.
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Joseph Weinberger,
Jr., Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
Joe Weinberger, Jr.
Attorney and Counselor at Law
ll4 NORTH MAIN STREET
P.O. BOX l2l5
ROXBORO, NORTH CAROLINA 27573
JOE WEINBERGER, JR. TELEPHONE
336-599-2239
FAX 336-599-2239
E-MAIL wein@osinc.net
______________, 2017
To: Person County Department of Social Services
Certification:
I, Joseph Weinberger, Jr., certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1,
at the federal, State, or local level. I further understand that any person who makes a false statement in
violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.)
143C-10-1b.
Sworn Statement:
I, Joseph Weinberger, Jr., being duly sworn, say that the foregoing certification is true, accurate and complete
to the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment
agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Joseph Weinberger, Jr., Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Joseph Weinberger, Jr.
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Joseph Weinberger, Jr.
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Child Support Contract # 1007
Joe Weinberger, Jr.
Page 27
Attachment N
CERTIFICATION OF
ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Joseph Weinberger, Jr., Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Joseph Weinberger, Jr., Attorney At Law, shall not utilize on any contract with
the State agency any subcontractor that is identified on the Final Divestment List;
and
3. that Joseph Weinberger, Jr., Attorney At Law, is authorized to make this Certification.
Joseph Weinberger, Jr., Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
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Contract # 1008 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
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 collectively as
the “Parties”). The Contractor’s federal tax identification number is 20-2272 781.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Primary Attorney Thomas
L. Fitzgerald is $135 per hour.
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Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Thomas L. Fitzgerald, Attorney
P.O. Box 770 P.O. Box 1519
355B South Madison Boulevard 22 Court Street
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 599-2567
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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Thomas L. Fitzgerald
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 20-2272-781
NORTH CAROLINA
DUPLICATE ORIGINAL
PERSON COUNTY
LEGAL SERVICES AGREEMENT
THIS Agreement, made and entered into this the 1st day of July, 2017, by
and between the PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES,
hereinafter referred to as Agency, and Thomas L. Fitzgerald, Attorney at Law,
hereinafter referred to as Attorney.
W I T N E S S E T H :
THAT WHEREAS, the Agency has determined that it has need for legal services
and consultation beyond those presently being provided by the county attorney;
AND WHEREAS, the Attorney is a member of a reputable law firm with an office
in Person County, North Carolina, and has expertise in the field of social services law,
rules and regulations, and the Agency is desirous of obtaining such legal services from
said Attorney on a continuing basis;
NOW, THEREFORE, it is hereby agreed that the Attorney shall provide legal
services to the Agency in the nature of consultations, interpretation of social services
laws and regulations and drafting of legal document when necessary on the following
terms and conditions:
1
The Attorney shall make himself available and on call to the Agency on a prompt
basis for the purposes herein above described until June 30, 2018. At the end of said
period, the arrangement herein described will be analyzed by the parties hereto to
determine if same is effective and fair to all parties concerned and revised or terminated
accordingly as deemed necessary.
2
The Agency shall pay for such legal services to the Attorney the sum of one hundred
thirty-five dollars ($135.00) per hour for out of court time and one hundred thirty-five
dollars ($135.00) per hour for in court time for each hour of legal services performed,
same to be due and 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. Such hourly rate shall encompass all expenses, including,
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but not limited to, those for salary, supplies, office space, heating and maintenance for
office space, telephone service, long-distance telephone calls, and travel. The party of
the second part is not to be reimbursed for any extraordinary expense incident to
performing the services included under this agreement; except, that the party of the first
part 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.
3
The Attorney will assist the Agency in maintaining records of the legal services
provided as same are necessary for the agency in filing its reports and funding
statements.
4
The party of the second part shall notify the Agency when a conflict of interest
arises for the Attorney. In all such cases, referral shall be made to another attorney with
whom the Department has contracted for secondary employment for the provision of
legal services when conflicts arise.
5
It is understood and agreed that the legal services provided pursuant to this
contract will be in addition to those provided by the county attorney and not in
substitution nor duplication of such services by the county attorney.
6
The party of the second part further agrees to attend seminars regarding
Protective Services and other matters related to Social Services as part of his duty to
the agency in addition to Child Support Enforcement training. Further, the party of the
first part agrees to compensate the party of the second part 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.
Reimbursement shall be made in the amount of fifty-four cents ($0.54) per mile for
travel and expenses not to exceed a total of three hundred twenty-five dollars ($325.00)
per year.
7
It is specifically agreed that the Attorney is an independent contractor and shall
perform the legal services herein provided according to his own judgment and method
and shall not be subject to control of the Agency except as to the result of his work.
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8
The Attorney shall not under any circumstance be considered an employee of the
Agency. The Agency shall not withhold federal or state taxes from sums paid to the
Attorney pursuant to this agreement.
IN WITNESS WHEREOF, the parties have executed this agreement in duplicate
originals, one of which is retained by each of the parties hereto, on the day and year
first above written.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
22 Court Street, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Thomas L. Fitzgerald, Attorney At Law
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Thomas L. Fitzgerald,
Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
THOMAS L. FITZGERALD
ATTORNEY AT LAW
22 COURT STREET
P.O. BOX 1519
ROXBORO, NORTH CAROLINA 27573
(336) 599-2567
Fax (336) 599-5782
______________, 2017
To: Person County Department of Social Services
Certification:
I, Thomas L. Fitzgerald, certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at
the federal, State, or local level. I further understand that any person who makes a false statement in violation
of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b.
Sworn Statement:
I, Thomas L. Fitzgerald, being duly sworn, say that the foregoing certification is true, accurate and complete to
the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment
agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Thomas L. Fitzgerald, Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Thomas L. Fitzgerald
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Thomas L. Fitzgerald
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Attachment N
CERTIFICATION OF
ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Thomas L. Fitzgerald, Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Thomas L. Fitzgerald, Attorney At Law, shall not utilize on any contract with
the State agency any subcontractor that is identified on the Final Divestment List;
and
3. that Thomas L. Fitzgerald, Attorney At Law, is authorized to make this Certification.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
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Contract # 1009 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
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 collectively as
the “Parties”). The Contractor’s federal tax identification number is 20-2272-781.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Primary Attorney Thomas
L. Fitzgerald is $135 per hour.
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Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Thomas L. Fitzgerald, Attorney
P.O. Box 770 P.O. Box 1519
355B South Madison Boulevard 22 Court Street
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 599-2567
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 20-2272-781
STATE OF NORTH CAROLINA )
)
) CONTRACT FOR LEGAL SERVICES
)
COUNTY OF Person )
THIS CONTRACT made and entered into this the 1st day of July, 2017, by and
between the Person County Commissioners, party of the first part, and Thomas L.
Fitzgerald, Attorney, party of the second part;
W I T N E S S E T H
The parties hereby agree that the party of the second part shall provide legal
services to the party of the first part pursuant to the following mutual covenants:
1. This Contract shall begin July 1, 2017, and unless sooner terminated by 30
days’ notice of either party shall exist and continue through June 30, 2018.
2. Said party of the second part, upon reasonable notice, is 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.
3. Said party of the second part agrees to comply with all the requirements of
Sections 128 through 140 of Chapter 110 of the North Carolina General Statutes, Title
42 of the United States Code, Sections 651 through 660, and the regulations
promulgated pursuant thereto relating to the performance of program legal services
including, but not limited to, maintaining such records as are required by the party of the
first part, to make said records available for federal or state audit if required, and to
make financial, statistical, and program progress reports as are required.
4. For their services under this contract, the party of the first part agrees to pay
the party of the second part one hundred thirty-five dollars ($135.00) per hour for out of
court time and one hundred thirty-five dollars ($135.00) per hour for in court time for
each hour spent by the party of the second part 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, and
travel (other than travel to attend the Child Support Enforcement Training). The party of
the second part is not to be reimbursed for any extraordinary expense incident to
performing the services included under this agreement; except, that the party of the first
part 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.
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5. The party of the second part shall notify the Agency when a conflict of interest
arises for the Attorney. In all such cases, referral shall be made to another attorney with
whom the Department has contracted for secondary employment for the provision of
legal services when conflicts arise.
6. The party of the second part further agrees to attend at least one training
session on Child Support Enforcement per year conducted by the Child Support
Enforcement Agency. Reimbursement shall be made in the amount of fifty-four cents
($0.54) per mile for travel and expenses not to exceed a total of three hundred twenty-
five dollars ($325.00) per year. In addition the party of the first part agrees to
compensate the party of the second part 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. Failure to attend one
approved workshop per year shall be construed as an indication that the party of the
second part does not wish to continue providing services under this agreement.
7. 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.
8. It is specifically agreed that the party of the second part is an independent
contractor and the party of the second part shall perform the services herein provided
according to his own judgment and method and shall not be subject to the control of the
party of the first part except as to the result of his work.
9. The party of the second part shall not under any circumstance be considered
an employee of the party of the first part. The party of the first part shall not withhold
federal or state taxes from sums to be paid to the party of the second part pursuant to
this agreement.
IN TESTIMONY WHEREOF, said parties have executed this contract in triplicate
originals, one of which is to be retained by the party of the first part, one of which is to
be retained by the party of the second part, and one of which is to be filed with Child
Support Enforcement Section, Division of Social Services of the Department of Human
Resources, Raleigh, North Carolina.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
22 Court Street, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Thomas L. Fitzgerald, Attorney At Law
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Thomas L. Fitzgerald,
Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
THOMAS L. FITZGERALD
ATTORNEY AT LAW
22 COURT STREET
P.O. BOX 1519
ROXBORO, NORTH CAROLINA 27573
(336) 599-2567
Fax (336) 599-5782
______________, 2017
To: Person County Department of Social Services
Certification:
I, Thomas L. Fitzgerald, certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at
the federal, State, or local level. I further understand that any person who makes a false statement in violation
of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b.
Sworn Statement:
I, Thomas L. Fitzgerald, being duly sworn, say that the foregoing certification is true, accurate and complete to
the best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment
agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Thomas L. Fitzgerald, Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Thomas L. Fitzgerald
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Thomas L. Fitzgerald
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Attachment N
CERTIFICATION OF
ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Thomas L. Fitzgerald, Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Thomas L. Fitzgerald, Attorney At Law, shall not utilize on any contract with
the State agency any subcontractor that is identified on the Final Divestment List;
and
3. that Thomas L. Fitzgerald, Attorney At Law, is authorized to make this Certification.
Thomas L. Fitzgerald, Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
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Contract # 1010 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
This contract is hereby entered into by and between the Person County Department of Social
Services (the "County") and Walter B. Cates (the "Contractor") (referred to collectively as the
“Parties”). The Contractor’s federal tax identification number is 56-135 0472.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Secondary Attorney
Walter B. Cates is $75 per hour.
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Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Walter B. Cates, Attorney
P.O. Box 770 P.O. Box 679
355B South Madison Boulevard 36 Court Street
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 597-2251
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 56-135 0472
NORTH CAROLINA
DUPLICATE ORIGINAL
PERSON COUNTY
LEGAL SERVICES AGREEMENT
THIS Agreement, made and entered into this the 1st day of July, 2017, by and between
the PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES, hereinafter referred to as
Agency, and Walter B. Cates, Attorney at Law, hereinafter referred to as Attorney.
W I T N E S S E T H :
THAT WHEREAS, the Agency has determined that it has need for legal services and
consultation beyond those presently being provided by the county attorney;
AND WHEREAS, the Attorney is a member in a reputable law firm with an office in
Person County, North Carolina, and has expertise in the field of social services law, rules and
regulations, and the Agency is desirous of obtaining such legal services from said Attorney on a
continuing basis;
NOW, THEREFORE, it is hereby agreed that the Attorney shall provide legal services to
the Agency in the nature of consultations, interpretation of social services laws and regulations
and drafting of legal documents when necessary on the following terms and conditions:
1
The Attorney shall make himself available and on call to the Agency on a prompt basis
for the purposes herein above described until June 30, 2018. At the end of said period, the
arrangement herein described will be analyzed by the parties hereto to determine if same is
effective and fair to all parties concerned and revised or terminated accordingly as deemed
necessary.
2
The Agency shall pay for such legal services to the Attorney the sum of 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 hour of legal services performed, same to be due and 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.
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3
The Attorney will assist the Agency in maintaining records of the legal services provided
as same are necessary for the agency in filing its reports and funding statements.
4
It is understood and agreed that the legal services provided pursuant to this contract will
be in addition to those provided by the county attorney and not in substitution nor duplication of
such services by the county attorney.
5
It is specifically agreed that Attorney is an independent contractor and shall perform the
legal services herein provided according to his own judgment and method and shall not be
subject to control of the Agency except as to the result of his work.
6
The Attorney shall not under any circumstance be considered an employee of the
Agency. The Agency shall not withhold federal or state taxes from sums paid to the Attorney
pursuant to this agreement.
IN WITNESS WHEREOF, the parties have executed this agreement in duplicate
originals, one of which is retained by each of the parties hereto, on the day and year first above
written.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
36 Court Street, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Walter B. Cates
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Walter B. Cates,
Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
______________, 2017
To: Person County Department of Social Services
Certification:
I, Walter B. Cates, certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the
federal, State, or local level. I further understand that any person who makes a false statement in violation of
N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b.
Sworn Statement:
I, Walter B. Cates, being duly sworn, say that the foregoing certification is true, accurate and complete to the
best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment
agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Walter B. Cates, Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Walter B. Cates
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Walter B. Cates
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Attachment N
CERTIFICATION OF ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Walter B. Cates, Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Walter B. Cates, Attorney At Law, shall not utilize on any contract with the
State agency any subcontractor that is identified on the Final Divestment List; and
3. that Walter B. Cates, Attorney At Law, is authorized to make this Certification.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
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Contract # 1011 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
This contract is hereby entered into by and between the Person County Department of Social
Services (the "County") and Walter B. Cates (the "Contractor") (referred to collectively as the
“Parties”). The Contractor’s federal tax identification number is 56-135 0472.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Secondary Attorney
Walter B. Cates is $75 per hour.
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Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Walter B. Cates, Attorney
P.O. Box 770 P.O. Box 679
355B South Madison Boulevard 36 Court Street
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 597-2251
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 56-135 0472
STATE OF NORTH CAROLINA )
)
) CONTRACT FOR LEGAL SERVICES
)
COUNTY OF Person )
THIS CONTRACT made and entered into this the 1st day of July, 2017, by and
between the Person County Commissioners, party of the first part, and Walter B. Cates,
Attorney, party of the second part;
W I T N E S S E T H :
The parties hereby agree that the party of the second part shall provide legal
services to the party of the first part pursuant to the following mutual covenants:
1. This Contract shall begin July 1, 2017, and unless sooner terminated by 30
days’ notice of either party shall exist and continue through June 30, 2018.
2. Said party of the second part, upon reasonable notice, is 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.
3. Said party of the second part, agrees to comply with all the requirements of
Sections 128 through 140 of Chapter 110 of the North Carolina General Statutes, Title
42 of the United States Code, Sections 651 through 660, and the regulations
promulgated pursuant thereto relating to the performance of program legal services
including, but not limited to, maintaining such records as are required by the party of the
first part, to make said records available for federal or state audit if required, and to
make financial, statistical, and program progress reports as are required.
4. For his services under this contract, the party of the first part agrees to pay
the party of the second part 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 hour spent by the
party of the second part 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, and travel. The party of the second
part is not to be reimbursed for any extraordinary expense incident to performing the
services included under this agreement; except, that the party of the first part 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.
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5. It is specifically agreed that the party of the second part is an independent
contractor and the party of the second part shall perform the services herein provided
according to his own judgment and method and shall not be subject to the control of the
party of the first part except as to the result of his work.
6. The party of the second part shall not under any circumstance be considered
an employee of the party of the first part. The party of the first part shall not withhold
federal or state taxes from sums to be paid to the party of the second part pursuant to
this agreement.
IN TESTIMONY WHEREOF, said parties have executed this contract in triplicate
originals, one of which is to be retained by the party of the first part, one of which is to
be retained by the parties of the second part, and one of which is to be filed with Child
Support Enforcement Section, Division of Social Services of the Department of Human
Resources, Raleigh, North Carolina.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
36 Court Street, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Walter B. Cates
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Walter B. Cates,
Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
______________, 2017
To: Person County Department of Social Services
Certification:
I, Walter B. Cates, certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the
federal, State, or local level. I further understand that any person who makes a false statement in violation of
N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b.
Sworn Statement:
I, Walter B. Cates, being duly sworn, say that the foregoing certification is true, accurate and complete to the
best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment
agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Walter B. Cates, Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Walter B. Cates
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Walter B. Cates
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Attachment N
CERTIFICATION OF
ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Walter B. Cates, Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Walter B. Cates, Attorney At Law, shall not utilize on any contract with the
State agency any subcontractor that is identified on the Final Divestment List; and
3. that Walter B. Cates, Attorney At Law, is authorized to make this Certification.
Walter B. Cates, Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
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Contract # 1012 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
This contract is hereby entered into by and between the Person County Department of Social
Services (the "County") and Julie A. Ramsey (the "Contractor") (referred to collectively as the
“Parties”). The Contractor’s federal tax identification number is 56-199 9585.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Secondary Attorney
Julie A. Ramsey is $75 per hour.
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Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Julie A. Ramsey, Attorney
P.O. Box 770 P.O. Box 3130
355B South Madison Boulevard 22 Court Street, Suite 200
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 599-5004
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 56-199 9585
NORTH CAROLINA
DUPLICATE ORIGINAL
PERSON COUNTY
LEGAL SERVICES AGREEMENT
THIS Agreement, made and entered into this the 1st day of July, 2017, by and between
the PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES, hereinafter referred to as
Agency, and Julie A. Ramsey, Attorney at Law, hereinafter referred to as Attorney.
W I T N E S S E T H :
THAT WHEREAS, the Agency has determined that it has need for legal services and
consultation beyond those presently being provided by the county attorney;
AND WHEREAS, the Attorney is a member in a reputable law firm with an office in
Person County, North Carolina, and has expertise in the field of social services law, rules and
regulations, and the Agency is desirous of obtaining such legal services from said Attorney on a
continuing basis;
NOW, THEREFORE, it is hereby agreed that the Attorney shall provide legal services to
the Agency in the nature of consultations, interpretation of social services laws and regulations
and drafting of legal documents when necessary on the following terms and conditions:
1
The Attorney shall make herself available and on call to the Agency on a prompt basis for
the purposes herein above described until June 30, 2018. At the end of said period, the
arrangement herein described will be analyzed by the parties hereto to determine if same is
effective and fair to all parties concerned and revised or terminated accordingly as deemed
necessary.
2
The Agency shall pay for such legal services to the Attorney the sum of 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 hour of legal services performed, same to be due and 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.
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3
The Attorney will assist the Agency in maintaining records of the legal services provided
as same are necessary for the agency in filing its reports and funding statements.
4
It is understood and agreed that the legal services provided pursuant to this contract will
be in addition to those provided by the county attorney and not in substitution nor duplication of
such services by the county attorney.
5
It is specifically agreed that Attorney is an independent contractor and shall perform the
legal services herein provided according to her own judgment and method and shall not be
subject to control of the Agency except as to the result of her work.
6
The Attorney shall not under any circumstance be considered an employee of the
Agency. The Agency shall not withhold federal or state taxes from sums paid to the Attorney
pursuant to this agreement.
IN WITNESS WHEREOF, the parties have executed this agreement in duplicate
originals, one of which is retained by each of the parties hereto, on the day and year first above
written.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
22 Court Street, Suite 200, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Julie A. Ramsey, Attorney At Law
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Julie A. Ramsey,
Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
JULIE A. RAMSEY
--------------------------------------ATTORNEY AT LAW------------------------------------
22 Court Street, Suite 200 336-599-5004 – Telephone
P.O. Box 3130 336-599-5007 – Fax
Roxboro, NC 27573 julie.ramsey@esinc.net
______________, 2017
To: Person County Department of Social Services
Certification:
I, Julie A. Ramsey, certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the
federal, State, or local level. I further understand that any person who makes a false statement in violation of
N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b.
Sworn Statement:
I, Julie A. Ramsey, being duly sworn, say that the foregoing certification is true, accurate and complete to the
best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Julie A. Ramsey, Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Julie A. Ramsey
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Julie A. Ramsey
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Attachment N
CERTIFICATION OF
ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Julie A. Ramsey, Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Julie A. Ramsey, Attorney At Law, shall not utilize on any contract with the
State agency any subcontractor that is identified on the Final Divestment List; and
3. that Julie A. Ramsey, Attorney At Law, is authorized to make this Certification.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
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Contract # 1013 Fiscal Year Begins July 1, 2017 Ends June 30, 2018
This contract is hereby entered into by and between the Person County Department of Social
Services (the "County") and Julie A. Ramsey (the "Contractor") (referred to collectively as the
“Parties”). The Contractor’s federal tax identification number is 56-199 9585.
Contract Documents: This Contract consists of the following documents:
This contract
The General Terms and Conditions (Attachment A)
The Scope of Work, description of services, and rate (Attachment B)
Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
Conflict of Interest (Attachment D)
No Overdue Taxes (Attachment E)
Federal Certification Regarding Lobbying (Attachment G)
Federal Certification Regarding Debarment (Attachment H)
HIPAA Business Associate Addendum (Attachment I)
State Certification (Attachment M)
Certification of Eligibility Under the Iran Divestment Act (Attachment N)
These documents constitute the entire agreement between the Parties and supersede all prior
oral or written statements or agreements.
Precedence among Contract Documents: In the event of a conflict between or among the
terms of the Contract Documents, the terms in the Contract Document with the highest relative
precedence shall prevail. The order of precedence shall be the order of documents as listed in
Paragraph 1, above, with the first-listed document having the highest precedence and the last-
listed document having the lowest precedence. If there are multiple Contract Amendments, the
most recent amendment shall have the highest precedence and the oldest amendment shall
have the lowest precedence.
Effective Period: This contract shall be effective on July 1, 2017 and shall terminate on
June 30, 2018. This contract must be twelve months or less.
Contractor’s Duties: The Contractor shall provide the services and in accordance with the
approved rate as described in Attachment B, Scope of Work.
County’s Duties: The County shall pay the Contractor in the manner and in the amounts
specified in the Contract Documents.
[ x ] a. There are no matching requirements from the Contractor.
[ ] b. The Contractor’s matching requirement is $__________, which shall consist of:
[ ] In-kind [ ] Cash [ ] Cash and In-kind [ ] Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed 1,000 hours
collectively for all attorneys under contract. Rate of compensation for Secondary Attorney
Julie A. Ramsey is $75 per hour.
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Reversion of Funds:
Any unexpended grant funds shall revert to the County Department of Social Services upon
termination of this contract.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and
OMB Circular- CFR Title 2 Grants and Agreements, Part 200, and shall disclose all information
required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope
of Work, Attachment B.
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: For the Contractor:
Wendy Bowman, Accounting Technician
Person County Department of Social Services Julie A. Ramsey, Attorney
P.O. Box 770 P.O. Box 3130
355B South Madison Boulevard 22 Court Street, Suite 200
Roxboro, NC 27573 Roxboro, NC 27573
(336) 599-8361 (336) 599-5004
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.
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.
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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.
Federal Certifications: Individuals and Organizations receiving federal funds must ensure
compliance with certain certifications required by federal laws and regulations. The contractor is
hereby complying with Certifications regarding Nondiscrimination, Drug-Free Workplace
Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and
Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and
certifications are to be signed by the contractor’s authorized representative.
Signature Warranty: The undersigned represent and warrant that they are authorized to bind
their principals to the terms of this agreement.
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 executed this contract in duplicate originals, with one original being retained by
each party.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
PERSON COUNTY
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control
Act.
______________________________ ___________________________
Amy Wehrenberg, County Finance Director Date
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ATTACHMENT A
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: Forward the
Contractor's payment check(s) directly to any person or entity designated by the Contractor, or Include any person or entity
designated by Contractor as a joint payee on the Contractor's payment check(s). 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 and any of their officers, agents and
employees, from any claims of third parties arising out or any act or omission of the Contractor in connection with the
performance of this contract.
Insurance: During the term of the contract, the Contractor at its sole cost and expense shall provide commercial insurance
of such type and with such terms and limits as may be reasonably associated with the contract. As a minimum, the
Contractor shall provide and maintain the following coverage and limits:
Worker’s Compensation - The contractor shall provide and maintain Worker’s Compensation Insurance as required
by the laws of North Carolina, as well as employer’s liability coverage with minimum limits of $500,000.00, covering all
of Contractor’s employees who are engaged in any work under the contract. If any work is sublet, the Contractor shall
require the subcontractor to provide the same coverage for any of his employees engaged in any work under the
contract.
Commercial General Liability - General Liability Coverage on a Comprehensive Broad Form on an occurrence basis in
the minimum amount of $1,000,000.00 Combined Single Limit. (Defense cost shall be in excess of the limit of liability.)
Automobile Liability Insurance: The Contractor shall provide automobile liability insurance with a combined single
limit of $500,000.00 for bodily injury and property damage; a limit of $500,000.00 for uninsured/under insured
motorist coverage; and a limit of $2,000.00 for medical payment coverage. The Contractor shall provide this insurance
for all automobiles that are:
(a) owned by the Contractor and used in the performance of this contract;
(b) hired by the Contractor and used in the performance of this contract; and
(c) Owned by Contractor’s employees and used in performance of this contract (“non-owned vehicle insurance”).
Non-owned vehicle insurance protects employers when employees use their personal vehicles for work
purposes. Non-owned vehicle insurance supplements, but does not replace, the car-owner’s liability insurance.
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The Contractor is not required to provide and maintain automobile liability insurance on any vehicle – owned,
hired, or non-owned -- unless the vehicle is used in the performance of this contract.
(d) The insurance coverage minimums specified in subparagraph (a) are exclusive of defense costs.
(e) The Contractor understands and agrees that the insurance coverage minimums specified in subparagraph (a) are
not limits, or caps, on the Contractor’s liability or obligations under this contract.
(f) The Contractor may obtain a waiver of any one or more of the requirements in subparagraph (a) by
demonstrating that it has insurance that provides protection that is equal to or greater than the coverage and
limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(g) The Contractor may obtain a waiver of any one or more of the requirements in paragraph (a) by demonstrating
that it is self-insured and that its self-insurance provides protection that is equal to or greater than the coverage
and limits specified in subparagraph (a). The County shall be the sole judge of whether such a waiver should be
granted.
(h) Providing and maintaining the types and amounts of insurance or self-insurance specified in this paragraph is a
material obligation of the Contractor and is of the essence of this contract.
(i) The Contractor shall only obtain insurance from companies that are authorized to provide such coverage and
that are authorized by the Commissioner of Insurance to do business in the State of North Carolina. All such
insurance shall meet all laws of the State of North Carolina.
(j) The Contractor shall comply at all times with all lawful terms and conditions of its insurance policies and all
lawful requirements of its insurer.
(k) The Contractor shall require its subcontractors to comply with the requirements of this paragraph.
(l) The Contractor shall demonstrate its compliance with the requirements of this paragraph by submitting
certificates of insurance to the County before the Contractor begins work under this contract.
Transportation of Clients by Contractor:
The contractor will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina
Utilities Commission.
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
Provider 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.
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Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Federal Intellectual Property Bankruptcy Protection Act: The Parties agree that the County shall be entitled to all rights and
benefits of the Federal Intellectual Property Bankruptcy Protection Act, Public Law 100-506, codified at 11 U.S.C. 365 (n)
and any amendments thereto.
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.
Title VI, Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) and U.S.
Department of Health and Human Services (HHS) policy, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age or disability. Under the Food Stamp Act and USDA policy, discrimination is prohibited
also on the basis of religion or political beliefs.
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.
(a) 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.
(b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the local Department of
Social Services/Human Services 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.
(c) Cost Borne by Contractor: If any applicable federal, state, or local law, regulation, or rule requires the Contractor
to give written notice of a security breach to affected persons, the Contractor shall bear the cost of the notice.
Trafficking Victims Protection Act of 2000: The Contractor will comply with the requirements of Section 106(g) of the
Trafficking Victims Protection Act of 2000, as amended (22 U.S.C. 7104).
Executive Order # 24: It is unlawful for any vendor, contractor, subcontractor or supplier of the state to make gifts or to give
favors to any state employee. For additional information regarding the specific requirements and exemptions, contractors
are encouraged to review Executive Order 24 and G.S. Sec. 133-32.
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.
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Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all contracts or
grants entered into by State agencies or political subdivisions in accordance with General Statute 147-64.7. Additionally, as
the State funding authority, the Department of Health and Human Services shall have access to persons and records as a
result of all contracts or grants entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of the
Division. State basic records retention policy requires all grant records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the contract is subject to federal policy and regulations, record
retention may be longer than five years since 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.
Warranties and Certifications
Date and Time Warranty: The Contractor warrants that the product(s) and service(s) furnished pursuant to this contract
(“product” includes, without limitation, any piece of equipment, hardware, firmware, middleware, custom or commercial
software, or internal components, subroutines, and interfaces therein) that perform any date and/or time data recognition
function, calculation, or sequencing will support a four digit year format and will provide accurate date/time data and leap
year calculations. This warranty shall survive the termination or expiration of this contract.
Certification Regarding Collection of Taxes: G.S. 143-59.1 bars the Secretary of Administration from entering into contracts
with vendors that meet one of the conditions of G.S. 105-164.8(b) and yet refuse to collect use taxes on sales of tangible
personal property to purchasers in North Carolina. The conditions include: (a) maintenance of a retail establishment or
office; (b) presence of representatives in the State that solicit sales or transact business on behalf of the vendor; and (c)
systematic exploitation of the market by media-assisted, media-facilitated, or media-solicited means. The Contractor certifies
that it and all of its affiliates (if any) collect all required taxes.
E-Verify
Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the Contractor named below, and the
Contractor’s subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including
the requirement for each employer with more than 25 employees in North Carolina to verify the work authorization of its
employees through the federal E-Verify system." E-Verify System Link: www.uscis.gov
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 the county is which the contract originated. The
place of this contract and all transactions and agreements relating to it, and their situs and forum, shall be the county where
the contract originated, 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.
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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.
Time of the Essence: Time is of the essence in the performance of this contract.
Key Personnel: The Contractor shall not replace any of the key personnel assigned to the performance of this contract
without the prior written approval of the 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 established in County policy.
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.
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ATTACHMENT B – Scope of Work Federal Tax Id. 56-199 9585
STATE OF NORTH CAROLINA )
)
) CONTRACT FOR LEGAL SERVICES
)
COUNTY OF Person )
THIS CONTRACT made and entered into this the 1st day of July, 2017, by and
between the Person County Commissioners, party of the first part, and Julie A. Ramsey,
Attorney, party of the second part;
W I T N E S S E T H :
The parties hereby agree that the party of the second part shall provide legal
services to the party of the first part pursuant to the following mutual covenants:
1. This Contract shall begin July 1, 2017, and unless sooner terminated by 30
days’ notice of either party shall exist and continue through June 30, 2018.
2. Said party of the second part, upon reasonable notice, is 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.
3. Said party of the second part, agrees to comply with all the requirements of
Sections 128 through 140 of Chapter 110 of the North Carolina General Statutes, Title
42 of the United States Code, Sections 651 through 660, and the regulations
promulgated pursuant thereto relating to the performance of program legal services
including, but not limited to, maintaining such records as are required by the party of the
first part, to make said records available for federal or state audit if required, and to
make financial, statistical, and program progress reports as are required.
4. For her services under this contract, the party of the first part agrees to pay
the party of the second part 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 hour spent by the
party of the second part 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, and travel. The party of the second
part is not to be reimbursed for any extraordinary expense incident to performing the
services included under this agreement; except, that the party of the first part 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.
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5. It is specifically agreed that the party of the second part is an independent
contractor and the party of the second part shall perform the services herein provided
according to his own judgment and method and shall not be subject to the control of the
party of the first part except as to the result of his work.
6. The party of the second part shall not under any circumstance be considered
an employee of the party of the first part. The party of the first part shall not withhold
federal or state taxes from sums to be paid to the party of the second part pursuant to
this agreement.
IN TESTIMONY WHEREOF, said parties have executed this contract in triplicate
originals, one of which is to be retained by the party of the first part, one of which is to
be retained by the parties of the second part, and one of which is to be filed with Child
Support Enforcement Section, Division of Social Services of the Department of Human
Resources, Raleigh, North Carolina.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT C
CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS
AND CERTIFICATION REGARDING NONDISCRIMINATION
Person County Department of Social Services
I. By execution of this Agreement 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: (1) The dangers of drug abuse in the workplace; (2) The Contractor’s policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and
(4) 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:
(1) Abide by the terms of the statement; and
(2) 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 County within ten days after receiving notice under subparagraph (D)(2) 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)(2), with respect to any employee who is so convicted:
(1) Taking appropriate personnel action against such an employee, up to and including termination; or (2) 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
Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (A), (B), (C), (D), (E), and (F).
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The site(s) for the performance of work done in connection with the specific agreement are
listed below:
22 Court Street, Suite 200, Roxboro, NC 27573
Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment,
suspension or termination of grants, or government-wide Federal suspension or debarment
45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620.
Certification Regarding Nondiscrimination
The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination.
These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352)
which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which
prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as
amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d) the Age
Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits
discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.
92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the
Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of
1970 (P.L. 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as
amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food
Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political
beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this
Agreement.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT D:
CONFLICT OF INTEREST
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
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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.
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.
NOTARIZED CONFLICT OF INTEREST POLICY
Julie A. Ramsey, Attorney At Law
_________________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
I, __________________________, a Notary Public of said County and State do hereby certify that Julie A. Ramsey,
Attorney at Law, personally appeared before me this date and acknowledged the due execution of the foregoing
agreement for the purposes therein expressed and by that authority duly given and as the act of the Organization,
affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Directors/Trustees or other
governing body in a meeting held on the __________ day of ___________, _________.
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
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ATTACHMENT E – OVERDUE TAXES
JULIE A. RAMSEY
--------------------------------------ATTORNEY AT LAW------------------------------------
22 Court Street, Suite 200 336-599-5004 – Telephone
P.O. Box 3130 336-599-5007 – Fax
Roxboro, NC 27573 julie.ramsey@esinc.net
______________, 2017
To: Person County Department of Social Services
Certification:
I, Julie A. Ramsey, certify that I do not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the
federal, State, or local level. I further understand that any person who makes a false statement in violation of
N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S.) 143C-10-1b.
Sworn Statement:
I, Julie A. Ramsey, being duly sworn, say that the foregoing certification is true, accurate and complete to the
best of my knowledge and was made and subscribed by me. I also acknowledge and understand that any
misuse of State funds will be reported to the appropriate authorities for further action.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
NORTH CAROLINA
PERSON COUNTY
Sworn to and subscribed before me this _________ day of ______________________, 2017.
___________________________
Notary Public
My Commission expires: __________________
____________________
1 G.S. 105-243.1 defines: Overdue tax debt. – Any part of a tax debt that remains unpaid 90 days or more after the notice of final
assessment was mailed to the taxpayer. The term does not include a tax debt, however, if the taxpayer entered into an installment agreement for the tax debt under G.S. 105-237 within 90 days after the notice of final assessment was mailed and has not failed to
make any payments due under the installment agreement.”
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ATTACHMENT G
Person County Department of Social Services
Certification Regarding Lobbying
Certification for Contracts, Grants, Loans and Cooperative Agreements
The undersigned 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 Federal, state or local
government agency, a Member of Congress, a Member of the General Assembly, an officer or employee of
Congress, an officer or employee of the General Assembly, an employee of a Member of Congress, or an
employee of a Member of the General Assembly in connection with the awarding of any Federal or state
contract, the making of any Federal or state grant, the making of any Federal or state loan, the entering into
of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state 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 Federal, state or local government
agency, a Member of Congress, a Member of the General Assembly, an officer or employee of Congress,
an officer or employee of the General Assembly, an employee of a Member of Congress, or an employee of
a Member of the General Assembly in connection with the awarding of any Federal or state contract, the
making of any Federal or state grant, the making of any Federal or state loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal or state contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard
Form LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the award documents for
all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) 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 and not more than $100,000 for each
such failure.
Notwithstanding other provisions of federal OMB Circulars-CFR Title 2, Grants and Agreements, Part 200, costs
associated with the following activities are unallowable:
Paragraph A.
(1) Attempts to influence the outcomes of any Federal, State, or local election, referendum, initiative, or
similar procedure, through in kind or cash contributions, endorsements, publicity, or similar activity;
(2) Establishing, administering, contributing to, or paying the expenses of a political party, campaign, political
action committee, or other organization established for the purpose of influencing the outcomes of
elections;
(3) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation through communication with any member or
employee of the Congress or State legislature (including efforts to influence State or local officials to
engage in similar lobbying activity), or with any Government official or employee in connection with a
decision to sign or veto enrolled legislation;
(4) Any attempt to influence: (i) The introduction of Federal or State legislation; or (ii) the enactment or
modification of any pending Federal or State legislation by preparing, distributing or using publicity or
propaganda, or by urging members of the general public or any segment thereof to contribute to or
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participate in any mass demonstration, march, rally, fundraising drive, lobbying campaign or letter writing
or telephone campaign; or
(5) Legislative liaison activities, including attendance at legislative sessions or committee hearings, gathering
information regarding legislation, and analyzing the effect of legislation, when such activities are carried on
in support of or in knowing preparation for an effort to engage in unallowable lobbying.
The following activities as enumerated in Paragraph B are excepted from the coverage of Paragraph A:
Paragraph B.
(1) Providing a technical and factual presentation of information on a topic directly related to the performance
of a grant, contract or other agreement through hearing testimony, statements or letters to the Congress or a
State legislature, or subdivision, member, or cognizant staff member thereof, in response to a documented
request (including a Congressional Record notice requesting testimony or statements for the record at a
regularly scheduled hearing) made by the recipient member, legislative body or subdivision, or a cognizant
staff member thereof; provided such information is readily obtainable and can be readily put in deliverable
form; and further provided that costs under this section for travel, lodging or meals are unallowable unless
incurred to offer testimony at a regularly scheduled Congressional hearing pursuant to a written request for
such presentation made by the Chairman or Ranking Minority Member of the Committee or Subcommittee
conducting such hearing.
(2) Any lobbying made unallowable by subparagraph A (3) to influence State legislation in order to directly
reduce the cost, or to avoid material impairment of the organization's authority to perform the grant,
contract, or other agreement.
(3) Any activity specifically authorized by statute to be undertaken with funds from the grant, contract, or other
agreement.
Paragraph C.
(1) When an organization seeks reimbursement for indirect costs, total lobbying costs shall be separately
identified in the indirect cost rate proposal, and thereafter treated as other unallowable activity costs in
accordance with the procedures of subparagraph B.(3).
(2) Organizations shall submit, as part of the annual indirect cost rate proposal, a certification that the
requirements and standards of this paragraph have been complied with.
(3) Organizations shall maintain adequate records to demonstrate that the determination of costs as being
allowable or unallowable pursuant to this section complies with the requirements of this Circular.
(4) Time logs, calendars, or similar records shall not be required to be created for purposes of complying with
this paragraph during any particular calendar month when: (1) the employee engages in lobbying (as
defined in subparagraphs (a) and (b)) 25 percent or less of the employee's compensated hours of
employment during that calendar month, and (2) within the preceding five-year period, the organization has
not materially misstated allowable or unallowable costs of any nature, including legislative lobbying costs.
When conditions (1) and (2) are met, organizations are not required to establish records to support the
allowability of claimed costs in addition to records already required or maintained. Also, when conditions
(1) and (2) are met, the absence of time logs, calendars, or similar records will not serve as a basis for
disallowing costs by contesting estimates of lobbying time spent by employees during a calendar month.
(5) Agencies shall establish procedures for resolving in advance, in consultation with OMB, any significant
questions or disagreements concerning the interpretation or application of this section. Any such advance
resolution shall be binding in any subsequent settlements, audits or investigations with respect to that grant
or contract for purposes of interpretation of this Circular; provided, however, that this shall not be
construed to prevent a contractor or grantee from contesting the lawfulness of such a determination.
Paragraph D.
Executive lobbying costs. Costs incurred in attempting to improperly influence either directly or indirectly, an
employee or officer of the Executive Branch of the Federal Government to give consideration or to act
regarding a sponsored agreement or a regulatory matter are unallowable. Improper influence means any
influence that induces or tends to induce a Federal employee or officer to give consideration or to act regarding
a federally sponsored agreement or regulatory matter on any basis other than the merits of the matter.
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Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT H
PERSON COUNTY DEPARTMENT OF SOCIAL SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY
AND VOLUNTARY EXCLUSION-LOWER TIER COVERED TRANSACTIONS
Instructions for Certification
1. By signing and submitting this proposal, 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
originated 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 the 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. You may contact the person to
which 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 proposal that it will
include this 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 of which it determines the eligibility of its
principals. Each participant may, but is not required to, check the Nonprocurement List.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge
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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 Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower
Tier Covered Transactions
(1) The prospective lower tier participant certifies, by submission of this proposal, 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.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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ATTACHMENT I
PERSON COUNTY
DEPARTMENT OF SOCIAL SERVICES
BUSINESS ASSOCIATE ADDENDUM
This Agreement is made effective the 1st day of July, 2017, by and between Person County
Department of Social Services (“Covered Entity”) and Julie A. Ramsey, Attorney at Law
(“Business Associate”) (collectively the “Parties”).
1. BACKGROUND
a. Covered Entity and Business Associate are parties to a contract entitled Legal Services
Contract (the “Contract”), 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 (DSS) 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 HIPAA
Privacy Rule.
d. The Parties enter into this Business Associate Addendum to the Contract 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. “Individual” shall have the same meaning as the term “individual” in 45 CFR160.103 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.
f. “Secretary” shall mean the Secretary of the United States Department of Health and Human
Services or his designee.
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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
Person County Department of Social Services, in a time and manner designated by the
Secretary, for purposes of 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 information to Covered Entity or an
Individual to permit such a response.
4. PERMITTED USES AND DISCLOSURES
a. Except as otherwise limited in this Agreement or by other applicable law or agreement, if the
Contract 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
Contract, 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.
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b. Except as otherwise limited in this Agreement or by other applicable law or agreements, if the
Contract 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
Contract 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
Contract 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 Contract or
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 Contract 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
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 Contract 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.
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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 Contract.
b. Except as provided in this Agreement, all terms and conditions of the Contract 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 Contract, the interpretation
that is in accordance with the Privacy Rule shall prevail. In the event that a conflict then
remains, the Contract 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 Contract for cause.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
Tracey L. Kendrick
____________________________ _________________________
Chairman, County Commissioners Date
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Attachment M
State Certification
Contractor Certifications Required by North Carolina Law
Instructions
The person who signs this document should read the text of the statutes listed below and consult with
counsel and other knowledgeable persons before signing.
The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/ByArticle/Chapter_64/Article_2.pdf
The text of G.S. 105-164.8(b) can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_105/GS_105-
164.8.pdf
The text of G.S. 143-48.5 (S.L. 2013-418, s. 2.(d)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
The text of G.S. 143-59.1 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.1.pdf
The text of G.S. 143-59.2 can be found online at:
http://www.ncga.state.nc.us/EnactedLegislation/Statutes/PDF/BySection/Chapter_143/GS_143-
59.2.pdf
The text of G.S. 147-33.95(g) (S.L. 2013-418, s. 2.(e)) can be found online at:
http://www.ncga.state.nc.us/Sessions/2013/Bills/House/PDF/H786v6.pdf
Certifications
(1) Pursuant to G.S. 143-48.5 and G.S. 147-33.95(g), the undersigned hereby certifies that the
Contractor named below, and the Contractor’s subcontractors, complies with the requirements of
Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer
with more than 25 employees in North Carolina to verify the work authorization of its employees
through the federal E-Verify system." E-Verify System Link: www.uscis.gov
Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina
General Statutes. However, local government is subject to and must comply with North Carolina
General Statute §153A-99.1., which states in part as follows:
Counties Must Use E-Verify. - Each county shall register and participate in E-Verify to verify the
work authorization of new employees hired to work in the United States.
(2) Pursuant to G.S. 143-59.1(b), the undersigned hereby certifies that the Contractor named below
is not an “ineligible Contractor” as set forth in G.S. 143-59.1(a) because:
(a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied
under Article 5 of Chapter 105 of the General Statutes on its sales delivered to North
Carolina when the sales met one or more of the conditions of G.S. 105-164.8(b); and
(b) [check one of the following boxes]
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Neither the Contractor nor any of its affiliates has incorporated or reincorporated
in a “tax haven country” as set forth in G.S. 143-59.1(c)(2) after December 31,
2001; or
The Contractor or one of its affiliates has incorporated or reincorporated in a “tax
haven country” as set forth in G.S. 143-59.1(c)(2) after December 31, 2001 but
the United States is not the principal market for the public trading of the stock of
the corporation incorporated in the tax haven country.
(3) Pursuant to G.S. 143-59.2(b), the undersigned hereby certifies that none of the Contractor’s
officers, directors, or owners (if the Contractor is an unincorporated business entity) has been
convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or
the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid
solicitation.
(4) The undersigned hereby certifies further that:
(a) He or she is a duly authorized representative of the Contractor named below;
(b) He or she is authorized to make, and does hereby make, the foregoing certifications on
behalf of the Contractor; and
(c) He or she understands that any person who knowingly submits a false certification in
response to the requirements of G.S. 143-59.1 and -59.2 shall be guilty of a Class I
felony.
Contractor’s Name: Julie A. Ramsey
Signature of Contractor’s Authorized Agent
Date
Printed Name of Contractor’s Authorized Agent
Julie A. Ramsey
Title
Attorney at Law
Signature of Witness
Title
Printed Name of Witness
Date
The witness should be present when the Contractor’s Authorized Agent signs this certification and should
sign and date this document immediately thereafter.
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Attachment N
CERTIFICATION OF
ELIGIBILITY
Under the Iran
Divestment Act
Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in
Iran, determined by appearing on the Final Divestment List created by the State
Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North
Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S.
147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify,
and the undersigned on behalf of the Vendor does hereby certify, to the following:
1. that Julie A. Ramsey, Attorney At Law, is not identified on the Final
Divestment List of entities that the State Treasurer has determined engages in
investment activities in Iran;
2. that Julie A. Ramsey, Attorney At Law, shall not utilize on any contract with the
State agency any subcontractor that is identified on the Final Divestment List; and
3. that Julie A. Ramsey, Attorney At Law, is authorized to make this Certification.
Julie A. Ramsey, Attorney At Law
____________________________ _________________________
Signature Date
* Note: Enacted by Session Law 2015‐118 as G.S. 143C‐55 et seq., but has been renumbered for
codification at the direction of the Revisor of Statutes.
The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:
https://www.nctreasurer.com/inside‐the‐department/OpenGovernment/Pages/Iran‐Divestment‐Act‐Resources.aspx
and will be updated every 180 days. For questions about the Department of State Treasurer’s Iran Divestment
Policy, please contact Meryl Murtagh at Meryl.Murtagh@nctreasurer.com or (919) 814‐3852.
625
AGENDA ABSTRACT
Meeting date: June 19, 2017
Agenda Title: Fiscal Year 2017-2018 Annual Budget Ordinance
Summary of Information: General Statute 159-13(a) directs that the annual budget must
be adopted by July 1. The budget ordinance may be adopted at any regular or special
meeting at which a quorum is present, by a majority of those present and voting. The
Ordinance for FY17-18 will be sent separately from the agenda packet and will be before
the Board for adoption having fulfilled the legal requirements including the conducting of
a public hearing.
Recommended Action: Adopt the Fiscal Year 17-18 Budget Ordinance
Submitted By: Heidi York, County Manager and Amy Wehrenberg, Finance Director
626
AGENDA ABSTRACT
Meeting Date: June 19, 2017
Agenda Title: Appointments to Boards and Committees
Summary of Information:
The Person County Board of Commissioners solicited volunteers to fill positions on the following
boards, commissions, authorities, and committees through advertisement in the Courier-Times
edition dated May 13, 2017 and May 20, 2017 with notice to submit applications by the deadline of
June 6, 2017. The highlighted boards denote a competitive board and are eligible for the informal
interview process only should the Board desire this process to aid them in making appointments.
Should the Board be interested in holding the informal interview process for some or all the
competitive boards, please direct the Clerk to organize and inform the applicants of the informal
interview date as set by the Board. Should the Board consider waiving the process, I respectively
request that the Board nominate and appoint as deemed appropriate.
Attached are interested citizen applications for consideration for appointments. The Board of
Commissioners are encouraged to recruit citizens to fill the current vacancies for those which no
applications have been received.
- ABC Board
3-Year Term: 1 position available
1) RD (Danny) Bumpass, Jr. requests reappointment
- Adult Care Home Community Advisory Committee
1-Year Initial Term; 3-Year Reappointment: 2 positions available
- Board of Adjustment
3-Year Term: 2 positons
- Board of Health
3-Year Term:
1 position for a pharmacist: Ted Michie requests reappointment
1 position for an engineer: Steven Bailey requests reappointment
1 position from the general public: Christopher Atkins, Jr. requests reappointment
627
- Economic Development Commission
5-Year Term: 7 positions available for a citizens-at-large
1) Kenneth Perry requests appointment
2) Jeff Fitzgerald requests appointment
3) Ernie Wood requests appointment
4) Charles Derrick Sims requests appointment
5) Dale Reynolds requests appointment
6) Carl Jewell Stonbraker requests appointment
7) Merilyn Newell requests appointment
8) Michael Wilkins requests appointment
9) Danny Talbert requests appointment
10) David Newell, Sr. requests appointment
11) Henry Daniel requests appointment
12) Frances Blalock requests appointment
13) Donald Long requests appointment
14) Phillip Allen requests appointment
- Environmental Issues Advisory Committee
3-Year Term: 1 position each representing the following townships:
Bushy Fork
Flat River: Faye Boyd requests appointment
Woodsdale
Holloway
Mt. Tirzah: Kenneth Hill requests reappointment
Olive Hill
Roxboro
- Home Health and Hospice Advisory Committee
3-Year Term:
1 position representing a consumer
1 position for a hospital representative
1 position for a representative of the Health Dept.: Leigh Ann Creson request reappointment
- Industrial Facilities and Pollution Control Financing Authority
6-Year Term: 4 positions available
- Jury Commission
2-Year Term; 1 position available
1) Bayard Crumpton requests reappointment
2) Marie Hanley requests appointment
628
- Juvenile Crime Prevention Council
1-Year Initial Term: 2-Year Reappointment
1 position for a person under the age of 21,
1 position representing the faith community, and
1 position representing the business community
1) Charles Harvey requests reappointment
2-Year Term:
1 position for a Juvenile Defense Attorney
2 positions for citizens-at-large
1) Erika Johnson requests appointment
2) Shiron Terrell requests reappointment
3) Kay Farrell requires reappointment
- Kerr Tar Regional Council of Government Board
2 citizens-at-large positions to serve as an alternate with an affiliation to represent the private sector
business, minority or the retired community for an unspecified term.
- Library Advisory Board
3-Year Term: 2 positions available
1) Lynn Jones requests reappointment
- Mental Health Community Oversight Board
3-Year Term: 1 position available
1) Antoinetta Royster requests appointment
- Nursing Home Advisory Committee
1-Year Initial Term: 3-Year Reappointment; 3 positions available
- Person Area Transportation System Board
3-Year Term:
1 position available for a representative of private industry,
1 position available for a representative of economic development, and
1 position available for a citizen-at-large
- Person-Caswell Lake Authority
3-Year Term: 1 position available
1) Tracy Lee Harris requests appointment
2) John Bullock requests appointment
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- Piedmont Community College Board of Trustees
4-Year Term: 1 position available
1) Charles Harvey requests appointment
2) Clarence Smith requests appointment
- Planning Board
3-Year Term: 3 positions available
1) Robert Allen requests reappointment
2) Kenneth Montgomery requests reappointment
- Recreation Advisory Board
3-Year Term: 2 positions available
1) Froncello Bumpass requests reappointment
- Region K Aging Advisory
3-Year Term: 1 position
- Voluntary Agricultural District Board
3-Year Term: 1 position available to represent each of the following townships and designation:
Bushy Fork: Chris Brann requests appointment
Flat River: Ronald Foushee requests reappointment
Mt. Tirzah: Pete Thomas requests reappointment
Farm Bureau: Coleman Whitfield requests reappointment
Grange: Norman Boyette requests reappointment
- Workforce Development Board
1-Year Initial Term; 2-Year Reappointment
1 position available for a representative of a registered apprenticeship program, and
1 position available for a member or an officer of organized labor
Recommended Action: Board nomination for appointment as deemed appropriate.
Submitted By: Brenda B. Reaves, Clerk to the Board
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AGENDA ABSTRACT
Meeting Date: June 19, 2017
Agenda Title: Designate NACo Voting Delegate for the 2017 Annual Conference
Summary of Information: Voting Credentials for the 2017 Annual Conference to be held
July 21-24, 2017, in Franklin County, Ohio, must be submitted by July 7, 2017 in order for
Person County’s delegate to participate in the association’s annual election of officers and
policy adoption.
Recommended Action: Designate a commissioner to serve as Person County’s delegate
with an alternate should the Board deem appropriate. At this time, no one has requested
registration to attend. Should no one attend the conference, please see the general voting
guidelines for the procedure to casting Person County’s vote.
Submitted By: Chairman Kendrick
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