FY15 SHIIP RSVP $500 grantRQ 18026362
COUNTY • WAKE
This Contract and its attachments shall be completed and returned to the Agency within 45 days of receiving the
electronic document in order for the Agency to process the award and provide funds to the Grantee. The Grantee
shall provide the agency with progress reports and a final report detailing the Grantee's use • State funds.
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1. Contract Documents: This Contract shall consist • the following documents, incorporated herein by
reference:
These documents constitute the entire agreement between the Parties and supersede all prior statements or
agreements.
3. Effective Period: This Contract is effective 10/1/2014 and terminates on 1213112014.
5. Agency's Duties: The Agency shall reimburse the Grantee for the costs of services and activities described
in Attachment B and in accordance with the approved budget in Attachment C. The Agency shall monitor
the Grantee for compliance with the terms • this Contract; and shall specify all reports and other
deliverables required from the Grantee.
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The total amount paid by the Agency to the Grantee under this Contract shall not exceed $500.00. This
amount consists • $500.00, CFDA # 93.779.
b. The Grantee's matching requirement is $ which shall consist of-
In-kind ] Cash
Cash and In-kind ] Cash and/or In-kind
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6. Conflict of Interest Policy: The Agency has determined that this Contract is not subject to NCGS 14 -C -6-
22 & 23.
7. Reversion of Unexpended Funds: Any unexpended grant funds shall revert to the Agency upon
termination of this Contract.
8. Grants: The Grantee has the responsibility to ensure that all sub-grantees, if any, provide all information
necessary to permit the Grantee to comply with the terms and conditions set forth in this Contract.
9. Payment Provisions: As provided in NCGS 143C-21 this Contract is an annual appropriation • $100,000
or less to or for the use of a non-profit corporation and payment shall be made in a single annual payment.
M 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, address, telephone number and fax number of the Parties' respective
initial Contract Administrators are set out below. Either Party may change the name, address, telephone
number and fax number of its Contract Administrator by giving timely written notice to the other Party.
•
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flew Hanover Co-Sr Resource Ctr/RSVP
2222 S. College Rd, Wilmington NC 284
Phone 910-798-6410
Fax i
11. Supplementation of Expenditures of Public Funds: The Grantee assures that funds received under this
Contract shall be used only to supplement, not to supplant, the total amount of federal, state and local public
funds the Grantee otherwise expends for SHIIP 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 Grantee's total expenditure of other public funds for such services.
12. Disbursements: As a condition of this Contract, the Grantee acknowledges and agrees to make
disbursements in accordance with the following requirements:
71. Implement adequate internal controls over disbursements;M
b. Pre-audit all vouchers presented for payment to determi 'I
ne
Validity and accuracy of payment;
Payment due date;
Adequacy of documentation supporting payment; a
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° Legality of
C. Assure adequate control Vf signature otauopa6nlutma;
d Assure adequate control of and
e. Implement procedures to ensure that the account balance is solvent and reconcile the account
monthly.
A. Certification Regarding Lobbying.
B. Certification Regarding Department.
C. Certification Regarding Drug-Free Workplace Requirements.
17. Signature Warranty: The undersigned represent and warrant that they are authorized to bind their
principals to the terms • this agreement.
In witness whereof, the Grantee and the Agency have executed this Agreement witli one original, which is
retained by Agency.
ftew Aanover County -
BY:
LA�CA PtAokkc ( A' Ooci twuyr
Printed Name Printed Name
DATE:
IM
R. Van Braxton
M i - 041411aW
-JW-Jj_!j INI RIVIRM61 111KI I M438 rAftZ.11
141RENS • Ing
Now 11"IMMUGMUM-
I TBL 9-5-2014 ) Format reviewed & approved by Controller's Offics
Attachment A
General Terms and Conditions
DEFINITIONS individuals for Medicare and Medicaid patient
definitions below) shall mean and include
every public office, public officer or official
(State or local, elected or appointed),
institution, board, commission, bureau,
council, department, authority or other unit of
government of the State or of any county, unit,
special district or other political subagency of
government. For other purposes in this
Contract, "Agency" shall mean the entity
identified as one of the parties hereto.
(2) "Audit" means an examination of records or
financial accounts to verify their accuracy.
(3) "Certification of Compliance" means a report
provided by the Agency to the Office of the
State Auditor that states that the Grantee has
met the reporting requirements established by
this Subchapter and included a statement of
certification by the Agency and copies of the
submitted grantee reporting package.
(4) "Compliance Supplement" refers to the North
Carolina State Compliance Supplement,
maintained by the State and Local
Government Finance Agency within the North
Carolina Department of State Treasurer that
has been developed in cooperation with
agencies to assist the local auditor in
identifying program compliance requirements
and audit procedures for testing those
requirements.
(5) "Contract" means a legal instrument that is
used to reflect a relationship between the
agency, grantee, and subgrantee.
(6) "Fiscal Year" means the annual operating year
of the non-State entity.
(7) "Financial Assistance" means assistance that
non-State entities receive or administer in the
form of grants, loans, loan guarantees,
property (including donated surplus property),
cooperative agreements, interest subsidies,
insurance, food commodities, direct
appropriations, and other assistance. Financial
assistance does not include amounts received
as reimbursement for services rendered to
services.
(8) "Financial Statement" means a report
providing financial statistics relative to a given
part of an organization's operations or status.
(9) "Grant" means financial assistance provided
by an agency, grantee, or subgrantee to carry
out activities whereby the grantor anticipates
no programmatic involvement with the grantee
or subgrantee during the performance of the
grant.
(10) "Grantee" has the meaning in NCGS 1430 -6-
23(a)(2): a non-State entity that receives a
grant of State funds from a State agency,
department, or institution but does not include
any non-State entity subject to the audit and
other reporting requirements of the Local
Government Commission. For other purposes
in this Contract, "Grantee" shall mean the
entity identified as one of the parties hereto.
(11) "Grantor" means an entity that provides
resources, generally financial, to another entity
in order to achieve a specified goal or
objective.
(12) "Non-State Entity" has the meaning in NCGS
143C-1-1(d)(18): Any of the following that is
not a State agency: An individual, a firm, a
partnership, an association, a county, a
corporation, or any other organization acting
as a unit. The term includes a unit of local
government and public authority.
(13) "Public Authority" has the meaning in NCGS
143C-1-1(d)(22): A municipal corporation
that is not a unit of local government or a local
governmental authority, board, commission,
council, or agency that (i) is not a municipal
corporation and (ii) operates on an area,
regional, or multiunit basis, and the budgeting
and accounting systems of which are not fully
a part of the budgeting and accounting systems
of a unit of local government.
(14) "Single Audit" means an audit that includes an
examination of an organization's financial
statements, internal controls, and compliance
with the requirements of Federal or State
awards.
(15) "Special Appropriation" means a legislative act
authorizing the expenditure of a designated
amount of public funds for a specific purpose.
(16) "State Funds" means any funds appropriated
by the North Carolina General Assembly or
collected by the State of North Carolina. State
Subgrantees: The Grantee has the responsibility to
ensure that all subgrantees, if any, provide all
information necessary to permit the Grantee to comply
with the standards set forth in this Contract.
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Termination by Mutual Consent: The Parties may
terminate this Contract by mutual consent with 60 days
notice to the other party, or as otherwise provided by
law.
entitled to receive just and equitable compensation for
any satisfactory work completed on such materials,
minus any payment or compensation previously made.
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 • funds for this purpose to the Agency.
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Executive Order # 24: "By Executive Order 24, issued
• Governor Perdue, and NCGS 133-32, it is unlawful
for any vendor ♦ contractor ( i.e. architect, bidder,
contractor, construction manager, design professional,
engineer, landlord, offeror, seller, subcontractor,
supplier, or vendor), to make gifts or to give favors to
any State emIL(lypee of the Governor's Cabinet Agencies
Administration, Commerce, Correction, Crime
Control and Public Safety, Cultural Resources,
Environment and Natural Resources, Health and Human
Services, Juvenile Justice and Delinquency Prevention,
Revenue, Transportation, and the Office of the
Governor). This prohibition covers those vendors and
contractors who have a contract with a governmental
agency;
• have performed under such a contract within
the �sast rAear*.
the future.
For additional information regarding the specific
requirements and exemptions, vendors and contractors
are encoura0ed to review Executive Order 24 ani&MviW
Sec. 133-32.
Executive Order 24 also encouraged and invited other
State Agencies to implement the requirements and
prohibitions of the Executive Order to their agencies.
Vendors and contractors should contact other State
Agencies to determine if those agencies have adopted
Executive Order 24."
Copyrights and Ownership • Deliverables: All
deliverable items produced pursuant to this Contract are
the exclusive property • the Agency. The Grantee shall
not assert a claim of copyright or other property interest
in such deliverables.
Compliance with Applicable Laws
Compliance with Laws: The Grantee 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.
I
Equal Employment Opportunity: The Grantee shall
comply with all federal and state laws relating to equal
employment opportunity.
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Choice of Law: The validity • 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 Grantee, by signing this Contract,
agrees and submits, solely for matters concerning this
Amendment: This Contract may not be amended orally
or • performance. Any amendment must be made in
written form and executed by duly authorized
representatives of the Agency and the Grantee.
Aeadings: 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.
Advertising: The Grantee shall not use the award of
this Contract as a part of any news release or commercial
advertising.
Attachment M
Statement of 1
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ttachment C
For the period 10/1/2014 — 12/31/2014
`'
Provide a budget and short narrative on the use of the funding amount reflected on the contract. Please provide details of
all expenses including routine charges. These expenditures may include telephone, postage, salary, equipment purchases,
internet services etc. Upon termination of contract as a SHIIP Coordinating Site, any equipment or property less than five
(5) years old purchased by grantee with grant funds to perform SHIIP functions shall be returned to the Agency in good
working order.
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Grantee Name: New Hanover County - Senior Resource Center/RSVP
We will be purchasing;
Pens for participants
2 Fruit Trays
2 Cheese Sampler Trays
I Vegetable Tray
Drinking cups
Coffie
Juice
Ice Tea
Napkins
Creamer
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Attachment D
Certifications Regarding, Drug-Free Work-Place; Lobbying; and
Debarment, Suspension and Other Responsibility Matters
MHERIMONSUMM,
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(b) 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 • employee of any agency, a Member • Congress, an
officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal
contract, grant, loan or cooperative agreement, the undersigned shall complete and submit Standard Form -
LLL, "Disclosure of Lobbying Activities," in accordance with its instructions;
(c) 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, contracts and contracts under grants, loans
and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation • 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 3 1, 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.
13WIT-M
NOTE: In accordance with 45 CFR Part 76, amended June 26, 1995, any debarment, suspension, proposed debarme
or other government wide exclusion initiated under the Federal Acquisition Regulation (FAR) on or after August 25,
1995, shall be recognized by and effective for Executive Branch agencies and participants as an exclusion under 45
CFR Part 76.
(a) Primary Covered Transactions
Trir#=of =is or Her Knowledgeand-6—eff6r, that the
,pplicant, defined as the primary participant in accordance with 45 CFR Part 76, and its principals:
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Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or
iestruction of records, making false statements, or receiving stolen property;
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"Cer;ification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion -- Lower Tier
Covered Transaction" (Appendix B to 45 CFR Part 76) in all lower tier covered transactions (i.e., transactions with
subgrantees and/or contractors) and in all solicitations for lower tier covered transactions:
Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion -- Lower Tier
Covered Transactions
(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.
Signature of Authorized Certifying Official Title
AvrI *( pa` vitr
Ar-
New Hanover County - Senior Resource
Center/RSVP
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