HomeMy WebLinkAboutFY23 SRC NCDOI SHRED-A-THON 6-1-22 TO 5-31-23 AWARDNORTH CRLI1A
DEPARTMENT OF INSURANCE
ACE
MIKE CAUSEY, COibiMMSION£R
State of North Carolina
County of Wake
Grant Name: CIP — Senior Medicare Patrol Project
Federal Award Agency: US Department of Health & Human Services,
Administration for Community Living
CDFA # 93.048
Fiscal Year: 2022-2023
Federal Award Date: 05/26/2022 Performance Period: 06/01/2022-05/31/2023
Account # 536405
Grant Award # 90MPPGO043- Cost Center: 16001643g22 Award Amount $ $3,600.00
05-00
Recipient:
State of North Carolina
Department of Insurance
SHIIP Division
Total Amount
$ $3,600.00
Contract Between
Subrecipient•
Name:
New Hanover County/ Senior
Resource Ctr/RSVP
County:
New Hanover
Tax ID/FIN #
56-6000324
DUNS #
40029563
Chis Contract and its attachments shall be completed and returned to the Recipient within 45 days of
-eceiving the electronic document in order for the Recipient to process the award and provide funds to the
Subrecipient. The Subrecipient shall provide the Recipient with progress reports and a final report
letailing the Subrecipient's use of State funds.
1. Contract Documents: This Contract shall consist of the following documents, incorporated herein by
reference:
(1) This Contract;
(2) General Terms and Conditions for Public Sector Contracts (Attachment A)
(3) Statement of Work (Attachment B)
(4) Line Item Budget and Budget Narrative (Attachment C)
(5) Certifications Regarding, Drug -Free Work -Place; Lobbying; and Debarment, Suspension and Other
Responsibility Matters (Attachment D)
These documents constitute the entire agreement between the Parties and supersede all prior statements
or agreements.
2. Precedence Among Contract Documents: In the event of a conflict between or among the terms of the
Contract Documents, the terms in the Contract Document with the highest relative precedence shall
prevail. The order of precedence shall be the order of documents as listed in Paragraph 1, above, with the
first -listed document having the highest precedence and the last -listed document having the lowest
precedence. If there are multiple Contract Amendments, the most recent amendment shall have the
highest precedence and the oldest amendment shall have the lowest precedence.
3. Subrecipient's Duties: The Subrecipient shall provide the services as described in Attachment B with
the terms of this Contract and in accordance with the approved budget in Attachment C. The Subrecipient
shall maintain and make available all records, papers, vouchers, books, correspondence or other
documentation or evidence at reasonable times for review, inspection, or audit by duly authorized officials
of the Recipient, the North Carolina State Auditor, or applicable federal agencies. Upon termination of
contract as a SHIIP Coordinating Site, any equipment or property less than five (5) years old purchased
by Subrecipient with grant funds to perform SHIIP functions shall be returned to the Recipient in good
working order. The Subrecipient shall submit to the Recipient all plans, reports, documents, or other
products that the Recipient may require, in the form specified by the Recipient, including at the least
following:
A) An Annual Expense Report for the dates of August 1 through May 31, due June 6;
B) Administration on Aging (AoA) OIG Progress -to -date for period June 1 through November 30, due
December 9 and for period December 1 through May 31, due June 9;
C) Progress -to -date for period June 1 through November 30, due December 9 and for period December
1 through May 31, due June 9;
D) Key personnel to participate in scheduled meetings and/or conference calls; provide oral reports;
E) Providing a copy of all written and taped materials for review and approval prior to use; and
F) Notifying the North Carolina SMP Program Director of any contact with media.
4. Recipient's Duties: The Recipient shall reimburse the Subrecipient for the costs of services and activities
described in Attachment B and in accordance with the approved budget in Attachment C. The Recipient
shall monitor the Subrecipient for compliance with the terms of this Contract; and shall specify all reports
and other deliverables required from the Subrecipient. The Recipient shall pay the Subrecipient in the
manner and in the amounts specified in the Contract Documents.
[ X ] a. There are no matching requirements from the Subrecipient.
[ ] b. The Subrecipient's matching requirement is $n/a, which shall consist of:
[ ] In -kind [ ] Cash
[ ] Cash and In -kind [ ] Cash and/or In -kind
The contributions from the Subrecipient shall be source from non-federal funds.
5. Conflict of Interest Policy: The Recipient has determined that this Contract is not subject to NCGS
143C6-22 & 23.
6. Reversion of Unexpended Funds: Any unexpended grant funds shall revert to the Recipient upon
termination of this Contract.
7. Grants: The Subrecipient has the responsibility to ensure that all sub -grantees, if any, provide all
information necessary to permit the Subrecipient to comply with the terms and conditions set forth in this
Contract. The grant award for the contract is not to be used for Research & Development (R&D).
8. Payment Provisions: As provided in NCGS 143C-6-21 this Contract is an annual appropriation of
$100,000 or less to or for the use of a non-profit corporation and payment shall be made in a single annual
payment.
9. Contract Administrators: All notices permitted or required to be given by one Party to the other and all
questions about the contract from one Party to the other shall be addressed and delivered to the other
Party's Contract Administrator. The name, 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.
For the Recipient:
Melinda Munden, Deputy Commissioner
SHIIP Division
1201 Mail Service Center
Raleigh, NC 27699-1201
Telephone: 919-807-6900
For the SubreciDient:
Tufanna Bradley
New Hanover County/ Senior
Resource Ctr/RSVP
2222 S. College Road Wilmington,
NC 28403
Telephone: (910) 798-6400
10. Supplementation of Expenditures of Public Funds: The Subrecipient 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 Subrecipient otherwise expends for NCSMP and 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 Subrecipient's total expenditure of other public funds for such
services.
11. Disbursements: As a condition of this Contract, the Subrecipient 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; and
• Legality of disbursement;
c. Assure adequate control of signature stamps/plates;
d. Assure adequate control of negotiable instruments; and
e. Implement procedures to ensure that the account balance is solvent and reconcile the account
monthly.
12. Outsourcing: The Subrecipient certifies that it has identified to the Recipient all jobs related to the Contract
that have been outsourced to other countries, if any. Subrecipient further agrees that it will not outsource any
such jobs during the term of this Contract without providing notice to the Recipient.
13. Executive Order # 24: NCGS 133-32 and Executive Order 24 prohibit the offer to, or acceptance by, any
State Employee of any gift from anyone with a contract with the State, or from any person seeking to do
business with the State. By execution of any response in this procurement, you attest, for your entire
organization and its employees or agents, that you are not aware that any such gift has been offered, accepted,
or promised by any employees of your organization.
14. Audit: The Recipient reserves the right to conduct an audit through the NCSMP Program Director. The
Subrecipient must permit access to records and financial statements by the audit staff of Recipient as
necessary.
15. Federal Certifications: The Subrecipient agrees to execute the following federal certifications that are
attached to this agreement (applicable when receiving federal funds).
A. Certification Regarding Lobbying.
B. Certification Regarding Department.
C. Certification Regarding Drug -Free Workplace Requirements.
16. Signature Warranty: The undersigned represent and warrant that they are authorized to bind their
principals to the terms of this agreement.
Subrecipient:
BY: - T-tAo-mm L Sradlcy
Division of SHIIP,
BY: x !A&mdn_
DATE: 03/22/2023 01:02 PM
DATE: 03/21/2023 04:25 PM
BY. _ � � dux'` � DATE: 03/24/2023 4:32:13 PM GMT
n
Date: 03/24/2023 GMTcdoi.gov
Contract is not executed until last signature is obtained.
Attachment A
General Terms and Conditions
DEFINITIONS
Unless indicated otherwise from the context, the following terms shall have the following meanings in this
Contract. If the rule or statute that is the source of the definition is changed by the adopting authority, the change
shall be incorporated herein.
(1) "Recipient" (as used in the context of the 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 sub -agency of government. For other purposes in this Contract, "Recipient" shall mean the entity
identified as one of the parties hereto.
(2) "Audit" has the meaning in 09 NCAC 03M .0102(2): an examination of records or financial accounts to
verify their accuracy.
(3) "Contract" has the meaning in 09 NCAC 03M .0102(4): a legal instrument that is used to reflect a
relationship between the Recipient, Subrecipient, and sub -grantee.
(4) "Fiscal Year" has the meaning in 09 NCAC 03M .0102(7): the annual operating year of the non -State entity.
(5) "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 individuals for Medicare and
Medicaid patient services.
(6) "Financial Statement" has the meaning in 09 NCAC 03M .0 102(8):a report providing financial data relative
to a given part of an organization's operations or status.
(7) "Grant" means financial assistance provided by a Recipient, Subrecipient, or sub -grantee -to carry out
activities whereby the grantor anticipates no programmatic involvement with the Subrecipient or sub -
grantee during the performance of the grant.
(8) "Subrecipient" has the meaning in G.S. § 143C-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, "Subrecipient" shall mean the entity identified as one of the parties hereto.
(9) "Grantor" means an entity that provides resources, generally financial, to another entity in order to achieve
a specified goal or objective.
(10) "Non -State Entity" has the meaning in G.S. § 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.
(11) "Public Authority" has the meaning in G.S. § 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.
(12) "State Funds" has the meaning in 09 NCAC 03M .0102(12): any funds appropriated by the North Carolina
General Assembly or collected by the State of North Carolina. State funds include federal financial
assistance received by the State and transferred or disbursed to non -State entities. Both Federal and State
funds maintain their identity as they are disbursed as financial assistance to other organizations. Pursuant
to G.S. § 143C-6-23(a)(1), the terms "State grant funds" and "State grants" do not include any payment
made by the Medicaid program, the State Health Plan for Teachers and State Employees, or other similar
medical programs.
(13) "Sub -grantee" has the meaning in G.S. § 143C-6-23(a)(4): a non -State entity that receives State funds as a
grant from a subrecipient or from another sub -grantee but does not include any non -State entity subject to
the audit and other reporting requirements of the Local Government Commission.
(14) "Unit of Local Government" has the meaning in G.S. § 143C-1-I(d)(29): A municipal corporation that has
the power to levy taxes, including a consolidated city -county as defined by G.S. § 160B-2(1), and all boards,
agencies, commissions, authorities, and institutions thereof that are not municipal corporations.
Relationships of the Parties
Independent Contractor: The Subrecipient 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 Subrecipient 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 Recipient.
Subcontracting: The Subrecipient shall not subcontract any ofthe work contemplated under this Contract without
prior written approval from the Recipient. Any approved subcontract shall be subject to all conditions of this
Contract. Only the subcontractors or sub -grantees specified in the contract documents are to be considered
approved upon award of the contract. The Recipient shall not be obligated to pay for any work performed by any
unapproved subcontractor or sub -grantee. The Subrecipient shall be responsible for the performance of all of its
sub -grantees and shall not be relieved of any of the duties and responsibilities of this Contract.
Sub -grantees: The Subrecipient has the responsibility to ensure that all sub -grantees, if any, provide all
information necessary to permit the Subrecipient to comply with the standards set forth in this Contract.
Assignment: No assignment of the Subrecipient's obligations or the Subrecipient's right to receive payment
hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, the
State may:
(a) Forward the Subrecipient's payment check(s) directly to any person or entity designated by the
Subrecipient; or
(b) Include any person or entity designated by Subrecipient as a joint payee on the Subrecipient's payment
check(s).
In no event shall such approval and action obligate the State to anyone other than the Subrecipient and the
Subrecipient 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 Recipient and the named Subrecipient. 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
Recipient and Subrecipient that any such person or entity, other than the Recipient or the Subrecipient, receiving
services or benefits under this Contract shall be deemed an incidental beneficiary only.
Ineligible Vendors: As provided in G.S. § 147-86.60 and G.S. § 147-86.82, the following companies are
ineligible to contract with the State of North Carolina or any political subdivision of the State: a) any company
identified as engaging in investment activities in Iran, as determined by appearing on the list of restricted
companies created by the State Treasurer pursuant to G. S. § 147- 86.58, and b) any company identified as engaged
in a boycott of Israel as determined by appearing on the list of restricted companies created by the State Treasurer
pursuant to G.S. § 147-86.81. A contract with the State or any of its political subdivisions by any company
identified in a) or b) above shall be void ab initio.
Indemnity
Indemnification: The Subrecipient agrees to indemnify and hold harmless the Recipient, the State of North
Carolina, and any of their officers, agents and employees, from any claims of third parties arising out of any act or
omission of the Subrecipient in connection with the performance of this Contract to the extent permitted by law.
Default and Termination
Termination by Mutual Consent: The Parties may terminate this Contract by mutual consent with 60 days'
notice to the other parry, or as otherwise provided by law.
Termination Without Cause: The Recipient may terminate this contract without cause by giving 60 days written
notice to the Subrecipient. In that event, all finished or unfinished deliverable items prepared by the Subrecipient
under this contract shall, at the option of the Recipient, become its property and the Subrecipient shall be entitled
to receive just and equitable compensation for any satisfactory work completed on such materials, minus any
payment or compensation previously made.
Termination for Cause: If, through any cause, the Subrecipient shall fail to fulfill its obligations under this
Contract in a timely and proper manner, the Recipient shall have the right to terminate this Contract by giving
written notice to the Subrecipient and specifying the effective date thereof. In that event, all finished or unfinished
deliverable items prepared by the Subrecipient under this Contract shall, at the option of the Recipient, become its
property and the Subrecipient 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 Subrecipient shall not be relieved of liability to the Recipient for damages sustained by
the Recipient by virtue of the Subrecipient's breach of this agreement, and the Recipient may withhold any
payment due the Subrecipient for the purpose of setoff until such time as the exact amount of damages due the
Recipient from such breach can be determined.
Waiver of Default: Waiver by the Recipient of any default or breach in compliance with the terms of this Contract
by the Subrecipient 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 Recipient and the Subrecipient 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 Recipient.
Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event or act of God.
Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, 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.
Health Insurance Portability and Accountability Act (HIPAA): The Subrecipient agrees that, if the Recipient
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 Recipient may
require to ensure compliance.
Executive Order # 24: By Executive Order 24, issued by Governor Perdue, and G.S. § 133-32, it is unlawful for
any vendor or 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 employee
of the Governor's Cabinet Agencies (i.e., 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; or have performed under such a contract
within the past year; or anticipate bidding on such a contract in the future.
For additional information regarding the specific requirements and exemptions, vendors and contractors are
encouraged to review Executive Order 24 and G.S. § 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.
Intellectual Property Rights
Copyrights and Ownership of Deliverables: All deliverable items produced pursuant to this Contract are the
exclusive property ofthe Recipient. The Subrecipient shall not assert a claim of copyright or other property interest
in such deliverables.
Compliance with Applicable Laws
Compliance with Laws: The Subrecipient shall comply with all laws, ordinances, codes, rules, regulations, and
licensing requirements that are applicable to the conduct of its business, including those of federal, state, and local
agencies having jurisdiction and/or authority.
Equal Employment Opportunity: The Subrecipient shall comply with all federal and state laws relating to equal
employment opportunity.
Confidentiality
Confidentiality: Any information, data, instruments, documents, studies or reports given to or prepared or
assembled by the Subrecipient 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 Recipient. The Subrecipient
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.
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 G.S. § 147-64.7.
Additionally, as the State funding authority, the Recipient and all applicable federal agencies or their agents 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 Recipient. 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.
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 Subrecipient, by signing this
Contract, agrees and submits, solely for matters concerning this Contract, to the exclusive jurisdiction of the courts
of North Carolina and agrees, solely for such purpose, that the exclusive venue for any legal proceedings shall be
Wake County, North Carolina. The place of this Contract and all transactions and agreements relating to it, and
their situs and forum, shall be Wake County, North Carolina, where all matters, whether sounding in contract or
tort, relating to the validity, construction, interpretation, and enforcement shall be determined.
Amendment: This Contract may not be amended orally or by performance. Any amendment must be made in
written form and executed by duly authorized representatives of the Recipient and the Subrecipient.
Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this
Contract violates any applicable law, each such provision or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this
Contract shall remain in full force and effect.
Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of
the agreement and should not be used to construe the meaning thereof.
Time of the Essence: Time is of the essence in the performance of this Contract.
Key Personnel: The Subrecipient shall not replace any of the key personnel assigned to the performance of this
contract without the prior written approval of the Recipient. 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 Subrecipient 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
Recipient for loss of, or damage to, such property. At the termination of this Contract, the Subrecipient shall
contact the Recipient for instructions as to the disposition of such property and shall comply with these instructions.
Travel Expenses: Reimbursement to the Subrecipient for travel mileage, meals, lodging and other travel expenses
incurred in the performance of this Contract shall be reasonable and supported by documentation. State rates
should be used as guidelines. International travel shall not be reimbursed under this Contract.
Sales/Use Tax Refunds: If eligible, the Subrecipient and all sub -recipients 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 Subrecipient shall not use the award of this Contract as a part of any news release or commercial
advertising, except as allowed in Attachment B.
Attachment B
For the period 06/01/2022 - 05/31/2023
Statement of Work
Subrecipient: New Hanover County/ Senior Resource Ctr/RSVP
This statement should be a short summary describing what the Subrecipient does and how the Subrecipient will
use these funds. The terms of the contract between the SHIIP office and the agencies require local programs
meet these goals for the contract period. The uses of these funds are not limited to but MUST include the
following activities:
1. Describe the type of Identity Shred-A-Thon/Fraud Prevention event that you will be hosting.
Provide information to include but not limited to a health fair type activity, or presentation style event
with speakers from various agencies discussing fraud prevention. Your description should explain why
you need to host an Identity Theft Shred-A-Thon/Fraud Prevention event. Funds may be used to the
promote event, pay for the event location, staff time working on the event, and pay for the shred activity.
No food can be purchased using these funds for the event.
2. How will you promote the NCSMP Program during the event?
3. Will you enter the data into STARS and select the "Send to SMP" button on the Public and Media
Outreach Form?
Subrecipient Response to Scope of Work:
1. We have a drive thru shred-a-thon event scheduled for April 14, 2023, at two separate locations to
make the event accessible to as many New Hanover County residents as possible. The New Hanover
County Senior Resource center is partnering with the Area Agency on Aging and the Elder Abuse
Prevention Network to put together bags of information that will be distributed to participants as they
drive through lines. We will have volunteers to talk with participants as needed. We are using the funds
to pay for the shredding company, promotion, and possibly additional staff working the event.
2. We plan on working with the AAA to make sure NCSMP is promoted during the event. We will be
handing out material in bags provided by the AAA and the Elder Abuse Prevention Network.
3. We will attempt to enter the data into STARS and select the "Send to SMP" button on the Public and
Media Outreach Form.
Attachment C
For the period 06/01/2022 - 05/31/2023
Line Item Budget and Budget Narrative
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 Subrecipient with grant funds to perform SHIIP
functions shall be returned to the Recipient in good working order.
All budgets must be approved by the Recipient.
Subrecipient Name: New Hanover County/ Senior Resource Ctr/RSVP DOI Award Amount:
3 600.00
Total Project Budget: $3,600.00
All fields must be completed.
Zero is an acceptable answer
Must agree to the award amount.
Budget
Amount
Contractual
$3,600.00
Construction
$0.00
Supplies
$0.00
Equipment
$0.00
Other
$0.00
Travel
$0.00
Personnel
$0.00
Fringe
$0.00
Total
$3, 600.00
Written description of planned expenditures:
The money will be used to pay for the shredding services at two site locations.
Attachment D
Certifications Regarding, Drug -Free Work -Place; Lobbying; and Debarment,
Suspension and Other Responsibility Matters
1. Drug -Free Work -Place
The undersigned (authorized official) certifies that it will provide a drug -free workplace in accordance with the
Drug -Free Work -Place Act of 1988, 45 CFR Part 76, subpart F. The certification set out below is a material
representation of fact upon which reliance will be placed when awarding the grant. False certification or
violation of the certification shall be grounds for suspension of payments, suspensions or termination of grants
or government wide suspension or debarment.
The Subrecipient certifies that it will or will continue to 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 Subrecipient's workplace and
specifying the actions that will be taken against employees for violation of such prohibition;
(b) Establishing an on -going drug -free awareness program to inform employees about—
(1) The dangers of drug abuse in the workplace;
(2) The Subrecipient'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 to be engaged in the performance of the grant be given
a copy of the statement required by paragraph (a); above;
(d) Notifying the employee in the statement required by paragraph (a) that, as a condition of employment
under the grant, the employee will
(1) Abide by the terms of the statement; and
(2) Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five calendar days after such conviction;
(e) Notifying the Recipient, in writing, within 10 calendar days after receiving notice under
subparagraph (d)(2), above, from an employee or otherwise receiving actual notice of such
conviction. Employers of convicted employees must provide notice, including position title, to
Recipient on whose grant activity the convicted employee was working.
Notices shall include the identification number(s) of each affected grant;
(f) Taking one of the following actions, within 30 days of receiving notice under subparagraph (d)(2),
above, with respect to any employee who is so convicted
(1) Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended;
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;
(g) Making a good faith effort to continue to maintain a drug -free workplace through implementation of
paragraphs (a), (b), (c), (d), (e), and (f).
The Subrecipient certifies that, as a condition of the grant, it will not engage in the unlawful manufacture,
distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant.
2. Lobbying
Title 31 of the United States Code, Section 1352, entitled "Limitation on use of appropriated funds to influence
certain Federal contracting and financial transactions," generally prohibits recipients of Federal grants and
cooperative agreements from using Federal (appropriated) funds for lobbying the Executive or Legislative
Branches of the Federal Government in connection with a SPECIFIC grant or cooperative agreement. Section
1352 also requires that each person who request or received a Federal grants or cooperative agreement must
disclose lobbying undertaking with non -Federal (non -appropriated) funds. These requirements apply to grants
and cooperative agreements EXCEEDING $100,000 in total costs (45 CFR Part93).
The undersigned (authorized official) certifies, to the best of his or her knowledge and belief, that:
(a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee of
any agency, a member of Congress, any officer or employee of Congress, or an employee of a
Member of Congress in connection with the awarding of any Federal contract, the making of
any Federal grant, the making of any Federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification of any
Federal grant, loan or cooperative agreement;
(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 or employee of any agency, a Member of
Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with this 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 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.
3. Debarment, Suspension and Other Responsibility Matters
NOTE: In accordance with 45 CFR Part 76, amended June 26, 1995, any debarment, suspension, proposed
debarment 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
The undersigned (authorized official) certifies to the best of his or her knowledge and belief, that the
applicant, defined as the primary participant in accordance with 45 CFR Part 76, and its principals:
(1) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded by any Federal department or agency;
(2) have not within a 3-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (Federal, State or local) transaction or contract under
a public transaction; violation of Federal or State antitrust statutes or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property;
(3) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (a)(2)
of this certification; and
(4) have not within a 3-year period preceding this application/proposal had one or more public
transactions (Federal, State, or local) terminated for cause or default.
Should the applicant not be able to provide this certification, an explanation as to why should be placed
under the assurances page in the application package.
(b) Lower Tier Covered Transactions
The applicant agrees by submitting this proposal that it will include, without modification, the following clause
titled "Certification 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 subrecipients and/or contractors) and in all solicitations for lower tier covered transactions:
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.
Signature of Authorized Certifying Official
Title
Assistant County Manager
Subrecipient Name
Date Submitted
New Hanover County/ Senior Resource Ctr/RSVP
03/22/2023 01:02 PM
SMP-Gov-Contract
Created: 03/23/2023
Status: Signed
Transaction ID: 5c070ae8-c967-45b6-9301-52c3f9471ccc
"SMP-Gov-Contract" history
Tanya Oginski created the document.
03/23/2023 12:43:29 PM GMT - IP address 149.168.74.8
I Document was emailed to Jackie Obusek
03/23/2023 12:43:30 PM GMT
fig Jackie Obusek signed the document.
03/24/2023 4:32:14 PM GMT - IP address 174.238.49.220:2779
Document was successfully signed and filed
03/24/2023 4:32:15 PM GMT