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9. Funding will not be released until Person County Health Department receives notification of <br /> budget approval at the state level. <br /> As a contractor of Person County Health Department,HIPAA privacy practices and policies must be <br /> maintained at all times. Individual information obtained for use in media in any format must be accompanied <br /> by a consent release form for the said individual to give active consent for use of his/her name,photo,and/or <br /> likeness in any media. <br /> Furthermore, as a contractor of Person County Health Department, Contractor agrees to conduct itself in a <br /> manner that at all times complies with the lobbying restrictions outlined in APPENDIX A. <br /> Oranee County Health Department is to submit this signed contract along with a completed Form W-9 <br /> (Federal Tax Identification)to Person County Health Department Attn: Dawn Coleman, 355 A South <br /> Madison Blvd.Roxboro,NC 27573.An electronic copy of the contract or form will be accepted to Dawn <br /> Coleman at dcoleman.pchd @personcounty.net <br /> All activities under this policy will be conducted in accordance with Title VI,Civil Rights Act of 1964, <br /> Section 504 of Rehabilitation Act for 1973. <br /> Colleen Bridger,Ph.D,MPH Valth Director Date <br /> Director of Heath,Orange County <br /> v <br /> Michael Tal ert Date <br /> Interim County Manager, Orange County <br /> l� <br /> Jan, Clayton, Date <br /> Health Director <br /> Person County Health Department <br /> This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. <br /> Persol ounty Financtepartment <br /> cer, Date <br /> Person County Health <br /> This instrument has been pre-audited in the <br /> manner required by the Local Government <br /> Budget andf is ontrol Act <br /> Clarence G. Grier,Assistant Co. Manager& <br /> CFO <br />