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3 <br />CONTRACT# <br />NORTH CAROLINA <br />ORANGE COUNTY <br />Fiscal Year Begins <br />Ends <br />IN-HOME AIDE PROVIDER SERVICES AGREEMENT <br />THIS AGREEMENT, is made and entered into this _ day of , 2008 by <br />and between Orange County, North Carolina for and on behalf of the Orange County Department <br />of Social Services and the Orange County Department of Aging (the "County"); and <br />(the "Contractor") whose federal tax identification number or <br />Social Security Number is: <br />WITNESSETH: <br />For the purpose and subject to the terms and conditions hereinafter set forth, the County <br />hereby contracts for the services of the Contractor, and the Contractor agrees to provide the <br />services to the County in accordance with the terms of this Agreement. <br />1. Contract Documents: This Agreement consists of this document as well as each of the <br />documents listed below as indicated (collectively referred to as the "Contract Documents"). If <br />the word "Yes" appears beside the title of the contract document at the time both parties execute <br />this Agreement, then that document is included as part of this Agreement. If the word "No" <br />appears beside the title of the contract document at the time both parties execute this Agreement, <br />then that document is not included as part of this Agreement. Each of the Contract Documents <br />made part hereof are attached hereto and incorporated herein by reference to the same: <br />TITLE OF CONTRACT DOCUMENT <br />(a) The General Terms and Conditions (Attachment A) <br />(b) The Scope of Work, services, and rate (Attachment B) <br />(c) Federal Drug Free Workplace Certification (Attachment C) <br />(d) Conflict of Interest Policy (Attachment D) <br />(e) No Overdue Taxes Certification (Attachment E) <br />(fl <br />YES/NO <br />YES <br />YES <br />(g) Certification Regarding Lobbying (Attachment G) <br />