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DocuSign Envelope ID: 1582AE24-D793-4A66-9311-4472000BOEC3 <br /> Contract 968-2004 <br /> Personalized Patient Home Assistance,Inc. <br /> CONTRACT 4 68-2004 Fiscal Year Begins_Jutyl, 2015 Ends June 30. 2016_ <br /> NORTH CAROLINA <br /> ORANGE COUNTY <br /> IN-HOME AIDE PROVIDER SERVICES AGREEMENT <br /> THIS AGREEMENT, is made and entered into this _ day of 2015 by and <br /> between Orange County, North Carolina for and on behalf of the Orange County Department of Social <br /> Services and the Orange County Department of Aging (the "County"); and Personalized Patient Home <br /> Assistance, Inc. (the "Contractor")whose federal tax identification number or Social Security Number is: <br /> <br /> WITNESSETH: <br /> For the purpose and subject to the terms and conditions hereinafter set forth,the County hereby <br /> contracts for the services of the Contractor,and the Contractor agrees to provide the services to the <br /> 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 the word <br /> "Yes"appears beside the title of the contract document at the time both parties execute this Agreement, <br /> then that document is included as part of this Agreement. If the word"No"appears beside the title of the <br /> contract document at the time both parties execute this Agreement,then that document is not included as <br /> part of this Agreement. Each of the Contract Documents made part hereof are attached hereto and <br /> incorporated herein by reference to the same: <br /> TITLE OF CONTRACT DOCUMENT YES/NO <br /> (1) The General Terms and Conditions (Attachment A) YES <br /> (2) The Scope of Work, services, and rate(Attachment B) YES <br /> (3) Federal Drug Free Workplace &Nondiscrimination Certification(Attachment C) YES <br /> (4) Conflict of Interest Policy(Attachment D) YES <br /> (5) No Overdue Taxes Certification(Attachment E) YES <br /> (6) . Certification Regarding Lobbying(Attachment G) YES <br /> (7) Certification Regarding Debarment(Attachment H) YES <br /> (8) Business Associate Addendum(Attachment 1) YES <br /> (9) Certification Regarding Transportation(Attachment J) YES <br />