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DocuSign Envelope ID: 1582AE24-D793-4A66-9311-4472000BOEC3 <br /> Contract 468-2004 <br /> Personalized Patient Home Assistance, Inc. <br /> ATTACHMENT J <br /> CERTIFICATION REGARDING TRANSPORTATION <br /> Orange County Department of Social Services and Orange County Department on Aging <br /> By execution of this Agreement the Contractor certifies that it will provide safe client transportation by: <br /> I. Insuring that all drivers (including employees, contractors, contractor's employees, and <br /> volunteers) shall be at least 18 years of age; <br /> 2. Insuring that all drivers(including employees, contractors, contractor's employees, and <br /> volunteers) shall be licensed to operate the specific vehicle used in transporting clients in <br /> accordance with Chapter 20-7 of the General Statutes of North Carolina and the Division of <br /> Motor Vehicle requirements; <br /> 3. Insuring that all vehicles transporting clients shall have at least the minimum level of liability <br /> insurance appropriate for the type of vehicle as defined by Article 7, Rule R2-36 of the North <br /> Carolina Utilities Commission; <br /> 4. Insuring that the contractor shall have written policies and procedures regarding how drivers <br /> handle and report client emergencies and/or vehicle crashes involving clients to contractor and <br /> how contractor notifies the Orange County Department of Social Services; <br /> 5. Contractor will maintain records documenting the following(County may require contractor to <br /> provide): <br /> a.Valid current copies of Drivers License for all drivers; <br /> b.Current valid Vehicle Registration, for all vehicles transporting clients; <br /> c.Driving records for all drivers for the past three years and with annual updates; <br /> d.Criminal Background checks through North Carolina Law Enforcement or NCIC <br /> prior to employment and every three years thereafter; <br /> e.Alcohol and Drug Testing policy to meet the Federal Transit Authority guidelines. <br /> 6. Disclosing, at the outset of the contract, upon renewal and upon request, any criminal convictions <br /> or other reasons for disqualifications from participation in Medicare,Medicaid or Title XX <br /> gara'grrr Signature on this form confirms this statement. <br /> �bVbTU�.AAVytln�fbin Agency director <br /> Signature Title <br /> Personalized Patient Home Assistance 7/14/2015 <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> Transportation Certification(05/09) Page 1 of 1 <br />