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DocuSign Envelope ID: 9BE92A26-4CEE-4AC3-BC41-BB345E3551A4 <br /> Contract#68-2004 <br /> Personalized Patient Home Assistance, Inc. <br /> CONTRACT# 68'2004 Fiscal Year Begins Ju|yl- 20\6 Ends June}O` Z0]7_ <br /> NORTH CAROLINA <br /> ORANGE COUNTY <br /> IN-HOME AIDE PROVIDER SERVICES AGREEMENT <br /> THIS AGREEMENT, is made and entered into this I day of July, 2016 by and between Orange <br /> County, North Carolina for and on behalf of the Orange County Department of Social Services and the <br /> Orange County Department of Aging (the "County"); and Personalized Patient Home Assistance, Inc. (the <br /> "Contractor") whose federal tax identification number or Social Security Number is: <br /> _ <br /> W |TN E S S ET H: <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 /> (I) The General Terms and Conditions (Attachment A) Y28 <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) `/£8 <br /> (7) Certification Regarding Debarment (Attachment H) YES <br /> (8) Certification Regarding Transportation (Attachment J) YES <br /> (9) State Certifications (Attachment M) YES <br /> (10) Outcomes & Reporting (Attachment N) YES <br /> l <br /> Rev. &70 <br />