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DocuSign Envelope ID: OF933o0E -D182- 4824- AB97- AB4A8DFC99A5 <br />Contract #68 -2017 <br />Express Support Group, LLC <br />CONTRACT # 68 -2017 Fiscal Year Begins December 5, 2017_ Ends June 30, 2018_ <br />NORTH CAROLINA <br />ORANGE COUNTY <br />IN -HOME AIDE PROVIDER SERVICES AGREEMENT <br />THIS AGREEMENT, is made and entered into this 5 day of December, 2017 by and between <br />Orange County, North Carolina for and on behalf of the Orange County Department of Social Services <br />and the Orange County Department of Aging (the "County"); and Express Support Group, LLC (the <br />"Contractor ") whose federal tax identification number or Social Security Number is: _80- <br />0406469 <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 <br />Rer. 6116 <br />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) Certification Regarding Transportation (Attachment J) YES <br />(9) State Certifications (Attachment M) YES <br />(10) Outcomes & Reporting (Attachment N) YES <br />