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DocuSign Envelope ID: A07C4620 -D9F0- 4228- 9B2F- lD499E5F8796 <br />Contract #68 -2036 <br />Personalized Patient Home Assistance, Inc. <br />CONTRACT # _68 -2036 Fiscal Year BeginsJJuly 1.201$ Ends June 30.2019` <br />NORTH CAROLINA <br />ORANGE COUNTY <br />IN -HOME AIDE PROVIDER SERVICES AGREEMENT <br />THIS AGREEMENT, is made and entered into this 1 day of July, 2018 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: 56- 1629016. <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 />(1) <br />(2) <br />(3) <br />(4) <br />(5) <br />(6) <br />(7) <br />(8) <br />(9) <br />(10) <br />(11) <br />Rev. 6116 <br />YES/NO <br />The General Terms and Conditions (Attachment A) <br />The Scope of Work, services, and rate (Attachment B) <br />Federal Drug Free Workplace & Nondiscrimination Certification (Attachment C) <br />Conflict of Interest Policy (Attachment D) <br />No Overdue Taxes Certification (Attachment E) <br />Certification Regarding Lobbying (Attachment G) <br />Certification Regarding Debarment (Attachment II) <br />Certification Regarding Transportation (Attachment J) <br />State Certifications (Attachment M) <br />Non - Discrimination, Clean Air Act, Clean Water Act (Attachment N) <br />Outcomes & Reporting (Attachment O) <br />YES <br />YES <br />YES <br />YES <br />YES <br />YES <br />YES <br />YES <br />YES <br />YES <br />YES <br />