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DocuSign Envelope ID: A07C4620 -D9F0- 4228- 9B2F- lD499E5F8796 <br />ATTACEMHNT 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 <br />transportation by: <br />1. 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 <br />of Motor Vehicle requirements; <br />3. Insuring that all vehicles transporting clients shall have at least the minimum level of <br />liability insurance appropriate for the type of vehicle as defined by Article 7, Rule R2 -36 <br />of the North Carolina Utilities Commission; <br />4. Insuring that the contractor shall have written policies and procedures regarding how <br />drivers handle and report client emergencies and/or vehicle crashes involving clients to <br />contractor and how contractor notifies the Orange County Department of Social Services; <br />5. Insuring that no more than one quarter of one percent of all trips be missed by the <br />contractor during the course of the contract period; (Medicaid only) <br />6. Insuring that that no more than five percent (5 %) of trips should be late for recipient drop <br />off to their appointment per month; (Medicaid only) <br />7. Contractor will maintain records documenting the following (County may require <br />contractor to 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 />8. Disclosing, at the outset of the contract, upon renewal and upon request, any criminal <br />convictions or other reasons for disqualifications from participation in Medicare, <br />Mprlic.airl nr TitiP Yx programs (signature on this form confirms this statement). <br />1DocuSigned by, <br />1)73Br-2FODOAA94BE 6A" h. faV�tt� MA, Agency director <br />. <br />Signature Title <br />Personalized Patient Home Assistance 7/22/2018 <br />Agency /Organization Date <br />(Certification signature should be same as Contract signature.) <br />Transportation Certification (06116) Page 1 of 1 <br />