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DocuSign Envelope ID:412EAE5F-3824-43FA-AC95-54AOC4DF83A2 <br /> Contract 968-2045 <br /> Personalized Patient Home Assistance, Inc. <br /> ATTACHMENT d <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 /> Oacusig tl A;Psi `� "r T;tlp X programs(signature on this form confirms this statement). <br /> 101)73Br-2FODOAA94BE <br /> bVbiu�.ak. aYVtln btn. Agency director <br /> . <br /> Signature Title <br /> Personalized Patient Home Assistance 9/30/2019 <br /> Agency/Organization Date <br /> (Certification signature should be same as Contract signature.) <br /> Transportation Certification(06/16) Page 1 of i <br />