Fiscal Year Begins July 1, 2015 Ends June 30, 2016
This contract is hereby entered into by and between the Bladen County Department of Social Services (the "County") and
(the "Contractor") (referred to collectively as the “Parties”). The Contractor’s federal tax identification
number or Social Security Number is _____________ and DUNS Number (optional).
1. Contract Documents: This Contract consists of the following documents:
(1) This contract
(2) The General Terms and Conditions (Attachment A)
(3) The Scope of Work, description of services, and rate (Attachment B)
(4) Federal Certification Regarding Drug-Free Workplace & Certification Regarding Nondiscrimination (Attachment C)
(5) Conflict of Interest (Attachment D)
(6) No Overdue Taxes (Attachment E)
(7) Federal Certification Regarding Environmental Tobacco Smoke (Attachment F)
(8) Federal Certification Regarding Lobbying (Attachment G)
(9) Federal Certification Regarding Debarment (Attachment H)
applicable, HIPAA Business Associate Addendum (checklist and forms)
(11) Certification of Transportation (Attachment J)
applicable, IRS federal tax exempt letter or 501 (c)(Attachment K)
(13) Certain Reporting and Auditing Requirements (Attachment L)
(14) Contract Determination Questionnaire (required)
These documents constitute the entire agreement between the Parties and supersede all prior oral or written statements
2. Precedence among Contract Documents: In the event of a conflict between or among the terms of the Contract
Documents, the terms in the Contract Document with the highest relative precedence shall prevail. The order of
precedence shall be the order of documents as listed in Paragraph 1, above, with the first-listed document having the
highest precedence and the last-listed document having the lowest precedence.
If there are multiple Contract
Amendments, the most recent amendment shall have the highest precedence and the oldest amendment shall have the
3. Effective Period: This contract shall be effective on
July 1, 2015
and shall terminate on
June 30, 2016.
This contract must be twelve months or less.
4. Contractor’s Duties: The Contractor shall provide the services and in accordance with the approved rate as described in
Attachment B, Scope of Work.
5. County’s Duties: The County shall pay the Contractor in the manner and in the amounts specified in the Contract
Documents. The total amount paid by the County to the Contractor under this contract shall not exceed $ 150,000.00.
This amount consists of $
in Federal funds (CFDA # 93.778), $
in State Funds,
in County funds
a. There are no matching requirements from the Contractor.
b. The Contractor’s matching requirement is $
, which shall consist of:
Cash and In-kind
Cash and/or In-kind
The contributions from the Contractor shall be sourced from non-federal funds.
The total contract amount including any Contractor match shall not exceed
6. Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. § 143C-6-22 & 23 and OMB Circular A-133. and
shall disclose all information required by 42 USC 455.104, or 42 USC 455.105, or 42 USC 455.106.
7. Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope of Work,
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