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COUNTY CONTRACT FORMS
(FOR COUNTY USE ONLY)

Effective for the State Fiscal Year 2016, the Division of Social Services has been updated in accordance with the Omni Circular-CFR Title 2, Grants and Agreements, Part 200.

http://www.maximus.com/sites/default/files/MAXIMUS_2%20CFR%20200.pdf

Any organization that receives Federal or State financial assistance from a State agency is called a "subrecipient". Counties, as subrecipients of the state, must develop monitoring and management procedures to ensure that funds are appropriately spent by any subaward or contractor with whom they may contract to provide services.

The following definition has been developed to assist in determining when a contract must be utilized: "Any service purchased by a County Department of Social Services/Human Services must have a contract unless a purchased service is covered in a specific program which does not require use of this specific contract and has Federal and/or State funding".

Local Department of Social Services/Human Services should use the following documents and instructions as guidance when entering into any contract. If a county has its own contractual procedures, these are permissible but at a minimum must include:

  1. General Contract

  2. Attachment A - General Terms and Conditions

  3. Attachment B - Scope of Work

  4. Attachment C - Certification Regarding Drug-Free Workplace Requirements & Certification Regarding Nondiscrimination ** (Required if any Federal Funds are involved)

  5. Attachment D - Conflict of Interest Policy
    (must be notarized & policy attached)

  6. Attachment E- No Overdue Taxes (must be notarized)

  7. Attachment F - Certification Regarding Environmental Tobacco Smoke
    ** (Required if any federal funds are involved and contractor provides health, child care, education, or library related services to children under 18 in an indoor facility)

  8. Attachment G - Certification Regarding Lobbying **
    (Required if $25,000 of Federal participation is involved)

  9. Attachment H - Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion-Lower Tier Covered Transactions
    ** (Required if $25,000 of Federal participation is involved)

  10. Attachment I - HIPAA Assessment Form
                             Business Associates Addendum
                             Government Associates Addendum
    ** (Required if any health related information is shared)

  11. Attachment J - Certification Regarding Transportation
    ** (Required if providing Transportation Services)

  12. Attachment K - IRS Federal Tax Exemption (See 501(c)(3) and Tax-Exempt Status)

  13. Attachment L- Certain Reporting and Auditing Requirements & *Contract Determination Questionnaire
    *Contract Determination Questionnaire must be completed on all contracts.  If the Contract is for Financial Assistance Attachment L must be provided to the Contractor/Provider.

  14. Attachment M – State Certification

  15. Contract Amendment

  16. Contract Log

**Forms May Be Required

We strive to keep this information as accurate as possible. If information on this page needs to be updated, please contact Carlotta Dixon, NC DSS Contract Manager, 919-527-6421.

 

 

 

We strive to keep this information as accurate as possible. If information on this page needs to be updated, please Email us.

 

Page Modified 06/10/2015

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