Contract # Fiscal Year Begins Ends
This contract is hereby entered into by and between the Craven County Department of Social Services (the "County") and (the "Contractor") (referred to collectively as the 00arties00. The Contractor00 federal tax identification number or Social Security Number is .
Contract Documents: This Contract consists of the following documents: This contract The General Terms and Conditions (Attachment A) The Scope of Work, description of services, and rate (Attachment B) Federal Certification Regarding Drug-Free Workplace (Attachment C) Conflict of Interest (Attachment D) No Overdue Taxes (Attachment E) Federal Certification Regarding Environmental Tobacco Smoke (Attachment F) Federal Certification Regarding Lobbying (Attachment G) Federal Certification Regarding Debarment (Attachment H) If applicable, HIPAA Business Associate Addendum (Attachment I) Certification of Transportation (Attachment J) If applicable, IRS federal tax exempt letter or 501 (c)(Attachment K) a. There are no matching requirements from the Contractor.
00nbsp; b. The Contractor00 matching requirement is $, which shall consist of: 00/font> In-kind 00/font> Cash 00/font> Cash and In-kind 00/font> 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 $.
Reporting Requirements:
Contractor shall comply with audit requirements as described in N.C.G.S. 搂 143C-6-23 and OMB Circular A-133.
Payment Provisions:
Payment shall be made in accordance with the Contract Documents as described in the Scope of Work, Attachment B.
Contract Administrators: All notices permitted or required to be given by one Party to the other and all questions about the contract from one Party to the other shall be addressed and delivered to the other Party00 Contract Administrator. The name, post office address, street address, telephone number, fax number, and email address of the Parties00respective initial Contract Administrators are set out below. Either Party may change the name, post office address, street address, telephone number, fax number, or email address of its Contract Administrator by giving timely written notice to the other Party.
For the County:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Name & Title Name & Title County County Mailing Address Street Address City, State, Zip City, State, Zip Telephone Fax Email
For the Contractor:
IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Name & Title Name & Title Company Name Company Name Mailing Address Street Address City State Zip City State Zip Telephone Fax Email
Signature Warranty:
The undersigned represent and warrant that they are authorized to bind their principals to the terms of this agreement.
The Contractor and the County have executed this contract in duplicate originals, with one original being retained by each party.
__________________________________________________________________________________________________ Signature Date
___________________________________________________________________________________ Printed Name Title
COUNTY
___________________________________________________________________________________________________ Signature (must be legally authorized to sign contracts for County DSS) Date
_____________________________________________________________________________ Printed Name Title
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act.
________________________________________________________________________________________________ Signature of County Finance Officer Date Contract-General (06/04) Page of 3

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