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100713a Agenda PackageHARNETT COUNTY BOARD OF COMMISSIONERS County Administration Building 102 East Front Street Lillington, North Carolina Regular Meeting October 7, 2013 9:00am 1. Call to order Chairman Jim Burgin 2. Pledge of Allegiance and Invocation-Commissioner Gordon Springle 3. Consider additions and deletions to the published agenda 4. Consent Agenda A. Minutes B. Budget Amendments C. Tax refunds, rebates and releases D. Administration requests approval of Resolution to Honor Stanley Bass E. Finance Officer requests approval of a lease purchase agreement with US Bank in the amount of$830,160 for the purchase of30 cars for the Sheriffs Office and two EMS conversion vans. The interest rate for the transaction is 1. 70%. F. Finance Officer requests approval of a reimbursement resolution which will allow the County to reimburse itself in the amount of $7 4,970 for the purchase of an EMS ambulance with lease proceeds. G. Finance Officer requests that the vacant Accounting Clerk position in the Finance Office be reclassified to an Accounting Technician IV. The reclassification is requested to address contingency and staffing issues within the Finance Office. H. Health Director requests approval to write-off $30,055.75 for program services. Debt set-off collection for the past two years equaled $34,110.26. Every attempt has been made to collect this debt and will be re-instated if client returns for services. I. Health Director requests approval of the Amended Clinical Fee Schedule, the Clinical Patient Fees, Eligibility and Bad Debt Write-Off Policy and Flat Fee Billing Policy amendments. J. Sheriffs Office requests permission to surplus four vehicles and donate them to CCCC to be used for training by the Fire/EMS training department. These vehicles are older vehicles that have low resell value. K. Sheriffs Office requests permission to accept the temporary donation a Mine Resistant Vehicle. After the vehicle is no longer required it will be returned to the Military. L. Sheriffs Office requests permission to reclassify two vacant Fingerprint Technician positions to Detention Officer positions. The pay grade is the same for both classifications so no new money will be requested. Reclassification of these positions from civilian to sworn detention officers will assist the Sheriffs Office in scheduling of hours and qualifY this position to back up and assist in Detention as needed. M. Register of Deeds requests approval ofRecords Retention and Disposition Schedule Page 1 N. Carolina Lakes Board of Directors respectfully requests that the speed limit within Carolina Lakes be modified to incorporate all bus stop locations within their community. 0. General Services requests adoption of the project ordinance which allocates necessary funds to pay for the upgrade of the Automated Weather Observation Systems (AWOS) at the Harnett County Jetport. The upgrade cost will be reimbursed by the North Carolina State Department of Transportation/Division of Aviation by 90% with the County contributing 1 0%. P. County Engineer requests approval of the Transportation and Disposal Agreement with Sampson County Disposal, LLC, a subsidiary of Waste Industries. 5. Presentation of Resolution to Honor Stanley Bass 6. Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation 7. Appointments 8. Public Hearing: Rural Operating Assistance Program Grant Funds, Dionne White, Transit Services Manager ROAP funds are used for the operating cost of trips and other transportation services. These funds will be used to provide transportation services when there are no other available funding sources. ROAP includes the Elderly and Disabled Transportation Assistance Program, the Employment Transportation Assistance Program and the Rural General Public Program. 9. NCACC Video for Commissioners 10. Early Retirement Incentive Program for the Department of Social Services 1 L County Manager's report Tommy Bums, County Manager -Veterans Affairs Activities Report September 2013 -Public Health Activities Summary August 2013 12. New Business 13. Closed Session 14. Adjourn Page2 HARNETT COUNTY BOARD OF COMMISSIONERS Minutes of Regular Meeting September 16, 2013 The Harnett County Board of Commissioners met in regular session on Monday, September 16 2013, in the Commissioners Meeting Room, County Administration Building, 102 East Front Street, Lillington, North Carolina. Members present: Jim Burgin, Chairman Staff present: Gary House, Vice Chairman Beatrice B. Hill, Commissioner Joe Miller, Commissioner C. Gordon Springle, Commissioner Tommy Burns, County Manager Joseph Jeffries, Deputy County Manager Tony Wilder, Deputy County Manager Dwight Snow, County Attorney Kimberly Honeycutt, Interim Finance Officer Margaret Regina Wheeler, Clerk to the Board Chairman Burgin called the meeting to order at 7:00 pm. Commissioner Hill led the pledge of allegiance and invocation. Chairman Burgin called for additions and deletions to the published agenda. Chairman Burgin requested the addition of the Harnett County Library's requests for approval of application for State Aid. Commissioner Springle moved to approve the agenda as amended. Vice Chairman House seconded the motion which passed unanimously. Vice Chairman House moved to approve the items listed on the consent agenda. Commissioner Miller seconded the motion which passed unanimously. 1. Minutes: September 3, 2013 Regular Meeting 2. Budget Amendments: 51 Health Department Code 110-7600-441.11-00 110-7600-441.21-00 110-7600-441.21-04 110-7600-441.21-05 11 0-7 600-441.22-00 110-7600-441.23-00 110-7600-441.26-08 110-7600-441.33-45 Salaries & Wages Group Insurance HSA 7, 1 00 increase 839 increase 14 2 increase 71 increase 543 increase Clinic FICA Retirement 502 increase Worker's Compensation 178 increase Contracted Services 9,375 decrease September 16, 2013, Regular Meeting Minutes Harnett County Board of Commissioners Page 1 of7 52 Health Department Code 110-0000-331.76-31 Evidence Based Intervention Services 110-0000-3 31.76-03 HIV Prevention 53 Health Department Code 110-7600-441.60-33 Materials & Supplies 110-7600-441.60-46 Medical Supplies 110-0000-331.76-12 Family Planning 110-0000-3 31.7 6-14 Maternal Health 54 Animal Control Code 110-5500-420.11-00 Salaries & Wages 110-5500-420.11-06 Salaries & Wages Comp Time Payout 110-5500-420.22-00 FICA Tax Expense 110-5500-420.23-00 Retirement 110-5500-420.26-08 Worker's Compensation 110-0000-399.00-00 Fund Balance Appropriated 58 Emergency Management Code 110-5300-420.35-77 Disaster Debris Management 110-0000-356.53-07 Reimbursement Disaster Debris Management 59 Cooperative Extension Code 110-7324-465.11-00 Salaries & Wages 110-7324-465.32-26 Incentives 110-0000-334.73-24 Revenue 4-H Teen Court 63 Cooperative Extension 110-7301-465-11-00 Salaries & Wages 110-7301-465.60-33 Materials & Supplies 65 Health Department (Aging) Code 110-7510-441.58-14 Travel 110-7501-441.32-11 Family Caregiver Support 110-7501-441.55-12 Printing 110-7501-441.58-01 Training 110-7501-441.58-14 Travel 110-0000-331.77-04 National Senior Service Corp 110-0000-334.75-03 Medicare Counseling SHIIP 66 Social Services 110-7710-441.80-70 Duke Merger Settlement 110-0000-354.77-02 Duke Merger Settlement 50,000 increase 50,000 decrease 8 87 decrease 1 ,512 decrease 1 ,512 decrease 8 87 decrease 2,000 increase 1 0,250 increase 1,167 increase 1,078 increase 453 increase 14,948 increase 50,000 increase 50,000 increase 1,011 decrease 1 ,261 decrease 2,272 decrease 2 increase 2 decrease 1,500 increase 675 decrease 200 decrease 150 decrease 1,000 decrease 1,500 increase 2,025 decrease 139,734 increase 139,734 increase September 16, 2013, Regular Meeting Minutes Harnett County Board of Commissioners Page 2 of7 67 Cooperative Extension Code 110-7300-465.74-74 Capital Outlay Equipment 110-0000-399.00-00 Fund Balance Appropriated 69 Sheriffs Office Code 110-5100-420.11-00 Salaries & Wages 110-5100-420.21-00 Group Insurance 110-5100-420.21-04 Group Insurance-HSA 110-5100-420.21-05 Group Insurance-Employee Clinic 11 0-51 00-4 20.22-00 FICA Tax Expense 110-5100-420.23-02 LEO Retirement 110-5100-420.23-05 LEO Supplemental Retirement 110-5100-420.25-10 Unemployment Benefits 110-5100-420.26-08 Worker's Compensation 110-5100-420.60-33 Materials Supplies & Equipment 110-5100-420.60-29 Weapons 110-5100-420.60-36 Uniforms 110-0000-356.40-00 Board of Education Resource Officers 71 Solid Waste Code 580-6600-461.74-76 Lease-Other Finance Uses 580-0000-370.20-00 Capital Lease 73 Public Utilities Code 531-9000-431.43-21 Admin/CS/MR Maint & Repair Auto 531-9015-431.43-21 WTP Maint and Repair Auto 531-9020-431.43-21 NH WWTP Maint & Repair Auto 531-9021-431.43-21 SH WWTP Maint & Repair Auto 531-9025-431.43-21 Distribution Maint & Repair Auto 531-9030-431.43-21 Collection Maint & Repair Auto 531-0000-399.00-00 Fund Balance Appropriated 3. Tax refunds, rebates and releases (Attachment 1) 656 increase 656 increase 40,371 increase 5,350 increase 1,000 increase 3 00 increase 3,088 increase 2,939 increase 2,019 increase 423 increase 1 ,590 increase 26,720 increase 2,200 increase 4,000 increase 90,000 increase 15 7, 1 0 1 increase 157,101 increase 26,250 increase 8,750 increase 8,750 increase 8,750 increase 26,250 increase 26,250 increase 105,000 increase 4. Resolution to Honor Campbell University for the Establishment of the School of Osteopathic Medicine (Attachment 2) 5. NC DENR Division of Parks and Recreation requested that the tipping fee be waived for the trash collected by volunteers participating in North Carolina Big Sweep on October 5, 2013 and September 27, 2013. In 2012 in Harnett County, 19 volunteers removed over 870 pounds of debris from cleanup sites along the Cape Fear River. 6. Sheriff's Office requested approval of funds needed to recruit, outfit and equip a new school resource officer position which will be funded by the Harnett County Board of Education. September 16, 2013, Regular Meeting Minutes Harnett County Board of Commissioners Page 3 of7 7. Emergency Services, on behalf of Dunn Emergency Services, requested approval of a resolution approving the finance of an amount up to $3 50,000 to purchase a 2013 E 1 Rescue Pumper/Tanker. Dunn Emergency Services are seeking to enter into a finance agreement with Branch Banking and Trust Company (BB&T) for the $350,000 over a 15 year term. (Attachment 3) 8. Airport Administrator requested approval of the Fixed Base Operator's Agreement with the County of Harnett and Warren Investments ofNC, Inc. to operate airport operations. This agreement shall commence on October 1, 2013, and expire on June 30~ 2018 with renewal options. 9. Harnett County Library requested approval of application for State Aid. Approximately 15% to 20% of the library's total budget derives from direct aid from the state. Chairman Burgin presented the Resolution Honoring the City of Dunn for winning the 2013 All- America City A ward to Mayor Oscar Harris. Mayor Harris addressed the group. Chairman Burgin opened the floor for informal comments by the public, allowing up to 3 minutes for each presentation up to 30 minutes. -Susan Shaddock of 114 South Carrie Street in Coats shared her concerns regarding Animal Control. Mrs. Shaddock asked that resources be diverted to animal care, said their public hours are not convenient to the public, thinks some community service training for some Animal Control staff would be helpful and asked for consistency in policies. -Betty Harmon of 118 Benton Place Drive in Angier said the County doesn't follow state policy for recycling and are illegally sending recyclables to Wake County. She also shared her concerns regarding Animal Control and requested clarification on euthanizing as well as consistency on the rescue/adoption policy. Mrs. Harmon said Harnett County Animal Control should be a member of the National Animal Control Association. -Penny Christman of 4 7 Quail Hollow in Cameron reference the Governor's Bill regarding landfills and said our area is destine for a landfill. She said she would remain vigilant to fighting against this. -Linda James of20 Vic McLeod Court in Coats asked why Animal Control is only open 15 hours a week to the public assuming employees work a 40 hour work week. She said there are too many animals being put to sleep and they need to be given more of an opportunity to get in and get those animals. -Alison Minard of 269 Ernest Brown Road in Lillington also spoke about Animal Control and said the rescue groups work 24/7 and don't rest until they find homes for the animals. She said if Animal Control was open one more night a week more animals could be saved. September 16,2013, Regular Meeting Minutes Harnett County Board of Commissioners Page 4 of7 Commissioner Springle moved to approve the appointments listed below. Commissioner Hill seconded the motion which passed unanimously. BOARD OF ADJUSTMENT Richard S. "Dick" Cruickshank (nominated by Commissioner Springle) was appointed to serve on the Board as an alternate member for District 4 for a term of 3 years ending September 30, 2016. CEMETERY BOARD OF TRUSTEES Patrick Fitzgerald (nominated by Commissioner Springle) was appointed to serve on this Board as the representative for the Public Library for a term of 3 years ending September 30,2016. The Board of Commissioners of the County of Harnett, North Carolina, sitting as the Governing Body of the South Central Water and Sewer District ofHarnett County, gave public notice ofthe Settlement of 12 CVS 00169, South Central Water and Sewer District of Harnett County v. Terry L. Burgess, Christine A. Burgess, Wells Fargo Home Mortgage Inc., and First Citizens B&T Co., for $35,000.00. The commissioners reconvened as the Harnett County Board of Commissioners. Mark Locklear, Interim Planning Services Director, petitioned the Board for a Public Hearing on a proposed text amendment requested by Harnett County Planning Services, Unified Development Ordinance, Article VII, Section 13 .1. Staff proposes to reduce or eliminate recreational fees associated with developments that willingly provide recreational areas and/or park lands. The Planning Board considered the original proposed text amendment at their September 3, 2013, meeting where Board members expressed concerns and issues associated with the proposed amendment which was approval3 tol. Mr. Locklear noted a version of the text amendment was previously discussed during a recent special session of the Harnett County Board of Commissioners. Mr. Locklear explained the amendment would allow developers of subdivisions to use private amenities to serve in lieu of paying their recreational fees which are $500 per lot each time they record a development. He noted currently recreational fees collected go to that portion of the county to purchase land. This request would give developers full credit for installing recreational amenities inside their subdivision if those amenities are open to the public but would only give 50% of the credit if the amenities are private. This amendment does not include a look-back and would only apply going forward. Mr. Locklear took the group through the proposed text amendment and pointed out the portion where there was an option based on staff conversation. Chairman Burgin asked for examples to help explain the option offered for reducing the credit. Commissioner Miller said he does not support giving any credit to the developers for amenities, saying residents in such communities already pay fees through their POA or HOA to have amenities. He said the recreational fees collected for western Harnett go toward making payments on the 1 000 acre park. Commissioner September 16, 2013, Regular Meeting Minutes Harnett County Board of Commissioners Page 5 of7 Springle said the intent of the text amendment is to encourage developers to provide some sort of recreation in their development. Chairman Burgin said he has requested to change the requirement that recreational fees can only be used to purchase land. It was also noted that such amenities are usually given to the POA or HOA and are not taxable however tax values in subdivisions may be higher due to the amenities. Discussions among commissioners continued regarding this request. Chairman McNeill called to order a public hearing on the matter and opened the meeting for comments from the public. The following citizens spoke: -Paul Long of 601 Old Buies Creek Road of Lillington spoke against the proposed text amendment. -Joe Langley of298 Kirk Adams Road in Angier spoke against the proposed text amendment. -Linda James of20 Vic McLeod Court in Coats spoke against the proposed text amendment -Betty Harmon of 118 Benton Place in Angier spoke in favor ofthe proposed text amendment. -Peter Lamb of 245 East Julia Street in Angier questioned why the revised text amendment was being discussed by the Board of Commissioners before going back to the Planning Board to be voted on. Seeing no one else move, Chairman Burgin closed the public hearing. Vice Chairman House said he did not like receiving changes the day of voting and said he would like time to be able to study the change and understand how it would impact the County. He asked if the proposed text amendment needed to go back before the Planning Board with the new language. Mr. Locklear explained that the Planning Board is a recommending body to this governing body. He said staff would take the proposed amendment back before the Planning Board if that is the wishes of this Board. Vice Chairman House said he did not see an urgency for this and moved to table the request Commissioner Hill seconded the motion which passed unanimously. Mr. Bums presented the following reports: Planning Services Statistics from 2001-2013 Veterans Mfairs Activities Reporting August 2013 Community Development Monthly Performance Status Report August 2013 Inter-Departmental Budget Ordinance Amendments Mr. Bums reminded the group of their September 24, 2013, special session when they will meet jointly with the Board of Education to discuss the upcoming 1;4 cent sales tax referendum. Staff is preparing a draft informational flyer/brochure for the 'l4 cent sales tax referendum. Mr. Bums reminded commissioners that the Moore County Water Purchase Agreement would be a voting item for consideration at their upcoming special session. He noted the transfer station at the Dunn-Erwin Landfill is still closed due to a crack in the new floor. He also reminded the group about the ribbon cutting for the new Campbell University Medical School at 10:00 am on September 19, 2013. Chairman Burgin encouraged commissioners to attend the ribbon cutting September 16, 2013, Regular Meeting Minutes Harnett County Board of Commissioners Page 6 of7 ceremony where they will present their resolution Honor Campbell University for the Establishment of the School of Osteopathic Medicine. There was no new business. There was no need for closed session. Commissioner Hill moved to adjourn the meeting at 8:00pm. Commissioner Miller seconded the motion which passed unanimously. Jim Burgin, cn.mrman Margaret Regina September 16, 2013, Regular Meeting Minutes Harnett County Board of Commissioners Page 7 of7 TO : HARNETI COUNTY BOARD OF COMMISSIONERS RE: CONSIDERATION OF REFUND FOR TAXES, INTEREST AND PENALTIES FOR ALL MUNICIPALITIES BROWN, NICOLE R 78 NORTH HARRIS DR 0002084254-2012-2012-000000 City 0.00 Military FT RUCKER AL, 36362 222.83 Refund Exemption County 222.83 2 IJ\IRD, TRACI LYNN 23 GOLDEN KNIGHT TER 0001879411-2011-2011-000000 City 0.00 Military CAMERON, NC, 28326-6379 53.24 Refund Exemption County 53.24 3 IJ\IRD, TRACI LYNN 23 GOLDEN KNIGHT TER City 0.00 Military CAMERON, NC 283266379 0001884935-2011-2011-000000 125.30 Refund Exemption CAMERON, NC, 28326-6379 County 125.30 4 IJ\IRD, TRACI LYNN 23 GOLDEN KNIGHT TER City 0.00 Military CAMERON, NC 283266379 0001891295-2011-2011-000000 185.31 Refund Exemption CAMERON, NC, 28326-6379 County 185.31 5 IJ\IRD, TRACI LYNN 23 GOLDEN KNIGHT TER City 0.00 Military CAMERON, NC 283266379 0002004147-2012-2012-000000 146.19 Refund Exemption CAMERON, NC, 28326-6379 County 146.19 6 STEHM, DANIEL JOSEPH 23 GOLDEN KNIGHT TER City 0.00 Military CAMERON, NC 283266379 0001899033-2011-2011-000000 179.64 Refund Exemption CAMERON, NC, 28326-6379 County 179.64 WM. A. TONY WILDER City Total 0.00 Revenue Administrator County 912.51 Total Total to be 912.51 Refunded CC: WM. A TONY WILDER TO :HARNETT COUNTY BOARD OF COMMISSIONERS RE: CONSIDERATION OF REFUND FOR TAXES, INTEREST AND PENALTIES FOR ALL MUNICIPALITIES 1 BROWN, ELTON E CAROLYN, BROWN 71 ARCHIE STREET SPRING LAKE NC, 28390 - 0000 2 GODWIN, JERRY W TERRI, GODWIN 175 SPENCE RD LILLINGTON NC, 27546 0000 WM. A. TONY WILDER Revenue Administrator CC: WM. A. TONY WILDER City 0000006688-2013-2013-000000 County City 0000019995-2013-2013-000000 County 0.00 805.64 805.64 0.00 739.60 739.60 City Total 0.00 County 1,545.24 Total Total to be 1,545.24 Refunded Reason Veterans Exemption Refund Veterans Exemption Refund A RESOL"CTION TO HONOR CAMPBELL UNIVERSITY FOR THE ESTABLISHMK'\T OF THE SCHOOL OF OSTEOPATHIC MEDICINE THAT WHEREAS, since 1887 \\hen James Archibald Campbell began his dream of prm iding quality education for the young people of Harnett County. hi~ leadership successors hnve continued that quest through the development and growth of Campbell Cnhersity; and WHEREAS, in addition to its organization of an excellent undergraduate college of studies, Campbell University has shown '"isdom and prudent foresight by identifying societal needs in North Carolina and then filling those needs through the creation of graduate school programs which have produced qualified and exemplary doctoral graduates in the areas of law. pharmacy, busine~s. divinity and education; and WHEREAS, based upon various factors. including the conclusion by the North Ca10lina Institute of :Medicine, that North Carolina faces a severe shortage of physicians, the leadership at Campbell University began the process of researching and planning the establishment of a medical school; that those efforts culminated with Campbell's decision to incorporate into its new medical school curriculum the osteopathic medical education model of ""Whole-person" medicine which includes the treatment of the mind. body and spirit as characterized by the creator of osteopathic medicine. Andrew Taylor Still; that the teaching of osteopathic medicine, while established throughout the nation. is unique to i\orth Carolina as it perfectly coincides with the Campbell University mission to provide qualified and caring physicians in our state, particularly in rural and underserved areas; and WHEREAS, Campbell University has dedicated itself to emphasize health care education as part of its mission which will be anchored by the first new medical school in North Carolina in 35 years; this initiative has achieved reality through wperh planning, sound fiscal policy and generous benefactors which have resulled in the much anticipated opening of the University Health Science Campus. ~OW, THEREFORE, BE IT RESOLVED, by the Harnett County Board of Commissioners that Campbell University President Jerry M. Wallace, the University Board of Tn1stees, administration and faculty are hereby congratulated and commended for their vision, sound judgment and hard work in establishing the Campbell University School of Osteopathic Medicine; that the founding dean, Dr. John M. Kauffman, Jr., and his faculty, staff and charter student class are hereby extended the Commissioners' prayers and best wishes as they begin their initial academic year at the Leon Levine Hall of Medical Sciences and evolve as an exemplary medical school that will continue to expand the Campbell legacy of "the miracle at Buies Creek." Duly adopted this the sixteenth day of September, 20 !3. HARNETT CO Resolution Approving the Financing by Dunn Emergency Services, Inc. Of up to $350,000.00 for the 2013 El Rescue Pumper/Tanker Project WHEREAS: Dunn Emergency Services, Inc. (VFD) has determined to finance an amount of up to $350,000.00 for the 2013 E1 Rescue Pumper/Tanker. The United States Internal Revenue Code requires that for such financing to be carried out on a tax-exempt basis, this Board must first approve the financing. The VFD has reported the proceedings of the hearing to this Board. BE IT THERFORE RESOLVED by the Board of Commissioner ofHarnett County, North Carolina as follows: 1. The Cmmty approves the VFD's entering into the financing, as required under the Code for the financing to be carried out on a tax-exempt basis. The VFD's conduct of the required public hearing is approved. I hereby certify that the foregoing resolution was duly adopted at a meeting of the Harnett County Board of Commissioners duly called and held on -Seriernher 19 , 2013, and that a quorum was present and acting throughout such meeting. Such resolution remains in full effect today. Dated this__l_j_+f, day of l';" [SEAL] BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2014; Section 1. To amend the General Fund, Health Department, the appropriations are to be changed as follows: EXPENDITURE CODE NUMBER 110-7600-441.33-45 110-7600-441.44-21 110-7600-441.58-18 110-7600-441.60-33 REVENUE CODE NUMBER 110-0000-399-00-00 EXPLANATION: APPROVALS: AMOUNT AMOUNT DESCRIPTION OF CODE INCREASE DECREASE Contracts $ 131,so3.oo 1 Equipment Rental $ 1,200.00 Travel/Volunteer $ 1,200.00 Materials & Supplies $ 1,000.00 AMOUNT AMOUNT DESCRIPTION OF CODE INCREASE DECREASE Fund Balance Appropriated $ 134,903.00 To budget carryforward funds for the CC4C and PCM programs for FY 2012-2013 per the Sandhills contract. Revenues received in each program exceeded act.ual expenditures. (See attached.) Section 2. Copies of this budget amendment shall be furnished to the Clerk of the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this Margaret Regina Wheeler, Clerk to the Board day of ,2013 Jim Burgin, Chairman Harnett County Board of Commissioners 756 13th MonthFY 2012-2013 HEALTH DEPARTMEN" YTD REPI iRT YEAR-TO-DATE BUDGET SUMMARY Acct. Code llil ~~~, .. Environ Home General Vital Other -Adult Health Child 110-7600-Line Item Oescriptlon Health • To-Date Balance Hth ·Co Health Admin Records Services Health STD Education Health 441.11-00 Salaries & Wages $ 3,687,204. 1,571.30 $ 466,632.70 238,636.36 784,865.83 (0.12 20,096.62 1,447.53 73,565.32 100,971.62 57,101.66 367,252.46 441.11-05 Overtime $ • $ • $ . . . . . . ----441.11-06 Comp Time Payout $ -$ . $ . --. ---. -- 441.21-00 Group Insurance Expense $ 404,285.00 $ 324,893.00 $ 79,392.00 22,262.64 73,864.26 (0.02 2,720.12 197.09 7,781.97 9,824.41 5,877.77 37,246.48 441.21-01 Retirees $ 42 565.00 $ 41,805.75 $ 759.25 . -41,805.75 . . ----441.21-04 HSA $ 92,514.00 $ 79,766,72 $ 12,747.28 4,364.74 17,699.60 7,000.00 544.19 (2.73 1,786.93 2,042.31 949.83 9,664.78 441.21-05 CLINIC $ 26,038.00 $ 20 937.50 $ 5,100.50 1,247.81 4,529.82 1,999.97 151.72 10.37 440.51 550.37 330.12 2,288.58 441.22-00 FICA $ 281,794.00 $ 237,012.13 $ 44,781.87 17,600.60 58,221.18 0.01 1,512.18 110.91 5,580.42 7,613.90 4,313.80 27,908.81 441.23-00 Retirement $ 248 702.00 $ 214,601.22 $ 34,100.78 16,081.76 51,715.34 0.18 1,354.42 99.40 5,054.43 6,943.65 3,848.31 25,208.45 441.25-10 Unemployment $ 39,754.00 $ 39,753.55 $ 0.45 --39,753.55 -. ---- 441.26-08 Worker's Compensation $ 94,455.00 $ 45,233.43 $ 49,221.57 4,571.75 16,647.43 0.03 94.34 8.09 821.65 584.93 782.89 4,406.61 441.30.04 Professional Services $ 12,268.00 $ 6 867.00 $ 5,411.00 -1,700.00 3,322.00 . . ---. 441.32.26 Incentives $ 22,026.00 $ 15,858.68 $ 6,167.32 . 6,162.28 -----2,595.87 191.16 441.32-51 Bank Charges $ 900.00 $ -$ 900.00 . . -. . -. -. 441.32-68 Board Members $ 2,240,00 $ 1,519.94 $ 720.06 . . 1,519.94 ---. . 441.32-77 Credit Card Processing Fee $ 540.00 $ 653,64 $ {113.54 4.76 -. . 83.91 189.82 -0.58 112.65 441.33-45 Contracted Services $ 1,295,225.00 $ 1,007 325.47 $ 287,899.53 449.28 354,855.55 72,871.33 -61.50 2,382.80 25,716.17 508.32 150,463.13 441.41-11 Telecommunic. & Postage $ 70 904.00 $ 37,720.31 $ 33,183.69 5,202.66 9,770.13 932.02 122.30 188.70 384.62 349.24 739.74 2,972.89 441.41-13 Utilities $ 32,425.00 $ 27,915.64 $ 4,509.36 . -27,915.64 ----. - 441.43-16 Main! & Repair-Equip $ 12,218.00 $ 3,785.26 $ 8 432.74 . 1,750.00 90.00 . . . --362.50 441.44-21 Bldg_& Equip RENT $ 54,241.00 $ 52,368.93 $ 1,872.07 4,436.32 15,794.42 3,075.24 -350.24 2,018.84 572.52 2,653.04 6,914.44 441.52-54 Insurance & Bonds $ 18,164.00 $ 15,728.95 $ 2,435.05 . 3,220.00 1,701.95 . . 693.00 575.00 -4,600.00 441.54-26 Advertisln~ $ 11,996.00 $ 7,660.70 $ 4,335.30 . . -. . --646.00 - 441.55-12 Printing & Binding $ 11,367.00 $ 5 615.19 $ 5,751.81 42.00 2,151.74 1,130.60 . . 15.00 -195.00 179.75 441.58-01 Training $ 22,526.00 $ 11 568.98 $ 10,957.02 • 1,300.00 2,809.00 993.00 . . 408.00 . 125.00 3,310.00 441.58-14 Travel Employee $ 190,250.00 $ 114,573.52 27,646.10 37,509.34 6,444.13 100.00 -1,757.10 57.23 1,701.30 1,943.09 441.58-18 Travei-(Contract-Volunteer) $ 5,165.00 $ 2897.01 $ 2 267.99 -573.21 ---. . 281.66 - 441.60.31 Gas, 011, Auto $ 6 000.00 $ 531.78 $ 5,468.22 531.78 . . --. 441.60.33 Materials & Supplies $ 116,844.00 $ 61,394.78 $ 55 449.22 3,046.49 8,121.95 6,647.50 3.50 2,123.79 3.50 1,714.06 6,658.92 441.60-36 Uniforms $ 4,725.00 $ 225.00 $ 4500.00 225.00 . . . . . -. 441.60-45 Drugs $ 258,863.00 $ 125,109.81 $ 133,753.19 -. 2,337.98 . . 36,823.70 . -7,596.47 441.60-46 Medical Supplies $ 357 985.00 $ 151,634.38 $ 206 350,62 . 80,767.19 -. -3,127.96 578.50 -4,255.67 441.60.47 Food & Provisions $ 10,763.00 $ 8 278.56 $ 2,484.44 . 462.22 3,674.87 . . . . 79.00 - 441.60.53 Dues & Subscriptions $ 7 665.00 $ 6,245.37 $ 1,419.63 . 3,317.00 1,966.42 . 455.00 . 40.00 - 441.60.57 Miscellaneous Expense $ 1,250.00 $ 95.00 $ 1,155.00 . 85.00 10.00 -. . -. . 441.64-25 Books & Publications $ 15 484.00 $ 10 640.42 $ 4 843.58 . 629.95 38.00 . . 135.28 . 1,270.76 756.74 441.64-27 Property Tax $ 1,033.00 $ -$ 1,033.00 . ----. . . . 441.74-74 Capital Outlay • Equipment $ -$ . $ . -. . ---. . - Total Monthly Expenditures $ 7,460,378.00 $ 5,881,778.82 $ 1,578,599.18 $ 347,650,05 $ 1,537,222.44 $ 225,229.97 $ 26,695.89 $ 2,558.51 $ 145,546.14 $ 156,383.35 $ 85,654.71 $ 664,293.58 Y·T.O Expend Balance EH·Co HH Gen/Adm Vffal Reeds Olher sves AH STD H. Educ ChlldHth Health 1,301,646.28 4,000.00 112,743.00 500.00 765,461.71 5.59 9,103.56 6,808.51 237,195.00 17,614.37 21,688.01 331,545.00 1 ,502,296.11 11,358.16 51,997.04 122.26 25,810.95 2,000.00 34,926.33 112,486.97 26,695.89 127 264.57 85 654.71 232 374.13 $ 1,537,222.44 $ 225,229,97 $ 26,695.89 $ $ 156,383.35 $ 85,654,71 $ 664,293.58 1 Jth Mm thFY 2012-2013 YEAR-TO-DATE BUDGET SUMMARY YEAR-TO-DATE BUI 1iJ ~.>are ' Acct. Code CFPT lmmun Action Management/ Family TB Comm HIV-STD Health WIC WIC WIC WIC 110-7600· Line Item Description (CH) Plan esc Prenatal Planning Program Disease County Promotion Cl!entSer Nutr Ed G-Adm BF 441.11-00 Salaries & Waqes 1,952.92 31,436.30 18,088.78 140,048.09 202,993.96 25,665.33 15,351.33 25,141.57 35,424.11 239,711.05 109,936.83 31,527.18 12,633.10 441.11-05 Overtime -------------441.11-06 Comp Time Payout -------------441.21-00 Group Insurance Expense 171.32 2,604.21 1,972.92 13,191.69 19,645.11 2,335.11 1,251.30 2,732.01 3,938.09 31,526.65 13,552.61 3,378.64 1,527.38 441.21-01 Retirees -------------441.21-04 HSA 61.97 1,100.81 391.81 2,485.57 3,917.08 574.92 173.79 758.97 874.11 6,627.72 3,537.63 491.62 477.19 441.21-05 CLINIC 10,61 134.42 116.48 731.36 1,125.20 126.46 65.48 151.58 203.90 1,686.85 803.14 185,02 98.14 441.22-00 FICA 135.72 2,315.51 1,329.00 10,089.46 14,557.66 1,918.97 1,129.67 1,903.64 2,671.54 17,659.38 8,103.27 2,296.59 902.63 441.23-00 Retirement 121.30 2,118.81 1,219.20 9,162.98 13,127.37 1,729.23 1,034.67 1,694.50 2,387.58 16.143.32 7,409.69 2,124.91 851.47 441.25-10 Unemplovment --. -------. -. 441.26-08 Worker's Compensation 37.48 571.72 409.48 766.34 1,665.31 254.22 246.10 296.82 231.89 1.127.72 522.30 152.37 59.91 441.30-04 Professional Services -------1,500.00 ---- 441.32.26 Incentives 300.00 ------312.00 880.36 296.81 --- 441.32-51 Bank Charaes ------------- 441.32-68 Board Members --------. ---. 441,32-77 Credit Card Processing Fee ---16.56 174.00 -. ----. 441.33-45 Contracted Services -300,00 . 25,491.54 6,217.51 7,885.23 ---16,276.57 3,428.75 -- 441.41-11 Telecommunic. & Postaqe 7.20 1,512.06 -717.10 2,416.80 63.21 40.31 174.36 101.80 2,697.49 476.91 421.30 63.75 441.41-13 Utilities ------------ 441.43-16 Main! & Repair-Equip -1,250.00 . -. ----332.76 --- 441.44-21 Bldg & Equip RENT ---1,827.68 1,596.16 -448.26 195.04 -4,344.00 --. 441.52-54 Insurance & Bonds ---339.00 4,025.00 345.00 -. ----- 441.54-26 Aclvertisina 591.00 -----278.70 ---- 441.55-12 Prinlina & Bindino ---18.00 71.10 -----49.00 -- 441.58-01 Trainina ---165.00 558.98 150.00 -20.00 -360.00 360.00 -40.00 441.58-14 Travel Emolovee ---699.51 726.17 3,462.92 -37.85 250.00 4,298.63 2 516.66 466.59 1,008.71 441.58-18 Travei-IContract-Volunteerl ------------- 441.60-31 Gas, Oil, Auto --------. ---- 441.60-33 Materials & Supplies 232.20 420.00 -898.97 1,721.87 3.50 --883.48 3,194.39 2,061.26 -1,390.03 441.60-36 Unifonns ---. --. ------ 441.60-45 Drugs ---1,945.00 76,406.66 -------- 441.60-46 Medical Supplies -9,304.75 -1,250.64 3 694.61 691.49 -175.50 600.00 4,349.06 --- 441.60-47 Food & Provisions 705.00 -----. 67.00 1,100.00 249.39 --. Dues & Subscriptions --466.95 ---. ---441.60-53 . - 441.60-57 Miscellaneous Expense . --. ----. ---- --304.99 482.34 -. 194.57 --1,378.06 -441.64-25 Books & Publications . Property Tax . ----. -. 441.64-27 --- Capital Oullav-Equipment -. ----. ---441.74-74 --- Total MonthlY Expenditures $ 4,328.72 $ 53,068.59 $ 23,527.67 $ 210,149.46 $ 355,589.84 $ 45,225.59 $ 19,740.91 $ 33,855.41 $ 51,325.54 $ 350,881.79 $ 154,136.31 $ 41,044.22 $ 19,052.31 13th MonlhFY 2012-2013 CFPT lAP care Mgmi/CSC PN FP TBProgmm REVENUE SUMMARY CommDis HIV-STD Coun!y HthProm WIC/CS WIC/NE WICIGA WICIBF State & Federal Contracts 1,282.00 34,669.00 25,032.00 11,302.00 102,468.00 33,969.00 4,001.00 --349,736.62 144,927.50 18,982.36 3rd Party Medicaid Eamlngs --. 155,535.08 29,862.61 319.46 -------Medicaid Cost Settlement Funds ---30,805.14 49,206.45 6,311.15 ------Other Grants (Hth Ck. Susan G Kamen) -----. ----. --Environmental & Food & Lodg Fees -. ---. --. --. -Home Health Fees -------------Family Planning Fees ----32,790.30 --------~~~ ---5,558.83 ------------2,000.00 ----4,250.00 ---. -------~ -11~ -. - I Total Local Aooronrlatlons I 3 044.72 18,399.59 (1 504.3311 94 948.41 I 141,262.48 4625.98 15,739.91 47075.541 9 208.81 1,595.19 69.95 r Total Y-T-0 Expenditures/Revenues I $ 4,326.72 $ 53,068.59 $ 23,527.67 1 $210,149.46 r $355,589.84 $ 45,225.59 $ 19,740.91 $ 33,855.41 I $ 51,325.54 I $ 350,881.79 $164,136.31 $ 41,044.22 $ 19,052.31 13th MonthFY 2012-2013 Acct. Code "'It 110-7600-Line Item Description 441.11-00 Salaries & Wages 441.11-05 Overtime 441.11-06 Como Time Pavout 441.21-00 Group Insurance Exoense 441.21-01 Retirees 441.21-04 HSA 441.21-05 CLINIC 441.22-00 FICA 441.23-00 Retirement 441.25-10 Unemployment 441.26-06 Worker's Compensation 441.30-04 Professional Services 441.32.25 Incentives 441.32-51 Bank Charges 441.32-68 Board Members 441.32-77 Credit Card Processin!:l Fee 441.33-45 Contracted Services 441.41-11 Telecommunic. & Postaae 441.41-13 Utilities 441.43-16 Maint & Repair-Equip 441.44-21 Bldg & Equip RENT 441.52-54 Insurance & Bonds 441.54-26 Advertising 441.55-12 Printing & Bindin~ 441.5&-01 Traininq 441.58-14 Travel Employee 441.56-18 Travei-{Contract-Volunteer) 441.60-31 Gas, Oil, Auto 441.60-33 Materials & Supplies 441.60-36 Uniforms 441.60-45 Drugs 441.60-46 Medical Supplies 441.60-47 Food & Provisions 441.60-53 Dues & Subscriptions 441.60-57 Miscellaneous Expense 441.64-25 Books & Publications 441.64-27 Property Tax 441.74-74 Capital Outlay -Equipment Total Monthly Expenditures 13th MonthFY 2012-2013 REVENUE SUMMARY State & Federal Contracts 3rd Party Medicaid Earnings Medicaid Cost Settlement Funds Other Grants (Hth Ck, Susan G Komen) Environmental & Food & Lodg Fees Home Health Fees Family Planning Fees )GET SUMMARY WIC Lead Food& BT 8 F PEER Prevention Lodging #514 5,247.05 12,793.85 245,752.15 ---- ---- 601.78 1,250.16 24,046.85 1,036.62 ---- 244.91 246.04 5,447.20 433.11 28.06 74.75 1,335.30 50.30 383.17 971.27 18,054.87 715.45 353.64 862.31 16,631.16 649.41 ---- 22.00 289.26 4 673.18 51.67 ---- ---- ---- ---- -70.21 - 12,119.63 . 12,440.00 15,542.73 45.18 0.45 -1,474.14 --- ---- --1,232.40 1,768.65 -230.00 -. ---- ---1,509.00 --175.00 - -302.06 12,426.82 214.22 14.70 --- ---- 230.75 -1,283.25 13,428.71 ---- ---- -189.90 -9,029.13 ---- -------- ---- ---- ---- $ 19,290.87 $ 17,210.06 $ 344,768.39 $ 55,538.31 $ WICIBF Peer lead F&L BT#514 18,645.77 8,938.00 53,901.00 -- 17,000.00 - YEAR-TO-DATE BbiU ~ ~~~ ' ~J:: CoordlnaUon Pregnancy School Healthy Prev cal Ast~ma All lOA for Children Health Nurse Communities 37,724.63 Dlabete~ s 4,165.28 --------- -------- 3,055.28 -3,410.85 -9,682.04 14,982.81 8,759.87 -464.98 --------- 556.25 -650.13 -1,675.00 3329.80 1,661.24 -- 161.54 -180.58 -530.91 1,079.89 487.77 -20.49 2,002.12 -2,719.17 5,878.85 12 287.67 5,809.18 -315.53 1,771.18 -2,542.63 -5,462.87 11,327.43 5288.92 -280.74 --------- 252.87 -153.69 -387.36 3,352.33 1 561.12 -30.57 270.00 --65.00 ----- 3,440.11 --700.00 ----980.09 --------- --------- -----· ... ·. -1.05 -- 5,000.00 ---29,386.04 45,274.87 ~ .00 - 3.64 ---1,814.60 2;764.44 -17.02 --------- -------- ----572.52 2,747c24 1,821.92 . - -------- -1,116.00 -250.00 ----4,879.00 -----127.00 127.00 -- --250.00 --545.00 -- 1,343.16 --355.34 -4,727.21 4,271~ -287.57 -----962.78 1,064. -- -----··.··. ---- 961.75 --200.44 -1,941c20 1,791.42 -2,431.85 ------·•·. --- -------. -- ----33,120.98 ---499.00 1,018.86 --515.97 -176.00 18.37 -211.88 -----·. --- ------- 974.48 --336.25 ----4,139.00 --------- --------- .. 47,090.49 $ 1,116.00 $ 47,381.68 $ 2,673.00 $ 169,561.97 $ 271,511.45 $ 183,754.60 $ 150,000.00 $ 18,723.00 HIVPrev Local Aslhma Agmg 01abetes lab CCC PCM SHNui'Se i&althy Communllle 40,000.00 1,116.00T 2,500.00 --150,000.00 18,685.00 40.38 2,519.56 253,080.00 230,44i.34 -I -I --- Miscellaneous f'ees (lns-Medlca,....Pnvate,;_P•::!Y:....l --,;---~--!---~·:-+-----+------+---_;;-_f-__ _;;-_T-__ _:.--f---5:;:8~5:;,:.7;.::5~--..;1;,:!3;::.8~0+..._...;.,...,;,;·;_+---...,;,;-;_.j... __ _;;-_+----_:-~ I ' :og, ""'""'~"~.lt~~6~45~~r1ott:::17:2:1:o-::o:6t:3~1~a~s3~o~~3~9tt::!~1~6~3t7~~31rt::j]7~o~s~o~~41Qs]T:::1~~~~c:4:7:.3:8:1~~s:sr~= ~ 167 o2a~s1 , ~ ~ ¢~~===:i,"il'l!l"l1 •• ,1> ii:l!a11s~~.uif-ouo;:~1 'l Total Y-T-D Expenditures/Revenues $ 19,290.87 $ 17,210.06 $344,768.39 $ 55,538.31 $ 47,090.49 $ 1,116.00 $ 47,381.68 $ 2,673.00 $169,561.97 $~$150,000.00 $ 18,723.00 BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2014: Section 1. To amend the General Fund, Sheriff's Office-Communications, the appropriations are to be changed as follows: · EXPENDITURE AMOUNT AMOUNT I CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE ! 110-5100-420-73-01 Equipment not capitalized 800 110-5100-420-60-33 I Materials and supplies 800 r----- I REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE - ounty Manager (date) /O .. ;t .. 13 Section 2. Copies of this budget amendment shall e furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of Margaret Regina 9m"rtet, LA:teriFA Clerk to the Board 12013. Jim Burgin, Chairman Harnett County Board of Commissioners BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2014: Section 1. To amend the General Fund, Sheriff's Department, the appropriations are to be changed as follows: ; EXPENDITURE AMOUNT AMOUNT I CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE i 110-5100-420-60-33 Materials and Supplies 1281 ! I i ! i AMOUNT AMOUNT OF CODE INCREASE DECREASE Appropriated 1,281 EXPLANATION: To increase fund balance appropriated in the amount of$ 1,281 due to State Asset forfeitures received in the 2012-2013 budget year. Funds received 6/21/13 1,281.45. These forfeiture funds will be used for the purchase of Law enforcement equipment/supplies. APPROVALS: ~~9/zq/B Department Head (date) ~\.2..!;:;+2.0r3> unty Ma ger (date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of Margaret Regina..Qaliiel, ~Clerk to the Board 12013. Jim Burgin, Chairman Harnett County Board of Commissioners I Transaction Search p us n Date Range: Jun 03, 2013 to Jul 10, 2013 ACH Credits USD Items 1-1 of 1 https :1 /wvvw. treasury. pnc bank. co m/reporting/trasactionSearch. htm -cache Page 1 of 1 Show Search CSV XLSC!':JWDa Jul 10,2013 05:20:02 PM \ 7/10/2013 Marie Hairr From: Sent: Subject: TO: Harnett Co Sheriffs Office RE: Direct Deposit Notification OSC.nc.payment@osc.nc.gov Thursday, June 20, 2013 2:39 PM NC E-Pay Remittance Advice Within three business days, pending agency funding approval, your bank account will receive a direct deposit of $1281.45 for payment number 45PR0000576722. It is your responsibility to confirm that this deposit was made and is available for your use. These funds were paid by the following agency: DEPARTMENT OF REVENUE TAX DISTRIBUTIONS PO BOX 871 REVENUE BLDG RALEIGH, NC Agency Contact Phone: 919-733-6800 27602-0871 Please direct all questions regarding this payment/deposit to the agency contact phone number listed directly above. This agency maintains information regarding your payment records. Any questions concerning payment amount and invoice information/documentation should be directed to the agency's Accounts Payable office and they will be happy to assist you with your inquiries PLEASE DO NOT REPLY TO THIS EMAIL. CONTACT THE PAYING AGENCY AT THE NUMBER LISTED ABOVE. Invoice Number lnv Date Invoice Amount Discount Amount Net Amount USUB062113 06/18/13 $1281.45 $00.00 $1281.45 UNAUTHORIZED SUB TAX DIST-TAX QUESTIONS?: 919-733-4214 "'-TOTAL: $1281.45 1 This notification was sent from the North Carolina Office of the State Controller. If this notification has been sent in error, please contact the agency listed above to make corrections. 2 BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board ofthe County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2014: Section 1. To amend the General Fund, Cooperative Extension, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-7319-465-26-08 Worker's Camp 635 110-7319-465-32-26 Incentives 500 110-7319-465-58-14 Travel Admin 1,040 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-0000-331-73-19 Revenue-Adolescent Parenting Program 905 EXPLANATION: APPROVALS: To increase revenue and operating budget for 2013-2014 Adolescent Parenting Program and to make budget corrections in Workers Compensation and Travel. b 1/1 qfr"(8 ~~: Dfpa/tm nt Head (da/~) Finance Offic&e) ounty Manager (date) /D -;~ ... J3 Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this Margaret Regina Wheeler Clerk to the Board day of Jim Burgin, Chairman Harnett County Board of Commissioners BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2014: Section 1. To amend the General Fund, Sheriffs Department, the appropriations are to be changed as follows· L EXPENDITURE AMOUNT AMOUNT i CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE L0-5103-(new) I 2013 Edward Byrne Grant 16,280.00 i ' I i REVENUE AMOUNT AMOUNT ~CODE NUMBER j DESCRIPTION OF _CODE INCREASE DECREASE ~1-0-0000-(new) i 2013 Edward Byrne Grant i i I 16,280.00 EXPlANATION: To set up the 2013 Edward Byrne Memorial Justice Assistance Grant (no county match). These funds will be used to purchase software to meet the requirements for computers used by deputies in the fields for secure sign-on rules established by the FBI. APPROVALS: Section 2. Copies of this budget amendments all be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of 12013, Margaret Regina ~1, e. e. en Jim ~Clerk to the Board Harnett County Board of Commissioners Date: 10/07/2013 Approved Sy : TO : HARNETI COUNTY BOARD OF COMMISSIONERS RE: CONSIDERATION OF REFUND FOR TAXES, INTEREST AND PENALTIES FOR ALL MUNICIPALITIES BONAR, WILLIAM MATIHEW City 0.00 Military Exemption BONAR, MYRLA B 0002097341-2013-2013-000000 65.46 Refund 346 COLONIAL HILLS DR County 65.46 LILLINGTON, NC, 27546 -6259 2 BRYANT, BILLY JOE City 0.00 Double-Listed 27TRIVERST 0001280560-2012-2012-000000 11.08 Refund FUQUAY VARINA NC, 27526 -County 11.08 5607 3 CARROLL, JAMES L CARROLL, E City 0.00 Value Decrease 7154 COKESBURY ROAD 0000009844-2008-2008-000000 76.78 Refund HOLLY SPRINGS NC, 27540 -County 76.78 0000 4 CARROLL, JAMES L CARROLL, E City 0.00 Value Decrease 7154 COKESBURY ROAD 0000009844-2009-2009-000000 71.96 Refund HOLLY SPRINGS NC, 27540 -County 71.96 0000 5 CARROLL, JAMES L City 0.00 Value Decrease CARROLL, E 7154 COKESBURY ROAD 0001730088-2010-2010-000000 71.97 Refund HOLLY SPRINGS NC, 27540 -County 71.97 0000 6 CARROLL, JAMES L City 0.00 Value Decrease CARROLL, E 7154 COKESBURY ROAD 0001730088-2011-2011-000000 71.97 Refund HOLLY SPRINGS NC, 27540 • County 71.97 0000 7 CARROLL, JAMES L City 0.00 Value Decrease CARROLL, E 71.97 Refund 7154 COKESBURY ROAD 0001730088-2012-2012-000000 HOLLY SPRINGS NC, 27540 -County 71.97 0000 8 FRISONE, MICHAEL G City 0.00 Military Exemption 210 SAWTOOTH DR. APT.1 0 0002096272-2013-2013-000000 241.48 Refund FAYETTEVILLE, NC, 28314 County 241.48 9 GRANT, ELLIOT SCOT City 0.00 Military Exemption GRANT, TIFFANY A 0001888949-2013-2013-000000 74.42 Refund 33 SHALLOW FORD ST County 74.42 CAMERON, NC, 28326 10 GREGORY, WARREN BRETT City 0.00 Military Exemption 345 GREEN SPRING DR 0001981033-2012-2012-000000 53.70 Refund SANFORD, NC, 27332 -1301 County 53.70 11 HAMIL TON, NATHAN HANNIBLE City() 4.64 Situs Correction 633 RAIFORD RD 0001774155-2013-2013-000001 4.64 Refund ERWIN, NC, 28339-8461 County 0.00 12 HOLDERNESS, PETER ALAN City 0.00 Military Exemption 286 HORSE WHISPERER LN 0001993245-2012-2012-000000 199.16 Refund LILLINGTON, NC, 27546 County 199.16 13 MORGANTHAL, ANGELA City 0.00 Military Exemption MORRIS 0002008853-2012-2012-000000 82.89 Refund 420 VALLEY OAK DR County 82.89 BUNNLEVEL, NC, 28323-9127 14 MORGANTHAL, KEVIN 0002085053-2012-2012-000000 City 0.00 168.74 Refund Military Exemption MICHAEL MORGANTHAL, ANGELA MORRIS 420 VALLEY OAK DR County 168.74 BUNNLEVEL, NC, 28323 -9127 15 PASTERNAK, AMY LYNNE City() 28.02 Situs Correction 278 GOLD CT 0001890583-2013-2011-000000 32.75 Refund BROADWAY, NC, 27505 8192 County 4.73 16 PASTERNAK, AMY LYNNE City() 22.86 Situs Correction 278 GOLDCT 0001890583-2013-2012-000000 23.22 Refund BROADWAY, NC, 27505-8192 County 0.36 17 PENNINGTON, CHAD ERIC City 0.00 Military Exemption 7 BRAVETRL 0001896300-2011-2011-000000 132.74 Refund CAMERON, NC, 28326-6280 County 132.74 18 PENNINGTON, CHAD ERIC City 0.00 Military Exemption 7 BRAVETRL 0001896300-2012-2012-000000 130.19 Refund CAMERON, NC, 28326 6280 County 130.19 19 SHULTZ, DUSTIN HAROLD City 0.00 Military Exemption 250 MAPLEWOOD DR 0002086950-2013-2013-000000 204.93 Refund SANFORD, NC, 27332-0117 County 204.93 20 STULTZ, JOSHUA DEREK City 0.00 Military Exemption 341 PEACHTREE LN 0001971487-2011-2011-000000 32.36 Refund SANFORD, NC, 27332 -1352 County 32.36 21 STULTZ, JOSHUA DEREK City 0.00 Military Exemption 341 PEACHTREE LN 0001971487-2012-2012-000000 27.11 Refund SANFORD, NC, 27332 -1352 County 27.11 22 WESLEY, AUNDRA MONTESIZE City 0.00 Military Exemption 34 LINDLEY CT 0001991657-2012-2012-000000 35.48 Refund CAMERON, NC 283266169 County 35.48 CAMERON, NC, 28326-6169 WM. A. TONY WILDER City Total 55.52 Revenue Administrator County 1,829.48 Total Total to be 1,885.00 Refunded Date: 10/07/2013 Approved By: ________ _ TO : HARNETT COUNTY BOARD OF COMMISSIONERS RE: CONSIDERATION OF REFUND FOR TAXES, INTEREST AND PENALTIES FOR ALL MUNICIPALITIES ACGC LLC 125 WHISPERING PINES DR SPRING lAKE NC, 28390 0000 2 WEAVER, GENE 8 WEAVER, HILDA G 1378 CHESTERFIELD LAKE ROAD ANGIER NC, 27501 -0000 WM. A. TONY WILDER Revenue Administrator CC: WM. A. TONY WILDER 0000063220-2009-2009-000000 0000057224-2013-2013-000001 City 0.00 County 8,797.82 City 0.00 County 702.44 City Total County Total Total to be Refunded Settlement of Property Tax 8, 797.82 Refund Commission Appeal Listed on Another 702.44 Refund Parcel 0.00 9,500.26 9,500.26 Agenda Item __ '1 __ -___,QIO!!:::.._ A RESOLUTION TO HONOR STANLEY BASS THAT WHEREAS, .StanleyBassbecameinvolved as. a Hamett~ounty volunteer by.being appointed to the Harnett County Airport Committee on December 6, 1993; and WHEREAS, Stanley's knowledge and love of aviation, along with his love for HarnettCounty was an assetto the Airport Committee .and due to t!le suddenresignation.ofthe Airport Fixed Base Operator in December of 1996, Stanley stepped in and assumed the duties thereby making a smooth transition; and WHEREAS, due to his enthusiasm, professionalism and friendly attimde,Stanley was recommended by the Airport Committee and appointed Fixed Base Operator by the Board of Commissioners September 1, 1997; and WHEREAS, Stanley's business became known as"Bass Air Service, Inc." which included his wife Marie Bass and other great employees and has been involved day to day and supported the transition of the Harnett County Airport to the Harnett Regional Jetport as it is known today; and WHEREAS, it is because of Stanley and Marie's "welcome to Harnett County" attitude that Harnett County is known far a:hd wide to the aviation community and we recognize their efforts due to their recent retirement on October I, 2013. NOW, THEREFORE BE IT RESOLVED by the Harnett County Board of Commissioners that they do hereby recognize Stanley Bass for his efforts, his professionalism, and his support in transforming the Harnett County Airport into the Harnett Regional Jetport and does hereby commend him and wife Marie for their contributions to our community and the aviation community as a whole. Duly adopted this 7th day of October, 2013. HARNETT COUNTY BOARD OF COMMISSIONERS Jim Burgin, Chairman Gary A. House, Vice Chairman Beatrice B. Hill Joe Miller C. Gordon Springle Board Meeting Agenda Item Agenda Item MEETING DATE: TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Approval of Lease Purchase Agreement with US Bank REQUESTED BY: Kimberly Honeycutt, Interim Finance Officer REQUEST: Oc..+. 7, ~ 013 That the Harnett County Board of Commissioners approve a lease purchase agreement with US Bank in the amount of$830,160 for the purchase of30 cars for the Sheriff and two EMS Conversion Vans. The interest rate for the transaction is 1.70%. FINANCE OFFICER'S RECOMMENDATION: Yes COUNTY MANAGER'S RECOMMENDATION: DOCUMENT CHECKLIST PLEASE EXECUTE TWO (2) ORIGINALS OF ALL DOCUMENTS RETURN ALL ORIGINALS TO: U.S. BANCORP GOVERNMENT LEASING AND FINANCE, INC. FRANCINE NEVILLE 950 17TH STREET, rH FLOOR DENVER, CO 80202 303-585-4077 ;;.. Addendum/Amendment to Master Tax-Exempt Lease Purchase Agreement -This document must be executed in the presence of a witness/attestor. The attesting witness does not have to be a notary, just present at the time of execution. ;;.. Property Schedule No. 2 -This document must be executed in the presence of a witness/attestor. The attesting witness does not have to be a notary, just present at the time of execution. ;;.. Property Description and Payment Schedule-Exhibit 1 ;;.. Lessee's Counsel's Opinion -Exhibit 2. This exhibit will need to be executed by your attorney, dated and placed on their letterhead. Your attorney will likely want to review the agreement prior to executing this opinion. ;;.. Lessee's Certificate -Exhibit 3. 1) Please fill in the person's title who will be executing the certificate in the first paragraph (note: the person who signs this exhibit cannot be the same person as the executing official(s) for all other documents); 2) Please fill in the date that the governing body met in Line 1; 3) In the middle set of boxes, please print the name of the executing official(s) in the far left box, print their title{s) in the middle box and have the executing official(s) sign the line in the far right hand box; 4) Include in your return package a copy of the board minutes or resolution for our files; and 5) The exhibit should be executed by someone other than the executing official(s) named in the center box. ).> Payment of Proceeds Instructions -Exhibit 4. This is for the vendor payment information. If more than one vendor is being paid please make copies of this exhibit and fill out as many as are needed. ).> Acceptance Certificate-Exhibit 5. The date that all equipment is delivered, installed and accepted is the date that should be placed on the "DATE" line. If moneys are being deposited into escrow this exhibit should be held and returned with the final disbursement from the escrow account. ).> Bank Qualification and Arbitrage Rebate-Exhibit 6. ).> Insurance Authorization and Verification To be filled out by the Lessee and sent to your insurance carrier. A valid insurance certificate, or self-insurance letter if the Lessee self-insures, is required prior to funding. ;.. Notification of Tax Treatment-Please provide your State of Sales/Use tax Exemption Certificate, if applicable. ).> Form 8038-G-Blank form provided to Lessee. Please consult your local legal/bond counsel to fill out. ).> Vehicle Titling Addendum ).> Escrow Agreement -This document needs to be executed by the Executing Official defined in the Lessee's Certificate-Exhibit 3. o Investment Direction Letter-Exhibit 1. This document needs to be executed by the Executing OfficiaL o Schedule of Fees -Exhibit 2. o Requisition Request-Exhibit 3. This document should be retained by Lessee and utilized to request disbursements from the escrow account. Please make copies and fill out as many as are needed. o Acceptance Certificate -Exhibit 4. This document should be retained by Lessee and provided to Lessor once all the proceeds have been disbursed from the escrow account. o Class Action Negative Consent Letter-Exhibit 6. o IRS Form W-9. This document should be retained by Lessee and submitted with the Requisition Request(s) for each vendor being paid. Please make copies and fill out as many as are needed. ).> First Payment Invoice-Invoice included for your convenience. ADDENDUM (NORTH CAROLINA) Master Tax-Exempt Lease/Purchase Agreement THIS ADDENDUM, which is entered into as of October 15, 2013 between U.S. Bancorp Government Leasing and Finance, Inc. ("Lessor") and County of Harnett ("Lessee"), is intended to modify and supplement Property Schedule No. 2 (the "Property Schedule") to the Master Tax-Exempt Lease/Purchase Agreement between Lessor and Lessee dated as of September 3, 2013 (the "Master Agreement"). Capitalized terms not otherwise defined herein shall have the meanings set forth in the Master Agreement In addition to the representations, warranties and covenants set forth in the Master Agreement, Lessee represents, warrants and covenants for the benefit of Lessor that (i) Lessee has reviewed the Property Schedule with legal counsel regarding the need to obtain approval of the Local Government Commission, and if determined that such approval is needed, has so obtained such approval, and (ii) if Lessee is a school district, Lessee has reviewed Section 115C-528 of the General Statutes of North Carolina with its legal counsel for compliance with all of the terms and conditions set forth therein for lease-purchase contracts, and has complied with all said terms and conditions with respect to the Property Schedule. IN WITNESS WHEREOF, Lessor and Lessee have caused this Addendum to be executed in their names by their duly authorized representatives as of the date first above written. Lessor: U.S. Bancorp Government Leasing and Finance, Inc. By: Name: Title: Lessee: County of Harnett By: -Bul?\;~ Name: <.Jim - Title: C~;~V\ Attest: By Name: Title: !Property Schedule No. 21 Master Tax-Exempt Lease/Purchase Agreement This Property Schedule No. 2 is entered into as of the Commencement Date set forth below, pursuant to that certain Master Tax- Exempt Lease/Purchase Agreement (the "Master Agreement"), dated as of September 3, 2013, between U.S. Bancorp Government Leasing and Finance, Inc., and County of Harnett. 1. Interpretation. The terms and conditions of the Master Agreement are incorporated herein by reference as if fully set forth herein. Reference is made to the Master Agreement for all representations, covenants and warranties made by Lessee in the execution of this Property Schedule, unless specifically set forth herein. In the event of a conflict between the provisions of the Master Agreement and the provisions of this Property Schedule, the provisions of this Property Schedule shall control. All capitalized terms not otherwise defined herein shall have the meanings provided in the Master Agreement. 2. Commencement Date. The Commencement Date for this Property Schedule is October 15,2013. 3. Property Description and Payment Schedule. The Property subject to this Property Schedule is described in Exhibit 1 hereto. Lessee shall not remove such property from the locations set forth therein without giving prior written notice to Lessor. The Lease Payment Schedule for this Property Schedule is set forth in Exhibit 1. 4. Opinion. The Opinion of Lessee's Counsel is attached as Exhibit 2. 5. Lessee's Certificate. The Lessee's Certificate is attached as Exhibit 3. 6. Proceeds. Lessor shall disburse the proceeds of this Property Schedule in accordance with the instructions attached hereto as Exhibit 4. 7. Acceptance Certificate. The form of Acceptance Certificate is attached as Exhibit 5. 8. Additional Purchase Option Provisions. In addition to the Purchase Option provisions set forth in the Master Agreement, Lease Payments payable under this Property Schedule shall be subject to prepayment in whole at any time by payment of the applicable Termination Amount set forth in Exhibit 1 (Payment Schedule) and payment of all accrued and unpaid interest through the date of prepayment. 9. Bank Qualification and Arbitrage Rebate. Attached as Exhibit 6. 10. Expiration. Lessor, at its sole determination, may choose not to accept this Property Schedule if the fully executed, original Master Agreement (including this Property Schedule and all ancillary documents) is not received by Lessor at its place of business by December 11, 2013. IN WITNESS WHEREOF, Lessor and Lessee have caused this Property Schedule to be executed in their names by their duly authorized representatives as of the Commencement Date above. Lessor: U.S. Bancorp Government Leasing and Lessee: County of Harnett Finance, Inc. By: By: Name: Title: Attest: By Name: Title: !EXHIBIT 1j !Property Description and Payment Schedule] Re: Property Schedule No.2 to Master Tax-Exempt Lease/Purchase Agreement U.S. Bancorp Government Leasing and Finance, Inc. and County of Harnett. THE PROPERTY IS AS FOLLOWS: The Property as more fully described in Exhibit A incorporated herein by reference and attached hereto. It includes all replacements, parts, repairs, additions, accessions and accessories incorporated therein or affixed or attached thereto and any and all proceeds of the foregoing, including, without limitation, insurance recoveries. PROPERTY LOCATION: Po!iec W)'S ~ t-brndtccuv.9 ~rift-175 &in St-Lilli htAhm NC Address <...J 27 54-t:: tlvlS Con~o\11 ~s ·. ~G::vtv-.~ EN\c:;. 1oos 5:twarc:Ds B--e,s City, State Zip Code D , 1 ··I'. 1.. ~""' ' '\\II!. 1,...-.J II~TOV) {\jC2...t~ USE: Police Vehicles and Ambulances This use is essential to the proper, efficient and economic functioning of Lessee or to the services that Lessee provides; and Lessee has immediate need for and expects to make immediate use of substantially all of the Property, which need is not temporary or expected to diminish in the foreseeable future. Lease Payment Schedule Total Principal Amount: $830,160.00 Termination Payment No. Due Date Lease Principal Interest Amount Payment Portion Portion (After Making Payment for said Due Date) 1 15-Nov-20 13 14,676.69 13,500.63 1,176.06 841 '159.15 2 15-Dec-20 13 14,676.69 13,519.75 1,156.93 827,233.81 3 15-Jan-2014 14,676.69 13,538.91 1,137.78 813,288.73 4 15-Feb-2014 14,676.69 13,558.09 1 '118.60 799,323.90 5 15-Mar-2014 14,676.69 13,577.29 1,099.39 785,339.29 6 15-Apr-2014 14,676.69 13,596.53 1,080.16 771,334.87 7 15-May-2014 14,676.69 13,615.79 1,060.90 757,310.60 8 15-Jun-2014 14,676.69 13,635.08 1,041.61 743,266.47 9 15-Jul-2014 14,676.69 13,654.40 1,022.29 729,202.45 10 15-Aug-2014 14,676.69 13,673.74 1,002.95 715,118.49 11 15-Sep-2014 14,676.69 13,693.11 983.58 701,014.59 12 15-0ct-2014 14,676.69 13,712.51 964.18 686,890.71 13 15-Nov-2014 14,676.69 13,731.93 944.75 672,746.81 14 15-Dec-2014 14,676.69 13,751.39 925.30 658,582.88 15 15-Jan-2015 14,676.69 13,770.87 905.82 644,398.89 16 15-Feb-2015 14,676.69 13,790.38 886.31 630,194.80 17 15-Mar-2015 14,676.69 13,809.91 866.77 615,970.58 18 15-Apr-2015 14,676.69 13,829.48 847.21 601,726.22 19 15-May-2015 14,676.69 13,849.07 827.62 587,461.68 20 15-J un-2015 14,676.69 13,868.69 808.00 573,176.93 21 15-Jul-2015 14,676.69 13,888.34 788.35 558,871.94 22 15-Aug-2015 14,676.69 13,908.01 768.67 544,546.69 23 15-Sep-2015 14,676.69 13,927.72 748.97 530,201.14 24 15-0ct-2015 14,676.69 13,947.45 729.24 515,835.27 25 15-Nov-2015 14,676.69 13,967.21 709.48 501,449.05 26 15-Dec-2015 14,676.69 13,986.99 689.70 487,042.45 27 15-Jan-20 16 14,676.69 14,006.81 669.88 472,615.44 28 15-Feb-2016 14,676.69 14,026.65 650.04 458,167.99 29 15-Mar-2016 14,676.69 14,046.52 630.17 443,700.07 30 15-Apr-2016 14,676.69 14,066.42 610.27 429,211.66 31 15-May-2016 14,676.69 14,086.35 590.34 414,702.72 32 15-Jun-2016 14,676.69 14,106.30 570.38 400,173.23 33 15-Jul-2016 14,676.69 14,126.29 550.40 385,623.15 34 15-Aug-2016 14,676.69 14,146.30 530.39 371,052.46 35 15-Sep-2016 14,676.69 14,166.34 510.35 356,461.13 36 15-0ct-2016 14,676.69 14,186.41 490.28 341,849.13 37 15-Nov-2016 14,676.69 14,206.51 470.18 327,216.43 38 15-Dec-20 16 14,676.69 14,226.63 450.05 312,562.99 39 15-Jan-2017 14,676.69 14,246.79 429.90 297,888.80 40 15-Feb-2017 14,676.69 14,266.97 409.72 283,193.82 41 15-Mar-2017 14,676.69 14,287.18 389.51 268,478.03 42 15-Apr-2017 14,676.69 14,307.42 369.27 253,741.38 43 15-May-2017 14,676.69 14,327.69 349.00 238,983.86 44 15-Jun-2017 14,676.69 14,347.99 328.70 224,205.43 45 15-Jul-2017 14,676.69 14,368.31 308.37 209,406.07 46 15-Aug-2017 14,676.69 14,388.67 288.02 194,585.74 47 15-Sep-2017 14,676.69 14,409.05 267.63 179,744.42 48 15-0ct-2017 14,676.69 14,429.47 247.22 164,882.07 49 15-Nov-2017 14,676.69 14,449.91 226.78 149,998.66 50 15-Dec-2017 14,676.69 14,470.38 206.31 135,094.17 51 15-Jan-2018 14,676.69 14,490.88 185.81 120,168.57 52 15-Feb-2018 14,676.69 14,511.41 165.28 105,221.82 53 15-Mar-2018 14,676.69 14,531.97 144.72 90,253.89 54 15-Apr-2018 14,676.69 14,552.55 124.14 75,264.76 55 15-May-20 18 14,676.69 14,573.17 103.52 60,254.40 56 15-Jun-2018 14,676.69 14,593.81 82.87 45,222.77 57 15-Jul-2018 14,676.69 14,614.49 62.20 30,169.85 58 15-Aug-2018 14,676.69 14,635.19 41.50 15,095.60 59 15-Sep-2018 14 676.69 14 655.93 20.76 0.00 TOTALS: 865,924.57 830,160.00 35,764.57 Interest Rate: 1.70% Lessee: County of Harnett By: Name: Jim 'Bur.qi V\ \...) Title: C~'b-i~f) jEXHIBIT Aj !Property Description! Thirty (30) 2013 Dodge Charger Police Cars Two (2) Ford Type II Remount Conversion Vans for EMS VIN #s to be determined !EXHIBIT 21 !Lessee's Counsel's Opinion! [To be provided on letterhead of Lessee's counsel.] October 15,2013 U.S. Bancorp Government Leasing and Finance, Inc. 13010SW68th Parkway, Suite 100 Portland, OR 97223 County of Harnett P.O. Box 760 Lillington, NC 27546 Attention: Kimberly A. Honeycutt RE: Property Schedule No. 2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government Leasing and Finance, Inc. and County of Harnett. Ladies and Gentlemen: We have acted as special counsel to County of Harnett ("Lessee"), in connection with the Master Tax-Exempt Lease/Purchase Agreement, dated as of September 3, 2013 (the "Master Agreement"), between County of Harnett, as lessee, and U.S. Bancorp Government Leasing and Finance, Inc. as lessor ("Lessor"), and the execution of Property Schedule No. 2 (the "Property Schedule") pursuant to the Master Agreement. We have examined the law and such certified proceedings and other papers as we deem necessary to render this opinion. All capitalized terms not otherwise defined herein shall have the meanings provided in the Master Agreement and Property Schedule. As to questions of fact material to our opinion, we have relied upon the representations of Lessee in the Master Agreement and the Property Schedule and in the certified proceedings and other certifications of public officials furnished to us without undertaking to verify the same by independent investigation. Based upon the foregoing, we are of the opinion that, under existing law: 1. Lessee is a public body corporate and politic, duly organized and existing under the laws of the State, and has a substantial amount of one or more of the following sovereign powers: (a) the power to tax, (b) the power of eminent domain, and (c) the police power. 2. Lessee has all requisite power and authority to enter into the Master Agreement and the Property Schedule and to perform its obligations thereunder. 3. The execution, delivery and performance of the Master Agreement and the Property Schedule by Lessee has been duly authorized by all necessary action on the part of Lessee. 4. All proceedings of Lessee and its governing body relating to the authorization and approval of the Master Agreement and the Property Schedule, the execution thereof and the transactions contemplated thereby have been conducted in accordance with all applicable open meeting laws and all other applicable state and federal laws. 5. Lessee has acquired or has arranged for the acquisition of the Property subject to the Property Schedule, and has entered into the Master Agreement and the Property Schedule, in compliance with all applicable public bidding laws. 6. Lessee has obtained all consents and approvals of other governmental authorities or agencies which may be required for the execution, delivery and performance by Lessee of the Master Agreement and the Property Schedule. 7. The Master Agreement and the Property Schedule have been duly executed and delivered by Lessee and constitute legal, valid and binding obligations of Lessee, enforceable against Lessee in accordance with the terms thereof, except insofar as the enforcement thereof may be limited by any applicable bankruptcy, insolvency, moratorium, reorganization or other laws of equitable principles of general application, or of application to municipalities or political subdivisions such as the Lessee, affecting remedies or creditors' rights generally, and to the exercise of judicial discretion in appropriate cases. 8. As of the date hereof, based on such inquiry and investigation as we have deemed sufficient, no litigation is pending, (or, to our knowledge, threatened) against Lessee in any court (a) seeking to restrain or enjoin the delivery of the Master Agreement or the Property Schedule or of other agreements similar to the Master Agreement; (b) questioning the authority of Lessee to execute the Master Agreement or the Property Schedule, or the validity of the Master Agreement or the Property Schedule, or the payment of principal of or interest on, the Property Schedule; (c) questioning the constitutionality of any statute, or the validity of any proceedings, authorizing the execution of the Master Agreement and the Property Schedule; or (d) affecting the provisions made for the payment of or security for the Master Agreement and the Property Schedule. This opinion may be relied upon by Lessor, its successors and assigns, and any other legal counsel who provides an opinion with respect to the Property Schedule. Very truly yours, By: __________________________ _ Dated:----------- !EXHIBIT 3! !Lessee's Certificate! Re: Property Schedule No. 2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government Leasing and Finance, Inc. and County of Harnett The undersigned, being the duly elected, qualified and acting of the County of Harnett ("Lessee") do hereby certify, as of October 15, 2013, as follows: 1. Lessee did, at a meeting of the governing body of the Lessee held by resolution or ordinance duly enacted, in accordance with all requirements of law, approve and authorize the execution and.delivery of the above-referenced Property Schedule (the "Property Schedule") and the Master Tax-Exempt Lease/Purchase Agreement (the "Master Agreement") by the following named representative of Lessee, to wit: NAME TITLE SIGNATURE OF EXECUTING OFFICIAL OF EXECUTING OFFICIAL OF EXECUTING OFFICIAL 2. The above-named representative of the Lessee held at the time of such authorization and holds at the present time the office set forth above. 3. The meeting(s) of the governing body of the Lessee at which the Master Agreement and the Property Schedule were approved and authorized to be executed was duly called, regularly convened and attended throughout by the requisite quorum of the members thereof, and the enactment approving the Master Agreement and the Property Schedule and authorizing the execution thereof has not been altered or rescinded. All meetings of the governing body of Lessee relating to the authorization and delivery of Master Agreement and the Property Schedule have been: (a) held within the geographic boundaries of the Lessee; (b) open to the public, allowing all people to attend; (c) conducted in accordance with internal procedures of the governing body; and (d) conducted in accordance with the charter of the Lessee, if any, and the laws of the State. 4. No event or condition that constitutes, or with the giving of notice or the lapse of time or both would constitute, an Event of Default or a Nonappropriation Event (as such terms are defined in the Master Agreement) exists at the date hereof with respect to this Property Schedule or any other Property Schedules under the Master Agreement. 5. The acquisition of all of the Property under the Property Schedule has been duly authorized by the governing body of Lessee. 6. Lessee has, in accordance with the requirements of law, fully budgeted and appropriated sufficient funds for the current budget year to make the Lease Payments scheduled to come due during the current budget year under the Property Schedule and to meet its other obligations for the current budget year and such funds have not been expended for other purposes. 7. As of the date hereof, no litigation is pending, (or, to my knowledge, threatened) against Lessee in any court (a) seeking to restrain or enjoin the delivery of the Master Agreement or the Property Schedule or of other agreements similar to the Master Agreement; (b) questioning the authority of Lessee to execute the Master Agreement or the Property Schedule, or the validity of the Master Agreement or the Property Schedule, or the payment of principal of or interest on, the Property Schedule; (c) questioning the constitutionality of any statute, or the validity of any proceedings, authorizing the execution of the Master Agreement and the Property Schedule; or (d) affecting the provisions made for the payment of or security for the Master Agreement and the Property Schedule. County of Harnett By: Title: Cte:.r~-1-ntk~ SIGNER MUST NOT BE THE SAME AS THE EXECUTING OFFICIAL(S) SHOWN ABOVE. !EXHIBIT 41 !Payment of Proceeds Instructions! U.S. Bancorp Government Leasing and Finance, Inc. 13010 SW 68th Parkway, Suite 100 Portland, OR 97223 Re: Property Schedule No. 2 (the "Property Schedule") to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government Leasing and Finance, Inc. ("Lessor") and County of Harnett ("Lessee"). Ladies and Gentlemen: The undersigned, an Authorized Representative of the Lessee hereby requests and authorizes Lessor to disburse the net proceeds of the Property Schedule as follows: NameofPayee: -------------------------------- By check __ _ By wire transfer __ __ If by check, Payee's address: If by wire transfer, instructions as follows: Pay to Bank Name: Bank Address: Bank Phone#: For Account of: Account No.: ABA No.: Lessee: County of Harnett B: Name: Title: jEXHIBIT 5j V\cceptance Certificate! U.S. Bancorp Government Leasing and Finance, Inc. 13010 SW 68th Parkway, Suite 100 Portland, OR 97223 Re: Property Schedule No. 2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government Leasing and Finance, Inc. and County of Harnett Ladies and Gentlemen: In accordance with the above-referenced Master Tax-Exempt Lease/Purchase Agreement (the "Master Agreement"), the undersigned ("Lessee") hereby certifies and represents to, and agrees with, U.S. Bancorp Government Leasing and Finance, Inc. ("Lessor''), as follows: (1) The Property, as such terms are defined in the above-referenced Property Schedule, has been acquired, made, delivered, installed and accepted on the date indicated below. (2) Lessee has conducted such inspection and/or testing of the Property as it deems necessary and appropriate and hereby acknowledges that it accepts the Property for all purposes. (3) No event or condition that constitutes, or with notice or lapse of time, or both, would constitute, an Event of Default or a Nonappropriation Event (as such terms are defined in the Master Agreement) exists at the date hereof. Acceptance Date: -------------- Lessee: County of Harnett By: Name: ~n,\x~~ ~~~lt ' Title: \ vrl"!:nVv\ ltiht\1ue OFPic.er !EXHIBIT 6j !Bank Qualification And Arbitrage Rebate! U.S. Bancorp Government Leasing and Finance, Inc. 13010 SW 68th Parkway, Suite 100 Portland, OR 97223 Re: Property Schedule No.2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government Leasing and Finance, Inc. and County of Harnett Bank Qualified Tax-Exempt Obligation under Section 265 Lessee hereby designates this Property Schedule as a "qualified tax-exempt obligation" as defined in Section 265(b)(3)(8) of the Code. Lessee reasonably anticipates issuing tax-exempt obligations (excluding private activity bonds other than qualified 501 (c)(3) bonds and including all tax-exempt obligations of subordinate entities of the Lessee) during the calendar year in which the Commencement Date of this Property Schedule falls, in an amount not exceeding $10,000,000. Arbitrage Rebate Eighteen Month Exception: Pursuant to Treasury Regulations Section 1.148-?(d), the gross proceeds of this Property Schedule will be expended for the governmental purposes for which this Property Schedule was entered into, as follows: at least 15% within six months after the Commencement Date, at least 60% within 12 months after the Commencement Date, and 1 00% within 18 months after the Commencement Date. If Lessee is unable to comply with Section 1.148-?(d) of the Treasury Regulations, Lessee shall compute rebatable arbitrage on this Agreement and pay rebatable arbitrage to the United States at least once every five years, and within 60 days after payment of the final Lease Payment due under this Agreement. Lessee: County of Harnett By: Name: ,J 1 1n Bu.~ V) ......._, Title: ~ \'IY'(;\, \1\ language for UCC Financing Statements Schedule 2 SECURED PARTY: U.S. Bancorp Government Leasing and Finance, Inc. DEBTOR: County of Harnett This financing statement covers all of Debtor's right, title and interest, whether now owned or hereafter acquired, in and to the equipment leased to Debtor under Property Schedule No. 2 dated October 15, 2013 to that certain Master Tax- Exempt Lease Purchase Agreement dated as of September 3, 2013, in each case between Debtor, as Lessee, and Secured Party, as Lessor, together with all accessions, substitutions and replacements thereto and therefore, and proceeds (cash and non-cash), including, without limitation, insurance proceeds, thereof, including without limiting, all equipment described on Exhibit A attached hereto and made a part hereof. Debtor has no right to dispose of the equipment. INSURANCE AUTHORIZATION AND VERIFICATION Date: October 15, 2013 Property Schedule No: 2 From: U.S. Bancorp Government Leasing and Finance, Inc. (the "Lessor") To: County of Harnett (the "Lessee") 13010 SW 68th Parkway, Suite 100 Portland, OR 97223 Attn: Francine Neville TO THE LESSEE: In connection with the above-referenced Property Schedule, Lessor requires proof in the form of this document, executed by both Lessee• and Lessee's agent, that Lessee's insurable interest in the financed property (the "Property") meets Lessor's requirements as follows, with coverage including, but not limited to, fire, extended coverage, vandalism, and theft: Lessor, AND ITS SUCCESSORS AND ASSIGNS, shall be covered as both ADDITIONAL INSURED and LENDER'S LOSS PAYEE with regard to all equipment financed or leased by policy holder through or from Lessor. All such insurance shall contain a provision to the effect that such insurance shall not be canceled or modified without first giving written notice thereof to Lessor and Lessee at least thirty (30) days in advance of such cancellation or modification. Lessee must carry GENERAL LIABILITY (and/or, for vehicles, Automobile Liability) in the amount of no less than $1,000,000.00 (one million dollars). Lessee must carry PROPERTY Insurance (or, for vehicles, Physical Damage Insurance) in an amount no less than the 'Insurable Value' $830,160.00, with deductibles no more than $10,000.00. *Lessee: Please execute this form and return with your document package. Lessor will fax this form to your insurance agency for endorsement. In lieu of agent endorsement, Lessee's agency may submit insurance certificates demonstrating compliance with all requirements. If fully executed form (or Lessee-executed form plus certificates) is not provided within 15 days, we have the right to purchase such insurance at your expense. Should you have any questions, please contact Francine Neville at 303-585-4077. By signing, Lessee authorizes the Agent named below: 1) to complete and return this form as indicated; and 2) to endorse the policy and subsequent renewals to reflect the required coverage as outlined above. Agency/Agent: Address: Phone/Fax: Email: of Harnett TO THE AGENT: In lieu of providing a certificate, please execute this form in the space below and promptly fax it to Lessor at 303-585-4732. This fully endorsed form shall serve as proof that Lessee's insurance meets the above requirements. Agent hereby verifies that the above requirements have been met in regard to the Property listed below. Print Name of Agen :5urnnu By: X·------:- (Agent's Print Name: X De r~ k:: t3Latc. Date: x._q'-f-j-=02CJ=-,/f-L<L_3...___ ___ _ I I Insurable Value: $830,160.00 ATTACHED: PROPERTY DESCRIPTION FOR PROPERTY SCHEDULE NO.: 2 Notification of Tax Treatment to Tax-Exempt Lease/Purchase Agreement This Notification of Tax Treatment is pursuant to the Master Tax-Exempt Lease/Purchase Agreement dated as of September 3, 2013 and the related Property Schedule No.2 dated October 15, 2013, between Lessor and Lessee (the "Agreement"). X Lessee agrees that this Property Schedule SHOULD be subject to sales/use taxes Lessee agrees that this Property Schedule should NOT be subject to sales/use taxes and Lessee has included our tax-exemption certificate with this document package Lessee agrees that this Property Schedule should NOT be subject to sales/use taxes and no tax-exemption certificate is issued to us by the State Lessee agrees that this Property Schedule is a taxable transaction and subject to any/all taxes Lessee agrees that this Property Schedule is subject to sales/use taxes and will pay those taxes directly to the State or Vendor IN WITNESS WHEREOF, Lessee has caused this Notification of Tax Treatment to be executed by their duly authorized representative. Lessee: County of Harnett By: Name: J\Yh BlAt;;;"\.\ V\ '-' Title: c~~ Instructions for Form 8038-G (Rev. September 2011) ~l\\ Department of the Treasury \j&JJI Internal Revenue Service Information Return for TaxMExempt Governmental Obligations Section references are to the Internal Revenue Code unless otherwise noted. General Instructions Purpose of Form Form 8038-G is used by issuers of tax-exempt governmental obligations to provide the IRS with the information required by section 149(e} and to monitor the requirements of sections 141 through 150. Who Must File IF the issue price THEN, for tax-exempt (line 21, column (b)} governmental is... obligations issued after December 31, 1986, issuers must file .•• $100,000 or more Less than $100,000 A separate 8038-G for each issue Information Return for Small Tax-Exempt Governmental Bond Issues, Leases, and Installment Sales For all build America bonds and recovery zone economic development bonds use Form 8038-B, Information Return tor Build America Bonds and Recovery Zone Economic Development Bonds. For tax credit bonds and specified tax credit bonds use Form 8038-TC, Information Return for Tax Credit Bonds and Specified Tax Credit Bonds. When To File File Form 8038-G on or before the 15th day of the 2nd calendar month after the close of the calendar quarter in which the bond is issued. Form 8038-G may not be filed before the issue date and must be completed based on the facts as of the issue date. Late filing. An issuer may be granted an extension of time to file Form 8038-G under Section 3 of Rev. Proc. 2002-48, 2002-37 I.R.S. 531, if it is determined that the failure to file timely is not due to willful neglect. Type or print at the top of the form "Request for Relief under section 3 of Rev. Proc. 2002-48" and attach a letter explaining why Form 8038-G was not submitted to the IRS on time. Also indicate whether the bond issue in question is under examination by the IRS. Do not submit copies of the trust Sep 20,2011 indenture or other bond documents. See Where To File next Where To File File Form 8038-G, and any attachments, with the Department of the Treasury, Internal Revenue Service Center, Ogden, UT 84201. Private delivery services. You can use certain private delivery services designated by the IRS to meet the "timely mailing as timely tiling/paying" rule tor tax returns and payments. These private delivery services include only the following: • DHL Express (DHL): DHL Same Day Service. • Federal Express (FedEx}: FedEx Priority Overnight, Fed Ex Standard Overnight, FedEx 2Day, FedEx International Priority, and FedEx International First. • United Parcel Service (UPS}: UPS Next Day Air, UPS Next Day Air Saver, UPS 2nd Day Air, UPS 2nd Day Air A.M., UPS Worldwide Express Plus, and UPS Worldwide Express. The private delivery service can tell you how to get written proof of the mailing date. Other Forms That May Be Required For rebating arbitrage (or paying a penalty in lieu of arbitrage rebate} to the Federal government, use Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate. For private activity bonds, use Form 8038, Information Return tor Tax-Exempt Private Activity Bond Issues. For build America bonds (Direct Pay), build America bonds (Tax Credit}, and recovery zone economic development bonds, complete Form 8038-B, Information Return for Build America Bonds and Recovery Zone Economic Development Bonds. For qualified forestry conservation bonds, new clean renewable energy bonds, qualified energy conservation bonds, qualified zone academy bonds, qualified school construction bonds, clean renewable energy bonds, Midwestern tax credit bonds, and all other qualified tax credit bonds (except build America bonds}, file Form 8038-TC, Information Return for Tax Credit Bonds and Specified Tax Credit Bonds. Cat. No. 637740 Rounding to Whole Dollars You may show amounts on this return as whole dollars. To do so, drop amounts less than 50 cents and increase amounts from 50 cents through 99 cents to the next higher dollar. Questions on Filing Form 8038-G For specific questions on how to file Form 8038-G send an email to the IRS at TaxExemptBondQuestions @irs.gov and put "Form 8038-G Question" in the subject line. In the email include a description of your question, a return email address, the name of a contact person, and a telephone number. Definitions Tax-exempt obligation. This is any obligation, including a bond, installment purchase agreement, or financial lease, on which the interest is excluded from income under section 1 03. Tax-exempt governmental obligation. A tax-exempt obligation that is not a private activity bond (see below} is a tax-exempt governmental obligation. This includes a bond issued by a qualified volunteer fire department under section 150(e}. Private activity bond. This includes an obligation issued as part of an issue in which: • More than 1 0% of the proceeds are to be used for any private activity business use, and • More than 1 0% of the payment of principal or interest of the issue is either (a) secured by an interest in property to be used for a private business use (or payments for such property) or (b) to be derived from payments for property (or borrowed money} used for a private business use. It also includes a bond, the proceeds of which (a) are to be used directly or indirectly to make or finance loans (other than loans described in section 141 (c}(2)) to persons other than governmental units and (b) exceeds the lesser of 5% of the proceeds or $5 million. Issue price. The issue price of obligations is generally determined under Regulations section 1.148-1 (b). Thus, when issued for cash, the issue price is the first price at which a substantial amount of the obligations are sold to the public. To determine the issue price of an obligation issued for property, see sections 1273 and 127 4 and the related regulations. Issue. Generally, obligations are treated as part of the same issue if they are issued by the same issuer, on the same date, and in a single transaction, or a series of related transactions. However, obligations issued during the same calendar year (a) under a loan agreement under which amounts are to be advanced periodically (a "draw-down loan") or (b) with a term not exceeding 270 days, may be treated as part of the same issue if the obligations are equally and ratably secured under a single indenture or loan agreement and are issued under a common financing arrangement (for example, under the same official statement periodically updated to reflect changing factual circumstances). Also, for obligations issued under a draw-down loan that meet the requirements of the preceding sentence, obligations issued during different calendar years may be treated as part of the same issue if all of the amounts to be advanced under the draw-down loan are reasonably expected to be advanced within 3 years of the date of issue of the first obligation. Likewise, obligations (other than private activity bonds) issued under a single agreement that is in the form of a lease or installment sale may be treated as part of the same issue if all of the property covered by that agreement is reasonably expected to be delivered within 3 years of the date of issue of the first obligation. Arbitrage rebate. Generally, interest on a state or local bond is not tax-exempt unless the issuer of the bond rebates to the United States arbitrage profits earned from investing proceeds of the bond in higher yielding nonpurpose investments. See section 148(f). Construction issue. This is an issue of tax-exempt bonds that meets both of the following conditions: 1. At least 75% of the available construction proceeds are to be used for construction expenditures with respect to property to be owned by a governmental unit or a section 501 (c)(3) organization, and 2. All the bonds that are part of the issue are qualified 501 (c)(3) bonds, bonds that are not private activity bonds, or private activity bonds issued to finance property to be owned by a governmental unit or a section 501 (c)(3) organization. In lieu of rebating any arbitrage that may be owed to the United States, the issuer of a construction issue may make an irrevocable election to pay a penalty. The penalty is equal to 1112% of the amount of construction proceeds that do not meet certain spending requirements. See section 148(f)(4)(C) and the Instructions for Form 8038-T. Specific Instructions Part 1-Reporting Authority -Amended return. An issuer may file an amended return to change or add to the information reported on a previously filed return for the same date of issue. If you are filing to correct errors or change a previously filed return, check the Amended Return box in the heading of the form. The amended return must provide all the information reported on the original return, in addition to the new or corrected information. Attach an explanation of the reason for the amended return and write across the top, "Amended Return Explanation." Failure to attach an explanation may result in a delay in processing the form. Line 1. The issuer's name is the name of the entity issuing the obligations, not the name of the entity receiving the benefit of the financing. For a lease or installment sale, the issuer is the lessee or the purchaser. Line 2. An issuer that does not have an employer identification number (EIN) should apply for one on Form SS-4, Application for Employer Identification Number. You can get this form on the IRS website at IRS.gov or by calling 1-800-TAX-FORM (1·800-829-3676). You may receive an EIN by telephone by following the instructions for Form SS-4. Line 3a. If the issuer wishes to authorize a person other than an officer or other employee of the issuer (including a legal representative or paid preparer) to communicate with the IRS and whom the IRS may contact about this return (including in writing or by telephone), enter the name of such person here. The person listed in line 3a must be an individual. Do not enter the name and title of an officer or other employee of the issuer here (use line 1 Oa for that purpose). Note. By authorizing a person other than an authorized officer or other employee of the issuer to communicate with the IRS and whom the IRS may contact about this return, the issuer authorizes the IRS to communicate directly with the individual entered on line 3a and consents to disclose the issuer's return information to that individual, as necessary, to process this return. Lines 4 and 6. If you listed an individual on line 3a to communicate with the IRS and whom the IRS may contact about this return, enter the number and street (or P.O. box if mail is not delivered to street address), city, town, or post office, state, and ZIP code of that person. Otherwise, enter the issuer's number and street (or P.O. box if mail is not delivered to street address), city, town, or post office, state, and ZIP code. Note. The address entered on lines 4 and 6 is the address the IRS will use for all written communications regarding the processing of this return, including any notices. Line 5. This line is for IRS use only. Do not make any entries in this box. Line 7. The date of issue is generally the date on which the issuer physically -2- exchanges the bonds that are part of the issue for the underwriter's (or other purchaser's) funds. For a lease or installment sale, enter the date interest starts to accrue in a MM/DD/YYYY format. Line 8. If there is no name of the issue please provide other identification of the' issue. Line 9. Enter the CUSIP (Committee on Uniform Securities Identification Procedures) number of the bond with the latest maturity. If the issue does not have a CUSIP number, write "None." Line 1 Oa. Enter the name and title of the officer or other employee of the issuer whom the IRS may call for more information. If the issuer wishes to designate a person other than an officer or other employee of the issuer (including a legal representative or paid preparer) whom the IRS may call for more information about the return enter the name, title, and telephone n~mber of such person on lines 3a and 3b. Complete Jines 1 Oa and 1 Ob even if you complete fines 3a and 3b. Part II-Type of Issue Elections referred to in Part II are made on the original bond documents, not on this form. ldent~fy the type of obligations issued by entenng the corresponding issue price (see Issue price under Definitions earlier). Attach a schedule listing names and EINs of organizations that are to use proceeds of these obligations, if different from those of the issuer, include a brief summary of the use and indicate whether or not such user is a governmental or nongovernmental entity. Line 18. Enter a description of the issue in the space provided. Line 19. If the obligations are short-term tax anticipation notes or warrants (TANs) or short-term revenue anticipation notes or warrants (RANs), check box 19a. If the obligations are short-term bond anticipation notes (BANs), issued with the expectation that they will be refunded with the proceeds of long-term bonds at some future date, check box 19b. Do not check both boxes. Line 20. !?heck this box if property other than cash rs exchanged for the obligation, for example, acquiring a police car, a fire truck, or telephone equipment through a series of monthly payments. (This type of obligation is sometimes referred to as a "municipal lease.") Also check this box if real property is directly acquired in exchange for an obligation to make periodic payments of interest and principal. Do not check this box if the proceeds of the obligation are received in the form of cash, even if the term "lease" is used in the title of the issue. Part Ill-Description of Obligations Line 21. For column (a), the final maturity date is the last date the issuer must redeem the entire issue. For column (b), see Issue price under Definitions earlier. For column (c), the stated redemption price at maturity of the entire issue is the sum of the stated redemption prices at maturity of each bond issued as part of the issue. For a lease or installment sale, write "N/A" in column (c). For column (d), the weighted average maturity is the sum of the products of the issue price of each maturity and the number of years to maturity (determined separately for each maturity and by taking into account mandatory redemptions), divided by the issue price of the entire issue (from line 21, column (b)). For a lease or installment sale, enter instead the total number of years the lease or installment sale will be outstanding. For column (e), the yield, as defined in section 148(h), is the discount rate that, when used to compute the present value of all payments of principal and interest to be paid on the obligation, produces an amount equal to the purchase price, including accrued interest. See Regulations section 1 .148-4 for specific rules to compute the yield on an issue. If the issue is a variable rate issue, write "VR" as the yield of the issue. For other than variable rate issues, carry the yield out to four decimal places (for example, 5.3125%). If the issue is a lease or installment sale, enter the effective rate of interest being paid. Part IV-Uses of Proceeds of Bond Issue For a lease or installment sale, write "N/A" in the space to the right of the title for Part IV. Line 22. Enter the amount of proceeds that will be used to pay interest from the date the bonds are dated to the date of issue. Line 24. Enter the amount of the proceeds that will be used to pay bond issuance costs, including fees for trustees and bond counsel. If no bond proceeds will be used to pay bond issuance costs, enter zero. Do not leave this line blank. Line 25. Enter the amount of the proceeds that will be used to pay fees for credit enhancement that are taken into account in determining the yield on the issue for purposes of section 148(h) (for example, bond insurance premiums and certain fees for letters of credit). Line 26. Enter the amount of proceeds that will be allocated to such a fund. Line 27. Enter the amount of the proceeds that will be used to pay principal, interest, or call premium on any other issue of bonds within 90 days of the date of issue. Line 28. Enter the amount of the proceeds that will be used to pay principal, interest, or call premium on any other issue of bonds after 90 days of the date of issue, including proceeds that will be used to fund an escrow account for this purpose. Part V-Description of Refunded Bonds Complete this part only if the bonds are to be used to refund a prior issue of tax-exempt bonds. For a lease or installment sale, write "N/A" in the space to the right of the title for Part V. Lines 31 and 32. The remaining weighted average maturity is determined without regard to the refunding. The weighted average maturity is determined in the same manner as on line 21, column (d). Line 34. If more than a single issue of bonds will be refunded, enter the date of issue of each issue. Enter the date in an MM/DD/YYYY format. Part VI-Miscellaneous Line 35. An allocation of volume cap is required if the non qualified amount for the issue is more than $15 million but is not more than the amount that would cause the issue to be private activity bonds. Line 36. If any portion of the gross proceeds of the issue is or will be invested in a guaranteed investment contract (GIG), as defined in Regulations section 1.148-1 (b), enter the amount of the gross proceeds so invested, as well as the final maturity date of the GIG and the name of the provider of such contract. Line 37. Enter the amount of the proceeds of this issue used to make a loan to another governmental unit, the interest of which is tax-exempt. Line 38. If the issue is a loan of proceeds from another tax-exempt issue, check the box and enter the date of issue, EIN, and name of issuer of the master pool obligation. Line 40. Check this box if the issue is a construction issue and an irrevocable election to pay a penalty in lieu of arbitrage rebate has been made on or before the date the bonds were issued. The penalty is payable with a Form 8038-T for each 6-month period after the date the bonds are issued. Do not make any payment of penalty in lieu of arbitrage rebate with this form. See Rev. Proc. 92-22, 1992-1 G.B. 736 for rules regarding the "election document." Line 41a. Check this box if the issuer has identified a hedge on its books and records according to Regulations sections 1.148-4(h)(2)(viii) and 1.148-4(h)(5) that permit an issuer of tax-exempt bonds to identify a hedge for it to be included in yield calculations for computing arbitrage. Line 42. In determining if the issuer has super-integrated a hedge, apply the rules of Regulations section 1.148-4(h)(4). If the hedge is super-integrated, check the box. Line 43. If the issuer takes a "deliberate action" after the issue date that causes -3- the conditions Of the private business tests or the private loan financing test to be met, then such issue is also an issue of private activity bonds. Regulations section 1 .141 -2 ( d)(3) defines a deliberate action as any action taken by the issuer that is within it:> control regardless of whether there rs intent to violate such tests. Regulations section 1.141-12 ex~lains the conditions to taking remedial act1on that prevent an action that causes an issue to meet the private business te~ts or private loan financing test from be1ng treated as a deliberate action. Check the box if the issuer has established written procedures to ensure timely remedi~l action for all nonqualified bonds according to Regulations section 1.141-12 or other remedial actions authorized by the Commissioner under Regulations section 1.141-12(h). Line 44. Check the box if the issuer has established written procedures to monitor com~li~nce with the arbitrage, yield restnct1on, and rebate requirements of section 148. Line 45a. Check the box if some part of the proceeds was used to reimburse expenditures. Figure and then enter the amount of proceeds that are used to reimb~~se the issuer for amounts paid for a qualified purpose prior to the issuance of the bonds. See Regulations section 1.150-2. Li':'e 4~b. An issuer must adopt an off1c1almtent to reimburse itself for preissuance expenditures within 60 days after payment of the original expenditure unless excepted by Regulations section 1.150-2(f). Enter the date the official inte~t was adopted. See Regulations sectiOn 1.150-2( e) for more information about official intent. Signature and Consent An authorized representative of the issuer mus! sign Fo~.8038-G and any applicable ~ert1f1cation. Also print the name and t1t1e of the person signing Form 803~-G. Th~ a~thorized representative of the 1ssuer s1gnmg this form must have the authority to consent to the disclosure of the issuer's return information, as necessary to process this return, to the person(s) that have been designated in Form 8038-G. Note. If the issuer in Part 1 lines 3a and 3b authorizes the IRS to co~municate (i~cluding in writing and by telephone) With a person other than an officer or other employ~e of the issuer, by signing thiS form, the Issuer's authorized representative consents to the disclosure of the issuer's return information as necessary to process this return,' to such person. Paid Preparer If an authorized officer of the issuer filled in this return, the paid preparer's space should remain blank. Anyone who prepares the _return but does not charge the organization should not sign the return. Certain others who prepare the return should not sign. For example, a regular, full-time employee of the issuer, such as a clerk, secretary, etc., should not sign. Generally, anyone who is paid to prepare a return must sign it and fill in the other blanks in the Paid Preparer Use Only area of the return. The paid preparer must: • Sign the return in the space provided for the preparer's signature (a facsimile signature is acceptable), " Enter the preparer information, and " Give a copy of the return to the issuer. Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. You are required to give us the information. We need it to ensure that you are complying with these laws. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by section 6103. The time needed to complete and file this form varies depending on individual circumstances. The estimated average time is: -4- Learning about the law or the form ............ . Preparing, copying, assembling, and sending the form to the IRS ..... . 2 hr., 41 min. 3 hr., 3 min. If you have comments concerning the accuracy of these time estimates or suggestions for rnaking this form simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:M:S, 1111 Constitution Ave. NW, IR-6526, Washington, DC 20224. Do not send the form to this office. Instead, see Where To File. Form 8038-G Information Return for Tax-Exempt Governmental Obligations (Rev. September 2011) ~Under Internal Revenue Code section 149(e) OMB No. 1545·0720 Department of the Treasury ~ See separate instructions. Internal Revenue Service Caution: If the issue price is under $100,000, use Form 8038-GC. liiii:.F.Tiilllll Reporting Authority If Amended Return, check here ~ 0 1 !sst's nam~Jt-2 Issuer's employer identification number (EIN) I r-i""',A..~ Sic r--~1.~t:. Sa Name of person (other than issuer) w~h whom the IRS may communicate about this return (see instructions) DWI~ l-Jmne . .v.:Jf ((f\oJBJ~;~shown on 3a 4 -l\lumber and street (dr P.O. box if mail ;I; not delivered to street address) I Room/suite 5 Report number (For IRS Use Only) .ro PJo>< 7&:o '31 I 6 iJff!w~,; t ~ice, s~d Zl21e~ 7 Date of issue $S Nameofi~ .A .l La~ H...t""'1"C')<:c.. ~re"~>'V!e-.'\J 9 CUSIP number 60t0/'v1""' ~ CXeh'l~t NON& 10a Name and title of officer or other employee of the issuer whom the IRS may call for more ~mation (see 10b Telephone number of officer or other instructions) employee shown on 1Da Ill ::.P.Ii illllll Type of Issue {enter the issue price). See the instructions and attach schedule. 11 Education. 11 12 Health and hospital 12 13 Transportation 13 14 Public safety . 14 15 Environment (including sewage bonds) 15 16 Housing 16 17 Utilities . . . . . . . . . • • • • • • • o-+ ~ • • 17 18 Other. Describe ~ !f:rtwl U~ EMS Co\1\~0 V\ \Jo..YI 18 8.3::> IG:>c 00 19 If obligations are TANs or RANs, check only box 19a ~ D -.. If obligations are BANs, check only box 19b ~ D 20 If obligations are in the form of a lease or installment sale, check box ~ D -·· I::.F.Tiiill Ill Description of Obligations. Complete for the entire issue for which this form is being filed. (a) Final maturity date (b)lssue price (c) Stated redemption (d) Weighted (e) Yield price at maturity average maturity 21 ~o1S $ S30 IW $ CC'.30LG::o A .'1 :1.-vears 1.10 % II ::F.Tii Ill ••• Uses of Proceeds of Bond Issue (including underwriters' discount) 22 Proceeds used for accrued interest 22 23 Issue price of entire issue (enter amount from line 21, column (b)) 23 ~~I '=a OC) 24 Proceeds used for bond issuance costs (including underwriters' discount) . 24 ·•. 25 Proceeds used for credit enhancement 25 26 Proceeds allocated to reasonably required reserve or replacement fund 26 27 Proceeds used to currently refund prior issues 27 28 Proceeds used to advance refund prior issues 28 29 Total (add lines 24 through 28) . 29 83::JtW oo 30 Nonrefunding proceeds of the issue (subtract line 29 from line 23 and enter amount here) 30 ll!:.mill'AII Description of Refunded Bonds. Complete this part only for refunding bonds. .. 31 Enter the remam1ng weighted average matunty of the bonds to be currently refunded . ~ years 32 Enter the remaining weighted average maturity of the bonds to be advance refunded ~ years 33 Enter the last date on which the refunded bonds will be called (MM/DDIYYYY) ~ 34 Enter the date(s) the refunded bonds were issued ~ (MM/DDIYYYY) For Paperwork Reduction Act Notice, see separate instructions. cat. No. 63773S Form 8038-G (Rev. 9-2011) Form 8038-G (Rev. 9-2011) Page2 I :F.Iii !l'JI Miscellaneous 35 Enter the amount of the state volume cap allocated to the issue under section 141 (b)(5) 35 36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract (GIC) (see instructions) 36a b Enter the final maturity date of the GIC Ill> c Enter the name of the GIC provider Ill> .·· 37 Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans .·.• .. to other governmental units 37 38a If th1s 1ssue IS a loan made from the proceeds of another tax-exempt 1ssue, check box Ill> and enter the follow1ng information: b Enter the date of the master pool obligation Ill> --------------------- c Enter the EIN of the issuer of the master pool obligation Ill> ----------------- d Enter the name of the issuer of the master pool obligation Ill> -------------:----:---- 39 If the issuer has designated the issue under section 265(b)(3)(B)(i}(lll) (small issuer exception), check box ..,_ 0 40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box . .,. 41a If the issuer has identified a hedge, check here Jlo-0 and enter the following information: b Name of hedge provider Jlo- c Type of hedge J1o------------------- d Term of hedge J1o------------------- 42 If the issuer has superintegrated the hedge, check box Jlo-O 43 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated according to the requirements under the Code and Regulations (see instructions), check box . Jlo-0 44 If the issuer has established written procedures to monitor the requirements of section 148, check box . J1o-0 45a If some portion of the proceeds was used to reimburse expenditures, check here.,. ~ and enter the amount of reimbursement . . .,_ _J-t-=41-1-l-Ju.O,!...,..J. o~D:_ ___________ _ b Enter the date the official intent was adopted Ill> Signature and Consent Paid Preparer Use Only Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. I further declare that I consent to the IRS's disclosure of the issuer's return information, as necessary to process this return, to the person that I have authorized above. Date Firm's name "" Firm's address "" Form 8038-G (Rev. 9-2011) VEHICLE TITLING ADDENDUM Master Tax-Exempt Lease/Purchase Agreement dated September 3, 2013 and related Property Schedule No.2 dated October 15, 2013, between County of Harnett as Lessee and U.S. Bancorp Government Leasing and Finance, Inc. as Lessor. 1. Lessor and Lessee hereby agree to amend the above referenced Agreement to add additional terms and conditions as set forth below: Lessee agrees that it will provide to Lessor the original title documentation to the Equipment. Lessee shall provide such title documentation to Lessor within 15 days of Lessee's receipt of such title documentation from the appropriate titling authority. Lessee's failure to provide Lessor with title documentation to the Equipment in a timely fashion shall be deemed a condition of Default as defined in the default paragraph herein subject to remedies available to Lessor pursuant to the remedies paragraph. Lessee further agrees to pay a month to month unobtained titling fee if Lessor has not received the correct transferred title in Lessor's office. 2. Location: Lessor agrees that in regard to the location of the equipment, Lessee must be responsible for maintaining records showing the location of each piece of Leased equipment. Lessee will report this location to Lessor upon written request by Lessor. Failure to do so shall constitute a breach of the Agreement, which default shall be governed by the terms and conditions specified in the default and/or remedies paragraph of the Agreement. 3. Lessee will complete the physical titling of the vehicle as required by the state of Lessee's residence and guarantee U.S. Bancorp Government Leasing and Finance, Inc. that U.S. Bancorp Government Leasing and Finance, Inc. will receive the original title to the leased vehicle in a timely manner. Lessee agrees to indemnify U.S. Bancorp Government Leasing and Finance, Inc. from any damage or loss it incurs, including legal fees, due to its failure to complete its agreement herein. THE APPLICATION FOR TITLE MUST INCLUDE THE FOLLOWING AS 1sT LIEN HOLDER: U.S. BANCORP GOVERNMENT LEASING AND FINANCE, INC. 1310 MADRID STREET MARSHALL, MN 56258 By signing this Addendum, Lessee acknowledges the above changes to the Agreement and authorizes Lessor to make such changes. In all other respects the terms and conditions of the Agreement remain in full force and effect. Lessor: u.s. Ban corp Government Leasing Lessee: County of Harnett and Finance, Inc. By: Name: Title: Date: Date: ESCROW AGREEMENT THIS ESCROW AGREEMENT ("Escrow Agreement'} is made as of October 15, 2013 by and among U.S. Bancorp Government Leasing and Finance, inc. ("Lessor'), County of Harnett ("Lessee") and U.S. BANK NATIONAL ASSOCIATION, as escrow agent ("Escrow Agent"). Lessor and Lessee have heretofore entered into that certain Master Tax-Exempt Lease/Purchase Agreement dated as of September 3, 2013 (the "Master Agreement') and a Property Schedule No. 2 thereto dated October 15, 2013 (the "Schedule" and, together with the terms and conditions of the Agreement incorporated therein, the "Agreement'). The Schedule contemplates that certain personal property described therein (the "Equipment') is to be acquired from the vendor(s) or manufacturer(s) thereof (the "Vendor''). After acceptance of the Equipment by Lessee, the Equipment is to be financed by Lessor to Lessee pursuant to the terms of the Agreement. The Master Agreement further contemplates that Lessor will deposit an amount equal to the anticipated aggregate acquisition cost of the Equipment (the "Purchase Price'), being $830,160.00, with Escrow Agent to be held in escrow and applied on the express terms set forth herein. Such deposit, together with all interest and other additions received with respect thereto (hereinafter the "Escrow Fund'') is to be applied to pay the Vendor its invoice cost (a portion of which may, if required, be paid prior to final acceptance of the Equipment by Lessee); and, if applicable, to reimburs~ Lessee for progress payments already made by it to the Vendor of the Equipment. The parties desire to set forth the terms on which the Escrow Fund is to be created and to establish the rights and responsibilities of the parties hereto. Now, THEREFORE, in consideration of the sum of Ten Dollars ($10.00) in hand paid, and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows: 1. Escrow Agent hereby agrees to serve as escrow agent upon the terms and conditions set forth herein. The moneys and investments held in the Escrow Fund are irrevocably held in trust for the benefit of Lessee and Lessor, and such moneys, together with any income or interest earned thereon, shall be expended only as provided in this Escrow Agreement, and shall not be subject to levy or attachment or lien by or for the benefit of any creditor of either Lessee or Lessor. Lessor, Lessee and Escrow Agent intend that the Escrow Fund constitute an escrow account in which Lessee has no legal or equitable right, title or interest until satisfaction in full of all conditions contained herein for the disbursement of funds by the Escrow Agent therefrom. However, if the parties' intention that Lessee shall have no legal or equitable right, title or interest until all conditions for disbursement are satisfied in full is not respected in any legal proceeding, the parties hereto intend that Lessor have a security interest in the Escrow Fund, and such security interest is hereby granted by Lessee to secure payment of all sums due to Lessor under the Master Agreement. For such purpose, Escrow Agent hereby agrees to act as agent for Lessor in connection with the perfection of such security interest and agrees to note, or cause to be noted, on all books and records relating to the Escrow Fund, the Lessor's interest therein. 2. On such day as is determined to the mutual satisfaction of the parties (the "Closing Date''), Lessor shall deposit with Escrow Agent cash in the amount of the Purchase Price, to be held in escrow by Escrow Agent on the express terms and conditions set forth herein. On the Closing Date, Escrow Agent agrees to accept the deposit of the Purchase Price by Lessor, and further agrees to hold the amount so deposited together with all interest and other additions received with respect thereto, as the Escrow Fund hereunder, in escrow on the express terms and conditions set forth herein. 3. Escrow Agent shall at all times segregate the Escrow Fund into an account maintained for that express purpose, which shall be clearly identified on the books and records of Escrow Agent as being held in its capacity as Escrow Agent. Securities and other negotiable instruments comprising the Escrow Fund from time to time shall be held or registered in the name of Escrow Agent (or its nominee). The Escrow Fund shall not, to the extent permitted by applicable law, be subject to levy or attachment or lien by or for the benefit of any creditor of any of the parties hereto (except with respect to the security interest therein held by Lessor). 4. The cash comprising the Escrow Fund from time to time shall be invested and reinvested by Escrow Agent in one or more investments as directed by Lessee. Absent written direction from Lessee, the cash will be invested in the U.S. Bank National Association Money Market Deposit Fund. See Exhibit 1 Investment Direction Letter. Lessee represents and warrants to Escrow Agent and Lessor that the investments selected by Lessee for investment of the Escrow Fund are permitted investments for Lessee under all applicable laws. Escrow Agent will use due diligence to collect amounts payable under a check or other instrument for the payment of money comprising the Escrow Fund and shall promptly notify Lessee and Lessor in the event of dishonor of payment under any such check or other instruments. Interest or other amounts earned and received by Escrow Agent with respect to the Escrow Fund shall be deposited in and comprise a part of the Escrow Fund. Escrow Agent shall maintain accounting records sufficient to permit calculation of the income on investments and interest earned on deposit of amounts held in the Escrow Fund. The parties acknowledge that to the extent regulations of the Comptroller of Currency or other applicable regulatory entity grant a right to receive brokerage confirmations of security transactions of the escrow, the parties waive receipt of such confirmations, to the extent permitted by law. The Escrow Agent shall furnish a statement of security transactions on its regular monthly reports. Attached as Exhibit 6 is the Class Action Negative Consent Letter to be reviewed by Lessee. 5. Upon request by Lessee and Lessor, Escrow Agent shall send monthly statements of account to Lessee and Lessor, which statements shall set forth all withdrawals from and interest earnings on the Escrow Fund as well as the investments in which the Escrow Fund is invested. 6. Escrow Agent shall take the following actions with respect to the Escrow Fund: (a) Upon Escrow Agent's acceptance of the deposit of the Purchase Price, an amount equal to Escrow Agent's set-up fee, as set forth on Exhibit 2 hereto, shall be disbursed from the Escrow Fund to Escrow Agent in payment of such fee. (b) Escrow Agent shall pay costs of the Equipment upon receipt of a duly executed Requisition Request (substantially in the format of Exhibit 3) signed by Lessor and Lessee. Lessor's authorized signatures are provided in Exhibit 5. Lessee's authorized signatures will be provided in Exhibit 3 of Master Lease Purchase Agreement. Escrow Agent will use best efforts to process requests for payment within one (1) business day of receipt of requisitions received prior to 2:00 p.m. Central Time. The final Requisition shall be accompanied by a duly executed Acceptance Certificate form attached as Exhibit 4 hereto. (c) Upon receipt by Escrow Agent of written notice from Lessor that an Event of Default or an Event of Nonappropriation (if provided for under the Master Agreement) has occurred under the Agreement, all funds then on deposit in the Escrow Fund shall be paid to Lessor for application in accordance with the Master Agreement, and this Escrow Agreement shall terminate. (d) Upon receipt by Escrow Agent of written notice from Lessor that the purchase price of the Equipment has been paid in full, Escrow Agent shall pay the funds then on deposit in the Escrow Fund to Lessor to be applied first to the next Lease Payment due under the Master Agreement, and second, to prepayment of the principal component of Lease Payments in inverse order of maturity without premium. To the extent the Agreement is not subject to prepayment, Lessor consents to such prepayment to the extent of such prepayment amount from the Escrow Fund. Upon disbursement of all amounts in the Escrow Fund, this Escrow Agreement shall terminate. (e) This Escrow Agreement shall terminate eighteen (18) months from the date of this Escrow Agreement. It may, however, be extended by mutual consent of Lessee and Lessor in writing to Escrow Agent. All funds on deposit in the Escrow Fund at the time of termination under this paragraph, unless otherwise directed by Lessee in writing (electronic means acceptable), shall be transferred to Lessor. 7. The fees and expenses, including any legal fees, of Escrow Agent incurred in connection herewith shall be the responsibility of Lessee. The basic fees and expenses of Escrow Agent shall be as set forth on Exhibit 2 and Escrow Agent is hereby authorized to deduct such fees and expenses from the Escrow Fund as and when the same are incurred without any further authorization from Lessee or Lessor. Escrow Agent may employ legal counsel and other experts as it deems necessary for advice in connection with its obligations hereunder. Escrow Agent waives any claim against Lessor with respect to compensation hereunder. 8. Escrow Agent shall have no liability for acting upon any written instruction presented by Lessor in connection with this Escrow Agreement, which Escrow Agent in good faith believes to be genuine. Furthermore, Escrow Agent shall not be liable for any act or omission in connection with this Escrow Agreement except for its own negligence, willful misconduct or bad faith. Escrow Agent shall not be liable for any loss or diminution in value of the Escrow Fund as a result of the investments made by Escrow Agent. 9. Escrow Agent may resign at any time by giving thirty (30) days' prior written notice to Lessor and Lessee. Lessor may at any time remove Escrow Agent as Escrow Agent under this Escrow Agreement upon written notice. Such removal or resignation shall be effective on the date set forth in the applicable notice. Upon the effective date of resignation or removal, Escrow Agent will transfer the Escrow Fund to the successor Escrow Agent selected by Lessor. 1 0. Lessee hereby represents, covenants and warrants that pursuant to Treasury Regulations Section 1.148-?(d), the gross proceeds of the Agreement will be expended for the governmental purposes for which the Agreement was entered into, as follows: at least 15% within six months after the Commencement Date, such date being the date of deposit of funds into the Escrow Fund, at least 60% within 12 months after the Commencement Date, and 100% within 18 months after the Commencement Date. If Lessee is unable to comply with Section 1.148-?(d) of the Treasury Regulations, Lessee shall, at its sole expense and cost, compute rebatable arbitrage on the Agreement and pay rebatable arbitrage to the United States at least once every five years, and within 60 days after payment of the final rental or Lease Payment due under the Agreement. 11. In the event of any disagreement between the undersigned or any of them, and/or any other person, resulting in adverse claims and demands being made in connection with or for any moneys involved herein or affected hereby, Escrow Agent shall be entitled at its option to refuse to comply with any such claim or demand, so long as such disagreement shall continue, and in so refusing Escrow Agent may refrain from making any delivery or other disposition of any moneys involved herein or affected hereby and in so doing Escrow Agent shall not be or become liable to the undersigned or any of them or to any person or party for its failure or refusal to comply with such conflicting or adverse demands, and Escrow Agent shall be entitled to continue so to refrain and refuse so to act until: (a) the rights of the adverse claimants have been finally adjudicated in a court assuming and having jurisdiction of the parties and the moneys involved herein or affected hereby; or (b) all differences shall have been adjusted by Master Agreement and Escrow Agent shall have been notified thereof in writing signed by all of the persons interested. 12. All notices (excluding billings and communications in the ordinary course of business) hereunder shall be in writing, and shall be sufficiently given and served upon the other party if delivered (a) personally, (b) by United States registered or certified mail, return receipt requested, postage prepaid, (c) by an overnight delivery by a service such as Federal Express or Express Mail from which written confirmation of overnight delivery is available, or (d) by facsimile with a confirmation copy by regular United States mail, postage prepaid, addressed to the other party at its respective address stated below the signature of such party or at such other address as such party shall from time to time designate in writing to the other party, and shall be effective from the date of mailing. 13. This Escrow Agreement shall inure to the benefit of and shall be binding upon the parties hereto and their respective successors and assigns. No rights or obligations of Escrow Agent under this Escrow Agreement may be assigned without the prior written consent of Lessor. 14. This Escrow Agreement shall be governed by and construed in accordance with the laws in the state of the Escrow Agent's location. This Escrow Agreement constitutes the entire Agreement between the parties hereto with respect to the subject matter hereof, and no waiver, consent, modification or change of terms hereof shall bind any party unless in writing signed by all parties. 15. This Escrow Agreement and any written direction may be executed in two or more counterparts, which when so executed shall constitute one and the same agreement or direction. IN WiTNESS WHEREOF, the parties hereto have caused this Escrow Agreement to be duly executed as of the day and year first above set forth. U.S. Bancorp Government Leasing and Finance, Inc., as Lessor By: Name: Title: Address: 13010 SW 68" Parkway, Suite 100 Portland, OR 97223 Count of Harnett, as Lessee U.S. BANK NATIONAL ASSOCIATION, as Escrow Agent By: Name: Title: Address: U.S. Bank National Association 5540 Center View Dr., Ste 200 RaleiQh, NC 27606-3386 EXHIBIT 1 TO ESCROW AGREEMENT INVESTMENT DISCLOSURE AND AUTHORIZATION LETTER U.S. Bancorp and U.S. Bank TRADE SERVICES Proprietary and Non-Proprietary Products U.S. Bancorp offers investment trading services to Corporate Trust customers ("Accounts") through its fixed income trading unit (U.S. Bank, NA) or an affiliated broker dealer (collectively the "Money Center"). Such trades may include: fixed income U.S. Government securities; U.S. Government Agency securities; negotiable or non-negotiable certificates of deposit; unsecured commercial paper; bank notes; medium term notes; municipal bonds; corporate bonds; and variable rate demand notes where U.S. Bancorp, its affiliates or an associated party is the issuer or product provider, e.g., U.S. Bank Notes and U.S. Bancorp Medium Term Notes (collectively "Proprietary Assets"). Descriptions of Proprietary Assets are set forth in Exhibit A attached hereto. Additional specific information on assets available through the Money Center, including credit ratings, may be obtained upon request to your Account Manager. Corporate Trust Services Customers using the Money Center receive competitive market pricing on directed asset transactions as follows: Non-Proprietary Assets. Purchasers are charged a spread or "mark" which is the difference between the Money Center's purchase price for the asset and the sale price to an Account. The mark on non-proprietary assets is typically less than .50% of the securities' par value, and in no case will it exceed 2% of the securities' par value, calculated on an annualized basis. Proprietary Assets. US Bank receives a financial benefit from the sale of Proprietary Assets. The yield for Proprietary Assets is set as a spread below U.S. Bank's wholesale funding cost, i.e., the cost of raising funds from other, non-retail sources. Generally, the resulting financial benefit to U.S. Bank will be equivalent to .25% to . 75% of the product's par value calculated on an annualized basis. By signing this form and providing investment directions to U.S. Bank, you acknowledge that you have reviewed investment alternatives and you approve asset purchases using the Money Center, including purchases of Proprietary Assets, and U.S. Bank's or an affiliate's receipt of compensation (as described above) resulting from such directed trades. Unless specifically waived by written agreement, you will receive written confirmation notices of all Money Center Account trades from U.S. Bank. You will be provided prior written notice of any changes in the Money Center pricing structure described above. As a directing Account party you control the initiation and terms of investments selected for your Account. At any time, you may direct that the purchase of an asset be executed through an independent broker. Further, you may revoke this Investment Disclosure and Authorization Letter at any time upon written notice to U.S. Bank. If you desire to engage U.S. Bank to provide trading services to your Account, including the purchase of Proprietary Assets for your Account, and you approve of U.S. Bank's or its affiliates' compensation in connection with such transactions, all as described herein, please sign below and return this Letter. Authorization will continue to be required directing U.S. Bank to buy or sell securities as required by the Account's governing documents. In the absence of specific written direction to the contrary regarding any future directed investments for your Account, U.S. Bank will utilize the Money Center for placing and executing directed investments for your Account. ACKNOWLEDGED AND APPROVED: County of Harnett Company Name Trust Account Number-includes existing and future sub-accounts unless otherwise designated. Signature of Authorized Directing Party Title\~~+, I. om .. f d l en\'YJ ~'J o.zrnce-U/l Date EXHIBIT A U.S. BANK PROPRIETARY PRODUCTS Certificates of Deposit. Certificates of deposit may be negotiable or non-negotiable, i.e., required to be held by the account until their deposit maturity date. Certificates evidence the general deposit liability of U.S. Bank to hold for a fixed period the funds deposited with it for, and pay interest to, the deposit owner at a rate as in effect for the deposit period on the date the certificate of deposit is issued. Interest rates paid on such certificates of deposit are set at the time they are issued at levels equal to current rates for comparable deposits established by U.S. Bank from time to time. Certificates of deposit are FDIC insured per depositor, as determined under FDIC regulations, up to applicable FDIC limits. Eurodollar Deposits. Eurodollar deposits evidence the general liability of U.S. Bank to hold for a fixed period the funds deposited with it for, and pay interest to, the deposit owner at a rate as in effect for the deposit period on the date the certificate of deposit is made. Such deposits are established and maintained at the Cayman Island foreign branch of U.S. Bank. Interest rates paid on such Eurodollar deposits are set at the time they are issued at levels equal to current rates for comparable deposits established by U.S. Bank from time to time. As deposits maintained outside the United States, the Eurodollar deposits could be subject to law changes or other actions by the government of the country where the deposits are maintained. Eurodollar deposits are not FDIC insured or guaranteed by any governmental agency or authority, or by U.S. Bank. Repurchase Agreements. Repurchase agreements are contracts with U.S. Bank for the purchase of U.S. government or other debt securities at a specified price and U.S. Bank's obligation to repurchase those securities back at a higher price after a specified period, or at the demand of the investing party. The differences in the purchase and repurchase price provides earnings to the trust account and both prices are established at market competitive levels at the commencement of the transaction at the earning rate for non-collateralized U.S. Bank obligations less the collateral value costs based on market levels for the type and amount of collateraL The repurchase price paid on such repurchase agreements are set at the time they are issued at levels equal to current rates for comparable repurchase agreements established by U.S. Bank from time to time. The repurchase agreements are not FDIC insured or guaranteed by any governmental agency or authority, or by U.S. Bank. Bankers' Acceptances. Bankers' Acceptances are a method of financing that a bank may provide to its customers to support the import, export or domestic shipment of goods or to finance the storage of properly titled goods. A bankers' acceptance is often issued in conjunction with a Letter of Credit. A U.S. Bank bankers' acceptance is purchased at a discount to its face value and redeemed on the maturity date at the face value. The bankers' acceptances are not FDIC insured or guaranteed by any governmental agency or authority. U.S. Bank or U.S. Bancorp Term or Daily Liquid Commercial Paper. Interest rates paid on fixed-income unsecured term commercial paper securities issued by U.S. Bank, or its parent corporation, U.S. Bancorp, are set at the time they are issued at levels comparable to current rates for commercial paper securities of similar terms, security and market demand as indicated by Bloomberg on-line quotations of such rates. Interest rates paid on the daily liquid (open-ended) unsecured commercial paper issued by U.S. Bank is calculated on the daily balance method (actual/360), accrued daily and paid monthly. Daily liquid commercial paper interest rates are determined at U.S. Bank's discretion as a daily variable rate priced based on nationally recognized indexes including the Target Fed Funds (TFF) index less a funding spread or 1 month LIBOR less a funding spread. Reset and payment date of LIBOR priced products will be the first of each month. Commercial paper securities are not FDIC insured or guaranteed by any governmental agency or authority, or by U.S. Bank. If you determine to discontinue investment of your trust account funds in an investment described above, you can direct U.S. Bank as account trustee to sell such investment and purchase different securities. U.S. Bank does not have a duty nor will it undertake any duty to provide investment advice to you. Investment advice, if needed, should be obtained from your financial advisor. 1 1 Revised 2/15111 U.S. BANK NATIONAL ASSOCIATION DAILY LIQUID COMMERCIAL PAPER AUTHORIZATION FORM The daily liquid (open-ended) U.S. Bank commercial paper investment is an unsecured promissory note issued by U.S. Bank National Association which meets the liquidity needs of U.S. Bank's Corporate Trust Services customers. U.S. Bank uses the daily balance method to calculate interest on this product (actual/360). Interest is accrued daily and credited monthly to the trust account. The owner of the accounts is U.S. Bank as agent for its trust customers. Interest rates are determined at U.S. Bank's discretion as a daily variable rate priced based on nationally recognized indexes including the Target Fed Funds (TFF) index less a funding spread or 1 month LIBOR less a funding spread. Reset and payment date of LIB OR priced products will be the first of each month. U.S. Bank daily liquid (open-ended) commercial paper is not FDIC insured or guaranteed by any government agency or authority, or by U.S. Bank. US Bank does not have a duty nor will it undertake any duty to provide investment advice to you. Investment advice, if needed, should be obtained from your financial advisor. For current interest rate information, please contact your account manager. AUTOMATIC AUTHORIZATION Based upon your prior review of investment alternatives, in the absence of specific written direction to the contrary, U.S. Bank is hereby directed to invest and reinvest proceeds and other available moneys on your behalf in a U.S. Bank Open-Ended Commercial Paper. The U.S. Bank Commercial Paper is a permitted investment under the operative documents and this authorization is the permanent direction for investment of the moneys until notified in writing of alternate instructions. The Account Number listed is intended to include any and all existing and future sub-accounts, unless specific written instructions are given excluding such accounts. COUNTY OF HARNETT Company Name Trust Account Number-includes existing and future sub-accounts unless otherwise designated. Revised effective 9/15/10 Signature of Authorized Directing Party Title \J!\kri rY\ E\'VlN\(L D£Dai CTS01010A CTS04460 EXHIBIT 2 Schedule of Fees for Services as Escrow Agent For County of Harnett Equipment Lease Purchase Escrow Acceptance Fee The acceptance fee includes the administrative review of WAIVED documents, initial set-up of the account, and other reasonably required services up to and including the closing. This is a one-time, non-refundable fee, payable at closing. Escrow Agent Annual fee for the standard escrow agent services $500.00 associated with the administration of the account. Administration fees are payable in advance. Direct Out of Pocket Expenses Reimbursement of expenses associated with the performance of our duties, including but not limited to publications, legal counsel after the initial close, travel expenses and filing fees. Extraordinary Services Extraordinary Services are duties or responsibilities of an unusual nature, including termination, but not provided for in the governing documents or otherwise set forth in this schedule. A reasonable charge will be assessed based on the nature of the services and the responsibility involved. At our option, these charges will be billed at a flat fee or at our hourly rate then in effect. At Cost Account approval is subject to review and qualification. Fees are subject to change at our discretion and upon written notice. Fees paid in advance will not be prorated. The fees set forth above and any subsequent modifications thereof are part of your agreement. Finalization of the transaction constitutes agreement to the above fee schedule, including agreement to any subsequent changes upon proper written notice. In the event your transaction is not finalized, any related out-of-pocket expenses will be billed to you directly. Absent your written instructions to sweep or otherwise invest, all sums in your account will remain uninvested and no accrued interest or other compensation will be credited to the account Payment of fees constitutes acceptance of the terms and conditions set forth. IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. For a non-individual person such as a business entity, a charity, a Trust or other legal entity we will ask for documentation to verify its formation and existence as a legal entity. We may also ask to see financial statements, licenses, identification and authorization documents from individuals claiming authority to represent the entity or other relevant documentation. EXHIBIT 3 REQUISITION REQUEST The Escrow Agent is hereby requested to pay from the Escrow Fund established and maintained under that certain Escrow Agreement dated as of October 15, 2013 (the "Escrow Agreement") by and among U.S. Bancorp Government Leasing and Finance, Inc. (the "Lessor'), County of Harnett (the "Lessee"), and U.S. Bank National Association (the "Escrow Agent"), the amount set forth below to the named payee(s). The amount shown is due and payable under a purchase order or contract (or has been paid by and not previously reimbursed to Lessee) with respect to equipment being financed under that certain Master Tax-Exempt Lease Purchase Agreement dated as of September 3, 2013 (the "Master Agreement") and Property Schedule No. 2 thereto dated October 15, 2013 (the "Schedule" and, together with the terms and conditions of the Master Agreement incorporated therein, the "Master Agreement}, by and between the Lessor and the Lessee, and has not formed the basis of any prior requisition request. PAYEE AMOUNT INVOICE NO. EQUIPMENT Total requisition amount T------- The undersigned, as Lessee under the Master Agreement, hereby certifies: 1. The items of the Equipment being acquired with the proceeds of this disbursement have been delivered and installed at the location(s) contemplated by the Master Agreement. The Lessee has conducted such inspection and/or testing of the Equipment being acquired with the proceeds of this disbursement as it deems necessary and appropriate, and such Equipment has been accepted by Lessee. 2. The costs of the Equipment to be paid from the proceeds of this disbursement have been properly incurred, are a proper charge against the Escrow Fund and have not been the basis of any previous disbursement. 3. No part of the disbursement requested hereby will be used to pay for materials not yet incorporated into the Equipment or for services not yet performed in connection therewith. 4. The Equipment is covered by insurance in the types and amounts required by the Agreement. 5. No Event of Default or Event of Nonappropriation (if applicable), as each such term is defined in the Master Agreement, and no event which with the giving of notice or lapse of time, or both, would become such an Event of Default or Event of Nonappropriation has occurred and is continuing on the date hereof. 6. If Lessee paid an invoice prior to the commencement date of the Master Agreement, and is requesting reimbursement for such payment, Lessee has satisfied the requirements for reimbursement set forth in Treas. Reg. §1.150-2. Request Date: Lessor: U.S. Bancorp Government Leasing and Finance, Inc. By: Name: Title: Lessee: County of Harnett Exhibit 4 Acceptance Certificate U.S. Bancorp Government Leasing and Finance, Inc. 13010 SW 68th Parkway, Suite 100 Portland, OR 97223 Re: Property Schedule No. 2 to Master Tax-Exempt Lease/Purchase Agreement between U.S. Bancorp Government Leasing and Finance, Inc. and County of Harnett Ladies and Gentlemen: In accordance with the above-referenced Master Tax-Exempt Lease/Purchase Agreement (the "Master Agreement"), the undersigned ("Lessee") hereby certifies and represents to, and agrees with, U.S. Bancorp Government Leasing and Finance, Inc. ("Lessor"), as follows: (1) The Property, as such terms are defined in the above-referenced Property Schedule, has been acquired, made, delivered, installed and accepted on the date indicated below. (2) Lessee has conducted such inspection and/or testing of the Property as it deems necessary and appropriate and hereby acknowledges that it accepts the Property for all purposes. (3) No event or condition that constitutes, or with notice or lapse of time, or both, would constitute, an Event of Default or a Nonappropriation Event (as such terms are defined in the Master Agreement) exists at the date hereof. Acceptance Date: -------------- Lessee: County of Harnett B Name: Title: Octobe :15, 2013 County of rnett P.O. Box 76 Lillington, NC 546 Exhibit 6 Class Action Negative Consent Letter RE: USBGLF/Co nty of Harnett--Class Action Litigation Claims U.S. Bank National As ciation ("U.S. Bank") has established its policies and procedures relative to class action litigation claims filed on I) half of its clients' accounts. This policy may impact future claims filed by U.S. Bank on behalf of the above-referen d account. Listed below are the policies regarding class action litigation claims: 1. U.S. Bank will file ass action litigation claims, at no charge, on behalf of open, eligible agency or custody accounts upon rece t of proper documented authorization. This notice, with your ability to opt out as further described bela , constitutes such documented authorization. 2. U.S. Bank will not file cl ims for agency or custody accounts that were open during the class action period but were closed prior to r eipt of any notice of the class action litigation. 3. Assuming requisite inform tion is provided by the payor to identify the applicable account, settlement proceeds of the class actio litigation will be posted within a reasonable time following receipt of such proceeds to the entitled acco nts that are open at such time. If entitled accounts are closed prior to distribution and receipt of settle ent proceeds, they will be remitted to entitled beneficiaries or successors of the account net of any resea h and filing fees. Proceeds, less any research and filing fees, will be escheated if the entitled beneficiari s successors of the account cannot be identified /located. If you wish U.S. Bank to continue to file class a litigation proofs of claim on behalf of your account, you do not need to take any further action. However, if you d o wish U.S. Bank to file class action proofs of claim on behalf of your account, you may notify us of this election by turning this letter with your signature and date provided below within 30 days or by filing a separate authorization lette with your Account Manager by the same date. The authorization and understanding contained in this c mmunication constitutes an amendment of any applicable provisions of the account document for the above-reference account. If you have any questions, please contact me at the below num er. Sincerely, Shawna Hale Vice President 919-424-3944 0 No, U.S. Bank is not authorized to file class action litigation proofs of clai on behalf of the above-referenced account(s). By making this election, I acknowledge that U.S. Bank is not respo ible for forwarding notices received on class action or litigation claims. Authorized Signer Date Form -9 (Rev. December 2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. cJ (!) ~r-----------------------------------------------------------------------------r----------~ Check appropriate box for federal tax classification: 0 0 Individual/sole proprietor C Corporation 0 S Corporation 0 Partnership 0 Trust/estate Exempt payee 0 limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)"" --------------------------------1 Requester's name and Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. l Employer identification number j ~ -leolololo!31o~! l@ilil Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that 1 am no longer subject to backup withholding, and 3. 1 am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Signature of Here u.s. person.,.. Date "" General Instructions Section references are to the Internal Revenue Co noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301. 7701-7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 12-2011) Form W-9 (Rev. 12-2011) The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: • The U.S. owner of a disregarded entity and not the entity, • The U.S. grantor or other owner of a grantor trust and not the trust, and • The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax an certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. Jaw, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Fomn W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nanemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Page2 Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9. Also see Special rules for partnerships on page 1. Updating Your Information You must provide updated information to any person to wham you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 far each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty tor false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal Jaw, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the fomn. Sole proprietor. Enter your individual name as shown on your income tax return on the "Name" line. You may enter your business, trade, or "doing business as (DBA)" name on the "Business name/disregarded entity name" line. Partnership, C Corporation, or S Corporation. Enter the entity's name on the "Name" line and any business, trade, or "doing business as (DBA) name" on the "Business name/disregarded entity name" line. Disregarded entity. Enter the owner's name on the "Name" line. The name of the entity entered on the "Name" line should never be a disregarded entity. The name on the "Name" line must be the name shown on the income tax return on which the income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the "Name" line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the "Business name/disregarded entity name" line. If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8. Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the "Name" line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, TrusVestate). Limited Liability Company (LLC). If the person identified on the "Name" line is an LLC, check the "Limited liability company" box only and enter the appropriate code for the tax classification in the space provided. If you are an LLC that is treated as a partnership for federal tax purposes, enter "P" for partnership. If you are an LLC that has filed a Farm 8832 or a Form 2553 to be taxed as a corporation, enter "C" for C corporation or "S" for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC {required to be identified on the "Name" line) is another LLC that is nat disregarded for federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the "Name" line. Form W-9 (Rev. 12-2011) Other entities. Enter your business name as shown on required federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name/ disregarded entity name" line. Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the "Exempt payee" box in the line following the "Business name/ disregarded entity name," sign and date the form. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. The following payees are exempt from backup withholding: 1. An organization exempt from tax under section 501 (a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401 (f)(2), 2. The United States or any of its agencies or instrumentalities, 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities, 4. A foreign government or any of its political subdivisions, agencies, or instrumentalities, or 5. An international organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: 6. A corporation, 7. A foreign central bank of issue, 8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States, 9. A futures commission merchant registered with the Commodity Futures Trading Commission, 1 0. A real estate investment trust, 11. An entity registered at all times during the tax year under the Investment Company Act of 1940, 12. A common trust fund operated by a bank under section 584(a), 13. A financial institution, 14. A middleman known in the investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. IF the payment is for ••• Interest and dividend payments Broker transactions Barter exchange transactions and patronage dividends THEN the payment is exempt for •.• All exempt payees except for 9 Exempt payees 1 through 5 and 7 through 13. Also, C corporations. Exempt payees 1 through 5 Payments over $600 required to be Generally, exempt payees reported and direct sales over 1 through 7 ' $5,000' 1 See Form 1 099-MISC, Miscellaneous Income, and its instructions. 'However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and hea~h care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency. Page 3 Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an !TIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676). If you are asked to complete Form W-9 but do not have a TIN, write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and items 4 and 5 on page 4 indicate otherwise. For a joint account, only the person whose TIN is shown in Part 1 should sign (when required). In the case of a disregarded entity, the person identified on the "Name" line must sign. Exempt payees, see Exempt Payee on page 3. Signature requirements. Complete the certification as indicated in items 1 through 3, below, and items 4 and 5 on page 4. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You ":JUS! sign the certification or backup withholding will apply. !f you are subject to backup w1thholdmg and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. Form W·9 {Rev. 12-2011) 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a non employee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments {under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: i. Individual 2. Two or more individuals ijoint account) 3. Custodian account of a minor (U nifonn Gift to Minors Act) 4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law 5. Sole proprietorship or disregarded entity owned by an individual 6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1 .671-4(b)(2)(i)(A)) For this type of account: 7. Disregarded entity not owned by an individual 8. A valid trust, estate, or pension trust 9. Corporation or LLC electing corporate status on Form 8832 or Form 2553 10. Association, club, religious, charitable, educational, or other tax-exempt organization 1 1. Partnership or multi-member LLC 12. A broker or registered nominee 13, Account with the Department of Agricutture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form i 099 Filing Method 2 (see Regulation section 1.671-4(b)(2)(i)(B)) Give name and SSN of: The individual The actual owner of the account or, if combined funds, the first individual on the account ' The minor' The grantor-trustee' The actual owner ' The owner' The grantor• Give name and EIN of: The owner Legal entity ' The corporation The organization The partnership The broker or nominee The public entity The trust " Us1 t1rst and circle the name of the person whose number you furnish, If only one person on a joint account has an SSN, tha1 person's number must be furnished. 2 Circle the minor's name and furnish the minor's SSN. 3 y 00 must show your individual name and you may also enter your business or "DBA» name on the "Business name/disregarded entity" name line. You may use either your SSN or EIN Of you have one), but the IRS encourages you to use your SSN. 4 List ftrst and circle the name of the trust, estate~ or pension trust (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for parTnerships on page 1. '*Note. Grantor also must provide a Form W-9 to trustee of trust, Privacy Act Notice Page4 Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic hanm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (fAS) assistance. You can reach TAS by calling theTAS toll-free case intake line at 1-877-777-4778 or TTYfTDD 1-800-829-4059. Protect yourself from suspicious em ails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emaiis and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access infonmation for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: spam@uce.gov or contact them at www. ftc.gov/idtheft or 1-877 -IDTHEFT (1-877-438-4338). Visit IRS.gov to learn more about identity theft and how to reduce your risk. Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons ~ncluding federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you: mortgage interest you paid: the acquisition or abandonment of secured property: the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice lor civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. FIRST PAYMENT INVOICE Government Leasing and Finance, Inc. PLEASE RETURN THIS PORTION WITH YOUR PAYMENT SCHEDULE NUMBER: 077-0019215-002 DUE DATE: November 15, 2013 CREATE DATE: September 19,2013 AMOUNT DUE: $14,676.69 County of Harnett P.O. Box760 Lillington, NC 27546 U.S. Bancorp Government Leasing and Finance, Inc. ATTN: Francine Neville Attention: Accounts Payable Dept. Customer Phone Number: 910-814-6093 950 17th Street, 7th Floor Denver, CO 80202 >»»»> PLEASE RETAIN THIS PORTION FOR YOUR RECORDS <«<<«< All payments MUST be sent to this address: U.S. Bancorp Government Leasing and Finance, Inc. PO BOX 959067 ST. LOUIS, MO 63179-9067 U.S. Bancorp Government Leasing and Finance, Inc. ATTN: Francine Neville ACCOUNT: 077-0019215-002 AMOUNT DUE: $14,676.69 950 1ih Street, ih Floor Denver, CO 80202 DUE DATE: November 15,2013 CREATE DATE: September 19,2013 QUESTIONS? PLEASE CALL (303-585-4077} INVOICE SUMMARY Current Charges [Payment #1] $14,676.69 Total Due $14,676.69 TOTAL AMOUNT DUE THIS INVOICE MUST BE PAID WITHIN TEN (10) DAYS OF DUE DATE TO AVOID LATE CHARGES Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Approval of Reimbursement Resolution for Lease Proceeds REQUESTED BY: Kimberly Honeycutt, Interim Finance Officer REQUEST: That the Harnett County Board of Commissioners approve a reimbursement resolution. This resolution will allow the County to reimburse itselfin the amount of$74,970 for the purchase of an EMS ambulance with lease proceeds. The capital outlay purchase and use of lease proceeds was approved in the 2013 -2014 budget and the Master Tax-Exempt Lease Purchase Agreement are also on this Board meeting for the Commissioner's approval with an interest rate of 1. 70%. FINANCE OFFICER'S RECOMMENDATION: Yes COUNTY MANAGER'S RECOMMENDATION: www.harnett.org RESOLUTION OF THE HARNETT COUNTY BOARD OF COMMISSIONERS OF THE COUNTY OF HARNETT DECLARING ITS INTENTION TO REIMBURSE ITSELF FROM THE PROCEEDS OF ONE OR MORE TAX-EXEMPT FINANCINGS FOR CERTAIN EXPENDITURES MADE AND/OR TO BE MADE IN CONNECTION WITHTHE ACQUISITION, CONSTRUCTION AND EQUIPPING OF CERTAIN CAPITAL IMPROVEMENTS WHEREAS, The County of Harnett (the "Issuer") is a political subdivision organized and existing under the laws of North Carolina; and WHEREAS, the Issuer has paid, on and after the date hereof, certain expenditures (the "Expenditures") in connection with the capital project (the "Project"}, as more fully described in Appendix A attached hereto; and WHEREAS, the Harnett County Board of Commissioners of the Issuer (the "Board") has determined that the money to be advanced on and after the date hereof to pay the Expenditures are available only for a temporary period and it is necessary to reimburse the Issuer for the Expenditures from the proceeds of one or more issues of tax-exempt obligations (the "Obligations"}; NOW, THEREFORE, BE IT RESOLVED BY THE BOARD AS FOLLOWS: Section 1. The Board hereby declares the Issuer's intent to reimburse the Issuer with the proceeds of the Obligations for the Expenditures with respect to the Project made on and after the date hereof. The Issuer reasonably expects on the date hereof that it will reimburse the Expenditures with the proceeds of the Obligations. Section 2. Each Expenditure [was and] will be (a) of a type properly chargeable to capital account under general federal income tax principles (determined in each case as of the date of the Expenditure} and (b) complies with all applicable Literary Fund regulations. Section 3. The maximum cost of the Project is expected to be $830,160. Section 4. The Issuer will make a reimbursement allocation, which is a written allocation by the Issuer that evidences the Issuer's use of proceeds of the Obligations to reimburse an Expenditure, no later than 18 months after the later of the date on which the Expenditure is paid or the Project is placed in service or abandoned, but in no event more than three years after the date on which the Expenditure is paid. The Division recognizes that exceptions are available for certain "preliminary expenditures," costs of issuance, certain de minimis amounts, expenditures by "small issuers" (based on the year of issuance and not the year of expenditure} and expenditures for construction projects of at least 5 years. Section 5. This resolution shall take effect immediately upon its passage. PASSED AND ADOPTED this 7th day of October, 2013 Attest: Margaret Regina Wheeler, Clerk to the Board strong roots • new growth Jim Burgin, Chariman APPENDIX A DESCRIPTION OF PROJECT To purchase two EMS ambulances in the amount of $74,970 and $73,500 and the purchase of 30 vehicles for the Sheriffs department at a cost of $22,723 each. Agenda Item '-1-G- Board Meeting Agenda Item MEETING DATE: TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Reclassification of Position REQUESTED BY: Kimberly A. Honeycutt, Interim Finance Officer REQUEST: Request that the vacant Accounting Clerk position be reclassified to an Accounting Technician IV. The following information is provided. Description Grade Minimum Job Rate Accounting Clerk 59 $26,016 $31,219 Accounting Technician IV 65 $33,494 $40,193 Difference $7,478 It is requested that this reclassification be made to address contingency and staffing issues within the Finance Office. Over the past several years, the complexity and volume of the work within the Finance Office has increased significantly, This job classification will require that the applicant have an accounting background and will enable us to recruit more qualified applicants. Additional funding in the 2013 -2014 budget will not be needed due to the retirement of the current finance officer. HUMAN RESOURCES RECOMMENDATION: INTERIM FINANCE OFFICER'S RECOMMENDATION: Yes COUNTY MANAGER'S RECOMMENDATION: HARNETT COUNTY JOB DESCRIPTION JOB TITLE: ACCOUNTING TECHNICIAN IV FINANCE DEPARTMENT Position Number: FLSA Status: Non-exempt GENERAL STATEMENT OF JOB Under general superv1s1on, an employee in this class performs a variety of professional accounting tasks in support of the finance operation of the County. Work involves researching and applying accounting or administrative procedures, principles of bookkeeping, and basic fund accounting to the review and processing of accounting and other financial documents. Performs other work as required. SPECIFIC DUTIES AND RESPONSIBILITIES ESSENTIAL JOB FUNCTIONS Reviews contract invoices to ensure completeness and compliance with federal, state and local laws, policies, and procedures and that the County has been correctly invoiced as evidenced by the current approved contract; ensures availability of funds for contract purchases in appropriate budget line items, records the department code, and submits for entry into computer records. Compiles monthly and quarterly reports; monitors state expenditures and reimbursement grants; prepares close out documents. Prepares and maintain grant accounting; ensures grant requirements for reporting are met. Compiles and analyzes data; prepares spreadsheets for comparison, tracking and presentation for various County programs. Keys data into specialized software; reconciles bank statements; reviews budget amendments for accuracy. Process daily deposits, ensuring that correct general ledger codes are recorded. Assists in the preparation of year end journal entries. Reconciles various projects with budget. Serves as back-up to or in the absence of other staff. Prepares journal entries ACCOUNTING TECHNICIAN IV ADDITIONAL JOB FUNCTIONS Performs other related work as required. MINIMUM TRAINING AND EXPERIENCE Graduation from a college or university with a major in accounting or business and two years of experience in a governmental fiscal operation; or an equivalent combination of education and experience. PERFORMANCE INDICATORS Knowledge of Job: Has general knowledge of the organization, operation, programs and policies of the Finance Department. Has general knowledge of the application of established bookkeeping and accounting principles and techniques to governmental accounting transactions. Has general knowledge of arithmetic. Has general knowledge of state and local fiscal regulations, policies and procedures. Has general knowledge of terminology used within the department. Has general knowledge of modern office practices and procedures. Has some knowledge of office accounting methods and procedures. Is able to use common office machines, including popular computer-driven word processing, spreadsheet and file maintenance programs. Is able to maintain clerical records and to compile reports from them. Is able to type accurately at a moderate rate of speed. Is able to understand and apply laws, regulations and policies to the maintenance of financial records. Is able to verify documents and forms for accuracy and completeness. Is able to understand and follow written and oral instructions. Is able to exercise independent judgment, discretion and confidentiality in the completion of work assignments. Is able to establish and maintain effective working relationships as necessitated by assignments. Quality of Work: Maintains high standards of accuracy in exercising duties and responsibilities. Exercises immediate remedial action to correct any quality deficiencies that occur in areas of responsibility. Maintains high quality communication and interacts within department and division, and with co-workers and the general public. Quantity of Work: Maintains effective and efficient output of all duties and responsibilities as described under "Specific Duties and Responsibilities." Dependability: Assumes responsibility for doing assigned work and meeting deadlines. Completes assigned work on or before deadlines in accordance with directives, County policy, standards and prescribed procedures. Accepts accountability for meeting assigned responsibilities in the technical, human and conceptual areas. Attendance: Attends work regularly and adheres to County policies and procedures regarding absences and tardiness. Provides adequate notice to higher management with respect to vacation time and time-off requests. Initiative and Enthusiasm: Maintains an enthusiastic, self-reliant and self-starting approach to meet job responsibilities and accountability. Strives to anticipate work to be done and initiates proper and acceptable direction for completion of work with a minimum of supervision and instruction. Judgment: Exercises analytical judgment in areas of responsibility. Identifies problems or situations as they occur and specifies decision objectives. Identifies or assists in identifying alternative solutions to problems or situations. Implements decisions in accordance with prescribed and effective policies and procedures and with a minimum of errors. Seeks expert or experienced advice and researches problems, situations and alternatives before exercising judgment. Cooperation: Accepts supervisory instruction and direction and strives to meet the goals and objectives of same. Questions such instruction and direction when clarification of results or consequences are justified, i.e., poor communications, variance with County policy or procedures, etc. Offers suggestions and recommendations to encourage and improve cooperation between all staff persons within the department. Relationships with Others: Shares knowledge with supervisors and staff for mutual and departmental benefit. Contributes to maintaining high morale among all department employees. Develops and maintains cooperative and courteous relationships with department employees, staffers and managers in other departments, representatives from organizations, and the general public so as to maintain good will toward the department and project a good departmental image. Tactfully and effectively handles requests, suggestions and complaints from other departments and persons in order to maintain good will within the County. Interacts effectively with fellow employees, supervisor, professionals and the general public. Coordination of Work: Plans and organizes daily work routine. Establishes priorities for the completion of work in accordance with sound time-management methodology. Avoids duplication of effort. Estimates expected time of completion of elements of work and establishes a personal schedule accordingly. Attends meetings, planning sessions and discussions on time. Implements work activity in accordance with priorities and estim~ted schedules. Maintains a calendar for meetings, deadlines and events. Safety and Housekeeping: Adheres to all safety and housekeeping standards established by the County and various regulatory agencies. Sees that the standards are not violated. Maintains a clean and orderly workplace. Board Meeting Agenda Item Agenda Item ----'lj'-------=--"-- MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS artment REQUEST: At the September 20, 2013 meeting of the Board of Health the Board approved to write-off $30,055.75 for program services as follows: Other Services $816.80 Maternal Health/Prenatal $4,224.17 Adult Health $2,009.41 Family Planning $10,978.28 Child Health $12,027.09 Total $30,055.75 Debt Set-off collection for the past two years equalled $34,110.26. Every attempt has been made to collect this debt and will be re-instated if client returns for services. Attachment ( 1) COUNTY MANAGER'S RECOMMENDATION: Page 2013 REQUESTED HEALTH DEPARTMENT WRIT E-O FS OS $ 816.80 MH/PN $ 4,224.17 AH $ 2,009.41 FP $ 10,978.28 CH $ 12,027.09 GRAND TOTAL $ 30,055.75 OS= Other Services (Tuberculin Skin Test, Flat Fees--sports physicals, camp physicals, etc.) MH =Pregnancy Test & Prenatal AH =Adult Health FP = Family Planning CH = Child Health ~ · Chairman/Chairwoman Harnett County Board of Health Chairman/Chairwoman Date Harnett County Board of Commissioners THIS INSTRUMENT HAS BEEN REVIEWED V THE FINANCE OFFICER Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS es, Eligibilty and Bad Debt-Write Off Policy and Flat Fee Billing Policy REQUEST: The Board of Health at their regular meeting on September 19, 2013 approved the Amended Clinicial Fee Schedule, the Clinicial Patient Fees, Eligibility and Bad Debt-Write OffPolicy and Flat Fee Billing Policy amendments. The amendments were as follows to the Clinical Patient Fees, Eligibility and Bad Debt-Write Off Policy: on page 2 added the new wording "No client will be denied service based soleyly on the inability to pay or regardless of the source of payment; on page 4 added new wording "Family Planning patients will have fees assessed based on declaration of income if no proof of income is provided"; page 9 no residence requirement for program services". Flat Fee Billing Policy amendments were as follows: deleted Department of Correction Physicials (DOC PE); added Adult Women's Wellness Clinic; Updated to current Immunizations offered. Thank you for your consideration of these two amended policy. COUNTY MANAGER'S RECOMMENDATION: U:\my documents\1-Winword\BOC Mtg Request\Billing Policy Amendment 09-13 .doc 1 of2 Page Policy and Procedure HARNETT COUNTY HEALTH DEPARTMENT ' Title: FLAT FEE BILLING POLICY APPROVED: 3-17-2005 DATES VISED: ;J-J-13 9~(1-f] APPROVED BY: I /1/\./(;v\Ai/ -------;2~~ a~ ~e'---_7t_-'---H-e-a---"---~hl----'---"l_"=~=e'---ct-o-r ·Board of Health, Barbara Ross, Admin. Assistant Board of Commissioners, Chairman Purpose To collect fees for services not mandated or provided by the state. Policy Flat Fee Service (This is clinical services not on a sliding fee scale, vaccine is purchased by this agency and is not mandated or provided by the state; age limit for physicals -once they have had their 21st birthday they can no longer be seen by the Child Health practitioner) 1) Camp Physical 2) Sports Physical 3) College Physical 4) Group Home Physical 5) Foster Care Physical 6) Influenza Vaccine (charge for vaccine not provided by State supplied) 7) Hepatitis A Vaccine 8) Hepatitis B Vaccine (*see state law for exemption to no charge service) 9) Pneumococcal Vaccine (over 18 years) 1 0) PPD/Tuberculin Skin Test (*see state guideline on State supplied) 11) MMR Vaccine (*see state law for exemption to no charge service) 12) HPV (Human Papillomavirus) 13) Varicella 14) Menactra 15) Tdap (*see state guideline on State supplied) 16) Any vaccine that the state does not provide and the health department purchases 17) Adult Women's Wellness Clinic (pap smear, labs-( cholesterol, urinalysis) Procedure • Flat fee service will be collected at the billing office before the client is seen in clinic . . ,iS INSTRUMENT HAS BEEN REVIEWED E FINANCE OFFICER Page 2 • If the client needs additional clinical service this will also be collected before being seen. For Example: A college physical may be required to receive a tuberculin skin test. This would be collected prior to the physical. All other services will follow the Clinical Billing Fees Policy. • If the client does not receive the service then a refund will be issued. • The billing procedure will be explained to the client at the time of collection. If the client does not have the monies to pay for this service then the services will not be denied merely rescheduled. • Medicaid does not pay for PPD/Tuberculin Skin Test if related to work or school, so in this instance the client is responsible for the charge. State Provided Vaccine (not purchased by health department) These vaccines are provided by the state and not purchased by the Harnett County Health Department. *North Carolina Universal Childhood Vaccine Distribution Program (UCVDP) Coverage Criteria for all North Carolina Children (Effective November 1, 2000) Td Adult: 2:: 7 years through 18 years 1. Does 1-3 if child did not receive adequate does before age 7. 2. Recommended as a booster dose every 5-10 years. 3. May be given at the 6th grade visit. 4. Can be given to any person entering a North Carolina college/university for the first time who has not had a booster in 10 years. 5. Any person may receive Td at the local health department Hep B:Through 18 years 1. Required by law for children born on or after July 1, 1994. 2. Available fall all children through 18 years of age, regardless of risk factors. 3. Household contacts ofHep B carriers, sexual or needle sharing contacts of acute or chronic Hep B infected individuals who are greater than 18 years of age must be referred to the local health department for testing and vaccination. 4. Immigrants with refugee status who are from endemic countries who are greater than 18 years of age must be referred to the local health department for testing and vaccination. 5. If the first dose of Hep B is administered before the 19th birthday, the series must be completed before the 20th birthday if using state- supplied vaccine. Page 3 MMR: 2:. 12 months through 18 years 1. Two doses of measles containing vaccine are available and required by law for: • Children beginning Kindergarten/First Grade for the first time on or after July 1, 1994 or • Persons (born in1957 or later) entering a North Carolina college/university for the first time on or after July 1, 1994. 2. Any refugee of any age without documentation of a prior MMR may receive MMR at the local health department. 3. All women of childbearing age without documentation of a prior MMR may receive MMR at the local health department. This policy shall be signed and reviewed by the Health Director annually. If there is a revision/amendment to this policy then it shall be brought back to the Board of Health for approval at the next meeting date of the Board. Policy and Procedure HAR~ETT COUNTY HEALTH DEPARTMENT Title: CLINICAL PATIENT FEES, ELIGIBILTY AND BAD DEBT -WRITE OFF APPROVED: 3 -\l -J 00 5 ATES REVISED: 5-1£-(l(,., APPROVED Bw-1 ~ B~rbara Ross, Administrative Assistant II Purpose Public health services are increasingly costly to provide. The Health Department serves the public's interest best by assuring that all legally required public health services are furnished for all citizens. The department provides recommended and requested public health services based upon the priorities established by the Board of Health. Fees are a means to help provide services to the citizens of Harnett County. Fees help finance and extend public health services when government funding is not sufficient to support the full cost of providing all required and requested services. Fees are considered appropriate in the sense, that the entire population benefits from the availability of public health services for those in need, it is the direct recipient of services who gains the greatest direct benefit. Policy The clinic is to operate a system of financial management to: e meet the standard of grantor agencies • safeguard all income and expenditures • assure collection ofrevenues from all sources with financial obligations of the serv1ce The policy will include procedures for (I) Setting Charges, (II) Billing Clients and (III) Procedure for Aging of Accounts (Bad Debt Write-Off), Encounter Forms and (V) Determining Eligibility for Discounts. THIS INSTRUMENT HAS BEEN REVIEWED V T E FINANCE OFFICER Page2 Procedure 1. Setting Charges for Service a. In accordance with G.S. 130-A-39(g), the Board of Health has the authority and duty to establish charges for services provided in clinics. Specific methods used in seeking reimbursement will be through third-party coverage, including Medicaid, Medicare (for massive immunizations), private insurance, and individual patient pay. The Board of County Commissioners adopts fees established by the Board of Health. The Board of Health and Board of Commissioners adopt the fees along with the fiscal years budget process. b. No client will be denied service based solely on the inability to pay or regardless ofthe source of payment c. Eligibility: Each client must cooperate in: • an eligibility determination; and • provision of documentation of third party eligibility (Medicaid, Medicare, private insurance) for which they are eligible; and • provision of declaration of income. 2. Cost-based services: Charges are to be based on an accounting analysis of all services provided. The Board of Health accepts the Medical Fees in the United States 501h percentile times geographic adjustment factors for North Carolina, unless the approved Medicaid rates are greater. If the Medicaid rate is greater then that will be the acceptable charge. A comparison of the Medicaid cost study is considered. The Setting Committee reviews and makes recommendations to Board of Health. 3. Service discounts: A schedule of discounts is to be used to adjust most service charges for clients between 100 and 250% of poverty. 4. The discounts will be based on: 1. household members (economic unit), and 2. income. 5. Financial Agreements/ Assignment of Benefits Authorization is to be on file in client charts to acknowledge responsibility for services not covered by third party carriers. Patients at 0% do not have to sign Financial Agreement. Page 3 Service-Specific Eligibility/Charge Adjustments: Definition: 1. Adults and Emancipated minors: 164.502(g)(2) a. Emancipated minors: In North Carolina, there are only two ways for a minor to be emancipated (see G.S. 7B-3500 et seq): • By marriage, or • By an order of emancipation granted by a court. b. Adults: In North Carolina, a person age 18 or older is an adult for purposes of making health care decisions. 2. Minor's consent sufficient for certain medical health services (G.S. 90-21.5) a. Any minor may give effective consent to a physician licensed to practice medicine in North Carolina for medical health services for the prevention, diagnosis and treatment of(i) venereal disease and other diseases reportable und G.S. 130A-135, (ii) pregnancy, (iii) abuse of controlled substances or alcohol, and (iv) emotional disturbance. This section does not authorize the inducing, of an abortion, performance of a sterilization operation, or commitment to a mental institution or hospital for confinement or treatment of a mental condition. This section does not prohibit the admission of a minor to a treatment facility upon his own written application in an emergency situation as authorized by G.S. 122C-222. b. Any minor who is emancipated may consent to any medical treatment, dental and health services for himself or for his child. (1971, c. 35; 1977, c.582, s.2; 1983, c.302, s 2; 1985, c. 5899, s. 31,) 3. Services to minors: • Family planning services shall be available to all who voluntarily request such services without regard to age or parental consent. (15A NCAC 21A.0503) 4. Family Planning clients must be charged based on household members and income and discounts may be established for persons between 100-250% of poverty based on sliding fee scale. Birth control pills are included in the Family Planning physical fee, unless client loses pills. If client loses pills a $10.00 per pack will be accessed to the client and sliding fee scale will apply. Depo-Provera is to be billed separately from physical fee. If Page 4 during the course of a Family Planning or Maternity visit the clinician needs to rule out STDs to meet standards of care, the patient cannot be charged for STD testing and treatment. Private insurance can be charged for these services. When a client is unable to pay, for good cause (as determined by the health director), for family planning services the fee may be waived. The billing staff must determine, as accurately as possible, the client's ability to pay based upon family income. This determination and notice of any applicable waiver should be made prior to the delivery of services and must be conducted each time a client requests services. When considering charges to minors for family planning, several conditions must be taken into account. If the minor is unemancipated and confidentiality of services is not a concern, the family's income must be considered in determining the charge for the services. When a minor requests confidential services, without the involvement of a principal family member, charges for services must be based on the minor's income. Income actually available to the minor, such as wages from part-time employment, stipends and allowances paid directly to the minor, should be considered in determining the minor's ability to pay for services. Those services normally provided by parents/guardians, e.g., food, shelter, transportation, tuition, etc., should not be included in determining a minor's income. Under certain circumstances where confidentiality is restricted to limited members of the family, e.g., one parent is aware of the minor seeking services but the other is not because of disagreement regarding the minor's right to receive family planning services, the charges shall be based on the minor's income if the minor's confidentially would be breached in seeking the full charge. Billing staff must seek payment from third parties who are authorized or legally obligated to pay for services unless, in doing so, patient confidentiality would be compromised. Third parties should be billed at full charge and not discounted. Family Planning patients will have fees assessed based on declaration of income if no proof ofincome is provided. 5. Child Health clients must be charged based on household members and income and discounts established for clients between 100-250% of poverty based on sliding fee scale. 6. Maternity clients must be charged based on household members and income and discounts established for clients between 100-250% of poverty based on sliding fee scale. 7. Adult Health clients must be charged based on household members and income and discounts established for clients between 100-250% of poverty based on sliding fee scale. 8. Communicable Disease and immunizations services must be provided at no cost to the client. Page 5 9. Flat Fee Service: (This is clinical service not on a sliding fee scale; vaccine is purchased by this agency or services provided by agency and is not mandated by the state) (This has a policy of its ovm): See Flat Fee Policy 10. Billing clients for Care a. See Policy for Flat Fee Charges for non-discounted services b. Bills (printed from accounting system) are to be given directly to the client at the time of their clinic visit and/or claim sent to another payment source, i.e. Medicaid, Medicare or private insurance. If payment is not made in full then a payment schedule (dollar amount, daily, weekly, monthly, charge) will be discussed with client and put on file. c. Emancipated minors (by legal emancipation, or married) fees are to be based on household members and income. Fees for clients requesting confidentiality or no contact must be based on the client's income alone and a family size of one. d. Bills to clients are to show full charge less the appropriate sliding fee discount. e. Bills to third party payer sources are to reflect the full charge and no sliding fee discount. f. When a bill is not paid in full during the clinic visit, a bill is to be mailed to the client's address sixty (60) days after the visit and monthly thereafter until written off. After three consecutive bills with "no" response then a letter will be sent with bill (see form letter attached). Bills are not to be mailed to adolescents when it may undermine their confidentiality or when a client requests no contact or no mail. When confidentially or no mail is requested by client see if alternate billing address can be used. Also, see Debt Set-Off Policy for further collection. g. Clients are to receive a receipt for any payment. (Printed from "Medware" Accounting System, unless after closeout for daily deposit then hand written numbered receipt will be issued). h. Donations may be accepted and a receipt issued. If the donation is from a client with an account balance, it is payment, not a donation. 11. No mail is sent to confidential clients, or if requested by a client to receive no mail. Page 6 12. Aging of Accounts (Bad Debt Write-Off) Aging of account is an accounting procedure to periodically provide an update and realistic value for accounts receivable. Accounts Vv'ill be aged every 2 years or annually, if deemed by Health Director or Designee and VvTitten off as "uncollectible" only after two (2) years following the date of last service and no effort to pay has been made. Unless, approval by Board of Health and/or Board of Commissioners to delay mite-offs. Process for billing clients and aging accounts follows: Billing a. Explain to client charges for that day's services and request payment during clinic visit; inform client of balance due and have client sign "Financial Agreement/ Assignment of Benefits Authorization. b. If client is unable to pay full amount of bill for that day's service, prepare "Payment Agreement Form" for clients to sign. Processing Unit Supervisor and/or Patient Relations Representative will review payment Agreement Forms every sixty (60) days or designee. c. Label will be kept on each client in a notebook and at the end of the day the encounter forms shall be matched back to the label sheet to ensure all encounter forms are accounted for. If encounter forms are not accounted for follow-up with supervisor of that clinic. (A duplicate encounter form may need to be created if original is not found). d. Mail statement of account to client sixty (60) days after visit and monthly thereafter until mitten off or collected through Debt Set-off. e. After 3 months; mail "payment agreement form" to client to select payment option(s) or if client has already made a selection send a copy of "payment agreement form" on file to the client along with statement of balance from HIS accounting system. f. Mail past due notice to client sixty (60) days after the "payment agreement form" has been mailed. g. Inform client of balance due at time of service and • Next telephone call (if applicable) • Next walk-in service. Page 7 Aging Patient Accounts a. Patient Relations Representative V will review outstanding balances semi-annually (June and December). b. Two years after the initial visit balance and payment has not been rendered, and client has not been in for service any balance remaining after two years will be written-off as "uncollectible". c. As long as a balance remains, the client is to be informed of the current balance. d. In the event a client should offer payment on an amount previously written-off, the charge will be re-entered into the system and payment accepted. Entries reflecting the amount written-off will be entered in the accounting system. If client returns for Health Department services reinstate write-off and inform client of amount owed. e. The client ledger card (HIS accounting system) will indicate the recording of the bill as "uncollectible". f. The Harnett County Board of Health authorizes the Health Director to write-off debts deemed "uncollectible" under this policy; the Health Director will report to the Board of Health the total amount write-off in each program. The Health Director will then request approval of the write-off debts from the Board of Commissioners. After approval by the Board of Commissioners then the debts will be written off. The Harnett County Health Department utilizes "HIS Accounting System & Medware Accounting System -for Influenza and Pneumonia" for receivables. 14. Encounter Forms a. An encounter form will be initiated and completed for every service provided. b. Personal data required at the top of the encounter form includes: e Last name, First name, Middle Initial (if one) e Social Security number if not one then made up Patient number e Date ofBirth • Race and Ethnicity • Sex • County of Residence Code • Address and phone number (optional) Page 8 c. Clinic and financial information required at the top of the encounter fonn includes: • Date of visit • Clinic • Reason for visit • Medicaid number • Medicare information • Insurance information • Self-Pay% • SSI information e Health Choice information • New to program or Continuation to program d. Encounter forms will be kept for 2_ years from the date of service or when agency need ends and then destroyed. Instructions for Determining Eligibility for Scale Fee Discount: Definition: 1. Economic Unit: The Economic Unit will consist of people living in the home related to the client and those living in the home providing direct or indirect financial support for the client. A family shall be defined as a group of related or non-related individuals who are living together as an economic unit. Individuals are considered members of a single family or economic unit when their production of income and consumption of goods are related. (Related to client by blood, marriage, or adoption, father of unborn child or client's boyfriend, and/or live in the same household as the client and contribute to the client's support; rent, utilities, grocies, clothes, etc.). Those who are financially responsible for the client or those who dependent on the client for financial assistance are included in economic unit. 2. "HIS" Client Household/Contact (Paper-Personal Data Sheet/Eligibility) Complete Client Household/Contact (Personal Data Sheet) on each client every 12 months; unless client has a change then it will be updated and resigned earlier. a. Enter the following information: e Last name, First name, Middle Initial (if one) e CNDS e Date of Birth e Race and Ethnicity Page 9 • Sex • County of Residence Code (no residence requirement for programs services) • Address and phone number • Note clients maiden name or any other last name • Social Security Number for parents or patient to be used for Debit Set Off or billing insurance • Write "Confidential" on sheet printed from "HIS" (client household/contact) • Date of screening and whether or not the client wishes to receive mail at the address to be listed. • Present and permanent address: list the street address in addition to any post office box; rural routes should be followed by the road name (also, update client data screen in HIS) • Home/work/school telephone numbers that indicate where they can be reached. Telephone numbers should be for home work. Also have to update client information screen. • Complete with the economic unit information (Persons living in home), date of birth or age, sex, relationship to patient. b. SOURCES OF INCOME section is to be completed on the first visit and updated as changes occur or 12 month anniversary date whichever occurs first. (date, name of economic unit with incomes, list all employers or sources of income, date of employment, wages, AFDC, SSI, Retirement, other, total income before taxes). • Income Calculation: a. Determine Family Size (Economic Unit) First, determine the number of individuals in the client's family. Remember that for family planning, the "family" is not limited by the "related by blood, marriage, or adoption" test. The Title X regulations [42 CFR 59.2] define a family as "a social unit composed of one person, or two or more persons Page 10 living together as a household." Household members included for family size determination consist of people living in the home related to the client and those living in the home providing direct or indirect financial support for the client. A family shall be defined as a group of related or non-related individuals who are living together as one economic unit. Individuals are considered members of a single family or economic unit when their production of income and consumption of goods as related. There are some special situations. If a "family member" is seeking confidential services, the client should be treated as a "family of one" and considered on the basis of the client's resources alone. Many adolescents will probably fall into this category, as well as some non-adolescents. Some clients may live in a setting with a number of family members, sometimes distantly related, making up "a household." They share daily expenses such as food, rent, utilities, etc. and, therefore, constitute an "economic unit." If the client indicates that the entire group shares health care expenses-including contraceptive services-and if there is no confidentiality concern related to the sharing of such expenses, then the entire "economic unit" should be considered in determining the unit's gross mcome. b. Determine Family's or Economic Unit Gross Income Secondly, determine the economic unit's gross income. Gross income is also the income before deductions for income taxes, social security taxes, insurance, or other voluntary deductions. Determine income by the documentation. Income includes most types of financial payments. c. Documentation: Acceptable sources of income verification, but not required for proof. 1. Check/Pay stubs 2. W-2 forms 3. Letter from employer, etc. 4. Self-employed clients can provide the latest tax return 5. Declaration d. To and From date used to determine employment: • Continuously employed wage earners must show income from past 12 months (one year back from date of service), or Page 11 11 If multiple employment within past 12 months then verify present employment with client and then use patient word to verify with ESC Website for employment to equal 12 months, or • If individuals are unemployed today or during the past year, they must show income for the past 6 months and an income projection for the future 6 months. • Weekly or monthly figures should be annualized. e. Financial payment/other sources: Financial payment/other sources of income that may exist include but not limited to cash, or that can be readily converted to cash, social security payments, public assistance payments, retirement, alimony payments, child support, and unemployment compensation-generally, money received from sources outside of the household. etc ... f. Some items not included as income: Housing allowance for military personnel is not counted. The eligibility specialist will have to identify the proper amount of the housing allowance and subtract it from the total gross income shown on the check, non-cash benefits such as WIC vouchers, food stamps, food, rent or fuel received in lieu of wages, in-kind housing assistance, school lunches, etc ... Individuals and emancipated minors seeking confidential or no contact service are to be considered a family unit of one (family planning, etc) g. Client documentation required---refused--- Client/guardian may be requested to declare income annually or as changes occur, but documentation is not required. If client refuses income information he will be accessed at 100% except Family Planning will not be accessed. See calculation of income under definition above. h. Statement of accuracy- • Eligibility specialist is to read to the client the statement of accuracy in reporting (read from the Personal Data Sheet the statement: THE ABOVE INFORMATION I HAVE GIVEN IS CORRECT. I UNDERSTAND THE HEALTH DEPARTMENT HAS THE RIGHT TO CHECK THIS INFORMATION.) Page 12 • Eligibility specialist will have client sign and date • Eligibility specialist will sign and date Responsibility of Billing Staff-each visit 1. All clients are screened to determine financial eligibility at the time of visit 2. Explain to the client the reason for charging fees 3. Discuss with client acceptable forms of income verification, declaration is accepted 4. Complete financial eligibility form/personal data form HIS -if no income, refer to Department of Social Services with "Third Party Confirmation Letter" (attached to policy) or accept declaration of income. 5. Explain sliding fee scale 6. Explain that the expectation of the Health Department is that reimbursement is expected same day as service and have the client sign a contract agreeing to pay for the cost of the services. If, on subsequent visits, the client has not made payment, remind client of signed agreement. (see attached "Financial Agreement/ Assignment ofBenefits Authorization" Form) 7. Billing staff shall copy insurance card and a form of identification to ensure the correct insured client is using the insurance card. 8. Billing staff should collect insurance co-insurance/deductibles will be accessed according to the sliding fee scale. Co-pays are not subject to sliding fee scale and will be collected at 100%. Eligibility 1. Clients will not be denied statutorily required services based solely on the inability to pay. Services may be denied if the department does not have the resources needed to provide a quality non-mandated service. Also, falsification of eligibility by the clients may result in denial or limitation of services. 2. The Health Department shall not deny a service due to religion, race, national origin, creed, sex, marital status or age. Page 14 Laboratory Billing-AFP-Prenatal Patients UNCLABORATORY AFP labs will be sent to UNC for testing on the following patients: Medicaid eligible Presumptive Medicaid Insurance 0% pay patients I until UNC meets quota for 0% pay patients If patient is 20% or above and not eligible for Presumptive Medicaid this lab will be sent to Lab Corp LAB CORP LABORATORY AFP labs on 0% pay patients will be sent to LabCorp for testing after UNC meets quota. If patient is 20% pay or above and not eligible for Presumptive Medicaid, these labs will also be sent to LabCorp. The patient will be notified at intake that LabCorp will bill them at the current rate. The prenatal nurse or practitioner for prenatal clinic will determine when AFP labs are needed. The prenatal nurse will bring the form and patient to an intake management support staff member to complete the form and at the time the determination will be made which reference lab to send the test to. Also, the patient will be told at this time if there will be a charge for the labs. This policy shall be reviewed by the Health Director annually. If there is a revision/amendment to this policy then it shall be brought back to the Board of Health for approval at the next meeting date and the Board and Board of Commissioners at their next meeting date. PAYMENT AGREEMENT FORM In accordance \\'ith the policy of the Harnett County Health Department, payment is due when service is rendered. However, we realize that there are times when an individual dose not have the total amount of money owed to the clinic, therefore, this written agreement is established as a method of adopting a payment plan for those clients who have an outstanding balance. Name ----------------------------of Birth ------ I, ----------------------' agree to establishing a payment plan for my account and to the _____ __;My account balance is (client's initial) ______ I will pay the amount (client's initial) ~---------on my bill. _____ Monthly ______ Weeldy _____ Bi-Weekly (initial) I understand that the Harnett County Health Department can not operate efficiently without my adhering to the agreement as stated above. I further state that my options were explained to me and I fully understand. (initial) I understand that I am responsible for any balance left owing if my insurance company should not pay the bill in full and that it will be based on my sliding fee scale status. (excluding co-pays that are not subject to sliding fee scale) This is a binding agreement by signatures of both parties. The agreement will be filed in a tickler file (notebook) until bill is paid. Failure to comply with this agreement will greatly affect the overall services of the Health Department operation. Signature of Patient-------------- Signature of Witness------------ Date _______ _ CONTRATO DE PAGO En acuerdo con la p6liza del Departamento de la Salud del Condado de Harnett, se debe el pago cuando los servicios son rendidos. Nos damos cuenta de que hay veces cuando un individuo no tiene la cantidad total que debe a la clinica, por eso, este contrato es establecido como el metodo para adoptar un plan de pago para los clientes que deben dinero a la clinica. Nombre ________________________ FDN SSN _____ _ Direcci6n ---------------------------------------------------------- Yo, , acuerdo a establecer un plan de pago de mi · cuenta bajo las estipulaciones aqui escritas: El balance de mi cuenta es $ ------------------ (iniciales) _______ Yo pagare la cantidad de $ _______ __ (iniciales) Mensual ------Semanal -------Quincenal --------- (iniciales) Yo entiendo que el Departamento de la Salud del Condado de Harnett no puede operar eficientemente si yo no me adhero al contrato arriba mencionado. Tambien dejo saber que me explicaron las opciones y las entiendo completamente. (iniciales) Yo entiendo que soy reponsable por el balance debido en mi cuenta si mi compafiia de seguros no lo paga completarnente, y que ese balance esta basado en una escala basada en los ingresos de la casa.(son excluidos los copagos que no son basados en la escala de ingresos) Este es un contrato firmado por las dos personas. El contrato se va a guardar en un libro hasta que la cuenta este pagada por completo. Si no se adhera a este contrato afectara grandemente la operaci6n de los servicios del Departamento de Salud. Firma del Cliente Pecha ------------------------------------- Firma del Testigo Pecha ------------------------------------------ Harnett County Department of Public Health (attach label here) Last Name First Name Ml Financial Agreement/ Assignment of Benefits Authorization Purpose: To acknowledge financial responsibility for services not covered by third party carriers, to authorize assignment of insurance benefits for services provided and to grant permission to release information from the record of the patient necessary to justify any claims made to the patient's insurance carrier. Social Security Number Preparation: Complete all blanks before signature is signed in ink. Retention: For adult records, retain 10 years from the date of service. For pediatric records, retain until the individual reaches 28 years of age and has not received services within the last 1 0 years. For exclusions to this schedule, refer to Standards in the Records Disposition Schedule . 1 understand that payment for any services not covered by 3rd party carriers is my responsibility and I will be billed accordingly. In addition, there may be charges for lab tests these carriers do not cover and I will be responsible for paying the performing lab directly. Witness To assure proper management of my account, I agree to the following terms: 1. To provide accurate information including: a. Disclosure of financial information b. Personal data such as legal name, mailing address, telephone number or other identifying information necessary to establish identification to 3rd party carriers. c. Insurance, Medicaid, or Medicare information. 2. Payment of outstanding balances: If I am unable to make payment in full at the time the service is provided, I agree to make regular, established monthly payments until the debt is cleared. 3. 1 authorize the release of information necessary to substantiate and process any 3rd party claims. 4. INSURANCE: I hereby understand that my insurance company will not pay for services received and I further understand that I am responsible for the bill and will follow item # 2 on this document. 5. 1 hereby assign benefits to the Harnett County Department of Public Health for any 3rd party payments made for claims related to my account and that I am responsible for any charges not covered. My signature on this form will serve as a legal "Signature on File" for purposes of filing my insurance claims. Patient, Parent, or Legal Appointed Representative Date Date Departamento de Ia Salud del Condado de Harnett (attach label here) Apellido Nombre Contrato Financiero/ Autorizaci6n para Ia Asignaci6n de Beneficios Razon: Para reconozer Ia responsabilidad financiera por los servicios que no estan cubiertos bajo Ia compaiiia de seguros, para autorizar Ia asignaci6n de los beneficios de Ia compaiila de seguros par los servicios recibidos y para dar permiso a disponer de Ia informacion necesaria del archivo del paciente para justificar Ia cantidad facturada a Ia campania de seguros. Numero del Segura Social ----------------------Preparacion: Complete todo antes de firmar con boligrafo. Fecha de Nacimiento Retencion: Archivos de adultos, retener 10 af\os desde Ia fecha de los servicios. Archivos lnfantiles, retener hasta que el lndividuo cumpla 28 aiios y no haya recibido ningun servicio en los ultimos 10 alios. Para excepciones referir al Standars in the Records Disposition Schedule. Entiendo que el pago por los servicios que no estan cubiertos porIa compafiia de seguros es mi responsabilidad y que recibire una factura. En adici6n, si hay pruebas de taboratorio que tam poco estan cubiertas yo sere responsable de pagarlas directa mente. Para asegurar el mantenimiento de mi cuenta, yo me adhero a los siguientes terminos: 1. Proveer Ia informacion adecuada incluyendo: a. Informacion financiera. b. Informacion personal: nombre, direcci6n, numero de teletono o cualquier otra informacion personal para establecer identificacion con Ia campania de seguros. c. Informacion de Ia Compaiifa de Seguros, Medicaid o Medicare. 2. Pago de Ia cuenta: Si no pudiera pagar Ia cantidad completa cuando recibo los servicios, yo me adhero a hacer pagos mensuales regularmente hasta que mi cuenta este completamente pagada. 3. Yo autorizo a que se use mi informacion cuando se mande Ia factura a Ia campania de seguros. 4. COMPANIA DE SEGUROS: Yo entiendo que mi comparifa de seguros no va a pagar por los servicios recibidos y tambien entiendo que yo soy responsible porIa factura y que voy a cumplir los terminos escritos en el # 2 en este documento. 5. Yo asigno los beneficios de mi factura que mi compaiifa de seguros page al Departamento de Ia Salud del Condado de Harnett y que yo soy responsable par cualquier servicio no cubierto. Mi firma en este contrato servira como una legal "Firma en Archive" para Ia raz6n de mandar facturas a mi compafifa de seguros. Paciente, Padre/Madre, o Representante Legal Asignado Fecha Harnett COUNTY Department of Public Health www.harnett.org '"iarre:t Cm,nty Gr:verr.rner:t Co;rtp]ex 3C7 Co·nei:Js Harnetl Bc~levard ~:l!ngton, NC 27546 Date Dear ____________________ _ We are here to serve your needs, but in order for our agency to continue the types of services we provide we need your help. Upon receiving your services, you made payment arrangements with our billing staff to make payments on your account. Your account is currently seriously past due. We need you to honor that agreement and start making payments within 30 days. If this account is not paid and others like it, we may have to cut the services that we provide to the citizens of Harnett County. We appreciate your prompt attention in this matter and we hope that we can continue to meet your health care needs. Sincerely, Billing Department pc: patient chart strong roots • new growth ph 91:1·893-75SJ fax 91 0-893-9429 Harnett COUNTY Department of Public Health www.harnett.org 387 Ccr:-:e:,~s Harr.e1t 2ou:eva'd i\;C 27545 Fecha Estimado/a --------------------- Estamos aqui para servirle, pero necesitamos su ayuda para que nuestra agencia continue dando los servicios que proveemos. Usted firm6 un contrato con nosotros cuando vino a recibir sus servicios con el cual pidi6 pagar su cuenta a plazos y esa cuenta esta muy atrasada. Necesitamos que usted honore su palabra y empieze a hacer pagos en 30 dias. Si su cuenta y otras como la suya no son pagadas tendremos que cortar los servicios que proveemos a los ciudadanos del Condado de Harnett. Apreciamos su pronta atenci6n a este asunto y esperamos poder continuar ofreciendole sus cuidados medicos. Sinceramente, Departamento de Finanzas pc: archivo del paciente strong roots · new growth fax 91 J·893S429 Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Donate surplus vehicles to CCCC for Training REQUESTED BY: Sherifrs Office REQUEST: The Sheriffs Office request persission to surplus the below vehicles and donate them to CCCC to be used for training by the Fire/EMS training department. These vehicle are older vehicle that have low resell value. 1995 Chev. 1G1BL52P5SR174712 1985 Mere 2MEBP95FXFX632566 1996 Chev 1G1BL52P2TR115604 1992 Ford 1FMDU34X7NUD73580 COUNTY MANAGER'S RECOMMENDATION: C:\Users\gwheeler\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\Z5TP9EAN\Surplus Vehicles Sept 20 2013 (2).doc Page 1 of 1 STATE OF NORTH CAROLINA COlJNTY OF HARNETT RESOLUTION AUTHORIZING DISPOSITION OF PERSONAL PROPERTY WHEREAS, County of Harnett (the "County") owns the following motor vehicles, utilized by the Harnett County Sheriff's Department in connection with its public safety function: YEAR MAKE VIN 1995 Chev. 1GlBL52P5SR174712 1985 Mere 2MEBP95FXFX632566 1996 Chev 1G1BL52P2TR115604 1992 Ford 1FMDU34X7NUD73580 WHEREAS, such vehicles are now obsolete and surplus to the needs of the County; WHEREAS, said vehicles have little, if any, value on the open and public market; WHEREAS, Central Carolina Community College ("CCCC"), located in Lee County, could utilize such vehicles for training purposes at its Emergency Services Training Center, said Center is often used by the various local government jurisdictions within Harnett County for training purposes; WHEREAS, the transfer of such vehicles to CCCC would provide for and promote the safety and welfare of the citizens of Harnett County by affording County law enforcement personnel and other local government jurisdiction law enforcement personnel equipment to be used for training purposes. NOW, THEREFORE, BE IT RESOLVED BY THE HARNETT COUNTY BOARD OF COMMISSIONERS, that the Harnett County Sheriff shall be and is hereby authorized and directed to take any such action as might be necessary and advisable to transfer the above-referenced vehicles to Central Carolina Community College, without consideration, pursuant to the provisions of North Carolina General Statute § 153-176. Duly adopted this the 7th day of October, 2013 County of Harnett ATIEST: Margaret Regina Wheeler, Clerk Harnett County Board of Commissioners Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: BARKETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Donation REQUESTED BY: SheriffRollins REQUEST: The Harnett County Sheriffs is requesting to accept the temporary donation a Mine Resistant Vehicle. After the vehicle is no longer required it will be returned to the Military Paperwork attached. COlJNTY MANAGER'S RECOMMENDATION: Page I or I ' C_ \tAC.;c) ], \... \c fn°;C. /' ~-- H\!T ERhf J\T'!ONt,L.® Max xPro\D The lr.te:::aber.al t.•laxxPro IYline Resisl<tnt.A.~-:b:Jsh Pro1u:;ted \•eh>:~c i~ bui:! to \\•ilhstand baltisi:C a1ms iirl::!. mi:-.e blts1~. IE)s, a·ld N~.:clear, Sio!oyical and Cbemiccl €Mir.:..,rre;-:ts ·.ha: tllre21en the safely oi !ls crew. Se've~~i s·i?.e .. ·ari~'ltS c:~O a····oC:1g :"a,;i':!ility a!iCY.-.· cus tomiLation and ~1pgrc:~es 10 achfE~l;€ thl::l' ::>Jrre:f.lo,·e~ of .o:ol~cl!c:-. taSl::!:': :n mission rt~uireu·enls. Navis la:'s proven -sa.,crc sen·ir.a ;.da.tfo·m r.uts ~uati:~·, <lurab:li:y and ra!tabili\y where you need it r:l..:sl-on t'lP. batl le6(;1::i. \\~E CCI8&$e Gtcun : Clc::!tantc A1~fe :J' App1ooch :'\rlglfl ci Jc~·f.-:i. ·e ~ 153" (30!Q :r:n) j !53' (3886 mrr.J '•1" (~~5 1111) (C611lct uf vl\"ttdc) 1'1'' (21~ lilM) (di"fe·::t~~i~l ::lc:xanoo) 42 ::egrees 147'(:;70Smm) 17' (43! nm) i«nlor cl >elide) 1 s.~·· :39? :r:r ,· (::.~eroof~l . clea rail ce) 461k~rees 53oe~rees C11(b Weight (GVM} i 37,6-!iQ ~s (17, 158 <;I F{•::ir·g Ol:pt1 . ~~.90l•lbs(1/,04Skp) ; ~.o~-: lbs (1S,L22 kg) 36' (~ !4.'1rr'O:· witt~·.lt pre::.;:J~Iitn : J7.2!1l lbs (l &.9!Q kg) ~ 47' (1•3?7 m•n:• \~il'!CUI !i'~P3'tJUCil I GVV'iR ~ 43,500 ·::Js tH. 131 <;;. : 53:1)00 i~s (24,001 kQ/· 4~.0:·: lbs (22.226 kgj 1 5!,5L'() lbs (n .3W kg) Ccnfigurelbl -~.rrir.g ~:i:c.G (:: <:.:• Pto!QC60Jl Le'.,.·e! 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IYf ne prdecticrr ~p&iab:cd ~ 'V'·shaped hull des:Sn prOie<:I.S ayeinst l':'li•:e/1!:0 .:il<rsls. · · • · shapcO h1.1ll desh:" prolcca ~aiMt · minP.!IED blasts:· OI<'!Cke»J! ligniSidiamctld lcgic~l!ice.l sys:en ~ 'I•J•bo iot~;-o:x:led, d:·cc: ;;tew:.-.1ic injoctioo, four stroke 9.~i_ {Si'C· ci) 4 x 1 7-\•o.'tbaltl:lri~ Alllsor 3200 SP!S·spe~d auto.n.:rtie 4 x 4 ty.~o-spee<:l r•JII air t:rak::s \'i'lt'l AIJS ,\!(..:!C6•,a;c:J. :tand·:>.::crated, rear :J~e brak~ ~ Hulth•:;sor, Ruflfl<rts ~! Cell SpiU1g · S~1gk: f>'rd . .o;!:n :;S5.'3S~?.O XZI. Fr~nt : Sinale M~hef..n 3i:•SJ8$R?O XZL f r{.(lt : Single M.::ht;lin jttiis5R21l XZL ... Frorl : gn.gle McfTelin 16.00R20 Xll · ooORea r ' Dt;t.: Go~yc~: 12'.00R20 G212 Rear McfReer : From anti Re<11 3. SHIP TO 2YTE43 9. PS ; II i I ~IUIIIIIIIIIIIIII ~ I m IIIII ~II illllllllllllllli Ill >~ w 2YTE4332411610 16. FREIGHTCLASSIFICATION NOMENCLATURE EHICLES: (ATV) SUBl 7 MINE RESISTANT VEHI 21. TOTAL CUBE ~ In 11111111111111 ~Iii IIIII i~l ~lllllli IIUIIIii IIIII~ ~iII 23. DATE RECEIVED ONW 2355015534634 : m I H I i I~ 11!11 ~li IIi IIi II~ IIUI~ ~~~~II~ 11111111111111111111~111111 ~~I ~ 0 go sz9 EA 00001 B saooooo llllllllllllllll Jllllllllllllllllllllilllllll H1WLC9T < -' '7 o..: " :i!t<:HCC MSG: .o ~ I I DT3242ITI2253 1lV9~YRD3205COC1 REC OCN: JON: SPI: DMIL: C HCC: CIIC: 7 TY CARGO MSG: SZ9A003 MFRDT EXPDT MSDS STOCK FUND BIN: DIC-PK: I I DSG: PCN: HlWLC9T SHiPPii\lG ADDRESS HARNETT COUNTY SHER~FF DEPT 1005 EDWARDS DRIVE ~t::.!,.~lv I C:.iJ D t; Sign/Date~~~~~~~ ·· Prlnt.~·~~~ ULUNGTON NC 27546 PULLED BY: Sign/Date.~~~~~-·· ~.-·.;..,;,11_· '3--· Print .. RECEIVED BY: EXCEPTION SHIPPING ADDRESS DO NOT SHIP CUSTOMER WILL ARRANGE FOR TRANSPORTATION. THIS ITEM IS DEM!l REQUIRED AND WilL BE RETURNED TO DLA DiSPOSITION SERVICES VIA lESO WHEN NO LONGER REQUIRED BY LEA Sign/Date ... . . ~, Prlr.t , > "'t£LC}-r, ).k"",~~ 13.1VCO Board Meeting Agenda Item MEETING DATE: September 16, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Reclassification REQUESTED BY: Sheriff Rollins REQUEST: Sheriff Rollins is requesting to reclass two vacant Fingerprint Technician positions to Detention Officer positions. The pay grade is the same for both classifications so no new money will be requested. Reclassification of these positions from civilian to sworn detention officers will assist the Sheriffs Office in scheduling of hours and qualify this position to back up and assist in Detention as needed. COUNTY MANAGER'S RECOMMENDATION: Page 1 or 1 Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Approval of Records Retention and Disposition Schedule REQUESTED BY: Kimberly S. Hargrove, Register of Deeds REQUEST: Local retention and disposition schedules are a tool for the employees oflocal governments across the state to use when managing the records in their offices. It lists records commonly found in local governmental offices, and gives an assessment of their value by indicating when (and if) those records should be destroyed. These schedules are an agreement between the local government office/department and the Department of Cultural Resources, and as the inventory and schedule that the Department of Cultural Resources is directed by G.S. §121-5 (c) and G.S. §132-8 to provide. These schedules must be approved by the governing board before you are permitted to destroy records according to the schedule. That approval should be made in a regular meeting and recorded as an action in the minutes. It may be done as part of the consent agenda, by resolution, or other action. A copy of the completed signature page should be sent to the Records Analysis Unit, Government Records Section, 4615 Mail Service Center, Raleigh, NC 27699-4615 or fax it to 919-715-3627. The Records Retention & Disposition Schedule for Register of Deeds was issued October 12, 2012 and an amendment was issued August 29,2013. Requesting approval ofboth. COUNTY MANAGER'S RECOMMENDATION: C: \U sers\khargrove\AppData\Local\Microsoft\ Windows\ Temporary Internet Files\Content. Outlook \6S54 YNA8\agendaform20 13. doc Page 1 of 1 From: Sent: NCARD <ncard@ncardlist.us> on behalf of Vincent, Tom <tom.vincent@NCDCR.GOV> Tuesday, September 10, 2013 12:51 PM To: ncard@NCARDUST.US Subject: [NCARD] Amendment to Register of Deeds Schedule Hi everyone, We've published an amendment to the County Register of Deeds Records Retention and Disposition Schedule. We did not change any program records (land records, vital records, etc.), these are all changes to standard personnel and ad min records we have to do across all schedules. The item for unclaimed property was changed due to a statutory change, and the other changes were to clarify some items. We have amended: 1. Changes retention period for Escheat and Unclaimed Property reports filed after July 2012 2. Clarifies language for retention period of employee eligibility records to match U.S. Code 3. Consolidates 3 different types of leave records The schedule amendment is available on our website here and needs to be approved by the Board of County Commissioners: http://www.ncdcr.gov/archives/ForGovernment/RetentionSchedules/LocaiSchedules.aspx Direct link to the .pdf: http://www.ncdcr.gov/Portals/26/PDF/schedules/Register of Deeds Amendment.pdf Please send a copy of the completed signature page to me via email, fax or U.S. mail. Let me know if you have any questions. Sincerley, Tom Vincent Supervisor, Records Analysis Unit N.C. Department of Cultural Resources 4615 Mail Service Center, Raleigh, NC 27699-4615 (919) 807-7364 (919) 715-3627 (fax) tom. vincent@ncdcr. gov ============~========================== The opinions expressed in this email may not be those of my agency. E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law "NCGS.Ch. 132" and may be disclosed to 1 Register of Deeds Records Retention Schedule Amendment Amending the Register of Deeds Records Retention and Disposition Schedule published October 10, 2012. STANDARD 2. BUDGET, FISCAL, AND PAYROll RECORDS Amending item 26 Escheat and Unclaimed Property File as shown on substitute page 17. STANDARD 5. PERSONNEL RECORDS Amending item 18 Employee Eligibility Records as shown on substitute page 39. Amending Items 36 Family Medical Leave Act (FMLA) Records, 45 Leave File, and 46 Leave Without Pay File as shown on substitute pages 45 and 47. APPROVAL RECOMMENDED ~1>.~ Register of Deeds -\j ~'2-~ Sarah E. Koonts, Director Division of Archives and Records APPROVED Chairman 4o~::}:~~.:\~ Board of County Commissioners Department of Cultural Resources August 29, 2013 County ITEM# 18. 19. 20. 21. 22. 23. 24. 25. 26. RECORD SERIES TITLE CREDIT CARD AND DEBIT SLIPS Records of payments received from customers in the transaction of county business. CREDIT CARD USE FILE OAIL Y CASH REPORTS Daily status of cash. Reports include receipts, disbursements, cash and invested balances. DAILY DETAIL REPORTS DEPOSITS DETAIL REPORT FILE (FINANCIAL RECORDS FOR GENERAL FUND OR GENERAL LEDGER) DIRECT DEPOSIT APPLICATIONS/AUTHORIZATIONS Includes related records such as bank account numbers and routing numbers. DISTRICT INVESTMENT RECORDS ESCHEAT AND UNCLAIMED PROPERTY FILE DISPOSITION INSTRUCTIONS Destroy in office after 3 years.* Destroy in office after 1 year.* Destroy in office after 1 year.* Destroy in office after 1 year.* a) Destroy in office official/audit copies after 3 years.* b) Destroy in office remaining records after 1 year. a) Destroy in office annual reports after 3 years.* b) Destroy in office all other reports after 1 year. Destroy in office when superseded or obsolete. Destroy in office after 3 years.* a) Destroy in office after 10 years if report was filed prior to July 16, 2012. * b) Destroy in office after 5 years if report was filed after July 16, 2012. * CITATION G.S. § 159-32 Comply with applicable confidentiality provisions of G.S. §132-l.lO(b)(S) regarding personal identifying information. Comply with applicable provisions of G.S. §116B-60 and §116B- 73. *Records may be disposed of following minimum retention period only if released from audits or other official action (excluding litigation). if applicable, see Litigation Case File, STANDARD-1. ADMINISTRATIONAND MANAGEMENT RECORDS, item30. **Records in this series that are more than 60 years old, or have severe conservation concerns, may be offered to the State Archives of North Carolina for Permanent transfer. t See signature page. The agency hereby agrees that it will establish and enforce internal policies setting minimum retention periods for the records that Cultural Resources has scheduled with the disposition instruction "destroy when administrative value ends." Please use the space provided. 17 ITEM# 17. 18. 19. 20. RECORD SERIES TITLE EMPLOYEE EDUCATIONAL ASSISTANCE PROGRAM RECORDS Includes records requesting tuition assistance, repayments, and other related records. See also PERSONNEL RECORDS (OFFICIAL COPY} item SO, page 48. EMPLOYEE ELIGIBILITY RECORDS Includes the United States Immigration and Naturalization Services, Employment Eligibility Verification {1-9) forms. EMPLOYEE EXIT INTERVIEW RECORDS See also PERSONNEL RECORDS (OFFICIAL COPY) item SO, page 48. EMPLOYEE HEALTH CERTIFICATES Includes health or physical examination reports, or certificates created in accordance with Title VII and the Americans with Disabilities Act (ADA). DISPOSITION INSTRUCTIONS Destroy in office 3 years after completion, denial, repayment, or removal from program.* a) Destroy in office certificates, 1-9 forms, and statements, 3 years after individual was hired or 1 year from date of separation, whichever occurs later. b) Destroy in office registers after 2 years. Destroy in office after 1 year. a) Transfer records as applicable to PERSONNEL RECORDS (OFFICIAL COPY} item SO, page 48. b) Destroy in office all other records 2 years after resolution of all actions. CITATION 8 usc 274a.2 29 CFR 1602.31 *Records may be disposed of following minimum retention period only if released from audits or other official action (excluding litigation). If applicable, see Litigation Case File, STANDARD-1. ADMIN!STRATIONAND MANAGEMENT RECORDS, item30. **Records in this series that are more than 60 years old, or have severe conservation concerns, may be offered to the State Archives of North Carolina for Permanent transfer. t See signature page. The agency hereby agrees that it will establish and enforce internal policies setting minimum retention periods for the records that Cultural Resources has scheduled with the disposition instruction "destroy when administrative value ends." Please use the space provided. 39 ITEM# 35. 36. 37. 38. RECORD SERIES TITLE EQUAL PAY RECORDS Includes reports, studies, aggregated or summarized data, and similar documentation compiled to comply with the Equal Pay Act. FAMILY MEDICAL LEAVE ACT (FMLA) RECORDS Records concerning leave taken, premium payments, employer notice, medical examinations considered in connection with personnel action, disputes with employees over FMLA and other related records. FRINGE BENEFITS FILE GRIEVANCE FILE Includes initial complaint, investigations, actions, summary, and disposition. May include disciplinary correspondence, including email. See also DISCIPLINARY FILE item 10, page 36 and PERSONNEL RECORDS (OFFICIAL COPY) item SO, page 48. DISPOSITION INSTRUCTIONS CITATION Destroy in office after 2 years. 29 CFR 1620.32 Item discontinued. See LEAVE FILE, item 45, page 47. Destroy in office when administrative value ends. t Agency Policy: Destroy in office after-------- Destroy in office after 2 years. *Records may be disposed of following minimum retention period only if released from audits or other official action (excluding litigation). If applicable, see Litigation Case File, STANDARD-1. ADM/N/STRATIONAND MANAGEMENT RECORDS, item30. **Records in this series that are more than 60 years old, or have severe conservation concerns, may be offered to the State Archives of North Carolina for Permanent transfer. t See signature page. The agency hereby agrees that it will establish and enforce internal policies setting minimum retention periods for the records that Cultural Resources has scheduled with the disposition instruction "destroy when administrative value ends." Please use the space provided. 45 ITEM# RECORD SERIES TITLE DISPOSITION INSTRUCTIONS CITATION 45. LEAVE FILE Records concerning employee leave, including requests for and approval of sick, vacation, overtime, buy-back, shared, donated, military, etc. Includes premium payments, employer notice, medical examinations considered in connection with personnel action, disputes with employees over the Family Medical Leave Act (FMLA), and other related records. Destroy in office 3 years after return of employee or termination of employment.* 29 CFR 825.110(b)(2)(i) 29 CFR 825.SOO(b) 46. 47. 48. 49. LEAVE WITHOUT PAY FILE LONGEVITY PAY REQUESTS MERIT AND SENIORITY SYSTEM RECORDS PERSONNEL ACTION NOTICES Records used to create or change information in the personnel records of individual employees concerning such issues as hiring, termination, transfer, pay grade, position or job title, name change and leave. Item discontinued. See LEAVE FILE, item 45, page 47. Destroy in office when released from all audits. a) Destroy in office employee-specific records after 3 years. b) Destroy in office system and plan records 1 year after no longer in effect. a) Transfer records as applicable to PERSONNEL RECORDS (OFFICIAL COPY) item 50, page 48. b) Destroy in office all remaining records 2 years from date record was created, received, or the personnel action involved. 29 CFR 1627.3 *Records moy be disposed of following minimum retention period only if released from audits or other official action (excluding litigation). If applicable, see Litigation Case File, STANDARD-1. ADMINISTRA TIONA NO MANAGEMENT RECORDS, item30. **Records in this series that are more than 60 years old, or have severe conservation concerns, may be offered to the State Archives of North Cora/ina for Permanent transfer. t See signature page. The agency hereby agrees that it will establish and enforce internal policies setting minimum retention periods for the records that Cultural Resources has scheduled with the disposition instruction "destroy when administrative value ends." Please use the space provided. 47 RECORDS RETENTION AND DISPOSITION SCHEDULE REGISTER OF DEEDS Issued By: North Ca r olina Department of Cultural Reso u rces Division of Archives and Records St ate Archives of North Caroli n a Government Records Branch October 10, 2012 CONTENTS EXECUTIVE SUMMARY .................................................................................................................................................. ii MANAGING PUBLIC RECORDS IN NORTH CAROLINA ................................................................................................. iii AUDITS, LITIGATION AND OTHER OFFICIAl ACTIONS ................................................................................................. vi DESTRUCTION OF PUBLIC RECORDS ........................................................................................................................... vii ElECTRONIC RECORDS: EMAil, BORN DIGITAl RECORDS, AND DIGITAl IMAGING ................................................ viii MICROFilM ................................................................................................................................................................... x DISASTER ASSISTANCE ................................................................................................................................................. xi STAFF TRAINING ........................................................................................................................................................... xi STANDARD·l. ADMINISTRATION AND MANAGEMENT RECORDS ............................................................................. ! STANDARD-2. BUDGET, FISCAl, AND PAYROll RECORDS ........................................................................................ 14 STANDARD-3. INFORMATION TECHNOlOGY (IT) RECORDS ..................................................................................... 23 STANDARD-4. lEGAl RECORDS .................................................................................................................................. 30 STANDARD-S. PERSONNEl RECORDS ........................................................................................................................ 34 STANDARD-G. PUBliC RELATIONS RECORDS ............................................................................................................. 53 STANDARD-7. PROGRAM OPERATIONAl RECORDS .................................................................................................. 55 REQUEST FORMS ......................................................................................................................................................... 72 INDEX .......................................................................................................................................................................... 76 Register of Deeds Records Retention and Disposition Schedule The records retention and disposition schedule and retention periods governing the records series listed herein are hereby approved, In accordance with the provision of Chapters 121 aod 132 of the General Statutes of North Carolina, it is agreed that the records do not and wlll not have further use or value for official business, research, or reference purposes after the respective retention periods specified herein and are authorized to be destroyed or otherwise disposed of by the agency or official having custody of them without further reference to or approval of either party to this agreement. However, records §ubject to audit or those legally required for ongoing official proceedings must be retained until released from such audits or official proceedings, notwithstanding the instructions of this schedule. Public records including electronic records not listed in this schedule are not authorized to be destroyed. This local government agency and the Department of Cultural Resources agree that certain records series possess only brief administrative, fiscal, legal, research, and reference value. These records series have been designated by retention periods which allow these records to be destroyed when "administrative value ends." The local government agency hereby agrees that it will establish and enforce internal policies setting minimum retention periods for the records that Cultural Resources has scheduled with the disposition instruction "destroy when administrative value ends." If an office does not establish internal policies and retention periods, the office is not complying with the provisions of this retention schedule and is not authorized by the Department of Cultural Resources to destroy the records with the disposition instruction "destroy when administrative value ends." It Is further agreed that these records may not be destroyed prior to the time periods stated; however, for sufficient reason they may be retained for longer periods. This schedule ls to remain in effect from the date of approval until it is reviewed and updated. APPROVAl RECOMMEN:J J~~.~ Sara~~e:to~ APPROVED Chairman Board of County Commissioners October 10, 2012 Division of Archives and Records in'da A. Carlisle;secretary Department of Cultural Resources Name of County EXECUTIVE SUMMARY ./ According to G.S. §121-5 and G.S. §132-3, you may only destroy public records with the consent of the Department of Cultural Resources (OCR). The State Archives of North Carolina is the division of OCR charged with administering a records management program. This schedule is the primary way the State Archives of North Carolina gives its consent. Without approving this schedule, your agency is obligated to obtain the State Archives of North Carolina's permission to destroy any record, no matter how insignificant . ./ Each record series listed on this schedule has specific disposition instructions which will indicate how long that series must be kept in your offices. In some cases, the disposition instructions are simply "Retain in office permanently," which means that those records must be kept in your offices forever. In other cases, the retention period may be "destroy in office when administrative value ends.~~ Administrative value is defined as, "the usefulness of records to support ancillary operations and the routine management of an organization." Your agency must establish and enforce internal policies by setting minimum retention periods for the records that the State Archives of North Carolina has scheduled with the disposition instructions, "destroy when administrative value ends." ./ Email is a record as defined by G.S. §121-5 and G.S. §132. It is the content of the email that is critical when determining the retention period of a particular email, including attachments not the media in which the records were created. Email should be retained in the same manner as its paper counterpart. It is important for all agency employees and officials to determine the appropriate record series for specific emails and retain them according to the disposition instructions . ./ The State Archives of North Carolina recommends that all county employees and officials take our online tutorials in order to familiarize themselves with records management principles and practices. The State Archives of North Carolina's online tutorials include topics such as records management, utilizing the retention schedule, email management, and scanning guidelines . ./ The State Archives of North Carolina provides microfilming of the minutes of major decision-making boards and commissions. The State Archives will also microfilm Plats for the register of deeds. Once those records are filmed, we will store the silver negative (original) in our security vault . ./ There is a nominal fee for filming and duplicating film. Contact the Records Management Analyst assigned to your county for the most current information. ii Agenda Item __ L{..r;___---=-1\1....:::... __ CAROLINA LAKES PROPERTY OWNERS' ASSOCIATION 91 Clubhouse Drive, Sanford NC 27332 September 25,2013 Mr. Tommy Bums Harnett County Manager 102 E. Front Street Lillington, NC 27546 Dear Mr. Burns, www .carolinalakes.info On behalf of the Carolina Lakes Board of Directors we respectfully request our County Commissioners review and authorize a speed limit modification that incorporates all bus stop locations within our community. Background: In accordance with General Assembly ofNorth Carolina, Session Law 2005-260, House Bill601 (attached): Section 3 " ... any proposed change in the speed limit shall be submitted to and approved by the Board of Commissioners of Harnett County, Pursuant to G.S. 20-141, the Harnett County Board of Commissioners may authorize by ordinance higher or lower speeds". Summary: The modified community code incorporates "all" school bus stop areas ·within Carolina Lakes (marina, clubhouse, and any future approved locations). Old Language Community Code 11.1.1 The speed limit in front of the marina during school bus hours of 6:45AM-8:00AM and 3:00PM-4:15PM is 15 mph. Speed limit is to be enforced Monday through Friday during the current school year and does not include holidays or summer months. Class C violation. New Language Motion to modify Community Code 11.1.1 Traffic and Vehicles. 11.1.1 The speed limit in all school bus stop areas in Carolina Lakes during school bus hours from 6:45 AM-8:00 AM and 3:00 PM-4: 15 PM is 15 mph. This also includes any time and days that school buses come into Carolina Lakes. Speed limit is to be enforced Monday through Friday during the current school year and does not include holidays or summer months. Class C violation. Roll call vote: Passed unanimously on 09/19/2013. Your help is greatly appreciated and please do not hesitate to contact me directly at 919 418-3 795 with any questions or concerns. Thank you. Best Regards, 'Uiaftett tJum Community Manager GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2005 SESSION LAW 2005-260 BOUSE BILL 601 AN ACT TO PROVIDE TIIAT Tiffi LAWS RELATING TO MOTOR VEIDCLES APPLY ON THE STREETS OWNED BY THE CAROLINA LAKES PROPERTY OWNERS' ASSOCIATION IN HARNETT COUNTY. The General Assembly of North Carolina enacts: SECTION 1. With the exception of any provisions prohibiting or regulating the operation of private golf carts, all-terrain vehicles, off-road motorcycles, and go-carts, the provisions of Chapter 20 of the General Statutes relating to the use of the highways of the State and the operation of motor vehicles are applicable to the streets, roadways, and alleys on the properties owned by or under the control of the Carolina Lakes Property Owners' Assoctation, Inc., or the members of the Carolina Lakes Property Owners' Association, Inc. For purposes of this act, streets, roadways, and alleys in the Carolina Lakes Community shall have the same meaning as highways and public vehicular areas pursuant to G.S. 204.01. SECTION 2. This section is enforceable by any law enforcement officer acting within his territorial jurisdiction. SECTION 3. This act shall not be construed as in any way interfering with the ownership and control of the streets, roadways, and alleys of the Carolina Lakes Property Owners' Association, Inc., or its members as is now vested by law in that association or its members. The speed limits within the Carolina Lakes Community shall be the same as those in effect at the time of ratification of this act. Any proposed change in the speed limit shall be submitted to and approved by the Board of Commissioners of Harnett County. Pursuant to G.S. 20-141, the Harnett County Board of Commissioners may authorize by ordinance higher or lower speeds. SECTION 4. This act applies to Harnett County only. SECTION 5. This act is effective when it becomes law. In the General Assembly read three times and ratified this the lith day of August, 2005. s/ Beverly E. Perdue President of the Senate s/ James B. Black Speaker of the House of Representatives Gina Wheeler From: Sent: To: Cc: Subject: Attachments: Mr. Burns, Grim, Walter <wgrim@talismgmt.com> Wednesday, September 25, 2013 1:32 PM Tommy Burns Tony Wilder; Gina Wheeler Agenda Item -Carolina Lakes Speed Limit Change Harnett County Agenda Item Request -September 25, 2013.pdf; House Bill 601 - Session 2005-260.pdf Carolina Lakes Property Owners Association respectfully requests an agenda item be presented to our commissioners for review and approval. The formal request is attached along with HB601; the mandate requiring Harnett County Commissioners approval. Please contact me soonest if further information is required. Thank you. Best Regards, Walter Grim Community Manager 919 418-3795 1 Gina Wheeler From: Sent: To: Cc: Subject: Attachments: Tommy, Grim, Walter <wgrim@talismgmt.com> Wednesday, September 25, 2013 8:15 PM Tommy Burns Tony Wilder; Gina Wheeler; Jennifer Slusser RE: Agenda Item -Carolina Lakes Speed Limit Change 2013_09 _19 _ Cl_BOARD _MEETING_MIN UTES.pdf Relevant minutes attached--unfinished business; motion passed u,nanimously. If the minutes must be approved & signed .. .! will initiate an action without meeting in lieu of waiting until the next monthly board meeting to do so. Please advise. Thank you. Best Regards, Walter -----Original Message----- From: Tommy Burns [mailto:tburns@harnett.org] Sent: Wednesday, September 25, 2013 7:16 PM To: Grim, Walter Cc: Tony Wilder; Gina Wheeler; Jennifer Slusser Subject: Re: Agenda Item -Carolina lakes Speed Limit Change Walter Please provide a copy of the relevant property owners minutes where the association voted to formally request this action by the board of commissioners. Sent from my iPhone On Sep 25, 2013, at 1:33 PM, "Grim, Walter" <wgrim@talismgmt.com> wrote: >Mr. Burns, >Carolina Lakes Property Owners Association respectfully requests an agenda item be presented to our commissioners for review and approval. The formal request is attached along with HB601; the mandate requiring Harnett County Commissioners approval. Please contact me soonest if further information is required. Thank you. >Best Regards, >Walter Grim >Community Manager > 919 418-3795 > ><Harnett County Agenda Item Request September 25, 2013.pdf> <House > Bill 601-Session 2005-260.pdf> 1 CAROLINA LAKES PROPERTY OWNERS' ASSOCIATION 91 Clubhouse Drive Sanford, North Carolina 27332 Phone: (919) 499-9122 Fax: (919) 499-4048 Present: Allen Truhan, Larry Wojcik, John Hausfeld, Paul Russell, Art McRoberts, Lori Jones, Paul Volpe, and Walter Grim; Community Manager. The meeting of the Carolina Lakes Property Owners' Association Board of Directo President Allen Truhan on September 19, 2013 at 7:30pm in the Carolina L OPENING REMARKS President Allen Truhan verified a quorum, followed by the pledge of MINUTES Larry Wojcik motioned to approve the August 15, 2013 board Roll call vote: Passed unanimously. TREASURER'S REPORT See attached. MANAGEMENT REPORT See attached. UNFINISHED BUSINESS 1 -Traffic and Vehicles. arolina Lakes during school bus hours IS 15 mph. This also includes any time and Speed limit is to be enforced Monday through not include holidays or summer months. nanimously. rder by nal approval required. In accordance with General Assembly of 60, House Bill601: " ... any proposed change in the speed limit shall be Board of Commissioners of Harnett County, Pursuant to G.S. 20-141, om missioners may authorize by ordinance higher or lower speeds ... ". int Richard Varela to the Lakes and Dams committee. ed unanimously. (b) Motion to approve Diamond Constructors, Inc., to complete road line striping for: The entire length of Coachman Way (single yellow centerline with white edge line) and Carolina Way (with double yellow centerline with white edge line) from Coachman Way past the marina parking lot up to where the road splits. Total cost is $9,988.43 to be funded from 2013 operational budget line item 53512. Roll call vote: Passed unanimously. (c) Motion to modify Community Code-Section 12 NSRVs: As of September 20, 2013, only golf carts will be allowed to operate on Carolina Lakes roads. The one exception: On school days only, school children may use NSRVs on Carolina Lakes roads to travel directly from their residence to an official Carolina Lakes designated bus stop location and return directly back to their residence only. No NSRVs of any type can be operated off-road on Carolina Lakes common land. (An NSRV is any powered vehicle not requiring state registration such as ATVs, go karts, mini-bikes, and the like.) Class A violation. Larry Wojcik motioned to table1 Lori Jones seconded-roll call vote: Passed (Yes-Paul Volpe, John Hausfeld, Larry Wojcik1 Lori Jones) (No-Paul Russell and Art McRoberts). Tabled. COMMIITEE REPORTS 7.1) Architectural-Larry Wojcik: No new homes under construction this month. new construction slows down our road reserve fund revenue of $3,000 per hognedi notify the POA office if you observer anything that appears to be "not in c "liance wi rules". 7.2) Buildings1 Grounds-Art McRoberts: Water drainage complaints mind the POA is only responsible for common grounds. During ' board member-a concern that many property addresses are n delay for first responders. 7 .3) Community Affairs-Vacant: Halloween Costume R 2013. If you're interested in helping out please rnr,t::11-t clrun@carolinalakes.info 7.4) Lakes and Dams-Paul Volpe: *''~lease keep in taming R&R is may cause a -Buoy's-we have four volunteers to -Committee members are now trained completion date is 09/30/13. ate "all" our lake valves-in lieu of dependent on a single individual. -Lake Rules-posted at the b complying with the no wake zone 7 .5) R and R-Vacant: 7 .6) Roads-Vac;;ui't: No re :y~;;;, ity of complaints continue to be speeding and not shoreline. 7.7) Securi .• -So far t~,~~ appears to· dal'i§~ in our community is extremely low; please report anything that to either our Security Guards 919 499-4617 or 911. 7.8 -Johni'Fiausf~l<:k · Appr -If your www.caroli ately 3,0po Carolina Lakes registered vehicles are now using the RFID system. e ~hat's going on around our community please register on our new website at es:info. This forum is to help ensure accurate and seamless communication. 7.9) Recreation-Allen Truhan: Pool closed-September 9, 2013; another very successful and safe season. 7 .10) Judicial -No Report Firewise-Community Firewise Day is scheduled for Sunday, October 13, 2013. 8.) Administer Oath of Office for newly appoint Board Members: Allison Davenport Community Affairs; Joy Crowe Secretary; Elaine Robinson R&Rs; William Crocker Roads. Open Forum -POA President Allen Truhan clarified that all POA "Common Ground" property belongs to the POA exclusively. Furthermore, no individual or group has authority or legal rights to claim any POA Common Ground as their own or for personal use. -Ongoing discussion concern ATV 1 NSRVs (motion was tabled). -Concerns about Halloween Fun Run being opened to the public. Inquiry about status of on-line voting; John Hausfeld (IT Chair) responded-committee is still researching all viable options and services available. -Nelson Edwards briefed the status of our geese population (Federal Permit Program). Status: original geese population in Carolina Lakes 225; current population 24. Nels committee members go out every year between March and June to help ensure This past year was difficult because the lower lake level prevented access to ce -Community Watch Program-Please login into Carolinalakes.info to share an in Carolina Lakes. -School Bus stop concerns: speeding, lack of volunteers, security and enforcement-all discussed. Paul Russell motioned to adjourn the meeting, Art McRoberts s Respectfully submitted and approved by the CLPOA Boar Allen Truhan President Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Project Ordinance-Jetport State Aid of Upgrade to A WOS and Installation REQUESTED BY: Barry Blevins REQUEST: General Services request the Board of Commissioners consider adopting the project ordinance that allocates necessary funds to pay for the upgrade of the Automated Weather Observation Systems(AWOS) at the Harnett County Jetport. The upgrade cost will be reimbursed by the North Carolina State Department of Transportation/Division of Aviation by 90% with the County contributing 10%. COUNTY MANAGER'S RECOMMENDATION: Page 1 ofl PROJECT ORDINANCE Harnett County Regional Jetport State Aid To Airports for Upgrading the Automated Weather Observation System (A WOS) and Installation BE IT ORDAINED by the Board of Commissioners ofHarnett County; North Carolina, sitting as the governing board for Harnett County. Section I: Section II: The County of Harnett desires to upgrade the Automated Weather Observation System at the Harnett County Jetport. The County of Harnett will receive a 90% federally funded grant under the Federal Aviation Century of Flight Authorization Act (Vision 1 00). Harnett County local match is a 1 0% contribution. The upgrade costs will be reimbursed by North Carolina Department of Transportation, Division of Aviation. The following amounts are hereby appropriated for this project: State Block Grant Non-Primary Entitlement County Contribution Total $ 22,127 2,459 $ 24,586 Section III: It is estimated that the following revenues will be available for the startup of this project: North Carolina Department of Transportation $ 22,127 Division of Aviation Interfund Transfer (110-8701-490-90.28) $ 2,459 Duly adopted this 7th day of October 2013. Jim Burgin, Chairman Harnett County Board of Commissioners ATTEST: Margaret Regina Wheeler, Clerk to the Board BLOCK GRANT AGREEMENT NON PRIMARY ENTITLEMENT FUNDING STATE AID TO AIRPORTS BLOCK GRANT BETWEEN AIRPORT: HAR..;~ETT REGIO~AL JETPORT THEN. C. DEPARTMENT OF TRANSPORTATION, AN AGENCY OF THE STATE OF NORTH CAROLINA AND PROJECT NO: 36237.25.12.4 HARNETT COUNTY THIS AGREEMENT made and entered into this the --------'by and between the NORTH CAROLINA DEPARTMENT OF TRANSPORTATION (hereinafter referred to as "Department") and HARNETT COUNTY, the owners of the HARNETT REGIONAL JETPORT (hereinafter referred to as "Sponsor"). WITNESSETH WHEREAS, Chapter 63 of the North Carolina General Statutes authorizes the Department to administer a program of State Aid to Airports, subject to the limitations stated in that Chapter; and WHEREAS, the Department has received the approval of the Federal Aviation Administration to administer certain Airport Improvement Program Funds in North Carolina under the provisions of the FAA Modernization and Reform Act of 20/2;and WHEREAS, the Department has approved a grant of funds to the Sponsor under the State Block Grant Program Non Primary Entitlement funds. NOW THEREFORE, the Department and the Sponsor do hereby mutually agree as follows: 1) That the approved scope of this project shall consist of: AWOS UPGRADE & INSTALLATION 2) That the Grant of funds shall include maximum funding obligations for federal funds which shall be: State Block Grant NPE Program: $22,127 (not to exceed 90% of the final total costs) 3) That the funding obligations referenced in (2) above shall be the maximum obligations based on the final cost of eligible work items in the approved project, as certified by the Sponsor 4) That the Sponsor shall promptly undertake the Project and complete all work on the Project no later than JULY 1, 2014, unless a written extension of time is granted by the Department. DOA FORM { 12/1 0) 5) That all work perfonned on the Project shall confonn to the approved scope of work referenced in this Agreement. Any amendments or modifications to the approved scope of work, approved grant amounts, or this Agreement shall not be authorized by the Department unless they are contained in a written modification to this Agreement and fully executed by both the Sponsor and the Department. 6) Debannent and Suspension: The Grantee agrees to comply, and assures the compliance by each of its third party contractors and subrecipients at any tier, with the provisions of Executive Orders Nos. 12549 and 12689, "Debannent and Suspension," 31 U.S.C. § 6101 note, and U.S. DOT regulations on Debannent and Suspension at 49 C.F.R. Part 29. 7) The Sponsor certifies that it has adhered to all applicable laws, regulations, and procedures in the application for and Sponsor's approval of this Grant. 8) For a material breach of this Agreement or the Sponsor's Assurances, the Sponsor shall be liable to the Department for the return of all grant monies received. 9) The Sponsor agrees to adhere to the standards and procedures contained in the State Aid to Airports Program Guidance Handbook (third edition, dated January 1997), unless the Department issues a written waiver to the contrary. 1 O) The Sponsor agrees to adhere to and be bound by the Grant Assurances of the Federal Aviation Administration, said Grant Assurances contained in Appendix I of this Grant Agreement. Further, the Sponsor agrees that it shall be responsible to the Federal Aviation Administration, or its designated agent, for enforcement of such Grant Assurances including any penalties, sanctions, or other actions which may be legally enforceable for lack of compliance with said Grant Assurances. 11) The Sponsor agrees to comply with the "Sponsor Assurances" contained as part of this Agreement. 12) N.C.G.S. § 133-32 and Executive Order 24 prohibit the offer to, or acceptance by, any State Employee of any gift from anyone with a contract with the State, or from any person seeking to do business with the State. By execution of any response in this grant agreement, you attest, for your entire organization and its employees or agents that you are not aware that any such gift has been offered, accepted, or promised by any employees of your organization. DOA FORM (12/10) Page 2 of 11 IN WITNESS WHEREOF, THE PARTIES HERETO EXECUTED THIS GRANT AGREEMENT THE DAY AND YEAR FIRST WRITTEN ABOVE: NORTH CAROLINA DEPARTMENT OF TRANSPORTATION: NCDOTSEAL BY: ----------------------------------- Deputy Secretary for Transit ATTEST: ------------------------------ SPONSOR: SIGNED: ______________________________ __ TITLE: ________________________________ __ SPONSOR SEAL ATTEST: ______________________________ __ STATE OF NORTH CAROLINA, COUNTY OF '-----------------------------~ a Notary Public in and for the County and State aforesaid, do hereby certifY came before me this day and acknowledged that he is---------------------------of the------------------------------- (Title) (Sponsor) (hereinafter referred to as "Sponsor" and by authority duly given and as an act of said Sponsor, the foregoing instrument was signed by him, attested by-------------------------------------· (Name and Title) Seal of the Sponsor affixed hereto. WITNESS my hand and Notarial Seal, this the _____ day My Commission DOA FORM (12/10) Page 3 of 11 Notary Public (Signature) SEAL Sponsor, and the RESOLUTION A motion was made by-------------------------and seconded by (Name and Title) (N arne and Title) being put to a vote was duly accepted: the adoption of the following resolution, and upon WHEREAS, a Grant in the amount of$22,127 has been approved by the Department based on total estimated cost of $24,586; and WHEREAS, an amount equal to or greater than ten percent (10%) of the total estimated project cost has been appropriated by the Sponsor for this Project. NOW THEREFORE, BE AND IT IS RESOLVED THAT THE-~~-~--_,, ______ _ (Title) of the Sponsor be and he hereby is authorized and empowered to enter into a Grant Agreement with the Department, thereby binding the Sponsor to the fulfillment of its obligation incurred under this Grant Agreement or any mutually agreed upon modification thereof. ''------------------------------------------------------ofthe (Name and Title) hereby certifY that (Sponsor) the above is a true and correct copy of an excerpt from the minutes of the of a meeting (Sponsor) duly and regularly held on the ___ day This, the ____ day SPONSOR SEAL Signed: Title: OfThe: _______________ _ DOA FORM (121! 0) Page 4 of 11 SECTION A: SPONSOR'S ASSURANCES: GENERAL CONDITIONS A-1. The Sponsor certifies that it holds fee simple title to the property on which this project is to be constructed. In the event any work is proposed on property which has an easement or lease in the Sponsor's name, the Sponsor agrees that it will comply with the Department's conditions and receive written approval prior to any construction on such lease or easements. This condition does not apply to planning projects. A-2. The Sponsor agrees to operate the Airport for the use and benefit of the general public and shall not deny reasonable access to public facilities by the general public. A-3. The Sponsor agrees to operate, maintain, and control the Airport in a safe and serviceable condition for a minimum of twenty (20) years following the date of this Agreement and shall immediately undertake, or cause to be undertaken, such action to correct safety deficiencies as may be brought to its attention by the Department. A-4. The Sponsor agrees that any land purchased, facilities constructed, or equipment acquired under this Agreement shall not be sold, swapped, leased or otherwise transferred from the control of the Sponsor without written concurrence of the Department. A-5. The Sponsor agrees that the state share of any land purchased, facilities constructed, or equipment acquired under this Agreement shall be credited to the Department in a manner acceptable to the Department in the event such land, facilities or equipment are subsequently disposed of through sale or lease. A-6. Insofar as it is within its power and reasonable, the Sponsor shall, either by the acquisition and retention of property interest, in fee or easement, or by appropriate local zoning action, prevent the construction of any object which may constitute an obstruction to air navigation under the appropriate category of Federal Air Regulation Part 77, 14 CFR 77. A-7. Insofar as it is within its power and reasonable, the Sponsor shall, restrict the use of land adjacent to or in the immediate vicinity of the airport to activities and purposes compatible with normal airport operations, including landing and taking off of aircraft and the noise produced by such operations by adoption of zoning laws, by acquisition and the retention of property interest, in fee or easement. A-8. Terminal building spaces constructed under this Grant Agreement shall be for the use of the general public. The Sponsor agrees that it will not use any space so constructed for private use, or charge fees for the use of such space, without the written approval of the Department. Page 5 of 11 SECTION B: SPONSOR'S ASSURANCES: PROJECT ADMINISTRATION B-1. The Airport shall comply with all requirements of the State Aid to Airports Program Guidance Handbook (third edition, January 1997). B-2. It is the policy of this State, to encourage and promote participation by disadvantaged minority owned and women owned businesses (MBE and WBE) in contracts let by the Department pursuant to OS 136-28.4 for the planning, design, preconstruction, construction, alteration, or maintenance of State transportation infrastructure construction, and in the procurement of materials for these projects. All State agencies, institutions, and political subdivisions shall cooperate with the Department of Transportation and among themselves in all efforts to conduct outreach and to encourage and promote the use of disadvantaged minority owned and women owned businesses in these contracts. This is designed to ensure minority MBEs and WBEs have maximum opportunity to participate in performance of NCDOT contracts Jet using state funding. The sponsor assures and certifies with respect to this grant that they will pursue these requirements as stipulated by the Department in the advertising, award and administration of all contracts, and require the same for all contractors, sub recipient or subcontractors. MBE\WBE program is governed by G.S. 136-28.4 and administered in accordance with Title 19A Chapter 02 SubChapter D Section .1101-.1112 ofNorth Carolina Administrative Code (19A NCAC 020.1101). B-3. The Sponsor shall submit draft plans and specifications. or approved alternate, for the project for review by the Department prior to advertising for bids on the Project Should bids not be required on the project, the Sponsor shall submit a detailed scope of work and estimated costs prior to requesting "Project Concurrence and Notice to Proceed" form (A V-CONCUR/AV-503) for undertaking the project. All plans (and alternate) shall be supported by engineer's report. A list of deliverable(s) from the Sponsor to the Department is as follows: Planning Projects 1. Interim Planning Submittals -All Airport Layout Plan Sheets, Reports, Projections, Construction Cost Estimate, drawings, sketches and all other pertinent information -electronic copy: PDF format Paper copy, if requested: bond copy true half-size. 2. Final Submittal -All Airport Layout Plan Sheets, Reports, Projections, Construction Cost Estimate, drawings, sketches and all other pertinent information electronic copies: PDF format and AutoCAD or MicroStation format-Paper copy: bond-true half-size for plan sheets I sketches a. All reports, projections PDF Format Any element of the documents shall be delivered in its original electronic format (i.e. MSWord, Excel, AutoCAD ... ) if requested by the Department b. Sketches and drawings -electronic copies: PDF format and AutoCAD or MicroStation format - Paper copy: bond true half-size for plan sheets I sketches. Page 6 of II Construction Projects 1. Interim Design Submittals (i.e. 30%, 60%, 90% .... ) -Plan Sheets, Technical Specifications, Itemized Construction Cost Estimate and Engineers Report-electronic copy: PDF format. Paper copy, if requested: bond true half-size for plan sheets. 2. 100% Design and Issue for Bid Submittals Plan Sheets, Technical Specifications, Itemized Construction Cost Estimate, Engineer's Report, and Bid Tab -Any element of the documents shall be delivered in electronic format (i.e. MS Excel and PDF format) and AutoCAD or MicroStation fonnat and Paper copy: bond-true half-size for plan sheets. 3. As-built I Record Drawings a. Contract Documents (Plan and Detail Sheets, Technical Specifications) -electronic copies: PDF format and AutoCAD or MicroStation format and Paper copy: bond-true half-size for plan sheets. b. Technical Specifications electronic copies: MS Word File and PDF format c. Final Engineers Report-electronic copies: PDF format unless otherwise requested. B-4. Bids will be taken in accordance with N. C. General Statute 143-129. Following bid opening or final contract negotiations, the Sponsor shall submit the "Project Concurrence and Notice to Proceed" (AV-CONCUR!AV-503) request along with the bid tabulations to the Department for review. The Department will take action on the request including the approval or disapproval ofthe Sponsor's Employment of specific contractors within ten (10) days of receipt. Approval will be communicated via a Contract Goal Requirements Letter sent directly to the Sponsor. B-5. All contractor(s) who bid or submit proposals for contracts in connection with this project must submit a statement of non-collusion to the Sponsor. B-6. The Sponsor shall not commence construction or award construction contracts on the project until a written "Project Concurrence and Notice to Proceed" (AV-CONCUR/AV-503) is co-signed by the Sponsor's Representative and the Department or alternate written approval is provided by the Department. B-7. The Sponsor shall submit quarterly status reports (AV-STATUS/AV-502) to the Department, unless otherwise instructed, and will immediately notifY the Department of any significant problems which are encountered in the completion of the project. B-8. The Sponsor shall notifY the Department of any significant meetings or inspections involving the Sponsor, his contractor(s), consultant(s), and/or federal funding agencies concerning Project. B-9. The Sponsor shall notifY the Department within thirty (30) days of completion of all work performed under this agreement for the purpose of final acceptance inspection and completion of audit requirements by the Department Page 7 of 11 B-10. The Sponsor has full responsibility for assuring the completed Project meets the requirements of the Department and appropriate federal funding agencies. The Sponsor further certifies that all local, state, and federal requirements for the conduct of this Project shall be met. B-1 1. It is the policy of the Department not to award contracts to contractors who have been removed from the Department's list of pre-qualified bidders without subsequent reinstatement. Therefore, no State funds will be provided for any work performed by the contractor(s), or sub-contractor(s) which had been removed from the Department's list of pre- qualified bidders without subsequent reinstatement as of the date of the signing of the construction contract. It shall be the responsibility of Sponsor to insure that only properly qualified contractors are given construction contracts for work. SECTION C: SPONSOR'S ASSURANCES: PROJECT ACCOUNTING AND PAYMENT C-1. The Sponsor shall record all funds received under this Agreement and shall keep the same in an identifiable Project account. The Sponsor, and his contractor(s) and/or consultant(s), shall maintain adequate records and documentation to support all Project costs incurred under this Grant. All records and documentation in support of the Project costs must be identifiable as relating to the Project and must be acceptable costs only. Acceptable costs are defined as those costs which are acceptable under "Federal Acquisition Regulations 1-31.6, 48 CFR (OMC Circular A-87)". Acceptable items of work are those referenced in the State Aid to Airports Program Guidance Handbook and North Carolina General Statutes. The Sponsor's accounting procedures which were established for work as set out in this Agreement must be reviewed and accepted by the Department prior to the final execution of this Agreement and payment of State funds, except for Sponsor reporting under OMB Circular A-133. C-2. The Sponsor and his contractor(s) and/or consultant(s) shall permit free access to its accounts and records by official representatives ofthe State ofNorth Carolina. Furthermore, the Sponsor and contractor(s) and/or consultant(s) shall maintain all pertinent records and documentation for a period of not less than five {5) years from the date of final payment. C-3. In accordance with OMB Circular A-133, "Audits of States, Local Governments and Non-Profit Organizations" (w\vw.whitehouse.gov/wh/eop/omb), the Airport shall arrange for an independent financial and compliance audit of its fiscal operations. The Airport shall furnish the Department with a copy of the independent audit report within thirty (30) days of completion of the report, but not later than nine (9) months after the Airports fiscal year ends. The Airport shall maintain all books, documents, papers, accounting records, and such other evidence as may be appropriate to substantiate costs incurred under this Agreement. Further, the Airport shall make such materials available at its office at all reasonable times during the contract period, and for five (5) years from the date of final payment under this agreement, for inspection and audit by the Department's Fiscal Section Page 8 of 11 C-4. Payment of the funds obligated under this Grant Agreement shall be made in accordance with the following schedule, unless otherwise authorized by the Department: A. Payments from NCDOT to the Sponsor are made on a reimbursement basis. The Sponsor must pay all contractorsivendors prior to or within 3 business days of receipt of the Department's reimbursement. B. Payments will be made on the basis of progress payments which may be requested by the Sponsor as costs are incurred, but not more frequently than monthly. Progress payments will be made provided the following requirements have been met.: (I) The Grant Agreement has been executed and a Project Concurrence (AV-CONCUR/AV-503) issued. (2) The Project has received an appropriate environmental finding. (3) The Sponsor has submitted a Proposed Project Budget (AV-BUDGET/AV-504) accurately reflecting costs to date. The initial and revised AV-BUDGETIAV-504 shall be approved by the Department. With each AV-BUDGET/AV- 504, the Sponsor shall provide the following documentation: a) Scope of Services for the project, Consultant Fee Man-hours Breakdown by task with hourly rates, Breakdown of Sub-consultant and I or Vendor Cost, Schedule of Deliverables, Estimated Construction Cost, Plan Sheet List b) Actual Bidding Cost (once a project is bid) -Bid Tabulation I Bid Schedule, Recommendation for Award. (4) Additional information shall be provided as requested. (5) The Sponsor has submitted an executed Interim Payment Request (A V -PAY I A V -505) accurately reflecting costs incurred to date. (6) The Sponsor has complied with all applicable conditions of the State Aid to Airports Program Guidance Handbook C. The submission of progress payments is expected to parallel the value of work actually completed and costs incurred. At such point the Sponsor has requested payments equaling I 00% of the State Grant, it is expected that the approved Project will be 100% complete. D. Upon receipt of 100% of the State Grant, the Sponsor will promptly complete Project acceptance and submit the Project Completion and Final Payment Request (A V-FINALIA V -506). C-5. If after the acceptance of the Project by the Department, the final State share of approved eligible items is less than the amount of State funds actually disbursed for the Project, the Sponsor shall reimburse the Department in an amount equal to the difference between the amount of State funds actually disbursed and the final State share of the final, audited, approved eligible Project costs within thirty (30) days of notification by the Department of the amount due. Page 9 of 11 C-6. If after the acceptance of the Project by the Department, the final State share of approved eligible Project costs shall be more than the amount of State funds obligated for the Project, the Sponsor may make application to the Department for a corresponding increase which will be considered for funding in accordance with their relative priority versus other applications for available State funds. C-7. Under certain conditions, projects originally involving only state and local funds may subsequently be eligible for reimbursement from federal funding agencies. In such cases, the Sponsor shall notifY the Department of its intent to apply for federal reimbursement and shall keep the Department informed of the status of such application. In the event federal funds are obtained for all or a portion of the Project, the Sponsor shall refund to the Department an amount equal to the difference between State funds originally disbursed for the work item(s) subsequently receiving federal funds and the final State share of the costs of the affected item(s) of work. Reimbursement will be made within ninety (90) days of the date of the final execution of the FAA Grant Agreement affecting the work elements in the approved Project. C-8. For the purpose of calculating the State share of the Project, federal funds are defined as funds provided by an agency of the federal government for the specific purpose of undertaking the Project, including Block Grant funds administered by the Department. SECTION D: SPONSOR'S ASSURANCES: REAL PROPERTY ACQUISITION D-1. The acquisition of land, buildings, and other real property involving the use of State Airport Aid funds shall be in compliance with the provisions of this Section. D-2. The Sponsor shall depict each parcel to be acquired on an airport property map containing the identity of the parcel and its metes and bounds. D-3. The acquisition cost of each parcel, building, or other real property acquired with State financial assistance shall be based on the fair market value of the property as determined by an appraisal process acceptable to the Department. D-4. For each parcel or building with an estimated cost of $100,000 or less, fair market value shall be established by a single original appraisal and a review appraisal. For complex acquisitions, fair market value shall be established by two original appraisals and one review appraisal. D-5. All original and review appraisals shall be conducted by qualified appraisers who have no financial or other interest in the property to be acquired. D-6. The fair market value of a parcel will be established by the review appraiser based upon the infonnation contained in the original appraisal or appraisals. Page 10 of 11 D-7. No negotiation for property acquisition shall be commenced between the Sponsor and the property owner until the fair market value ofthe property has been established. Initial negotiations shall be based upon the fair market value. D-8. Negotiated values above the fair market value shall not be eligible for State funds unless, prior to the final agreement for acquisition, the Sponsor has received the concurrence of the Department for paying such negotiated values in lieu of the appraised fair market value. D-9. Sponsors who adhere to the federal "Uniform Guidelines for the Acquisition of Property" shall be deemed to have conformed to the Department's guidelines, except that Paragraph 8 above shall also be applicable under such acquisitions. D-1 0. In the event the Project is a low value, non-complex acquisition, the Department at its option, may accept the original appraisal without the review appraisal. In such cases, all other provisions of this Section shall apply. D-11. Failure to follow the requirements of this Section shall disqualify the property from State participation for any parcel which has not been acquired in accordance with such standards. SECTION E: Sponsor's Acknowledgement of Executive Order 24. issued by Governor Perdue, and N.C. G.S.§ 133-32 E-1 Sponsor acknowledges and agrees that it is unlawful for any vendor or contractor ( i.e. architect, bidder, contractor, construction manager, design professional, engineer, landlord, offeror, seller, subcontractor, supplier, or vendor), to make gifts or to give favors to any State employee ofthe Governor's Cabinet Agencies (i.e., Administration, Commerce, Correction, Crime Control and Public Safety, Cultural Resources, Environment and Natural Resources, Health and Human Services, Juvenile Justice and Delinquency Prevention, Revenue, Transportation, and the Office of the Governor). This prohibition covers those vendors and contractors who: ( 1) have a contract with a governmental agency; or (2) have performed under such a contract within the past year; or (3) anticipate bidding on such a contract in the future. For additional information regarding the specific requirements and exemptions, vendors and contractors are encouraged to review Executive Order 24 and G.S. Sec. 133-32. Revised 1/2/13 Page 11 of 11 ' ' U.S. Department of Transportation Federal Aviation Administration Terms and Conditions January 9, 2013 of Accepting Airport Improvement Program Grants This document contains the terms and conditions of accepting Airport Improvement Program (AlP) grants from the Federal Aviation Administration (FAA) for the purpose of carrying out the provisions of Title 49, United States Code. These terms and conditions become applicable when the Sponsor accepts a Grant Offer from the FAA that references this document. The FAA may unilaterally amend the terms and conditions by notification in writing, and such amendment will only apply to grants accepted after notification. I. DEFINITIONS A. Sponsor-An agency that is legally, financially, and otherwise able to assume and carry out the certifications, representations, warranties, assurances, covenants and other obligations required in this document and in the accepted Grant Agreement. B. Project-Work as identified in this grant Agreement. c. Primary Airport-A commercial service airport the Secretary of Transportation determines to have more than 10,000 passengers boarding each year. D. "this grant"-In this document the term "this grant" refers to the applicable grant agreement or grant agreements that incorporate(s) these Terms and Conditions as part of the grant agreement. II. CERTIFICATIONS Title 49, United States Code, section 47105(d), authorizes the Secretary to require certification from the Sponsor that it will comply with statutory and administrative requirements in carrying out a project under the AlP. The following list of certified items includes major requirements for this aspect of project implementation. However, the list is not comprehensive, nor does it relieve sponsors from fully complying with all applicable statutory and administrative standards. In accepting this grant, the Sponsor certifies that each of the following items was or will be complied with in the performance of grant agreements. If a certification cannot be met for a specific project, the Sponsor must fully explain in an attachment to the project application. A. Sponsor Certification for Selection of Consultants. General standards for selection of consultant services within Federal grant programs are described in Title 49, Code of Federal Regulations (CFR), and Part 18.36. Sponsors may use other qualifications-based procedures provided they are equivalent to specific standards in 49 CFR 18 and Advisory Circular 150/5100- 14, Architectural, Engineering, and Planning Consultant Services for Airport Grant Projects. 1. Solicitations were (will be) made to ensure fair and open competition from a wide area of interest. 2. Consultants were (will be) selected using competitive procedures based on qualifications, experience, and disadvantaged enterprise requirements with the fees determined through negotiations. 1 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 9. The project was (will be) physically completed without Federal participation in costs due to errors and omissions in the plans and specifications that were foreseeable at the time of project design. C. Sponsor Certification for Equipment/Construction Contracts. General standards for equipment and construction contracts within Federal grant programs are described in Title 49, CFR, Part 18.36. AlP standards are generally described in FAA Advisory Circular (AC) 150/5100-6, Labor Requirements for the Airport Improvement Program; 150/51 00-15, Civil Rights Requirements for the Airport lm provement Program; and 150/5100-16, Airport Grant Assurance One-General Federal Requirements. Sponsors may use State and local procedures provided procurements conform to these Federal standards. 1. A code or standard of conduct is (will be) in effect governing the performance of the Sponsor's officers, employees, or agents in soliciting and awarding procurement contracts. 2. Qualified personnel are (will be) engaged to perform contract administration, engineering supervision, construction inspection, and testing. 3. Unless the FAA approved (has approved) otherwise, the procurement was (will be) publicly advertised using the competitive sealed bid method of procurement 4. The bid solicitation clearly and accurately describes (will describe): a. The current Federal wage rate determination for all construction projects; and b. All other requirements of the equipment and/or services to be provided. 5. Concurrence was (will be) obtained from FAA prior to contract award under any of the following circumstances: a. Only one qualified person/firm submits a responsive bid; b. The contract is to be awarded to other than the lowest responsible bidder; c. Life cycle costing is a factor in selecting the lowest responsive bidder; or a. Proposed contract prices are more than 1 0 percent over the Sponsor's cost estimate. 6. All contracts exceeding $100,000 require (will require) the following provisions: a. A bid guarantee of 5 percent, a performance bond of 100 percent, and a payment bond of 1 00 percent; b. Conditions specifying administrative, contractual, and legal remedies, including contract termination, for those instances in which contractors violate or breach contact terms; and c. Compliance with applicable standards and requirements issued under Section 306 of the Clean Air Act (42 USC 1857(h)), Section 508 of the Clean Water Act (33 USC 1368), and Executive Order 11738. 7. All construction contracts contain (will contain) provisions for: a. Compliance with the Copeland "Anti-Kick Back" Act; and b. Preference given in the employment of labor (except in executive, administrative, and supervisory positions) to honorably discharged Vietnam-era veterans and disabled veterans. 8. All construction contracts exceeding $2,000 contain (will contain) the following provisions: a. Compliance with the Davis-Bacon Act based on the current Federal wage rate determination; and b. Compliance with the Contract Work Hours and Safety Standards Act (40 USC 327-330), Sections 103 and 1 07. 9. All construction contracts exceeding $10,000 contain (will contain) appropriate clauses from 41 CFR Part 60 for compliance with Executive Orders 11246 and 11375 on Equal Employment Opportunity. 3 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 b. Supporting documents for settlements are (will be) included in the project files. 11. If a negotiated settlement is not reached, the following procedures were (will be) used: a. Condemnation was (will be) initiated and a court deposit not less than the just compensation was (will be) made prior to possession of the property; and b. Supporting documents for awards were (will be) included in the project files. 12. If displacement of persons, businesses, farm operations, or non-profit organizations is involved, a relocation assistance program was (will be) established, with displaced parties receiving general information on the program in writing, including relocation eligibility, and a 90-day notice to vacate. 13. Relocation assistance services, comparable replacement housing, and payment of necessary relocation expenses were (will be) provided within a reasonable time period for each displaced occupant in accordance with the Uniform Act. E. Sponsor Certification for Construction Project Final Acceptance. General requirements for final acceptance and closeout of Federally funded construction projects are in Title 49, CFR, Part 18.50. The Sponsor shall determine that project costs are accurate and proper in accordance with specific requirements of this grant Agreement and contract documents. 1. The personnel engaged in project administration, engineering supervision, construction inspection, and testing were (will be) determined to be qualified as well as competent to perform the work. 2. Daily construction records were (will be) kept by the resident engineer/construction inspector as follows: a. Work in progress b. Quality and quantity of materials delivered c. Test locations and results d. Instructions provided the contractor e. Weather conditions f. Equipment use g. Labor requirements h. Safety problems i. Changes required. 3. Weekly payroll records and statements of compliance were (will be) submitted by the prime contractor and reviewed by the Sponsor for Federal labor and civil rights requirements (Advisory Circulars 150/5100-6 and 150/5100-15). 4. Complaints regarding the mandated Federal provisions set forth in the contract documents have been (will be) submitted to the FAA. 5. All tests specified in the plans and specifications were (will be) performed and the test results documented as well as made available to the FAA. 6. For any test results outside of allowable tclerances, appropriate corrective actions were (will be) taken. 7. Payments to the contractor were (will be) made in compliance with contract provisions as follows: a. Payments are verified by the Sponsor's internal audit of contract records kept by the resident engineer; and b. If appropriate, pay reduction factors required by the specifications are applied in computing final payments; and a summary of pay reductions are made available to the FAA. 5 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 d. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. 3. Each employee to be engaged in the performance of the work has been (will be) given a copy of the statement required within item 1 above. 4. Employees have been (will be) notified in the statement required by item 1 above that, as a condition of employment under this grant, the employee will: a. Abide by the terms of the statement; and b. Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction. 5. The FAA will be notified in writing within ten calendar days after receiving notice under item 4b above from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title of the employee, to the FAA. Notices shall include the project number of each affected grant. 6. One of the following actions will be taken within 30 calendar days of receiving a notice under item 4b above with respect to any employee who is so convicted: a. Take appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or b. Require such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement or other appropriate agency. 7. A good faith effort will be made to continue to maintain a drug-free workplace through implementation of items 1 through 6 above. Ill. GENERAL CONDITIONS A. The allowable costs of the project shall not include any costs determined by the FAA to be ineligible for consideration under Title 49 U.S.C. 8. Payment of the United States' share of the allowable project costs will be made pursuant to and in accordance with the provisions of such regulations and procedures as the Secretary shall prescribe. Final determination of the United States' share will be based upon the final audit of the total amount of allowable project costs, and settlement will be made for any upward or downward adjustments to the Federal share of costs. C. The Sponsor shall carry out and complete the Project(s) without undue delays and in accordance with the terms hereof, and such regulations and procedures as the Secretary shall prescribe. D. The FAA reserves the right to unilaterally terminate this grant if the Sponsor does not make at least one draw down of funds under their Letter of Credit or submit at least one written Request for Reimbursement, as applicable, in each twelve month period after grant acceptance. E. The Sponsor agrees to monitor progress on the work to be accomplished by this grant. For engineering services, the Sponsor agrees to make payment only for work that has been satisfactorily completed and that ten percent (10%) of the total value of the engineering services contract will not be paid to the Engineer until acceptable final project documentation is provided. F. The Sponsor agrees to submit final grant closeout documents to the FAA within 60 days after physical completion of the project(s), but no greater than four (4) years from the date of the grant, unless otherwise agreed to by the FAA. G. The FAA reserves the right to amend or withdraw this grant offer at any time prior to its acceptance by the Sponsor. 7 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 system and require the grantee to complete two forms. The grantee will complete a web based DOT registration form and download the Proof of Identification form to verify the grantee's identity. b. The grantee must complete the Proof of Identification form, and present it to a Notary Public for verification. The grantee will return the notarized form to: DOT Enterprise Services Center FAA Accounts Payable, AMZ-100 PO Box 25710 Oklahoma City, OK 73125 c. The DOT will validate the both forms and email a user ID and password to the grantee. Grantees should contact the FAA Airports District/Regional Office with any changes to their system information. Note: Additional information, including access forms and training materials, can be found on the DOT elnvoicing website (http://www.dot.gov/cfo/delphi-einvoicing- system.html). 3. Waivers. a. DOT Financial Management officials may, on a case by case basis, waive the requirement to register and use the electronic grant payment system based on user requests and concurrence of the FAA. Waiver request forms can be obtained on the DOT elnvoicing website (http://www.dot.gov/cfo/delphi-einvoicing-system.html) or by contacting the FAA Airports District/Regional Office. Recipients must explain why they are unable to use or access the Internet to register and enter payment requests. b. All waiver requests should be sent to the FAA Airports District/Regional Office for concurrence, prior to sending to the Director of the Office of Financial Management, US Department of Transportation, Office of Financial Management, B-30, room W93- 431, 1200 New Jersey Avenue SE, Washington DC 20590-0001, DOTEiectroniclnvoicing@dot.gov.:. The Director of the DOT Office of Financial Management will confirm or deny the request within approximately 30 days. c. If a grantee is granted a waiver, the grantee should submit all hard-copy invoices directly to: DOT/FAA PO Box 25082 AMZ-110 Oklahoma City, OK 73125 M. Unless otherwise approved by the FAA, it will not acquire or permit any contractor or subcontractor to acquire any steel or manufactured products produced outside the United States to be used for any project for airport development or noise compatibility for which funds are provided under this grant. The Sponsor will include in every contract a provision implementing this condition. N. Central Contractor Registration and Universal Identifier Requirements 1. Requirement for Central Contractor Registration (CCR) Unless you are exempted from this requirement under 2 CFR 25.110, you as the recipient must maintain the currency of your information in the CCR until you submit the final financial report required under this award or receive the final payment, whichever is later. This requires that you review and update the information at least annually after the initial registration, and more frequently if required by changes in your information or another award term. 9 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 provisions and tests required by the Federal specifications. The program shall include as a minimum: a. The name of the person representing the Sponsor who has overall responsibility for contract administration for the project and the authority to take necessary actions to comply with the contract. b. Names of testing laboratories and consulting engineer firms with quality control responsibilities on the project, together with a description of the services to be provided. c. Procedures for determining that testing laboratories meet the requirements of the American Society of Testing Materials standards on laboratory evaluation, referenced in the contract specifications (03666, C 1 077}. d. Qualifications of engineering supervision and construction inspection personnel. e. A listing of all tests required by the contract specifications, including the type and frequency of tests to be taken, the method of sampling, the applicable test standard, and the acceptance criteria or tolerances permitted for each type of test. f. Procedures for ensuring that the tests are taken in accordance with the program, that they are documented daily, that the proper corrective actions, where necessary, are undertaken. 2. Submit at completion of the project, a final test and quality control report documenting the results of all tests performed, highlighting those tests that failed or did not meet the applicable test standard. The report shall include the pay reductions applied and reasons for accepting any out-of-tolerance material. An interim test and quality control report shall be submitted, if requested by the FAA. 3. Failure to provide a complete report as described in paragraph 2, or failure to perform such tests, shall, absent any compelling justification, result in a reduction in Federal participation for costs incurred in connection with construction of the applicable pavement. Such reduction shall be at the discretion of the FAA and will be based on the type or types of required tests not performed or not documented and will be commensurate with the proportion of applicable pavement with respect to the total pavement constructed under this grant agreement. 4. The FAA, at its discretion, reserves the right to conduct independent tests and to reduce grant payments accordingly if such independent tests determine that Sponsor tests results are inaccurate. P. For a project to replace or reconstruct pavement at the airport, the Sponsor shall implement an effective airport pavement maintenance management program as is required by Airport Sponsor Assurance Number 11. The Sponsor shall use such program for the useful life of any pavement constructed, reconstructed, or repaired with Federal financial assistance at the airport. As a minimum, the program must conform with the following provisions: Pavement Maintenance Management Program An effective pavement maintenance management program is one that details the procedures to be followed to assure that proper pavement maintenance, both preventive and repair, is performed. An airport sponsor may use any form of inspection program it deems appropriate. The program must, as a minimum, include the following: 1. Pavement Inventory. The following must be depicted in an appropriate form and level of detail: a. Location of all runways, taxiways, and aprons; b. Dimensions; c. Type of pavement, and; d. Year of construction or most recent major rehabilitation. 11 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 accomplished by the Sponsor, the Sponsor shall maintain as a portion of the cost records covering this project, separable cost records pertaining to the above-identified work excluded from Federal participation under this project, which records shall be made available for inspection and audit by the FAA to the end that the cost of the excluded work may be definitely determined. It is further understood and agreed that the Sponsor will submit a Program StatemenUcost estimate depicting the excluded costs or a cost estimate depicting only those costs eligible for Federal participation in this project. T. Utility Relocation in Project. It is understood and agreed by and between the parties hereto that the United States shall not participate in the cost of any utility relocation unless and until the Sponsor has submitted evidence satisfactory to the FAA that the Sponsor is legally responsible for payment of such costs. FAA participation will be limited to those utilities located on private right-of-way or utilities that exclusively serve the Airport. U. Revenue from Real Property -land in Project. The Sponsor agrees that all net revenues produced from real property purchased in part with Federal funds in this grant shall be used on the airport for airport planning, development or operating expenses, except that all income from real property purchased for noise compatibility purposes or for future aeronautical use be used only to fund projects which would be eligible for grants under the Act. Income from noise or future use property may not be used for the Sponsor's matching share of any airport grant Airport fiscal and accounting records shall clearly identify actual sources and uses of these funds. v. Future Development land. If this grant includes acquisition of land for future development, the Sponsor agrees to implement within five years of such grant the airport development that requires this land acquisition, unless the FAA agrees to a different duration. Furthermore, the Sponsor agrees not to dispose of the land by sale or lease without prior consent and approval of the FAA. In the event the land is not used within ten years for the purpose for which it was acquired, the Sponsor will refund the Federal share of acquisition cost or the current fair market value of the land, whichever is greater, unless the FAA agrees to a different duration. w. Runway Protection Zones. The Sponsor agrees to take the following actions to maintain and/or acquire a property interest, satisfactory to the FAA, in the Runway Protection Zones: 1. Existing Fee Title Interest in the Runway Protection Zone: The Sponsor agrees to prevent the erection or creation of any structure or place of public assembly in the Runway Protection Zone, except for NAVAIDS that are fixed by their functional purposes or any other structure approved by the FAA. Any existing structures or uses within the Runway Protection Zone will be cleared or discontinued unless approved by the FAA. 2. Existing Easement Interest in the Runway Protection Zone: The Sponsor agrees to take any and all steps necessary to ensure that the owner of the land within the designated Runway Protection Zone will not build any structure in the Runway Protection Zone that is a hazard to air navigation or which might create glare or misleading lights or lead to the construction of residences, fuel handling and storage facilities, smoke generating activities, or places of public assembly, such as churches, schools, office buildings, shopping centers, and stadiums. 3. Future Interest in the Runway Protection Zone: The Sponsor agrees that it will acquire fee title or less-than-fee interest in the Runway Protection Zones that presently are not under its control under an agreed schedule with the FAA. Said interest shall provide the protection noted in above Subparagraphs 1 and 2. x. Noise Projects on Privately Owned Property. No payment shall be made under the terms of this grant agreement for work accomplished on privately owned land until the Sponsor submits the agreement with the owner of the property required by Assurance 5d of the ASSURANCES Airport Sponsors, and such agreement is determined to be satisfactory. As a minimum, the agreement with the private owner must contain the following provisions: 1. The property owner shall subject the construction work on the project to such inspection and approval during the construction or installation of the noise compatibility measures and after 13 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 IV. ASSURANCES The following FAA document titled ASSURANCES Airport Sponsors, dated April 2012, is incorporated as part of these Terms and Conditions: A. General. Assurances Airport Sponsors April2012 1. These assurances shall be complied with in the performance of grant agreements for airport development, airport planning, and noise compatibility program grants for airport sponsors. 2. These assurances are required to be submitted as part of the project application by sponsors requesting funds under the provisions of Title 49, U.S.C., subtitle VII, as amended. As used herein, the term "public agency sponsor" means a public agency with control of a public-use airport; the term "private sponsor" means a private owner of a public-use airport; and the term "Sponsor" includes both public agency sponsors and private sponsors. 3. Upon acceptance of this grant offer by the Sponsor, these assurances are incorporated in and become part of this grant agreement. B. Duration and Applicability. 1. Airport development or Noise Compatibility Program Projects Undertaken by a Public Agency Sponsor. The terms, conditions and assurances of this grant agreement shall remain in full force and effect throughout the useful life of the facilities developed or equipment acquired for an airport development or noise compatibility program project, or throughout the useful life of the project items installed within a facility under a noise compatibility program project, but in any event not to exceed twenty (20) years from the date of acceptance of a grant offer of Federal funds for the project. However, there shall be no limit on the duration of the assurances regarding Exclusive Rights and Airport Revenue so long as the airport is used as an airport. There shall be no limit on the duration of the terms, conditions, and assurances with respect to real property acquired with federal funds. Furthermore, the duration of the Civil Rights assurance shall be specified in the assurances. 2. Airport Development or Noise Compatibility Projects Undertaken by a Private Sponsor. The preceding paragraph 1 also applies to a private sponsor except that the useful life of project items installed within a facility or the useful life of the facilities developed or equipment acquired under an airport development or noise compatibility program project shall be no less than ten (10) years from the date of acceptance of Federal aid for the project. 3. Airport Planning Undertaken by a Sponsor. Unless otherwise specified in this grant agreement, only Assurances 1, 2, 3, 5, 6, 13, 18, 30, 32, 33, and 34 in section C apply to planning projects. The terms, conditions, and assurances of this grant agreement shall remain in full force and effect during the life of the project. C. Sponsor Certification. The Sponsor hereby assures and certifies, with respect tq this grant that: 1. General Federal Requirements. It will comply with all applicable Federal laws, regulations, executive orders, policies, guidelines, and requirements as they relate to the application, acceptance and use of Federal funds for this project including but not limited to the following: Federal Legislation a. Title 49, U.S.C., subtitle VII, as amended. b. Davis-Bacon Act-40 U.S.C. 276(a), et seq.1 15 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 e. 29 CFR Part 3 Contractors and subcontractors on public building or public work financed in whole or part by loans or grants from the United States.1 f. 29 CFR Part 5 Labor standards provisions applicable to contracts covering federally financed and assisted construction (also labor standards provisions applicable to non- construction contracts subject to the Contract Work Hours and Safety Standards Act).1 g. 41 CFR Part 60 Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor (Federal and federally assisted contracting requirements).1 h. 49 CFR Part 18 Uniform administrative requirements for grants and cooperative agreements to state and local governments.3 i. 49 CFR Part 20 -New restrictions on lobbying. j. 49 CFR Part 21 -Nondiscrimination in federally-assisted programs of the Department of Transportation -effectuation of Title VI of the Civil Rights Act of 1964. k. 49 CFR Part 23 -Participation by Disadvantage Business Enterprise in Airport Concessions. I. 49 CFR Part 24 -Uniform relocation assistance and real property acquisition for Federal and federally assisted programs.1 2 m. 49 CFR Part 26 -Participation By Disadvantaged Business Enterprises in Department of Transportation Programs. n. 49 CFR Part 27 -Nondiscrimination on the basis of handicap in programs and activities receiving or benefiting from Federal financial assistance.1 o. 49 CFR Part 29 -Government wide debarment and suspension (nonprocurement) and government wide requirements for drug-free workplace (grants). p. 49 CFR Part 30 -Denial of public works contracts to suppliers of goods and services of countries that deny procurement market access to U.S. contractors. q. 49 CFR Part 41 -Seismic safety of Federal and federally assisted or regulated new building construction.1 Office of Management and Budget Circulars a. A-87 -Cost Principles Applicable to Grants and Contracts with State and Local Governments. b. A-133 -Audits of States, Local Governments, and Non-Profit Organizations 1· These laws do not apply to airport planning sponsors. 2 These laws do not apply to private sponsors. 3 49 CFR Part 18 and OMB Circular A-87 contain requirements for State and Local Governments receiving Federal assistance. Any requirement levied upon State and Local Governments by this regulation and circular shall also be applicable to private sponsors receiving Federal assistance under Title 49, United States Code. Specific assurances required to be included in grant agreements by any of the above laws, regulations or circulars are incorporated by reference in this grant agreement. 17 Terms and Conditions of Accepting Airport Improvement Prog~am Grants January 9, 2013 against the local government if there is substantial non-compliance with the terms of the agreement. d. For noise compatibility program projects to be carried out on privately owned property, it will enter into an agreement with the owner of that property which includes provisions specified by the Secretary. It will take steps to enforce this agreement against the property owner whenever there is substantial non-compliance with the terms of the agreement. e. If the Sponsor is a private sponsor, it will take steps satisfactory to the Secretary to ensure that the airport will continue to function as a public-use airport in accordance with these assurances for the duration of these assurances. f. If an arrangement is made for management and operation of the airport by any agency or person other than the Sponsor or an employee of the Sponsor, the Sponsor will reserve sufficient rights and authority to insure that the airport will be operated and maintained in accordance Title 49, United States Code, the regulations and the terms, conditions and assurances in this grant agreement and shall insure that such arrangement also requires compliance therewith. g. Sponsors of commercial service airports will not permit or enter into any arrangement that results in permission for the owner or tenant of a property used as a residence, or zoned for residential use, to taxi an aircraft between that property and any location on airport. Sponsors of general aviation airports entering into any arrangement that results in permission for the owner of residential real property adjacent to or near the airport must comply with the requirements of Sec. 136 of Public Law 112-95 and the sponsor assurances. 6. Consistency with Local Plans. The project is reasonably consistent with plans (existing at the time of submission of this application) of public agencies that are authorized by the State in which the project is located to plan for the development of the area surrounding the airport. 7. Consideration of Local Interest. It has given fair consideration to the interest of communities in or near where the project may be located. 8. Consultation with Users. In making a decision to undertake any airport development project under Title 49, United States Code, it has undertaken reasonable consultations with affected parties using the airport at which project is proposed. 9. Public Hearings. In projects involving the location of an airport, an airport runway, or a major runway extension, it has afforded the opportunity for public hearings for the purpose of considering the economic, social, and environmental effects of the airport or runway location and its consistency with goals and objectives of such planning as has been carried out by the community and it shall, when requested by the Secretary, submit a copy of the transcript of such hearings to the Secretary. Further, for such projects, it has on its management board either voting representation from the communities where the project is located or has advised the communities that they have the right to petition the Secretary concerning a proposed project. 10. Air and Water Quality Standards. In projects involving airport location, a major runway extension, or runway location it will provide for the Governor of the state in which the project is located to certify in writing to the Secretary that the project will be located, designed, constructed, and operated so as to comply with applicable air and water quality standards. In any case where such standards have not been approved and where applicable air and water quality standards have been promulgated by the Administrator of the Environmental Protection Agency, certification shall be obtained from such Administrator. Notice of certification or refusal to certify shall be provided within sixty days after the project application has been received by the Secretary. 19 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 17. Construction Inspection and Approval. It will provide and maintain competent technical supervision at the construction site throughout the project to assure that the work conforms to the plans, specifications, and schedules approved by the Secretary for the project. It shall subject the construction work on any project contained in an approved project application to inspection and approval by the Secretary and such work shall be in accordance with regulations and procedures prescribed by the Secretary. Such regulations and procedures shall require such cost and progress reporting by the sponsor or sponsors of such project as the Secretary shall deem necessary. 18. Planning Projects. In carrying out planning projects: a. It will execute the project in accordance with the approved program narrative contained in the project application or with the modifications similarly approved. b. It will furnish the Secretary with such periodic reports as required pertaining to the planning project and planning work activities. c. It will include in all published material prepared in connection with the planning project a notice that the material was prepared under a grant provided by the United States. d. It will make such material available for examination by the public, and agrees that no material prepared with funds under this project shall be subject to copyright in the United States or any other country. e. It will give the Secretary unrestricted authority to publish, disclose, distribute, and otherwise use any of the material prepared in connection with this grant. f. It will grant the Secretary the right to disapprove the Sponsor's employment of specific consultants and their subcontractors to do all or any part of this project as well as the right to disapprove the proposed scope and cost of professional services. g. It will grant the Secretary the right to disapprove the use of the Sponsor's employees to do all or any part of the project. h. It understands and agrees that the Secretary's approval of this project grant or the Secretary's approval of any planning material developed as part of this grant does not constitute or imply any assurance or commitment on the part of the Secretary to approve any pending or future application for a Federal airport grant. 19. Operation and Maintenance. a. The airport and all facilities which are necessary to serve the aeronautical users of the airport, other than facilities owned or controlled by the United States, shall be operated at all times in a safe and serviceable condition and in accordance with the minimum standards as may be required or prescribed by applicable Federal, state and local agencies for maintenance and operation. It will not cause or permit any activity or action thereon which would interfere with its use for airport purposes. It will suitably operate and maintain the airport and all facilities thereon or connected therewith, with due regard to climatic and flood conditions. Any proposal to temporarily close the airport for non-aeronautical purposes must first be approved by the Secretary. In furtherance of this assurance, the Sponsor will have in effect arrangements for- 1) Operating the airport's aeronautical facilities whenever required; 2) Promptly marking and lighting hazards resulting from airport conditions, including temporary conditions; and 3) Promptly notifying airmen of any condition affecting aeronautical use of the airport. Nothing contained herein shall be construed to require that the airport be operated for aeronautical use during temporary periods when snow, flood or other climatic conditions interfere with such operation and maintenance. Further, nothing herein shall be construed as requiring the maintenance, repair, restoration, or replacement of any structure or facility 21 . . Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 g. In the event the Sponsor itself exercises any of the rights and privileges referred to in this assurance, the services involved will be provided on the same conditions as would apply to the furnishing of such services by commercial aeronautical service providers authorized by the Sponsor under these provisions. h. The Sponsor may establish such reasonable, and not unjustly discriminatory, conditions to be met by all users of the airport as may be necessary for the safe and efficient operation of the airport. i. The Sponsor may prohibit or limit any given type, kind or class of aeronautical use of the airport if such action is necessary for the safe operation of the airport or necessary to serve the civil aviation needs of the public. 23. Exclusive Rights. It will permit no exclusive right for the use of the airport by any person providing, or intending to provide, aeronautical services to the public. For purposes of this paragraph, the providing of the services at an airport by a single fixed-based operator shall not be construed as an exclusive right if both of the following apply: a. It would be unreasonably costly, burdensome, or impractical for more than one fixed-based operator to provide such services, and b. If allowing more than one fixed-based operator to provide such services would require the reduction of space leased pursuant to an existing agreement between such single fixed- based operator and such airport. It further agrees that it will not, either directly or indirectly, grant or permit any person, firm, or corporation, the exclusive right at the airport to conduct any aeronautical activities, including, but not limited to charter flights, pilot training, aircraft rental and sightseeing, aerial photography, crop dusting, aerial advertising and surveying, air carrier operations, aircraft sales and services, sale of aviation petroleum products whether or not conducted in conjunction with other aeronautical activity, repair and maintenance of aircraft, sale of aircraft parts, and any other activities which because of their direct relationship to the operation of aircraft can be regarded as an aeronautical activity, and that it will terminate any exclusive right to conduct an aeronautical activity now existing at such an airport before the grant of any assistance under Title 49, United States Code. 24. Fee and Rental Structure. It will maintain a fee and rental structure for the facilities and services at the airport which will make the airport as self-sustaining as possible under the circumstances existing at the particular airport, taking into account such factors as the volume of traffic and economy of collection. No part of the Federal share of an airport development, airport planning or noise compatibility project for which a grant is made under Title 49, United States Code, the Airport and Airway Improvement Act of 1982, the Federal Airport Act or the Airport and Airway Development Act of 1970 shall be included in the rate basis in establishing fees, rates, and charges for users of that airport. 25. Airport Revenues. a. All revenues generated by the airport and any local taxes on aviation fuel established after December 30, 1987, will be expended by it for the capital or operating costs of the airport; the local airport system; or other local facilities which are owned or operated by the owner or operator of the airport and which are directly and substantially related to the actual air transportation of passengers or property; or for noise mitigation purposes on or off the airport. The following exceptions apply to this paragraph: 1) If covenants or assurances in debt obligations issued before September 3, 1982, by the owner or operator of the airport, or provisions enacted before September 3, 1982, in governing statutes controlling the owner or operator's financing, provide for the use of the revenues from any of the airport owner or operator's facilities, including the airport, to support not only the airport but also the airport owner or operator's general debt obligations or other facilities, then this limitation on the use of all revenues generated by the airport (and, in the case of a public airport, local taxes on aviation fuel) shall not apply. 23 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 would unduly interfere with use of the landing areas by other authorized aircraft, or during any calendar month that- a. Five (5) or more Government aircraft are regularly based at the airport or on land adjacent thereto; or b. The total number of movements (counting each landing as a movement) of Government aircraft is 300 or more, or the gross accumulative weight of Government aircraft using the airport (the total movement of Government aircraft multiplied by gross weights of such aircraft) is in excess of five million pounds. 28. land for Federal Facilities. It will furnish without cost to the Federal Government for use in connection with any air traffic control or air navigation activities, or weather-reporting and communication activities related to air traffic control, any areas of land or water, or estate therein, or rights in buildings of the Sponsor as the Secretary considers necessary or desirable for construction, operation, and maintenance at Federal expense of space or facilities for such purposes. Such areas or any portion thereof will be made available as provided herein within four months after receipt of a written request from the Secretary. 29. Airport layout Plan. a. It will keep up to date at all times an airport layout plan of the airport showing (1) boundaries of the airport and all proposed additions thereto, together with the boundaries of all offsite areas owned or controlled by the Sponsor for airport purposes and proposed additions thereto; (2) the location and nature of all existing and proposed airport facilities and structures (such as runways, taxiways, aprons, terminal buildings, hangars and roads), including all proposed extensions and reductions of existing airport facilities; (3) the location of all existing and proposed non-aviation areas and of all existing improvements thereon; and (4) all proposed and existing access points used to taxi aircraft across the airport's property boundary. Such airport layout plans and each amendment, revision, or modification thereof, shall be subject to the approval of the Secretary which approval shall be evidenced by the signature of a duly authorized representative of the Secretary on the face of the airport layout plan. The Sponsor will not make or permit any changes or alterations in the airport or any of its facilities which are not in conformity with the airport layout plan as approved by the Secretary and which might, in the opinion of the Secretary, adversely affect the safety, utility or efficiency of the airport. b. If a change or alteration in the airport or the facilities is made which the Secretary determines adversely affects the safety, utility, or efficiency of any federally owned, leased, or funded property on or off the airport and which is not in conformity with the airport layout plan as approved by the Secretary, the owner or operator will, if requested, by the Secretary (1) eliminate such adverse effect in a manner approved by the Secretary; or (2) bear all costs of relocating such property (or replacement thereof) to a site acceptable to the Secretary and all costs of restoring such property (or replacement thereof) to the level of safety, utility, efficiency, and cost of operation existing before the unapproved change in the airport or its facilities, except in the case of a relocation or replacement of an existing airport facility due to a change in the Secretary's design standards beyond the control of the airport sponsor. 30. Civil Rights. It will comply with such rules as are promulgated to assure that no person shall, on the grounds of race, creed, color, national origin, sex, age, or handicap be excluded from participating in any activity conducted with or benefiting from funds received from this grant. This assurance obligates the Sponsor for the period during which Federal financial assistance is extended to the program, except where Federal financial assistance is to provide, or is in the form of personal property or real property or interest therein or structures or improvements thereon in which case the assurance obligates the Sponsor or any transferee for the longer of the following periods: (a) the period during which the property is used for a purpose for which Federal financial assistance is extended, or for another purpose involving the provision of similar services or benefits, or (b) the period during which the Sponsor retains ownership or possession of the property. 25 Terms and Conditions of Accepting Airport Improvement Program Grants January 9, 2013 foreign country is listed by the United States Trade Representative as denying fair and equitable market opportunities for products and suppliers of the United States in procurement and construction. 34. Policies, Standards, and Specifications. It will carry out the project in accordance with policies, standards, and specifications approved by the Secretary including but not limited to the advisory circulars listed in the "Current FAA Advisory Circulars Required for Use in AlP Funded and PFC Approved Projects", dated (the latest approved version as of this grant offer) and included in this grant, and in accordance with applicable state policies, standards, and specifications approved by the Secretary. 35. Relocation and Real Property Acquisition. (1) It will be guided in acquiring real property, to the greatest extent practicable under State law, by the land acquisition policies in Subpart B of 49 CFR Part 24 and will pay or reimburse property owners for necessary expenses as specified in Subpart B. (2) It will provide a relocation assistance program offering the services described in Subpart C and fair and reasonable relocation payments and assistance to displaced persons as required in Subpart D and E of 49 CFR Part 24. (3) It will make available within a reasonable period of time prior to displacement, comparable replacement dwellings to displaced persons in accordance with Subpart E of 49 CFR Part 24. 36. Access By Intercity Buses. The airport owner or operator will permit, to the maximum extent practicable, intercity buses or other modes of transportation to have access to the airport; however, it has no obligation to fund special facilities for intercity buses or for other modes of transportation. 37. Disadvantaged Business Enterprises. The recipient shall not discriminate on the basis of race, color, national origin or sex in the award and performance of any DOT -assisted contract or in the administration of its DBE program or the requirements of 49 CFR Part 26. The Recipient shall take all necessary and reasonable steps under 49 CFR Part 26 to ensure non discrimination in the award and administration of DOT-assisted contracts. The recipient's DBE program, as required by 49 CFR Part 26, and as approved by DOT, is incorporated by reference in this agreement. Implementation of this program is a legal obligation and failure to carry out its terms shall be treated as a violation of this agreement. Upon notification to the recipient of its failure to carry out its approved program, the Department may impose sanctions as provided for under Part 26 and may, in appropriate cases, refer the matter for enforcement under 18 U.S.C. 1001 and/or the Program Fraud Civil Remedies Act of 1986 (31 U.S.C. 3801). 38. Hangar Construction. If the airport owner or operator and a person who owns an aircraft agree that a hangar is to be constructed at the airport for the aircraft at the aircraft owner's expense, the airport owner or operator will grant to the aircraft owner for the hangar a long term lease that is subject to such terms and conditions on the hangar as the airport owner or operator may impose. 39. Competitive Access. a. If the airport owner or operator of a medium or large hub airport (as defined in section 47102 of title 49, U.S.C.) has been unable to accommodate one or more requests by an air carrier for access to gates or other facilities at that airport in order to allow the air carrier to provide service to the airport or to expand service at the airport, the airport owner or operator shall transmit a report to the Secretary that- 1) Describes the requests; 2) Provides an explanation as to why the requests could not be accommodated; and 3) Provides a time frame within which, if any, the airport will be able to accommodate the requests. b. Such report shall be due on either February 1 or August 1 of each year if the airport has been unable to accommodate the request(s) in the six month period prior to the applicable due date. 27 Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Sampson County Disposal, LLC. Agreement REQUESTED BY: Amanda Bader, County Engineer REQUEST: As previously discussed and authorized by the Board of Commissioners, staff has renegotiated our Transportation and Disposal Agreement with Sampson County Disposal, LLC, a subsidiary of Waste Industries. We respectfully request that the board approve this agreement. Listed below are some of the changes that will have significant and positive impact for Harnett County. It is estimated that these changes will generate savings in the range of$122,000 to $191,000 in the first year and additional savings throughout the term of the contract. 1. Increase fuel surcharge from $3.00 to $4.50 2. Eliminate a CPI for the first two years ofthe contract 3. Change the CPI index used and cap at 3% 4. Extend the term of the contract 6.5 years Staff believes that the renegotiated terms are imperative for the stability of rates and improving the solid waste service to the residents of Harnett County. COUNTY MANAGER'S RECOMMENDATION: C:\U sers \gwheeler\AppData \Local'u\tlicrosoft\ Windows\ Temporary Internet Files\Content.Outlook\Z5TP9EAN\agendaforrn20 13 .doc Page I of 1 TRANSPORTATION AND DISPOSAL AGREEMENT BY AND BETWEEN SAMPSON COUNTY DISPOSAL, LLC AND HARNETI COUNTY, NORTH CAROLINA September 1, 2013 Transportation and Disposal Agreement This Transportation and Disposal Agreement (the "Agreement") is made and entered into this 1st day of September, 2013, by and between County of Harnett, a political subdivision created and existing under the laws of the State of North Carolina ("County") and Sampson County Disposal, LLC, a North Carolina Limited Liability Corporation authorized to conduct business in the State of North Carolina ("Sampson"). RECITALS A. The County and Sampson are parties to a Transportation and Disposal Agreement dated December 3, 2007, as amended (the "2007 Agreement"). B. The County and Sampson desire this Agreement to supersede and replace the 2007 Agreement in its entirety. C. The County owns and operates solid waste transfer stations located in Harnett County, North Carolina. D. The County desires to retain Sampson to provide transportation and disposal services to the County. E. Sampson desires to perform transportation and disposal services upon the terms and conditions set forth below. Now, therefore, in consideration of these premises and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto, each intending to be legally bound agree as follows: 1. Definitions. The capitalized terms in this Agreement shall have the definition as set forth below: a. "Acceptable Solid Waste" means mixed household solid waste and mixtures of household, commercial and industrial solid waste that are permitted under the governing permits and then applicable laws to be accepted at the applicable disposal facilities and that are not otherwise Unacceptable Waste. b. "Agreemenf' means this Agreement between the County and Sampson. c. "C&D" means construction and demolition waste material permitted under the governing permits of the landfill, and that is not otherwise Unacceptable Solid Waste. 2 d. "CPI" means the Consumer Price Index published by Bureau of Labor Statistics U.S. Department of Labor, U.S. City Average, All items (1982-84=100), All Urban Consumers, May issue. e. "Commencement Date" means September 1st, 2013. f. "Effective Date" means the date first above written. g. "Force Majeure" means any event reasonably relied upon by the County or Sampson as justification or excuse from performing any obligation hereunder, which event is beyond the reasonable control of the party relying on such event, including, without limitation: (i) An act of God, epidemic, landslide, lightning, earthquake, fire, explosion, storm, flood or similar occurrence; (ii) War, blockade, riot or restraint of government and people; (iii) a strike or similar industrial or labor action; (iv) The order or judgment or other act of any federal, state, county, or local court, administrative agency or governmental office or body, including, without limitation, such an order or judgment which stays, invalidates, or otherwise affects this Agreement. h. "Hazardous Substance" means any hazardous, toxic or carcinogenic substance or wastes that are now or in the future defined, determined or identified as such by any federal, state or local statute, regulation, rule, ordinance, or other law relating in any way to protection of the environment or the public health and safety, whether now in effect or as amended or enacted in the future. i. "Landfill" means the landfill owned and operated by Sampson County Disposal, LLC located in Roseboro, Sampson County, North Carolina or any other landfill selected by Sampson for disposal, which landfill is properly permitted for acceptance of Acceptable Waste. k-:-L"MSW" means municipal solid waste material permitted under the governing permits of the Landfill, and that is not otherwise Unacceptable Solid Waste. h).s_"Special Waste" means any waste requiring special handling, treatment or processing under the governing permits of the Landfill or under applicable law. 3 "Transfer Station" or "Transfer Stations" means the solid waste transfer stations owned and operated by the County located at NC State Road 1724/ 449 Daniel's Rd., Dunn, N.C. and NC State Road 1164/1086Poplar Dr., Anderson Creek, N.C. ·;_:_;.;c__ __ "Unacceptable Waste" means (i) any material that is not Acceptable Waste; (ii) any material that by reason of its composition, characteristics or quantity is defined or characterized as a Hazardous Substance; (iii} any material that requires other than normal handling, storage, management, transfer or disposal; or (iv) any other material that may present a substantial endangerment to public health or safety, may cause applicable air quality or water effluent standards to be violated by the normal operation of the landfill, or because of its size, durability or composition cannot be disposed of at the landfill or has a reasonable possibility of otherwise adversely affecting the operation or useful life of the landfill. 2. Representations, Warranties and Covenants of County 2.1 Existence and Good Standing. The County is, and will continue to throughout the term hereof, validly exist as a political subdivision under North Carolina law. 2.2 Approval and Authorization. The County has full power and authority to enter into this Agreement and to fully perform all of its duties and obligations hereunder. The County has duly authorized the execution and delivery of this Agreement and the County's performance of all of its duties and obligations contained herein, and this Agreement constitutes a valid and legally binding obligation of the County, enforceable in accordance with its terms. 2.3 No litigation or Conflicts. The County acknowledges that there is no action, suit, or proceeding pending or, to the best of the County's knowledge and belief, threatened against or affecting the County, at law or in equity or before or by any federal, state, municipal or other governmental department, commission, board, bureau, agency or instrumentality wherein any decision, ruling or finding would adversely affect the transactions contemplated herein, and that the execution, delivery and performance of this Agreement by the County will not result in a violation of or be in conflict with any ordinance, agreement, instrument, judgment, decree, order, state, rule or government regulation to which the County is subject or by which the County is bound. 2.4 Public Interest. The County has determined that it is in the public interest of the citizens of Harnett County to enter into this Agreement with Sampson to perform transportation and disposal services. 4 2.5 Statements. No statement, information, representation or warranty of the County contained in this Agreement or furnished by or on behalf of the County in connection with the transactions contemplated in this Agreement contains any untrue statement of a material fact or omits to state a material fact necessary in order to make a statement contained herein not misleading. 3. Representation, Warranties and Covenants of Sampson. Sampson represents warrants and agrees as follows: 3.1 Existence and Good Standing. Sampson has been duly organized as a limited liability corporation under the laws of the State of North Carolina and is and will continue to be throughout the term hereof qualified to do business in the State of North Carolina. 3.2 Approval and Authorization. Sampson has all requisite corporate power and authority to enter into and fully perform this Agreement. Sampson's execution and delivery of this Agreement and Sampson's performance of all of its duties and obligations contained herein have been duly authorized by all necessary corporate action on the part of Sampson and this Agreement of Sampson is enforceable against Sampson in accordance with its terms. 3.3 No Litigation. There is no action, suit or proceeding pending or, to the best knowledge and belief of Sampson, threatened against or affecting Sampson at law or in equity or before or by any federal, state, municipal, or other governmental department wherein any decision would materially and adversely affect the transactions contemplated herein. 4. Services. The County hereby engages Sampson to provide transportation and disposal of all "MSW" from the Transfer Stations to the Sampson County Landfill (the "Services"}. Sampson will provide all equipment and labor necessary to provide the Services. Sampson will be the exclusive provider of the Services and the County will not enter into any agreement with any person or entity other than Sampson for the same or similar services as contemplated hereunder. 5. Transfer Station Operations. The County shall operate the Transfer Stations in accordance with all permits, licenses, laws, regulations, ordinances, order and decrees. The County shall load all Acceptable Solid Waste accepted at the Transfer Stations onto Sampson's or its subcontractor's transport vehicles. The County shall be responsible for any damage it causes to Sampson's or its subcontractor's vehicles (including trailers). Any vehicle damage claim shall be reported to the County within seventy-two (72) hours by Sampson. Once Acceptable Solid Waste is loaded into Sampson's (or its subcontractor's) equipment, title to the Acceptable Solid Waste shall pass to Sampson. 5 6. Transportation of Waste. 6.1 Generally. Sampson agrees to transport to and dispose of in the Landfill all Acceptable Solid Waste delivered to the Transfer Stations. Sampson shall be solely responsible for all aspects of such transportation of the Solid Waste, and agrees to operate all vehicles and otherwise engage in the safe transportation of Solid Waste according to generally accepted standards for the transportation of Solid Waste under the direction and supervision of qualified, trained personnel, and in accordance with (i} the terms of this Agreement and (ii) all applicable laws, ordinances, regulations and orders. Notwithstanding any provisions to the contrary, it is understood and agreed to by the parties that Sampson may subcontract any and all aspects of transportation. 6.2 Maintenance of Vehicles. All vehicles used to transport Solid Waste from the Transfer Station to the Landfill shall be road-worthy and in good condition and repair in accordance with the approved Harnett County Solid Waste Ordinance. Any changes in the Harnett County Solid Waste Ordinance that affects the Agreement, Sampson will receive written notice 30 days prior and must approve applicable changes. Sampson agrees to operate the vehicles at all times in a safe manner, in full compliance with all speed limits and other highway and traffic safety laws. All vehicles containing Solid Waste shall be covered so as to insure that no litter blows or falls from the vehicles, all trailer tarp systems shall be operable from the ground only. Sampson shall inspect and maintain all vehicles on a regular basis to insure that its vehicles are safe and in compliance with the terms of this Agreement and all applicable laws. Sampson shall also be responsible for (i} providing the rolling stock necessary for the transportation of all Solid Waste from the Transfer Station to the landfill for final disposal: (ii} the expense of maintaining and repairing all rolling stock; and (iii} all taxes, fees and assessments associated with the ownership and operation of all rolling stock. Notwithstanding any provisions to the contrary, it is understood and agreed to by the parties that Sampson may subcontract any and all aspects of transportation. 6.3 Employee Rules. Sampson shall ensure that all employees abide by the following rules: a. Supervisors/employees shall abide by rules and regulations set forth by the State of North Carolina which are applicable to the performance of the Services. b. That the transportation and disposal of solid waste under the terms of the Agreement take place under the direction and supervision of qualified, 6 trained, personnel, and in accordance with all applicable laws, ordinances, regulations and orders. c. At Sampson's sole expense, all of Sampson's personnel engaged in the services provided under this Agreement shall satisfy safety training and review as are commercially reasonable and standard in the industry, which may include, without limitation: 1. Verified Satisfactory Background Check 2. Verified Reference Checks 3. OSHA Training 4. Product Knowledge 5. Personal Protection Equipment 6. Safety Training To the extent Services are provided by a subcontractor, Sampson shall receive reasonable assurance that the subcontractor has complied with the foregoing. d. Upon written request of the County to Sampson, any of Sampson's employees or subcontractors who fail to abide by these or other rules established by the County, other than non-material or inadvertent failures which are promptly remedied, will be immediately removed from the job and replaced. 7. Fees/Payment 7.1 PerTon Rate. (a) Effective from the Commencement Date, County shall pay Sampson $36.45 per ton (the /{Per Ton Rate") for Services rendered during the previous month. The Per Ton Rate includes the current State of North Carolina trash tax. Any future additions in governmental (including State, Federal or local government) fees will be added as a straight pass-through to the most current Per Ton Rate, as may have been adjusted hereunder. The calculation of Sampson's fees shall be based on the tonnage accepted at landfill in connection with the Services. The County will average twenty-two (22) tons per load (averaged quarterly). load weight will be reviewed at the end of each quarter and if the total hauls for the quarter average less than twenty-two (22) tons per load then County shall pay to Sampson an amount based on the average shortage multiplied by the most current Per Ton Rate and further multiplied by the total number of loads accepted from the County at the landfill during such quarter. (b) In the event that, at any time during the term of this Agreement, the County causes all C&D waste over which it has control to be delivered to the 7 Transfer Stations rather than the County C&D landfills, the Per Ton Rate will be reduced by $2.60 per ton so long as such exclusivity condition is met. In addition, under such circumstances, they average tons per load will be reduced from twenty- two (22) to nineteen {19). All other provisions of Section 7.1(a) above will remain in effect. 7.2 A fuel surcharge will be added to the Per Ton Rate, which shall increase by one (1%) for every eight cents {$0.08) increase in the price of diesel fuel above the threshold price of $4.50 per gallon. Calculations shall be made and become effective the first Monday of each month based upon the changes in the price of fuel as reported in the Energy Information Association Index of the On-Highway Diesel Fuel Prices, U.S., East Coast, r'the Fuel Price"). The definition of "Per Ton Rate" shall include the then-current fuel surcharge. 7.3 The County shall pay Sampson no later than the fifteenth (15th) day of the month following the month when the Services were rendered. 7.4 Commencing June 30, 2015, and each successive year thereafter for the duration of this Agreement the Per Ton Rate provided for in this Section shall be adjusted in amount equal to the percentage change in the CPl. The adjustment in fees shall be calculated in accordance with Schedule A attached hereto and made a part hereof, not to exceed three {3) percent. The definition of "Per Ton Rate" shall include the annual CPI adjustment. 8. Special Waste With respect to any Special Waste transportation and/or disposal needs the County may have, the County will provide Sampson with the opportunity to discuss and provide pricing for the County's Special Waste needs at all times during the term of this Agreement. The parties will work in good faith to come to mutually agreeable terms on the handling of the Special Waste, acknowledging that the fees for handling, transporting and disposal of Special Waste will in some instance be higher and in some instance lower than fees for transporting and disposing of solid waste. 9. Term/Termination 9.1 Term. Subject to earlier termination under the provision hereof, the term of this Agreement shall commence on the Effective Date and shall continue through December 31, 2020. The term of this Agreement may be extended for three {3} additional five-year terms by mutual agreement of the parties upon satisfactory negotiation of the terms of the extension. 9.2 Termination by County. It is mutually understood and agreed that the County upon written notice to Sampson, may {but is not obligated to) terminate this 8 Agreement if (i) Sampson breaches a material provision of this Agreement and fails to cure such breach in accordance with Section 11.2 below or (ii) an Event of Force Majeure continues for sixty (60) days and renders Sampson unable, wholly or in part, to continue performance under this Agreement. 9.3 Termination by Sampson. It is mutually understood and agreed that Sampson upon written notice to County, may {but is not obligated to) terminate this Agreement if County breaches a material provision of this Agreement and fails to cure such breach in accordance with Section 11.2 below. 10. Indemnification by Sampson. Sampson agrees to indemnify and hold harmless the County, its members, officers and employees, against any loss, claim, liability, penalty, fine, forfeiture, demand, cause of action, suit and costs and expenses incidental thereto (including cost of defense, settlement and reasonable attorney's fees ("Indemnified Costs"L caused by or resulting from (a) any negligent act or omission of or willful misconduct of Sampson, its agents or employees, in connection with Sampson's performance of this Agreement, or (b) the breach by Sampson of any of the agreements, representations, or warranties of Sampson contained in or referred to in this Agreement; provided, however, that Sampson shall not indemnify the County or any of its officers or employees from any Indemnified Costs to the extent caused or resulting from any act or omission of the County or any of its members, commissioners, employees, agents or contractors, any breach by the County of any agreement, representation or warranty of the County contained in this Agreement. The indemnity obligation of Sampson under this Section 10 shall survive the expiration or termination of the Agreement subject to any applicable statute of limitation. 11. Breach; Remedies 11.1 Breaches. A breach of this Agreement shall mean a material failure to comply with any of the material provisions of this Agreement. 11.2 Obligation to Cure Breaches. Each party shall in the case of any breach of its obligations under this Agreement either (a) cure the breach within thirty (30) day period of receipt of written notice from the non-breaching party, or (b) continuously demonstrate within such cure period that it is actively and continuously pursuing a course of action which can be reasonable be expected to lead to a curing of the breach. The thirty (30) day period will be extended for so long as the breaching party is actively and continuously pursuing such a course; provided, however that, in the event of the failure of any party to this Agreement to pay the other party or parties any sum or dollar amount required to be paid when due hereunder, cure shall consist of payment which shall be made within fifteen (15) days of written demand from the non-breaching party. Together with interest accruing at the legal rate from the date the payment was due. 11.3 Remedies for Default. 9 (a) In the event of a default under this Agreement, the non-defaulting party, following the applicable cure period, upon five (5) days prior Written notice to the defaulting party, shall have the right, but not the obligation or duty, to cure such default, including the right to offset the costs of curing the default against any sums due or which become due to the defaulting party under this Agreement. In any event, such costs shall be considered Indemnified Costs, to the extent they are allowed under the Agreement. (b) In an event of default occurs and is not cured in the manner allowed hereunder, then this Agreement shall continue in force and the non-defaulting party shall have the right to take whatever action permitted at law or in equity that it deems necessary or desirable to collect any amounts then due or thereafter to become due under this Agreement or to enforce performances of any covenant or obligation ofthe breaching party under this Agreement. (c) The rights and remedies under this Agreement are cumulative, and the exercise of any one remedy does not preclude the exercise of one or more of any other available remedies. (d) Non-Appropriation of Funds. If County does not appropriate the funding needed by the County to make payments under this Contract for a given fiscal year, the County will only be obligated to pay amounts due for Acceptable Solid Waste already disposed of which funds were appropriated. No act or omissions by the County, which is attributable to non-appropriation of funds shall constitute a breach of or default under this Contract. 12. Miscellaneous 12.1 Notices. All notices or other communications to be given hereunder shall be in writing and may be personal delivery or by registered or certified United States mail, return receipt request, properly addressed as follows: To the County: With copy to: To Sampson: Harnett County Attn: County Manager PO Box 759 Lillington, North Carolina 27546 Harnett County Staff Attorney PO Box 238 Lillington, North Carolina 27546 Sampson County Disposal, LLC Attn: Landfill Manager 10 With copy to: PO Box 640 Roseboro, North Carolina 28382 Waste Industries Attn: Corporate Attorney 3301 Benson Drive, Suite 501 Raleigh, NC 27609 Change of address by either party shall be by notice given to the other in the same manner as above specified. Any notice or other communication under this Agreement shall be deemed given at the time of actual delivery, if it is personally delivered, or if such notice or other communication is sent by registered or certified United States mail, as above provided, upon the third regular business day following the day on which such notices or other communication is deposited with a United States Post Office or branch Post Office or upon actual delivery as shown by the return receipt, whichever first occurs. 12.2 Assignment. Unless otherwise provided herein, neither party shall assign, transfer or delegate, or permit the assignment, transfer or delegation of, this Agreement or any right or duty hereunder, without the prior written consent of the other party, which shall be unreasonably withheld. Notwithstanding the above, Sampson may, with the consent of the County assign its right and duties under this Agreement to a corporate affiliate or wholly-owned subsidiary of Sampson, in which event said assignee shall become "Sampson" as defined herein; provided, however, that Sampson County Disposal, llC shall not, by reason of such assignment, be relieved of any of its obligations hereunder. Notwithstanding the foregoing, the County acknowledges that Sampson is permitted to subcontract its duties hereunder. 12.3 Force Majeure. In the event the County or Sampson is rendered unable, wholly or in part, by an event of Force Majeure to carry out any of its obligations under this Agreement, then the obligations of the County or Sampson may be suspended during the continuation of any inability so caused by the event of Force Majeure, but for no longer period, any time that the County or Sampson intends to rely upon an event of Force Majeure to suspend obligations are provided in this Section, the County or Sampson shall notify the other party to this Agreement as soon as reasonable practicable, describing in reasonable detail the circumstance of the event of Force Majeure. Notice shall again be given when the effect of the even or Force Majeure has ceased. 12.3 Insurance. During the term of this Agreement, Sampson agrees to procure and maintain insurance in accordance with Schedule of Insurance as Exhibit B, naming the County as an Additional Insured on their policies of liability insurance. 12.4 Severability. In the event any one or more of the provisions contained in this Agreement shall, for any reason, be held to be invalid, illegal or unenforceable in any 11 respect, such invalidity, illegality or unenforceabi!ity shall not affect any other provision of this Agreement and this Agreement shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein. 12.5 Governing law. This Agreement shall be governed by and construed in accordance with the laws of the state of North Carolina. 12.6 Mediation. Any claim, dispute or other matter in question arising out of or related to this Agreement shall be subject to mediation as a condition precedent to the institution of legal or equitable proceedings by either party. The Parties agree that the mediation will be conducted and governed by the North Carolina Rules Implementing Statewide Mediated Settlement Conferences in Superior Court Civil Actions, and N.C.G.S. Sect. 7A-38.1{c) except as specifically provided otherwise herein. The parties shall share the mediator's fee and any filing fees equally. The mediation shall be held in Harnett County, unless another location is mutually agreed upon. Agreements reached in mediation shall be enforceable as settlement agreements in any court having jurisdiction thereof. 12.7 Binding Effect. This Agreement shall be binding upon, and inure to the benefit of, the parties hereto and their respective successors and assigns. 12.8 Construction. This Agreement shall be binding upon, and inure to the benefit of, the parties hereto and their respective successors and assigns. 12.9 Entire Agreement. This Agreement constitutes the entire understanding between the County and Sampson, and, unless otherwise specifically provided, cancels and supersedes all prior negotiations, representations, understandings and agreements, either written or oral, between such parties with respect to the subject matter hereof. Without limiting the foregoing, this Agreement expressly supersedes and replaces the 2007 Agreement in its entirety. No changes, amendments, alterations, or modification to this Agreement will be effective unless in writing and signed by the parties hereto. 12.10 Counterparts. This agreement may be executed in two {2) counterparts, each which will be considered an original. 12.11 Further Assurance. The parties represent to one another that they entered into this Agreement in good faith and in a spirit of mutual cooperation and, by the execution of this Agreement, do pledge their continued cooperation and support of the goals of this undertaking which is intended to provide a long-range solution for the disposal of Solid Waste, not only to meet all governmental requirements, but in order to provide an efficient, effective and environmentally sound mechanism for the management of Solid Waste. The parties each agree to enter into such amendments or addenda to this Agreement as shall be reasonable necessary to carry out the purposes of this Agreement. 12 12.12 Equal Opportunity Employer. Harnett County is an equal employment opportunity employer. The County is a federal contractor, and therefore the provisions and affirmative action obligations of 41 CFR & 60-1.4(a), 41 CFR 60-741.5(a), and 41 CFR 60- 250.4 are incorporated herein by reference/ where applicable. 12.13 E-Verify Compliance. Sampson represents and covenants that Sampson shall comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Further, if Sampson provides any services to County utilizing a subcontractor, Sampson shall require the subcontractor to comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. 12.13 Authority of Parties. The individuals who have executed this Agreement on behalf of the respective parties expressly represent and warrant that they are authorized to sign on behalf of such entities for the purpose of duly binding such entities to this Agreement. [Signature page follows.] IN WITNESS WHEREOF, the County and Sampson have caused their respective duly authorized officers to execute this Agreement under seal as of the day and year first written above. HARNETT COUNTY: By: Chairman, Harnett County Board of Commissioners Attest: Clerk to the Harnett County Board of Commissioners Date of Execution: ---------------- SAMPSON COUNTY DISPOSAL, llC: By: Title: 13 Attest: Date of Execution: ---------------------------------- This instrument has been pre audited in the manner required by the Local Government Budget and Fiscal Control Act. By: County Finance Officer Date: 14 Board Meeting Agenda Item Agenda Item J./-P _.....___..L-__ MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Sampson County Disposal, LLC. Agreement REQUESTED BY: Amanda Bader, County Engineer REQUEST: As previously discussed and authorized by the Board of Commissioners, staff has renegotiated our Transportation and Disposal Agreement with Sampson County Disposal, LLC, a subsidiary of Waste Industries. We respectfully request that the board approve this agreement. Listed below are some of the changes that will have significant and positive impact for Harnett County. It is estimated that these changes will generate savings in the range of$122,000 to $191,000 in the first year and additional savings throughout the term of the contract. 1. Increase fuel surcharge from $3.00 to $4.50 2. Eliminate a CPI for the first two years of the contract 3. Change the CPI index used and cap at 3% 4. Extend the term of the contract 6.5 years Staff believes that the renegotiated terms are imperative for the stability of rates and improving the solid waste service to the residents of Harnett County. COUNTY MANAGER'S RECOMMENDATION: C:\Users\gwheeler\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\Z5TP9EAN\agendaform2013.doc Page I ofl TRANSPORTATION AND DISPOSAL AGREEMENT BY AND BETWEEN SAMPSON COUNTY DISPOSAL, LLC AND HARNETI COUNTY, NORTH CAROLINA September 1, 2013 Transportation and Disposal Agreement This Transportation and Disposal Agreement (the "Agreement") is made and entered into this 1st day of September, 2013, by and between County of Harnett, a political subdivision created and existing under the laws of the State of North Carolina ("County") and Sampson County Disposal, LLC, a North Carolina Limited liability Corporation authorized to conduct business in the State of North Carolina ("Sampson"}. RECITALS A. The County and Sampson are parties to a Transportation and Disposal Agreement dated December 3, 2007, as amended (the "2007 Agreement"}. B. The County and Sampson desire this Agreement to supersede and replace the 2007 Agreement in its entirety. C. The County owns and operates solid waste transfer stations located in Harnett County, North Carolina. D. The County desires to retain Sampson to provide transportation and disposal services to the County. E. Sampson desires to perform transportation and disposal services upon the terms and conditions set forth below. Now, therefore, in consideration of these premises and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto, each intending to be legally bound agree as follows: 1. Definitions. The capitalized terms in this Agreement shall have the definition as set forth below: a. "Acceptable Solid Waste" means mixed household solid waste and mixtures of household, commercial and industrial solid waste that are permitted under the governing permits and then applicable laws to be accepted at the applicable disposal facilities and that are not otnerwise Unacceptable Waste. b. "Agreement" means this Agreement between the County and Sampson. c. "C&D" means construction and demolition waste material permitted under the governing permits of the landfill, and that is not otherwise Unacceptable Solid Waste. 2 d. "CPI" means the Consumer Price Index published by Bureau of Labor Statistics U.S. Department of labor, U.S. City Average, All items (1982-84=100), All Urban Consumers, May issue. e. "Commencement Date" means September 1st, 2013. f. "Effective Date" means the date first above written. g. "Force Majeure" means any event reasonably relied upon by the County or Sampson as justification or excuse from performing any obligation hereunder, which event is beyond the reasonable control of the party relying on such event, including, without limitation: (i) An act of God, epidemic, landslide, lightning, earthquake, fire, explosion, storm, flood or similar occurrence; (ii) War, blockade, riot or restraint of government and people; (iii) a strike or similar industrial or labor action; (iv) The order or judgment or other act of any federal, state, county, or local court, administrative agency or governmental office or body, including, without limitation, such an order or judgment which stays, invalidates, or otherwise affects this Agreement. h. "Hazardous Substance" means any hazardous, toxic or carcinogenic substance or wastes that are now or in the future defined, determined or identified as such by any federal, state or local statute, regulation, rule, ordinance, or other law relating in any way to protection of the environment or the public health and safety, whether now in effect or as amended or enacted in the future. i. "Landfill" means the landfill owned and operated by Sampson County Disposal, LLC located in Roseboro, Sampson County, North Carolina or any other landfill selected by Sampson for disposal, which landfill is properly permitted for acceptance of Acceptable Waste. *'-L"MSW" means municipal solid waste material permitted under the governing permits of the landfill, and that is not otherwise Unacceptable Solid Waste. "Special Waste" means any waste requiring special handling, treatment or processing under the governing permits of the landfill or under applicable law. 3 {/Transfer Station" or {/Transfer Stations" means the solid waste transfer stations owned and operated by the County located at NC State Road 1724/ 449 Daniel's Rd., Dunn, N.C. and NC State Road 1164/1086Poplar Dr., Anderson Creek, N.C. ":.,;;.,;_; ___ "Unacceptable Waste" means {i) any material that is not Acceptable Waste; (ii) any material that by reason of its composition, characteristics or quantity is defined or characterized as a Hazardous Substance; (iii) any material that requires other than normal handling, storage, management, transfer or disposal; or (iv) any other material that may present a substantial endangerment to public health or safety, may cause applicable air quality or water effluent standards to be violated by the normal operation of the Landfill, or because of its size, durability or composition cannot be disposed of at the Landfill or has a reasonable possibility of otherwise adversely affecting the operation or useful life of the Landfill. 2. Representations, Warranties and Covenants of County 2.1 Existence and Good Standing. The County is, and will continue to throughout the term hereof, validly exist as a political subdivision under North Carolina law. 2.2 Approval and Authorization. The County has full power and authority to enter into this Agreement and to fully perform all of its duties and obligations hereunder. The County has duly authorized the execution and delivery of this Agreement and the County's performance of all of its duties and obligations contained herein, and this Agreement constitutes a valid and legally binding obligation of the County, enforceable in accordance with its terms. 2.3 No Litigation or Conflicts. The County acknowledges that there is no action, suit, or proceeding pending or, to the best of the County's knowledge and belief, threatened against or affecting the County, at law or in equity or before or by any federal, state, municipal or other governmental department, commission, board, bureau, agency or instrumentality wherein any decision, ruling or finding would adversely affect the transactions contemplated herein, and that the execution, delivery and performance of this Agreement by the County will not result in a violation of or be in conflict with any ordinance, agreement, instrument, judgment, decree, order, state, rule or government regulation to which the County is subject or by which the County is bound. 2.4 Public Interest. The County has determined that it is in the public interest of the citizens of Harnett County to enter into this Agreement with Sampson to perform transportation and disposal services. 4 2.5 Statements. No statement, information, representation or warranty of the County contained in this Agreement or furnished by or on behalf of the County in connection with the transactions contemplated in this Agreement contains any untrue statement of a material fact or omits to state a material fact necessary in order to make a statement contained herein not misleading. 3. Representation, Warranties and Covenants of Sampson. Sampson represents warrants and agrees as follows: 3.1 Existence and Good Standing. Sampson has been duly organized as a limited liability corporation under the laws of the State of North Carolina and is and will continue to be throughout the term hereof qualified to do business in the State of North Carolina. 3.2 Approval and Authorization. Sampson has all requisite corporate power and authority to enter into and fully perform this Agreement. Sampson's execution and delivery of this Agreement and Sampson's performance of all of its duties and obligations contained herein have been duly authorized by all necessary corporate action on the part of Sampson and this Agreement of Sampson is enforceable against Sampson in accordance with its terms. 3.3 No Litigation. There is no action, suit or proceeding pending or, to the best knowledge and belief of Sampson, threatened against or affecting Sampson at law or in equity or before or by any federal, state, municipal, or other governmental department wherein any decision would materially and adversely affect the transactions contemplated herein. 4. Services. The County hereby engages Sampson to provide transportation and disposal of aii"MSW" from the Transfer Stations to the Sampson County Landfill (the "Services"). Sampson will provide all equipment and labor necessary to provide the Services. Sampson will be the exclusive provider of the Services and the County will not enter into any agreement with any person or entity other than Sampson for the same or similar services as contemplated hereunder. 5. Transfer Station Operations. The County shall operate the Transfer Stations in accordance with all permits, licenses, laws, regulations, ordinances, order and decrees. The County shall load all Acceptable Solid Waste accepted at the Transfer Stations onto Sampson's or its subcontractor's transport vehicles. The County shall be responsible for any damage it causes to Sampson's or its subcontractor's vehicles (including trailers). Any vehicle damage claim shall be reported to the County within seventy-two (72) hours by Sampson. Once Acceptable Solid Waste is loaded into Sampson's (or its subcontractor's) equipment, title to the Acceptable Solid Waste shall pass to Sampson. 5 6. Transportation of Waste. 6.1 Generally. Sampson agrees to transport to and dispose of in the Landfill all Acceptable Solid Waste delivered to the Transfer Stations. Sampson shall be solely responsible for all aspects of such transportation of the Solid Waste, and agrees to operate all vehicles and otherwise engage in the safe transportation of Solid Waste according to generally accepted standards for the transportation of Solid Waste under the direction and supervision of qualified, trained personnel, and in accordance with (i) the terms of this Agreement and (ii) all applicable laws, ordinances, regulations and orders. Notwithstanding any provisions to the contrary, it is understood and agreed to by the parties that Sampson may subcontract any and all aspects of transportation. 6.2 Maintenance of Vehicles. All vehicles used to transport Solid Waste from the Transfer Station to the Landfill shall be road-worthy and in good condition and repair in accordance with the approved Harnett County Solid Waste Ordinance. Any changes in the Harnett County Solid Waste Ordinance that affects the Agreement, Sampson will receive written notice 30 days prior and must approve applicable changes. Sampson agrees to operate the vehicles at all times in a safe manner, in full compliance with all speed limits and other highway and traffic safety laws. All vehicles containing Solid Waste shall be covered so as to insure that no litter blows or falls from the vehicles, all trailer tarp systems shall be operable from the ground only. Sampson shall inspect and maintain all vehicles on a regular basis to insure that its vehicles are safe and in compliance with the terms of this Agreement and all applicable laws. Sampson shall also be responsible for (i) providing the rolling stock necessary for the transportation of all Solid Waste from the Transfer Station to the Landfill for final disposal: (ii) the expense of maintaining and repairing all rolling stock; and (iii) all taxes, fees and assessments associated with the ownership and operation of all rolling stock. Notwithstanding any provisions to the contrary, it is understood and agreed to by the parties that Sampson may subcontract any and all aspects of transportation. 6.3 Employee Rules. Sampson shall ensure that all employees abide by the following rules: a. Supervisors/employees shall abide by rules and regulations set forth by the State of North Carolina which are applicable to the performance of the Services. b. That the transportation and disposal of solid waste under the terms of the Agreement take place under the direction and supervision of qualified, 6 trained, personnel, and in accordance with all applicable laws, ordinances, regulations and orders. c. At Sampson's sole expense, all of Sampson's personnel engaged in the services provided under this Agreement shall satisfy safety training and review as are commercially reasonable and standard in the industry, which may include, without limitation: 1. Verified Satisfactory Background Check 2. Verified Reference Checks 3. OSHA Training 4. Product Knowledge 5. Personal Protection Equipment 6. Safety Training To the extent Services are provided by a subcontractor, Sampson shall receive reasonable assurance that the subcontractor has complied with the foregoing. d. Upon written request of the County to Sampson, any of Sampson's employees or subcontractors who fail to abide by these or other rules established by the County, other than non-material or inadvertent failures which are promptly remedied, will be immediately removed from the job and replaced. 7. Fees/Payment 7.1 Per Ton Rate. (a) Effective from the Commencement Date, County shall pay Sampson $36.45 per ton (the "Per Ton Rate") for Services rendered during the previous month. The Per Ton Rate includes the current State of North Carolina trash tax. Any future additions in governmental (including State, Federal or local government) fees will be added as a straight pass-through to the most current Per Ton Rate, as may have been adjusted hereunder. The calculation of Sampson's fees shall be based on the tonnage accepted at landfill in connection with the Services. The County will average twenty-two (22) tons per load (averaged quarterly). load weight will be reviewed at the end of each quarter and if the total hauls for the quarter average less than twenty-two (22) tons per load then County shall pay to Sampson an amount based on the average shortage multiplied by the most current Per Ton Rate and further multiplied by the total number of loads accepted from the County at the landfill during such quarter. (b) In the event that, at any time during the term of this Agreement, the County causes all C&D waste over which it has control to be delivered to the 7 Transfer Stations rather than the County C&D Landfills, the Per Ton Rate will be reduced by $2.60 per ton so long as such exclusivity condition is met. In addition, under such circumstances, they average tons per load will be reduced from twenty- two {22) to nineteen {19). All other provisions of Section 7.1{a) above will remain in effect. 7.2 A fuel surcharge will be added to the Per Ton Rate, which shall increase by one (1%} for every eight cents ($0.08} increase in the price of diesel fuel above the threshold price of $4.50 per gallon. Calculations shall be made and become effective the first Monday of each month based upon the changes in the price of fuel as reported in the Energy Information Association Index of the On-Highway Diesel Fuel Prices, U.S., East Coast, ("the Fuel Price"). The definition of "Per Ton Rate" shall include the then-current fuel surcharge. 7.3 The County shall pay Sampson no later than the fifteenth (15th) day of the month following the month when the Services were rendered. 7.4 Commencing June 30, 2015, and each successive year thereafter for the duration of this Agreement, the Per Ton Rate provided for in this Section shall be adjusted in amount equal to the percentage change in the CPl. The adjustment in fees shall be calculated in accordance with Schedule A attached hereto and made a part hereof, not to exceed three (3} percent. The definition of "Per Ton Rate 11 shall include the annual CPI adjustment. 8. Special Waste With respect to any Special Waste transportation and/or disposal needs the County may have, the County will provide Sampson with the opportunity to discuss and provide pricing for the County's Special Waste needs at all times during the term of this Agreement. The parties will work in good faith to come to mutually agreeable terms on the handling of the Special Waste, acknowledging that the fees for handling, transporting and disposal of Special Waste will in some instance be higher and in some instance lower than fees for transporting and disposing of solid waste. 9. Term/Termination 9.1 Term. Subject to earlier termination under the provision hereof, the term of this Agreement shall commence on the Effective Date and shall continue through December 31, 2020. The term of this Agreement may be extended for three (3} additional five-year terms by mutual agreement of the parties upon satisfactory negotiation of the terms of the extension. 9.2 Termination by County. It is mutually understood and agreed that the County upon written notice to Sampson, may (but is not obligated to) terminate this 8 Agreement if (i) Sampson breaches a material provision of this Agreement and fails to cure such breach in accordance with Section 11.2 below or (ii) an Event of Force Majeure continues for sixty (60) days and renders Sampson unable, wholly or in part, to continue performance under this Agreement. 9.3 Termination by Sampson. It is mutually understood and agreed that Sampson upon written notice to County, may (but is not obligated to) terminate this Agreement if County breaches a material provision of this Agreement and fails to cure such breach in accordance with Section 11.2 below. 10. Indemnification by Sampson. Sampson agrees to indemnify and hold harmless the County, its members, officers and employees, against any loss, claim, liability, penalty, fine, forfeiture, demand, cause of action, suit and costs and expenses incidental thereto (including cost of defense, settlement and reasonable attorney's fees ("'ndemnified Costs"), caused by or resulting from (a) any negligent act or omission of or willful misconduct of Sampson, its agents or employees, in connection with Sampson's performance of this Agreement, or (b) the breach by Sampson of any of the agreements, representations, or warranties of Sampson contained in or referred to in this Agreement; provided, however, that Sampson shall not indemnify the County or any of its officers or employees from any Indemnified Costs to the extent caused or resulting from any act or omission of the County or any of its members, commissioners, employees, agents or contractors, any breach by the County of any agreement, representation or warranty of the County contained in this Agreement. The indemnity obligation of Sampson under this Section 10 shall survive the expiration or termination of the Agreement subject to any applicable statute of limitation. 11. Breach; Remedies 11.1 Breaches. A breach of this Agreement shall mean a material failure to comply with any of the material provisions of this Agreement. 11.2 Obligation to Cure Breaches. Each party shall in the case of any breach of its obligations under this Agreement either (a) cure the breach within thirty (30) day period of receipt of written notice from the non-breaching party, or (b) continuously demonstrate within such cure period that it is actively and continuously pursuing a course of action which can be reasonable be expected to lead to a curing of the breach. The thirty (30) day period will be extended for so long as the breaching party is actively and continuously pursuing such a course; provided, however that, in the event of the failure of any party to this Agreement to pay the other party or parties any sum or dollar amount required to be paid when due hereunder, cure shall consist of payment which shall be made within fifteen {15) days of written demand from the non-breaching party. Together with interest accruing at the legal rate from the date the payment was due. 11.3 Remedies for Default. 9 (a) In the event of a default under this Agreement the non-defaulting party, following the applicable cure period, upon five (5) days prior written notice to the defaulting party, shall have the right, but not the obligation or duty, to cure such default, including the right to offset the costs of curing the default against any sums due or which become due to the defaulting party under this Agreement. In any event, such costs shall be considered Indemnified Costs, to the extent they are allowed under the Agreement. (b) In an event of default occurs and is not cured in the manner allowed hereunder, then this Agreement shall continue in force and the non-defaulting party shall have the right to take whatever action permitted at law or in equity that it deems necessary or desirable to collect any amounts then due or thereafter to become due under this Agreement or to enforce performances of any covenant or obligation of the breaching party under this Agreement. (c) The rights and remedies under this Agreement are cu mutative, and the exercise of any one remedy does not preclude the exercise of one or more of any other available remedies. (d) Non-Appropriation of Funds. If County does not appropriate the funding needed by the County to make payments under this Contract for a given fiscal year, the County will only be obligated to pay amounts due for Acceptable Solid Waste already disposed of which funds were appropriated. No act or omissions by the County, which is attributable to non-appropriation of funds shall constitute a breach of or default under this Contract. 12. Miscellaneous 12.1 Notices. All notices or other communications to be given hereunder shall be in writing and may be personal delivery or by registered or certified United States mail, return receipt request, properly addressed as follows: To the County: With copy to: To Sampson: Harnett County Attn: County Manager PO Box 759 Lillington, North Carolina 27546 Harnett County Staff Attorney PO Box238 Lillington, North Carolina 27546 Sampson County Disposal, LLC Attn: Landfill Manager 10 With copy to: PO Box 640 Roseboro, North Carolina 28382 Waste Industries Attn: Corporate Attorney 3301 Benson Drive, Suite 501 Raleigh, NC 27609 Change of address by either party shall be by notice given to the other in the same manner as above specified. Any notice or other communication under this Agreement shall be deemed given at the time of actual delivery, if it is personally delivered, or if such notice or other communication is sent by registered or certified United States mail, as above provided, upon the third regular business day following the day on which such notices or other communication is deposited with a United States Post Office or branch Post Office or upon actual delivery as shown by the return receipt, whichever first occurs. 12.2 Assignment. Unless otherwise provided herein, neither party shall assign, transfer or delegate, or permit the assignment, transfer or delegation of, this Agreement or any right or duty hereunder, without the prior written consent of the other party, which shall be unreasonably withheld. Notwithstanding the above, Sampson may, with the consent of the County assign its right and duties under this Agreement to a corporate affiliate or wholly-owned subsidiary of Sampson, in which event said assignee shall become "Sampson" as defined herein; provided, however, that Sampson County Disposal, LLC shall not, by reason of such assignment, be relieved of any of its obligations hereunder. Notwithstanding the foregoing, the County acknowledges that Sampson is permitted to subcontract its duties hereunder. 12.3 Force Majeure. In the event the County or Sampson is rendered unable, wholly or in part, by an event of Force Majeure to carry out any of its obligations under this Agreement, then the obligations of the County or Sampson may be suspended during the continuation of any inability so caused by the event of Force Majeure, but for no longer period, any time that the County or Sampson intends to rely upon an event of Force Majeure to suspend obligations are provided in this Section, the County or Sampson shall notify the other party to this Agreement as soon as reasonable practicable, describing in reasonable detail the circumstance of the event of Force Majeure. Notice shall again be given when the effect of the even or Force Majeure has ceased. 12.3 Insurance. During the term of this Agreement, Sampson agrees to procure and maintain insurance in accordance with Schedule of Insurance as Exhibit B, naming the County as an Additional Insured on their policies of liability insurance. 12.4 Severability. In the event any one or more of the provisions contained in this Agreement shall, for any reason, be held to be invalid, illegal or unenforceable in any 11 respect, such invalidity, illegality or unenforceability shall not affect any other provision of this Agreement and this Agreement shall be construed as if such invalid, illegal or unenforceable provision had never been contained herein. 12.5 Governing law. This Agreement shall be governed by and construed in accordance with the laws of the state of North Carolina. 12.6 Mediation. Any claim, dispute or other matter in question arising out of or related to this Agreement shall be subject to mediation as a condition precedent to the institution of legal or equitable proceedings by either party. The Parties agree that the mediation will be conducted and governed by the North Carolina Rules Implementing Statewide Mediated Settlement Conferences in Superior Court Civil Actions, and N.C.G.S. Sect. 7A-38.1(c) except as specifically provided otherwise herein. The parties shall share the mediator's fee and any filing fees equally. The mediation shall be held in Harnett County, unless another location is mutually agreed upon. Agreements reached in mediation shall be enforceable as settlement agreements in any court having jurisdiction thereof. 12.7 Binding Effect. This Agreement shall be binding upon, and inure to the benefit of, the parties hereto and their respective successors and assigns. 12.8 Construction. This Agreement shall be binding upon, and inure to the benefit of, the parties hereto and their respective successors and assigns. 12.9 Entire Agreement. This Agreement constitutes the entire understanding between the County and Sampson, and, unless otherwise specifically provided, cancels and supersedes all prior negotiations, representations, understandings and agreements, either written or oral, between such parties with respect to the subject matter hereof. Without limiting the foregoing, this Agreement expressly supersedes and replaces the 2007 Agreement in its entirety. No changes, amendments, alterations, or modification to this Agreement will be effective unless in writing and signed by the parties hereto. 12.10 Counterparts. This agreement may be executed in two (2) counterparts, each which will be considered an originaL 12.11 Further Assurance. The parties represent to one another that they entered into this Agreement in good faith and in a spirit of mutual cooperation and, by the execution of this Agreement, do pledge their continued cooperation and support of the goals of this undertaking which is intended to provide a long-range solution for the disposal of Solid Waste, not only to meet all governmental requirements, but in order to provide an efficient, effective and environmentally sound mechanism for the management of Solid Waste. The parties each agree to enter into such amendments or addenda to this Agreement as shall be reasonable necessary to carry out the purposes of this Agreement. 12 12.12 Equal Opportunity Employer. Harnett County is an equal employment opportunity employer. The County is a federal contractor, and therefore the provisions and affirmative action obligations of 41 CFR & 60-1.4(aL 41 CFR 60-741.5(a), and 41 CFR 60- 250.4 are incorporated herein by reference, where applicable. 12.13 E-Verify Compliance. Sampson represents and covenants that Sampson shall comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Further, if Sampson provides any services to County utilizing a subcontractor, Sampson shall require the subcontractor to comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. 12.13 Authority of Parties. The individuals who have executed this Agreement on behalf of the respective parties expressly represent and warrant that they are authorized to sign on behalf of such entities for the purpose of duly binding such entities to this Agreement. [Signature page follows.] IN WITNESS WHEREOF, the County and Sampson have caused their respective duly authorized officers to execute this Agreement under seal as of the day and year first written above. HARNETT COUNTY: By: Chairman, Harnett County Board of Commissioners Attest: Clerk to the Harnett County Board of Commissioners Date of Execution: ---------------- SAMPSON COUNTY DISPOSAL, LLC: By: Title: 13 Attest: Date of Execution: -------------------------------- This instrument has been pre audited in the manner required by the Local Government Budget and Fiscal Control Act. By: County Finance Officer Date: 14 Agenda Item 7 October 7, 2013 APPOINTMENTS NEEDED ADULT CARE HOME COMMUNITY ADVISORY COMMITTEE We need members on this committee. Members receive mileage reimbursement as claimed. AGRICULTURAL ADVISORY BOARD We have a vacancy for on this board for District 4. BOARD OF ADJUSTMENT We have a vacancy for an alternate member on this board for District 1. DANGEROUS DOG COMMITTEE We have a vacancy on this committee that needs to be filled by an attorney in the County. HARNETT COUNTY PUBLIC LIBRARY BOARD OF TRUSTEES We have a vacancy for an at-large member on this board. HARNETT NURSING HOME COMMUNITY ADVISORY COMMITTEE We need members on this committee. Members receive mileage reimbursement as claimed. HISTORIC PROPERTIES COMMISSION We currently have a vacancy for a regular member in District 3. Bryan Avery recently resigned recently. We currently have a vacancy for a regular member in District 5. LOCAL FIREMEN'S RELIEF FUND TRUSTEES Please see the attached list•ofappointees interested in·being appointed to serve. MID-CAROLINA AGING ADVISORY COMMITTEE We need members on this committee. Members receive mileage reimbursement as claimed. Page 1 -Appointments Board Meeting Agenda Item Agenda Item ------ MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Appointment ofLocal Firemen's Relief Fund Trustees REQUESTED BY: Gary L. Pope, Director of Emergency Services REQUEST: For the fire department to participate in the Local Firemen's Relief Fund each year they must submit a North Carolina Rural Fire District Report of Fire Conditions. It requires the appointment of two relief fund trustees by the fire department and the appointment of two trustees by the Harnett County Board of Commissioners and the appointment of one trustee by the Insurance Commissioner. I am requesting the Board of Commissioners appoint two trustees per department as submitted. COUNTY MANAGER'S RECOMMENDATION: U:\My October 7, 2013 Appointment of Local Firemen's Relief Fund Trustees: In order for the fire departments to participate in the Local Firemen's ReliefFund each year, they must submit a North Carolina Rural Fire District Report of Fire Conditions. This report requires the appointment of two Trustees by the Fire Department, two by the Board of Commissioners and one by the Insurance Commissioner. Recommended appointments by the Board of Commissioners are listed below: Spout Springs Emergency Services George Williams Robert Doberstein Anderson Creek Emergency Services Elizabeth Rodriguez Robby Fink Erwin Fire Department Ricky Blackman John Wilkins Buies Creek Rural Fire Department Wayman Byrd ~arshal}Cornegay Flat Branch Volunteer Fire Department Ron Burgess Holt Felment A verasboro/Dunn Emergency Services Arnold B. Barefoot, Sr. Richard E. Hedgepeth Coats·Grove Fire and Rescue Department Todd Pope Jay Smith Angier & Black River Fire Department Jody Milliron Harold Flowers, Jr. Summerville/Bunnlevel Fire & Rescue, Inc. Boone Trail Emergency Services Jerry Cornelius Vernon Cox Jackson Byrd Donald O'Quinn Benhaven Emergency Services Gary Briggs Margaret H. Douglas Northwest Harnett Volunteer Fire Dept. Craig McKinney Richard Braswell Board Meeting Agenda Item MEETING DATE: October 7, 2013 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Rural Operating Assistance Program (ROAP) REQUESTED BY: Dionne C. White REQUEST: Public Hearing be held on the use of the Rural Operating Assistance Program Grant Funds. ROAP funds are used for the Operating Cost of trips and other transportation services. These funds will be used to provide transportation services when there are no other available funding sources. Rural Operating Assistance Program (ROAP) includes the following programs: Elderly and Disabled Transportation Assistance Program (EDT APP) provides operating assistance funds for the transportation of the state's elderly and disabled citizen. ($85,399.00) Employment Transportation Assistance Program (EMP) provides transportation for the general public to work, employment training and any other employment destinations. ($28,605.00) Rural General Public Program (RGP) funds are intended to provide transportation for individuals of the county who do not have a human service agency or organzation that will pay for there transportation services. ($133,682.00) COUNTY MANAGER'S RECOMMENDATION: C:\Users\gwheeler\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content. Outlook\Z5TP9EAN\agendaform20 13 .doc Page 1 of l PAT MCCRORY GovE~"'OR STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION August 21, 2013 MEMORAJ\l])UM TO: FROM: SUBJECT: County Managers County Finance Officers Community Transportation System Directors Teresa Hart Director, Public Transportation Division Fll 2014 Rural Operating Assistance Program Application ANTHONY J. TATA SECRETARY The Rural Operating Assistance Program (ROAP) is a state-funded public transportation grant program administered by the North Carolina Department of Transportation-Public Transportation Division. ROAP consolidates the Elderly and Disabled Transportation Assistance Program (EDT AP), the Employment Transportation Assistance Program (EMPL) and the Rural General Public (RGP) Transportation Program into a single application package. ROAP funds and any additional funds supplementing the ROAP programs are allocated to each county by formula. The additional funds change unpredictably from year to year and may not be available some years. The details of these formulas are in the ROAP State Management Plan included in the application package. The ROAP funds are to be used for the operating cost of trips, but not for administrative or capital costs. It will be the responsibility of the eligible ROAP recipients to sub- allocate and distribute the funds to the community transit system and/or local agencies and organizations as allowed within the program guidelines. County governments and eligible transportation authorities are the only eligible applicants for ROAP funds. All eligible applicants must submit an annual application to receive these funds. Officials should read all of the ROAP documents completely before starting their application. The General Assembly approved a state budget in July. The attached ROAP Allocations Table is final. The period of performance will remain July 1, 2013 to June 30,2014 regardless ofthe dates the ROAP funds are disbursed. September 16, 2013 is the first deadline for applications. October 18, 2013 is the second chance deadline. ROAP funds will be disbursed based on which deadline the applicant meets. Copies of the application documents for ROAP funds must be individually scanned and emailed by this deadline to the Public Transportation Division ofNCDOT. A checklist is provided to help you attach and email all the required application documents. Electronic copies must be submitted to NCDOT-PTD at MAILING ADDRESS: NC DEPARTMENT OF TRANSPORTATION PUBLIC TRANSPORTATION DIVISiON 1550 MAIL SERVICE CENTER RALEIGH, NC 27699-1550 TELEPHONE: 919-707-4670 FAX: 919-733-1391 WWWNCDOT GOV/NCTRANSIT LOCATION: TRANSPORTATION BUILDING 1 SOUTH WILMINGTON STREET RALEIGH, NC Application for Transportation Operating Assistance FY 2014 Rural Operating Assistance Program Funds Name of Applicant (County) County Of Harnett .. ·.· .•. ·.··•.· ... County l\;latul~er Tommy Burns County Manager's Email Address tbums@hamett.org County Finance Officer Kimberly Honeycutt .·.··· ·•·· .. · ... ·.·. · .. · ... ·· .... ·•··· · .... ·. CFQ's EITiailAddr~s khoneycutt@hamett.org (910) 814-6093 Persori.Ctn1leietinrrthis . ... Application Dionne C. White .·. ·••· • .•...••..•. Pe'rson's Job Title Transit Service Manager .. ·· .. > < .. ···•• Pcrson'sEniailAddiess dwhite@hamett.org '•. .· }'erson'sPho1leNumbe·r··· .•..•. ·.•. . .····. •• • j (910) 814-4019 Community Transportation .··.· .· •. ··· ...•. · System Harnett Area Rural Transit System .Nam~ ofTrllnsitContactPerson Dionne C. White Transit Contact Person's Email Address dwhite@hamett.org Application Completed by: Date: ? -;;{ rz 20 /J Signature 1 certify that the content of this application is complete and accurately describes the county's administration of the ROAP Program, and the use of the ROAP funds in accordance with applicable state guidelines. Application Instructions Date: 1/ I :2_)J 3 Date: q\H{l!> County officials should read the ROAP Program State Management Plan which contains guidance on the administration of the ROAP Program and information about the preparation of grant applications. • The application must be completed by an official of the county or his/her designee. • Click on the gray rectangle and type each answer. If needed, the text will automatically wrap to the next row. The answer may wrap to the next page if necessary. • If the county wishes to explain their response to any questions or provide more information, the county may include additional pages with this application form. All the pages of the application and any pages added by the applicant should be scanned into the same file. • If there are questions regarding this application, contact the NCDOT -PTD Mobility Development Specialist assigned to the area served by the transit system. FY2014 ROAP Program Schedule ROAP funds will be disbursed based on which deadline the applicant meets. First Application Deadline Disbursement if 1st Deadline is met { 100%) Second Chance Application Deadline Disbursement if 2nd Deadline is met (100%) September 16, 2013 September 30, 20 13 October 18, 2013 October 31,2013 County's Management ofROAP Funds All counties are eligible to receive Rural Operating Assistance Program (ROAP) funding from the State of North Carolina. As a recipient ofROAP funds, the county must implement administrative processes that will ensure the following: • ROAP funds are expended on needs identified through a public involvement and! or planning process. • ROAP funds are expended on eligible activities only. • Supporting documentation of expenditures is maintained. • Service recipients meet eligibility requirements and their eligibility is documented. • Trips funded with ROAP funding are monitored and evaluated throughout the period of performance. • An accounting of trips and expenditures is provided in a semi-annual report to NCDOT. • ROAP funds received and expended are included in the local annual audit. ........ ................. · ·... . •..•.... ·.. .i Trllnspo#ationNI!e<~s.andPublic lnvotvemellt iJ1Filnding.Q~cisi!lnsic ·· ' 2<. ··.·.··.·• ..... : . .··. ..)'esllrNo ••···· A. Did the county ask the Community Transportation Advisory Board (TAB), which is affiliated with the community transit system, to recommend how the ROAP funds should be sub- allocated? But the TAB will meet in October and be informed on how much monies was No allocated to transportation and recommend how the funds should be allocated base on the transportation services and needs survey. B. In addition to the public hearing notice and the public hearing, were other outreach efforts conducted to inform the public about the availability ofROAP funds and to discuss Yes transportation needs BEFORE the county decided to sub-allocate the ROAP funds? C. Does the federally funded Community Transportation System operating in the county have a Community Transportation Service Plan (CTSP) or Community Transportation Improvement Plan (CTIP) that was developed in the last five years or being completed at this time? Yes Date oftlte plan: NCDOTIPTD have allocated the funds for the Community Transportation Dl 4'~ F,,..,...,J .,.,.,,.. ')01 ~ 'Xl<>intin tA ~ • · -> '"""'" th"'" ,.,;nJ...., J..,.,.,., D. Does your county have a Coordinated Public Transit-Human Services Transportation Plan (LCP) that provides a list ofunmet transportation needs and/or gaps in transportation services? Yes Date oftheplan: 2013 E. Does the county have other transportation plans that address public transportation needs? No If yes, list and describe these plans. F. How did the county decide who would receive the ROAP funds? List the names of anyone who participated in the decision to sub allocate the ROAP funds and their role in the community. The TAB will review the transportation services and needs survey and make the recommendation to the Board of Commissioners to whom and how the funds should be allocated . Board Members are Mr. John Finger-Disabled Veteran, Mrs. Beatrice Hill-County Commissioner, Mr. Barry Blevins-General Services/Transportation Director, Mr. Gary Pope-Emergency Services, Mrs. Colleen Kelly-Department of Social Service, Ms. Laura Weeks-Johnston County Industries, Mr. Carl Davis-Director of Parks and Recreation 2 G. How did the county decide on the amount ofROAP funds to sub-allocate to a sub recipient? ·.· .. ·· .. ·.·. ...•• ..... ·... .• •i' ; •iu . UA""Yi:cC.i . ··•·•• !.:iy.;i.iJ,••:i 'ki•·; .'•i ·•, ;i :'j.Lt~ ·. ::!•~NI) ·. i H. Does the county disburse/allocate ROAP funds to any county governmental departments? Yes I. If yes, how does the county account for these funds within the county's accounting system? J. Does the county pass through any ROAP funds to agencies or organizations that are not NO county governmental departments or agencies? K If yes, does the county have a written agreement with these agencies that addresses the N/A proper use and accountability of these funds? (Include a sample agreement with application) L. ROAP funds cannot be used instead of using the existing transportation funding an agency or organization receives from any other funding source. If any of the departments, agencies or organizations receiving ROAP funding from the county get transportation funding from other Federal, State or Local funding sources, list those funding programs: N/A M. Do any sub recipients receive ROAP funds before any trips are provided, and refund the No unused portion at the end of the period of performance? N. Are ROAP funds being deposited in an interest bearing account? Yes If no, then why aren't ROAP funds deposited in an interest bearing account 0. What does the county do with the interest from the ROAP funds? Place in an interest bearing account. P. Does the county provide any local funds for transportation operating assistance to any ofthe No ROAP sub-recipients in addition to the state ROAP funds? Q. Is supporting documentation maintained for all ROAP grant financial transactions for five Yes years? IMPORT ANT: Yes is the only correct answer. •• >··.··• . • • /c·• ·· .... • Monitoring·,aiidQversiglttRespoJI.sibilities·· . •. ; ; . •... ········.···· .. · .. ········· .. .. · .... Yes or No .····· R. The Finance Officer OR the Executive Director of an eligible transportation authority will be responsible for the oversight and evaluation of the transportation services provided with the Yes ROAP funding? IMPORTANT: Yes is the only correct answer. S. Does the county require the sub recipients ofROAP funds to provide progress reports and statistical data about the trips provided with ROAP funds? Transportation Advisory Board will Yes be given quarterly reports about the funds received and also reimbursements. T. If progress reports and/or operating statistical reports are required by the county, how frequently are these provided to the county for evaluation? Quarterly reports will be presented to the county board on the progress of transportation and reimbursement funds received. U. Does the county require the sub recipients ofROAP funds to use the transportation services No of the federally funded Community Transit System operating in the county? 3 V. Are subrecipients ofROAP funds coordinating transportation services with other Yes subrecipients in the county therefore reducing any duplication of effort? . ···•····.··•······ .. ·· .. . i ··•··· ......... ~T'I.Ul <• ·'~·: •• •;; <:•········,c.·;•·;~,·.i· .. • . .. > .••.•.. •'Y'es .. orNo • g . w. Is the method used to sub-allocate the ROAP funds fair and equitable? Open and Yes transparent? X. Is the county prepared to provide documentation that an eligible citizen was provided an Yes eligible service or trip on the billed date, by whatever conveyance, at the specified cost? Y. A semi-annual ROAP Report must be completed and sent to NCDOT. Who will be designated to complete these reports inFY2014? (name, title, employer) Dionne C. White/Transit Service Manager Elderly and Disabled Transportation Assistance Program The Elderly and Disabled Transportation Assistance Program (EDTAP), originally enacted by legislation in the 1989 Session of the North Carolina General Assembly (Article 2B, 136-44.27), provides operating assistance funds for the transportation ofthe state's elderly and disabled citizens. This transportation assistance allows the elderly and disabled to reside for a longer period in their homes, thereby enhancing their quality of life. Eldetlyl!'nd Di!labledTrans(loitation Ass.istalice Pl'l)grllm Qnestioll.s • > ; .. · .•. · .. ····•· YesorNo. ;; A. What will be the purposes of the trips provided with EDT AP funds? (Check all that apply) [8J Personal care activities, medical appointments, pharmacy pick-up, shopping, bill paying, meetings, classes, banking 0 Job interviews, job fair attendance, job readiness activities or training, GED classes 0 Transportation to workplace [8J Group field trips/tours to community special events (Federal charter regulations apply to transit.) 0 Overnight trips to out-of-county destinations (Federal charter regulations apply to transit) 0 Human service agency appointments B. How will the transportation service be provided? (Check all that apply) [8J Public Transportation System 0 Private Provider 0 Taxi Service 0 Agency Staff Driver 0 Volunteer Driver Program c. Are any of the EDTAP services you are funding, listed as an unmet need or gap in service in the Public Transit-Human Service Coordination Plan or any other transportation plan for your No county? See these page numbers in the plan: Plan Title: D. Does the federally funded Community Transit System operating in your county receive a Yes sub-allocation of EDT AP funds? If yes, does the county dictate which agencies and organizations will receive No transportation services with any of the EDT AP funds the transit system receives? Can the Community Transit System use any of the EDTAP funds it receives to provide transportation for elderly and disabled citizens of the county who do not have a human Yes service agency or organization to pay for the service? 4 ..•... · . .Elderly and J)isablet!,ft~~sp6ft:~tion }\ssista,n£el~r~gfa!il Ques,(iiin~ (~~!i~~). ,::---:;'\-_-, ·· .. Ws:orNo ., ; :;: . -f:-/-~i- If the transit system's Community Transportation Service Plan (CTSP) is Jess than six I years old, does it describe and evaluate the services the transit system is providing for N/A the elderly and disabled? See these page numbers in the plan: Plan Title: Does the CTSP recommend any new EDTAP funded services for FY2014? See these page numbers in the plan: N/A Plan Title: E. Will any of the sub recipients use their EDT AP sub-allocation as matching funds for any of the following programs? (lYfatchingfunds for operating assistance only.) 5310-Elderly Individuals and Individuals with Disabilities Program 5311 -Non-urbanized Area Formula Program No 5316 Job Access and Reverse Commute Program (JARC) 5317 New Freedom Program F. Will any of the sub recipients of EDT AP funds charge a fare for an EDT AP funded trip? No If yes, how much will the fare be? If yes, how will the fare revenue be used? G. Do any of the sub recipients of EDT AP funds restrict EDT AP funded trips based on the origin, timing or destination of the trip? Due to EDT APP funds being cut restrictions maybe No necessary in order for funding to last the entire year. H. Is there a process or policy for determining when it is appropriate to transfer EDT AP funds from one sub-recipient to another to prevent there being unspent funds at the end of the period of No performance? I. EDT AP funded trips are expected to be provided throughout the entire year. IftheEDTAP funds are expended in less than a year, will the county provide county funds to prevent the No discontinuation of transportation trips? Employment Transportation Assistance Program The Employment Transportation Assistance Program (EMPL) is intended to help DSS clients that transitioned off Work First or TANF in the last 12 months, Workforce Development Program participants and/or the general public to travel to work, employment training and/or other employment related destinations . . · .. ·· ·.··•.· . . Employment Transportation }>rogram Questions . · .. . ········· .. ··· . ··.~ I Yes.orNo .· . < A What will be the purposes of the transportation services provided with EMPL funds? (Check all that apply) rgJ Job interviews, job fair attendance, job readiness activities or training, GED classes 0 Transportation to workplace (Scheduled by the individual only. No agency scheduled trips.) 0 Child(ren) of working parent transported to Child Care B. How will the transportation service be provided? (Check all that apply) rgJ Public Transportation System 0 Private Provider 0 Taxi Service 0 Agency Staff Driver 0 Volunteer Driver Program 5 ·.·. upovJ ···~·~itt~~ c-" i(c'ri,~ltJ'ii~:JQ'~!I?i:'/'',;f:,:;,;',!,Cf,y'····j , .• ·.•, )'~s:or~o} .!, .•... i~~·":'u• :v6•~ .. , C. Describe the eligibility criteria to be used in this county to determine who will be provided EMPL funded trips. Department of Social Services determines who is eligible for EMPL funded trips. Work First and Sheltered workshop clients are eligible and this is determined bv their DSS Case Manager. D. Are any of the EMPL services you are funding, listed as an unmet need or gap in service in the Public Transit-Human Service Coordination Plan or any other transportation plan for your No county? See these page numbers in the plan: Plan title: E. Does the federally funded Community Transit System operating in your county receive a sub-No allocation of EMPL funds? If yes, does the county dictate which agencies and organizations will receive N/A transportation services with any of the EMPL funds the transit system receives? Can the Community Transit System use any of the EMPL funds it receives to provide transportation for citizens in the county who need transportation to a job or employment N/A related destination and who do not have a human service agency or organization to pay for the service? If the transit system's Community Transportation Service Plan (CTSP) is less than six years old, does it describe and evaluate the services the transit system is providing for NIA the employed or unemployed? See these page numbers in the plan: Plan title: Does the CTSP recommend any new EMPL funded services for FY20 14? See these page numbers in the plan: N/A Plan title: F. Will any of the subrecipients ofEMPL funds charge a fare for an EMPL funded trip? No If yes, how much will the fare be? If yes, how will the fare revenue be used? G. Do any of the subrecipients ofEMPL funds restrict EMPL funded trips based on the origin, No timing or destination of the trip? H. Is there a process or policy for determining when it is appropriate to transfer funds from one sub-recipient to another to prevent there being unspent funds at the end of the period of Yes performance? L Has the county transferred any EMPL funds to EDT AP or RGP in the last two years? No J. Will any of the subrecipients use their EMPL sub-allocation as matching funds for any of the following programs? (Matching funds for operating assistance only.) 5310 -Elderly Individuals and Individuals with Disabilities Program 5311 Non-urbanized Area Formula Program No 5316-Job Access and Reverse Commute Program (JAR C) 5317 New Freedom Program K. EMPL funded trips are expected to be provided throughout the entire year. IftheEMPL funds are expended in less than a year, will the county provide county funds to prevent the No discontinuation of transportation services? 6 Rural General Public Program The Rural General Public Program assistance funds are intended to provide transportation services for individuals from the county who do not have a human service agency or organization that will pay for the transpmtation service. The county, in consultation with the Community Transportation System, must determine the RGP services to be provided with the RGP funds. ' Rural Genei'aLPubHcti'ansportation Program QuestiollS • • ,,, .. · ... , · · · ·· · ' .... . < Yes or No ·.· .. A. What will be the trip purposes ofthe transportation services provided with RGP funds? (Check all that apply) X Personal care activities, medical appointments, pharmacy pick-up, shopping, bill paying, meetings, classes. banking L8J Job interviews, job fair attendance, job readiness activities or training, GED classes L8J Transportation to workplace (Scheduled by the individual only. No agency scheduled trips.) L8J Child(ren) of working parent transported to child care 0 Group field trips/tours to community special events (Federal charter regulations apply to transit.) 0 Overnight trips to out-of-county destinations (Federal charter regulations apply to transit) L8J Human service agency appointments B. How will the transportation service be provided? (Check all that apply) L8J Public Transportation System 0 Private Provider 0 Taxi Service 0 Volunteer Driver Program c. Are any of the RGP funded services the transit system will provide listed as an unmet need or gap in service in the Public Transit-Human Service Coordination Plan or any other transportation NO plan for your county? See these page numbers in the plall: Plan title: D. If the transit system's Community Transportation Service Plan (CTSP) is less than six years old, does it describe and evaluate the general public services the transit system does in the county for citizens who need transportation but don't have a human service agency or organization to N/A pay for the service? See these page numbers in tile plan: Plan title: E. Does the CTSP recommend any new RGP funded services for FY2013-14? See these page numbers in tile plan: N/A Plan title: F. Will RGP trips be provided to citizens who need transportation but don't have a human YES service agency or organization to pay for the trip? G. Will any of the RGP funded trips be restricted based on origin, timing or destination of the NO trip to control the expenditure of funds overtime? H. Since the subrecipient can only use RGP funds to pay for 90% of the cost of a trip, will the I Community Transit System use fare revenue to generate the local 10% match requirement for YES RGP funds? If yes, how much will the fare be? $300 per trip If yes, how will the fare revenue be used? To provide 10% local match. 7 ~-.::._ .••· R.ul-aiG~ne[afPiiiilicfl'ari~nortal ~ : ~ ~·c:.c 'c'C''J~j)"~~~~i§cS0H~;~,·,~''±'{;'····.·?;. iii.;; ,'•• • ···.····.·,·· )'esor No .. ,· .. ·: J If no, describe the source of the required matching funds? I. Will RGP funded trips be coordinated with human service agency trips? YES J. How will the Community Transit System market the proposed RGP funded services? Advertisement on radio and other local new source K. Will the Community Transit System use any of their RGP sub-allocation as matching funds for any of the following programs? (Matching funds for operating assistance only) 5310-Elderly Individuals and Individuals with Disabilities Program 5311 -Non-urbanized Area Formula Program NO 5316 Job Access and Reverse Commute Program (JARC) 5317-New Freedom Program L Is any part of the county in an urbanized area according to the 20 I 0 census? NO M. RGP funded trips are expected to be provided throughout the entire year. If the RGP funds are expended in less than a year, will the county provide county funds to prevent the YES discontinuation of transportation services? 8 CERTIFIED STATJ~MEN T FY2Ul4 RURAL OPER ATING ASSISTANCE PRO Coun ty of Harnett _._,., WliER.RAS , the sta te-funded, fonnula-baSI::d Rura l Operating Assistance Program (ROAP) admini stered by the 1\'orth Carolina Department of Transpo rtation, Public Transportat ion Div1~ion provi d~ fu ndin g for the operat ing co st of passenger tr ips for counties with in the state; WH.t:REA.S, the county uses the most recent transportation plans (i.e. CTSP, C TIP, LCP) available and other p u b lic involvement strategies to leam about the tran8 ponation needs of agencies and individ uals in the c ounty befo re determin ing t he 8Ub-allocation of these ROAP fund~; WIIFREAS, the county governme nt or r egional public tran~ponation authorities created pursuant to Art icle 25 o r A•ticle 26 of Chapter 160A of the General Sta tutes (upon wr itten aJ,'Teement with the municipalities or counties served) are the only e lib-ibl e recipients of Rural Opera ting Assis t ance Program funds which are allocated to the coun ties based on a fonnula as described in the P rogra m Guide lines incl u ded in the ROA1' State Management Plan. NCDOT wi ll d isbu rse the ROAl' funds only to counti c~ and eligible t ranspo rtat ion au thorities and n ot t o any sub-recipients selected by the county; WHEREAS, the county fin ance oflicer will be considered the county official accountable for tbe adm inistrat ion of the Ru r al Operat ing Assi sta.nce Program in the county, unless otherwise d esignated by the Board of County Commissioners; WHEREAS, rhe passenger trips provided wi th RO AP funds mu~t be accessible t o in dividuals with disabilities and be p rovided w ithout discrimination on th(; ba.<is of national o r igin , creed, age, race or gender (ITA C 4702.1 A, rTA C 47041, Amer icans with Di sabiliti~ Act 19 90); and WHE IU::AS, the pe riod of performance for these funds will be July J, 2013 t o June 30, 2 014 r egardless o f t he date on which ROAl' funds are disbursed ro th e cow1ty. l'iOW, T HEREFORE, by signing b elow, the duly authorized rcpresentalivcs of the C ounty of Ha rnett North Carol.ina certify that the foUowing stat eme nts are true and accu.-ate: • The county employed a documented methodology for sub-a llocating R.OAP fu nds th at involved the p articipation of eligible agenci es and c i tizens . Ou treach effort.< to iJ1clude the parti ci pation of the e lderly and individ uals with disabilities, persons with limited English proficiency, millOrities and low incom e persons in the county's sub -allocation d e cision have been d ocumented. • The cou nt y will advi se any sub-recipients a bou t the source o f the ROAP funds, specific program requirements and restrict ions, eligi ble pmgram expenses and reporting rcquirt:ments. The c ounty will be respons ible for i nvoicing an y sub·rccipie nts for unex pended RO.AP funds a s needed. • The count y wi ll monitor ROAP funded service~ r outinely to v<.Tify that RO AP fu nds are being spent on allowa ble activities and tha t the e ligibi l ity of service reci pients is being properly d o cumented. Tbe cou n ty will main tai n records of trips <md services fo r fi ve years thar prove that an eligible ci tizen wa s pro vided an eligible t ransp01tation service on the hilled date, by whatever conveyance at the spec itied cost. • The c ounty w ill be responsible for monito ring the ~afety , quality and cost of ROAP funded service s and assures that any procurements by subrccipi ents for contracted services will follow ~tate guid elines. • The county w ill conduct regul a r evaluations of ROAl' fu nded passenger trips provided t h ro ughou t the p eriod of pelfom1ance. • The county will only use the ROAP funds to provide trips when other funding sources are not available for the same purpose or the other funding sources for the same purpose have been completely exhausted. 11 The county assures that the required matching funds for the FY2014 ROAP can be generated from fares and/or provided from local funds. • The county will notify the Mobility Development Specialist assigned to the county if any ROAP funded services are discontinued before the end of the period of performance due to the lack of funding. No additional ROAP funds will be available. 11 The county will provide an accounting of trips and expenditures in a semi-annual report and a final year-end report to NCDOT Public Transportation Division or its designee. • Any interest earned on the ROAP funds will be expended for eligible program uses as specified in the ROAP application. The County will include ROAP funds received and expended in its annual independent audit on the schedule of federal and state financial assistance. Funds passed through to other agencies will be identified as such. • The county is applying for the following amounts ofFY2014 Rural Operating Assistance Program funds: Elderly & Disabled Transportation Assistance Program (EDTAP) $85,399 $85,399 Employment Transportation Assistance Pro ram (EMPL) $28,605 $28,605 Rural General Public Program (RGP) $133,682 $133,682 TOTAL $247,686 $247,686 WITNESS my band and county seal, this __ day of __ , .:.20;:;:.... __ Signature of Board of County Commissioners Chairperson Printed Name of Chairperson State of North Carolina County of County Seal Here FY2014 ROAP Sub-Allocation Worksheet Elderly and Disabled Transportation Employment Transportation Assistance Rural General Public Transportation Assistance Program Program Agencies Receiving Sub-Allocations Proposed Proposed Proposed Amount of request to be Number of One Way Amount of requesl to be Number of One Way Amount of request to be Number of One Way auballocatad Passenger Trips .!iuballocated Passenger Trips subaUooated Passenger Trips Harnett Area Rural Transit System $85,399 3573 821 $133,682 5045 DSS-Workfirst $0 $14,303 $0 Joblink $0 $14,303 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 TOTAL AMOUNT $85,399 3573 $28,605 821 $133,682 5045 EDTAP EMPL RGP ~"'''' R•~Mog S"b·AIIoo .. oM Avg Cost of Trip Avg Cost of Trip Avg Cost of Serv tt Area Rural Transit System $7.00 $0.00 $7.84 Workfirst $0.00 $25.90 $0.00 Joblink $0.00 $17.39 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 0 $0.00 $0.00 $0.00 County of Harnett Name of Applicant (County) Signature -MDS Reviewer Important-A public hearing MUST be conducted whether or not requested by the Public. ROAP PUBLIC HEARING RECORD Date Public Notice was published: September 25, 2013 APPLICANT: County of Harnett DATE: October 7, 2013 PLACE: 102 E. Front Street, Lillington NC 27546 TIME: 7:00 p.m. How many members of the PUBLIC attended the public hearing? Public Attendance Surveys D (Attached) D (Offered at Public Hearing but none completed) I, the undersigned, representing (Legal Name of Applicant) County of Harnett do hereby certify to the North Carolina Department of Transportation, that a Public Hearing was held as indicated above and During the Public Hearing D (NO public comments) D (Public Comments were made and meeting minutes will be submitted after board approval) The estimated date for board approval of meeting minutes is: ------------ Signature of Clerk to the Board Printed Name and Title Public Heanng Notice Page 1 of 1 Aviso de audiencia publica Los residentes del Condado de Harnett Esto es para informar al publico sobre !a opcrtunidad de asistir a una audiencia publica sobre Ia aplicaci6n de prograrna asistencia operativo Rural (Asia) propuesto para ser sometida al Departamento de transporte de Carolina del norte no mas tardar el18 de octubre de 2013 por el Condado de Harnett La audiencia publica se celebrara el 07 de octubre de 2013 a 9:00 en Ia reunion de los ccmisionados del Condado de Harnett en el edificio de administraci6n del Condado de Barnett ubicada en 102 E. Front St., Lillington, NC 27546. Con dado de Harnett proporcionara ayudas auxiliares y servicios bajo Ia ADA para personas con discapacidad que deseen participar en Ia audiencia. Cualquiera que requiercn servicios especiales debe contactar a Gina \\'heeler, Gerente de servicios de transito en (91 0) 893-7555 tan pronto como sea posible para que se pueden hacer arreglos. Los programas incluidos en las aplieaciones del programa de asistencia Rural de funcionamiento son: 1. Ancianos y discapacitados transporte asistencia (EDTAP) program a provee asistencia operativa para el transporte de los ciudadanos ancianos y discapacitados. 2. Programa de asistencia de transporte de empleo esta destinado a proporcionar ayuda para el transporte de personas con empleo de funcionamiento relacionados con las necesidades de transporte. 3. Fondos del publico General (RGP) program a rurales pretenden proporcionar asistencia operativa para el transporte de personas que no tienen asistencia de agencia de servicios humanos para pagar su transporte y viven en areas no-urbanizado. El plazo de ejecucion de rondos del programa de asistencia Rural de funcionamiento es OJ de julio de 2013 a traves de 30 de junio de 2014. Los totales deFY 2014 ROAP individual del programa son: Programa Total EDTAPP $85.399 EMP$28.605 E.GP $133.682 TOTAL $247.686 Esta aplieaci6n puede ser inspeccionada en el sistema de transito Rural Area de Harnett situada a 250 Alexander Drive, Lillington, NC 27546 de 8:00- 17:00, dellunes al viemes. Comentarios por escrito deben ser dirigidas a Dionne C. White. jefe de servicio de transito y P.O. Box 85. Lillington, NC 27546 antes de 25 de septiembre de 2013 http:/1131.253.14.98/bvsandbox.aspx?&lo=TP&dl=en&from=en&to=es 8/27/2011 Public Hearing Notice Harnett County Residents This is to inform the public of the opportunity to attend a public hearing on the proposed Rural Operating Assistance Program (ROAP) application to be submitted to the North Carolina Department of Transportation no later than October 18, 2013 by the County of Harnett. The public hearing will be held on October 7, 2013 at 9:00a.m. at the Harnett County Commissioners meeting in the Harnett County Administration Building located at 102 E. Front St, Lillington, NC 27546. Harnett County will provide auxiliary aids and services under the ADA for disabled persons who wish to participate in the hearing. Anyone requiring special services should contact Gina Wheeler, Transit Service Manager at (91 0) 893-7555 as soon as possible so that arrangements can be made. The programs included in the Rural Operating Assistance Program applications are: 1. Elderly & Disabled Transportation Assistance (EDT AP) Program provides operating assistance for the transportation of elderly and disabled citizens. 2. Employment Transportation Assistance Program is intended to provide operating assistance for the transportation of persons with employment related transportation needs. 3. Rural General Public (RGP) Program funds are intended to provide operating assistance for the transportation of individuals who do not have human service agency assistance to pay for their transportation and live in no-urbanized areas. The period of performance for Rural Operating Assistance Program funds is July 1, 2013 through June 30, 2014. The FY 2014 ROAP individual program totals are: Program EDTAPP EMP RGP TOTAL Total $85,399 $28,605 $133,682 $247,686 This application may be inspected at the Harnett Area Rural Transit System located at 250 Alexander Drive, Lillington, NC 27546 from 8:00a.m.-5:00p.m., Monday through Fliday. Written comments should be directed to Dionne C. White, Transit Service Manager, and P.O. Box 85, Lillington, NC 27546 before September 25, 2013 Voluntary Title VI Public Involvement Title VI of the Civil Right's Act of 1964 requires North Carolina Department of Transportation to gather statistical data on participants and beneficiaries of the agency's federal-aid highway programs and activities. The North Carolina Department of Transportation collects information on race, color, national origin and gender of the attendees to this public meeting to ensure the inclusion of all segments of the population affected by a proposed project. The North Carolina Department of Transportation wishes to clarify that this information gathering process is completely voluntary and that you are not required to disclose the statistical data requested in order to participate in this meeting. This form is a public document. The completed forms will be held on file at the North Carolina Department of Transportation. For Further information regarding this process please contact Sharon Lipscomb, the Title VI Manager at telephone number 919.508.1808 or email at slipscomb@ncdot. gov. Project Name: I Date: Meeting Location: I Gender: . 0 Male 0 Female Name (please print) General ethnic identification categories (check one) 0 Caucasian I [ ] Hispanic American [ ] American Indian/Alaskan Native 0 African American I 0 Asian/Pacific Islander Other: Color: National Origin: After you complete this form, please fold it and place it inside the designated box on the registration table. Thank you for your cooperation. Formula A ddt' I Formula Addt'l EMPL Formula Addt'l RGP COUNTIES EDTAP 14 EDTAP14 TOTAL EDTAP EMPL 14 14 TOTAL EMPL RGP14 14 TOTAL RGP Total 2013-14 ROAP Eastern Band of the Cherokee $0 $0 $0 $0 $0 $0 $24,555 $27,923 $52,478 $52,478 Edgecombe I $46,701 $21,972 $68,673 $38,642 $0 $38,642 $34,801 $39,575 $74,376 $181,691 Forsyth $110,804 $52,133 $162,937 $50,215 $0 $50,215 $0 $0 $0 $213,152 Franklin $45,851 $21,572 $67,423 $15,141 $0 $15,141 $42,700 $48,556 $91,256 $173,820 Gaston $86,251 $40,579 $126,830 $32,266 $0 $32,266 $67,674 $76,957 $144,631 $303,727 Gates $33,144 $15,591 $48,735 $6,874 $0 $6,874 $25,836 $29,379 $55,215 $110,824 Graham $32,539 $15,307 $47,846 $4,277 $0 $4,277 $24,128 $27,438 $51,566 $103,689 Granville $44,521 $20,946 $65,467 = $15,023 $0 $15,023 $40,779 $46,372 $87,151 $167,641 Greene $35,319 $16,615 $51,934 $7,346 $0 $7,346 $29,038 $33,020 $62,058 $121,338 Guilford $147,766 $69,522 $217,288 $66,039 $0 $66,039 $65,540 $74,529 $140,069 $423,396 Halifax $47,433 $22,316 $69,749 $16,795 $0 $16,795 $40,139 $45,642 $85,781 $172,325 Harnett $58,076 $27,323 $85,399 1 $28,605 $0 $28,605 $62,551 $71 '131 $133,682.,( $247,686/ Haywood $48,520 $22,828 $71,348 $23,526 $0 $23,526 $41,633 $47,343 $88,976 $183,850 Henderson $63,396 $29,826 $93,222 $22,818 $0 $22,818 $53,800 $61 '179 $114,979 $231,019 Hertford $37,986 $17,870 $55,856 $11,834 $0 $11,834 $30,105 $34,234 $64,339 $132,029 Hoke $41,248 $19,405 $60,653 $16,440 $0 $16,440 $38,644 $43,944 $82,588 $159,681 Hyde $31,329 $14,738 $46,067 $4,394 $0 $4,394 $23,702 $26,952 $50,654 $101,115 Iredell $69,817 $32,847 $102,664 $49,390 $0 $49,390 $76,639 $87,152 $163,791 $315,845 Jackson $40,648 $19,123 $59,771 $10,064 $0 $10,064 $33,307 $37,876 $71,183 I $141,018 Johnston $71,884 $33,820 $105,704 $38,644 $0 $38,644 $80,695 $91,764 $172,459 $316,807 Jones $33,267 $15,649 $48,916 $4,985 $0 $4,985 $25,196 $28,651 $53,847 $107,748 Lee $44,141 $20,767 $64,908 $16,205 $0 $16,205 $41,633 $47,343 $88,976 $170,089 Lenoir $47,180 $22,197 $69,377 $23,999 $0 $23,999 $41,846 $47,585 $89,431 $182,807 Lincoln $50,678 $23,844 $74,522 $17,975 $0 $17,975 $48,463 $55,110 $103,573 $196,070 Macon $41,257 $19,410 $60,667 $8,765 $0 $8,765 $33,307 $37,876 $71,183 $140,615 Madison $35,565 $16,732 $52,297 $6,520 $0 $6,520 $28,824 $32,778 $61,602 $120,419 Martin $37,262 $17,529 $54,791 $10,654 $0 $10,654 $29,892 $33,991 $63,883 $129,328 McDowell $43,432 $20,433 $63,865 $13,252 $0 $13,252 $0 $0 $0 $77,117 Mecklenburg $217,398 $102,286 $319,684 $338,945 $0 $338,945 $92,863 $105,600 $198,463 I $857,092 Mitchell $34,714 $16,331 $51,045 $5,458 $0 $5,458 $26,903 $30,593 $57,496 $113,999 Montgomery $38,108 $17,928 $56,036 $9,827 $0 $9,827 $31,172 $35,449 $66,621 $132,484 Moore $56,997 $26,816 $83,813 $19,984 $0 $19,984 $52,305 $59,479 $111,784 $215,581 2013-14 ROAP Allocation Table North Carolina Department of Transportation Rural Operating Assistance Program State Management Plan N.C. Department of Transportation Public Transportation Division 1550 Mail Service Center Raleigh, NC 27699-1550 May 2, 2012 Introduction STATE RURAL OPERATING ASSISTANCE PROGRAM North Carolina Department of Transportation Public Transportation Division The Rural Operating Assistance Program (ROAP) is a state funded public transportation grant program administered by the North Carolina Department of Transportation Public Transportation Division (NCDOT-PTD). ROAP includes the following programs: • Elderly and Disabled Transportation Assistance Program (EDT AP) • Employment Transportation Assistance Program (EMPL) • Rural General Public (RGP) Program • Additional funds, subject to availability, may be added to supplement these programs ROAP funds and any additional funds supplementing the ROAP programs are allocated to each county by a formula. As a general rule, each county is eligible to receive an allocation from each program; however, counties that do not provide transportation services to the general public are not provided a RGP allocation. ROAP funds are to be used for the operating cost of trips or for other transportation services, but not for administrative or capital costs. All eligible ROAP recipients must submit an annual application to receive ROAP funds. It will be the responsibility of the eligible ROAP recipients to sub-allocate and distribute the funds to the community transit system and/or local agencies and organizations as allowed within the program guidelines. It is the intent of the program that these funds will be used to provide transportation when other funding sources are not available. The General Assembly must have an approved and certified state budget before ROAP funds can be disbursed. The period of performance will remain July 1 to June 30 regardless of the dates the ROAP funds are disbursed to eligible recipients. I. General Guidelines A. Eligible Recipients All one hundred (1 00) North Carolina counties are eligible to receive a formula-based allocation for EDT AP and EMPL funds. Only those counties providing transportation services to the general public will receive a RGP allocation. ROAP funds will be disbursed by NCDOT -PTD to the county or to a regional public transportation authority created pursuant to Article 25 or Article 26 of Chapter 160A of the General Statutes upon written agreement with the municipalities or counties served. No ROAP funds will be disbursed to any sub-recipients selected by the county or authority. The county finance officer or the executive director of an eligible authority will be responsible for program administration at the local leveL This responsibility cannot be delegated to any designee. B. Allocation ofROAP Funds ROAP funds are allocated to each county by formula. The annual allocation for ROAP programs are listed, by county, in a separate document of the application package. The methodology for calculating these allocations is described in the Program Guidelines section. The county will be required to complete semi-annual reports that account for the use of the ROAP funds and calculate whether there are unspent funds to be returned to NCDOT-PTD. Any unspent funds that are returned to NCDOT-PTD will be rolled over in to the next available fiscal year and allocated by the appropriate formula among all the counties with that year's ROAP Program funds. C. Application for ROAP Funds County governments or regional public transportation authorities created pursuant to Article 25 or Article 26 of Chapter 160A of the General Statutes (upon written agreement with municipalities or counties served) are the only eligible applicants for ROAP funds. All eligible recipients must submit an annual application to receive ROAP funds. An eligible recipient has the option of applying for a single program or for all of the programs included in ROAP. Each applicant should carefully evaluate past program expenditures and other operating costs to determine the amount to apply for within each program. A county should only apply for an amount ofROAP funds that can be expended in the 12-month period of performance, as the funds cannot be carried over into the next fiscal year by the county. Total funds should be managed so that services can be continued for the entire 12 months. The application documents will be posted at the NCDOT Web site at www.ncdot.gov by the Communication Office. County Managers, County Finance Officers, the Rural Planning Organizations (RPO) and Transit Directors will be notified by e-mail when the application is available. The application materials are designed to enable PTD staff to better understand the services to be provided and assure that the funds are utilized as intended. Failure to complete any portion of the application may result in processing delays. The county should contact the Mobility Development Specialist assigned to the county if there are questions about the application. The ROAP Application will not be entered into NCDOT's web-enabled grant system, Partner Connect. Instead, electronic copies of the application documents for ROAP funds must be submitted to the Public Transportation Division ofNCDOT on or before the deadline. There will be NO EXCEPTIONS. A checklist will be provided that describes which documents must be received . Electronic copies must be submitted to PTD at ctptransportation@ncdot.gov. D. Transportation Service Plans Funds distributed by the NCDOT-Public Transportation Division under the ROAP program shall be used in a manner consistent with the county's Coordinated Public Transit-Human Service Transportation Plan, the public transit system's Community Transportation Service Plan (fonnerly known as a transportation development plan) or its equivalent, and any other transportation development plan in place in the county. E. Public Outreach/Involvement Requirement The county or eligible authority must determine what the transportation needs of agencies and individuals are in the county before completing the application. It is important that eligible local agencies and interested citizens have the opportunity to participate in the sub-allocation decision. Outreach efforts beyond holding a public hearing should be conducted to inform the public including minorities, women, elderly, disabled, Limited English Proficiency (LEP), low income individuals, and persons who are not human service agency clients, about the availability ofROAP funds and to discuss transportation service needs. These efforts should include, but are not limited to presentations to groups, committees, fliers and/or posters. The intent is to remove barriers and conditions that prevent these groups from receiving access, participation and benefits of the ROAP services and activities. ROAP funded services and benefits must be distributed in a non-discriminatory manner. If a sub-recipient receives federal funds, Title VI of the Civil Rights Act of 1964 applies. F. Public Hearing Requirement It is required that the Board of County Commissioners hold a public hearing to provide the opportunity for local input regarding the sub-allocation ofROAP funds. A public hearing notice in English must be published in a newspaper having general circulation in the county. The notices MUST be published not more than fourteen (14) days, but not less than seven (7) days before the public hearing. In accordance 2 with the DOT LEP Guidance, 70 FR 74087, (December 14, 2005), a public notice will also be published in Spanish in counties that have 1000 or 5% of their population that speaks Spanish at home, but speaks English less than well. A list of counties that are required to publish the public notice in Spanish is in the Appendix B of this document. Applicants must use the Sample Public Hearing Notice included with the application package. An affidavit of publication and an original copy, not a duplicated copy, of any public hearing notices must also accompany the ROAP application. The public hearing must be accessible to individuals with disabilities in accordance with provisions of the Americans with Disabilities Act of 1990. These provisions include having written material available in alternative, accessible formats upon request, and providing special accommodations at your public hearing, such as a sign language interpreter, as may be requested. The public hearing shall be held at a time of day that affords a majority of the public an opportunity to attend and make comments. Applicants must make the Voluntary Title VI Public Involvement form readily available to all individuals attending the public hearing for ROAP funds. The applicant must submit with the hardcopy of their application all completed Voluntary Title VI Public Involvement forms and must keep a copy for their records. When an eligible public transportation authority is the applicant the public hearing shall be held at a regular meeting of the authority board. Public notices will be published in all the counties served by the authority. A Public Hearing Record which has been signed by the Clerk of the Board and has the county seal on it will accompany the county's ROAP application. A different Public Hearing Record form will be available for the eligible authorities. If any comments were received during the public hearing, then a copy of the signed minutes of the Commissioner's or authority's meeting during which the public hearing took place must be sent to NCDOT -PTD within 90 days of approval. G. Local Matching Requirement EDTAP and EMPL funding can be used to provide up to one hundred percent (100%) of the fully allocated cost of the trip and requires no local match. RGP funds may be used to provide up to ninety percent (90%) of the fully allocated cost of each general public trip. The remaining ten percent (10%) must be provided from fares, local funds or a combination of the two. Excess fares and/or local funds collected after 10% RGP match requirement has been met must be used to provide additional service, not as a source of administrative and capital funds. PTD encourages Community Transportation Systems to keep fares reasonable so as to encourage ridership. The ten percent local match requirement is based on the actual cost of providing RGP funded trips or other services, not the amount allocated from NCDOT. The example below is provided to help counties understand the local match requirement. Trip equals 10 miles X $1.23 per mile (based on fully allocated cost)= $12.30 cost of trip $12.30 Trip X 0.90 = $11.07 RGP funding reimbursement $12.30 Trip X 0.10 $1.23 fare and/or local funding required to provide service 15,431 RGP miles during yr. X $1.23 per mile= $18,980.13 RGP cost of service $18,980.13 X 0.90 = $17,082.12 RGP funding reimbursement $18,980.13 X 0.10 = $1,898.01 fares or local funding required to provide service H. Certifications and Assurances The chairperson of the County Board of Commissioners, the County Manager and the County Finance Officer are required to sign a certified statement that describes the roles and responsibilities associated with the application for and acceptance ofROAP funds and guarantees that certain actions will be taken at the county level to properly administer the program. The Certified Statement must be signed, sealed with the county seal and accompany the application in order for ROAP funds to be disbursed. Eligible 3 authorities will submit a copy of the Memorandum ofUnderstanding they executed with each municipality in their service area with their application. A MOU template will be provided by NCDOT. I. Application Review and Follow-up The Mobility Development Specialists (MDS) on staff at NCDOT-PTD will review the documents presented to NCDOT-PTD in the application for correctness and completeness. The MDS will determine if the county is prepared to manage the ROAP funds and whether the county presented plans for services or activities in the application that utilize the funds as intended. The MDS will follow-up as needed with the county finance officer if more details are needed or there is any doubt that the county's plans for use of the funds do not provide for improved services for the targeted populations. The Mobility Section director will review and approve the MDS recommendations. J. Disbursement of ROAP Funds to the County ROAP funds will be disbursed to the county or to an eligible transportation authority created pursuant to Article 25 or Article 26 of Chapter 160A of the General Statutes (upon written agreement with the municipalities or counties served). Funds will not be disbursed to any sub-recipients selected by the county or the authority. The General Assembly must have an approved and certified state budget before ROAP funds can be disbursed. The period of performance will remain July 1 to June 30 regardless of the dates the ROAP funds are disbursed to the county. The funds will be disbursed by electronic deposit (ACH) or check. The county is required to provide ROAP Reports after six months and at the end of the period of performance. ROAP funds will NOT be disbursed if the reports from the previous fiscal year have not been received and unspent funds have not been returned. The ROAP funds will not be disbursed all at one time. K. Sub-Allocation Determination It will be the responsibility of the county government or an eligible authority to determine how the ROAP funds will be sub-allocated within the county. Sub-allocation of the ROAP funds to the community transit system in the county and/or local agencies must be according to the program guidelines. A Sub- Allocation Worksheet must be completed by each county to document how the ROAP allocations will be distributed locally. This will enable PTD staffto better understand the services the county plans to provide and assures that the funds are utilized as intended. Each county must have and employ a documented methodology for sub-allocating ROAP funds. There is a Community Transportation System operating in most counties that is receiving federal and state administrative and capital funds to coordinate public transportation services with human service transportation in the county. These transit systems need operating funds in order to provide free or affordable transportation for the elderly, disabled and low income persons in the county that are not receiving transportation benefits from a human service agency or organization. The Community Transit System is an eligible sub-recipient of all ROAP funds. The county should take into consideration the need for and importance of the public transportation services provided by the Community Transportation System when determining the suballocation of the ROAP funds. If the county or eligible authority decides to disburse/allocate ROAP funds to any county governmental department, the county should be able to account for these funds within the county's or authority's accounting system. If the county or authority passes through any ROAP funds to agencies or organizations, the county or authority should have a written agreement with them that addresses the proper use and accountability for these funds. L. Eligible Expenses and Activities IMPORTANT! Counties and eligible authorities will NOT be allowed to use ROAP funds for other services including fuel assistance (gas vouchers, gas cards, reimbursement to fuel provider), vehicle repairs or vehicle insurance premiums beginning with the 2012-2013 ROAP Program year. 4 The fully allocated cost of a trip, which has traditionally been eligible for the EDTAP, EMPL and RGP programs will continue to be eligible. See the Eligible Transportation Expenses Matrix in Appendix A for examples of allowable trip purposes that can be provided under these programs. This matrix must be shared with any agency that receives a sub-allocation ofROAP funds to assure that funds are expended according to program guidelines. Community Transportation systems that use ROAP funds to provide trip services must also comply with the regulations of the FTA Section 5311 Program. M. Cost of Service Departments, agencies and/or organizations using ROAP funds to provide services shall determine a billing/reimbursement rate by mile, hour or trip that is based on the fully allocated cost of the service. The fully allocated cost of providing a trip should include both direct costs and shared costs. For the application, the applicant must calculate the average cost of a trip based on the projected number of trips on the Sub-allocation Worksheets. The average cost of a trip will be the sub-allocation amount divided by the proposed number of trips to be provided. These costs will be compared to the average cost of the trips in other counties to determine whether the cost of the proposed services is reasonable. N. Contracted Services If any ROAP funds are sub-allocated to agencies or organizations other than the Community Transportation System, these other agencies or organizations are encouraged to coordinate ROAP funded transportation trips with the local, federally-funded Community Transportation System in the county. The Community Transit Systems have insurance, vehicle maintenance, driver training and safety standards mandated by the FT A Sub-recipients are permitted to use ROAP funds to contract with private transportation providers. Sub- recipients who choose to contract services must follow all state procurement guidelines when selecting a contractor. Sub-recipients should inspect the safety record, service policies and vehicle condition of any private provider being considered. Private providers shall be required to provide documentation that a service was provided on the billed date, by whatever conveyance at the specified cost. 0. Funds Management The basic grant/funds management requirements in G.S. 159, Local Government Finance, and in the Policies Manual for Local Governments apply to ROAP funds. The cost principles of OMB Circular A- 87, Cost Principles for State, Local, and Indian Tribal Governments and OMB Circular A-122, Cost Principles for Non-Profit Organizations also apply to ROAP funds. Additionally, funds must be expended according to the program guidelines in the grant application for eligible program expenses identified. The period of performance for these funds will be July 1 to June 30. The period of performance will remain the same regardless of the date on which ROAP funds are disbursed to the county. Allowable expenses incurred from July 1 for each program are eligible for reimbursement. Any interest earned on the funds will be retained by the transportation program and must be used for transportation related expenses according to program guidelines. Following receipt of the year-end ROAP Report, NCDOT will invoice the county to collect any ROAP funds not expended by June 30. Suballocation and Control of Funds The county or eligible authority may choose to maintain control of the ROAP funds and reimburse sub- recipients for trip-based services after they have been provided. Or, the county or eligible authority may disburse the ROAP funds to the subrecipients before any trip is provided, assuming the county or authority plans to monitor throughout the period of performance whether the trips and transportation services are being provided to eligible individuals and whether all expenditures are allowable. 5 Continuation of Services throughout the Period of Performance The ROAP funds should be managed so that services can be continuously provided during the entire twelve months of the grant cycle. It may be necessary to restrict ROAP services to make the funds last. No additional ROAP funds will be available from the state. The county or eligible authority should budget local funding to avoid discontinuation of any ROAP funded service. The county must notifY the assigned Mobility Development Specialist in writing if any ROAP funded service is discontinued because all the funds have been spent before the end of the period of performance. If RGP funded services are discontinued before June 30 by the Community Transit System, and the county does not provide additional funds to continue the service(s), it will be assumed that the transit system is no longer providing general public service. In this case, the Community Transit System will not be reimbursed for any FT A Section 5311 and/or state CTP funded expenses incurred after the RGP services are discontinued. Passenger Fares Sub-recipients of the ROAP funds may charge passengers a fare for EDTAP, EMPL, or RGP funded services. PTD encourages Community Transportation Systems and agencies to keep fares reasonable so as to encourage ridership. Any fares collected for services will be retained by the transportation program and must be used to meet the matching requirement of a program or to provide additional trips or transportation services. Transferring Funds Between ROAP Programs EDTAP and RGP funds cannot be transferred to any other ROAP program. Counties or eligible authorities can transfer EMPL funds, all or in part, to the EDT AP and/or RGP programs. The EMPL funds must be transferred to the Community Transportation System if: 1. The county finance director or the executive director of an eligible authority determines that any subrecipient ofEMPL funds has spent 33% or less of their EMPL allocation by December 31st, OR 2. The county finance officer or eligible authority's executive director determines anytime after December 31st that any unexpended EMPL funds will not be needed for employment transportation from then until the end of the fiscal year. Once the funds are transferred to the Community Transportation System, the system will decide whether the funds will be transferred to EDT AP or RGP or used for employment transportation based on their predicted service demands. The transfer of any funds must be reported in the ROAP reports. Instead of transferring EMPL funds, ROAP recipients and their community transit systems should strategize ways of accommodating the public's work schedules by operating different hours, creating stops at the community colleges or universities, at JobLink Centers, Vocational Rehabilitation, Employment Security and/or offering voucher programs. In times of high unemployment, consider the people who need transportation to job interviews and re-training. EMPL funds that are transferred to another program assume the requirements of the program to which they are transferred. Any funds transferred from the EMPL program to the RGP program will have the same matching requirements as any other RGP funds. Additionally, EMPL funds transferred to RGP must be sub-allocated to the Community Transportation System. The county or eligible authority is responsible for billing their sub-recipients for any unspent funds. 6 Transferring Funds Between Counties in a Regional Transit System ROAP funds may be transferred between and/or among member counties of a regional transportation system if the county commissioners agree to the transfer. EDT AP and RGP funds must remain within the same program if such funds are transferred between and/or among counties. EMPL funds may be transferred either to the same program or to EDTAP or RGP, but the counties must abide by the transfer policies outlined in the previous section. (See Transferring Funds Between ROAP Programs) The annual ROAP Report form includes a Regional Transfer of Funds form and a Regional Receipt of Funds form to document any transfer or receipt ofROAP funds between and/or among member counties of the regional transportation system. The regional transportation systems that are eligible for this additional flexibility are: • • • • • • • • Albemarle Regional Health Services (Inter-County Public Transportation Authority) Choanoke Public Transportation Authority City of Rocky Mount (Tar River Transit) Craven County (Craven Area Rural Transit System) Kerr Area Transportation Authority Randolph County Senior Adults Association, Inc. (Randolph County Regional Coordinated Area Transit System) Yadkin Valley Economic Development District, Inc. (Yadkin Valley Public Transportation) Western Piedmont Regional Transit Authority Session Law 2011-207, House Bill229 does permit regional public transportation authorities created under Article 25 or Article 26 of Chapter l60A of the General Statutes, upon written agreement with the municipalities served by a public transportation authority or counties served by the regional public transportation authority, to apply for and receive any funds to which the member municipality or counties are entitled to receive based on the distribution formula set out in subsection (d) of this section. Transferring Funds to Match Other Grant Programs Subrecipients ofROAP funds are allowed to use their ROAP sub-allocation to leverage more operating funds by applying for other transportation grants administered by NCDOT -PTD. ROAP funds may ONLY be used as the local match to operating assistance for the federal grant programs including Section 5310-Elderly Individuals and Individuals with Disabilities, Section 5311 -Non-urbanized Formula Program, Section 5316-Job Access and Reverse Commute (JARC) Program, and Section 5317 -New Freedom Program, where operating is an eligible activity. A Call for Applications for these grants and the application documents are posted at least once a year on the NCDOT-PTD website. Transferring Funds Between Sub-recipients ROAP funds may be transferred from one sub-recipient to another within the county without NCDOT approval. EDT AP and RGP funds transferred from one sub-recipient to the other must stay within the same ROAP Program. If the transfer is EMPL funds, these funds may be transferred to another ROAP Program at another sub-recipient if all guidelines for EMPL fund transfer are met. A policy or procedure for determining when it is appropriate to transfer funds between sub-recipients should be developed by the county. P. Americans with Disabilities Act of 1990 (ADA) Titles II and III of the Americans with Disabilities Act of 1990 (ADA) provide that no entity shall discriminate against an individual with a disability in connection with the provision of transportation service. The law sets forth specific requirements for vehicle and facility accessibility. The passenger trips and transportation services provided with ROAP funds must be accessible to individuals with disabilities and be provided without discrimination on the basis of race, color, national origin, creed, sex or age. Sub- recipients should have procedures for investigating, tracking and documenting complaints. (See 49 CFR Parts 28 and 37) 7 Q. Monitoring and Evaluation ROAP services should be routinely monitored by the County Finance Officer or the authority's executive director to verify that funds are being spent on allowable expenditures, that the eligibility of service recipients is being property documented, and that sub-allocated funds will be expended by the end of the period of performance, June 30. The program should also be routinely evaluated to determine whether they are meeting program objectives. R. Reporting Requirements Beginning in FY20 12, two ROAP Reports will be required per grant cycle. The first report will be due not more than 45 days after the end ofthe second quarter (Dec 31) ofthe grant cycle. The final ROAP Report will be due not more than 60 days after the end of the fourth quarter (June 30). The county will be required to report trip and expense data associated with the EDTAP, EMPL, and RGP separately. The report fonn will be provided by NCDOT PTD. Completed reports will be returned to NCDOT-PTD or its designee. ROAP funds for the fiscal year will NOT be disbursed if the reports from the previous fiscal year have not been received and unspent funds returned to NCDOT-PTD. The County Finance Officer must certify and sign the final ROAP Report as it identifies the amount of unexpended funds to be returned to NCDOT. Based on this report, counties are invoiced for any unexpended funds for the given fiscal year. Upon receipt of the invoice for unexpended funds, the finance officer shall immediately reimburse NCDOT. The county may find it useful for agencies that have been sub-allocated ROAP funds to provide monthly or quarterly reports of the expenditure of funds and number of trips provided. Close monitoring by the county finance officer or the authority's director is required in order to ensure appropriate and maximum utilization of all program funds. It is the responsibility of the county finance officer to: • Record the receipt ofROAP grant funds in a manner that will disclose the source and the purpose/program to which the funds belong, together with evidence of deposit in a financial institution; • Ensure that ROAP funds and any interest earned on the funds are expended for eligible program expenses, that services are provided to eligible persons, and that written documentation that supports the expenditures is maintained for at least five years; • Advise any sub-recipients of the source of the funds, specific program requirements, eligible program expenses and reporting requirements; • Include ROAP funds received and expended in its annual independent audit on the Schedule of Expenditures of Federal and State Awards and identify any of the funds passed through to other agencies; • Complete and submit the semi-annual ROAP reports; and return unexpended ROAP funds as invoiced by NCDOT. S. Program Auditing and Documentation The Public Transportation Division (PTD) is responsible for providing sufficient program monitoring and oversight to ensure that the state funds are used for the intended purpose. PTD will rely upon the semi- annual reporting infonnation that identifies the number of passenger trips, other services and expenditures by program. The department's External Audit Branch compares infonnation in these reports to the ROAP expenses reported in the counties annual independent audit report. NCDOT's External Audit Branch will do on-site audits ofROAP expenditures. This requires meeting with the county finance officer or the authority's director to obtain documentation of costs reported to NCDOT in the semi annual reporting fonns. Common areas of deficiency include inadequate documentation of passenger eligibility and trips. The EDT AP program serves specific populations. Without documentation of eligibility, i.e. passenger is elderly or disabled, the auditor cannot determine if the rider met the program eligibility criteria that would allow the trip to be charged to the program. In addition, documentation of trips reported to NCDOT must be retained for up to five years following submittal of final ROAP reports. The inability to document trips with driver manifests, gasoline receipts, or any invoices associated with costs charged to the program would be considered ineligible expenses. The county or the authority will be invoiced for any undocumented costs. 8 Program Guidelines Elderly and Disabled Transportation Assistance Program Description The Elderly and Disabled Transportation Assistance Program (EDT AP), originally enacted by legislation in the 1989 Session of the North Carolina General Assembly (Article 2B, 136-44.27), provides operating assistance funds for the transportation of the state's elderly and disabled citizens. This transportation assistance allows the elderly and disabled to reside for a longer period in their homes, thereby enhancing their quality oflife. The following guidelines also apply to any additional funds provided to the counties to supplement the Elderly and Disabled Transportation Assistance Program. Allocation Formula The following formula was used to determine the county allocation of the funds available: • 50% divided equally among all counties; • 22 Y2 % based upon the number of elderly ( 60 years or older) residents per county as a percentage of the state's total elderly population; • 22 1h% based upon the number of disabled residents per county as a percentage of the state's total disabled population; and • 5% based upon a population density factor that recognizes the higher transportation costs in rural, sparsely populated counties. Eligibility Criteria For the purposes of EDT AP, an elderly person is defined as one who has reached the age of 60 or more years. A disabled person is defined as one who has a physical or mental impairment that substantially limits one or more major life activities, an individual who has a record of such impairment, or an individual who is regarded as having such impairment. Certification of eligibility will be the responsibility of the county or their designee. The county must be able to provide documentation that the EDT AP funded service was provided to an eligible person. Eligible Expenses ROAP funds are to be used for trips; not for capital or administrative expenses. Refer to the Eligible Transportation Expenses Matrix in Appendix A for a list of allowable transportation services that can be provided under these programs. A fare may be charged for eligible EDTAP services. Any fares collected must be used to provide more EDT AP transportation service. The inability to document trips with driver manifests, gasoline receipts, or any invoices associated with costs charged to the program will be considered ineligible expenses. The county will be invoiced for any undocumented costs. Restrictions EDTAP funds are to be used to provide trips for elderly and disabled individuals only when other funding sources are not available. The county or eligible authority can sub-allocate EDTAP funds to any government agency or 50l(c)3 non-profit organization that provides services to individuals with transportation needs. The county should take into consideration the need for and importance of the PUBLIC transportation services provided by the Community Transit System when determining the suballocation of the EDTAP funds. If the EDTAP funds are sub-allocated to other agencies besides the Community Transportation System, these other agencies are encouraged to coordinate EDTAP-funded transportation trips with the local Community Transportation System. EDT AP funds may be used as matching funds for operating assistance under 5310, 5311, 5316 and 5317 federally funded transportation 9 programs as appropriate. EDTAP funds cannot be transferred to any other ROAP program. EDTAP funded services are expected to be offered throughout the entire period of performance. The county must notify the assigned Mobility Development Specialist if an EDT AP funded service is discontinued. Employment·Transportation Assistance Program Description The Employment Transportation Assistance Program (EMPL) is intended to help DSS clients that transitioned off Work First or TANF in the last 12 months, Workforce Development Program participants and/or the general public to travel to work, employment training and/or other employment related destinations. The following guidelines also apply to any additional funds provided to the counties to supplement the Employment Transportation Assistance Program. Allocation Formula The following formula was used to determine the county allocation of the funds available: • 10% divided eq~ally atnong till counti~s; • 45% based upon the .populationofeach county as a percentageofthetotal state population*; and • 45% ba~ed uponthenumberofWorkFirst case loads percountya~ a percentage of the number of Work First caseloadsin the state as •ofJanuaryprior to application distribution. *Excludes the population ofany municipalities where an urban or smrul urban transit system is operating in counties with urbanized areas within their boundaries. Eligibility Criteria EMPL funded trips can be provided for: 1. Individuals that have transitionedoffthe Work First or Temporary Assistance for Needy Families program withilithe last 12 months; 2. Participants in Workforce Development Programs; and/or 3. The transportation disadvantaged public. EMPL funding may also be used to assist the general public with employment-related transportation needsiftheymeettheeligibility criteria established bythe county .. Certification of eligibility will be the respo~sibilityofthe county. Th~ countymustbe able to provide documentation that the EMPL funded service was provided to an eligible person. Eligible Expenses ROAP funds are to be used foroperational activities; not for capital or administrative expenses. Refer to the Eligible Transportation Expenses Matrix in Appendix A for a list of allowable transportation services under these programs, A fare may be charged for eligible EMPL services. Any fares collected must be used to provide mote EMPL transportation service. The inability to document trips with driver manifests, gasoline receipts, or any invoices associated with costs charged to the program will be considered ineligible expenses. The county will be invoiced for any undocumented costs. Restrictions The county or eligible authority can sub-allocate EMPL funds to any government agency or 501(c)3 non- profit organization that provides services to individuals with employment related transportation needs. If none of the Employment Transportation Assistance funds are sub-allocated to the Community Transportation System, sub-recipients are encouraged to coordinate EMPL-funded trips with the Community Transportation System. EMPL funds may be used as matching funds for operating assistance under 5310, 5311, 5316 and 5317 federally funded transportation programs as appropriate. 10 Counties or eligible authorities can transfer EMPL funds, all or in part, to the EDT AP and! or RGP programs. The EMPL funds must be transferred to the Community Transportation System if: 1. The county finance director or the executive director of an eligible authority determines that any subrecipient ofEMPL funds has spent 33% or less of their EMPL allocation by December 31st, OR 2. The county finance officer or eligible authority's executive director determines anytime after December 31st that any unexpended EMPL funds will not be needed for employment transportation from then until the end of the fiscal year. Once the funds are transferred to the Community Transportation System, the system will decide whether the funds will be transferred to EDT AP or RGP or used for employment transportation based on their predicted service demands. The transfer of any funds must be reported in the ROAP reports. Instead of transferring EMPL funds, ROAP recipients and their community transit systems should strategize ways of accommodating the public's work schedules by operating different hours, creating stops at the community colleges or universities, at JobLink Centers, Vocational Rehabilitation, Employment Security and/or offering voucher programs. In times of high unemployment, people need . transportation to job interviews and re-training. EMPL funds that are transferred to another program assume the requirements of the program to which they are transferred. Any funds transferred from the EMPL program to the RGP program will have the same matching requirements as any other RGP funds. Additionally, EMPL funds transferred to RGP must be sub-allocated to the Community Transportation System. The county or authority is responsible for billing their sub-recipients for any unspent funds. EMPL funded services are expected to be offered throughout the entire period of performance. The county must notifY the assigned Mobility Development Specialist in writing if an EMPL funded service is discontinued. Rural General Public Program Description The Rural General Public Program assistance funds are intended to provide transportation services for individuals from the county who do NOT have a human service agency or organization that will pay for the transportation service. The county, in consultation with the Community Transportation System, must determine the RGP services to be provided with the RGP funds. The following guidelines also apply to any additional funds provided to the counties to supplement the Rural General Public Program. Allocation Formula The following formula was used to determine the county allocation of the funds available: • 50% divided equally among all eligible counties; and • 50% based upon the rural population of each county as a percentage of tbe total state rural population. * * Excludes tbe population of any municipalities where an urban or small urban transit system is operating in counties with urbanized areas within their boundaries. Eligibility Criteria To use RGP funds, the passenger MUST live in or be visiting someone living in the non-urbanized area of a county. Either the origin or destination of the trip must be in the non-urbanized area. The RGP funds 11 cannot be used to provide service from an origin within the urban area or MPO boundaries to a destination within the urban area or MPO boundaries. Certification of eligibility will be the responsibility of the county or eligible authority. The county or eligible authority must be able to provide documentation that the RGP funded service was provided to an eligible person. See Appendix C for the urban-rural population data from the 201 0 Census. Eligible Expenses ROAP funds are to be used for operational activities; not for capital or administrative expenses. Refer to the Eligible Transportation Expenses Matrix in Appendix A for the allowable expenses under this program. A fare may be charged for eligible RGP services. Any fares collected must be used to match the RGP funds and/or provide more RGP transportation service. The inability to document trips with driver manifests, gasoline receipts, or any invoices associated with costs charged to the program will be considered ineligible expenses. The county will be invoiced for any undocumented costs. Restrictions The RGP funds must be sub-allocated by the county to the Community Transportation System. RGP funds must be used to provide transportation services to individuals who are not eligible for the same transportation services funded by any other means. Human service agencies cannot purchase RGP funded services (i.e passes, tickets, tokens) for the agency's program needs or their clients needs. RGP funds may be used as matching funds for operating assistance under 5310, 5311, 5316 and 5317 federally funded transportation programs as appropriate. RGP funds cannot be transferred to any other ROAP program. RGP funded services are required to be offered throughout the entire period of performance. The county must notify the assigned Mobility Development Specialist in writing if any ROAP funded service is discontinued before the end of the period of performance because all the ROAP have been spent. If both RGP funded services are discontinued before June 30 by the Community Transit System, and the county does not provide additional funds to continue the service(s), it will be assumed that the transit system is no longer providing general public service. In this case, the Community Transit System will not be reimbursed for any FTA Section 5311 and/or state CTP funded expenses incurred after the RGP funded services are discontinued. 12 Appendix A Eligible Transportation Expenses Matrix Services must be provided to a person that meets the eligibility criteria. Trip Based Services-Trips may be provided by car/vanpool, taxi, public transit vehicle, private transit vehicle, agency vehicle or mileage reimbursement to a volunteer. The most cost-effective option should be chosen. Public ;Private transportation providers shall be reimbursed based on the fully allocated cost per mile, per hour, or per passenger trip or for the cost of a token or ticket. Volunteers can be reimbursed for mileage only. If a human service agency uses an agency vehicle to provide the trip, the agency must include the fully allocated cost of a trip in their reimbursement request including fuel, staff time and benefits, depreciation, vehicle insurance and licensing. Trip Purpose EDTAP EMPL RGP Personal care, non-emergency medical appointments, pharmacy pickup, shopping, bill paying, Yes NO Yes public hearings, committee meetings, classes, banking, etc. Job interviews, job fair attendance, job readiness Yes Yes Yes activities or training, GED classes Transportation to Workplace (trip must be scheduled by the Yes Yes Yes individual passenger) Child(ren) ofWorking Parent NO Yes Yes transported to Child Care Group field trips/tours to Yes NO * community special events Overnight trips to out-of-county Yes NO * destinations Human Service Agency Yes NO Yes appointments Human service agencies cannot purchase passes, tickets or tokens from the community transit systems for the agency's program needs or their clients' needs. Human service agencies must pay the fully allocated cost for the transportation services they need. Clients must purchase their own passes, tickets and tokens from the community transit system. * Must be provided under the proVIsions of the federal Charter regulatiOns which can be viewed at http://www.fta.dot.gov/laws/leg reg 179.html IMPORT ANT! Counties and eligible authorities will no longer be allowed to use ROAP funds for other services including fuel assistance (gas vouchers, gas cards, reimbursement to fuel provider), vehicle repairs or vehicle insurance premiums beginning with the 2012-2013 ROAP Program. 13 Appendix B Public Hearing Notice Safe Harbor Requirement County population includes at least 1 000 persons who speak Spanish at home and English "less than well. n Alamance County, North Carolina Alleghany County, North Carolina Bladen County, North Carolina Brunswick County, North Carolina Buncombe County, North Carolina Burke County, North Carolina Cabarrus County, North Carolina Catawba County, North Carolina Chatham County, North Carolina Cleveland County, North Carolina Columbus County, North Carolina Craven County, North Carolina Cumberland County, North Carolina Davidson County, North Carolina Davie County, North Carolina Duplin County, North Carolina Durham County, North Carolina Forsyth County, North Carolina Franklin County, North Carolina Gaston County, North Carolina Granville County, North Carolina Greene County, North Carolina Guilford County, North Carolina Harnett County, North Carolina Henderson County, North Carolina Hoke County, North Carolina Iredell County, North Carolina 14 Johnston County, North Carolina Lee County, North Carolina Lenoir County, North Carolina Lincoln County, North Carolina Mecklenburg County, North Carolina Montgomery County, North Carolina Moore County, North Carolina Nash County, North Carolina New Hanover County, North Carolina Onslow County, North Carolina Orange County, North Carolina Pender County, North Carolina Pitt County, North Carolina Randolph County, North Carolina Robeson County, North Carolina Rockingham County, North Carolina Rowan County, North Carolina Sampson County, North Carolina Stanly County, North Carolina Surry County, North Carolina Union County, North Carolina Vance County, North Carolina Wake County, North Carolina Wayne County, North Carolina Wilkes County, North Carolina Wilson County, North Carolina Yadkin County, North Carolina Appendix C 2010 Census Data-Urban Population by County Urban Area %Pop in County Population Population Urban Area Alamance 151,131 107,971 71.44 1 Alexander 37,198 4,738 12.74 Alleghany 11,155 0 0 Anson 26,948 0 0 Ashe 27,281 0 0 Avery 17,797 0 0 Beaufort 47,759 0 0 Bertie 21,282 0 0 Bladen 35,190 0 0 Brunswick 107,431 39,915 37.15 Buncombe 238,318 180,932 75.92 Burke 90,912 52,136 57.35 Cabarrus 178,011 143,551 80.64 Caldwell 83,029 54,444 65.57 Camden 9,980 0 0 Carteret 66,469 0 0 Caswell 23,719 0 0 Catawba 154,358 101,101 65.5 Chatham 63,505 6,513 10.26 Cherokee 27,444 0 0 Chow an 14,793 0 0 Clay 10,587 0 0 Cleveland 98,078 11,171 11.39 Columbus 58,098 0 0 Craven 103,505 50,503 48.79 Cumberland 319,431 276,729 86.63 Currituck 23,547 0 0 Dare 33,920 0 0 Davidson 162,878 85,699 52.62 Davie 41,240 7,062 17.12 Duplin 58,505 0 0 Durham 267,587 252,528 94.37 Edgecombe 56,552 17,349 30.68 Forsyth 350,670 324,908 92.65 Franklin 60,619 4,829 7.97 Gaston 206,086 158,926 77.12 Gates 12,197 0 0 Graham 8,861 0 0 Granville 59,916 963 1.61 Greene 21,362 0 0 Guilford 488,406 426,406 87.31 Halifax 54,691 0 0 15 Urban Area %Pop in County Population Population Urban Area Harnett 114,678 12,294 10.72 Haywood 59,036 26,306 44.56 ' Henderson 106,740 71,227 66.73 Hertford 24,669 0 0 Hoke 46,952 26,692 56.85 Hyde 5,810 0 0 Iredell 159,437 98,991 62.09 Jackson 40,271 0 0 Johnston 168,878 37,449 22. Jones 10,153 0 0 Lee 57,866 0 0 Lenoir 59,495 0 0 Lincoln 78,265 10,797 13.8 McDowell 44,996 0 0 Macon 33,922 0 0 Madison 20,764 1,948 9.38 Martin 24,505 0 0 Mecklenburg 919,628 909,830 98.93 Mitchell 15,579 0 0 Montgomery 27,798 0 0 Moore 88,247 0 0 Nash 95,840 50,256 52.44 New Hanover 202,667 198,178 97.79 Northampton 22,099 0 0 Onslow 177,772 105,419 59.3 Orange 133,801 95,625 71.47 Pamlico 13,144 0 0 Pasquotank 40,661 0 0 Pender 52,217 2,143 4.1 Perquimans 13,453 0 0 Person 39,464 0 0 Pitt 168,148 117,798 70.06 Polk 20,510 0 0 Randolph 141,752 21,284 15.01 Richmond 46,639 0 0 Robeson 134,168 505 0.38 Rockingham 93,643 0 0 Rowan 138,428 84,687 61.18 Rutherford 67,810 0 0 Sampson 63,431 0 0 Scotland 36,157 0 0 Stanly 60,585 0 0 Stokes 47,401 11,520 24.3 Surry 73,673 0 0 Swain 13,981 0 0 Transylvania 33,090 235 0.71 Tyrrell 4,407 0 0 16 Urban Area %Pop in County Population Population Urban Area Union 201,292 146,361 72.71 Vance 45,422 0 0 Wake 900,993 833,188 92.47 Warren 20,972 0 0 Washington 13,228 0 0 Watauga 51,079 0 0 Wayne 122,623 61,054 49.79 Wilkes 69,340 0 0 Wilson 81,234 638 0.79 Yadkin 38,406 0 0 Yancey 17,818 0 0 17 Gina Wheeler From: Sent: To: Subject: Good Afternoon Gina, NCACC <ncacc@ncacc.org> Friday, September 27, 2013 12:02 PM Gina Wheeler NCACC Video for your October Board meeting Agenda Item ___ q_, __ _ We have prepared a short video that we request be shown at your first board of commissioners meeting in October. This video includes an introduction from NCACC President Ray Jeffers and features NCACC staff updating commissioners on Steering Committees and how commissioners can participate. It also gives an overview of an upcoming seminar on the Affordable Care Act and how it affects counties as well as the Association's Risk Management Services. The video is short-less than four minutes -and we have two ways it can be accessed. It is available for download via Google Drive and can be accessed on our You Tube channel. Direct links to both are provided below. We appreciate your consideration, and please let us know if you show the video at your meeting. Direct Links Google Drive: https://docs.google.com/file/d/OBx6fCloKngQQbWN4QilPOEJ3NlE/edit?usp=sharing YouTube: http://youtu.be/eEeYhyLwh3Q If you have any problems with downloading the program, need a different format, or have any other issues with the production, please feel free to contact us at communications@ncacc.org. Thank you, N.C. Association of County Commissioners 215 N. Dawson Street, Raleigh (919) 715-2893 www.ncacc.org 1 Employee ;nthia Milton Marshall Woodall Anne Plummer Joseph R. Parrish Brenda Greene Patsy Johnson Judith Darroch Jean Moore Goldie Pryor HARNEIT COUNTY DEPARTMENT OF SOCIAL SERVICES Early Retirement Incentive Program Plan Revision 9-25-13 Position Date of Plan for Coverage Hire Director 7-24-74 Fill with Interim Director Paul Polinski-Keep that (39 yrs.) employee's position open Attorney 7-1-03 Coverage by other staff attorney I contract attorney (10 yrs.) Fili1-2-14-Apply time from other agency vacancies toward the remaining 5 month period (Jui--Aug 10+ months} Placement 8-15-77 Coverage by 2 Placement Supervisors Supvr/PM (36 yrs.) Ratio of 1:5 State Standard 1:5 Prog Manager responsibilities covered by Supvrs. CPS Supervisor 2-1-84 Coverage by 3 CPS Supervisors-Fill 2-1-14 (29 yrs.) Apply time from other agency vacancies toward the remaining 4 month period Ratio of 1:6 State Standard 1:5 PI Investigator 2-1-92 Coverage by PI Investigator (21 yrs.} IMCW 11-Child 4-22-96 Coverage by other employees in Child Care Unit Care (17 yrs.) {4 positions) IMCW 1-F/C 11-4-04 Coverage by other IMCWs in F/C Medicaid Section (19 Medicaid (9 yrs.) positions) PA IV-PI 9-1-89 Coverage by other clerical support staff to complete (24 yrs.) required reports SW 11-WFES 6-1-92 Coverage of assessments by WFFA; employment cases {21 yrs.) will be covered by other SW and WFFA assistance Board Approval Yes Yes Yes Yes Yes Yes Yes Yes Yes Position Harnett County Social Services-7700 calculation of FY 2014 Retiree Payout and Funding Needed Current Annual Salary Six Months (5 for Retiree) Final Six Months ~~~~~~~~~~----------~ Position INCOME MAINTENANCE SUP II INCOME MAINTENANCE SUP II INCOME MAINTENANCE SUP II CHILD SUPPORT LEAD AGENT PARALEGAL I CHILD SUPPORT AGENT II CHILD SUPPORT AGENT II CHILD SUPPORT AGENT II CHILD SUPPORT AGENT If CHILD SUPPORT AGENT II CHILD SUPPORT AGENT II CHILD SUPPORT AGENT II CHILD SUPPORT AGENT II CHILD SUPPORT AGENT II Harnett County Social Services -7700 calculation of FV 2014 Retiree Payout and Funding Needed Current Six Months Final Six Annual Salary {5 for Retiree) Months 43,722 21,861 21,861 42,203 21,102 21,102 45,939 22,970 22,970 43,722 21,861 21,861 43,722 21,861 21,861 41,920 20,960 20,960 41,920 20,960 20,960 34,934 17,467 17,467 35,021 17,511 17,511 40,174 20,087 20,087 41,920 20,960 20,960 41,920 20,960 20,960 40,357 20,179 20,179 41,920 20,960 20,960 CHILD SUPPORT AGENT II ~ 20,420 Ill Freeze g,, "' 40,192 20,096 20,096 IM INVESTIGATOR II INCOME MAINTCASEWRKR Ill 39,494 1:::o, INCOME MAINT CASEWRKR Ill 38,793 19,397 19,397 INCOME MAINT CASEWRKR Ill 40,192 20,096 20,096 INCOME MAINT CASEWRKR Ill 37,461 18,731 18,731 INCOME MAINT CASEWRKR Ill 36,947 18,474 18,474 INCOME MAINTCASEWRKR Ill 40,753 20,377 20,377 INCOME MAINT CASEWRKR HI 34,149 17,075 17,075 INCOME MAINT CASEWRKR Ill 40,753 20,377 20,377 INCOME MAINT CASEWRKR Ill 38,792 19,396 19,396 INCOME MAINT CASEWRKR Ill 40,192 20,096 20,096 INCOME MAINT CASEWRKR Ill 42,222 21,111 21,111 INCOME MAINT CASEWRKR Ill 40,600 20,300 20,300 INCOME MAINT CASEWRKR Ill 38,794 19,397 19,397 INCOME MAINT CASEWRKR Ill c . 33,494 13,956 .. 16,747 terminated 9/16 one month delay in hiring to cover deficit INCOME MAINT CASEWRKR Ill 40,754 20,377 20,377 ADMINISTRATIVE ASSISTANT I 40,641 20,321 20,321 ADMINISTRATIVE ASSISTANT I 33,494 16,747 16,747 CHILD SUPPORT AGENT I 38,794 19,397 19,397 CHILD SUPPORT AGENT I 32,112 16,056 16,056 INCOME MAINT CASEWKR II 33,868 16,934 16,934 INCOME MAINT CASEWKR II 36,945 18,473 18,473 INCOME MAINT CASEWKR II 36,946 18,473 18,473 INCOME MAINT CASEWKR II 36,945 18,473 18,473 INCOME MAINT CASEWKR II 30,788 15,394 15,394 INCOME MAINT CASEWKR II 30,789 15,395 15,395 INCOME MAINT CASEWKR II 30,788 15,394 15,394 INCOME MAINT CASEWKR II 36,946 18,473 18,473 INCOME MAINT CASEWKR II 30,789 15,395 15,395 INCOME MAINT CASEWKR II 36,945 18,473 18,473 INCOME MAl NT CASEWKR II 30,789 15,395 15,395 INCOME MAINT CASEWKR II 30,788 15,394 15,394 ;i;c;;i.',iX:i'U';';. ~,:.; !?,.;,,,;;; r .• ·~:·•. ·:••n·.:••';c:~·" INCOME MAINT CASEWKR II 33,868 16,934 16,934 INCOME MAINT CASEWKR II 36,946 18,473 18,473 INCOME MAINT CASEWKR II 30,788 15,394 15,394 INCOME MAINT CASEWKR II 30,788 15,394 15,394 INCOME MAINT CASEWKR II 30,788 15,394 15,394 INCOME MAINT CASEWKR II 33,868 16,934 16,934 L Harnett County Social Services-7700 Calculation of FY 2014 Retiree Payout and Funding Needed Current Six Months Final Six Position Annual Salary (5 for Retiree) Months INCOME MAINTCASEWKR II 30,789 15,395 15,395 INCOME MAINTCASEWKR II 30,789 1S,39S 15,39S INCOME MAINTCASEWKR II 36,936 18,468 18,468 INCOME MAINTCASEWKR II 38,793 19,397 19,397 INCOME MAINTCASEWKR II 36,947 18,474 18,474 INCOME MAINTCASEWKR II 36,947 18,474 18,474 INCOME MAINTCASEWKR II 36,947 = 18,474 18,474 INCOME MAINTCASEWKR II 36,947 18,474 18,474 INCOME MAINT CASEWKR II 36,94S 18,473 18,473 INCOME MAINTCASEWKR II 30,789 1S,39S 15,39S INCOME MAINTCASEWKR II 36,94S 18,473 18,473 INCOME MAINT CASEWKR II 33,868 16,934 16,934 INCOME MAINTCASEWKR II 30,789 1S,39S 15,39S HUMAN RESOURCES PlACEMENT SPEC 30,788 1S,394 1S,394 HUMAN RESOURCES PlACEMENT SPEC 30,789 1S,39S 1S,39S HUMAN RESOURCES PlACEMENT SPEC 30,789 1S,39S 1S,39S FOREIGN lANGUAGE INTER II 36,946 18,473 18,473 INCOME MAINT CASEWKR I 28,301 14,1S1 14,151 INCOME MAINT CASEWKR I 28,300 14,1SO 14,1SO INCOME MAINTCASEWKR I 33,962 16,981 16,981 INCOMEMAINTCASEWKRI ~ 14,151 -~~~~F''''"~i./, .·,,;;:,,f'i!Cf0''' /( INCOME MAINTCASEWKR I 33,962 16,981 16,981 INCOME MAINTCASEWKR I 31,131 1S,566 15,566 INCOME MAINT CASEWKR I 31,131 1S,566 1S,S66 INCOME MAINT CASEWKR I 32,781 16,391 16,391 INCOME MAINTCASEWKR I 31,131 1S,566 15,S66 INCOME MAINT CASEWKR I 31,131 1S,S66 1S,S66 INCOME MAINT CASEWKR I 28,300 14,1SO 14,1SO INCOME MAINTCASEWKR I 28,300 14,150 14,1SO INCOME MAINT CASEWKR I 28,300 14,1SO 14,1SO INCOME MAINT CASEWKR I 28,300 14,1SO 14,1SO INCOME MAINT CASEWKR I 28,300 14,150 14,1SO ACCOUNTING CLERK IV-DSS 26,019 13,010 13,010 PROCESSING ASSISTANT V-OSS 31,219 1S,610 1S,610 ~ ACCOUNTING CLERK V 30,133 1S,067 1S,067 PROCESSING ASSISTANT 111-DSS 28,698 14,349 14,349 PROCESSING ASSISTANT 111-DSS 23,91S 11,9S8 11,9S8 PROCESSING ASSISTANT 111-DSS 23,914 11,957 11,957 PROCESSING ASSISTANT 111-DSS 23,915 11,958 11,9S8 PROCESSING ASSISTANT 111-DSS 26,307 13,154 13,154 PROCESSING ASSISTANT 111-DSS 28,698 14,349 14,349 PROCESSING ASSISTANT lll-DS5 23,915 11,958 11,958 PROCESSING ASSISTANT 111-DSS 23,91S 11,958 11,958 OFFICE ASSISTANT Ill-CHILD SUP 28,698 14,349 14,349 OFFICE ASSIST ANT Ill-CHILD SUP 28,698 14,349 14,349 COMMUNITY SOC SERVICE ASST 2S,293 12,647 12,647 COMMUNITY SOC SERVICE ASST 25,295 12,648 12,648 COMMUNITY SOC SERVICE ASST 21,077 10,539 10,539 COMMUNITY SOC SERVICE ASST 25,293 12,647 12,647 3 Harnett County Social Services -7700 Calculation of FY 2014 Retiree Payout and Funding Needed Current Six Months Final Six Position Annual Salary (5 for Retiree) Months 3/5 Adjustments 27,849 0 ~ty 92,241 0 dOn-Call 0 5,800 0 Special Salary Adjustments 0 22,840 0 Reclassification Requests 0 5,072 0 6,514,502 3,307,863 3,053,735 TOTAL BUDGETED (164 Positions) 6,514,502 3,307,863 3,053,735 $ 6,514,502 Current budget $ (513,157) July payroll $ (512,545) August payroll $ (511,670) September payrol $ (1,770,490.80) Projected payroll, October December $ (3,053,735) Projected payroll, January-June 3,307,862.50 -513,157.00 -512,545.00 -511,669.70 1,770,490.80 ~------------------~~~~ $ (85,263) Estimated retiree payout (includes vacation, comp time and longevity $ (67,000) DSS bonus _$;._ _________ .....;..-:6-42=-'""Estimated avail. 4 NCDVA-2 Rev. Dec. 2007 County/District:_ Harnett Name Total 291 26 NORTH CAROLINA DIVISION OF VETERANS AFFAIRS - I 52 ' 460 15 16 30 5 1 ACTIVITIES REPORTING FORM I 3 58 MonthNear: _<S.oo.Jem h,u, r:Q()/3 I I Eric Truesdale 1 Harnett County Veterans Officer I' 9 39 6 1 3 3 3 2 5 3 I •-t updated 9/09/2013 Harnett County Department of Public Health Activities Summary