The URL can be used to link to this page

Home My WebLink About011916a Agenda PackageHARNETT COUNTY BOARD OF COMMISSIONERS County Administration Building 102 East Front Street Lillington, North Carolina Regular Meeting (Tuesday) January 19,2016 7 :00pm 1. Call to order -Chairman Jim Burgin 2 . Pledge of Allegiance and Invocation -Commissioner Barbara McKoy 3. Consider additions and deletions to the published agenda 4 . Consent Agenda A . Minutes B. Budget Amendments C . Tax rebates , refunds and releases D . Resolution to add roads to state system E. Harnett County Information Technology Department requests approval of a minor reorganization which includes 1) transitioning the Applications Analyst position to the Systems Team and reduce the pay grade from 77 to 75; 2) increase the grade of the Systems Manager position from salary grade 77 to grade 78 to align this position to our succession plan; and 3) change their Admin. Assistant title to Admin Tech and increased one grade level from 63 to 64 that will correspond with newly assigned technical duties. These transitions will not change the current LT . Department budget. F. Harnett County Emergency Services requests approval of the EMS System Plan Renewal which describes how Harnett County provides the citizens with 24/7 EMS coverage. Harnett County Emergency Services al so requests approval to designate the County Manager signature authority for any EMS System Plan renewals and changes forward. G. Harnett County Emergency Services requests approval to create a new Deputy Emergency Services Director position at salary grade 80 and reclassify the current fire marshal position at salary grade 78. No additional funding is needed. H. Harnett County Facilities and Maintenance requests the reclassification of two Heavy Equipment Operator positions, salary grade 63 , to Solid Waste Crew Leaders with a salary grade of65. These reclassifications will be absorbed in the Solid Waste's current budget. I. Harnett County Health Department requests approval to reclassify a Public Health position to a Physician Extender II position. This reclassification can be absorbed in the Health Department's current budget. J. Harnett County Health Department requests approval to enter into a Memorandum of Understanding with Harnett Health to provide a morgue for medical examiner cases at a cost of $50 per case. K. Campbell University requests a waiver of all building permit fees for the construction of the new South Residence Hall that will be located on Leslie Campbell A venue. L. Boards and Committees on which Commissioners will serve on in 2016 Page 1 011916 HC BOC Page 1 5. Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation 6. Appointments 7. Presentation of County Audit for the Fiscal Year Ending 2015, Martin Starnes & Associates 8. County Manager's Report -Joseph Jeffries, County Manager -Harnett County Sales Tax Analysis by Article -November 2015 -Veterans Affairs Activities Reporting -December 2015 -Internal Budget Amendments 9. New Business 10. Closed Session 11. Adjourn Page2 011916 HC BOC Page 2 Agenda Item 48 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, 2016: Section 1. To amend the WIOA Youth In-School Program Fund, the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 234-7405-465 .11-14 Longevity 13.00 ~7405-465.58-01 Training & Meetings 13.00 7.J'f- REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION: Moving $13 from Training and Meetings (58-01) into Longevity (11-14) to fund the line for the remainder of Fiscal 2016. APPROVALS : Vvulitbc/UAciJ 12/JJ.fts 1 }sh~ Department Head (date) Finance Ot 1 er (date) o ty Manager (date) Section 2. Copies of this budget amendment shall be urnished 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 ll~b 011916 HC BOC Page 3 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 f isc al year ending June 30, 2016: Section 1. To amend the WIOA Youth In-School Program Fund, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 234-7407-465.11-14 Longevity 52.00 2-i34-7407-465.58-01 Training & Meetings 52.00 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION: Moving $13 from Training and Meetings (58-01) into Longevity (11-14) to fund the line for the remainder of Fiscal 2016. APPROVALS : UaJlcliLtmh fZ/dJ/1~ · ~N-1;: Department Head (date) Finan Officer (d ) I \7> /r c;. u~ger (date) Section 2. Copies of this budget amendment shall be furnish a 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 !l9b 011916 HC BOC Page 4 BU DGET ORDINANC E AMENDMENT BE IT ORDAINED by the Governing Boord of the County of Harnett, North Carolina, that th e following amendment be mode to the annual budget ordinance for the fiscal year ending June 30, 2016 Sectio n 1. To amend the General Fund , the appropriations are to be changed as follow s: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTI ON OF CODE INCREASE DECREASE 110-7999-441-35-11 Buddy Pockpock ProQ rom $2.500 110-7999-441-36-16 Corenet Counseling $3,000 11 0-8 199-450-31-67 Coots Museum $3.000 11 0-7999-441 -31-66 H.C Habitat for Humanity $15.000 11 0-7310-4 65-33-45 Par e nts as T e ochers $20.000 11 0-7099-465-36-17 H.C Partnership for Children $1 .000 11 0-51 03-420-35-67 Harnett United PAL $5 ,000 110-7999-441 -3 1-85 Johns o nville Community C e nter $500 110-7999-441-31-47 Johnston Lee Harnett Community Action $2.500 110-7999-44 1-36-18 Mid Carolina Area Agency (Senior Gomes) $2,500 110-7999-441-31-71 SAFE of Harnett County $20000 I REVENUE AMOUNT AMOUNT !CODE NUMBER I DESCRIPTION OF CODE INCREASE DECREASE 11 0-0000-399-00-00 Fund Ba lance Appropriated _175,000 EXPLANATION : To increase Fund Balance Appropriated to budget the approved fund in g for 10 nonprofit groups in the Hornell County area. The funding was opproved·ot the January 4, 2016 board meeting. •Buddy Backpack: Provides food to school children who may hove lillie or nothing else to eat at home on weekends. •CareNet C ou selfng : Provides free counseling services to residents who may not be able to afford it on thei r own . Services include marriage & family issues. emotional problems, etc. • Habitat fo r Humanity: Provides help to families in need of ho mes. •Pa rents as Teachers: Provides in home visitation whi c h helps parents learn how to parent more effectively. • Harnett Co u nty Pa rt nersh ip for Children: Dolly Parton's Imagination Library Program, which help provides developmentally appropriate books to children each month until age 5. •Harnett United PAL : Run by Sheriff's office, which provides athletic and after school activities for at-risk children in the area. •Johnsonville Community Center: Provides a venue for several local qroups to meet. •Johnston-Lee-Harnett Community Action Group: Provides resources to help permanently improve the lives of low-income & •Mid Carolina Area Agenc y(Sen ior Games): Oranizes the Senior Gomes for Hornell and other counties. encouraging seniors to •H arnett County SAFE: Provides assistance to victims of domestic violence. APPROVALS : /-/3-I C- Dept Head (dote) I {12 {1~ Section 2. Copies of this budget amendment shall be furnished to the Clerk t o the Boord, and to the Budget Officer Adopted __________________________________ __ Margaret Regina Wheeler, Clerk to the Boord Jim Bu rgin, Chairman Harnett County Boord of Commissioners 011916 HC BOC Page 5 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, 2016. ~lid c>J~ f> 1-e-. h, ,_ J . ' Section 1. To amend the Gene• al Fund, PubliE 81:lil~i.;;gs~t, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 580-6600-461-7 4 . 74 Capital Outlay-Equipment $91,000 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 580-0000-354-01.00 Sale of Other Assets $91,000 EXPLANATION: Purchase sheepsfoot roller for landfill use. The roller will be used for the construction of Dunn Erwin landfill expansion, Anderson Creek landfill expansion and landfill closure projects. M s/1/p · ;3.t-~ h?/~ ~artment Head (date) Finan 1 {1{ [fa Co~t)'M~a ~te) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of Margaret Regina Wheeler, Clerk to the Board 12016. Jim Burgin , Chairman Harnett County Board of Commissioners 011916 HC BOC Page 6 BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2016: Section 1. To amend the General Fund, Sheriff's Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-5100-420-74-74 Capital Outlay 9,525 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-0000-356-30-00 Insurance Claims 9,525 EXPLANATION: To transfer$ 9,525.0000 received from an insurance claims on a vehicle accident to help supplement the replacement of the totaled patrol car. APPROVALS: \Jh~~~ \/s)J~ Department Head (date) ~ J/I?-1~ unty ager (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 , 2015 . Margaret Regina Wheeler, Jim Burgin, Chairman · Interim Clerk to the Board Harnett County Board of Commissioners 011916 HC BOC Page 7 Harnett HARNETT COUNTY FINANCE DEPARTMENT CASH REPORT FORM COUNTY DATE PREPARED · January 5 2016 ' DEPARTMENT· Human Resources - ' DESCRIPTION ACCOUNT NUMBER AMOUNT 08 Services-OneBeacon Insurance Group 110-0000-356.30-00 Atlantic Specialty Insurance Company SHF DOL 11/23/15 VIN# 2A4RR5D18AR109210 2010 Chrysler Town & Country Touring Four Door Van (Veh . #5287) TOTAL $ COIN: 0 .00 CURRENCY: 0 .00 MONEY ORDER: 0.00 CHECKS : 9525.00 REMOTE DEPOSIT CHECKS : 0 .00 TOTAL $ 9525.00 SUBMITTED BY : .Aw;t .£ II~ rkJ RECEIVED BY : ~ 9525.00 9525.00 { SIGNATURE FINANCE SIGNATURE DATE RECEIVED : 1/512016 011916 HC BOC Page 8 OBServices 188 INVERNESS DR IVE WEST SUITE 600 ENGLEWOOD CO 80112 HARNEIT COUNTY Mall to : P.O. BOX 778 ATTNANGELM Lillington NC 27546 ., •o; ; 1 ;,. ~~ 1 OS Services EXPLANATION OF PAYMENT AD41211·3 PLEASE FORWARD ALL CORRESPONDENCE TO : OneBeacon Insurance Group 188 INVERNESS DRIVE WEST SUITE GOO ENGLEWOOD CO 80112 866-725-5171 PAY TO: HARNETT COUNTY AGENT: Suny Insurance Agency & Realt PO BOX 128 DOBSON NC 27017 IN PAYMENT OF : 10CHRYSLER COMPANY : DATE ISSUED: CHECKAMT: INSURED: POL ICY NO.: DATE/LOSS: CLAIM NO.: ATLANTIC SPECIALTY INSURANCE COMPANY 1212812015 $9 ,525.00 HARNETT COUNTY 7910005590003 11/23/2015 OAB-148082-01-01 CLAIM TYPE: COLLISION (NC) CLA IMANT: HARNETT COUNTY ADJUSTER: JJ 13-MANUEL SALGADO .. ; 7 .:.·;· ~~~.:. ;:;~ :" ·;;-~' 05898 0513 ( OETACii ~D RETAIN THIS J'ORTION FOR YOUR RECORDS TliE FACE OF TlilS DOCUMENT HAS A COLORED BACKGFiOUNQ • -NOT A 11/HITE BACKGROUND r .=:oaser.vices . . ~ . 1ms12o1s AD41211-3 ·. · .r . ;~~~~ . ' . '• --l!'lfWl~NT OFi: 10 CHRYSL.I;R ·: · '!'life !JwUSfmd five hundred twenty five and 001100 Dollars . . ·:-·)::~. ·~· ~~ __ ; -~· • ; ·INSURED: ·. · .~ f!iicv·No.: ' .... GLAIM NO.: ·-.:~IMAm:,' _.·.: ~;J.VsTeR: til·:'' !.:· Hfo.Rt'IETT COUNTY '7910005500003 OAB-148082-01-01 HARNETT COUNTY ~UEL SALGADo' LOSS DATE: 11/2312015 CLM TYPE : COLLISION-NC oo 2 2 a..oo? ~ * 3 211 • IW«OF~ NOT VALlO AFTER 80 O,.YS FRQN ISSUE ·' ~ .r .. ---r. _ .. :.-:~t\.·~· t ~-.. · ·.::~ • :: . • ~ J ,} f:t .. ~~~~ ~~ -~ . ',., · . .,;,~~... . ' .-..... · ·":'¥~ ::-· .. . •.";, .::· . ,. ,. . :. · ... •, ~~. - , . ra = 011916 HC BOC Page 9 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, 2016: Section 1. To amend the General Fund, Sheriffs Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-5100-420-74-74 Capital Outlay 16,437 REVENUE AMOUNT AMOUNT CODE NUMBER-DESCRIPTION OF CODE INCREASE DECREASE 110-0000-356-30-00 Insurance Claims 16,437 EXPLANATION: To transfer $16,437.00 received on insurance claims from Sheriff Vehicle accidents to supplement the replacement of three patrol cars totaled in vehicle accidents. APPROVALS: ·~ '/.:>)10 /-/1-;b Department Head (date) Section 2. Copies of this budget amendment shall be furnish to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of , 2015 . Margaret Regina Wheeler, Interim Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioners 011916 HC BOC Page 10 BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2016: Section 1. To amend the General Fund, Sheriff's Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMO,UNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-5100-420-74-74 Capital Outlay 9,619 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-0000-356-30-00 Insurance Claims 9,619 EXPLANATION: To transfer$ 9,619.0000 received from an insurance claims on a vehicle accident to help supplement the replacement of the totaled patrol car. APPROVALS: llil\~ ~~\/sA~ Department Head (date) ~ 1-;1/.6 untY age; (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 , 2015 . Margaret Regina Wheeler, Interim Clerk t o the Board Jim Burgin, Chairman Harnett County Board of Commissioners 011916 HC BOC Page 11 HARNETT COUNTY FINANCE DEPARTMENT Harnett CASH REPORT FORM COUNTY DATE PREPARED: January 5 , 2016 ------~~------ DEPARTMENT: Human Resources .. -·-· . - DESCRIPTION ACCOUNT NUMBER ·.AMOUNT •'.' :. 08 Services-OneBeacon Insurance Group 110-0000-356.30-00 9618.95 Atlantic Specialty Insurance Company SHF DOL 12/09/2015 VfN# 2C3CDXAT2CH2416n 2012 Dodge Charger RIT (Veh. #5299) TOTAL $ 9618.95 COIN: 0.00 CURRENCY: 0.00 - MONEY ORDER : 0.00 CHECKS: 9618.95 REMOTE DEPOSIT CHECKS: 0.00 TOTAL $ 9618.95 SUSMITIED BY: LAL!J/~ RECEIVED BY: \ I c. SIGNATURE FINANCE SIGNATURE DATE RECEIVED : 1/512016 011916 HC BOC Page 12 OS Services 1881NVERNESS DRIVE WEST SUITE 600 ENGLEWOOD CO 60112 HARNETT COUNTY Mail to: P.O. BOX 778 Lillington NC 27546 OS Services PLEASE FORWARD ALL CORRESPONDENCE TO: OneBeacon Insurance Group 1881NVERNESS DRIVE WEST SUITE 600 ENGLEWOOD CO 80112 866-725-5171 PAY TO: HARNETI COUNTY AGENT: Surry Insurance Agency & Reali PO BOX 128 DOBSON NC 27017 IN PAYMENT OF : VEHICLE DAMAGES • ,j ·. ·-. .. .. ~ EXPLANATION OF PAYMENT AD40780-6 COMPANY : DATE ISSUED: ATLANTIC SPECIALTY INSURANCE COMPANY 1212712015 CHECKAMT: $9,618.95 INSURED: HARNETT COUNTY POLICY NO.: 7910005590003 DATE/LOSS: 12/09/2015 CLAIM NO.: OAB-149617-01-01 CLAIM TYPE: COLLISION (NC) CLAIMANT: HARNETT COUNTY ADJUSTER : JJ92 • EZRA J FUELLING • ') y;_o . ·, . ~ . ~~ ... •. 058980513 DETACH AND RETA IN THIS PORTION FOR YOUR RECOilOS THE FACE OF THIS DOCUMENT HAS A COlOREO BACKGROUND • NOT A mif f: EIAC.f(!lROUNO .. ,,9~ ,$ervk:es /;. ~: ~~Z::.~~:t:; ~-.. ; : :'~~Y.i'o,THE HARNETT COUNTY ',. ;:QRPER OF: . ( IN PAYMENT OF: VEHICLE DAMAGES 12/27/2015 AD40780•6 . a.+oNK OF-AMERICA ... r \.1 .t ·.:.. . NOT VALlO N:fER 90 llo\YS FRoM ISSUE HARNETT COUNTY 7910005590003 0As·149617·01~1 HARNETT COUNTY . . . EZRA J FUELLING LOSS DATE : 12/09/2015 CLM TYPE: COLUSION-NC 0 0 2 2 ~ 0 0 ? ~ ~ 3 211' . . , 011916 HC BOC Page 13 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, 2016: Section l .To amend the CP1304 Single Family Rehab (SFR13} budget, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 303-8300-465.85-19 Administration Soft Cost 35,970 303-8300-465.85-80 Construction Hard Cost 135,000 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 303-0000-331.41-18 NC Housing Single Family Rehab 2013 170,970 EXPLANATION: The North Carolina Housing Finance Agency has awarded the County additional funds to rehabilitate 3 homes that meet the criteria for the SFR13 grant. A local match is not required. APPROVALS: ~ 1-/)JJ County M nager (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 ______ J ______ _ Margaret Regina Wheeler Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioner 011916 HC BOC Page 14 N~HFA Case M;magcr's Name__ Donno Coleman SFRLP Loan Application and Reservation Request Jnslrtlctlons: H.~1·r.r;~d 411.1f1UI.'> 1. Complete form Cc:u:l..jJt "Acli\'ity Number As.dgned) :uuJ submit this roun t.IOfl,C with the En"i rmunenl;.~l Review t~rnJ Hi,.;:luriral Funns by Moil, Fa.. Of E-mail 1oJi111 Cook··· NCHFA. PO Bo• 28066, Raleigh. NC 21611-1!066 c-moil:jcook@nchfu.com :2 . Jin1 Cook will enter the .. Activity Number A!.si~ncd " and faA ur c·nwillhc fomt ~ck to lhc pc110n illcnti(icd bcJow. lrvport11nt nnlt': Rcqui.silion~ for this activity will not b(' approved by your Case Manager unh."HS tht M:Juircd documcnb· idc:ntificd alJovt arc nccivcd at the Agency prior tn abe Requisition. !119.755.5135 Marit:~l SlulUs M~ri~al Status it~nr [!] ... SFRLP Environmental Screening Checklist tR•quirNIJi,.u/1 u.o"L<1nf uuits.) appropriate box (K] Original 0 Revision 2nd Rcvisinn 3rd Revision O ... SFRLP Historical Evaluation Form (RtquiuJ (m·u/IJHifrlrlitilly hhtm1t.Ytl pmprt11~J. p'r PmRmm Gtlitftlilft".t .~tc:llotl 2.6.3) D ... SHPO response to Historical Evalualion Form (Rt:qui"d if Hi.uurit..rll El'!llumitm Frm" , ... d.f rrquirt"d.J [!] ... Post-Rehabilitation Property Value Certififlllion (Re<Juircd (tJru/1 msi.trtd •mils.} .. Written Agrument (Rrquil-.dforc/11 ttui.•ted uuit .•. ) .. . ... : • • .......... .. . ., ---.. _ .. l. • I hcrchy n:<JUCSI •hallhc North Carolina Housing Finar.~c Agency rescne lhc total SFRLP projected assis1ancc lismd above to cover hard costs (loan amount) and son costs lo provide SFRLP assistance to the above-named applicant. • I certify: I) I hal the homcowncr'slborrowcr's income digibilily for SFRLP has been ver i f•cd and documenled in accordance wilh SFRLP guidelines; and 2) thai all the information pmvidcd above is true lo the besl of my knowledge. Pmjcct Admini1ara1or Confitmatiun certified by : 011916 HC BOC Page 15 NCHFA C3se Manag er's Name Donna Coleman SFRLP~ Jnstruc dom: m Application and Reservatio. ~equest I. Compldc fonn ("""f'f "Acti•ity Numher A>Sitn<>J) ond JUhmit lhi < fomt >lone "ith ohe f.nvimnmtJll:ll Review •ll<l lli>klrie>l l'onns hy Mo il, fu .. or E·m•il to J im Coot .... NCIIFA, l~l llox 211061i, U>kish, NC 27611 ·llll66 c:-moi l: jcooki!'nchfa..<nm 2. Jim Cook wiH cnlcrlhe .. Activity Number Assi~m'd '' :and fn. or c·mait the form back lo the person itJcntifi~ below. lmpoi'Unt •oft: Requisltioi\S for this o<li l'i ty will not be uppro>'<d by yo ur Cost Monocer wol,.. tloe n!QUirtd dMUmc•ls identitictl abon: ere ~tthcd at the A£cncy prior co Utt RtqulsitJon. lOIS Pmjecl Number: l Funding Agreement lt: l Agency Project 10 Number Oleck the nppropriol c bolli SFRLPI317 91571163 Mcnnber Name (Project): lXI Original Harnett CouaJy Mailing Addn:s$: Emnll Address (Projca AdmlnimiUor): D Revision 103 Eul Jvc:y Sln:el dmclarl•nd01bewoolencOIIliJllml.tom City, State, Zip: D 2nd Re vision LiUinaton • NC 27546 Phone: Fax : D 3rd Revision 919.828.0531 919.755.5135 Person cotnpleting this form : lou~ FOR NCHFA USE ONL-Y; Michael BoberJI/The Wooten Company IDJS: IMISTR< Data: Aclivlry Number Assigned for JDlS : d t,5tJ L (}l..)t:, .I ~ /llll~fldlwlll~~"'t.W4lltdl<llll' l</'1illl/r<ttJIIho•~J IJIIc:r. 4/Nd"'"\h·\ [I _, Name of Owner : last Name: First Name and Midd le Initial: Baker Lorry Date of Birth Gender Social Security Number Marital St at us 8/3011952 M11le . Married Name of Co·Owner. La st Name : Fi rs t Namo: and Middle: Initial: Balcer Sandra Date of Bir\h Gender Social Security Number Marital Status 1(17/1953 Female Married Relationsftip of Co·Owner to Owner: Wife Strc:ct Address of Ac:Livily: llS North Mcl..ron Sttect City : Co• Is I State: NC JZip: 27521 Maili r~Addrcss of Activity: (IJ tlilf<'ft"JOtjimu .w·et·t mltltt•.v.>J CHDO Tax ID Number: Not applicable for SFRLP JCHOO Loan?: No (Nor Applk:ob.le for SFRLP) Activity Set·up Type TOTAL Projected Assistance for this Unit. l IXJRehnbilitation only 2 0 New construction only SFRLP: ;)U os~uy Total: ' ft\IP"""" 3 0Acquisition only Hard Cost $45,000 $45,000 4 0Acq uisit ion and rehabilitation Soft Cost: $11z990 $11,990 5 0 Acquisition aod new conslruction Total: $56,990 $0 $56,990 Estimated Units Total HOMf!..nstlsted Loon GWIItllllcc:7 !Tfllllle Type: (check one box oaly) Upon Completion Units Upon Complelion : No , .. Fx Rental f•/~"OJI • I" for SFRLPI (a/M YIJS "I" forSFRl.P) (Nutltpp/icoble 2 Homeowncrsh ip First· Time Buyer 1 1 /nrSFRLPJ 3 X HomcownetllhjpRehobilitation Type of Ownership: 1 .. IAdiYldoal County Code: (see lis!) ldcnt1fy if the Community Holnlnc llewlopmc:n t OrpniJ.allon Harnett l'roj«t is Ownal, Sponsoral. or Devdopcll: (N/A for SFRt.l') Jouu_l!.snma~eG \M1S: ,:>0,~ {l~ttR /IHDI S FRLP fiNoJs /trHII oh<J1~ o1kl all ndttr puWidprl"'JJt ft1Hh) Hume I"UUIT11111DCc wllh Eaerv Star (HPwt;S) Coatrador; I Mtcnnclasobergranc: wootcnumpany •Rtsc.,·ntion cannot he pr~ without lll',vE.'I <:onlru~or Doauntntalion Attached ( Pll!o.<e check the box left of each ilem t!llclo.red) [!) .. , .. SFRLP Environmental Scr~cning Checkli!t IR<~tlllr<dfurollt<tsiJuJunirs.J o .... SFRLP Histori cal Evalualion Form (R~qulr.-,ljfl rctll ptJtnuiull)· hbtoricolt1rt1pe1Ti~s. per PmgrtJm GuldellMs sectioJI 2.6.3.J 0 .. , SHPO response lo Historical Evnluution Form IR"'trfl'f!d /fHLIInrltal E•"Oiooooirm Fnn • ,.as rtquirttl.l [!] ... Post·Rehabilitation Property Value Certification IRcqnirf'dforn/f o.uisorJ omit>.} [!] ... WritWn Agl'<!cment (1/equlrrdfor .u.,;,uJ uuii>.J Requ•t aod Ccmfie~tlon: • I hereby requestlhDt the North Carolina Housing Finance Agency reserve lhe total SFRLP projccled assistance listed above to cover hurd costs (loan amount) and son costs to provide SFRLP assistance to the ubove·named applicant • I ccnlfy: l) that the homeowncr'slbormwer's income eligibility for SFRLP has been verified and documented in accordance with SFRLP guidelines: and 2) rhat all the in fo rm ation provided above is lnte to the best of my knowledge. Name: Dan Mcfarland 1itle: Community Dt..'Yclopn.:lll M1111.1111Cr I Signat ure : ~Afl ~/1 Date: ~/:7'11!;- NCHFA CoDftrmation of Reservation The rcquuted SFRLP ronds have been ':~e-~ Applicant .. This ruervatlon (original or revision) will ranaln in efl'ttt for 180 days (rom the the I restrvation was reuived. {.s;;:- Confi rrnut ion cenified by : ~ ~ Date: /l--/.lt,- C .. Williu"fff Dowse. Dine/or ofStrrllegic ftlve sltttenr Rev. 2/2014 • .... 011916 HC BOC Page 16 NCHFA C ase Manager's Name _________ ..::;D.:::o==::..;Co=l:.::e:::m.::a:::n ________ _ SFRLP Loan Application and Reservation Request JmtruC'buns: Ncwstd tJ/1/JUI ) I Complete fonn (\.TCqlt 'Activity Nam~ AiSign<ll) ond submit thi < fomt oton, wim·lht' Environmcntol Re view and Htstoncull'orms by M>il. Fox , or E·moil toJim Cook ··· NCHFA. PO Box 28066. Ra leigh, NC2761 1-8066 c-moil :jcook~nchfo .coon 2. J im Cook will enter the· Activity Numb.:r Assi&ncd " ond f;u or c·moi l the fom • bock to the penon idcnririCd below, Important nfltc: Rcquisitio~ ror this acliYiQ' "''ill nut he: appravc:d by your CaH: ftbua1er unh:s. llw rrt.~uircd documents identified •bovc are rtcei vtd atlhe-Aac:ncy prior to the Rcquili tion. F unding Agreement II: SFRLP1317 {]] Ori gina l 0 Rcvi~ion D 2nd Revision D 3nl Revision [!) ... SFRLP Environmental Scree ning Checklist (R•quir"<rl {uruU rrs.ri.Tt<tl ""irs.) D ... SFRLP Hisroric al Eva luation Form t lltquiredftwull poltmiully M.wu;,:nl pmprttit.r, per Pm~:mm G,id~t;,,..'f x«L"Iitm 2.6 .. ~ J o ... SHPO response to Histori cal Evaluation Form (/ltq•l••td ifiii.<Wiirol Ewllllurilm Fomtll'(l.l rY:qllirttl.j [!) ... Post-Rehabilitation Property V olue Cerdfi cotlon (llt<fllir-.d fnr all msimd ,,us.) ·1··-'·-~ .. .-.,:.._ ~ -..... ...~ __ .. __ ~--·· -----· _ .. •I hereby rcques1 the North Carolina Housing Finance Ag~ncy reserve 1he total SFRLP projected assislHncc listed above to cover hard costs (loan :unount) and sofl costs to provide SFRLP :~Ssislance to the above-named applican t. • I certify : I) lhatlhc homcowncr'slhorrowcr's income eligibility for SFRLP has been verified untl documcnt etl in accordance with SFRL P g;ui tl clincs; and 2) that all the information provided above is true to the best of my knowledge. Proj.:ct Administrator Confi rmation certified hy: 011916 HC BOC Page 17 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, 2016: fMtl'lt~ r:;..e, 1to.vhtr5 Section 1. To amend the General Fund , Cooperative Extension Adole!eent Pa~entil'lB Prosra~. the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-7310-465 .33-45 Contracted Services 8,514 110-7310-465.60-53 Dues and Subscriptions 1,689 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-0000-353-73-10 Parents as Teachers Revenue 10,203 EXPLANATION: To increase the Parents as Teachers Budget to include funds raised during the "BOOtiful Night of Hope" Fundraising Event. Funds were received by Campbell University and will be sent to the Harnett County Finance Office for use by the Parents as Teachers program. 9~Pvt--1-!J-16 County Manager (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 Margaret Regina Wheeler Clerk to the Board day of Jim Burgin, Chairman Harnett County Board of Commissioners 011916 HC BOC Page 18 C~i\~l\iPB J3:LJ~ U N f \1 t: R S f T Y Accounlin g Offi ce MEMORANDUM TO: Tyrone Fisher Harnett County Cooperative Extension Director FROM : DATE: Kimberly Honeycutt Harnett County Finance Director Alton W. Hardison, Jr. Assistant Vice President for Business Campbell University January 6, 2016 Please be advised that Campbell University is currently holding $10,203.02 for the benefit of Harnett County Parents As Teachers . This represents the balance from funds rai sed to help support the program. I would like to send the funds to the county and close this fund as soon as possible. If I can be of further assistance, do not hesitate to contact me. Alton W . Hardison, Jr. Assistant Vice President for Business Campbell University P. 0. Box 97 Buies Creek, NC Office: 910-893-1441 hardi son@ campbell.edu Many thanks. If I may be of further assistance, do not hesitate to contact me. 011916 HC BOC Page 19 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, 2016: Section 1. To amend the General Fund , Emergency Medical Services Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-5400-420.43-16 Maint & Repair-Equipment 1,207 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-0000-356.30-00 Reimbursements-Insurance Claims 1,207 EXPLANATION : To budget the transfer of funds to Maintenance & Repair -Equipment from Insurance p roceeds to pay for damages to Flatwoods EMS Station Bay Door caused by Harnett County EMS employees. APPROVALS : 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 ____ , 2015 . Margaret Regina Wheeler Clerk to the Board Jim Burgin , Chairman Harnett County Board of Commissioners ,_ Js -u 011916 HC BOC Page 20 Bo a r d Re p o r t Da t e : 01 / 1 9 / 2 0 1 6 To : Ha r n e t t Co u n t y Bo a r d o f Co m m i s s i o n e r s Re : Co n s i d e r a t i o n o f Re f u n d fo r Ta x e s , In t e r e s t an d Pe n a l i t i e s fo r al l Mu n c i p a l i t i e s Re a s o n Fu l l re b a t e Ad j u s t m e n t Fu l l re b a t e Fu l l re b a t e El d e r l y Ex c l u s i o n Fu l l re b a t e El d e r l y Ex c l u s i o n S. Ke i t h Fa u l k n e r Ta x Ad m i n i s t r a t o r Bi l l # ~ 00 0 0 0 0 2 6 6 3 -20 1 5 - 20 1 5 - 00 0 0 - 0 0 00 0 2 0 0 2 6 1 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 -00 00 0 2 1 8 4 2 7 4 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 00 0 2 1 8 1 4 5 4 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 -00 00 0 0 0 5 6 4 7 9 - 20 1 5 - 2 0 1 5 -00 0 0 -01 00 0 1 7 1 4 5 4 1 - 2 0 1 4 - 2 0 1 4 - 0 0 5 0 - 0 0 00 0 0 0 2 2 2 9 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 1 Ty p e Re c e i v e d RE I 50 0 . 4 5 RE I 2, 55 4 .31 RE I 1, 9 0 9 .20 RE I 1, 9 0 9 .20 RE I 1, 48 8 .99 RE I 89 1 . 8 2 RE I 1, 9 9 5 . 7 6 Ag e n d a Item 4C Ap p r o v e d _ _ _ _ _ _ _ _ _ _ _ Re f u n d e d Na m e 50 0 . 4 5 BA K E R , JO S E P H EVERETIE JR 35 7 . 6 8 MC C L A M B , MI C H A E L ANTHONY 1, 90 9 .2 0 FA I R W A Y POINT LLC 1, 9 0 9 . 2 0 FA I R W A Y POINT LLC 70 9 . 5 EN G W E R , KATHLEENM 89 1 . 8 2 MC K O Y , JO S E P H EUGENE 96 2 . 8 8 HA R D I S O N , J AUBREY 011916 HC BOC Page 21 Da t e ru n : 1/ 1 2 / 2 0 1 6 8:37 :1 0 AM Da ta as of : 1/ 11 /20 1 6 8 :25 :33 PM T R -30 4 Bi l l Re l e a s e R e p o r t Re p o r t Pa r a m e t e r s : Re l e a s e Da t e St a r t : 12/1/ 20 1 5 Re lea s e Date End : 12 / 3 1 / 2 0 1 5 Ta x Di s t r i c t : AL L De f a u l t So r t -B y: Bi l l # ,Ta x p a y e r Na m e ,Re l e a s e Da t e ,Bi l l i n g Da t e ,Op e r a t o r lD , Re l e a s e Am o u n t Gr o u p i n g : Ta x Di s t r ic t ,Re l e a s e Re a s o n B i l l # T a x p a y e r Na m e TA X DIST R I C T : AN D E R S O N CR E E K FI R E RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 3 0 9 9 4 - 2 0 1 5 -20 1 5 -00 0 0 -00 -REG LE E , LO UI SE Op e r a t o r ID (N a m e ) 8/ 8/ 20 1 5 AMY BA I N N C P T S V4 12/22 / 2 0 1 5 13.49 Re l e a s e A m o u n t ( $ ) 2.81 Su b t o t a l 2.81 TA X DI S T R I C T : AN D E R S O N CR E E K FI R E RE L E A S E RE A S O N : As s e s s e d In Er r 00 0 003 0 995 -20 1 5- 20 1 5 - 0 0 0 0 -00 -R E G LEE, LO U I S E 00 0 0 058 5 0 9 - 20 15-20 1 5 -00 0 0-00 -REG WEST MO BI L E HOME PA R K 8/ 8/ 20 15 AM Y BAI N 8/8/20 15 AM Y BA IN 12/22 /20 15 12 /3/20 1 5 45 .75 25 .10 23. 75 5.82 Su b t o t a l 29 .57 TA X DI S T R I C T : AN D E R S O N CR E E K FI R E RE L E A S E RE A S O N : Le s s th a n mi n am t 00 0 113 7 8 13-20 15- 2 0 1 2 -00 0 0 -00- R E G FOO D LI ON LLC #2 5 94 00 0 1 1 3 7 8 13- 2 0 15- 2 0 1 3 - 0 0 0 0 - 00 - R EG FOO D LI ON LL C #2 5 9 4 00 0113 7 8 13- 2 0 1 5 - 2 0 1 4-0 0 0 0 - 0 0 -REG FOO D LI ON LL C #2 5 9 4 00 0 113 7 8 13-20 1 5 - 2 0 1 5 - 0 0 0 1 - 0 0 -R E G FO O D LI ON LL C #2 5 9 4 12/ 2 0 /20 1 5 C TS I 12/ 20/ 20 1 5 C TSI 12 /20 / 20 1 5 C TS I 12/ 20 / 20 1 5 C TSI 12/ 20 /20 15 12/ 20 /20 1 5 12/20 / 20 15 12/20 / 20 1 5 0 .49 0 .38 0.36 0.35 0.49 0.38 0.36 0.35 Su b t o t a l 1.58 TA X DI S T R I C T : AN D E R S O N CR E E K FI R E RE L E A S E RE A S O N : Pe n a l t y In Er r 00 0 0 0 0 108 2 -20 1 5 -20 1 5 - 00 0 0 - 0 0 - R EG AM ER IC A N SEL F ST OR A G E Su b t o t a l PA G E 1 of 27 8/ 8/ 20 15 S HERRY LO C K A M Y 12 /2/ 20 15 9 .39 0.85 0.85 -. 10.68 22.00 19.28 0.00 0.00 0.00 0.00 8.54 011916 HC BOC Page 22 B i l l # Ta x p a y e r Na m e O p e r a t o r I D (N a m e ) TA X DI S T R I C T : AN D E R S O N CR E E K FI R E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 1 5 7 0 6 0 2 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G GO D I N E A U X , JO B I N A MA R I E A 7/ 1/20 1 3 YV O N N E MC A R T H U R 00 0 1 6 5 8 7 4 6 - 2 0 0 8 - 2 0 0 8 - 0 0 0 0 - 0 0 - R E G BO N N E R , SH A K I M A LA T I C E 4/ 1/20 0 9 YV O N N E MC A R T H U R Su b t o t a l TA X DI S T R I C T : AN G I E R RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 0 0 3 4 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SA N F O R D AN D SO N LL C 8/ 8 /20 1 5 CA R O L Y N T AR 1 Su b t o t a l TA X DI S T R I C T : AN G I E R / B L A C K RI V E R RE L E A S E RE A S O N : Ad j u s t m e n t 00 022 4 7 1 9 0 - 2 0 1 5 - 2 0 1 0 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 / 20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 1 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 / 20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 2 - 0 0 1 1 -00 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 / 20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 / 20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/16 / 20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/16 /20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 4 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 /20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y Su b t o t a l TA X DI S T R I C T : AN G I E R / B L A C K RI V E R RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 0 0 3 4 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SA N F O R D AN D SO N LL C 8/ 8 /20 1 5 CA R O L Y N TA R 1 00 0 1 9 7 7 1 5 9 - 2 0 1 2 - 2 0 1 2 - 0 0 0 0 - 0 0 - R E G BA L L E N T I N E , RO S E T T A 5/ 1/ 20 1 3 CA R O L Y N T AR 1 Su b t o t a l TA X DI S T R I C T : AN G I E R / B L A C K RI V E R RE L E A S E RE A S O N : So l d / T r a d e d 00 0 0 0 2 0 5 5 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G GR A Y, CH A R L E S KE N N E T H JR 8/ 8/ 20 1 5 AM Y BA I N Su b t o t a l PA G E 2 of 27 12 / 31 / 2 0 1 5 9. 4 5 12 /2/20 1 5 0 .76 12 / 2 2 / 2 0 1 5 21 9 .21 12 / 3/ 2 0 1 5 22 .86 12 / 3/ 20 1 5 17 . 7 1 12 / 3/ 20 1 5 19 .95 12 / 3/ 20 1 5 14 .96 12 /3/ 20 1 5 13 .72 12 /3/20 1 5 13 .09 12 /3/ 2 0 1 5 12 .01 12 / 22 /20 1 5 28 .95 12 / 28 / 20 1 5 5.03 12 / 30 /20 1 5 5. 0 5 Re l e a s e A m o u n t ( $ ) 0. 0 7 0 .01 0. 0 8 0 .14 0. 1 4 3.81 2.53 2.30 1.24 0.63 13 . 0 9 0 .54 24 . 1 4 0.02 0.04 0.06 3.66 3.66 -. 9.38 0.75 219.07 19.05 15.18 17.65 13.72 13.09 0.00 11.47 28.93 4.99 1.39 011916 HC BOC Page 23 B i l l # Ta x p a y e r Na m e TA X DIST R ICT : AV E S SC H RE L E A S E RE A S O N : Ad j u st me nt 00 0 0 0 1 4 5 1 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G DE N N I S , CA D I L L A C OL D S 00 0 0 0 2 6 7 9 8 - 2 0 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G JERN I G A N , RO B E R T N 00 0 0 0 5 2 6 5 4 - 2 0 1 5 - 2 0 1 5 - 0 0 1 1 - 0 0 - R E G TA R T , CH A R L E S M 00 0 2 1 8 2 8 16- 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G NE I G HBO R S , FR A N C E S M 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 0- 0 0 1 1 -00 - R E G BR A INE R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 1 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 2 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 20 1 5 - 2 0 1 4 -00 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G BR A INE R D LL C Su b t o ta l TA X DI S T R ICT: AV E S SC H RE L E A S E RE A S O N : As s e s s e d In Er r 00 0 2 1 7 7 7 7 8 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 00 -RE G ME R I D I A N LE AS I N G CO R P O R A T I O N Su b t o tal TA X DI S T R ICT : AV E S SC H RE LE A S E RE A S O N : El d er ly Exc l u s i on 00 0 0 0 0 1 7 6 6 - 2 0 1 5 -20 1 5 -00 0 0 - 0 0 -RE G AR T I S , CL I F F O U S S 00 0 0 0 2 2 2 9 8 -20 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G HA R D I S O N , J AU BRE Y 00 0 0 0 2 7 7 7 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO HNS O N , RA C H EL B 00 0 0 0 5 7 0 9 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R EG WA T T S , FR E D G Su b tota l PA G E 3 o f 27 Op e r a t o r 10 (N a m e ) 8/8/20 1 5 AM Y BA I N 8/8/20 1 5 MA R G A R E T WR I G H T 9/ 1 7 / 2 0 1 5 SH E R R Y LO C K A M Y 8/ 8 / 2 0 1 5 MA R G A R E T WR IGH T 3/ 3 / 2 0 1 5 SHER R Y LO C K A M Y 3/ 3 /20 1 5 SH E R R Y LO C K A M Y 3/3/20 1 5 SH ERR Y LO C K A M Y 3/3/20 1 5 SH E R R Y LO C K A M Y 3/3/20 1 5 SH E R R Y LO C K A M Y 8/8/20 1 5 SH E R R Y LO C K A M Y 8/ 8 / 2 0 1 5 SH E R R Y LO C K A M Y 8/8/20 1 5 A MY BA I N 8/8/20 1 5 AM Y BA IN 8/8/20 1 5 AM Y BA IN 8/8/20 1 5 MA R G A R E T WR I G H T 12 /7/20 1 5 56 .55 12 /28 /20 1 5 0.31 12 / 3/20 1 5 40 .09 12 / 2/20 1 5 11 .12 12 / 2 3 /20 1 5 34 .35 12 /23 /20 1 5 29 .24 12 /23 /20 1 5 63 .53 12 /23 /20 1 5 62 .66 12 / 23 /20 1 5 66 .05 12 / 23 /20 1 5 93 .98 12/ 28 / 2 0 1 5 0 .08 12/ 10 /20 1 5 19 .72 12/ 30 /20 1 5 28 .32 12/ 10 / 20 1 5 61 .15 12 /8/20 1 5 20 .29 Re l e a s e Am o u n t ( $ ) 18 . 9 5 0.18 3. 6 4 2. 9 4 6. 4 4 4.88 9.07 7. 2 3 5. 5 1 4 .27 63 . 11 0. 0 8 0 .08 19 .72 28 . 3 2 61 .15 20 . 2 9 129 .48 -37.60 0.13 36.45 8.18 27.91 24.36 54.46 55.43 60.54 89.71 0.00 0.00 0.00 0.00 0.00 011916 HC BOC Page 24 Bi l l # Ta x p a y e r Na m e TA X DI S T R ICT : AV E S SC H RE L E A S E RE A S O N : La n d u s e ch a n g e 00 0 0 0 0 3 544 -20 1 5 - 2 0 1 5 -00 0 0 -00 -RE G BA S S , BAR B A R A WA R R E N Su b t o t al TA X DI S T R I C T : AV E S SC H RE L E A S E RE A S O N : Re m o v a l o f SW Fe e 00 0 0 0 2 61 6 6- 2 0 1 5 - 2 0 15- 0 0 0 0 - 0 0 - REG JA C K S O N , BOBB Y G LE NN Su b t o t a l TA X DI S T R I C T : AV E S SC H RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 2 5 65 2- 20 15- 2 0 1 5 -00 0 0 - 0 0 - R EG HUDSO N, JU DY T 00 0 0 0 2 81 02 - 20 15- 2 0 15-00 0 0 - 0 0 -R EG JO N ES , AU BR E Y DONAL D Su b t o t a l TA X DI S T R I C T : BA N N E R FI R E RE L E A S E RE A S O N : As s e s s e d In Er r 00 0 2 1 7 7 7 7 8 -20 15-20 1 5 - 0 0 0 0 - 0 0 - R E G MER ID I A N LEAS I NG CO R P O R A T ION Su b t o t al TA X DI S T R I C T : BE N H A V E N FI R E RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 4 0 71 1-20 15 - 20 15-00 0 0 -0 0-REG PAGE , PH I L L I P V IR G E L Su b t o t a l TA X DI S T R I C T : BE N H A V E N FI R E RE L E A S E RE A S O N : A s se s s e d In Er r 00 0 0 0 498 8 1 - 2 0 1 5 -20 15- 0 0 0 0 - 0 0 - RE G SP I V EY , EDI E SEAW E L L Su b t o t a l TA X DI S T RI C T : BE N H A V E N FI R E RE L E A S E RE A S O N : De f e r r e d B i l l 00 0 2 1 8 5 5 4 4- 20 1 5 -20 15-00 7 0 -00 -DL D PA G E , PH I LLI P VI RGE L Su b t o t a l PA G E 4 o f 27 ' O p e r a t o r 1 0 (N a m e ) 8/8/20 15 ST A C IE TA Y L O R 8/ 8 / 2 0 1 5 ST A C IE TA Y L O R 8/ 8 /20 15 KI M BE R LY BA K E R 8/8/20 1 5 KI M BE RL Y BA K E R 8/8/20 1 5 SHE RR Y LO C K A M Y 8/8/2 0 15 MA R G A RE T WR I G HT 8/8/20 15 AM Y BA I N 12 /18 /20 15 ST A C I E TA Y L O R 12 /31 /20 1 5 10 .53 12 / 3 1 /20 1 5 3 1.84 12 /17/20 1 5 17. 5 1 12 /30 /20 1 5 1.09 12 /28 /20 1 5 0 .27 12 / 18/20 15 191 . 3 9 12 /22 /20 15 39 .69 12 / 18 /20 1 5 16 3 .70 Re l e a s e A m o u n t ( $ ) 10 . 5 3 10.53 0. 0 0 0. 0 0 0.01 0. 0 1 0.02 0. 2 7 0. 2 7 27 . 0 6 27 .06 17 .34 17 .34 16 3 . 7 0 16 3 .70 -. 0.00 31.84 17.50 1.08 0.00 164.33 22.35 0.00 011916 HC BOC Page 25 B i l l # Ta x p a y e r Na m e TA X DI S T R I C T : BE N H A V E N FI R E RE L E A S E RE A S O N : El d e r l y Ex c l u s i o n 00 0 0 0 5 2 2 3 0 - 2 0 1 5 - 2 0 15-00 0 0 - 0 0 - RE G SW A N N , LE N A E Su b t o t a l TA X DI S TRICT: BE N H A V E N FI R E RE L E A S E RE A S O N : La n d f il l er ro r 0000 0 0 5 9 5 5 -20 1 5 - 2 0 1 5 -00 0 0 - 0 0 -REG BRA F F O R D , RA N D Y HA R T Su b t o t a l TA X DI S T R I C T : BE N H A V E N FI R E RE L E A S E RE A S O N : La n d u s e ch a n g e 00 0 2 1 8 5 5 4 4 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 00-REG PA G E , PH I L LI P VI R G E L Su bt o t al TA X DIST R ICT : BE N H A V E N FI R E RE L E A S E RE A S O N : Le s s th a n min am t 00 0 2 2 5 3 473 - 2 0 15- 2 0 1 5 - 0 0 0 0 -00 -REG MC LAM B, ROBE R T C Su b t o t a l O p e r a t o r ID (N a m e ) 8/ 8/20 1 5 AM Y BA I N 8/8/20 1 5 AM Y BA I N 8/8/ 2 0 1 5 ST A C IE TA Y LO R 12/ 18 / 20 1 5 AM Y BAI N TA X DI S T R I C T : BE N H A V E N FI R E RE L E A S E RE A S O N : Re m o v a l o f SW Fe e 00 0 0 0 0 5 9 5 6 - 2 0 1 5 - 2 0 1 5 -00 0 0 - 0 0 - RE G BRA F F O R D , RA N D Y HAR T 8/ 8/ 20 1 5 MA R G A R ET WR IGHT 00 0 0 0 5 1 6 44- 20 1 5 - 2 0 15- 0 0 0 0 -00 -REG SHAW , MA L CO L M 8/ 8 /20 1 5 MA R G A R ET WR I G H T Su b t o t a l TA X DI S T R I C T: BE N H A V E N FIRE RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 2 2 6 8 0 - 2 0 1 5 - 2 0 15- 0 0 0 0 - 0 0 - R EG HA RRING T O N , NEI L L 8/8/ 2 0 1 5 TR A G I FE R R E L L 00 0 0 0 2 9 6 6 5 - 20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R EG KO C H , NO RB ER T 8/ 8 /20 1 5 PE G G Y BA R EFO O T 00 0 2 1 0 1 0 2 4 -20 1 3 - 2 0 13- 0 0 0 0 -00 -R E G DO W D Y , TA M EKI A LAS H O N D A 9/ 3/ 2 0 1 3 YV O N N E MC A RTHUR Su b t o t al TA X DI S T R I C T : BO O N E TRA I L EM E R RE L E A S E RE A S O N : Ad j u s t m e nt 00 0 1 1 6 9 6 4 9 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R EG ST A N L Y RI C H M O ND AN D CO LL C 8/ 8/20 15 AM Y BA IN PA G E 5 o f 27 12 /3/20 1 5 75 .21 12 / 22 /20 1 5 7 .57 12/ 18 / 2 0 1 5 22 1.26 12/ 18 / 20 1 5 0.30 12 /23 / 20 1 5 12.11 12 /23 /20 1 5 16 .90 12 / 10 /20 1 5 16 .25 12 /2/20 1 5 55 .05 12 / 2/ 20 1 5 4 .65 12 / 8/20 15 23 .32 Re l e a s e A m o u n t ( $ ) 75 .21 75 .21 0 .00 0.00 22 1.26 22 1 .26 0.30 0.30 0.00 0.00 0.00 0.01 0.02 0.03 0.06 23 .32 -. 0.00 7.57 0.00 0.00 12.11 16.90 16.24 55.03 4.62 0.00 011916 HC BOC Page 26 B i l l # Ta x p a y e r Na m e 00 0 1 16 9 7 0 9 -20 15-20 15- 0 0 0 0 -00 - REG ST A NLY RI C H MO ND A ND CO LLC 00 0 11 697 10-2 01 5 -20 15- 0 0 0 0 - 0 0 - REG S TA NL Y RI CH MON D A ND CO LL C 00 0 2 0 7 6 8 7 0 -20 14 - 20 1 4- 00 0 0 -00 - RE G A ND ERS O N , C LI F TON ROBE RT 00 0 2 0 7 6 8 7 0 -20 1 5 -20 15-00 0 0 -00 - REG A NDER SO N , CL I FTO N ROBE RT Su b t o t a l TA X DI S T R I C T : BO O N E TR A I L EM E R RE L E A S E RE A S O N : De f e r r e d Bi l l 0000 05 0 3 2 9-20 15 - 2 01 5-0 07 0 - 0 0 - D LD STA NL Y RI C H M O N D AN D CO LL C 00 0 1 09 2 6 49 - 20 15- 2 0 1 5 - 0 0 7 0 - 0 0 - D LD MO S S , W IL L I AM A LAN 00 0 11 69 6 49-20 15- 2 0 1 5 -00 7 0 -00 -D LD ST AN L Y R IC HM O N D AN D CO LL C 00 0 1 169 7 0 9 -20 1 5 -20 1 5 -00 7 0 -00 - D LD ST A N LY R IC HMON D AND CO LLC 00 0 1 169 7 1 0- 2 0 1 5 - 2 0 1 5 -00 7 0 -00 - DL D ST A N LY R IC HMON D AND CO LL C 00 0 2 184 2 1 5- 20 1 5 - 2 0 1 5 -00 7 0 - 00 -DL D CU M M ING S , EL B E RT L Su b t o t a l TA X DI S T R I C T : BO O N E TR A I L EM E R RE L E A S E RE A S O N : La n d f i l l er r o r 00 0 0 0 1 474 6 -20 1 5 -20 15-00 0 0 -00 -R EG DICK EN S , JI M M Y Su b t o t a l 'O p e r a t o r 1 0 (N a m e ) 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 20 15 AM Y BA I N 12 / 16/20 14 AM Y BA IN 8/ 8 /20 15 AM Y BAI N 12 / 10/ 2 0 15 AM Y BA IN 12 / 2 2 / 2 0 15 AM Y BA IN 12 / 8 /20 1 5 AM Y BA IN 12 /8/20 15 AM Y BA IN 12/ 8/20 15 AM Y B AI N 12/4/ 20 15 AM Y BA I N 8/ 8/ 20 1 5 AM Y BA I N TA X DI S T R I C T : BO O N E TR A I L EM E R RE L E A S E RE A S O N : La n d u s e ch a n g e 00 000 50329 -2 0 15-20 15-00 0 0 -00 -R EG ST A NL Y RICH MON D A ND CO LL C 8/ 8 / 2 0 1 5 AM Y BA IN 00 0 1 0 9 2 6 49 - 2 01 5 -20 15-00 0 0 -00 - RE G MO S S , W IL L I AM ALA N 8/ 8/ 20 15 AM Y BA IN 00 0 2 184 2 15-20 1 5 -20 15- 00 0 0 -00 - R E G CU M M IN GS , EL B E RT L 8/ 8/ 20 1 5 AM Y BA IN Su b t o t a l TA X DI S T R I C T : BO O N E TR A IL EM E R RE L E A S E RE A S O N : Re m o v a l of SW Fe e 00 0 0 0 0 2 6 6 3 -2 01 5 -20 15-00 0 0 - 0 0 - RE G BAK E R , JO S E PH EVER E TT E J R 8/8/20 1 5 MA R G A R ET WR I G H T 00 0 0 0 2 7 5 9 0 -20 1 5 -20 15 - 00 0 0 -00 -R E G TA T U M , HA RV EY R 8/8/20 1 5 ST A C I E TA Y LOR PA G E 6 o f 27 12 /8/20 1 5 27 . 1 4 12 / 8 / 2 0 1 5 32 . 0 1 12 / 1/20 1 5 16 .39 12 / 1/20 1 5 15 .64 12/ 10/ 2 0 15 15 .09 12/ 22 /20 1 5 2. 3 5 12 /8 / 20 1 5 17. 9 6 12 /8 / 20 1 5 21 .2 3 12 / 8/ 20 1 5 25 .39 12 /4/2 0 15 20 . 4 0 12 / 10 / 20 1 5 35 . 6 7 12 / 10/ 20 15 20 .4 2 12 /22 / 20 15 10 3 .90 12/4/2 015 26 .39 12 / 23 /20 1 5 42 .72 12 / 15 /2 0 15 30 . 6 6 Re l e a s e Am o u n t ( $ ) 27 . 1 4 32 . 0 1 16 . 3 9 15 . 6 4 11 4 .50 15 .09 2 .35 17 .96 21 .23 25.39 20 . 4 0 102 .42 0. 0 0 0.00 20 . 4 2 10 3 . 9 0 26 . 3 9 15 0 .71 0. 0 0 0. 0 0 -. . 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 35.67 0.00 0.00 0.00 42.72 30.66 011916 HC BOC Page 27 B i l l # Ta x p a y e r Na m e 00 0 0 0 53 7 7 5 - 20 15 - 20 1 5 -00 0 0 - 00 -R E G MO O RE , HA R O L D Su b t o t a l O p e r a t o r ID (N a m e ) 8/ 8 /20 15 ST A C IE TA Y L O R TA X DI S T R I C T : BO O N E TR A I L EM E R RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 14 06 5 11 -2 0 0 8 - 2 0 0 8 -00 0 0 - 0 0 - R E G WI L L I A M S , JO A N N E 9/ 2 / 2 0 0 8 YV O NN E MC A R T H U R 00 0 2 0 7 8 3 16- 2 0 1 2 - 2 0 12- 0 0 0 0 -00 - RE G JO Y C E, JEN N I F E R LE A N N E 3/ 1 / 2 0 1 3 YV O N NE MC A R T HU R 00 0 2 0 9 15 9 4 - 2 0 13-20 1 3 -00 0 0 -00 - R E G AR G U EL L O , KE N N Y 7/ 1 / 2 0 1 3 YV O N N E MC A R T H U R 00 0 2 1 1 09 5 2 - 2 0 13- 2 0 1 3 -00 0 0 - 0 0 - R E G BL A C K M O N , BE V E R L Y HO W E L L 12/ 2 / 2 0 1 3 YV O N N E MC A R T H U R Su b t o t a l TA X DI S T R I C T : BU I E S CR E E K FI R E RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 5 7 2 2 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G PO O L E , BR E N D A W 8/8/20 1 5 AM Y BA I N 00 0 2 0 9 103 1- 20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HO R T O N , WI L LI AM AD D I S O N JR 8/ 8 /20 1 5 ST A C I E TA Y L O R Su b t o t a l TA X DI S T R I C T : BU I E S CR E E K FI R E RE L E A S E RE A S O N : De f e r r e d Bi l l 00 0 0 0 5 7 2 2 8 -20 1 5 - 2 0 15 - 0 0 7 0 - 0 0 - D L D PO O L E , BR E N D A W 12 / 4 / 2 0 1 5 AM Y BA I N Su b t o t a l TA X DI S T R I C T : BU I E S CR E E K FI R E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 1 8 9 8 8 6 0 -20 1 1-20 1 1 - 0 0 0 0 -00 -RE G CA R M O D Y , ER I N LYNN 12 /1/2 0 1 1 YV O N N E MC A R T H U R Su b t o t a l TA X DI S T R I C T : BU N N L E V E L FI R E RE L E A S E RE A S O N : Si t u s er r o r 00 0 1 3 8 7 3 5 6 -20 1 5 - 2 0 0 7 - 0 0 0 0 -00 - RE G CEL L C O PA R T N E R S H I P 12 / 18 /20 1 5 C TS I Su b t o t a l PA G E 7 of 27 12 / 15 /20 1 5 42 .56 12 / 10 /20 1 5 0. 4 7 12 /10 /2 0 15 0.77 12/ 2 2 /20 15 0. 9 9 12/14/20 1 5 7.36 12 /4/20 1 5 12 0 .69 12 /2 /20 1 5 0. 9 7 12 /4 /20 1 5 45 .68 12/ 18 /20 1 5 3. 6 9 12 / 18 /20 1 5 27 .57 Re l e a s e A m o u n t ( $ ) 0. 0 0 0. 0 0 0. 0 1 0.01 0. 0 3 0. 0 5 0.10 12 0 . 6 9 0. 3 4 12 1 . 0 3 45 . 6 8 45 .68 0. 0 3 0. 0 3 27 .57 27 . 5 7 -0 42.56 0.46 0.76 0.96 7.31 0.00 0.63 0.00 3.66 0.00 011916 HC BOC Page 28 B i l l # Ta x p a y e r N a m e TA X DI S T R I C T : CO A T S / G R O V E FI R E RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 2 1 1 3 7 -2 0 1 5 -20 1 5 - 0 0 0 0 - 0 0 - R E G GR I F F I N , RA L P H E Su b t o t a l Op e r a t o r I D (N a m e ) 8/ 8 / 20 1 5 AM Y BA I N TA X DI S T R I C T : CO A T S / G R O V E FI R E RE L E A S E RE A S O N : El d e r l y Ex c l u s i o n 00 0 0 0 5 9 2 9 3 - 2 0 1 5 - 2 0 1 5 - 000 0 - 0 0 - R E G WI L B O U R N E , LO I S P 8/8/20 1 5 AM Y BA I N Su b t o t a l TA X DI S T R I C T : CO A T S / G R O V E FI R E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 1 5 6 0 2 6 7 - 2 0 0 7 - 2 0 0 7 - 0 0 0 0 - 0 0 - R E G TA R T , TE R E S A MA R I E 5/ 1 / 2 0 0 8 YV O N N E MC A R T H U R 00 0 1 9 0 2 3 15- 2 0 1 1 - 2 0 1 1 - 0 0 0 0 - 0 0 - R E G BR O W N , KIMB ER LY AN N 1/3/ 20 1 2 YVO N N E MC A R T H U R 00 0 2 1 0 2 8 2 5 -20 13 - 2 0 1 3 - 0 0 0 0 -00 - R E G RO D R I Q U E Z , GA R Y AL L E N II 10 / 1/ 20 1 3 YV O N N E MC A R T H U R 00 0 2 1 0 5 0 8 5 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G AV E R Y , CR Y S T A L NI CO L E 10 / 1/ 2 0 1 3 YV O N N E MC A R T H U R Su b t o t a l TA X DI S T R I C T : DU K E FI R E RE L E A S E RE A S O N : Ad j us t m e n t 00 0 0 0 1 9 9 0 0 - 2 0 1 5 - 20 15- 0 0 00- 0 0 - R E G LI S E C , KE N D R A 8/ 8/ 20 1 5 AM Y BA I N 00 0 0 0 1 9 9 0 1 - 2 0 1 5 -20 1 5 - 0 0 0 0 - 0 0 - R E G LI S E C , SC O T T E 8/ 8/ 2 0 1 5 AM Y BA I N 00 0 0 0 1 9 9 0 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R EG LI SE C , SC O T T 8/ 8/ 20 1 5 AM Y BA I N 00 0 0 0 1 9 9 0 3 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G LI S E C , SC O T T 8/ 8/ 20 1 5 AM Y BA I N Su b t o t a l TA X DI S T R I C T : DU K E FI R E RE L E A S E RE A S O N : As s e s s e d In Er r 00 0 0 0 4 2 9 7 8 - 2 0 1 5 -20 1 5 -00 0 0 -00 -R E G PO O LE , PH I L L I P W 8/8/20 1 5 AM Y BA I N Su b t o t a l TA X DI S T R I C T : DU K E FI R E RE L E A S E RE A S O N : La n d f i l l er r o r 00 0 0 0 3 5 2 4 5 - 2 0 1 0 -20 1 0 -00 0 0 - 0 0 -RE G MC K O Y , JA M E S ED W A R D 7/9/20 1 0 AM Y BA I N 00 0 0 0 3 5 2 4 5 - 2 0 11- 2 0 1 1 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 8/ 5/20 1 1 AM Y BA I N PA G E 8 of 27 12 /14 / 20 1 5 92 .23 12 / 14 /20 1 5 62 .77 12 / 10 /20 1 5 1 .15 12 / 11/20 1 5 1.24 12 / 28 /20 1 5 3.06 12 / 2 2 / 20 15 2.57 12 / 4/ 20 1 5 11 3 .92 12 / 4/ 20 1 5 17 .50 12 / 4 / 2 0 1 5 17 .50 12 / 4/ 20 1 5 17 .50 12 /21 /20 15 3 .32 12 /4 /20 1 5 51 .57 12 /4/20 1 5 51 .5 7 Re l e a s e Am o u n t ( $ ) 59 .78 59 . 7 8 62 .77 62 . 7 7 0 .01 0 .01 0 .03 0. 0 6 0 .11 15 .92 3.50 3.50 3.50 26 . 4 2 0 .23 0 .23 0 .00 0 .00 -' 32.45 0.00 1.14 1.23 3.03 2.51 98.00 14.00 14.00 14.00 3.09 51.57 51.57 011916 HC BOC Page 29 B i l l # Ta x p a y e r Na m e 00 0 0 0 3 5 2 4 5 - 2 0 1 2 - 2 0 1 2 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 4 5 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 4 5 - 2 0 1 4 - 2 0 1 4 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 4 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 9 9 1 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , KE N N E T H E 00 0 0 0 3 9 9 1 4 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , KE N N E T H E 00 0 0 0 3 9 9 1 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , KE N N E T H E 00 0 0 0 4 9 0 4 1 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SM ITH , EU G E N E W Il l Su b t o t a l TA X DI S T R I C T : DU K E FI R E RE L E A S E RE A S O N : La n d u s e ch a n g e 00 0 0 0 5 6 2 0 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G WA D E , OD E L L Su b t o t a l TA X DI S T R I C T : DU K E FI R E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 5 7 7 6 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HU M M E L , MI C K E Y A Su b t o t a l TA X DI S T R I C T : DU N N RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 1 4 5 1 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G DE N N I S , CA D I L L A C OL D S 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 0- 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 1 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 2 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 4 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C PA G E 9 of 27 Op e r a t o r I D (N a m e ) 7/ 2 6 /20 1 2 AM Y BA I N 8/7/20 1 3 AM Y BA I N 8/ 9/20 1 4 AM Y BA I N 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 20 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/8/20 1 5 ST A C I E TA Y L O R 8/ 8/ 20 1 5 KI M B E R L Y BA K E R 8/ 8/ 20 1 5 AM Y BA I N 3/3/20 1 5 SH E R R Y LO C K A M Y 3/3/20 1 5 SH E R R Y LO C K A M Y 3/ 3 /20 1 5 SH E R R Y LO C K A M Y 3/ 3 /20 1 5 SH E R R Y LO C K A M Y 3/ 3 / 20 1 5 SH E R R Y LO C K A M Y 12 / 4 / 2 0 1 5 51 .57 12 /4/ 20 1 5 51 .57 12 /4/ 20 1 5 51 .57 12 /4/ 20 1 5 51 . 5 7 12 /17 / 20 1 5 7.91 12 /17 / 20 1 5 29 .23 12 / 1 7 / 20 1 5 15 .82 12 /18 /20 1 5 19 2 . 11 12 / 28 /20 1 5 69 .07 12 / 29 / 20 1 5 24 .50 12 /7/20 1 5 1, 4 1 3 .80 12 / 23 / 2 0 1 5 82 4 .35 12 / 2 3 /20 1 5 70 1 .79 12 / 23 / 2 0 1 5 1, 5 2 4 .64 12 / 23 / 20 1 5 1,56 6 . 5 5 12 / 23 / 20 1 5 1,65 1 .06 Re l e a s e Am o u n t ( $ ) 0. 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0.01 0.01 47 3 . 8 0 15 4 .56 11 6 .97 21 7 .80 18 0 . 7 5 13 7 .59 -. . 51.57 51.57 51.57 51.57 7.91 29.23 15.82 192.11 69.07 24.49 940.00 669.79 584.82 1,306.84 1,385.80 1,513.47 011916 HC BOC Page 30 Bi l l # Ta x p a y e r Na m e 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BR A I N E R D LL C Su b t o t a l TA X DI S T R I C T : DU N N RE L E A S E RE A S O N : El d e r l y Ex c l u s i o n 00 0 0 0 0 1 7 6 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G AR T I S , CL I F F O U S S 00 0 0 0 2 2 2 9 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HA R D I S O N , J AU B R E Y 00 0 0 0 2 7 7 7 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , RA C H E L B 00 0 0 0 5 7 0 9 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G WA T T S , FR E D G Su b t o t a l TA X DI S T R I C T : DU N N RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 1 5 4 6 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G R A N D V BU I L D E R S LL C Su b t o t a l TA X DI S T R I C T : DU N N / A V E S FI R E RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 1 4 5 1 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G DE N N I S , CA D I L L A C OL D S 00 0 0 0 2 6 7 9 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JE R N I G A N , RO B E R T N 00 0 0 0 5 2 6 5 4 - 2 0 1 5 - 2 0 15 - 0 0 1 1 - 0 0 - R E G TA R T , CH A R L E S M 00 0 2 1 8 2 8 1 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G NE I G H B O R S , FR A N C E S M 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 0- 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 1 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 2 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 4 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C PA G E 10 of 27 Op e r a t o r I D (N a m e ) 8/ 8 / 2 0 1 5 SH E R R Y LO C K A M Y 8/ 8 / 20 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA IN 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 20 1 5 MA R G A R E T WR I G H T 8 /8/20 1 5 CA R O L Y N TA R T 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 2 0 1 5 MA R G A R E T WR I G H T 9/ 1 7 / 20 1 5 SH E R R Y LO C K A M Y 8/ 8 / 2 0 1 5 MA R G A R E T WR I G H T 3/ 3 / 20 1 5 SH E R R Y LO C K A M Y 3/3/20 1 5 SH E R R Y LO C K A M Y 3/ 3 /20 1 5 SH E R R Y LO C K A M Y 3/ 3 / 2 0 1 5 SH E R R Y LO C K A M Y 3/ 3/20 1 5 SH E R R Y LO C K A M Y 12 / 2 3 /20 1 5 2, 3 4 9 . 5 3 12 / 10 / 20 1 5 49 3 . 1 0 12 /30 / 20 1 5 70 8 .00 12 /10 / 20 1 5 1, 5 2 8 .85 12 / 8/ 20 1 5 50 7 .35 12 / 10 / 2 0 1 5 74 3 .30 12 / 7/ 20 1 5 25 4 . 4 8 12 /28 / 20 1 5 1. 4 0 12 / 3/ 20 1 5 18 0 . 4 2 12 /2/20 1 5 50 .04 12 /23 / 20 15 12 0 .22 12 /23 /20 1 5 10 2 .34 12 / 2 3 /20 1 5 22 2 .35 12 / 23 / 2 0 1 5 21 9 . 3 2 12 / 23 / 20 1 5 23 1 .14 Re l e a s e Am o u n t ( $ ) 10 6 .79 1, 3 8 8 . 2 6 49 3 .10 70 8 .00 1, 5 2 8 .85 50 7 .35 3, 2 3 7 .30 0 .03 0. 0 3 85 .28 0.83 16 . 4 1 13 . 2 3 22 .54 17 .05 31 . 7 7 25 . 3 0 19 .26 -2,242.74 0.00 0.00 0.00 0.00 743.27 169.20 0.57 164.01 36.81 97.68 85.29 190.58 194.02 211.88 011916 HC BOC Page 31 B i l l # Ta x p a y e r Na m e 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BR A I N E R D LL C Su b t o t a l TA X DI S T R I C T : DU N N / A V E S FI R E RE L E A S E RE A S O N : El d e r l y Ex c l u s i o n 00 0 0 0 0 1 7 6 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G AR T I S , CL I F F O U S S 00 0 0 0 2 2 2 9 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HA R D I S O N , J AU B R E Y 00 0 0 0 2 7 7 7 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , RA C H E L B 00 0 0 0 5 7 0 9 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G WA T T S , FR E D G Su b t o t a l TA X DI S T R I C T : DU N N / A V E S FI R E RE L E A S E RE A S O N : La n d u s e ch a n g e 00 0 0 0 0 3 5 4 4 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BA S S , BA R B A R A WA R R E N Su b t o t a l TA X DI S T R I C T : DU N N / A V E S FI R E RE L E A S E RE A S O N : Re m o v a l of SW Fe e 00 0 0 0 2 6 1 6 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JA C K S O N , BO B B Y GL E N N Su b t o t a l Op e r a t o r I D (N a m e ) 8/ 8 / 2 0 1 5 SH E R R Y LO C K A M Y 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 8/ 20 1 5 MA R G A R E T WR I G H T 8/ 8 / 20 1 5 ST A C I E TA Y LO R 8/ 8 / 20 1 5 ST A C I E TA Y L O R TA X DI S T R I C T : DU N N / A V E S FI R E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 2 5 6 5 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HU D S O N , JU D Y T 8/ 8 / 2 0 1 5 KI M B E R L Y BA K E R 00 0 0 0 2 8 1 0 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO N E S , AU B R E Y DO N A L D 8/8/20 1 5 KI M B E R L Y BA K E R 00 0 0 0 5 7 3 2 1 - 2 0 1 5 - 2 0 1 5 - 0 0 1 1 - 0 0 - R E G WE B B , CL A W S O N H 10 / 6/ 20 1 5 KI M B E R L Y BA K E R Su b t o t a l TA X DI S T R I C T : ER W I N RE L E A S E RE A S O N : Re m o v a l of SW Fe e 00 0 1 7 0 2 1 3 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G ST O N E , LE W I S AL G E R JR 8/ 8/ 20 1 5 MA R G A R E T WR I G H T Su b t o t a l PA G E 11 o f 27 12 / 2 3 /2 01 5 42 2 . 9 2 12 / 10 /20 1 5 88 .76 12 / 30 / 2 0 1 5 12 7 .44 12 / 10/ 2 0 15 27 5 .19 12 / 8/ 20 1 5 91 .32 12 / 31 / 2 0 1 5 47 .38 12 / 31 /2 01 5 14 3 .26 12 / 17 / 2 0 1 5 78 . 7 8 12/ 3 0 / 2 0 1 5 4 .91 12 / 3/ 20 1 5 9.72 12 / 1/2 01 5 16 8 .0 0 Re l e a s e Am o u n t ( $ ) 19 .23 25 0 . 9 0 88 . 7 6 12 7 . 4 4 27 5 . 1 9 91 .32 58 2 . 7 1 47 .38 47 . 3 8 0 .00 0.00 0.06 0.04 0.01 0.11 0.00 0.00 -. . 403.69 0.00 0.00 0.00 0.00 0.00 143.26 78.72 4.87 9.71 168.00 011916 HC BOC Page 32 Bi l l # Ta x p a y e r N a m e TA X DIST R I C T : ER W IN RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 1 2 7 3 8 1 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - RE G TE R RY, MICHA EL RA Y Su b t o t al O p e r a t o r ID (N a m e ) 8/8/20 15 PE G G Y BA R E F O O T TA X DI S T R ICT : ER W I N FI R E ( T O W N ) RE L E A S E RE A S O N : Re m o v a l o f SW Fe e 00 0 170 2 1 3 9 -20 1 5 - 2 0 1 5- 0 0 0 0 - 0 0 -R E G ST O N E , LE W IS A LG E R JR 8/8/20 1 5 MA R G A R ET WR IG HT Su b t o t al TA X DI S T R I C T : ER W I N FI R E (TO W N ) RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 127 3 8 1 9 - 2 0 15-20 15- 0 0 0 0 -00 - R EG TER RY , MI C HAEL RA Y 8/ 8/ 20 1 5 PE G G Y BAR EFO O T Su b t ot a l TA X DI S T R I C T : FL A T B R A N C H FI R E RE L E A S E RE A S O N : Ad j us t m e n t 00 0 2 2 4 4 61 9 - 20 15-20 1 5-00 0 0 - 0 0 - RE G G4 M K EN T E R P R I S ES LLC 8/ 8 / 2 0 15 AM Y BA IN Su b t o t a l TAX DI S T R I C T : FL A T B R A N C H FI R E RE L E A S E RE A S O N : Bi l l i ng Co r r e c t i o n 00 0 2 2 4 7 2 1 3 - 2 0 1 5 -20 1 5 - 0 0 0 0 - 0 0 - R E G SO U T H RIV E R E M C 8/8/ 2 0 1 5 AM Y BA IN Su b t o t a l TA X DI S T R I C T : FL A T B R A N C H FI R E RE L E A S E RE A S O N : La n d f i l l er r o r 00 0 0 0 3 0 9 9 1 -20 1 5 -20 1 5 -00 0 0 -00 -R E G LEE, L OU IS E 8/ 8/ 20 1 5 AM Y BA I N 00 0 0 0 3 7 6 9 1 - 2 0 1 4 - 2 0 1 4 - 0 0 0 0 - 0 0 - RE G G4 M K ENT ERP R ISES LL C 8/ 9/ 2 0 14 AM Y BA I N 00 0 2 0 0 3 0 2 1-2 0 14-20 1 4 - 0 0 0 0 -00 -REG G4 M K ENT ERPRI S ES LL C 8/ 9 / 20 14 AM Y BA IN Su b t o t al TA X DI S T R I C T : FL A T W O O D S FI R E RE L E A S E RE A S O N : Ad j us t m e n t 00 0 0 0 3 0 3 8 1- 2 0 1 5 - 2 0 15- 0 0 0 0 - 0 0 - RE G LA S A T E R , NAN CY J 8/ 8/ 20 1 5 MA R G A RE T WR IGH T Su b t ot a l PAG E 12 o f 27 12 / 1 5 / 2 0 15 2. 2 1 12 / 1/ 20 15 24 .50 12/ 15 / 20 1 5 0.32 12/ 4/2 0 15 53 8 .6 1 12 / 22 /20 1 5 7 .39 12 / 2 2 / 20 15 173 .68 12 / 15 / 2 0 1 5 14 3 .77 12 / 15 / 20 1 5 159 .32 12/15/ 2 0 1 5 8. 4 0 Re l e a s e A m o u n t ( $ ) 0. 2 0 0.20 0. 0 0 0.00 0.03 0. 0 3 153 .58 15 3 .58 7. 3 9 7. 3 9 0. 0 0 0. 0 0 0.00 0.00 0.00 0.00 -. 2.01 24.50 0.29 385.03 0.00 173.68 143.77 159.32 8.40 011916 HC BOC Page 33 B i l l # Ta x p a y e r Na m e Op e r a t o r I D (N a m e ) TA X DI S T R ICT : FL A T W O O D S FI R E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 3 4 54 2 -20 15- 2 0 1 5 -00 0 0 - 0 0 - RE G MC D O N A L D GEOR G E S T R US T E E 00 0 1 3 9 0 0 0 7 -20 0 6 - 2 0 06- 0 0 0 0 - 0 0 - R EG BRO W N , AN N I T A CHAR L E N E Su b tota l TA X DI S T R I C T : HA R N E T T CO U N TY RE LEA S E RE A S O N : Ad j u s t m e n t 00 0 0 0 1 4 5 15- 2 0 1 5 - 2 0 15-00 0 0 - 0 0 - R EG DE N N IS, CA D I L L A C OL D S 00 0 0 0 1 9 9 0 0 - 20 1 5 -20 1 5 -000 0 - 0 0 - RE G LI S E C , KE N D R A 00 0 0 0 1 9 9 0 1 -20 1 5 -20 1 5 - 000 0-0 0 - R E G LI S E C , SC O T T E 00 0 0 019 9 0 2 - 2 0 1 5 - 2 0 15 -00 0 0 - 0 0 - R EG LI S E C , SC O T T 00 0 0 0 1 9 9 0 3 -20 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G LI S E C , SC O T T 00 0 0 0 2 1 1 3 7 - 2 0 1 5 - 20 1 5 -00 0 0 - 0 0 - R EG GR I F F I N , RA L P H E 00 0 0 0 2 6 7 9 8 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JERN I G A N , RO B E R T N 00 0 0 0 303 8 1 - 2 0 1 5 - 20 1 5 -00 0 0 - 0 0 - R E G LA S A T E R , NA N C Y J 00 0 0 0 3 0 9 9 4 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G LE E , LO U I S E 00 0 0 0 3 1 4 8 8 -20 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R EG LI L L I N G T O N AU T O PA R T S 00 0 0 0 3 148 8 - 2 0 1 5 - 2 0 1 4 -00 1 1 - 0 0 - RE G LI L L I N G T O N AU T O PA R T S 00 0 0 0 3 1 4 8 8 - 2 0 1 5 - 2 0 1 5 - 0 0 1 1 - 0 0 -RE G LI L L I N G TON AU T O PA R T S 00 0 0 0 4 0 7 1 1 - 2 0 15-2 0 1 5 -00 0 0-00 -RE G PA G E , PH I L L I P VI R G E L 00 0 0 0 4 6 3 2 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R EG WE L L S , JO HN TH O M A S 00 0 0 0 5 2 6 5 4 - 2 0 1 5 - 2 0 15- 0 0 1 1 - 0 0 - R EG TA R T , CHAR L E S M 00 000 5 7 2 2 8 - 2 0 1 5 -20 1 5 -00 0 0 - 0 0 - R EG PO O LE, BR E N D A W 00 0 1 16 9 6 4 9 -20 1 5 - 2 0 1 5 -0 000 - 0 0 - R EG ST A N L Y RI C H M O N D AN D CO LL C 00 0 1 1 6 9 7 0 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G ST A N LY RI C H M O N D AN D CO LL C 8/8/20 1 5 KIMB ERLY BA K E R 5/ 1/ 20 0 7 YV O N N E MC A R T H U R 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 20 1 5 AM Y BA I N 8/8/20 1 5 AM Y BAI N 8 /8/20 1 5 AM Y BAI N 8/8/20 1 5 AM Y BA I N 8/8/20 1 5 AM Y BA I N 8/8/ 20 1 5 MA R G A R E T WR I G H T 8/ 8/ 20 1 5 MA R G A R E T WR I G H T 8/ 8/ 20 1 5 AM Y BA I N 10 /29 / 20 15 SH ERR Y LO C K A M Y 10 / 2 9 / 20 1 5 SH E R R Y LO C K A M Y 10 /29 / 20 1 5 SH E R R Y LO C K A M Y 8 /8/20 1 5 MA R G A R E T WR I G H T 8/ 8 /20 1 5 MA R G A R E T WR I G H T 9/ 17 /20 1 5 SH E R R Y LO C K A M Y 8/ 8/20 1 5 AM Y BA IN 8/ 8 /20 1 5 AMY BA IN 8/ 8/ 20 15 AM Y BA I N PA G E 13 of 27 12 / 30 / 20 15 12 / 31 / 20 15 12/ 7/ 20 1 5 12 /4/ 20 15 12 /4/20 1 5 12 /4/20 1 5 12 /4 /20 15 12 / 14 /20 1 5 12 / 28 / 20 15 12 / 15 / 20 1 5 12 /2 2/ 2 01 5 12 / 8/ 20 1 5 12 /8/ 20 15 12 /23/ 20 1 5 12 / 18 / 20 1 5 12 / 3/20 1 5 12 / 3/ 2 0 1 5 12 /4 / 20 1 5 12/8/20 1 5 12 / 8/ 20 1 5 42 .10 1.14 2 ,190 .70 1 ,29 0 .55 18 7 .50 187 .50 18 7 .50 90 8 .60 11 .63 12 2 .50 91 .95 57 1 .58 4 62 . 4 0 40 5 .84 1,66 4 .88 1,89 7 .38 1,50 3 . 4 7 97 5 .18 24 9 .90 29 0 .78 Re l e a s e Am o u n t ( $ ) 0. 0 3 0.01 0 .04 71 0 .70 17 0 .55 37 .50 37 .50 37 .50 56 8 .15 6 .92 70 .00 19 .12 13 1 .90 89 .92 40 5 .84 22 5 . 4 5 26 2 .50 13 6 .68 97 5 .18 24 9 .90 29 0 .78 -. 42.07 1.13 1,480.00 1,120.00 150.00 150.00 150.00 340.45 4.71 52.50 72.83 439.68 372.48 0.00 1,439.43 1,634.88 1,366.79 0.00 0.00 0.00 011916 HC BOC Page 34 B i l l # Ta x p a y e r Na m e 00 0 1 1 6 9 7 1 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G ST A N L Y RI C H M O N D AN D CO LL C Op e r a t o r I D (N a m e ) 8/ 8 / 2 0 1 5 AM Y BA I N 00 0 2 0 7 6 8 7 0 - 2 0 1 4 - 2 0 1 4 - 00 0 0 - 0 0 - R E G AN D E R S O N , CL I F T O N RO B E R T 12 / 1 6 /20 1 4 AM Y BA I N 00 0 2 0 7 6 8 7 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G AN D E R S O N , CL I F T O N RO B E R T 8/8 /20 1 5 AM Y BA I N 00 0 2 0 9 1 0 3 1 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HO R T O N , WI L L I A M AD D I S O N JR 8/ 8 /20 1 5 ST A C I E TA Y L O R 00 0 2 1 7 8 3 3 1 - 2 0 1 5 - 2 0 1 5 - 0 0 1 1 - 0 0 - R E G BJ ' S DI N E R IN C 11 /6/20 1 5 MA R G A R E T WR I G H T 00 0 2 1 7 8 4 7 7 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G R C CO N S T R U C T I O N CO IN C 8/ 8 / 20 1 5 SH E R R Y LO C K A M Y 00 0 2 1 8 2 8 1 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 -00 - R E G NE I G H B O R S , FR A N C E S M 8/ 8/ 20 1 5 MA R G A R E T WR I G H T 00 0 2 2 4 4 6 1 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G G4 M K EN T E R P R I S E S LL C 8/ 8/ 20 1 5 AM Y BA I N 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 0- 0 0 1 1 - 0 0 - R EG BR A I N E R D LL C 3/ 3/ 20 1 5 SH E R R Y LO C K A M Y 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 1 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 3/ 3 / 2 0 1 5 SH E R R Y LO C K A M Y 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 2 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 3/ 3/ 20 1 5 SH E R R Y LO C K A M Y 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 3/ 3/ 20 1 5 SH E R R Y LO C K A M Y 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 4 - 0 0 1 1 - 0 0 - R E G BR A I N E R D LL C 3/ 3/20 1 5 SH E R R Y LO C K A M Y 00 0 2 2 4 5 2 7 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BR A I N E R D LL C 8/8/20 1 5 SH E R R Y LO C K A M Y 00 0 2 2 4 7 1 9 0 -2 0 15 - 2 0 1 0 -00 1 1 - 0 0 -R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 /20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 -20 1 1 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 /20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 2 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 /20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 1 6 / 2 0 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 1 6 /20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y 00 0 2 2 4 7 1 9 0 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G BE N N E T T S LA N D S C A P I N G AN D 7/ 16 /20 1 5 SH E R R Y MA I N T E N A N C E LO C K A M Y PA G E 14 of 27 12 / 8 /20 1 5 12 /1/ 2 0 1 5 12 /1/20 1 5 12 / 2/20 1 5 12 / 21 / 20 1 5 12 / 2 3 / 20 1 5 12/ 2/ 20 1 5 12 /4/ 20 1 5 12 /23 / 20 1 5 12 / 2 3 / 20 1 5 12 /23 / 20 1 5 12 /23 / 20 1 5 12 /23 /20 1 5 12 /23 /20 1 5 12 /3/20 1 5 12 /3/20 1 5 12 / 3/20 1 5 12 / 3/ 20 1 5 12 / 3/20 1 5 12 /3/20 1 5 34 2 .98 17 5 .56 16 7 .58 7 .29 55 2 .34 47 5 . 4 1 48 7 .00 3, 4 3 6 .30 1,24 5 . 12 1 ,05 9 .99 2, 3 0 2 .84 2 ,27 1 .50 2, 4 7 6 .57 3, 5 2 4 .30 23 6 .73 18 3 . 4 3 20 6 .66 15 4 . 9 6 14 2 .04 13 5 .59 Re l e a s e Am o u n t ( $ ) 34 2 . 9 8 17 5 .56 16 7 . 5 8 2 .56 28 9 .84 42 .65 11 0 .25 95 9 .85 23 3 . 4 6 17 6 .67 32 8 .97 26 2 .09 20 6 .38 16 0 . 1 9 39 . 4 6 26 . 2 1 23 .84 12 . 9 2 6.45 13 5 .59 -. . 0.00 0.00 0.00 4.73 262.50 432.76 376.75 2,476.45 1,011.66 883.32 1,973.87 2,009.41 2,270.19 3,364.11 197.27 157.22 182.82 142.04 135.59 0.00 011916 HC BOC Page 35 Bi l l # T a x p a y e r Na m e 00 0 2 2 471 90-20 15-20 14-00 1 1- 00 -R E G BE NN ET I S LAN DS CAPI N G AN D MA I N T E N A N C E Su b t o t a l Op e r a t o r ID (N a m e ) 7/ 16/20 1 5 SH ER RY LO C K A M Y TA X DI S T R I C T : HA R N ETT CO U N T Y RE L E A S E RE A S O N : Ad j u s t m e n t Re l e a s e 00 0 0 0 4 8 1 3 9 - 2 0 1 5 -20 1 5 - 0 0 7 0 - 0 0 - D L D SI M M O N S , ER NEST G 12 / 1 5 / 2 0 1 5 ST A C I E TA Y L O R Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : As s e s s e d In Err 00 0 0 0 3 0 9 9 5 -20 1 5 -20 15-00 0 0 -00 -R E G LEE , LOU ISE 8/ 8 / 201 5 AM Y BAIN 00 0 0 0 4 2 9 7 8 - 2 0 1 5 -20 15-00 0 0 -00 -R EG POO LE , PH I LLI P W 8/ 8 / 2 0 15 AM Y BA I N 00 0 0 0 4 9 8 8 1 - 2 0 15- 2 0 15-00 0 0 -00 -RE G SP I V E Y , ED IE S EAW ELL 8/ 8 / 2 0 15 AM Y BA I N 00 0 0 0 5 5 3 6 5 - 2 0 15-20 15- 0 0 0 0 -00 -REG RE ID, MA R Y ELL EN 8/8/20 1 5 AM Y BA I N 00 0 0 0 5 8 5 0 9 -20 15-20 15- 0 0 0 0 - 0 0 - R EG W EST MO B I L E HO M E PAR K 8/8/20 1 5 AM Y BA I N 00 0 2 1 7 7 7 7 8 -20 1 5 - 2 0 15- 0 0 0 0 - 0 0 - R E G MERI D I A N LEAS I N G CO R P O R A T I O N 8/8/20 1 5 SH ERR Y LO C K A M Y Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Bi l l i n g Co rr ec t i o n 00 0 2 2 4 7 2 13- 20 1 5 -20 1 5 -00 0 0 -00 - REG SO U T H R IV ER E M C 8/ 8 / 2 0 1 5 AM Y BA IN Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : De f e r r e d Bi l l 00 0 0 0 4 8 1 3 8 -20 15- 2 0 1 5 - 0 0 7 0 - 0 0 - D LD SIMM O N S, ERNE ST G 12/ 1 5 / 2 0 1 5 ST A C IE TA Y L O R 00 0 0 0 4 8 1 3 9 -20 1 5 - 2 0 1 5 - 0 0 7 0 -0 1-DL D SIMM O NS, ERN E S T G 12 / 15 / 2 0 1 5 ST A C IE TA Y LOR 00 0 0 0 4 8 1 4 0 - 2 0 1 5 - 2 0 1 5 - 0 0 7 0 - 0 0 - D L D SI M M O N S , ERN EST GR I G G S 12 / 15 /20 1 5 ST A C IE TA Y L O R 00 0 0 0 4 8 1 4 1 - 2 0 1 5 -20 1 5 - 0 0 7 0 -00 -DLD SI M M O N S , ERN EST GR I G G S 12 / 15 /20 1 5 ST A C I E TA Y L O R 00 0 0 0 5 0 3 2 9 - 2 0 1 5 -20 1 5 -00 7 0 -00 - D L D ST A N LY RI C H M O N D AN D CO LL C 12 / 10 / 20 1 5 AM Y BA I N 00 0 0 0 5 7 2 2 8 -20 1 5 - 2 0 15 -00 7 0 - 0 0 - D L D POO LE, BRE ND A W 12 / 4 / 2 0 1 5 AM Y BA IN PA G E 15 of 27 12 /3/20 1 5 12 8 .74 12 / 15 /20 1 5 42 . 9 0 12 /22 /20 1 5 38 1 .93 12 /21 /20 1 5 35 .56 12 /22 /20 1 5 40 0 . 7 5 12/31 /20 1 5 22 2 . 1 0 12 /3/20 1 5 171 .11 12 /28 /20 1 5 2.89 12 /22 /20 1 5 46 . 2 0 12 / 15 /20 1 5 36 1.6 5 12 / 15 /20 1 5 42 . 9 0 12 / 15 /20 1 5 15 8 .33 12 / 15 /20 1 5 35 0 .10 12 / 10 /20 1 5 16 1 .70 12 /4/20 1 5 34 2 .60 Re l e a s e A m o u n t ( $ ) 5. 8 5 8,1 35 .44 42 . 9 0 42 . 9 0 23 1 . 9 3 2. 4 7 14 4 . 5 2 14 7 .10 39 .67 2.89 56 8 .58 46 . 2 0 46 .20 36 1 .65 42 . 9 0 15 8 . 3 3 35 0 . 1 0 16 1 .70 34 2 .60 -122.89 0.00 150.00 33.09 256.23 75.00 131.44 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 011916 HC BOC Page 36 B i l l # Ta x p a y e r Na m e 00 0 0 0 6 3 0 5 6 -20 1 5 - 2 0 1 5 - 0 0 7 0 -00 - DL D SI M M O NS , ERNE ST G 00 0 1 09 2 6 4 9 -20 1 5 - 2 0 1 5 - 0 0 7 0 - 0 0 - D L D MO S S , W IL LI A M AL A N 00 0 1 1 6 9 6 4 9 -20 15 - 2 0 1 5 -00 7 0 - 0 0 - D L D ST A N LY RI C H M O N D AN D CO LL C 00 0 1 1 6 9 7 0 9 - 2 0 1 5 - 2 0 1 5 - 0 0 7 0 - 0 0 - D L D ST A N LY R ICH M O N D AN D CO LL C 00 0 1 1 6 9 7 1 0 -20 1 5 - 2 0 15-00 7 0 -00 -DL D ST A NL Y R IC HMO N D AN D CO LL C 00 0 2 1 8 4 2 1 5 -20 15- 2 0 15- 0 0 7 0 -00 - D L D CU M M I NGS , EL B E R T L 00 0 2 1 8 5 5 4 4-20 1 5 - 2 0 15 -00 7 0 - 0 0 - D L D PAG E, PH IL LI P VIRG EL Op e r a t o r ID (N a m e ) 12 / 15 / 20 1 5 ST A C I E TA Y L O R 12 /22 /20 1 5 AM Y BA I N 12 /8/20 1 5 AM Y BA I N 12 /8/20 1 5 AM Y BA I N 12 / 8 /20 1 5 AM Y BA I N 12 / 4 / 20 1 5 AM Y BA I N 12 / 18/ 2 0 1 5 ST AC I E TA Y L O R 12 /1 5/20 15 12 / 22 /20 1 5 12 / 8/20 1 5 12 /8/20 1 5 12 / 8 / 20 1 5 12 /4 /2 0 1 5 12 / 18 / 20 1 5 - ' 10 3 .1 3 25 . 2 0 19 2 . 3 8 22 7 . 4 8 27 2 . 0 3 21 8 . 5 5 1, 3 6 4 .18 Re l e a s e A m o u n t ( $ ) 10 3 . 1 3 25 . 2 0 19 2 .38 22 7 . 4 8 27 2 .03 21 8 .55 1,3 6 4 .18 Su b t o t al 3,82 0 .23 TA X DI S TRI C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : E lde r ly Ex cl u s io n 00 0 0 0 0 1 7 6 6 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R EG AR T I S , C LI FF O U S S 00 0 0 0 0 3 7 3 4-2 0 15- 2 0 15- 0 0 0 0 -00 -RE G BA U C O M , EU LA DO R I S 00 0 0 0 2 2 2 9 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HA R D I S O N , J AU B R E Y 00 0 0 0 2 7 7 7 6 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , RA C H EL B 00 0 0 0 5 2 2 3 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SW A N N , LE N A E 00 0 0 0 5 7 0 9 2 - 2 0 1 5 -20 1 5 -00 0 0 -00 - R E G WA T T S , FR E D G 00 0 0 0 5 9 2 9 3 - 2 0 1 5 -20 15-00 0 0 -00 - R E G W IL BO U R N E , LO IS P 8/ 8/2 0 15 AM Y BA I N 8/8/ 20 1 5 AM Y BA I N 8/8/ 20 1 5 AM Y BA I N 8/ 8/2 0 1 5 AM Y BA I N 8/ 8/ 20 1 5 AM Y BA I N 8/ 8/ 2 0 1 5 MA R G A R E T WR I G H T 8/ 8 / 2 0 15 AM Y BA IN 12 / 10 / 20 1 5 12 / 9/ 20 1 5 12 /3 0/ 20 1 5 12 / 10 / 20 1 5 12 / 3/ 20 1 5 12 / 8/20 1 5 12 / 14 / 20 15 80 9 . 6 5 99 5 .50 1,13 2 .00 2 ,36 3 .28 69 6 .78 83 1 . 0 3 59 3 .0 5 80 9 .65 99 5 .50 1,13 2 .00 2,36 3 . 2 8 69 6 .78 83 1 . 0 3 59 3 . 0 5 Su b t o t a l 7,42 1. 29 TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Exem p t Prop e r t y 00 0 0 0 5 9 2 8 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BE A C O N RE S C U E MI S S I O N 8/ 8 / 2 0 1 5 AM Y BA IN 12 /28 /20 1 5 2, 4 8 0 . 7 3 2, 4 1 0 .73 Su b t o t al 2, 4 1 0.73 TA X DI S T R ICT : HA R N E T T CO U N T Y RE L E A S E RE A S O N : F ull re b a t e 00 0 0 0 0 8 4 0 9 -20 1 5 -20 1 5 - 0 0 0 0 - 0 0 -RE G BY R D , RO Y H 00 0 0 0 102 5 0 - 2 0 1 2 - 2 0 1 2 - 0 0 0 0 - 0 0 - R E G TO D D CE C IL E WELD I N G SE R V I C E 00 0 0 0 1 0 2 5 0 - 2 0 1 5 -20 1 3 - 0 0 1 1 - 0 0 - R E G TO D D CE C I L E W ELD I N G SE R V I C E 8/8/ 2 0 1 5 SH E R R Y LO C K A M Y 7/ 2 6 / 2 0 1 2 SH E R R Y LO C K A M Y 12 / 3 1 /20 1 4 MA R G A R E T WR IGH T PA G E 16 of 27 12 / 30 /20 1 5 67 6 . 4 4 67 6 . 4 4 12 / 10 /20 1 5 0. 0 0 63 . 5 0 12 / 10 /20 1 5 0. 0 0 72 . 4 3 -. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 70.00 0.00 -63.50 -72.43 011916 HC BOC Page 37 B i l l # Ta x p a y e r N a m e 00 0 0 0 1 0 2 5 0 - 2 0 1 5 - 2 0 14 -0 0 1 1 - 0 0 - R E G TO D D CE C I L E WE LD I N G SE R V I C E Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : La n d f i l l er r o r 00 0 0 0 0 1 4 9 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G AN G I E R BA P T I S T CH U R C H 00 0 0 0 0 5 9 5 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BR A F F O R D , RA N D Y HA R T 00 0 0 0 1 4 7 4 6 -2 0 1 5- 2 0 1 5 - 0 0 0 0 - 0 0 - R E G DI C K E N S , JI M M Y 00 0 0 0 2 7 6 4 8 - 2 0 13- 2 0 1 3 -0 0 0 0 -0 0 - R E G JO H N S O N LO U I S E M TR U S T E E 00 0 0 0 2 7 6 4 8 - 2 0 1 4 - 2 0 1 4 - 0 0 0 0 - 0 0 - R E G JO H N S O N LO U I S E M TR U S T E E 00 0 0 0 3 0 9 9 1- 2 0 1 5- 2 0 1 5 -00 0 0 - 0 0 - R E G LE E , LO U I S E 00 0 0 0 3 3 5 6 6 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MA T T HE WS , DA V E Y EL M O 00 0 0 0 3 5 2 4 5 - 2 0 1 0 - 2 0 1 0 -00 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 45 -2 0 1 1 - 2 0 1 1 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 4 5 - 2 0 1 2 -2 01 2 - 0 0 0 0 -00 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 4 5 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 4 5 - 2 0 1 4 -2 01 4 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 5 2 4 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MC K O Y , JA M E S ED W A R D 00 0 0 0 3 7 6 9 1 - 2 0 1 4 - 2 0 1 4 - 0 0 0 0 - 0 0 - R E G G4 M K EN T E R P R I S E S LL C 00 0 0 0 3 9 9 1 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , KE N N E T H E 00 0 0 0 3 9 9 1 4 - 2 0 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G JO H N S O N , KE N N E T H E 00 0 0 0 3 9 9 1 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO H N S O N , KE N N E T H E 00 0 0 0 4 9 0 4 1 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SM I T H , EU G E N E W I l l 00 0 2 0 0 3 0 2 1 -20 1 4 - 2 0 1 4 - 0 0 0 0 - 0 0 - R E G G4 M K EN T E R P R I S E S LL C Su b t o t a l Op e r a t o r ID (N a m e ) 12 / 31 /20 1 4 MA R G A R E T WR I G H T 11 / 12 /2 0 15 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 7 / 2 0 1 3 AM Y BA I N 8/ 9 / 2 0 1 4 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 8 /20 1 5 AM Y BA I N 7/9/20 1 0 AM Y BA IN 8/5/20 1 1 AM Y BA I N 7/26 /20 1 2 AM Y BA I N 8/7/ 20 1 3 AM Y BA I N 8/9/2 0 14 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA IN 8/ 9 / 2 0 1 4 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA I N 8/8/ 20 15 AM Y BA I N 8/8/ 20 1 5 AM Y BA I N 8/9/20 1 4 AM Y BA I N PA G E 17 of 27 12 / 10 /20 1 5 12 /4/20 1 5 12 /22 /20 1 5 12 / 10 /2 01 5 12 / 15 /2 01 5 12 / 15 /20 1 5 12 /22 /20 1 5 12 / 16 /20 1 5 12 /4 /20 1 5 12 /4/20 1 5 12 /4/20 1 5 12 /4/20 1 5 12 /4/20 1 5 12 / 4/ 20 1 5 12 / 1 5 / 20 1 5 12 / 17 /20 1 5 12 /17 /20 1 5 12 /17 /20 1 5 12 /18 /20 1 5 12 / 15 /20 1 5 61 .56 70 . 0 0 27 3 .0 8 52 2 . 2 0 4,40 7 . 9 3 4,55 0 .28 2,06 5 . 4 8 28 6 .23 62 4 .11 63 4 . 1 1 67 4 .11 67 4 .11 69 2 .53 69 2 . 5 3 1 ,3 88 .58 22 4 .75 1, 4 3 3 . 13 44 9 .50 2, 1 9 8 .30 1,13 5 .78 Re l e a s e A m o u n t ( $ ) 67 . 7 0 88 0 . 0 7 70 . 0 0 14 0 . 0 0 70 .00 14 0 . 0 0 14 0 . 0 0 42 0 . 0 0 70 . 0 0 45 .00 50 .00 70 . 0 0 70 .00 70 . 0 0 70 . 0 0 21 0 .00 14 0 .00 1,12 0 .00 28 0 . 0 0 70 . 0 0 70 . 0 0 3 ,31 5 . 0 0 -. -6.14 0.00 133.08 452.20 4,267.93 4,410.28 1,645.48 216.23 579.11 584.11 604.11 604.11 622.53 622.53 1 '178.58 84.75 313.13 169.50 2,128.30 1,065.78 011916 HC BOC Page 38 B i l l # Ta x p a y e r Na m e TA X DI S TRI C T: HA R N E TT CO U N TY RE L E A S E RE A S O N : La n d u s e c ha ng e 00 0 0 0 0 3 5 4 4 - 2 0 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G BA S S , BA R B A R A WA R R E N 00 0 0 0 4 8 1 3 8 - 2 0 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G SI M M O N S , ER N EST G 00 0 0 0 4 8 1 3 9 -20 1 5 - 2 0 1 5 -00 0 0 -00 - R E G SI M M O N S , ERN EST G 00 0 0 0 4 8 139 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 1 -RE G SI M M O N S , ERN E S T G 00 0 0 0 4 8 1 3 9 - 2 0 15-20 15 -00 7 0 -00 -DL D SI M M O N S , ERN EST G 00 0 0 0 4 8 1 4 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SI M M O N S , ER N EST GR I G G S 00 0 0 0 4 8 1 4 1 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SI M M O N S , ER N EST GR I G G S 00 0 0 0 5 0 3 2 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G ST A N L Y RI C H MO N D AN D CO LLC 00 0 0 0 5 6 2 0 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G WA D E , OD E L L 00 0 0 0 6 3 0 5 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SI M M O N S , ER N E S T G 00 0 1 0 9 2 6 4 9 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MO S S , WI L L I A M AL A N 00 0 2 1 8 4 2 1 5 -20 1 5 -20 15- 0 0 0 0 - 0 0 - R E G CU M M I N G S , EL B ER T L 00 0 2 185 5 4 4- 20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R EG PA G E , PHI L L I P VI RGE L Su b t o t a l O p e r a t o r I D (N a m e ) 8/ 8 /20 1 5 ST A C I E TA YLO R 8/8/20 1 5 ST A C I E TA Y L O R 8/ 8 / 2 0 1 5 ST A C I E TA Y L O R 8/ 8 / 2 0 1 5 ST A C I E TA Y L O R 12 / 1 5 / 2 0 1 5 ST A C I E TA Y LOR 8/ 8/ 20 1 5 ST A C IE TAY L O R 8/ 8/ 20 1 5 ST A C I E TA Y L O R 8/ 8/ 20 1 5 AM Y BA I N 8/8/ 20 1 5 ST A C I E TA Y L O R 8/ 8/20 1 5 ST A C I E TA Y L O R 8/8/20 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA IN 8/ 8 / 2 0 1 5 ST A C I E TA Y L OR TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Le s s th an m in am t 00 0 1 1 3 7 8 13- 2 0 1 5 -20 1 2 - 0 0 0 0 - 0 0 - R E G FO O D LI O N LL C #2 5 9 4 12 / 20 / 2 0 1 5 C TS I 00 0 1 1 3 7 8 13- 2 0 1 5 - 2 0 1 3 - 0 0 0 0 -00 - R E G FO O D LI O N LL C #2 5 9 4 12 / 20 /20 1 5 C T S I 00 0 1 1 3 7 8 1 3 -20 1 5 - 2 0 1 4 - 0 0 0 0 -00 - R E G FO O D LI O N LL C #2 5 9 4 12 / 20 /20 1 5 C TS I 00 0 1 1 3 7 8 1 3 - 2 0 1 5 - 2 0 1 5 - 0 0 0 1 - 0 0 - R E G FO O D LI O N LL C #2 5 9 4 12 / 20 / 20 1 5 C TS I 00 0 1 7 5 5 8 2 5 - 2 0 1 5 -20 1 5 - 0 0 0 0 - 0 0 - R EG EA S T CO A S T BAS EBA L L AC A D E M Y 12 / 15 /20 1 5 SH E R R Y U S A - LL C LO C K A M Y 00 0 2 2 5 3 4 6 2 - 2 0 1 5 - 2 0 14- 0 0 0 0 -00 -RE G DE A N , VI O L A BL A N C H A R D 12 / 14/2 01 5 ST A C I E TA Y LO R PA G E 18 of 27 12 /31 /20 1 5 39 4 . 8 0 12 / 15 /20 1 5 38 3 .40 12 / 15 /20 1 5 46 .3 5 12 / 15 /20 1 5 3. 4 5 12 / 15 /20 1 5 0.00 12 / 15 /20 1 5 19 4 . 5 5 12 / 15 /20 1 5 38 7 . 7 5 12 / 10 /20 1 5 21 8 .78 12 /28 /20 1 5 1,23 0 .03 12 / 15 /20 1 5 10 9 .35 12 / 22 /20 1 5 1, 18 3 . 2 3 12 /4 /20 1 5 28 2 . 7 5 12 / 18 / 2 0 1 5 1,84 3 . 8 0 12/ 20 /20 1 5 3. 2 2 12/ 20 /20 1 5 2 .47 12/ 20 / 20 1 5 2.44 12 /20 / 20 1 5 2.33 12 / 15 / 20 1 5 3.71 12 / 14 /20 1 5 4 .50 Re l e a s e A m o u n t ( $ ) 39 4 .80 38 3 . 4 0 46 . 3 5 3. 4 5 42 . 9 0 19 4 .55 38 7 . 7 5 21 8 . 7 8 70 . 0 0 10 9 . 3 5 1, 18 3 . 2 3 28 2 . 7 5 1, 8 4 3 . 8 0 5,16 1 .11 3. 2 2 2. 4 7 2. 4 4 2.33 3. 7 1 4. 5 0 -. . 0.00 0.00 0.00 0.00 -42.90 0.00 0.00 0.00 1,160.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 011916 HC BOC Page 39 B i l l # Ta x p a y e r Na m e 00 0 2 2 5 3 462 -20 1 5 -20 15-00 0 0 -00 -R EG D EAN, VI O L A BL A NC H AR D 00 0 2 2 5 3 47 3- 2 0 1 5 - 2 0 15- 0 0 0 0 - 0 0 -REG MC L A M B, RO BE RT C Su b t o t a l O p e r a t o r ID (N a m e ) 12/ 14/20 1 5 ST A C IE TA Y LOR 12 / 18 /20 1 5 AM Y BAI N TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : MH as re a l pr o p e r t y 00 0 1 9 7 2 9 1 2 -20 1 5 -20 15- 0 0 0 0 -00 - R E G PA RR I SH, TERRI M ICHEL LE 8/ 8 / 2 0 1 5 AM Y BA IN Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Mi l i t a r y 00 0 167 8 7 40-20 1 1-20 11 - 00 0 0 -00 - REG MA LONE , S HE R M AI NE DEL ON 11 / 1 / 2 0 1 1 ST A C IE TA Y LOR Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : No t i n Co u n t y 00 0 0 0 4 4 6 9 1 - 20 1 5 -20 1 5 - 0 0 0 0 -00 - R E G RE A R D O N , JO S EP H W ESL EY 8/8/20 15 SH E R R Y LO C K A M Y Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : NS F Re l e a s e 00 0 0 0 1 0 2 5 0 -20 1 2 - 2 0 12- 0 0 0 0 - 0 0 -R EG TO D D CECI LE W EL DING SE R V I C E 7/26 / 2 0 1 2 AM Y BA I N Su b t o t a l TA X DI S T R ICT : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Ot h e r 00 0 0 0 1 025 0-20 15- 20 13- 0 0 1 1 - 0 0 -R E G TO DD CECIL E W EL D I N G SER VI C E 12/ 3 1/2 0 14 SH ER R Y LO C K A M Y Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Pe n a l t y In Er r 00 0 0 0 0 1 0 8 2 - 2 0 1 5 -20 15-00 0 0 -00 - R E G AM E R I C A N S ELF ST O R A G E 8/8/20 1 5 SH E R R Y LO C K A M Y Su b t o t a l TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Re m o v a l o f SW Fe e 00 0 0 0 0 2 6 6 3 - 2 0 1 5 - 2 0 15- 0 0 0 0 - 0 0 - R EG BA K E R , JO S E P H EVER E TT E J R 8/ 8 /20 1 5 MA R G A R ET WR I G H T 00 0 0 0 0 5 9 5 6 - 2 0 1 5 - 2 0 15- 0 0 0 0 - 0 0 - R EG BR A F F O R D , RA N D Y HAR T 8/ 8 / 2 0 1 5 MA R G A R ET WR I G H T PA G E 19 of 27 12 / 14 /20 1 5 4. 13 12 / 18 /20 1 5 2. 4 8 12 /30 /20 1 5 21 6 . 2 2 12 / 15 /20 15 85 . 2 6 12/ 2/20 1 5 1,38 4 . 17 12 / 10 /20 1 5 63 . 5 0 12/ 10 / 2 0 1 5 60 . 3 9 12 /2/20 1 5 64 .07 12/23 /20 1 5 52 7 . 7 3 12 /23 /20 1 5 24 0 .88 Re l e a s e A m o u n t ( $ ) 4 .13 2. 4 8 25 .28 21 6 .22 2 16 .22 85 . 2 6 85 . 2 6 19 0 . 4 8 19 0 .48 63 . 5 0 63 . 5 0 60 . 3 9 60 .39 5.82 5 .82 70 . 0 0 14 0 .00 -. . 0.00 0.00 0.00 0.00 1,193.69 0.00 0.00 58.25 457.73 100.88 011916 HC BOC Page 40 Bi l l # Ta x p a y e r Na m e 00 0 0 0 2 6 1 6 6 - 2 0 1 5 -20 1 5 - 0 0 0 0 - 0 0 - R EG JA C K S O N , BO BB Y G LE N N 00 0 0 0 2 7 5 9 0 -20 1 5 -20 1 5 -00 0 0 -00 - R EG TA T U M , HAR V EY R 00 0 0 0 4 1 3 2 4 -20 1 5 -20 15-00 5 0 -00 - R EG CA R T A , LAU R A P 00 0 0 0 5 1 6 44- 2 0 15-20 15 - 00 0 0 - 0 0 - RE G SH A W . MA L C O LM 00 0 0 0 5 3 7 7 5 - 20 15-20 15-00 0 0 -00 - RE G MO O R E, HAR O LD 00 0 170 2 1 3 9 -20 1 5 - 2 0 15 -00 0 0 - 0 0 -RE G ST O NE , LEW IS AL G ER JR Op e r a t o r I D (N a m e ) 8/8/20 1 5 ST A C I E TA Y L O R 8/ 8/ 20 15 ST A C I E TA Y L O R 9/ 14 / 20 1 5 MA R G A R ET WR I G H T 8/ 8 / 2 0 1 5 MA R G A R ET WR I G H T 8/ 8 / 2 0 15 ST A C I E TA Y L O R 8/ 8 / 2 0 15 MA R G A R E T WR I G H T 12 /31 /20 1 5 1, 4 0 3 .85 12 / 15 /20 1 5 39 8 .50 12 / 30 /20 1 5 1,59 8 .68 12 /23 /20 1 5 21 0 .85 12/ 1 5 /20 1 5 59 6 . 0 0 12 11/20 1 5 54 2 .50 Re l e a s e Am o u n t ( $ ) 14 0 .00 70 . 0 0 70 . 0 0 70 . 0 0 70 . 0 0 70 . 0 0 Su b t o t a l 70 0 . 0 0 TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : Si t u s er r o r 00 0 138 7 3 5 6 -20 15- 2 0 0 7 -0 0 0 0 -00 -RE G CELL CO PAR T NE R S HIP Su b t o t a l 12 / 18 /20 1 5 C TS I 12 / 18 /20 1 5 TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 0 0 2 6 8 -20 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G AD A M S , JO S EPH R 8/8/20 1 5 YV O N N E 12 / 30 / 20 1 5 MC A R T H U R 00 0 0 0 0 0 2 7 0 -20 1 5 - 2 0 1 5 -00 0 0 - 0 0 - R E G AD A MS, JO S EPH R 8/ 8 / 2 0 1 5 YV O N N E 12 /30 /20 1 5 MC A R T H U R 00 0 0 0 0 0 3 40-20 1 5 -20 1 5 - 0 0 0 0 -00 - R EG SA NF O RD AN D SON L LC 8/ 8 / 2 0 1 5 CA R O L Y N TA R T 12 /22 /20 15 00 0 0 0 0 6 439 -20 15 -20 15- 0 0 0 0 -00 - R E G BR O C K, CLI F T O N SR 8/ 8 / 2 0 15 PEGG Y 12 / 10/ 2 0 15 BA R E FOO T 00 0 0 0 0 9 16 7 -20 1 5 - 2 0 1 5 - 0 0 0 0 -00 - R E G CA M P BEL L , JU LI A T 8/ 8 / 2 0 1 5 K IMB E R L Y 12 /31 /20 15 BA K E R 00 0 0 0 1 5 468 -20 1 5 - 2 0 1 5 -00 0 0 -00 - R E G R A N D V BU I L D ERS LL C 8/ 8/ 20 15 CA R O L Y N TA R T 12 / 10 /20 15 00 0 0 0 1 7 3 5 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MA R T INEZ , EFR EN RO J A S 8/8/20 1 5 YV O N N E 12/ 1/ 20 15 MC A R T H U R 00 0 0 0 1 8 6 7 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 -RE G FU N D ERB U R K , JA M E S S 8/8/ 20 15 KI M B E R L Y 12 /29 /20 1 5 BA K E R 00 0 0 0 2 1 3 42- 2 0 1 5 -20 1 5 -00 0 0 -00 -REG GU N N , NA T HAN IEL JR 8/8/ 20 15 CA R O LYN TA R T 12 /22 /20 1 5 00 0 0 0 2 2 6 8 0 - 20 1 5 -20 1 5 -00 0 0 -00 - R E G HAR R INGT O N , NE ILL 8/ 8 / 20 1 5 TR A G I 12 / 10 /20 1 5 FE R R E L L PA G E 20 of 27 18 4 . 2 6 81 .19 11 4 . 9 8 38 0 .20 1,37 2 . 5 3 32 7 .81 1 ,18 4 .95 95 3 .80 99 . 0 0 53 1 . 0 3 13 5 .38 18 4 . 2 6 18 4 .26 0. 0 2 0. 0 1 0. 2 0 0. 0 6 0.04 0. 0 3 0. 0 1 0. 0 1 0. 1 9 0. 0 9 -1,263.85 328.50 1,528.68 140.85 526.00 472.50 0.00 81.17 114.97 380.00 1,372.47 327.77 1,184.92 953.79 98.99 530.84 135.29 011916 HC BOC Page 41 B i l l # Ta x p a y e r Na m e 00 0 0 0 2 5 6 5 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HU D S O N , JU D Y T 00 0 0 0 2 8 1 02 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G JO N E S , AU B R E Y DO N A L D 00 0 0 0 2 9 6 6 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G KO C H , NO R B E R T 00 0 0 0 3 1 6 5 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G LI V I N G S T O N LI V I N G TR U S T 00 0 0 0 3 4 5 4 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MC D O N A L D GE O R G E S TR U S T E E 00 0 0 0 4 0 6 6 4 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G PA G E , GE N E 00 0 0 0 5 4 9 9 7 -2 0 1 5 - 2 015 - 0 0 0 0 - 00 -R E G TU R L I N G T O N , ED W A R D 00 0 0 0 5 7 3 2 1 - 2 0 1 5 - 2 0 1 5 - 0 0 1 1 - 0 0 - R E G W EB B , CL A W S O N H 00 0 0 0 5 7 5 1 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G WE L C H , AL M E D A B 00 0 0 0 5 7 7 6 8 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G HU M M E L , MI C K E Y A 00 0 0 0 6 0 2 0 1 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G W IL S O N , RO B E R T A 00 0 0 0 6 2 8 8 5 - 2 0 1 4 - 2 0 1 4 - 0 0 0 0 - 0 0 - R E G KE L L Y , RE B E C C A S 00 0 1 2 7 3 8 1 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G TE R R Y , MI C H A E L RA Y 00 0 1 3 8 4 7 8 8 - 2 0 0 6 - 2 0 0 6 - 0 0 0 0 - 0 0 - R E G DA V I S , GE R R Y CU L L E N JR 00 0 1 3 8 6 0 4 5 - 2 0 0 6 - 2 0 0 6 - 0 0 0 0 - 0 0 - R E G BO N N E R , SH A K I M A LA T I C E 00 0 1 3 9 0 0 0 7 - 2 0 0 6 - 2 0 0 6 - 0 0 0 0 - 0 0 - R E G BR O W N , AN N I T A CH A R L E N E 00 0 1 4 0 6 5 1 1 - 2 0 0 8 - 2 0 0 8 - 0 0 0 0 - 0 0 - R E G WI L L I A M S , JO A N N E 00 0 1 5 6 0 2 6 7 - 2 0 0 7 - 2 0 0 7 - 0 0 0 0 - 0 0 - R E G TA R T , TE R E S A MA R I E 00 0 1 5 7 0 6 0 2 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G GO D I N E A U X , JO B I N A MA R I E A 00 0 1 6 5 8 7 4 6 - 2 0 0 8 - 2 0 0 8 - 0 0 0 0 - 0 0 - R E G BO N N E R , SH A K I M A LA T I C E PA G E 21 of 27 Op e r a t o r I D (N a m e ) 8/ 8 / 2 0 1 5 KI M B E R L Y BA K E R 8/ 8 / 2 0 1 5 K IMB E R L Y BA K E R 8/ 8 / 2 0 1 5 PE G G Y BA R E F O O T 8/ 8 / 2 0 1 5 CA R O L Y N TA R T 8/ 8 / 2 0 1 5 KIM B E R LY BA K E R 8/ 8 / 2 0 1 5 KI M B E R L Y BA K E R 8/ 8 / 2 0 1 5 CA R O L Y N TA R T 10 / 6 / 2 0 1 5 KI M B E R L Y BA K E R 8/ 8 / 2 0 1 5 KI M B E R L Y BA K E R 8/ 8 / 2 0 1 5 KI M B E R L Y BA K E R 8/ 8 / 2 0 1 5 TR A G I FE R R E L L 8/ 9 / 2 0 1 4 TR A G I FE R R E L L 8/ 8 / 2 0 1 5 PE G G Y BA R E F O O T 4/ 2 / 2 0 0 7 YV O N N E MC A R T H U R 4/ 2 / 2 0 0 7 YV O N N E MC A R T H U R 5/ 1 / 20 0 7 YVON N E MC A R T H U R 9/ 2/ 20 0 8 YV O N N E MC A R T H U R 5/ 1/ 2 0 0 8 YV O N N E MC A R T H U R 7/ 1 / 2 0 1 3 YV O N N E MC A R T H U R 4/ 1 / 2 0 0 9 YV O N N E MC A R T H U R 12 / 17 / 20 1 5 72 6 . 4 8 12 /30 / 20 15 40 .88 12 / 2/20 1 5 52 8 .78 12 /30 /20 1 5 54 4 .30 12 / 30 /20 1 5 26 3 . 1 0 12 / 15 /20 1 5 1,66 9 . 3 0 12 / 22 /20 1 5 16 8 . 3 0 12 /3/20 1 5 81 . 0 6 12 /3/20 1 5 35 3 .01 12 / 29 /20 1 5 26 2 .50 12 / 30 /20 1 5 1,36 6 .98 12 / 10 / 20 15 84 .38 12 / 15 / 20 1 5 3. 4 5 12 / 14 / 20 15 5.00 12 / 16 / 20 1 5 16 . 3 9 12 /31 / 20 1 5 5. 5 9 12 / 10 / 20 15 4. 9 1 12 / 10 /20 1 5 10 .58 12 / 31 /20 1 5 62 . 2 8 12 / 2/ 20 1 5 5. 0 7 Re l e a s e Am o u n t ( $ ) 0.53 0.35 0. 1 8 0. 0 3 0. 1 7 0. 0 1 0 .01 0 .09 0. 0 3 0. 09 0. 5 3 0.01 0.31 0. 1 7 0. 0 8 0.04 0. 0 9 0. 0 8 0. 4 8 0. 0 3 -725.95 40.53 528.60 544.27 262.93 1,669.29 168.29 80.97 352.98 262.41 1,366.45 84.37 3.14 4.83 16.31 5.55 4.82 10.50 61.80 5.04 011916 HC BOC Page 42 B i l l # Ta x p a y e r Na m e 00 0 1 6 6 7 4 0 4 - 2 0 0 9 - 2 0 0 9 - 0 0 0 0 - 0 0 - R E G CH A N C E , JO H N FI T Z E R A L D 00 0 1 7 5 8 1 2 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G GO D W I N , AN N A MA R G A R E T 00 0 1 7 7 9 7 6 8 - 2 0 1 2 - 2 0 1 2 - 0 0 0 0 - 0 0 - R E G MC R O R I E , MA R K RO B E R S O N 00 0 1 8 9 8 8 6 0 - 2 0 1 1 - 2 0 1 1 - 0 0 0 0 - 0 0 - R E G CA R M O D Y , ER I N LY N N 00 0 1 9 0 0 3 4 4 - 2 0 1 1 - 2 0 1 1 - 0 0 0 0 - 0 0 - R E G PA T T E R S O N , ST E V E N DO U G L A S 00 0 1 9 0 2 3 1 5 - 2 0 1 1 - 2 0 1 1 - 0 0 0 0 - 0 0 - R E G BR O W N , KI M B E R L Y AN N 00 0 1 9 7 7 1 5 9 - 2 0 1 2 - 2 0 1 2 - 0 0 0 0 - 0 0 - R E G BA L L E N T I N E , RO S E T T A 00 0 2 0 7 8 3 1 6 - 2 0 1 2 - 2 0 1 2 - 0 0 0 0 - 0 0 - R E G JO Y C E , JE N N I F E R LE A N N E 00 0 2 0 8 7 3 9 3 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G FO N T E N O T , JE R E M Y WA Y N E 00 0 2 0 9 1 5 9 4 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G AR G U E L L O , KE N N Y 00 0 2 0 9 2 9 0 3 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G FO R B E S , RO N A L D DA L E JR 00 0 2 0 9 8 9 5 8 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G BA L D W I N , AN N A FO S K E Y 00 0 2 1 0 1 0 2 4 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G DO W D Y , TA M E K I A LA S H O N D A 00 0 2 1 01 8 4 9 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G GA R C I A , FR A N C I S C A 00 0 2 1 0 2 8 2 5 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G RO D R I Q U E Z , GA R Y AL L E N II 00 0 2 1 0 5 0 8 5 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G AV E R Y , CR Y S T A L NI C O L E 00 0 2 1 1 0 9 5 2 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G BL A C K M O N , BE V E R L Y HO W E L L 00 0 2 2 5 3 4 7 1 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MA R I O N , CO N N I E W Su b t o t a l I Op e r a t o r I D (N a m e ) 7/ 1 / 2 0 0 9 YV O N N E MC A R T H U R 8/ 8 / 2 0 1 5 PE G G Y BA R E F O O T 2/ 1 / 2 0 1 3 YV O N N E MC A R T H U R 12 / 1/2 0 1 1 YV O N N E MC A R TH U R 12 / 1 / 2 0 1 1 YV O N N E MC A R T H U R 1/ 3 / 2 0 1 2 YV O N N E MC A R T H U R 5/ 1 / 2 0 1 3 CA R O L Y N TA R T 3/ 1 / 2 0 1 3 YV O N N E MC A R T H U R 6/ 3 / 2 0 1 3 YV O N N E MC A R T HU R 7/ 1/ 20 1 3 YV O N N E MC A R T HU R 7/1 / 2 0 1 3 YV O N N E MC A R T H U R 8/ 1 / 2 0 1 3 YV O N N E MC A R T H U R 9/ 3 / 2 0 1 3 YV O NN E MC A R T H U R 9/ 3 / 2 0 1 3 YV O N N E MC A R T H U R 10 / 1 / 2 0 1 3 YV O N N E MC A R T HU R 10 / 1 / 2 0 1 3 YV O N N E MC A R T H U R 12 / 2 / 2 0 1 3 YV O N N E MC A R T H U R 12 / 2 8 / 2 0 1 5 KI M B E R L Y BA K E R PA G E 22 o f 27 12 / 3 1 / 2 0 1 5 3. 6 8 12 / 11 / 2 0 1 5 78 . 9 0 12 / 1 4 / 2 0 1 5 5. 1 5 12 / 1 8 /20 1 5 26 . 7 5 12 / 10 / 2 0 1 5 5. 5 8 12 / 1 1 / 2 0 1 5 11 . 2 4 12 /2 8 / 2 0 1 5 52 . 1 3 12 /1 0 / 20 1 5 8. 0 2 12 /1 0 / 20 1 5 10 . 8 8 12 / 22 /20 1 5 10 . 2 2 12 / 15 /20 1 5 13 . 1 2 12 / 28 / 20 1 5 6 .89 12 / 2/ 20 1 5 42 . 1 2 12 / 18 /2 0 15 11 3 . 0 3 12/28 / 20 1 5 24 .65 12 /22 /2 01 5 20 .7 4 12 / 1 4 / 20 1 5 76 . 2 0 12 /28 / 2 0 1 5 80 . 8 5 Re l e a s e Am o u n t ( $ ) 0. 4 7 0. 0 2 0. 0 4 0. 2 0 0. 0 9 0. 1 1 0. 3 7 0. 0 6 0. 0 8 0. 2 7 0. 1 0 0. 0 5 0 .31 0. 1 1 0. 2 2 0. 4 9 0. 5 7 0 .01 7. 5 4 -3.21 78.88 5.11 26.55 5.49 11.13 51.76 7.96 10.80 9.95 13.02 6.84 41.81 112.92 24.43 20.25 75.63 80.84 011916 HC BOC Page 43 B i l l # Ta x p a y e r Na m e TA X DI S T R I C T : HA R N E T T CO U N T Y RE L E A S E RE A S O N : So l d i T r a d e d 00 0 0 0 2 0 5 5 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G GR A Y , CH A R L E S KE N N E T H JR Su b t o t a l TA X DI S T R I C T : LI L L I N G T O N RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 3 1 4 8 8 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G LI L L I N G T O N AU T O PA R T S 00 0 0 0 3 1 4 8 8 - 2 0 1 5 - 2 0 1 4 - 0 0 1 1 - 0 0 - R E G LI L L I N G T O N AU T O PA R T S 00 0 0 0 3 1 4 8 8 - 2 0 1 5 - 2 0 1 5 - 0 0 11 - 0 0 - R E G Ll LL I N G T O N AU T O PA R T S 00 0 2 1 7 8 3 3 1 - 2 0 1 5 - 2 0 1 5 - 0 0 1 1 - 0 0 - R E G BJ ' S DI N E R IN C Su b t o t a l TA X DI S T R I C T : LI L L I N G T O N RE L E A S E RE A S O N : As s e s s e d In Er r 00 0 0 0 5 5 3 6 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G RE I D , MA R Y EL L E N Su b t o t a l TA X DI S T R I C T : LI L L I N G T O N RE L E A S E RE A S O N : Ex e m p t Pr o p e r t y 00 0 0 0 5 9 2 8 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BE A C O N RE S C U E MI S S I O N Su b t o t a l TA X DI S T R I C T : LI L L I N G T O N RE L E A S E RE A S O N : La n d f i l l er r o r 00 0 0 0 2 7 6 4 8 - 2 0 1 3 - 2 0 1 3 - 0 0 0 0 - 0 0 - R E G JO H N S O N LO U I S E M TR U S T E E 00 0 0 0 2 7 6 4 8 - 2 0 1 4 - 2 0 1 4 - 0 0 0 0 - 0 0 - R E G JO H N S O N LO U I S E M TR U S T E E Su b t o t a l TA X DI S T R I C T : LI L L I N G T O N RE L E A S E RE A S O N : Re m o v a l o f SW Fe e 00 0 0 0 4 1 3 2 4 - 2 0 1 5 - 2 0 1 5 - 0 0 5 0 - 0 0 - R E G CA R T A , LA U R A P Su b t o t a l O p e r a t o r ID (N a m e ) 8/ 8 /20 1 5 AM Y BA I N 10 /2 9 / 2 0 1 5 SH E R R Y LO C K A M Y 10 / 2 9 / 2 0 1 5 SH E R R Y LOC K A M Y 10 / 2 9 / 2 0 1 5 SH E R R Y LO C K A M Y 11 / 6 / 2 0 1 5 MA R G A R E T WR IG H T 8/ 8 / 2 0 1 5 AM Y BA I N 8/ 8 / 2 0 1 5 AM Y BA IN 8/ 7 / 2 0 1 3 AM Y BA I N 8/ 9 / 2 0 1 4 AM Y BA I N 9/ 1 4 / 2 0 1 5 MA R G A R E T WR IG H T PA G E 23 of 27 12 /30 / 20 1 5 54 . 1 0 12 /8/ 20 1 5 40 9 . 9 6 12 /8/20 1 5 32 0 . 5 9 12/23 /20 1 5 28 1 . 3 8 12 /21 /20 1 5 38 2 . 9 6 12 /31 / 2 0 1 5 10 5 . 4 6 12 /28 /20 1 5 1, 6 7 1 . 4 4 12 / 1 5 / 2 0 15 2 ,96 0 .72 12 /15 /20 1 5 2 ,96 0 .72 12/30 /20 1 5 1,01 1 .3 5 Re l e a s e A m o u n t ( $ ) 39 .21 39 .21 94 .61 53 . 4 3 28 1 . 3 8 20 0 . 9 6 63 0 .38 53 . 4 6 53 . 4 6 1, 6 7 1 . 4 4 1,67 1 . 4 4 0. 0 0 0. 0 0 0. 0 0 0. 0 0 0.00 -. 14.89 315.35 267.16 0.00 182.00 52.00 0.00 2,960.72 2,960.72 1,011.35 011916 HC BOC Page 44 B i l l # Ta x p a y e r N a m e O p e r a t o r I D (N a m e ) TA X DI S T R I C T : LI L L I N G T O N RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 0 0 0 6 4 3 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BR O C K , CL I F T O N SR 8/8/20 1 5 PE G G Y BA R E F O O T 00 0 0 0 0 9 1 6 7 -2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - RE G CA M P B E L L , JU L I A T 8/8/20 1 5 KI M B E R L Y BA K E R Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : Ad j u s t m e n t Re l e a s e 00 0 0 0 4 8 1 3 9 -2 0 1 5 - 2 0 15 - 0 0 7 0 - 0 0 - D L D SI M M O N S , ER N E S T G 12 / 15 / 2 0 1 5 ST A C IE TA Y L O R Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : De f e r r e d Bi l l 00 0 0 0 4 8 1 3 8 - 2 0 1 5 - 2 0 1 5 - 0 0 7 0 - 0 0 - D L D SI M M O N S , ER N E S T G 12 / 15 /2 0 15 ST A C I E TA Y L O R 00 0 0 0 4 8 1 3 9 - 2 0 1 5 - 2 0 1 5 - 0 0 7 0 - 0 1 - D L D SI M M O N S , ER N E S T G 12 / 15 /20 1 5 ST A C I E TA Y L O R 00 0 0 0 4 8 1 4 0 - 2 0 15 -20 1 5 -00 7 0 -00 - D L D SI M M O N S , ER N E S T GR I G G S 12 / 15 /20 1 5 ST A C I E TA Y L O R 00 0 0 0 4 8 1 4 1 - 2 0 1 5 - 2 0 1 5 - 0 0 7 0 - 0 0 - D L D SI M M O N S , ER N E S T GR I G G S 12 / 15 /20 1 5 ST A C I E TA Y L O R 00 0 0 0 6 3 0 5 6 - 2 0 1 5 - 2 0 1 5 - 0 0 7 0 - 0 0 - D L D SI M M O N S , ER N E S T G 12 / 15 / 2 0 1 5 ST A C I E TAY L O R Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : El d e r l y Ex c l u s i o n 00 0 0 0 0 3 7 3 4 - 2 0 1 5 - 2 0 1 5 - 00 0 0 - 0 0 - R E G BA U C O M , EU L A DO R I S 8/ 8 / 2 0 1 5 AM Y BA I N Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : Fu l l re b a t e 00 0 0 0 1 0 2 5 0 - 2 0 1 2 - 2 0 1 2 - 0 0 0 0 - 0 0 - R E G TO D D CECI L E W EL D I N G SE R V I C E 7/26 /20 1 2 SH E R R Y LO C K A M Y 00 0 0 0 1 0 2 5 0 - 2 0 1 5 - 2 0 1 3 - 0 0 1 1 - 0 0 - R E G TO D D CE C I L E WE L D I N G SE R V I C E 12 /31 /20 1 4 MA R G A R E T WR I G H T 00 0 0 0 1 0 2 5 0 - 2 0 1 5 - 2 0 1 4 - 0 0 1 1 - 0 0 -RE G TO D D CE C I L E WE L D I N G SE R V I C E 12 /31 /20 1 4 MA R G A R E T WR I G H T Su b t o t a l PA G E 24 of 27 12 /10/ 2 0 15 90 3 .0 8 12 /31 /20 1 5 17 8 .75 12 / 1 5 /20 1 5 4. 5 8 12 / 15/20 15 38 .58 12 / 15 /20 1 5 4. 5 8 12 / 1 5 /20 1 5 16 . 8 9 12 / 15 /20 1 5 37 .34 12 / 15 / 20 1 5 11 . 0 0 12 /9/ 2 0 1 5 98 .72 12 /1 0/20 1 5 0. 0 0 12 / 1 0 /20 1 5 0 .00 12 / 1 0 / 20 1 5 6 .56 Re l e a s e A m o u n t ( $ ) 0.04 0. 0 2 0. 0 6 4. 5 8 4. 5 8 38 . 5 8 4 .58 16 . 8 9 37 . 3 4 11 .00 10 8 . 3 9 98 . 7 2 98 . 7 2 7. 0 1 7. 9 9 7. 2 2 22 .22 903.04 178.73 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -7.01 -7.99 -0.66 011916 HC BOC Page 45 Bi l l # Ta x p a y e r Na m e O p e r a t o r ID (N a m e ) TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : La n d u s e ch a n g e 00 0 0 0 4 8 13 8 - 2 01 5 - 2 0 1 5 -0 0 0 0- 0 0 - R EG SI M M O N S , ER N E S T G 8/8/20 1 5 ST A C I E TA Y L O R 00 0 0 0 4 8 1 3 9 -2 01 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SI M M O N S , ER N E S T G 8/8/20 1 5 ST A C I E TA Y L O R 00 0 0 0 4 8 1 3 9 -2 01 5 - 2 0 1 5 -00 0 0 -01 - R E G SI M M O N S , ER N E S T G 8/8/ 2 0 1 5 ST A C I E TA Y L O R 00 0 0 0 4 8 1 3 9 - 2 0 1 5 - 2 0 15 - 0 0 7 0 -0 0 - D LD SI M M O N S , ER N E S T G 12 / 15/ 2 0 1 5 ST A C I E TA Y LOR 00 0 0 0 4 8 1 4 0 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SI M M O NS , ER N E S T GR I G G S 8/ 8 / 2 0 1 5 ST A C I E TA Y LOR 00 0 0 0 4 8 1 4 1 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SI M M O N S , ER N E S T GR I G G S 8/8/ 2 0 1 5 STAC I E TA Y L O R 00 0 0 0 6 3 0 5 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G SI M M O N S , ER N E S T G 8/8/20 1 5 ST A C IE TA Y L O R Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : Le s s th a n mi n am t 00 0 2 2 5 3 4 6 2 - 2 0 1 5 - 2 0 1 4 - 0 0 0 0 - 0 0 - R E G DE A N , VI O L A BL A N C H AR D 12 /14 /20 1 5 ST A C I E TA Y L O R 00 0 2 2 5 3 4 6 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G DE A N , VI O L A BL A N C H A R D 12 / 14 /20 1 5 ST A C I E TA Y L O R Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : MH as re a l pr o p e r t y 00 0 1 9 7 2 9 1 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G PA R R I S H , TE R R I MI C H E L L E 8/ 8 / 2 0 1 5 AM Y BA I N Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : No t in Co u n t y 00 0 0 0 4 4 6 9 1 - 2 0 1 5 - 2 0 1 5 -00 0 0 -00 - R E G RE A R D O N , JO S EP H W ES L E Y 8/8/20 1 5 SH E R R Y LO C K A M Y Su b t o t a l TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : NS F Re l e a s e 00 0 0 0 1 0 2 5 0 - 2 0 1 2 -20 1 2 - 0 0 0 0 - 0 0 - R E G TO D D CE C I L E W EL D I N G SE R V I C E 7/26 /20 1 2 AM Y BA IN Su b t o t a l PA G E 25 of 27 12 / 15 /20 1 5 40 .90 12 / 15 /20 1 5 4 .94 12 / 15 /20 1 5 0.37 12 / 15 /20 1 5 0.00 12 / 15 /20 1 5 20 .75 12 / 15 / 20 1 5 4 1.36 12 / 15 /20 1 5 11 .66 12 /14 /20 1 5 0 .48 12 / 14 /20 15 0 .4 4 12 /30 /20 1 5 23 .07 12 /2/20 1 5 14 7 .64 12 / 10 /20 1 5 7.01 Re l e a s e A m o u n t ( $ ) 40 .90 4. 9 4 0 .37 4 .58 20 .75 41 .36 11 . 6 6 12 4 .56 0. 4 8 0. 4 4 0. 9 2 23 .07 23 . 0 7 20 .31 20 .31 7.01 7. 0 1 -. 0.00 0.00 0.00 -4.58 0.00 0.00 0.00 0.00 0.00 0.00 127.33 0.00 011916 HC BOC Page 46 B i l l # Ta x p a y e r Na m e TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : Ot h e r 00 0 0 0 1 0 2 5 0 -20 15- 2 0 1 3 - 0 0 1 1 - 0 0 - R EG TO D D CE C IL E W EL D ING SERV ICE Su b t o t a l Op e r a t o r ID (N a m e ) 12/31 /20 1 4 SH ER R Y LO C K A M Y TA X DI S T R I C T : NO R T H W E S T HA R N E T T RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 2 0 8 7 3 9 3 -20 13-20 1 3 -00 0 0 -00 - R EG FO NTE N O T , J ER E MY WA Y NE 6/ 3 / 2 0 13 YV O NNE MC A R T H UR Su b t o t a l TA X DI S T R I C T : SP O U T SP R I N G S FI R E RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 0 0 463 2 5 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G W EL LS , JO HN T HOMAS 8/ 8 / 2 0 1 5 MA R G A R ET W RIG H T Su b t o t a l TA X DI S T R I C T : SP O U T SP R I N G S FI R E RE L E A S E RE A S O N : Le s s th a n m in am t 00 0 1 7 5 5 8 2 5 -20 1 5 - 2 0 1 5 -00 0 0 -00 -REG EAS T CO A S T BA S EB ALL AC A D EMY 12/ 15 /20 1 5 SH E R R Y U S A - LL C LO C K A M Y Su b t o t a l TA X DI S T R I C T : SP O U T SP R I N G S FIRE RE L E A S E RE A S O N : Mi l i t a r y 00 0 167 8 7 4 0 - 2 0 11- 2 0 1 1 - 0 0 0 0 - 0 0 - REG MA LO NE , SH ER MA INE DE LO N 11 / 1 / 2 0 1 1 ST A C I E TA Y L O R Su b t o t a l TA X DI S T R I C T : SP O U T SP R I N G S FI R E RE L E A S E R E A S O N : S M A L L U N D E R P A Y M E N T 00 0 0 0 6 0 20 1- 20 15-20 1 5 -00 0 0 -00 -R EG W IL SO N, RO BE RT A 8/ 8 / 2 0 1 5 TR A C I FER R ELL 00 0 1 3 8 478 8 -20 0 6 -20 0 6 -00 0 0 - 0 0 - R EG DA V IS, GER RY CUL L E N JR 4/ 2 / 2 0 0 7 YV O N NE MC A R T H U R 00 0 2 0 9 2 9 0 3 -20 13-20 1 3 -00 0 0 -00 - R EG FO R B ES , RO NA LD DA LE JR 7/ 1/20 1 3 YV O NNE MC A R T H U R Su b t o t al PA G E 26 of 27 12 / 10 /20 1 5 6 .66 12 / 10 /20 1 5 1.20 12 /3/20 1 5 24 3 .65 12 / 15 /20 1 5 0. 4 9 12/ 15 /20 1 5 11 . 7 6 12/30 /20 1 5 172 .93 12/ 14 /20 1 5 0.68 12/ 15 /20 1 5 1.81 Re l e a s e A m o u n t ( $ ) 6. 6 6 6.66 0.01 0.01 35 .00 35 .00 0. 4 9 0.49 11 . 7 6 11 . 7 6 0. 0 7 0. 0 2 0. 0 1 0.10 -. 0.00 1.19 208.65 0.00 0.00 172.86 0.66 1.80 011916 HC BOC Page 47 B i l l # Ta x p a y e r Na m e Op e r a t o r ID (N a m e ) TA X DI S T R I C T : SU M M E R V I L L E BU N N L E V E RE L E A S E RE A S O N : Ad j u s t m e n t 00 0 2 1 7 8 4 7 7 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G R C CO N S T R U C T I O N CO IN C 8/ 8 / 20 1 5 SH E R R Y LO C K A M Y Su b t o t a l TA X DI S T R I C T : SU M M E R V I L L E BU N N L E V E RE L E A S E RE A S O N : Fu l l re b a t e 00 0 0 0 0 8 4 0 9 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G BY R D , RO Y H 8/ 8 / 2 0 1 5 SH E R R Y LO C K A M Y Su b t o t a l TA X DI S T R I C T : SU M M E R V I L L E BU N N L E V E RE L E A S E RE A S O N : La n d f i l l er r o r 00 0 0 0 3 3 5 6 6 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G MA T T H E W S , DA V E Y EL M O 8/ 8 / 2 0 1 5 AM Y BA I N Su b t o t a l TA X DI S T R I C T : SU M M E R V I L L E BU N N L E V E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 12 /23 / 20 1 5 12 / 30 /20 1 5 12 / 16 /20 1 5 00 0 0 0 2 1 3 4 2 - 2 0 1 5 - 2 0 1 5 - 0 0 0 0 - 0 0 - R E G GU N N , NA T H A N I E L JR 8/ 8 / 2 0 1 5 CA R O L Y N TA R T 12 /22 / 20 1 5 Su b t o t a l TA X DI S T R I C T : SU M M E R V I L L E FI R E RE L E A S E RE A S O N : SM A L L UN D E R P A Y M E N T 00 0 1 6 6 7 40 4 - 2 0 0 9 - 2 0 0 9 - 0 0 0 0 - 0 0 - R E G CH A N C E , JO H N FI T Z E R A L D 7/ 1/ 20 0 9 YV O N N E 12 /31 / 20 1 5 MC A R T H U R 00 0 1 9 0 0 3 4 4 - 2 0 11 - 2 0 1 1 - 0 0 0 0 - 0 0 - R E G PA T T E R S O N , ST E V E N DO U G L A S 12 / 1 / 20 1 1 YV O N N E 12 / 10 / 20 1 5 MC A R T H U R Su b t o t a l To t a l PA G E 27 o f 27 I 50 . 7 1 72 . 1 5 23 . 0 6 49 . 1 8 0 .35 0 .54 Re l e a s e A m o u n t ( $ ) 4. 5 5 4. 5 5 72 .15 72 . 1 5 0. 0 0 0. 0 0 0 .02 0. 0 2 0 .05 0. 0 1 0 .06 43 , 4 2 6 .03 -. 46.16 0.00 23.06 49.16 0.30 0.53 011916 HC BOC Page 48 Har nett Agenda Item 40 COU N T Y N~O~R~T-H ~C~A~R~O ~LI~N~A ----------------------------------------------------w-ww--.h-ar-ne-tt.-or--g RESOLUTION BE IT RESOLV ED that the Harnett County Board of Commissioners does hereby, by proper execution of this document, request that the North Carolina Department of Transportation add to the State's Secondary Road System the below listed street. Westerfield Farms Subdivision Bedford Road (SR 2480 Extension) Mosby Lane Kirby Smith Circle Duly adopted this 191h day of January, 2016. ATTEST: Margaret Regina Wheeler Clerk to the Board strong roots • new growth HARNETT COUNT Y BOARD OF COMMISSIONERS Jim Burgin, Chairman 011916 HC BOC Page 49 PAT McCRORY Governor NICHOLAS j. TENNYSON Transportation Janu ary 5, 2 016 Mrs. Gi na Wheeler C le rk Harnett Coun ty Board of Commi ss ioners Po st Office Box 759 L illin gton, North Carolin a 27546 Subject : Secondary Road Addition To Whom It May Concern: Secretary This is in refere nce to a petit io n subm itted to thi s o ffice requesting street(s) in Harn ett County be placed on th e State 's Secondary R oad System. Please be advised that these street(s) have been investi gated and our findings a re th at the below li sted street(s) are e li g ible for addition to the Sta te Syst e m . Westerfield Farms Subdivision • Bedford Road (S R 2480 Extens ion) • Mosby Lane • Kirby Smith C ircle It is o ur recommendation th at the above na med street(s) be placed on th e State's Second a ry Road System . If you and your Board co nc ur in o ur recommendation, please submit a resoluti o n t o thi s office. S in ce:J~ a d Plummer Eng in eeri ng Technician ~Nothing Compares ~ State ofNor1h Carolina I Depanment of Transponation 1 Divi sion 6, Di strict 2 600 South em Av enue I Pos t Office Box I I 50 I Fayettevill e, Nonh Carolina 28302 9 10 486 1496 T 011916 HC BOC Page 50 .6 9 z ~1 "- . . . -! > A "'<· ~ l- ' ~ ___. 1 1 2 2 / ~ 2 . 5 8 c ~ ------' ''- - ' l / _/ CU M B E R L A N D COUNTY 011916 HC BOC Page 51 Agenda Item 4 £ Board Meeting Agenda Item MEETING DATE: January 19, 2016 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Department Reorganization REQUESTED BY: Ira Hall, Director of Harnett County Information Technology REQUEST: With recent staff changes, the Information Technology Department is requesting a minor department reorganization to realign positions for our "succession plan" and provide more comprehensive support for the county's core infrastructure. I would like to: 1) transition the Applications Analyst position to the Systems Team and reduce the pay grade from 77 to 75. 2) increase the grade of the Systems Manager position from salary grade 77 to grade 78 to align this position to our succession plan 3) Change our Admin Assistant title to Admin Tech and increased one grade level from 63 to 64 that will correspond with newly assigned technical duties. These transitions will not change the current LT. Department budget. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: C:\Users\gwheeler\AppData\Local\Microsoft\ Windows\ Temporary Internet Files\Content.Outlook\98RKKOE5\agendaform2016 (002).doc I of I Page 011916 HC BOC Page 52 Board Meeting Agenda Item Agenda Item 4F MEETING DATE: January 19,2016 TO: HARNETI COUNTY BOARD OF COMMISSIONERS SUBJECT: Approval of the EMS System Plan Renewal REQUESTED BY: Jimmy Riddle, Emergency Services Director REQUEST: Request for approval of the EMS System Plan Renewal. The EMS System Plan Renewal currently has to be approved by the Harnett County Board of Commissioners. The EMS System Plan describes how Harnett County provides the citizens with 24/7 EMS coverage. The plan includes the individual EMS departments that provide these services including the 911 center. The plan explains the training for our EMS personnel and the staffing of our EMS units. Request for approval to designate the County Manager signature authority for any EMS System Plan renewals or changes forward. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: C:\Users\bstanci i\Ap p Data \Locai\T cmp\agenda fo ml20 16-EMS Pl a n Ren ewa l Approval_ 4508583\agendaform20 16-EMS Pl an Re newal Approval.doc Page I of I 011916 HC BOC Page 53 County of Harnett Emergency Medical Services System Plan Mission To ensure Harnett County citizens, patrons and visitors are provided the highest level of prehospital care in the most efficient, professional and cost-effective manner. 011916 HC BOC Page 54 ~ECTION 1: SYSTEM OVERVIEW a. Harnett County is located in the south central portion ofNorth Carolina. The county is 642 square miles and according to the 20 l 0 census has 114 ,678 citizens. The following counties border Harnett County: Sampson, Johnston, Wake, Chatham, Lee , Moore and Cumberland. b. The following is a list of all providers located in Harnett County, the level of care provided, how it is provided and the square miles of the service area: Anderson Creek EMS -EMT-1 level with combination of paid and volunteers (120 square miles) Benhaven EMS -EMT-1 Level with combination of paid and volunteers (140 square miles) Boone Trail EMS-EMT Level with combination of paid and volunteers (65 square miles) Buies Creek EMS-EMT Level with combination of paid and volunteers (42 square miles) Coats Rescue-EMT Level with combination ofpaid and volunteers (60 square miles) Dunn Rescue-EMT-P Level with combination of paid and volunteers (120 square miles) Erwin Rescue -EMT Level with combination of paid and volunteers (40 square miles) Harnett County EMS-EMT-P Level with paid employees (642 square miles) Lillington Fire -MR Level with combination of paid and volunteers (I 0 square miles) Spout Springs Fire -MR Level with combination of paid and volunteers ( 46 square miles) Each area has 24/7 coverage by Harnett County EMS and/or squad paid and volunteer personnel. c. The following providers are dispatched through the Harnett Central Communications center. Anderson Creek EMS -Harnett Central Communications Center with a Paramedic Benhaven EMS -Harnett Central Communications Center with a Paramedic Boone Trail EMS -Harnett Central Communications Center with a Paramedic Buies Creek EMS -Harnett Central Communications Center with a Paramedic Coats Rescue -Harnett Central Communications Center with a Paramedic QRV Dunn Rescue -Harnett Central Communications Center with a Paramedic ambulance Erwin Rescue -Harnett Central Communications Center with a Paramedic ambulance Harnett County EMS -Harnett Central Communications Center with a Paramedic ambulance Lillington Fire -Harnett Central Communications Center with a Paramedic ambulance Spout Springs Fire -Harnett Central Communications Center with a Paramedic ambulance d. The following specialty care transport programs may be used in Harnett County for the following situations. Harnett County EMS-One wheelchair bus 12 hours a day Monday through Friday. One 24 hour transport unit stationed at Dunn Emergency Services Building. One 24 hour transport unit stationed at Angier Fire Department. Carolina Air Care-911 scene response and patient transports from hospitals in the county. Air unit stationed at 1638 Owens Drive Fayetteville Lat. N 35 01 96 Long. W 78 55 92 2 011916 HC BOC Page 55 Duke Life Flight -911 scene response and patient transport from hospitals in the county Unit located at 2301 Erwin Road Durham Lat. N 36 00 79 Long. W 78 23 24 Unit Located at 3149 Swift Creek Road Smithfield Lat. N 35 32 27 Long. W 78 23 25 Duke Life Care ground ambulance-patient transport from hospitals in the county UNC ground ambulance -patient transport from hospitals in the county Wake Mobile -patient transport from hospitals in the county Wake Air Mobile -911 scene response and patient transports from hospitals in the county Unit located at 3000 New Bern Avenue Raleigh Lat. N 35 47 10 Long W 78 25 19 LifeLink -patient transport from hospitals in the county Vidant Air 2 Services -911 scene response and patient transport from hospitals in the county Unit located at 7265 Air Tenninal Drive Rocky Mount N.C . Lat. N 35 06 55 Long. W 77 03 51 The air medical transport unit will be contacted by the dispatch center per the Harnett County EMS System Policy and Procedures, and the request of the incident commander to proceed to the scene of the accident. The hospitals can also contact air medical transport and ground transport providers for transfers from the hospitals to other facilities. e. Each hospital provides orientation to their employees regarding the receiving of EMS patients. EMS personnel will assist on an as needed basis. The appointed nurse liaison at each hospital will ensure that the orientation and education is provided to the hospital staff. f. Harnett County is fortunate to have available, if the situation arises, several specialty teams that will be dispatched by Harnett Central Communications at the request of the incident commander. The teams available are: 1. Harnett County Dive Team 2. Harnett County Search and Rescue 3. STAR (Special Tactics and Rescue) Team -for confined space and high level rescue 4 . Trench Team-for trench and structural collapse 5. SMA T III Team-for state-wide multi-hazard responses 6 . 2 -Decontamination Teams with equipment 7. g. The following Paramedic QRV ALS zones are established in Harnett County and were created to ensure parity level of patient care to anyone needing assistance in Harnett County: Anderson Creek-Harnett County EMS Paramedic stationed at Flat Branch Fire Department on Anderson Creek Ambulance Harnett County EMS Paramedic stationed at Anderson Creek Fire Department on Anderson Creek ambulance. Angier Fire -Harnett County EMS Paramedic ambulance stationed at the Angier Fire Department 3 011916 HC BOC Page 56 Benhaven EMS -Harnett County EMS Paramedic stationed at Spout Springs Fire Department on Benhaven Ambulance Harnett County EMS Paramedic stationed at Benhaven Station 1 on Benhaven ambulance Boone Trail EMS -Harnett County EMS Paramedic stationed at Boone Trail station I on Boone Trail ambulance. Buies Creek Fire -Harnett County EMS Paramedic stationed at Buies Creek Fire Department on Buies Creek Ambulance Coats Rescue-Harnett County EMS QRV Paramedic stationed at the department Dunn Rescue -Paramedic on first & second out Ambulance during day hours and QRV Paramedic at night Erwin Rescue -Dunn Paramedic on Erwin ambulance stationed at Erwin Fire Department Harnett County EMS -Paramedic Ambulance at the North Harnett Fire station. Lillington Fire-Harnett County EMS Paramedic Ambulance at the Flatwoods station Harnett County EMS-Paramedic Ambulance/QRV at EMS Base in Buies Creek h. See Section VI -Data Collection regarding Data Collection for Harnett County. 1. Overall management of the Harnett County EMS System include: I. Patients will be triaged and transported to the appropriate facility, if the closet facility is not indicated. An example will be a psychiatric patient experiencing a psychiatric crisis will be transported to appropriate facility because that facility provides psychiatric services. 2 . The Harnett County EMS System transports to fifteen different hospitals. We have two hospitals in Harnett County. In order to reach the other facilities, the county line is crossed. Any of these facilities are appropriate transports for the system due to proximity and also patient preference. Hospitals that we routinely transport to are: Harnett Health Betsy Johnson Dunn, Harnett Health Central Harnett Lillington, Wake Medical Center Raleigh,Cary&Apex, Rex Health Care Raleigh, Duke Health Raleigh & Durham, Central Carolina Hospital Sanford, UNC Hospital Chapel Hill, Cape Fear Valley Fayetteville, Womack Army Hospital Ft. Bragg, Johnston Medical Center Clayton & Smithfield, First Health Moore Regional Pinehurst. 3. The local hospital has a diversion policy. If diversions are needed it is entirely a case by case basis in which the hospital will arrange the receiving of the patient that was intended for hospital A and needed to be transported to hospital B. 4. Harnett County has an established goal of 10 minute or less response time for calls within the county. This is monitored on a monthly basis by the system. 4 011916 HC BOC Page 57 5 . See attached Harnett County Disaster Plan & Harnett County Mass Gathering Plan 6 . Harnett County provides paramedic stand-by coverage for any and all public requests if the service is needed or desired. Examples include sky diving events, Fourth of July celebrations, high school football games, etc. J. Harnett County is involved in several injury prevention and community health programs. Agencies involved in these programs include: Harnett County Sheriffs Department, Dunn Police Department, Angier Police Department, Lillington Police Department, Harnett County Emergency Services, Dunn Rescue Squad, Coats Fire and Rescue, Erwin Fire and Rescue and various other organizations within the county. k. The Harnett County EMS System is an active member of the Caprac Trauma Regional Advisory Committee. See attached Zeller confirming membership. I. The Harnett County EMS System has participated in several studies that have been sponsored by the Capital Trauma RAC in which the data was reviewed and incorporated as needed in the patient care protocols. 5 011916 HC BOC Page 58 Section II: Communication A. Accessing the 911 system 1. Harnett Central Communications Center is presently using Enhanced 911 system. At the present time the center has (6) 9111ines and one seven-digit lines. All of the 911 lines and seven digit lines are taped and all have rollovers. The center can receive up to (6) 911 calls and (6) calls on the seven digit lines simultaneously. Calls are routed to Harnett Central from the various parts of the county that the center covers by selective call routing. This is important because some areas of the county are on the Sanford, Fayetteville, Raleigh, Johnston County, Sampson County, Lee, or Moore County telephone exchanges and these 911 calls would not be received at Harnett Central Communications without this technology. If calls are received by other communications they are transferred directly to Harnett Central Communications via a seven digit emergency number. All callers will talk directly with a telecommunicator in the communications center and will never be required to speak with more than two persons to request emergency assistance. In some cases, Harnett Central Communications receives calls that should have been routed to one of the out of county communications centers Harnett Central Communications transfers these calls to the appropriate communications center. Emergency calls are typically transferred directly between the communications centers with the telecommunicator who took the call at the receiving center staying on the line until the call is taken at the correct center. Harnett Central Communications has a language line through Fluent Language Solutions that handles any language that they may encounter. B. Functions of the Communications Centers 7 011916 HC BOC Page 59 1. Harnett Central Communications Center is a division of the Harnett County Sheriff's Department. Staffing presently consists of one Communications Supervisor. There are twenty six telecommunicators that are NC EMD's. All telecommunicators are trained to dispatch Fire/EMS calls or law enforcement calls. There are four to five EMD telecommunicators on duty at all times, one for Fire/EMS, one for the Harnett County Sheriff's Department, and one for the five municipal police departments also dispatched by Harnett Central . All telecommunicators are required to obtain the EMD credentials and are cross- trained in all areas. In addition, the communications supervisor is available Monday-Friday from 0700 -1800 to assist with dispatching duties if needed. C. Dispatch of Emergency Resources 1. The Communications Center uses the Medical Priority Dispatch System, version 12.2 to dispatch initial EMS calls and mutual aid EMS calls. The Communications Center use the call determinates to determine what resources respond to each call. 2 . See attached policy for dispatching other mutual aide and specialty equipment/resources to calls. D. Communications Hardware/Frequencies 1. All transport and QRV units have the capabilities of contacting each facility that a patient may be transported ~o via the State Viper system. As a backup, each unit has a cellular phone to contact the facility if needed. 2 . Harnett Central Communications is currently using the State Viper system as their primary means of radio communications. Harnett Central Communications Center can communicate directly with Fire/EMS/Police via the Viper system. Harnett Central maintains VHF capabilities on 155 .760 and 154.205 for the purpose of dispatching. Harnett Central Communications 8 011916 HC BOC Page 60 has a backup generator at their center and at each communications tower in the event of a power outage. In the event of a natural disaster, Harnett Central Communications Center will be moved to Harnett County Emergency Services center or the backup center located in Clayton, which is in Johnston County. The phone company will switch the phone lines to Harnett County Emergency Services Center for the 911 system and the communications center functions as they normally do in their communication center. 3. Attached you will find copies of letters from Harnett Central in regards to their FCC radio licenses. They chose to write a letter due to the number of licenses they have to have to function. E. Communications Committee's 1. The Harnett County Chiefs Association formed a committee that involves ns, Harnett Central Communications Centers and representatives of all Emergency Services in Harnett County. This committee reviews all operations of communications. 2. There is a Communications Sub-Committee formed to address all technical problems that arise with the communications hardware. F. Quality Management Harnett Central Communications center performs monthly quality management reviews to address any trending problems and training concerns that will improve the communication process. 9 011916 HC BOC Page 61 ~ECTION III: MEDICAL OVERSIGHT A. The Harnett County Board of Commissioners will appoint the Medical Director of the Harnett County EMS System. The Medical Director of the system shall meet the required criteria defined in the ''North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection." Dr. Mark Glaser is the current Medical Director for the Harnett County EMS System. Dr. Glaser is a certified diplomat with the American Board of Emergency Medicine. Dr. Glaser. See attachments (American Board of Emergency Medicine letter dated December 27, 1996, Current Medical License with expiration date of 8/9 /2016, Several certification cards, Copies of Certificates of Continuing Medical Education, Copy of Certificate of Attendance for NC EMS Medical Directors Course and Update on Domestic Preparedness, Copy of letter from Harnett County confirming appropriate medical liability coverage for Dr. Glaser, copy_ of letter from Dr. Glaser addressing NCCEP requirements,_ Dr. Glaser can be reached at: Harnett County Emergency Services Center 910-893-7563 910-814-2570 (fax) B . The Medical Director will be responsible for the following: (1) Ensure that medical control is available 24 hours a day (See Section III -G) (2) The establishment, approval and updating of treatment protocols as required. (See Section VII-F) (3) For the EMD program, establishment, approval and annual updating of the program. (See Section VII-F) (4) Medical supervision ofthe selection, system orientation, continuing education, and performance of EMS personnel. (See Section VII -and V -AI) (5) Medical supervision ofthe scope of practice performance evaluation for all EMS personnel in the system based on the treatment protocols for the system. (See Section V -AI and VII -B) (6) The medical review of care provided to patients. (See Section III -Eii) (7) Provide guidance regarding decisions about equipment, medical supplies, and medications carried on ambulances and QRV's. (See Section IV -F) (8) Ensure the care provided is up to date with current medical practice. (See Section Ill -A. VII -F) 13 011916 HC BOC Page 62 C. All ALS providers will function within the protocols established by the Harnett County EMS System. All EMD dispatchers will follow the protocols established by the Harnett County EMS System for EMD's. The EMS System policies, procedures and protocols are adopted following the NCCEP document guidelines . The Medical Director can suspend temporarily, pending due process review, any EMS personnel from further participation in the EMS system when it its determined the activities or medical care rendered by such personnel may be detrimental to the care of the patient, constitute unprofessional behavior, or result in non-compliance with privileging requirements. Due process consists of review and action by the Peer Review Quality Management committee or sub-committee (Peer Review Performance Sub-Committee). D. Harnett County Peer Review Quality Management Committee consists of the following voting representatives: 1) Medical Director (Chairman) 2) ED Physician from Harnett Health Hospital or Physician Representative 3) Nurse Liaison from Harnett Health Hospital 4) Harnett Health Hospital Representative 5) Harnett County Manager 6) A designated County Commissioner 7) EMS Provider -a representative from each provider Exofficio members include: County Attorney , Representative from Central Carolina Community College, Chief of Staff from Harnett Health Hospital and a representative from Harnett County Emergency Management. 1. The committee will meet a minimum of four times a year and more often if needed. Each department will perform I 00% quality assurance review. Each training officer will report the statistics and results of the designated review determined by the Medical Director with recommendations by the training officer. The information will be reported to the Peer Review Quality Management Committee. Each provider 14 011916 HC BOC Page 63 in the system has data points assigned by the Medical Director that are reviewed on a quarterly basis. The results of the data points are reported to the Systems Continuing Education Coordinator and Medical Director. The results are also presented to the Peer Review Quality Manage ment Committee. The acceptable percentage goal for compliance is 90% or above. The data points can be changed at the discretion of the Medical Director when the percentage goal is met. If the compliance is less than 90%, the provider will review these data points again for the next quarter and be recommended to cover these data points in there continuing education by the Medical Director. Harnett County will have a Critical Intervention Peer Review Sub-Committee responsible review of all critical interventions in the Harnett County EMS System. This sub-committee is tasked with reporting their findings to the Medical Director with any recommended actions or remediation. The Medical Director will then report these findings to the Peer Review Quality Management Committee at each quarterly meeting. This committee will consist of one EMT-Paramedic from each Paramedic provider under the medical oversight of the Harnett County EMS System approved by the Medical Director. The following guidelines are established for the Due Process procedure for the Peer Review Performance Sub- Committee. Members of the Peer Review Performance Sub-Committee include: • ALS Medical Director (Chairman) • County Attorney • Peer Review Quality Management Committee Medical Physician (One of the ED physicians) • An EMT-Paramedic from each Paramedic provider (minimum of one EMT-P) This committee will meet on an as needed basis . The decisions made by this subcommittee will be considered final. The following will apply to the Peer Review Performance Subcommittee a . A simple majority of the committee must be available to hold a com.mittee meeting. b. The Medical Director or his/her designee must be present at the meeting. 15 011916 HC BOC Page 64 c. Individuals required to appear before the committee will be notified as soon as possible and will be accompanied to the meeting with the chief or director of their agency/provider. d. If the individual requested to appear before the committee is not present the committee will meet and take appropriate action. e. The individual will be given the opportunity to discuss the details of the questioned action and the committee can ask appropriate questions of the individual. f. The committee will review and discuss the findings and make a decision. If possible the individual will be informed of the decision at the time of the meeting. In the event that a decision cannot be made at the time of the meeting, the chairman will notify the individual as soon as possible, either by phone or in person. g. A written summary will be provided to the individual and their chief officer. h. Minutes of the Peer Review Performance Subcommittee meeting will be maintained and regarded "confidential." u. The Peer Review Quality Management Committee meeting minutes will be maintained by the EMS system and maintained at the department designated by the Medical Director. That location is Harnett County Emergency Services Center. All documents and meeting minutes of all committees are considered confidential and can only be reviewed by committee members. Each committee member for the Peer Review Quality Management Committee is appointed by each agency listed. The Peer Review Quality Management Committee officers will be appointed by the Harnett County Board of Commissioners and/or the Medical Director (chairman of the committee). The length of term on the Peer Review Quality Management Committee is ongoing/continuous. There are no established requirements regarding attendance. A simple majority of the Peer Review Quality Management Committee must be available to conduct business. 16 011916 HC BOC Page 65 E . On-line medical direction will be provided to EMS personnel as follows: • On-line medical direction is restricted to medical orders that fall within the scope of practice of EMS personnel in the approved treatment protocols for the Harnett County EMS System. • Physicians, EMS-physician assistants or EMS -Nurse Practitioners provide on-line medical direction . Only physicians may deviate from th e written treatment protocols for the Harnett County EMS system. • On-line medical direction will be provided by two-way voice communication that is maintained throughout the entire patient encounter. F . Harnett Health Hospitals will provide online medical direction for the Harnett County EMS system. Each facility has a physician, EMS-physician assistant or EMS-Nurse practitioner available 24 hours a day . A physician is available for back up to the EMS-PA and EMS-NP to provide on-line medical direction. Each hospital will have a representative as a voting member on the Peer Review Quality Management Committee that will be able to provide feedback to the committee. The representative for each hospital will ensure that each person responsible for providing on-line medical direction will be provided current and up to date treatment protocols for the Harnett County EMS System. 17 011916 HC BOC Page 66 SECTION IV: VEHICLES, EQUIPMENT, SUPPLIES A. The Harnett County EMS System has 29 permitted ambulances and 7 permitted QRV 's stationed strategically throughout the county to provide 24-hour EMS coverage. Each provider in the Harnett County EMS System is responsible for providing maintenance on the permitted units for their department. It is the responsibility of each EMS provider to maintain their maintenance records, and keep these on file for the length of time the vehicle is in service. B. Documentation of permitted ambulances is on file at the Harnett County EMS office. C . See attached Harnett County EMS System Occupational Exposure to Bloodborne Pathogens and Tuberculosis Exposure Control Plan (January 2013 version). All providers in the Harnett County EMS System are required to take the established Department of Insurance Emergency Vehicle Driving Course. Records are maintained by each departments training officer and on file at the Harnett County EMS office. All EMS personnel privileged at the MR or above level in the Harnett County EMS System are allowed to drive permitted vehicles. The curriculum/training is provided by Central Carolina Community College. The Harnett County EMS System has a standardized minimum supply and equipment list for all permitted ambulances and QRV's. The lists are reviewed and approved by the medical director on an annual and as needed basis. The list is attached for each level of care provided. D. It is the responsibility of each EMS provider to keep all units clean and properly maintained at all times. Daily inspections are done on all first line units. This ensures that no medications or equipment are expired on each unit. This is documented on a daily inspection sheet that is maintained at each provider's base of operations, for a minimum of 30 days. 18 011916 HC BOC Page 67 Harnett County EMS System will store all medications in a temperature-controlled atmosphere according to manufacturer specifications. Examples of how to accomplish this when necessary are: Leave trucks running at the hospitals but not in front of access doors or under canopies at access doors, take drugs off vehicles with keys attached to the drug bags or boxes and temperature control when cold with heated bays which every provider in the Harnett County EMS System has available, etc. 19 011916 HC BOC Page 68 SECTION V: PERSONNEL A. Privileging for EMS Personnel 1. Individuals that will enter into the Harnett County EMS System must meet the following criteria before functioning in the Harnett County System. a. Provide proof of current continuing education hours. b. Provide a current State certification at the level they will function in the system. c . EMT-Paramedics will show proof of ACLS, ITLSIPHTLS, and PALSIPEPP and CPR or provide proof of completing topics and skills. d. EMT -I and EMT -P are required to complete a written/skiJls/performance review at the level the individual will be privileged in the Harnett County EMS System. EMD, EMR, & EMT -level personnel may be privileged by the Training Officer at their department. This is at the discretion of the Medical Director. Procedures for privileging these individuals are contained in the document entitled: "Educational Guidelines and Training Officers Resource". e. After successful completion of the skills evaluation, and performance review the EMD, EMR, EMT, will be allowed to function in the Harnett County EMS System. f. After successful completion of written examination, ski Us evaluation, oral boards, and performance review the EMT-1 will be required to precept in the field under the supervision of an approved preceptor/field training officer. The amount of calls that will be successfully completed will be determined by the Medical Director. If the evaluations reflect that an individual needs additional remediation it will be assigned by the Medical Director. 20 011916 HC BOC Page 69 The amount and/or details of such remediation will be at the discretion of the Medical Director. g. After successful completion of the written examination, skills evaluation, oral boards, and performance review the EMT-P will be required to precept in the field under the supervision of an approved system preceptor/field training officerl The amount of calls that will be successfully completed is at the discretion of the Medical Director. If the evaluations reflect that an individual needs additional remediation it will be assigned by the Medical Director. The amount and/or details of such remediation will be at the discretion of the Medical Director. h . All EMT-1/EMT-P will be required to complete performance evaluations on each call for the quantity assigned by the Medical Director, once complete, the evaluations must be turned into the Systems Continuing Education Coordinator for review and approval by the Medical Director. The EMT-1/EMT-P and EMS provider will receive a written letter from the Medical Director confirming satisfactory/unsatisfactory completion of all requirements for the Harnett County EMS System. l· See attached: Personnel Verification Form; Privileging/Re- Privileging; Current Harnett County EMS System Roster k . These individuals will have 6 months to complete this process or they may or may not repeat this entire process at the discretion of the Medical Director. 2. Approved Preceptor/Field Training Officer 1. EMT -I Preceptor must have the following: a. A minimum of one year of field experience a s an EMT -I. b . A minimum of six months field experi ence as an E MT-I in the Harnett County EMS System. c . Attendance at an approved preceptor's workshop. d. Approval by the Medical Director. 21 011916 HC BOC Page 70 e. Approval by the provider Chief or Director. 2. EMT-P Preceptor/Field Training Officer must have the following: a. A rninimwn of one-year field experience as an EMT-P. b. A minimum of six months field experience as an EMT-P in the Harnett County EMS System. c. Attendance at an approved preceptor's/Field Training Officer Workshop . d . Approval by the Medical Director. e . Approval by the provider Chief or Director. 3. Maintaining Preceptor/Field Training Officer Status a. All preceptors/field training officers must attend a preceptor's/FTO workshop annually . b. All preceptors/FTO must remain certified at their present level. c. All preceptors/FTO must maintain good standing with the Medical Director and EMS System 1• d . All preceptors/FTO must maintain approval by the provider Chief or Director to function as a preceptor. B. Training Officer Requirements I. In order to be eligible to serve as a Training Officer in the Harnett County EMS System, the candidate must: a . Be privileged at the highest certification level provided by his or her EMS Agency . b. Have 2 years of field experience (at the highest level of certification provided by the EMS agency). c. Have 1 year experience in the Harnett County EMS System d. Remain in good standing within the system. 22 011916 HC BOC Page 71 e. Be familiar with the Educational Guidelines and Training Officers Resource Manual. f. Attend an orientation on the Educational Guidelines and Training Officers Resource Manual. g . Be familiar with the Education Section of the Harnett County EMS Systems Plan. h. Be available for meetings such as Peer Review , Training Officers meetings or unscheduled but necessary meetings or training sessions (as needed). C. Staffing Requirements Each provider will ensure that their service area is covered 24 hours a day by properly privileged personnel in the Harnett County EMS System. See attached Harnett County EMS provider contract. D. Non-Traditional Practice Settings At the present time the Harnett County EMS System will not use EMS personnel in a non-traditional practice setting. 23 011916 HC BOC Page 72 SECTION VI: DATA COLLECTION 1. All providers in the Harnett County EMS System are reporting the data points that are required by the NCCEP document by January 1, 2005. The Harnett County EMS System has software that meets the Model system requirement for transmitting the data required by OEMS. Each EMS provider in Harnett County utilizes EMS Charts which exports this data to PreMis every 24 hours. 2. This data will be available for the Harnett County EMS Medical Director daily at the Harnett County EMS office. 3. The original PCR reports, (digital or paper), are to be maintained a minimum of 12 years at each individual provider. 25 011916 HC BOC Page 73 SECTION VII: EDUCATION A. Continuing Education 1. The Medical Director will provide requirements for continuing education. Each provider will have a designated training officer who will maintain the training at each department. The training officer will select topics to be covered in continuing education for the department following guidance from the National Education Standards and Scope of Practice model as well as educational requirements set in rule by the NCOEMS. These topics will be submitted to the Medical Director for approval annually. The continuing education schedule will follow the January 1 -December 31 calendar. The continuing education will be handled through a state approved teaching facility (i.e. Central Carolina Community College), and will be coordinated by a Level 1 instructor. In-house education will be accepted through the approved Teaching Facility as long as the instructor requirements are met and the Medical Director has approved the offering. The training officer will be able to make changes to the continuing education schedule if the need arises due to needs identified during Peer Review, but must be approved by the Medical Director before the changes are made. The procedure a training officer should follow when altering the continuing education schedule is outlined in a docwnent entitled: "Educational Guidelines and Training Officer's Resource". Protocol 26 011916 HC BOC Page 74 updates and/or new skills, equipments and/or drug_changes are included in continuing education and will be added to the schedule on an as needed basis. 2. EMR, EMT, EMT-1 and EMT-P level personnel must have 24 hours of continuing education per year, and attend classes covering content specified by the National Education Standards, Scope of Practice Model and educational requirements as set by the NCOEMS. EMD level personnel must have 18 hours of continuing education per year. 3. Continuing education hours may be awarded through a variety of traditional and non-traditional methods. (i.e. seminars, conferences, professional meetings, peer review and other methods approved by the Medical Director). All EMS personnel are encouraged to attend classes, conferences or seminars to promote professional development for the individual. Individuals that work or volunteer in other EMS systems can provide their continuing education hours to the department training officer and receive credit. All mandatory educational offerings identified as Harnett County specific must be attended in Harnett County classes unless otherwise approved by the Medical Director. 4. The Medical Director will maintain the continuing education requirements set forth by the NCCEP standards and will be required to attend the Medical Directors Update annually as offered by the NCOEMS. The Medical Director will also stay up to date on topics that are relevant to the prehospital setting. The Medical Director will provide copies of all 27 011916 HC BOC Page 75 continuing education to the Systems Continuing Education Coordinator, which will be entered into the Harnett County EMS system database. The Medical Director will respond to EMS calls in the system as required by the NCCEP and NCOEMS rule. 5. The Training Officers from each department will submit the continuing education schedule by December 1st of each year to the Medical Director for review and approval. A copy of schedules for each department will be available so providers may attend classes throughout the County if needed. If a change is needed in the schedule the Training Officer will submit the change to the Medical Director for approval and forward the information to the other providers in the system. 6. The Education Committee and Medical Director will review the continuing education program on an annual basis. The Education Committee is comprised of all department training officers in the Harnett County EMS System and the Medical Director. The Chairman of the Committee is the Systems Continuing Education Coordinator. The committee meets at least annually or on an as needed basis. This committee develops educational goals and reviews all continuing education programs for the Harnett County EMS System. 7. The educational goals of the Harnett County EMS System will be consistent with the National Education Standards, Scope of Practice Model and Educational requirements set by the NCOEMS. Instructors delivering education in the system are expected to be qualified and 28 011916 HC BOC Page 76 approved through the State approved Teaching Facility and the system Medical Director. The quality of educational offerings is important and we encourage students to provide feedback through the System Continuing Education Coordinator and/or approved Teaching Facility. B. Re-Privileging 1. The educational hours of all EMS Personnel will be reviewed annually. It is the policy ofthe Harnett County EMS System that if an individual is deficient in hours the individual will be contacted and given a designated period of time to become current with the hours. If the individual does not meet the annual 24 hour (18 hours for EMD) continuing education requirements the Medical Director may suspend the individual from the EMS System until the hours are made up. If this occurs more than once in a four year period the Education Conunittee will review the situation and make recommendations to the Medical Director for his/her decision about the individual continuing to participate in the Harnett County EMS System 2 . All EMS personnel will be required to successfully complete a scope of practice performance evaluation during their credential period. The scope of practice performance evaluation can be assessed through a variety of methods including; simulated patient scenarios, classroom skill reviews and/or through the peer review and performance improvement program (i.e . review of actual call performance). Most ofthe scope of practice performance evaluations will be completed in the course of regularly scheduled training sessions, however 29 011916 HC BOC Page 77 additional sessions will be held as needed. The Medical Director can require any provider to complete a scope of practice performance evaluation at his/her discretion. The individual must be up to date with the continuing education requirements at the time of recredentialing (24 hours per year and all topics mandated by the EMS System and/or educational standards). 3 . The department Training Officer will assess clinical skills and complete and maintain skilVscenario checklists for each individual when applicable. Clinical skills can be assessed using a variety of methods including; simulated patient scenarios, classroom skill reviews and/or through the peer review and performance improvement program (i.e. review of actual call performance). 4 . The scope of practice performance evaluation will be assessed using protocol- based modules (simulated scenarios or "on call" performance review). The scope of practice evaluation should incorporate the recommended baseline skills for each credentialing level as outlined in the North Carolina College of Emergency Physicians Standards for EMS Patient Care Procedures (Skills) and Protocols. Below are a list of simulated and/or performance review based scenarios that will be assessed: EMD Scope of Practice Evaluation -Emergency Medical Dispatchers will be expected to demonstrate their ability to successfully manage the following scenarios using the approved card sets: a . Chest pain b. Cardiac Arrest (medical, trauma or pediatric) c . Dyspnea d . Normal or Abnormal Childbirth e . At least one of these performance evaluations must be on a pediatric patient. 30 011916 HC BOC Page 78 EMR Scope of Practice Evaluation -Emergency Medical Responders will be expected to demonstrate their ability to successfully manage the following patient events: a. Cardiac Arrest (medical, trawna or pediatric) b. Dyspnea c. Musculoskeletal (Fracture or Dislocation) d. Spinal Injury (with or without neurological deficit) e. At least one of these performance evaluations must be on a pediatric patient. f. System allergic reaction utilizing EPI IM protocols/procedures (Annually) EMT Scope of Practice Evaluation -EMTs will be expected to demonstrate their ability to successfully manage the following patient events: a. Cardiac Arrest (medical, trawna or pediatric) b. Dyspnea c. Musculoskeletal (Fracture or Dislocation) d. Spinal Injury (with or without neurological deficit) e . Systemic Allergic Reaction utilizing EPI IM protocols/procedures (Annually) f. At least one of these performance evaluations must be on a pediatric patient. EMT -Intermediate Scope of Practice Evaluation-EMT -Intermediates will be expected to demonstrate their ability to successfully manage the following patient events: a. Chest pain b. Cardiac Arrest (medical, trawna or pediatric) c. Altered Mental Status/Sy ncope /Seizure d. Dyspnea e. Systemic Allergic Reaction f. At least one of these performance evaluations must be on a pediatric patient. Paramedics Scope of Practice Evaluation -EMT -Paramedics will be expected to demonstrate their ability to successfully manage the following patient events: a. Chest Pain b. Cardiac Arrest (medical, trawna, pediatric) c. Altered Mental Status/Syncope/Seizure d . Dyspnea e. Systemic Allergic Reaction f. At least one of these performance evaluations must be on a pediatric patient. 31 011916 HC BOC Page 79 There will be an evaluation form done for each scenario and a skills sheet completed when applicable. If the individual does not successfully complete the scope of practice performance evaluation the individual will be remediated at another time by the Training Officer and scheduled a time with the Medical Director and/or his/her designee to complete the scope of practice evaluation. 5 . EMD, EMR, & EMT -level personnel may be privileged/re-privileged by the Training Officer at their department in conjunction with the State Teaching Facility after all requirements have been met. 6. Forms, procedures and regulatory information concerning Continuing Education and Re-privileging are contained in the docwnent entitled: "Educational Guidelines and Training Officer's Resource". Nothing in this manual will conflict with any part of the EMS Plan. 7 . For EMT-1/EMT-P levels, after successful completion ofthe educational requirements the department Training Officer will complete the Harnett County Certification Verification form with the provider, which will be forwarded for approval by the Medical Director and processed for State re-credentialing. 8. Recredentialing materials must be completed and forwarded to the State approved Teaching Facility in a timely manner. All materials are expected to be submitted for review by the Medical Director no later than the 30 days prior to the provider's expiration date. 32 011916 HC BOC Page 80 C. Training Officers 1. Each Department Training Officer will maintain and make available upon request (or as scheduled) to the EMS Systems Office the following : a. Continuing Education topics/hours b. Peer Review and Performance Improvement data by the 15th working day of the month prior to the Peer Review meeting c . Updated rosters (additions and deletions) 2. It is required that the Training Officer maintain a record of all education at each department. This information will be available for audit by NCOEMS, Harnett County System Continuing Education Coordinator, Harnett County System Coordinator and the Medical Director only. 3. It is required that department Training Officers (or other designee) maintain an up to date roster in the State CIS database and local Electronic Patient Care Reporting system. D. CHnical & Field Internship Clinical and field internship~ are available for individuals in the Harnett County EMS System. This internship can be done at Dunn Emergency Services, Harnett County EMS, Harnett Health System Hospitals or any other site that is pre- approved by the Medical Director and/or his/her designee. The internship will be determined based on the needs of the CE program, initial class requirements or individual need. The Medical Director will appoint a designee that will be the 33 011916 HC BOC Page 81 contact for scheduling the internship at departments and at the local hospitals. The internships will be done when an individual enters the Harnett County EMS System, when personnel display problems with patient care, have been out of the system for 6 or more months and any others at the discretion of the Medical Director. The individual will have performance evaluation forms and will be assigned to an FTO/approved preceptor for evaluation. Individuals may also be evaluated in the clinical setting with the forms being completed by the nurse observing the skill(s). Once the performance requirement(s) are completed the individual will turn the packet into the EMS Systems Office (Harnett County EMS) for review. It will be determined if the individual can be released to function in the Harnett County EMS System after review by the Medical Director or his/her designee. The EMT-1/EMT-P will receive a written letter from the_Medical Director confirming satisfactory/unsatisfactory completion of all_requirements for the Harnett County EMS System. E. System Continuing Education Coordinator The Harnett County System Medical Director and or Harnett County System Administrator will appoint the Systems Continuing Education Coordinator. All continuing education schedules will be reviewed by the Systems Continuing Education Coordinator and forwarded to the Medical Director for approval. The Systems Continuing Education Coordinator is responsible for review of all educational components of the Harnett County EMS System. The Systems 34 011916 HC BOC Page 82 Continuing Education Coordinator will conduct audits for all personnel in the Harnett County EMS System to ensure they continue to meet the educational and clinical components for the system. Any discrepancies noted will be reported to the Medical Director. The Systems Continuing Education Coordinator will assist department Training Officers as needed in developing their educational goals based on feedback from system EMS Care data and evaluation of patient outcomes and quality management peer reviews. As well, assuring requirements set by the Medical Director are implemented into the Education Standards. 35 011916 HC BOC Page 83 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 12707 Mail Service Center 1 Raleigh , NC 27603-20081 Phone : (91 9) 855-39351 Fax : (919) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Elfec:tive: 611/2014 This application is for renewal of a current EMS Provider License only. Each highlighted section must be completed . Information in the Credentialing Information System (CIS) must be current prior to application submission . Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fixed-wing providers), and County Manager (if applicable) are required. Renewals must be submitted at least thirty (30) davs prior to expiration to the appropriate regional office indicated below. GENERAL INFORMATION Provider Name: Coats Grove Fire & Rescue Office Number: (910) 897-7575 Physical Address: 91 N. Mckinley Street Fax Number: (910) 891-4174 City: Coats State: NC Provider Admin Contact: Jay Smith County: Harnett Zip: 27521 Title: Chief Mailing Address: PO Box 835 Office Number: (910) 897-7575 City: Coats State: NC Mobile Number: (910) 984-4705 County: Harnett Zip: 27521 Fax Number: (910) 891-4174 PROPERTIES E-mail Address: district6dc@charter. net f 'ce Level: EMT-Basic System Affiliation: Harnett - Provider Number: 0430392 Provider Lie No: 1285 License Exp. Date: I Jan 31, 2016 Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below : CENTRAL EASTERN wesTERN Central Regional Office of EMS Eastern Regional Office of EMS Western Regional Office of EMS 801 Biggs Drive 404 St. Andrews Drive , Suite 7 3305 16"' Avenue SE, Suite 302 2717 Mail Service Center Greenville, NC 27834-6850 Conover, NC 2861~9213 Raleigh, NC 27699-2717 Office : (2 52) 355-9026 Office: (828) 466-5548 OffiCe : (9 19) 855-4678 Fax: (2525) 355-9063 Fax : (828) 466-5651 Fax: (919) 715-0498 BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST FffAt'JiYAR/11?014 011916 HC BOC Page 84 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 10A NCAC 13P .0204 (a) Any firm. corporation. agency, organization or association that provides emergency medical services shall be licensed as an EMS Provider by meeting and continuously maintaining the following criteria: 10A NCAC 13P .0204 (a)(1) Be affiliated as defined in Rule .0102(4) of this Subchapter with each EMS System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport within the system; ENTER SYSTEM NAME: Harnett County 10A NCAC 13P .0204 (a)(2) Present an application for a permit for any ambulance that will be in service as required by G.S. 131E-156; 10A NCAC 13P .0204 (a)(3) Submit a written plan delailing how the EMS Provider will furnish credentialed personnel; We provide 24 hour paid staff to staff the first duty crew ambulance. We supplement second duty crew with our roster of EMT volunteers. BRIEFLY DESCRIBE HOW EMS PROVIDER WILL FURNISH CREDENTIALED PERSONNEL: Where there are franchise ordinances pursuant to G.S 153A-250 in effect that cover the proposed service areas of each EMS system of operation, show the affiliation as defined in Rule .0 102(4) of this Subchapter with each EMS System. as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1) of this Rule, by being granted a current franchise to operate, or present written documentation of impending receipt of a franchise , from each county. In counties where there is no franchise ordinance in effect , present a signature from each EMS System representative authorizing the EMS Provider to affiliate as defined in Rule .0 102(4) of this Subchapter and as required by Paragraph (a)(1) of this Rule; DOES COUNTY HAVE A FRANCHISE ORDINANCE? (e) YES ()NO IF YES, IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a)(5) Provide systematic, periodic inspection, repair. cleaning, and routine maintenance of all EMS responding ground vehicles and maintain records available for Inspection by the OEMS which verify compliance with this Subparagraph ; Ambulances are restocked after each call and the first out ambulance is checked for BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS inventory daily, the second out ambulance is checked off every Monday and Thursday. THIS REQUIREMENT TO INCLUDE HOW UNITS ARE Also mechanical checkoffs are performed and recorded. These records are kept for 3 CLEANED, MAINTAINED, AND REPAIRED : years or 1 year after retirement of vehicle . Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary 10A NCAC 13P .0204 (a)(6) as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection ," incorporated by reference in accordance with G.S. 1508-21 .6 . incl uding subsequent amendments and additions. We are currently entering and submitting all EMS calls on EMS Charts and is done on a BRIEFLY DESCRIBE HOW EMS PROVIDER routine basis MEETS THIS REQUIREMENT: . Develop and implement written operational prolocols for the management of equipment. supplies and medications and 10A NCAC 13P .0204 (a)(7) maintain records available for inspection by the OEMS which verify compliance with this Subparagraph. These protocols shall include a methodology : 10A NCAC 13P .0204 (a)(7)(A) to assure that each vehicle contains the required equipment and supplies on each response ; Ambulances are restocked after each call. First out ambulance is checked daily and BRIEFLY DESCRIBE HOW EMS PROVIDER second out ambulance checked on Mondays and Thursdays MEETS THIS REQUIREMENT: 10A NCAC 13P .0204 (a)(7)(B) for cleaning and maintaining the equipment and vehicles; and Ambulances are sanitized and cleaned after each call and the first out ambulance is BRIEFLY DESCRIBE HOW EMS PROVIDER checked for maintenance daily and the second out is checked on Mondays and MEETS THIS REQUIREMENT: Thursdays. Vehicles are serviced at required intervals by local mechanic shop, Angier Tire and Auto in Angier, NC 1 OA NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored in a tempera ture controlled atmosphere according to manufacturer's specifications. All inventory with date expirations are examined before use and during the written BRIEFLY DESCRIBE HOW EMS PROVIDER checkoffs. Ambulances are kept in a temperature controlled bay when not on calls and all MEETS THIS REQUIREMENT: excess inventory is kept in a temperat ure controlled room prior to being put in service on the ambulance. BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION U PON REQUEST EMS Provider License Renewal OHHS/D HSRIOEMS 4913 Page 2 of 3 Effective 611/2014 011916 HC BOC Page 85 10A NCAC 13P .0204 (a)(b) In addition to the general requirements detailed in Paragraph (a) of th is Rule, if providing fixed-w ing air medical services , affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined in Ru le .0 102(30) of this Subchapter is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. In addition t o the general requirements detailed in Paragraph (a) of this Rule , if providing rotary-wing air medical services. affiliation as defined in Rule .0102(4) of this Subch apter with a level I or level II Trauma Center as defined in Rules 10A NCAC 13P .0204 (a)(c) .0102(35) and (36) of this Subchapter designated by the OEMS is required to ensure the provision of peer review, medical director oversight and treatm ent protocol maintenance. Due to the geographical barriers unique to the County of Dare, the Medical Ca re Commission exempts the Dare County EMS System from this Paragraph . 10A NCAC 13P .0204 (a)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraphs (a) through (c) of this Rule . EMS PROVIDER LICENSE RENEWAL Effective: 8/1/2014 PROVIDER NAME : Coats Grove Fire & Rescue Inc PROVIDER NUMBER : 0430392 ----------------- ENDORSEMENTS We. the undersigned , recommend this EMS Provider for license Renewal by the North Carolina Office of EMS. We fully approve. support. and endorse this application to the North Carolina Office of EMS wi th thorough knowledge and understanding of our respective roles and respon sibilities In maintaining an EMS Provider within our EMS System in the State of N orth Caro lina pursuant to the rules of the North Carolina Medical Care Commission. PROVIDER ADMINISTRATOR Fixed Wing Provider: QvEs ~0 Type/Print Name Data EMS SYSTEM ADMINISTRATOR -~~~ 1 .. ~ Date 7 *HOSPITAL ADMINISTRATOR Type/Print Name Signature Date **COUNTY MANAGER Type/Print Name Signature Date * Hospital Administrator's signature is required for fixed wing providers. ** The County Manager's signature is not required when through written delegation or resolution, the system administrator has been delegated authority to act on behalf of the county. If the county manager or system administrator has changed since last submission, a new letter from the county is required. EMS Provider License Renewal DHHS/DHSRIOEMS 4913 NOTE: If a provider operates i n multiple county EMS Systems, an Endorsements page must be completed for each of the county EMS Systems. BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Page 3ol3 Effective 611120 14 011916 HC BOC Page 86 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 12707 Mail Service Center I Raleigh, NC 27603-20081 Phone ; (919) 855-39351 Fax: (919) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Effective: 81112014 This application is for renewal of a current EMS Provider License only. Each highlig hted section must be completed. Information in the Credentialing Information System (CIS) must be current prior to application submission. Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fi xed-wing providers), and County Manager (if applicable) are required. Renewals must be submitted at least thirty (30) davs prior to expiration to the appropriate regional office indicated below. GENERAL INFORMATION Provider Name: Erwin Fire Department & Rescue Squad Inc Office Number: (910) 897-8151 Physical Address: 200 South 13th Street Fax Number: (910) 897-7829 City: Erwin State: NC Provider Admin Contact: Ricky Blackmon County: Harnett Zip : 28339 Title: Chief Mailing Address: P .O . Box 36 Office Number: (910) 897-8151 City: Erwwin State: NC Mobile Number: (910) 890-2769 County: Harnett Zip: Fax Number: PROPERTIES E-mail Address: rblackmon@erwinfd.org 1. Service Level: EMT-Basic System Affiliation: Harnett County 'rovlder Number: 0430456 Provider Lie No: 1286 License Exp. Date: Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below: CENTRAL Ce ntral Regional Office of EMS 801 Biggs Drive 2717 Mail Service Center Raleigh , NC 27699-2717 Office: (919) 855-4678 Fax: (919) 715-Q498 E MS P"""""r Llcense Renewal OHHS/DHSRIOEMS ~913 EASTERN WESTERN Eastern Regional Office of EMS Western Regional Office of EMS 404 St. Andrews Drive, Suite 7 3305 16'" Avenue SE , Suite 302 Greenville, NC 27634-6850 Conover, NC 28613 -9213 Office: (252) 355 -9026 Office: (828) 466-5548 Fax : (2525) 355-9063 Fax :(828)466-5651 BE PREPARED TO PRESENT S UPPORnNG DOCU MENTATION UPON REQUEST Page 1 ol3 !Jan 31,2016 Effective 8/112014 011916 HC BOC Page 87 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 10A NCAC 13P .0204 (a) Any firm. corporation . agency. organization or associati on th at provides emergency medical services shall be licensed as an EMS Provider by meeting and continuously mainta ining the following criteria: 10A NCAC 13P .0204 (a)(1) Be affiliated as defined in Rule .0102(4) of this Subchapter with each EMS System where there is to be a phys ical base of operation or where the EMS Pro vider will provide point-to-point patient transport w ithin the system; ENTER SYSTEM NAME : Harnett County 10A NCAC 13P .0204 (a)(2) Present an application for a permit for any ambulance that will be in service as required by G.S. 131 E -156; 10A NCAC 13P .0204 (a)(3) Submit a written plan detailing how the EMS Provider will furnish credentialed personnel ; We provide 24/7 EMS coverage utilizing paid and volunteer personnel BRIEFLY DESCRIBE HOW EMS PROVIDER WILL FURNISH CREDENTIALED PERSONNEL: Where there are franchise ordinances pursuant to G.S 153A-250 in effect that cover the proposed service areas of each EMS system of operation , show the affiliation as defined in Rule .01 02(4) of this Subchapter with each EMS System, as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1) of this Rule, by being granted a current franchise to operate. or present written documentation of impending receipt of a franchise , from each county. In counties where there is no franchise ordinance in effect, present a signature from each EMS System representative authorizing the EMS Provide r to affiliate as defined in Rule .0102(4) of this Subchapter and as required by Paragraph (a)(1) of this Rule; DOES CO UNTY HAVE A FRANCHISE ORDINANCE? (e) YES ()NO IF YES, IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a)(S) Provide systematic, periodic inspection, repair. cleaning , and routine maintenance of all EMS responding ground vehicles and maintain records available for inspection by the OEMS which verify compliance with this Subparagraph; Conduct daily inspection. cleaning, and routine repairs as needed, annual maintenance is BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS conducted January or each year. Maintenance records are kept in a record book located THIS REQUIREMENT TO INCLUDE HOW UNITS ARE in paid staff offices. Records are kept for life of vehicle C LEANED, MAINTAINED, AND REPAIRED : Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary 10A NCAC 13P .0204 (a)(6) as specified in "North Carolina College of Emergency Physicians : Standards for Medical Oversight and Data Collection." incorporated by reference In accordance with G.S. 1508-21.6, including subsequent amendments and additions. We utilize EMS Charts software to collect and transmit data to premis. Data is stored on BRIEFLY DESCRIBE HOW EMS PROVI DER the county server and is transmitted on a routine bases by the county MEETS THIS REQUIREMENT : Develop and implement written operational protocols for the management of equipment. supplies and medications and 10A NCAC 13P .0204 (a){7) maintain records available for Inspection by the OEMS which verify compliance with this Subparagraph . These protocols shall include a methodology: 10A NCAC 13P .0204 (a)(7)(A) to assure that each vehicle contains the required equipment and supplies on each response ; We use a daily check off sheet daily and after each caiiVehicles are clean BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS THIS REQUIREMENT: 10A NCAC 13P .0204 (a)(7)(8) for cleaning and maintaining the equipment and vehicles; and Vehicles are cleaned and inspected daily and after each call (when possible). Department BRIEFLY DESCRIBE HOW EMS PROVIDER provides equipment and chemicals to disinfect each unit. MEETS T HIS REQUIREMENT: 10A NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications. Check off sheets are used to i nspect medications and equi pment for expiration dates on a BRIEFLY DESCRIBE HOW EMS PROVIDER monthly basis. All vehicle bays are heat ed to maintain manufacturers recommendations in MEETS THIS REQUIREMENT : the w inter and in summer moved inside and placed on unit when on call. Vehicles are left running to maintain temperatures. BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST EMS Provider License Renewal OHHS/OHSR/OEMS 4913 Page 2 of 3 EtfectJI/8 8/112014 011916 HC BOC Page 88 In addition to the general requirements detailed in Paragraph (a) of this Rule , if providing fixed-wing air medical services. 10A NCAC 13P .0204 (a)(b) affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined In Rule .0102(30) of this Subchapter is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. In addition to the general requirements detailed in Paragraph (a) of this Rule, if providing rotary-wing air medical services, affiliation as defined in Rule .0102(4) of this Subchapter with a Level I or Level II Trauma Center as defined in Rules 10A NCAC 13P .0204 (a)( c) .0102(35) and (36) of this Subchapter designated by the OEMS is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. Due to the geographical barriers unique to the County of Dare. the Medica l Care Commission exempts the Dare County EMS System from this Paragraph. 110A NCAC 13P .0204 (a)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraphs (a) through (c) of this Rule . EMS PROVIDER LICENSE RENEWAL Effective: 8/1/2014 PROVIDER NAME : Erwin Fire Department & Rescue Squad Inc PROVIDER NUMBER: _0_34_0_4_5_6 ___ _ ENDORSEMENTS We, the undersigned, recommend this EMS Provider for Ucense Renewal by the North Carolina Office of EMS. We fully approve , support. and endorse this application to the North Carolina Office of EMS with thorough knowledge and understanding of our respective roles and responsibilities in maintaining an EMS Provider within our EMS System in the State of North Carolina pursuant to the rules of the North Carolina Medical Care Commission. PROVIDER ADMINISTRATOR Fixed Wing Provider: QvES (!)NO Ricky Blackmon - Type/Print Name SYSTEM MEDICAL DIRECTOR Mark Glaser 12/9/2015 Type/Print Name Date .:MS SYSTEM ADMINISTRATOR Ricky Denning 12/9/2015 Type/Print Name Date *HOSPITAL ADMINISTRATOR Type/Print Name Signature Date **COUNTY MANAGER Joseph Jeffries Type/Print Name Signature Date * Hospital Administrator's signature is required for fixed wing providers. ** The County Manager's signature is not required when through written delegation or resolution. the system administrator has been delegated authority to act on behalf of the county. If the county manager or system administrator has changed since last submission, a new Jetter from the county is required. EMS ProVider Lioense Renewal DHHSIDHSRIOEMS 4913 NOTE: If a provider operates in multiple county EMS Systems, an Endorsements page must be completed for each of the county EMS Systems. BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Page 3 of 3 Effedive 8/1/2014 011916 HC BOC Page 89 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive I 2707 Mail Service Center 1 Raleigh, NC 27603-2008 1 Phone: (919) 855-3935 I Fax: (919) 733-7021 EMD CENTER RENEWAL APPLICATION Effective: 8/1/2014 This application is for renewal of Emergency Medical Dispatch (EMD) Centers. EMD Centers must be operational twenty-four (24) hours a day, seven (7) days a week . Each highlighted section must be completed . Information in the Credentialing Information System (CIS ) must be current prior to application submission. Endorsements from the EMD Center Director. EMS System Administrator , System Medical Director , and County Manager (if applicable) are required . Renewals must be submitted to the appropriate reg ional EMS office indicated below. GENERAL INFORMATION EMO Center Name: Harnett County Sheriffs Dept Office Number: (91 0) 893-9111 Physical Address: 175 Bain St. Fax Number: (910) 814-8314 City: Lillington State : NC Provider Admin Contact: Dianne M. Raynor County: Harnett Zip : 27546 Title: Communications Director Mailing Address: P.O. Box 399 Office Number: (910) 893-0221 City: Lillington State: NC Mobile Number: County: Harnett Zip : 27546 Fax Number: (910) 814-8314 PROVIDER PROPERTIES E-mail Address: draynor@harnett.org I Provider Number: 0431035 System Affiliation : Harnett Renewals must be submitted to the appropriate regional office indicated below: CENTRAL EASTERN WESTERN Central Regional Office of EMS Eastern Regional Office of EMS Western Regional Office of EMS 801 Biggs Drive 404 St. Andrews Drive, Suite 7 3305 16'" Avenue SE , Suite 302 2717 Mail Service Center Greenville, NC 27834-6850 Conover, NC 28613-9213 Raleigh, NC 27699-2717 Office: (252) 355-g026 Office: (828) 466-5548 Office: (919) 855-4678 Fax : (2525) 355-9063 Fax :(626)466-5651 Fax: (9 1g) 715-0498 BE PREPARED TO PRESENT SU PPORTING DOCUMENTATION UPON REQUEST EMD Center Renewal OHHS/DHSRIOEMS 4917 EKecbve 8/112014 011916 HC BOC Page 90 SECTION .0400 • MEDICAL OVERSIGHT 10A NCAC 13P .0401 COMPONENTS OF MEDICAL OVERSIGHT FOR EMS SYSTEMS Each EMS System shall have the following components in place to assure medical oversight of the system: 10A NCAC 13P .0401(3) for systems providing EMD service, an EMDPRS approved by the medical director. NOTE: Medical Oiroctor's signature is required on this applicati on. 10A NCAC 13P .0403 RESPONSIBILITIES OF THE MEDICAL DIRECTOR FOR EMS SYSTEMS 10A NCAC 13P .0403(a) I The Medical Director for an EMS System is responsible for the following : 1 OA NCAC 13P .0403(a)(3) I EMD programs, the establishment, approval, and annual updating of the EMDPRS . DATE OF LAST EMDPRS REVIEW: 18/1/2015 10A NCAC 13P .0407 REQUIREMENTS FOR EMERGENCY MEDICAL DISPATCH PRIORITY REFERENCE SYSTEM 10A NCAC 13P .0407(a) EMDPRS used by an EMD within an approved EMD program shall : be approved by the OEMS Medical Director and meet or exceed the statewide standard for EMDPRS as defined by the "North 10A NCAC 13P .0407(a)(1) C arolina College of Emergency Physicians : Standard s for Medical Oversight and Data Collection ," incorporated by reference in accordance with G .S . 1506-21 .6, including subsequent amendments a nd editions. 10A NCAC 13P .0407(a)(2) not exceed the EMD scope of practice defined by the North Carolina Medical Board pursuant to G .S . 143-514. An EMDPRS developed locally shall be reviewed and updated annually and su bmitted to the OEMS Medical Di rector for 10A NCAC 13P .0407(b) approval. Any change in the EMDPRS shall be submitted to the OEMS Med ical Director for review and approval at least 30 days prior to the implementation of the change . (EXAMPLE : EMDPRS will be reviewed every January or as changes occur throughout the year.) EMDPRs cARD I P . .t 0 . h c . EMD SET NAME : non y tspatc orporatton -I VERSION NO : J 12.2 I EMOPRS I LICENSE NO : 90-10808 NOTE : If tho EMDPRS Ia developed locally, please provide a complete copy of card set and assurance that tho EMDPR S wtll be reviewed annually and submit to OEMS Medical Director for approva l. VERIFY THE EMD ROSTER LISTED IN THE C REDENTIALING INFORMATION SYSTEM (C IS) IS CORRECT (!)YES O NO (if no, update in CIS): BRIEFLY DESCRIBE THE EMD PROGRAM EMD requires 18 hours of mandatory annual continuing education. 12 o f the 18 hours a re CONTINUING EDU CATION AND conducte d in a c lassroom setting . The remainder are obtained either, online through RECREDENTIALING REQUIREMENTS TO INCLUDE EDCUATIONAL INSTITUTION Richmond Community College, or industry specific professional publications. Instructors are AND INSTRUCTOR INF ORMATION : state or nationally certified. Re-credentialing is submitted through Central Carolina Community College . VERIFY THE FCC CALL SIGN AND EXPIRATION DATE OF THE CENTER THAT WILL BE UTILIZING THE (!)vEs EMD PROGRAM IN THE CREDENTI ALING INFORMATION SYSTEM (CIS) IS CORRECT (if no, update in CI S}: FC C C A LL SIGN : INc Viper I EXPIRATION DATE: NOTE: EMD Centers must have representation at Peer Review Committee Meetings . EMO Center Renewal DHHSIOHSRIOEM S 4917 BE PREPARED TO PRESENT SUPPORTiNG DOCUMENTATION UPON REQUEST O NO Elfectove 811120 1< 011916 HC BOC Page 91 EMD CENTER RENEWAL APPLICATION El!ective: 81112014 .MD CENTER NAME: Harnett County Sheriffs Department 0431035 PROVIDER NUMBER :-------- ENDORSEMENTS We , the undersigned. recommend this EMD Center for renewal by the North Carolina Office of EMS . We fully approve , support, and endorse this application to the North Carolina Office of EMS with thorough knowledge and understanding of our respective roles and responsibi lities in maintaining an EMD Center within our EMS System in the State of North Ca rolina pursuant to the rules of the North Carolina Medical Care Commission. EMD CENTER DIRECTOR Dianne M . Raynor Type/Print Name EMS SYSTEM ADMINISTRATOR Ricky G . Denning Type/Print Name SYSTEM MEDICAL DIRECTOR Dr. Mark Glaser Type/Print Name *COUNTY MANAGER Joseph Jeffries Type/Print Name Date Signature Date * The County Manager·s signature is not required when through written de legation or resolution. the system administrator has been delegated authority to act on behalf of the county. If the county manager or system administrator has changed since last submission, a new fe ller from /he county is required. EMO Center Renewal OHHS/OHSRIOEMS 49t7 BE PREPARED TO PRESEN T SUPPORTING DOCUMENTATION UPON REQUEST Effective 611120 14 011916 HC BOC Page 92 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVlCE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 1 2707 Ma il Service Center 1 Ra lei gh , NC 27603-2008 1 Phone: (919) 855-39351 Fax : (919) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Effective: 8/112014 This application is for renewal of a current EMS Provider License only. Each highlighted section must be completed. Information in the Credentialing Information System (CIS) must be current prior to application submission. Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fixed-wing providers), and County Manager (if applicable) are required . Renewals must be submitted at least thirtv (301 davs prior to exp iration to t he appropriate regional office indicated below. GENERAL INFORMATION Provider Name : Anderson Creek Emergency Services, Inc. Office Number: (910) 497-0395 Physical Address : 6200 Overhills Road Fax Number: (910) 497-3891 City: Spring Lake State : NC Provider Admin Contact: Elizabeth Rodriguez County : Harnett Zip: 28390 Title: Assistant Chief, EMS Mailing Address : 6200 Overhills Road Office Number: (910) 497-0395 City: Spring Lake State : NC Mobile Number: (91 0) 916-3933 County: Harnett Zip: 28390 Fax Number: (910) 497-3891 PROPERTIES E-mail Address: aces312chief@yahoo.com Service Level: EMT -lntennediate System Affiliation: Harnett County Provider Number: 043592 Provider Lie No : 1114 license Exp. Date : !Jan 31, 2016 Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below: CENTRAL Central Regional Office of EMS 801 Biggs Drive 2717 Mail Service Center Raleigh, NC 27699-2717 Office: (919) 855-4678 Fax: (91 9) 715-0498 EMS Provoder l icense Renewal OHH SIOHSR/OEM S 491 3 EASTERN WESTERN Eastern Regional Office of EMS Western Regional Office of EMS 404 St. Andrews Drive, Suite 7 3305 16'" Avenue SE, Suite 302 Greenvil le, NC 27834~850 Co nover, NC 2861 3-9213 Office: (252) 355-9026 Office: (828) 466-5548 Fax: (2525) 355-9063 Fax : (828) 466-5651 BE PREPARED TO PRESENT SUPPORTING DOCUMENTATIO N UPON REQUEST E!!ective 811/201 4 Page 1 of 3 011916 HC BOC Page 93 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 1 OA NCAC 13P .0204 (a) Any firm, corporation. agency, organization or association that provides emergency medical services shall be licensed as an EMS Provider by meeting and continuously maintaining the following crlteria: 1 OA NCAC 13P .0204 (a)(1) Be affiliated as defined in Rule .01 02(4) of this Subchapter with each EMS System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport within the system , ENTER SYSTEM NAME : Harnett County 10A NCAC 13P .0204 (a)(2) Present an application for a pennit for any ambulance that will be in service as required by G.S. 131E-156; 10A NCAC 13P .0204 (a)(J) Submit a written plan detailing how the EMS Provider will furnish credentialed personnel ; Units are staffed 24/7 with part-time paid personnel. Units are always staffed with a minimum of an EMT Intermediate and Medical Responder. BRIEFLY DESCRIBE HOW EMS PROVIDER WILL FURNISH CREDENTIALED PERSONNEL: Where there are franchise ordinances pursuant to G.S 153A·250 in effect that cover the proposed service areas of each EMS system of operation. show the affiliation as defined in Rule .01 02(4) of this Subchapter with each EMS System, as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1) of this Rule, by being granted a current franch ise to operate, or present written documentation of impending receipt of a franchise, from each county. In counties where there is no franchise ord inance in effect , present a signature rrom each EMS System representative authorizing the EMS Provider to affiliate as defined in Rule .01 02(4) of this Subchapter and as required by Paragraph (a)(1) of this Rule; DOES COUNTY HAVE A FRANCHISE ORDINANCE? (e) YES ()NO IF YES , IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a)(S) Provide systematic, period ic inspection, repair, cleaning, and routine maintenance of all EMS responding ground vehicles and maintain records available for inspection by the OEMS which verify compliance w ith th is Subparagraph; Units are inspected and cleaned every morning and after every call. Oil changed every BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS 5000 miles. All check-off sheets are maintained for one year and maintenance records THIS REQUIREMENT TO INCLUDE HOW UNITS ARE for the life of the vehicle. CLEANED, MAINTAINED, AND REPAIRED: Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set a nd data dictionary 10A NCAC 13P .0204 (a)(6) as specified in "North Carolina College of Emergency Physicians : Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 1508-21.6, including subsequent amendments and additions . We utilize EMS Charts software to collect patient data and that is submitted to PREMIS BRIEFLY DESCRIBE HOW EMS PROVIDER on a routine basis by the county. MEETS THIS REQUIREMENT: De ve lop and implement writ1en operational protocols for the management of equipment, supplies and medications and 10A NCAC 13P .0204 (a)(7) maintain records available for inspection by the OEMS which verify compliance with this Subparagraph . These protocols sha ll include a methodoiOQy: 10A NCAC 13P .0204 (a)(7)(A) to assure that each vehicle conta ins the reQuired equipment and supplies on each response; Units are inspected daily with an approved check-off sheet and every drug and piece of BRIEFLY DESCRIBE HOW EMS PROVIDER equipment Is checked for expiration date at the first of the month. MEETS THIS REQUIREMENT : 10A NCAC 13P .0204 (a)(7)(8) for Cleaning and maintaining the equipment and vehicles; and Units are inspected each morning for cleanliness and units and equipment is BRIEFLY DESCRIBE HOW EMS PROVIDER decontaminated after each call. MEETS THIS REQUIREMENT: tOA NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications. Units are checked for expiration dates at the first of the month and replaced if expiring BRIEFLY DESCRIBE HOW EMS PROVIDER that month and all units have a shoreline equipped heater/air conditioner to maintain drug MEETS THIS REQUIREMENT : temperature. Units are left running while on calls and at the hospital to maintain temp. within specifications. BE PR EPARED TO PRESENT SUPP ORTING DOCUM ENTATIO N UP ON REQU EST EMS Pr ovider Ucense Renewal OHHS/OHSRIOEMS 491 3 EffeCiive 8/1/201 4 011916 HC BOC Page 94 In addition to the general requirements detailed in Paragraph (a) of this Rule, if providing fixed-wing air medical services. 10A NCAC 13P .0204 (a)(b) affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined in Rule .0102(30) of this Subchapter is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. In addition to the general requirements detailed in Paragraph (a) of this Rule , if providing rotary-wing air medical services , affiliation as defined in Rule .0102(4) of this Subchapter with a Level I or Level II Trauma Center as defined in Rules 10A NCAC 13P .0204 (a)(c) .01 02(35) and (36) of this Subchapter designated by the OEMS is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. Due to the geographical barriers unique to the County of Dare, the Medical Care Commission exempts the Dare County EMS System from this Paragraph. 110A NCAC 13P .0204 (a)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraphs (a) through (c) of this Rule. EMS PROVIDER LICENSE RENEWAL Effective: 8/1/2014 PROVIDER NAME: Anderson Creek Emergency Services, Inc. PROVIDER NUMBER: _0_43_5_9_2 ___ _ ENDORSEMENTS We, the undersigned, recommend this EMS Provider for License Renewal by the North Carolina Office of EMS. We fully approve, support, and endorse this application to the North Carolina Office of EMS with thorough knowledge and understanding of our respective roles and responsibilities in maintaining an EMS Provider within our EMS System in the State of North Carolina pursuant to the rules of the North Carolina Medical Care Commission. PROVIDER ADMINISTRATOR Fixed Wing Provider: Q ves @ No Robert J. Wilson/Chief /0-22-/.J Type/Print Name Date SYSTEMM Type/Print Name EMS SYSTEM ADMINISTRATOR Type/Print~ / Date *HOSPITAL ADMINISTRATOR Type/Print Name Signature Date **COUNTY MANAGER TypeiPrtnt Name Signature Date * Hospital Administrator's signature is required for fixed wing providers. ** The County Manager's signature is not required when through written delegation or resolution. the system administrator has been delegated authority to act on behalf of the county. If the county manager or system administrator has changed since last submission, a new letter from the county is required. EMS Provider license Renewal OHHS/OHSR/OEMS 4913 NOTE: If a provider o perates in multiple county EMS Systems, an Endorsements pag e must be com pleted for each of the county EM S Systems. BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Page 3of 3 Elfectivo 811/2014 011916 HC BOC Page 95 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 12707 Mail Service Center 1 Raleigh , NC 27603-20081 Phone : (919) 855-39351 Fax: (919) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Effective : 811/2014 This application is for renewal of a current EMS Provider License only. Each highlighted section must be completed . Information in the Credentla11ng Information System (CIS) must be current prior to application submission. Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fixed -wing providers), and County Manager {if applicable) are required. Renewals must be submitted at least thirty (30} days prior to expiration to the appropriate regional office indicated below. GENERAL INFORMATION Provider Name: Dunn Emergency Services, Inc. Offk:e Number: (910) 892-1211 Physical Address: 101 W. Cumberland Street Fax Number: (910) 892-7777 City: Dunn State: NC Provider Admin Contact: Gary Whitman County: Harnett Zip: 28334 Title: Chief/President - Mailing Address: PO Box 203 Office Number: (910) 892-1211 City: Dunn Stale: NC Mobile Number: (910) 263-0278 County: Harnett Zip: 28335 Fax Number: (910) 892-7777 PROPERTIES E-mail Address: drschief@nc .rr.com Service Level: EMT-Parame dic System Affiliation: Harnett County Provider Number: 0430141 Provider Lie No: 1113 Llcenae Exp. Date: IJa·n 31 ,2016 Renewals must be submitted at least thlrtv (30) davs prior to expiration to the appropriate regional office indicated below: CENTRAL Cenlral Regional Office of EMS 801 Biggs Drive 2717 Mall Service Center Raleigh, NC 27699-2717 Office: (919) 855-4678 Fax: (919) 715 -0498 EM S Ptol'l<ler Ucensa ReMwal OHHSIDHSRIOE MS 491 3 EASTERN WESTERN Eastern Regional Office of EMS Western Regional Office of EM S 404 Sl. Andrews Drive, Suite 7 3305 16111 Avenue SE. Suite 302 Greenville, NC 27834-6850 Conover, NC 28613·9213 Office: (252) 355-9026 Office: (828) 466-5548 Fax: (2525) 355-9063 Fax : (828) 466-5651 BE f'REP/I.Rt:O TO !'RESEN T SUPI'OIHING DOCUMEN TATION UPON RE QUES T Paget of3 Effective 8/t/20 14 011916 HC BOC Page 96 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 10A NCAC 13P .0204 (a) Any firm, corporation, agency, organization or associallon thai provides emergency medical se/VIces shall be licensed as an EMS Provider by meeting and continuously maintaining the following criteria: 10A NCAC 13P .0204 (a)(1) Be affiliated as defined In Rule .0102(4) of tilts Subchapter with each EMS System where there Is to be a physical base of oparaUon or whore tho EMS Provider will provide point-to -point patient transport within the system; ENTER SYSTEM NAME : Harnett County 10A NCAC 13P .0204 (a)(2) Present an appXcaUon for a permit for any ambulance that will be In service as required by G.S. 131E·156; 10A NCAC 13P .0204 (a)(3) Submit a written plan detailing how the EMS Provider will furnish uedenUaled personne l: Career Paramedic provided 24/7 supplemented by part-time and volunteer staff BRIEFLY DESCRIBE HOW EMS PROVIDER WILL FURNISH CREDENTIALED PERSONNEL : VI/here there are franchise ordinances pursuant to G.S 153A·250 In effect that cover the proposed service areas of each EMS system of operation, show the affiliation as defined In Rule .0102(4) of this Subchapter with each EMS System, as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1) of this Rule, by being granted a current franchise to opetate. or present \vrlllen documenlation of Impending receipt of a franchise, from each county. In counties where there Is no franchise ordinance In effect, present a signature from each EMS System representallve authorizing the EMS Provider lo affiliate as defllled In Rule .0102(4) of this Subchaptet and as required by Paragraph (a)(1) of this Rule; DOES COUNTY HAVE A FRANCHISE ORDINANCE? (e) YES ()NO IF YES, IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a)(6) Provide systemallc, periodic Inspection. rep air. cleaning, and routine maintenance of all EMS responding QI'OUnd vehicles and maintain records available for Inspection by the OEMS which verify compliance with this Subparagraph; All In service vehicles are Inspected dai ly, cleaned after each response , maintenance is BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS done on a scheduled basis on each vehicle, and vehicles are repaired as soon as THIS REQUIREMENT TO INCLUDE HOW UNITS ARE possible after problems are reported. Records of inspection, maintenance and repairs are CLEANED, MAINTAINED, AND REPAIRED : maintained at our facllily for lnspeclion. Collect and within 24 hours electronically submit to the OEMS EMS Care data thai uses the EMS data se t and data dictionary 10A NCAC 13P .0204 (a){6) as specified in "North Cacolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference In accordance with G.S. 150B-21.6,1ncludlng subsequent amendments and addillons. We are using EMS Charts software to collect and transmit data. Patient data is sto re d on BRIEFLY DESCRIBE HOW EMS PROVIDER EMS Charts' server and submllled by them. MEETS THIS REQUIREMENT: Develop and Implement written operational protocols for the management of equipment. supplies and medicallons and 10A NCAC 13P .0204 (a)(7) maintain records available for lnspecUon by the OEMS which verify compliance with this Subparagraph . These protocols shan Include a methodology: 10A NCAC 13P .0204 (a)(7J(A) lo assure that each vehicle contains the required equipment and supplies on each respo nse; Technicians are required to Inspect and document the presence or the equipment and BR IEF LY DESCRIBE HOW EMS PROVIDER supplies required by the system and NCOEMS by using a check sheet provided by the MEETS THIS REQUIREMENT: department. Inspections are required daily. 10A NCAC 13P .0204 (a)(7J(B) for cleaning and maintaining the equipment and vehicles; and Technicians are required to clean. decontaminate, and restock each vehicle a lter each BRI EFLY DESCRIBE HOW EMS PROVIDER response. MEETS THIS REQUIREMENT: 10A NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored In a temperature controlled atmosphere according to manufacturer's specifications. Suppl ies and medications are inspected monthly for expiration dates. Supplies and BRIEFLY DESCRIBE HOW EMS PROVIDER medications whose expiration dales are approaching are removed from the vehicle and MEETS THIS REQUIREMENT : replaced. Medicallons are maintained at the manufacturers temperature specifications. BE PREPAR ED '10 PRESEN T SUPPOilTING DOCUMEIHAliON UI'ON REQUEST EMS PIO\i4ef' I.Jcense RellO'IIal DHHSIDHSR/OEMS 41113 P3ge 2ol3 El!ldivaB/112014 011916 HC BOC Page 97 In addition to the general requirements detailed In Paragraph (a} of thts Rule, if providing fixed-wing air medical services, 10A NCAC 13P .0204 (a)(b) affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined in Rule .0102(30) of this Subchapter Is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. In addillon to the general requirements detailed In Paragraph (a) of th is Rule , if providing rotary-wing air medical services, affiliation es dellned in Rule .0102(4) of this Subchapte1 wilh a Level I or Level ll Trauma Cenler es defined In Rules fOA NCAC 13P .0204 (a)(c) .0102(35) and (36) of this Subchapter designated by the OEMS Is required to ensure the provision of peer reVIew, medical director oversight and treatment protocol maintenance . Due to the geographical ba rriers unique to the County of Dare, the Medical Care Commission exempts the Dare County EMS System from INs Paragraph. 10A NCAC 13P .0204 (a)(d) An EMS Provider may renew lis license by presenting documentation to the OEMS that the Provlder meets the criteria found In Paragraphs (a) through (c) of this Rule. EMS PROVIDER LICENSE RENEWAL Effective: 8/11201-4 PROVIDER NAME : Dunn Emergency Services, Inc. PROVIDER NUMBER : 0430141 ---------------- ENDORSEMENTS We, the undersigned, recommend this EMS Provider for License Renewal by the North Carolina Office or EMS . We fully approve, support , and endorse this application to the North Carolina Office of EMS wflh thorough knowledge and understanding of our respective roles and responsibilities In maintaining an EMS Provider wllhtn our EMS System In the Slate of North Carolina pursuant to lhe rules of the North Carolina Medical Care Commission . PROVIDER ADMINISTRATOR Fixed Wing Provid~r: Qves (!)tw Gary Whitman 1/1-/1s TypeiPrlnt N1111111 Dale TypeiPrfnt Name EMS SysTEM ApMIN!STRATOB l!.?/¥s TYJlelPrlnt Namt Signature Date **COUNTY MANAGER Type/Prrnt Name Signature Date * Hospital Administrator's signature Is required for fixed wing providers. ** The County Manager's signature Is not required when through written delegation or resolution. the system administrator has been delegated authority to act on behalf of the counly. If the county manager or system administrator has changed since lesl submission. a neiV feller from the county is required. EMS PrOV.der Ueef\>o Re.,.,Nal DHHSIDHSRIOEI.IS ~913 NOTE : If a provider operates in multiple county EMS Systems, an Endorsements page must be completed for each of the county EMS Systems. BE PREPAREO TO PRES~N T SUPPORTING DOCUM EtHA liON Uf'ON REQUEST Pa:~G3ol3 Effecwe 81112014 011916 HC BOC Page 98 10A NCAC 13P .0201 (a) 10A NCAC 13P .0201 (a)(1) ENTER SYSTEM NAME: NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 12707 Mail Service Center 1 Raleigh , NC 27603-20081 Phone : (919) 855-39351 Fax : (919) 733-7021 EMS SYSTEM APPROVAL APPLICATION Effective: 8/1/2014 SECTION .0200 -EMS SYSTEMS 10A NCAC 13P 0201 EMS SYSTEM REQUIREMENTS Coun1y governments shall establish EMS Systems. Each EMS System shall have: a defined geographical service area for the EMS System . The minimum service area for an EMS System shall be one county. There may be multiple EMS Provider service areas within the service area ci an EMS System. The highest level of care offered within any EMS Provider service area must be available to the dtizens within that service area 24 hours per day; Harnett County Harnett County Ia covered 24fT by paramed ic level prov ldera .We atatf 13 Paramed ic level ambulances 2417.Harnett County ema ,Dunn Emergency aervlcee,Anderaon Creek Emergency BRIEF DESCRIPTION OF SYSTEM DELIVERY servlcea,Benhaven Emergency services, Boone Trail Emergency Servlces,Bulea Creek Emergency (include primary and secondary provider roles): Services, Coats Grove Fire Department, Erwin Fi re Department & rescue work together to provide this service. 10A NCAC 13P .0201 (a)(2) a defined scope of practice for all EMS personnel. functioning I n the EMS System. within the parameters set forth by the North Carolina Medical Board pursuant to G.S. 143-514; VERIFY THE INFORMATION LISTED IN THE CREDENTlALING INFORMATION SYSTEM (CIS) IS CORRECT: I (•) YES ()NO 10A NCAC 13P .0201 (a)(3) written policies a nd procedures desctibing the dispatch, coordination and ovefSight of an responders that provide EMS care. specialty patient care skills and procedures as defined in Rule .0301(a)(4 ) of this Subchapter. and ambulance transport within the system; Our Harnett County EMS System util izes policies and procedures from the 2012 NCCEP protocols document to meet the needs of our EMS System and approved by NCOEMS. BRIEFLY DESCRIBE HOW EMS SYSTEM MEETS nilS REQUIREMENT: 10A NCAC 13P .0201 (a)(4) at least one licensed EMS Provider, 10A NCAC 13P .0201 1•1(5) a listing ci permitted ambulances to provide coverage to the servioe area 24 hours per day; personnel credentialed to perform within the scope of ptactic:e of the system and to staff the ambulance vehicles as required by 10A NC AC 13P .0201 (aJ(6) G .S. 131E-158. There shall be a written plan for the use of cnedentialed EMS personnel for all pradioe settings used within 1he system; Please refer to the attached Hamett County system plan. Section V paga 20 & 2 1 BRIEFLY DESCRIBE THE WRITTEN PLAN FOR THE USE OF CREDENTlALED EMS PERSONNEL FOR ALL PRACTlCE SEmNGS USED WITHIN THE SYSTEM: 10A NCAC 13P .0201 (al(71 written policies and procedures specific to the uti~zation ci the EMS System's EMS Care data for the daily and on-going managemen1 of all EMS System resources: All data is collected using EMS Charts and is transmitted to PreMis daily. All data is available to the system medical Director. Data is maintained for 12 years. BRIEFLY DESCRIBE HOW EMS SYSTEM MEETS THIS REQUIREMENT: 10A NCAC 13P .0201 (a)(81 a written Infectious Disease Control Pot icy as defined In Rule .01 02(33) ot this Subchapter and written procedures which are approved by the EMS System medical director that address the deansing and disinfecting of vehides and eqoipmen1 that are used to t reat or transport patien1s; VERIFY THAT EMS SYSTEM HAS AN INFECTlOUS DISEASE CONTROL POLICY: I (e) YES ()NO 10A NCAC 13P .0201 (a)(9) I a listing of fadlities that will provide online medical direction for all EMS Providers operating within the EMS System: Central Harnett Hospital Li llington ENTER NAME OF FACILITY/FACILITlES THAT Will Betsey Johnson Hospital Dunn PROVIDE ONLINE MEDICAL DIRECTION WITHIN THE EMS SYSTEM: BE PREPARED TO PRESENTSUPPORTlNG DOCUMENTATlON UPON RE QUEST System Approval Appbl100 OHHSIOHSRIOEMS 4912 Page 1 of 8 e nec11ve 8/112014 011916 HC BOC Page 99 10A NCAC 13P .0201 (a)(10) an EMS communication system that provides for. public access using the emergency telephone number 9-1-1 within the public dial telephone network as the primary method for the public to request 10A NCAC 13P .0201 {a)(10)(A) emergency assistance. This number shall be connected to the emergency communications center or PSAP with immedia1e assistance available such that no caller will be instructed to hang up the telephone and dial another telephone number. A person calling for emergency assistance shall not be required to speak with more than two persons to request emergency medical assistance; Please see attached EMS system plan Section II page 7 BRIEFLY DESCRIBE HOW EMS SYSTEM MEETS THIS REQUIREMENT: 10A NCAC 13P .0201 {a){10){8) an emergency communications system operated by public safety telecommunicators with training in the management of calls for medical assistance available 24 hours per day; DOES EMS SYSTEM PROVIDE EMD SERVICES? (e) Y ES ()NO dispatch of the most appropriate emergency medical response un ~ or unns to any calle(s request for assistance. The dispatch of all response 10A NCAC 13P .0201 (a)(10)(C) vehicles shall be in accordance with a written EMS System plan for the management and deployment of response vehicles including requests for mutual aid; and 911 center uses the medical Priority Dispatch System version 12.2 to dispatch initial EMS calls and mutual aid EMS calls. The 911 center uses the call determinants to determine what resources BRIEFLY DESCRIBE HOW EMS SYSTEM DISPATCHES EMERGENCY RESPONSE UNITS: respond to each call. 10A NCAC 13P .0201 (a)(10)(D) two-way radio voice communications from within the defined service area to the emergency communications center or PSAP and to facilities where patients are routinely transported. The emergency communications system shall maintain all required FCC radio licenses or autho~ions: VERIFY THE INFORMATION LISTED IN THE CREDENTIAUNG INFORM ATION SYSTEM (CIS) I S CORRECT: I (e) YES ()NO 10A NCAC 13P .0201 (a)(11) written policies and procedures for addressing the use of SCTP and Air Medical Programs within the system: Harnett EMS system utilizes the 2012 NCCEP Polic ies & procedures for air medical responses. BRIEFLY DESCRIBE EMS SYSTEM'S POLICY FOR ADDRESSING THE USE OF SCTP AND AIR MEDICAL PROGRAMS: a written continuing education program for all credentialed EMS personnel. under the direction of a System Continuing Education Coordinator, dewloped and modified based on feedback from system EMS Care data, rE!IIiew, and evaluation of patie nt outcomes and qual~y management peer reviews, that follows the guidelines of the: .OA NCAC 13P .0201 {a)(12) (A) "US DOT NHTSA First Responder Refresher: National Standard Curriculum" for MR personnel; (8) "US DOT NHTSA EMT-Basic Refresher. National Standard Curriculum" for EMT personnel; (C) "EMT .P and EMT-1 Continuing Education National Guidelines" for EMT-1 and EMT-P personnel; and (D) "US DOT NHTSA Emergency Madical Dispatcher: National Standard Curriculum" for EMD personnel . Please see attached EMS plan section VII page 26-29 BRIEFLY DESCRIBE HOW SYSTEM COORDINATOR MEETS THIS REQUIREMENT, HOW OFTEN THE PROGRAM IS REVIEWED, AND T HE LOCATION OF THE CONTINU TING EDUCATION RECORDS: VERIFY THE EMS SYSTEM CONTINUING EDUCATION COORDINATOR I S DE SI GNA TED IN THE I (•)Yes ()No CRED ENTIALING INFORMATI ON SYSTEM (CIS) (if no , update in CIS): 10A NCAC 13P .0201 (a)(13) written policies and procedures to address management of the EMS System t hat indudes: triage and transport of all acutely ill and injured patients with time-dependent or other specialized care issues including trauma. stroke, STEM!, burn. 10A NCAC 13P .0201 (a)(13)(A) and pediatric patients that may require the by-pass of other licensed health care facilities and which are based upon the expanded dinical capabilities of the selected healthcare facilities: (NOTE: This requirement addreued though adoption of cui'T8nt NCCEP plans) 10A NCAC 13P .0201 (a)(13)(B) triage and transport of patients to facilities outside of the system: Harnett County System routinely transports to facilities outside of the county per the triage and BRIEFLY DESCRIBE EMS SYSTEM'S POLICY FOR transport destination policies. TRIAGE AND TRANSPORT OF PATIENTS TO FACILITIES OUTSIDE OF THE SYSTEM: 10A NCAC 13P .0201 (a)(13)(C) arrangements for transporting patients to appropriate facimies when diversion or bypass plans are activated; Harnett health does not have a diversion plan. BRIEFLY DESCRIBE EMS SYSTEM 'S POLICY FOR TRANSPORTING PATIENTS WHEN DIVERSION OR BYPASS PLANS ARE ACTIVATED: BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST System Approval Application DHHSIDHSRIOEMS 4912 Page 2 of8 Effectve e11not4 011916 HC BOC Page 100 10A NCAC 13P .0201 (a)(13)(0) I reporting, monitoring, and establishing standards for system response times using data provided by the OEMS; Hamett County system utilizes data gathered from Premis as well as our reporting software to monitor response times throughout the county. Hamett County strives to have a 10 minute or less '3RIEFL Y DESCRIBE EMS SYSTEM'S POLICY FOR average response time. MONITORING SYSTEM RESPONSE TIMES : 10A NCAC 13P .0201 (a)(13)(E) weekly updating of the SMARTT EMS Provider information; Updates are provided to the state by the System administrator and or his designe every Monday BRIEFLY DESCRIBE EMS SYSTEM'S POLICY FOR morning before 8:00 PROVIDING WEEKLY UPDATES OF THE SMARTT EMS PROVIDER INFORMATION: 10A NCAC 13P .0201 (a)(13)(F) a disaster plan; and VERIFY THAT EMS SYSTEM HAS A DISASTER PLAN: I (e) YES ()NO 10A NCAC 13P .0201 (a)(13)(G) a mass-gathering plan; VERIFY THAT EMS SYSTEM HAS A MASS-G ATHERING PLAN: I (e) YES ()NO 10A NCAC 13P .0201 (a)(14) affiliation as deflned in Rule .0102(4) of this Subchapter with the trauma RAC as required by Rule .1101(b) of this Subchapter. and SELECT NAME OF RAC AFFILIA TlON: Captial RAC 10A NCAC 13P .0201 (a)(15) medical oversight as required by Section .0400 of this Subchapter. 10A NCAC 13P .0201 (b) An application to establish an EMS System shall be submitted by the county to the OEMS for review. When the system is comprised of more than one county, only one application shall be submitted . The proposal shall demonstrate that the system meets the requirements in Paragraph (a) of this Rule. System approval shall be granted for a period of six years. Systems shall apply to OEMS for reapprove!. 10A NCAC 13P .0203 SPECIAL SITUATIONS {For Informational Purposes Only) Upon applicabon of citizens in North Carolina, the North Carolina Medical Care Commission shall approve the furnishing and providing of programs within the scope of practice of EMD, EMT, EMT-1, or EMT-P in North carolina by persons who have been approved to provide these services by an agency of a state adjoining North Carolina or federal jurisdiction. This approval shall be granted where the North Carolina Medical Care Commission condudes that the requirements enumerated in Rule .0201 of this Subchapter cannot be reasonably obtained by reason or lack or geographical access. 10A NCAC 13P .0401 COMPONENTS OF MEDICAL OVERSIGHT FOR EMS SYSTEMS Each EMS System shall have the following components in place to assure medical oversight of the system: a medical director for adutt and pediatric patients appointed, either diredly or by written delegation , by lhe county responsible for establishing the EMS System . Systems may elect to appoint one or more assistant medical diredors. The medical dlredor and assistant medical directors shall meet 10A NCAC 13P .0401 {1) the criteria defined in the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection ," incorporated by reference in accordance with G.S. 150B-21 .6, induding subsequent amendments and editions . {NOTE: Medical and Aaslstant Medical Director, if applicable, must be designated In Credentlallng Information System. Any changes to medical direction must be submitted to OEMS for approval) 10A NCAC 13P .0401(2) written treatment protocols for adult and pediatric patients for use by EMS personnel; 10A NCAC 13P .0401 (3) for systems providing EMO service, an EMDPRS approved by the medical diredor; (NOTE: See EMD prog,.m approval) 10A NCAC 13P .0401 (4) an EMS Peer Review Committee; and written procedures for use by EMS personnel to obtain on-line medical direction. On-line medical direction shall: (a) be restricted to medical orders that fall within the scope of practice of the EMS personnel and within the scope of approved system 10A NCAC 13P .0401 (5) treatment protocols; (b) be provided only by a pllysidan, MICN, EMS-NP, or EMS-PA. Only physicians may deviate from written treatment protocols; and (c) be provided by a system of two-way voice communication that can be maintained throughout the treatment and disposition of the patient. Please see attached EMS Plan section Ill page 17 BRIEFLY DESCRIBE EMS SYSTEM 'S WRITTEN PROCEDURES TO OBTAIN ON-LINE MEDICAL DIRECTION: System Approval Application DHHSIDHSR/OEMS 4912 BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Effective 8/112014 Page 3 of 8 011916 HC BOC Page 101 10A NCAC 13P .0403 RESPONSIBILITIES OF THE MEDICAL DIRECTOR FOR EMS SYSTEMS 10A NCAC 13P .0403 (a) The Medical Director for an EMS System is responsible for the fOllowing : 10A NCAC 13P .0403 (a)l1) ensuring that medical control is available 24 hours a day; Please see EMS Plan attached section Ill page 17 RIEFL Y DESCRIBE HOW EMS SYSTEM MEDICAL DIRECTOR ENSURES THAT MEDICAL CONTROL IS AVAILABLE 24 HOURS A DAY: 10A NCAC 13P .0403 (a)l2) the establishment, approval and annual updating of adult and pediatric treatment protocols; 10A NCAC 13P .0403 (a)(3) EMD programs. the establishment, approval, and annual updating or the EMDPRS; 10A NCAC 13P .0403 (a)(4) medical supeMsion or the selection, system orientation, continuing education and performance of all EMS personnel; Please see attached EMS Plan section V page 20 & 21 BRIEFLY DESCRIBE HOW EMS SYSTEM MEDICAL DIRECTOR MEETS THIS REQUIREMENT: 10A NCAC 13P .0403 (a)(S) medical supeMsion of a scope or practice perfomnance evaluation for all EMS personnel in the system based on the treatment protocols for the system; Please see attached EMS Plan section V page 21 BRIEFLY DESCRIBE HOW EMS SYSTEM MEDICAL DIRECTOR MEETS THIS REQUIREMENT: 10A NCAC 13P .0403 (a)(6) the medical review of the care provided to patients; Please see attached EMS System Plan section Ill page14 &15 BRIEFLY DESCRIBE HOW EMS SYSTEM MEDICAL DIRECTOR MEETS THIS REQUIREMENT: 10A NCAC 13P .0403 (a)(7) providing guidance regarding decisions about the equipment, medical supplies, and medications t hat will be carried on all ambulances and EMS nontransporting vehicles operating within the system; Our EMS System Peer Review committee will review current practice and provide guidance regarding the equipment,supplies,and medications carried in our system. BRIEFLY DESCRIBE HOW EMS SYSTEM MEDICAL DIRECTOR MEETS THIS REQUIREMENT: 10A NCAC 13P .0403 (a)(S) keeping the care provided up to date with current medical practice: and Developing and implementing an orientation plain for all hOspitals within the EMS system thai use MICN, EMS-NP, or EMS.PA personnel to provide on-line medical direction to EMS personnel, which includes: (A) a discussion of all EMS System treatment protocols and procedures; (8) an explanation of the specific scope or practice for credentialed EMS personnel. as authorized by the approved EMS System treatmenl 10A NCAC 13P .0403 (a)(9) protocols as required by Rule .0405 of this Section; (C) a discussion of all practice settings within the EMS System and how soope of practice may vary in each setting; (0) a mechanism to assess the abil~y t o effactively use EMS System communications equipment including hospital and prehospital devices , EMS communication prOiocols, and communications oontingency plans as related to on-line medical direction; and (E) the successful completion of a scope of practice performance evaluation which verifies competency in Parts (A) through (D) of this Subparagraph and which is administered under the direction of the medical director. Please see attached EMS Plan section Ill page 17 BRIEFLY D ESCRIBE HOW EMS SYSTEM MEDICAL DIRECTOR MEETS THIS REQUIREMENT, IF APPLICABLE: 10A NCAC 13P .0403 (b) Any tasks related to Paragraph (a) of this Rule may be completed, through written delegation. by assisting physioans, physician assistants, nurse practitioners, registered nurses, EMDs. or EMT-Ps. DOES EMS SYSTEM HAVE WRITTEN DELEGA noN TO PERFORM ANY TASKS RELATED TO PARAGRAPH (a) OF TH IS RULE? I ()YES (e) NO IF YES, INDICATE POSITION OF PERSON RESPONSIBLE: I The Medical Director may suspend temporarily, pending due process review, any EMS personnel from further participation in the EMS System when 10A NCAC 13P .0403 (c) System Approval Applicallon OHHSIDHSRJOEMS 4912 it is determined the activities or medical care rendered by such personnel are detrimental to the care of the patient, constitute unprofessional conduct, or result in non-compliance with credentialing requirements . BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Effective 81112014 Page 4 of 8 011916 HC BOC Page 102 Please see attached ENS Plan section II page14 BRIEFLY DESCRIBE EMS SYSTEM MEDICAL DIRECTOR 'S PROCESS TO MEET THIS REQUIREMENT: 10A NCAC 13P .0405 REQUIREMENTS FOR ADULT AND PEDIATRIC TREATMENT PROTOCOLS FOR EMS SYSTEMS (For Informational Purposes Only) 10A NCAC 13P .0405 (a) Treatment Protocols used in EMS Systems shall: Be adopted in their original form from the standard aduH and pedia1ric treatment protocols as defined in the "North Carolina College of Emergency 10A NCAC 13P .0405 (a)(1) Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 1508-21.6, induding subsequent amendments and editions. 10A NCAC 13P .0405 (a)(2) Not contain medical procedures. medications. or intravenous fluids that exceed the scope of practice defined by the North Carolina Medical Board pursuant to G.S. 143-514 for tha level of care offered in the EMS System and any other applicable heaHh care licensing board. Individual adult and pediatric treatment protocols may be modified locally by EMS Systems if there is a change in a specific protocol which will optimize care within the local community which adds additional medications or medical procedures, or rearranges the order of care provided in the protocol contained within the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection" as described 10A NCAC 13P .0405 (b) in Paragraph (a) of this Rule. Additional written Treatment Protocols may be developed by any EMS System in addition to the required protocols contained within the "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection" as required by the EMS System . All North Carolina College of Emergency Physicians Policies and Procedures must be induded and may be modified at the local level. Aff EMS System Treatment Protocols which have been added or changed by the EMS System shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. 10A NCAC 13P .0407 REQUIREMENTS FOR EMERGENCY MEDICAL DISPATCH PRIORITY REFERENCE SYSTEM (For Informational Purposes Only) 10A NCAC 13P .0407 (a) EMDPRS used by an EMD within an approved EMD program shall : be approved by the OEMS Medical Director and meet or exceed the statewide standard for EMDPRS as defined by the "North Carolina College of 10A NCAC 13P .0407(a)(1) Emergency Physicians: Standards for Medical Oversight and Ds1a Collection," incorpora1ed by reference in accordance with G.S. 150B-21.6, including subsequent amendments and editions. 10A NCAC 13P .0407 (a)(2) not exceed the EMD scope of practice defined by the North Carolina Medical Board pursuant to G.S . 143-514. 10A NCAC 13P .0407 (b) An EMDPRS developed locally shall be reviewed and updated annually and submitted to the OEMS Medical Director for approval. Any change in the EMDPRS shall be submitted to the OEMS Medical Director for review and approval at least 30 days prior to the implementation of the change. 10A NCAC 13P .0408 EMS PEER REVIEW COMMITTEE FOR EMS SYSTEMS The EMS Peer Review Committee for an EMS System shall: 10A NCAC 13P .0408 (1) I be composed of membership as defined in G.S. 131E-155(6b). Please see attached EMS Plan section Ill page 14 LIST OF COMMITTEE MEMBERS BY POSITION: 10A NCAC 13P .0408(2) I appoint a physician as chairperson; DOES EMS SYSTEM MEDICAL DIRECTOR SERVE AS CHAIRPERSON: I (e) YES ()NO IF NO, PLEASE EXPLAIN : 10A NCAC 13P .0408 (3) I meet at least quarterty; The system quarterly meetings are held the month following the end of the quarter. IDENTIFY THE EMS SYSTEM QUARTERLY MEETINGS SCHEDULE : 10A NCAC 13P .0408 (4) I use information gained from the analysis of system da1a submitted to the OEMS to evaluate the ongoing quality of patient care and medical diredion within the system; System Approval Awlication DHHSIDHSRIOEMS 49!2 BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Page 5 of 8 Effedive 81112014 011916 HC BOC Page 103 . Data received from premis as welt as 100% peer review of patient care reports and imput from our BRIEFLY DESCRIBE HOW EMS SYSTEM USES Peer Review Committee, will help us to evaluate ongoing quality of patient care in Harnett County DATA ANALYSIS TO EVALUATE PATIENT CARE AND MEDICAL DIRECTION: 10A NCAC 13P .0408 (5) use information gained from the analysis of system data submitted to the OEMS to make recommendations regarding the content of continuing education programs for all EMS personnel functioning within the EMS system : Harnett County will utlize system data as well as recommendations from the Peer Review BRIEFLY DESCRIBE HOW EMS SYSTEM USES Committee and imput from our Medical Director to enhance our education program. DATA ANALYStS TO MAKE RECOMMENOA TIONS FOR CONTINUING EDUCATION PROGRAMS: 10A NCAC 13P .0408 (6) review adult and pediatric treatment protocols of the EMS System and make re<:ammendations to the medical d irector for changes: The EMS System protocols are developed locally following the NCCEP document guidelines. There BRIEFLY DESCRIBE HOW EMS SYSTEM MEETS is a designated Protocol Committee that meets every six months of the year or on an as needed basis. At that time protocols are reviewed and changes made, as needed, and submitted for review THIS REQUIREMENT TO INCLUDE HOW OFTEN by the Peer Review Quality Management Committee. THE PROTOCOLS ARE REVIEWED: 10A NCAC 13P .0408 (7) establish and implement a written procedure to guarantee due process reviews for EMS personnel temporarily suspended by the medical director: 10A NCAC 13P .0408 (8) record and maintain minutes of committee meetings throughout the appro1181 period of the EMS System: Minutes of the Peer Review Performance Subcommittee meeting will be maintained and regarded "confidential. "The Peer Review Quality Management Committee meeting minutes will be maintained BRIEFLY DESCRIBE HOW EMS SYSTEM by the EMS system and maintained at the department designated by the Medical Director. That RECORDS AND MAINTAINS MEETING MINUTES: location is Harnett County EMS. All documents and meeting minutes of all committees are considered confidential and can only be reviewed by committee members. establish and implement EMS system performance improvement guidelines that meet or exceed the statewide standard as defined by the "North 10A NCAC 13P .0408 (9) Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection,• incorporated by reference in accordance with G.S. 150B·21 .6 , induding subsequent amendments and editions. adopt written guidelines that address: (a) structure of committee membership; (b) appointment of committee officers : 10A NCAC 13P .0408 (10) (c) appointment of committee members; (d) length of terms of committee members; (e) frequency of attendance of committee members; (f) establishment of a quorum for conducting business: and (g) confidentiality of medical records and personnel issues. Please see attached EMS Plan section Ill page 14-16 BRIEFLY DESCRIBE EMS SYSTEM'S WRITTEN GUIDELINES TO MEET THIS REQUIREMENT : 10A NCAC 13P 0506 PRACTICE SETTINGS FOR EMS PERSONNEL Credentialed EMS Personnel may function in the following practice settings in accordance with the protocols approved by the medical director of the EMS System or Specialty Care Transport Program with which they are affiliated, and by th e OEMS: (1) 10A NCAC 13P .0506 (2) (3) (4) (5) INDICATE SETTINGS WITHIN YOUR EMS SYSTEM (check all that appl y): System Approval Application DHHSIDHSRIOEMS 491 2 at the location of a physiological or psychological illness or injury including transportation to an appropriate treatment facility if required; at publ ic or community health facilities in conjunction with public and commun~y health initiatives: in hospitals and clinics; in residences, facilities, or other locations as part of wellness or injury prevention in~iatives w~hin the community and the public health system: and at mass gatherings or special events. 0 Mobile Integrated Healthcare • Urban Search and Rescue • High Angle Rescue 0 NTPS 0 \Midemess Rescue • Swift Water Rescue 0 TacticaiTeam 0 Air Medical 0 Medical Evacuation Sus 0 BombSquad • Ambulance Strike Team 0 Specialty Care BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Effectiw 8/1/2014 Page6of8 011916 HC BOC Page 104 EMS SYSTEM APPROVAL APPLICATION Effective: 611/2014 EMS SYSTEM NAME: Harnett County --------------------------- ENDORSEMENTS We, the undersigned, recommend this EMS System for approval by the North Carolina Office of EMS. We fully approve, support, and endorse this application to the North Carolina Office of EMS with thorough knowledge and understanding of our respective roles and responsibilities in maintaining an EMS System in the State of North Carolina pursuant to the rules of the North Carolina Medical Care Commission. SYSTEM MEDICAL DIRECTOR Mark Glaser Type/Print Name EMS SYSTEM ADMINISTRATOR Ricky Denning Type/Print Name COUNTY MANAGER Joseph Jeffries Type/Print Name PROVIDER ADMINISTRATOR I AGENCY NAME: Type/Print Name PROVIDER ADMINISTRATOR I AGENCY NAME: ;ypeiPrint Name PROVIDER ADMINISTRATOR I AGENCY NAME: Type/Print Name PROVIDER ADMINISTRATOR I AGENCY NAME: Type/Print Name PROVIDER ADMINISTRATOR I AGENCY NAME: Type/Print Name PROVIDER ADMINISTRATOR I AGENCY NAME: Type/Print Name PROVIDER ADMINISTRATOR I AGENCY NAME: Type/Print Name Date Signature Date {!) licensed Agency 0 Non-licensed Agency Signature Date {!)licensed Agency 0 Non-licensed Agency Signature Date @ Licensed Agency 0 Non-licensed Agency Signature Date {!)Licensed Agency 0 Non-licensed Agency Signature Date (!) Licensed Agency 0 Non-lice nsed Agency Signature Date (!) Li censed Agency 0 Non-licensed Agency Signature Date {!)licensed Agency 0 Non-licensed Agency Signature Date BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST System Approval App~cation DHHS/OHSR/OEMS 4912 Page 7 of8 Elfediw 81112014 011916 HC BOC Page 105 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 1 2707 Mail Service Center 1 Raleigh, NC 27603-2008 1 Phone : (919) 855-3935 1 Fax: (919) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Effective: 8/112014 This application is for renewal of a current EMS Provider License only. Each highlighted section must be completed . Information in the Credentialing Information System (CIS) must be current prior to application submission. Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fixed-wing providers), and County Manager (if applicable) are required . Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below. GENERAL INFORMATION Provider Name: Harnett County EMS Office Number: (91 0) 893-7563 Physical Address: 1005 Edwards bROTHERS dRIVE Fax Number: (910) 814-2570 City: lillington State: NC Provider Admin Contact: Ricky Denning County: Harnett Zip: 27504 Title: EMS Divsion Chief Mailing Address: P.O. Box 370 Office Number: (910) 893-7563 City: Lillington State: NC Mobile Number: (910) 984-6283 County: Harnett Zip: 27504 Fax Number: (91 0) 814-2570 PROPERTIES E-mail Address: rdenning@harnett,org r Service Level : EMT -Paramedic System Affiliation: Harnett County ·ovider Number: 0430604 Provider Lie No: 1115 License Exp. Date: Renewals must be submitted at least thirty !30) days prior to e xpiration to the appropriate regional office indicated below: CENTRAL Central Regional Office of EMS 801 Biggs Drive 2717 Mail Service Center Raleigh , NC 27699-2717 Office : (919) 855-4678 Fax : (919) 715-0498 EMS Provider License Renewal DHHS/DH SRIOE MS 491 3 EASTERN WESTERN Eastern Regional Office of EMS We stern Regional Office of EM S 404 St. Andrews Drive, Suite 7 3305 16'" Avenue SE, Suite 302 Greenville , NC 27834-B850 Conover, NC 2861 3-9213 Office: (252) 355-9026 Office: (828) 466-5548 Fax : {2525) 355-9063 Fax : (828) 466-5651 BE PREPARED TO PRESENT SUPPORTING OOCUMENTATlON UPON REQUEST Page 1 of 3 jJan 31 ,2016 Effective 8/1/2014 011916 HC BOC Page 106 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 10A NCAC 13P .0204 (a) Any firm , corporation , agency, organization or association that provides emergency medical services shall be licensed as an EMS Provider by meeting and continuously maintaining the following criteria: 10A NCAC 13P .0204 (a)(1) Be affiliated as defined in Rule .0102(4) of this Subchapter with each EMS System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport with in the system ; ENTER SYSTEM NAME: Harnett County 10A NCAC 13P .0204 (a)(2) Present an application for a permit for any ambulance that will be in service as required by G.S. 131E-156; 10A NCAC 13P .0204 (a)(3) Submit a written plan detailing how the EMS Provider will furnish credentialed personnel; Harnett County EMS employees 40 Full time Paramedics, 12 lntermediateJBasics and 74 part time employees to cover our response area 24!7. BRIEFLY DESCRIBE HOW EMS PROVIDER WILL FURNISH CREDENTIALED PERSONNEL: INhere there are franchise ordinances pursuant to G.S 153A-250 in effect that cover the proposed service areas of each EMS system of operation , show the affiliation as defined in Rule .0102(4) of this Subchapter with each EMS System, as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1) of this Rule , by being granted a current franchise to operate, or present written documentation of impending receipt of a franchise. from each county. In counties where there is no franchise ordinance in effect, present a signature from each EMS System representative authorizing the EMS Provider to affiliate as defined in Rule .0102(4) of this Subchapter and as required by Paragraph (a)(1) of this Rule; DOES COUNTY HAVE A FRANCHISE ORDINANCE? (e) YES ()NO IF YES , IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a)(5) Provide systematic, periodic inspection, repair, cleaning , and routine ma intenance of all EMS responding ground vehicles and maintain records available for inspection by the OEMS which verify compliance with this Subparagraph; Units are inspected daily at shift change. Units are serviced every 5000 miles. When BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS repairs are needed they are done either at the county garage or a local independent THIS REQUIREMENT TO INCLUDE HOW UNITS ARE certified mechanic. CLEANED, MAINTAINED, AND REPAIRED: Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary 10A NCAC 13P .0204 (a)(6) as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G .S. 1508-21.6, including subsequent amendments and additions . Harnett County EMS utilizes EMS Charts for its reporting software. Data collected is BRIEFLY DESCRIBE HOW EMS PROVIDER submitted on a regular bases. MEETS THIS REQUIREMENT : Develop and implement written operational protocols for the management of equipment , supplies and medications and 10A NCAC 13P .0204 (a)(7) maint ain records available for inspection by the OEMS which verify compliance with this Subparagraph . These protocols shall include a methodology : 10A NCAC 13P .0204 (a)(7)(A) to assure that each veh icle contains the required equipment and supplies on each response; A list of required medications and supplies is set by our Medical Director and a daily BRIEFLY DESCRIBE HOW EMS PROVIDER check off sheet is filled out to ensure proper quantities on each unit. MEETS THIS REQUIREMENT : 10A NCAC 13P .0204 (a)(7)(B) for deaning and maintaining the equipment and vehicles; and Units are inspected and cleaned on a daily bases at the beginning of every shift. Cleaning BRIEFLY DESCRIBE HOW EMS PROVIDER supplies are furnished as well as disinfectant to kill germs. ME ETS THIS REQUIREMENT: 10A NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications. Medications and equipment with expiration dates are checked on a monthly base and BRIEFLY DESCRIBE HOW EMS PROVIDER replaced prior to them expiring. Medications are temperature controlled by leaving the unit MEETS THIS REQUIREMENT: running when temps are either to cold or to hot . When in quarters our bags are removed from units and placed inside . BE PREPARED TO PRESENT SUPPORnNG DOCUMENTATION UPON REQUEST EMS Provider Ucense Renewal DHHSIOHSR/OEMS .91 3 Page 2 of3 Effec1"'" 81112014 011916 HC BOC Page 107 In addition to the general requirements detailed in Paragraph (a) of this Rule , if providing fixed-wing air medical services , 10A NCAC 13P .0204 (a)(b) affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined In Rule .0102(30) of this Subchapter is required to ensure the provision of peer review, medical director oversight and treatment_ protocol maintenance. In addition to the general requirements detailed in Paragraph (a) of this Rule , if providing rotary-wing air medical services, affiliation as defined in Rule .0102(4) of this Subchapter with a Level I or Level II Trauma Center as defined in Rules 10A NCAC 13P .0204 (a)( c) .0102(35) and (36) of this Subchapter designated by the OEMS is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. Due to the geographical barriers unique to the County of Dare, the Medical Care Commission exempts the Dare County EMS System from this Paragraph. 110A NCAC 13P .0204 (a)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraphs (a) through (c) of this Rule. EMS PROVIDER LICENSE RENEWAL Effective: 8/112014 PROVIDER NAME : Harnett County EMS PROVIDER NUMBER : _0_43_0_6_0_4 ___ _ ENDORSEMENTS We, the undersigned, recommend this EMS Provider for License Renewal by the North Carolina Office of EMS. We fully approve, support. and endorse this application to the North Carolina Office of EMS with thorough knowledge and understanding of our respective roles and responsibilities in maintain ing an EMS Provider within our EMS System in the State of North Carolina pursuant to the rules of the North Carolina Medical Care Commission. PROVIDER ADMINISTRATOR Signature / Fixed Wing Provider: QvES {!)No I ;17'); ~ Daiil' ~r Ricky Denning Type/Print Name SYSTEM MEDICAL DIRECTOR Mark Glaser Type/Print Name .MS SYSTEM ADMINISTRATOR Ricky Denning Type/Print Name Signature Date *HOSPITAL ADMINISTRATOR Type/Print Name Signature Date -COUNTY MANAGER Joseph Jeffries Type/Print Name Signature Date * Hospital Administrator s signature is required for fix ed wi ng providers. ** The County Managers signature is not required when through written delegation or resolution. the system administrator has been delegated authority to act on behalf of the county. If the oounty manager or system administrator has changed since lest submission, a new letter from the oounty is required. E MS Provider l.ioense Renewal OHHSIDH SRIOEMS ~91 3 NOTE: If a provider operates in multiple county EMS Systems, an Endorsements page must be completed f o r each of t h e county EMS Systems. BE PREPARED TO PRESENT SUPPORllNG DOCUMENTATION UPON REQUEST Page 3ol3 Effective 8/1120 14 011916 HC BOC Page 108 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 12707 Mail Service Center 1 Raleigh, NC 27603-20081 Phone : (919) 855-39351 Fax: (9 19) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Effective: 8/1/2014 Thi s application is for renewal of a current EMS Provider License only. Each highlighted section must be completed . Information in the Credentialing Information System (CIS) must be current prior to application submission . Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fixed-wing providers), and County Manager (if applicable) are required . Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below. GENERAL INFORMATION Provider Name: Buies Creek Rural Fire Department INC . Office Number: (910) 893-4327 Physical Address: 112 Marshbanks St Fax Number: (910) 893-8475 City : Lillington State: NC Provider Admin Contact: Justin Riewestahl County: Harnett Zip: 27546 Title: Chief of Department Mailing Address: P.O. Box 447 Office Number: (910) 893-4327 City: Buies Creek State: NC Mobile Number: (919) 337-8018 County: Harnett Zip: 27506 Fax Number: (910) 893-8475 PROPERTIES E-mail Address: chief@buiescreekfirerescue.org s-·;ce Level: EMT-Basic System Affiliation: Harnett County EMS - Pru"lfider Number: 0431053 Provider Lie No: 1544 License Exp. Date: !Jan 31, 2016 Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below: CENTRAL EASTERN WESTERN Central Reg ional Office of EMS Eastern Regional Office of EMS Western Regional Office of EMS 801 Biggs Drive 404 St. Andrews Drive, Suite 7 3305 1610 Avenue SE, Suite 302 2717 Mail Service Center Greenville , NC 27834-6850 Conover, NC 28613-9213 Raleigh, NC 27699-2717 Office: (252) 355-9026 Office : (828) 466-5548 Office: (919) 855-4678 Fax: (2525) 355-9063 Fax : (828) 466-5651 Fax: (919) 715-0498 BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST FM~ PmvirtAr I irAn.ctA RAnAWAI FffAt"JivA R/11?014 011916 HC BOC Page 109 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 10A NCAC 13P .0204 (a) Any firm, corporation , agency , organization or association that provides emergency medical services shall be licensed as an EMS Provider by meeting and continuously maintaining the following criteria: 10A NCAC 13P .0204 (a)(1) Be affiliated as defined in Rule .0102(4) of this Subchapter with each EMS System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport within the system ; 'HER SYSTEM NAME : Hamett County '- 10A NCAC 13P .0204 (a){2) Present an application for a permit for any ambulance that will be i n service as required by G.S. 131E-156; 10A NCAC 13P .0204 (a){3) Submit a written plan detailing how the EMS Provider will furnish credentialed personne l; We provide EMS coverage 24 hrs a day, 7 days a week by utilizing paid and volunteer duty crew staff. We have a minimum of EMT-B and MR on every crew. BRIEFLY DESCRIBE HOW EMS PROVIDER WILL FURNISH CREDENTIALED PERSONNEL: Where there are franchise ordinances pursuant to G.S 153A-250 in effect that cover the proposed service areas of each EMS system of operation, show the affiliation as defined in Rule .01 02(4) of this Subchapter with each EMS System, as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1) of this Rule, by being granted a current franchise to operate, or p re sent written documentation of impending receipt of a franchise, from each county . In counties where there is no franchise ordinance in effect, present a signature from each EMS System representative authorizing the EMS Provider to affiliate as defined in Rule .0102(4) of this Subchapter and as required by Paragraph (a)(1) of this Rule; DOES COUNTY HAVE A FRANCHISE ORDINANCE? (e) YES (J NO IF YES, IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a)(S) Provide systematic, periodic i nspection , repair, cleaning , and routine maintenance of all EMS responding ground vehicles and ma intain records ava ilable for inspection by the OEMS which verify compliance with this Subparagraph; We check ambulances daily and clean/d isinfect after each response. We utilize certified BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS mechanics to perfonn routine maintenance on our vehicles. We keep all records for the life THIS REQUIREMENT TO INCLUDE HOW UNITS ARE of the vehicles. CLEANED, MAINTAINED, AND REPAIRED: Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary 10A NCAC 13P .0204 (a)(6) as specified in "North Carolina College of Emergency Physicians : Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G .S. 150B-21 .6 , including subsequent amendments and additions. 1- We are presently utilizing EMS charts software to capture EMS data and its submitted to BRIEFLY DESCRIBE HOW EMS PROVIDER the state on routine basis by Hamett county on our behalf. MEETS THIS REQUIREMENT: Develop and implement written operational protocols for the management of equipment, supplies and medications and 10A NCAC 13P .0204 (a)(7) maintain records available for inspection by the OEMS which verify compliance with this Subparagraph. These protocols shall include a methodology: 10A NCAC 13P .0204 (a)(7)(A) to assure that each vehicle contains the required equipment and supplies on each response ; We inspect the ambulances daily and after each call to restock used items. BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS THIS REQUIREMENT: 1 OA NCAC 13P .0204 (a)(7)(B) for cleaning and maintaining the equipment and vehicles; and The ambulances are checked for maintenance problems on a daily basis. We BRIEFLY DESCRIBE HOW EMS PROVIDER clean/disinfect ambulances after each call. We inspect the ambulanc es and check the MEETS THIS REQUIREMENT: equipment stock after each call to maintain readiness. 10A NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications . We maintain climate control of our ambulances in the station. On our EMS incidents we BRIEFLY DESCRIBE HOW EMS PROVIDER keep operational with heat or AC operational to maintain manufacturer's specifications on medications. The medications are checked at the beginning of each month to ensure MEETS THIS REQUIREMENT : expiring drugs are removed and replaced. - BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST F'ffN':tivA R/11'?014 011916 HC BOC Page 110 In addition to the general requirements detailed in Paragraph (a) of this Rule , if providing fixed-wi ng air medical services , 10A NCAC 13P .0204 (a)(b) affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined i n Rule .0102(30) of this Subchapter is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. In addition to the general requirements detailed in Paragraph (a) of this Ru le, if providing rotary-wing air medical services , affiliation as defined in Rule .0102(4) of this Subchapter with a Leve l I or Level II Trauma Center as defined in Rules 10A NCAC 13P .0204 (a)(c) .01 02(35) and (36) of this Subchapter designated by the OEMS is requ ired to ensure the provision of peer review, med ical director oversight and treatment protocol maintenance. Due to the geographical barriers unique to the County of Dare, the 1-Med ical Care Commission exempts the Dare County EMS System from this Paragraph. 10A NCAC 13P .0204 (a)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraphs (a) through (c) of this Rule. EMS PROVIDER LICENSE RENEWAL Effective: 8/112014 PROVIDER NAME : Buies Creek Rural Fire Department INC. 0431053 PROVIDER NUMBER : ------- ENDORSEMENTS We, the undersigned, recommend this EMS Provider for License Renewal by the North Carolina Office of EMS . We fully approve, support, and endorse th is application to the North Carolina Office of EMS with thorough knowledge and understanding of our respective roles and responsibilities in maintaining an EMS Provider within our EMS System in the State of North Carolina pursuant to the rules of the North Carolina Med ica l Care Commission . PROVIDER ADMINISTRATOR Fixed Wing Provider: Q vES @N o Justin Riewestahl Type/Print Name SYSTEM MEDICAL DIRECTOR Mark Glaser ,rlntName EMS SYSTEM AOMINISTRA TOR Ricky Denning Type/Print Name *HOSPITAL ADMINISTRATOR Type/Print Name Signature Date **COUNTY MANAGER Joseph Jeffries Type/Print Name Signature Date * Hospital Administrator's signature is required for fixed wing providers. ** The County Manager's signature is not required when through written delegation or resolution, the system administrator has been delegated authority to act on behalf of the county. If the county manager or system administrator has changed since last submission, a new letter from the county is required. NOTE: If a provider operates in multiple county EMS Systems, an Endorsements page must be completed for each of the county EMS Systems. BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST l=ffAr.tiiiA AJ11?014 011916 HC BOC Page 111 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVIC E REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive 12707 Mail Sel\lice Center 1 Raleigh, NC 27603-20081 Phone: (919) 855-3935 1 Fax: (919) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Effective: 8/112014 This applicat ion is for renewal of a current EMS Provider License only . Each highlighted section must be completed. Information in the Crede ntialing Informat ion System (C IS) must be current prior to application submission . Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fixed-wing providers), a nd County Manager (if applicable) are required . Renewals m ust be submitted at least thirty !30) davs prior to expiration to the appropriate regional office indicated below. GENERAL INFORMATION Provid er Name : Benhaven Emergency Services, Inc. Office Number: (919) 499-9511 Physical Address : 4023 N. Carolina Highway 87 North Fax Number: (919) 498-0188 City: Sanford State: NC Provider Admin Contact: RA Thomas County: Harnett Zip: 27332 Title: Chief Mailing Address: P.O. Box 301 Office Number; (919) 499-9511 City: Olivia State: NC Mobile Number: (919) 356-5311 County: Harnett Zip: 28368 Fax Number: (919) 499 -1569 PROPERTIES E-mail Address: athomas@benhavenfirerescue .com Sol\llce l evel : EMT -Intermediate System Affiliation: Harnett County Provider Number: 0430699 Provider lie No: 1287 lfcenso Exp. Date: Renewa ls must be submitted at least thirty {30) davs prior to expiration to the appropriate regional office indicated below: CENTRAL Centra l Regional Offi ce of EMS 801 Biggs Drive 2717 Mail Service Center Raleigh . NC 27699-271 7 Office : (919) 855-4678 Fax: (919) 715-0498 EMS ProVIder t.ronse Re newal OHHSIOHSR/OEMS 4913 EASTERN WESTERN Eastern Regional Office of EMS Western Regional Office of EMS 404 St. Andrews Drive, Suite 7 3305 16"' Avenue SE . Suite 302 Greenville . NC 27834 -6850 Conover. NC 28613-g2 13 Office : (252) 355-9026 Office: (828) 466 -5548 Fax : (2525) 355 -9063 Fax : (828 ) 466-5651 BE PREPARED TO PRESENT SU PPORTING DOCUM ENTATION UPON REQUEST Page 1 ot 3 j Jan 3 1,2016 Effective 0/1 120 14 011916 HC BOC Page 112 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 10A NCAC 13P .0204 (a) Any firm. corporation. agency . organization or association that provides emergency medical services shall l>e licensed as an EMS Provider by meeting and continuously maintaining the following criteria : 10A NCAC 13P .0204 (a)(1) Be affiliated as defined in Rule .01 02(4) of this Subchapter with each EMS System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport within the system: ENTER SYSTEM NAME: Harnett County 10A NCAC 13P .0204 (a)(2) Present an application for a permit for any ambulance that will be in service as required by G.S . 131E-156: 10A NCAC 13P .0204 (a)(3) Submit a written plan detailing how the EMS Provider will furnish credentialed personnel; A ll members are required to submit a written application to include all certifications and credentials. Driving and criminal checks are completed by our agency. Certification and BRIEFLY DESCRIBE HOW EMS PROVIDER WILL credential verifications are through transcripts and the State CIS System. FURNISH CREDENTIALED PERSONNEL : Where there are franchise ordinances pursuant to G .S 153A-250 in effect that cover the proposed service areas of each EMS system of operation, show the affiliation as defined in Rule .01 02(4) of this Subchapter with each EMS System, as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1) of this Rule, by being granted a current franchise to operate. or present written documentation of impending receipt of a franchise. from each county . In counties where there is no franchise ordinance in effect , present a signature from each EMS System representative authorizing the EMS Provider to affiliate as defined in Rule .0102(4) of this Subchapter and as required by Paragraph (a)(1) of this Rule : DOES COUNTY HAVE A FRANCHISE ORDINANCE? ( .. ) YES (J NO IF YES, IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a}(S) Provide systematic. periodic inspection. repair. cleaning . and routine maintenance of all EMS responding ground vehicles and maintain records available for inspection by the OEMS which verify compliance with this Subparagraph; All vehicles are on a preventative maintenance program provided by a local fleet BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS maintenance facil ity. All service and repair records are maintained in our Administrative THIS REQUIREMENT TO INCLUDE HOW UNITS ARE office. The patient compartment and interior spaces are cleaned in accordance with CLEANED, MAINTAINED, AND REPAIRED : Infectious Control Standards. Deconed per s Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary 10A NCAC 13P .0204 (a)(G) as specified in "North Carolina College of Emergency Physicians: Standards for Medical Oversight and Data Collection .· incorporated by reference in accordance with G.S. 1506-21.6. including subsequent amendments and additions. The system uses a county wide server with all squads using EMS CHARTS. The software BRIEFLY DESCRIBE HOW EMS PROVIDER is designed to cover all parameters as required by the State. We provide members with MEETS THIS REQUIREMENT : desktop units, mobile data collection, high speed internet and mobile air cards to facilitate the electronic submission. Develop and implement written operational protocols for the management of equipment , suppli es and medications and 10A NCAC 13P .0204 (a)(7) maintain records availabl e !Of inspection by the OEMS which verify compl iance with this Subparagraph. These protocols shall include a methodolocw: 10A NCAC 13P .0204 (a)(7)(A) to as sure lhat each vehicle contains the required equipment and supplies on each response: Vehicles are stocked a nd inspected based on form EMS 4905 provided by NCOEMS. BRIEFLY DESCRIBE HOW EMS PROVIDER Vehicles are inspected for compliance at the beginning of each shift and after each call. MEETS THIS REQUIREMENT : Shift inspection forms are maintained in the Administrative office for at least one year . 10A NCAC 13P .0204 (a)(7}(B) tor cl eaning and maintaining the equipment and vehicles : and All members are provided SOG's and job descriptions that outline how vehicles and BRIEFLY DESCRIBE HOW EMS PROVIDER equipment are to be cleaned and maintained. The squad maintains contracts for MEETS THIS REQUIREMENT: equipment that require a third party to service. Vehicles are maintained a s outlined in Section 5 of this plan. 10A NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications. Any stocked item with an expi ra tion date is inspecte d on the last day of the month for BRIEFLY DESCRIBE HOW EMS PROVIDER compliance. All units are stored in a climate controlled environment w h en not responding MEETS THIS REQUIREMENT: to calls. When out of stati ons departmental S OG's require the vehicle to maintain a controlled environment bas ed o n weather BE PREPARED TO PRESENT SUPPORTING DOCUMENTAT ION UPON REQUEST EMS ProVKJer License Renewal DHHSIOHSRIOEMS 4913 Page 2 ol 3 Effectovo 6111201 4 011916 HC BOC Page 113 In addition lo the general requirements detailed in Paragraph (a) of this Rule, if providing fixed-wing air medical services. 10A NCAC 13P .0204 (a)(b) affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined 111 Rule 0102(30) of this Subchapter 1s required to ensure the provision of peer review . medical director oversight and treatment protocol maintenance. In addition to the general requirements detailed in Paragraph (a) of this Rule , 1f providing ro tary-wing air medical services, affiliation as defined in Rule .0102(4) of this Subchapter with a Level I Of Level II Trauma Center as defined in Rules 10A NCAC 13P .0204 (a)(c) .0102(35) and (36) of this Subchapter designated by the OEMS 1s required to ensure the provision of peer review. medical director oversight and treatment protocol maintenance. Due to the geographical barners unique to the County of Dare. the Medical Care Commission exempts the Dare County EMS System from this Paragraph. 10A NCAC 13P .0204 (a)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraphs (a) through (c) of this Rule EMS PROVIDER LICENSE RENEWAL Effec~~...e · 811/2014 PROVIDER NAME: Benhaven Emergency Services, Inc. PROVIDER NUMBER : _0_43_0_6_9_9 ___ _ ENDORSEMENTS We, the undersigned, recommend this EMS Provider for License Renewal by lhe North Carolina Office of EMS. We fully approve , support, and endorse !his application lo the North Carolina Office of EMS with thorough knowledge and underslanding of our respeclive roles and responsibilities in maintaining an EMS Provider wilhin our EMS System in the State of North Carolina pursuant to the rules of the North Carolina Med ical Care Commission. PROVIDER ADMINISTRATOR RA Thomas Type/Print Name Signature V\1\~ ~'\ ~ Signature EMS SYSTEM ADMINISTRATOR Type/tfW IJ!/,I~ *HOSPITAL ADMINISTRATOR Type/Print Name Signature **COUNTY MANAGER Type/Print Name Signature * Hospital Administrator's signature is required for fixed wing providers. Fixed Wing Provider: QvEs @No 1 10/30/20 15 Dato Date Date ** The County Manager's signature is not required when thro ugiJ written delegation or resolution, the system administrator has been delegated authority to act on behalf of the county. If the county manager or system administrator has changed smce la st submisston, a new letter from the county is required. l;MS ProYider Llcenoe Reoowal "'"iSRIOEMS 491 3 NOTE: If a provider operates in multiple county EMS Systems, an Endorsements page must be completed for each of the county EMS Systems. BE PREPARED TO PRESENT SUPPORTING DOCUMENTATION UPON REQUEST Page 3 or 3 Effec11ve 81112014 011916 HC BOC Page 114 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT OF HEALTH SERVICE REGULATION OFFICE OF EMERGENCY MEDICAL SERVICES 1201 Umstead Drive )2707 Mail Service Center 1 Raleigh, NC 27603-20081 Phone: (919) 855-3935 I Fax: (919) 733-7021 EMS PROVIDER LICENSE RENEWAL APPLICATION Effective: 8/1/2014 This application is for renewal of a current EMS Provider License only. Each highlighted section must be completed. Information in the Credentialing Information System (CIS) must be current prior to application submission . Endorsements from the Provider Administrator, System Medical Director, EMS System Administrator, Hospital Administrator (for fixed-wing providers), and County Manager (if applicable) are required . Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below. GENERAL INFORMATION Provider Name: Boone Trail Emergency Services, Inc. Office Number: (910) 893-3750 Physical Address: 7016 US Hwy 421 North Fax Number: (910) 893-5092 City: Lillington State: NC Provider Admin Contact: Tony Currin County: Harnett Zip: 27546 Title: Chief Mailing Address: PO Box 411 Office Number: (910) 893-3750 City: Mamers State: NC Mobile Number: (910) 814-7192 County: Harnett Zip: 27552 Fax Number: (91 0) 893-5092 PROPERTIES E-mail Address: btes.harnett@yahoo.com I !iervice Level: EMT-Basic System Affiliation: Harnett County I tovider Number: 0430660 Provider Lie No: 1412 License Exp. Date: Renewals must be submitted at least thirty (30) days prior to expiration to the appropriate regional office indicated below: CENTRAL Central Regional Office of EMS 801 Biggs Drive 2717 Mail Service Center Raleigh , NC 27699-2717 Office : (919) 855-4678 Fax: (919) 715-0498 EMS Provider L•oense Renewal OHHSIDHSR/OEMS 491 3 EASTERN WESTERN Eastern Regional Office of EMS Western Regional Office of EMS 404 St. Andrews Drive , Suite 7 3305 16111 Avenue SE, Suite 302 Greenville, NC 27834-6850 Conover. NC 28613-9213 Office: (252) 355-9026 Office: (828) 466-5 548 Fax : (2525) 355-9063 Fax: (828) 466-5651 Page 1 of 3 !Jan 1, 2016 Effec1ive 811/2014 011916 HC BOC Page 115 10A NCAC 13P .0204 EMS PROVIDER LICENSE REQUIREMENTS 10A NCAC 13P .0204 (a) Any firm, corporation, agency, organization or association that provides emergency medical services shall be licensed as an EMS Provider by meeting and continuously maintaining the following criteria: 10A NCAC 13P .0204 (a)(1) Be affiliated as defined in Rule .0102(4) of this Subchapter with each EMS System where there is to be a physical base of operation or where the EMS Provider will provide point-to-point patient transport within the system; ENTER SYSTEM NAME: Harnett County 10A NCAC 13P .0204 (a)(2) Present an application for a permit for any ambulance that will be in service as required by G.S. 131E-156; 10A NCAC 13P .0204 (a)(J) Submit a written plan detailing how the EMS Provider will fumish credentialed personnel : Credentialed staff will be furnished through a combination of Paid and Volunteer staffing and credential status monitored through CIS. BRIEFLY DESCRIBE HOW EMS PROVIDER WILL FURNISH CREDENTIALED PERSONNEL : Where there are franchise ordinances pursuant to G.S 153A-250 in effect that cover the proposed service areas of each EMS system of operation, show the affiliation as defined in Rule .0102(4) of this Subct\apter with each EMS System, as required 10A NCAC 13P .0204 (a)(4) by Subparagraph (a)(1 ) of this Rule, by being granted a current franct\ise to operate, or present written documentation of impending receipt of a franchise, from each county. In counties where there is no franchise ordinance in effect. present a signature from each EMS System representative authorizing the EMS Provider to affiliate as defined in Rule .01 02(4) of this Subchapter and as required by Paragraph (a)(1) of this Rule: DOES COUNTY HAVE A FRANCHISE ORDINANCE? (e) YES ()NO IF YES, IS FRANCHISE AGREEMENT GRANTED? (e) YES ()NO 10A NCAC 13P .0204 (a)(5) Provide systematic, periodic inspection, repair, cleaning, and routine maintenance of all EMS responding ground vehides and maintain records available for inspection by the OEMS which verify compliance with this Subparagraph; Units are checked off on a daily basis which includes cleaning exterior and interior. Daily BRJEFL Y DESCRIBE HOW EMS PROVIDER MEETS cleaning with disinfectant. Crews maintain cleanliness of unit after each call. Routine THIS REQUIREMENT TO INCLUDE HOW UNITS ARE maintenance and unscheduled repairs are provided through 2 local service locations. CLEANED, MAINTAINED, AND REPAIRED: Collect and within 24 hours electronically submit to the OEMS EMS Care data that uses the EMS data set and data dictionary 10A NCAC 13P .0204 (a)(6) as specified in "North Carolina Co llege of Emergency Physicians: Standards for Medical Oversight and Data Collection," incorporated by reference in accordance with G.S. 1508-21 .6 , induding subsequent amendments and add itions. Patient care reports submitted utilizing EMS Charts. BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS THIS REQUIREMENT : Develop and implement written operational protocols for the management of equipment, supplies and medication s and 10A NCAC 13P .0204 (a)(7) maintain records available for inspection by the OEMS which verify compliance with this Subparagraph. These protocols shall indude a methodology : 10A NCAC 13P .0204 (a)(7)(A) to assure that each vehide contains the required equipment and supplies on each response ; Units checked daily to comply with Harnett County approved Equipment. Supply and BRIEFLY DESCRIBE HOW EMS PROVIDER Medication supply matrix. MEETS THIS REQUIREMENT: 10A NCAC 13P .0204 (a)(7)(B) for cleaning and maintaining the equipment and vehides ; and Cleaned daily using appropriate cleaning solution and after each use. Stretcher BRIEFLY DESCRIBE HOW EMS PROVIDER maintenance contract in place. MEETS THIS REQUIREMENT: 10A NCAC 13P .0204 (a)(7)(C) to assure that supplies and medications are not used beyond the expiration date and stored in a temperature controlled atmosphere according to manufacturer's specifications . BRIEFLY DESCRIBE HOW EMS PROVIDER MEETS THIS REQUIREMENT: EMS Provider License Renewal DHHSIOHSRIOEMS 4913 Unit is checked daily and an end of month check off is completed to ensure supplies in date. Unit is housed in temperature controlled bay when not in use. Units remain running for duration of call. Effective 8/112014 Page 2 of 3 011916 HC BOC Page 116 In addition to the general requirements detailed in Paragraph (a) of this Rule, if providing fixed-wing air medical services , 10A NCAC 13P .0204 (a)(b) affiliation as defined in Rule .0102(4) of this Subchapter with a hospital as defined in Rule .0102(30) of this Subchapter is required to ensure the provision of peer review, medical director oversight and treatment protocol maintenance. In addition to the general requirements detailed in Paragraph (a) of this Rule , if provid ing rotary-wing ai r medical services , affiliation as defined in Rule .0102(4) of this Subchapter with a Level I or Level II Trauma Center as defined in Rules 10A NCAC 13P .0204 (a)(c) .01 02(35) and (36) of this Subchapter designated by the OEMS is required to ensure the provision of peer review, medica l director oversight and treatment protocol maintenance. Due to the geographical barriers unique to the County of Dare, the Medical Care Commission exempts the Dare County EMS System from this Paragraph. 10A NCAC 13P .0204 (a)(d) An EMS Provider may renew its license by presenting documentation to the OEMS that the Provider meets the criteria found in Paragraphs (a) through (c) of this Rule. EMS PROVIDER LICENSE RENEWAL Effective : 81112014 PROVIDER NAME: Boone Trail Emergen cy SeNices, In c. PROVIDER NUMBER : _0_43_0_6_6_0 ___ _ ENDORSEMENTS We, the undersigned , recommend this EMS Provider for License Renewal by the North Carolina Office of EMS. We fully approve, support, and endorse this application to the North Carolina Office of EMS with thorough knowledge and understanding of our respective roles and responsibil ities in maintaining an EMS Provider within our EMS System in the State of North Carolina pursuant to the rules of the North Carolina Medical Care Commission . PROVIDER ADMINISTRATOR Fixed Wing Provi der: QvES (!)No Tony C urrin, Chief Type/Print Name Date SYSTEM MEDICAL DIRECTOR o.x lb_ r C\ <&~"'~ EMS SYSTEM ADMINISTRATOR , .. ~4i::.hr ~:; I ;d;)/, Da(e *HOSPITAL ADMINISTRATOR Type/Print Nam e Signature Date **COUNTY MANAGER Type/Print Name Signature Da te * Hospital Administrator's signature is required for ftxed wing providers. ** The County Manager's signature is not required when through written delegation or resolution, the system administrator has been delegated authority to act on behalf of the county. If the county manager or system administrator has changed since last submission, a new letter from the county i s required. EMS Provider License Renewal OHHSIOHSR/OE MS 49 13 ~OTE lf a orovider operates in multi1fe cc •''lty EMS S\ ems. :tn Endorsements page must he completed for each of the county EMS Sysrems Page 3 o1 3 Effec~ve 8/1/201 4 011916 HC BOC Page 117 Board Meeting Agenda Item Agenda Item 4G MEETING DATE: January 19,2016 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Reclassification and new position request REQUESTED BY: Jimmy Riddle, Emergency Services Director REQUEST: I. Request new Fire Marshal position. The County Fire Marshal duties currently fall under the vacant Deputy Emergency Services Director's position. Due to the nature of the duties, and the increasing activity within the County, we would like to request that a new position, County Fire Marshal Grade 78, be added to the department. This position will also serve as the division supervisor. 2. Reclassification of job duties for the Deputy Emergency Services Director position (DESD). In direct correlation to the new position request, it is requested that the current vacant DESD job duties be reclassified to remove the duties of the Fire Marshal, and that new and broader duties be added. The additional duties will allow the job to function in a manner which will greater complement the Emergency Services Director's position. Additionally, it is also requested that this position be graded from a 79 to a Grade 80 (the Emergency Services Director's position is a grade 82). This request will allow the department a broader flexibility in meeting its long-range plan and staffing requirements. FINANCE OFFICER'S RECOMMENDATION: Yes COUNTY MANAGER'S RECOMMENDATION: C :\U sers\gwheeler\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\98RKKOE 5\Emergency Services Ne w PO sition .doc Page I of I 011916 HC BOC Page 118 EMERGENCY SERVICES DEPUTY DIRECTOR General Statement of Duties Performs management and professional work directing the emergency medical, emergency management, and fire marshal services for the County as assigned or in the absence of the Emergency Services Director. Distinguishing Features of the Class An employee in this class plans, develops, organizes and directs the activities of the emergency services for the County. Work involves budget preparation and administration , personnel staffing and training, equipment maintenance oversight, development and implementation of policies and procedures, legal issues, and regulatory management and compliance for the department. Work involves a broad scope of public contacts requiring facilitation skills, a variety of technical and detailed knowledge in the area of emergency medical services, emergency management, disasters, homeland security, and fire; and considerable independent initiative and judgment. The employee is subject to hazards in the emergency services work including working in both inside and outside environmental conditions, extreme temperatures, hazardous fumes , dusts, odors, mists , and gases and working in close quarters. Work may expose the employee to human blood or body fluids and thus the job is subject to the OSHA requirements on blood borne pathogens. Work is supervised by the Emergency Services Director and is evaluated through conferences, results of work, reports, and public feedback. Duties and Responsibilities Essential Duties and Tasks Plans, organizes, and directs the emergency preparations and response of the County; coordinates with state and local officials; responds to emergency situations and may assume command; writes and administers grants for EOC and emergency response equipment; provides public education and awareness programming; maintains EOC; ; chairs emergency planning committee. Coordinates emergency planning and response with a wide variety of federal , state, regional and local officials and agencies. Plans, organizes and directs the activities of emergency medical services department and staff; coordinates procedures and regulations with agencies served; assures maintenance of up to date procedures and protocols; research and implementation of new and revised protocols ; insures proper quality control of documentation and medical response; insures proper training of staff; coordinates and monitors the maintenance of emergency medical facilities, vehicles, equipment, and materials. Develops plans for mitigation, response and recovery of all types of man-made or natural disasters, including national security, nuclear plant, weather, hazardous materials spills and others. Participates as necessary in the work of the Fire Marshal's office . Researches, recommends and obtains needed equipment; insures proper purchasing procedures are followed . Develops and recommends budget requests; handles purchasing of equipment, materials, and supplies ; monitors and administers the approved budget; coordinates efforts for billing and collections. Identifies resources at the state and local levels that may be utilized in emergency situations. Develops and implements new programs , policies, standards, criteria , and procedures for existing medical services. Establishes and coordinates a Local Emergency Planning Committee . Handles personnel functions for staff including recruiting , training , disciplining , monitoring, and evaluating work; responds to complaints , questions, and information about the services ; responds to major emergency incidents. Assures the maintenance and completion of records , reports, and other information required in the department. Assures compliance with Jaws , rules, and regulations such as OSHA, FCC, third party 011916 HC BOC Page 119 Emergency Services Director Page 2 standards, fire codes, other ordinances and federal or state legislation . Develops methods for evaluation of programs and systems designed to help with better resource management. Additional Job Duties Attends conferences, training classes, meetings and reads literature to remain current with new trends and development in the field . Performs related duties as required . Recruitment and Selection Guidelines Knowledges. Skills and Abilities Thorough knowledge of federal, state, and local laws, policies, procedures, and regulations pertaining to emergency medical , emergency management, communications, and other services. Thorough knowledge of emergency medical practices and procedures. Considerable knowledge of public management practices including planning , budgeting , purchasing , personnel , and related supervisory requirements. Considerable knowledge of fire properties , the principles and practices of fire suppression and prevention, and related laws and regulations and of OSHA requirements Ability to interpret, explain, and apply a wide variety of policies, procedures, and regulations. Ability to prepare reports and make effective public presentations. Ability to analyze situations and services and react quickly, effectively, and professionally in emergency situations and to use sound judgment and determine best options and decisions for handling emergency matters. Ability to plan and organize work to meet deadlines and governmental requirements. Ability to establish and maintain effective working relationships with law enforcement agencies, volunteer fire services, public officials, hospitals , schools, and general public. Ability to plan, supervise , monitor, and direct a department spread over multiple locations and functions. Ability to communicate effectively in oral and written forms . Physical Requirements Must be able to perform the physical life functions of climbing , balancing , stooping , kneeling , crouching , reaching , walking , pushing , pulling, lifting, fingering , talking, and hearing . Must be able to perform very heavy work exerting in excess of 1 00 pounds of force occasionally, and/or in excess of 50 pounds of force frequently, and/or in excess of 20 pounds of force constantly to move objects. Must possess visual acuity to prepare and analyze data and figures , perform accounting functions, operate a computer terminal , operate a motor vehicle, do extensive reading and use measurement devices . Desirable Education and Experience Graduation from college or un iversity with a BA/BS degree in health services, public or business administration, or related field and considerable experience in emergency services including supervisory experience; or an equivalent combination of education and experience . Special Requirements Possession of a valid NC driver's license. Ability to obtain state certification in emergency management. Harnett County 2016 011916 HC BOC Page 120 FIRE MARSHAL General Statement of Duties Perfo rms administrative and supervisory work manag ing the f ire suppressi on , prevention , investigations and inspections programs functions for the County. Distinguishing Features of the Class An employee in this class is responsible for the overall County fire inspecti on and safety function, and for assisting in overall emergency management plann ing and response. . Work involves conducting a fire prevention and inspection program to ensure compliance with State and local fire laws, codes, rules , and regulations. Work includes supervising inspections of commercial and reta il establishments, schools , and health care facilities ; supervising and conducting fire education and safety programs, fire investigations and training ; and serving as liaison with the fire departments in the County. The employee is also responsible for assisting in developing and implementing emergency action plans in the event of natural and man-made disasters. Considerable independence and judgment are required in all aspects of the work, particularly in fire inspections . Considerable public contact requires that the employee exhibit tact and diplomacy in seek ing compliance with fire laws, codes, rules, and regulat ions. The employee is subject to hazards associated with f ire inspection , administrative, and firefighting work including working in both inside and outside environments, in extreme cold weather, and exposure to various hazards such as exposure to high heat, exposure to chemicals, and in the proximity to moving mechanical parts, electrical current, and working in high places. The employee is also exposed to atmospheric conditions and blood borne pathogens, and is sometimes required to wear a respirator, and may be required to work in close quarters. Work is performed under the general direction of the Emergency Services Director and is evaluated through observation , conferences , and written reports concerning the quali ty and effectiveness of work performed . Duties and Responsibilities Essential Duties and Tasks Directs the operation of the Fire Marshall's office includ ing supervision of staff and program operations; supervises and participates in fire inspection, fire code enforcement, plans review and other techn ical functions . Participates in the planning and implementation of County-wide plans fo r multiple responses to natural or man-made disasters; works in the EOC to coord inate activities with local fire departments. responds to emergency incidents and conditions in the County and supervise operations or backs up staff in response activities. Evaluates and monitors the performance of volunteer fire agencies providing contract services to the citizens of the county; meets with officials appointed and elected to carry out fire and emergency response m itigation and assist them as needed to ensure they are meeting the needs of their respective communities and complying with state law and local gu idel ines, and w ith maintain ing their state insurance protection grade. Assists Emergency Services D irector on specialized projects, reports and activities; applies for grants and provides grant reporting . Manages, supervises and maintains software database program for County and statewide fire reporting ; makes updates; works w ith departments on technical issues ; compi les data f or County reports and assists other agencies with data needs. Plans and conducts a program of reducing fi re hazards by sec uring compl iance w ith State and local laws, codes, rules , a nd regulations ; enforces the State Buil d ing Codes re lated to fire prevention in 011916 HC BOC Page 121 Fire Marshal Page2 the County. Participates in plan review including attending technical review comm ittee meetings when needed; reviews plans for compliance with fire prevention codes and for meeting water supply needs for firefighting . Travels to all parts of the county at various hou rs to perform an evaluation of circumstances/causal relationships using scientific methods to determine the cause of fire. Develops, maintains and manages standard operating procedures and guidelines for office; manages budget. Advises local communities on the organizing of a volunteer fire Department and serves as a resource to fire departments in purchasing fire equipment. Additional Job Duties Attends lectures; studies manuals; participates in fire drills and learns modern firefighti ng techniques; attends training to maintain certifications and increase sk ills. Performs related duties as required . Recruitment and Selection Guidelines Knowledges . Skills. and Abilities Thorough knowledge of the types of industrial and commercial operations in the county and any related potential hazards. Thorough knowledge of the methods of readily ascertaining the presence of existing or potential fire hazards. Thorough knowledge of the laws, codes, regulations, p ri ncip les and practices regarding fire prevention . Thorough knowledge of fire equipment operation and maintenance, and skill in its operation. Thorough knowledge of specialized fire database program and ability to use program to develop fire reports and data . Considerable knowledge of the cause and origins of fire and scientific detection principles. Skill in collaborative conflict resolution . Ability to read , interpret and apply a wide variety of codes, pol icies, procedures , and regulations. Ability to prepare reports and make effective public presentations. Ability to react quickly, effectively, and professionally in emergency situations. Ability to use sound judgment and determine best options and decisions for handling emergency matters . Ability to est ablish and maintain effective working re l ationships w ith law enforcement agencies, volunteer fire services, public officials, hospitals, schools, and general public. Ability to enforce codes and laws with firmness and fairness . Physical Requirements Must be able to physically perform the basic life operational functions of climbing, balancing , stooping , kneeling , crouching , craw li ng, reaching , standing , walking , pushing , pulling , lifting, fingering , grasping , feeling , talking , hearing , and perform repetitive motions. Must be able to perform very heavy work exerting in excess of 1 00 pounds of force occasionally, and 50 pounds of force frequently , and up to 20 pounds of force constantly. Must possess the visual acu ity to prepare and analyze data , for extens ive reading and work w ith figures; to operate a computer, to inspect fire sites , to use measu ri ng devices, to operate a motor vehicle ; and to determine accuracy and neatness of work . 011916 HC BOC Page 122 Fire Marshall Page3 Desirable Education and Experience Completion of high school and fire inspection and prevention schools and advanced courses and seminars in fire service and emergency response activities, and considerable experience in the fire service and/or fire inspections; or an equivalent combination of education and experience. Prefer AS in Fire Protection Technology. Special Requirement Possession of a valid North Carolina driver's license. Possession of a level Ill Fire Code Inspector certification as requ ired by the state to enforce volume V of the state building code. Possession of a Fire Investigator certification or equ ivalent. Harnett County 2008 011916 HC BOC Page 123 Board Meeting Agenda Item Agenda Item 4H MEETING DATE: January 19, 2016 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Reclassification of two Heavy Equipment Operator positions-pay grade 63 to Solid Waste Crew Leader-pay grade 65 REQUESTED BY: Amanda L . Bader, County Engineer REQUEST: County Engineer requests the reclassification of two Heavy Equipment Operator positions, pay grade 63 to Solid Waste Crew Leaders, pay grade 65. The reason for this reclassification is to create a construction crew under the Solid Waste department. This crew will be responsible for ongoing construction at the landfill such as the Dunn-Erwin vertical expansion, Anderson Creek expansion, Sheriffs firing range and other County projects. This crew will operate independently and schedule projects, coordinate meetings with design engineers, coordinate third party construction testing, relocate construction equipment, stage equipment and materials, coordinate construction staking and maintain compliance with construction permitting including erosion control , stormwater, and DEQ requirment s. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: C:\Users\bblinson\AppData\Locai\Microsoft \Windows \Temporary Int ernet Fi les\Content.Outlook\YSZDEOOQ\1 6 0 I 04- BO C Agenda Request -Reclassifi ati on Hea vy Equipme nt Operators. doc Page I of2 011916 HC BOC Page 124 Board Meeting Agenda Item Agenda Item 41 MEETTNG DATE: January 19,2016 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Reclassification REQUESTED BY: John Rou e, Jr., e REQUEST: At our last Board of Health meeting on November 19. 2015 the board approved for us to move forward with reclassifying a Public Health Nurse position to a Physici an Extender II position. This reclassification will cause a small increase in the salary which we can absorb in our current budget. However this will be les s expensive than contracting out for this service. We are seeking Board of Commissioner approval. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: U:\rn) docurnents\1-W inword\BOC Mtg Reques t \Ph )' Ext II request 1-20 16.doc I of I Pa g.: 011916 HC BOC Page 125 FORMPD-U8 NORTH CAROLINA OFFICE OF STATE PERSONNEL INSTRUCTIONS POR COMPLBTING FORM PD-118 North Carotiua Office of State Pc:nooncl L Submit o.dFDai aad (1) copy ID OSP Couultfng Toam POSITION ACTION PORM 2. Sec:tiOIUI1,2,3.4, & 5 to be c:omplebld by Joca1 apacy, Local Human Semc:.ea A.&alc:iea: alped by CoiiiU)' ofllcW (it required) & 1ecdou 6 by Dt:purtmcut of Soc:ia1 Servicea Ofllce of StaR PenGDDCI Public H~th 3. Aaacb odgtaal ad (1) copy of PcnddoD De~cdpdoo Area Mental Heulth (PD102) 1D all Rqaeata acept llbo"•hmmt 4. Aaacla apclated orpm••tlcm•l c1w1 1. LOCALAGENCYt HARNETT COUNTYHRALTH DBP.ABTMINT DATB SUBMITrBD 12-14-15 UNrT/SECTIO~'----~\~JW~t~Ii~~~u~th~t~ru~·~t ____________________________________ __ 2. BASIC POSITION I:SPORMATlON; 'Cumplete fur fill :.acuont n.oqucsn:d) Currcut Cllwificatioo: Publ:c; Health Nunc II T)l'e ufpo&ition: X Pt-nn •. u.nL. Tuuprmuy __ Pun tmn: __ Dooftim..,.· _____ _ ~Ulqw.:.n:J £ffi:c:n, e l>.u~ _._! :!..:·:..~.I""S."':!I .. J ... l5..__ ____ _ .\..-~:TIIhiWl ::\~.·ow PWJtin.:t: Clu..slliultK>n __ • --------------------- ,\!lf'tc.>n:d Sal:~r . \3r.oc.iL ___ .\JlPnml'lSaWy.RanGc: $, ________ _ .B ~ 1o 11lloc ~r.:· l''''JXl''-d c·r,,:..J fic-anon Pb)tUdep Extrpda II l1~11ion #pending . \pfi:l•\ ,·.j Sal~· Gr.ru!r..ll \ppto'•cd ~ala~ Range 1§5,692-178.831-11Q1,82.l L :\l•nbh: l'x1s1ing l'n"lnon Clm•JU'icatinn ____________ Prn.irion # ______ _ 4. EXl'I..A :\A 1' I ON: (Sunc nc,-u, for rcquealcd action. Identify tpecial project poaldon•.) . hl' (lO'\I ri• 111 H l ;nlll) :t.:';l !.l o.:' 1\.'d tu :,·d:l~!116canon from PEL'\ II poa;nion tllllll Ph) sidun F..xn:ndL'f II posinon due to o.:hao~tc ~ in d:mL·.a! :IL'<U' \ppm1•Li )I Bt >Hand~ HO(. 3. AUTH 0 R1ZA T 1 0~ .BY LOC.-\L DEPARTMENT fbiB n:quut hu bL-cn offichtll\ authorized and suffic~tml fum!~ lH DUd!'' l 'ci ud P''lC>I l l.. tilt usc.. c:. ,. ..,....,.. A.v.jl----- .\g~ '· '-' r • ~ >r Dalt John Rou '•· 1·· :-.l!!L ')'r<·ctor County Officuu (If applicable) Date Poutiuu # h(fcc:Tin· Dart• /2//~//S II 011916 HC BOC Page 126 Board Meeting Agenda Item Agenda Item 4J MEETfNG DATE: January 19,2016 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Morgue MOU with REQUESTED BY: John Ro6, J ., ealth Director REQUEST: The County is required by the General Statues to have a Morgue available for Medical Examiner Cases. I am seeking Board of Commissioner approval to enter into a Memorandum of Understanding with Harnett Health to provide these services at a cost of $50 per case. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: U:\m) d ocuments\ 1-Winword\BOC Mt g Req uest\Morgue request I -20 I 6.doc I of I Page 011916 HC BOC Page 127 HARNETT COUNTY SERVICES AGREEMENT NORTH CAROLINA THIS AGREEMENT is made and entered into as of this _ day of January 2016 by and between County of Harnett, North Carolina (hereinafter referred to as "County") and Harnett Health, Inc. (hereinafter referred to as "Harnett Health"). This Agreement recognizes that County has a need for a medical morgue. Pursuant to § 130A-381 of the North Carolina General Statutes, each county shall provide or contract for an appropriate facility for the examination and storage of bodies under Medical Examiner jurisdiction. It is in County's interest, to the community 's benefit, and for the enhancement of patient care that these services be provided. Harnett Health is prepared to assume the responsibility of providing said services to County. THEREFORE, County and Harnett Health agree as follows: 1. Harnett Health shall provide a Morgue for County. 2. County shall reimburse Harnett Health $50.00 per Medical Examiner case. Billing for this service will be done through the Harnett County Department of Public Health. Billing shall be done monthly, or otherwise as needed. 3. Harnett Health agrees to provide and maintain adequate liability insurance coverage, to include general liability insurance coverage, as well as professional errors and omissions insurance coverage, with minimum limits of $1,000,000.00 per claim and $3,000,000.00 aggregate. 4. It is understood and agreed that Harnett Health is an independent contractor and is not an employee of County. As such, County shall not control the manner or method by which Harnett Health shall perform services as called for by this Agreement. 5. County understands and agrees that Harnett Health shall have the latitude to coordinate coverage for said services with other providers as necessary and appropriate. 6. This Agreement sets forth the entire understanding of the parties and supersedes any and all prior agreements , arrangements, and understandings relating to the subject matter hereof. This Agreement may not be altered or terminated, except as provided herein, and no waiver of compliance with any provision or condition thereof with consent provided for herein shall be effective unless evidenced by an instrument in writing duly exercised by the parties hereto . 7. This agreement shall be binding upon and inure to the benefit of the parties and their respective successors, legal representatives, and assigns ; provided, however, this Agreement may not be assigned by either party without the prior written consent of the other party. 8. This Agreement may be amended by written consent of both parties, and all amendments shall be attached to this Agreement and made part thereof. 011916 HC BOC Page 128 9. This Agreement shall be effective January _, 2016 and shall automatically renew in successive one (1) year periods unless earlier terminated as herein provided. Either party, with 60 days ' notice to the other party, may terminate this Agreement without cause, at any time. This Agreement may be immediately terminated by the written consent of all parties and shall be automatically terminated if funds are not authorized by the Harnett County Board of Commissioners and the State of North Carolina. COUNTY OF HARNETT By: -----------------------------John Rouse, Public Health Director By: ______________ _ Joseph Jeffries , County Manager THIS INSTRUMENT HAS BEEN PREAUDITED IN THE MANNER REQUIRED BY THE LOCAL GOVERNMENTAL BUDGET AND FISCAL CONTROL ACT. Kimberly Honeycutt, Finance Officer HARNETT HEALTH, INC. By: ----------------------------Print Name/Title ------------------- 011916 HC BOC Page 129 RECEIVED NOV 18 2015 HARNE1T COU NTY MANAGER'S OFFICE North Carolina Department of Health and Human Services Office of the Chief Medical Examiner Pat 1\fcCro~ Gcwemor Richard 0 Bra.ra Secretar~ Deborah L Radt~ch . M 0 .. M P.H. Cht ef Medical r:xammer Count~ Manager~. As~ ou ma~ a l read~ ~llO\\. and purs uant to '\onh l arullna :>t:~rute 130A-JK I . ea .. h .tJWI/.1 )hull pru1 ·ide ur LIIJI/rac/for an appropr~ttl< /.t< t/11.1 I" the e.\ummalloll ,mJ .)/vra;;e of f.ud1e.\ under \1.-,/Jcul E>·umukr fllrisdtettOil. So that \\e can update our listing please pro\ tde the designatc:d bod~ storage faciht) for ~our count;. b~ cmallmg L) nn Poole at L)nn .Poole cidhhs .nc gm Be sure to mclude. County !\arne Name of Facilit~ Facilit~ Address Facllrt;. Contact Name Facility Contact Title Facillt;. Contact Phone ;; Facilit~ Contact Emarl Please provide this infonnatron no latc:r than 1-nda). December -l. 20 15 Abu pro' tdc:d iur ~our rc:fe1ence 1s a cop) oi a memorJndum that'' as mailed out t o Count~ Manager5 rn lJecember 20 I I, b) our Ch1et Med1cal Exam mer. Dr. Dehorah Radisch. funher disctbSi ng legt s lauon and appropnate ~torage. I Please 1gnore the lasr paragraph in the attached memo. as staffing changes have occurred I lf~ou ha\e ques t ions. p le a~e feel tree to reach out to me direct I~ Regards. PuuJu 1/mnit-Roed, UB~ Operation .s .t-lanager, Office uf the ( ltief \tedical Exami11er Eprdemtolog~ Section of the 01\ I'.IUn ol Public Health 1\C Dtpt ot Health and Human Sen rces Ph~~i,·a l Addre~~ .pI:! Distru.:r Or I\ t' Raletgh NC 27flO"~-q<>o Maihng Address MSC 1025 Raletgh . NC 27699-~02" Phone: 919-7-13-907 4 Fa'\· QI9 -1-!)-9QQ9 Emat l Paula .Hennre-Rpedadhhs.nc gO\ OC MI:: Website . hqp. \\W\\ ocrne .dhh~ nr go\ "'' '' .ncd hhs go\ • '' "'" .oc me dhhs .nc .go' ·lei919-74J-9000 • ta\ 919-7-13-9099 Location 431 2 Dtstrict Dri\e • Rale1gh . NC 27607 l\1admg Addre~~ 302" \1ail Scn1ce Ce nter • Ralergh . NC 27<'99-30~5 .1\n Equal Oppor1unit) .Affi rmatrw Action Emplo~e1 i A.~c ...ak" 011916 HC BOC Page 130 Beverly F.aves Perdue , Go vern or La me r M. Can sl er, Secre ta ry December 15, 2011 To : County Managers df~~ .. (f 1\'orth Carolina Department of Health and Human ScrYices Division of Public Health Epidemiology Office of the Chief Medical Examiner Campus Box 7580 Chapel Hill, North Carohna 27599-7580 Courier 17 6 1-02 Tel (919) 966-2253 fax (919) 962-6263 Jeffre y P. Engel. MD. State Health Dtrector Dcborl h L. Radt~h . ~m . !\1PH . Chie fMedt cal Exa m mcr From: Deborah L. Radisch, MD, MPH dl._.,/' Chief Medical Examiner Re: Body storage In 2 00 7, an addition to the medical examiner (ME) statutes was made (see below, in bold): § 130A381. Additional services and facilities. In order to provide proper facilities for investigating deaths as authorized in this Part, the Chief Medical Examiner may arrange for the use of existing public or private laboratory facilities . Each county shall provide or contract for an appropriate facility for the examination and storage of bodies under Medical Examiner jurisdiction. The Chief Medical Examiner may contract with qualified persons to perform or to provide s upport services for autopsies and other s tudies and investigations. ( 1967 , c . 1154, s. 1 ; 1973, c. 476, s. 128 ; 1983, c. 891 , s. 2; 2007187, s. 5.) The technical change to the statute was intended to clarify the role the county shares with the state in death investigation. Historically, under the coroner system that preceded the medical examiner system, the county provided a faci l ity suitable for temporary storage o f bodies. The county's responsibility for s uch a facility continued as the state transitioned to the medical examiner system. Each county through its governmental structure and local health departme nt was and is expected to provide a facility where b o dies can be stored pending a decision on death investigation. examination by the medical examiner, transportation to an autopsy facility, notification of next oflcin, or arrangements for final disposition . The faci lity would be used for deaths under ME jurisdiction as well as natural deaths that do not fall under ME jurisdiction. Based on interactions with many different agencies over the past year, few counties are aware of this. The object ive of this letter is to bring this legJ s lation to your attentiOn and urge your compliance w ith it. In many counties , hospitals have served as the place where ME bodies can be taken and held until they are examined by the ME and then released to the next of kin . ME rules permit hospitals to assess the state a fcc of $40.00 when a county medical examiner orders a body taken to the hosp ital and later examines the bod y in that fa cility. Loc atio n· Bn n kho u ~·Bullt n Bu1lding u~C-C H Chapei l!ill, N.C 2i599-7580 An Eqoa l Opp ortunHy I Affi nn auvc Act1on Emp loyer 011916 HC BOC Page 131 1 OA NCAC 44 .0204 Hospital Fee A fee of fony doUars ($40 .00) is paid by the state to a hospital when a county medical examiner orders a body taken to the hospital and la ter examines the bod y in that facility. ~o payment is due 2. bosp1tal when an a:Jtopsy is perfonned in th2.t facility. No payment is due when the county medical examiner utilizes a hospital emergency room or other hospital facility for examination of a body transported to the hospital for examination. However, many counties do not have a hosp ital, or the hospital is net willing or able to provide tills space. In these counties, a funeral home with a cooler might be an appropriate option, with the county contracting with the funeral home to compensate that establishment for the short-tenn use of their facility. In the rest of the counties , none of these ma y be an option and other arrangements must be made. In addition, there are many cases when a death clearly or most probably does not fall under ME jurisdiction; however, the next of kin is not immediately available to instruct where the body is to be transported. These cases cannot be covered under ME jurisdiction . In some of these counties, EMS and/or law enforcement is often detained at the scene of death, waiting for next of kin or the attending physician to be identified and contacted, wasting valuable county emergency resources. Even though this is not a* system responsibility, I would encourage you to make similar facility and payment arrangements for these cases--in other words, establish a county morgue for all deaths. I propose a deadline of June J, 20 I 2 for all counties to have tltis in place. Please contact Patricia Barnes at pat.bames@dhhs.nc.gov with your designated facility so that we can quickly and correctly provide the appropriate information to callers requesting 1t. 011916 HC BOC Page 132 CAMPBELL U N V E R S January 13, 2016 Mr. Joseph Jefferies Harnett County Manager P. 0. Box 65 Lillington, NC 27546 Dear Mr. Jefferies: T y RECEIVED JAN 13 201~ ~ETTCOUNry . ·'1--., '~~l=...R•s OFFICE Agenda Item 4K Office of the Vice President for Business and Treasurer Campbell University is grateful for the wonderful relationship with Harnett County . In our efforts to continue to grow and improve we are planning to build another residence hall. Please accept this as a formal request to waive all building permits for the construction of the new South Residence Hall that will be located on Leslie Campbell Avenue. We thank you for your continued support. Sincere ly, ~~o~~~M ~a~e~bell University Vice President for Business & Treasurer PO Box 97 • Buies Creek, North Carolina 275 06 • (91 0) 893-1240 www.ca m pbe ll.cdu 011916 HC BOC Page 133 Agenda Item lf L 2016 Boards and Committees on which Commissioners Serve Commissioner Jim Burgin CCCC Board of Trustees Home & Community Care Block Grant Committee Mid-Carolina Council of Governments Board of Directors Mid-Carolina Aging Advisory Committee Industrial Facilities/Pollution Control Financing Authority Commissioner C. Gordon Springle Architectural Committee (Schools) Capital Area Metropolitan Planning Organization (CAMPO) Employee Benefits Committee Johnston-Lee-Barnett Community Action Board of Directors Rural Planning Organization for Transportation (T AC) Social Services Board Southeastern Economic Development Commission Transportation Advisory Committee (F AMPO) Transportation Advisory Board Commissioner Abe Elmore Airport Committee Averasboro Township Tourism Development Authority Central Carolina Works Advisory Committee (3 /2/15) Commissioner Barbara McKoy Board of Health Juvenile Crime Prevention Council Library Board Sandhills Center for Mental Health DDSHS Commissioner Joe Miller Architectural Committee (Schools) Cape Fear River Assembly Board CCCC Harnett County Campus Advisory Comm. Extension Advisory Leadership Council Good Hope Board 011916 HC BOC Page 134 AGENDA ITEM 6 JANUARY 19, 2016 APPOINTMENTS NEEDED ADULT CARE HOME COMMUNITY ADVISORY COMMITTEE We need eight additional members appointed to serve on this committee. Members receive mileage reimbursement as claimed. This Committee was established to work to maintain the spirit of the Rest Home Bill of Rights and to promote community involvement and cooperation with rest homes, family care, and an integration of these homes into a system of care for the elderly. This group holds quarterly training and facility visits. Members receive mileage reimbursement as claimed. HARNETT NURSING HOME COMMUNITY ADVISORY COMMITTEE We need one additional member appointed to serve on this committee. This Committee was established to work to maintain the intent of the Nursing Home Resident Bill of Rights and to promote community involvement and cooperation with nursing homes. This group holds quarterly training and faci lity visits. Members receive mileage reimbursement as claimed. HISTORIC PROPERTIES COMMISSION Patricia Chalmers is interested in serving as a regular member for District 5 on this commission. (application attached) HOME AND COMMUNITY CARE BLOCK GRANT COMMITTEE We currently have four vacancies on this committee. SANDHILLS CENTER BOARD OF DIRECTORS We have a vacancy on the Sandhills Center Board of Directors. Page 1 -Appointments 011916 HC BOC Page 135 APPLICATION TO SERVE ON A BOARD APPOINTED BY THE HARNETT COUNTY BOAJR.D OF COMMTSSlONERS aoARD: __ ll ':i_s_dpJ:L(;_.Tr_~_;_e~----·---·-~-- NAME: .J :lxi~Q.-_Ck.:I,.,U5_. ADDRESS: -~:?.-~ .. L~_soo.v-.JJ_~_.S..c...h~oJ._gJ,_Cr.aro .. ~.@Y4_rj[:_,l{_32 ~ ----~-----""--··--··--··--- VOTING D.lSTF [CT: (Please check district number in which you live): D District 1, Cnmmissioner McKoy's b}j>istrict 4, Commissioner Springlc's 0 Disnict 2, C.;mmissioner Elmore's l!6District 5, Commissioner Miller's 0 District 3, C •mmissioner Burgin's (WORK) ___ JfA YEARS OF FORMAL EDUCA TlON : ___ 4 L) ·-----·--·---·--·--·--__ l>JJEASE TELJ. WHY YOU WOULD LJKE TO SERVE ON THE ABOVE LTSTBD BOARD: '"'=" .&:~~-·--------·--·-·-----·------··-----------···--·----·--···--· ·-··· ---·----------···--------·--·---··--·---·--·-···--~- ,-----·--------·---·---·----.. --··----- DATE: _}~~2-,;2..iJi/;_,. SIGNATURJ;: .ii~~~) ·----- fOR OFFICE }SE ON.L Y: DATE RECEJ ·TED: ---------·--·--·-----··--·· ,---·-,·- DATE FORW •\ROED TO COUNTY COMMISS.£0NERS : --·---····--··"··--- 011916 HC BOC Page 136 ... 0 ...... 'e I am in .:erested in serving on the Historic Properties committee because I have c;l ·.-.:~·;~ ~e~n rnncemed with the preservation of properties that reflect our culture • and oast beauty. I believe that it is through i.i11: p;;::::::".':;!!!'::'!l nf \la:uat ~:: h!!:!'::'rir~l properties that an ongoing aJJJii"cdaticn by th~ (:itizenry of our cn unty/state is established of the various arciureci..urd: .;t"y:;:::, eth!!:~l divers 1ties, and heritage significances. '' , I . .. 011916 HC BOC Page 137 POLICY AND PROCEDURES FOR APPOINTMENTS TO COUNTY BOARDS , COMMISSIONS , COMMITTEES OR AUTHORITIES RULE 30 . ~pointments (See Attachment) This is tc affirm that I ha.ve read and understand the intent of Rule 30. Please Return Signed Form To: I P . 0 . Be K 7 59 Lillingtc ·n, NC 2 7546 _f?4uu4< (]. ~ Signature _t/iJJJbri <-2..-oPtrfi_e....__. s....__ Name ofBo<&-d _ ___.I __ -__.L-=2 -:l..t:> I (a Date 011916 HC BOC Page 138 Board Meeting Agenda Item Agenda Item 7 MEETING DATE: January 19,2016 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Presentation of County Audit for the Fiscal Year Ending 2015 REQUESTED BY: Kimberly A. Honeycutt, Finance Officer REQUEST: The County's auditors, Martin, Starnes & Associates, will present the Comprehensive Annual Financial Report (CAFR) for the fiscal year ending June 30, 2014 . The presentation will be made by Matt Braswell, CPA. COUNTY MANAGER'S RECOMMENDATION: C:\Users\gwheeler\AppData\Locai\Mi crosoft\Windows\Temporary Internet Files\Content.Outlook\98RKKOE5\Audit Presentation for FYE 20 15.doc Page I of I 011916 HC BOC Page 139 HARNETT COUNTY FINANCIAL SUMMARY REPORT Agenda Item 8 2016 November, 2015 GENERAL FUND FYE 2016 Activity Total 2015-2016 (includes Percent Same Period Department FYE 2014 FYE 2015 Adjusted Budget encumbrances) to Date Last Fiscal Year Governing Body $ 164,631 $ 158,070 $ 252,888 $ 115,862 45.82% $ 103,797 Administration 250,759 280,372 263,472 180,673 68.57% 202,657 Legal Services 103,351 8,609 69,617 83,889 120.50% 130,043 Engineering 1 23,395 Human Resources 254,738 247,154 238,649 117,855 49.38% 127,211 Board of Elections 303,532 305,481 442,442 125,848 28.44% 169,652 Finance 729,469 833,532 842,115 421,549 50.06% 426,914 Clerk of Court 77,704 79,320 411,771 34,182 8.30% 37 ,924 Tax 1,569,231 1,588,997 1,695,468 647,169 38.17% 651,895 General Services 140,485 153,360 161,852 56,628 34.99% 64,040 Fleet Maintenance 438,847 603,102 579,622 212,139 36.60% 229,762 Transportation 1,004,266 839,486 1,859,552 374,808 20.16% 246,527 Transportation-Admin 194,790 209,741 219,108 59,217 27.03% 64,965 Facilities Maintenance 3,400,887 3,736,788 3,708,493 1,351,166 36.43% 1,244,528 Register of Deeds 730,166 695,654 790,642 307,793 38.93% 249,918 Information Technology 1,301,628 1,726,510 1,917,855 884,370 46.11% 862,753 GIS 432,327 436,602 615,987 255,795 41.53% 166,550 Sheriff 10,166,283 10,205,366 10,106,545 3,391,622 33.56% 3,924,295 Campbell Deputies 354,232 389,674 480,900 161,447 33 .57% 165,960 Harnett CJPP 80,119 Sheriff's Department Grants 15,213 1,607 46,161 19,059 41.29% Child Support Enforcement 66,257 70,126 76,867 25,464 33.13% 28,862 Governor's Highway Safety 26,536 Communications 1,219,142 1,389,574 1,722,028 527,657 30.64% 492,454 Schoo l Resource Officers 691,067 224,191 32.44% Jail 4,306,490 4,407,161 4,792,299 1,715,357 35.79% 1,812,418 Emergency Services 737,021 765,164 843,812 263,861 31.27% 292,615 Emergency Services Grant 32,000 120,000 0.00% Emergency Medical Service 3,991,897 4,080,768 4,324,060 1,472,916 34.06% 1,595,997 EMS Transport 1,083,318 1,144,801 1,151,414 406,988 35.35% 406,258 Rescue Districts 3,314,704 3,361,704 3,361,704 1,680,853 50.00% 1,680,853 Animal Services 376,744 431,707 493,913 146,698 29.70% 152,804 Medical Examiner 50,000 47,050 65,000 13,100 20.15% 25,150 JCPC Admin 4 ,516 8,040 1,670 20.77% 464 Public Safety Appropriations 124,334 79,180 66,168 27 ,297 41.25% 28,983 Emergency Telephone System 240,521 236,688 104,898 Radio System 300,204 246,495 285,000 63,324 22 .22% 88,964 Harnett Regional Jetport 174,955 208,990 209,736 70,901 33.80% 65 ,744 Soil & Water 124,133 161,801 183,879 65,953 35.87% 56,349 Environmental Pr otection 4,000 4 ,000 4,000 4,000 100.00% 4,000 Forestry Program 114,849 112,289 111,511 32,316 28.98% 35,731 Economic/Physical Dev. App . 449,748 458,2 53 575,000 170,795 29.70% 132,275 Industrial Development 776,3 01 1,382,346 684,272 154,224 22.54% 320,473 Planning & Inspections 1,321,571 1,362,552 1,365,164 509,613 37.33% 549,946 Community Development (BG) 1,129 735 300 2 0.67% 320 Abandoned MFG Home 31,903 57,241 36,298 13,914 38.33% 15,526 Cooperative Extension 351,557 289,118 382,276 82,056 21.47% 96,608 CCR&R-Block Grant 31,419 25,623 16,836 3,120 18.53% 13,312 CCR&R -Un it ed Way 2,483 379 600 83 13.83% 298 Parents As Teachers 158,263 44,813 28,151 16,069 57.08% 12,250 Adolescent Parenting 59,107 60,321 70,295 25,827 36.74% 25 ,544 U :\My Oocuments\MonthJy Reports\2015 -2016\Novtmber 2015-Ftnancial Statements.xlu 1 011916 HC BOC Page 140 HARNETI COUNTY FINANCIAL SUMMARY REPORT 1/4/2016 November, 2015 GENERAL FUND FYE 2016 Activity Total 2015 -2016 (includes Percent Same Period Department FYE 2014 FYE 2015 Adjusted Budget encumbrances) to Date Last Fiscal Year 4-H Teen Court & At Risk 45 ,686 49,773 14,869 29.87% Chi ld Care Youth Training 27,367 50,723 16,941 Race to t he Top 13,570 11,107 1,191 10 .72% Adolescent Parenting -BJR H 3,789 14,200 6,667 Special Programs 22,950 9,389 40.91% Department on Aging 283 ,332 307,602 317,411 114,824 36.18% 115,226 Family Caregiver Support 51,769 64,108 62,029 23,707 38.22% 24,601 RSVP 73,276 77,658 77,258 27,601 35.73% 32,386 CAP -Disabled Adult s 326,783 328,753 378,328 122,801 32.46% 136,625 Nutrition for Elderly 378,087 414,989 437,457 165,769 37.89% 160,262 Hea lth 5,787,018 6,014,268 7,269,516 2,270,467 31.23% 2 ,283,675 Mental Health 815,679 605,679 605,679 302,840 50.00% 302,840 Socia l Services 9,359,396 10,155,398 10,585,495 3,968,595 37.49% 3,811,247 Public Assistance 7,829,453 7,905,017 9,254,809 3,436,968 37.14% 2,892,952 Veteran's Services 172,197 178,634 183,173 71,634 39.11% 73,265 Re s titution 110,369 100,304 120,965 38,655 31.96% 46,333 Human Services App. 99,840 90,780 99,000 75,298 76.06% 75,298 Library 928,107 941,972 1,001,229 337,211 33 .68% 378,579 Cultural & Recreational App . 100,000 150,000 150,000 0.00% Parks & Recreation 363,011 403,871 455,928 179,266 39.32% 160,526 Education Board of Education -cur rent 20,523,700 21,523,700 21,267,993 8,861,664 41.67% 8,968,208 Board of Ed u cation -capital 280,707 111,885 39.86% Central Ca rolina -current 927,711 928,467 1,002,467 4 58,734 45.76% 382,278 Ce ntral Carolina-capit al Central Carolina -works 25,000 25,000 25 ,000 0.00% lnterfu nd Transfers 1,903,876 64,701 283,334 43,334 15.29% 26,667 Debt Service 13,902,144 44,265,436 16,033,752 16,088,184 100.34% 9,722,390 Contingency 999,000 0.00% Tota l s 105,23 4,405 s 137,544,080 s 117,347,189 s 53,244,206 4 5 .37% s 46,748 ,848 Total 2015 -2016 FYE 2016 Percent Same Period Revenues : FYE 2014 FYE 2015 Adjusted Budget Activity to Date last Fiscal Year Ad Valorem Taxes Real a nd Personal $ 54,120,822 $ 5 3 ,930,707 $ 54,295,343 $ 29,163 ,650 53.71% $ 28,963,289 Motor Vehi cl es 3,949,979 5,712,141 5,654,182 2,090,890 36.98% 1,900,883 Sales Tax 14,884,497 16,757,810 16,154,459 2,482,047 15.36% 2,399,701 Other taxes 1,0 37,719 1,053,493 1,200,000 397,884 33.16% 332,256 Permi t s & Fe es 2,763,205 2,515,489 3,718,955 935,95 8 2 5.1 7% 791,667 Inte rgovernmental Revenu e 19,304,274 18,884,854 18,977,335 5,589,8 7 6 29.46% 5,062,986 Sales & Services 7 ,658,151 7,838,973 8,839,415 2,628,492 2 9.74% 2,471,721 Ot he r Reve nues 3,451,519 3,741,739 3,454,194 449,145 13.0 0% 1,097,612 Rents, Concessions. & Fees 77 ,898 77,652 78,779 2 9,297 3 7.19% 24,356 Othe r Finance Sources 857,548 29,108,938 1,008,803 5 ,938,000 588.62% lnterfund Transfers 460,947 322,415 55,656 7,501 13.48% Fund Balance Appropr ia ted 3 ,910,068 0.00% Total s 108,566,559 s 139,944,211 s 117,347,189 s 49,712,740 42.36% $ 43,044,471 Reve nues over/(under) expenditures $ 2,400,131 $ (3,5 31,466) (3, 704,377) U:\My Oocuments\Monthly Reports\2015 . 2016\November 2015 -Financial Statements.xlu 2 011916 HC BOC Page 141 HARNETI COUNTY FINANCIAL SUMMARY REPORT 1/4/2016 November, 2015 GEN ERAL FUND Cash and Investments Ca sh Tax Lockbo x MBS NCCMT Total November, 2015 $ $ $ 4,715,250 $ 24,697,474 $ 29,412,724 October, 2015 $ $ $ 3,415,750 $ 15,184,900 $ 18,600,650 September, 2015 $ $ $ 1,799,750 $ 16,262,992 $ 18,062,742 August, 2015 $ $ $ 1,799,750 $ 14,138,439 $ 15,938,189 July, 2015 $ 482,070 $ $ 1,199,750 $ 19,037,670 $ 20,719,491 June, 2015 $ 6,004,643 $ $ 999,750 $ 18,681,713 $ 25,686,107 May, 2015 $ 3,587,900 $ s 1,149,750 $ 22,024,531 $ 26,762,181 April, 2015 $ 10,758,278 $ $ 1,099,750 s 20,688,202 $ 32,546,230 Mar c h , 201 5 $ 19,176,680 $ $ 1,099,750 $ 19,2 19,802 $ 39,496,232 February, 20 15 $ 20,516,681 $ 475 $ 1,099,750 $ 16,737,860 $ 38,354,765 January, 20 15 $ 25,1 24,005 $ 475 $ 874,750 $ 15,004,637 $ 41,003,866 December, 2014 $ 2,815,021 $ 475 $ 62 4,759 $ 32,414,000 s 35,854,255 Novem ber, 20 14 s 2,599,381 $ 475 $ 400,000 $ 26,992,531 $ 29,992,387 Debt Service and Transfer Requirements Estimat ed Fund Balan ce In t he governme nta l fund f inanc ial state men ts, f und balance is composed of five classi fi cations designed t o disclose the hier archy of constraints pl aced on how fu nd ba lance ca n be spent . They are as fo llows: Non-S penda ble Fund Balance- Rest ri cte d Fu nd Ba lance - This classification includes amounts that cannot be spent because they are either (a) not in spendable form or (b) legally or co ntractually required to be maintained intact. The class ifica t ion includes amou nt that are restricted to specific purposes externally imposed by creditors or im posed by law. This classification represents t he portion of fu nd balance that can only be used for specific purposes Commi tted Fund Ba lance -imposed by majority vote by a quor um of the Cou nty Commissioners, that can by adoption of an ordinance, commit fund balance. Assig ned Fund Ba lance - Unassigned Fund Balance - That portion of f und ba lance t hat t he County intends to use for specific purposes. T he County Com missioners have t he authority to assig n fun d balances . This class ification represents the portion of fun d ba lance that has not been ass igned to another fund or is not restricted, committed, or assigned to speci f ic pur poses wit hin the gene r al fund . U:\My Documents\Monthly Reports\2015-2016\November 2015 -Ftnancial Statements.xlsx 3 011916 HC BOC Page 142 HARNETT COUNTY FINANCIAL SUMMARY REPORT November, 2015 GENERAL FUND Unassigned Fund Ba lance at June 30, 2015 Year to Da t e Revenues over/(under) Expenditures Remaining Debt Payments for this Year Outstanding budget amendments Year to Date Fund Balance Appropriated If the County were to stop operation s at the end of this month and had no further rece ivable s or payables, then this would be the estimated fund balance amount and its percentage of expenditures. Amount by which fund balance percentage w ill change 54,432 (3,910,068) $ 19,417,388 (3 ,531,466) 15,885,922 (3 ,855 ,636) $ 12,030,286 10.25 % $ 1,173,472 17.89% The Harnett County Board of Commissioners have approved a fund balance policy which strives to maintain a minimum fund balance of 15%. U:\My Document~\Monthly Reports\2015 • 2016\November 2015 ·Financial St atements.xlsx 1/4/20 16 4 011916 HC BOC Page 143 HARNETT COUNTY FINANCIAL SUMMARY REPORT 1/4/2016 November, 2015 PUBLIC UTILITIES FUND FYE 2016 Activity Total 2015-2016 (includes Percent Same Period Department FYE 2014 FYE 2015 Adjusted Budget encumbrances) to Date Last Fiscal Year Admin/CSR/Meter Services $ 19,229,033 $ 40,477,963 $ 11,620,244 $ 2,761,172 23.76% $ 3,853,491 Water Trea tment 3,671 ,291 3,965,881 4,466,822 1,576,039 35.28% 1,197,942 Wastewater Treatment 1,965,319 1,908,016 2,397,828 619,110 25.82% 628,634 Wastewater Treatment SHWW 1,860,402 1,869,169 2,354,624 678,371 28.81% 607,551 Di stribu t ion 3,383,463 3,607,800 4 ,578,923 1,242,979 27.15% 1,421,651 Co ll ections 2,975,052 3,006,906 3,363,958 995,684 29.60% 1,063,632 Total s 33,084,560 s S4 ,835,735 s 28,782,399 s 7,873,355 27 .35% s 8 ,772 ,901 Total 2015 -2016 FYE 2016 Percent Same Period Revenues: FYE 2014 FYE 2015 Adjusted Budget Act ivity to Date Last Fiscal Year Int ergovernmenta l Revenue $ 3,703 $ 3,703 $ 3,703 $ 0.00% $ Sa les & Services 30,275,723 30,134,602 26,984,920 14,314,730 53.05% 12,036,665 Other Revenues 13,281 ,536 1 19,895,351 1,793,776 475,089 26.49% 471,536 Rents, Concess. & Feees 96 172 14 Other Finance Sources 473,683 13,731,430 1,230,196 ln terfund Transfers 150,000 1,452,130 Fund Balance Appropriated Total s 44,184,741 s 165,217,388 s 28,782,399 s 14 ,789,8 19 51 .38% s 13,738,411 Revenues over/(under) expenses $ 6,916,464 $ 4,965 ,510 Cash and Investments cash Lock box NCCMT Total November, 2015 $ 24,058,100 $ 3,267,333 $ 552,071 $ 27,877,S05 October, 2015 $ 23,345,138 $ 3,268,625 $ 549,91 6 $ 27,163,678 September, 2015 $ 22 ,373,066 $ 3,142,028 $ 549,700 $ 26,064,794 Augu st, 2015 $ 20,802,670 $ 3,162,849 $ 549,270 $ 24,514,789 July, 2015 $ 19,413,391 $ 3,411,495 $ 549,057 $ 23 ,373 ,942 Jun e, 2015 $ 21,051,962 $ 2,602,443 $ 548,475 $ 24,202 ,879 May, 2015 $ 20,248,407 $ 2,565,016 $ 547,616 $ 23,361,038 Apri l, 2015 $ 22,900,249 $ 2,178,132 $ 544,445 $ 25,622,825 March, 2015 $ 24,744,895 $ 1,692,081 $ 543,143 $ 26,980,119 February, 2015 $ 25 ,190,4 26 $ 1,237,290 $ 524,212 $ 26,951,928 January, 2015 $ 24,654,644 $ 878,473 $ 520,942 $ 26,054,059 December, 2014 $ 28,444,625 $ 391,704 $ 520,942 $ 29,357,270 November, 2014 $ 29 ,119,405 $ 38,435 $ 519,270 $ 29,6 77,110 Debt Service and Transfer Requirements Current Year Outstanding Interest $ 2,660,203 $ 29,561,667 Pr incipal $ 4,621,391 80,736,891 Tran sfers Out $ s 7,281 ,594 s 110,298,558 U:\My Oocu me:nt s\Monthly Repons\2015 • 2016\November 2015 • Financial Stateme nts.xlsx 5 011916 HC BOC Page 144 HARNETT COUNTY FINANCIAL SUMMARY REPORT 1/4/2016 November, 2015 SOLID WASTE FUND FYE 2016 Act ivity Tot al 2015-2016 (includes Percent Same Period Departme nt FYE 2014 FYE 2015 Adjusted Budget e ncumbrances ) to Date last Fiscal Ye ar Solid Waste $ 5 ,161,897 $ 6,827,067 $ 5,943,005 $ 1,923,417 32.36% $ 1,599,394 Total s 5,161,897 s 6,827,067 s 5,943,005 s 1,923,417 32 .36% s 1,599,394 Tot a l 2015 -2016 FYE 2016 Pe rcent Same Period Revenues: FYE 2014 FYE 2015 Ad just ed Budget Activity to Da te last Fis cal Year Taxes $ 237,297 $ 234,276 $ 239,000 $ 63,515 26.58% $ 59,931 Intergovernmental Revenue 25,000 130,000 0.00% Sales & Serv ices 5,006,3 15 5,165,089 5,111,300 2 ,345,038 45.88% 2,429,769 Other Reven u es 378,116 499,631 400 10,871 ####### 887 Rents, Concess. & Feees 243 276 43 64 Other Finance Sources 739,763 1,402,161 lnterfund Transfers Fund Balance Appropriated 462,305 0 .00% Total s 6,361,734 s 7,326,433 s 5,943,005 s 2,419,467 40.71% s 2,490,651 Revenues over/(under) expen ses $ 496,050 $ 891,257 Cash and Investments Ca s h Sun Trust/BB& T First Bank NCCMT Total November, 2015 $ 795,755 $ 469,359 $ 439,402 $ 123,226 $ 1,827,742 October, 2015 $ 160,831 $ 456,391 $ 422,540 $ 59,824 $ 1,099,587 September, 2015 $ 182,041 $ 425,002 $ 394,917 $ 59,824 $ 1,061,785 Aug u st, 2015 $ 372,508 $ 425,018 $ 395,198 $ 59,824 $ 1,252,548 July, 2015 $ 350,504 $ 379,409 $ 365,494 $ $ 1,095,407 June,2015 $ 575,612 $ 375,758 $ 368,150 $ $ 1,319,520 May, 2015 $ 954,650 $ 359,056 $ 333,965 $ 443,279 $ 2,090,950 Apri l, 2015 $ 1,166,505 $ 343,2 48 $ 333,965 $ 387,764 $ 2,231,482 March, 2015 $ 1,347,614 $ 316,331 $ 312,432 $ 387,764 $ 2,364,141 February, 2015 $ 1,654,243 $ 296,898 $ 294,942 $ 415,261 $ 2,661,345 Ja nu ary, 2015 $ 2,189,209 $ 290,5 27 $ 289 ,211 $ 356,254 $ 3,125,201 December, 20 14 $ 1,734,168 $ 294,082 $ 268,8 60 $ 356,254 $ 2,653 ,365 November, 2014 $ 1,2 39,986 $ 267 ,007 $ 268,860 $ 356,254 $ 2,132,107 Debt Service and Transfer Requirements Curre nt Year Outst a nding Interest $ 127,831 $ 335,060 Principal 510,937 2,700,856 Tra nsfers Out s 638,767 s 3,035,917 U:\My Documents\Monthly Reports\2015 -2016\November 2015 -Financial Statements.xlsx 6 011916 HC BOC Page 145 HAR N ETI COUNTY FI NANCIAL SUMMARY REPORT 1/4 /2016 November, 2015 WORKER'S COMPEN SATION FUND FYE 2016 Acti vity Tot al 2015-2016 (i n cl udes Percent Same Period Category FYE 2014 FYE 2015 Adjusted Budget e ncumbrances) to Date last Fi scal Year Fixed Cost $ $ 29,000 $ 35,000 $ 7,000 20.00% $ 15,000 Claims Fu nded 2,979,815 123,636 1,865,000 589,646 3 1.62% 123,064 Tota l s 2,979,8 15 s 152,636 s 1,900,000 s 596,646 31.40% s 138,064 Total 2015-2016 FYE 2016 Percent Same Period Re venues: FYE 2014 FYE 2015 Adjusted Budget Activity to Date last Fiscal Ye ar Departmental Charge $ 1,704,822 $ 1,821,371 $ 1,750,000 $ 378,325 21.62% $ 365,839 Other revenues 280,523 250,795 150,000 106,600 71.07% $ 53,937 Fund Bala nce Ap p ropriated To t a l s 1,985,345 s 2,072,166 s 1,900,0 00 s 484,925 25.52% s 419,776 Revenues over/(under) expenses $ {111,721) $ 281,712 Cash and Investments Cash NCCMT Total November, 2015 $ 1,273,094 $ 562,026 $ 1,835,120 Oc t ober, 2015 $ 1,329,590 $ 1,211 ,772 $ 2,541,362 September, 2015 $ 1,238,990 $ 1,211,772 $ 2,450,762 Au gust, 2015 $ 1,234,512 $ 1,211,772 $ 2,446,284 Ju ly, 2015 $ 1,140,351 $ 1,211,772 $ 2,352,123 June,2015 $ 1,588,872 $ 1,234 ,390 $ 2,823,262 May, 2015 $ 1,273,019 $ 562,026 $ 1,835,045 April, 2015 $ 1,248,082 $ 562,026 $ 1,810,108 March, 2015 $ 1,114 ,579 $ 562,026 $ 1,676,605 February, 2015 $ 710,2 18 $ 562,026 $ 1,272,244 January, 2015 $ 678,017 $ 562,026 $ 1,240,043 December, 2014 $ 603,529 $ 562,026 $ 1,165,555 November, 2014 $ 740,74 9 $ 562,026 $ 1,302,775 liability liability as o f Ju ly 1 $ 2 ,839,689 Current year claim s and #of Claims this 32 changes in estimates 84,758 fiscal year Actual claim payments 37,842 liability as of end of month $ 2,886,605 U:\My Documents\Monthly Reports\2015 -2016\November 2015 -Financial Statements.xlsx 7 011916 HC BOC Page 146 HARNETI COUNTY FINANCIAL SUMMARY REPORT 1/4/20 16 November, 2015 EMPLOYEE CLINIC FUND FYE 2016 Activity Total 2015 -2016 (includes Percent Same Period Category FYE 2014 FYE 2015 Adjusted Budget encumbrances) to Date Last Fiscal Year Employee Cli nic $ 83,5 14 $ 121,440 $ 254,588 $ 44,238 17.38% $ 39,366 To t al $ 83,5 14 $ 121.440 $ 25 4 ,588 $ 44,238 17.38% $ 39,366 Total 2015-2016 FYE 2016 Percent Same Period Revenues: FYE 2014 FYE 2015 Adjusted Budget Activity to Date Last Fisca l Yea r Departmenta l Charge $ 282,984 $ 228,950 $ 254,588 $ 97,675 38.37% $ 74,900 Othe r revenu es Fun d Balance Ap propri at ed Tot a l $ 282,984 $ 228,950 $ 254 ,588 $ 97,675 38 .37% $ 74,900 Reven ues over/(und e r) expen ses $ 53,43 7 $ 35,53 4 Cash and Investments Cash NCCMT Total Novemb er, 2015 $ 592,428 $ 29,241 $ 621,670 Octo be r, 2015 $ 582,054 $ 29,241 $ 6 11 ,295 September, 2 015 $ 55 4 ,324 $ 29,241 $ 583 ,566 August , 2015 $ 544,121 $ 29,241 $ 573,362 Ju ly, 2015 $ 533,487 $ 29,241 $ 562,729 Ju ne,2015 $ 542,686 $ 29,241 $ 571,928 May, 2015 $ 534,685 $ 29,241 $ 563,926 Ap ril , 2015 $ 529,1 75 $ 29,241 $ 558,416 March , 2015 $ 520,088 $ 29,24 1 $ 549,33 0 February, 2015 $ 487,335 $ 29,241 $ 516,576 Ja nu ary, 2015 $ 502,826 $ 29,241 $ 532,068 Dece m ber, 2014 $ 491,74 8 $ 29,24 1 $ 520,990 Nove mber, 2014 $ 461,196 $ 29,241 $ 490,437 U:\My Document s\Monthly Reports\2015 • 2016\November 201S-Financial St atements kl sx 8 011916 HC BOC Page 147 HARNETI COUNTY FI NANCIA L SUMMARY REPORT 1/4/2016 November, 2015 MEDICAL INSURANCE FUND FYE 2016 Activ ity Tota l 2015 -2016 (in cl udes Perce nt Same Perio d Category FYE 2014 FYE 2015 Adjusted Budget encumbrances ) to Da te Last Fiscal Yea r Paid Claims $ $ 5,205,337 $ 5,500,000 $ 2,319,785 42.18% $ 1,200,569 Fixed Cost 655,329 685,000 381,478 55.69% 316,134 Well ness 1,507 15,000 7,174 47.83% Tot al $ 5,862,173 $ 6,200,000 $ 2,708,437 43.68% $ 1,516,703 Tota l 2015 -2016 FYE 2016 Percent Same Period Rev e nues : FYE 2014 FYE 2015 Adjusted Budget Activity to Da te La st Fisca l Ye ar Medica l Premium Equivilents $ $ 6,687,178 $ 6,200,0 00 $ 2 ,688,100 43.36% $ 2,972,245 Other reven u es 588,107 10,783 22,372 10,783 Total $ 588,107 $ 6,697,961 $ 6,200,000 $ 2,710,472 43.72% $ 2,983,028 Revenues over/(under) expenses $ 2,035 $ 1,466,325 Cash and Investments Cash NCCMT Total November, 2015 $ 1,387,910 $ 543,297 $ 1,931,207 October, 201 5 $ 1,290,451 $ 543,297 $ 1,833,748 September, 2015 $ 1,502,651 $ 543,297 $ 2,045,949 August, 2015 $ 1,387,676 $ 543,297 $ 1,930,973 July, 2015 $ 1,204,970 $ 543,297 $ 1,748,267 June,2015 $ 1,393,258 $ 543,297 $ 1,936,5 55 May, 2015 $ 1,272,924 $ 543,297 $ 1,816,222 Ap ril, 2015 $ 1,300,653 $ 543,297 $ 1,84 3,950 March, 2015 $ 1,212,904 $ 543,297 $ 1,756,201 February, 2015 $ 1,154,305 $ 543,297 $ 1,697,602 January, 2015 $ 1,085,587 $ 543,297 $ 1,628,884 December, 2014 $ 1,252 ,111 $ 543,297 $ 1,795,409 November, 2014 $ 1,271 ,922 $ 543,297 $ 1,815,219 Medical Paid Claims Summary Employees & Tota l Lo s s Pre m ium Pre-65 Retirees Membership Net Paid Clai ms Fix ed Cost Ratio Eq ui va lent July, 2015 800 1,162 $ 320,633.21 $ 54,321.22 69.90% $ 536,400.67 Au gust , 2015 802 1,167 $ 383,357.49 $ 56,855.83 82.22% $ 535,395.42 September, 2015 802 1,169 $ 465,117.51 $ 55 ,311.71 96.87% $ 537,247.45 October, 2015 808 1,174 $ 650,383.71 $ 103,099.20 141.27% $ 533,359.40 November, 20 15 808 1,173 $ 531,699.65 $ 59,136.25 108.27% $ 545,697.46 December, 2015 January, 2016 February, 2016 March, 2016 April , 2016 May, 2016 June, 2016 Yea r to Date (m ember sh ip= avg) 804 1,169 $ 2,351,191.57 $ 328,724.21 99.70% $ 2,688,100.40 U:\My Oocuments\Monthly Reports\2015 -2016\November 2015 · Fmanc•al Statements.xlsx 9 011916 HC BOC Page 148 HARNETT COUNTY FINANCIAL SUMMARY REPORT 1/4/2016 Nov ember, 2015 DENTAL INSURANCE FU ND FYE 2016 Activity Total 2015 -2016 (includes Percent Sa me Pe r iod Category FYE 2014 FYE 2015 Adjuste d Budget encumbrance s ) to Date La st Fiscal Year Pa id Claims s s 306,584 s 506,000 s 116,744 23.07% s 85,443 Fixed Cost 35,323 40,000 15,168 37.92% 14,786 Total $ 341,907 $ 546,000 $ 131,912 24.16% $ 100,229 Total 2015 -2016 FYE 2016 Percent Same Period Reve nues: FYE 2014 FYE 2015 Adjusted Budget Activity to Date last Fiscal Yea r Den t al Premium Equivilents s s 544,448 s 546,000 s 149,283 27.34% s 155,965 Ot h er reven ues 166,433 Total $ 544,448 $ 546,000 $ 149,283 27.34% $ 322,398 Reven ues over/(under) expenses s 17,371 s 222,170 Cash and Investments Cash NCCMT Total November, 2015 s 251,362 s s 251 ,362 Octo ber, 2015 $ 242,621 s $ 242 ,621 September, 2015 $ 249,844 s s 249,844 August, 2015 $ 249,852 s s 249,852 July, 2015 $ 248,3 09 $ s 248,309 June,2015 $ 247,472 $ s 24 7,472 May , 2015 $ 24 6,685 $ $ 246,685 April, 2 015 $ 246,310 $ s 246,310 March, 2015 s 245,180 $ s 245,180 February, 2015 $ 232,347 $ s 232,347 Ja nuary, 2015 $ 232,396 $ $ 232,396 Decem b er, 2014 $ 228,907 $ $ 228,907 November, 2014 $ 222,170 s $ 222,170 Dental Paid Claims Summary Total Loss Premium Total Employees Membe rs hip Ne t Paid Cla ims Fi xe d Co st Ratio Equiva lent July, 2015 399 653 s 14,975.40 s 6,090.62 70.66% s 29,813 .15 August, 2015 398 651 $ 31,428.55 $ 3,033 .66 116.21 % s 29,654.93 September, 2015 399 650 $ 28,953.57 $ 3,033.66 106.13% s 30,140.02 October, 2015 403 654 $ 30,171.44 $ 3,033 .66 114.74 % s 28,939.38 November, 2015 400 651 $ 19,987 .80 $ 3,010.36 74.83% s 30,735 .68 De cember, 2015 January, 2016 Febr uary, 2016 March, 2016 Apr il , 2016 May, 2016 June, 2016 Year to Date (membershi p = avg) 400 652 $ 125,516.76 $ 18,201.96 96.27% $ 149,283 .16 U:\Mv Oocuments\Monthtv Reports\2015-2016\Novembtr 2015 -financial Statements.xlsx 10 011916 HC BOC Page 149 Co u nt y . I D t s t r i ct :_ Hn r n o r t NO R TH CA R O U H A OM S t O N 0. F VE T E R A N S AF F A I R S Q A C T I V m E S RE P O R T I NG FO R M Agenda Item _J;}_ Monl t l i ' Y e a r :~'V e c ( m.'o~ - L'l-co ; . • ; . .. z R.e - . - Oe = . ; a ) 7 Co mn ; po n 4 a n c : e Re q u o c 1 fo r So rv k : e Ou t (T e . . ph o n e an d ln . . f ) ft S O A ) Wr l n c n Ae t to n T& b : D n (d a i ma & de v e J o p m e ntJ I . IJ t . P t ' , . O " ·. Sl v > t ~ ~r == E "E · e ~ t= • <. ; c ... s~ "C ~ I - "- 2 1 c ~ 'c 8 ... I~ 0 ~ I 0 I = ·m - 0 c ... t ; J ~ 0 CD j • • ... . ,. ; ; t 0 0 Ci c ... . g B, s lQ E c ~ ~ 5 ~· ~ 0 . 0 ... i. ~ 8 LL . ... 0 ~ · I Cl ~ E ~ I ·~ a. . ; I t: :C ·g, 01 ~ c s: ·0 } l t i ' ~ ·'l ~ ~ ·E ... . . A . 11. 1 m :g C ) .! ! N _. e . I. , ; ~ 0 CCI .!': I ) - .~ s ~ 10 t l t! • ~ ~ ~!:I ~ ... . .! l 1. 1 . . ~ ·~ ~~ ·II ec & ~ l: 8 )i C $: : . w ~ ~ .t = 0 " 0 £f ~ Na m e ~ 0 : 6 ~ 5 8_ ~ ;: . Gj '0 ~ ~ 0 6 1Uj I • ,. . ~ 49 1 10 9 ... 5' l 2 ' 5 35 5- 8 8 ., Z2 31 " 2 3 3 I 2 2 2 2 1 n I I I I I I I I I ' I I I I i - ~ - 7 ,. . . ~ / r ., . , . , . , (, . , ~ ( , / - ~ - I I I I E riC T ru ~sd a -e I I I I Ve t e l ' 3 n s Se N co ~ ' l . - ~ /- ' $ !. ( j . , l' ,: . , . i- " fl ._s I I I I I I I I I I I I - - 40 1 10 0 58 4 7i 22 . 31 46 2 2 2 2 '" To t a l ... 45 ~ ~S B 8 3 l 2 11 - 011916 HC BOC Page 150 Agenda Item _ _.:8~--- 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 fi scal year ending June 30, 2016: Section 1. To amend the HC WIOA Dislocated Worker Program Fund, the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 234-7411-465.22-01 FICA Ta x -Participant 500.00 234-7411-465 .32 -26 Incentives/Participants 700.00 234 -7411-465 .35-26 Participant Cost 800.00 234-7411 -465.35-61 Paid Work Experience 500.00 234-7411-465.58-01 Training & Meetings 1,500.00 234-7411 -465 .58-14 Trave l Administrative 907 .00 234-7411-465.58-19 Travel Participant 1,500.00 234-7411-465 .21-05 Employee Clinic 130.00 234-7411-465.41 -13 Utilities 1,312.00 234-7411-465.35-83 Training Vouchers-Authorizations 4,965.00 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : M ov ing a t o tal of $6,407 i nto other lin e item s to keep those lines funded f o r the r emainde r of th e f iscal year. Mov ing from FICA ta x-parti cipant (22-01), Incentiv es (32 -26), Participant Cost (35-26), Paid Work Experience (35 -61), Tr aining & Meetings (58 -01}, Travel Admin (58 -14), and Tra ve l Pa rticipant (58-19), and mov ing those fund s into Empl oyee Clini c (21 -05), Utilities (41 -13), and Training V ouchers (35 -83 ). APPROVALS : ~hWt/;k;lJ!ttfJiJ 1 ~/~/I!/ ---=-+-+------'---=¥\---12/14/15 Depa rtm ent Head (d at e) (date) Secti on 2. Copies of this bud get am endment shall be furni shed to the Cler k to the Board, and to the Budget Officer and the Finance Offi cer for their directio n. Adopted this day of Margaret Regina Wheeler Cl erk t o the Board Jim Burgin, Chairman Harn ett Co unty Bo ard o f Commiss i o n er s 011916 HC BOC Page 151 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, 2016: Section 1. To amend the General Fund , Emergency Medical Services Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-5400-420.11-14 Salaries & Wages-Longevity 1,302 110-5401-420.11 -14 Salaries & Wages-Longevity 1,302 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : To budget the transfer of funds to Salaries & Wages-Longev ity for longevity payout Novembe r 2015. APPROVALS : ~ j.l-11?-/) :lfnt\{; aier{date) Section 2 . Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Offi cer and the Finance Officer for their direction. Adopted this ___ day of ____ , 2015. Margaret Regina Wheeler Clerk to the Board Jim Burgin , Chairman Harnett County Boa rd of Commis sioners 011916 HC BOC Page 152 BUDGETORDINANCEAMENDMENT ~ .--~~,1\~l~ 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, 2016: Section 1. To amend the Public Utilities Department Capital Project PU 1002 SCWW 1B -2, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 574-9100-431.45-20 Legal and Admin $25,000.00 574-9100-431.45-80 Contingency $23,803.00 574-9100-43-45-40 Land and ROW $1,197.00 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : To fund on-going litigation concerning Key Constructors De par 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 Wheeler, Clerk to the Board 12015. Jim Burgin , Chairman Harnett County Board of Commissioners I ~5 1 011916 HC BOC Page 153 BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Go verning Bo ard 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, 2016: Section 1 . To amend Capital Project Fund PU0704 Ft Bragg W&WW, Public Utilities Department, the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 568-9100 -431-45.33 Materials and Supplies $737.00 568 -9100-431-41'-20 Legal and Admin $737.00 ~ REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : Fund bid advertisement for a pump station, liquid lime chemical feed system. APPRO~ALS : /} ll_ 12/14/15 ' Department Head (date) Section 2. Copies of thi s 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 Wheeler, Clerk to the Board 12015 . Jim Burgin , Chairman Harnett County Board of Commissioners 011916 HC BOC Page 154 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, 2016: Section 1. To amend the PU1501 42 MGD Water Plant Expansion Capital Project, Department of Public Utilities, the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 545-9100-431 -45-01 Construction $88,281.00 545-9100 -431-45 -80 Contingency $88,281.00 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : Change Order 1 increase to include chemical skids, pumps, and electrical additions and modifications . 12 10 15 Department Head (date) i er (date) 12._{ IS 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 Wheeler, Clerk to the Board J 2015 . Jim Burgin, Chairman Harnett County Board of Commissioners I ~ll 011916 HC BOC Page 155 BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Caro l ina that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2016 : Section 1 . To amend the Planning Services Departments, the appropriat ions are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-7200-465-11-00 Salaries & Wages 4,988 .00 110-7200-465-11 -13 Salaries & Wages-Vacation Payout 4,878.00 110-7200-465-11-06 Salaries & Wages-Comp Time Payout 110.00 I REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION: To move funds to cover Vacation & Comp-Time Payout for the 2015-2016 fiscal year. Adopted this M(lrgaret Regina Wheeler Clerk to the Board day of Jim Burgin, Chairman Harnett County Board of Commissioners no; 011916 HC BOC Page 156 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, 2016: Section 1. To amend the General Fund, Sheriffs Department/Communication, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-5110-420-11-05 Salaries & Wages Overtime 37,000 110-5110-420-11-13 Vacation Payout 11,343 110-5110-420-11-14 Longevity 3,000 110-5110-420-12-00 Salaries & Wages Part-time 15,000 110-5110-420-21-00 (.;.rol.lo I n4lA.r~I'\Ge. Exoer\5~ 30,343 I I REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : To transfer funds to cover Overtime being paid in the 911 center due to covering vacancies. APPROVALS : r (date) J 1/ ..-~2 [IS 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 , 2015 . Margaret Regina Wheeler, Interim Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioners lll I 011916 HC BOC Page 157 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 yea r end i ng June 30, 2016: Section 1. To amend the WIOA Adults Program Fund , the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 234 -7410-465-35-61 Paid Work Experience 1,000 .00 234-7410-465 .32 -26 lncentives/Pa rticipa nts 600.00 234-7410-465.35-26 Participant Cost 500.00 234-7410-465 .35-27 Child Care 1000.00 2 34-7 410 -465.58-01 Training & Meetings 1,3 12 .00 234-7410-465.58-14 Travel Administrative 1,000.00 234-7410-465.60-33 Materials & Supplies 1,700.00 234-7410-465.21-05 Employee Clinic 155.00 234-7410-465.41-13 Utilities 1,000 .00 234 -7410 -465.32-73 Training Vouchers -ITA 4,957 .00 2 34-7 410-465.3 5-83 Training Vouchers-Authorizations 1,000 .00 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : To move funds into line items to keep them funded the remainder of the Fiscal Year. Moving a total of $7,112 from Incentives {32-26), Participant Cost {35-26), Child Care {35-27), Training & Meetings {58-01), Travel Administrative {58-14), Materials & Supplies {60-33),and Pa i d Work Experience {35-61) into Employee Clinic {21-05), Utilities {41-13), Train i ng Vouchers -ITA {32-73), and Training Vouchers-Authorizations {35-83). APPROVALS : Section 2. Copies of th is budget amendment shall be furn ished to the Clerk to t he Board , and to t h e Budget Officer and the Finance Officer for their direction. Adopted this Margaret Regina Wheeler Clerk to the Board day of Jim Burgin , Chairma n Harnett County Board of Commissi oners 011916 HC BOC Page 158 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, 2016. Section 1. To amend the General Fund , Public Buildings Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-4 700-410-41.10 Utilities $318,040 110-4700-410-41.13 Utilities-Public Buildings $4,182 110-4700-410-41.14 Utilities-Admin $13,497 110-4700-410-41.17 Utilities -IT $3,427 110-4700-410-41.18 Utilities-EMS $3,267 110-4 700-410-41.19 Utilities-Garage $6,150 110-4 700-410-41.20 Utilities-Court Services $10,580 110-4700-410-41.22 Utilities -IT Annex $3,273 110-4700-410-41.24 Utilities-Planning & Inspections $7,041 110-4700-410-41.26 Utilities-Bd of Elections $12,882 110-4700-410-41.27 Utilities-Parks & Rec $1,394 110-4 700-410-41.28 Utilities-Nobles Bldg $2,272 110-4700-410-41.29 Utilities-Courthouse $142,776 110-4700-410-41.30 Utilities-Tax/Reg of Deeds $16,208 110-4700-410-41.34 Utilities -Ag Bldg $25,359 110-4700-410-41.33 Utilities-Facilities & Services $39,302 110-4700-410-41.31 Utilities-Fire Marshall $830 110-4700-410-41.37 Utilities-Veterans Memorial $403 110-4700-410-41.39 Utilities -EOC $25,197 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE ~l·tt-/L ounty nager (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 Wheeler, Clerk to the Board '2015. Jim Burgin, Chairman Harnett County Bo ard of Commissioners 011916 HC BOC Page 159 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, 2016. Section 1. To amend the General Fund, Public Buildings Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-4700-410-60.33 Materials & Supplies $5,000 110-4700-410-43.15 Repair & Maint Bldg $5,000 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 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 Wheeler, Clerk to the Board 12015. Jim Burgin , Chairman Harnett County Board of Commissioners 011916 HC BOC Page 160 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, 2016: Section 1. To amend the HC WIOA Dislocated Worker Program Fund, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 234-7411-465 .21-00 Group Insurance 1,428.00 234-7411-465.33-45 Contracted Services 1,000.00 234-7411-465.35-27 Child Care 500.00 234-7411-465.35-61 Paid Work Experience 2,500.00 234-7411-465.35-83 Training Vouchers-Non ITA 5,428.00 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : Transferring funds from line items 21 -00, 33 -45, 35-27, and 35-61 into line item 234-7411- 465.35-83 (Training Vouchers-Non ITA) in the amount of $5,428. This is to cover the cost of additional tuition and fees for new participants being enrolled into school. APPROVALS : ~ 1~/01;;!)1 . ~ /-./~ Department Head (date) Finance Offi (date1L-J \.t Co anager (date) \ £ I~ 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 Wheeler Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioners 011916 HC BOC Page 161 BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Caro li na, that the followi ng amendment be made to t he annua l budget ordinance for the fiscal year ending June 30, 2016: Section 1.To amend the Transportation's budget, the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-4650-410.11-06 Comptime Payout 69 110-4650-410.11-14 longevity 271 110-4650-410.12-00 Salary & Wages-Part-Time 133,620 110-4650-410.22-00 FICA 3,113 110-4650-410.23 -00 Regular Retirement 3,257 110-4650-410.25-10 Unemployment 569 110-4650-410.11-00 Salary & Wages-Full-time 105,993 110-4650-410.11-05 Salary & Wages-Overtime Payout 152 110-4650-410.11-13 Salary & Wages-Vacation Payout 166 110-4650-410.21-00 Group Insurance 31,190 110-4650-410.21-05 Employee Clinic 1,466 110-4650-410.23-Q1 Supplemental Reti rement 1,932 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : On September 21, 2015 the Board of Commissioners agreed to add 10 full-time transit driver positions and increase the hourly pay rate to salary grade 54 for full-time and part-time transit drivers effective January 1, 2016. A budget amendment is needed to allocate monies to the Salary and Wages and Fringe Benefit expenditure accounts. APPROVALS : ~~ ..... -~Jc-2/r D partment Head (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 ______ J ______ _ Margaret Regina Wheeler Clerk to the Board Jim Burgi n, Chairman Harnett County Board of Commissioner 011916 HC BOC Page 162 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, 2016. Section 1. To amend the General Fund, Public Bu ildings Department, the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 580-6600-461-44.21 Building & Equip Rent $10,000 580-6600-461-43.15 Building-Repair & Maint $10,000 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : Move monies to cover lease for equipment including computer and printer equipment. Also, for rental of incidental construction e ·pment. ~~fl?jJ& ~()~. f-2-/t tment Head (J..te) icer (date) 1 7 { 1 (, County M~~r (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 Wheeler, Clerk to the Board 1 2016. Jim Burgin, Chairman Harnett County Board of Commiss ioners \~ l i 011916 HC BOC Page 163 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, 2016; Section 1. To amend the General Fund, Health Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION Of CODE INCREASE DECREASE 110-7600-441.43-16 Repairs and Maintenance to Equipment $ 420.00 110-7600-441.60-46 Medical Supplies $ 420.00 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION: Budget Amendment to cover the cost of maintenance on the microscopes in the lab. APPROVALS: 'f 9k~~';; Departme~) 9£~ hi'/-6 county Man er(Date) 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 ,2015 Jim Burgin, Chairman Harnett County Board of Commissioners 011916 HC BOC Page 164 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, 2016: Section 1. To amend the General Fund, Social Services Department, the appropriations are to be changed as follows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110-7700-441.60-33 Materials & Supplies 7,000 110-7700-441.74-74 Capital Outlay 7,000 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION: To budget funds for the office renovation . APPROVALS: k ·/JuQ /]JuwJJ 1-¥~1 t Department Head (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 _____ 2 __ Margaret Regina Wheeler, Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioners 011916 HC BOC Page 165 BUDGET ORD INANCE AMENDMENT BE IT ORDA INED by the Governing Board of t he County of Harnett, North Carolina; that the fo ll owing am endment be made to the annua l budget ordinance for the f isca l year ending June 30 , 2016 : Section 1. To amend the Board of Elections Departmen t , the approp r iations are to be changed as fo ll ows : EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCR IPTION OF COD E INCREASE DECREASE 110-4300 -410.60 -53 Dues and Subscriptions $100 110-4300-410 .60-5 7 Miscellaneous $100 REVENUE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE EXPLANATION : The Board of El ect ions respe ctfully requests that the above appropriations are changed to move fund s ne eded to f ix a shortage in a line item. APPROVALS : /(t"' ,{) ~b /-12· It /-1)-1( Depa rtmlnt Head (date) ( ate) 1 I 1 Se ct ion 2. Copies of th is b udget amendment sh all be f urn is hed t o t h e Clerk to the Boa r d, and to the Budge t Officer and the Finance Officer for t h eir d irect i on . Adopt ed ~th~is~----------~d~aLy~o~f------------~------------~ Margaret Regina Whee ler Clerk to t he Board Jim Burgin, Chairman Harnett County Boa r d of Comm issioner s 011916 HC BOC Page 166