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Exhibit 14A: List of Subcontractors Region FY ($ <br /> Provider—C C_L r_,V f C',L4 L4 U H f Provider Code: Or L County <br /> List each subcontractor in the chart below. A subcontractor is defined as an entity that has been contracted to do a job within the scope of the service provider's <br /> grant award. The subcontractor is accountable for the same requirements as the service provider, depending on the terms of the subcontract. Subcontractors <br /> must adhere to service standard requirements by the Division of Aging and Adult Services. Do not list vendors who provide services through a 'purchase of <br /> service'. These are services which do not follow prescribed service standards and are goods or services sold equally to all consumers. <br /> Subcontractor Type Agency Subcontracted Subcontractor Contact Name, Scope of the Subcontract(Briefly describe any service <br /> Name Non-Profit Service Name Address requirements that will be delegated to the subcontractor, e.g. <br /> For-Profit & phone Number eligibility determination, service authorization, <br /> assessments/reassessments, preparation and delivery of <br /> Government meals, provision of a ride and drivedrequirements, tasks on <br /> an In-Home Aide plan of care, aide competency testing, aide <br /> supervision,etc.) <br /> Sandy Mullins <br /> In-Home Aide 1000 Copperfield Blvd NE <br /> Senior Helpers For-Profit Services II & III Concord, NC 28025 Provision of In-Home Aide Services Level II & III <br /> 704-792-1001 <br /> Dana Ramsey <br /> ResCare For-Profit In-Home Aide 320 Copperfield Blvd Provision of In-Home Aide Services Level II & III <br /> Homecare Services II & III Concord, NC 28025 <br /> 704-793-4220 <br /> Attest Statement: Providers utilizing subcontractors must provide assurance that both for profit and non-profit subcontractors are compliant with slate and federal regulations. These assurances are <br /> the subcontractor:A)has not been suspended or debarred(G.S.§143C-6-23:09NCAC03M), B)has not been barred from doing business at the federal level.C)is able to produce a notarized"State <br /> Grant Certification of No Overdue Tax Debts", D)has obtained all licenses, permits,bonds and insurance necessary for carrying out HCCBG Services. In addition,Non-Profit Subcontractors are <br /> registered as a charitable(501 c3)organization with the federal government. �(� <br /> Provider Signature: �'��%�!%G JG� Title: 4 �� C/L Date: <br /> Version 2016 Page of <br /> Attachment number 1 \n <br /> Version 2016 <br /> F-4 Page 118 <br />