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Exhibit 14A: List of Subcontractors <br />Provider: CCDHS -- Transportation Provider Code: 011 <br />County: Cabarrus <br />Region F FY 17 <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 <br />Type Agency <br />Subcontracted <br />Subcontractor Contact Name, <br />Scope of the Subcontract (Briefly describe any service <br />Name <br />Non- Profit <br />For- Profit <br />Service Name <br />Address <br />�= Phone Number <br />requirements that will be delegated to the subcontractor, e.g. <br />eligibility determination, service auMorizatiola, <br />assessmentsfreassessments, preparation and delivery of <br />Government <br />meals, provision of a ride and driver /requirements, tasks on <br />an In -Home Aide plan of care, aide competency testing, aide <br />supervision,etc. ) <br />NIA <br />Attest Statement: Providers utilizing subcontractors must provide assurance that both for profit and non - profit subcontractors are compliant with state and federal regulations. These assurances are <br />the subcontractor: A) has not been suspended or debarred (G.S. §143C -6 -23; 09NCACO3M), 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 (501c3) organiz tion with thhgpfederal government. <br />D ' / <br />3 Provider Signature: :/ T itle: POT Date: <br />m <br />Version 2016 <br />a <br />m <br />Ver�ron 2016 <br />Page 1 of 1 <br />F -6 <br />Page 128 <br />