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Interim Healthcare <br />of the Triad, Inc. <br />For - Profit <br />In -Home Aide <br />Services 11 & III <br />Julie Conrad <br />250 Branchview Dr. <br />Suite D <br />Concord, NC 28025 <br />704- 784 -3483 <br />Provision of In -Home Aide Services <br />Level 11 & III <br />Sandy Mullins <br />51 Union St. S <br />Senior Helpers <br />For - Profit <br />In-Home Aide <br />Suite 204 <br />Provision of In -Home Aide Services <br />Services 11 & III <br />Concord, NC 28025 <br />Level II & III <br />704 -490 -4673 <br />Helen Bedu <br />Prospect Home <br />in -Home Aide <br />685 N Cannon Blvd, <br />Care Services, <br />For- Profit <br />Services Level 11 <br />Kannapolis NC 28083 <br />Provision of In -Home Aide Services <br />LLC <br />& 111 <br />704 -934 -2330 <br />Level 11 & III <br />Attest Statement: Providers utilizing subcontractors must provide assurance that both for profit and non - profit subcontractors are compliant with state and federal <br />regulations. These assurances are the subcontractor: A) has not been suspended or debarred (G.S. §143C -6 -23; 09NCACO3M), B) has not been barred from doing <br />business at the federal level, C) is able to produce a notarized "State Grant Certification of No Overdue Tax Debts ", D) has obtained all licenses, permits, bonds and <br />insurance necessary for carrying out HCCBG Services. In addition, For- Profit Subcontractors have provided a copy of their business license and Non - Profit Subcontractors <br />are registered as a charitable (501c3) organization with the federal government. <br />T <br />/ _ <br />Signature: " Date: � 3 (1 4 1 <br />Attachment number 1 <br />F -3 Page 99 <br />