HomeMy WebLinkAbout2014-442 Finance - Community Empowerment Fund - Outside Agency Performance Agreement $5,000 0,r)
2014-15 OUTSIDE AGENCY PERFORMANCE AGREEMENT
THIS AGREEMENT,made and entered into the first day of July 2014,("Effective Date")by and between
the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street,
Hillsborough, North Carolina, 27278, ("County") and Community Empowerment Fund, a not-for-profit
corporation, located at 133 1/2 E. Franklin Street, Suite 105,Chapel Hill,NC 27514("Provider").
WITNESSETH:
WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby
enhance its availability to residents of the County, and said program addresses an important community
human services need,as identified by the Board of Commissioners;
NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set
forth,the County and Community Empowerment Fund agree as follows:
1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1,
2014 to June 30,2015.
2. Scope of Services.
a. Provider will provide services, as outlined in the attached Outside Agency Funding
Application Scope of Services and any amendments or revision thereto which is attached as
Exhibit"A" and incorporated by reference, to the residents of Orange County. The Scope
of Services may be different from the original application based on County appropriation;
however, any revisions or amendments to this Agreement must be approved in writing by
the County and attached to this Agreement.
b. The Provider shall be solely responsible for the means, methods, techniques, sequence,
safety program and procedures necessary to properly and fully complete the work set forth
in the Scope of Services.
3. Funding.
a. The County agrees to appropriate for the provision of services described in Exhibit A,
Scope of Services and more particularly described in the Program Budget, the maximum
sum of$5,000.
b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not
used for the purposes stated shall be returned to the County. Any changes in the use of
funds must be authorized in writing by the County prior to any expenditure of the funds by
the Provider. If the funds are expended not in accordance with the Scope of Services,at the
discretion of the County the Provider may be required to repay the funds to the County.
c. The Provider shall be paid in.four equal installments in the amount of$1,250. The first
payment is contingent upon receipt of the agency's performance agreement; the remaining
payments are contingent upon receipt of the request for reimbursement and related
supporting documentation.
G)
AUG 2=2 2014
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page I of 7
1 - I
d. The County's obligation to make the three quarterly payments is contingent upon receipt of
Progress Reports, which show satisfactory progress toward completion of performance
measures and an accounting of expenditures as detailed in the attached Scope of Services.
e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21
days after receipt of the Progress Report and Request for Reimbursement or 21 days after
due date of Progress Report whichever is later.
f. The County is not obligated to provide any other support to Provider in this or in
succeeding fiscal years.
4. Agency Reporting.
a. Provider will provide Orange County a Progress Report that includes a fiscal report and
updates on 2014-15 performance measures as outlined in the Scope of Services. Progress
Report dates are: July 1 — December 31; January 1 — March 31 and April 1 - June
30. Reports are due on January 9,April 15,and July 10 of the program fiscal year.
b. Provider agrees to allow the County to inspect its financial books and records, which
document costs of those services,upon reasonable notice during normal working hours.
5. Termination.
a. In the event of any of the circumstances set forth below (hereinafter referred to as
"default"), the County may immediately terminate this Agreement, in whole or in part, and
from time to time.Notice of termination must be in writing, state the reason or reasons for
the termination,and specify the effective date of the termination:
i. In the event that Provider shall cease to exist as an organization or shall enter
bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all
of its assets, or significantly reduce its services or accessibility to Orange County
residents during the term of this Agreement; or
ii. In the event that Provider shall fail to render a satisfactory accounting as provided
section 4 above, the County may terminate this Agreement and Provider shall
return all payments already made to it by the County for services which have not
been provided or for which no satisfactory accounting has been rendered; or
iii. In the event of any fraudulent representation by the Provider in an invoice or other
verification required to obtain payment under this Agreement or other dishonesty
on a material matter relating to the performance of services under this Agreement.
iv. Nonperformance, incomplete service or performance,or failure to satisfactorily
perform any part of the work identified in the Scope of Services or to comply with
any provision of this Agreement,as determined by the County in its sole discretion.
v. Failure to adhere to the terms of applicable county, state or federal laws,
regulations,or stated public policy.
b. In the event of default by the Provider,the county may elect to terminate this Agreement, in
whole or in part and/or require the Provider to repay the funds within ten(10)business days
from written notice of default. The County may (but shall not be required to) grant the
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page 2 of 7
Provider an opportunity to cure the default without termination of this Agreement. This
clause shall not be interpreted to limit the County's remedies in law or in equity.
c. Notwithstanding the foregoing, either party may terminate the agreement at any time
without penalty; provided that written notice of such termination is furnished to the other
party at least 30 days prior to termination. In the event of such termination, any payment
due shall be prorated to the date of termination and any unused funds shall be returned to
the County within 10 days of termination.
d. Any termination of this Agreement for default under this section that is later deemed to be
unjustified shall be deemed a termination for convenience.
6. Insurance.
a. General Requirements. The Provider shall purchase and maintain,during the period of
performance of this Agreement, insurance:
i. Worker's Compensation. For protection from claims under workers'or workmen's
compensation acts;
ii. Comprehensive General Liability Insurance covering claims arising out of or
relating to bodily injury, including bodily injury, sickness, disease or death of any
of the Consultant's employees or any other person and to real and personal property
including loss of use resulting thereof;
iii. Comprehensive Automobile Liability Insurance, including hired and non-owned
vehicles, if any,covering personal injury or death,and property damage; and
b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows:
INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE
• Worker's Compensation Limits for Coverage A- Statutory State
NC &Coverage B -Employers Liability
$100,000 each accident, $500,000 disease policy limit
and$100,000 disease each employee
• Commercial General $1,000,000 Each Occurrence
Liability $2,000,000 Aggregate
• Automobile Liability $500,000 Combined Single Limit
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page 3 of 7
c. All insurance policies(with the exception of Worker's Compensation and Professional
Liability)required under this Agreement shall name the County as an additional insured
party and as a certificate holder. Evidence of such insurance and all correspondence shall
be sent to:
Orange County Risk Manager
Post Office Box 8181
Hillsborough,NC 27278
d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity
defenses.
7. Relationship of the Parties. Provider is an independent contractor of the County. Provider
represents that they have or will secure, at his own expense, all personnel required in performing
the services under this Agreement. Such personnel shall not be employees or have any
contractual relationship with the County. All personnel engaged in work under this Agreement
shall be fully qualified and shall be authorized and permitted under federal, state and local law to
perform such services.
8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws,
ordinances, orders and regulations of the federal, state or local governments, as well as their
respective departments, commissions, boards, and officers, which are in effect at the time of
execution of this Agreement or are adopted at any time following execution of this agreement.
9. Subcontract. The County and Provider deem the services provided under this Agreement to be
personal in nature and Provider may not subcontract any rights or duties under this Agreement to
any other party without prior written consent from the County.
10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to
any other party without the prior written consent of the County.
11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all
loss, liability, claims or expense(including reasonable attorney's fees)arising from bodily injury,
including death or property damage, to any person or persons caused in whole or in part by the
negligence or willful misconduct of the Provider, except to the extent same are caused by the
negligence or willful misconduct of the County. It is the intent of this section to require Provider
to indemnify the County to the extent permitted under North Carolina law. Nothing in this
section is intended to affect or abrogate the County's sovereign immunity defenses.
12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the
specified services and may be terminated at any time if such funds become unavailable.
13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange
County the parties hereto for themselves,their agents,officials, employees and servants agree not
to discriminate in any manner of these basis of race, color, gender,national origin, age, handicap,
religion, sexual orientation, familial status or veterans status with reference to any activities
carried out by the grantee, no matter how remote. The parties hereto further agree in all respects
to conform to the provision and intent of Orange County Civil Rights Ordinance, as
amended. This provision is enforced by action for specific performance, injunctive relief, or
other remedy as by law provided; this provision shall be binding on the grantees, the successors
and assigns of the parties hereto with reference to the above subject manner.
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page 4 of 7
14. Living Wage. Orange County is committed to providing its employees with a living wage and
encourages agencies if funds to pursue the same goal. The County's living wage is $12.76 per
hour. To the extent possible, Orange County recommends that Community Empowerment Fund
provide a living wage to its employees.
15. Notke. The Parties hereto agree and understand that written notice, mailed or delivered, to the
last known address shall constitute sufficient notice to the County and the Provider. All notices
required and/or made pursuant to this Agreement to be given to the County and the Provides shall
be in writing and mailed to the party addressed as follows:
County: Finance&Administrative Services Provider: Community Empowerment Fund
Orange County 133 1/2 E. Franklin Street, Suite
Post Office Box 8181 105
Hillsborough,NC 27278 Chapel Hill,NC 27514
16. Entire Agreement. This Agreement, including any referenced attachments,constitutes the entire
Agreement between the parties and shall supersede, replace or nullify any and all prior
Agreements of understandings; written or oral, relating to the matters set forth herein, and any
such prior Agreements or understandings shall have no force or affect whatsoever on this
Agreement. The County and Provider have read this Agreement and agree to be bound by all of
its terms, and further agree that this Agreement constitutes the complete and exclusive statement
of the Agreement between the County and Provider.
17. Severability. All clauses found herein shall act independently of each other. If a clause is found
to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It
is understood by the parties hereto that if any part,term or provision of this Agreement is by the
Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United
States, the validity of the remaining portions or provisions shall not be affected, and the rights
and obligations of the parties shall be construed and enforced as if the Agreement did not contain
the particular part,term or provision held to be invalid.
18. Governing Law. The laws of the State of North Carolina shall govern all aspects of this
Agreement. In the event that it is necessary for either party to initiate legal action regarding this
Agreement, venue shall lie in Orange County, North Carolina. The parties hereby waive their
right to trial by jury in any action, proceeding or claim, arising out of this Agreement,which may
be brought by either of the parties.
[SIGNATURES ON FOLLOWING PAGE]
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page 5 of 7
IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement,effective on
the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures
below.
For and on behalf of the Provider
SignatureV I Dat
14 —
Printed ame
For and on behalf of Orange County Government
Bonnie Hammersley, County M ager Date
Appro a as t o and legal sufficiency
Offi4 of the Co my Atiorney Dke
Approved as to technical content
This instrument has been pre-audited in the manner required by the Local Government Budget and
Fisc ntrol Act
Clarence Grier,Assistant County Manager/ Date
Chief Financial Officer
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page 6 of 7
ATTACHMENT"A"
Orange County Certifications—FY 2014-15
Outside Agency Performance Agreement
Chief Contact,Administrators,Chief Executive Officer and Chief Financial Officer
I certify that I have provided a list of the chief contact,administrators,chief executive officer and chief
financial officer for my agency with this Agreement and that I will keep it current to the County of Orange.
The list should be in writing with the name,title,residential address;phone and email address and if
possible,fax number.
Officers and Board of Directors
I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and
that we will continue to update the list as changes occur. The list should be in writing,with the name,
physical address,mailing address and if possible,phone,fax and email address.
Budget Submission
I certify that I have provided a budget for the period to be covered by funding Orange County,and that any
substantive changes made to this budget have been in advance authorized in writing by Orange County.
Annual Financial Review
I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget
adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a
separate sheet of paper.
Alignment with Organization's Mission
I certify that the programs and services for which this funding is requested align with the mission of the
organization.
Intended Purpose
I certify that the funds provided to the agency under the terms of this Agreement will be used for a public
purpose and shall only be used for the purposes intended and any money not used for those purposes will be
promptly returned to Orange County.
Certified by: P, A V Title: Ag 4)ate: O�6 f 26 ZZ
(Prow is Signature)
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page 7 of 7
ATTACHMENT "A"
Orange County Certifications—FY 2014-15
Outside Agency Performance Agreement
Chief Contact,Administrators,Chief Executive Officer and Chief Financial Officer
I certify that I have provided a list of the chief contact,administrators,chief executive officer and chief
financial officer for my agency with this Agreement and that I will keep it current to the County of Orange.
The list should be in writing with the name,title,residential address;phone and email address and if
possible, fax number.
Officers and Board of Directors
I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and
that we will continue to update the list as changes occur. The list should be in writing,with the name,
physical address,mailing address and if possible,phone, fax and email address.
Budget Submission
I certify that I have provided a budget for the period to be covered by funding Orange County,and that any
substantive changes made to this budget have been in advance authorized in writing by Orange County.
Annual Financial Review
I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget
adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a
separate sheet of paper.
Alignment with Organization's Mission
I certify that the programs and services for which this funding is requested align with the mission of the
organization.
Intended Purpose
I certify that the funds provided to the agency under the terms of this Agreement will be used for a public
purpose and shall only be used for the purposes intended and any money not used for those purposes will be
promptly returned to Orange County.
Certified by: J�� Title: 44,Vk Date:
(Provide s'Signature)
(Community Empowerment Fund)
Orange County Outside Agency Performance Agreement Page 7 of 7
EXHIBIT"A"
Scope of Services—FY 2014- 15
Outside Agency Performance Agreement
Agency Name: Community Empowerment Fund
Program Name: Advocate Program
Funding Award: $5,000
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
Salary and FICA costs for Program Coordinator $4,500
Program Supplies $100
Food and Drinks for Trainin s and Events $400
Program Services
For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the
contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes
below,by June 30,2015.
• Employment Counseling: One-on-one support from volunteer advocates to assist members in
building resumes,preparing for interviews,completing applications,and securing employment
• Financial Coaching: Personalized coaching for members experiencing financial hardship to
address banking,budgeting,and credit issues
• Volunteer Coordination: To provide these and other services, CEF recruits, trains, coordinates,
and mentors a base of volunteers to provide the comprehensive,person-centered advocate support
to CEF mmbers
Anticipated Outcomes
The Anticipated Results column must include quantifiable results in the form of number of persons/units served within OranSe
County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants
within that measure's description or for an earlier performance measure.
Performance Measures Anticipated
Results
At least 120 members will gain greater employment 120
At least 75 members will make progress towards personalized savings goals 75
At least 40 households will transition into independent housing 40
CEF will continue to grow our volunteer base and 190 volunteer advocates will provide active 190
support to CEF members
Certified by: 1-� L`J Title: ?rJ Q7n„yks✓c�.{�� Date:
— .—
(Provi „,r's Signature)
Y,C H DA lE(NI%I,DD,'%N YN)
8/52914
CERTIFICATE OF LIABILITY INSURANCE R022 /
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATIONIS WAIVED,subject to the
terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
I NAME
I PHONE. '866) -7) 538-529
BB&T INSURANCE SERVICES INC/PHS "'C' EXI), 4 6�-87 3'� 'A',xC N.) 8 7 1
1 E-MAIL
'272545 P: (866) 467-8730 F: (8717 '/ �, 538-5295t ADDRESS
PO BOX 2961-1 t INSURER(S)AFFORDING COVERAGE NAIC#
CHARLOTTE NC 28229 INSURER A Sentinel Ins Co LTD
INSURED INSURER 6
INSURER C:
COMMUNITY EMPOWERMENT FUND INSURER D
133 1/2 E FRANKLIN ST STE 104 INSURER E:
CHAPEL HILL NC 27514 INSURER F.
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
411111- 81111?1 1 EVF pw/()�vvj, I I
T)Pf'UF bVVUR4 NCE POLIC),Al IIIIER
LIR NSR K I'D yorymly)I Y) f1vr1111I)I)1yyyl)
EACH OCCURRENCE s2, 000, 000
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE r-171 OCCUR 4 DAMAGE TO RENTED
PREMISES(Ea occurrence) -1, 000, 000
/IbI4 0 1 2 6 2 0 11)
X General Liab 22 SRI Bt�S,653 '1-1126 MED EXP(Any one person) "10, 000 li
PERSONAL&ADV INJURY 82, 0 0 0, 000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 000, 000 J
POLICY PRO- LOC I PRODUCTS-COMP/OP AGG ;4, 000, 000
E7JECT
JOTHER'
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s2, 000, 000
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
AL OWNED SCHEDULED 2� SBM BN9653 BODILY INJURY(Per accident) $
A AUTOS AUTOS /2�,,/2014 01/26/2015
NON-OWNED PROPERTY DAMAGE
X HIRED AUTOS X AUTOS I (Per accident)
UMBRELLA LIAB OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE AGGREGATE
DODI IRETFNT CN S PER CTH-
MORKERS COAHIFNA4TION PT.,I T1
AAD FHP1.0YERS "
'LIULII)'
ANY PROPRIETOR/PAR-TNER/EXECUTIVE YIN E L EACH ACCIDENT
OFFICER/MEMBER EXCLUDED ❑ NIA
(Mandatory in NH) E L.DISEASE-EA EMPLOYEE
If yes,describe under
EL DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES(ACORD 101 Additional Remarks Schedule,may be attached if more space is required)
Those usual to the Insured' s O-oerations.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE
Orange County DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 81.81 AUTHORIZED REPRESENTATIVE
200 S CAMERON ST
HILLSBOROUGH, NC 27278
(D 1988-2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
, — T`?
BB&T INSURANCE SERVICES INC/PHS
s PO BOX 29611
CHARLOTTE NC 28229
Orange County
PO Box 8181
200 S CAMERON ST
HILLSBOROUGH NC 27278
ACORb 25(2014/01) ft,
h
COMMEMP OP ID:DC
CERTIFICATE OF LIABILITY' INSURANCE D0811912011 YY)
as11 s12a14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
CONTACT
PRODUCER Phone:919-682AS14 NAME: Debbie Callahan
The Sorgl Insurance Agency Fax:919-68211906 acONo Eac:919-682.4814 c No: 919-682-4906
16 Consultant Place Suite 102
Durham, NC 27707 E-MAIL
James E.Sorgi,CIC ADDRESS,dabble sor iinsuranCe.com
INSURER(S).AFFORDING COVERAGE NAIC#
INSURERA:Erie Insurance Exchange 26271
INSURED Community Empowerment Fund INSURERS:
133 112 E Franklin St,Ste 1055 INSURERC:
Chapel Hill, NC 27514
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE POLICY NUMBER MMID MMlDD LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
DAMAGE TO RENTED
HCOMMERCIAL GENERAL,LIABILITY PREMISES Ea occurrence $
CLAIMS-MADE 1-1 OCCUR MED EX.P(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $
POLICY PRO- LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS NON-OWNED Per PROPERde;4 $
J $
HIRED AUTOS AUTOS
UMBRELLA LIAB, OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-- AGGREGATE $
DED RETENTION $ $
WORKERS COMPENSATION X WC STATtJ- ER
AND EMPLOYERS'LIABILITY TORY LIMITS ER
YIN
A ANY PROPRIETORIPARTNERIEXECUTIVE BINDER CEF0811 08111/2014 08/11/2015 E.L.EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ S�d,DO
Q2 12
DESCRIPTION 0 A N"ttL eh ACORD 101,Additional Remarks Schedule,it more space is required)
AUG L u 2014
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
a County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Oran
g ty ACCORDANCE WITH THE POLICY PROVISIONS.
PO Box 8181
200 Cameron St AUTHORIZED REPRESENTATIVE
Hillsborough,NC 27278
Ce?1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
032-0627-0
CUNA MUTUAL GROUP 293489-000
CUMIS Insurance Society,Inc,
Home Offloe: Administrative Offioe: DECLARATIONS
2000 Heritage Way 5910 Mineral Point Rd
W&�.,Iy,IA 50577 Madi—,W1 53706 MANAGEMENT& PROFESSIONAL LIABILITY POLICY
THIS IS A CLAIMS MADE POLICY. DEFENSE COSTS ARE INCLUDED WITHIN THE
ANNUAL AGGREGATE LIMIT OF LIABILITY. ANY DEDUCTIBLES SHALL APPLY TO
DEFENSE COSTS. READ THIS POLICY CAREFULLY.
The effective date of these Declarations begins at 12:01 a.m. on 09/29/2013 for the Coverage, Annual
Aggregate Limit(s) Of Liability and Deductible(s) shown below. These Declarations supersede any previous
Declarations.
Reason for new Declarations:
New Issue
ITEM 1. INSURED ORGANIZATION PoEcv No: 293489-000
Self-Help Credit Union
PO Box 3619
Durham NC 27702 3619
ITEM 2. POLICY PERIOD begins 09/29/2013 at 12:01 a.m. and expires 09/29/2014 at 12:01 a.m.
ITEM 3. COVERAGE
If "no coverage" is shown opposite A} (B) (C)
any coverage below, that coverage is Coverage Coverage Is Part Of Per
not provided and is deleted from this Annual Aggregate Polic Annual Aggregate Claim
99 1 y 99
Policy. Limit Of Liability Limit Of Liability Deductible
Management Liability $5,000,000
Individual Included No $0
Reimbursement Included No $50,000
Entity
No Coverage N/A N/A
Employment Practices Liability No Coverage N/A N/A
Fiduciary Liability No Coverage N/A N/A
ITEM 4. POLICY ANNUAL AGGREGATE LIMIT OF LIABILITY N/A
TAH 09/27/2013
MPL 0001 03 11 CUMIS Insurance Society,Inc. Page 1 of iii
DECLARATIONS
MANAGEMENT& PROFESSIONAL LIABILITY POLICY
ITEM 5. EXTENDED REPORTING PERIOD
Additional Annual Premium: 100%
Additional Period: 12 Months
ITEM 6. ADDITIONAL INSUREDS (A) (B) (C)
Insureds Subject to Annual
Are Included Annual Aggregate Aggregate
In Sub-Limit Of Sub-Limit Of
This Policy Liability Liability
Management Liability
Employees And Leased Employees Yes No N/A
Employment Practices Liability
Employees And Leased Employees N/A N/A N/A
Independent Contractors N/A N/A N/A
Fiduciary Liability
Employees And Leased Employees N/A N/A N/A
ITEM 7. PRIOR AND PENDING LITIGATION Date
Management Liability
Individual 09/29/2013
Reimbursement 09/29/2013
Entity N/A
Director And Officer Umbrella N/A
Employment Practices Liability N/A
Fiduciary Liability N/A
TAN 09/27/2013
MPL 0001 03 11 CUMIS Insurance Society,Inc. Page ii of iii
DECLARATIONS
MANAGEMENT&PROFESSIONAL LIABILITY POLICY
ITEM 8. ENHANCED COVERAGES (A) (B) (C)
Enhanced Coverage Part of Coverage Per
Annual Aggregate Annual Aggregate Claim
Limit Of Liability: Limit Of Liability Deductible
Management Liability
Investigative Costs No Coverage N/A N/A
Outside Director Liability $5,000,000 Yes $0
Director And Officer Umbrella No Coverage N/A N/A
Director And Officer ID Theft— No Coverage N/A N/A
$7,500 Limit Per Director or Officer
Employment Practices Liability
Fair Labor Standards Act No Coverage N/A N/A
Terrorism Risk Insurance Act Coverage Waived
Total Annual Premium $10,066.00
The folioNving forms along with these Declarations complete this Management & Professional Liability
Policy.
Countersignature
(Where Required)
TAH 09/27/2013
MPL 0001 03 11 CUMIS Insurance Society,Inc. Page iii of iii
FIDELITY BOND
DEFINITIONS
Electronic Funds Transfer System
"Electronic funds transfer system" means an automated clearinghouse or other electronic
communications system, including but not limited to Fedwire, Clearing House Interbank Payment
System (CHIPS) and Society for Worldwide International Financial Telecommunication (SWIFT).
Electronic Signature
"Electronic signature" means an electronic sound, symbol, or process attached to or logically associated
with a contract or other record and executed or adopted by a person with the intent to sign the record.
E-Mail
"E-mail" means a message transmitted from one person to another person by use of the Internet or any
network of two or more computers,including but not limited to:
a. Computer instant messaging;
b. Online chat systerns;
c. Online forms that are completed and forwarded to an "employee" for processing; or
d. Mobile device teat messaging.
Employee
1. "Employee" means persons who were, are, or may be in the future, acting under your immediate
direction and control in the conduct of your business and while in the course or scope of
performance of their assigned duties; and
a. Are paid a regular wage or salary by you or by an employment service that provides such persons
to you;
b. Serve on your committees appointed or elected by your Board Of Directors or by your voters in
accordance with your bylaws or by written resolution of your Board Of Directors;
c. Serve as "volunteers," except for "directors" acting as "directors";
d. Serve as a guest student while pursing studies or duties on your "premises"; or
e. Serve as "directors" but are acting in the capacity-of an "employee," as defined here.
2. "Employee" also means:
a. Persons legally appointed to act on your behalf as your trustee, receiver or liquidator; or
individuals employed by a conservatorship for you established by any federal or state
governmental regulator of financial institutions; or
Bond 500 03 11 Copyright CUMIS Insurance Society,Inc.,2009,2010,2011 Page 20 of 64
FIDELITY BOND
DEFINITIONS
Employee - continued
b. Employees of an institution merged with you prior to the effective date of this Bond.
3. For Employee Or Director Dishonesty Coverage only, "employee" also means:
a. Persons retained by you to act on your behalf to collect the unpaid balance of your delinquent
"loan" account; or
b. Any "director" or person who meets the definition of "employee" in paragraph 1. above who
handles funds or other property of any "employee benefit plan" owned, controlled or operated
by you, while such "director" or person handles funds or other property of any such "employee
benefit plan," or any other person who is a trustee, manager, officer or employee of any such
"employee benefit plan."
c. Persons you authorize, or persons employed by a partnership or corporation you authorize, to
perform services as a data processor of your checks, drafts, share drafts, automated
clearinghouse items, "accountholder" bill payments or accounting records and only while
performing those services. All persons employed by any partnership or corporation you
authorize to perform such services, including its partners, officers and employees, will
collectively be considered one "employee" for all purposes of this Bond, except for the
Termination Or Limitation Of Coverage For Employee Or Director Condition. However, the
following processors, and the persons employed by them, will not be considered "employees"
under this Bond:
1) Developers or modifiers of computer software programs;
2) A Federal Reserve Bank or a clearinghouse; or
3) A credit card or debit card processor.
d. Retained accountants and their staff only while performing accounting services for you;
e. Retained attorneys and their staff only while performing legal services for you; or
f. "Servicing contractors." All persons employed by any "servicing contractor," including its
partners, officers and employees,will collectively be considered one "employee" for all purposes
of this Bond, except for the Termination Or Limitation Of Coverage For Employee Or Director
Condition.
4. Unless specifically listed in paragraphs 1., 2. or 3. above, "employee" does not mean:
a. Independent contractors;
b. Agents,meaning persons authorized by you to act for you;
c. Brokers;
Bond 500 03 11 Copyright CUMIS Insurance Society, 009 2010 2011 Page 21 of 64
Y�Inc.,� � 9
FIDELITY BOND
DEFINITIONS
Employee - continued
d. Persons employed by the Federal Reserve system;
e. Consultants;
f. "Third-party vendors"; or
g. Persons acting on behalf of a "service center," including those who might otherwise be your
"employee."
Employee Benefit Plan
"Employee benefit plan" means:
a. A group accident or health insurance plan,including a dental or vision plan;
b. A group life insurance plan;
c. A pension plan; or
d. Any other plan qualified under Section (3) of the Employee Retirement Income Act of 1974
(ERISA) as amended and any regulations promulgated thereunder.
Environment
"Environment" means:
a. Any person,
b. Any man-made object or feature;
c. Any animals, crops or vegetation; or
d. Any land, bodies of water, underground water or water table supplies, air and any other feature of
the earth or its atmosphere, whether or not altered, developed or cultivated and whether or not
owned, controlled or occupied by you.
Extortion-Kidnap Expenses
"Extortion-kidnap expenses" means the following reasonable fees and expenses incurred and paid by
you with our prior written consent for the purpose of mitigating the consequences to you of an
"extortion, kidnap or ransom":
a. An independent security consultant;
b. An independent public relation consultant;
Bond 500 03 11 Copyright CUMIS Insurance Society,Inc.,2009,2010,2011 Page 22 of 64
FIDELITY BOND
DEFINITIONS
Voice Computer System - continued
d. Voice over Internet Protocol (VoIP),
or provides a similar capability used for the direction or routing of telephone calls in a voice
communications network.
Volunteers
"Volunteers" mean persons:
a. Serving on your committees that are appointed by your Board Of Directors or elected by your
voters;or
b. Performing services without compensation solely in the conduct of your business and with the
approval of your Board Of Directors.
Website
"Website" means a group of related electronic documents, ii-rages and other information having a
unique address on the World Wide Web and published under the auspices of a single domain name,
which can include text, graphics, sound and automatic links or connections to other such websitcs or
web pages.
Withdrawal Order
"Withdrawal order" means a written, non-negotiable instrument, signed by a person authorizu-19 the
debit of an account maintained by you in the amount stated on the"withdrawal order."
Bond 500 03 11 Copyright CUMIS Insurance Society,Inc.,2009,2010,2011 Page 33 of 64