HomeMy WebLinkAbout2015-524-E Health - Mental Health America of the Triangle DocuSign Envelope ID:24392949-6CFE-4A47-8FC6-54FF2C794193
2015-16 Family Success Alliance Zone Navigators Agreement
THIS AGREEMENT, made and entered into the 19'h day of September 2015, ("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") by and through the Orange County
Health Department ("Department") and Mental Health American of the Triangle, located at PO Box
16246, Chapel Hill,NC 27516 ("Provider") (all collectively"the Parties").
WITNESSETH
WHEREAS, it is an important community service need to improve support provided to low-income
families by providing assistance to navigate the system of supports in Orange County; and
WHEREAS, the Family Success Alliance Zone Navigator Program ("Program") is a pilot program to
improve connections and referrals to programs and services; and
WHEREAS, the Program assisted by the Provider would enhance the availability of the Program to the
residents of the County; and
NOW, THEREFORE,in consideration of the above and the mutual covenants and conditions hereafter set
forth, the County and Provider agree as follows:
1. Term of the Agreement. The term of this Agreement shall be a program year beginning
9/19/15 to 6/30/16.
2. Scope of Services.
a. Provider will provide Services, as outlined in Family Success Alliance Zone Navigators
and any amendments or revision thereto which is attached as Exhibit "A" and
incorporated by reference, to the residents of Orange County. 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 Categories, the
maximum sum of Thirty Eight Thousand, Eight Hundred Seventeen dollars
($38,817.00).
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 installments in the amount of $9,704.25. The first
payment is contingent upon receipt of the agency's fully executed performance
Family Alliance Success Zone Navigators
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agreement; the remaining payments are contingent upon receipt of the request for
reimbursement and related supporting documentation.
d. The County's obligation to make the 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 2015-2016 performance measures as outlined in the Scope of Services.
Progress Report dates are: July 1 — September 30, 2015; October 1 —December 31, 2015;
January 1 —March 31, 2016 and April 1 —June 30, 2016. Reports are due on October 15,
2015; January 15, 2016; April 15, 2016 and July 15, 2016 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.
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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 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
iv. Professional Liability Insurance, covering personal injury,bodily injury and
property damage and claims arising out of or related to the performance under
this Agreement by the Consultant or his agents, consultants and employees.
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
$500,000 each accident, disease policy limit and
disease each employee
• Commercial General $1,000,000 Each Occurrence
Liability $2,000,000 Aggregate
• Automobile Liability $500,000 Combined Single Limit
• Professional Liability $1,000,000 Each Occurrence
$2,000,000 Aggregate
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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.
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 Provider pay a living wage to its
employees.
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15. Notice. 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: Mental Health America of the
Orange County Triangle
Post Office Box 8181 PO Box 16246
Hillsborough,NC 27278 Chapel Hill,NC 27516
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.
19. Signatures. This Agreement together with any amendments or modifications may be executed
electronically. All electronic signatures affixed hereto evidence the intent of the Parties to
comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66.
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.
F(A adbeha lf of the Provider
9/20/2015
445...
Signature Date
Marci White
Printed Name
C bPa d-wbheha1f of Orange County Government
6V�AA'f, h*mtysb� 9/23/2015
nA�70ae a77,_,
Bonnie Hammersley, County Manager Date
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DocuSign Envelope ID:24392949-6CFE-4A47-8FC6-54FF2C794193
Exhibit A
Ref: Family Success Alliance Zone Navigators
Purpose: To host and provide joint supervision with respect to two part-time zone Family
Success Alliance navigators as provided in Exhibit C, Navigator Job Description.
Proiect Scope:
Provider will:
1. Coordinate logistics to allow navigators to operate out of provider office.
a. Provide Wi-Fi password for internet connection and printing.
b. Provide key or other procedures to allow navigator access to the office during regularly
scheduled hours.
c. Provide a work space for each navigator.
d. Offer an orientation to review office procedures and locations for supplies, printing,
meeting space, and payroll procedures and reporting weekly hours.
e. Include navigator in agency meetings as relevant and appropriate.
2. Provide program support to the navigators in conjunction with the Family Success
Alliance staff from the Orange County Health Department.
a. Either the Executive Director or other program staff is available to answer questions
about the services of the organization or other related community-based services.
b. Either the Executive Director or other program staff will provide guidance on how to assist
zone families with service referrals and issues of confidentiality.
c. Either the Executive Director or other program staff will work with navigators to identify
areas of collaboration and partnership between provider and FSA to include client
referrals, co-sponsoring of community and outreach events and other options.
d. Either the Executive Director or other program staff will provide support and guidance as
needed in other unspecific areas.
3. Orientation/Training.
a. OCHD and provider will discuss training needs and requirements and develop a mutually
agreed upon schedule to meet the requirements. Training and orientation may cause the
normal work schedule to vary.
4. Oversee performance measures outlined below and update bi-annually.
a. Community Engagement and Outreach: Navigator will attend or hold 3-4 meetings per month
with community-based organizations (examples service providers, faith groups, neighborhood
associations)to present FSA project and to identify opportunities for mutual support and
objectives. Procedures for documenting outreach will be developed.
b. Resource Referrals: Navigator will identify and connect zone families to needed resources
with a minimum of 8-10 referrals per month. Procedures for documenting referrals will be
developed.
c. School-based Support: Navigator will be available to zone schools on an as needed basis to
support FSA-related activities. Navigator will document hours and activities on a monthly
basis as a way to more formalize this component of the position.
d. Data Collection: Navigators will work with OCHD staff to determine methods for conducting
ongoing needs assessment data and incorporating local knowledge and conditions into
evaluation of FSA.
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5. Conduct joint supervision of the navigators in conjunction with the Family Success
Alliance staff from the Orange County Health Department.
a. Review weekly activities reports and conduct a brief weekly check in with each navigator.
Refer any issues that cannot be addressed internally to FSA staff.
b. Review and approve monthly progress of performance measures report for each
navigator with designated FSA staff.
c. Conduct formal 6 month and one year performance reviews in conjunction with
designated FSA staff. Review documents will include a section for navigators to review
provider scope of work responsibilities.
6. Provisional status and monitoring of agreement
a. Hiring: Provider will coordinate with OCHD to recruit, interview and select appropriate
candidates.
b. Probationary period: A 90-day probationary period will be established to assess if the
employee can perform proficiently.
c. Disciplinary action: Provider will follow internally established protocols for monitoring any
activity or behavior that requires disciplinary action and report that to OCHD.
d. Termination: Provider will follow internally established protocols for termination and will
notify OCHD. Any final termination decision will be made in conjunction with OCHD.
e. Navigator reporting: Navigator will provide written feedback to OCHD regarding any
perceived violation of the agreement and OCHD will provide guidance to develop
solutions amenable to all parties.
OCHD Project Coordinator will:
1. Serve as a liaison between Provider and zone navigators.
2. Provide assistance with logistics for monitoring navigator activities and performance.
3. Provide supplies for navigators as needed for community events and outreach.
4. Identify ongoing learning and training opportunities for zone navigators.
Personnel: 2 part-time zone navigators
Cost: $38,817 to be paid in four, quarterly installments with the first payment at the start of the
contract.
Budget Categories
1. Salaries: $29,520 (2 part-time staff paid $18 for up to 20 hours per week)
2. Taxes: $2,633.78 (FICA/Social Security- 0.062, Medicare - 0.0145, NC Unemployment-
0.01272)
3. Overhead: $4,823.22 (15% of salary plus taxes)
4. Mileage: $840 (@.35/mile for up to 100 miles per month per navigator)
5. Training: $1,000 ($500 per navigator)
Total: $38,817.00
Deliverables:
1. Provide a quarterly expense invoice that documents each budget category and include
receipts as appropriate to FSA project Coordinator.
2. Work with FSA project coordinator to develop performance review documents.
3. Monitor navigator completion of monthly performance measures, including 8-10 referrals
per month, 3-4 meetings per month, and at least 3 zone meetings per year to receive
regular community input on project.
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4. Sign off on monthly performance reports and provide one written paragraph of
performance highlights and opportunities for professional growth.
5. Meet monthly with each navigator and designated FSA staff to check in and review
monthly progress.
6. With designated FSA staff, conduct a formal 6 month performance review and an annual
review at one year.
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Exhibit `B"
Orange County Certifications—FY 2015-16
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.
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.
DocuSignrre''d11lby:LL
A-a�U (N k 9/20/2015
Certified by: Title: Executive Director Date:
E�P78DEm;5&��5...
(Provider's Signature)
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Exhibit"C"
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Bilingual/Bi-Cultural Zone Navigator Job Announcement
Salary: Based on education and experience, includes benefits
Opening Date: Immediate
Closing Date: July 10, 2015
Description: This is an invitation to join a strong team of dedicated professionals working to dramatically
improve student achievement and family success for families struggling to make ends meet in the downtown
Chapel Hill and Carrboro zone, known as Zone 6, of the Family Success Alliance.The position will serve as a
"navigator' for families living in Zone 6 as part of the pilot work of the Family Success Alliance.This position
will be a dynamic one, responding to the needs of the community and zone partners to assist the work.This
will not be an office position; the majority of the wok will be done in neighborhoods and community settings
with families.
We are looking for someone who knows the community well and understands the challenges faced by families
living in poverty.This versatile, on the ground position will connect with families to make program and
resource referrals in areas such as housing, mental health, mentoring, health and wellness and career training
and financial education while reporting on needs and obstacles to child and family success. We are looking for
someone who can work independently and passionately while partnering with school staff, service providers,
faith-based and community groups and neighborhood organizers and activists to develop a culture of
achievement and success among all children and families in the zone.This position will report to the Executive
Director of a local nonprofit organization.
Examples of Duties
This position will be responsible for the long-term strategy and day to day activities required to support child
and family success in Zone 6.
Duties include but are not limited to:
• Assist in recruiting and supporting families participating in summer 2015 kindergarten readiness and
parent literacy programs at Carrboro Elementary and Frank Porter Graham Elementary.
• Be the go-between and "connector' between families and service providers so that families are aware
of programs and services for children and families.
• Support families to access needed programs and assist them in signing up and participating in
programs.
• Work with pre-k parent liaisons, school social workers and service providers to document and respond
to un-meet needs of children and families in each school site. Assist in leading workshops for families so
that they have the tools and capacity to advocate for their children.
• Coordinate with project staff to plan and lead zone partner meetings.
DocuSign Envelope ID:24392949-6CFE-4A47-8FC6-54FF2C794193
• Attend community meetings such as neighborhood association meetings, related local task force and/or
coalition meetings to promote FSA, build relationships with other advocates and stay abreast of
community changes, challenges and opportunities.
• Document and celebrate project successes in the zone and contribute to the overall community-based
identity of FSA.
• Attend FSA project meetings and participate in overall project planning and decision-making.
Typical Qualifications
• Prefer candidates that are from the community and can identify with families struggling to make ends
meet.
• Must possess strong people skills.
• Ideal candidates are bilingual (Spanish) and bicultural applicants.
• Requires a minimum combination of education and experience equivalent to a high school diploma or
a GED with a preference for candidates that are enrolled in or have goals for higher education.
Skills/Abilities
• Ability to connect with and build trusting relationships with families struggling to make ends meet.
• An excitement and passion for identifying and connecting with students and families who can benefit
from program participation.
• Demonstrate cultural sensitivity and the ability to work with diverse groups.
• Possess a range of communication skills that can be employed in various settings and with families that
are the most in need.
• Be able to communicate personal and professional commitment to closing achievement and health
gaps as a way to reach and motivate individuals.
Knowledge
• Candidates should be resourceful and knowledgeable of community resources, with a working
knowledge of county/municipal systems and agencies that support children and families.
• An understanding of the role that structural barriers play in health and academic disparities is
preferable.
• Knowledge of the history of the community and the ways that may shape local culture, and individual
behavior and identity.
• Knowledge of public housing developments in Chapel Hill.
Requirements
• This position requires transportation and some night and weekend hours.
Apply
To apply, please send a resume to Meredith McMonigle at mmcmoni le@orangecountync.gov
DocuSign Envelope ID:24392949-6CFE-4A47-8FC6-54FF2C794193
® DATE(MMIODIYYVY)
,4 r� CERTIFICATE OF LIABILITY INSURANCE 11J6/2014
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(ies) must be endorsed. If SUBROGATION i5 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 Diana Mausling
PRODUCER NAME:
B1151riesS Insurers of Carolinas PHONi {919)968-4611 fAJC (91919fi6^SS91
AIC Mali-
800 Eastowne Drive, Suite 208 AoaIL _dmausling @Business-Tnsurers.com
PO Box 2536 INSURE S)AFFORDING COVERAGE NAIC11
Chapel Hill NC 27515-2536 INSURERA:Continental Western Ins Company 10804
INSURED INSURER B:The Hartford 29424
Mental Health_ America of the Triangle INSURERC:
PO Box 16246 INSURER D
INSURER E:
Chapel Hill NC 27516 INSURER F
COVERAGES CERTIFICATE NUMBER:CD1411611709 REVISION NUMBER:
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EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Xff5UVU8R POLICY EFF POLICY EXF
LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A E N ED 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S
A CLAIMS-MADE OCCUR PA422752044 1/22/2014 1/22/2015 MEDEXP(Any one person) S 20,000
X Professional Liabillty PERSONAL&ADV INJURY $ 1,000,000
X AbUse or Molestation GENERAL AGGREGATE S 3,000,000
GENT AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMPIOP AGG $ 3,000,000
X POLICY PRO- S
LOC COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY fEa accident $
BODILY INJURY(Per person) S
A ANY AUTO
ALL OWNED SCHEDULED PA422752044 1/22/2014 1/22/2015 BODILY INJURY(Per accident) S
AUTOS AUTOS PROPERTY DAMAGE
X HIRED AUTOS X AUOTOSWNED Per accident S
H&NO 5 l 009 000
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS UA6 CLAIMS-MADE AGGREGATE $
$
DEO RETENTION S
A WORKERS COMPENSATION wC STA IT ER
X RY I 17 X
AND EMPLOYERS'LIABILITY
ANY PROPR ETORIPARTNERIEXECUTIVE Y� E.L.EACH ACCIDENT 5 5OO OQO
OFFICERIMEABER EXCLUDED? N NIA CA422752144 11/22/2014 1/22/2015 E L DISEASE-EA EMPLOYEE 5 500,000
(Mandatory in NH)
Ifyes,describe under E.L-DISEASE-POLICY LIMIT S 500,00o
DESCRIPTION OF OPERATIONS below
13 Directors & Officers aOA1308922 /20/2014 /2012015 PelClalrn $1,000,000
Deductible $2,500
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ACCORDANCE WITH THE POLICY PROVISIONS,
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PO BOX 16246 AUTHORIZED REPRESENTATIVE
Chapel Hill, NC 27516
Tarred Chappell/DIANA
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