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HomeMy WebLinkAbout2015-554-E Health - Empowerment, Inc. FSA zone navigators DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 2015-16 Family Success Alliance Zone Navigators Agreement THIS AGREEMENT, made and entered into the 17"' day of October 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 Empowerment, Inc., located at 109 North Graham Street, 9200, 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 10/17/15 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 Six Thousand, Five Hundred Seventy Six dollars ($36,576.00). 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 three installments in the amount of $12,192. The first payment is contingent upon receipt of the agency's fully executed performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. Family Alliance Success Zone Navigators Rev. 8115 Page 1 of 10 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D d. The County's obligation to make the 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: October 17—December 31, 2015; January 1 —March 31, 2016 and April 1 — June 30, 2016. Reports are due on 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. Family Alliance Success Zone Navigators Page 2 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 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 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 Family Alliance Success Zone Navigators Page 3 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 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. Family Alliance Success Zone Navigators Page 4 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 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: Empowerment, Inc. Orange County 109 N. Graham St. 4200 Post Office Box 8181 Chapel Hill, NC 27516 Hillsborough,NC 27278 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. �ncapninwPhehalf of the Provider 10/14/2015 B.CE548f' �-l9FenG Signature Date Delores Bailey Printed Name roaaad a behalf of Orange County Government OVUkAf, ( aMMLYSb-� 10/19/2015 Bonnie Hammersley, County Manager Date Family Alliance Success Zone Navigators Page 5 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 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. Family Alliance Success Zone Navigators Page 7 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 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: $36,576 to be paid in three installments with the first payment at the start of the contract and the second and third following Provider's submission of progress reports on January 15 and April 15. Budget Categories 1. Salaries: $26,640 (2 part-time staff paid $18 for up to 20 hours per week starting Oct 17th) 2. Taxes: $2,377 (FICA/Social Security- 0.062, Medicare -0.0145, NC Unemployment- 0.01272) 3. Overhead: $4,352 (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) 6. Neglect and Abuse Insurance Policy: $1,367 Total: $36,576.00 Deliverables: 1. Provide a quarterly expense invoice that documents each budget category and include receipts as appropriate to FSA project Coordinator. 2. Work with designated FSA staff to develop performance review documents. Family Alliance Success Zone Navigators Page 8 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 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. 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. Family Alliance Success Zone Navigators Page 9 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D 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. DocuSigned by: LvdBCE.bms b� - I Executive Di rector 10/14/2015 Certified by: �a�sE�1SG^nF__ Title: Date: (Provider's Signature) Family Alliance Success Zone Navigators Page 10 of 10 Rev. 8115 DocuSign Envelope ID:09753F27-6363-4410-92C8-6DEEA3C8F09D Exhibit"C" ,,,,r �� �,�� ° � ll,., ,,,1 DUr �V �'�,,,,,� ,,, 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:09753F27-6363-4410-92C8-6DEEA3C8F09D • 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:09753F27-8363-4410-92C8-6DEEA3C8F09D �-- , EMPOW-1 OP ID: MR ACORC�"' CERTIFICATE OF LIABILITY INSURANCE DATE(M6/20 10/06/20 5 �►.--""' 15 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 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). PRODUCER CONTACT Margo G. Roberts,AAI,CISR Summers Thompson Lowry,Inc. PHONE FAx 100 Europa Drive,Suite 571 A/c No Ext:919-969-5300 (A/C No): 919-942-4221 Chapel Hill,NC 27517 E-MAIL C.Duke Thompson CPCU ARM ADDRESS: margo@stlinsure.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Am Trust Financial Services INSURED Empowerment, Inc. INSURER B: Laurie Weller 109 N. Graham St.#200 INSURER C7 Chapel Hill, NC 27516-2328 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. INSR TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY NPP1005089 06/16/2015 06/16/2016 DAMAGE TO RENTED INCL PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ INCL POLICY PE CT RO- LOC Sex Abuse $ 1,000,000 J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER ACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER • ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N TWC3479297 06/16/2015 06/16/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 • Prof Liab NPP1005089 06/16/2015 06/15/2016 Occ. 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) For Information Purposes Only Sexual Abuse Coverage with a $1,000,000 limit was added to the policy effective October 1, 2015. CERTIFICATE HOLDER CANCELLATION EMPOWER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Empowerment, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 109 N Graham St Chapel Hill, NC 27516 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD