Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2016-500-E DSS - The Community Empowerment Fun for Emergency Solutions Grant
DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA Contract 468-2025 The Commun Empowerment Fund Contract# _60'Z025 Fiscal Year Begins \_ 20L6 Ends June 3O, 20|7 This contract is hereby entered into by and between the Orange County Department of Social Services(the"County")and The Community Empowerment Fund(the "Contractor")(referred to collectively as the"Parties"). The Contractor's federal tax identification number or Social Securit Number is 1. Contract Documents: This Contract consists of the following documents (1) This contract (2) The General Term s and Conditions(Attachment A) (3) The Scope of Work, description of services, and rat e (Attachment B) (4) Federal Certification K cga rdi n�Drug-Free Workplace&Certification Regarding Nondiscrimination(Attachment C) (5) Conflict of Interest (Attachment D) (6) No Overdue Taxes(Attachment E) (7) IRS Federal Tax Exempt Letter or 501(cX3) (Attachment K) (8) State and Local Certifications(Attachment M) (9)Outcomes and Reporting(Attachment N) (\O)Contract Determination Questionnaire These documents conoti�o\c the entire agreement b tween the Parties and supersede all prior oral or written statements or agreements. 2. Precedence Among Contract Documents: In the event of a conflict between or among the terms of the Contract Documents and this Agreement,the terms of this Agreement shall control. In the event of a conflict between or among the terms of the Contract Documents,then the Contract Documents with the highest relative precedence shall prevail. The order of precedence shall be the order of documents as listed in Section 1,above, with Attachment A having precedence over Attachment B and so forth. If there are multiple Contract Amendments,the most recent amendment shall have the highest precedence and the oldest amendment shall have the lowest precedence. 3. Effective Period: This contract shall be effective on July 1, 2016 and shall terminate on June 30, 2017. This contract must be twelve months or less. 4. Contractor's Duties: The Contractor shall provide the services and in accordance with the approved rate as described in Attachment B, Scope of Work, and shall meet the requirements set forth in Attachment N, Outcomes and Reporting. 5. County's Duties: The County shall pay the Contractor in the manner and in the amounts specified in the Contract Documents. The amount by the County the Contractor under this contract shall not exceed $10,000. This � unouniconuixtoo($]O,OU0 in Federal (CFDA # ), State and County funds, $0 (source of other 6-nus if applicable). [X] a. There are no matching requirements from the Contractor. [ ] b. The Contractor's matching requirement is $ , which shall consist of: | l In-kind [ Cash [ ] Cash and In-kind [ ] Cash and/or In-kind The contributions from the Contractor shall be sourced from non-federal funds. The total contract amount including any Contractor match shall not exceed $10,000. 6. Reversion of Funds: Any unexpended grant funds shall revert to the County Department of Social Services upon termination of this contract. Page m[5 Contract-General (07/10) 000vSign Envelope ID: r83r8on8euo&4Er4~^C81~^ACr048010eA Contract 468'2025 The Commu ity Empowerment Fund 7. Reporting Requirements: Cunoactoruha|\cmmp\yvvithuudhreqmiruruentuusdcscribodioN.C.{}.S. Q 143C-6-22&23 and 0MB Circular A-133 and shall disclose all information required by 42 USC 455.104,or 42 USC 455.105,or 42 USC 455.106. 8. Payment Provisions: Payment shall be made in accordance with the Contract Documents as described in the Scope of Work, Attachment B. 9. Contract Administrators: All notices permitted or required to be given by one Party to the other and all questions about the contract from one Party to the other shall be addressed and delivered to the other Party's Contract Administrator. The name,post office address,street address,telephone number,fax number,and email address of the Parties'respective initial Contract Administrators are set out below. Either Party may change the name, post office address, street address, telephone number,fax number,or email address of its Contract Administrator by giving timely written notice to the other Party. For the County: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Suzanne Hitt, Social Work Supervisor II Suzanne Hitt, Social Work Supervisor II Orange County Department of Social Services Orange County Department of Social Services P.O. Box 8181 P.O. Box 8181 Hillsborough, NC 27278 Hillsborough,NC 27278 (919)245-2850 hbqonangecountync.gov For the Contractor: IF DELIVERED BY US POSTAL SERVICE IF DELIVERED BY ANY OTHER MEANS Maggie West, Program Coordinator Maggie West, Program Coordinator The Community Empowerment Fund The Community Empowerment Fund l08VV. Rosemary St. 108 W. Rosemary St. Chapel Hill,NC 27516 Chapel Hill, NC 27516 (919)200-0233 � nuuggiew@connoouni(ycmpowenneutfundorg Contract-General 7/10) Page 2 of 5 000vSign Envelope ID: r83r8on8euo&4Er4~^C81~^ACr048010eA Contract#68-2025 The Communit Fund un d 10. No Assignment or Sub-Contract: Contractor shall not sub-contract out any of the services provided for in this Agreement or make any assi 000ntwftbisAgrecneot(indudiughghtstopoyoeoro)withou1d)epciorvrittenConsen\nf the County as specified more fully in Attachment A, General Tenris and Conditions. 11. Supplementation of The Conkxczw,assures that funds received puouuuttodhscontract ' shall be used only to supplement, not to supplant, the total amount of federal, state and local public funds that the Contractor otherwise expends for contract services and related programs.Funds received under this contract shall be used to provide additional public funding for such services; the funds shall not be used to reduce the Contractor's total expenditure of other public funds for such services. 12, Disbursements: As a condition of this contract, the Contractor acknowledges and agrees to make disbursements in accordance with the following requirements: a. Implement adequate internal controls over disbursements; b. Pre-audit all vouchers presented for payment to determine: i. Validity and accuracy of payment ii. Payment due date iii. Adequacy of documentation supporting payment iv. Legality of disbursement c. Assure adequate control of signature stamps/plates; d. Assure adequate control of iiegotiable instruments; and e. Implement procedures to insure that account balance is solvent and reconcile the account monthly. 13. Outsourcing to Other Countries: The Contractor certifies that it has identified to the County all jobs related to the contract that have been outsourced to other countries. if any.The Contractor further agrees that it will not outsource any such jobs during the term of this contract without providing notice to the County. 14` Certifications: Individuals and Organizations receiving federal funds must ensure compliance with certain certifications required by federal laws and regulations. The contractor is hereby complying with Certifications regarding Nondiscrimination, Drug-Free VVnrko|moe Requirements, Environmental Tobacco Smoke, Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions, and Lobbying. These assurances and certifications are to be signed by the contractor's authorized representative. 15` Relationship of the Parties: Contractor is an independent contractor of the County, Contractor represents that it has or will secure u1 its own expense,aOpemonne| required in performing the services under this y\grecnueot Such personnel shall not b�eonpinyccxm[or have any contractual relationship vviththe County. ��||personnel engaged iovvork under this /\grosnoen-shall bc fully quoiifiedand shall bc authorized ncpero�itLed under state and local law to perform such services, ltixfurthe-u�r��dhyCon�ruo{nr�hati�uho||oh��uU�ta(�andF�d�ro\s����ua,rules and zegulabnncvvhicbare applicable further of Contractor ubu||��d��nn�dao to provisions of the services called for herein. l�citber(�ootructmrnor any ecup|nyeco officer, employee or agent of the County. 16. Termination: This Agreement may be terminated as specified in Attachment A, General Terms And Conditions. 17. Insurance Requirements:Contractor shall obtain,at its sole expense,all insurance as required in Attachment A,General Terms And Conditions. 18. Indemnification: Conn.actor agrees to defend, indemnify,and hold harmless the County,for all loss, liability,u|uimonr 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 Contractor in accordance with Attachment A, General Terms And Conditions. It is the intent of this Section that Contractor indemnify County to the full extent permitted by law. 19' Entire/k rAgreement: The parties have read this Agreement, including the Contract Documents, and agree to he bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties. 20. When Agreement indicates that such is the intent,words shall in the singular number shall include the plural and vice versa. The masculine gender shall include the feminine and neuter. Contract-General (87/10) Page 3 of 5 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA Contract#68-2025 The Community Empowerment Fund IN WITNESS WHEREOF,the County and the Contractor have been first duly authorized,have executed and entered into this Agreement as of the day and year First above written. THE C • 1' 'MTV:EMPOWERMENT FUND I' M-st 8/24/2016 96C92B63621445B Signature Date Maggie Program coordinator Printed Name Title ORANGE COUNTY riDocuSigned by: ttAAA:it, AWAKAWS(Lbi 9/1/2016 0637994B755E477 Bonnie Hammersley, County Manager Date Contract-General (07/10) Page 4 of 5 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA ATTACHMENT A GENERAL TERMS AND CONDITIONS Orange County Department of Social Services Relationships of the Parties the County or the Contractor,receiving services or benefits under this contract shall be deemed an incidental Independent Contractor: The Contractor is and shall be beneficiary only. deemed to be an independent contractor in the performance of this contract and as such shall he wholly responsible for Indemnity and Insurance the work to be performed and for the supervision of its employees. The Contractor represents that it has, or shall Indemnification: The Contractor agrees to indemnify and secure at its own expense, all personnel required in hold harmless the County and any of their officers,agents performing the services under this agreement. Such and employees,from any claims of third parties arising out employees shall not be employees of, or have any or any act or omission of the Contractor in connection with individual contractual relationship with the County. the performance of this contract. Subcontracting: The Contractor shall not subcontract any Insurance: During the term of the contract,the Contractor of the work contemplated under this contract without prior at its sole cost and expense shall provide commercial written approval from the County. Any approved insurance of such type and with such terms and limits as subcontract shall be subject to all conditions of this may be reasonably associated with the contract. As a contract.Only the subcontractors specified in the contract minimum, the Contractor shall provide and maintain the documents are to be considered approved upon award of following coverage and limits: the contract. The County shall not be obligated to pay for (a) Worker's Compensation - The contractor shall any work performed by any unapproved subcontractor. provide and maintain Worker's Compensation The Contractor shall be responsible for the performance of Insurance as required by the laws of North all of its subcontractors. Carolina,as well as employer's liability coverage with minimum limits of$500,000.00,covering all Assignment: No assignment of the Contractor's of Contractor's employees who are engaged in any obligations or the Contractor's right to receive payment work under the contract. If any work is sublet,the hereunder shall be permitted. However, upon written Contractor shall require the subcontractor to request approved by the issuing purchasing authority, the provide the same coverage for any of his County may: employees engaged in any work under the (a) Forward the Contractor's payment check(s) contract. directly to any person or entity designated by the (b) Commercial General Liability - General Contractor, or Liability Coverage on a Comprehensive Broad (b) Include any person or entity designated by Form on an occuiTence basis in the minimum Contractor as a joint payee on the Contractor's amount of$1,000,000.00 Combined Single Limit. payment check(s). (Defense cost shall be in excess of the limit of In no event shall such approval and action obligate the liability.) County to anyone other than the Contractor and the (c)Automobile Liability Insurance: The Contractor Contractor shall remain responsible for fulfillment of all shall provide automobile liability insurance with a contract obligations, combined single limit of$500,000.00 for bodily injury and property damage; a limit of Beneficiaries: Except as herein specifically provided $500,000.00 for uninsured/under insured motorist otherwise,this contract shall inure to the benefit of and be coverage; and a limit of$25,000.00 for medical binding upon the parties hereto and their respective payment coverage. The Contractor shall provide successors. It is expressly understood and agreed that the this insurance for all automobiles that are: enforcement of the terms and conditions of this contract, (a) owned by the Contractor and used in the and all rights of action relating to such enforcement, shall performance of this contract; be strictly reserved to the County and the named (b) hired by the Contractor and used in the Contractor. Nothing contained in this document shall give performance of this contract; and or allow any claim or right of action whatsoever by any (c) Owned by Contractor's employees and other third person. It is the express intention of the County used in performance of this contract("non- and Contractor that any such person or entity, other than owned vehicle insurance"). Non-owned General Terms and Conditions--(06/16) Page 1 of 5 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA vehicle insurance protects employers when employees use their personal vehicles for Termination Without Cause: *The County may terminate work purposes. Non-owned vehicle this contract without cause by giving 30 days written insurance supplements, but does not notice to the Contractor. replace,the car-owner's liability insurance. Termination for Cause: If, through any cause, the The Contractor is not required to provide and maintain Contractor shall fail to fulfill its obligations under this automobile liability insurance on any vehicle—owned, contract in a timely and proper manner, the County shall hired, or non-owned -- unless the vehicle is used in the have the right to terminate this contract by giving written performance of this contract. notice to the Contractor and specifying the effective date (d) The insurance coverage minimums specified in thereof. In that event,all finished or unfinished deliverable subparagraph (a) are exclusive of defense costs. items prepared by the Contractor under this contract shall, (e) The Contractor understands and agrees that the at the option of the County, become its property and the insurance coverage minimums specified in Contractor shall be entitled to receive just and equitable subparagraph (a) are not limits, or caps, on the compensation for any satisfactory work completed on such Contractor's liability or obligations under this contract. materials,minus any payment or compensation previously (f) The Contractor may obtain a waiver of any one or more made. Notwithstanding the foregoing provision, the of the requirements in subparagraph (a) by Contractor shall not be relieved of liability to the County demonstrating that it has insurance that provides for damages sustained by the County by virtue of the protection that is equal to or greater than the coverage Contractor's breach of this agreement,and the County may and limits specified in subparagraph (a). The County withhold any payment due the Contractor for the purpose shall be the sole judge of whether such a waiver of setoff until such time as the exact amount of damages should be granted. due the County from such breach can be determined. In (g) The Contractor may obtain a waiver of any one or more case of default by the Contractor, without limiting any of the requirements in paragraph(a)by demonstrating other remedies for breach available to it, the County may that it is self-insured and that its self-insurance procure the contract services from other sources and hold provides protection that is equal to or greater than the the Contractor responsible for any excess cost occasioned coverage and limits specified in subparagraph(a). The thereby. The filing of a petition for bankruptcy by the County shall be the sole judge of whether such a Contractor shall be an act of default under this contract. waiver should he granted. . (h) Providing and maintaining the types and amounts of Waiver of Default: Waiver by the County of any default insurance or self-insurance specified in this paragraph or breach in compliance with the terms of this contract by is a material obligation of the Contractor and is of the the Provider shall not be deemed a waiver of any essence of this contract. subsequent default or breach and shall not be construed to (i) The Contractor shall only obtain insurance from be modification of the terms of this contract unless stated companies that are authorized to provide such to be such in writing, signed by an authorized coverage and that are authorized by the Commissioner representative of the County and the Contractor and of Insurance to do business in the State of North attached to the contract. Carolina. All such insurance shall meet all laws of the State of North Carolina. Availability of Funds: The parties to this contract agree (j) The Contractor shall comply at all times with all lawful and understand that the payment of the sums specified in terms and conditions of its insurance policies and all this contract is dependent and contingent upon and subject lawful requirements of its insurer, to the appropriation, allocation, and availability of funds (k) The Contractor shall require its subcontractors to for this purpose to the County. comply with the requirements of this paragraph. (I) The Contractor shall demonstrate its compliance with Force Majeure: Neither party shall be deemed to be in the requirements of this paragraph by submitting default of its obligations hereunder if and so long as it is certificates of insurance to the County before the prevented from performing such obligations by any act of Contractor begins work under this contract. war,hostile foreign action,nuclear explosion,riot,strikes, civil insurrection,earthquake,hurricane,tornado,or other Transportation of Clients by Contractor:The contractor catastrophic natural event or act of God. will maintain Insurance requirements if required as noted under Article 7 Rule R2-36 of the North Carolina Utilities Survival of Promises: All promises,requirements,terms, Commission. conditions, provisions, representations, guarantees, and warranties contained herein shall survive the contract Default and Termination expiration or termination date unless specifically provided General Terms and Conditions—(06/16) Page 2 of 5 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA otherwise herein, or unless superseded by applicable that comply with all applicable federal, state and Federal or State statutes of limitation. local laws, regulations, and rules. Intellectual Property Rights (b) Duty to Report: The Contractor shall report a suspected or confirmed security breach to the Copyrights and Ownership of Deliverables: All local Department of Social Services Contract deliverable items produced pursuant to this contract are the Administrator within twenty-four(24) hours exclusive property of the County. The Contractor shall not after the breach is first discovered, provided that assert a claim of copyright or other property interest in the Contractor shall report a breach involving such deliverables. Social Security Administration data or Internal Revenue Service Data within one (1)hour after Federal Intellectual Property Bankruptcy Protection the breach is first discovered. Act: The Parties agree that the County shall be entitled to all rights and benefits of the Federal Intellectual Property (c) Cost Borne by Contractor: If any applicable Bankruptcy Protection Act, Public Law 100-506,codified federal, state, or local law, regulation or rule at 1 I U.S.C. 365 (n) and any amendments thereto, requires the Contractor give written notice of a security breach to affected persons,the Contract Compliance with Applicable Laws shall bear the cost of the notice. Compliance with Laws: The Contractor shall comply Trafficking Victims Protection Act of 2000: with all laws, ordinances, codes, rules, regulations, and The Contractor will comply with the requirements of licensing requirements that are applicable to the conduct of Section 106(g)of the Trafficking Victims Protection Act its business, including those of federal, state, and local of 2000, as amended (22 U.S.C. 7104) agencies having jurisdiction and/or authority. 13y executing this Agreement Provider certifies that Executive Order#24: It is unlawful for any vendor, Provider has not been identified, and has not utilized contractor, subcontractor or supplier of the state to make the services of any agent or subcontractor, on the list gifts or to give favors to any state employee. For created by the State Treasurer pursuant to G.S. 147- additional information regarding the specific requirements and exemptions, contractors are 86.58. encouraged to review Executive Order 24 and G.S. Sec. 133-32. Title VI,Civil Rights Compliance: In accordance with Federal law and U.S. Department of Agriculture (USDA) Confidentiality and U.S. Department of Health and Human Services (HHS) policy, this institution is prohibited from Confidentiality: Any information, data, instruments, discriminating on the basis of race, color, national origin, documents, studies or reports given to or prepared or sex, age or disability. Under the Food Stamp Act and assembled by the Contractor under this agreement shall be USDA policy, discrimination is prohibited also on the kept as confidential and not divulged or made available to basis of religion or political beliefs. any individual or organization without the prior written approval of the County.The Contractor acknowledges that Equal Employment Opportunity: The Contractor shall in receiving, storing, processing or otherwise dealing with comply with all federal and State laws relating to equal any confidential information it will safeguard and not employment opportunity. further disclose the information except as otherwise provided in this contract. Health Insurance Portability and Accountability Act (HIPAA): The Contractor agrees that, if the County Oversight determines that some or all of the activities within the scope of this contract are subject to the Health Insurance Access to Persons and Records: The State Auditor shall Portability and Accountability Act of 1996, P.L. 104-91, have access to persons and records as a result of all as amended ("HIPAA"), or its implementing regulations, contracts or grants entered into by State agencies or it will comply with the HIPAA requirements and will political subdivisions in accordance with General Statute execute such agreements and practices as the County 147-64.7. Additionally,as the State funding authority,the may require to ensure compliance. Department of Health and Human Services shall have access to persons and records as a result of all contracts or (a) Data Security: The Contractor shall adopt and grants entered into by State agencies or political apply data security standards and procedures subdivisions. General Terms and Conditions—(06/16) Page 3 of 5 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA subcontractors,complies with the requirements of Article 2 Record Retention: Records shall not be destroyed, of Chapter 64 of the NC General Statutes. purged or disposed of without the express written consent of the Division. State basic records retention policy Miscellaneous requires all grant records to be retained for a minimum of five years or until all audit exceptions have been resolved, Choice of Law: The validity of this contract and any of its whichever is longer. If the contract is subject to federal terms or provisions, as well as the rights and duties of the policy and regulations,record retention may be longer than parties to this contract, are governed by the laws of North five years since records must be retained for a period of Carolina. The Contractor, by signing this contract, agrees three years following submission of the final Federal and submits,solely for matters concerning this Contract,to Financial Status Report, if applicable, or three years the exclusive jurisdiction of the courts of North Carolina following the submission of a revised final Federal and agrees, solely for such purpose, that the exclusive Financial Status Report. Also, if any litigation, claim, venue for any legal proceedings shall be Orange County, negotiation, audit, disallowance action, or other action North Carolina. The place of this contract and all involving this Contract has been started before expiration transactions and agreements relating to it, and their situs of the five-year retention period described above, the and forum,shall be Orange County,North Carolina,where records must be retained until completion of the action and all matters,whether sounding in contract or tort,relating to resolution of all issues which arise from it,or until the end the validity,construction, interpretation,and enforcement of the regular five-year period described above,whichever shall be determined. is later. The record retention period for Temporary Assistance for Needy Families (TANF) and MEDICAID Amendment: This contract may not be amended orally or and Medical Assistance grants and programs must be by performance. Any amendment must be made in written retained for a minimum of ten years. form and executed by duly authorized representatives of the County and the Contractor. Warranties and Certifications Severability: In the event that a court of competent Date and Time Warranty: The Contractor warrants that jurisdiction holds that a provision or requirement of this the product(s) and service(s) furnished pursuant to this contract violates any applicable law, each such provision contract("product"includes,without limitation,any piece or requirement shall continue to be enforced to the extent it of equipment, hardware,firmware,middleware,custom or is not in violation of law or is not otherwise unenforceable commercial software,or internal components,subroutines, and all other provisions and requirements of this contract and interfaces therein) that perform any date and/or time shall remain in full force and effect. data recognition function, calculation, or sequencing will support a four digit year format and will provide accurate Headings: The Section and Paragraph headings in these date/time data and leap year calculations. This warranty General Terms and Conditions are not material parts of the shall survive the termination or expiration of this contract. agreement and should not be used to construe the meaning thereof. Certification Regarding Collection of Taxes: G.S. 143- 59.1 bars the Secretary of Administration from entering Time of the Essence: Time is of the essence in the into contracts with vendors that meet one of the conditions performance of this contract. of G.S. 105-164.8(b)and yet refuse to collect use taxes on sales of tangible personal property to purchasers in North Key Personnel: The Contractor shall not replace any of Carolina. The conditions include: (a) maintenance of a the key personnel assigned to the performance of this retail establishment or office; (b) presence of contract without the prior written approval of the County. representatives in the State that solicit sales or transact The term "key personnel" includes any and all persons business on behalf of the vendor; and (c) systematic identified as such in the contract documents and any other exploitation of the market by media-assisted, media- persons subsequently identified as key personnel by the facilitated, or media-solicited means. The Contractor written agreement of the parties. certifies that it and all of its affiliates (if any) collect all required taxes. Care of Property: The Contractor agrees that it shall be responsible for the proper custody and care of any property E-Verify furnished to it for use in connection with the performance of this contract and will reimburse the County for loss of, Pursuant to G.S. 143-48.5,the undersigned hereby certifies or damage to, such property. At the termination of this that the Contractor named below, and the Contractor's contract, the Contractor shall contact the County for General Terms and Conditions—(06/16) Page 4 of 5 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA instructions as to the disposition of such property and shall comply with these instructions. Orange County Living Wage: Orange County is committed to providing its employees with a living wage Travel Expenses: Reimbursement, if provided in this and encourages agencies to which it provides funding to Agreement, to the Contractor for travel mileage, meals, pursue the same goal. The County's living wage hourly lodging and other travel expenses incurred in the standard, as adopted by the Orange County Board of performance of this contract shall not exceed the rates County Commissioners annually, can be found in the established in County policy. Orange County Budget Ordinance. To the extent possible, Orange County recommends that the Contractor and all Sales/Use Tax Refunds: If eligible,the Contractor and all subcontractors provide a living wage, as defined in this subcontractors shall: (a) ask the North Carolina section, to their employees. Department of Revenue for a refund of all sales and use taxes paid by them in the performance of this contract, Signatures: This Agreement together with any pursuant to GS. 105-164.14; and (b) exclude all amendments or modifications may be executed refundable sales and use taxes from all reportable electronically. All electronic signatures affixed hereto expenditures before the expenses are entered in their evidence the intent of the Parties to comply with Article reimbursement reports. I IA and Article 40 of North Carolina General Statute Chapter 66. Advertising: The Contractor shall not use the award of this contract as a part of any news release or commercial advertising. General Terms and Conditions -(06/16) Page 5 of 5 DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA ATTACHMENT B SCOPE OF WORK Orange County Department of Social Services Federal Tax Id. or SSN Contract# _68-2025 A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Community Empowerment Fund 2. I/different from Contract Administrator Information in General Contract: Address �� ���� Telephone Number: _ Fax Number: Email: 3. Name of Program (s): Emergency, Solutions Grant 4. Status: ( ) Public ( X ) Private, Not for Profit ( ) Private, For Profit 5. Contractors Financial Reporting Year July 1, 2016 through June 30. 2017 B. Explanation of Services to be provided and to whom (include SIS Service Code): The Contractor will assist homeless individuals to obtain and maintain permanent housing through individualized housing stabilization case management services. as well as other supportive services as needed and as funds allow, including medical and mental health ncatmeoccuunse|in�, life skills, and other services essential for each household to achieve housing stability, while linking households to othcrfederu|,staAc, \ocu\, and private assistance for which individuals are eligible. The Contractor is required to meet all goals and outcomes listed i Attachment N. C. Km1cperundof5orvice (d*OnothruuiM: I. If Standard Fixed Rate, Maximum Allowable, (See Rates for Services Chart) 2. Negotiated County Rate. $20 per hour D. Number of units to be provided: E. Details of Billing process and Time Frames; The County will reimburse the Contractor for services described in this contract up to the budgetary limits of the contract allotment. For reimbursement, the Contractor must submit an original and two copies of ap invoice by the tentt of the month for the preceding month's expenditures to the designated County Administrator. The Contractor must use forms supplied by the State with required documentation of xpenses (copies gFinvoiceu/hi||s/rcccioty and .roof of payment(copies of ledgers or copies of checks used ro pay expenses). The_Contractor will maintain additional required documentation in household (participant) files. The County will reimburse the Contractor monthly for staff time upon receipt Contract-Scope of Work(06/04) Page \n[1 DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA of a complete ani correctly fibdreport. Reimbursements for Contractor staff time will require dnuuohcets and/or documentation of approved indirect cost rates F. Area to be sen'ed/De\ivery*i|e(m): Orange County n"""ow",u»,: u°""aw"°uby: riltAyitt. �^ �k� ^ /'J°h' o"u�' ' `"7 u`°` .om,M3u21^45a (Sigoatorwf ����� wrioedPeroom) (Signature of Contractor) 8/31/2016 8/24/2016 -- (Date Submitted) (Date Submitted) Contract-Scope of Work(06/04) Page 2of 2 DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA ATTACHMENT C CERTIFICATION REGARDING DRUG FREE WORKPLACE REQUIREMENTS AND CERTIFICATION REGARDING NONDISCRIMINATION Orange County Department of Social Services I. By execution of this Agreement the Contractor certifies that it will provide a drug-free workplace by: A. Publishing a statement notiling employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the Contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; B. Establishing a drug-free awareness program to inform employees about: (1) The dangers of drug abuse in the workplace; (2) The Contractor's policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C. Making it a requirement that each employee be engaged in the performance of the agreement be given a copy of the statement required by paragraph (A); D. Notifying the employee in the statement required by paragraph(A)that, as a condition of employment under the agreement, the employee will: (1) Abide by the terms of the statement; and (2) Notify the employer of any' criminal drug statute conviction for a violation occurring in the workplace no later than five days after such conviction; B. Notifying the County within ten days after receiving notice under subparagraph (D)(2)from an employee or otherwise receiving actual notice of such conviction; F. Taking one of the following actions, within 30 days of receiving notice under subparagraph (D)(2), with respect to any employee who is so convicted: (I)Taking appropriate personnel action against such an employee, up to and including termination; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; and Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (/\), (B), (C), (D), (F), and (F). Federal Certification- Drug-Free Workplace& Nondiscrimination rev. 06-2015 Page I of ___ � | DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA D. The site(s)for the performance ofv/orkdooeiuuooucoLionwitb(bc specific xgreononture |is\sd below: /. (Street address (City, county, state, zip code) 2. (Street address) (City, county, state zip code) Contractor will inform the County of any additional sites for performance of work under this agreement. False certification or violation of the certification shall be grounds for suspension of payment, suspension or termination of grants, or government-wide Federal suspension or debarment 45 C.F.R. Section 82.510. Section 4 CFR Part 85, Section 85.615 and 86.620. CERTIFICATION REGARDING NONDISCRIMINATION The Vendor certifies that it will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; (d)the Age Discrimination Act of 1975, as amended (42 U.S.C. O§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (0 the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of \97O (P.L. 9L'h|0), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) Title VIII of the Civil Rights Act of 1908 (42 O.S.C. §63601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (h) the Food Stamp Act and USDA policy, which prohibit discrimination on the basis of religion and political beliefs; and (i) the requirements of any other nondiscrimination statutes which may apply to this Agreement. DocuSigned by: o" �^ � �o� Program coordinator ^.c92E611,2,44,y Signature - Title community Empowerment Fund 8/24/2016 Agency/Organ i ion Date (Certification signature should be same as Contract signature.) Federal Certification - Drug-Free Workplace&Nondiscrimination rev. 06-2015 Pu2c2of2 DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA Contract#6S-2025 The Communit Empowerment Fund ATTACHMENT D CONFLICT OF INTEREST POLICY Orange County Department of Social Services The Board of Director /Tivatees or other governing persons, officers, employees or agents are to avoid any conflict of interest, even the appearance of a conflict of interes . The Organization's Board oyDircx1om/Truot:ex or other governing body, officers, staff and agents are obligated to always act in the best interest of the organization.This obligation requires that any Board member or other governing person, officer, employee or agent, in the performance of Organization duties, seek only the furtherance of the Organization mission. At all times, Board members or other governing persons, officers, employees or agents, are prohibited from using their job title, the Organizations nane or property, for private profit or benefit. A. The Board members or other governing persons, officers, employees, or agents of the Organization should neither solicit nor accept gratuities, favors, or anything of monetary value from current or potential contractors/vendors,persons receiving benefits from the Organization or persons who may benefit from the actions of any Board member or other governing person, officer, employee or agent. This is not intended to preclude bona-fide Organization fund raising- ucdvibes. B. A Board or othe governing body member may, with the approval of Boar or other governing body, receive honoraria for lectures and other such activities while not acting in any official ` for the Organization. Officers may, with the approval of the Board or other governing capacity r � r&uo u� oc/s rn , bndy receive honoraria for lectures an d other such activities while on personal days, compensatory time, annual leave, or leave without pay. Employees may, with the prior pdtton approval of their supervisor, receive honoraria for lectures and other such activities while on time, annual leave, or leave without pu� personal days, compensatory mo' unnuu ��v , " pay. If a Board or other governing body member, officer, employee or agent is acting in any official capacity, honoraria received in connection with activities relating to the Organization are to be paid to the Organization. C.No Board member or other governing person, officer, cmokmcv, or agent of the Organization shall participate in the selection, award, or administration of a purchase or contract with a vendor where,to his knowledge,any of the following has a financial interest in that purchase or contract: I. The Board member or other governing person,officer,employee,or agent; 2. Any member of their family by whole or half blood, step or personal relationship or relative-in-law; 3. An organization in which any of the above is an officer, director,or employee; 4. A person or organization with whom any of the above individuals is negotiating or has any arrangement concerning prospective employment or contracts. D. Duty to Disclosure -- Any conflict of interest, potential conflict of interest, or the appearance of a conflict of interest is to be reported to the Board or other governing body or one's supervisor immediately. E. Board Action -- When a conflict of interest is relevant to a matter requiring action by the Board of Directors/Trustees or other governing body,the Board member or other governing person,officer,employee,or agent(person(s))must disclose the existence of the conflict of interest and be given the opportunity to disclose all material facts to the Board and members of Conflict of Interest Policy(06/04) Page 1 of 3 �� ��� DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA � . Contract#68-2025 The Commu ity Empowerment Fun committees with governing board delegated powers considering the possible conflict of interest. After disclosure of all material facts,and after any discussion with the person,he/she shall leave the governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining board or committee members shall decide if a conflict of interest exists. In addition the person(s)shall not participate in the final deliberation or decision regarding the matter under consideration and shall leave the meeting during the discussion of and vote of the Board of Directors/Trustees or other governing body. F. Violations of the Conflicts of IntenentPmbmy — lf the Board of Directors/Trustees or other governing m� tw o� has rouxonabl e cause to believe a member, officer, employee or agent has failed to disclose actual or possible conflicts of interest, it shall inform the person of the basis for such belief and afford the person an opportunity to explain the alleged failure to disclose. If, after hearing the person's response and after making further investigation as warranted by the circumstances, the Board of Directors/Trustees or other governing body determines the member, officer, employee or agent has failed to disclose an actual or possible conflict of interes . it shall take appropriate disciplinary and corrective action. O. Record of Conflict -- The minutes of the governing board and all committees with board delegated powers shall contai I. The names of the persons who disclosed or otherwise were found to have an actual or possible conflict of interest, the nature of the conflict of interest, any action taken to determine whether a conflict of interest was present, and the governing board's or committees decision as to whether a conflict of interest in fact existed. 2. The names of the persons who were present for discussions and votes relating to the transaction or arr g t that presents a possible conflict of interest, the content of the discussion, including any alternatives to the transaction or arrangement, and a record of any votes taken in connection with the proceedings. Approved by: ,�. L,�w1ue°t_4 Name of �~ G tP125-0) ignature of Organiza on Official 01/61 1 0-51U[o » ~ Conflict of Interes Policy(06/04) Page 2 of 3 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA Contract#68-2025 The Community Empowerment Fund NOTARIZED CONFLICT OF INTEREST POLICY State of North Carolina County of Orange af or) CC)14-/J C- , Notary Public for said County and State, certify that ...acea; Vo personally appeared before me this day and acknowledged that he/she is of and by that authority duly given and as the act of the corporation, affirmed that the foregoing Conflict of Interest Policy was adopted by the Board of Direc rs in a meeting held on the day of Sworn s s ribed before me this .drA : • P of ‘4. t). vp (S fled SeS6) Notary Public ©, My Commission expires ...ila/ 0 ' 'GE ,20 /9/ Conflict of Interest Policy(06/04) Page 3 of 3 1 DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA oommun/ty.ompowormernjund 208 N.Columbia Street,Suite 100 • Chapel Hill, NC, 37514,9l9`ZOO'0l33 info@communityempowe,mentfund.or0 • www.communityempowermentfund.org July 27, 2016 To: Orange County Department of Social Services Certification: We certify that the Community Empowerment Fund does not have any overdue tax deb\a, as defined by N.C.G.S. 105-243.11. at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C-6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S. 143C-10-1(b). Sworn Statement: Eric Breit and Jennifer Sherwin being duly sworn, say that we are the Board Chair and Board Tm*asuror, respectively, of Community Empowerment Fund of Chapel Hill in the State of NC; and that the foregoing certification is true, accurate and complete to the best of our knowledge and was made and subscribed by us. We also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. -. ‘-- A) B -^dChair ' ) '.' -~fir ^- -r -jo'e-- ~��� ' '*-pdTre.:urer Sworn to and subscribed before me on the day of the date of said certification. / ' / My Commission Expires: 5261� ( tary signature .°d6~~|) ' G.S, 105-2481 defines: Overdue tax debt.—Any part ofe �nohceoffino|auowoonentwaumoDedtothntaxpaye�Tho�rmdoesmtinduk# dnb . howawer. ifUhetaxpeyo/ entered into an installment agreement for the tax debt under G.S 105-237 within 90 days after the notice of final assessment was mailed and has not failed to make any payments due under the installment agreement." DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA ATTACHMENT K 501(c)(3) and TAX EXEMPT STATUS Orange County Department of Social Services What is a Private Non Profit Agency? Answer: A private non profit is an organization that is incorporated under State law and whose purpose is not to make a profit, but rather to further a charitable, civic, religious, scientific, or other lawful purpose. The Secretary of State's office grants corporate status to organizations in North Carolina. What is a 501(c)(3) designation? Answer: When the agency becomes a state private non profit corporation, it can then apply for 501(c)(3) designation through the IRS. Once the IRS grants 501(c)(3) status, the organization is exempt from certain taxes and any donations to the charitable organization are tax deductible. Many individuals and organizations prefer to make donations to 501(c)(3) private non profits. Who can obtain a 501(c)(3) designation? Answer: Any organization or group can apply for 501(c)(3) status, provided their charter or mission focuses on the non profit's objective. Another option is to apply for a 509(a)(1) status which falls under the 501(c)(3) umbrella. Being a 509(a)(1) designates an organization as a tax-free public charity that receives most of its support from a governmental unit or from the general public. Becoming a 509(a)(1) provides public recognition of tax-exempt status, advance assurance to donors of deductibility of contributions, exemption from certain State and federal taxes, and non profit mailing privileges. Organizations that typically qualify are churches, educational institutions, hospitals, and governmental units. To learn more about non profits, visit www.irs.gov, or call the tax-exempt helpline at 877-829- 4933. How does a Private Non Profit obtain Tax Exempt Status? A private non profit must apply to the IRS for tax exempt status. To qualify, applicants must complete and submit to the IRS Form 1023. Once federal tax exempt status is granted, the private non profit applies for State tax exempt status by completing Form CD-435 and submitting it to the N. C. Department of Revenue. Please attach proof of 501(c)(3) or IRS tax-exempt status to this page. DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA ATTACHMENT M STATE AND LOCAL CERTIFICATION Contractor Certifications Required by North Carolina Law Orange County Department of Social Services Instructions The person who signs this document should read the text of the statutes listed below and consult with counsel and other knowledgeable persons before signing. • The text of Article 2 of Chapter 64 of the North Carolina General Statutes can be found online at: • The text of U.S. 105-1.64.8(b)can be found online at: • The text o[G.5. l43-48.5 /5I_ 2Ol3'4lQ, m. 2/d8 can be found online at: • The text ofO.S. l4]-50.\ can bo found online at: • The text of G.S. 143-59.2 can be found online at: • The text o{G.S. l47'3].95(o)(3.L. 2Ol]'4|8, s. 2. (c))can be found online at: • The text of Orange County Living Wage Contractor Policy which is attached to this document. Certifications (I) Pursuant to G.S. 843-48,5, the undersigned hereby certifies that the Contractor named below, and the Contractor's subcontractors, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with more than 25 employees in North Carolina to veri1 ' the work authorization of its employees through the federal E-Verify system." E-Verify System Link: www.usciszpv Local government is specifically exempt from Article 2 of Chapter 64 of the North Carolina General Statutes. However, local government is subject to and must comply with North Carolina General Statute §153A-99.1., which states in part as follows: Counties Must Use E-Verify. Each county shall register and participate in E-Verify to verify the work authorization of new employees hired to work in the United States. (2) Pursuant to G.S. 843-59.1(b), the undersigned hereby certifies that the Contractor named below is not an 'ineligihle Contractor"as set forth iu G.S. 143-59.1(a)because: (a) Neither the Contractor nor any of its affiliates has refused to collect the use tax levied under Article 5 of Chapter |Oj of the General Statutes on its sales delivered to North Carolina when the sales met one or Contractor Certifications Required by North Carolina Law Page 1 of DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA more of the conditions of G.S. 105-164.8(6); and (b) [check one of the following boxes] Neither the Contractor nor any of its affiliates has incorporated or reincorporated in a"tax haven country" as set forth in G.S. 143-59.1(c)(2)after December 31, 2001; or �— The Contractor or one of its affiliates has incorporated or reincorporated in u"tax haven country" -- as set forth in G.S. 143'59.l(o)(2) after December 31, 2001 but the United States is not the principal market for the public trading of the stock of the corporation incorporated in the tax haven country. (3) Pursuant to G.S. 43-59.2(b), the undersigned hereby certifies that none of the Contractor's officers, directors, or owners (if the Contractor is an unincorporated business entity) has been convicted of any violation of Chapter 78A of the General Statutes or the Securities Act of 1933 or the Securities Exchange Act of 1934 within 10 years immediately prior to the date of the bid solicitation. (4) The undersigned hereby certifies further that: (a) He or she is a duly authorized representative of the Contractor named below; (b) He or she is authorized to make, and does hereby make, the foregoing certifications on behalf of the Contractor; and (c) He or she understands that any person who knowingly submits a false certification in response to the requirements of G.S. 143-59.1uud '59.2 shall be guilty of a Class I felony. (5) Pursuant to the Orange County Living Wage Contractor's Policy: (u} The undersigned certifies that the Contractor pays the employees who perform services under this contract a � living wage (in Orange County currently $13.15 per/hr.) Check here 11 if contractor pays employees performing under this contract a living wage. If Contractor does not pay employees a living wage, what is the wage that employees performing services under this contract paid community Empowerment Fund fitottiSivneub/. Contractor ume- 8 � � o"c�' 8/24/2016 wm,asau_LuaL Signature of Contractor's Authorized Agent Date maggie west program coordinator rtor's Printcd7�u c /\uthor� Agent�d ��n� Titic "~'~ V operations coordinator +c^- Signature of Witness Title J on Young 8/30/2016 Printed Name of Witness Date The witness should be present when the Contractor's Authorized Agent signs this certification and should sign and date this document immediately thereafter. Contractor Certifications Required by North Carolina Law Page 2 of 2 DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA General G \ (l n`co\ and &dnziuiot�Vicm Section 1: Government Policy 10D: Living Wage Contractor Policy Reviewed by: County Attorney/County Manager Approved by: County Manager Original Effective Date: April 21, 2016 Revisions: Policy Statement It is the pnU of Orange County to ensure its employees, and all individuals who provide services for Orange County, are paid a living wage. Purpose To encourage all vendor and contractors to pay a living wage to all employees who perform work pursuant to a contract with Orange County Applicability Applies to all Orange County contracts and purchases. Policy ]0.l Living Wage 10.1.1 Orange County is committed to providing its employees with a living wage and encourages all contractors and vendors doing business with Orange County to pursue the same goal. Orange County's living wage is $13.15 per hour. To the extent possible, Orange County recommends that contractors and vendors seeking to do business with Orange County provide a living wage to their employees. 10.1.2 Prior to final execution of a contract with Orange County all contractors and vendors seeking to do business with Orange County shall submit to the County's representative a statement indicating whether those employees who will perform work on the Orange County contract are paid at least the living wage amount set out above. If such employees do not make at least the living wage amount set out above the contractor or vendor shall indicate in the statement the actual amount paid to such employees. For bid projects this statement should be submitted as part of the bid packet. This policy may be reviewed annually and updated as needed by the Managon"mO0fiuu Contractor Certifications Required by North Carolina Law Page 3 of 3 DocuSign Envelope ID: r8378o58e2084Er4~^C81~^AC7048010eA ATTACHMENT N OUTCOMES AND REPORTING orange County Department of Social Services By signing and submitting this document, the Contractor certifies that it agrees to the following; I. The Contractor agrees to participate in program, fiscal and administrative monitoring and/or audits, making records and staff time available to Federal, State and County staff. The Contractor will turn over all program documents to the County at the end of the contracting period or when a participant exits the program, whichever occurs first. The Contractor will keep participant fi 1 e s in a locked room or filing cabinet that only approved employees can access. 2. The Contractor agrees to take necessary steps for corrective action, as negotiated within a corrective action plan, for any items found to be out of compliance with Federal, State, and County laws, regulations, standards and/or terms of the Contract. 3. The Contractor agrees that continuation of and/or renewal of this Contract is contingent on meeting the following requirements. The Contractor agrees to: A. Attend all relevant ESG trainings provided during the fiscal year. Trainings will be conducted via webinar and/or conference call when feasible. Some trainings may require face to face participation. a. The Contractor will provide copies of certificates of training completion, training sign- in sheets, webinar participation sign-ins, and/or agency certification that appropriate staff have completed offered trainings. Persons unable to attend w/ehioo,truiningx must view webinars within one month of the training session being posted online. B. Document all federal and state eligibility criteria, including but not limited to housing and homeless status, income eligibility, financial supports, assets,and social supports, for Housing Stability activities using County approved forms. The Contractor will only provide ESG funded services to eligible participants. If the Contractor provides services to ineligible participants using ESG funds or ESG matching funds, the Contractor will reimburse the County for those funds from a non-ESG funding source. a. The Contractor will maintain participant files and will provide these files to the County when participants exit the program, C. Emphasize immediate access to safe, affordable housing that complies with the quality standards that HUD uses for its Section 8 program. Housing Stability services, including the number of months support is provided, should be personalized to meet the needs of each household. The County must approve all program eligibility decisions. The Contractor will be responsible for assisting the program participants to develop and implement a Housing Stabilization Action Plan. a. The Contractor will provide staff tiniesheets, participant files, housing status documents, leases, invoices/bills, cheoko/hunkotu1enn*nto/i*Jgeo, case notes, and reimbursement requests. The County has the right to request additional documentation as deemed necessary. The number of days the average person experiences homelessness should be less than the previous year until a community average of no more than 30 days of homelessness is met. D. Provide assistance foi' Housing Stability activities based on individual household need. Financial assistance should be strategic and intentionally used to support long term housing stability. Participant files should provide a rationale for decisions about financial assistance amounts and types. Outcomes (06/04) Page | ofl DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA MOD DATE(MNVDDIYYYYI CERTIFICATE OF LIABILITY INSURANCE R054 1/22/2016 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). PRO0UCER CONTACT NAME PHONE BB&T INSURANCE SERVICES INC/PHS PHONE EaR (866) 467-8730 Ac,Nol (888) 443-8112 272545 P: (866) 467-8730 F : (888) 443-6112 A DRESS - PO BOX 29611 INSURERISI AFFORDING COVERAGE NAIICI CHARLOTTE NC 28229 INSURERA, Sentinel Ins Co LTD 1100C INSURED INSURER B: INSURER.C COMMUNITY EMPOWERMENT FUND INSURER D: 108 W ROSEMARY ST INSURER CHAPEL HILL NC 27516 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. INS? TYPE OF 1550RANCE ADM. SUER. POLICY NUMBER POLICY EPP' POLICY EX!' LIMITS I TR, USSR WY'D /MM.'DDR"YYEl /MM/OD YYYG COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 52, 000, 000 DAMAGE TO CLAIMS-MADE X OCCUR PREM SET Ea occur ence) $1, 000, 000 I A X General Liab ''' 22 'CBs BN9653 01/26/2'010 01/26/2017 MEDEXP(Any one person) $10, 000 PERSONAL&ADV INJURY 52, 0 0 0, 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE :4, 0 0 0, 0 0 0 POLICY PRO' [X I LOG PRODUCTS-COMPIOP AGG .;4, 0 0 0, 0 0 0 JECT I J OTHER: COMBINED SINGLE LIMIT 2, 000, 000 AUTOMOBILE LIABILITY '(Ea accident) ANY AUTO BODILY INJURY(Per person) , A ALL OWNED SCHEDULED 22 CBs 259553 C1/26/2016 C1./26/2017 BODILY INJURY(Per accident) AUTOS AUTOS X NON-OWNED ' PROPERTY DAMAGE X HIRED AUTOS AUTOS Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DES RETENTION$ ~ PER 07 H- .WORX'RSCOSLES LIABILITY STATUTE ER AND EMPLOYERS' BIL ITY ANY PROPRIETOR(PARTNER,EXECUTIVE YIN E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N/A a (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE If yes,describe under E.L..DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES IACORD 101,Additional Remarks Schedule,may be attached If more space is required) Those usual to the Insured' s Operations. 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 8 1 8 1 AUTHORIZED REPRESENTATIVE 200 S CAMERON ST A—C- -7 --\----/ HILLSBOROUGH, NC 27278 ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA COMMEMP OP ID: LH AWRL CERTIFICATE OF LIABILITY INSURANCE DATE(MMfDDNYYY) 0811812016 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 Phone: 919-682-4814 NAMEACT Lee Hammond The Sergi Insurance Agency Fax: 919-682-4906 PHONE 919-682-4814 FAX 16 Consultant Place Suite 102 {a2,NNE%Em1 iNc,,wol;919.682-4906 Durham, NC 27707 E-MAIL James E.Sergi,CIC ADDRESS:lee@sorgiinsurance.com INSURER{S)AFFORDING COVERAGE NAIL INSURER A;Erle Insurance Exchange 26271 INSURED Community Empowerment Fund INSURERB: 108 W.Rosemary St. Chapel Hill, NC 27516 INSURER C- 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. ILTR U POLICY EFF POLICY EXP TYPE OF INSURANCE INSR WVD POLICY NUMBER [MMlDD/YYYY} IMMrDDlYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO-RENTED '------ PREMISES(Ea occurrence) $ J CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER- PRODUCTS-COMP/OP AGG $ POLICY �E LOC ........ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT . 1Eaaccudent)_.... ......_ ....$._._...----- ANY AUTO BODILY INJURY(Per person) '.S ALL OWNED SCHEDULED - AUTOS AUTOS BODILY INJURY(Per accident) S '.... '' '. HIRED AUTOS NON-OWNED UT OWNED PROPERTY DAMAGE AGE S ....__ , AUTOS (Per acclQent!_,., . .... S UMBRELLA LIAR OCCUR ,' T EACH OCCURRENCE '... $ EXCESS UAB CLAIMS-MADE AGGREGATE i $ DED RETENTION$ - $ WORKERS COMPENSATION WCSTATU- 'iOTH-� AND EMPLOYERS'LIABILITY _X.--ITOBY,„LIMIT$ ER._- ,. A ANY PROPRIETOR/PARTNER/EXECUTIVE Y r N IQ921100539 08/11!2016 08111!2017 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? y N/A -------.. (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 Of yes,describe under ........... ..........._.... _ . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES{Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ty ACCORDANCE WITH THE POLICY PROVISIONS. 200 S.Cameron St. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA j - aritermr _41616se* ' wgrp, N 0 R T I-1 Nc:(:i." CAROLINA ASSOCIATION OF COUNTY COMMISSIONERS WORKERS COMPENSATION COVERAGE CERTIFICATE COVERAGE PROVIDER: NCACC Liability and Property Pool 215 North Dawson Street This certificate is provided by the NCACC Workers'Compensation Pool Raleigh, NC 27603 and is issued as a matter of information only. This certificate confers no MEMBER: rights upon the certificate holder other than those provided in the coverage document. This certificate does not amend,extend,or alter the Chatham Transit Network coverage afforded by the coverage documents listed herein, 480 Hillsboro Street,Suite 110 Pittsboro, NC 27312 COVERAGES Type of Coverage Coverage Effective Expiration Contract# Date Date Limits Coverage A: WORKERS'COMPENSATION WC-CH-475-16 July 1,2016 July 1,2017 Statutory — Coverage B: EMPLOYERS'LIABILITY WC-CH-475-16 July 1,2016_July 1,2017, $2000,000 Coverage C: OTHER STATES WC-CH-475-16 July 1,2016 July 1,2017 Statutory Additional Information: Evidence to Coverage. CERTIFICATE HOLDER: Cancellation: Should any of the described coverage documents herein be cancelled before the expiration date shown, the NCACC Pools will endeavor to mail written notice to the Orange County Dept.o Social Certificate Holder named herein,but failure to mail such notice shall impose no obligation Services or liability of any kind upon the NCACC Pools, its agents or representatives,or the issuer of P.O.Box 8181 this certificate. Hillsborough, NC 27278 By: Collin Klein, Underwriting I - I Technician for the NCACC 7/12/2016 Certificate Mailed/E-Mailed or Faxed to: Orange County Dept. o Social Services P.O. Box 8181 Hillsborough, NC 27278 DocuSign Envelope ID: F9379D59-22D8-4EF4-AC91-AAC7649616BA • tr. AP eV e/PW 2o NORTH 111"lr CAROLINA ASSOCIATION OF COUNTY COMMISSIONERS LIABILITY AND PROPERTY COVERAGE CERTIFICATE COVERAGE PROVIDER: NCACC Liability and Property Pool This certificate is provided by the NCACC Liability and Property 215 North Dawson Street Pool and is issued as a matter of information only. This Raleigh,NC 27603 certificate confers no rights upon the certificate holder other than MEMBER: those provided in the coverage document. This certificate does Chatham Transit Network not amend,extend,or alter the coverage afforded by the 480 Hillsboro Street,Suite 110 coverage documents listed herein. Pittsboro,NC 27312 COVERAGES Type of Coverage I Coverage 1 Effective I Expiration I 1 Contract# 1 Date 1 Date Limits Liability General Liability— X Each Occurrence, No Aggregate applies LP-CH-475-16 July 1,2016 July 1,2017 X Public Officials Liability, $2,000,000 occurrence Each Wrongful Act LP-CH-475-16 July 1,2016 July 1,2017 X Law Enforcement Liability, Each Occurrence $1,000,000 aggregate Cyber Liability LP-CH-475-16 July 1,2016 July 1,2017 Claims Made Excess Liability Automobile Liability All Owned Autos, X Each Accident LP-CH-475-16 July 1,2016 July 1.2017 Hired Autos, X $2,000,000 occurrence Each Accident LP-CH-475-16 July 1,2016 July 1,2017 Excess Auto Liability for Non-Owned Autos _ LP-CH-475-16 July 1,2016 July 1 2017_ Automobile Physical Damage X Scheduled Vehicles Actual Cash Value at the time of LP-CH-475-16 July 1,2016 July 1,2017 the Loss,unless otherwise specified in the Coverage Hired Autos(if coverage is not Document;Deductible Applies purchased elsewhere) LP-CH-475-16 July 1,2016 July 1,2017 Limit Deductible Property—Risks of Direct Physical Loss, Blanket Limit LP-CH-475-16 July 1,2016 July 1,2017 $ 1,117,200 1 $1,000 Additional Information: Evidence of Coverage. CERTIFICATE HOLDER: Cancellation: Should any of the described coverage documents herein be cancelled before the expiration date shown, the NCACC Pools will endeavor to Orange County Dept.Social Services mail written notice to the Certificate Holder named herein,but failure to mail such P.O.Box 8181 notice shall impose no obligation or liability of any kind upon the NCACC Pools,its Hillsborough,NC 27278 agents or representatives,or the issuer of this certificate. By:Willie J.Allen Jr., •7,,I1r 7/12/2016 X Underwriter for the NCACC Certificate Mailed/E-Mailed or Faxed to: Orange County Dept. Social Services P.O. Box 8181 Hillsborough, NC 27278 0