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HomeMy WebLinkAbout2016-581-E Finance - Behavioral Insights, Inc.- Outside Agency Performance Agreement DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2016, ("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough,North Carolina, 27278, ("County") and Behavioral Insights, Inc., a not-for-profit corporation, located at 100 North Churton Street, Hillsborough,NC 27278 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Behavioral Insights, Inc. agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2016 to June 30, 2017. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit"A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. 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 Revised Program Budget, the maximum sum of 4000. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of $1,000. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (Behavioral Insights,Inc.) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 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 performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31; January 1 —March 31 and April 1 - June 30. Reports are due on January 13,April 14, and July 14 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default"), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten(10)business days from written notice of default. The County may (but shall not be required to) grant the 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. (Behavioral Insights,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 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 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. (Behavioral Insights,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 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 and the Orange County Anti-discrimination Policy. 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 $ 13.15 per hour. To the extent possible, Orange County recommends that Behavioral Insights, Inc.provide a living wage to its employees. 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: (Behavioral Insights,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 County: Finance&Administrative Services Provider: Behavioral Insights, Inc. Orange County 100 North Churton Street Post Office Box 8181 Hillsborough,NC 27278 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. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. 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. For and on e citYf1 Pr vider cr. f 10/25/2016 9B9759CDF8FA424... Date For and of _a,,' .(f ,{)range County Government botiutA,tt, tka" turst t1 10/26/2016 Bonnie Hammers ey,Tounty Manager Date (Behavioral Insights,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 ATTACHMENT "A" Orange County Certifications—FY 2016-17 Outside Agency Performance Agreement Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title,residential address;phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name, physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DocuSigned by: Dor- f' 64.1A, Executive Director 10/25/2016 Certified by: 9B75 GDFAFA424 Title: Date: (Provider's Signature) (Behavioral Insights,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Behavioral Insights, Inc. Date/Time / Complete Y/N Program(s) _DV classes and Sentencing Plan Service Section For CDBG & HOME - Subsection HUD Regulations 1. Cover Page a. xLI Applicant Contact Information b. xE Project/Program Contact Information c. x❑ Funding Requests Identified d. xEl Signed Application Cover Page 2. Agency a. x❑ Agency's Years in operation 24 CFR 570.506, Information - b. x❑ Agency's Purpose/Mission 570.507, 570.610; 24 c. x Agency's Types of Services Provided CFR Parts 84 or 85 Ll d. xE Agency's Experience e. x❑ Other Pertinent Information 3. Program/ a. XD Type of Application.and Program Identified 24 CFR 570.200(a), Project b. XE Summary of Program 570.201-570. 208, Information - c. X Description of Identified Need 507.503 ❑ (for each d. X❑ Description of Population to be Served program/ project for e. XD Activity Manager and Location Description which funding f. X1 Activity Implementation Timeline is requested) g• Agency Collaboration h. XD Describe Impact of Reduced/No Allocation i. X❑ Other Pertinent Information j. XD Complete Target Population/Beneficiary Chart k. XD Complete Schedule of Positions I. X❑ Signed Conflict of Interest Disclosure m. XE Complete Work Statement ilPage DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's INORecfixigication 24 CFR 570.200(a), 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, each expenses for the entire program and ALL sources of 507.503 program/ funding. 24 CFR 570.506, project for 570.507, 570.601, which funding a. X❑ Program Budget Worksheet 570.602, 570.607(b), is requested) b. X❑ Program Budget Detail 570.611 c. X Cost Per Unit 24 CFR)CI 570.502-570.504, d. X❑ Agency Operating Budget Worksheet 570.506, 570.507, 570.610; 24 CFR Parts 84 or 85, and OMB Circulars A-87 or A- 122; Treasury Circular 1075 5. Supplemental A. ❑ Part A: CDBG & HOME Sections (as B. 0 Part B: Construction/Rehab applicable) 6. Attachments a. [' Audit: Organizations receiving$300,000 or more OMB Circular A-133 in Federal financial assistance, and/or organizations with more than $500,000 of receipts and expenditures in a fiscal year, must secure an audit. b. x❑ IRS Federal Form 990 c. x❑ NC Solicitation License d. x❑ IRS Federal Tax-Exemption Letter e. x❑ Certificate of Insurance f. xn List of Board of Directors 24 CFR Parts 84 or 85 g. x❑ Articles of Incorporation/Bylaws 24 CFR 570.208, h. x❑ Authorization to Request Funds 570.500(c), 570.611 i. x❑ Authorized official designation j. xE Solid Waste Program Fee (SWPF) Verification Main Application 1/20/2016 4:35:53 PM Page 2 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's kt dx elrGA I I lication 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Behavioral Insights, Inc. Applicant Organization's Physical Address: 100 N. Churton Street, Ste. 207, Hillsborough, NC 27278 Applicant Organization's Mailing Address: 100 N. Churton Street, Ste. 207, Hillsborough, NC 27278 Applicant Organization's Web Address: www. DVclassesorangenc.org (under development) Executive Director: Joyce Kuhn Telephone Number: 919 245-3310 E-Mail: kuhnjoyce @gmail.com DUNS Number: 07-871-8903 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) Proiect/Program Contact Information Project/Program Name: Sentencing Plan Service Project/Program Primary Contact and Title: Joyce Kuhn Executive Director Telephone Number: (919) 245-3310 E-Mail: kuhnjoyce @gmail.com c) Funding Request Identification Total Project/Program Cost: $18,000 Total Amount of Funds Requested: $$18,000 Proposed Use of Funds Requested (2-3 Line Maximum): to continue to provide sentencing expert services (written bio-psycho-social plans with links to program referrals to match risk (for recidivism) areas of that individual offender. The cost of preparing these plans is reimbursed in part by the AOC —state funding, $500 per plan. To accommodate fluctuations in referrals staff and contractors prepare them. Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source. *The Participating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. ❑ CDBG Non-Construction (CH) $ ❑ Grant ❑ Loan ❑ CDBG Construction (CH) $ ❑ Grant ❑ Loan ❑ HOME CHDO (OC) $ C Grant [' Loan n HOME Other (OC) $ ❑ Grant ❑ Loan XEI Human Services: X❑ Carrboro $6,000 X❑ Chapel Hill $$8,000 ❑ Orange County $4,000 d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Main Application 1/20/2016 4:35:53 PM Page 3 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider'}R} ys pO em®Riplication d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing ;oard of the appli nt. OV(D , Signature: : ■ s 1 E -c ti - 'erector-Joyce Kuhn Date Signature: L_,---77)71-�,..— ,— t h1 (( (p Board Chairperson-Mani Dexter Date Main Application 1/19/2016 3:09:25 PM Page 4 of 24 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's t xAge c� jcation 2. AGENCY INFORMATION provide the following information about your agency (Limit of 2 pages total): a) Years in Operation, Date of Incorporation (Month/Year) b) Agency's Purpose/Mission c) Types of Services the Agency Provides d) Agency's Experience with Similar Programs as the Funding Request e) Other Pertinent Agency Information a) Years in Operation: Years in Operation: Twenty six: Originally operating under the auspices of the Dispute Settlement Center since 1987 providing sentencing proposals for those adults facing incarceration. Pretrial Services (inmate release and supervision) began in 1994 and was initially funded by the North Carolina's Criminal Justice Partnership. In September of 2015, Pretrial Services was moved to Orange County government. The new mission was decided by the board of directors on December 8, 2015. Date of Incorporation: June 1993. The name of the agency was changed from Pretrial Services to Behavioral Insights in December 2015. b) Mission Statement: Behavioral Insights, Inc.provides classes to meet the needs of those required by a North Carolina mandate to participate in domestic violence treatment programs. Additionally, Behavioral Insights intends to provide other services to identify client needs and link clients to services to address risk areas related to potential recidivism. Services. Written sentencing plans resulting from an ex parte order submitted for a particular defendant continued to be prepared by a sentencing expert. c) Brief History of Agency: The agency has a history of over two decades (since 1994) becoming an integral part of assisting the county, and the courts directly working with those in the county detention center by increasing the social safety net as a `first response' to the issues confronting detainees and monitoring court order pretrial conditions. Sentencing plans to provide options to address identified risk areas and detail the background of the defendant continue to be provided when a sentencing expert is ordered. These projects excel due to a strong relationship with judicial officials and history of linking detainees to community resources. Case management and other best practices assured community safety. Mental health and substance abuse treatment referrals were ongoing. Sentencing plans are prepared by experts: are written plans providing analysis and options for treatment placements for individuals facing criminal charges. The plans outline background of the defendant and are presented to the sentencing judge. These plans benefit the defendant and the community by matching resources with underlying issues related to criminal behavior and other needs for stabilization that are determined to be criminogenic. The agency is long established in making links for defendants to services with local and statewide agencies to address the risk areas of each defendant related to potential recidivism. Motivational Interviewing and cognitive behavioral skills make the most of potential engagement and enrollment in programs the defendant needs. The agency has successfully prepared sentencing plans in Orange County contributing to the Main Application 1/20/2016 4:35:53 PM Page 5 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's WtIx e�c�iteAcation community's safety net. Probation officers receive the plan after sentencing which provides some background on treatment recommended and client history. e) d)Domestic violence treatment is being added to sentencing expert work. This is a close match for existing functions of addressing factors related to recidivism. The social safety and community safety nets are fortified by these services. Courtroom presence and justice system interfaces are well established. f) e)Behavioral Insights is the new agency name, formerly Pretrial Services Main Application 1/20/2016 4:35:53 PM Page 6 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's WATIV Ogri18 pdNcation 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Behavioral Insights, Inc., Sentencing Plan Service As you complete your application, complete only those sections that pertain to the type of application you are submitting. The application is divided into several sections and not all sections apply to every project. Every applicant MUST complete the main application. a) Check the type of funding request for this application package submittal and complete the required application and required supplemental sections (Parts) as specified below: XE Human Services (Main Application Only) ❑ CDBG Non-Construction —(Main Application AND Part A) ❑ CDBG Construction —(Main Application AND Part A AND Part B) ❑ HOME CHDO Set-aside —(Main Application AND Part A) E HOME Other —(Main Application AND Part A AND Part B) Indicate the type of program for which you are requesting funding: Program Category Youth Adult Elderly Disabled Public Housing (not elderly) Neighborhoods/Residents Education X X X X Health and Nutrition Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentoring Transportation Housing Other: Please specify---linkage to programs to address instability; and underlying issues with information and referral X X X X Program/Project Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: ��k�{��;�A�z � ` r 5 x 3 E e f : t ✓t't s 1 � s?`f�������� Main Application 1/20/2016 4:35:53 PM Page 7 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's C 71141 AnIna �INication � ��Z �� I F Z � t - * r9 �: a {3 tt 4 u�-� 'yS�r E c'i_,� L {y y ''r,r L 1 s i &. Sc E - {a 1:emu ts' . �'z ..m-r zh_`,aCxm''a tt, r d,za to- `'.r £ x rm ro{ �'t£��, t{ F {;» s.. b) Sentencing plans are dynamic tools which launch the defendant toward services to address the risk areas related to criminal activity. These reports provide detailed options and analysis useful to the court and after court to the probation officer assigned. These reports occur at a critical juncture. The defendants are a group that can tax the community in property crimes and therefore this work makes a significant impact in the community safety net.. c)Describe the local need or problem to be addressed in relation to the Consolidated Plan or other community priorities (i.e. Council/Board Goals). Cite local data to support the need for this program and the population being served. Youth are served by this effort at a critical point in criminal court. This is an opportunity at sentencing to divert those in criminal court to resources to address needs related to recidivism. This process guides the defendant to engage with a resource to add stability thereby reducing damage to the community caused in property and drug crimes. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries: The beneficiaries are identified when an ex parte order is signed by a judge to order an expert in sentencing to prepare a plan. They benefit by an analysis of risk areas and level of insight, motivation and an analysis of barriers to this. Recommendations are made for a specific resource to address the underlying issues to reduce the likelihood of recidivism and increase success with probation. g) Who specifically will carry out the activities and in what location will they be carried out? A trained sentencing expert prepares the plan by meeting with the defendant in a public place realistically accessible to him such as a public meeting room or in a jail conference area. h) Describe specifically the period over which the activities will be carried out, the frequency with which the activities will be carried out, and the frequency with which services will be delivered. Include an implementation timeline. The sentencing plan is carried out in weeks leading up to the sentencing hearing; records are requested, contacts with family and health care professionals occur. The plan is developed to match a level of engagement that may consider mental illness, cognitive ability, substance addiction and other barriers to avoiding criminal activity such as employment issues. i) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, give specific examples of the coordinated/collaborative efforts. When links are made to agencies during sentencing plan development, case management efforts prompt the defendant and resolves barriers as much as possible with problem solving and encouragement. • Cardinal Innovations Healthcare Solutions for assessments and counseling • FIRST at Blue Ridge, as well as other residential and outpatient facilities such as Tarheel Challenge, New Life Launch Pad and Freedom House Recovery Center. Southlight in Raleigh or Horizons for women are some placements linked to defendants in individual plans. • Alamance Homes is an example of a group home. Such a facilitated application can be offered as an option for a disabled defendant. Main Application 1/20/2016 4:35:53 PM PageE of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's tgAgeency.t Ncation • Vocational Rehabilitation Services can increase employability if the defendant qualifies. • The Compass Center is recommended for victims of domestic violence. • CTI of UNC is a program for those with comprehensive needs such as housing. • Alliance Behavioral Health and the Criminal Justice Resource Center are resources considered for substance abuse issues and employment coaching for defendants who may live in Durham County. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. The board would consider continuing the effort until funding is exhausted. b) Include any other pertinent information. Orange County indicates that possible in kind support for this effort would include office space for the next fiscal year. Program/Project Information c) Complete the Target Population and Program Beneficiary Demographics Chart d) Complete the Schedule of Positions Chart for Program Staff e) Disclosure of Potential Conflicts of Interested must be signed f) Complete the Work Statement Chart to describe the work to be performed, and be sure to attach copies of all data collection tools that will be used to verify achievement of program goals and objectives. Describe who will be responsible for monitoring progress. Information to Complete j.) Target Population Complete the following tables to the best of your ability. Show numbers of participants and percentages, as applicable, in each category. Please indicate whether this project/program will serve: X❑ Persons ❑ Households ❑ Units Program: Sentencing Plan Services Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender 45 42 40 Male 41 39 37 Female 4 3 3 Total 45 42 40 Of the females, how many are single- female Head of Households (Omit for Human Services) 2 2 2 Ethnicity African-American 22 21 20 American Indian or Alaska Native Asian .........._..... ..... . ..._... . Main Application 1/20/2016 4:35:53 PM Page 9 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 t it A continued Provider's MAI 1 API�LICATIONication Caucasian 21 19 18 Native Hawaiian or other Pacific Islander Other 2 2 2 Total 45 42 40 Of the above, how many Hispanic/Latino 2 2 2 Of the above, how many non- Hispanic/Latino 43 40 38 Total 45 42 40 Age 0-5 years 6-18 years 1 2 2 19-50 years 43 39 37 51-61 years 1 1 1 62+ years Total 45 42 40 Geographic Location Durham City 4 3 3 Durham County Carrboro 15 12 10 Chapel Hill 10 10 11 Chapel Hill Public Housing Residents 1 2 3 Orange County 15 15 13 Raleigh Wake County Total 45 42 40 Income Level—See following chart j (Omit for HS) < 30%Area Median Income 42 40 39 31-50%Area Median Income 3 2 1 51-80% Area Median Income > 80%Area Median Income Total 45 42 40 Special Needs (Omit for HS) Elderly(Over 62) 0 1 1 Disabled (not elderly) 1 2 1 Homeless 2 2 2 People with HIV/Aids Total 3 5 4 Main Application 1/20/2016 4:35:53 PM Page 10 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued pppp Provider's 1Vf 1sN eAPPCICATIONcation k.) Schedule of Positions I Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). If provided, indicate: Position Titles % (R) FTE* Actual Estimated Projected %Total = Position Program 201415 2015-16 2016-17 Bud et Retirement Vacant Staff+ g Plan (H) Health Plan E.D. sentencing expert .10 16,800 16,800 16,800 16,800 .93 IDS reimbursement . - Makes contractual work necessary& possible in times of peak workload Notes: • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. • ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. ® + Denotes the percentage of staff time involved with this program. ® Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 1,960 Main Application 1/20/2016 4:35:53 PM Page 13 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's Outside Agency Application MAIN APPLICATION I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO ❑ X❑ a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? ❑ X❑ b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? ❑ X ❑ c) Current beneficiaries of the project/program for which funds are requested? ❑ X❑ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the project ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. 1 /4/ep Signature: ()Exec tive Director Date Signature: Board Chairperson Date Main Application 1/20/2016 1:50:49 PM Page 15 of 23 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's VAT6I0Fiu8 ArpcsiVation m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Main Application 1/20/2016 4:35:53 PM Page 15 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's 1?s410pE[16x pDNcation Actual Estimated Projected 2014-2015 2015-2016 2016-2017 investigate background, investigate background, investigate background, analyze risk of re-offend analyze risk of re-offend analyze risk of re-offend Program Activity 1 areas, set up referrals areas,set up referrals areas, set up referrals provide analyis and action provide analyis and action provide analyis and action Program Goal plan plan plan written plan delivered to written plan delivered to written plan delivered to Performance Measures court officials court officials court officials the court has existing the court has existing the court has existing options to consider at options to consider at options to consider at Program Results sentencing. sentencing. sentencing. plan shared with Comm. plan shared with Comm. plan shared with Comm. Program Activity 2 Corrections Corrections Corrections orientation to client and orientation to client and orientation to client and Program Goal treatment needs-referrals treatment needs-referrals treatment needs-referrals Performance Measures 45 plans presented 42 plans presented 40 plans presented probation off.verifies probation off.verifies probation off.verifies Program Results receipt receipt receipt Program Activity 3 Program Goal Performance Measures Program Results Program Activity 4 Program Goal Performance Measures Program Results Program Activity 5 Program Goal Performance Measures Program Results Main Application 1/20/2016 4:35:53 PM Page 16 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's MAIN APPLggICAyy TIpppp�I ONication 4. FINANCIAL INFORMATION FOR SERVICE PROGRAMS a.) Program Budget Please complete a Program Budget Excel Form for each requested program. The Program Budget should reflect only figures and amounts associated with the Program(s) for which you are seeking funding and not the total agency budget. If the program's finances experienced significant changes that you would like to explain, please use the space below. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/20/2016 4:35:53 PM Page 17 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's iZ 1$fipt 8sMAcation Local Government Grants: Orange County $ - $ - $ 4,000 0 Town of Chapel Hill $ 7,500 $ 7,500 $ 8,000 7% Town of Carrboro $ 5,500 $ 5,600 $ 6,000 7% Other Local: --- 0 Other Local: --- 0 Other Local: $ 320 $ 320 -100% If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way --- 0 State Government --- 0 Federal Government --- 0 Other Grants: --- 0 Other Grants: IDS plan reimbursement $ 4,680 $ 4,580 -100% Miscellaneous/Other Revenue 0 Please list 3 largest Miscellanous sources: $ - $ - $ - Total Agency Revenue 18 000 18 000 18 000 0% AGENCY EXPENSES Compensation $ 16,800 $ 13,800 $ 16,200 17% Rent&Utilities $ 4,200 in kind re.uest #VALUE! Supplies&Equipment $ 1,200 $ 1,200 0 Travel&Training $ 600 0 Other Expenses: 0 Please list 3 largest"Other Expenses": $ - $ - $ - Total Agency Expenses 18 000 18 000 18 000 0% SURPLUS/(DEFICIT)FOR PERIOD: I$ - I $ - I $ - I 01 Main Application 1/20/2016 4:35:53 PM Page 18 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provid Aslk' NOglCW I 'gnApplication b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Example Program: Credit Counseling Class Cost Elements Cost ($)�; Quanti#Yitinituf Measure Subtotal ($) Credit Counseling Teacher–in class $25 96 hours (8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours (4hrs/mth x 12 mths) $1,200 Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the project/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: Sentencing Plan Service Cost Elements Cost($) Quantity/Unit of measure - Subtotal ($) Expert staff-case investigation/preparation $30/hr. 7 hours X 40 cases $8,400 Intake/request records, contacts-collateral $30/hr. 3 hours X 40 cases $3,600 Analyze criminogenic factors,review history $30/hr. 2 hours X 40 cases $2,400 Consult officials, deliver-Probation interface $30/hr. 2 hours X 40 cases $2,400 Materials-copy,scan, files, electronic $30 Report material x 40 cases $1,200 Total $18,000 c.) Cost per Unit Actual 2014-15 Estimated 2015.16 Projected 2016-17 Total Cost of Program $18,000 $18,000 $18,000 Total # of Units 45 42 40 Cost Per Unit $400 $430 $450 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/20/2016 4:35:53 PM Page 19 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's WIN APPLIUA I ION cation d.) Agency Operating Budget U Please show all sources and amounts of funding for your entire current fiscal year. What is your agency's fiscal year? Example: July 1, 2016 through June 30, 2017. Submit operating budget in your own format. Do not include funds that have been applied for but not yet awarded: If the total revenue is not the same amount as the budget for any fiscal year, please attach a statement explaining the deficit or surplus. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/20/2016 4:35:53 PM Page 20 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued Provider's Outside Agency Application MAIN APPLICATION Section VI.Financial Data Operating Budget for Entire Agency AGENCY NAME: Behavioral Insights,Inc. Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Chan•e Private Donations 0 Agency Generated Revenue(fees) $ 4 000 0 Local Government Grants: Orange County -- $ 142 760 0 Town of Chapel Hill $ 7 500 $ 7 500 $ 15 000 100% Town of Carrboro $ 5 500 $ 5 600 $ 11 000 96% Other Local: --- 0 Other Local: $ 320 $ 320 -100% Other Local: $ 4 680 $ 4,580 -100% If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way --- 0 State Government --- 0 Federal Government --- 0 Other Grants: --- 0 Other Grants: --- 0 Miscellaneous/Other Revenue 0 Please list 3 largest Miscellanous sources: $ - $ - $ Total Agency Revenue $ 18 000 $ 18 000 $ 172 760 860% AGENCY EXPENSES Compensation $ 16 800 $ 13 800 $ 160 060 1060% Rent&Utilities $ 4 200 in kind #VALUE! Supplies&Equipment $ 1 200 $ 2 900 0 Travel&Training $ 1 200 0 Other Expenses: $ 8 600 0 Please list 3 largest"Other Expenses": $ - $ - $ - Total Agency Expenses $ 18 000 $ 18 000 $ 172 760 860% SURPLUS/(DEFICIT)FOR PERIOD: $ - I$ - I$ - I 0 Main Application 1/20/2016 4:35:53 PM Page 21 of 21 DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Behavioral Insights, Inc. Funding Award: $4,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Provide sentencing expert services.The cost of preparing these plans is reimbursed in part 4,000 By the AOC—state funding,at$500 per plan. Program Services For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes below,by June 30,2016. • Investigate background, analyze risk of re-offend areas, set up referrals • Plan Shared with Comm Corrections Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Sentencing plans presented 40 DocuSigned by: Dor- f' 64.1A, Executive Director 10/25/2016 Certified by: 9. D.F_8FAaza Title: Date: (Provider's Signature) DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 AC o DATE(MM/DD/YYYY)® CERTIFICATE OF LIABILITY INSURANCE 8/18/2016 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 Crystal Ireland NAME: y Business Insurers of Carolinas (A/CNNo,Ext): (919)968-4611 FAX No): (919)968-8991 800 Eastowne Drive, Suite 208 aDRle55.cireland @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA:Transportation Insurance Co 20494 INSURED INSURER B:Lloyds of London 00432 Behavioral Insights Inc INSURER C: 100 N CHURTON ST STE 207 INSURER D: INSURER E: HILLSBOROUGH NC 27278 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1681816074 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 300,000 X 6021140912 7/1/2016 7/1/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ 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 LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Professional Liability MPL148440816 8/25/2016 8/25/2017 LIMIT $1,000,000 AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is an additional insured with respect to general liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 S. Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE � ., C Ireland/IREL01 ti/L x ^�tek./ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nmam i