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HomeMy WebLinkAbout2016-583-E Finance - Farmer Foodshare, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B 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 Farmer Foodshare, a not-for-profit corporation, located at 902 North Mangum Street, Durham,NC 27701 ("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 Farmer Foodshare 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 2500. 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 $ 625. 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. (Farmer Foodshare) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B 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. (Farmer Foodshare) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B 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. (Farmer Foodshare) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B 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 Farmer Foodshare 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: (Farmer Foodshare) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B County: Finance&Administrative Services Provider: Farmer Foodshare Orange County 902 North Mangum Street Post Office Box 8181 Durham,NC 27701 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 Wetft t "�q 'the Provider l ln,t jt 10/25/2016 AE195B3E83BE435... Date For and i r^,z,;Aruf Orange County Government 156lA,uttt, tkawtmt-IrStt,i 10/26/2016 ----0637994B755E477... Bonnie Hammersley, County Manager Date (Farmer Foodshare) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B 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. e. —DocuSigned by: Executive Director 10/25/2016 Certified by. —nE195B3E838E435_ Title: Date: (Provider's Signature) (Farmer Foodshare) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Farmer Foodshare Date/Time / Complete Y/N Program(s) Donation Station & POP Market Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. x❑ Applicant Contact Information b. x❑ Project/Program Contact Information c. x❑ Funding Requests Identified d. ❑ Signed Application Cover Page 2. Agency x❑ Agency's Years in operation 24 CFR 570.506, Information - a. x❑ Agency's Purpose/Mission 570.507, 570.610; 24 b. x Agency's Types of Services Provided CFR Parts 84 or 85 n c. xn Agency's Experience d. xn Other Pertinent Information 3. Program/ a. ❑ Type of Application and Program Identified 24 CFR 570.200(a), Project b. 570.201-570. 208, ❑ Summary of Program Information - c. ❑ Description of Identified Need 507.503 (for each d. ❑ Description of Population to be Served program/ project for e. ❑ Activity Manager and Location Description which funding f. ❑ Activity Implementation Timeline is requested) g• ❑ Agency Collaboration h. ❑ Describe Impact of Reduced/No Allocation i. ❑ Other Pertinent Information j. ❑ Complete Target Population/Beneficiary Chart k. ❑ Complete Schedule of Positions I. ❑ Signed Conflict of Interest Disclosure m. ❑ Complete Work Statement iiv ) age DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION 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. ❑ Program Budget Worksheet 570.602, 570.607(b), is requested) b. ❑ Program Budget Detail 570.611 24 CFR c. ❑ Cost Per Unit 570.502-570.504, d. ❑ 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. ❑ 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. ❑ IRS Federal Form 990 c. ❑ NC Solicitation License d. ❑ IRS Federal Tax-Exemption Letter e. ❑ Certificate of Insurance f. ❑ List of Board of Directors 24 CFR Parts 84 or 85 g. ❑ Articles of Incorporation/Bylaws 24 CFR 570.208, h. ❑ Authorization to Request Funds 570.500(c), 570.611 i. ❑ Authorized official designation j. ❑ Solid Waste Program Fee (SWPF) Verification Main Application 5/25/2016 8:50:30 AM 0':°' , 2 of 1 DocuSign Envelope ID:*An08reu~^0C3-4n0C-9r07-9ooC08r8C1ne i A - continued Provider's Outside Agency Application MAIN APPLICATION 1. COVER PAGE (Each program requires separate ) Applicant Contact Information Applicant Organization's Legal Name: Farmer Foodshare Applicant Organization's Physical Address: 902 N. Mangum St. Durhenn, NC 27701 Applicant Organization's Mailing Address: P.O. Box 2873. Chapel Hi||, NC 27515 Applicant Organization's Web Address: www.farmerfoodshare.org Executive Director: Gini Bell Telephone Number: 819.300.6358 E-Mail: ginifornnerfnodshmre.org DUNS Number: 04-707-5380 (Dun & Bradotraet. |no. providosthionunoberetnoohargo. anditisrequiredforFedera} fundinU /eoipiento) b) Project/Program Contact Information Project/Program Name: Donation Station/POP Market Project/Program Primary Contact and Title: Katy Phillips Telephone Number: 918.381.0671 E-Mail: katy@fornnerfoodshare.org c) Funding Request Identification Total Project/Program Cost: $ Total Amount of Funds Requested: $10.000 Proposed Use of Funds Requested (2-3 Line Maximum): Funds will support two programs in Orange County that support small, local farmers and supply fresh, healthy food to area hunger relief agencies. 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 p jects from any funding source, subject to e and funding constraints. [� C[>B(� Non-(�onatrun{ion (CH) $ [l�� Gnont �� Loan CDBG Construction (CH) Fl�� Grant F��� Loan HOME CHDO (00) 0 Grant 111 Loan U HOME Other (0C) U Grant 0 Loan xr_11 Human Services: x[l Carrboro $2.500 n0 Chapel Hill $5.000 x0 Orange County $250O 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. • - ^/ ' Signature: ��'�~. � __/���`' ),/� ()Executive Director �� ' Date ~ v~' Signature: " 1/25/2016 Board Chairperson Date Main Application 2/4/2016 9:38:02 AM DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION I.) •ISCLOSURE OF POTENTIAL CO 'FLICTS 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 rj xn a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? El x[1] b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? El xi] c) Current beneficiaries of the project/program for which funds are requested? El xEl 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 1 y k lowledge ani belief all of the bove infor Ilati.n is true and current. I acknowledge an understand that the existence of a potential conflict of interest does not necessarily make the project ineligible for funding, is ut the existence of an undisclosed conflict may result in the termination of a y_grant awarded. , . Signature: 1A _ /I Ll /ixecutive 6- Director Date Signature O4/ - ;._A I 1 /2) '7__ /it, ;toard Chaiterson 1 , Date Main Application 1/26/2016 10:50:19 AM P ,), ,cj r.- 1 3 (-) t 1 9 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION 2. AGENCY INFORMATION Please provide the following information about your agency (Limit of 2 pages total): a) Years in Operation:6 Date of Incorporation (Month/Year) 2010 b) Agency's Purpose/Mission Farmer Foodshare connects people who grow food with people who need food in ways that are economically sustainable and socially just. We believe that everyone has a right to healthy, fresh food, and that farmers deserve to make a fair wage— a system where everyone wins. c) Types of Services the Agency Provides Both the Donation Station and POP Market program address hunger and malnutrition in our communities while supporting the local farm economy. We provide reliable markets for local farmers and fresh, healthy food for people in need, who would often receive filling, but less healthy highly processed, shelf-stable food. Donation Station collects fresh produce and food at Farmers Markets in Orange County. It pays the farmers and shares the food with a hunger relief agency in the area. POP Market connects local agencies with local farmers, providing reliable markets for small farmers at a fair price and fresh, healthy food for agencies to purchase at a good price from the local farmer. d) Agency's Experience with Similar Programs as the Funding Request Since our inception, we have collaborated with farmers, community members, and local hunger- relief agencies e) Other Pertinent Agency Information Both our Donation Station and our POP Market programs strengthen the health of Orange County residents, particularly people facing diet-related diseases, such as obesity, diabetes and heart disease. Main Application 5/25/2016 8:50:30 AM Pag 41 of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Farmer Foodshare: Donation Station and POP Market 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: x❑ 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) ❑ 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 Health and Nutrition X X X X x Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentoring Transportation Housing Other: Please specify Program/Project Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: b) Summarize the program services proposed and how the program will address the chosen Town/County priority? The Donation Station program addresses the Human Services Priority Area #3: Improving the health and nutrition of needy residents. The Donation Station does this by collecting fresh, local food donated by farmers at farmers markets and bought from those farmers with funds donated by shoppers at the markets and by funds provided by Farmer Foodshare. Each market is paired with an agency of their choice, specifically chosen because the agency serves the most urgent hunger needs and the lowest income populations. The food is delivered the day it is donated for maximum freshness. Main Application 5/25/2016 8:50:30 AM Pag 6 of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION 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. In a state where life bursts through the cracks in the sidewalks, it is appalling that our state has consistently ranked in the top 10 states for citizens experiencing food shortage. One in four children under the age of 18 faces food insecurity. While highly processed foods are cheaper and typically line the shelves of agencies designed to help the hungry, they are shown to lead to higher rates of obesity and obesity related diseases. Farmer Foodshare attacks this problem by helping agencies provide healthy choices, and when desired Farmer Foodshare offers recipes and food demonstrations to help both agencies and the people they deserve enjoy using fresh produce. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. Farmer Foodshare partners with agencies that serve populations in need: children, the elderly, individuals with disabilities or who are food insecure. Agencies are selected in conjunction with the Farmers Market in Orange County with a focus on urgent hunger and persistent need. Diverse groups are intentionally chosen. e) Who specifically will carry out the activities and in what location will they be carried out? Farmer Foodshare orchestrates the efforts of the following markets: Carrboro, Chapel Hill, Eno River, Hillsborough, and Southern Village. Together the Donation Stations and the POP Market partner with: Amigas en Salud, Camp Chestnut Ridge, Central Elementary School families in dire need (as identified by the school social worker), Chapel of the Cross, Charles House, Child Care Services Association of Chapel Hill, Club Nova, Community Nutrition Partnership, Friends of the DSS, Human Rights Center of Carrboro and Chapel Hill, IFC, Meals on Wheels of Chapel Hill, PORCH, and TABLE. Additionally, our programs partner with a community of more than 200 farmers. Donation Stations are run by volunteer under the supervision of our Volunteer Manager, Katy Phillips, who also coordinates efforts of our partner agencies in retrieving donated food and sharing it with clients. f) 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 activities occur weekly whenever the farmers markets are open. g) 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. Donation Stations gather funds and fresh, healthy food each week at each of the following Farmers Markets: • Carrboro, • Chapel Hill, • Eno River, • Hillsborough, • Southern Village Donation Stations and POP Markets provide fresh, healthy food to the following agencies: • Amigas en Salud, • Camp Chestnut Ridge, • Central Elementary School families in dire need (as identified by the school social worker), • Chapel of the Cross, Main Application 5/25/2016 8:50:30 AM Pag , of °f DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION • Charles House, • Child Care Services Association of Chapel Hill, • Club Nova, • Community Nutrition Partnership, • Friends of the DSS, • Human Rights Center of Carrboro and Chapel Hill, • IFC, • Meals on Wheels of Chapel Hill, • PORCH, and • TABLE. h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Less funding results in less healthy produce for each of the above agencies and the people they serve. i) Include any other pertinent information. Farmer Foodshare works collaboratively in all our efforts to end hunger and food insecurity. By working with agencies within the community to distribute fresh produce to their networks of individual in need, we are able to support and enhance existing efforts, while keeping overhead costs low. Additionally, we have regular dialogue with our partners to provide support like recipes and fresh food safety information and help in sourcing the right kinds of produce in the right amounts. When requested, we connect with our partner agencies to provide cooking demonstrations and provide volunteers to help with food prep and packing. We also provide support in purchasing cold storage. Program/Project Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff I) Disclosure of Potential Conflicts of Interested must be signed m) 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 Because we supply goods to agencies,we rely on each agency's report of individual participants. Program: Farmer Foodshare Donation Stations Program Beneficiary Demographics Main Application 5/25/2016 8:50:30 AM Pag of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 9,500 2800 3000 Female 10,318 5100 5300 7900 (Focused on 8300(Focused Orange on Orange County. More County. More 19,818 (This focused with focused with included a increased increased broader educational educational region than services and services and just Orange more food more food Total County) servings) servings) Of the females, how many are single- female Head of Households (Omit for Human Services) Ethnicity African-American 8,918 (45%) 3,318 (42%) 3,486 (42%) American Indian or Alaska Native 213 (2.7%) 224 (2.7%) Asian 237 (3%) 249 (3%) Caucasian 5,350 (27%) 1,580 (20%) 1,660)(20%) Native Hawaiian or other Pacific Islander 79 (1%) 83 (1%) Other 992 (5%) 181.7 (2.3%) 190.9 (2.3%) 5,608 (more 5,893 (more focused on focused on Orange Orange Total 15,260 County) County) Of the above, how many Hispanic/Latino 4,558 (23%) 2,292 (29%) 2,407 (29%) Of the above, how many non- Hispanic/Latino Total 19,818 7,900 8,300 Age 0-5 years 198 958 1006 6-18 years 5250 1561 1640 19-50 years 13079 3423 3596 51-61 years 1187 760 798 62+ years 19,818 7,900 8,300 Total 0 0 0 Geographic Location Durham City x x x Durham County x x x Carrboro x x x Chapel Hill x x x Chapel Hill Public Housing Residents x x x Main Application 5/25/2016 8:50:30 AM pag of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION Orange County x x x Raleigh Wake County Total 0 0 0 Income Level —See following chart (Omit for HS) < 30%Area Median Income 31-50% Area Median Income 51-80% Area Median Income > 80%Area Median Income Total 0 0 0 Special Needs (Omit for HS) Elderly(Over 62) Disabled (not elderly) Homeless People with HIV/Aids Total 0 0 0 Main Application 5/25/2016 8:50:30 AM P 10 of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION CDBG & HOME ONLY- Area Benefit Activities (Infrastructure and Public Facilities) Street Census Tract Block Group Total Persons #LMI Persons 2015 Area Median Family income Limits U.S. Department of Housing & Urban Development (HUD) 2015 Area Median Family Income Limits Effective March 15, 2015 Income 1 2 3 4 5 6 7 8 Level person people people people people people people people 30% AMI $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 50% AMI $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 80% AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 100% AMI $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115% AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www.huduser.ord/portal/datasets/il/ill 5/FY2015 IL nc.pdf Main Application 5/25/2016 8:50:30 AM Pag , 11 of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION k.) Schedule of Positions 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 FTE* Program Actual Estimated Projected %Total Retirement Staff+ 2014-15 2015-16 2016-17 Budget Plan (H) Health Plan Donation Station Program Manager 1 100% 34,000 40,000 43,000 9% Donation Station Intern 2 20% N/A N/A N/A N/A 95% P1 Volunteer Hours 3.25 5% P2 N/A N/A N/A N/A 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 5/25/2016 8:50:30 AM P 12 of 1 DocuSign Envelope ID:AA509FB2-AOC3-456C-9F67-9DDC0879C15B Exhibit A - continued Provider's Outside Agency Application Stated Program Activities Actual Results for Estimated Results Projected Results Evaluation Method Program FY 14-15 for FY 15-16 FY 16017 Goals (Donation Station Each week Donation Stations are $14,188 in donations $ 14,500 in donations $15,000 in donations Weekly records kept at that farmers able to operate spent at Orange spent at Orange spent at Orange donation Station of markets successfully every County farmers County farmers County farmers produce collected and operate week,collecting markets. markets. markets,. purchased with cash ensure that donations of fresh Stations operate at donations. fresh produce produce and spending Stations operated at Stations operated at Orange County is regularly cash donations on Orange County Orange County markets every week Track dollars collected purchased produce at local markets every week markets every week that markets run. and spent with farmers. and collected markets.Specific that markets ran, that markets ran, from local activities pursued: including an added including an added Track pounds of food farmers to mid-week market at mid-week market at donated to agencies.. donate to Appropriate level of the Chapel Hill the Chapel Hill local agencies volunteers are trained Farmers Market. Farmers Market. and recruited by staff and volunteer network Donation Station supplies are well stocked and in good condition Advanced meetings between Market managers and Agency representatives have taken place,and roles and responsibilities agreed upon DocuSign Envelope ID:AA509FB2-AOC3-456C-9F67-9DDC0879C15B Exhibit A - continued Provider's Outside Agency Application Each week With volunteer and Fresh food was Fresh food was Fresh food was Track pounds of fresh ensure that staff coordination,an consistently consistently integrated consistently produce donated to each agencies have agency representative integrated into local into local pantry and integrated into local agency. access to regularly comes to pantry and social social service agency pantry and social healthy,local their local market to service agency distribution,where it service agency Track servings of fresh, food for their pick up fresh food distribution,where it was received by low- distribution,where it healthy food donated to clients donations collected at was received by low- income community was received by low- agencies weekly. the weekly Donation income community members at risk for income community Station.Agency members at risk for hunger through the members at risk for communicates about hunger through the Human Rights Center hunger through the types and quantities of Human Rights Center (51 weeks),TABLE Human Rights Center produce most needed. (51 weeks),TABLE (30 weeks), Homestart (51 weeks),TABLE (30 weeks), (20 weeks),Club Nova (30 weeks), Homestart(20 (51 weeks),Amigas en Homestart(20 weeks),Club Nova (51 Salud (20 weeks), weeks),Club Nova weeks),Amigas en Friends of the DSS (51 (51 weeks),Amigas Salud(20 weeks), weeks) and Central en Salud(20 weeks), Friends of the DSS (51 Elementary families Friends of the DSS weeks) and Central (40 weeks (51 weeks) and Elementary families Central Elementary 40 weeks . families 40 weeks Increase Make produce storage, Cooking demos or Cooking demos or Cooking demos or Create a baseline of capacity of usage,and recipes informational recipes informational recipes informational recipes agency capacity to handle Agency to available to agency and fact sheets were and fact sheets were and fact sheets were fresh food based on handle fresh partners provided for every provided for every provided for every agency surveys.Track produce and Donation Station Donation Station Donation Station need based on anecdotal recipients to Verify that agency has recipient this year. recipient this year. recipient this year. evidence from agencies. use produce. appropriate storage Track information facilities,or help Community Community Community supplied to agencies. agency increase engagement events engagement events engagement events Compare capacity at the storage capacity. and regular check ins and regular check ins and regular check ins beginning and end of the. were put in place to were put in place to were put in place to ensure consistent ensure consistent ensure consistent feedback. feedback feedback DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION 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 5/25/2016 8:50:30 AM Pag , 15 511 * DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application Section III. Program Information Program Budget Worksheet AGENCY NAME: Farmer Foodshare Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 21,978 $ 21,000 $ 25,399 21% Program Generated Revenue (fees) $ - $ - $ - 0 Local Government Grants: Orange County $ 1,000 $ 5,000 $ 5,000 0% Town of Chapel Hill $ 1,000 $ 2,500 $ 2,500 0% Town of Carrboro $ 1,000 $ 1,500 $ 2,500 67% Other Local: 0 Other Local: 0 Other Local: 0 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: Private Foundation $ 25,000 $ 26,000 $ 30,000 15% Other Grants: 0 Miscellaneous/Other Revenue $ 10,000 $ 10,500 5% Please list 3 largest Miscellanous sources: )onsorships and business suppc $ $ 10,000 $ 10,500 Total Program Revenue $ 49,978 $ 66,000 $ 75,899 15% PROGRAM EXPENSES Compensation $ 37,971 $ 48,000 $ 55,959 17% Rent& Utilities $ 1,800 $ 5,000 $ 5,000 0% Supplies &Equipment $ 5,995 $ 7,500 $ 8,630 15% Travel &Training $ 4,212 $ 5,500 $ 6,310 15% Other Expenses: $ - $ - $ - 0 Please list 3 largest"Other Expenses": $ - Total Program Expenses $ 49,978 $ 66,000 $ 75,899 15% SURPLUS/(DEFICIT) FOR PERIOD: $ - I $ - I $ - I 0 FY 2015-16 Program Budget Revised 9/29/2014 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION 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($) Quantity/Unit of Measure Subtotal ($) 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: _Donation Station Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) Personnel $22.30 160 hours per month x 12= 1,920 $43,000 Transportation $0.56 937.7 miles per month $6,310 Program Supplies $12 719 (59 units per month x 12) $8,630 Rent $416.66 416.66 months Rent x12) $5,000 Total C.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $49,978 $66,000 $75,899 Total # of Units Cost Per Unit 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 5/25/2016 8:50:30 AM P of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application MAIN APPLICATION d.) Agency Operating Budget 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. 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 5/25/2016 8:50:30 AM P I of 1 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B t A - continued Provider's Outside Agency Application Section VI. Financial Data Comparative Budget for Entire Agency AGENCY NAME Farmer Foodshare Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 44,545 $ 52,733 $ 72,000 37% Agency Generated Revenue (fees) $ 110,643 $ 152,000 $ 315,000 107% Local Government Grants: Orange County $ 5,000 $ 5,000 $ 5,000 0% Town of Chapel Hill $ 1,000 $ 2,500 $ 2,500 0% Town of Carrboro $ 1,000 $ 1,500 $ 2,500 67% Other Local: $ - $ - 0 Other Local: $ - $ - 0 Other Local: 0 If more than 3 sources, please provide a separate Non-Local Government Grants Triangle United Way $ - $ - $ 20,000 0 State Government $ - $ 25,000 $ - -100% Federal Government $ - $ 9,000 $ 106,000 1078% Other Grants: Foundation grants $ 291,569 $ 332,281 $ 217,875 -34% Other Grants: 0 Miscellaneous/Other Revenue $ 343 $ 1,237 $ 5,342 332% Please list 3 largest Miscellanous sources: Investment Income $ 343 $ 1,237 $ 5,342 Released from Reserves $ - $ 30,000 Total Agency Revenue $ 447,100 $ 581,251 $ 746,217 28% AGENCY EXPENSES Compensation $ 197,767 $ 215,814 $ 324,930 51% Rent& Utilities $ 8,781 $ 17,063 $ 25,290 48% Supplies &Equipment $ 15,767 $ 20,530 $ 53,150 159% Travel &Training $ 10,152 $ 14,500 $ 27,595 90% Other Expenses: $ 214,633 $ 313,344 $ 315,252 1% Please list 3 largest"Other Expenses": Cost of Goods Sold I $ 137,889 $ 185,991 $ 299,142 Contractor Fees $ 15,503 $ 17,052 $ 13,900 retained for future projecll $ 61,241 $ 110,301 $ 2,210 Total Agency Expenses $ 447,100 $ 581,251 $ 746,217 28% SURPLUS/(DEFICIT) FOR PERIOD: $ - I $ - I $ - I 0 FY 2016-17 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Farmer Foodshare Funding Award: $2,500 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Support for managing the Donations Stations in Orange County 2,500 Supplies for Donation Stations 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. • Each week that farmers markets operate ensure that fresh produce is regularly purchased and collected from local farmers to donate to local agencies • Each week ensure that agencies have access to healthy, local food for their clients • Increase capacity of Agency to handle fresh produce and recipients to use produce 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 Donations spent at Orange County farmers markets. Stations operate at Orange County $ 15,000 markets every week that markets run. Number of Meals supplemented with fresh food by Orange County Donation stations 100,000 (using the serving size of pound of fresh food per serving.) DocuSigned by: 7,, Au" 10/25/2016 Certified by: AE195B3E83BE435_ Title: Executive Di rector ate. (Provider's Signature) DocuSign Envelope ID:AA509FB2-A0C3-456C-9F67-9DDC0879C15B AC J CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)5/26/2016 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 Jeff Darling g Cooley and Darling Insurance Agency (A/CNNo,Ext): (703)881-0113 FAX No): (703)659-0029 PO Box 1228 E-MAIL jdarling @cd-insure.com INSURER(S)AFFORDING COVERAGE NAIC# Haymarket VA 20168 INSURER A Alliance of Nonprofits 10023 INSURED INSURER B:Travelers Property Casualty Company 25674 Farmer Foodshare, Inc. INSURER C: P.O. Box 2873 INSURERD: INSURER E: Chapel Hill NC 27515 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1512205744 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) $ 500,000 X 2015-34971 12/1/2015 12/1/2016 MED EXP(Any one person) $ 20,000 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: Add'I for policy minimum $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS 2015-34971 12/1/2015 12/1/2016 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A B (Mandatory in NH) UB2E891975-16 5/29/2016 5/29/2017 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is included as additional insured as their interests may appear, but only with respect to claims arising out of the operations of the named insured and only per the terms, conditions and exclusions of the policies as issued. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Chapel Hill THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 405 Martin Luther King Jr Blvd ACCORDANCE WITH THE POLICY PROVISIONS. Chapel Hill, NC 27514 AUTHORIZED REPRESENTATIVE Andy Cooley/TREAD ©1988-2014 ACORDDCORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nmam i