Loading...
HomeMy WebLinkAbout2016-574 Finance - Orange County Living Wage - Outside Agency Performance Agreement 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 Orange County Living Wage, a not-for-profit corporation, located at 218 Lake Manor Road,Chapel Hill,NC 0("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 Orange County Living Wage 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 16750. 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$4,188. 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. (Orange County Living Wage) Orange County Outside Agency Performance Agreement Revised 812016 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. (0� Orange County Outside Agency Performance Agreement Rev. 8116 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. Orange County Outside Agency Performance Agreement Rev. 8116 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 Orange County Living Wage 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: �`b�'rxng+�:;�du�sty�tv�ttg ag Orange County Outside Agency Performance Agreement Rev. 8116 County: Finance&Administrative Services Provider: Orange County Living Wage Orange County 218 Lake Manor Road Post Office Box 8181 Chapel Hill,NC 0 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'�nd on behqr1f of the Provider Date o For and bel if nge County Government Bonnie Hammersley,County Manager Date at'ttrrge �� ' Orange County Outside Agency Performance Agreement Rev. 8116 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. Certified by: X 't VP(-7 v Date: P (Provider's Signature) 1 _ +ax� ±ltug ig Orange County Outside Agency Performance Agreement Rev. 8116 EXHIBIT A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Orange County Living Wage Date/Time / { Complete Y/t Program{s} Living Wage Certification Program Section Subsection For CDBG & HOME Regulations HUD 1. Cover Page a. **D Applicant Contact Information b. *' ProjecVPrograrn Contact Information c. **Q Funding Requests identified d. **[ Signed Application Cover Page 2. Agency a. **Q Agency's Years in operation 24 CFR 570.506, Information b. **Q Agency's Purposelmission 570.507, 570.510; 24 c. ***Q Agency's Types of Services Provided CFR Parts 84 or 85 d. *D Agency's Experience e. **El Other Pertinent Information 3. Program/ a. *"El Type of Application and Program Identified 24 CFR 570.200(a), Project b. *" ] Summary of Program 570.201-5701. 208, Information- c. ** Description of Identified Need 507.503 (for each d. **El Description of Population to be Served program/ e. **[] Activity Manager and Location Description project for which funding f. Activity Implementation Timeline which g• *" Agency Collaboration h. * Describe Impact of Reduced/No Allocation i. n Other Pertinent Information j. Complete Target Population/Beneficiary Chart k. **Q Complete Schedule of Positions I. Signed Conflict of Interest Disclosure m. "' Complete Work Statement EXHIBIT A- continued Provider's Outside Agency Application MAIN APPLICATION 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Orange County Living Wage Applicant Organization's Physical Address: 218 Lake Manor Rd., Chapel Hill, NC 27516-4321 Applicant Organization's Mailing Address: PO Box 1502, Carrboro, NC 27510-1502 Applicant Organization's Web Address: httpl lwww.orangecountylivingwage.org/ Executive Director Susan Romaine(Steering Committee and Board of Directors Chair) Telephone Number. 919-619-3408 E-Mail: susansmmaine @gmail.com DUNS Number. 942152575 (Dun& Bradstreet, Inc. provides this number at no charge,and it is required for Federal funding recipients.) b) Proiect/Prooram Contact Information Project/Program Name: Orange County Living Wage Certification Program Project/Program Primary Contact and Title: Susan Romain, Chair, Steering Committee and Board of Directors Telephone Number. 919-619-3408 E-Mail: susanromain @gmaii.com c) Funding Request Identification Total Project/Pmgram Cost: $24,850 Total Amount of Funds Requested: $16,750 Proposed Use of Funds Requested(2-3 Line Maximum): The funds will be used to hire a half-time administrative assistant to coordinate the major activities of the organization, thereby making possible the attainment of the goals specified for 2016-17 in section 3(m)of this application. Please check all types,sources, and amounts of funding being requested. You must submit an application package for each funding source. *The Participating Jurisdiction deserves 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) $ ❑Grant ❑ Loan ❑ HOME Other(OC) $ ❑Grant ❑ Loan "❑ Human Services: ❑ Carrboro$ []Chapel Hill$ "❑ Orange County 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. 6Aftin Ar%nlinftNnn 4mr%i,)nia 44.4x1.77 AAA D ., n n o f 7 7 EXHIBIT 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, Date of Incorporation(MonMear) The first meeting of the steering committee was May 2,2015, so we have existed for about 9 months. The date of incorporation is July 20, 2015. We did not begin certification contacts or financial exchanges until after June 30,2015,so we show no goals or budget figures for 2014-15. b) Agency's Purpose/Mission Orange County Living Wage is a non-profit 501c3 organization that is focused on promoting a living wage In Orange County,North Carolina. Through our employer certification program,we certify Orange County employers that pay their employees a living wage. The certification is voluntary on the part of employers. Our goals are to: • Reward and recognize employers based in Orange County who pay their workers a living wage; • Provide employers with incentives to pay a living wage;and • Connect consumers to employers that provide a living wage and encourage them to become customers,patients,and clients of those businesses and organizations. C) Types of Services the Agency Provides A member of our certification team meets with each business owner who wishes to apply for certification. An application is completed at this meeting or can be submitted through our website before the meeting. The certification team determines whether our criteria for certification are met. If so,the business/organization Is certified and receives materials including a decal that can be displayed at the work site Indicating certification. Other materials Include a certificate, a poster describing the program and a car magnet to publicize the program. Our website provides an anonymous avenue for employees to inform our certification team if they question whether their wages meet the criteria. Once certified, owners can advertise their certified status in their promotions on their social media,websites and other outreach efforts. Orange County Living Wage will display businesses that have become certified on our website and in our social media communications. We will engage in periodic outreach promotions to make the public of Orange County aware of our organization,businesses that are certified and the Importance of a living wage for all employees. d) Agency's Experience with Similar Programs as the Funding Request We have been certifying employers and carrying out our functions since mid-summer 2015. To this point our work has been done solely by volunteers.Fortunately,we have not had to start from scratch in implementing this program. It is modeled on a program in Asheville that was founded seven years ago and has certified around 500 employers and one in Durham that has operated for about a year. e) Other Pertinent Agency Information We are happy that Orange County government Is one of the 46 organizations that have become certified as living wage employers. Adding a paid staff member to coordinate efforts is necessary for us to significantly increase the impact our program has on the community and to insure the sustainability of the organization. KAoin AnnRrn 2+inn 9/9Rmniit 91•'311.77 ARA D n ., .. C .. F 7 7 EXHIBIT A - continued Provider's Outside Agency Application MAIN APPLICATION covered, the threshold for certification is $11.25. If a business's eligibility depends on employees' tips, commissions or other payments that vary, a member of the certification team interviews a sample of employees. If the criteria are met, the business/organization is certified and receives materials induding a decal that can be displayed at the work site indicating certification. Other materials include a certificate,a poster describing the program and a car magnet to publicize the program. Our website provides an anonymous avenue for employees to inform our certification team if they question whether their wages meet the criteria. Once certified, owners can advertise their certified status in their promotions on their social media, websites and other outreach efforts. Orange County Living Wage will display businesses that have become certified on our website and in our social media communications. We will engage in periodic outreach promotions to make the public of Orange County aware of businesses that have been certified,the work of our organization and the importance of a living wage for all employees. For example,we plan to hold several "buy-cots"In which we encourage the public to use a particular certified business on a designated day. The work of Orange County Living Wage addresses Orange County's emphasis on affordable housing, as described in the Consolidated Plan for 2015-2020. Increasing the wages of employees expands the housing options they can afford for themselves and their families. Increased wages are likely to enable some employees to spend their housing funds within Orange County rather than having to go outside the county to find housing that is affordable for them. c) Describe the local need or problem to be addressed in relation to the Consolidated Plan or other community priorities (i.e. CounciUBoard Goals). Cite local data to support the need for this program and the population being served. Nearly 40 percent of workers in Orange County earn less than a living wage. If these workers'wages were brought up to the Orange County living Wage standard,they would be lifted out of poverty. Not only would these individuals be better able to provide for themselves,their children and other dependents,the overall economy in the county would benefit substantially. Research has shown that low wage employees spend much of what they earn. Every dollar going to a low wage employee adds$1.21 to the local economy. A substantial number of employees are unable to afford to live in Orange County and have to commute from neighboring areas where housing is more affordable. A Chamber of Commerce survey revealed that 41 percent of employees in the county commute from outside locations. Only 12 percent of employees of the town of Chapel Hill live in Chapel HIII/Carrboro zip codes. Only 46 percent of Chapel Hill-Carrboro school employees live in the city. Of UNC-Chapel Hill employees,49 percent live in the county,and only 18 percent of UNC Health Care employees live In Chapel Hill zip codes. If the wages of some workers are raised so that their employers can become certified by Orange County Living Wage,more will be able to afford housing in the county and thereby funnel more of their pay checks into the county economy. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. County employers who pay their employees a living wage will benefit from being publicly recognized. Hopefully,this publicity will encourage employers who do not meet our criteria to re-examine their business plans and work out a way to raise their wages. Employees of certified businesses will benefit,particularly if the employer raised wages in order to qualify for certification.Through December 2015,Orange County Living Wage had certified 46 employers with a total of 4,028 employees. Of these employees, 142 received pay raises so that the employer would qualify;the annual total of these raises is$276,240. A notable example of an employer raising wages in order to qualify for certification is Carol Woods Retirement Community. This organization raised the wages of 58 of their 335 employees by a total of$220,000. RA•ain Anniirno+inn 1/1,011 IA 11.4f1.77 ARA EXHIBIT A - continued Provider's Outside Agency Application MAIN APPLICATION not be able to increase our contacts with businesses or certifications over our current level. Our other goals would be equally suppressed. If a reduced allocation is made,we would be able to increase our services proportionate to the percent of our request that is granted. 1) Include any other pertinent information. ProaramlProlect Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff 1) 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 Note: We do not collect information on individual employees. We are following the practice of other certification programs that have been our models,including those in Durham and Asheville. Therefore,we are unable to address most of the categories in the table. We consider only employees who are eighteen years of age or older. We make an effort to target businesses in low-paying industries,so many of the employees of certified businesses fall into the<30 percent of area median income. All of the businesses/organizations are In Orange County and all of the employees work in the county. Please indicate whether this project/program will serve: **❑ Persons **❑ Households **❑ Units Program: Orange County Living Wage Program Program Ban ficlary Derriographim Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male Female Total 0 8,000 12,000 Of the females, how many are single- female Head of Households(Omit for Human Services) Ethnicity African-American American Indian or Alaska Native Asian Caucasian 11A.sin Annlinalinn 1MRnnir% 41.1!1.77 ARA D _ _ ^ O _ f 7 7 EXHIBIT A - continued Provider's Outside Agency Application MAIN APPLICATION CDBG&HOME ONLY- Area Benefit ActivMes 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) 2095 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 httD://www.huduser.ora/Doii Udetasetef1Ui115tFY2015 IL nc.rrdt AAoin Annlin•2+inn i mat is 11-,an-)7 AAA D ., .. ., 4 ..F 7 7 EXHIBIT A - continued Provider's Outside Agency Application MAIN APPLICATION 1.) 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 **❑ a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? See comment below. c) Current beneficiaries of the project/program for which funds are requested? 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, One board member who is on the certification team currently serves on the Orange County Housing Authority and is running for a seat on the Orange County Commissioners. These roles would not appear to present a conflict of interest in regard to the work of Orange County Living Wage or our application for this grant. If elected,he would not take office before decisions about the grant are made. if decisions about funding our organization were made in later years and he is on the board of commissioners, he would need to decide whether to recuse himself. 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. ;Z Signature: Chair of Bp of Direc Steering Committee Date Signature: IX 1-116 Vice Chair of Board of Directors Date 7 AAr;n 11-Zn-07 AKA EXHIBIT A - continued Provider's Outside Agency Application MAIN APPLICATION • Actual Program Results use program results to indicate the actual measureable achievement of goals. if goals were not met, please explain. hA-ain AnnUr-mNnn 1MR/7n1R 44-%n•77 ARA D a n n A A o f 7 7 EXHIBIT 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. RA�in Annlin7+inn 4/4win1R 11.4/1.77 ARA EXHIBIT A - continued Provider's Outside Agency Application MAIM APPI-IC ATION b.j Program Budget Detail What is the cast 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 Counselin Class Cost Elements Cost(s) QuantttylUnffi of Measure Subtotal($) Credit Counseling Teacher–in class $25 96 hours (8 hrslmth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours(4hrslmth x 12 mths) $1,200 Credit Counselor--one-on-one $20 120 hours(10 hrslmth x 12 mths $2,400 Materials $25 120 course packetslcredit reports $3,000 Total $9,000 Complete-the-table below for thep pLe ct/pra ram for which yqp are reguestinq funds. Attach additional rows/ es as needed. Program: Orange County Living Wage certification Program Cast Elements _ cash} N Quanti IUnft of measure S+ubtb�l{ Produce/maintain website $1,400 $1,000 design; 400 hest fees 1,400 Produce&refine video 500 500 Deve eebrochures & publicity tools 700 700 Certification materials€or em Lgyers 400 400 Develop fundraising materials 1,000 1,000 Postage for publicity_&correspondence 100 100 Accounting services 500 500 Legal services 3,000 3,000 Half-time Administrative Assistant $15 per hour X 1000 hrs $15,000 16,750 c.} Cost per Unit Soc Sec/Medicare = 1,150 Payroll prep/background 600 Unit=employes in certified businesses/organizations TOTAL $24,850 Actual 2014-: Estitmated 2015- Projected 2016--- 15 16 17 Total Cost of Pro ram $7,210 $24,850 Total # of Units 8.000 12,000 Cost Per Unit $.90 $2.07 AA-#;n t1 4 141;1'11119 1 1-?rl•'77 AAA r EXHIBIT A - continued Provider's Outside Agency Application MAIN APPI ICATION 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. 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. w A�s'r. 414C210n40 4 4.9n•77 AAA D n r n 7 4 o f 7 7 EXHIBIT"B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Orange County Living Wage Program Name: Funding Award: $16,750 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel—Salaries 16,750 Programmatic Expenses 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. • Contact businesses and organizations through personal contacts,promotional activities and media outreach and encourage employers to apply for certification. • Certfication team member visit the employer and discusses the Living Wage application and determines whether the appropriate criteria is met. 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 Contact organization for Living Wage certification 285 organizations Certify organizations for paying a Living Wage 135 organizations Utilize Social Media to reach employers and address living wage issues 1,000 people Certified by: r Title: it',9Gufi V-0 D- a cl,y Date: to —Z > (Provider's Signature) t w. o v., 4 IQ. ORANGE COUNTY UYING WAGE January 28,2016 Dar Orange County Government Representatives, We have reviewed the liability insurance requirement in Orange County's Outside Agency FY 2016-17 funding application and believe Orange County Living Wago to be exempt from the liability insurance requirement. Please feel free to contact us if you have any questions. Sincerely, p) Susan Romaine Executive Director,Orange County Living Wage s u. smamin.QP-gmnil-com. Annie Sullivan Law Fh=of Annie L Sullivan 919.636.1687 alslaw0bellsouth Rej