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2016-596-E Finance - El Centro Hispano, Inc. - Outside Agency Performance Agreement
DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 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 El Centro Hispano, Inc., a not-for-profit corporation, located at 2000 Chapel Hill Road, Suite 26A, Durham,NC 27707 ("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 El Centro Hispano, Inc. agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2016 to June 30, 2017. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit"A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of 28810. 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 $7,203. 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. (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 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. (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 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. (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 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 El Centro Hispano, Inc.provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 County: Finance&Administrative Services Provider: El Centro Hispano, Inc. Orange County 2000 Chapel Hill Road, Suite 26A Post Office Box 8181 Durham,NC 27707 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 o r€2, , ',4 be Provider a4ti go -gati 10/26/2016 226DDB39C1744D1... Date E For and � 'vOrange County Government 156lA tit, tka"mt-I'Stt,t1 10/31/2016 O63Z924B75SF477-- Bonnie Hammersley, County Manager Date (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 ATTACHMENT "A" Orange County Certifications—FY 2016-17 Outside Agency Performance Agreement Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title,residential address;phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name, physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DocuSigned by: goe44-qatitoi President&CEO 10/26/2016 Certified by: 22SRFlR39C17441T1 Title: Date: (Provider's Signature) (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 000vSign Envelope ID:0eoour84-5EC0-4orr'e4F6-r480A1C3Ae13 =xhibit /\ Provider's Outside Agency Application MAIN APPLICATION —'-- - — -- 1. COVER PAGE (Each program uires a separate app lication.) _-� a) Applicant Contact Information Applicant Organization's Legal Name: El Centro Hiapano. Inc Applicant Organization's Physical Address: 600 E, Main Street, Durham, NC 27701 Applicant Organizations Mailing Address: same as above Applicant Organization's Web Address: www.elcentconcorcJ Executive Director. pUarRoohaGoldberg Telephone Number:_1S19> 687'4035Ext. 43 E-Mail: proohmAe|cenhono.opq DUNS Number: 159206015 (Dun & Bradstreet, Inc. provides this number at no charge and it is required for Federal funding recipients.) b) Proect1Proqram Contact Information Project/Program Name: Center for Employment& Leadership Development Project/Program Primary Contact and Title: |dbeKl. PreeidenUCEQ Telephone Nomber1S19) 0G7'4835 Ext. 43 E'K8mi|: Qrocha@ nc�&rg c) Funding Request Identification � Tota Project/Program Cost: $$211,338 Total Amount of Funds Requested: $25.040 / Proposed Use of Funds Requested (2-3 Line Maximum): Requesting funds to support activities through the Center for Employment and Leadership focused on outreach to workers/employers, ( kfo i i l b ■i � small and worker uuppodservices public workforce or r�et[on n� o � �oemen . ` Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source *The Participating Jurisdictknnmroeo/eahhe right to fund projects from any funding oouo;e. oubkpc/ tmeliA/bJJvandfon/ingconntrai/ts. CDBG Non-Construction (CH) $ Grant E Loan CDF3G Construction (CH) $ |lGrant EI Loan HOME CHDD ((}C) $ �� Grant Loan El HOK8E Other({}{�) $ | Grant �] Loan EM ` ' X Human Services: x Carrboro $ 5,000 x Chapel Hill $L,500 x Orange County $12.54O 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 t app Ucon. Signature: W/ fiLW P-C)cLS 0( fc f( °= ' Director -~ Date Signature: 0 0 ( /2-.5 /J, Board Chairperson _ _ Date P 3 Q � 3 Main Application 1/25/2016 12:33:55 PM age DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 i /\ - continued Provider's Outside Agency Application MAIN APPLICATION • 1. COVER PAGE (Each program reqmires a separate application.) i - - - ---' - -- a) Applicant Contact Information App'icant Organization's Legal Name: B Centro Hispano. Inc Applicant Organization's Physical Address: 600 E. Main Gtroet, Durham, NC 27701 AppUcant Organizton's Mailing Address: same a above AppHcant Organization's Web Address: wwweIcentronc.or Executive Director: Pilar Rocha Goldberg Telephone Number: (919) 687-4635 Ext. 43 E'K8oU: proCh8e|uentroncorq DUNS Number 150206015 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) ProiectlProqram Contact Information Project/Program Name: Community Services & Support Project/Program Primary Contact and Title: F8@rRooha'Go|dberO. President CE(} Telephone Number: 018> 087'4035 Ext. 43 E'&4ei|: proohme|oentnono.org c) Funding Request Identification Total Project/Program Cost $185.491 Total Amount of Funds Requested: $25^040 Proposed Use of Funds Requested (2-3 Line Maximum): Requesting funds to support provision of community services for Latino individuals and families in Orange County and its municipalities. Services include information, referral and support services, Jeqal assistance, community education & outreach, citizenship classes, and linkage to area resources. Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source *Th Parlicipating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. —� CDBGNnn'Cunatruct|on (CH> $ Grant Loan . . CDBG Construction (CH) [71 Grant El Loan E HOME CHDO (OC) Grant El Loan |l HOME Other � r Grant _] Loan _~ (00) X Human Services: x Carrboro $5,000 x Chapel Hill $7 500 x Orange County $12.54O 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: ki e« av ~ / / f �� �«z i Di Date Signature: Of 2.5 /(0/ Board Chairperson Date Main Application 1/2512016 12:35:53 PM Page 3 of 3 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 A - continued Provider's Oaf : Agato Ai ■-tion 1. COVER PAGE (Each program requires a separate application.) a) A. slicant Contact Information Applicant Organization's Legal Name: El Centro Hispano, Inc Applicant Organization's Physical Address: 600 E. Main Street, Durham, NC 27701 Applicant Organization's Mailing Address: same as above Applicant Organization's Web Address: www.elcentrono.org Executive Director: Filar Rocha Goldberg Telephone Number: (919) 687-4635 Ext, 43 E-Mail. prochaP,elcentronc.org DUNS Number: 159206015 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) Project/Program Contact Information Project/Program Name: Education Initiatives Project/Program Primary Contact and Title: Pilar Rocha-Goldberg, President/CEO Telephone Number:_(919) 687-4635 Ext. 43 E-Mail: prochaelcentronc.org c) Funding Request Identification Total Project/Program Cost: $97865 Total Amount of Funds Requested: $25,040 Proposed Use of Funds Requested (2-3 Line Maximum): Requesting funds to support education initiatives for children, youth, and adults in Carrboro-Chapel Hill and surrounding areas. Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source. *The Participating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. Li CDBG Non-Construction (CH) $ Grant Loan CDBG Construction (CH) Grant El Loan HOME CHDO (00) E Grant Loan HOME Other (0C) E Grant Loan p 12 ir,):1C X Human Services: x Carrboro $5,000 x Chapel Hill $7500 x 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. CC3611?I'Q( & 'q of Signature: Execu Eirector Date Signature: , r Board Chairperson Date Main Application 1/25/2016 12:37:11 PM Page 3 of 3 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION Section VI. Financial Data Operating Budget for Entire Agency AGENCY NAME: El Centro Hispano, Inc Actual Estimated Projected ' Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Chan.e Private Donations $ 17,168 $ 20,300 $ 20,625 2% Agency Generated Revenue(fees) $ 149,374 $ 234,656 $ 234,656 0% Local Government Grants: Orange County $ 15,000 $ 20,000 $ 37,620 88% Town of Chapel Hill $ 6,500 $ 15,000 $ 15,000 0% Town of Carrboro $ 14,000 $ 9,500 $ 15,000 58% Town of Carrboro-Outreach $ 36,970 $ 36,970 $ 36,970 Other Local: Orange Co ABC Board $ 6,651 $ 15,000 $ 15,000 0% Other Local: Durham County $ 29,421 $ 29,421 $ 29,421 0% Other Local: Durham ABC $ 20,000 $ 20,000 $ 20,000 0% If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way -- 0 State Government $ 72,456 $ 40,000 $ 40,000 0% Federal Government --- 0 Other Grants:Foundations $ 99,960 $ 107,502 $ 107,502 0% Other Grants:Non-Profit Grants $ 188,689 $ 202,772 $ 179,652 -11% Miscellaneous/Other Revenue $ 66,352 $ 160,325 $ 160,000 0% Please list 3 largest Miscellanous sources: Revenue from Programs $ 44,135.00 Other Income $ 22,217.00 $ Total Agency Revenue $ 911 446 IMI 0% AGENCY EXPENSES Compensation $ 353,738 $ 474,807 $ 474,807 0% Rent&Utilities $ 124,791 $ 117,762 MN 0% Supplies&Equipment $ 6,860 $ 10,020 $ 10,020 0% Travel&Training $ 15,850 $ 15,850 $ 15,850 0% Other Expenses: $ 316,785 $ 293,007 $ 293,007 0% Please list 3 largest"Other Expenses": Contracted Services $ 190,225.00 Program Expenses $ 115,495.00 Dues,fees,etc $ 11,065.00 Total Agency Expenses $ 818 024 $ 911 446 $ 911 446 0% SURPLUS/(DEFICIT)FOR PERIOD: 1$ (95,483)l$ - I$ - I 01 Main Application 2/3/2016 10:21:53 AM DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 i /\ - continued Provider's Outside Agency Application MAIN APPLICATION [\ DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO x a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? Fl x b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? x Current beneficiaries of the project/program for which funds are requested? . | x d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the project ineligible but the existence of '~^ funding, an undisclosed conflict may result in the termination of any grant awarded. Signature: ac4e_to 9 67 6o_c2c~uR 0 / / c / / , Executive Director Date / //&Signature: 0 / /��s Board Chairperson Date / Main Application 1/35/2016 2:29:32 PM Page 8 o f 9 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 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, Date of Incorporation (Month/Year) El Centro Hispano, Inc (ECH) is the largest Latino-led/Latino-serving organization in the State and has been working with and on behalf of the Hispanic/Latino community in Durham, Orange, and neighboring counties since 1992 in an effort to provide representation, address issues affecting the lives of Hispanics/Latinos, link individuals and families to area resources, and to build community capacity for inclusion, integration, and engagement. In July 2010, ECH opened a satellite office in Carrboro-Chapel Hill in Orange County at the request of county leaders to fill the gap in services for the large Latino population in the area. In January 2014, ECH relocated its Carrboro-Chapel Hill office to the 201 W. Weaver Street location to be more centrally located and in April 2015, it officially opened the Center for Leadership and Employment(CEL) to address concerns with domestic and day laborers in the area. ECH has two locations, one in the City of Durham, Durham County and the other in the Town of Carrboro, Orange County. b) Agency's Purpose/Mission El Centro Hispano, Inc works to strengthen the community, build bridges, and serve as advocates for equity and inclusion of Hispanics /Latinos in the Triangle area of North Carolina. The Triangle Area encompasses cities and towns with Durham, Orange, and neighboring counties. We achieve these purposes by making advancements in Education, Economic Development, and Health and Well-being. c) Types of Services the Agency Provides Education interventions include 1) Academic focused programs such as Pre-K prep, K-12 Tutoring, Adult Literacy and ESOL, Adult Elementary Education, and Job skills Training, and 2) Community Education/Engagement efforts such as information &referral services, community forums, citizenship classes, immigration counseling & legal assistance, and youth/adult leadership programs. Economic Development initiatives are under the leadership of our Center for Employment and Leadership located in Carrboro (CEL). The center helps connect job seekers with employment, particularly that of day laborers. It also works on worker rights, work protection/worksite safety, and/or financial literacy through trainings,job placement services, community outreach, and community organizing. Main Application 5/24/2016 4:42:59 PM P I of 2 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION Our Health & Wellbeing programs focus on health promotion and access to healthcare/health insurance through outreach, community education, health screenings, linkages to health services, and training of agencies/organizations. Health promotion focuses on building healthy behaviors and linking to services. This is achieved by working through peer educators/health ambassadors. d) Agency's Experience with Similar Programs as the Funding Request The organization has been providing education, outreach, direct support, and human services referrals since its inception and has partnered with community and government organizations to provide services that benefit the community in general,particularly to address community needs. e) Other Pertinent Agency Information While the primary population served are individuals of Hispanic/Latino origins across the life span and the individuals/entities that seek to reach, work with, and serve this population, the organization also serves other racial, ethnic, and gender minorities, new immigrants, and low- income/poor communities. Our Carrboro-Chapel Hill Office, in particular, has experienced an increase of individuals of different ethnic/cultural/socio-economic backgrounds seeking assistance, such as African Americans, Asians, homeless individuals, and displaced workers. All initiatives work to improve outcomes for community members but also to inform service and policy improvements of institutions serving the population. The organization and staff is grounded in the language and culture of the Hispanic/Latino community being served and strives to serve as a bridge and cultural broker. It works with other community groups to serve other ethnic minorities with limited English proficiency and/or of low socio-economic backgrounds. Main Application 5/24/2016 4:42:59 PM P , 2 of 2 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Center for Employment and Leadership 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 Job Training x x Sports and Arts Activities Pre-School Activities After-School Activities Mentoring Transportation Housing Other: Please specify: Job Placement, Public safety, x x Community Education & Outreach 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 Center for Employment and Leadership opened doors April 2015 in response to a need identified by the Day Laborer Task Force in Carrboro-Chapel Hill to develop a Workers' Center to 1) provide a safe and comfortable space for workers of all races/ethnicities to seek work with dignity; 2) connect workers and employers; 3) empower workers to access local services, develop Main Application 5/24/2016 4:43:09 PM Pag I of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION new employment skills, and learn about occupational safety and labor rights; 4) strengthen social relationships among community members by easing tensions with neighborhoods surrounding the current informal hiring location on Jones Ferry Road and Davie Road in Carrboro; and 5) improve the quality of life of low-wage workers and promote social equality and inclusive economic growth in Carrboro, Chapel Hill and surrounding areas in Orange County. 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. This project aligns with the goals and objectives of the Economic Development Priority of the Consolidated Plan to increase employment, self-sufficiency, education, job training, technical assistance, and economic empowerment of low and moderate income residents in the County and addresses the Jobs and Jobs Training and Community Engagement priorities of the 2012 Human Services Report. Furthermore, it addresses a need identified by community members. Between 1995 and 2005, the number of Hispanic/Latino workers in North Carolina increased 431%, which accounted for 35% of the state's total workforce.1 By the end of 2005, three out of four Latinos residing in North Carolina were employed in construction, wholesale, manufacturing, and the retail industries.2 Given the dramatic growth of Latinos residing in North Carolina over the years and unstable economies, men were gathering daily at the corner of Jones Ferry Road and Davie Road in Carrboro to obtain work. The majority of the workers gathering at the Carrboro site are from Mexico, Guatemala, Honduras and El Salvador; however, Caucasian and African American day laborers also frequent the site. While Orange County was holding its own with a 3.5% unemployment rate, there was a upsurge in that rate, 4.20%, toward the end of 2015. This site has become an informal Day Laborer hiring site (also known as "the corner"). People who stand there are sought out to do work in construction, landscaping, painting, housekeeping, food, moving and service industries in Carrboro, Chapel Hill and other areas throughout Orange County and the Triangle. Some workers reported being victimized by presumed employers; others were promised a day's wage that was never paid; others were paid less than promised, and so on. In addition, neighbors and police have cited problems at the corner such as littering and public consumption of alcohol at the site, which led to a 2007 town ordinance prohibiting loitering at the site between 11 am and 5 am; limiting opportunities to get work for the day. Surveys conducted by outreach workers gathered information from day laborers about their employment needs and they cited need of a safe place to go to connect with employment, further education, job training, information and assistance with worker rights, health insurance, and more. Other issues affecting day laborers that the center will address include lack of opportunities to access local resources and need for a collective voice. Kasarda, J. D., &Johnson, J. H. (2006). The Economic Impact of the Hispanic Population on the State of North Carolina. Chapel HiII, NC: Frank Hawkins Kenan Institute of Private Enterprise. 2 Ibid. Main Application 5/24/2016 4:43:09 PM Pag , 2 of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. ECH's Center for Employment and Leadership serves primarily Hispanic/Latino residents in Orange County and surrounding areas as well as those seeking to work with, reach, and/or serve this population. Day laborers are the primary beneficiaries of this intervention in that they can secure employment and fair wage through services. Staff serve as mediators and advocates for the workers before employers. Employers that seek workers through CEL are also beneficiaries of the program in that they have a place to connect with skilled workers. Staff ensure workers understand the job to be done, proper worksite safety precautions, and/or all labor related agreements. The general community also benefit in that there is a reduction of individuals loitering at "the corner" contributing to public safety and community appeal. Also, residents of Orange County are also seeking workers from CEL to do small jobs for their homes which present another source of employment for the Day laborers and affordable services for Home owners. Staff connect with day laborers and potential employers through outreach efforts to the corner, neighborhood canvassing, presentations to community groups, social media, and word of mouth. e) Who specifically will carry out the activities and in what location will they be carried out? All activities will be carried out by staff of El Center Hispano who operate the Center of Employment and Leadership located within the Carrboro-Chapel Hill office as well as the partner agencies that collaborate on this project; particularly those on the Day Laborers Task Force. Staff includes a Program Coordinator, Worker's Project Leader, Community Organizer/Outreach Workers, AmeriCrops/Interns, and volunteers. The Program Coordinator is primarily responsible for all Program related interventions and outcomes, coordination of activities, and supervision of staff. Worker's Project Leader is the in-office staff responsible for workers intake, job placement, job training, employer communications, worker support, and all other activities related to the assuring improvements and deliverable for the workers. The Community Organizer/Outreach is the in-the- field staff person that goes out to the corner and other areas to conduct outreach to workers, provide information on CEL, worker rights, worker protection, worksite safety and mobilizes worker to address issues affecting day laborers; building community leaders. This staff person also conducts outreach and presentation to potential employers and other partner agencies. This year will recruit an AmeriCorp volunteer, interns, and additional volunteers to assist with the project. Additional staff like the President/CEO, Financial Director, Human Resources Directors, Grant Officer, and Community Engagement Director assist with supporting different administrative components of the grant as well as participate in meetings related to the project. 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 will be conducted daily through the 2016 — 2017 fiscal year during the hours the center is open from 6am to 2pm in the afternoon. Outreach occurs throughout the day, evenings, and weekend hours. 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. Main Application 5/24/2016 4:43:09 PM Pag , 3 of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION • Chapel Hill-Carrboro Chamber of Commerce: ECH is a member of the Chapel Hill-Carrboro Chamber of Commerce and participates in the Carrboro Day Laborer Task Force. • Day Laborer Task Force: ECH is very active in the Carrboro Day Laborer Task force, which includes representatives from the Carrboro Mayor's office, the Chapel Hill-Carrboro Chamber of Commerce, Justice United, Carrboro Day Laborers, the Human Rights Center and El Centro Hispano. ECH has hired an Outreach Worker with funds from the Town of Carrboro to work as a liaison between all of these groups and to help develop a Worker's Center for Carrboro Day Laborers and domestic workers. • El Futuro, Inc.: Accepts referrals for mental health and substance abuse treatment from ECH. • Human Rights Center: Through the Carrboro Day Laborer Task Force, ECH partners with the Human Rights Center to develop initiatives for Carrboro day laborers. In addition, the Human Rights Center will be using ECH's space to operate some of its community programs during its transition to a new location. • Immigrant Rights Project: Help hold immigration related forums, especially those related to DACA applications and learning about their legal rights when faced with deportation or other immigration-related questions. • National Day Laborer Organizing Network— ECH has joined this network which has at least 30 centers nationwide and helps identify funding options and engage workers in the process of establishing a Workers' Center. • El Centro Hispano (ECH) continued our partnership with Humans Rights Center, lending our office space to host their programs. • ECH collaborated with a group of fellows from UNC Public Health to provide a series of workshops in health and safety to Day Laborers. • ECH staff attended workshops in California to develop and gather useful information for the Workers Center through NDLON. • Partnership with Community Church of Chapel Hill to distribute information about our programs and recruit volunteers, they also helped out with a fundraising event hold at the church for the construction of the Workers Center within the ECH building. • ECH Carrboro staff member Natalia Lenis received recognition of WCHL as a Hometown Hero for the hard work in the community. • Partnership with OWASA to develop a video and new brochure for the Latino community and for those who can't read and write. • New partnership with Durham Tech to create special ESL curriculum for Day Laborers. • Informative session with the community for Deferred Action for Parental Accountability (We had an attendance of 42 community members). • Collaboration with the Health Department project to detect the communities and zones at risk, due that we are the only Latino agency in the area we are participating providing information for the 6 zones. • ECH Developed a relationship with the Home Builder's Association to collaborate with CEL h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Main Application 5/24/2016 4:43:09 PM Pag 41 of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION It would impact our ability to provide services and meet all program components i) Include any other pertinent information. Since it first opened its doors in April 2015, CEL has served a diverse group of individuals from all cultural and socio-economic backgrounds. While originally, it was meant to reach and work with Latino Day Laborers, it is serving all individuals that are seeking employment. In particular, CEL is seeing an increasing number of homeless people seeking assistance and there is a need to connect them with human service and mental health services already available through the county. Staff has reported many success stories regarding workers who have been able to acquire and sustain employment in a more regular basis and who report wages are being paid as agreed upon. Three such examples are the following: • Two workers that arrived from Texas saw the CEL sign as they walked on the street toward "the corner". They asked what the organization was about and staff informed them of services. They were able to assist them that day with information about local shelters. They continued going to the center to look for work on the online database until one of them found work at a local Waffle House. He was found to be a good worker and was given permanent employment. This allowed him to leave the shelter and now rents from a Latino family. He visits the center on occasions to update staff of his progress. He is now a supervisor at the restaurant and on his own time sings Mexican rancheras. • Another success story is that of a Day Laborer that frequented "the corner". When CEL opened its doors, he was among the first to use the center. He was able to find work for each day until one employer from Weaver Street company liked the way he worked so much that he hired him as a full-time employee. • Mr.G (name withheld for privacy) arrived from Honduras. He is married to a US born and reside in the area. He did not speak English so he visited CEL to help find work. He had experience in pating, carpentry, welding, and in doing all form of renovations. He attend the ESL classes at CEL all summer and part of fall and has recently secured a full-time job as a plumber. He still attends CEL for classes and to get weekend work as a Day Laborer. More employers are beginning to seek workers from CEL and the process for hiring a day laborer has been formalized so as to ensure safe working conditions and a fair wage. Workers are seeking educational opportunities and learning how to review contracts and budget services. Residents in the area also use the center and employ laborers to do work in their homes. In order to continue providing services and better focus job training/placement efforts, ECH has secure staff and resources allocated to this project. When the building was first opened, ECH had to invest funds for upgrades and construction that had not been budgeted for. Now that it is coming on a year of operation, it has a better grasp of the amount of resources needed to provide services and seeks support from the County and its Towns to help us get people back to work. We are also quickly outgrowing our facility and hope to expand space to meet the needs of the increasing number of workers seeking assistance. Main Application 5/24/2016 4:43:09 PM Pag 5 of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 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 Program: ECH Center for Education and Leadership Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 90 120 275 Female 21 45 50 Total 111 165 325 Of the females, how many are single- female Head of Households (Omit for Human Services) Ethnicity African-American 22 25 30 American Indian or Alaska Native 0 Asian 1 Caucasian 10 15 15 Native Hawaiian or other Pacific Islander Other 78 125 280 Total 111 165 325 Of the above, how many Hispanic/Latino 78 125 280 Of the above, how many non- Hispanic/Latino 33 40 45 Total 111 165 325 Age 0-5 years 6-18 years 1 1 7 19-50 years 79 137 280 Main Application 5/24/2016 4:43:09 PM Pag 6 of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 51-61 years 20 25 33 62+ years 1 2 5 Unknown 10 Total 111 165 325 Geographic Location Durham City 9 15 28 Durham County Carrboro 32 70 95 Chapel Hill 59 65 177 Chapel Hill Public Housing Residents Orange County 3 7 15 Raleigh Wake County Other 8 8 10 Total 111 165 325 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) 1 Disabled (not elderly) Homeless 17 25 30 People with HIV/Aids Total 18 25 30 Main Application 5/24/2016 4:43:09 PM Pag , / of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 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 (R) *= Position FTE* program Actual Estimated Projected %Total Retirement Vacant Staff+ 2014-15 2015-16 2016-17 Budget Plan (H) Health Plan 0.15 President/CEO 1 $9,360.00 $9,360 3.7 (R) Director of 0.08 Finances 1 0 $4,160 1.6 (R) (H) Human Resources/ 0.08 Development Dir 1 $3,910.00 $3,910 1.6 (R) (H) 0.08 Grant Officer 1 $2,330.00 $2,330 0.9 (H) Administrative 0.08 Assist 1 0 $2,496 1 Comm Engagement 0.10 Director 1 $3,744.00 $3,744 1.5 (H) CEL Program 1.00 Coordinator 1 $37,440.00 $37,440 15 (H) Worker's Project 1.00 Leader 1 $33,280.00 $33,280 13 (H) Community 1.00 Organizer 1 $33,290.00 $33,280 13 (H) 1.00 AmeriCorps 1 0 $12,500 5 (H) 0.5 Volunteers/Interns 2 0 $3,000 1.2 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 5/24/2016 4:43:09 PM Pag , of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Program Activity 1 Outreach/Worker Protection Outreach/Worker Protection Carrboro Day Laborers w ill no Carrboro Day Laborers w ill no Carrboro Day Laborers w ill no longer use the informal hiring longer use the informal hiring longer use the informal hiring site in Carrboro in order to site in Carrboro in order to site in Carrboro in order to Program Goal obtain w ork. obtain w ork. obtain w ork. Of the 30 workers that are at Performance the corener, 18 w ill use Ca to At least 160 workers w ill use At least 325 workers w ill use Measures find w ork CEL for w ork-related services CEL for w ork-related services 67 workers used CEL to find Program Results w ork since April 2015 Program Activity 2 Outreach/Employers Outreach/Employers Outreach/Employers Employers w ill use ca rather Employers w ill use Ca to find Employers w ill use CEL to find Program Goal than the corner to find laborers workers workers Performance Contact at least 10 employers Contact at least 100 potential Contact at least 100 potential Measures about using Ca employers bout CEL services employers bout CEL services Program Results 90 employers w ere contacted Program Activity 3 Job Skills Training Job Skills Training Job Skills Training At least 60%of Carrboro Day At least 60%of Carrboro Day At least 60%of Carrboro Day Laborers w ill learn a new skill, Laborers w ill learn a new skill, Laborers w ill learn a new skill, such as ESOL,Spanish such as ESOL, Sanish Literacy, such as ESOL, Sanish Literacy, literacy,computer skills or job- OSHA, and toehr job-related OSHA, and toehr job-related related skills through ECH's skills training skills training Program Goal Workers'Center. Performance At least 15 workers w ill AT least 96 workers w ill At least 150 workers w ill use Measures participate in jobs skills trainin participate in job skills training CEL for w ork-related servcies 36 workers participated in ESL classes and 24 workers participated in occupational safety,employment skills,and Program Results labor rights workshps Program Activity 4 Financial Literacy Workers w ill learn budgeting, tax prep,and financial management skills, particularly Program Goal related to self employement At least 30%of the workers Performance w ill participate in Fiancial Measures Literacy counseling/training At least 74 workers w ill particpate in financial literacy Program Results education/counseling Main Application 5/24/2016 4:43:09 PM Pag , 10 of 11 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Community Engagement & Support Services 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) El HOME Other — (Main Application AND Part A AND Part B) Indicate the type of program for which you are requesting funding: Program Category Youth Adult Elderly Disabled Public Housing (not elderly) Neighborhoods/Residents Education x x x x Health and Nutrition Job Training Sports and Arts Activities Pre-School Activities x After-School Activities x Mentoring Transportation Housing Other: ESL classes, x x secondary education, computer training, etc. 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? El Centro Hispano seeks funding to support offering Education initiatives at the Carrboro-Chapel Hill Office. Education priorities include Adult Education and Literacy program, and Youth Tutoring, Parenting Education, and leadership development activities. Main Application 5/24/2016 4:41:23 PM P I of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 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. This initiative aligns with the following priorities listed in the 2012 Human Services Report, such as: 1) Education and Family Support and 2) increasing language services to individuals with limited English proficiency. The ECH Education Program addresses many of the educational needs among the Latino Community in Carrboro, Chapel Hill and Orange County. In North Carolina, 69.4% of foreign-born Spanish speakers older than age 5 have Limited English Proficiency (LEP). Thirty-one percent of NC Spanish-speaking households are linguistically isolated, meaning all persons ages 14 and over in the household are LEP, which is higher than other immigrant groups.1 In addition to limited English proficiency, many Latino immigrants have very low education levels as compared to the general population. In the U.S., 23.5% of all Latinos and 34% of foreign-born Latinos have less than a 9th grade education.2 In Chapel Hill-Carrboro City Schools, only 66.2% of Latino youth graduated from high school in 4 years in 2010, as compared to 92.5% for white students.3 Research shows that low literacy and education levels make it difficult to get a job, access resources, and assist with children's education or literacy development. Furthermore, low literacy levels in Spanish make it more difficult for native Spanish speakers to learn English. Developing English proficiency is an important pathway to improving employability and economic success in the United States for immigrant families.4 Many Orange County Latino families also face additional barriers to improving their education and economic situation as well as to raising healthy and academically successful children. In North Carolina, Latina women are at a higher risk than white women for unintended pregnancy and reporting physical violence during pregnancy. North Carolina's Latina formal maternal education level is among the lowest in the nation.5 In North Carolina, only 25% of Latina mothers read to their children at least once a day in 2005, compared to more than 50% of mothers in the general state population.6 Latino parents in North Carolina are more likely to report that their children have fair or poor health and have had no health insurance in the past year than White parents.7 Moreover, national evidence shows that Latinos are less likely than children of any other racial or ethnic group to be enrolled in an early childhood program or to receive early intervention services. In 2005-06, 27% of Latino four-year-olds lacked regular, non-parental arrangements for child care, compared with 18% of white preschoolers and 16% of black preschoolers.8 Thus, many Latino children reach school age without having been exposed to developmentally appropriate preschool settings. Such preschool education engages children in activities that get them ready to learn; these activities are designed to build cognitive, social, and emotional skills. Lack of mastery of these important developmental steps makes it difficult for children to begin learning when they enter a formal kindergarten classroom. In 2008-09, a national evaluation found that more than 80% of 1 Migration Policy Institute,2010 2 2008 National Survey of Latinos,Pew Hispanic Center 3 2011 Orange County Health Assessment 'Annie E. Casey Foundation 2005 5 Action for Children NC,2010 6 Ibid. SCHS,2010 8 Action for Children NC,2010 Main Application 5/24/2016 4:41:23 PM P , 2 of DocuSign Envelope ID:6BDD2794-5EC0-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION Latino fourth graders were not reading proficiently, compared with 68% of all fourth graders.9 By providing children with a developmentally appropriate preschool experience with certified Early Childhood Education Specialists, the ECH Education program helps to prepare children for success in kindergarten d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. El Centro Hispano Carrboro-Chapel Hill serves primarily Hispanic/Latino residents in Orange County and surrounding areas as well as those seeking to work with, reach, and/or serve this population. Since ECH does not discriminate, all services are open and available to all residents notwithstanding their ethnic, racial, gender, and socio-economic status. Individuals learn about our resources by word of mouth but we also conduct outreach to the community through neighborhood canvassing, participating in area events, presentations to community groups, radio show, social media, and more. Our Education programs serve children, teens, and adults. Pre-K aged children are granted an early preschool experience to prepare them for Kindergarten. Children and teens are supported with the assistance of tutors to help them with reading and math. Adults participate in basic literacy and/or ESL classes offered in collaboration with Orange Literacy Council. Secondary education is provided to adults through "Plazas Comunitaria" in collaboration with Department of Education through the Mexican Embassy. Families are supported through the "Circle of Parents"program that provides parent education and support. e) Who specifically will carry out the activities and in what location will they be carried out? The Education staff made up of the Education Program Director, Education Supervisor/Educator, for Education Specialist, AmeriCorps worker, and interns/volunteers will help provide services to residents in the Carrboro-Chapel Hill area. The Education Director helps coordinate and implement education interventions as well as supervises staff. She works to secure tutors for afterschool and summer camps. The Education Supervisor/Educator works directly with individuals and families providing instruction and supporting learning through "Circle of Parents" & "Plaza Comunitaria". She also supervises Education Specialist that work with children in the pre-school experience program. Additional staff like the President/CEO, Financial Director, Human Resourcesaectors, Grant Officer, and Community Engagement Director assist with supporting different administrative components of the grant as well as participate in meetings related to the project. 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. Services are delivered year-round. Office hours are 9am — 5pm with some evening and weekend hours available for some services. Outreach is conducted during day, evenings, and weekend hours. s Ibid. Main Application 5/24/2016 4:41:23 PM 0' g 3 of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 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. • Orange County Literacy Council: Provides ESOL at ECH-Carrboro and collaborates with ECH on the Family Literacy Program for Latino and Burmese families with children ages 0-5 (funded by the Orange County Partnership for Young Children). • The Mexican Embassy"Plaza Comunitaria"Program provides secondary education for Mexican residents. Once they complete their education they receive a certificate that is recognized in Mexico attesting they have completed their schooling. • UNC Chapel Hill: Students volunteer services at ECH-Carrboro including providing referrals and helping Latino community members complete employment application forms, and after school tutoring for students grades K-12. h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. It would impact the amount of services rendered i) Include any other pertinent information. This program establishing itself at the Carrboro-Chapel Hill office and seeks to build literacy, academic excellence, and build language/work skills of Latinos and other minority populations in order to assist them in assuring a better quality of life and participation in society. Staff is working to replicate interventions that have been successful at our Durham location and meet a request from community members to have such programs in Orange County. ESL classes were expanded to day laborers and many have taken advantage of these classes when they do not secure work for the day. When made available, 51 workers took advantage of the service. Additionally, we have seen an increase of Burmese community members attending classes. The tutoring program was also very successful in recruiting and maintaining participation of area kids need homework assistance. Staff has also incorporated music instruction and made presentations about career, like that of engineering, to engage kids and keep them interested. Kids were also taken to participate in small field trips to the library and other community organization. A summer camp was held and 13 children participated. Program included diverse topics to include archeology, reading,painting, music, and more. Children interacted kids of diverse backgrounds. Parent education has focused on how families can support learning at home; however, in collaboration with the Rape Crisis Center, four workshops were held to discuss "safe touching" of children. Unemployed mothers who sought services from CEL were able to get assistance through our community support component at the Carrboro-Chapel Hill office thanks to bags of food donated to the center. Some stop by to just get food bags. Main Application 5/24/2016 4:41:23 PM P of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 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 Program: Community Engagement and Support Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 60 12 60 Female 90 29 90 Total 150 41 150 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 Native Hawaiian or other Pacific Islander Other 150 41 150 Total 150 41 150 Of the above, how many Hispanic/Latino 130 34 130 Of the above, how many non- Hispanic/Latino 20 7 20 Total 150 41 150 Age 0-5 years 35 n/a 6-18 years 40 n/a Main Application 5/24/2016 4:41:23 PM P , 5 of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 19-50 years 75 n/a 51-61 years 62+ years Unknown Total 150 44 150 Geographic Location Durham City Durham County Carrboro 50 50 Chapel Hill 60 20 60 Chapel Hill Public Housing Residents 13 Orange County 30 4 30 Raleigh Wake County Other 10 7 10 Total 150 44 150 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 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 *= Position Vacant * Staff+ 2014-15 2015-16 2016-17 Budget Plan (H) Health Plan 0.08 President/CEO 1 $9,360.00 $4,992 5.9 (R) Main Application 5/24/2016 4:41:23 PM P 6 of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 0.08 Director of Finances 1 0 $4,160 4.9 (R)(H) Human Resources/ 0.08 Development Dir 1 $3,910.00 $3,910 4.6 (R)(H) 0.08 Grant Officer 1 $2,330.00 $2,330 2.7 (H) 0.08 Administrative Assist 1 0 $2,496 2.9 (H) Education Program 0.50 Director 1 $37,440 $18,720 22.1 (H) Education 0.50 Supervisor/Educator 1 $33,280 $16,640 19.7 (H) 0.50 AmeriCorps 1 0 $6,250 7.4 (H) 0.50 $1,500 Volunteers/Interns 1 0 1.7 (H) 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 5/24/2016 4:41:23 PM P of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Program Activity 1 ESL Instruction ESL Instruction ESL Instruction Provide 100 adults with 4 hours Provide 100 adults with 4 hours Provide 100 adults with 4 hours per week of education related per week of education related per week of education related to literacy and/or language skills to literacy and/or language skills to literacy and/or language skills through ESOL classes.This w ill through ESOL classes. This w ill through ESOL classes.This w ill be accomplished through be accomplished through be accomplished through collaboration with the Orange collaboration with the Orange collaboration with the Orange Program Goal County Literacy Council. County Literacy Council. County Literacy Council. Performance Measures 100 individual in class 100 individuals 100 individuals 30 ppl paraticpated; 36% As of 12/31,fifteen individuals Program Results demontstrated english served Program Activity 2 "Circle of Parents" "Circle of Parents" "Circle of Parents" Provide parenting support Provide parenting support Provide parenting support classes to at least 20 parents classes to at least 20 parents classes to at least 20 parents using the Frevent Child Abuse using the Prevent Child Abuse using the Frevent Child Abuse North Carolina's Circle of North Carolina's Circle of North Carolina's Circle of Program Goal Parents program model Parents program model Parents program model Performance Measures At least 20 parents At least 20 parents At least 20 parents Program Results 32 parents participated Listed in final report • Program Activity 3 Preschool Experience Preschool Experience Preschool Experience Provide developmentally Provide developmentally Provide developmentally appropriate preschool appropriate preschool appropriate preschool experience for at least 25 experience for at least 25 experience for at least 25 Program Goal children. children. children. Performance Measures 25 children 25 children 25 children Program Results 15 children Listed in final report Program Activity 4 Tutoring Tutoring Tutoring Provide 4 hours per week of Provide 4 hours per week of Provide 4 hours per week of homework tutoring to 25 homework tutoring to 25 homework tutoring to 25 Program Goal children from grades K-12. children from grades K-12. children from grades K-12. Performance Measures 25 children 25 childrenc 25 children As of 12/31/2015, 25 children Program Results 29 children particpated serviced Main Application 5/24/2016 4:41:23 PM P of DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 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 5/24/2016 4:41:37 PM P I of 5 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 1,081 $ 350 $ 500 43% Agency Generated Revenue(fees) $ 2,445 0 Local Government Grants: Orange County $ 20,000 $ 11,400 $ 12,540 10% Town of Chapel Hill $ 13,000 $ 5,700 $ 7,500 32% Town of Carrboro $ 14,000 $ 3,610 $ 5,000 39% Other Local: Town of Carr-Outreach $ 27,728 $ 36,970 $ 40,667 10% 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:Foundations $ 95,954 $ 28,126 $ 104,284 271% Other Grants: 0 Miscellaneous/Other Revenue $ 20,611 $ 15,000 0 Rease list 3 largest Miscellanous sources: Program Revenue $ 15,000.00 $ - $ - Total Agency Revenue $ 194 819 $ 86 156 $ 185 491 115% AGENCY EXPENSES Compensation $ 73,836 $ 75,938 $ 145,673 92% Rent&Utilities $ 44,413 $ 17,792 $ 17,792 0% Supplies&Equipment $ 2,878 $ 3,100 $ 3,600 16% Travel&Training $ 6,132 $ 1,900 $ 2,345 23% Other Expenses: $ 59,971 $ 17,615 $ 16,081 -9% Rease list 3 largest"Other Expenses": IT Servcies $ 2,366.00 Project Expenses $ 13,125.00 other fees dues $ 590.00 Total Agency Expenses $ 187,230 $ 116,345 $ 185,491 59% SURPLUS/(DEFICIT)FOR PERIOD: L$ 7,588 1 $ 130,1894 $ - J 100%l Main Application 5/24/2016 4:41:37 PM .. 2 o of 5 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION 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. a.) Program: Center for Employment and Leadership Cost Elements Cost($) Quantity/Unit of Measure Subtotal ($) Direct Project Staff:Director, Project $15.15 9610 hrs (800 hrs x 12 mths) $145,673 Leaders, Outreach Staff, AmeriCorps, Interns Rent& Utilities $1,483 $1483 x 12 mths $17,792 Project Expenses:Educational Materials& $1,094 $1094 x 12 mths $13,125 supplies, communications, printing, etc Travel& Training: (9) Project Staff, $195 $195 x 12 mths $2,345 (1)AmeriCorps, (2) Interns, & volunteers Meetings:Forums, seminars, gatherings $100 $100 x 10 months or$250 x 4 large $1,000 with community members/leaders events/year Other Direct Expenses;Dues, fees, IT $463.8 $464 x 12 mths $5,556 support, etc. Total $185,491 b.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program n/a n/a $185,491 Total # of Units n/a n/a 1200 Cost Per Unit n/a n/a $15.49 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 5/24/2016 4:41:37 PM .. g 3 of 5 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION c.) 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. Main Application 5/24/2016 4:41:37 PM P 41 of 5 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 t A - continued Provider's Outside Agency Application MAIN APPLICATION Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 17,168 $ 20,300 $ 20,625 2% Agency Generated Revenue(fees) $ 149,374 $ 234,656 $ 234,656 0% Local Government Grants: Orange County $ 15,000 $ 20,000 $ 20,000 0% Town of Chapel Hill $ 6,500 $ 15,000 $ 15,000 0% Town of Carrboro $ 14,000 $ 9,500 $ 15,000 58% Town of Carrboro-Outreach $ 36,970 $ 36,970 $ 36,970 Other Local: Orange Co ABC Board $ 6,651 $ 15,000 $ 15,000 0% Other Local: Durham County $ 29,421 $ 29,421 $ 29,421 0% Other Local: Durham ABC $ 20,000 $ 20,000 $ 20,000 0% If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way 0 State Government $ 72,456 $ 40,000 $ 40,000 0% Federal Government 0 Other Grants:Foundations $ 99,960 $ 107,502 $ 107,502 0% Other Grants:Non-Profit Grants $ 188,689 $ 202,772 $ 197,272 -3% Miscellaneous/Other Revenue $ 66,352 $ 160,325 $ 160,000 0% Please list 3 largest Miscellanous sources: Revenue from Programs $ 44,135.00 Other Income $ 22,217.00 Total Agency Revenue $ 722 541 $ 911 446 $ 911 446 0% AGENCY EXPENSES Compensation $ 353,738 $ 474,807 $ 474,807 0% Rent&Utilities $ 124,791 $ 117,762 $ 117,762 0% Supplies&Equipment $ 6,860 $ 10,020 $ 10,020 0% Travel&Training $ 15,850 $ 15,850 $ 15,850 0% Other Expenses: $ 316,785 $ 293,007 $ 293,007 0% Please list 3 largest"Other Expenses": Contracted Services $ 190,225.00 Program Expenses $ 115,495.00 Dues,fees,etc $ 11,065.00 Total Agency Expenses $ 818,024 $ 911,446 $ 911,446 0% SURPLUS/(DEFICIT)FOR PERIOD: $ (95,483)1$ - I $ - I 0 Main Application 5/24/2016 4:41:37 PM .. 5 o of 5 DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: El Centro Hispano, Inc. Funding Award: $28,810 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel—Salaries,FICA and Fringe and Program Support Services 28,810 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. • Education Initiatives for children,youth, and adults in Carrboro-Chapel Hill • Support provision of Communtiy Services for Latino individuals and families in Orange County • Support activities through the Center for Employment and Leadership 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 At least 325 workers will use CEL for work-related services—Carrboro Day Laborers 325 Contact at least 100 potential employers about CEL services-Outreach 100 At least 150 workers will use CEL for work-related services—Job Skills Training 150 At least 74 workers will participate in Financial Literacy education and counseling 74 DocuSigned by: //,,--'' Pa44 go -G •`�k President&cEO 10/26/2016 .\`---22BDDB39C1744D1--- DocuSigned by: [F:iort,U,A, A-6m Grant officer 10/27/2016 Certified by: 56CBDC4AC1o94DD... Title: Date: (Provider's Signature) DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1 C3AB13 �r^��ry�- ELCENTR-04 SPIKE Ai4CDC i�L...�'" DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/18/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hub International Southeast PHONE 919 337-0000 FAX 866 553-5124 4000 CentreGreen Way (A/C,No,Ext):( ) (A/c,No): ( ) Suite 140 E-MAIL ADDDRDR ESS: Cary,NC 27513 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: El Centro Hispano,Inc. INSURER C: 2000 Chapel Hill Road,Ste 26A INSURER D: Durham,NC 27707 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK1456165 04/06/2016 04/06/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT PRODUCTS-COMP/OP AGG $ 2,000 000 JECT � OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A ANY AUTO PHPK1456165 04/06/2016 04/06/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NATO-OWNED PROPERTY DAMAGE HIRED AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE PHUB530876 04/06/2016 04/06/2017 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Crime PHPK1456165 04/06/2016 04/06/2017 Employee Dishonesty 120,000 A Professional Liab PHPK1456165 04/06/2016 04/06/2017 Each Claim Limit 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE range County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN O O a S e County Cameron t ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE /4r ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD