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2016-598-E Finance - Orange County Literacy Council - Outside Agency Performance Agreement
DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E 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 Literacy Council, a not-for-profit corporation, located at 200 N Greensboro Street, Suite C-2, Carrboro,NC 27510 ("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 Literacy Council 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 15000. 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 $3,750. 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 Literacy Council) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E 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. (Orange County Literacy Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E 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 Literacy Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E 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 Literacy Council 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: (Orange County Literacy Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E County: Finance&Administrative Services Provider: Orange County Literacy Council Orange County 200 N Greensboro Street, Suite C- Post Office Box 8181 2 Hillsborough,NC 27278 Carrboro,NC 27510 16. E ntire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on Rtfu&f heProvider lkce Vemio" 10/27/2016 5BE44E187F8B412... Date For and on bagefO ange County Government 156lA ttt, tkA mt-IrStt 1 10/31/2016 a®-`Hra7s5E477... Bonnie Hammersley, County Manager Date (Orange County Literacy Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E 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. Ekce Vemiom DocuSigned by: Certified by. 5BE44E187F8B412_ Title. Executive Di rector Date. 10/27/2016 (Provider's Signature) (Orange County Literacy Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Oran•e Count Literac Council Date/Time �m Complete Y/N Program(s) Adult Literacy Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. Applicant Contact Information b. ®Project/Program Contact Information c. ®Funding Requests Identified d. Signed Application Cover Page 2. Agency a. ®Agency's Years in operation 24 CFR 570.506, Information - b. ®Agency's Purpose/Mission 570.507, 570.610; 24 c. ®Agency's Types of Services Provided CFR Parts 84 or 85 d. ® Agency's Experience e. ® Other Pertinent Information 3. Program/ a. El Type of Application and Program Identified 24 CFR 570.200(a), Project b. Summary of Program 570.201-570. 208, Information - c. Description of Identified Need 507.503 (for each d. Description of Population to be Served program/ project for e. ® Activity Manager and Location Description which funding f. ®Activity Implementation Timeline is requested) g• ® Agency Collaboration h. Describe Impact of Reduced/No Allocation i. ® Other Pertinent Information j. ® Complete Target Population/Beneficiary Chart k. ® Complete Schedule of Positions I. Signed Conflict of Interest Disclosure m. ® Complete Work Statement i l Page DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider'saAki lication 24 CFR 570.200(a), 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, each expenses for the entire program and ALL sources of 507.503 program/ I funding. 24 CFR 570.506, project for 570.507, 570.601, which funding a. ® Program Budget Worksheet 570.602, 570.607(b), is requested) b. ® Program Budget Detail 570.611 24 CFR c. ® Cost Per Unit 570.502-570.504, d. ® Agency Operating Budget Worksheet 570.506, 570.507, 570.610; 24 CFR Parts 84 or 85, and OMB Circulars A-87 or A- 122; Treasury Circular 1075 5. Supplemental A. ❑Part A: CDBG & HOME Sections (as B. ❑Part B: Construction/Rehab applicable) 6. Attachments a. ® Audit: Organizations receiving$300,000 or more OMB CircularA-133 in Federal financial assistance, and/or organizations with more than $500,000 of receipts and expenditures in a fiscal year, must secure an audit. b. ® IRS Federal Form 990 c. ® NC Solicitation License d. ® IRS Federal Tax-Exemption Letter e. ®Certificate of Insurance f. ® List of Board of Directors 24 CFR Parts 84 or 85 g. ® Articles of Incorporation/Bylaws 24 CFR 570.208, h. ® Authorization to Request Funds 570.500(c), 570.611 i. ® Authorized official designation j. ®Solid Waste Program Fee (SWPF) Verification Main Application 1/26/2016 5:06:15 PM Page 2 of 21 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider'saNki lication 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Orange County Literacy Council, Inc. Applicant Organization's Physical Address: 200 N Greensboro St, Suite C-2, Carrboro, NC 27510 Applicant Organization's Mailing Address: 200 N Greensboro St, Suite C-2, Carrboro, NC 27510 Applicant Organization's Web Address: www.or'angelitoracv.orq Executive Director: Alice L. Denson Telephone Number: 919-914-6153 E-Mail: info • Oran•eliterac :or• DUNS Number: 931145122 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) Pro'ect/Pro•ram Contact Information Project/Program Name: Adult Literacy Project/Program Primary Contact and Title: Joy Turner Telephone Number: 919-914-6153 E-Mail: 'tub rnera arang literacv,orq c) Funding Request Identification Total Project/Program Cost: $ Total Amount of Funds Requested: $ Proposed Use of Funds Requested (2-3 Line Maximum): Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source. *The Participating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. ❑ CDBG Non-Construction (CH) $ ❑ Grant [' Loan ❑ CDBG Construction (CH) $ ❑ Grant ❑ Loan ❑ HOME CHDO (OC) $ _ [' Grant ❑ Loan ❑ HOME Other(OC) $ ❑ Grant ❑ Loan ® Human Services: ® Carrboro $5,000 ® Chapel Hill $15,000 ® Orange County $15,000 d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant.Awe`Signature: . �� �!' • er utie Director Date Signature: . _ .- /- ZG —/G Bard Chairperson Date Main Application 1/26/2016 5:06:15 PM Page 3 of 2 1 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider'sgAgi -,mlication 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) The Orange County Literacy Council was incorporated in October 1984. We have been in operation for 31 years. b) Agency's Purpose/Mission Orange Literacy envisions a community where literacy is available to all. Our mission is to help adults reach their education, employment and life goals. We do this by providing free, flexible instruction in reading, writing and basic math, English and computer skills and GED preparation. c) Types of Services the Agency Provides Orange Literacy provides free one-on-one and small group instruction in reading, writing, basic math, computer literacy, GED preparation and English language skills throughout Orange County. Orange Literacy partners with El Centro Hispano and the Chapel Hill Training and Outreach Project to offer comprehensive family literacy in Carrboro and Hillsborough respectively, under funding from the Orange County Partnership for Young Children. Further, Orange Literacy offers citizenship education as a sub-grantee of Church World Services (CWS) on a U.S. Citizenship and Immigration grant. d) Agency's Experience with Similar Programs as the Funding Request Since it's inception in 1984, Orange Literacy has built a strong and successful record of helping adult learners identify and achieve their short- and long-term goals. Many adult literacy and ESOL students have progressed in their employment goals, such as getting a job, being promoted to a higher-paying job or moving to a new job that pays a higher wage. Other adult learners have achieved their goal of a better education for themselves and their children by passing the GED, developing the literacy skills of their young children and grandchildren, or helping their older children with homework. In addition to Adult Literacy, our flagship program, Orange Literacy offers comprehensive family literacy (in partnership with El Centro Hispano and Orange County Head Start/Early Head Start), citizenship classes (through USCIS funding) and weekly writing workshops at the area homeless shelters. We work very closely with the NC Community College System (NCCCS), the entity charged with providing formal Basic Skills and adult ESL instruction in the state. Orange Literacy staff adheres to NCCCS standards for program quality, staff and tutor training and students and program evaluation. e) Other Pertinent Agency Information n/a Main Application 1/26/2016 5:06:15 PM Page 4 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued ProviderskAkicA*Epcm-pgmlication Agency & Program Name: Orange County Literacy Council, Adult Literacy 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: Human Services (Main A+ .lioationOn! ) ❑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 A llicltion AND Part A AND Part B) Indicate the type of program for which you are requesting funding: Program Category Youth Adult II Elderly Disabled Public Housing (not elderly) Neighborhoods/Residents Education x Health and Nutrition .�. ...................................... Job Training mmmmmmmmmmmmm I Sports and Arts ._ .... ._.__._ ._.�...._. Pre-School Activities After-School Activities Mentoring Transportation Housing 9 Other: Please specify Main Application 1/26/2016 5:06:15 PM Page 5 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's Op(isjunlication 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) Program Services/Priorities Orange Literacy will continue to provide high quality, free one-on-one and small group instruction in reading, writing, basic math, digital literacy, English and GED and citizenship prep to adults living or working in Orange County. By helping individuals to build the literacy and language skills they need to participate more fully in the local workforce, the educational system and the community as a whole, we are helping to create a welcoming and friendly community that provides all people with access to opportunities and supports and improves economic vitality. c) Local Need Orange Literacy addresses the problem of adult illiteracy in Orange County. Strong literacy skills are fundamental to getting and keeping a well-paying job, which in turn affects the ability to find adequate housing, secure healthcare and develop the resources necessary to care for a family. Although studies vary on the exact number of adults with significant literacy needs in Orange County, most estimate the need to be between 12% and 15% of the adult population. Conservative estimates place the percent of adults (25 years old and older) without a high. school diploma or GED at 6.8% and those who never progressed past the 9th grade at 4%. Further, for young adults between the ages of 18 and 24, 6.5% have not earned a high school diploma or GED and are not enrolled in school (American FactFinder, 2005-2009 U.S. Department of the Census). These numbers do not take into account the growing number of county residents needing ESOL instruction. English is not the primary language in approximately 12% of Orange County households; 4.9% of residents report that they do not speak English "very well." In North Carolina, 84% of Latinos report speaking a language other than English at home (Pew Hispanic Center). Studies find that almost half of adults classified as Limited English Proficiency (LEP) have nine years or less of education, and 64% do not have a high school degree (The Language of Opportunity, 2003). 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% of white students (2011 Orange County Health Assessment). Similarly, most Karen/Burmese refugees have had little to no access to formal education and are often unable to read or write in their native language. Many immigrants live in isolation and lack access to community resources due to low education levels and unfamiliarity with U.S. education, health, government, housing, and economic systems. In addition, racial and ethnic diversity differs across the county. Hillsborough has the largest percentage (37.1%) of non-white residents, with 29.5% Black residents and 6.6% Hispanic/Latino residents. Orange County's Hispanic/Latino population almost doubled between 2000 and 2010 -- from 4.5% to 8.2% respectively. The highest concentration is in Carrboro, where Hispanics/Latinos comprise 13.8% of the population. And while Orange County's Hispanic/Latino population mirrored that of the state (8.2%), the county's Asian population was almost three times higher: 6.7% for the county compared to 2.2% for the state. The highest concentration of Asians was in Chapel Hill, totaling 11.9% of the population in 2010, up from only 4.1% in 2000 (2011 Orange County Health Assessment). According to data from the National Adult Literacy Survey (NALS), 15% of Orange County adult residents have Level 1 literacy skills (functionally illiterate) and 18% have Level 2 literacy skills (significant literacy needs). The majority of Orange Literacy students are in this group: adults who are not yet ready for GED or even ABE classes, who cannot communicate in English and/or who face multiple barriers to educational enhancement. Most of our students have low educational achievement levels. Many of our students had limited opportunities to attend school, or fell behind in the traditional public school system and never caught up, becoming public Main Application 1/26/2016 5:06:15 PM Page 6 of 2 1 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's GoaticApitecAyrftiNlication school dropouts as soon as they were old enough. Non-native speakers face additional challenges. For example, by the time Latino children enter kindergarten, there is already a considerable gap between their reading and math skills and those of children in different socio- economic class and racial/ethnicity groups in the United States (West, Denton & Germino- Hausken, 2000; Reardon, 2005). This gap widens as children progress through their educational careers (Rathbun, West, & Hausken, 2004), leading to inequitable outcomes in high school graduation rates and in subsequent enrollment and completion of higher education. d) Population to be served/identification of beneficiaries We will provide services to any interested adults living or working in Orange County. Individuals select themselves into the program. Using nationally-accepted, standardized tests, we pre-test potential students to determine their skill level and post-test to measure progress. ESOL students who pre-test out of the program (too high) can participate in conversation classes. For students who have tested out of regular classes, we hold novels-based reading/discussion classes designed to help them transition to the reading requirements of a University class. e) Personnel and locations Most tutoring is done by volunteers. However, we do use paid instructors in specific cases, when it is required by a funding source, or when the hours are not conducive to recruiting volunteers (such as those designed for workers during an overnight shift). We hold classes and have pairs meet all over the county, including at Orange County elementary schools, on UNC campus, at both the Chapel Hill and Orange County (Main) Libraries and at our Carrboro office. f) Timeline We offer literacy services year-round. However, the number of classes and variety of location is fewer during the summer months. In a typical year, our timeline is: June-September • On-going ABE/GED pairs (each pair meets for at least 3 hours/week) • On-going GED prep class at UNC-Chapel Hill (meets 3 times per week) • ESOL -twice weekly morning and evening classes at Orange Literacy office September-December • On-going ABE/GED pairs (each pair meets for at least 3 hours/week) • On-going GED prep class at UNC-Chapel Hill (meets 3 times per week) • ESOL -twice weekly morning and evening classes at Orange Literacy office • Fall Semester ESOL classes at Orange County Elementary Schools and Seymour Senior Center • Fall Semester Family Literacy classes at El Centro Hispano and Fairview Child and Family Center • January-M • On-going ABE/GED pairs (each pair meets for at least 3 hours/week) • On-going GED prep class at UNC-Chapel Hill (meets 3 times per week) • ESOL - twice weekly morning and evening classes at Orange Literacy office • Spring Semester ESOL classes at Orange County Elementary Schools and Seymour Senior Center • Spring Semester Family Literacy classes at El Centro Hispano and Fairview Child and Family Center g) Collaborators and partners • Orange Literacy holds two twice-weekly classes at Efland-Cheeks Elementary School, Grady Brown Elementary School and New Hope Elementary School for Main Application 1/26/2016 5:06:15 PM Page 7 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider'som6w,flication non-English speaking parents of elementary school students to help them learn to communicate with teachers and school administrators and at Chapel Hill Public Housing. Our partners provide space, childcare and student recruitment. Orange Literacy provides intakes, pre- and post-testing, goal-setting, curriculum development, tutor training and support, instruction and instructional materials. • Orange Literacy collaborates with the other partners of the Skills Development/NCWorks Center. We provide and receive client referrals to agencies including DSS Work First staff, NC Department Commerce-Employment Security Division, Joint Orange Chatham Community Action Agency, Vocational Rehabilitation, Good Work, and Disabilities Awareness Council. • We work closely with Adult Basic Education (ABE), GED and ESOL instructors from Durham Technical Community College and Alamance Community College. We provide tutors for students who need individual assistance at DTCC's Skills Development Center site as well as other sites across the county. We also work similarly with ACC for students in northern Orange who choose to go to this school. • We receive client referrals and self-referrals from human services agencies including: Freedom House, Community House, Project HomeStart, Orange County Health Department, Orange County Mental Health, Horizons, IFC, Chapel Hill Housing Authority, Chapel Hill Carrboro Schools, Orange County Schools, El Centro Hispano, Church World Service • A number of area churches, organizations, agencies and businesses provide free space for Orange Literacy programs. These include: Orange County Public Library, Carrboro Branch Library, Chapel Hill Public Library, UNC-CH. • We hold on-going classes at: Robert and Pearl Seymour Senior Center, Chapel Hill Public Library, UNC Healthcare at Eastowne (for housekeeping staff) • Orange Literacy works with Project Literacy students (a UNC Campus Y program) to tutor University employees, work with ESOL students and volunteer in the Creative Writing Program at the InterFaith Council's men's and women's shelters. • Orange Literacy sources AmeriCorps Members from the Student Coalition for Action in Student Education (SCALE) at UNC's School of Education. • With funding from the Orange County Partnership for Young Children, Orange Literacy works in partnership with El Centro Hispano and Orange County Early HeadStart/HeadStart at Fairview to provide a comprehensive family literacy program, with instruction for both parents and their pre-school children. • Orange Literacy is an active participant in the Orange County Family Success Alliance Collaborative. We provide literacy instruction to parents and other caregivers, targeting the curriculum to skills and content necessary to help them work with their children to build both their own and their child's literacy skills. Further, Orange Literacy's Executive Director is a member of the Family Success Alliance Advisory Council. • In collaboration with Church World Service, Orange Literacy has received a grant from the U.S. Citizenship and Immigration Service (USCIS) to provide citizenship instruction in Orange, Durham and Alamance Counties. In Orange County, we are currently holding classes in conjunction with the Orange County Public Library, the Refugee Support Center and the Chapel Hill Public Library. Each of these partners provides space and assistance in recruiting students. Orange Literacy provides intakes, pre- and post-testing, goal-setting, curriculum development, tutor training and support, instruction and instructional materials. h) Effect of reduced funding If we were to receive reduced funding, we would need to scale back the services that we can offer. i) Include any other pertinent information. n/a Main Application 1/26/2016 5:06:15 PM Page 8 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's C tRic 38 Nlication Pro•ram/Pro'ect 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: Persons ❑Households ['Units Program: Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender _._._._....._..._..._........ Male 170 203 220 Female 345 412 447 Total 515 615 667 Of the females, how many are single- female Head of Households (Omit for Human Services) Ethnicity African-American 47 50 55 American Indian or Alaska Native 1 I 1 1 Asian 165 I 214 232 Caucasian 299 347 I 376 Native Hawaiian or other Pacific Islander I 0 0 I 0 Other I 3 3 rIIIIIIIIIIIIII Total IIIIIIIIIIIIMMI 615 667 Of the above, how many Hispanic/Latino 266 316 - 343 Of the above, how many non- Hispanic/Latino 249 299 324 Total 515 615 667 Age Y 0 0-5 years �_.�_._...... _....... . _.._ 6-18 years 3 3 Main Application 1/26/2016 5:06:15 PM Page 9 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's tai ea , lication 19-50 years 405 485 1 526 51-61 years 69 83 90 62+ years 38 44 48 Total 515 615 667 Geographic Location Durham City 82 120 130 Durham County 0 0 0 Carrboro 91 100 108 Chapel Hill 239 264 286 Chapel I Public Housing Orange Residents unknown Unknown unknown Count _.� ........ ......���_ ..........................._�....�....�_i 9 County I 90 98.._.......__._.........._........� Alamance County 11 41 45 Raleigh i 3 0 0 Wake County 2 0 0 Other Counties 4 0 0 Total 515 615 667 Income Level—See following chart (Omit for HS) < 30%Area Median Income 31-50%Area Median Income 51-80% Area Median Income > 80%Area Median Income Total 0 0 0 Special Needs (Omit for HS) Elderly (Over 62) _........................... Disabled (not elderly) Homeless People with HIV/Aids Total 0 0 0 Note — In addition to drawing in students who live in Alamance County, but work in Orange, we will be offering a number of citizenship classes in Alamance, I have added a row to account for those students. Further, we have a few students in our UNC employee classes that work at the University, but live in Lee, Guilford or other more distant counties, I have added an "Other counties" row to account for them. Main Application 1/26/2016 5:06:15 PM Page 10 of 21 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider'sathifEW,tlication CDBG & HOME ONLY- Area Benefit Activities Infrastructure and Public Facilities) Street Census Tract Block Group Total Persons #LMI Persons 2015 Area Median Family income Limits U.S. Department of Housing & Urban Development (HUD) 2015 Area Median Family Income Limits Effective March 15, 2015 Income �m_........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 htt'«:llww w.hluduser.orw:lworta''1datasetslillr"1151FY2015 IL n+ .; df Main Application 1/26/2016 5:06:15 PM Page 11 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's rcijitgiEtcNlication 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 * % %Total (R) , * = Position FTE Program Actual Estimated Projected Retirement Vacant R Staff+ 2014-15 2015-16 2016-17 Budget Plan (H) Health Plan Executive Director 1 60% 59,084 60,856 62,681 13% R, H PrDirector 1 100% 42,332 43,602 44,910 9% R, H Program Coordinator, ABE 1 100% 30 000 L 31,500 33,075 6 7% R H Program 100% 30,000 31.500 33,075 6.7% R, H Coordinator, ESOL 1 10 ..........................._.�-w ._ Program Coordinator, Citizenshi. 1 100% I n/a 30,000 31.500 6.5% R, H AmeriCorps— .....,... .....__-____�. ._........ �........ .�. ��__ ._._... .. t. ( ) .... ° 15,000 3% n/a fulltime 2 .....2...... 100/° 12,000 12,400 m_mmmmm_„ AmeriCorps— ( 100% 300 n/a n/a n/a minimum time 1� 14 ....__. .100/° 300 ._._......_ Instructors—varies FY15-8 2.5 100% FY16-12 3.3 100% FY -12 3.3 100% 31,325 88,764 90,000 18.4% , n/a j Volunteers-120 I 5.6 75% $0 $0 $0 0% n/a Notes: • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. • ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • + Denotes the percentage of staff time involved with this program. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 1,960 Main Application 1/26/2016 5:06:15 PM Page 12 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's GA ,mlication I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YESNO ❑® 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? ❑® 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. 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. ;r .,�� Signature: " , t ,Executive Director Date Signature: � / - 2G -/6 :oard Chairperson Date Main Application 1/26/2016 5:06:15 PM Page 1 3 of 2 1 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's (, tHecwr,pNlication m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish SMART,Goai • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Main Application 1/26/2016 5:06:15 PM Page 14 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider'slgmtgjqcf'1fAIication Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Staff will work with potential I Staff will work with potential Staff will work with potential students to complete intake, students to complete intake, students to complete intake, set goals and pre-test. set goals and pre-test. set goals and pre-test. Students will be either Students will be either Students will be either matched with 1:1 tutor or matched with 1:1 tutor or matched with 1:1 tutor or assigned to an appropriate assigned to an appropriate assigned to an appropriate Program Activity 1 class. 1 class. class. 60%of all students will I160%of all students will 60%of all students will receive 12 or more hours of receive 12 or more hours of receive 12 or more hours of Program Goal instruction. instruction. instruction. Instructional hours will be Instructional hours will be Instructional hours will be counted for one-on-one counted for one-on-one counted for one-on-one tutoring,classes and time tutoring, classes and time tutoring,classes and time spent working on approved spent working on approved spent working on approved instructional software in instructional software in instructional software in monitored computer lab. monitored computer lab. monitored computer lab. Hours will be tracked in Hours will be tracked in Hours will be tracked in LACES,an online database LACES,an online database LACES,an online database provided by the NC provided by the NC provided by the NC Performance Measures Community College System. Community College System. ''Community College System. Program Results 62% 1 64% 65% Once a student has reached Once a student has reached Once a student has reached the prescribed number of the prescribed number of the prescribed number of instructional hours,s/he will instructional hours,s/he will instructional hours,s/he will be post-tested using be post-tested using be post-tested using nationally-accepted, nationally-accepted, nationally-accepted, standardized tests-either standardized tests-either standardized tests-either Program Activity 2 CASAS or TABE. CASAS or TABE. CASAS or TABE. Of those fulltime students Of those fulltime students Of those fulltime students who are tested,60%will who are tested,60%will who are tested,60%will make measurable progress make measurable progress make measurable progress on a federally recognized on a federally recognized on a federally recognized Program Goal standardized test. standardized test. I standardized test. Progress will be tracked in Progress will be tracked in Progress will be tracked in LACES. Progress is defined as LACES. Progress is defined as LACES. Progress is defined as increasing one's score on the increasing one's score on the increasing one's score on the Performance Measures appropriate post-test. appropriate post-test. appropriate post-test. Program Results 72% 74% 75%1 Program Activity 3 Program Goal Performance Measures Program Results Program Activity 4 Program Goal Performance Measures Program Results Program Activity 5 Program Goal Performance Measures Program Results Main Application 1/26/2016 5:06:15 PM Page 1 5 o f 2 1 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's rAtRi m ,osoication 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. Through Church World Services, Orange Literacy was awarded a grant from the U.S. Citizenship and Immigration Service (USCIS) for citizenship education in Orange, Durham and Alamance Counties. Orange Literacy's portion of the grant is $142,408 over the two-year period beginning October 1, 2015 and ending September 30, 2017. This grant is reflected in the sharp increase in program funding and expenses between FY14-15 and FY15-16. The program budget reflects only the amount we estimate we will spend in Orange County. Main Application 1/26/2016 5:06:15 PM Page 16 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider's C ltNi e 8m- lication Program Budget Agency/Program: Orange County Literacy Council Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Chant Private Donations $ 10„000 1 $ 10,000 $ 10,000 0% Agency Generated Revenue(fees) 0 Local Government Grants: Orange County 12,000 $ 19,815 15,000 -24%11 Town of Chapel Hill $ 13,000 $ 14„000 $ 15„000 7Y Town of Carrboro $ 3„500 $ 4000 $ 5,000 25% Other Local: Hillsborough $ 1,200 0 Other Local: aliliMIIIIIIIIIIIIIIIIIIIIIIIII. 0 Other Local: IIIIIIIIIIIIIIIIMIIIIIIIIIIIIIIIOIIIIIIIIIIIII 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way UNIKEEMI $ 46,112 $ 52,000 13%1 State Government 0 Federal Government 1 $ 119,951 $ 176,696 $ 194,992 10% Other Grants: I $ 1,750 111111111111111111111111111111111111 0 Other Grants: JIIIIIIIIIIIIIIIIIIIIIIIINIIMIIIIIMIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 0 Miscellaneous/Other Revenue $ 61,769 I $ 55,406 1 $ 51,526 Please list 3 largest Miscellanous sources: Events $ 34,769 00 Contracts $ 27,000 00 $ Total Agency Revenue $ 260 381 326.029 INIMI 5% AGENCY EXPENSES Compensation $ 212,396 $ 264,703 $ 276,912 MI Rent&Utilities $ 19,700 $ 25,540 $ 27.031 6% Supplies&Equipment I $ 20,490 $ 29,500 $ 31,500 Travel&Training $ 7,795 $ 6,286 $ 8,075 28% Other Expenses: IIM 0 Please list 3 largest"Other Expenses": $ . $ Total Agency Expenses $ 260 381 $ 326 029 LE SURPLUS/(DEFICIT)FOR PERIOD: $ - $ - $ 0 Main Application 1/26/2016 5:06:15 PM Page of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provic XNDJ Application b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Exam•le Program: Credit Counseling Class Cost Elements Cost($) Quantity/Unit of Measure Subtotal ($) Credit Counseling Teacher-in class $25 96 hours (8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class $25 ' 48 hours (4hrs/mth x 12 mths) $1,200 prep Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the project/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: Adult Literacy Cost Elements Cost($) Quantity/Unit of measure -.__.._ Subtotal ($) Program Director 26.52 2040 hr/yr+health+retirement 54,814 ABE Program Coordinator 18.50 2080 hr/yr+health+retirement 38,472 ESOL Program Coordinator 20.24 2080 hr/yr+health+retirement 42,096 19.63 . WWW . Citizenship Program Coordinator 19.63 2080 hr/yr+health+retirement 40,835 AmeriCorps-ABE 7500 1700 hours/year 7500 AmeriCorps- ESOL 7500 1700 hours/year 7500 Contract Instructors- per class meeting 50 22- 16 wk classes (704 mtgs) 35,200 Executive Director 37.79 1336 hr/yr+health+retirement 50,495 Rent, utilities 1950.23 82% of rent, utilities 22,919 Rent-instructional space 100% instructional space-offsite 4112 Instructional Materials and Equipment 31500 Training 1000 Most training covered by NCCCS 1000 Travel 590/m Reimbursed at IRS rate 7075 Total 343,518 Main Application 1/26/2016 5:06:15 PM Page 18 of 21 DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued ProvicJAier Application c.) Cost per Unit Actual Act001201415-1 Estimated 2015-16 Projected 2016-17 Total Cost of Program 260381 326029 343518 Total # of Units _�. ...................... ....._........ ... ..... 515 615 667 Cost Per Unit $505.59 530.13 515.02 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/26/2016 5:06:15 PM Page 1 9 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued Provider'satki m- lication 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. Orange Literacy has a July 1 to June 30 budget cycle. Our audit for FY14-15 is currently underway, therefore the information for that time period is unaudited. We will supply a revised budget as soon as the audit is complete. The numbers shown for FY14-15 are on a cash basis. Due to the United Way transitioning to a July to June fiscal year, a portion of the United Way funding will accrue back to FY13-14. The surplus in the FY14-15 budget should be approximately $1,000. Main Application 1/26/2016 5:06:15 PM Page 20 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E t A - continued ProvidermAls1 FoRpyMplication AGENCY NAME: Orange County Literacy Council Actual Estimated Projected ' AGENCY REVENUE 2014-15 2015-16 2016-17 Private Donations $ 27,000 $ 28,500 Agency Generated Revenue(fees) MIIIIIIIIMMI 0 Local Government Grants: Orange County I $ 12,000 $ 19,815 $ 15„000 -24 Town of Chapel Hill I $ 13,000 $ 14,000 $ 15,000 7% Town of Carrboro $ 3,500 $ 4,000 $ 5,000 25% Other Local: Hillsborough $ 1,200 1111.11111111111111111111, 01 Other Local: EMIIIIIIMMIIIIIIIIIIIIIMIIMIIIIIIIIIIIIIIIII 0! Other Local: ._._1 IIIMEMI.__ I 0 more than 3 sources,please provide a separate list.. Non-Local Government Grants Triangle United Way I $ 37,211 $ 52,112 $ 52,000 0% Federal Government $ 120,580 $ 183,696 $ 2011,992 10% Other Grants: Strowd Roses $ 1,750 $ 4,000 1 -100% Other Grants: 111111.1.1111 $ 4,678 $ 5,000 7%I Miscellaneous/Other Revenue $ 110,739 ,IIIIIIIIM $ 105,000 1 Please list 3 largest Miscellanous sources: Events $ 76,786.00 Contracts $ 31,420,00 Misc $ 2,533 00 Total Agency Revenue 385 855 466 165 MIMMIIIIIIPM AGENCY EXPENSES MICompensation $ 245,086 $ 339,770 $ 357,688 Rent&Utilities $ 24,025 $ 28,540 $ 30,000 IIM Supplies&Equipment $ 27.290 $ 32.190 $ 35.000 Travel&Training $ 9,505 IIIM $ 8,000 IM Other Expenses: $ 65,290 $ 58,000 $ 56.804 Please list 3 largest"Other Expenses": I Subgrantee(ECH) $ 22,079.00 Fundraisin« $ 25,605 00 Management/Other 'mm$ 17,606 00 Total Agency 05 $ IIIM MIEIMIIPEI 1 SURPLUS/(DEFICIT)FOR PERIOD: $ 1059 I $ I $ - IF- 01 Main Application 1/26/2016 5:06:15 PM Page 21 of DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Orange County Literacy Council Funding Award: $15,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Programmatic Expenses—rent,internet access,phone service 15,000 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. • Adult Literacy Program — on-going individualized and small group instruction to adult learners who want to improve their reading, writing, basic math, basic computer, English language and GED preparation skills 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 Number of full-time students making measureable progress 75 % Number of enrolled studetns who become full-time(12 hours or more) 65 % DocuSigned by: ce J��so Executive Di rector 10/27/2016 Certified by: Title: Date: BC44-E187F8B412... (Provider's Signature) DocuSign Envelope ID:990F6965-575D-4E0D-A54F-9DAD6D65198E OP ID: CR coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `••--°''� 10/26/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jeffrey A. Rubish High&Rubish Insurance Agency PHONE FAX P.O.Box 3040 (A/C,No,EXt):919-913-1144 (A/C,No): 919-913-1155 6015 Farrington Rd.Ste 101 ADDRESS:Jeff @highandrubish.com Chapel Hill,NC 27517 PRODUCER ORCOU-1 Jeffrey A.Rubish CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Orange County Literacy Council INSURER A:Auto-Owners Insurance 18988 Inc. 200 N. Greensboro St,Ste C2 INSURER B Carrboro, NC 27510-1833 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR TYPE OF INSURANCE I POLICY EFF POLICY EXP INSR WVD POLICY NUMBER /Y LIMITS (MM/DD YYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 9115937201 11/20/2016 11/20/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (PER ACCIDENT) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE 35022549 06/17/2016 06/17/2017 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Additional Insured: Orange County CERTIFICATE HOLDER CANCELLATION ORANG-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ORANGE COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. attn: Risk Manager PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD