Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2016-601-E Finance - Public Gallery of Carrboro - Outside Agency Performance Agreement
DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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 Public Gallery of Carrboro, DBA WCOM-LP Radio, a not-for-profit corporation,located at 300-G East Main Street, 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 Public Gallery of Carrboro, DBA WCOM-LP Radio 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 1000. 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 $ 250. 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. (Public Gallery of Carrboro,DBA WCOM-LP Radio) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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. (Public Gallery of Carrboro,DBA WCOM-LP Radio) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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. (Public Gallery of Carrboro,DBA WCOM-LP Radio) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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 Public Gallery of Carrboro, DBA WCOM-LP Radio 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: (Public Gallery of Carrboro,DBA WCOM-LP Radio) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC County: Finance&Administrative Services Provider: Public Gallery of Carrboro, DBA Orange County WCOM-LP Radio Post Office Box 8181 300-G East Main Street 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. Ea For an n 1f luf the Provider tt7LluS 10/27/2016 OD86CAODAA5D48C... Date LU F and d iakf Orange County Government uit, tka"mt-IrStui 10/31/2016 0637991 B755E177... Bonnie Hammersley, County Manager Date (Public Gallery of Carrboro,DBA WCOM-LP Radio) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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: apt t IUS chai rman of the Boar 10/27/2016 Certified by: Title: ate: (Provi er sTiignature) (Public Gallery of Carrboro,DBA WCOM-LP Radio) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency _Public_Gallery of Carrboro dba WCOM, Date/Time / 1 Complete Y/N Program(s) _Community Radio Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. XX❑ Applicant Contact Information b. XX❑ Project/Program Contact Information c. XX❑ Funding Requests Identified d. XX❑ Signed Application Cover Page 2. Agency a. XX❑ Agency's Years in operation 24 CFR 570.506, Information - b. XX❑ Agency's Purpose/Mission 570.507, 570.610; 24 c. )0(1-1 Agency's Types of Services Provided CFR Parts 84 or 85 d. )Xn Agency's Experience e. XXn Other Pertinent Information 3. Program/ a. XX❑ Type of Application and Program Identified 24 CFR 570.200(a), Project b. 570.201-570. 208, XX❑ Summary of Program Information - c. )0411 Description of Identified Need 507.503 (for each d. )Xn Description of Population to be Served program/ project for e. )0411 Activity Manager and Location Description which funding f. XX❑ Activity Implementation Timeline is requested) g. )0411 Agency Collaboration h. XX❑ Describe Impact of Reduced/No Allocation i. XX❑ Other Pertinent Information j. XX❑ Complete Target Population/Beneficiary Chart k. XX❑ Complete Schedule of Positions I. XXn Signed Conflict of Interest Disclosure m. XXn Complete Work Statement i o:° DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION 24 CFR 570.200(a), 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, each expenses for the entire program and ALL sources of 507.503 program/ funding. 24 CFR 570.506, project for 570.507, 570.601, which funding a. XXn Program Budget Worksheet 570.602, 570.607(b), is requested) b. XXn Program Budget Detail 570.611 24 CFR c. XX❑ Cost Per Unit 570.502-570.504, d. XX❑ 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. XX❑ Audit: Organizations receiving $300,000 or OMB Circular A-133 more 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. XX❑ IRS Federal Form 990 c. XX❑ NC Solicitation License d. XX❑ IRS Federal Tax-Exemption Letter e. XX❑ Certificate of Insurance 24 CFR Parts 84 or 85 f. XXn List of Board of Directors 24 CFR 570.208, g. XX❑ Articles of Incorporation/Bylaws 570.500(c), 570.611 h. XX❑ Authorization to Request Funds i. XX❑ Authorized official designation j. XX❑ 3-R Fee Verification Main Application 5/25/2016 10:00:47 AM 0 I:° 2 of 2 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Public Gallery of Carrboro Applicant Organization's Physical Address: 300-G East Main St.; Carrboro, NC 27510 Applicant Organization's Mailing Address: 300-G East Main St.; Carrboro, NC 27510 Applicant Organization's Web Address: www.wcomfm.org Executive Director: WCOM is all volunteer. Art Menius is chairman of the board of directors Telephone Number: 919-675-2787 E-Mail: art@artmenius.com DUNS Number: 133894746 (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: General Operating Support Project/Program Primary Contact and Title: Art Menius, Chairman of the Board Telephone Number: 919-675-2787 E-Mail: art@artmenius.com c) Funding Request Identification Total Project/Program Cost: $ 18003.00 Total Amount of Funds Requested: $2000 Proposed Use of Funds Requested (2-3 Line Maximum): General Operating support of non-profit community radio programming, training of community radio hosts, replacement and maintenance of broadcast and production equipment. 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 El HOME CHDO (OC) $ ❑ Grant [' Loan ❑ HOME Other (OC) $ ❑ Grant ❑ Loan X❑ Human Services: XX❑ Carrboro $1000 ❑ Chapel Hill $0 XX❑ Orange County $1000 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: No Executive Director N/A Executive Director Date Signature: January 22, 2016 Board Chairperson Date Main Application 5/25/2016 10:00:47 AM .. g 3 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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) b) Agency's Purpose/Mission c) Types of Services the Agency Provides d) Agency's Experience with Similar Programs as the Funding Request e) Other Pertinent Agency Information a. Date of Incorporation: January 30, 1997 Years in Operation: 19 years as a non-profit, 11 as a community radio station. b. Mission or Vision Statement (if applicable): Facilitating the exchange of ideas and music with particular regard for those who are overlooked or under-represented by other media outlets. Providing a mechanism for volunteers to become creators and contributors. c. Locally owned and operated broadcast media Training for residents in radio production and broadcasting Practical broadcasting experience for residents Delivery of public service announcements In depth interviews with area politicians, government officials, authors, and other leaders. Programing produced by local teenagers A significant number of radio programs produced by local African-American programmers Local event calendar Locally produced Spanish language programs d. WCOM has been providing all these services to the community since late 2004. Our 73 volunteer hosts range in age from 15 to 84 and include blind and elderly hosts. e. Brief History of Agency: Public Gallery of Carrboro was originally created to facilitate the extraordinary Art on Weaver public art project in 1997. Ruffin Slater filed an application with the FCC for a low power FM radio license in June 2001 for WCOM. License granted in December 2002. In September 2003 WCOM received a federal PTP grant for 75% of startup costs. WCOM began broadcasting in 2004 from an old bank building on Weaver Street in Carrboro with its transmitter at Scroggs Elementary in Chapel Hill. The studio moved first to 208 East Main and then in September 2012 to space rented from The ArtsCenter. The Carrboro BOA named November 6, 2014 "Community Radio Day" in Carrboro to recognize WCOM's tenth anniversary. Main Application 5/25/2016 10:00:47 AM .. of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: _Public Gallery of Carrboro dba WCOM Community Radio 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: xx❑ 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: Yout Elderl Disabled Public Housing Program Category Adult y (not elderly) Neighborhoods/Resident Education Health and Nutrition Job Training Sports and Arts Activities XX XX XX XX XX Pre-School Activities After-School Activities Mentoring XX XX XX XX XX Transportation Housing Other: Please specify XX Broadcasting Training & experience XX XX XX XX Program/Project Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: Answers Inserted Below a) Summarize the program services proposed and how the program will address the chosen Town/County priority? b) 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. c) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. d) Who specifically will carry out the activities and in what location will they be carried out? Main Application 5/25/2016 10:00:47 AM P 5 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION e) 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. f) 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. g) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. h) Include any other pertinent information. Program/Project Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: a) Summarize the program services proposed and how the program will address the chosen Town/County priority? As a community radio station WCOM, the Public Gallery of Carrboro provides broadcasting training and opportunity for citizens of all ages, sexual orientations, and races; WCOM provides ample opportunity for airing Public Service Announcements (PSAs)from non- profits, schools, and government agencies in the towns and counties; locally owned and operated media on a daily basis. Carrboro's 20/20 vision reads "The town should continue to encourage and support artistic and cultural activity." Orange County's Comprehensive plan calls for expanding recreational activities available to citizens of all ages. b) 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. The need for recreational opportunities and entertainment to citizens; the need for locally produced media on a daily basis; the need for opportunities for non-profits, schools, and government entities to distribute information to citizens; the need for citizens to hear interviews from government officials and candidates for office; the need to promote and provide artistic and cultural activity. c) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. The Public Gallery of Carrboro provides radio to Carrboro, Chapel Hill, and southern Orange County. Residents throughout the county and the world can listen to WCOM over the Internet. WCOM offers programming training to any citizen who desires it. WCOM provides broadcasting opportunities to any citizen who completes training and has an acceptable program concept. WCOM offers more Spanish language, all locally produced, than any station in Orange County. d) Who specifically will carry out the activities and in what location will they be carried out? These activities will be carried out by the roughly 75 WCOM volunteers at the WCOM studio at 300-G East Main Street, Carrboro. e) 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. July 1, 2016 to June 30, 2017: WCOM will broadcast 24 hours per day, each day of the year, offering diverse voices of our community with both talk and music programming. July 1, 2016 to June 30, 2017: WCOM will provide radio broadcasting training to all who request it. July 1, 2016 to June 30, 2017: WCOM will continue daily air Public Service Announcements (PSAs) from non-profits in Orange County whenever provided to us in Main Application 5/25/2016 10:00:47 AM .. g 6 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION time. Each Friday we will continue to offer a weekly calendar of local events at 6PM Fridays. f) 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. • The "Wacqueline Stern Show" is video recorded and broadcast on the People's Channel • We have discussed expanding the collaboration to other programs • TPS has shot and provided to us video resources for promotion of the station and its services. • Collaboration is developing with Little Raleigh Radio and WHUP-LPFM in Hillsborough. g) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Public Gallery of Carrboro would continue to operate community radio station WCOM 24 hours per day. If we are unable to match the revenue from another source, we would be forced to reach into our limited reserves as we have the past three years. Those losses totaling $5372 have reduced our operating reserve from $9632 to $4260. h) Include any other pertinent information. Our service to the community We offer a number of radio programs produced by local African-American programmers and featuring music rooted in African-American traditions. We offer locally produced Spanish language programs. This provides diverse voices of the community unavailable elsewhere. Through WCOM the Public Galley of Carrboro offers an open platform for PSAs from local non-profits throughout our offerings. The "Time Out" program on Mondays at 5PM provides in depth and thought interviews with important people in our community, including annual visits by Congressman David Price and regular appearances by former Carrboro mayor and State Senator Ellie Kinaird. Currently, "Time Out" presents monthly interviews with Town of Carrboro department heads. Wednesday's "Wake Up Call" offers interviews with Orange County leaders such as County Commissioner Renee Price and former Chapel Hill mayor Mark Kleinschmidt. Listeners Served WUNC-FM 91.5 is the only radio station licensed to Orange County that subscribes to the Arbitron rating service. WCHL, WXYZ, WCOM, and WHUP do not due both to the expense and because there are little more than a dozen Arbitron reporters in Orange County, making for less than accurate reports. WCOM does collect data for online listenership, however, most recently for September, October, and November 2015. Our website receives 800 visits per day. The median number of listeners at any one time to our Internet streaming is 8.85. We broadcast 24 hours per day. Thus any one 24-hour period would generate 212.4 listener-hours. For a year that computes to 77,526 listener hours. The eight-week sampling period in the autumn of 2015, www.wcomfm.orq gained 314 new unique visitors, roughly 6 per day or a 1.8% increase of over the weight weeks. During the same time, mean total hits on www.wcomfm.orq increased from 521.7 per day to 800.2 during the eight weeks, an increase of 278.5 per day or 53.3%. Program/Project Information i) Complete the Target Population and Program Beneficiary Demographics Chart j) Complete the Schedule of Positions Chart for Program Staff k) Disclosure of Potential Conflicts of Interested must be signed Main Application 5/25/2016 10:00:47 AM P g of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION I) 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. Demographic information presented below in this application reflects those of WCOM volunteers. Lacking any means to measure them,we assume that listener demographics resemble those of Chapel Hill and Carrboro since our service is delivered free of charge. 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: XX❑ Persons ❑ Households ❑ Units Program: Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 45–63% 44–59% 44–57% Female 28–37% 31 –41% 33–43% Total 73 75 77 Of the females, how many are single- female Head of Households (Omit for Human Services) Ethnicity African-American 7- 10% 8- 11% 9- 12% American Indian or Alaska Native 1 – 1% 1 – 1% 1 – 1% Asian 2–3% 3–4% 4–5% Caucasian 63–86% 63–84% 63–82% Native Hawaiian or other Pacific Islander 0 0 0 Other 0 0 0 Total 73 75 77 Of the above, how many Hispanic/Latino 4–5% 6–7% 7–9% Of the above, how many non- Hispanic/Latino 69–95% 69–93% 70–91% Total 73 75 77 Age 0-5 years 0 0 0 6-18 years 4-5% 4-5% 4-5% 19-50 years 40–55% 42–55% 43–55% Main Application 5/25/2016 10:00:47 AM .. of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION 51-61 years 17-24% 17-24% 18-24% 62+ years 12— 16% 12— 16% 12— 16% Total 73 75 77 Geographic Location Durham City 10- 15% 10- 15% 10- 14% Durham County 2—3% 2—3% 2—3% Carrboro 23—34% 24—36% 24—35% Chapel Hill 19—29% 19—28% 19—28% Chapel Hill Public Housing Residents Unknown Unknown Unknown Orange County 10— 15% 11 — 16% 11 — 16% Raleigh 2—3% 2—3% 2—3% Wake County 1 — 1% 1 — 1% 1 — 1% Total 65—93% 67—93% 69—93% Income Level —See following chart (Omit for HS) < 30%Area Median Income Unknown unknown unknown 31-50% Area Median Income Unknown unknown unknown 51-80% Area Median Income Unknown unknown unknown > 80%Area Median Income Unknown unknown unknown Total 0 0 0 Special Needs (Omit for HS) Elderly(Over 62) 12— 16% 12— 16% 12— 16% Disabled (not elderly) 1 — 1% 1 — 1% 1 — 1% Homeless 0 0 0 People with HIV/Aids Unknown unknown unknown Total 13- 18% 13- 18% 13- 18% Main Application 5/25/2016 10:00:47 AM .. • of 2 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION CDBG & HOME ONLY- Area Benefit Activities (Infrastructure and Public Facilities) Street Census Tract Block Group Total Persons #LMI Persons 2015 Area Median Family income Limits U.S. Department of Housing & Urban Development (HUD) 2015 Area Median Family Income Limits Effective March 15, 2015 Income 1 2 3 4 5 6 7 8 Level person people people people people people people people 30% AMI $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 50% AMI $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 80% AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 100% AMI $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115% AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www.huduser.ord/portal/datasets/il/ill 5/FY2015 IL nc.pdf Main Application 5/25/2016 10:00:47 AM F 0 , 10 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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 Bookkeeper(1) 0.05 1.4% n/a $512 $700 4% Board secretary(1) 0.15 1.4% 0 0 0 0 Board Treasurer(1) 0.15 1.4% 0 0 0 0 Chair of the Board (1) 0.20 1.4% 0 0 0 0 Engineering volunteer(1) 0.15 1.4% 0 0 0 0 At large board 0.10 members (4) each 5.5% 0 0 0 0 Development 0.075 volunteers (4) each 5.5% 0 0 0 0 60 programming 0.8 volunteers each 82% 0 0 0 0 Total Volunteer FTE 6.13 Notes: • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. • ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • + Denotes the percentage of staff time involved with this program. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours = Volunteer FTE 1,960 Main Application 5/25/2016 10:00:47 AM P 11 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO ❑ XX❑ a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? ❑ XX❑ b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? ❑ XX❑ c) Current beneficiaries of the project/program for which funds are requested? ❑ XX ❑ 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. Signature: None Executive Director Date Signature: January 22, 2015 Board Chairperson Date Main Application 5/25/2016 10:00:47 AM P 12 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Actual Estimated Projected 2014-15 2015-16 2016-17 Program Activity 1 Broadcasting Broadcasting Broadcasting Program Goal Broadcast 100%of time Broadcast 100%of time Broadcast 100%of time Performance Measures Time we broadcast Time we broadcast Time we broadcast Program Results 99.7% (malfunctions) 99.9% (malfunctions) 100% Program Activity 2 Training Training Training Program Goal Train 10 broadcasters Train 13 broadcasters Train 15 broadcasters Performance Measures Number trained Number trained Number trained Program Results 12 13 15 Program Activity 3 Add new programming Add new programming Add new programming Program Goal 5 new shows 6 new shows 7 new shows Performance Measures Number added Number added Number added Program Results 6 6 7 Program Activity 4 Program Goal Performance Measures Program Results Activity 5 Program Goal Performance Measures Program Results Main Application 5/25/2016 10:00:47 AM .. g 13 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 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. Since the Public Gallery of Carrboro is applying for general operating support, both budget spreadsheets are the same. The Public Gallery of Carrboro received at the beginning of 2016 a one-time $2500 marketing grant for the Carrboro Tourism Development Authority which raises the income and expenses for the current year significantly higher than the last or next year. The funding was used for an autumn 2015 campaign to raise awareness of WCOM throughout the Triangle. Main Application 5/25/2016 10:00:47 AM P 14 of 2 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION Program Budget Agency/Prograrr Public Gallery of Carroro/General Operating Support Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 2,775 $ 3,500 $ 4,000 14% Agency Generated Revenue (fees) $ 7,500 $ 8,850 $ 9,350 6% Local Government Grants: Orange County 0 Town of Chapel Hill 0 Town of Carrboro $ 500 0 Other Local: Carrboro Tourism $ 2,500 -100% 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: 0 Other Grants: 0 Miscellaneous/Other Revenue $ 2,250 $ 2,100 $ 3,000 43% Please list 3 largest Miscellanous sources: Fundraising Events $ 2,250.00 Total Agency Revenue $ 13 025 $ 16 950 $ 16 350 -4% AGENCY EXPENSES Compensation $ 876 $ 825 $ 750 -9% Rent&Utilities $ 9,099 $ 9,300 $ 9,600 3% Supplies&Equipment $ 600 $ 700 $ 700 0% Travel&Training $ - $ - $ - 0 Other Expenses: $ 5,369 $ 7,178 $ 5,500 -23% Please list 3 largest"Other Expenses": Insurance $ 2,000.00 music licensing fees&dues $ 2,275.00 advertising $ 558.00 Total Agency Expenses $ 15,944 $ 18,003 $ 16,550 -8% SURPLUS/(DEFICIT)FOR PERIOD: $ (2,919) $ (1,053) $ (200) 81% Main Application 5/25/2016 10:00:47 AM 0 I:°' , 15 of 2 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Example Program: Credit Counseling Class Cost Elements Cost($) Quantity/Unit of Measure Subtotal ($) Credit Counseling Teacher–in class $25 96 hours (8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours (4hrs/mth x 12 mths) $1,200 Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the project/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: _General Operating Expenses Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) Rent $675 12 $8100 Insurance $1000 2 policies $2000 Utilities $100 12 months $1200 Licensing and programming fees $1367 1 year $1380 Advertising $224 10 ads in Indy $2240 Compensation $77 12 months $925 Office Supplies $58.33 12 months $700 Bank and PayPal Fees $125 1 year $125 Taxes $350 1 year $350 Postage $75 1 year $75 Dues $908 1 year $908 Total $18003 c.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $15843.00 $18003.00 $16,550.00 Total # of Units 2190 2196 2190 Cost Per Unit $7.23 $8.20 $7.56 Main Application 5/25/2016 10:00:47 AM P 16 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 5/25/2016 10:00:47 AM P 17 of 2 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION d.) Agency Operating Budget Please show all sources and amounts of funding for your entire current fiscal year. What is your agency's fiscal year? Example: July 1, 2016 through June 30, 2017. 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. Since the Public Gallery of Carrboro is applying for general operating support, both budget spreadsheets are the same. The Public Gallery of Carrboro received at the beginning of 2016 a one-time $2500 marketing grant which raises the income and expenses for the current year significantly higher than the last or next year. The deficits result from moving too slowly to address the end of the station's rent-free existence in 2012. The $7800 addition to expenses more than doubled the budget. Heretofore, WCOM underwriter fees had been sufficient for the Public Gallery of Carrboro to function with a sustainable modest surplus. With such a dramatic growth of expenses, the all-volunteer organization has been forced to build gradually a fundraising function. Fortunately, the Public Gallery of Carrboro had a nearly $6000 operating surplus which has been sufficient to sustain it through the transition. Main Application 5/25/2016 10:00:47 AM F 0 1 of 20 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION Section VI.Financial Data Operating Budget for Entire Agency AGENCY NAME: Public Gallery of Carrboro Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 2,775 $ 3,500 $ 4,000 14% Agency Generated Revenue(fees) $ 7,500 $ 8,850 $ 9,350 6% Local Government Grants: Orange County 0 Town of Chapel Hill 0 Town of Carrboro $ 500 0 Other Local: Carrboro Tourism $ 2,500 -100% 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: 0 Other Grants: 0 Miscellaneous/Other Revenue $ 2,250 $ 2,100 $ 3,000 43% Rease list 3 largest Miscellanous sources: Fundraising Eventss $ - $ - $ - Total Agency Revenue $ 13 025 $ 16 950 $ 16 350 -4 AGENCY EXPENSES Compensation $ 876 $ 825 $ 750 -9% Rent&Utilities $ 9,099 $ 9,300 $ 9,600 3% Supplies&Equipment $ 600 $ 700 $ 700 0% Travel&Training 0 Other Expenses: $ 5,369 $ 7,178 $ 5,500 -23% Rease list 3 largest"Other Expenses": Insurance $ 2,000.00 Music Licensing Fees&Dues $ 2,275.00 advertising $ 558.00 Total Agency Expenses $ 15,944 $ 18,003 $ 16,550 -8% SURPLUS/(DEFICIT)FOR PERIOD: $ 2,919 $ 1,053 $ 200 81% Main Application 5/25/2016 10:00:47 AM .. I of 2 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC t A - continued Provider's Outside Agency Application MAIN APPLICATION Main Application 5/25/2016 10:00:47 AM .. 2 0 o of 2 DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Public Gallery of Carrboro,DBA WCOM-LP Radio Funding Award: $1,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount General Operation Support—Training,Replacement and Maintenance of broadcast equipment 1,000 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. • Broadcasting • Training and development of communication methods via radio • New Programming implemention 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 Train broadcasters in Community Radio communications 15 broadcasters Time broadcasting 100% Add new programming via new shows 7 new shows DocuSigned by: apt M 1 AritAS chairman of the Board 10/27/2016 Certified by: 0.1384CAGe4W Title: Date: (Provider's Signature) DocuSign Envelope ID: E9553E7D-3748-4C37-A9D7-602D42934ACC 1 OP ID:SF coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `••--°''� 09/15/2016 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 Lee-Moore Insurance Agency Inc PHONE FAX P.O.Box 667 (A/C,No,Ext): (A/C,No): West End,NC 27376 E-MAIL Alex Maiolo ADDRESS: PRODUCER PUBLI-1 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Public Gallery of Carrboro Inc INSURER A:Hartford Insurance 14397 Ruffin Slater 201-A N Greensboro St INSURER B Carrboro, NC 27510 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 22SBABG0187 06/03/2016 06/03/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 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 22WECPD4664 06/03/2016 06/03/2017 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE a County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Oran g ty ACCORDANCE WITH THE POLICY PROVISIONS. Allison Chambers 200 S Cameron St Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Alex Maiolo ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD