HomeMy WebLinkAbout2016-602-E Finance - Historical Foundation for Hills and OC - Outside Agency Performance Agreement DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F
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 Historical Foundation of Hillsborough and Orange
County, a not-for-profit corporation, located at 201 N. Churton Street, Hillsborough, NC 27278
("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 Historical Foundation of Hillsborough and Orange County 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 6600.
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 $1,650. 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.
(Historical Foundation of Hillsborough and Orange County)
Orange County Outside Agency Performance Agreement
Revised 8/2016
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F
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.
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
(Historical Foundation of Hillsborough and Orange County)
Orange County Outside Agency Performance Agreement
Rev. 8/16
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F
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.
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
(Historical Foundation of Hillsborough and Orange County)
Orange County Outside Agency Performance Agreement
Rev. 8/16
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F
d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity
defenses.
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 Historical Foundation of
Hillsborough and Orange County 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
(Historical Foundation of Hillsborough and Orange County)
Orange County Outside Agency Performance Agreement
Rev. 8/16
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F
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:
County: Finance&Administrative Services Provider: Historical Foundation of
Orange County Hillsborough and Orange County
Post Office Box 8181 201 N. Churton Street
Hillsborough,NC 27278 Hillsborough,NC 27278
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 b /othe Provider
C.r3,vl,a rt ce. O aea,e.-1.1 10/28/2016
74939B35B1D615F...
For and o Date E 6�, 'LOrange County Government
6lA uit, tkA mt-IrStui 10/31/2016
_0.6.37_9.94R755F477
Bonnie Hammersley, County Manager Date
(Historical Foundation of Hillsborough and Orange County)
Orange County Outside Agency Performance Agreement
Rev. 8/16
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F
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:
CCertifiedb Title: Director, 10/28/2016
y• 74TigR3SR1ne45F llaLe.
(Provider's Signature)
(Historical Foundation of Hillsborough and Orange County)
Orange County Outside Agency Performance Agreement
Rev. 8/16
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F Exhibit A
Provider's Outside Agency Application
APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY
Received By
Agency Historical Foundation of Hillsborough Date/Time / 1
and Orange County Complete Y/N
Program(s) Orange County Historical Museum Heritage
Education Programs, Community Workshops, Exhibits, Collections
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 N/A
3. Program/ a. ® Type of Application and Program Identified 24 CFR 570.200(a),
Project b. 570.201-570. 208,
❑ Summary of Program
Information - c. ❑ Description of Identified Need 507.503
(for each d. ❑ Description of Population to be Served
program/
project for e. ❑ Activity Manager and Location Description
which funding f. ❑ Activity Implementation Timeline
is requested) g. ❑ Agency Collaboration
h. ❑ Describe Impact of Reduced/No Allocation
i. ❑ Other Pertinent Information
j. ❑ Complete Target Population/Beneficiary Chart
k. ® Complete Schedule of Positions
I. ❑ Signed Conflict of Interest Disclosure
m. ❑ Complete Work Statement
i o:°
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F t A - continued
Provider's Outside Agency Application
MAIN APPLICATION
24 CFR 570.200(a),
4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208,
each expenses for the entire program and ALL sources of 507.503
program/ funding. 24 CFR 570.506,
project for 570.507, 570.601,
which funding a. ❑ Program Budget Worksheet SEE ATTACHMENT 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 SEE 570.506,
ATTACHMENT 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 N/A
Sections (as B. ® Part B: Construction/Rehab N/A
applicable)
6. Attachments a. ® Audit: Organizations receiving $300,000 or more OMB Circular A-133
in Federal financial assistance, and/or organizations
with more than $500,000 of receipts and
expenditures in a fiscal year, must secure an audit.
N/A
b. ® IRS Federal Form 990
c. ® NC Solicitation License
d. ® IRS Federal Tax-Exemption Letter
e. ® Certificate of Insurance 24 CFR Parts 84 or 85
f. ® List of Board of Directors 24 CFR 570.208,
g. ® Articles of Incorporation/Bylaws 570.500(c), 570.611
h. ❑ Authorization to Request Funds
i. ❑ Authorized official designation
j. ® 3-R Fee Verification
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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: The Historicaj Foundation of Hillsborough & Orange County
Applicant Organization's Physical Address: 201 N. Churton Street, Hillsborough NC 27278
Applicant Organization's Mailing Address: 201 N. Churton Street Hillsborough NC 27278
Applicant Organization's Web Address: www.orangenchistory.org
Executive Director: Candace Midgett
Telephone Number: (919) 732-2201 E-Mail: director@orangenchistory.prg
DUNS Number: 931145098
(Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.)
b) Prpject/Program Contact Information
Project/Program Name: Orange County,.Historical Museum Heritage Education Programs,
Community Workshops, Exhibits, Collections
Project/Program Primary Contact and Title: Candace Midgett
Telephone Number: (919) 732-2201 E-Mail: director@orangenchistory.org
c) Funding Request Identification
Total Project/Program Cost: $31,787.00Total Amount of Funds Requested: sg,o_oo
Proposed Use of Funds Requested (2-3 Line Maximum): Materials costs, transportation,_personnel
expenses for Heritage Education outreach to OC K-12 students;_public education via museum
exhibitions; preservation/collections care/research efforts to benefit museum stakeholders.
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) $ E] Grant 111 Loan
Li CDBG Construction (CH) El Grant n Loan
El HOME CHDO $ ID Grant 11 Loan
LI HOME Other Grant L Loan
Human Services: OCarrboro $ Hill $ I Orange County $6,600
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: ■
Excutive Director Date
Signature: (
Board airpeson Date '77
Main Application 1/25/2016 1:35:10 PM
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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: Orange County Historical Museum (OCHM), in operation for 58
years, was incorporated in 1983. The Historical Foundation of Hillsborough and Orange
County (HFHOC) was incorporated in 2007, and has been operating the museum for eight
years. The museum is open six days per week, and offers free admission to visitors.
b. Mission of HFHOC: To enlighten and engage our community and visitors from around
the world by preserving and interpreting the history of Orange County.
c. Types of services OCHM provides: Collection, preservation, cataloging, housing historic
artifacts and documents relevant to Orange County history. Using collections as a tool for
educating the public through outreach, including exhibitions, public programs, publications,
and special events. Making historic documents, artifacts, photographs, and other records
available to researchers. Providing support for historic preservation efforts in Orange
County.
d. Agency's experiences with similar programs as the funding request: The museum has
extensive experience with programs for which we seek FY16-FY17 funding:
Program 1: Heritage Education:
Traveling trunks: OCHM has had an active and successful traveling trunk program since
2002. The programs were developed in accordance with North Carolina curricular
standards for elementary students. The contents and lesson plans were updated in 2012,
to better meet contemporary Common Core goals, and to add a traveling trunk program for
middle school students. The rental fee for this program has remained modest, to insure
that it is accessible for a broad range of community users.
Outreach: The first school tours to Orange County students were given to seventh grade
students at OCHM in 1957. The museum has continued to invest significant staff time in
developing and executing heritage education programs, both at the museum and as
outreach in Orange County public schools. The primary audience for museum heritage
outreach in Orange County schools is elementary school students, grades one through five.
History Fun Days: For the past ten years, OCHM, along with Burwell School and Hughes
Academy, have worked in collaboration with Alliance for Historic Hillsborough to present
History Fun Day heritage education. The museum presents tours and hands-on activities
to participating K-12 student groups.
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Special events: Orange County Historical Museum supports Alliance of Historic
Hillsborough's living history days with programs and activities designed for visiting families
with children. These include Revolutionary War and Colonial Living History Days, and
Hillsborough Fourth of July events. They offer workshops and demonstrations designed to
highlight Hillsborough's rich history.
Program 2: Education through exhibits:
Since 1958, the museum has provided public education through museum exhibits, both
temporary and permanent. The first museum tours were based on Colonial-era English
weights and measures and Native American artifacts from the Eno River area. Our latest
permanent exhibition looks again at weights and measures, and the critical role they play in
Orange County commerce.
Program 3: Preservation and Accessibility of Orange County Artifacts:
In the early 1950s the Hillsboro Garden Club conceived of the museum as an entity that
would provide 'substantial protection for these articles that have been so long cherished'.
Historic Foundation of Hillsborough and Orange County's mission statement reflects these
values: The mission of the Historical Foundation of Hillsborough and Orange County is to
enlighten and engage our community and visitors from around the world by preserving and
interpreting the history of Hillsborough and Orange County'.
The museum's collection continues to be a powerful tool for offering the public an
opportunity to engage with Orange County history. Collection preservation and
conservation efforts allow OCHM to share historical artifacts through exhibits designed to
educate and delight our visitors.
The museum offers access to its historic documents and other artifacts for those
researching Hillsborough and Orange County history. It also provides collections research
in support of community and individual historical projects.
OCHM's mandate supports and assists historic preservation efforts in Hillsborough and
Orange County. In 2015 the museum was a supporter of and participant in the Slave
Dwelling Project event in Hillsborough organized by Free Spirit Freedom and Coachman's
Quarters Project. The Slave Dwelling Project's mission is to promote the interpretation and
preservation of existing slave dwellings across the U.S.
e. Brief history of the museum: The Orange County Historical Museum, founded by the
Hillsborough Garden Club, first opened its doors at the Orange County Courthouse in 1957.
The collection focus: county history between 1754 and 1854. The museum incorporated in
1983 and moved to its present location at 201 North Churton Street. In 2007, the museum
merged with the Hillsborough Historical Society to create the Historical Foundation of
Hillsborough and Orange County. HFHOC continues to operate the museum.
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3. PROJECT/PROGRAM INFORMATION
Agency & Program Name: Historical Foundation of Hillsborough and Orange County-Orange
County Historical Museum Heritage Education, Programs, Community Workshops, Exhibits,
Collections
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
application and supplemental application sections as specified below:
® Human Services (Main Application Only)
❑ AH Non-Construction (Main Application Only)
❑ AH Construction — (Main Application AND Part B)
❑ AHDR Non-Construction (Main Application Only)
❑ AHDR Construction — (Main Application AND Part B)
❑ 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 Parts A AND Part B)
Indicate the type of program for which you are requesting funding:
Program Category Youth Adult Elderly Disabled Public Housing
(not elderly) Neighborhoods/Residents
Education X X X X
Health and Nutrition
Job Training
Sports and Arts
Activities X X X X
Pre-School Activities
After-School
Activities X X
Mentoring
Transportation
Housing
Other: Please
specify
Proaram/Proiect Description (Label your responses as outlined below; not to exceed 3 pages.)
Please provide the following information about the proposed program/project:
b) Summarize the program services proposed and how the program will address the chosen
Town/County priority?
c) Describe the local need or problem to be addressed in relation to the Consolidated Plan or
other community priorities (i.e. Council/Board Goals). Cite local data to support the need
for this program and the population being served.
d) Describe the population to be served or the area to benefit and indicate how you will
identify beneficiaries.
e) Who specifically will carry out the activities and in what location will they be carried out?
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f) Describe specifically the period over which the activities will be carried out, the frequency
with which the activities will be carried out, and the frequency with which services will be
delivered. Include an implementation timeline.
g) Provide a bulleted list of other agencies, if any, with which your agency
coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s)
to be funded. For each, give specific examples of the coordinated/collaborative efforts.
h) Describe what would happen if requested funding is not awarded at all or if a reduced
allocation is recommended.
i) Include any other pertinent information.
Program 1: Heritage Education:
Traveling trunks:
b)Three museum trunks contain lesson plans, activities, and objects for teachers to incorporate in interactive
hands-on learning experiences. Areas of study the traveling trunks support: conflict, war and peace during
the Revolutionary War and Civil War periods; Colonial Orange County daily life; and life as a mill worker.
c)The program augments curricular and extracurricular learning about Orange County history; it provides
hands-on interactive learning for a diverse group of students.
d) Users of the traveling trunks self-identify as interested learners. They come primarily from church groups,
home school groups, and county youth organizations.
e)The museum distributes trunks to user groups. They contain sufficient instructions and materials to
facilitate teaching by group leaders or other interested adults.
f)The trunks are part of the museum's current outreach program. Available year-round, groups may rent them
for a two-week period. We plan to rescript lesson plans and execute more frequent publicity FY16-17 to
increase their use by a more diverse cohort of users.
g)We collaborate with no other agencies on this project.
h) If requested funding is not received, it will inhibit our ability to refit traveling trunks for more diverse
audiences, and to more vigorously publicize the program's availability.
School outreach:
b)The museum's outreach programs for K-5 Orange County students enrich history curriculum opportunities
for elementary school teachers. Multiple interactive programs are offered: a `junior curator' activity on two
different topics, Native American artifacts and Civil War artifacts; a Colonial quilt activity; interactive looks at
the daily lives of Revolutionary War and Civil War soldiers; lives of Orange County textile mill workers.
c)Created to support and enrich NC's Standard Course of Study in history, museum outreach gives students
an opportunity to directly engage with Orange County history.
d) Each program is modifiable for different grade levels and classroom needs. Classroom teachers self-select
outreach programs by booking classes directly with the museum.
e) Programs are delivered in elementary school classrooms by the executive director.
f)This program is already being implemented. Outreach opportunities are offered to teachers on weekdays
from September through May, and serve approximately 2500 students during that period.
g)We collaborate with no other agencies on this project.
h) If requested funding is not received, it will inhibit our ability to modify K-5 program elements to more closely
conform to NC Essential Standards, to renew and refresh interactive materials that support program lesson
plans, and to more effectively publicize outreach programs to the Orange County K-5 teaching community.
Teaching with Historic Hillsborough sites:
b)The museum offers on-site tours and activities to school groups participating in the Alliance of Historic
Hillsborough's History Fun Day programs.
c)These programs help to enrich the teaching of North Carolina history in Orange County K-12 public
schools. Participating students have the opportunity to experience history directly by visiting Hillsborough's
historic sites.
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d)This program benefits students in grades K-12 in the Orange County public school system. Classroom
teachers self-select students who will participate in the program by booking outreach tours with the Alliance of
Historic Hillsborough.
e)These programs are delivered at Orange County Historical Museum by the executive director.
f)This program is already being implemented. Tour days are offered to teachers on Fridays during the
academic school term by the Alliance for Historic Hillsborough (scheduler for these tours). There are
approximately five to ten History Fun Day dates made available to Orange County teachers throughout the
calendar year.
g)Tours of non-profit sites address site-specific topics, and are given independently by each educator.
Students attend tours in rotation at the following sites:
•Alliance for Historic Hillsborough
•Burwell School
•Hughes Academy
•Orange County Historical Museum
h) If requested funding is not received, it will inhibit our ability to provide new lesson plans and supporting
materials that would allow us to present a broader scope of topics for tour participants.
Special historic events:
b)Orange County Historical Museum also supports Alliance of Historic Hillsborough's living history days with
programs and activities designed for visiting families with children. For example, we participate in
Revolutionary War and Colonial Living History Days, and Hillsborough Fourth of July events.
c)These special events attract visitors to Hillsborough. They allow visiting families to experience
Hillsborough through programs offered by the museum and other historic sites, and to become familiar with
the cultural resources Orange County has to offer.
d)Orange County Historical Museum's programs for special historical events are designed to attract families
with children to the area. Empirical evidence has shown that these families have been predominantly white
and middle class. In FY15-16 the museum began a significant effort to attract a more diverse audience of
families to the museum through new programs. For example, December workshops in support of
Hillsborough's Hometown Holidays program focused on Diwali, Kwanzaa and Hanukkah family traditions in
Orange County.
e)The museum's Historic Hillsborough tours, activities and programs are delivered at the museum by the
executive director.
f)Special historic events happen throughout the calendar year. We participate in approximately four to six
special historic events yearly.
g)Although done in conjunction with the Alliance for Historic Hillsborough's special events schedule, the
museum collaborates with no other agencies on these projects.
h) If requested funding is not received, we will be unable to purchase the materials that would allow us to
create and offer new workshops during the FY16-17 period.
Program 2: Education through exhibits:
b) Museum exhibits offer visitors a connection to the past by presenting the rich history of Orange County,
one of the oldest counties in the state, and a center for Native American, Colonial, antebellum, and twentieth
century history. Admission to museum is free; museum is open six days per week. OCHM is the only
history museum in Orange County, and has the singular responsibility and privilege of preserving and
interpreting Orange County history.
c)The museum researches, creates and installs exhibits covering a wide variety of topics, from post-
Reconstruction African American education, to the Orange Guards commemorative flag, the only known Civil
War Era flag from Orange County still in existence, to the 15th annual art show for Orange Smart Start
children. These exhibits enrich the cultural resources and opportunities available to the Orange County
community and its visitors.
d) Exhibit topics are carefully chosen to educate and entertain the broad audience of diverse museum goers
that represents the Orange County community, as identified by US census data about the county
(http://quickfacts.census.gov/qfd/states/37/37135.html).
e)The executive director is directly responsible for exhibits created for and installed in the museum.
f) Exhibits are on display at the museum throughout the year. New temporary exhibits are offered three to
four times a year. Permanent exhibit installations, more costly and time-intensive, are created every few
years.
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g) OCHM generally collaborates with no other agencies on exhibits. On occasion, the museum hosts exhibits
for other agencies. These exhibits are generally researched, created, and installed by museum personnel
without assistance from those agencies.
h)Grant funding is the primary source for the costs incurred in the creation and installation of new exhibits. If
requested funding is not received, it will curtail our ability in the FY16-17 period to invest the staff time
required for the research and planning required to create an exhibit, and to purchase supplies and materials
required to complete the installation process.
Program 3: Preservation and accessibility of Orange County artifacts:
b)The museum acts as steward for the county's historical artifacts. It offers security, preservation, and
conservation for the objects in its collections. The museum makes its collections and archives available to the
public. Historical context, provided by museum scholarship, makes objects more accessible to the museum's
community of users. OCHM offers UNCG and UNCH interns/volunteers collections management experience.
•Museum staff members assist the public with collection-related research. The museum coordinator and
historical interpreter work directly with visitors to fulfill research requests.
•The museum's mandate also extends to seeking conservation for at-risk Orange County artifacts. One such
artifact, a portrait of a Saponi-African American woman donated by a descendant, and conserved by
Etherington Conservation Services, has become a favorite part of our collection.
•These activities offer community members the chance to engage directly with the history of Orange County.
c)The preservation, conservation, and interpretation of Orange County's most important historical artifacts
provide context and depth to the cultural richness of Orange County. Museum visitors come from all over the
county, state, and world to experience the museum's collections, and to explore its archives.
d). Virtual and onsite visitors, outreach participants, event participants, and the Orange County community are
potential museum stakeholders and beneficiaries of these services.
e)The director works with the HFHOC board and other engaged and interested stakeholders in the Orange
County community to make collection, preservation and conservation decisions that are in the best interest of
all potential users of the museum. Preservation and research are ongoing on-site activities. Conservation is
generally done by contracted specialists at their offsite facilities.
f)The museum offers research services by request to interested stakeholders throughout the year.
Continuous preservation management is the principal responsibility of the museum director. Artifact
conservation occurs intermittently, as artifacts in need are identified and budgets allocated to meet requisite
costs.
g)We generally collaborate with no other agencies on research projects and preservation management.
Conservation activities are most often conducted with partner funding agencies (see example above of
conservation project by Etherington Conservation Services).
h) Reduced or denied funding would negatively affect our ability to budget staff time for artifact-based
research that informs the interpretation of objects for exhibits and purchases of archival supplies that are
necessary to protect and house objects for safe storage, and provide for their efficient tracking and retrieval.
Program Implementation Availability of Frequency of
Program elements timeline services services
As requested (2-
Heritage Education Traveling trunks Ongoing Calendar year 3x year)
School outreach Ongoing Sept.-May 20x year
Teaching with
Historic
Heritage Education Hillsborough sites Ongoing Calendar year 5-10x year
Heritage Education Special events
311x year
(museum closed
Mondays,
2. Education through Christmas and
exhibits Ongoing Calendar year Thanksgiving
Program/Project Information
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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: Heritage Education
Program Beneficiary Demographics
Actual Estimated Projected
2014-15 2015-16 2016-17
Gender
Male 1265 1250 1250
Female 1265 1250 1250
Total 2590 2500 2500
Of the females, how many are single-
female Head of Households (Omit for
Human Services)
Ethnicity
African-American 440 425 425
American Indian or Alaska Native
Asian
Caucasian 1450 1400 1400
Native Hawaiian or other Pacific
Islander
Other 700 675 675
Total 2590 2500 2500
Of the above, how many
Hispanic/Latino 440 425 425
Of the above, how many non-
Hispanic/Latino 2150 2075 2075
Total 0 2500 2500
Age
0-5 years
6-18 years 2590 2500 2500
19-50 years
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51-61 years
62+ years
Total 2590 2500 2500
Geographic Location
Durham City
Durham County
Carrboro 78 75 75
Chapel Hill 673 650 650
Chapel Hill Public Housing Residents
Orange County 1839 1775 1775
Raleigh
Wake County
Total 2590 2500 2500
Income Level —See following chart
(Omit for HS) N/A
< 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) N/A
Elderly(Over 62)
Disabled (not elderly)
Homeless
People with HIV/Aids
Total 0 0 0
*The Museum does not capture statistics on gender, ethnicity, and age
from visitors and program participants. Gender and ethnicity
demographics based on Orange County Public School data.
Program: 2 Education through Exhibits
Program Beneficiary Demographics
Actual Estimated Projected
2014-15 2015-16 2016-17
Gender
Male 2630 4500 4500
Female 2630 4500 4500
Total 5262 9000 9000
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Of the females, how many are single-
female Head of Households (Omit for
Human Services)
Ethnicity
African-American
American Indian or Alaska Native
Asian
Caucasian
Native Hawaiian or other Pacific
Islander
Other
Total 5262 9000 9000
Of the above, how many
Hispanic/Latino
Of the above, how many non-
Hispanic/Latino
Total 5262 9000 9000
Age
0-5 years
6-18 years
19-50 years
51-61 years
62+ years
Total 5262 9000 9000
Geographic Location
Durham City
Durham County
Carrboro
Chapel Hill
Chapel Hill Public Housing Residents
Orange County
Raleigh
Wake County
Total 5262 9000 9000 I
Income Level —See following chart
(Omit for HS) N/A
< 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) N/A
Elderly(Over 62)
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Disabled (not elderly)
Homeless
People with HIV/Aids
Total 0 0 0
*The Museum does not capture statistics on gender, ethnicity, and age
from visitors.
Program: 3 Preservation: Research requests fulfilled
Program Beneficiary Demographics
Actual Estimated Projected
2014-15 2015-16 2016-17
Gender
Male 14 15 15
Female 14 15 15
Total 28 30 30
Of the females, how many are single-
female Head of Households (Omit for
Human Services)
Ethnicity
African-American
American Indian or Alaska Native
Asian
Caucasian
Native Hawaiian or other Pacific
Islander
Other
Total 28 30 30
Of the above, how many
Hispanic/Latino
Of the above, how many non-
Hispanic/Latino
Total 28 30 30
Age
0-5 years
6-18 years
19-50 years
51-61 years
62+ years
Total 28 30 30
Geographic Location
Durham City
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Durham County
Carrboro
Chapel Hill
Chapel Hill Public Housing Residents
Orange County
Raleigh
Wake County
Total 28 30 30
Income Level —See following chart
(Omit for HS) N/A
< 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) N/A
Elderly(Over 62)
Disabled (not elderly)
Homeless
People with HIV/Aids
Total 0 0 0
*The Museum does not capture statistics on gender, ethnicity, and age
from museum visitors, program participants, or individual researchers.
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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
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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
17%(1)
17%(2)
Executive Director 0.75 16%(3) $26,364 $28,275 $31,900 62% N/A
Museum 90%(2)
Coordinator 0.75 10%(3) $5,464 $10,545 $12,584 25% N/A
Museum Interpreter 0.25 100%(2) $3385 $2927 $3003 6% N/A
Volunteers
Volunteers 75%(2)
(HFHOC) Board 0.50 25%(3) N/A N/A N/A N/A N/A
50%(2)
Volunteers (OCHM) 0.25 50%(3) N/A N/A N/A N/A N/A
Notes:
• Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item.
• ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc.
• + Denotes the percentage of staff time involved with this program.
• Calculate a Full Time Equivalent for all recorded volunteer hours using the following:
Total Volunteer Hours = Volunteer FTE
1,960
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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
El ' a) Employees of or closely related to employees of the Town of Chapel Hill, Orange
County, Carrboro, or Hillsborough?
El b) Members of or closely related to members of the governing bodies of Chapel Hill,
Carrboro, Hillsborough, or Orange County?
E] I c) Current beneficiaries of the project/program for which funds are requested?
[1] 11 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.
-----_
\ N
Signature
Executive Director \
)(---Z7— It 2 --1 '
Signature: e c q -, ,, i (:),,,t >,-e,-- , Di al ,,),,[4\ ):
, 2(( //// (/'/,,/ e" ,..,
Board Chairperson Date
Main Application 1/13/2016 3:04:09 PM ' ,i ci cs I 0 ) r ; c,
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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
The Executive Director The Executive Director
provided Heritage Education provides Heritage Education From 7.1.16-16.30.17, OCHM
Programs, both in the Programs and participates in
Program Activity 1: Use NC K-12 collaborative events. will incorporate NC Essential
classroom and at the
Essential Standards,deliver Traveling Trunks are rented Standards/revised Bloom's
Heritage Education program, Museum. The Executive Taxonomy, revise/deliver
Director rents Traveling to teachers. y,
outreach/onsite NC/OC
Trunks to teachers and lesson plans through
participates in collaborative illustrated presentations,
history events. group discussions, and
intoror4km nrniortc
Provide interactive history-
Serve at least 2,500 based learning that supports
children by providing Serve at least 2,500 children NC social studies Essential
Program Goal Heritage Education by providing Heritage Standards to 2500 OC K-5th
Programs, Traveling Education Programs, graders by June 30 2017.
Trunks, or through Traveling Trunks, or through Venues: K-5 schools,
Collaborative History Collaborative History
Events. HFD/Hillsborough, OCHM
The Executive Director The Executive Director will The Executive Director will
Performance Measures recorded the number of record the number of children record the number of children
children served during served. served during each outreach
each outreach. contact in FY16-17.
The Executive Director will:
provide curriculum based
2590 Orange County Heritage Education Programs
children were served The Museum anticipates at to 2500 culturally diverse
Program Results through Museum's least 2,500 Orange County students in FY 16-17, -
Heritage Education children will be served by one participate in collaborative
Programs, Traveling of the Museum's Heritage events,
Trunks or by attending a Education Programs -rent traveling trunks to
collaborative history event. teachers.
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Program Activity 2
Education thru exhibits OCHM will research, create
and install one exhibit in Q!-
02, and Q2-Q3FY-16-17,
that:
-are relevant,educational,
enriching;
Staff and volunteers will -provide accessible cultural
Staff and volunteers mount special exhibits and opportunities,
mounted special exhibits plan programs that make -serve Orange County's
and planned programs that community history available community of diverse
made community history to the public. museum goers
available to the public.
After a slow start in the first 2
quarters of FY15-16, OCHM
will deliver education
opportunities to 9,000
Program Goal visitors in Q3-Q4 of FY16-17
through permanent and
special exhibits and
The Museum will educate collections. Upcoming: OC
The Museum will educate 9,000 visitors with both campaign buttons, March
9,000 visitors with exhibits permanent and special 2016, Negro Baseball
and collections. exhibits. Leagues summer 2016(date
tbd)
Museum staff will tally and
Performance Measures Museum staff will record the recorded onsite museum
The Museum recorded the number of visitors to the
number of visitors to the museum and museum visitors and program
Museum. programs. participants.
The Museum educated OCHM will deliver educational
5262 visitors with exhibits opportunities to 9,000 visitors
and collections. Note: through permanent and During FY 16-17,OCHM will
Program Results remediation special exhibits and collection serve 9,000 visitors from a broad
for extensive water after a slow start in the first 2 audience of Orange County
damage on two floors of quarters of FY15-16. community members and visitors
the museum and severe Upcoming: OC campaign by providing rtui ie through permanent
through permanent
winter weather adversely buttons, March 2016, Negro and special exhibits and
affected FY14-15 Baseball Leagues summer collections.
visitation. 2016 (date tbd)
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OCHM will:
-provide research assistance
to inform community
members' research projects;
Program Activity 3 -offer college students the
Preservation,conservation, opportunity to interact with its
research collections
-provide preservation and
Staff assisted researchers Staff assists inquiries by conservation to historic
by providing information on providing information held in Orange County artifacts held
history and collections that OCHM archives. in trust for museum
is housed in the Museum. stakeholders.
Throughout the year:
-offer UNCG and UNCH
interns/volunteers collections
To assist researchers with management experience(fall
Program Goal genealogy inquires and and winter/spring semesters
provide UNC Chapel Hill and 16-17).
Greensboro students with -make OCHM collections/
experience in collections archives available to the
management and public year-round;
The Museum will assist 25 conservation. To loan -provide year-round
researchers with their collections for community preservation/conservation
inquiries. education. collection artifacts
Museum
The Museum recorded and will:
tracked the number of -track number of research
researchers assisted. hours;
and staff research
hours;
Performance Measures -record number of student
Museum staff will record and interns/volunteers, and hours
tracked the number of worked;
researchers assisted, -Monitor collection condition
including the amount of time using quarterly environmental
required to assist datalogging reports and
researchers. monthly physical survey
OCHM will:
--assist 25 researchers with
inquiries;
Program Results -engage 3 college interns and
volunteers in collections
Staff assisted 28 management;
researchers with a variety OCHM will assist 25 -continue to conscientiously
of historical topics, utilizing researchers with their Orange preserve/conserve OCHM's
the Museum's archival County history related collections;
collection. questions.
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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.
Please note: OCHM experienced in F2015-16, and expects to experience in 2016-17, a
significant decrease in funding from the town of Hillsborough. 2015-2016 funding was
decreased by 38%. We estimate OCHM's FY16-17 grant funding by the town will be at a
level similar to that of the FY15-16 grant award received by the museum.
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b.) Agency/Program
Education Through Exhibits
Perce
nt
Actual Estimated Projected ! Chan
AGENCY REVENUE 2014-15 2015-16 2016-17 ge
Private Donations $7,591 $9,500 $10,450 10%
Agency Generated Revenue(fees) $- $- $- 0%
Local Government Grants:
Orange County $4,000 $6,000 $6,600 10%
Town of Chapel Hill 0
Town of Carrboro 0
OC Arts
Other Local: Commission $- $1,500 $1,650 10%
Town of
Other Local: Hillsborough $22,700 $14,000 $15,400 10%
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: tbd $1,500 $1,650 10%
Other Grants: 0
Miscellaneous/Other Revenue $19,302 $13,600 $14,960 10%
Please list 3 largest Miscellanous sources:
Investment 10,00
Income 0 $10,000.00
Home for the
Holidays $6,867.00
Gift Shop Sales $1,956.00
$ $ $
Total Agency Revenue 53,593 46,100 50,710 10%
AGENCY EXPENSES
Compensation $12,521 $16,941 $19,771.48 17%
Rent& Utilities $- $- $- 0
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Supplies & Equipment $- $300 $330 10%
Travel &Training $- $- $-
Other Expenses: 0
Please list 3 largest"Other Expenses":
Insurance $1,799.00
Fundraising $865.00
Fees $1,325.00
Total Agency Expenses $12,521 $17,241 $20,101 17%
SURPLUS/(DEFICIT) FOR PERIOD:
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MAIN APPLICATION
Agency/Program: Heritage Education
Perce
nt
Actual Estimated Projected Chang
AGENCY REVENUE 2014-15 2015-16 2016-17 e
Private Donations $7,591 $9,500 $10,450 10%
Agency Generated Revenue (fees) $- $- $- 0%
Local Government Grants:
Orange County $4,000 $6,000 $6,600 10%
Town of Chapel Hill 0
Town of Carrboro 0
OC Arts
Other Local: Commission $- $1,500 $1,650 10%
Town of
Other Local: Hillsborough $22,700 $14,000 $15,400 10%
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: tbd $1,500 $1,650 10%
Other Grants: 0
Miscellaneous/Other Revenue $19,302 $13,600 $14,960 10%
Please list 3 largest Miscellanous sources:
10,00
Investment Income 0 $10,000.00
Home for the
Holidays $6,867.00
Gift Shop Sales $1,956.00
$ $ $
Total Agency Revenue 53,593 46,100 50,710 10%
AGENCY EXPENSES
Compensation $4,482 $4,807 $5,423 13%
Rent & Utilities $- $- $- 0
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Supplies & Equipment $117 $600 $660 10%
Travel &Training $200 $200 $188 -6%
Other Expenses: 0
Please list 3 largest"Other Expenses":
Insurance $1,799.00
Fundraising $865.00
Fees $1,325.00
Total Agency Expenses $4,799 $5,607 $6,271 12%
SURPLUS/(DEFICIT) FOR PERIOD:
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Agency/Program: Preservation and Conservation
Perce
nt
Actual Estimated Projected Chang
AGENCY REVENUE 2014-15 2015-16 2016-17 e
Private Donations $7,591 $9,500 $10,450 10%
Agency Generated Revenue (fees) $- $- $- 0%
Local Government Grants:
Orange County $4,000 $6,000 $6,600 10%
Town of Chapel Hill 0
Town of Carrboro 0
OC Arts
Other Local: Commission $- $1,500 $1,650 10%
Town of
Other Local: Hillsborough $22,700 $14,000 $15,400 10%
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: tbd $1,500 $1,650 10%
Other Grants: 0
Miscellaneous/Other Revenue $19,302 $13,600 $14,960 10%
Please list 3 largest Miscellanous sources:
10,00
Investment Income 0 $10,000.00
Home for the
Holidays $6,867.00
Gift Shop Sales $1,956.00
$ $ $
Total Agency Revenue 53,593 46,100 50,710 10%
AGENCY EXPENSES
Compensation $4,218 $4,524 $6371 41%
Rent & Utilities $- $- $- 0
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Supplies & Equipment $- $300 $330 10%
Travel &Training $- $- $- 0
Other Expenses: 0
Please list 3 largest"Other Expenses":
Insurance $1,799.00
Fundraising $865.00
Fees $1,325.00
$ $ $
Total Agency Expenses 4,218 4,824 6701 39%
SURPLUS/(DEFICIT) FOR PERIOD:
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c.) 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 $9,000
Complete the table below for the project/program for which you are requesting funds.
Attach additional rows/pages, as needed.
Program: Heritage education
Cost Elements Cost($) Quantity/Unit of measure Subtotal( )
Compensation $20.44 265 hours (8 hrs per x 33) $5423.00
Supplies/materials tbd tbd: in-class supplies; computer $660.00
software
Travel and training .54 Mileage .54/mile x 348 $188.00
Total $6271.00
d.) Cost per Unit
Actual 2014-15 Estimated 2015-16 Projected 2016-17
Total Cost of Program $4799 $5607 $6271
Total # of Units 2590 2500 2500
Cost Per Unit $1.92 $2.24 $2.51
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Program: Education through exhibits
Cost Elements Cost($) Quantity/Unit of measure Subtotal ($)
Compensation (ED, Museum coord, $20.44 (ED) ED: 265 hrs=$5416.60 $19,771.48
Heritage interpreter) 10.78 (MC) MC: 1053 hrs=$11,351.34
7.22 (HI) HI: 416 hrs=$3003.54
Supplies & materials tbd tbd: materials to support exhibit $330.00
development/installation
Total $20,101.48
e.) Cost per Unit
Actual 2014-15 Estimated 2015-16 Projected 2016-17
Total Cost of Program $12,521 $16,941 $20,101.48
Total # of Units 5262 9000 9000
Cost Per Unit $2.38 $1.88 $2.23
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Program: Preservation, conservation, research
Cost Elements Cost($) Quantity/Unit of measure Subtotal ($)
Compensation ED $20.44 250 hours=$5110 $6371.26.
MC $10.78 117 hours=$1261
Supplies/materials tbd Tbd: computer software, $330.00
hardware to support collections
archival database
Total $6701
f.) Cost per Unit
Actual 2014-15 Estimated 2015-16 Projected 2016-17
Total Cost of Program $4218 $4824 $6701
Total # of Units 28 25 25
Cost Per Unit $150.64 $192.96 $268.00
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).
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g.) 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.
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Operating Budget for Historic Foundation of Hillsborough and Orange
Agency/Program: County
Percen
t
Actual Estimated Projected Chang
AGENCY REVENUE 2014-15 2015-16 2016-17 e
Private Donations $7,591 $9,500 $10,450 10%
Agency Generated Revenue (fees) $- $- $- 0%
Local Government Grants:
Orange County $4,000 $6,000 $6,600 10%
Town of Chapel Hill --- 0
Town of Carrboro --- 0
OC Arts
Other Local: Commission $- $1,500 $1,650 10%
Town of
Other Local: Hillsborough $22,700 $14,000 $15,400 10%
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: tbd $3,000 $3,300 10%
Other Grants: --- 0
Miscellaneous/Other Revenue $19,302 $13,600 $14,960 10%
Please list 3 largest Miscellanous sources:
Investment 10,00
Income 0 $10,000.00
Home for the
Holidays $6,867.00
Gift Shop Sales $1,956.00
$ $ $
Total Agency Revenue 53,593 46,100 50,710 10%
AGENCY EXPENSES
Compensation $37,333 $44,793 $49,272 10%
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Rent & Utilities $5,866 $6,480 $7,128 10%
Supplies & Equipment $1,398 $2,740 $3,014 10%
Travel &Training $195 $370 $407 10%
Other Expenses: $10,300 $7,885 $8,674 10%
Please list 3 largest"Other Expenses":
Insurance $1,799.00
Fundraising $865.00
Fees $1,325.00
$ $ $
Total Agency Expenses 55,092 62,268 68,495 10%
SURPLUS/(DEFICIT) FOR PERIOD: $(1,499) I $(16,168) I $(17,785)
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EXHIBIT `B"
Scope of Services—FY 2016-17
Outside Agency Performance Agreement
Agency Name: Historical Foundation of Hillsborough and Orange County
Program Name:
Funding Award: $6,600
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
Personnel Expenses—Salaries and FICA 6,600
Program Expenses
Program Services
For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the
contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes
below,by June 30,2016.
•
•
•
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
Provide curriculm based Heritage Education Programs to culturally diverse students 2,500 students
Serve visitors from a broad audience of Orange County community members 9,000 visitors
Engage college interns and volunteers in collections management 3 interns
Assist researchers with inquiries 25 researchers
DocuSigned by:
E.A,VG111 iQee. a -4,
Certified by: Title: Executive Di rector, °CHl�ate: 10/28/2016
(Provider's Signature)
DECLARATIONS
DocuSign Envelope ID: 5BF9183D-3BD5-4FD7-80DE-F437539D2E9F
A ERIE INSURANCE EXCHANGE
Erie ULTRAFLEX POLICY
Insurance
loo En 16530ce Place RENEWAL CERTIFICATE - COINSURANCE CONTRACT
Erie,PA 16530
Agent ITEM 2. Policy Period Policy Number
111010 THE BALLARD AGY INC 08/22/16 TO 08/22/17 Q44 2250193 NC
ITEM 1. Named Insured and Address ITEM 3. Other Interest
THE HISTORICAL FOUNDATION OF
& ENDT #1
201 N CHURTON ST
HILLSBOROUGH NC 27278-2535
POLICY PERIOD BEGINS AND ENDS AT 12 .01 A . M . STANDARD TIME AT THE STATED
ADDRESS OF THE NAMED INSURED .
THE INSURANCE APPLIES TO THOSE PREMISES DESCRIBED AS PER THE ATTACHED
SUPPLEMENTAL DECLARATIONS . THIS IS SUBJECT TO ALL APPLICABLE TERMS OF THE
POLICY AND ATTACHED FORMS AND ENDORSEMENTS
DEDUCTIBLE (PROPERTY PROTECTION ONLY) - $ 200 .
COVERAGES : DEPOSIT
PROPERTY PROTECTION - AS PER THE ATTACHED SUPPLEMENTAL DECLARATIONS $PREMIUM
1 . BUILDINGS
2 . BUSINESS PERSONAL PROPERTY AND PERSONAL PROPERTY OF OTHERS $ INCL
3 . INCOME PROTECTION $
4 . GLASS AND LETTERING $
5 . SIGNS, LIGHTS AND CLOCKS
LIMITS OF INSURANCE $ INCL
EACH OCCURRENCE LIMIT $ 1, 000, 000
DAMAGE TO PREMISES
RENTED TO YOU LIMIT $ 1, 000, 000 ANY ONE PREMISES
MEDICAL EXPENSE LIMIT $ 5, 000 ANY ONE PERSON
PERSONAL & ADVERTISING INJURY LIMIT $ 1,000, 000 ANY ONE PERSON OR ORGANIZATION
GENERAL AGGREGATE LIMIT $ 2,000, 000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 2, 000,000
OPTIONAL COVERAGES SEE NEXT PAGE
TOTAL DEPOSIT PREMIUM - - - - - $ 525 .
APPLICABLE FORMS - SEE SCHEDULE OF FORMS
See Reverse Side C1T 06/15/16