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2016-605-E Finance - Hillsborough Arts Council - Outside Agency Performance Agreement
DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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 Hillsborough Arts Council, a not-for-profit corporation, located at 102 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 Hillsborough Arts Council agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2016 to June 30, 2017. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit"A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of 7500. 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 $1,875. 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. (Hillsborough Arts Council) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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. (Hillsborough Arts Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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. (Hillsborough Arts Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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 Hillsborough Arts Council provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: (Hillsborough Arts Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF County: Finance&Administrative Services Provider: Hillsborough Arts Council Orange County 102 N. Churton Street Post Office Box 8181 Hillsborough,NC 27278 Hillsborough,NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and b ' f the Provider L. tt Sfbit/5w 10/26/2016 766276FR9FAR4'1E Date E For and o idf f range County Government 1561A,ln,tt, tkA mt-IrS(Lt1 10/31/2016 _0.6.37_9.94R755F477 Bonnie Hammersley, County Manager Date (Hillsborough Arts Council) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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: LlEFA23F 10/26/2016 Certified b Title: chaff r Date:y (Provider's Signature) (Hillsborough Arts Council) Orange County Outside Agency Performance Agreement Rev. 8/16 Docu Sign Envelope ID DE3F0775B-3A75-4D97-9EA7-5AC7933304BE Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency: Hillsborough Arts Council Date/Time / Complete Y N Program(s): 2016 Sustainable Growth Plan iff/VW IfffilMiMilfffiffffiffl /f107110fWAY ffillff,111,1111,11111,11111,11110 Section For CDBG & HOME - Subsection HUD Regulations 1. Cover Page a. EI Applicant Contact Information b. El Project/Program Contact Information c. El Funding Requests Identified d. 111 Signed Application Cover Page 2. Agency a. El Agency's Years in operation 24 CFR 570.506, Information - b. El Agency's Purpose/Mission 570.507, 570.610; 24 CFR Parts 84 or 85 c. El Agency's Types of Services Provided d. El Agency's Experience e. El Other Pertinent Information 3. Program/ a. 1=1 Type of Application and Program Identified 24 CFR 570.200(a), Project b. El Summary of Program 570.201-570. 208, Information - c. El Description of Identified Need 507.503 (for each d. El Description of Population to be Served program/ e. El Activity Manager and Location Description project for which funding f. El Activity Implementation Timeline is requested) g. El Agency Collaboration h. El Describe Impact of Reduced/No Allocation i. El Other Pertinent Information j. El Complete Target Population/Beneficiary Chart k. El Complete Schedule of Positions I. El Signed Conflict of Interest Disclosure m. 111 Complete Work Statement i a • o DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF L 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. 111 Program Budget Worksheet 570.602, 570.607(b), is requested) b. [' Program Budget Detail 570.611 24 CFR c. El Cost Per Unit 570.502-570.504, d. 111 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. 111 Part A: CDBG & HOME Sections (as B. 111 Part B: Construction/Rehab applicable) 6. Attachments a. E 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. b. 111 IRS Federal Form 990 c. 1=1NC Solicitation License d. 111 IRS Federal Tax-Exemption Letter e. 111 Certificate of Insurance f. 1=1 List of Board of Directors 24 CFR Parts 84 or 85 g. 111 Articles of Incorporation/Bylaws 24 CFR 570.208, h. 111 Authorization to Request Funds 570.500(c), 570.611 I. 111 Authorized official designation j. 1113-R Fee Verification Main Application 1/22/2016 8:56:04 AM Pao ° 2 0 f 24 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside AgencTApplication MAIN APPLICATION 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Hillsborough Arts Council Applicant Organization's Physical Address: 102 North Churton Street, Hillsborough NC 27278 Applicant Organization's Mailing Address: Same Applicant Organization's Web Address: WWW.hillsboroughartscouncil.org Executive Director: Neil Stutzer, Chair (We don't have an Executive Director) Telephone Number: 919 643-2500 cell, 919-698-1859 E-Mail: info@hilisboroughartscouncil.org DUNS Number: 83-074-7544 (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: 2016 Sustainable Growth Plan Project/Program Primary Contact and Title: Neil Stutzer, Chair Telephone Number: cell 919 698-1859 E-Mail: nstutzerPhillsboroughartscouncil.org c) Funding Request Identification Total Project/Program Cost: $30,000Total Amount of Funds Requested: $15,000 Proposed Use of Funds Requested (2-3 Line Maximum): We ask for a combined total investment of $30,000/year from the Town of Hillsborough and Orange County that will allow HAG to professionalize its administration and develop the financial and service partnerships that will be sustainable into the future. 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. El CDBG Non-Construction (CH) $ LI Grant El Loan E CDBG Construction (CH) fl Grant ri Loan E HOME CHDO El Grant rj Loan El HOME Other El Grant L Loan XE1 Human Services: n Carrboro $ [' Chapel Hill $ XL Orange County $15,000 d) To the best of my knowledge and belief all information and data in this application is true and curre,t. The document has been duly authorized by the governing board of the applicant. Signature A --?-4-41 • _., / -16 •- IP Date ; ; "- /—./ 3g) Signature: 47 , /0 _ Treasurer f Date Main Application 1/18/2016 1:15:20 PM °'; DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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) The Hillsborough Arts council was formed 30 years ago this year as an exploratory committee for the town of Hillsborough and shortly became an all-volunteer organization until this year when we hired a part time Program Coordinator. This position is helping the organization meet the art and cultural needs of the community and surrounding areas. The organization received our nonprofit 501(3)(c) status on April 5, 2004. b) Agency's Purpose/Mission The mission of the Hillsborough Arts Council is to "Enrich our community through the arts". We have been fulfilling our purpose of education, supporting local artists and providing significant cultural events in our schools, in the Hillsborough Arts Council Gallery and Gift Shop and in public venues. c) Types of Services the Agency Provides The Hillsborough Arts Council and in our many partnerships provide education of the arts in our local schools, educational and entertainment events that include partnerships with local artists and writers. We also provide a reasonable outlet for local artists to sell their products through our Gallery and Gift Shop. d) Agency's Experience with Similar Programs as the Funding Request While the funding request is not for a program, it is for a need that will empower the Arts Council solid, sustainable growth. We seek to strengthen and centralize our administrative functions, while directing attention to developing a business plan and increasing outreach to previously underserved populations. To date marketing, outreach, development and fundraising has been the job of the program chairs and members of the board. This restructuring will allow not only solid growth to meet the growing needs of our county but assure that growth will be sustainable. e) Other Pertinent Agency Information We have had assistance from our Mayor, Tom Stevens as a facilitator in helping the board prepare for our strategic planning meeting on February 2nd. The planning session will be conducted by Leigh Ann Wilder, Arts in Communities Director of the North Carolina Arts Council. This is part of the Organizational Development Grant awarded to the Hillsborough Arts Council because of our standing in the community and the sound development we have and are achieving. One-to-one partnering like this, as well as with other key government departments and organizations, will help us create a firm base to work with and meet the growing needs of our community and of the County. Main Application 1/22/2016 8:56:04 AM Page 0 of 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Hillsborough Arts Council 2016 Sustainable growth Plan 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: Type of Application and Program identified Human Services Funding. Our interest is in receiving a three-year investment of support that will enable us to begin the work of formalizing our administrative processes and structure, building broader community partnerships, and developing a sustainable business plan. Please know that we are also open to developing a fee-for-service contract or receiving a line-item appropriation through a departmental budget, such as the Orange County Arts Commission. X❑ 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) Disabled Public Housing Program Category Youth Adult Elderly (not elderly) Neighborhoods/ Residents Education X X Health and Nutrition Job Training Sports and Arts Activities X X X X Pre-School Activities X X After-School Activities X X Mentoring X X Transportation Housing Other: Please Sustainable specify Organizational growth Main Application 1/22/2016 8:56:04 AM P a • e 5 o f 21 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION position Indicate the type of program for which you are requesting funding: Program/Project Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: b) Summarize the program services proposed and how the program will address the chosen Town/County priority? Summary of Program For thirty years, the Hillsborough Arts Council (HAC) has created venues for "community" and "creativity" to joyfully connect. In doing so, we generate benefits that range from the personal pleasure in attending a concert or purchasing an artist's product to broader social and financial benefits for this area. We bring people together to enjoy parades, music, and poetry, with spillover interactions with downtown merchants. We intentionally capture and share our diverse history in community events. We provide venues for local artists to showcase and share their talents. Our traditional community services include well- known events such as the Last Friday concerts and arts walks, the handmade puppet parade, parlor concerts, Music Masters Series, and Free Spirit Freedom. Comprehensive information is available at our website athttp.;;L http..liwww.hillsborouEhartscouncil.orE/ In late 2015, not only did we initiate two successful new events (Stickworks and the Solstice Paper Lantern Parade), but we also hired our first Program Coordinator who will serve as the key liaison between the HAC and the community. We ask Orange County to partner with the Town of Hillsborough and private donors to initially sustain this position through the first three years. 2016 is a year to reframe the work of the Hillsborough Arts Council. The community interest in and demand for our services requires that we shift from being an informal but effective grassroots effort to professionalizing our nonprofit organization. We are also aware that most of the work has been enabled by a relatively small number of core volunteers. We need to both institutionalize their knowledge of the logistical support required to host these special events and teach others how to provide support, relieving the original volunteers of the sole responsibility for our success. 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. Description of Identified Need We have a strategic planning process underway now. While the final goals have yet to be defined, we anticipate that they will include interests such as these: • Shift information storage from individuals to the organization so we have centralized records of our transactions, progress, and history (in progress, now that we have a Program Coordinator). Main Application 1/22/2016 8:56:04 AM Page 6 • f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION • Develop a business plan that will generate more revenue from fee-for-service contracts, sales, classes, and performances, as well as traditional fundraising and development efforts (to be developed). • Strengthen our internal capacity to sustain the HAC into the future through administrative oversight, development, and facilitation of mutually productive community partnerships (in progress, now that we have a Program Coordinator). • Broaden our interactions with communities of color, and expand participation across individuals and organizations that are diverse in terms of economic or social status, ethnicity, physical ability, or familiarity with creative processes (in the beginning stage, with potential yet to be tapped). We ask Orange County to invest in our infrastructure and planning as we build a sustainability blueprint for the future. We intend to formalize our administrative support and oversight while diversifying our audience and supporters, and reducing our dependency on grant support by increasing earned income. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. Description of Population to Be Served The approximately thirty individual events coordinated annually by the HAC are open to everyone. The number of participants range from less than a dozen (ongoing gatherings of the Orange Dog Poets Society) to several hundred (The Black Church, Freedom, and Civil Rights event,January, 2015) to thousands (over 1,900 people marched in the first Solstice Paper Lantern Parade in December, 2015). Total participation is estimated at 18,000 which is a duplicated count,given that we have a loyal following of repeat customers. During the last half of 2015, we asked visitors to the HAC Gallery& Gift Shop where they called "home." People came from 48 cities and towns from across North Carolina, 33 states, Washington DC, and ten foreign countries (Mexico, Columbia,Taiwan,Japan, England, Belgium, Netherlands, Spain, Russia, and the Virgin Islands.) We enjoy representing the creative spirit of Hillsborough to these visitors. With the new focus of our new Program Coordinator, we will be able to provide more inclusive programming by building community partnerships that will inform our program development. Invoking a practice of"doing with," and not"doing to," this programming will be designed based on the feedback we receive from the community: • We will explore new partnerships, such as by joining the Orange County Historical Museum in their monthly outreach efforts into the historically African-American Fairview community. • We will seek input from members of underserved communities, through one-on-one conversations and small group conversations, to learn more about the unrecognized artists within those communities, as well as the classes or events they would like to experience. The HAC board is developing a strategic plan (spring, 2016)which will facilitate the development of a long- term business plan. Our challenge will be to develop strategic choices with a gradual plan of implementation that is sustainable.The following are a few examples of potential fee-for-service projects waiting to be developed: Main Application 1/22/2016 8:56:04 AM Page / of 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION • Orange County Schools are interested in after-schooll[1] and summer arts programming. • Charter school and at-home educators are interested in programming. • Local artists are willing to host small workshops held in their studios or other suitable spaces. In short,we intend to strengthen and institutionalize the infrastructure that will enable HAC to serve as a convener and conduit for the considerable and varied creative energy that exists in Orange County. The benefits will be social as well as financial, providing opportunities for exchange across individuals, while contributing to our positive community identity. 1[1.' $4,000 in support for the after school programming has been requested of the Mary Biddle Duke Foundation; the decision should be received by mid-spring, 2016. e) Who specifically will carry out the activities and in what location will they be carried out? Activity Manager and Location Description The new Program Coordinator of HAC is Kristin Prelipp. Our offices are located in downtown Hillsborough at 102 North Churton. 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. Activity Implementation Timeline Late Fall, 2015: The HAC hires its first employee, a part time Program Coordinator Spring, 2016: The HAC works through a strategic planning process to decide on goals. The Program Coordinator and volunteers conduct outreach to previously underserved populations in Orange County. Summer, 2016: The HAC develops a business plan that emphasizes earned income, support from individuals, and private sponsors. The HAC completes the creation of a centralized repository of all organizational data and documentation. Begin developing fee-for-service opportunities with Orange County Schools, charter schools, and home school families. Begin developing a plan for expanded and enhanced involvement of previously underserved populations. Winter, 2016/17: Schedule new offerings for previously underserved populations. Main Application 1/22/2016 8:56:04 AM Page 8 • f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION The HAC board works to operationalize its strategic goals, particularly as they related to board development and fundraising. Throughout the calendar,the HAC will be offering its ongoing special events and programming. 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. Agency Collaboration Most of our informal relationships will continue as they have to date. We enjoy longstanding partnerships that support our shared interests with the Orange County Library, Burwell School, and St. Matthew's Church. Given the focus afforded by our Program Coordinator, some key relationships will deepen in terms of contact, such as sharing in the outreach to the Fairview community with the Orange County Historical museum. A few relationships will hopefully be formalized through descriptions of mutual expectations, such as the arts programming to be offered to school age children. h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Describe Impact of Reduced/No Allocation The impact of little or no support from Orange County will show up in the form of missed opportunities and delayed development of our infrastructure. While the HAC will always rely on the passion and efforts of its volunteers, our community is demanding a higher level of service that can only be sustained with the focus of professional staff and the investment in organizational strategic planning. We want to step up and meet our community's demand for involvement in the arts. Our traditional dedicated core of volunteers have worked hard, enjoyed great success, and are beginning to show signs of fatigue. Without a focused,formal staffing and administrative structure the most likely alternative is to scale back on what we are doing, which would negatively affect both community spirit and tourism. i) Include any other pertinent information. Program/Project Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff I) Disclosure of Potential Conflicts of Interested must be signed m) Complete the Work Statement Chart to describe the work to be performed, and be sure to attach copies of all data collection tools that will be used to verify achievement of program goals and objectives. Describe who will be responsible for monitoring progress. Main Application 1/22/2016 8:56:04 AM Page * • f 2 DocuSgn Envelope ID: oer0775e-3x75-4o97'9Ex7*xC7933304er A - continued Provider's Outside Agency Application MAIN APPLICATION Information to Complete j.) Target Population Complete the following tables to the best of your ability. Show numbers of participants and percentagee, as applicable, in each category. Please indicate whether this p ject/program will serve:X El Persons El Households El Units Program: Program Beneficiary Demographics ***Please note that our largest events are open to the public and attract anywhere from a dozen to several thousand participants. We estimate that all of our events and services touch 18,000 individuals in a duplicated count. Informal observations tell us that most participants are residents of Hillsborough and northern Orange county and had been primarily Caucasian, but that is changing now that our Free Spirit Freedom programming is building on its success. Families are attracted to particular events, such as Last Fridays and the Puppet Parade. Adults are more likely to populate the music and poetry events. Participation by gender seems equitable.*** We anticipate developing a business plan that will enable us to reach more school-aged children through fee-for-service contracts. We will be intentional in reaching out to communities of color to co-develop programming that will encourage their full participation in the arts. We project that primary outreach will be directed to African-American and Hispanic artists and community members. Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 8500 9000 9500 Female 8500 9000 9500 Total 17000 18000 19000 Of the females, how many are single- female Head of Households (Omit for Human Services) - - - Ethnicity African-American 5% 10% 20% American Indian orAlaska Native 1% 1% 1% Asian 2% 2% 2% Caucasian 90% 85% 73% Native Hawaiian or other Pacific Islander - - - Other 2% 2% 4% Total 0 0 0 |� Of the above, how many Hispanic/Latino Unknown Unknown Unknown Main Application 1/22/2016 8:56:04 AM 1H of 24 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION Of the above, how many non- Hispanic/Latino Unknown Unknown Unknown Total 0 0 0 Age-unavailable 0-5 years 6-18 years 19-50 years 51-61 years 62+years Total 0 0 0 Geographic Location—All events take place in and around Hillsborough, but participants for the events come from across Orange County, as well as the surrounding area. Durham City Durham County Carrboro Chapel Hill Chapel Hill Public Housing Residents Orange County Raleigh Wake County Total I 0 0 0 I Income Level—See following chart (Omit for HS) < 30% Area Median Income 31-50% Area Median Income 51-80% Area Median Income > 80% Area Median Income Total 0 0 0 Special Needs (Omit for HS) Elderly(Over 62) Disabled (not elderly) Homeless People with HIV/Aids Total 0 0 0 Main Application 1/22/2016 8:56:04 AM Page 1111 of 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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.org/portal/datasets/il/i115/FY2015 IL nc.pdf Main Application 1/22/2016 8:56:04 AM Pago 12 of 2 000wSWn Envelope ID: oor0rr50-3Ar5-4o8r-9EAr-5ACr833304or [ /\ - continued Provider's Outside Agency Application MAIN APPLICATION k.) Schedule of Positions Our regular volunteers serve on the board and organize and staff our events. Other volunteers participate less frequently, specifically in support of a particular event or function. We estimate that Lh8LOL8| nUmb8rOfvO|UnL88rhOUrSiSinLh8r8ng8Of4500 - 5000' wiLh90% OfLhOS8hOUrSCOming from a core group of 30 - 40 volunteers. 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 lUdmm Actual ��� ° ���� �1 �mdmm�t�� Projected ����t 1 = F�m�t1�� ° Program Total 2015-16 2016-17 Budget Vacant Staff+ Plan (H) Health Plan Program Coordinetor, hired in the Fall of 2015 .50 100 0 .5 FTE .75 FTE 30 None Bookkeeper .25 0 .25 .25 .25 10 None 15 15 15 volunteer Program Chairs 0 volunteers volunteers e 0 None 100 100 100 Volunteers Volunteers Volunteer Program Support 0 average average s average 0 None 10 10 10 Advisory and Volunteers Volunteers Volunteer Technical 0 average average s average 0 None 15 12 13 Volunteer HAC Board 0 Volunteers Volunteers e 0 None Notes: • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. • ^^ Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • + Denotes the percentage of staff time involved with this program. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 1,960 Main Application 1/22/2016 8:56:04 AM Page 113 of 2 �' DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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 LI Xn a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? E Xn b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? LII xEj c) Current beneficiaries of the project/program for which funds are requested? LI X E 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: ( B.ard Chair e rson Date -)r Signature: - , reasurer Date Main Application 1/18/2016 1:13:05 PM DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement Data collection and evaluation is one of the administrative functions that we hope to strengthen over the next year. When we develop our business plan, we will specify what "success" will mean in terms of the people reached, revenue generated, and outcomes achieved. In broad terms, during 2015 the HAC hosted 56 events of various kinds, provided opportunities of 380 artists to sell their products, and involved approximately 18,000 people. The outcomes achieved range from the satisfaction of listening to music to the community interaction generated by parading together to the sales generated by our local artists. Indirect outcomes include the financial benefit gained by the downtown merchants of Hillsborough during our events, as well as the positive publicity generated in the media. 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 Program Goal Performance Measures Program Results Program Activity 2 Program Goal Performance Measures Program Results Program Activity 3 Program Goal Performance Measures Program Results Program Activity 4 Main Application 1/22/2016 8:56:04 AM Pago 15 of 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION Program Goal Performance Measures Program Results Activity 5 Program Goal Performance Measures Program Results Main Application 1/22/2016 8:56:04 AM P 6 16 * f 2 o DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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. We will continue to seek support of individual events from other grants, sponsors, and donors. We are asking for $15,000 to support us in expanding our outreach to underserved populations, strengthening our administrative infrastructure and business planning, and partially supporting the position of our new Program Coordinator. As she assumes the responsibility of volunteer coordination and logistical support, our tenured volunteers will be able to direct more of their attention to our organizational development process and fundraising. Hillsborough Arts Council 4:59 PM Profit& Loss Budget Overview FY15-16 08/12/2015 July 2015 through June 2016 Accrual Basis Jul '15 -Jun 16 Ordinary Income/Expense Income 4000 • Contributions 4010 • Individual Contributions 10,750.00 4011 • Sponsorships 16,950.00 4210 • Corporate Grants& Donations 1,700.00 4610 • Organization/ Foundation Grants 0.00 4810 • Government Grants 34,850.00 Total 4000 • Contributions 64,250.00 5200 • Sale of Goods 19,200.00 5410 • Program Service Fees 0.00 5540 • Event Ticket Sales 17,740.00 5560 • Vendors Fees 7,125.00 5600 • Advertising& Equipment Rental 0.00 Total Income 108,315.00 Cost of Goods Sold 50000 • Cost of Goods Sold 11,725.00 Total COGS 11,725.00 Main Application 1/22/2016 8:56:04 AM II° g 1 "'" f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION Gross Profit 96,590.00 Expense 700 • Payroll Expenses 701 • Wages&Salaries 28,000.00 702 • Payroll Tax Expense 3,000.00 Total 700 • Payroll Expenses 31,000.00 7100 • Contracted Services 7110 • Performance Services 7110-1 • Production 5,750.00 7110 • Performance Services -Other 31,800.00 Total 7110 • Performance Services 37,550.00 7130 • Security Services 1,600.00 7160 • Accounting Service Fees 300.00 7198 • Other Contracted Services 3,710.00 Total 7100 • Contracted Services 43,160.00 73xx • Office Expenses 7310 • Supplies 1,785.00 7311 • Software Expense 300.00 7340 • Internet Access& E-mail 1,900.00 7350 • Website Maintenance & Hosting 2,400.00 7360 • Postage and Shipping 1,300.00 7380 • Printing& Copying 3,180.00 Total 73xx • Office Expenses 10,865.00 75xx • Occupancy Expenses 7510 • Rent& Utilities 15,290.00 Total 75xx • Occupancy Expenses 15,290.00 77xx •Travel Expenses 7710 • Mileage Reimbursements 50.00 Total 77xx •Travel Expenses 50.00 8xxx • Other Operating Expenses 8110 • Meeting/Event Rental 1,000.00 8120 • Reception Expenses 2,355.00 8150 • Honorarium 300.00 8160 • Materials/Supplies (not office) 2,875.00 8310 • Advertising 6,175.00 8333 • Insurance 840.00 8420 • Dues and Subscriptions 180.00 8430 • Licenses and Permits 790.00 8525 • Volunteer Recognition 260.00 8600 • Gifts for volunteers/performers 75.00 8720 • Equipment Rental 1,700.00 8730 • Repairs & Main. - Equipt. 200.00 Total 8xxx • Other Operating Expenses 16,750.00 93xx • Other Expenses 9323 • Bank Charges 680.00 9333 • PayPal transaction fee 470.00 Main Application 1/22/2016 8:56:04 AM Page t 8 • f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION Total 93xx • Other Expenses 1,150.00 Total Expense 118,265.00 Net Ordinary Income -21,675.00 Net Income * -21,675.00 *NOTE about Cover by carry-over of savings for Program Director and deficit Stickwork b.) Program Budget Detail Though the budget detail for this grant is shown below, we would like to submit additional information about existing programs we provide for the community. These are the actual expences from last FY '14-'15: Last Fridays - $5,783.65 Free Spirit Freedom - $3,658.46 Handmade Parade - $6,188.71 Artwalk - $2,409.01 Arts & Crafts Show- $2,735.92 Arts Alive - $744.08 Music Masters - $6,100.00 Sculpture Tour- $2,077.09 Gallery & Gift Shop - $14,382.92 Parlor Concert- $1,652.10 J. Watson Christmas Concert - $2,354.23 Orange Dog Poet Society- $0 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. 2016-17 Projected Budget Continuing business-as-usual for HAC with a .5 FTE Program Coordinator would require a budget of approximately $100,000. We request a three-year investment to strengthen our infrastructure and develop a sustainable business plan for the future, to be shared primarily by Hillsborough and Orange County. This projected budget reflects increasing the Program Coordinator's time from .5 FTE to .75 FTE. Administration New Goals: Projected Expenses: 1. Centralize records. Staffing —All volunteer -0- 2. Strengthen Infrastructure. Office rent/utilities (20%) 3,020 Dues/subscriptions 200 Repairs/maintenance 500 Communications 6,000 Office supplies/software 3,000 Postage/shipping 600 $13,320 Services, Goals remain consistent. Staffing — .4 FTE 17,913 Programs, & Contracted services 30,000 Sales Office rent/utilities (80%) 12,080 Advertising 7,000 Materials/supplies 5,000 Website maintenance 2,400 Printing/copying 2,830 Meeting/reception expenses 3,500 Bank fees 1,200 Insurance 1,000 Equipment/van rental 900 Licenses/permits 900 Main Application 1/22/2016 8:56:04 AM Page t f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION Postage/shipping 700 Honorariums/gifts 700 Volunteer recognition 300 $86,423 Marketing & New Goals: Staffing - .1 FTE 4,478 Outreach 1. Reach out to diverse and Outreach materials &supplies 1,000 under-served populations. $5,478 2. Strengthen community partnerships. Fundraising & New Goal: Staffing - .25 FTE 11,195 Development 1. Develop sustainable Annual fundraising letter 1,000 business plan. $12,195 Total Project Budget= $117,416 In the recent past, our work has primarily relied on project-specific support in the form of grants and sponsorships. Sales through our gallery are modest but steadily increasing, and we have untapped potential for fee-for-service partnerships and enhanced fundraising. We ask for a combined total investment of$30,000/year from the Town of Hillsborough and Orange County that will allow HAC to professionalize its administration and develop the financial and service partnerships that will be sustainable into the future. Example Program: Credit Counseling Class Cost Elements Cost($) 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: 2016 Sustainable Growth Plan The funding provided by Orange County and Hillsborough will be directed towards Marketing& Outreach ($5,478), Fundraising& Development ($12,195), with the remainder going to the Program Coordinators efforts to manage our services/programs/events, in order to free up other volunteer time to focus on strengthening our infrastructure and financial planning Cost Elements Cost($) Quantity/Unit of measure Subtotal($) Program Coordinator $20 30 hrs (30hrs x 4wks. X 12mos) $28,800 Tr f I t9R Rnn Main Application 1/22/2016 8:56:04 AM Page 2 11 f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION c.) Cost per Unit estimated 2015- Actual 2014-15 1 Projected 2011-17 Total Cost of Program 0 $19,200 $28,800 Total # of Units 0 80 hrs./month 120 hrs./month Cost Per Unit 0 $20.00 $20.00 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). 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. FY16-17 OCOAG FY14-15 FY15-16 Projected Actuals Budget Budget Ordinary Income/Expense Income 4000• Contributions 4010• Individual Contributions $24,527 $10,750 $15,000 4011 • Sponsorships $10,475 $16,950 $15,000 4210• Corporate Grants& Donations $1,500 $1,700 $1,500 4610• Organization/Foundation Grants $0 $0 $0 4810• Government Grants $35,767 $34,850 $41,500 Total 4000• Contributions $72,269 $64,250 $73,500 Main Application 1/22/2016 8:56:04 AM Pago 21 of 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION 5200• Sale of Goods $19,995 $19,200 $27,000 5410• Program Service Fees $0 $0 $0 5540• Event Ticket Sales $10,040 $17,740 $15,000 5560•Vendors Fees $7,827 $7,125 $8,500 5600•Advertising& Equipment Rental $25 $0 $0 Total Income $110,156 $108,315 $123,500 Cost of Goods Sold 50000• Cost of Goods Sold $11,567 $11,725 $17,000 Total COGS $11,567 $11,725 $17,000 Gross Profit $98,589 $96,590 $106,500 Expense 66900• Reconciliation Discrepancies $100 $0 $0 700• Payroll Expenses 701 •Wages&Salaries $6,132 $28,000 $33,000 702 • Payroll Tax Expense $502 $3,000 $3,486 Total 700• Payroll Expenses $6,634 $31,000 $36,486 7100• Contracted Services 7110• Performance Services 7110-1 • Production $750 $5,750 $3,500 7110• Performance Services- Other $20,433 $31,800 $17,000 Total 7110• Performance Services $21,183 $37,550 $20,500 7120• Instructors Fees $1,274 $0 $1,500 7130• Security Services $900 $1,600 $2,000 7160•Accounting Service Fees $273 $300 $500 7198 • Other Contracted Services $3,705 $3,650 $4,000 7100• Contracted Services-Other $1,180 $60 $500 Total 7100• Contracted Services $28,515 $43,160 $29,000 73xx• Office Expenses 7310• Supplies $2,273 $1,785 $2,000 7311 • Software Expense $220 $300 $1,000 7340• Internet Access& E-mail $2,055 $1,900 $4,000 7350•Website Maintenance& Hosting $2,400 $2,400 $4,400 7360• Postage and Shipping $1,250 $1,300 $1,300 7380• Printing&Copying $1,470 $3,180 $2,830 Total 73xx• Office Expenses $9,668 $10,865 $15,530 75xx• Occupancy Expenses 7510• Rent& Utilities $15,054 $15,290 $16,100 Total 75xx• Occupancy Expenses $15,054 $15,290 $16,100 77xx•Travel Expenses 7710• Mileage Reimbursements $55 $50 $0 Main Application 1/22/2016 8:56:04 AM Pogo 22 • f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION Total 77xx•Travel Expenses $55 $50 $0 8113 •Van Related costs $66 $0 $0 8xxx• Other Operating Expenses 8110• Meeting/Event Rental $1,716 $1,000 $1,100 8120• Reception Expenses $668 $2,355 $2,500 8150• Honorarium $600 $300 $500 8160• Materials/Supplies(not office) $3,582 $2,875 $4,000 8310•Advertising $7,035 $6,175 $7,000 8333 • Insurance $340 $840 $1,000 8420• Dues and Subscriptions $186 $180 $200 8430• Licenses and Permits $787 $790 $900 8525 •Volunteer Recognition $193 $260 $300 8600• Gifts for volunteers/performers $81 $75 $200 8720• Equipment Rental $680 $1,700 $900 8730• Repairs& Main.-Equipt. $227 $200 $500 8760•Assests Under$500 $0 $0 $0 Total 8xxx• Other Operating Expenses $16,095 $16,750 $19,100 93xx• Other Expenses 9323 • Bank Charges $759 $680 $700 9333 • PayPal transaction fee $498 $470 $500 Total 93xx• Other Expenses $1,257 $1,150 $1,200 99xx• Other $0 $0 $0 Total Expense $77,444 $118,265 $117,416 Net Ordinary Income $21,145 -$21,675 -$10,916 Other Income/Expense Other Expense 9982 • Interfund Expense $0 $0 $0 9999 • Suspense $0 $0 $0 Total Other Expense $0 $0 $0 Net Other Income (carry over from savings) $0 $21,675 $10,916 $21,145 $0 $0 Main Application 1/22/2016 8:56:04 AM Page 2 • f 2 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF t A - continued Provider's Outside Agency Application MAIN APPLICATION Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 36,502 $ 29,400 $ 31,500 7%, Agency Generated Revenue(fees) $ 7,827 $ 7,125 $ 8,500 19% Local Government Grants: Orange County $ - 5 - $ 15,000 0 Town of Chapel Hill 0' Town of Carrboro 0 Other Local: Town of Hillsborough 5 4,500 $ 4,500 $ 4,500 0% Other Local: Hillsborough Tourism Board $ 21,000 $ 24,380 $ 16,000 -34% Other Local: Orange Co Arts Commission $ 9,000 $ 6,000 $ 6,000 0% 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:NC Humanities Council $ 1,200 $ - $ - 0 Other Grants: 0, Miscellaneous/Other Revenue $ 18,560 $ 25,185 $ 25,000 -1% Please list 3 largest Miscellanous sources: Net Sale of Goods $ 8,428.00 Event Ticket Sales 5 10,400.00 Total Agency Revenue $ 98 589 $ 96 590 $ 106 500 10%' AGENCY EXPENSES Compensation $ 6,634 5 31,000 $ 36,486 18% Rent&Utilities $ 15,054 $ 15,290 $ 16,100 5% Supplies&Equipment $ 6,075 $ 4,960 $ 7,000 41% Travel&Training $ 55 $ 50 $ - -100% Other Expenses: $ 49,647 $ 66,965 $ 57,830 -14%, Please list 3 largest"Other Expenses": Performance Services $ 21,183.00 Advertising $ 7,035.00 Other Contracted Services $ 3,705.00 Total Agency Expenses $ 77,465 $ 118,265 $ 117,416 SURPLUS/(DEFICIT)FOR PERIOD: 1 $ 21,124 1 $ (21,675)1 $ (10,916)1 50% Main Application 1/22/2016 8:56:04 AM P a e 2 1 c f 2 1 DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Hillsborough Arts Council Program Name: Funding Award: $7,500 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel—Salaries and FICA 7,500 Program Support—Professionalize Administration and Develop Financial and Service Partnership 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. • Centralize Information Storage • Develop and Operationalize a business plan • Develop and/or strengthen community partnership • Broaden interactions with previously underserved populations to encourage participation 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 Documentation of the initial input,and ultimately the community participation 100% Documentation of meetings with representatives of key partnerships 4 partnerships Creation of a business plan and documented progress in implementation 100% Process documentation of events with how logistical arrangements are defined and assigned 100% DocuSigned by: a Shit/5w chair 10/26/2016 Certified by: l Title: Date: 7GG2761-89FA84a1- (Provider's Signature) Doc`uS Envelope ID: DBF0775B-3A75CEsRTIFICATE6©F LIABILITY INSURANCE � 1/18/2016 ) Ac-v�ru 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 pollcy(les)must be endorsed. If SUBROGATION IS WANED,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 hola,br In lieu of such endorsement(s). PRODUCER CONTACT BALLARD AGENCY INC PHONE FAx n19)732-9636 PO Box 1559 � Ari'E'�I' (919) 732-2b58 ArC No:( Hillsborough, NC 27278 ADDRESS;ballard @ballardagencyinc.com INBURERIBI AFFORDING COVERAGE HAICO INSURER A:GREAT AMERICAN INSURANCE C .A INSURED HILLSBOROUGH ARTS COUNCIL INSURER B: PO BOX 625 INSURER C HILLSBOROUGH, NC 27278 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. EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR AWL SUM ApApLICY EFF POLICY EXP LIMITS LER TYPE OF INSURANCE NO WM POLICY NUMBER (MMrDOrYYYY) (MMIDD/YYYY) COMMERCIAL GENERAL LuAOIUTY �E,ACH OCCURRENCE i 1 CLAIMS MADE pi OCCUR ■� , � """`�"''� i MED EXP(Any one person) S PERSONAL&ADV INJURY i GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE i PRO- l LOC PRODUCTS-COMP/OP AGG S POLICY J JECT J S OTHER: AUTOMOBILE LIABILITY (Es COMBINED SINGLE LIMUIr i ANYAUTO BODILY INJURY(Per person) i ALL OWNED SCHEDULED BODILY INJURY(Pea accident) S _ r HIRED AUTOS AUTOS NMED (Per accident) Tr $ S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ — EXCESS LIAB 'CLAIMS—MADE AGGREGATE S I DED I I RETENTIONS S WORKERS COMPENSATION I STATUTE I •. ER AND EMPLOYERS LIABILITY YRN ANY PRcpREIORRARTNElRRExEcUTIVE I NIA E.L.EACH ACCIDENT S OFFICERAaESIBER EXCLUDED? 111 iliaadalmy In NR) E.L. DISEASE-EA EMPLOYE, S II yes, acnDe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S $1,000,000 OCC WRONGFULL A DIRECTOR & OFFICERS EPP4917790 1/1.8/161/18/17 ACTS $1,000,000 OCC LIABILITY _ EMPLOYMENT PRACTICES DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is mewed) CERTIFICATE HOLDER CANCELLATION — ORANGE COUNTY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 8181 ACCORDANCE WITH THE POLICY PROVISIONS, HILLSBOROUGH, NC 27278 AUTOO!'`'''0 REPRESENTATIVE / 1 I:ag ■ r 01988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2 014101) The ACORD name and logo are registered marks of ACORD