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2016-578 Finance - Orange County Rape Crisis Center - Outside Agency Performance Agreement
oZDl ��S�� Franc- OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2016,("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ("County") and Orange County Rape Crisis Center, a not-for-profit corporation,located at 1506 E.Franklin St,Suite 302,Chapel Hill,NC 27515("Provider"). WTTNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need,as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Orange County Rape Crisis Center 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 35000. 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$8,750. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (Orange County Rape Crisis Center) Orange County Outside Agency Performance Agreement Revised 812016 e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31; January 1 —March 31 and April 1 -June 30. Reports are due on January 13,April 14,and July 14 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default"),the County may immediately terminate this Agreement, in whole or in part, and from time to time.Notice of termination must be in writing, state the reason or reasons for the termination,and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement;or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered;or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance,incomplete service or performance,or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement,as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county,state or federal laws, regulations,or stated public policy. b. In the event of default by the Provider,the county may elect to terminate this Agreement,in whole or in part and/or require the Provider to repay the funds within ten(10)business days from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. {Orange County Rape Crisis Center) Orange County Outside Agency Per Agreement Rev. 8116 c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain,during the period of performance of this Agreement,insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury,including bodily injury,sickness,disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance,including hired and non-owned vehicles,if any,covering personal injury or death,and property damage; and iv. Professional Liability Insurance,covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents,consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A-Statutory State NC&Coverage B-Employers Liability $500,000 each accident,disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies(with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. (Orange County Rape Crisis.Center) Orange County Outside Agency Performance Agreement Rev. 8116 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure,at his own expense,all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal,state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss,liability, claims or expense(including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves,their agents,officials,employees and servants agree not to discriminate in any manner of these basis of race, color,gender,national origin,age,handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee,no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance,as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 13.15 per hour. To the extent possible, Orange County recommends that Orange County Rape Crisis Center provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: (Orange.County Rape Crisis Center) Orange County Outside Agency Per Agreement Rev. 8116 County: Finance&Administrative Services Provider: Orange County Rape Crisis Orange County Center Post Office Box 8181 1506 E.Franklin St, Suite 302 Hillsborough,NC 27278 Chapel Hill,NC 27515 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 I IA 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 an on behalf th Provider ..Tr,A-r1- ,IDIY6 n 11 -414 i5Y ILG L" Z)mate For and on behalf of Orange County Government 41�i� - < l (o Bonnie Hammersley,County Man r Date Orange County Rape Crisis Center) Orange County Outside Agency Performance Agreement Rev. 8116 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. Certified by: itle: 1,C,_ L 1/'L ate: (Provider's gnature) ,(Orange County Rape Crisis Center) Orange County Outside Agency Performance Agreement Rev. 8116 Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY s I Received By Agency Orange County Rape Crisis Centeratelme J Ai yy Programs) Client Services & Community Education5w �, Section For CDBG & HOME Regulations Subsection HUD 1. Cover Page a. pplicant Contact Information b. ProjectlProgram Contact Information c. Funding Requests Identified d. [Signed Application Cover Page 2. Agency a. Wf Agency's Years in operation 24 CFR 570.506, Information - b. Agency's Purpose/Mission 570.507, 570.610, 24 C. [Agency's Types of Services Provided CFR Parts 84 or 85 d. Agency's Experience e. Other Pertinent Information 3. Program/ a. ype of Application and Program Identified 24 CFR 570.200(a), Project b. Summary of Program 570.201-570. 208, Information- C. escription of Identified Need 507.503 (for each d. escription of Population to be Served program/ e. [Activity Manager and Location Description project for which funding f. [Activity Implementation Timeline is requested) 9, Agency Collaboration h. QZ Describe Impact of Reduced/No Allocation I. [ Other Pertinent Information Complete Target Population/Beneficiary Chart k. 7 Complete Schedule of Positions I. [� Signed Conflict of Interest Disclosure m. Complete Work Statement 4. i Pagc Exhibit 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 570.602, 570.607(b), is requested) b. [Program Budget Detail 570.611 C. [`Cost Per Unit 24 CFR 570.502-570.504, d. [Agency Operating Budget Worksheet 570.506, 570.507, 570.610; 24 CFR Parts 84 or 85, and OMB Circulars A-87 or A- 122; Treasury Circular 1075 5. Supplemental A. ❑ Part A: CDBG & HOME Sections (as B. ❑ Part B: Construction/Rehab applicable) 6. Attachments a. [Audit: Organizations receiving $300,000 or more OMB Circular A-133 in Federal financial assistance, and/or organizations with more than $500,000 of receipts and ex enditures b. OT in a fiscal year, must secure an audit. C. [�RS Federal Form 990 NC Solicitation License d. [IRS Federal Tax-Exemption Letter e. [Certificate of Insurance f. List of Board of Directors 24 CFR Parts 84 or 85 g. Articles of Incorporation/Bylaws 24 CFR 570.208, h Authorization to Request Funds 570.500(c), 570.611 i. Authorized official designation j. Solid Waste Program Fee (SWPF) Verification s. Main Application 1/25/2016 12:55:42 PM P a g e 2 c f 3 2 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION 1. COVER PAGE (Each program requires a separate application. a) Applicant Contact Information Applicant Organization's Legal Name: Orange County Rape Crisis Center Applicant Organization's Physical Address: 1506 E. Franklin Street, Ste 302, Chapel Hill, NC 27514 Applicant Organization's Mailing Address: P.O. Box 4722, Chapel Hill, NC 27515 Applicant Organization's Web Address: ocrcc.org Executive Director: Alyson Culin Telephone Number: 919-968-4647 E-Mail: alyson(oocrcc.org DUNS Number: 835160862 b) Project/Program Contact Information (i) Project/Program Name: Client Services (ii) Project/Program Name: Community Education Project/Program Primary Contact and Title: Alvson Culin, Interim Executive Director c) Funding Request Identification (i)Total Project/Program Cost: $349,572.50 (ii)Total Project/Program Cost: $349,572.50 Total Amount of Funds Requested: $74,000 Proposed Use of Funds Requested (2-3 Line Maximum): Provide 24-hour crisis intervention services for survivors of sexual violence. Provide community education, training, and advocacy on sexual assault prevention and response, including programs in Chapel Hill-Carrboro City Schools, Orange County Schools, and independent schools. Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source. "The Participating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. ❑ CDBG Non-Construction (CH) $ ❑ Grant ❑ Loan ❑ CDBG Construction (CH) $ ❑ Grant ❑ Loan ❑ HOME CHDO (OC) $ ❑ Grant ❑ Loan ❑ HOME Other(OC) $ ❑ Grant ❑ Loan ® Human Services: ® Carrboro $12,000 ® Chapel Hill $27,000 ® Orange County$35,000 d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. / Signature: LuQ..�-V. t ! 2 5/1 (o Exec D' a Date / Signature: B 94q 4KdtKp er on Date Exhibit 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) 42 years in operation. Founded in 1974. Incorporated in December 1978. b) Agency's Purpose/Mission Our mission is to stop sexual violence and its impact through support,education,and advocacy. c) Types of Services the Agency Provides The Orange County Rape Crisis Center (OCRCC) provides support to survivors of sexual violence (SV), their loved ones, and professionals who serve survivors in Orange County. Our expert staff and trained volunteers("Companions") provide emotional support as well as resources and referrals through our 24-Hour Help Line. Companions are available at all times to provide assistance and advocacy through active listening, safety planning, suicide intervention, and other crisis intervention techniques. They are also available to accompany survivors to the hospital,to make an official report to law enforcement,and to court appointments. For clients with financial, housing,and other concerns,we connect them with community resources and agencies. For long-term support,we provide support groups and workshops for SV survivors and their loved ones. Our innovative support group program, which has served as a model for agencies across North Carolina, offers both traditional discussion-based groups as well as activity-based groups utilizing alternative healing methods. We also provide case management for high-need survivors with multiple concerns. For example, we have connected survivors with resources for emergency and long-term housing,job training and retention,substance abuse treatment,clothing,food,and more. Additionally, the OCRCC offers educational programs for raising awareness about sexual violence and teaching prevention skills. With a 35-year history of successful education programs, we now reach more than 13,000 youth and adults each year. Our curriculum incorporates research-based best practices utilizing both primary prevention and risk reduction strategies. The majority of our programs are delivered in elementary schools through our Safe Touch program. We are in every elementary school in both Chapel Hill-Carrboro City Schools (CHCCS) and Orange County Schools (OCS), offering annual safety education programs in every classroom. Our Start Strong program works through health education classes in middle and high schools, using primary prevention strategies to prevent perpetration of sexual violence.Our curriculum is designed to assist schools in meeting state-mandated learning objectives. We also offer prevention and response programs for parents,teachers,and professionals. The OCRCC's entire community education program is designed for continuous and comprehensive learning. For students,each year's curriculum builds on the skills and knowledge taught in previous years,offering students a clear and sustained message about safety and achieving best results for preventing violence. Furthermore, we provide take-home materials for students to share with their families, training programs for teachers and caregivers, and informational programs for parents and guardians. In this way,crucial safety messages are reinforced throughout the entire community. In 2007, the OCRCC launched our Latino Services Program with the hiring of a bilingual and bicultural Latino Services Coordinator. With this full-time position, multiple bilingual staff members, and trained Spanish-speaking volunteers, we are able to provide all our crisis services and education programs in both English and Spanish. Main Application 1/25/2016 12:55:42 PM Page 4 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION d) Agency's Experience with Similar Programs as the Funding Request The OCRCC has provided crisis intervention services for survivors of sexual violence for over 40 years. Our highly qualified staff members regularly attend continuing education trainings and review new research to ensure that we are providing the best level of trauma-informed care. Additionally, we have the most comprehensive volunteer training program in the state. With more than 60 hours of training,our volunteer crisis Companions—along with our staff—provide expert support and advocacy services to about 600 clients each year. Both qualitative and quantitative data show the high success level of our client services.As a leader in the field,our Client Services team regularly provides consultations for other anti-violence agencies. Among other things, we have presented at state-wide and national conferences; provided one-on-one consultations for agencies seeking advice; and offered trainings for victim service providers, healthcare professionals, and others on best practices for trauma-informed care.Additionally, we created a train-the-trainer program and accompanying manual on how to develop and expand a support group program; in collaboration with the NC Coalition Against Sexual Violence (NCCASA), our staff visited agencies across the state to offer this training. We are highly qualified to continue providing Client Services in Orange County. Launched 35 years ago, our Community Education program is one of the oldest in the country. Since the beginning,we have enjoyed a close relationship with the local school districts, delivering safety education to tens of thousands of students. Our staff members attend conferences, participate in continuing education trainings, and review new research to incorporate best practices and ensure the highest quality curriculum and pedagogy. We recently conducted a curriculum review of the Safe Touch program with input from community stakeholders, making changes to scripts and materials to improve content and delivery and to better align with new state-mandated learning objectives. Though we have already made many improvements to the Start Strong program, we plan on conducting a similar full review of that curriculum this spring. Like our Client Services program, our Community Education team also receives a large number of requests for assistance from school systems and other nonprofit groups seeking to establish or expand their safety education programs. The Community Education staff has also presented at statewide conferences and has provided consultations. Both quantitative and qualitative data prove the success of our Community Education program. We are well-positioned to continue providing sexual violence prevention and response education programs in Orange County. e) Other Pertinent Agency Information The OCRCC is the only agency in the county providing 24-hour crisis intervention services for survivors of sexual violence (SV). Orange County residents rely on us for services and advocacy. Additionally, as the gold standard for SV victim services in North Carolina and with a solid reputation among providers and clients alike, we often provide crisis intervention and long-term support services to survivors outside of Orange County as well. Because of the unique needs of SV survivors and the specific challenges they face, it is important that our services remain free and confidential. Funding from the town and county ensures that we can continue to provide these vital services to all who need them. With regards to our education programs, more than 80 percent of our programs are provided in public schools within Orange County, but they are not paid for by the two district school systems. We rely on town and county funding to ensure this crucial safety education can be delivered to local students. k E 'z Main Application 1/25/2016 12:55:42 PM P a g e 5 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION 3. (1) PROJECT/PROGRAM INFORMATION Agency& Program Name: Orange County Rape Crisis Center– Client Services As you complete your application, complete only those sections that pertain to the type of application you are submitting. The application is divided into several sections and not all sections apply to every project. Every applicant MUST complete the main application. a) Check the type of funding request for this application package submittal and complete the required application and required supplemental sections (Parts)as specified below: ® Human Services (Main Application Only) ❑ CDBG Non-Construction—(Main Application AND Part A) ❑ CDBG Construction —(Main Application AND Part A AND Part B) ❑ HOME CHDO Set-aside —(Main Application AND Part A) ❑ HOME Other —(Main Application AND Part A AND Part B Indicate the type of program for which you are requesting funding: Oisabted IPubi�c f"lous�ng fi�r�c�r�m Oa(ec�ory Mouth Adult ;Elderly {a�ot I+�etc�laborhoAtlsl ;elder: fesderats„ Education Health and Nutrition Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentorin Transportation Housing Other: Human Services X X X X X Main Application 1/25/2016 12:55:42 PM Page 6 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION 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? As described in section one, the Client Services program will provide crisis intervention services to survivors of sexual violence, their loved ones, and professionals who support survivors, Our services include our 24-Hour Help Line, support groups, workshops,and therapy referrals. Our program intersects with the Town/County priority for affordable healthcare as well as the priority for affordable housing.With regards to accessible healthcare,all of our services are free and confidential.As a free resource and with a strong agency commitment to accessibility for all, we provide crisis intervention and mental healthcare to people across all demographics in Orange County, including low-income residents who can't afford healthcare elsewhere. With regards to affordable housing, the connection between sexual violence and homelessness is well-documented, People with housing needs are more likely to experience violence and less likely to be able to afford healthcare. With our services being free,and with our location on a public bus line,our support is accessible for this high-risk population. 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. The 2010 National Intimate Partner Survey (NISVS) from the CDC found that 1 in 5 women in the United States are raped in their lifetime. It also found that nearly 1 in 2 women and 1 in 5 men experience some form of sexual violence other than rape, such as sexual coercion, unwanted touch, sexual harassment, and more.Although local crime statistics are difficult to obtain for any jurisdiction, our experience corroborates this finding and illustrates the need for sexual violence services. The OCRCC served 524 people last fiscal year. In that time, we had a total of 2,453 contacts, meaning that we saw each client an average of 4.7 times. The long-term effects of sexual violence can be profound and may include depression, anxiety, physical illness, substance abuse,eating disorders,suicidal thoughts and attempts,self-harming behaviors,and more.All of these factors can make it difficult for survivors to function on a daily basis, obtain and keep a job, and maintain safe housing. One study found that 50% of sexual assault victims lost their jobs or were forced to quit after being raped (Ellis, Atkeson, & Calhoun, 1993). Additionally, the abuse itself can cause a housing situation to become unsafe for individuals, such as when an intimate partner is the abuser. According to the Department of Justice, more than 50% of all sexual violence incidents occur at the victim's home or within one mile of their home. In terms of mental healthcare access, Mental Health America(MHA) reports that 2.6%of adults with mental illness and 12.3% of children with emotional/behavioral/developmental issues in North Carolina do not have consistent health insurance. But even with insurance,mental healthcare is lacking:MHA reports that 20.2%of adults with mental illness in North Carolina said they did not get the mental health services they needed and an astounding 45.7%of children who needed mental health services in North Carolina did not receive them. With affordable therapeutic resources lacking in our community and across the nation, OCRCC is committed to providing free short- and long-term services to all who need them, regardless of income level. With regards to housing access, sexual violence and homelessness are strongly connected. One study found that 92% of homeless mothers had experienced severe physical and/or sexual violence at some point in their lives; 43%of them had experienced sexual abuse as a child (Browne & Bassuk, 1997). Furthermore, if survivors are on the verge of homelessness or become homeless, their risk for experiencing additional violence increases. According to a study of homeless and marginally housed people, 32% of women, 27% of men, and 38% of transgendered people reported either physical or sexual victimization in the previous year(Kushel et al., 2003). As the local governments work toward improving housing access,our services will be needed and will increase the likelihood of success. Main Application 1/25/2016 12:55.42 PM Page 7 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION The OCRCC provides short- and long-term support, becoming a significant advocate for years throughout each survivor's healing process. Many long-term effects of sexual trauma can be mitigated if survivors receive early intervention and a supportive environment to disclose their abuse. Connecting with resources that can help survivors meet their basic needs is also crucial to healing. The OCRCC connects survivors to affordable medical care, mental health care,substance abuse treatment,housing,and financial assistance. Additionally, we provide information and support to other service providers in Orange County who are serving low-and moderate-income individuals.We can help these agencies provide trauma-informed services so that the individuals they serve receive holistic,trauma-informed care. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. The OCRCC's services are available to all survivors of sexual violence, stalking, human trafficking, and domestic violence in Orange and neighboring counties. Survivors hear about our services through internet research, word of mouth, promotional materials, referrals from community partners, and more. We conduct specific outreach advertising our services to underserved populations such as the Latino/a and LGBTQ communities,to give just two examples. e) Who specifically will carry out the activities and in what location will they be carried out? Our expert staff and trained volunteer Companions will provide crisis support via our 24-Hour Help Line as well as during business hours at the OCRCC office. Support groups will be facilitated by staff and trained facilitators; they are mostly offered at the OCRCC office,though some are offered off-site in collaboration with community partners,for example,the Freedom House Recovery Center. 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. Activities Timeline Program Activity 1—Crisis Support Operate a 24-hour hotline Ongoing Provide in-person crisis counseling during business hours at the OCRCC office Provide resources and referrals to other community partners Follow up with clients as needed to ensure case management is provided Update listings of resources in crisis counseling manual Recruit and train volunteer Crisis Companions in fall training 08/2016-1112016 Recruit and train volunteer Crisis Companions in spring training 01/2017-04/2017 Program Activity 2—Support Groups Review current waitlist of clients interested in participating in groups Ongoing Schedule support group facilitators to facilitate groups and workshops Publicize support groups and workshops Review client requests for group participation Screen clients and,if appropriate,place in group Facilitate groups and workshops Compile and review FY16-17 support group evaluation data 07/2017 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. OC Domestic Violence Needs Assessment Planning Committee:Along with community members, service providers and researchers,the OCRCC sits on this committee to address the need for a local shelter for violence survivors. Main Application 1/25/2016 12:55:42 PM P a e 8 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION • Carolina Outreach:OCRCC and Carolina Outreach provide cross-referrals.Additionally, OCRCC is hosting a support group for male survivors at Carolina Outreach during FYI 5-16. • NC Coalition Against Sexual Assault: In FY12-13 and FY13-14, the OCRCC collaborated with NCCASA to create a training program for establishing a comprehensive support group (SG) program. With our program as a model, we created a manual,guidelines,and training module,and OCRCC staff provided trainings to other anti-violence agencies on creating a SG program.We also partner on other projects,especially professional development and staff training. • University of North Carolina at Chapel Hill: • Since UNC hired the Interpersonal Violence Prevention Coordinator (IVPC) in 2009, we have maintained a strong relationship to assist their work in preventing sexual violence(SV)and relationship abuse on campus. • OCRCC staff members sit on the Sexual Assault and Relationship Violence Training and Education Task Force (SARVTAE),which provides education and resources to the UNC community. • Following national attention, UNC has worked to improve their response to SV. OCRCC staff served on the Title IX hiring committee,participated in a task forces,and provided consultations to various campus departments. • We work with the Dean of Students Office to provide services and to advocate for student survivors. • We work closely with the Carolina Women's Center in providing appropriate support for students, partnering on community events,and serving on joint committees together. • We provide education programs to UNC faculty and staff,classrooms,student groups,and Greek organizations. • We provide service-learning opportunities for students. With student volunteers and intems, the OCRCC is able to maximize our outreach and services while students gain invaluable professional experience. • Sexual Assault Response Team (SART): The Center coordinates the county-wide SART. This team brings together representatives from local law enforcement,the District Attorney's office, UNC Hospitals, UNC-Chapel Hill,and other local agencies to improve the overall community response to survivors.The goal is to collaboratively provide the best system of care for survivors needing services through a variety of local departments. Meeting monthly, SART receives training, shares experiences, and addresses issues as they arise. • The Compass Center for Women & Families: We collaborate with the Compass Center through all our services, referring clients to each other,coordinating shelter services for clients, providing mutual assistance for volunteer training, and conducting joint educational programs.Additionally,a representative from the Compass Center sits on SART. • El Centro Hispano: Our Latino Services Coordinator works closely with El Centro in order to improve services to the Latino community. In recent years, the LSC has provided client services and educational programs out of their office, allowing greater outreach to Latinos in our community. • Freedom House Recovery Center: In addition to cross-referrals, we work with Freedom House to provide support groups to survivors of sexual assault who also struggle with addiction. • Salvation Army—PROJECT FIGHT:We participate in the Rapid Response Team of the Triangle together in order to address the needs of trafficking victims in our area.The two agencies also provide cross-referrals. • Carrboro Community Clinic: In addition to cross-referrals, OCRCC provided professional training on trauma-informed care and how to connect clients with our services. • Orange Correctional Center: In this new partnership, OCRCC provides counseling in person or via phone or mail at the prison.We also provide accompaniment to the hospital if an inmate needs a forensic evidence kit("rape kit"). h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Without funding from local government,we would not be able to maintain the level of comprehensive, unique service that we currently offer to our clients, including the large number of support groups and workshops. Altogether, local government grants comprise about 10%of our budget. I) Include any other pertinent information. F The OCRCC measures the effectiveness of our support group services via participant evaluations. In FY2014-2015, our data showed that OCRCC support group participants, on average, experienced a reliable decrease in PTSD symptom severity. One participant said, "Participating in this support group has made me feel less alone, made me feel like I'm actually getting somewhere in healing, made it easier for me to talk about what happened, and made me start to reach out to old friends I'd isolated myself from." Main Application 1/25/2016 12:55:42 PM P a g e 9 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION Program/Project Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff 1) 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:Client Services Actual Estimated Projected 2014-15 2015-16 2016-17 .......... Male 69 66 72 Female 405 410 420 Other 4 6 10 Unknown* 46 108 98 Total 524 590 600 Of the females, how many are single-female N/A N/A N/A Head of Households Omit for Human Services M4 ■■yyam. Y African-American 26 18 30 American Indian or Alaska Native 1 1 1 Asian 10 2 4 Caucasian 130 174 175 Native Hawaiian or other Pacific Islander 0 0 0 Other 59 108 128 Unknown* 298 287 262 Total 524 590 600 Of the above, how many Hispanic/Latino 52 106 126 Of the above, how many non-Hispanic/Latino 174 197 212 Total 524 590 600 Main Application 1/25/2016 12:55:42 PM Page 10 of 3 2 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION Age 0-5 years 0 0 0 6-18 years 6 2 6 19-50 years 119 192 204 51-61 years 47 30 40 62+years 8 6 8 Unknown* 344 360 342 Total 524 590 600 Geographic Lcicatlon Durham City N/A NIA N/A Durham County 38 42 42 Carrboro 36 32 38 Chapel Hill (incl. UNC) 126 150 160 Chapel Hill Public Housing Residents NIA N/A N/A Orange County 27 12 29 Raleigh N/A N/A N/A Wake County 21 30 25 Homeless 6 4 12 Other 98 108 110 Unknown* 172 212 184 Total 524 590 600 A large amount of our contact with clients is over the phone on our 24-Hour Help Line. Many clients may be experiencing a mental or physical crisis situation,in which case it may not be appropriate to ask demographic questions. Further, because of the nature of our work, many clients may be very nervous about calling us,and they greatly value anonymity.Out of respect for their confidentiality, it may not be appropriate to ask demographic questions. It is easier and more appropriate for us to collect data on clients who utilize long-term services,such as support groups. t ( Main Application 1/25/2016 12:55:42 PM Page 1 1 of 32 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION k.) Schedule of Positions Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). 777777777777777 7777-77777777 77777777 "10 lf; rorriaed, k "�9 indt+cate R oSiition Tii#ilex *, Ac#uat tEs#rmalted iPro)e�#ea 1ro>tal { ATE 1Pr�gli�tin life#lirement: �-1r'esitl�n t/a�csnt 2094�� 20a��� 2oi6�'� 8ud 1F'��n(H) staff� �+et �galth�tat� 45%(1) Executive Director 1.0 55%(2) 75,929 74,235 77,673 11% R,H Client Services Director 1.0 100%(l) 58,207 55,411 56,929 8% R,H Crisis Response Coordinator 1.0 100%(l) 45,446 48,068 45,151 6.4% R,H 90%(1) Latina Services Coordinator 1.0 10%(2) 34,690 45,407 46,184 6.6% R,H Client Services Assistant .75 100%(l) 0 0 27,640 4% R,H 75% Community Education Director 1.0 100%(2) 0 52,918 54,335 7.7% R,H Prevention Coordinator 1.0 100%(2) 44,567 45,959 46,873 67% R,H Education&Finance 12%(1) Coordinator 1.0 88%(2) 42,701 49,314 50,116 7% R, H Education Assistant .50 100%(2) 14,524 16,227 2.3% R Development& 37%(1) Communications Director 1.0 63%(2) 53,049 58,374 62,944 9% R,H Administrative Services 65%(1) Coordinator 1.0 35% 2 28,736 33,195 38,838 5.5% R,H Crisis Response Assistant .25 100%(1) 7,230 8,419 11,590 1.6% R 50%(1) Volunteer Hours 4.0 50%(2) n/a 1) Client Services 2) Community Education 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 1/25/2016 12:55:42 PM p g 1 2 o f 3 2 Exhibit 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 ❑ ® a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? ❑ ® b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? ❑ ® c) Current beneficiaries of the project/program for which funds are requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. i 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: Executive Dire for Date—� Signature: Boar i n Date z` Ef t Main Application 1/25/2016 12:49:34 PM P a g e 1 3 o f 3 2 l Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Actual Estimated Projected 20142015 2015-2016 2016-2017 U' WINNER. u Program Activity 1 Crisis Support:Staff and trained volunteers("Companions")respond to walk-in clients and to calls on the 24-Hour Help Line.Companions provide emotional support;give resources, information,and referrals;and accompany survivors to medical,legal,and law enforcement appointments.Staff and trained volunteers facilitate support groups and workshops for survivors. Program Goal The OCRCC will provide The OCRCC will provide The OCRCC will provide assistance to approximately assistance to approximately assistance to approximately 620 individuals. 600 individuals. 600 individuals. Performance Measures Staff and volunteers keep records of each client contact. Program Results We served a total of 524 We expect to serve about 590 We expect to serve about 600 clients. clients. clients. We estimated client numbers based on growth rates from previous years, but service numbers unexpectedly declined.Though we saw fewer clients than anticipated, we now see each client more frequently than in the past. In the past 5 years,we have seen a 62%increase in the number of contacts we have per client. 62 of the 524 clients participated in 15 support groups and/or workshops.We held more groups than the expected 8,which takes more staff time for fewer clients. Main Application 1/25/2016 12:55:42 PM P a g e 14 of 32 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION Program Activity 2 Support Groups:Staff and trained volunteers facilitate support groups and workshops for survivors Some are traditional discussion-based groups and others are activity-focused groups utilizing alternative healing modalities. Program Goal Clients will report that they have more information about options and resources available to them. Additionally,they will have gained emotional support as a result of their contact with the Center. We expect that more than 90%of those who complete evaluations will: (1) Report that participation in a support group helped them feel less alone in their experience of sexual violence. (2) Report that participation in a support group increased feelings of being supported in their healing process. Performance Measures Using a quantitative standardized scale for measuring post-traumatic stress disorder(PTSD), support group participants will be given a pre-and post-test for these symptoms. Participants are also asked to provide qualitative feedback about the service(s)they utilized at the OCRCC,to evaluate their service provider,and to comment on the accessibility of our programs.The Client Services Director compiles data after each support group and at the end of the fiscal year. Program Results 95%of support group participants reported that our groups helped them feel less alone in their experience. 94%of support group participants reported that our groups made them feel more supported in their healing process. Main Application 1/25/2016 12:55:42 PM P a g e 1 5 o f 3 2 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION 3. (ii) PROJECT/PROGRAM INFORMATION Agency& Program Name: _ Orange County Rape Crisis Center– Community Education As you complete your application, complete only those sections that pertain to the type of application you are submitting. The application is divided into several sections and not all sections apply to every project. Every applicant MUST complete the main application. a) Check the type of funding request for this application package submittal and complete the required application and required supplemental sections (Parts) as specified below: ® Human Services (Main Application Only) ❑ CDBG Non-Construction—(Main Application AND Part A) ❑ CDBG Construction —(Main Application AND Part A AND Part B ❑ HOME CHDO Set-aside —(Main Application AND Part A) ❑ HOME Other — (Main Application AND Part A AND Part B Indicate the type of program for which you are requesting funding:ccv� :)�rprarp O�t��p� 'Y��Ifi� "� Adplt� �Iderly ��ot 1�lsrgfitta�rl�pt�dsf _ f i � ,i ;. �l�l�r] .l�$ra�S�$rlt5 1•° Education X X X X X Health and Nutrition Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentorin Transportation Housing Other: Human Services Main Application 1/25/2016 12:55:42 PM P a g e 1 6 c f 3 2 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION Program/Project Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: b) Summarize the program services proposed and how the program will address the chosen Town/County priority? The Orange County Rape Crisis Center(OCRCC)has provided safety education programs to local youth and adults for 35 years. Our Safe Touch program was innovative and groundbreaking when first launched, and we have continued to incorporate new research and best practices into our curriculum over the years to ensure the highest quality content and delivery. Our Safe Touch program is designed for preschool through fifth grade, focusing on protective factors against sexual abuse victimization. We teach age-appropriate messages for how to identify inappropriate touches, what to do if they experience violence, and who they can talk to about violence. In fourth and fifth grade,we introduce lessons about sexual bullying,internet safety, and cyber-bullying. Our Start Strong program works in middle and high schools, focusing on risk and protective factors for perpetration of sexual violence, in accordance with primary prevention theory. In keeping with evidence-based best practices, our messages focus on positive behavior development rather than negative behavior abatement as well as on bystander empowerment rather than risk reduction for potential victims.Our programs increase protective factors for youth, including developing positive and health relationships, promoting healthy sexuality, developing media literacy skills, increasing bystander efficacy,and challenging rape myths. Our adult and parent programs utilize both primary prevention and risk reduction strategies. Our major program is Stewards of Children®, a professional training curriculum provided by the Darkness 2 Light Coalition. Relying on evidence-based methodology, we teach parents and caregivers concrete steps and practical tips for preventing, recognizing,and responding to child sexual abuse. The OCRCC's education programs address community priorities by reducing what the CDC terms Adverse Childhood Experiences (ACEs), which form the root causes of many public health issues and contribute to negative life outcomes such as substance abuse, mental and behavioral health issues,and chronic disease. In addition to their prevention focus, the programs are designed to identify children and adolescents currently experiencing violence and connect them with appropriate professional supports. Over the last five years, our staff has assisted school personnel with providing intervention services to 544 students, including making reports to the Department of Social Services in cases where mandated or recommended. 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. According to the Darkness 2 Light Coalition, about one in ten children will be sexually abused before their 18th birthday. And as this statistic includes contact-only abuse, we know that even more children will experience other forms of non- contact sexual violence, such as exposure, voyeurism, sexual harassment, and exposure to pornography. Sexual violence occurs in all communities and across all demographic groups,and research shows that children and teens are at even higher risk of victimization than adults: 70 percent of all reported sexual assaults occur to children under the age of 18. Though local data on sexual violence is difficult to assess,our experience corroborates these national findings. In addition to the alarmingly high rates of child sexual abuse, we also know that the negative impacts of abuse can be severe. Children who experience sexual violence may have mental health issues such as anxiety, depression, aggression, or suicidal thoughts; difficulty with interpersonal relationships and sexuality; self-esteem and body image issues; difficulty at school such as poor performance, poor behavior, or poor attendance; physical illness; and more. Without proper support, these difficulties may persist into adulthood,creating limitations on their health,employment, and housing outcomes. But just as with adults, these long-term consequences can be diminished if children receive early Main Application 1/25/2016 12:55:42 PM Page 17 of 32 j Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION intervention and a supportive environment to disclose their abuse and begin to heal. Further, because offenders often perpetrate in an escalating manner, recognizing inappropriate behavior and intervening early can prevent more severe abuse from occurring. It is therefore crucial that we work both to prevent initial victimization and also to identify and provide services to those who do experience violence. With the majority of our programs taking place within local schools, we are able to educate youth and adults across all demographics in Orange County, including underserved populations as well as low-and moderate-income families. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. Because the program operates through the public schools,we will serve a majority of families with school-aged children in the county, with a particular emphasis on services to vulnerable and low-income families through our partnership with HeadStaWEarly HeadStart and the Exceptional Children programs in both CHCCS and OCS. Every preschool and elementary student enrolled in CHCCS,OCS,or HeadStart will benefit from our programs. Older students in middle and high school in Chapel Hill and Carrboro will also benefit from our program, which will reach every Th and 9th grader in each of the CHCCS schools. Beneficiaries in Orange County Schools will be determined based on which school personnel opt to include the program in their curriculum. While we do not collect demographic information related to housing or household income for the purposes of our educational program,we work within the public schools which maintain a commitment to serving homeless, low-income, moderate-income, and vulnerable children. We are assured that with 100% reach in the schools, we provide benefits to students from a variety of income levels and housing situations,approximately reflecting the population of the county. e) Who specifically will carry out the activities and in what location will they be carried out? Program activities will be carried out by qualified staff and trained volunteers in local schools. Safe Touch program activities at the elementary level are delivered through the regular classroom with support from classroom teachers and student support staff(i.e., counselors, social workers, nurses). Preschool classroom programs are coordinated either through the school for site-based pre-K classes,or through the Head Start/Eady HeadStart program. Students enrolled in both school-based and facility-based HS/EHS receive the program in the spring when they are most developmentally prepared for the content. Start Strong program activities at the middle and high school level are delivered by staff and volunteers in the Healthful Living classes,with support from classroom teachers. Our adult education programs are delivered in a variety of settings, including during the two district Open House events and at specific schools throughout the school year.These are delivered by certified presenters on our staff, 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. Activities Timeline Program Activity 1—Safe Touch Renew Memorandum of Agreement with OCS and CHCCS 07/2016-08/2016 Work with school personnel to coordinate program schedule 07/2016-09/2016 Recruit and train volunteers to present Safe Touch programs 08/2016-09/2016 Parent Open House in OCS 0912016 Implementation of Safe Touch programs in OCS 09/2016-11/2016 Parent Open House in CHCCS 11/2016 Implementation of Safe Touch programs in CHCCS 11/2016-04/2017 Main Application 1/25/2016 12:55:42 PM P a g e 1 8 o f 3 2 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION Implementation of Safe Touch programs in pre-K and HeadStart/Early HeadStart in OCS 05/2017 and CHCCS Schedule and implement Safe Touch programs as requested for charter schools, private Ongoing schools,community groups, professional organizations,faith communities,etc. Program Activity 2—.Start Strong Renew Memorandum of Agreement with OCS and CHCCS 07/2016-08/2016 Work with school personnel to coordinate program schedule 07/2016-09/2016 Recruit and train volunteers to present Start Strong programs 0812016-11/2016 Implementation of Start Strong 7th grade program in CHCCS & OCS middle schools 10/2016-0512017 4 sessions in each participating health class Implementation of Start Strong 9th grade program in CHCCS & OCS high schools 10/2016-05/2017 2 sessions in each participating health class Schedule and implement Start Strong programs as requested for charter schools, private Ongoing schools,community groups,professional organizations,faith communities,etc. Program Activity 3—Adult Education&Training Schedule and implement adult, parent, professional, and custom programs as requested for Ongoing charter schools, private schools, community groups, professional organizations, faith communities,etc. g) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, give specific examples of the coordinated/collaborative efforts. • Orange County Schools and Chapel Hill-Carrboro City Schools: The OCRCC maintains an annual Memorandum of Agreement (MOA) with OCS and CHCCS outlining responsibilities of both parties for program delivery, parent communication, and follow-up protocol with students who raise concerns during or immediately following a program. • Compass Center for Women&Families:The OCRCC collaborates with Compass to provide joint programming in the Start Strong program. The OCRCC provides 71h and 9th grade programs, and Compass provides 6th and 8th grade programs.We work together to ensure content and evaluation coherence. Department of Social Services: The OCRCC regularly refers families of students who raise concerns during classroom programs to DSS for follow-up services and intervention if needed. • The OCRCC also offers programming by request to a number of independent schools, community groups, professional organizations,faith communities,and others, h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Without funding from local governments, we would not be able to provide a large number of safety education programs to our community. With only two full-time and one part-time staff members, we are already stretched beyond capacity and often have to decline program requests.In FY14-15,the OCRCC provided a total of 898 programs to 13,614 people. More than 80% of programs were delivered to pre-K through grade 12 students. Additionally, education staff worked more closely than ever with client services staff to deliver community-wide education opportunities, bringing customized programs to faith communities, neighborhoods and families across the county. Altogether, local government grants comprise about 10%of our budget. i) Include any other pertinent information. The following comment from a parent was posted on Facebook and is shared with permission: "I wanted to let the community and the administration know HOW MUCH I appreciate the Safe Touch education program that the school implemented this past month. The fact that the administration and faculty made this a priority speaks volumes about putting the safety of our children first. I feel such gratitude that my children are in a safe place.... Thank you from the bottom of my heart to whomever made this happen in our school!" t Main Application 1/25/2016 12:55:42 PM P a g e 1 9 o f 3 2 I Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION Program/Proiect Information (j) Complete the Target Population and Program Beneficiary Demographics Chart (k) Complete the Schedule of Positions Chart for Program Staff (1) Disclosure of Potential Conflicts of Interest 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: Community Education T-1111111 111111 _ fro ram,8�erii�fircia'``Qet�rtActual Estimated Projected 2014-15 2015-16 2016-17 Male N/A N/A N/A Female N/A N/A N/A Total N/A N/A N/A African-American N/A N/A N/A American Indian or Alaska Native N/A N/A N/A Asian N/A N/A N/A Caucasian N/A N/A N/A Native Hawaiian or other Pacific Islander N/A N/A N/A Other N/A N/A N/A Unknown N/A N/A N/A Total N/A N/A N/A Of the above, how many Hispanic/Latino N/A N/A N/A Of the above, how many non-Hispanic/Latino N/A NIA N/A Total N/A N/A N/A AR 0 0-5 years 1,869 1,865 1,875 6-18 years 10,523 10,600 10,650 19-50 years 1,222 1,230 1,240 51-61 years 62+years Unknown Total 13,614 13,695 13,765 Main Application 1/25/2016 12:55:42 PM P a g e 20 of 32 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION Geographic Location Durham City 483 565 600 Durham County 240 200 200 Carrboro 1,136 1,135 1,135 Chapel Hill (incl. UNC) 7,673 7,660 7,660 Chapel Hill Public Housing Residents NIA NIA NIA Orange County 3,830 3,930 3,965 Raleigh 43 35 35 Wake County 0 0 0 Chatham 162 120 120 Other/Unknown 47 50 50 Total 13,614 13,695 13,765 We are not able to track education programs based on gender or ethnicity since they typically have mixed audiences. With the vast majority of our programs taking place in the local school districts, we can assume that our outreach numbers reflect county-wide demographic data. E" r Main Application 1/25/2016 12:55:42 PM Page 21 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION k) Schedule of Positions Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). �rdreat�e X, . Pbsltron�'�#les ��.�** : Prcyratn ;Actual estimated :' Ptc,�ected °l0 7o#al (�) �' �flsl#tin Y�cant '9 _ �Q14,1�' ;20'!,�18 . ' '1t1t� 1� Bu�lgBt Reitlra�r>1 @�t, Hea11i�Plan 45%(1) Executive Director 1.0 55% 2 75,929 74,235 77,673 11% R,H Client Services Director 1.0 100%(l) 58,207 55,411 56,929 8% R,H Crisis Response Coordinator 1.0 100%0) 45,446 48,068 45,151 6.4% R,H Latina Services 90%(1) Coordinator 1.0 10%(2) 34,690 45,407 46,184 6.6% R,H Client Services Assistant .75 100%(l) 0 0 27,640 4% R,H 75% Community Education Director 1.0 100%(2) 0 52,918 54,335 7.7% R,H Prevention Coordinator 1.0 100%(2) 44,567 45,959 46,873 6.7% R,H Education&Finance 12%(1) Coordinator 1.0 88%(2) 42,701 49,314 50,116 7% R, H Education Assistant .50 100%(2) 14,524 16,227 2.3% R Development& 37%(1) Communications Director 1.0 63%(2) 53,049 58,374 62,944 9% R,H Administrative Services 65%0) Coordinator 1.0 35% 2 28,736 33,195 38,838 5.5% R,H Crisis Response Assistant .25 100%(1) 7,230 8,419 11,590 1.6% R 50%(1) Volunteer Hours 4.0 50%(2) n/a 1) Client Services 2) Community Education 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 1/25/2016 12:55:42 PM P a c. e 2 2 o f 3 2 Exhibit 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 ❑ ® a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? ❑ ® b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? ❑ ® c) Current beneficiaries of the project/program for which funds are requested? ` ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the project ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature; E;Bo ec ive Di ctor Date Signature: r C arson Date 1 a A Main Application 1/25/2016 12:49:34 PM Page 1.3 of 32 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Program Activity 1 Present educational programs to youth and adults in the communit . Program Goal OCRCC will provide OCRCC will provide OCRCC will provide educational programs to educational programs to educational programs to 13,010 individuals. 13,010 individuals. 13,200 individuals. Performance Measures Program Record sheets maintained and monitored by OCRCC education staff. Program Results OCRCC provided educational programs to 13,614 individuals in the community. 115-�.. te ` . �E ��E� ME Program Activity 2 Present Safe Touch educational programs in elementary schools. Program Goal 90%of teachers and counselors whose classrooms receive Safe Touch programs will report an increase in student awareness of personal safety and protection against sexual violence. Performance Measures For each program within a school setting,the OCRCC provides each teacher and school counselor with an evaluation asking them to assess whether the program resulted in an increased awareness of personal safety and protection against sexual violence among students. OCRCC staff reviews evaluations periodically and compiles results biannually. Program Results 95%of teachers and counselors at schools that receive OCRCC programs reported an increase in student awareness of personal safety and protection against sexual violence. Main Application 1/25/2016 12:55:42 PM P a g e 2 4 o f 3 2 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION 4. fIN NGiAL 1NFORMATI©N FOFt SERVICE PR094� 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. F. i I. i; Main Application 1/25/2016 12:55:42 PM Page 25 of 32 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION Program Budget Agency/Program Client Services Aetual; Esimated ProJeCted ; Percent AGENCY REVENUE 464-15 3015=16 ..i 201,6-17:. Ch0n e. . Private Donations $ 25,000 $ 25,000 $ 25,000 0% Agency Generated Revenue (fees) $ $ - $ - 0 Local Government Grants: Orange County $ 15,000 $ 15,000 $ 17,500 17% Town of Chapel Hill $ 4,000 $ 10,000 $ 13,500 35% Town of Carrboro $ 2,000 $ 5,000 $ 6,000 20% Other Local: Town of Hillsborough $ 2,500 $ 2,500 $ - -100% Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants i6ift Triangle United Way $ 21,412 $ 26,365 $ 22,500 -15% State Government $ 43,784 $ 38,550 $ 35,500 -8% Federal Government $ 134,932 $ 158,655 $ 193,655 22% Other Grants: Contracts(LAV $ 14,103 $ 12,250 $ 4,000 -67% Other Grants: 0 Miscellaneous/Other Revenue $ 25,975 $ 26,893 $ 31,917 19% Please list 3 largest"scellanous sources: Fundraiser(annual auction) $ $ 24,475 $ 24,893 $ 30,417 Miscellaneous $ $ 1,500 $ 2,000 $ 1,500 Total Agency Revenue $ 288,706 $ 320,213 $ 349,572 9% AGENCY EXPENSES Compensation $ 202,540 $ 235,650 $ 267,250 13% Rent&Utilities $ 43,372 $ 45,411 $ 48,005 6% Supplies BEquipment $ 14,1851 $ 18,150 $ 15,100 17% Travel&Training $ 3,390 $ 3,000 $ 3,000 0% Other Expenses: $ 26,679 $ 18,002 $ 16,217 -10% Please list 3 largest"Other Expenses": Financial:Audit,bank fees,etc. $ $ 6,010 $ 6,627 $ 6,952 Professional dues,marketing,mist. $ $ 10,711 $ 7,625 $ 8,515 Client Emergency Funds,contract fees $ $ 9,958 $ 3,750 $ 750 Total Agency Expenses $ 290,1661 $ 320 213 $ 349,572 9% SURPLUS/(DEFICIT)FOR PERIOD: 1 $ (1,460) $ $ - 0 Main Application 1/25/2016 12:55:42 PM P J e, 2 6 o f 3 2 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element.Where necessary, allocate costs to the use of shared space, vehicles or equipment. Complete the table below for the proiect/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: Client Services .,.- Personnel staff time 5.5 HE $267,250 Supplies for volunteer trainin 40 25 volunteers $1,000 Client Emergency funds As many as needed 250 Communications costs for Hel line Phone internet cell $8,120 $72,952.50 Total $349,572.50 c.) Cost per Unit Np a ~ Total Cost of $290,166 $320,213 $349,572.50 Program Total #of 2453 2773 2820 Units Cost Per Unit $118.29 $115.47 $123.96 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/25/2016 12:55:42 PM P a g e 27 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION a.) Program Budget Please complete a Program Budget Excel Form for each requested program. The Program Budget should reflect only figures and amounts associated with the Program(s) for which you are seeking funding and not the total agency budget. If the program's finances experienced significant changes that you would like to explain, please use the space below. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/25/2016 12:55:42 PM P a g e 28 of 32 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION Program Budget Agency/Program: Community Education Actual., Esti!000 Pfojl3cted Pecent AGENCY REVENUE 20.j4.410 20 Private Donations $ 70,387 $ $ 92,000 0% Agency Generated Revenue(fees) $ 1,722 $ 4,800 $ 6,000 25% Local Government Grants: Orange County $ 15,000 $ 15,000 $ 17,500 17% Town of Chapel Hill $ 16,000 $ 10,000 $ 13,500 35% Town of Carrboro $ 7,000 $ 5,000 $ 6,000 20% Other Local: Town of Hillsborough $ 2,500 $ 2,500 $ -100% Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way $ 9,640 $ 15,016 $ 12,500 -17% State Government $ 52,065 $ 42,565 $ 45,500 7% Federal Government $ 59,533 $ 60,000 $ 60,000 0% Other Grants: Contracts $ $ $ 25,000 0 Other Grants: Private Foundations $ 15,500 $ 18,938 $ 21,190 12% Miscellaneous/Other Revenue $ 66,358 $ 54,394 $ 50,382 -7% Please list 3 largest Miscellanous sources: Fundraiser(annual auction) $ $ 46,047 $ 44,194 $ 40,882 Miscellaneous $ $ 1,574 $ 2,200 $ 1,500 Non-cash donations $ $ 18,737 $ 8 000 $ 8,000 Total Agency Revenue 288 705 320 213 349.572 1 9% AGENCY EXPENSES Compensation $ 202,540 $ 235,650 $ 267,250 13% Rent 8r Utilities $ 40,122 $ 41,911 $ 44,085 5% Supplies&Equipment $ 24,861 $ 17,950 $ 20,100 12% Travel&Training $ 3,050 $ 3,500 $ 3,000 -14% Other Expenses: $ 19,594 $ 21,202 $ 15,137 -29% Please list 3 largest"Other Expenses" Financial:Audit,bank fees,etc. $ $ 6,010 $ 6,627 $ 6,952 Professional dues,marketing,misc. $ $ 8,008 $ 10,075 $ 7,685 Client Emergency Funds,contract fees $ $ 5,576 $ 4,500 $ 500 Total Agency Expenses 290 167 320 213 349 572 9% ) r SURPLUSI(DEFICIT)FOR PERIOD: (1,462)1$ 1$ - 1 0 Main Application 1125/2016 12:55:42 PM Page 29 of 32 { Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Complete the table below for the pro'ect/program for which you are requesting funds. Attach additional rows/pages, as needed_ Program: Community Education ate" ,�-��� Personnel staff time 5 FTE $267,250 Classroom Materials-handouts $0.33 13,765 participants $4,500 General operating costs $77,822..50 Total $349,572.50 c.) Cost per Unit ON ME Mal ��FIN 1,s`w egsz.. ,p .ilo :. Total Cost of $290,166 $320,213 $349,572.50 Program Total # of Units 13,614 13,695 13,765 Cost Per Unit $21.31 $23.38 $25.40 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/25/2016 12:55:42 PM Page, 3 0 of 32 Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION d.) Agency Operating Budget Please show all sources and amounts of funding for your entire current fiscal year. What is your agency's fiscal year? Example: July 1, 2016 through June 30, 2017. Submit operating budget in your own format. Do not include funds that have been applied for but not yet awarded: If the total revenue is not the same amount as the budget for any fiscal year, please attach a statement explaining the deficit or surplus. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/25/2016 12:55:42 PM Page 31 of 32 Exhibit A- continued Provider's Outside Agency Application MAIN APPLICATION Section M.Financial Data Operating Budget for Entire Agency AGENCY NAME: Orange County Rape Crisis Center ' ♦4ctual Estimated Prole"c'ted :P.ercerit" AGENCY REVENUE �Oidab 201516'`I .. ;201647 Chiege. = Private Donations $ 95,387 $ 117,000 $ 117,000 0% Agency Generated Revenue(feesfor out of county community education programs) $ 1,722 $ 4,800 $ 6,000 25% Local Government Grants: Orange County $ 30,000 $ 30,000 $ 35,000 17% Town of Chapel Hill $ 20,000 $ 20,000 $ 27,000 35 Town of Canboro $ 9,0001s 10,0001$ 12,000 20% Other Local: Town of Hillsborough $ 5,000 1$ 5,000 $ 100 Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way $ 31,053 $ 41,381 $ 35,000 -15% State Government $ 68,849 $ 81,115 $ 81,000 0% Federal Gowrnment $ 194,465 $ 218,655 $ 253,655 16% Other Grants:Pri�ate Foundations $ 15,500 $ 18,938 $ 21,190 12% Other Grants:contracts $ 14,103 $ 12,250 $ 29,000 137% Miscellaneous/Other Revenue $ 92,333 $ 81,288 $ 82,300 1% Please list 3largest Mscellanous sources: Fundraiser annual auction $ 70,522 $ 69,088 $ 71,300 miscellaneous $ $ 3,074 $ 4,200 $ 3,000 Non-cash donations $ $ 18,737 $ 8,000 $ 8,000 Total Agency Revenue $ 577,412 $ 640,427 $ 699,145 9% AGENCY EXPENSES Compensation $ 405,079 $ 471,300 $ 534,500 13% Rent&Utilities $ 83,494 $ 87,322 $ 92,090 5% Supplies&Equipment $ 39,046 $ 36,100 $ 35,200 -2% Travel&Training $ 6,440 $ 6,500 $ 6,000 -8 Other Expenses: $ 46,271 $ 39,205 $ 31,355 -20% Please list 3 largest-Other Expenses": Financial:Audit,bank fees,etc. $ - $ 12,019 $ 13,255 $ 13,905 Professional dues,marketing,nisc. $ $ 18,719 $ 17,700 $ 16,200 OientEmrgency Funds,contract fees $ $ 15,534 $ 8,250 $ 1,250 Total Agency Expenses $ 580,330 $ 640,4271 $ 699.145 i % SURPLUS/(DEFICIT)FOR PERIOD; 1$ (2,918) $ $ 0 Main Application 1/25/2016 12:55:42 PM Page 32 of 32 EXHIBIT"B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Orange County Rape Crisis Center Funding Award: $35,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel—Salaries 35,000 Programmatic Supplies—Rent and Supplies 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. • Provide Orange County residents with 24 hour crisis intervention services for survivors of sexual violence and community memebers. • Provide Orange County residents with community eduction, training, and advocacy about sexual assault prevention • Provide educational programs for students in Chapel Hill — Carrboro City Schools and Orange County Schools. 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 24 Hour Help-Line Assistance 600 Orange County Residents Support Group participation 95% Certified by. Title: AXQ2im `pjeml�, Date: Q (Prov' er's Signature) -� OP ID:CR CERTIFICATE OF LIABILITY INSURANCE DATE 10/24/2016Y) 10/24/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CT Jeffrey A.Rubish,CIC High&Rubish Insurance Agency P.O Box 3040 PHONE No,Ext:919-913-1144 FAX No; 919-913-1155 6015 Farrington Rd.Ste 101 E-MAIL eff hi handrubish.com Chapel Hill,NC 27517 ADDRESS: 9 Christopher Ives Rubish PRODUCER U ORANG-2 CSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Orange Cty Rape Crisis Center INSURER A:Philadelphia Insurance Co 1506 E. Franklin St,Ste 302 INSURER B:Hartford Insurance Company Chapel Hill, NC 27514 INSURER C: INSURER D: INSURER E: INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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