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HomeMy WebLinkAbout2016-613-E Finance - Volunteers for Youth - Outside Agency Performance Agreement DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 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 Volunteers for Youth, a not-for-profit corporation, located at 205 Lloyd Street, Suite 103, Carrboro,NC 27510 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Volunteers for Youth 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. (Volunteers for Youth) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 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. (Volunteers for Youth) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 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. (Volunteers for Youth) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 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 Volunteers for Youth 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: (Volunteers for Youth) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 County: Finance&Administrative Services Provider:Volunteers for Youth Orange County 205 Lloyd Street, Suite 103 Post Office Box 8181 Carrboro,NC 27510 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 on '-,,'t,f :Provider G1/r•4� 10/26/2016 ,_ft g635666FF1 E6... Date For and on �, QhInge County Government 'OVcln,lt, 11/1/2016 O637994B755C477... Bonnie Hammersley, County Manager Date (Volunteers for Youth) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 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: G1/ t Executive Di 10/26/2016 Certified by: " �l Title: E Date: .-ar-fa1e (Provider'sSignature) (Volunteers for Youth) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 Exhibit A Provider's Outside Agency Application • APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Volunteers for Youth, Inc. Date/Time / 1 Complete Y/N Program(s) Volunteers for Youth, Inc. Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. ® Applicant Contact Information b. ® Project/Program Contact Information c. ® Funding Requests Identified d. ® Signed Application Cover Page 2. Agency a. ® Agency's Years in operation 24 CFR 570.506, Information - b. ® Agency's Purpose/Mission 570.507, 570.610; 24 c. ® Agency's Types of Services Provided CFR Parts 84 or 85 d. ® Agency's Experience e. ® Other Pertinent Information 3. Program/ a. ® Type of Application and Program Identified 24 CFR 570.200(a), Project b. 570.201-570. 208, ® Summary of Program Information - c. ® Description of Identified Need 507.503 (for each d. ® Description of Population to be Served program/ project for e. ® Activity Manager and Location Description which funding f. ® Activity Implementation Timeline is requested) g. ® Agency Collaboration h. ® Describe Impact of Reduced/No Allocation i. ® Other Pertinent Information j. ® Complete Target Population/Beneficiary Chart k. ® Complete Schedule of Positions I. ® Signed Conflict of Interest Disclosure m. ® Complete Work Statement i o:° DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION 24 CFR 570.200(a), 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, each expenses for the entire program and ALL sources of 507.503 program/ funding. 24 CFR 570.506, project for 570.507, 570.601, which funding a. ® Program Budget Worksheet 570.602, 570.607(b), is requested) b. ® Program Budget Detail 570.611 24 CFR c. ® Cost Per Unit 570.502-570.504, d. ® Agency Operating Budget Worksheet 570.506, 570.507, 570.610; 24 CFR Parts 84 or 85, and OMB Circulars A-87 or A- 122; Treasury Circular 1075 5. Supplemental A. ❑ Part A: CDBG & HOME Sections (as B. ❑ Part B: Construction/Rehab applicable) 6. Attachments a. ® Audit: Organizations receiving $300,000 or more OMB 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. ❑ IRS Federal Form 990 c. ❑ NC Solicitation License* d. ® IRS Federal Tax-Exemption Letter e. ® Certificate of Insurance f. ® List of Board of Directors 24 CFR Parts 84 or 85 g. ® Articles of Incorporation/Bylaws 24 CFR 570.208, h. ® Authorization to Request Funds 570.500(c), 570.611 i. ® Authorized official designation j. ❑ Solid Waste Program Fee (SWPF) Verification** *Volunteers for Youth has a 2/15/16 extension on its solicitation license. We will send it as soon as it is received. **Volunteers for Youth rents an office in a building owned by David Ontjes, who is responsible for paying the Solid Waste Program Fee. Main Application 5/25/2016 10:34:40 AM 0 I:° 2 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued ProviderVAsiOrkwhowlication I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO El a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? LI b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? LI Z c) Current beneficiaries of the project/program for which funds are requested? z 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. Nicole Hunter, with whom we contract to run the Every Girl Counts middle school group, is married to John French, who works for the town of Chapel Hill. 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: r/e"..a.ft.-47- xecutive Dire ir Date Signature: 111, 1121/2,01t, Boarai hairperson Date Main Application 1/21/2016 10:04:57 AM Page 16 of 2 1 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Providergtokii*MmeRlication 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Volunteers for Youth, Inc. Applicant Organization's Physical Address: 205 Lloyd Street, Suite 103 Carrboro, NC 27510 Applicant Organization's Mailing Address: 205 Lloyd Street, Suite 103 Carrboro, NC 27510 Applicant Organization's Web Address: www.volunteersforyouth.orq Executive Director: Susan Worley Telephone Number: 919-967-4511 E-Mail: susan(@yolunteersforyouth.org DUNS Number: 803184337 (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: Volunteers for Youth, Inc. Project/Program Primary Contact and Title: Susan Worley, Executive Director Telephone Number: 919-967-4511, E-Mail: susanvolunteersforyouth.org c) Funding Request Identification Total Project/Program Cost: $262,648 Total Amount of Funds Requested: $28,000 Proposed Use of Funds Requested (2-3 Line Maximum): Volunteers for Youth seeks funding to provide community service, teen court, and mentoring opportunities to at risk Orange County children and youth between the ages of 8 and 15. 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. Z CDBG Non-Construction (CH) $5,000 El Grant El] Loan Li CDBG Construction (CH) El Grant [] Loan 111 HOME CHDO (OC) El] Grant fl Loan ci HOME Other (OC) E] Grant Ei Loan Z Human Services: Z Carrboro $3,000 tsi Chapel HID $10,000 14 Orange County $10000 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: A ''rector A Date Signature: 111 r.c• Boars Chairperson Date - Main Applicatio 1/21/2016 11:03:12 AM Page 3 of 21 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION 2. AGENCY INFORMATION Please provide the following information about your agency (Limit of 2 pages total): a) Years in Operation, Date of Incorporation (Month/Year) b) Agency's Purpose/Mission c) Types of Services the Agency Provides d) Agency's Experience with Similar Programs as the Funding Request e) Other Pertinent Agency Information a)Years in Operation—34; Date of Incorporation— 12/1981 b) Agency's Purpose/Mission Volunteers for Youth (VFY) provides services to Orange County youth to integrate them into the community in ways that help them make responsible choices and recognize that they have a stake in their future. Formed in 1981 by professionals in our community who worked with court- involved youth, VFY is the only Orange County nonprofit agency dedicated to serving youth who have broken laws or who are at-risk of doing so. VFY seeks to bridge the gap between disconnected youth and the community through mentoring, community service, and teen court programs. c)Types of Services the Agency Provides Volunteers for Youth provides mentoring, community service, and teen court programs. The primary goal of the mentoring program is to develop positive relationships between high need children and adolescents and caring adults. In our one-on-one mentoring program, children are matched with volunteer adults who spend time with them weekly, engaging in activities that encourage relationship development and introduce the children to new experiences. In our Every Girl Counts mentoring group, adolescent girls meet weekly with two Volunteers for Youth staff members, participating in activities designed to develop positive life skills. In national studies of numerous youth-serving programs, the Center for the Prevention of Violence in Colorado found just ten types of programs that significantly reduce violence among young people—one of these ten is structured mentoring. Our newest effort will bring UNC students to spend time with Northside Elementary School students in after school, building friendships while providing academic assistance. With clear evidence that mentoring works, the goal of the mentoring program is to ensure successful relationships between adults and children so that the children may reap the benefits of mentoring. The community service and restitution program provides community service opportunities throughout Orange County for young people who have been adjudicated delinquent. The North Carolina Department of Juvenile Justice requires that all counties have community services options available for adjudicated youth. VFY has provided this service in Orange County since 1992. The primary goal of the program is to teach young people, through community service work, to be accountable for their actions. The program is also designed to educate the participants about volunteer and job opportunities, helping prepare them for productive futures. Main Application 5/25/2016 10:34:40 AM P of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION The teen court program is an alternative court program for young people who have committed minor offenses and are referred from law enforcement,juvenile services, or the schools. These first time offenders are tried and sentenced by a jury of their peers, with other teens playing the roles of defense attorney, prosecutor, and other court officials. Teen Court is run by young people and provides hands on opportunities for teens— both offenders and volunteers— to gain insight in the legal system while also learning from their mistakes and gaining valuable life skills along the way. Through positive peer pressure, participants learn to accept responsibility for their actions and then pay back their community through community service and other sentencing. d) Agency's Experience with Similar Programs as the Funding Requests Orange County is blessed with a network of youth resources with a longstanding tradition of working together to meet the needs of local children. Two excellent school systems, strong county agencies such as the Health Department and Department of Social Services, and a dynamic group of nonprofits come together in many ways every day to meet the needs of children and youth. In spite of these efforts, there is still much work to be done. Volunteers for Youth is part of the Juvenile Crime Prevention Council (JCPC), made up of youth-serving professionals in Orange County who assess local youth needs, evaluate youth programs, and make decisions about how money from the North Carolina Division of Juvenile Justice should be used to meet those needs. Our staff works closely with other JCPC agencies including Boomerang, Dispute Settlement Center, and Mental Health of America, as well as the court counselors from the Division of Juvenile Justice. Volunteers for Youth is also a part of the Family Success Alliance (FSA), an initiative spearheaded by the Orange County Health Department, which brings together agencies to work with families in two targeted high poverty zones in Orange County. As a member of FSA, Volunteers for Youth works with agencies such as Orange Literacy, Kidscope, and El Futuro as well as several local schools to coordinate services to families in these two zones. In coordination with the Buckley Public Service Scholars Program at the UNC Center for Public Service, Volunteers for Youth recruits, screens, trains, and supervises UNC students in the SMART program who serve as mentors to local kids while taking classes related to their mentoring experience. The SMART program is one component of our overall mentoring program. A network of community service worksites, including Hope Garden, Anathoth Garden, Camp Chestnut Ridge, and Boomerang, provide community service opportunities to the youth in our community service and teen court programs. Volunteers for Youth staff recruit volunteers at these local nonprofits who supervise court-ordered community service work of youth at their organization. Main Application 5/25/2016 10:34:40 AM P 5 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Volunteers for Youth, Inc. 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: Program Category Youth Adult Elderly Disabled Public Housing (not elderly) Neighborhoods/Residents Education X Health and Nutrition Job Training X Sports and Arts Activities X Pre-School Activities After-School Activities X Mentoring X Transportation Housing Other: Please specify Teen Court and Community Service X Proaram/Proiect Descriation (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? Through mentoring, community service, and teen court services, Volunteers for Youth will address Priority Area #2:To fund education, mentorship, and afterschool programming for youth facing a variety of challenges. Main Application 5/25/2016 10:34:40 AM P of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION Mentoring: • One-on-one mentoring: Volunteers for Youth will recruit, screen, train, and supervise volunteers to serve as one-on-one mentors to children who could benefit from the time and attention of a caring adult role model. Volunteers in the community mentoring component will commit to getting together with their mentees for at least two hours a week for one year and those in the SMART mentoring component will commit to a minimum of two hours a week for eight months. At least 30 children will participate in the one-on-one mentoring program during the 2016-17 fiscal year. • Group mentoring: Volunteers for Youth will host a weekly life skills group for seventh and eighth grade girls during the 2016-17 school year. A Volunteers for Youth staff person and UNC Bonner intern will lead the group, serving as mentors to at least 20 group participants. Volunteers for Youth will recruit, screen, train, and supervise volunteers to mentor elementary school children in an after school group. A minimum of 15 elementary school students will meet with mentors during after school for the course of the 2016-17 school year. Community service: During the 2016-17 fiscal year, Volunteers for Youth will oversee the community service hours of at least 110 youth who are court ordered to complete community service hours. Volunteers for Youth will recruit, screen, and supervise volunteers to supervise youth doing community service at ongoing work sites throughout Orange County. Volunteers for Youth staff will plan and facilitate single day community service events for these 110 youth throughout the year as well. Teen court: During the 2016-17 fiscal year, Volunteers for Youth will hold teen court sessions every other week, working with at least 55 youth who are referred to teen court for first time offenses. Volunteers for Youth will oversee the community service hours assigned to those youth as well as any other terms of their sentencing. Volunteers for Youth will recruit, screen, train, and supervise teen volunteers to serve as attorneys, bailiffs,jury members, and clerks. 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 Human Service Need Report, "Chapel Hill lacks sufficient, low- cost/free activities that positively engage children and youth especially those from at-risk and low-income households." Children and youth with little support and structure during out of school time are more likely than others to get into trouble. According to the North Main Application 5/25/2016 10:34:40 AM .. of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION Carolina Division of Juvenile Justice, there were a total of 197 delinquent complaints brought against Orange County youth in 2014 (the most recent year for which statistics are available). Volunteers for Youth provides services to youth who are involved in the court system as well as those at risk of such involvement. Providing these children and youth with constructive, enriching activities outside of school time while engaging them with caring adults is an important tool in delinquency prevention. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. Volunteers for Youth will work with Orange County children and youth between the ages of 8 and 15 who are referred by court counselors, police officers, school counselors, social workers, Family Success Alliance navigators, and parents. The youth will be referred either because they are involved in the court system, are first-time offenders, or are children who may be at risk for legal involvement without intervention from a program such as Volunteers for Youth. e) Who specifically will carry out the activities and in what location will they be carried out? Volunteers for Youth will recruit and supervise volunteers who will serve as mentors, work site coordinators, and teen court volunteers. For the one-on-one mentoring program, volunteer mentors will take children out once a week to engage in interactive pastimes in places as varied as playgrounds, greenways, museums, UNC's campus, and the volunteer's home. Group mentoring will take place in local schools. Community service projects will be carried out throughout Orange County in locations such as Anathoth Garden in Cedar Grove, the Hillsborough Farmers Market, and Boomerang in Chapel Hill. Teen court sessions will take place in the historic courthouse in Hillsborough. 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. All of the services Volunteers for Youth provides are ongoing and will take place throughout the year with children and youth coming and going. Children in the one-on-one mentoring program will spend time with their mentors once a week for the period of at least one year (for those in the community mentoring program) and eight months (for those in the SMART mentoring program). Children in the group mentoring programs will see their mentors once a week throughout the school year. Youth in the community service program will perform community service hours once a week until their hours are completed. Depending on the number of hours assigned and other factors, this generally takes between two and four months but can take as long as a year. Youth will participate in the teen court program for up to three months from the time of their sentencing. (See attached timeline.) g) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, give specific examples of the coordinated/collaborative efforts. • Orange County Office of Juvenile Justice—VFY staff works closely with court counselors to monitor progress of youth in our program, sending monthly progress reports on individual Main Application 5/25/2016 10:34:40 AM P of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION youth to the court counselors, attending court planning meetings and sessions of juvenile court, and communicating with them frequently via phone, email, and in person conversations • A network of community service worksites including Hope Garden, Anathoth Garden, Camp Chestnut Ridge, and Boomerang—VFY staff recruit volunteers at local nonprofits who supervise court-ordered community service work of youth at their organization. VFY staff check in with the work site coordinators regularly to monitor the youth's hours and conduct. • UNC's SMART Project— In coordination with the Buckley Public Service Scholars Program at the UNC Center for Public Service, VFY recruits, screens, trains, and supervises UNC students who serve as mentors to local kids while taking classes related to their mentoring experience. VFY staff attend regular planning meetings with the SMART coordinators and a SMART mentor works in VFY's office each summer to help with planning. • Family Success Alliance—Volunteers for Youth is one of a number of agencies who have come together through the Orange County Health Department's Family Success Alliance to provide services to families and children in two targeted zones in Orange County. VFY staff attends monthly planning meetings with other agency staff and FSA navigators to discuss ways to best meet needs in these zones. VFY provides one-on-one mentors and mentoring groups to youth in the zones. • Chapel Hill Police Department—VFY coordinates with the police department to send program participants on an annual, out of state, three-day field trip with a focus on African-American history • Third Sector Alliance—VFY's executive director spearheads an alliance of nonprofit organizations in Orange County aimed at strengthening the voice of local nonprofits for the benefit of our clients • Juvenile Crime Prevention Council - Volunteers for Youth is part of the Juvenile Crime Prevention Council (JCPC), made up of youth-serving professionals in Orange County who assess local youth needs, evaluate youth programs, and make decisions about how money from the North Carolina Division of Juvenile Justice should be used to meet those needs. VFY staff communicate regularly with other JCPC agencies including Boomerang, Dispute Settlement Center, and Mental Health of America, about the progress of shared clients and ways to best meet their needs. h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Volunteers for Youth has provided services to Orange County youth since 1982. In 2009, our mentoring program received a major blow when the North Carolina Legislature did away with funding for mentoring across the state. In 2015, our organization took another hit when the United Way of Greater Orange revamped its funding structure away from member agencies. Volunteers for Youth staff has been reduced from six to four positions but we have maintained our services with the help of dedicated volunteers, interns, and staff. If Volunteers for Youth receives a reduced allocation or none at all, we will have to look at reducing much needed services, most particularly our mentoring program. Mentoring is one of the most commonly cited needs of parents, including those in the Family Success Alliance Main Application 5/25/2016 10:34:40 AM P 10 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION zones, so we are hopeful that we can continue our highly effective program with the funding requested. i) Include any other pertinent information. From the early days of its inception in the early 1980s, Volunteers for Youth received funding from the towns of Chapel Hill, Carrboro, and from Orange County. In 2009, Orange County stopped providing outside agency funds to our organization. It is our understanding that this decision was made because the county awards Volunteers for Youth a 30% match for the funds received from the state of North Carolina to run the community service and teen court programs. As necessary as these funds are for significant services, they don't provide support to our mentoring program. Mentoring is a service that is repeatedly listed by parents and youth-serving professionals as a high need in Orange County, particularly for children in the Orange County school system where there are few mentoring alternatives. This year we seek funding from Orange County to help us meet this critical need. Program/Project Information j)Complete the Target Population and Program Beneficiary Demographics Chart k)Complete the Schedule of Positions Chart for Program Staff ()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: Volunteers for Youth, Inc. Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 101 104 112 Female 109 111 118 Total 210 215 230 Of the females, how many are single- female Head of Households (Omit for Human Services) Ethnicity African-American 82 84 89 American Indian or Alaska Native Main Application 5/25/2016 10:34:40 AM Pag 1 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION Asian 8 8 8 Caucasian 117 120 130 Native Hawaiian or other Pacific Islander Other 3 3 3 Total 210 215 230 Of the above, how many Hispanic/Latino 47 49 54 Of the above, how many non- Hispanic/Latino 163 166 176 Total 210 215 230 Age 0-5 years 6-18 years 210 215 230 19-50 years 51-61 years 62+ years Total 210 215 230 Geographic Location Durham City Durham County 6 6 6 Carrboro 20 21 24 Chapel Hill 108 110 117 Chapel Hill Public Housing Residents Orange County 76 78 83 Raleigh Wake County Total 210 215 230 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 5/25/2016 10:34:40 AM P 12 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION CDBG & HOME ONLY- Area Benefit Activities (Infrastructure and Public Facilities) Street Census Tract Block Group Total Persons #LMI Persons 2015 Area Median Family income Limits U.S. Department of Housing & Urban Development (HUD) 2015 Area Median Family Income Limits Effective March 15, 2015 Income 1 2 3 4 5 6 7 8 Level person people people people people people people people 30% AMI $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 50% AMI $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 80% AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 100% AMI $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115% AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www.huduser.ord/portal/datasets/il/ill 5/FY2015 IL nc.pdf Main Application 5/25/2016 10:34:40 AM 0 I:° 14 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION k.) Schedule of Positions Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). If provided, indicate: Position Titles % (R) *= Position FTE* Program Actual Estimated Projected %Total Retirement Vacant Staff+ 2014-15 2015-16 2016-17 Budget Plan (H) Health Plan Executive Director 1.0 80 57,053 57,053 57,053 (R) 3 Program Coordinators 1.0 100 110,957 109,005 110,573 (R) Volunteer Hours 2.5 Notes: • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. • ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • + Denotes the percentage of staff time involved with this program. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours = Volunteer FTE 1,960 Main Application 5/25/2016 10:34:40 AM P 15 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Main Application 5/25/2016 10:34:40 AM P Li of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Oversee volunteers and Oversee volunteers and Oversee volunteers and youth in community service youth in community service youth in community service worksites,teen court worksites,teen court worksites,teen court sessions, life skills groups, sessions, life skills groups, sessions, life skills groups, and mentoring and mentoring and mentoring Program Activity 1 relationships. relationships. relationships. At least 80%of youth will At least 80% of youth will At least 80%of youth will have no new charges have no new charges while have no new charges while Program Goal while in the program. in the program. in the program. Court counselors were Court counselors will be Court counselors will be contacted and data contacted and data will be contacted and data will be collected maintained in collected and maintained collected and maintained statewide database, NC in statewide database, NC in statewide database, NC Performance Measures Allies. Allies. Allies. Out of 210 program Out of 215 program Out of 230 program participants, 174 had no participants, 172 will have participants, 184 will have new charges while in the no new charges while in the no new charges while in the program. 83% result (above program. 80% result (above program. 80% result (above Program Results goal) goal) goal) Oversee volunteers and Oversee volunteers and Oversee volunteers and youth in community service youth in community service youth in community service worksites,teen court worksites,teen court worksites,teen court sessions, life skills groups, sessions, life skills groups, sessions, life skills groups, and mentoring and mentoring and mentoring Program Activity 2 relationships. relationships. relationships. At least 70%of youth will successfully complete At least 70% of youth will At least 70%of youth will their program successfully complete their successfully complete their Program Goal commitment. program commitment. program commitment. VFY staff tracks clients' VFY staff will track clients' VFY staff will track clients' progress through contact progress through contact progress through contact with clients,their families, with clients,their families, with clients,their families, their mentors,worksite their mentors,worksite their mentors,worksite supervisors, and court supervisors, and court supervisors, and court counselors and maintains counselors and maintains counselors and maintains individual records on each individual records on each individual records on each Performance Measures client. client. client. Out of 210 program Out of 215 program Out of 230 program participants, 182 participants, 172 participants, 161 successfullycompleted successfully completed successfully completed their program commitment. their program commitment. their program commitment. Program Results 87% result (above goal) 80% result(above goal) 70% result(above goal) DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 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. Volunteers for Youth is requesting funding as a single program that provides various services to at risk youth. Our agency budget is our program budget. Main Application 5/25/2016 10:34:40 AM 0 I:°' 20 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION Program Budget Agency/Program Volunteers for Youth,Inc. Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 34,565 $ 35,000 $ 38,000 9% Agency Generated Revenue (fees) $ - 0 Local Government Grants: Orange County $ - $ - $ 10,000 0 Town of Chapel Hill $ 8,000 $ 8,000 $ 10,000 25% Town of Carrboro $ 2,200 $ 2,200 $ 3,000 36% Other Local: $ 37,517 $ 37,517 $ 37,512 0% Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way $ 19,694 $ 15,281 $ 18,000 18% State Government $ 125,081 $ 125,081 $ 125,075 0% Federal Government 0 Other Grants: $ 11,000 $ 21,000 $ 16,061 -24% Other Grants: $ 1,500 $ 5,000 $ 5,000 0% Miscellaneous/Other Revenue 0 Rease list 3 largest Miscellanous sources: Total Agency Revenue $239 557 $249 079 $262 648 5% AGENCY EXPENSES Compensation $ 183,766 $ 179,489 $ 185,484 3% Rent&Utilities $ 27,532 $ 27,944 $ 28,364 2% Supplies&Equipment $ 11,588 $ 11,000 $ 10,300 -6% Travel&Training $ 1,979 $ 2,000 $ 2,150 8% Other Expenses: $ 36,164 $ 36,000 $ 36,350 1% Rease list 3 largest"Other Expenses": Total Agency Expenses $261,029 $256,433 $262,648 2% SURPLUS/(DEFICIT)FOR PERIOD: I $ (21,472)1 $ (7,354)1 $ - I 100%1 Main Application 5/25/2016 10:34:40 AM Pa 22 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Example Program: Credit Counseling Class Cost Elements Cost($) Quantity/Unit of Measure Subtotal ( ) Credit Counseling Teacher–in class $25 96 hours (8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours (4hrs/mth x 12 mths) $1,200 Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the project/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: Volunteers for Youth, Inc. Cost Elements Cost( ) Quantity/Unit of measure Subtotal( ) Mentor coordination $100/month 65 youth participants $78,000 Community service coordination $90/month 110 youth participants $118,800 Teen court coordination $100/month 55 youth participants $66,000 Total $262,000 C.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $261,029 $255,000 $262,648 Total # of Units 210 215 230 Cost Per Unit $1,243 $1,186 $1,142 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 5/25/2016 10:34:40 AM OI:° ag 23 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 t A - continued Provider's Outside Agency Application MAIN APPLICATION d.) Agency Operating Budget Please show all sources and amounts of funding for your entire current fiscal year. What is your agency's fiscal year? Example: July 1, 2016 through June 30, 2017. Volunteers for Youth's fiscal year is July 1, 2016 through June 30, 2017. Please see above for our agency operating budget. Volunteers for Youth's program budget is the same as our agency budget. 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 5/25/2016 10:34:40 AM P 241 of 25 DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Volunteers for Youth Funding Award: $7,500 Outline how the agency will spend Orange County's funding award. Expense Description Amount Programmatic Expenses—Community Services,Teen Court,Mentoring Opportunities 7,500 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. • Oversee volunteers and youth in community service worksites, teen court sessions, life skills groups, and mentoring relationships. 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 Youth will successfully complete their program commitment 70% Program participants 230 participants Program participants will have no new charges while in the program 184 participants Program participants will have successfully completed their program commitment 161 participants DocuSigned by: Certified by: acEe Title: Executive Director Date: 10/26/2016 (Provider's Signature) DocuSign Envelope ID: 3CD68914-055B-4274-9AF2-A50FD766FB76 VOLUN-3 OP ID:M4 AC-C]RifY DATE(MMlDDIYYYY) �---- CERTIFICATE OF LIABILITY INSURANCE 1E(MMiD016 I 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 1 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Anita Chick Senn Dunn•High Point PHON; 1400 Eastchester Drive,St 200 (AIC,NNo.Ext):336 878 7800 FAX NO 336 841 5319 High Point,NC 27265 ADDRESS:achick @senndunn.com Small Business Accounts-HP INSURER(S)AFFORDING COVERAGE I NAIL M I INSURER A:Accident Fund General Ins Co INSURED Volunteers for Youth, Inc. INSURER B:Alliance Member Services 10023 Susan Worley 205 Lloyd St. Suite 103 INSURER G Carrboro, NC 27510 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER ' POLICY EFF POLICY EXP I LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MM/DDIYYYY)j LIMITS B X COMMERCIAL GENERAL LIABILITY II EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 2016-20727 10101/2016 10101/2017 PREM PREMISES(Ea occurrence) $ 500,000 MED EXP{Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JERGT LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1000,000 (Ea accident) r B ANY AUTO 2016-20727 10/0112016 10/01/2017 BODILY INJURY(Per person) $ ALL OWNED ■ SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS © AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ . EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X S ATUTE ER H- AND EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE I WCV61168090103 10/0112016 10101/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? l NIA � (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 500,000 yI DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ORANGOV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD