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2016-617-E Finance - United Way of the Greater Triangle - Outside Agency Performance Agreement
DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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 United Way of the Greater Triangle, a not-for-profit corporation, located at 2400 Perimeter Park Drive, Suite 150,Morrisville,NC 27560 ("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 United Way of the Greater Triangle 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 16030. 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 $4,008. 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. (United Way of the Greater Triangle) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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. (United Way of the Greater Triangle) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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. (United Way of the Greater Triangle) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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 United Way of the Greater Triangle 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: (United Way of the Greater Triangle) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 County: Finance&Administrative Services Provider: United Way of the Greater Orange County Triangle Post Office Box 8181 2400 Perimeter Park Drive, Suite Hillsborough,NC 27278 150 Morrisville,NC 27560 16. E ntire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. r ku li Ohre Provider bliLGt. 11/1/2016 00BA4988BA6240B... Date For and on ,,,,aifi' Grange County Government 156lAkuit, tka"mt-IrStt 11/2/2016 0637994 B755E177... Bonnie Hammersley, County Manager Date (United Way of the Greater Triangle) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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: hatt 5holat. President & CEO 11/1/2016 Certified by: Title: Date: 60CA4986DA62408 (Provider's Signature) (United Way of the Greater Triangle) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency: United Way of the Greater Triangle Date/Time / 1 Complete Y/N Program(s): Orange County Food Council Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. X Applicant Contact Information b. XProject/Program Contact Information c. X Funding Requests Identified d. X Signed Application Cover Page 2. Agency a. X Agency's Years in operation 24 CFR 570.506, Information - b. X Agency's Purpose/Mission 570.507, 570.610; 24 c. X Agency's Types of Services Provided CFR Parts 84 or 85 d. X Agency's Experience e. X Other Pertinent Information 3. Program/ a. X Type of Application and Program Identified 24 CFR 570.200(a), Project b. X Summary of Program 570.201-570. 208, Information - c. X Description of Identified Need 507.503 (for each d. X Description of Population to be Served program/ project for e. X Activity Manager and Location Description which funding f. X Activity Implementation Timeline is requested) g. X Agency Collaboration h. X Describe Impact of Reduced/No Allocation i. X Other Pertinent Information j. X Complete Target Population/Beneficiary Chart k. X Complete Schedule of Positions I. X Signed Conflict of Interest Disclosure m. X Complete Work Statement DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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. X Program Budget Worksheet 570.602, 570.607(b), is requested) b. X Program Budget Detail 570.611 24 CFR c. X Cost Per Unit 570.502-570.504, d. X 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. NA Part A: CDBG & HOME Sections (as B. NA Part B: Construction/Rehab applicable) 6. Attachments a. X 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. X IRS Federal Form 990 c. X NC Solicitation License d. X IRS Federal Tax-Exemption Letter e. X Certificate of Insurance f. X List of Board of Directors 24 CFR Parts 84 or 85 g. X Articles of Incorporation/Bylaws 24 CFR 570.208, h. X Authorization to Request Funds 570.500(c), 570.611 i. X Authorized official designation j. NA Solid Waste Program Fee (SWPF) Verification Main Application 5/25/2016 10:30:45 AM 0'` 2 of 26 DocuSign Envelope ID: 9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: United Way of the Greater Triangle Applicant Organization's Physical Address: 2400 Perimeter Park Drive, Suite 150, Morrisville NC 27560 Applicant Organization's Mailing Address: 2400 Perimeter Park Drive, Suite 150 Morrisville, NC 27560 Applicant Organization's Web Address: www.unitedwaytriangle.org Executive Director: Mack Koonce Telephone Number: 919 463-5010 E-Mail: mkoonce@unitedwaytriangle.org DUNS Number: 00-398-6184 (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: Orange County Food Policy Council Project/Program Primary Contact and Title: Molly De Marco Telephone Number: 919-966-9563 E-Mail: molly_demarco@unc.edu c) Funding Request Identification Total Project/Program Cost: $32,060, Total Amount of Funds Requested: $32,060 Proposed Use of Funds Requested (2-3 Line Maximum): Facilitation and development of the Orange County Food Policy Council 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. xHuman Services: x Carrboro $8,015 x Chapel Hill $9,618 x Orange County$14,427 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: /frr Signature: E, yD Date 05 z0 Board Chairperso Date Main Application 1/21/2016 1:05:37 PM Page 3 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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): United Way of the Greater Triangle will be serving as the fiscal agent for the Orange County Food Policy Council through this application. All funding received will be used to support the development of the food policy council during the 2016-2017 year. a) Years in Operation, Date of Incorporation (Month/Year) 21 years as a combined United Way between Orange, Durham and Wake United Ways. Incorporated on August 15, 1995. b) Agency's Purpose/Mission United Way of the Greater Triangle recently completed its new strategic plan with a new purpose which is: Real solutions sparked by a community united for transformative change. United Way of the Greater Triangle is a catalyst for new approaches to solve social issues. We cannot let accolades for the Triangle mask the pervasiveness of families and children facing poverty, food insecurity, and educational disparity. Therefore, our work will create awareness of the issues, ignite a call-to-action around systems change, and unite the community around sustainable, scalable solutions. United Way of the Greater Triangle (UWGT) brings together the public, private, and social sector to address the most pressing needs of low-income households in North Carolina's Durham, Johnston, Orange, and Wake counties. UWGT responds to the immediate basic needs and, through collaborative partnerships that take a two-generational approach, works with the adults and children together to build household well-being, financial stability, food security, and educational success. For the first time this year, the majority of our funding (88%) went to: collaborative partnerships with a focus on a two-generational approach (working with children and their families together to improve the circumstances of low income households); increasing access to affordable health care; and building a food secure community. c) Types of Services the Agency Provides UWGT is a funder, convener, and catalyst for lasting social change in the region. As one of the largest philanthropic organizations in the Triangle, United Way makes a significant community investments annually into the four counties served. In 2015-16, $7.2 million will fund 24 collaborative partnerships using a two-generational approach (child and family interventions combined) and basic needs agencies. (We raise this money from 25,000 charitable donors who contribute through workplace campaigns at over 500 companies throughout the Triangle and major gifts.) We convene a broad sector of the community to activate social change. Thought leaders across the region serve through our Board of Directors, Community Impact Committee, Community Engagement Committee, Leaders United, and Tocqueville Society. United Way mobilizes volunteers across the region, with over 2,800 people on MLK Day of Service in 2015; an extensive volunteer online resource, Get Connected; and in-house projects for corporate partners to engage both human and intellectual capital. d) Agency's Experience with Similar Programs as the Funding Request As a result of United Way of the Greater Triangle's 2014 Social Innovation Challenge that focused on ending childhood hunger, UWGT reexamined its role in hunger relief. Traditional funding in the amount of $500,000 annually focused on food distribution and senior meals. However, with a $50,000 prize at stake, UWGT found 40 new ideas/organizations who were working on ending Main Application 5/25/2016 10:30:45 AM P 41 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION childhood hunger. UWGT realized that it was important to begin coordinating and mobilizing these new ideas. In the fall of 2014, UWGT convened its current partners and corporate volunteers, including volunteers from Bayer CropScience, Syngenta, Kellogg's, and John Deere. The volunteer group helped define priorities for future UWGT investments into hunger relief. Volunteers agreed that we must also make sure that we are providing hunger relief in the context of the entire food system. As a result, UWGT staff are participating in the three food policy councils emerging across Durham, Orange and Wake County. UWGT has provided initial funding to all three councils in the form of $12,000 from a coordinated Burt's Bees application. e) Other Pertinent Agency Information None Main Application 5/25/2016 10:30:45 AM P 5 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: United Way of the Greater Triangle: Orange County Food Council 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: x 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 Health and Nutrition X X X X X Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentoring Transportation Housing Other: Please specify 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? Since October 2014, a committed group of ten to fifteen Orange County stakeholders has convened monthly to develop the Orange County Food Council. The taskforce has formed the council with community input and county specific data collected by hosting two community forums and conducting a quantitative baseline food assessment. The result of these meetings, forums and data collection has resulted in a a Collaborative Agreement that includes a common purpose, values, and council structure, and a process for seating members of the council. The taskforce has created an application for potential members and will have a council seated by May 2016. Over the next Main Application 5/25/2016 10:30:45 AM P 6 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION year, the Orange County Food Council proposes to launch the council and further it's development through the following activities: hire a part-time coordinator; conduct the qualitative portion of the baseline community food assessment including working directly with the Orange County Family Success Alliance to assess food insecurity in their two zones; create a community food security action plan for Orange County; and hold two large community forums to continue to build collaborations and implement the action plan to strengthen the food system in Orange County. Our proposed activities will address one of the top six priority areas (Food), identified by Chapel Hill's Human Services Advisory Board, specifically by addressing the need for affordable food and access to healthy food in Orange County. Food affordability and access will be key features of the council's action plan and the taskforce has already engaged Orange County stakeholders addressing these issues including Farmer FoodShare and the InterFaith Council for Social Services. The food council activities are well aligned with the priorities currently coming out of the Orange County Health Department's Healthy Carolinians Community Health Assessment, which is occurring through June 2016. Physical activity and nutrition will be one of their three chosen areas of focus with a specific emphasis on building/increasing community gardens, working in the zones of the Family Success Alliance to pilot activities to assist with eliminating food insecurity, providing family education around healthy foods and cooking skills, partnering with local farms to increase access to low cost healthy foods, and working to improve school-provided nutrition for school kids. The food council will collaborate with the Healthy Carolinians Partnership on these activities. The food council's proposed activities will also support key goals in Carrboro. For example, the action plan will address the following policies in Carrboro's Vision 2020 document: Policy 5.6 to preserve farmland and Policy 1.31 to look for unmet need for human services. 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. We know that increased access to healthy fruits and vegetables is an effective strategy to address food insecurity; and, when this produce is grown locally, it also supports the local economy ("Research Based Support and Extension Outreach for Local Food Systems," Dunning, August 2013). For example, according to findings from the Robert Wood Johnson Foundation's Healthy Eating Research, consuming locally grown fruits and vegetables can both increase labor income and create new jobs locally. Bringing together community health and agriculture efforts as the Orange County Food Council proposes to do will help to mitigate poor health outcomes for Orange County citizens and address some of the challenges faced by local food producers and economic development in Orange County. The food system is complex as there are many players including producers, suppliers, and organizations and connecting consumers with local producers of healthy food is not always easy. Food councils are a solution to this problem by acting as connector to a cross-sector of individuals and organizations and by creating community partnerships that promote food access and addressing policy and programmatic barriers to a strong, local food system. Toward this end, a baseline community food assessment completed in November of 2015 analyzed all stages of the food system within Orange County, including food production, food processing and distribution, food consumption and food waste management. The purpose of the assessment was to form foundational knowledge for the food council to set priorities for action. The assessment gathered recent and historical data from established sources such as the United States Department of Agriculture and the American Community Survey, and combined it with stakeholder interviews to understand the strengths, weaknesses, threats, and opportunities facing the food system. The assessment described a strong farming culture in need of additional county support, a surprisingly high number of children needing food assistance at school, a burgeoning local food entrepreneurial environment, and a need for additional food waste management programming. More details can be found here: https://oranpecountyfoodcouncil.files.wordpress.com/2015/11/presentation orange- county-food®policy®council-2.pdf Main Application 5/25/2016 10:30:45 AM Pag of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. The Orange County Food Council will serve all residents of Orange County through it's work to bring together parties interested in building a strong, local food system that addresses food access, farmland preservation, and a local living economy. The council brings together representatives of town and county agencies including the Orange County Departments of Economic Development, Health, and Social Services, the Orange County Schools, the Chapel Hill Carrboro City Schools, elected officials, UNC representatives, representatives of non-profits, producers, and consumers. These diverse stakeholders and agencies already serve Orange County residents and by convening together there is greater potential to strengthen the reach and impact including to vulnerable populations and the underserved. The next phase of the food assessment and community forums will help to identify the audiences most in need and will inform the council's action plan. e) Who specifically will carry out the activities and in what location will they be carried out? With this funding, we will hire a part-time food council coordinator. The coordinator will work with the seated council of 12 to 15 members to carry out all activities. Up to five working groups are also being formed to carry out the activities from the action plan. The coordinator will be an employee of the United Way of the Triangle, our fiscal agent, but will be provided work space in Orange County with one of our partners (UNC or the InterFaith Council for example). 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. Frequency 1111111111111111 Jul-1fiAug--16 Sep-16 Oct-16 Nov-16i Dec-16 Jan-17 Felb-17 Mlar-17 Apr-17 IMay-17 Jun-17 Jul-17 Hirecoordinator Council meetings Monthly Engage 0000000000000000000 00 00 0000000000000111111 1 1114 11110 0 0 stakeholders community. forums 2 per year Qualitative baseline assessmem with E months, FSAassessment deveonotpmenG Development of 9 months, the action plan devellopment 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. The following organizations have provided staff members to plan and carry out the monthly task force meetings and two community forums including agenda design, outreach, and delivering presentations over the last 16 months: • Camp Chestnut Ridge • Carrboro Farmers' Market • Orange County Department of Health • Orange County Office of Economic Development • Orange County Schools • United Way of the Triangle • UNC-Chapel Hill Center for Healthy Promotion & Disease Prevention (also provides printing/copying, Spanish translation, website maintenance, grant-writing). The following is a partial list (due to space) of organizations and businesses who have sent Main Application 5/25/2016 10:30:45 AM ..l of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION representatives to meetings to provide input into the formation of the council and it's work: • InterFaith Council for Social Services • Farmer FoodShare • Orange County Office of Extension • Chapel Hill Farmers' Market • Vimala's Curryblossom Café • Seal the Seasons • Piedmont Food & Agriculture Processing Center • Orange County Solid Waste • Chapel Hill Carrboro City Schools h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. We have a number of avenues for funding should no or partial funding be awarded. We have collaborated with the United Way of the Triangle and two other food councils forming in the triangle (The Capital Area Food Council and the Durham Farm and Food Network) to seek funds through various mechanisms and will continue to do so. We have in-kind funds from UNC to provide Spanish translation, printing and copying, and limited staff time that has enabled the writing of this and other proposals and the scaffolding of the task force in developing the council. We are being provided technical assistance through the Carolina Farm Stewardship Association for facilitation that we may still be able to draw on. We have just been approved for a small grant from UNC's Food For All Academic Theme to partially support the qualitative portion of the food assessment. All of these potential resources and relationships will allow the council to continue to form, although at a slower pace. i) Include any other pertinent information. None Program/Project Information 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: X Persons ❑ Households ❑ Units Program: Orange County Food Council Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 66868 68038 69229 Female 73065 74344 75645 Total 139933 142382 144874 Of the females, how many are single- female Head of Households (Omit for Human Services) -- 5597 5695 Ethnicity Main Application 5/25/2016 10:30:45 AM P of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION African-American 15870 16148 16430 American Indian or Alaska Native 999 1016 1034 Asian 11107 11301 11499 Caucasian 108352 110248 112178 Native Hawaiian or other Pacific Islander -- -- -- Other 3605 3668 3732 Total 139933 142382 144874 Of the above, how many Hispanic/Latino -- 18431 20429 Of the above, how many non- Hispanic/Latino -- 128219 129334 Total -- 146650 149763 Age 0-5 years 7613 7746 7882 6-18 years 23644 24058 24479 19-50 years 65659 66808 67977 51-61 years 20166 20519 20878 62+ years 22402 22794 23193 Total 139933 142382 144874 Geographic Location Durham City Durham County Carrboro 21356 21730 Chapel Hill 59326 60364 Chapel Hill Public Housing Residents Orange County 145926 148479 Raleigh Wake County Total I -- -- - Income Level —See following chart (Omit for HS) < 30%Area Median Income 8757 8910 31-50% Area Median Income 5710 5810 51-80% Area Median Income 9266 9428 > 80%Area Median Income 30500 31034 Total -- 54288 55182 Special Needs (Omit for HS) Elderly(Over 62) 22402 22794 23193 Disabled (not elderly) 15459 15730 16005 Homeless 108 -- -- People with HIV/Aids 313 -- -- Total 38282 -- -- Main Application 5/25/2016 10:30:45 AM P 10 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION 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 10:30:45 AM 0:°' 6 1 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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 Facilitator/consultan t for Orange County Food Policy Council .50 100 $0.0 $0.0 $19200 .60 Not applicable 8 Volunteer Task Force Members .05 8 0 0 Not applicable 15 Volunteer Food Council Members .05 0 15 0 Not applicable 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 10:30:45 AM P 12 of 26 DocuSign Envelope ID: 9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO ❑ x a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? ❑ x b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? ❑ x c) Current beneficiaries of the project/program for which funds are requested? ❑ x 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: /4/ / !`" 4 417/C Exe Ivey it cto�r 4•.: Date Signature: t 1 Board Chairperson Date Main Application 1/21/2016 12:57:09 PM cl DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Actual Estimated Projected 2014-15 2015-16 2016-17 Program Activity 1 Form task force Hire coordinator Form a task force of a diverse set of food system stakeholders to Program Goal develop the Orange Hire a food council County Food Council by coordinator by January 1, 2015 that will September 30, 2016. meet monthly. Who is on the task force? Performance Measures What food system sectors do they represent? Do they meet regularly? Coordinator hired. A task force of 8 members was created representing economic development, production, food access, Program Results public health, institutions serving meals, child nutrition, and food retail. Monthly meetings to develop the council are on-going. Main Application 5/25/2016 10:30:45 AM P 1 ,1 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Complete Phase II (qualitative) baseline Program Activity 2 community food assessment + Family Success Alliance Secure seed funding component Complete the baseline community food assessment including the component on food Program Goal To secure feed funding insecurity within the to facilitate the work of FSA zones and submit a the task force to develop report to the council by a food council. October 31, 2016. Amount of funds Number of interviews secured. conducted. Performance Measures Sources of in-kind Report submitted. support Secured $4000 in funding from the Burt's Bees Foundation; $9000 from Orange County; $750 from UNC's Food For All theme. Obtained in-kind staff support from UNC-CH Program Results (3 staff), Community Food Strategies (1 staff), Orange County (Extension (1), Public Health (2), Econ. Development (1), Schools (1)), Camp Chestnut Ridge (1), Carrboro Farmers' Market (1). Creation of a Collaborative Program Activity 3 Agreement (including a purpose and council Engage diverse structure), and council stakeholders through member application workgroups Main Application 5/25/2016 10:30:45 AM 0'` 15 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Recruit up to 10 members for up to 5 workgroups who are diverse in age, gender, Program Goal race, socio- To develop a demographic status, Collaborative and geographical Agreement and a residence by November membership application. 30, 2016. Number of workgroup Collaborative members recruited. Agreement created. Performance Measures Number of workgroups Membership application formed. created and disseminated. Diversity of workgroups. A Collaborative Agreement was created (see attachment) A membership Program Results application was created in both English and Spanish and is currently being widely disseminated (see attachment). Program Activity 4 Hold two community forums Adopt an action plan Develop a comprehensive food Hold two countywide systems action plan that Program Goal community forums to presents priorities for solicit input and the council and feedback on the creation workgroups by March of the food council. 31, 2016. Action plan adopted. Performance Measures Forums held. Number and nature of Number of attendees. priorities set. Main Application 5/25/2016 10:30:45 AM 0'` 16 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Two community forums were held, one in September 2014 and one in November 2016. 100 people attended the forum in Sept. 2014 Program Results 65 people attended the forum in Nov. 2015 with 20 people signing up to actively participant in the work of the council (by applying to be on the council or by serving on a workgroup). Complete a Activity 5 quantitative baseline community food Hold two community assessment forums Hold one community forum by November 30, 2016 and one by May 31, 2017 that engage at Program Goal Complete a quantitative least 100 Orange baseline community County residents across food assessment using a diverse range of existing data by the sectors and second community demographics. forum. Sign-in sheets that query sectors and Performance Measures Presentation of findings demographics of made at the second attendees will be used community forum. for both events. A community food assessment was carried out by two UNC graduate students (one in Public Health and one in City & Regional Program Results Planning). The results of the baseline community food assessment where presented at the community forum on November 5, 2015. Main Application 5/25/2016 10:30:45 AM P Li of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Traditional data collection tools (pre/post tests to asses change in knowledge, attitudes, and behaviors) will not be used as we are not a service providing entity. We will use sign-in sheets to collect data on attendance and demographics of participants. The qualitative baseline community food assessment will use an interview guide that will be developed by the student team should funding be secured. They may also use the standard USDA Household Food Security Survey (http://www.ers.usda.cov/topics/food-nutrition-assistance/food-security-in-the-us/survey- tools.aspx#household, see attachment) to measure food insecurity in the two FSA zones, in collaboration with the Orange County Healthy Carolinians Partnership. Main Application 5/25/2016 10:30:45 AM .. of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 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. Main Application 5/25/2016 10:30:45 AM 0':°' , 1 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Agency/Prograrr Orange County Food Policy Council Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations 0 Agency Generated Revenue (fees) 0 Local Government Grants: Orange County $ 9,000 $ 14,427 60% Town of Chapel Hill $ 9,618 0 Town of Carrboro $ 8,015 0 Other Local: 0 Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way $ 4,000 -100% State Government 0 Federal Government 0 Other Grants: 0 Other Grants: 0 Miscellaneous/Other Revenue 0 Flease list 3 largest Miscellanous sources: Total Agency Revenue $ - $ 13 000 $ 32 060 147% AGENCY EXPENSES Compensation $ 12,500 $ 20,000 60% Rent&Utilities 0 Supplies&Equipment $ 500 $ 700 40% Travel&Training $ 8,800 0 Other Expenses: $ 2,560 0 Flease list 3 largest"Other Expenses": Access related services $ - $ 1,360 Communication - $ 1,200 $ Total Agency Expenses $ - $ 13,000 $ 32,060 147% SURPLUS/(DEFICIT)FOR PERIOD: $ I $ I $ I OI Main Application 5/25/2016 10:30:45 AM P ; 20 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Main Application 5/25/2016 10:30:45 AM .. 2 1 o of 2 6 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Program Budget Detail Program: Orange County Food Council Cost Measure Part-time Food Council Coordinator $20 20 hours/week x 4 $19,200 (Coordinator will lead the council in setting meeting weeks x 12 months agendas, facilitating meetings along with the chair, = 960 hours guiding the work of the baseline community food assessment and creation of the action plan, and coordinating the logistics for the two community forums.) Two Community Forums (We will hold two large $350 Costs include $200 $700 community forums to engage Orange County for refreshments residents in developing the actions of the council, and $150 meeting recruit participants for the working groups, and supplies including provide opportunities for sharing to facilitate flipcharts, easels, collaboration.) nametags: $350 x 2 = $700 Conduct the qualitative portion of the baseline $20 10 hours/week for $800 community food assessment including connecting 4 weeks =40 with the Orange County Family Success Alliance hours and working directly in the two zones to assess food insecurity via stipends to graduate students. Provision of child care to facilitate wide $30 $30 for on-site $420 participation in council meetings, community forums, child care per or workgroup meetings as needed community forum and council meeting (14 total instances) Training for council members on democratic $2000 for governance $2000 + $5000 $7000 governance and consent-based decision-making training provided by and racial equity the UNC School of Government, $5000 for Racial Equity Training provided by Dismantling Racism Works or the Racial Equity Institute Translation services provided by CHICLE $55 Burmese/Karen $440 live translation services provided by CHICLE required for two meetings at the rate of$55 an hour for minimum of 2 hours. $55/hour x 2 hours Main Application 5/25/2016 10:30:45 AM 0'` 22 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION x 2 meetings = $220 x 2 (Burmese and Karen) *Note, we have in- kind funding from UNC to cover Spanish translation. Interpretation services provided by CHICLE $50 Document $500 translation for up to 5 pages of documents, $50 per page x 5= $250 x 2 (Burmese and Karen) *Note, we have in- kind funding from UNC to cover Spanish interpretation. Communication/marketing including graphic $100 $100/month x 12 $1200 design to produce a logo and reproduction of copies, months printing of meeting materials Transportation to statewide events such as county $150 $150/month x 12 $1800 food council convenings and to council meetings to months facilitate wide participation Total: $32,060 b.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $32,060 Total # of Units 140,352 (population of Orange County in 2013) Cost Per Unit 22.8 cents 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 10:30:45 AM 0'` 23 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION c.) 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. 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 10:30:45 AM P 241 of 26 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 t A - continued Provider's Outside Agency Application MAIN APPLICATION Section VI.Financial Data Operating Budget for Entire Agency AGENCY NAME: United Way of the Greater Triangle Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 8,894,000 $ 9,325,000 $ 9,325,000 0% Agency Generated Revenue(fees) $ 436,000 $ 446,000 $ 446,000 0% Local Government Grants: Orange County 0 Town of Chapel Hill 0 Town of Carrboro 0 Other Local: 0 Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way 0 State Government 0 Federal Government $ 704,000 $ 450,000 $ 450,000 0% Other Grants:Premium Help $ 208,000 $ 695,000 $ 695,000 0% Other Grants:Communit Im.act $ 62,000 $ 405,000 $ 405,000 0% Miscellaneous/Other Revenue $ 100,000 $ 40,000 $ 40,000 0% Rease list 3 largest Miscellanous sources: Uncollectiblels $ (407,000.00) $ (356,000.00) $ (356,000.00) Direc Service $ 178,000.00 $ 187,000.00 $ 187,000.00 Events $ 129,000.00 $ 129,000.00 $ 129,000.00 Total Agency Revenue $ 10 204 000 $ 11 281 000 $ 11 281 000 0% AGENCY EXPENSES Compensation $ 2,897,212 $ 2,940,304 $ 2,940,304 0% Rent&Utilities $ 377,771 $ 396,695 $ 396,695 0% Supplies&Equipment $ 54,832 $ 55,148 $ 55,148 0% Travel&Training $ 98,816 $ 76,720 $ 76,720 0% Other Expenses: $ 6,762,749 $ 8,412,669 $ 8,412,669 0% Rease list 3 largest"Other Expenses": Commmunity Investments $ - $ 5,407,000 $ 6,695,000 $ 6,695,000 Grant Expenses $ - $ 1,004,000 $ 750,000 $ 750,000 Contracts and Consultation $ - $ 219,314 $ 193,197 $ 193,197 Total Agency Expenses $ 10,191,380 $ 11,881,536 $ 11,881,536 0% SURPLUS/(DEFICIT)FOR PERIOD: $ 12,620 $ 600,536 $ 600,536 0% Main Application 5/25/2016 10:30:45 AM .. 2 5 o of 2 6 DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: United Way of the Greater Triangle Funding Award: $16,030 Outline how the agency will spend Orange County's funding award. Expense Description Amount Facilitation and Development of the Orange County Food Policy Council 16,030 Programmatic Supplies Personnel Salaries 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. • Hire a Food Council coordinator to assist in the development and faciliation of the Food Council • Baseline Phase II community Food Assessment+Family Success Alliance Component • Engage diverse stakeholders through work groups • Adopt an action plan • Hold Communtiy Forums 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 Completed Phase II assessment 100% Recruit members for workgroups who are diverse in age, gender,race, socio-demographic 10 members/ status and geographical residence 5workgroups Adoption of action plan 100% Community Forum to engage Orange County Residents 100 residents DocuSigned by: 'a.(t 5bblat. President & CEO 11/1/2016 Certified by: Title: Date: Se6A49888AE2-406... (Provider's Signature) DocuSign Envelope ID:9859FC6D-3EEB-4C7D-9891-BE11A53D9413 l ® DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE L....../. 4/14/2016 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. 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