Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2016-618-E Finance - Habitat for Humanity, Orange County, NC, Inc. - Outside Agency Performance Agreement
DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E 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 Habitat for Humanity, Orange County, NC, Inc., a not-for-profit corporation, located at 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 ("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 Habitat for Humanity, Orange County,NC, Inc. 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 25000. 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 $6,250. 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. (Habitat for Humaiii1v, Orange Coiaw,NC,bic.) Orange C ount1�Outside Ageiic.v Performance Agreement Remised 812016 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31; January 1 —March 31 and April 1 - June 30. Reports are due on January 13,April 14, and July 14 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default"), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or 11. 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 In. 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 (Habitat for Huinaidty, Orange County,NC bic) Orange C ouwY Outside AgeneY Performance Agreement Reis. 8116 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof, in. 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 (Habitat for Huinaidty, Orange County,NC bic) Orange C ouwY Outside AgeneY Performance Agreement Reis. 8116 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 13.15 per hour. To the extent possible, Orange County recommends that Habitat for Humanity, Orange County,NC, Inc. 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 (Habitat for Huinaidty, Orange County,NC bic) Orange C ouwY Outside AgeneY Performance Agreement Reis. 8116 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance &Administrative Services Provider: Habitat for Humanity, Orange Orange County County,NC, Inc. Post Office Box 8181 88 Vilcom Center Drive, Suite Hillsborough,NC 27278 L 110 Chapel Hill,NC 27514 16. E ntire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on beh l SuAiie Provider Coulne USGIdiL v I 10/27/2016 ' 6887D8CO27AA4FC Date For and on ge County Government 7 I 11/2/2016 0637994B755E477 Bonnie Hammersley, County Manager Date (Habitat for Huinaidty, Orange County,NC bic) Orange C ouiaY Outside Agency'Performance Agreement Reis. 8116 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E 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. DocuSig ned by: �USGIdiL Executive Director 10/27/2016 Certified by: Title: Date: (Provider's Signature) (Habitat for Huinaidty, Orange County,NC bic) Orange C ouwY Outside Agency'Performance Agreement Reis. 8116 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E =Xhibit A Provider's Outside Agency Application MAIN APPLICATION FOR OFFICE USE ONLY APPLICATION SUBMITTAL CHECKLIST Received By Agency: Habitat for Humanity of Orange County Date/Time / Program(s): A Brush with Kindness Complete Y/ N 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 . 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 . Program/ a. ® Type of Application and Program Identified 24 CFR 570.200(a), Project b. ® Summary of Program 570.201-570. 208, Information (for c. ® Description of Identified Need 507.503 each program/ d. ® Description of Population to be Served 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 . Financial (for Program Budget Worksheet and Detail should 24 CFR 570.200(a), each program/ reflect expenses for the entire program and ALL 570.201-570. 208, project for sources of funding. 507.503 which funding 24 CFR 570.506, is requested) a. ® Program Budget Worksheet 570.507, 570.601, b. ® Program Budget Detail 570.602, 570.607(b), c. ® Cost Per Unit 570.611 d. ® Agency Operating Budget Worksheet 24 CFR 570.502-570.504, 570.506, 570.507, 570.610;24 CFR Parts 84 or 85, and OMB Circulars A- 87 or A-122, Treasury Circular 1075 . Supplemental A.❑ Part A: CDBG & HOME Sections (as B.❑ Part B: Construction/Rehab applicable) Main Application 1/25/2016 12:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION 6. Attachments a. ® Audit: Organizations receiving$300,000 or OMB Circular A-133 more 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 24 CFR Parts 84 or f. ® List of Board of Directors 85 g. ® Articles of Incorporation/Bylaws 24 CFR 570.208, h. ® Authorization to Request Funds 570.500(c), 570.611 i. ® Authorized official designation ® Solid Waste Program Fee (SWPF) Verification 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Habitat for Humanity of Orange County Applicant Organization's Physical Address: 88 Vilcom Center Dr. #L110, Chapel Hill, NC 27514 Applicant Organization's Mailing Address: 88 Vilcom Center Dr. #L110, Chapel Hill, NC 27514 Applicant Organization's Web Address: www.orangehabitat.org Executive Director: Susan Levy Telephone Number: (919) 932-7077 ext. 211 E-Mail: slevy0oranaehabitat.org DUNS Number: 095849568 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) Proiect/Program Contact Information Project/Program Name: A Brush with Kindness Project/Program Primary Contact and Title: Adwoa Asare, Community Development Manager Telephone Number: (919) 932-7077 ext. 233 E-Mail: aasare(@orangehabitat.org c) Funding Request Identification Total Project/Program Cost: $146,133 Total Amount of Funds Requested: $50,000 Proposed Use of Funds Requested (2-3 Line Maximum): Habitat is seeking $25,000 to assist with funding its A Brush with Kindness program. Habitat will serve 15-18 low and very low- income homeowners in Orange County who are in need of exterior repairs on their homes. Main Application 1/25/201 6 1 2:11 :11 PM :' "I .7 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source. *The Participating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. ❑ CDBG Non-Construction (CH) $ ❑ Grant ❑ Loan ® CDBG Construction (CH) $25,000 ❑ Grant ❑ Loan ❑ HOME CHDO (OC) $ ❑ Grant ❑ Loan ❑ HOME Other (OC) $ ❑ Grant ❑ Loan ® Human Services: ❑ Carrboro $ ❑ Chapel Hill $ ❑ Orange County $25,000 d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: 1/22/2016 Executive Director Date Signature: 1/22/2016 and Chairperson Date 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) Habitat was incorporated on April 13, 1984. It has been in operation for 31 years. b) Agency's Purpose/Mission Habitat for Humanity of Orange County changes lives by bringing together God's people and resources to help families in need build and own quality affordable homes in safe and supportive communities. Habitat's vision is an Orange County where everyone has a decent place to live. c) Types of Services the Agency Provides Habitat for Humanity of Orange County is a local nonprofit organization affiliated with Habitat for Humanity International (HFHI). Habitat provides affordable homeownership opportunities for families who live and/or work in Orange County, earn between 30% and 60% of the area median income (AMI), and live in substandard housing. Habitat also provides exterior and critical home repairs to low-wealth homeowners through its A Brush with Kindness program, launched in 2010. Habitat is committed to strengthening the neighborhoods where it builds, not only by building or repairing affordable homes, but also by developing relationships and supporting other neighborhood improvement initiatives identified by neighborhood residents. Main Application 1/25/201 6 1 2:11 :11 PM I p (;, a p 11 "I "", DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION Habitat was incorporated in 1984, and completed its first home in 1987. Since that first home, Habitat has built more than 250 affordable homes throughout the County. Through its New Home Construction program, Habitat uses donations and volunteer labor to construct energy- efficient, green-certified, high-quality homes, and then sells those homes to qualifying families. The buyers receive an affordable mortgage, which they pay back over 30 years. Mortgage payments are recycled to build future homes. Homebuyers are required to contribute 325 hours of sweat equity toward the construction of their own and other Habitat homes. Habitat retains the right of first refusal to repurchase a Habitat home if the owner wishes to sell. Habitat uses deferred-payment second mortgages and equity sharing to ensure that the community's investment of funds and labor will continue to benefit low-income families if the original buyer sells the home. A Brush with Kindness (ABWK) is a Habitat program which addresses the ongoing need for exterior repairs and beautification in the communities where Habitat builds. ABWK is an important aspect of Habitat's affordable housing programs because it offers low-cost assistance to homeowners living in deteriorating or unsafe homes, improving their quality of life and the quality of life of all of the residents in the neighborhood. Habitat has completed 63 ABWK projects since launching the program in FY 2009-10. In carrying out its affordable housing and community strengthening activities, Habitat seeks to educate and empower its homebuyers through a series of relevant workshops and one-on-one trainings. Habitat also strives to educate the broader community about the crisis in affordable housing by introducing and involving hundreds of new volunteers from all walks of life into its work each year. Habitat promotes the positive value of diversity by uniting people of varied economic, religious, social, and racial backgrounds to work together toward a common goal— building and repairing decent homes in partnership with families in need. d) Agency's Experience with Similar Programs as the Funding Request Habitat is requesting funding for its A Brush with Kindness exterior home repair program. Habitat first implemented this program in 2010, and has since successfully completed 63 repair projects. Habitat has received government funding for this program in the past, and has proven its ability to successfully complete and report the agreed upon work. e) Other Pertinent Agency Information n/a 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Habitat for Humanity of Orange County, A Brush with Kindness 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: Main Application 1/25/201 6 1 2:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION ® 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: Disabled (not Public Housing Program Category Youth Adult Elderly elderly) Neighborhoods/ Residents Education Health and Nutrition Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentorin Transportation Housing X X X Other: Please specify Program/Project Descri tp ion (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? Habitat will continue to address the county's priority need for affordable homeownership for low and very low-income renters through its new home construction program. However, Habitat's experience working with residents in the communities where it builds new homes has helped to identify an underserved need among low-income homeowners, especially those who are elderly or disabled. Habitat has had direct experience with low-income families in Orange County who are struggling to maintain the exterior of their homes, and who need modifications to their homes so that they can continue to live in and enjoy them. Rot, peeling paint, sagging gutters, broken doors, unsafe porches, yard waste, and lack of accessibility impact the safety, livability, and value of individual homes in neighborhoods like Fairview, Rogers Road, Northside, and Pine Knolls, as well as in more rural areas of the county like Efland. When combined with New Home Construction, these repairs allow Habitat to impact nearly 30 new families each year. 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. Habitat launched A Brush with Kindness (ABWK) as a pilot program in 2009 with two projects in Hillsborough. When Habitat formalized the program in 2010, it also created an informal Main Application 1/25/201 6 1 2:11 :11 PM I "°7 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION Advisory Committee, inviting other repair program providers to meet to share information and referrals for repairs within the county. The services Habitat provides through ABWK complement those provided by JOCCA, Rebuilding Together of the Triangle, and Orange County's Urgent Repair and Rehab programs. All of these agencies provide referrals to Habitat's ABWK program, and Habitat refers clients to them. To date, Habitat has received a total of 169 applications. In 2015 over 85% of the Orange County residents who applied to the program were elderly and/or disabled. Overall, 30% of applicants come through agency referrals, and the remaining 70% come through targeted neighborhood marketing and word of mouth. When Habitat expanded the ABWK program to the Rogers Road community, it utilized Success Measures, a data collection tool developed by NeighborWorks, to conduct a parcel observation survey of the Rogers Road community. Through this survey, Habitat identified 20 homes in need of minor exterior repairs such as yard clean up, siding repair, deck repair/replacement, handrail additions, gutter maintenance, and painting. Habitat developed a strategy to market the ABWK program specifically to these households, and to encourage participation among those who qualify. Of those 20 homes, Habitat has received 16 applications and completed 15 ABWK projects to date. In 2012, Habitat was asked by the Town of Chapel Hill to implement ABWK in the Northside/Pine Knolls neighborhoods on a pilot basis. Since that time, Habitat has completed a total of 23 repairs in both neighborhoods. This is part of an ongoing retention strategy to help existing homeowners stay in their homes, while also increasing the attractiveness of the neighborhood. Habitat will continue to market the program and complete exterior repair projects in both of these neighborhoods in FY 2016-17. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. ABWK recipients must own their home and be current on their mortgage, homeowners insurance, and property taxes. Recipients must earn 80% or less of the area median income. In 2015, over 98% of the Orange County residents who participated in the program were elderly and/or disabled. The average recipient income was less than 40% area median income (this includes both County and Town residents). Habitat does not consider age, race, gender, religion, or any other protected status when evaluating applications. Habitat receives referrals from and partners with local senior support organizations and other low-income service providers. e) Who specifically will carry out the activities and in what location will they be carried out? The activities of Habitat's ABWK program will primarily be carried out by Adwoa Asare, Community Development Manager, and Tate Hamlet, ABWK Construction Supervisor. Ms. Asare is responsible for marketing the program, processing program applications, meeting with homeowners, and recruiting volunteers, while Mr. Hamlet is responsible for assessing the scope of the project, purchasing supplies, and supervising volunteer work. The program activities will primarily be carried out at the Habitat office and on the project site, which could be the home of any qualifying family in Orange County. Main Application 1 25 2016 12:11 :11 II " ,p p..q �� �:!' l7 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION 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. ABWK is an ongoing program. Projects are completed throughout the year. At all times there will be projects at different stages in the process, such as application, approval, assessment of repairs needed, volunteer and funder recruitment, work days, and evaluation. There is an abundant need for home repairs in Orange County. Habitat repairs 1.5 homes on average each month. Construction work typically occurs on weekends with volunteers, while staff work throughout the week on program administration. The average family spends seven months as part of the ABWK program from the time they apply, to when the repairs are completed, until they make their final payment on the repairs and sign off that they are satisfied with the work done. 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. • To strengthen ABWK, Habitat created and implemented the ABWK Advisory Committee. Individuals from JOCCA, the Town of Chapel Hill Planning Department, the Orange County Housing and Community Development Department, faith congregations, and Rebuilding Together of the Triangle meet periodically to gain a greater understanding of the scope of programs and services offered by each, and to develop a more effective system of client referrals. • Habitat staff and volunteers work with established leaders in the neighborhoods they serve, and also strive to identify and nurture new leaders, providing support and training as needed. Habitat's commitment to strengthening neighborhoods includes a variety of trainings and workshops that promote leadership specifically for the youth and adults who reside there. Collaborative efforts that began several years ago with both the Rogers-Eubanks Neighborhood Association (RENA) and the Fairview Community Watch enhance the overall quality of life in each neighborhood, and also serve to spread the word about ABWK and ensure that residents who could benefit from the program are identified and referred. Collaborative efforts in the Rogers Road community have engaged representatives from the Department on Aging, Piedmont Health Services, St. Paul AME Church, RENA, Justice United, Habitat's Youth United program, Blue Ribbon Mentor Advocates, and the UNC Habitat Campus Chapter. • The local faith and business communities continue to provide funds and volunteer labor to support both ABWK and Habitat's new home construction program. • When Habitat expanded ABWK to the Northside/Pine Knolls neighborhoods, the Jackson Center was instrumental in introducing Habitat to key residents of that community, helping to market the program, and identifying potentially qualified families. In addition, Habitat's Executive Director participated as a member of a resource group assembled by Self-Help Credit Union and the Jackson Center, which worked with residents to develop a variety of strategies to address complex issues affecting their neighborhood. • Habitat coordinates with the Blue Ribbon Youth Leadership Institute to provide volunteer opportunities for high school students who can apply for a scholarship to assist with higher Main Application 1/25/201 6 1 2:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION education if they complete 30 hours of service with Habitat, primarily on ABWK projects. The funding for the scholarship program is provided by an anonymous donor. • Habitat is a member of the Orange County Affordable Housing Coalition, a group of housing providers and advocates who are working together to increase resources for the full range of housing needs in Orange County, including home repair. Habitat's Executive Director currently chairs the Coalition. h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. We arrived at this project design through a comprehensive strategic planning process and by identifying the critical actions necessary to achieve our mission and vision. The activities described in this project are inherently sustainable because they are aligned with our core values and are central to what we do. Funding for this project will enhance the quality and quantity of the services we provide. Our commitment to communities has been that we will partner with individuals, associations, government, and funders to carry out our mission to the best of our ability and provide safe, decent, affordable housing in Orange County to as many people as possible. If requested funding is not awarded at all, or if a reduced allocation is recommended, the core activities described in this proposal will still be carried out but to a lesser degree. i) Include any other pertinent information. n/a Program/Protect Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff 1) Disclosure of Potential Conflicts of Interested must be signed m) Complete the Work Statement Chart to describe the work to be performed, and be sure to attach copies of all data collection tools that will be used to verify achievement of program goals and objectives. Describe who will be responsible for monitoring progress. Information to Complete j) Target Population Complete the following tables to the best of your ability. Show numbers of participants and percentages, as applicable, in each category. Please indicate whether this project/program will serve: ❑ Persons ❑ Households ❑ Units Program: A Brush with Kindness Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 12 15 15 Female 12 21 21 Total 24 36 36 Main Application 1/25/201 6 1 2:11 :11 PM I p (;, µ B �: II "I .7 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION Of the females, how many are single-female Head of Households (Omit for Human Services) 8 9 9 Ethnicity African-American 23 32 33 American Indian or Alaska Native 0 0 0 Asian 0 0 0 Caucasian 1 2 1 Native Hawaiian or other Pacific Islander 0 0 0 Other 0 2 2 Total 24 36 36 Of the above, how many Hispanic/Latino 0 0 0 Of the above, how many non-Hispanic/Latino 24 36 36 Total 24 36 36 Age 0-5 years 0 0 0 6-18 years 2 1 1 19-50 years 5 4 2 51-61 years 2 2 2 62+ years 15 29 31 Total 24 36 36 Geographic Location Durham City 0 0 0 Durham County 0 0 0 Carrboro 0 4 1 Chapel Hill 15 20 29 Chapel Hill Public Housing Residents 0 0 0 Orange County 9 12 6 Raleigh 0 0 0 Wake County 0 0 0 Total 24 36 36 Income Level —See following chart (Omit for HS) < 30% Area Median Income 5 18 10 31-50%Area Median Income 11 10 14 51-80%Area Median Income 8 8 12 > 80% Area Median Income 0 0 0 Total 24 36 36 Special Needs (Omit for HS) Elderly (Over 62) 15 17 20 Disabled (not elderly) 2 4 1 Homeless 0 0 0 People with HIV/Aids n/a n/a n/a Main Application 1/25/201 6 1 2:11 :11 PM I p (;, ,: a p II "I .7 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION Total 1 17 21 21 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% AM $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 50% AM1 $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 80% AM1 $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 100% AMI $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115% AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www.huduser.org/portal/datasets/iI/iI15/FY2015 IL nc.pdf Main Application 1/25/201 6 1 2:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E Exhibit A - continued Provider's Outside Agency Application MAIN APPLICATION k.) Schedule of Positions Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). Position Titles (* = Position Vacant) FTE** % Program Actual Estimated Projected % Total If provided, indicate: (R) Staff+ 2014-15 2015-16 2016-17 Budget Retirement Plan, (H) Health Plan Executive Director 1.0 0% $83,512 $86,017 $88,598 2.9% R, H Development Director 1.0 2% $75,000 $77,438 $79,761 2.6% R, H Construction Director 1.0 5% $64,896 $67,005 $69,015 2.3% R, H Finance Director 0.8 1% $54,047 $56,925 $56,650 1.9% R, H Family Services Director 1.0 13% $54,786 $56,567 $58,264 1.9% R, H Construction Project Manager 1.0 4% $57,115 $53,300 $53,560 1.8% R, H Director of Leadership Giving 1.0 0% $50,000 $51,625 $53,174 1.8% R, H Associate Director of Administration 0.9 0% $45,487 $47,347 $47,347 1.6% R, H Community Development Manager 1.0 95% $41,600 $43,056 $44,348 1.5% R, H Homeowner Support Manager 1.0 5% $0 $32,308 $43,260 1.4% R, H Partnership Manager 1.0 4% $40,743 $42,435 $43,708 1.4% R, H Construction Site Supervisor (3) 3.0 0% $115,467 $122,578 $126,255 4.2% R, H Mortgage Program Manager* 0.0 0% $32,580 $0 $0 0.0% R, H Database and Grant Manager 1.0 0% $29,539 $30,417 $31,330 1.0% R, H Communications Manager 1.0 1% $0 $31,625 $36,823 1.2% R, H Volunteer and Youth Programs Coordinator 1.0 1% $26,749 $27,077 $32,960 1.1% R, H ABWK/Critical Repair Supervisor 0.6 100% $22,452 $22,500 $23,175 0.8% R, H Volunteer 10.6 9% $0 $0 $0 0.0% • 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/1,960 = Volunteer FTE Main Application 1/25/2016 12:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E 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 ❑ ® a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? ❑ ® b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? ❑ ® c) Current beneficiaries of the project/program for which funds are requested? ❑ ❑ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the project ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: 1/22/2016 Executive Director Date Signature: f 1/22/2016 and Chairperson Date 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 1/25/201 6 1 2:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Program Activity 1 A Brush with Kindness A Brush with Kindness A Brush with Kindness Provide exterior home Provide exterior home Provide exterior home repair/landscaping to repair/landscaping to repair/landscaping to Program Goal 15-18 low and 15-18 low and 15-18 low and moderate-income moderate-income moderate-income homeowners in homeowners in homeowners in Orange County. Orange County. Orange County. By June 2015, By June 2016, By June 2017, complete 15-18 complete 15-18 complete 15-18 Performance exterior repair exterior repair exterior repair Measures projects for low and projects for low and projects for low and moderate-income moderate-income moderate-income homeowners in homeowners in homeowners in Orange County. l0range County. Orange County. Program Results 115 repairs completed 117 repairs completed 18 repairs completed Adwoa Asare, Community Development Manager, will be responsible for monitoring progress. Achievement of goals will be verified by counting the number of completed repairs. A repair is officially completed when the homeowner signs a document certifying that the agreed-upon work has been accomplished to their satisfaction. 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 1/25/201 6 1 2:11 :11 PM 000wSWn Envelope ID:A05Er081'o 3roCrE [ /\ - continued Provider's Outside Agency Application MAIN APPLICATION Program Budget P|aaoa complete a Program Budget Excel Form for each requested program. The Program Budget should reflect only figures and amounts associated with the Program(o) for which you are seeking funding and not the total agency budget. If the pmgranfo finances experienced significant changes that you would like to axp|ain, please use the space ba|ovx Agency/Program:Habitat for Humanity of Orange County,A Brush with Kindness Actual Estimated Projected Percent AGENCY REVENUE Private Donations Agency Generated Revenue (feeo) Local Government Grants: wwwiiiiw Orange County Town of Chapel Hill Town ofCanboro Other Loca|:{%}BG Funds Other Local:/UHDR1Funds Other Loca|:ln/a U more than 3 sources, please provide aseparate list. Nun'Luoo| Government Grants Triangle United Way 0$ - 0$ 10$ 1"0 State Government Federal Government Other Grants:ln/& Other Grants:ln/& K8iooeUoneouoNOtherRevenue Please list 3 largest MiscaUanou000urcao: n/a Total Agency Revenue AGENCY EXPENSES Compensation Rent & Utilities Supplies& Equipment Travel &Troinin0 Other Expenses: Please list 3 largest"Other Expenses": Cost of Construction: $27,000 n/a Total Agency Expenses GURPLUG/(DEF|C|T) FOR PERIOD: Main Application 1/25/2016 12:11 :11 PM 7 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Example Program: Credit Counseling Class Cost Elements Cost ($) Quantity/Unit of Measure Subtotal ($) Credit Counseling Teacher—in 96 hours (8 hrs/mth x 12 class $25 months) $2,400 Credit Counseling Teacher— class rep $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 $3,000 reports Total $9,000 Complete the table below for the project/proaram for which you are reauestina funds. Attach additional rows/paaes, as needed. Program: A Brush with Kindness Cost Elements Cost ($) Quantity/Unit of measure Subtotal ($) Compensation $1,160,369 Total from agency budget x 8.6% $100,044 Rent and utilities $86,692 Total from agency budget x 8.6% $7,474 Supplies and equipment $92,718 Total from agency budget x 8.6% $7,994 Travel and training $30,396 Total from agency budget x 8.6% $2,621 Cost of construction $1,556 Average cost per project x 18 $28,000 Total $146,133 C.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $139,687 $141,795 $146,133 Total # of Units 15 17 18 Cost Per Unit $9,312 $8,341 $8,119 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/25/201 6 1 2:11 :11 PM I5 7 DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E 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. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/25/201 6 1 2:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E t A - continued Provider's Outside Agency Application MAIN APPLICATION Section VI. Financial Data Operating Budget for Entire Agency AGENCY NAME: Habitat for Humanity of Orange County FISCAL YEAR:July 1 -June 30 Actual Estimated Projected Percent 2014-15 2015-16 2016-17 Chan e AGENCY REVENUE Private Donations $ - $ - $ 0 Agency Generated Revenue (fees) $1,094,199 $1,006,306 $1,026,432 2% Local Government Grants: Orange County $ 20,000 $ 20,000 $ 25,000 25% Town of Chapel Hill $ 4,000 $ 3,000 $ - -100% Town of Carrboro $ 2,000 $ 2,000 $ - -100% Other Local: CDBG Funds $ 80,000 $ 25,000 $ 25,000 0% Other Local: HOME Funds $ 192,500 $ 222,441 $ 258,014 16% Other Local:AHDR Funds $ - $ 165,000 $ 185,000 1 12% Other Local:OC/Hillsborouah $ - $ - $ 90,000 0 If more than 3 sources, please provide a separate list. Non-Local Government Grants Triangle United Way $ 4,597 $ 5,547 $ 5,700 3% State Government $ - $ - $ - 0 Federal Government $ - $ - $ - 0 Other Grants: Corporate, Foundation $ 273,800 $ 275,000 $ 280,000 2% Other Grants: 0 Miscellaneous/Other Revenue $1,662,712 $1,366,000 $1,396,000 2% Please list 3 largest Miscellanous sources: Mortgage Payments: $550,000 NCHFA: $463,000 New Market Tax Credits: $420,890 (2014-15 only ReStore:$230,000 Total Agency Revenue $3 333 808 $3 090 294 $3 291 146 AGENCY EXPENSES Compensation $1,014,556 $1,122,021 $1,160,369 3% Rent & Utilities $ 78,057 $ 83,358 $ 86,692 4% Supplies & Equipment $ 100,785 $ 90,900 $ 92,718 2% Travel &Training $ 26,964 $ 29,800 $ 30,396 2% Other Expenses: $1,755,113 $1,788,152 $1,919,152 7% Please list 3 largest"Other Expenses": Construction, Land Costs: $1,403,845 Tithe to Habitat International: $49,500 Workers Comp, Directors Insurance: $36,170 Total Agency Expenses $2,975,475 $3,114,231 $3,289,327 6 Main Application 1/25/201 6 1 2:11 :11 PM DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Habitat for Humanity, Orange County,NC, Inc. Funding Award: $25,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount A Brush with Kindness Program Support—Personnel Expenses—Salaries and Benefits 25,000 Program Services For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes below,by June 30,2016. • Provide exterior home repair/landscaping to 15-18 low and moderate-income homeowners 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 Complete 15-18 ABWK projects in Orange County,which will result in a better quality of life for 15 the individual homeowners. DocuSigned by: Executive Director 10/27/2016 DocuSigned by: 1 ,b6us bvu Database and Grant Man er 11/1/2016 Certified by: 4,4,96469 Title: Bate: (Provider's Signature) DocuSign Envelope ID:A65EF081-BF54-47AC-9969-94226D3FBC7E DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE DA 73/24/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lori Moell NAME: Summit Insurance Group, Inc. HONE Ext: (704)659-2141 A/C No: (704)659-2148 PO Box 2485 E-MAIL ADDRESS:lmoell@sumins.com INSURER(S)AFFORDING COVERAGE NAIC# Huntersville NC 28070 INSURERA:Builders Mutual Insurance Company - INSURED INSURER B:QBE Insurance Corporation Habitat For Humanity Of Orange County, NC, Inc. INSURER C: 88 Vilcom Center Dr. Ste L110 INSURER D7 INSURER E: Chapel Hill NC 27514 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1632402409 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED A CLAIMS-MADE 1XI OCCUR PREM SESOEa occurrence) ccurrrence $ 500,000 X CPP0058155 4/1/2016 4/1/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS PCA0009233 4/1/2016 4/1/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peracadent Medical payments $ X UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED X RETENTION$ 10,000 UM0025059 4/1/2016 4/1/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE El EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) WCP1024619 4/1/2016 4/1/2017 El DISEASE-EA EMPLOYE $ 1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 B Volunteer/Accident DI NHH000489 4/1/2016 4/1/2017 $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Department of Housing, Human Rights & Community Developement is considered additional insured with regards to the general liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Department of Housing, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Human Rights & Community Development ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 Lori Moell/LORI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nmam t