Loading...
HomeMy WebLinkAbout2016-633-E Finance - EmPOWERment, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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 EmPOWERment, Inc., a not-for-profit corporation, located at 109 N. Graham Street, Suite 200, Chapel Hill,NC 27516("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 EmPOWERment, 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. 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. (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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. (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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. (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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 EmPOWERment, 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 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: (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB County: Finance &Administrative Services Provider: EmPOWERment,Inc. Orange County 109 N. Graham Street, Suite 200 Post Office Box 8181 Chapel Hill,NC 27516 Hillsborough,NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and i .fiefighe Provider PIL rt-S i _ I 11/3/2016 Date For and hofiOrange County Government bOtA,Wit, tbuitAWttxstu 11/4/2016 d^-9 3ZS9n0.Z55E477... Bonnie Hammersley, County Manager Date (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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: Certified by: Title: Executive Di rector Date: 11/3/2016 Y FICF54RrF111QF4f1F (Provider's Signature) (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency EmPOWERment, Inc. Date/Time Complete Y./N Program(s) Funding for Property Manager Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. E3Applicant Contact Information b. oject/Program Contact Information c. M-Funding Requests identified d. "'gned Application Cover Page 2. Agency a. 111 Agency's Years in operation 24 CFR 570.506, Information - b. El ;Agency's Purpose/Mission 570.507, 570.610; 24 c. Agency's Types of Services Provided CFR Parts 84 or 85 d. J - ''Agency's Experience e. E2/Other Pertinent Information 3. Program/ a. ZI,TY'pe of Application and Program Identified 24 CFR 570.200(a), Project b. 74—Symmary of Program 570.201-570. 208, Information - 507,503 C. 1, tescription of Identified Need (for each d. (L.../Description of Population to be Served program/ e. DActivity Manager and Location Description project for which funding .f It/ Activity Implementation Timeline U,Agency Collaboration is requested) g° h. Dt„escribe Impact of Reduced/No Allocation L :_td37er Pertinent InformationinCOA.S.... j. Complete Target Population/Beneficiary Chart k. [' complete Schedule of Positions V/Signed Conflict of Interest Disclosure m. Z,Complete Work Statement if DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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. Dirogram Budget Worksheet 570.602, 570.607(b), is requested) b. L fjogram Budget Detail 570.611 24 CFR c. g/Cost Per Unit 570.502-570.504, d. VAgency 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. H Part A: CDBG & HOME Sections (as B. T Part B: Construction/Rehab applicable) 6. Attachments a. 0 Audit: Organizations receiving$300,000 or more OMB Circular A-133 in Federal financial assistance, and/or organizations with more than $500,000 of receipts and expenditures in a fiscal year, must secure an audit. b. .] IRS Federal Form 990 c. -1 NC Solicitation License d. IRS Federal Tax-Exemption Letter e. 1 Certificate of Insurance f. El List of Board of Directors 24 CFR Parts 84 or 85 g. n Articles of Incorporation/Bylaws 24 CFR 570.208, h. LI Authorization to Request Funds 570.500(c), 570.611 i. Authorized official designation j. — Solid Waste Program Fee (SWPF) Verification Main Application 1/21/2016 2:38:15 PM P u 2 of 2 4, DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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: EmPOWERment, Inc. plicant Organization's Physical Address: 109 N. Graham Street, Suite 200, Chapel Hill, NC 2;516 Applicant Organization's Mailing Address: 109 N. Graham Street, Suite 200, Chapel Hill, NC 2516 Applicant Organization's Web Address: www.empowermentinc-nc.org Executive Director: Delores Bailey Telephone Number: 919-967-8779 E-Mail: empowermentincncgmail.com DUNS Number: 00-344-2803 (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: Funding for Property Manager Project/Program Primary Contact and Title: LaTanya Davis, Property Manager Telephone Number: 919-967-8779 E-Mail: Iddavis67gmail.com c) Funding Request Identification Total Project/Program Cost: $185.083 Total Amount of Funds Requested: $70,000.00 5;554W P earn Proposed Use of Funds Requested (2-3 Line Maximum): The total use of funds requested is for property manager and property manager assistant. 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. LI CDBG Non-Construction (CH) $15,000 XXXI7Grant I— Loan E CDBG Construction (CH) Grant 0 Loan E HOME CHDO (00) Grant El Loan LI HOME Other (0C) Ej Grant Loan Human Services: E Carrboro $10,000 Chapel Hill $20,000 E 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: .11-- U-K) "42-1)Cck_.(2e, — 2- — G Executive Director Date Signature: "14.0-...- CPita•A".4./ Board Chairperson Date Main Application 1/21/2016 2:46:54 PM r ci e 3 of 24 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLICATION 2. AGENCY INFORMATION Please provide the following information about your agency (Limit of 2 pages total): a) Years in Operation, Date of Incorporation (Month/Year) Years in Operation: 19 Date of Incorporation: March 27, 1996 b) Agency's Purpose/Mission The mission of EmPOWERment, Inc. is to empower people and communities to determine their own destinies through affordable housing, community organizing and grassroots economic development. c) Types of Services the Agency Provides With funding provided through the Human Services Grant, EmPOWERment, Inc. has created a one-stop shop for affordable rental programs and services. EmPOWERment, Inc. is the primary provider of much needed affordable rentals in Orange County. Local agencies such as Social Services, the Interfaith Council, Community Empowerment Fund, and Housing for New Hope and area churches are able to refer individuals and/or families that are in need of a safe, clean and affordable place to live. This fiscal cycle the affordable rental program will increase its services to include more Housing Choice voucher holders, veterans, more individuals transitioning from homelessness, senior and disabled populations. The property manager position is responsible for the management of 46 rental units throughout Orange County. These units are made available for families and individuals at income levels that range from moderate to low-low. d) Agency's Experience with Similar Programs as the Funding Request • EmPOWERment Inc. collaborates with Social Services, Habitat for Humanity, Community Home Trust, Interfaith Council, Housing for New Hope, Club Nova, UNC Chapel Hill School of Medicine Department of Psychiatry and Community Empowerment Fund to help place qualified residents in affordable rental units. We provide a range of services that include: assisting with acquiring rental housing, securing utility services and transitioning into home ownership. • We are partners with Project Homeless Connect providing counseling services when possible and making homeless persons who are ready for apartment living a priority. We work diligently with case workers to help some of these tenants secure rent or utility deposits. EmPOWERment, Inc. continues to assist families in transitioning from various states of homelessness into permanent housing. In this effort we worked closely with Housing for New Hope and Social Services on projects such as the Rapid Re-Housing Program and Orange County Partnership. • We work constantly with the Police Department, our neighborhood Watch Program and with UNC students and administrators to address the needs of underserved individuals in our community through program assistance and information sharing. Main Application 1/21/2016 2:38:15 PM Paue 4 of 24 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLICATION • EmPOWERment, Inc. continues to work with the TABLE program. This collaboration allows elementary age children of our residents to participate in TABLE's weekend backpack food program. • The Executive Director of EmPOWERment is the co-chair of Justice United,with whom we actively collaborate to bring light to neighborhood issues that may require Town Council attention. In conjunction with Justice United, the UNC Chapel Hill School of Law Clinic and the Orange County Department of Housing, Human Rights and Community Development, we have participated in discussion with landlords about the conditions of their units and necessary improvements. • EmPOWERment, Inc. continues to collaborate with Chapel of the Cross Church and local developers to provide free gently used furniture and appliances to low income families. • We have partnerships with local churches and faith based organizations to provide temporary financial assistance to residents in need. In early 2015 the i3Cares Foundation awarded ImPOWERment, Inc. a donation to establish an emergency assistance program. The fund provides assistance with rent and utilities when tenants are experiencing financial hardships. • We continue to partner with Community Empowerment Fund to transition homeless individuals into permanent housing through "home sharing" as housemates when possible. e) Other Pertinent Agency Information EmPOWERment's, inc. targeted neighborhoods are those that are traditionally African American, emerging Latino and low wealth. Our community outreach involves grassroots organizing primarily through our monthly Community Outreach Meeting. We stay connected to the residents by handing out flyers door-to-door to inform them about upcoming neighborhood events. The events that we sponsor include block parties, initiatives targeting student engagement in the neighborhood and the Rogers Road back to school project. We are members of Orange County Justice United (co-chaired by Delores Bailey, Executive Director)that addresses issues such as affordable housing, tenants' rights, living wage and the basic needs of the underserved populations throughout Orange County. We work closely with the following agencies that serve a diverse clientele: Project Connect UNC School of Medicine Dept of Psychiatry Department of Social Services Freedom House Rapid Rehousing Oxford House Housing Choice UNC Horizons Housing for New Hope Cardinal Innovations Health Care Solutions The Interfaith Council TABLE The Orange County Public Schools Family Success Alliance Community Empowerment Fund Mental Health Carolina Outreach Triangle Family Services Orange County Justice United Local Churches Club Nova Habitat for Humanity Community Home Trust UNC School of Law Main Application 1/21/2016 3:41:23 PM Page 5 of 24 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency& Program Name: EmPOWERment, Inc. As you complete your application, complete only those sections that pertain to the type of application you are submitting. The application is divided into several sections and not all sections apply to every project. Every applicant MUST complete the main application. a) Check the type of funding request for this application package submittal and complete the required application and required supplemental sections (Parts) as specified below: xxxi I Human Services (Main Application Only) CDBG Non-Construction — (Main Application AND Part A) Lii CDBG Construction — (Main Application AND Part A AND Part B) Li HOME CHDO Set-aside — (Main Application AND Part A) 0 HOME Other — (Main Application AND Part A AND Part B) Indicate the type of program for which you are requesting funding: Disabled Public Housing Program Category Youth Adult Elderly (not elderly) Neighborhoods/Residents Education (Housing Counseling) X X X X Health and Nutrition Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentoring Transportation Housing X X X X 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? Process for filling vacancies includes the following services Unit Turnover Cleaning and repairs Receiving Applications Through online submission and in office visits Main Application 1/21/2016 2:38:15 PM P a g e 7 a f 24 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLICATION Application Processing Income and Rental Verifications and Reference Check Pre Counseling Selection from verified applications on the wait list; Most recent verifications reviewed Lease Si.ning/ Document signing!Deposit Move In Procedure and Check list Walk through, utilities transferred to tenant Collection/ Deposit of Rent Pa ments Late Notices and Evictions Generating Monthly Rent Rolls, Board Reports and Quarterl Re•orts EmPOWERment's Rental Program services also include: Scheduling and overseeing repair requests Counseling for tenants with financial hardship Coordinating and facilitating Tenant Association Meetings Performing annual HQS inspections Managing annual tenant recertification Managing program payable and receivables using Quickbooks Overseeing court ordered community service workers for routine property maintenance Maintaining rental files c) Describe the local need or problem to be addressed in relation to the Consolidated Plan or other community priorities (i.e. Council/Board Goals). Cite local data to support the need for this program and the population being served. The Orange County 5 Year consolidated plan has Housing as a "High Priority"item that includes providing safe and affordable rental units for low to moderate income families. EmPOWERment's rental program fully embodies that objective. Town/Council goal-Adopt and implement affordable housing strategies. Town/Council Programs-Housing and Community: Rental Housing for Low-Income Families; Maintenance Services: Resident Services The EmPOWERment, Inc., rental program has a proven track record of implementing safe,clean and affordable places for low to moderate income families to live. We have provided these services for the past 15 years. Our inventory of units has increased to 39 owned by the organization and 7 that we manage for private landlords. EmPOWERment uses a tracking log to keep account of the number of telephone calls, in office visits and applications submitted requesting housing. In 2015 we fielded approximately 575 inquiries for rental homes. Many of the individuals seeking housing are below the poverty level and were referred to us through our collaborative efforts with other social service agencies. Seventy-seven percent of the inquiries and applications submitted were from minority populations and 100%were below the 80%level. We have found that approximately 60%of our inquiries are from female heads of households that include young children.The major property management agencies in the area are no longer accepting Housing Choice Vouchers. EmPOWERment gives these individuals priority because those individuals have a limited amount of time to use their vouchers. Main Application 1/25/2016 12:43:32 PM P 'icje 8 ot 24 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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. Orange County, with emphasis in the Northside and Pine Knolls communities of the Town of Chapel Hill, and the Town of Carrboro. The population includes those individuals whose income falls below the 80% area income. They are identified through the application and verification process. e) Who specifically will carry out the activities and in what location will they be carried out? The Property Manager and her team carry out all program activities. They operate out of the EmPOWERment Office located in the Midway Business Center, Chapel Hill, NC. EmPOWERment, Inc. has been in the property management business for 15 years. All of the EmPOWERment staff, UNC Bonner students (4) and volunteers are trained to help with the Rental Program. Our current property manager, LaTanya Davis, is a master's prepared Broker-in-Charge with over twenty years of experience that allows her to manage units that do not belong to EmPOWERment. We manages 7 rental properties that are privately owned along with the 39 units that we currently own. Ms. Davis has been the Property Manager for eight years, overseeing the Rental Property management program including but not limited to: rental counseling, apartment turnovers, maintenance, negotiating with vendors and rent collection. Reporting to the Property Manager is the Assistant Property Manager, Melissa Fitzpatrick. This role works with tenants, handles administrative rental duties, data collection and Website management of the Rental Program. Sarita Nwachuku, the Director of Community Programs, has a BS in Business Management and spends 30% of her time supporting the Rental Program. She manages registration of clients, phone calls, issue follow-up and resolution and rent collections. Volunteers assist with administrative duties and apartment turn-overs. The four Bonner students are UNC students who spend four years with EmPOWERment to complete their work-study hours. They are trained to work on many aspects of the Rental Program with Ms. Davis and provide tremendous support. The Executive Director, Delores Bailey, has 14 years of rental property management experience with EmPOWERment, Inc. With the approval of the Board, Ms. Bailey researches and negotiates potential affordable rental projects. These units will be included in EmPOWERment's affordable rental inventory. 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. Jan Feb March April May June July Augusj�_S ptember Oct November Dec Tenant HQS Inspections and Tenant Association Recertification Surveys and. Meeting Tenant Association Meeting 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. Main Application 1/25/2016 12:42:54 PM Pa c: e 9 of 24 onnunign Envelope ID:4FnBronn-0nEB-4ono*o7s-574eeeooeose [ /\- QoOtinued Provider's Outside Application MAIN APPLICATION I. Provide Housing and counseling for individuals that come through their programs in collaboration with: Department of Social Services Rapid Rehousing Housing Choice housing for New Hope Freedom House Oxford House 0NCf2o6umux Cardinal innovations Health Care Solutions UNC School of Medicine Department of Psychiatry 2. We work closely with the following agencies to provide Emergency funding sources to prevent evictions and utility disconnections: The Interfaith Council Local Churches JOCCA 3. Collaborate to find resources for financial planning to ensure property budgeting and to provide emergency financial assistance when needed: Community Empowerment Fund 4. Partner to provide weekend back packs to school age children: TABLE h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. A full time property manager is essential to fulfill the many requirements of the role in order to best serve the community's growing needs. Daily issue resolution, problem solving, education and proactive counseling requires full time support. Without a full time property manager, the number of families helped would decrease because of the lack of service time and support provided. The program could continue with a reduction in services and the timeliness of response and service would be greatly diminished. The current number of 575+ community member inquiries fielded would be greatly diminished. i\ Include any other pertinent information. Program/Project Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff I) Disclosure of Potential Conflicts of Interested must be signed m) Complete the Work Statement Chart to describe the work to be perforrned, and be sure to attach copies of all data collection tools that will be used to verify achievement of program goals and objectives. Describe who will be responsible for monitoring progress. Main Application 1/21/2016 3:28:01 PM 2 ,1 onnunign Envelope ID:4FnBronn-0nEB-4ono*o7s-574eeeooeose [ /\- QoOtinued Provideric,WWWLEpensrty plication Information to Complete j.) Target Population Complete the following tables to the best of your ability. Show numbers of participants and percenLages, as applicable, in each category. Please indicate whether this project/program will serve: xnEl Persons El Households L Units Program: EmpOWERment Rentals Program Beneficiary Demographics ^ " Actual Estimated Projected 2014-15 2015'16 2010'17 Gender~ ---- - Male 186�� -- 229 Female 345 | 346 363 Total 541 575 603 Of the females, how many are single- female Head of Households (Omit for Human Services) Ethnicity African-American 304 387 406 American Indian nrA|anka Native 0 0 0 Asian 6 3 3 | — Caucasian 1 125 171 179 Native Hawaiian or other Pacific - Islander 0 0 0 Other: Hispanic 46 14 15 Total 541 575 603 Of the above how many -- --_ ' Hispanic/Latino 46 14 15 Of the above, how many non- Hisponic/Ln!inn 495 561 588 Total 541 575 603 Age 0-5 years 106 66 60 6-18 years 127 59 62__ 19-50 years 193 255 267 51'61 years 90 143 153 62+ years 25 47 52 Total 541 575 603 Geographic Location Durham City Durham County Carrboro 131 335 352 Chapel Hill 394 240 251 Main Application 1/25/2016 1:17:41 PM of � u� onnunign Envelope ID:4FnBronn-0nEB-4ono*o7s-574eeeooeose [ /\- QoOtinued Provider's Outside pliC8tion M/\IN /\PPUCAT{]N Chapel Hill Public Housing Residents -- Orange County 10 0 . 0 Raleigh Wake County IMIIM Total 541 MEM 803 Income Level —See following chart (Omit for HS) « 30% Area Median Income 61% 61% 31-50% Area Median Income 17% 17% 51-80% Area Median Income 22% 22% >80%Area Median Income 0 0 0 Total 0 10096 100% Special Needs(Omit for HS) Elderly(Over 62) 47 _ 52 Disabled (not elderly) Homeless ' People with HIV/AIDS _ Total 0 47 52 Main Application 1/21/2016 2:38:15 PM e 1 2 ƒ 2 4 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider' i(En./L4sAdpeptrzytiplication CDBG & HOME ONLY- Area Benefit Activities (Infrastructure and public Facilities),_ Street Census Tract Block Group Total Persons #LMI Persons 2015 Area Median Family Income Limits U.S. Department of Housing & Urban Development (HUD) 2015 Area Median Family Income Limits Effective March 15, 2015 Income 1 2 3 4 5 6 7 8 Level person people People People people people People , people 30% AMI $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 50% AMI $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 80% AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 100% AMI $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115% AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www.huduser.ord/portal/datasets/ilfill 5/FY2015 IL nc.pdf Main Application 1/21/2016 2:38:15 PM 0 I 2 4 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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). I— If provided, indicate: Position Titles FTE* % (R) Actual Estimated Projected %Total *= Position , Program Retirement + Vacant Staff 2014-15 2015-16 2016-17 Budget Plan (H) Health Plan Pro•erty Manaser 1 100% 1 56272 56272 59086 H 1 Assistant Manager .5 100% 3571 8000 16000 Director of Community Programs .8 30% 32981 32981 34630 Executive Director 1 30% 74304 74304 78019 1 H Community Service 1 Volunteers 1 50% 1 1 Bonner Students 1 1 60% Finance Manager 1 .25 40% 7689 7689 873 Housing Counselor 1 1 5% 16148 0 0 1 1 FSA Navigator 1 0% 7450 37440 1 37440 Career Explorers 1 20% 1089 15000 15000 Notes: • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. • ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • + Denotes the percentage of staff time involved with this program. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 1,960 Main Application 1/21/2016 2:38:15 PM P %, e 1 4 r.1 ; 7 4 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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 II XXE a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? n XXLIIJ b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? Lii xx- 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: ( Executive Director Date Signature: 1- 2 -tL Board Chairperson Date Main Application 1/21/2016 2:14:46 PM P g I 5 o t 2 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Main Application 1/21/2016 2:38:15 PM Page. 16 of 24 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLICATION Program Activity Increase#of rental units increase#of rental units Increase#of rental units Program Goal Increase by 2 Increase by 8 increase by 2 Document new rental units Document new rental units Document new rental units Performance Measures on spreadsheet on spreadsheet on spreadsheet Program Results Program Activity 2 Housing for homeless Housing for Homeless Housing for Homeless Program Goal 2 2 Collaborations with other Collaborations with other Collaborations with other agencies to chart homeless agencies to chart homeless agencies to chart homeless Performance Measures population served population served population served Program Results 2 Innnow.. Work with agencies to Work with agencies to Work with agencies to Program Activity 3 support low vacancy rate support low vacancy rate support low vacancy rate Program Goal Maintain 92%vacancy Maintain 92%vacancy Maintain 92%vacancy Performance Measures Chart monthly vacancies Chart monthly vacancies Chart monthly vacancies Program Results 98.50% Complete annual housing Complete annual housing Complete annual housing Program Activity 4 inspections inspections inspections Complete 80%of Complete 80%of Complete 80%of Program Goal inspections, inspections inspections Chart completed Chart completed Chart completed Performance Measures inspections on spreadsheet inspections on spreadsheet inspections on spreadsheet Program Results 100% I 4 Program Activity 5 Increase Rental Stock Increase Rental Stock Increase Rental Stock Program Goal Convert unit to be leased Convert unit to be leased Convert unit to be leased Unit become tenant Unit become tenant Unit become tenant Performance Measures occupied occupied occupied Program Results 1 unit converted Main Application 1/21/2016 2:38:15 PM DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued ProviderkitiNt .emty I plication 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. *Program budget below does not reflect mortgage costs on rental properties. *This report is completed based on EmPOWERment's calender year. Main Application 1/25/2016 1:11:46 PM P u 1 2 4 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLI-CATIONI Program Budget Agency/Progrart EtTIPOVVERnr)ent,Inc-Rentals Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Chan te Private Donations 0 Agency Generated Revenue(fees) $ 301,832 $ 310,887 $ 30 2i 3% Local Government Grants: Orange County $ 20,000 $ 20,C300 $ 25,000 2570 Town of Chapel Hill $ 13,500 $ 3,500 $ 20,000 Town at Carrbero $ 9,500 $ 10,000 $ 10,000 0% Other Local Other Local' 0 Other Local° 0 nlorp than 3 solarces,please I provtde a separate list Non-Local Government Grants Triangle United Way 0 State Government Federal Government 0 Other Grants 1111 1111111 0 Other Grants, 0 MiscellaneoustOther Revenue 0 Flease hst 3 brgost MisceBWnoti,s sources $ $ $ - Total Agency Revenue IIIMINIE11111/1111111111111 AGENCY EXPENSES Compensation $ 58,707 $ 65,000 $ 75,086 163/o Rent&Utilities $ 26,457 $ 27,251 $ 28,068 3% Supplies&Equipment $ 41,227 $ 42,464 $ 43,738 39/c, Travel&Training Other Expenses: $ 58,692 $ 60,453 I $ 62,266 .3°/0 Please Ilst 3 largest"OtJler&penses" Management Fees $ 30,520.00 ROA Dues $ 24.883 00 Property Tax $ 2,836.0C) Total Arkgency Expenses $ 185 083 $ 195 168 $ 209 158 73/‘ SURPLUS/(DEFICIT)FOR PERIOD: $ 159,749 $ 169,219 $ 166,055 4% Main Application 1/21/2016 2:38:15 PM ■4 n 2 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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. Exam•le Pro.ram: Credit Counselino Class oast Elements Cost/4 Of Measure, ' Subtotal:0) , Credit Counseling Teacher–in class $25 96 hours(8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours(4hrsfmth x 12 mths) $1,200 Credit Counselor—one-on-one $20 120 hours(10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the protect/program for which you,are requesting funds. Attach additional rows/pages, as needed. Program: Rentals cost Elements ' 6t)stfhr, ,quaatity/Unit of rosasure ' ,Sebtetat(Sj: Prosert Manaser $22.11 2080 hours (40 his/week X 52 wks/ r $46,000.00 Assistant Prose Manager $ 8.65 1040 hours (20 hrs/week X 52 wks/yr) $ 9,000.00 Total $55,000.00 c ) Cost per Unit Actual 2014.15 ,Estitnated 201$46z: ,,:Projected'2010.11— Total Cost of Program $185,083.00 $195,168.00 $20958 Total if of Units 542 575 603 Cost Per Unit 8341.48 8339.42 8346.86 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 1/21/2016 3:39:14 PM Page 21 of 24 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB 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. Submit operating budget in your own format. Do not include funds that have been applied for but not yet awarded: If the total revenue is not the same amount as the budget for any fiscal year, please attach a statement explaining the deficit or surplus. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/21/2016 2:38:15 PM P a e 2 2 of 2 4 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB t A- continued Provider's Outside Agency Application MAIN APPLICATION Section Vi Financial Data Operating Budget for Entire Agency AGENCY NAME: EmPOWERment,Inc Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-11 Change Private Donations $ 9,317 $ 9,597 S 9,884 3% Agency Generated Revenue(fees) $ 18,240 $ 18,787 $ 19,351 3% Local Government Grants: Orange County $ 20,000 $ 20,000 $ 25,000 25% Town of Chapel HO $ 40,897 $ 40,500 $ 47,000 16% Town of Carrbora $ 9,500 $ 9,500 $ 10,000 5% Other Local: 0 Other Local: 0 Other Local: Orange County-FSA $ 24,384 $ 24,384 $ 24,384 OtY0 Non-Local Government Grants Triangle United Way 0 State Government $ 43,414 0 Federal Government 0 Other Grants.lnitative $ 3,250 $ 2,250 -100% Other Grants: 0 Miscellaneous/Other Revenue $ 394,414 $ 406,246 11111E11.1111M Rental Income $301,832 00 Property Sale $ 38,500 00 MBC income $ 44,963 00 Total Agency Revenue WHIM $ $54 0$3 11111111.!! AGENCY EXPENSES Compensation $ 199,504 $ 205,489 $ 211,654 3% Rent&Utilities $ 186,074 $ 191,656 $ 197,406 3°/. Supplies&Equipment $ 26,872 $ 27,678 $ 28,509 3% Travel&Training $ 3,426 $ 3,529 $ 3,635 Other Expenses: $ 153,702 $ 158,313 $ 163,062 35/o Flease list 3'largest'Other Expenses" Rental Property $126,375 00 Audit $ 8,548 00 Resale Expense $ 5,016 00 Total Agency Expenses $ 604,266 SURPLUS/(DEFICIT)FOR PERIOD: $ (6,162) $ (55,401)1$ (50,213)1 9% Main Application 1/21/2016 2:38:15 PM P q e 2 3 2 4 DocuSign Envelope ID:4F0B7605-00EB-4D90-837E-574BBBBD89EB EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: EmPOWERment, Inc. Funding Award: $25,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Expesnes associated with the Property Manager and Property Manager assistant positions 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. • Increase number of rental units • Housing for Homeless • Work with Agencies to support low vacancy rate • Increase rental stock 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 Document new rental units on spreadsheet 100% Providing housing for homeless population 2 Chart monthly vacancies 92% Complete annual housing inspections 80% Increase rental stock 2 DocuSigned by: 1,a1) a GUMS Property Manager 11/3/2016 Banc+ EVDocuSigned by: abVt S 15GUttAi Certified by: Title: Executive Director Date: 11/3/2016 y BCE548CED19F40F... (Provider's Signature) DocuSign Envelope ID:4F0B7605-OOEB-4D90-837E-574BBBBD89EB EMPOW-1 OP ID: LR A °R°w CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/29/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Margo G. Roberts,AAI, CISR Summers Thompson Lowry,Inc. PHONE FAx 100 Europa Drive,Suite 571 (NC,No,Ezt):919-969-5300 (A/C,No): 919-942-4221 Chapel Hill,NC 27517 E-MAIL o stlinsure.com Larry A.Summers ADDRESS:mar go@stlinsure.com AFFORDING COVERAGE NAIC# INSURER A:AmTrust Financial Services INSURED Empowerment, Inc. INSURER B: Delores Bailey 109 N. Graham St.#200 INSURER C: Chapel Hill, NC 27516-2328 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR W /Y VD POLICY NUMBER (MM/DD/YYYY) (MM/DDYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X NPP1005089 06/16/2016 06/16/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ INCL CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ INCL POLICY PRO JECT LOC Sex Abuse $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS JPER ACCIDENT) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N TWC3479297 06/16/2016 06/16/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Professional Liab NPP1005089 06/16/2016 06/16/2017 Occurrenc 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The Town of Chapel Hill is additional insured as respects written contract. CERTIFICATE HOLDER CANCELLATION TOWNCHA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Chapel Hill ACCORDANCE WITH THE POLICY PROVISIONS. 405 Martin Luther King Jr Blvd Chapel Hill, NC 27514 AUTHORIZED REPRESENTATIVE Larry A.Summers ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD