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2016-642-E Finance - Marian Cheek Jackson Center for Saving and Making History - Outside Agency Performance Agreement
DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 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 Marian Cheek Jackson Center for Saving and Making History, a not-for-profit corporation, located at 512 W. Rosemary Street, 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 Marian Cheek Jackson Center for Saving and Making History 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 10000. 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 $2,500. 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. (Marian Cheek Jackson Center for Saving and Making History) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 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 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 (Marian Cheek Jackson Center for Saving and Making History) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 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; 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 (Marian Cheek Jackson Center for Saving and Making History) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 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 Marian Cheek Jackson Center for Saving and Making History 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 (Marian Cheek Jackson Center for Saving and Making History) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 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: Marian Cheek Jackson Center for Orange County Saving and Making History Post Office Box 8181 512 W. Rosemary Street Hillsborough,NC 27278 Chapel Hill,NC 27516 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 an s,.ho of/the Provider I� V C1u�.Sb1A, atILLI t, 11/2/2016 D8787888152D488... Date For and oryOrange County Government E5-46:4AA/Lit, tbuitAMt-rStUi 11/10/2016 T.f9 . Bonnie HamOo.mers ey7 5t 7.,County Manager Date (Marian Cheek Jackson Center for Saving and Making History) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 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: t1 /MIA. Vale Senior Director 11/2/2016 Certified by: Title: Date: —DB7978961 32D48B... (Provider's Signature) (Marian Cheek Jackson Center for Saving and Making History) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency —The Marian Cheek Jackson Center Datefrime Complete Y j N Programi(s); Learning Across Generations: Youth Leadership&Civil Rights Education 1. Cover Page a. Applicant contact Information b. [aprojectlProgram Contact Information c, [Funding Requests Identified d. DISigned Application Cover Page 12. Agency a, [3 Agency's Years in operation 24 CFR 570.506, Information- 570�507,570-610:24 b. Agency's Purpose/ fission CFR Parts 84 or 85 c. `Agency's Types of Services Provided d. aAgency's Experience e, [110ther Pertinent Information I i 3. Program/ a, 0-Type of Application and Program Identified 24 CFR 570,200(a), Project 570,201-57 0, 208. � b. [ Summary of Program Information- i 1 50T503 C. Dpescription of Identified Need (for each d. if Description of Population to be Served program/ project for e. Activity Manager and Location Description which funding f, 0-1,Activity implementation Timeline is requested) g• aAgency Collaboration h. [1pescribe Impact of ReducedlNo Allocation I, [3,0ther Pertinent Infonnation j. El Complete Target Population/Seneficiary Chart k. El Complete Schedule of Positions 1. [11Slgned Conflict of Interest Disclosure in. ❑ omplete Work Statement DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA2820B225 Exhibit A - continued A ri Provider's G-1MAWP,,4q4@9fJ)6&p1 i cation__ 24 CFR 570.200ia), 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, ro- project for i 570.507, 570.601, which funding'a. OlProgram Budget Worksheat 570.602. 570.607(5). is requested) 1 b. m E3-'�rogra Budget Detail 570,611 C. acost Per Unit 24 CFR 570,502-570.504, d, 570.506, �Agency Operating Budget Worksheet 570.507, 570.610;24 1 CFR Parts 84 or 85, and OMB Circulars A-87 or A-! 122: 1 Treasury Circular 1075 15. Supplemental IA. ❑Part A: CDBG&HOME Sections(as 1 B, F-1 Part B. ConstructionlRehab applicable) Audit.-Organizations receiving$300000 or more F. Attachments , OMB CircularA-133 i in Federal financial assistance, andlor organizations with more than$500.000 of receipts and expenditures in a fiscal year,must secure an audit. b. ❑IRS Federal Form 990 c. E,1-�iC Solicitation License I d. EYIRS Federal Tax-Exemption Letter e. 'Certificate of Insurance f. DIList of Board of Directors 24 CFR Parts 84 or 85 1 g. EJArticies of Incorporation/Bylaws 24 CFR 570.208; h. [JAuthorization to Request Funds 570,500(c), 570.611 L aAuthorized official designation j. solid Waste Program Fee(SWPF) Verification Main Application 112412016 5:04:30 PM 2 2 2 DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA2820B225 Exhibit A - continued Provider's OM Rhatp%i�ppl i cation L. OVER PAGE (Each program requires a separate application a) Applicant Contact Information Applicant Organization's Legal Name:The Madan Cheek Jackson Center for Saving and Making History Applicant Organization's Physical Address:512 W. Rosemary Street,Chapel Hill, NC 27516 Applicant Organization's Mailing Address:Same as above Applicant Organization's Web Address:www.jackson center,info Executive Director: Delta Pollock Telephone Number:919-960-1670 E-Mail: Hudsonp_iacksoncenter.info DUNS Number: (Dun&Bradstreet,Inc.provides this number at no charge,and it is required for Federal funding recipients.) b) Prjoect[Program Contact Information Project/Program Name: Learning Across Generations:Youth Leadership&Civil Rights Education Project,'Program Primary Contact and Title: Hudson Vaughan Telephone Number:919-960-1670 E-Mail: Hudson @yjacksoncenter.info c) Funding Request Identification Total Project/Program Cost:$60.500 Total Amount of Funds Requested:517,000 Proposed Use of Funds Requested (2-3 Line Maximum): 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. ❑CDSG Non-Construction(CH) $ [-I Grant ❑Loan ❑CDBG Construction (CH) $_ ❑Grant ❑Loan ❑HOME CHDO(OC) $ ❑Grant ❑Loan ❑HOME Other(00) $ ❑Grant ❑Loan Z Human Services: 0 Carrboro$1,000 Z Chapel Hill$4,000 Z Orange County$10.O00 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: Executive Director Date, Signature: Board efiairpers, Date Main Application 112412016 5:04-130 PM oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's (]4�10 plic8tion 2.AGENCY INFORMATION Please provide the following information about your agency(Limit e,u pages twtaU' a) Years in Operation, Date vY Incorporation(momth/Yoar)' r years in operation (operated under fiscal sponsorship of 8t. Joseph CME before moorpns,dnn>:incorporated March 28,2012 b) Agency'sPurpos'yM|ssion The Jackson Center's mission is to honor, nanaw` and build community in the historic Nnrtbsida. Pine KnoUo, Tin Top, and Lloyd/Broad communities of Chapel Mi||/Cantom, The Jackson Center was established in 2008 to respond to rapid demographic ch nges in the Nnnhside. Pine KnoUs, Tin Top, and neighboring, historically African-American |m*wna|th communities in Orange County, NC These communities have been especially hard hit Lhm economic recession. increased cost mfliving, and market pressures to fulfill the demand for rental housing for UNC-Chapel Hill students, resulting in diminishing numbers of low-income and racially and ethnically diverse populations. We were founded as a history activis center: a community-based hub that brings history into active neighborhood dialogue in order to make history and change together. Our efforts have always intentionally engaged difference directly and crossed all preconceived boundaries of division [across race, class, religion, sexuality, university-neighborhood (historically segregated "service" communities)] with a sustained commitment to social justice and community-led development, o} Types mf Services the Agency Provides The Jackson Center inm place-based and oral history-driven organization. Our focus|mtu preserve the future of neighborhoods in transition,and we do this through a comprehensive set oY initiatives aimed at fulfilling our vision o,beloved community. Our main strategies include: • Youth Leadership and Civil Rights Emwweui*n We engage the wisdom of youth voices and wo amplify community perspectives through creative strategies like youth-led radio, educational work in the public schools,and neighborhood tours led by community elders. Primarily the services that wm offer inthis area include: o Civil Rights and Oral History Workshops(Grades K'12 and College) o |ntengonmre8ona|Community Education Tours � Fusion Youth Radio High School MuntoshipProgram o Oral History Trust&Neighborhood Svund*e|k • Organizing and Advocacy We challenge inequity and reverse unjust housing trends through community-first p|enning, nwssaoh. and relational organizing,activating neighborhood networks to strengthen communities and bring about systemic policy change, Primarily the services that wn offer in this area include: o Home repair advocacy m Lonahank organizing and affordable housing advocacy o Land preservation(legal u financial tools to preserving land ownership) o Student engagement(volunteer training, good neighbor work) u Coalition mobilization(proactive engagement on development policy) • Celebration and Connection We meet despair with hope;erasure with memory; isolation with connection.Our work ia founded on in-depth listening,reflected in our exhibitions, resident-driven newspaper, Main Application 1124/2016 5:04:30 PM oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's �qIpb6Anpiication and participatory events,We honor civil rights history and inspire consciousness and action, Primarily the services that wmuMe,in this area include: • Community Gatherings and Annual Celebratory Festivals • Interactive History Exhibits • Resident-Driven Newspaper d> Agency's Experience with Similar Programs aa the Funding Request Th|s|a the fourth year nf the Jackson Center's Youth Leadership m Civil Rights Education Program, Each year we have met and exceeded our goals and benchmarks laid out for our program, |nfact, half-way into the current year, we have already m,$ program goals that nearly doubled the outcomes from the previous year. In addition to a huU'maffmam of support, we have two staff members (including one onaUmo resident of the neighborhood) and three four-year long interns dedicated solely to this program ��d|dona|ly.we have inom the partners and of collaboration with other organizations (see list of partners in answer below) and have built community teacher team of dozen long-term residents who lived through and participated in the Civil Rights struggle. Finally,the Jackson Center has gained support from local, state, and national foundations because of the success of this program and has been invited to participate in |nca|, ma»o, and national presentations for our model ufp|eco'haasd learning and intmrgonwrmt|mnol civil rights and oral history curricula. e) Other Pertinent Agency Information The Jackson Center has been recognized with several awards for its work over the last six years: most recently, the Harlan Joel Gradin Award for Excellence in the Public Humanities from the NO Humanities Council&the Dr. Martin Luther King Jr. Bridge oui|der8wan1 from UNC'Chmpe|Hill. Additionally,we have received an Indy Citizen Award for our coalition building and work assisting in the implementation nf the Morthsido/pinm Knolls Community Plan;the Advocacy Award fmm Preservation Chapel Hill for our himtoriva|education mm�in Chapel MiU/nmrmom,yn award hvmthe Chapel M|Uchapter ofa black som��.and an award from UND'u Office of Engaged Scholarship for our neighborhood partnership work.Our Fusion Youth Radio program served as the inspiration for WUNC7s Youth Radio Institute and several of our youth pieces have won national awards.Our events and forums have been hailed uv civil rights and social justice activists as''themost genuinely integrated events"they have ever attended. Main Application 1/24/2016 5-04:30 PK8 P og e 5 of 2 % oocuaignsnvelopo 0:000081a4-3ne7-4aza*arA-CmnAcocueeco Exhibit A - continued P[Ovider'G NFYP p1ic8tion 3. PROJECTIPROGRAM INFORMATION Agency&Program Name: Learning Across Generations:Youth Leadership&Civil Rights Education As you complete your oppliomtion, 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 tu every project Every applicant MUST complete the main application. m) Check the type of funding request for this application package submittal and complete the required application and required supplemental sections(Purts) om specified below: Human Services(Main ) [�CDBG Non-Construction--(Main AND Part Ad 17 CDBgCoostrmiun-—( AND Part A AND Part B) [] HOME CHDO Set-aside— AND Part y F-1 HOME Other-- AND Part A AND Part B0 Indicate th f program for h| h YOU are requesting funding: rogram Category i Youth Adult Elderly Disabled Public Housing (not elderly) Neigh borhoodsiResidents Education X Health and Nutrition Job Training I Sports and Arts Activities X Pre-School Activities Activities Transportation Housing Other: Please specify (Label your responses ao outlined below: not uz exceed opanna) Please provide the following information about the proposed prngenm/pn4e«x: b} Summarize the program services proposed and how the program will address the chosen Tmwn/oountyp,iohty? Our Youth Leadership and Civil Rights Education program involve three main initiatives: 1)Civil Rights workshops and/v»e rgene rational community education tours:o series af workshops and tours that focus on civil rights,local and oral history,and cross-generational education.Our civil rights education workshops were created from over 200+area oral histories,primarily with Affican-American residents.and engage elder residents/"their implementation.Each civil rights and oral history wvnmhop/o an opportunity to elaborate on our design in collaboration with teachers and schools.Together we build Main Application 1/24/20165:04�30 PK4 DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA2820B225 Exhibit A - continued Provider's 0100 e� gn�yApplication customized modules that encompass teacher ideas and student creativity.All our workshops meet Common Core State Standards for grade and unit goals. Please views our video'Bel r j�_ -_sue' (https:llyoutu.befVA5loDH81rs),a glimpse into the freedom dreams of fourth graders,as a fine example of the significant learning and visioning made possible through our unique model of multicultural intergenerational education work. Wk Z 2) Fusion Youth Radio High School Mentorship Program: Fusion Youth Radio(FYR)is dedicated to cultivating community leadership among diverse,local high school students. This project fuses youth and civic leadership training,media arts and performance,and historical education, For the past four years. FYR co-directors and a team of adult mentors have worked with a total of sixty students to create a monthly radio show on UNC-Chapel Mill's student-run radio station,WXYC.. Live FYR broadcasts feature youth-produced audio documentaries,performances by local youth spoken ward artists,and discussions about issues that affect our students and their communities.Youth in FYR develop media literacy, production,script-writing:and public speaking skills,and they further their1 understanding of local history and politics. This year,we piloted a T" summer audio-immersion program in � � collaboration with the Beatmaking Lab and Sacrificial Poets to supplement s � the annual radio program. A dozen high school students traveled with us to the Allied Media Conference in Detroit,and then participated in a � I series of workshops that supported �� 1 the youth in the creation of audio documentaries. 3) Oral History Trust and Neighborhood Soundwalk: Our ongoing oral history initiatives with long-time residents of this County fuel and deepen our education work. our oral histories are held in the `Northside Memory Project"archive,which is utilized for our workshops and ongoing educational work. This year,we began a new oral history series on"Black Lives t0after"to document the histories of police relationships with communities of color and to explore the power of the ongoing work for racial justice in this county. Additionally,we have produced a No€thside Soundwalk,an audio-documentary-tour featuring fifteen oral histories of the neighborhood&civil rights struggle. This audio-tour orients hundreds of young people each year(250 so far this fiscal year)to learn about the history,transformation.and vision for our community. All of these programs aim to preserve and empower local communities:we work to preserve the historically African American community of Northside through oral history preservation work and a neighborhood sound walk;we empower elderly neighbors to share their history with younger generations and intentionally engage with the community;and we also empower youth to develop and share their stories and perspectives with the community through Fusion Youth Radio. We believe that our Youth Leadership and Civil Rights Education programs address a variety of chosen TownfCounty prwritlea.our programs faster creative engagement and civic participation across race,class. and age barriers by intentionally focusing on innovative,intergenerational education programs that address a Ruin Application 1124/2016 5.104.30 IPM oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's (]nf�� 7f� P1ication K�BY�RPP2n�\ �, variety n,social justice issmoe.inc|uuinomacw|pogmmMnvemammmo1mmtanoxamnnmmunxmvv, current political climate,We offer nuanced Civil Rights curricula that empowers and engages youth in the o/wssmwm(especially youth v,color and|m*4ncvmevpmM.and directly connects them with older community mentors.Through these vuuwmiun programs,we onmene and empower older residents m share their histories with youth�this in turn teaches the importance of listening and learning with youth in the community.We work m support the next generation of youth leaders through rumivo Youth neu|u,challenging students to ennupn with important social justice issues,and giving them the tools to share their perspectives with others,Through all this.°v work to create safe spaces and community mmmm,honor cultural practices,revitalize our community.explore u/nwmnvo,and connect diverse residents with|eogommp opportunities, n) Describe the local need ur problem vabo addressed in relation to the Consolidated Plan or other community priorities (i.e. 3ounciKBoa,d Goals). Cite local data to support the need for this program and the population uomm nonom. The Human Services mesmn Report talks extensively about the need for"quality.equitable education for everyone'and support for youth&activities that engage at-risk youth.Throughout the country,educators are working to address the ever-growing achievement gap that occurs between primarily low-income students mr color,and their more affluent white peers.Locally.4u%n,black students and 47mofLatino students passed end-of-grade and end-of-cour-se tests in 2014-201 S,versus 90%of white students,When spending time in o|oavmomo around Orange ooumv,these deficits are fairly easy mspot.and we m^oevv that our education programs work to address this critical need by connecting primarily low-income youth and youth of color with mentors in the community to which they can relate-sharing local history that resonates in n personal way,and helping to encourage oxmo,esmnomo by exposing students m skills and technology they would mxemwea not have been able to access.Teachers universally report these vmnranm having a substantial impact on students.noting increased engagement and excitement in English and Social Studies classes,as well as the sense that these program bring history to life for students.showing them that the Freedom Movement affected their homes,communities,and people they know.We believe these programs are essential to the curricula vf Chapel n|mcurrbomschools. Our program address these more documented and opmumo mm|issues as well: 0 The sharply and the increasing struggle to retain African-American families(cut in half to 25%in the neighborhoods with the highest black po ulation--fiJorthside. Pine Knolls, Tin Top,LloydlBroad): One of the most important ways to retain nasidents is for residents to be valued for their history,to have a stake in a community's future,and to improve the a'uality of life in our neighborhoods. Our oral histories honor.preserve,and enact the invaluable civil rights history of Orange County, Our civil rights workshops connect older community members to generations of young people in the schools- Our Fusion Youth Radio cultivates the power of youth voices and gives them a stake in our community's future. 2) The lack m in-depth curriculum m our Chapel+mm;enbom and Orange County schools,especially curriculum which honors families that mmhave generations of youth mthese scmavm.As we have developed and strengthened partnerships with Smith Middle School, Northside Elementary aohuu|.and Cxavn!*m High ovhuo|,it has uornmo clear that teachers in the Chapel Hovcsnunmauhoo|m rely on Jackson Center programming to effectively facilitate their Civil nium^ History units,as our programs have transformed the experience of students,and made this history mo/for them in s way they would not have experienced otherwise,Word has spread about the vnecu o,our programs,and we have more than uovmeu the number of community partners we serve in the past year-uio clear that,through onuepm0 local voices in sharing this important history,and developing collaborative model v,education that directly affects the families and communities m many students/"the Chapel mx and oenuomanhoo/s.we have answered m critical need in an mmpvaxxm and important way. 3) The lock"/m"um for sGing saniors fou°m=^=u and°cti=m°°ya that honor th^,dignity and contribute m our community's uaure: mu often,~e try m find ways m keep senior citizens active and Main Application 1124/2016 5:04:30 PM DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's OMtA0RAp?R%0pplication engaged,but we have few forums that really involve our senior citizens in historical education and leadership in envisioning our community's future. Our Youth Leadership and Education Program is based around the notion that our history is one of the most valuable tools.and we intensively involve elder through oral histories and connection to schools through workshops and local history tours. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. Our initiatives reach a wide range of beneficiaries across the county, as our demographic statistics show. Our civil rights education workshops were created from over 200+area oral histories; primarily with African- American residents, and engage 30+ elder residents in their implementation each year. The workshops reach full grade levels of every partner school involved and have already reached over 500 students this year, primarily in the Chapel HiIVCarrboro City Schools but also with the County, Hospital School, and homeschool partners. We plan to expend to four additional school partners in the coming year, including deepening our partnership with the Orange County School System to reach an increased number of young people outside of town designations. Our Fusion Youth Radio Program is available to high school youth throughout Orange County;we partner with all local schools to do outreach for the application process,and we strive to ensure that students from all different backgrounds and demographics are a part of our program each year. Last year,the program was 75%people of color and 60%low income.Our youth radio program has a track record of reaching across barriers,not just in the group's composition but also in the selection of show themes.Past radio broadcasts have focused on topics such as immigration legislation,LGST rights.race in local schools,feminism.mental and physical health,and democratic participation. e) Who specifically will carry out the activities and in what location will they be carried out? Our Youth Leadership and Civil Rights Education Program will be carried out by the following staff leaders, interns,and volunteers at the Jackson Center and in schools throughout the county: Assistant Director of Youth Leadership&Education: Leads coordination of our Youth Leadership& Education programming(.75 time) Coordinator of Youth Leadership & Education (VISTA, full time): Focuses on program implementation and impact measurements. Carries out workshops in schools and hosts Fusion Youth Radio Program at the Jackson Center • Administrative Associate: Serves as the primary administrator for our youth and education initiatives and organizes the community teacher team (this staff member is a community member with deep roots and connections) • Bonner Scholar Interns: Two four-year interns serve as primary Fusion Youth Radio mentors. An additional intern helps coordinate our Oral History®rust • Community Teacher Team.dearly 20 lifetime residents who participated in the civil rights movement are part: of our teacher team: who help lead tours and participate In ongoing interviews and workshops • Deputy Director&Executive Director. Oversee vision of program and assist in grants and personnel support 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. Our Youth Leadership & Civil Rights Education Program is carried out throughout the year. with workshops occurring nearly every week of the fall and spring with various partners; and Fusion Youth Radio hosted twice per week every week from August-May. A simple implementation timeline is as follows Summer. 2015: Host 2'� annual audio immersion youth summer program; build additional school partnerships for the Tall; deepen curriculum based on exit surveys by teachers and youth participants from 2015-2416; recruit student applicants for Fusion Youth Radio; receive applications for FYR & inaugurate next class of youth leaders:coordinate professional mentorship program Main Application 112412016 5:04:30 PM a oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's (] piic8tion Fall uo16-opnnm.co1n Coordinate in-depth training m new youth:support the creation n,monthly live radio shows: host student groups on weekly basis for neighborhood tours:carry out weekly workshops in partnerships with various schools throughout the year Summer,2017: Conduct onu'of-ynar evaluations:organize V year m audio immersion program (see program activities for list o/m depth steps) n) Provide auui|yum list of other agencies, n any,with which your agency nnommatvomu|lauomtey»a accomplish^,enhance the Projected Results m the r'og,wm(s)to be funded, For each,give specific examples m the coo rdinamdimouborao,wefforts, All of our work is essentially collaborative and based on community partnership. To name a few: • omatmam"u Lau: Coordinate youth media workshops, collaborated m create the youth aouio- immemioo summer program • Sacrificial Poets&WXYC:Our radio program is produced in partnership with Sacrificial Poets and mmYu'cxap*|Hill(me.oFm) Sacrificial Poets provides key mentors and connects vowith poets for nearly every episode,and vm«vo hosts the live broadcast and donates critical technical support wo could not otherwise access. • Chapel m|m:unbvm City Schools u Orange onuwty Schools:me have partnered with sschools this year,with plans to nearly double this in the-coming year. These school partnerships occur at every|evo|' meetings with administrators,teachers,and curriculum coordinators pre and post all educational work with the schools • UnowxACP: LING partner m educational design and college implementation • oxapo/ mn Library, Coordinate nuvcununm| o,onm, including oral history umupu exhibits and educational workshops • Southern Oral History Program: Assists m oral history archive support and|mr|onmnuv" • NO Central University: Course partnerships to develop community archives and educational material • WUNC:Our staff has partnered with WUNC to create a Youth Summer Radio Institute,which featured works by two alumni ot our program and enabled these youth to have their stories reach over oo.000 listeners throughout the state vo Morning Edition. Additionally,mmNC has provided professional mentors tu come and speak m our youth participants o,the summer audio immersion program • um- josepx oMe oon,uh, First oaptim, St, Paul amE. and u000m High Alumni Association-, Partners in the m*aoun of the community teacher oemvom to assist in all neighborhood workshops and tours M Describe what would happen nrequested mnu/no is not awarded at all o,xa reduced annoounn is recommended. x funding was not awarded u,was reduced,ws would struggle to sustain the full staff support that we are able to olfer to our programs&to keep our programs free of cost to participants,which is a key way in which we ensure true diversity in all of our programming, Having said this,we would be determined to find a way to continue at capacity because of the importance of these projects to our collective community, V Include any other pertinent information. We are excited'to continue to deepen intergenerational leadership in the year to come and happy to answer additional questions eaneeded, Progrann/Prollect information j> Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff V Disclosure ov Potential Conflicts nf Interested must uasigned nu) Complete the Work Statement Chao to describe the work to be p*rfonnmd, and be ouna to attach copies oy all data collection tools that will bn used tp verify achievement ofprogram goals and objectives- Describe who will be responsible for monitoring progress. Main Application 1124/20105�04:30 PK4 � age 1V or 22 DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA2820B225 Exhibit A - continued Provider's WNIq119P 4qqMt1App1 i cation lnformatlon_to Complete 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 projectiprogram will serve, 2 Persons []Households ❑Units Learning Across Generations:Youth Leadership Program: &Education FProgram Beneficiary Demo raphics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 394 1 539 680 Female 453 733 872 Total 847 1,272 1.584 Of the females,how many are single- female Head of Households(Omit for Human Services) Ethnicity African-American X258 384 495 American Indian or Alaska Native 12 21 26 Asian 55 91 1 105 Caucasian 453 572 744 Native Hawaiian or other Pacific Islander 10 14 24 Other IF-3 5 5 Total E 847 1,272 1 1,584 1 Of the above,how many Hispanic/Latino i 76 105 1 184 Of the above,how many non- Hispanic/Latino 771 1,167 1 1,400 Total 847 1.272 j 1,584 Age 0-5 years 0 6 142 7 1- 5-18 years 665 936 102 19-50 year 96 185 244 51-61 years 62 101 139 62+years 24 44 57 Total F8_47 1,272 1 1,584 Geographic Location Durham Cilv 1 0 0 0 Durham County i 0 70 70 T_ Carrboro L205 327 405 Main Application 1/24/2016 5:04:30 PM 1 2 2- oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's O�d�I #nplication Chapel Hill 50-, 695 795 ooapemnpvblic Housing Residents N/A WA NIA Orange County (847 totat) (1202 total) (1,514 total) Raleigh Wake County Total 1,272 1,584 In -See following chart (Omit for HS) <oom Area Median Income 31-50%Area Median Income s1-00%Area Median Income "ao%Area Median Income mtai Special Needs(Omit for HS) Elderly(Over 62) Disabled(not elderly) Mume|oox People with HIV/Aids Tvta| -Please note:we have removed estimated numbers for mmmmua News&community events.which were previously included m our breakdowns m this mpplica«on we have done this t better track pro youth and education in-depth services- This makes our numbers significantly lower than in | applications,but not because ma lower reach o,inaccuracy n,reporting,but m more focused impact analysis on this program. Main Application 1/24120165:04:30 PYN 2 2 2 DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's 0 y1RI P%&RR�yAppl i cation CDBG&HOME ONLY- Area Benefit Activities(infrastructure and Public Facilities) Street Census Tract Block Grou i Total Persons #L MI 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 -F 4 6 7 8 Income 2 Level person people people people I people people people people 30%AM 1 514,150 1 $16,200 j $20,090 $24,250 $28t410 532,570 836.730 $40,890 50%AMI $23.600 $27,000 $30,350 I533,700 $36,400 [ $39,100 $41,800 $44,500 III $6Z55 80%AMI $37,750 1 543,150 548,550 $53,900 $58.250 66i850 571,150 0 5 —T 100%AMI 1547,188 1553,93$ 560,688 567,375 $72,813 $78,188 $83563 1151 AMI $54.266 562M8 $69791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www huduser.orglgortalidat4setslslltll�tFY2418 IL ne�d' Main Application 1124/2016 5:04:30 PM DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's %A! i%A_Vpq Application N k.) Schedule of Positions Please 'Include program staff positions followed by volunteer positions', these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e,, 8 Occupational Therapists can be inserted as one line item). If provided, indicate: Po ¢1° Position Titles (R) Position FTE Progra Actual Estimated i Projected %Total Retirement m Staff 2014-15 2016-16 2016-17 Budget Vacant Plan + (H)Health Plan Deputy Director 1.0 10% $34,350.00 640.000 1 541,00€3 i 12% NA $13,000 Director of (only first Operations 1.0 i 10% S31 255,01 quarter 1 $4000 9% NA Associate Director of Organizing& Advocacy 1,o 0 0 629,000 1 $33,000 1 9% NA (20141 7 -5 Assistant Director (2015). of Youth& 75 Education I 2016) 100% $15,247,84 620-000 $22.750 6% NA Administrative Associate/Office Manager .5 30% 57.203.24 $15,000 $20,000 6% N Coordinator of Education IS TA 1,13 100% 1 $2162.50 $5,700 1 $15.900 2% NA Coordinator of i Organizin g{VISTA} 1.0 i 0% $3700 851700 56,900 2% NA 0 $8,000 Program Interns 2.0 D% (4) 2% NA Contract Vanes i I Employees I 1.0 I peryr $10.620 1 $40,700 517,450 1 4% NA 1 Payroll Expenses $7.914.37 j 510,250 $10,250 3% NA ee, & me,,s 1 2.0 20% 0 0 0 Notes: Similar positions can be combined: i.e.8 Occupational Therapists can be inserted as one line item, 4. Full Time Equivalent staff will be noted as 1.00;halftime 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 112412016 5.04:30 PM oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's J\nplication !.} DISCLOSURE OF POTENTIAL CONFLICTS QFINTEREST Are any of the Board Members or employees o,the agency which will ua carrying out this project, or members of their immediate families,or their business associates: YES NO F] 7 o) Employees of or closely related to employees of the Town of Chapel H0. Orange County, carrbonp.or Hillsborough? u> Members of or closely related to members of the governing bodies of Chapel Hill. Canuono. Hillsborough, nr Orange County? �J *Current beneficiaries of the pnVunUpmg,nm 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 1s true and current. | acknowledge and understand that the existence ofm potential conflict mfinterest uv*a not necessarily make the project ineligible for yunmimg, but the existence of an awarded,undisclosed conflict mav result in the termination of aln grant Signature: Executive Director Date Signature: Beard ChairpersQrC Date Main Application 1124/20185:04:30PNl Pa�e 1 � of 39 oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued P[Ovider'G ARN Application m.) Work Statement This form io used un document program activities, program goals, performance memsunaa, and actual results. (Add more rows as needed) If this is a new pmgmm, 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 achievelaccomplish. Goals are statements about what the program should accomplish, SMART:�:ualu • Performance Measures describe how you will ems|ua»a the degree in which you mch|evod the stated goals. • Actual Program Results use program results to indicate the actual meoswmab|e achievement nf goals. |f goals were not met. please explain. **The chart link did not work and neither did embedding a new one, so our chart is attached as a separate pdfdocument. Ale apologize for the inconvenience. Main Application 1/24120185:04:30 PNi /" ^ume 1a or 2z � DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 _315 Estima - U@ Projected 2016-2017 Program -Piloted a youi�roj jdeO*v G(AgM" g'"sAppf' ti69rave Fusion Youth Radio Activity 1 audio immersion i and curriculum by starting a roress one] trainings y strengthening partnership I program with a mentor network that will assist in skills with wXYC-Chapel Hill to provide a series of skills- and issue-based trainings. consistent group of mentors expert in based workshops -Fusion Youth Radio will work intensively radio production. I i . F &conference i with high school students(3 sessions per -Fusion Youth Radio will provide j travel to i week)throughout the year,tracking weekly sessions that teach basic showcase youth I increased civic engagement and journalism,audio production,writing, iwork leadership,improving script writing, and civic engagement that lead to Provided twice- interviewing,performing,and poetry demonstrated improvement in script weekly mentor i skills. writing,audio production,and support for nearly -Increase outreach and recruitment of i storytelling. a dozen youth Fusion youth Radio to involve even more -Fusion Youth Radio will provide a Youth learn,to diverse youth from across the county, summer audio immersion program write,edit,& [ -Improve our online forums for Fusion that further nuances student skills,and I Produce 9 radio j Youth Radio in order to track listenership. provides even more opportunities to shows,as they i network with professional mentors. discuss issues [ -Fusion Youth Radio will provide relevant to them students with the skills necessary to I and receive full create a portfolio of student work that j training and i can be used in college applications and support other professional opportunities. Merge online forums in order to better track listenership. Program Goal j Fusion Youth Radio: I Fusion Youth Radio Fusion Youth Radio Measurably improve Measurably increase youth empowerment Measurably improve student the confidence,media (especially youth of color)and I performance,engagement,and career skills,and writing engagement In classrooms,as well as i readiness by connecting students with abilities of youth connecting them with elder mentors and i a knowledgeable and consistent participants solid skill-based trainings in history, network of elder mentors,providing media,and writing. trainings in history,writing,and social justice,and producing a cohesive portfolio of work that showcases student talent. Performance ' Intake&exit surveys Intake and exit surveys around civic -intake and exit surveys around civic Measures i participation,confidence,and media participation,confidence,media and literacy skills, literacy skills. -Mentors lead monthly workshops on -Mentors provide copious issues of social justice that increase opportunities for student feedback on I students understanding and engagement. curricula and program development so that the program is tailored for -Exit interviews with partner teachers one student success. month after workshops to track -Exit interviews with partner teachers qualitative outcomes, one month after workshops to track qualitative outcomes. Program Results i Over 90%of youth -751 of Fusion Youth Radio participants 75%of Fusion Youth Radio participants reported will show measurable increase of civic participants will show measureable improvement in media skills and confidence in their voices. , increase in civic media skills and Please note:in 2014-2025,we only had four primary goals established for our program,hence the N/A for a few of these current goals. DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's Outside Agency Application writing,confidence, -10 youth with strong audio production eonfiderice in their voice,. and civic media skills skills,radio journalism job training, i -15 youth with strong audio increased confidence and social justice production skills,radio journalism job consciousness along with deeper belief in ' training,increased confidence and the power of their own voices. social justice consciousness along with a deeper belief in the power of their i , own voices. j I -15 youth have developed a digital portfolio of interviews,audio pieces, ipitches,and other clips useful in future j professional development. Program Developed asecond- i -Develop a Professional Learning -Strengthen Professional Learning Activity 2 year curriculum for k- i Community at Northside Elementary(and Community at Northside Elementary, S to build upon our other schools wherever in Orange County) 1 collaborating in the fall of 2016 to first year partnership to provide increased access to funding for I achieve funding for the 2016-2017 with local schools. ? Civil flights and Oral History workshops. workshops. Partnered with at -Engage early planning with partner Utilize completed exit surveys from least two new schools teachers to fully incorporate Civil Rights 2015-2016,as well as planning for the first year and Oral History curricula into local meetings with partner teachers,to curriculum I history,American history,and social 1 update program resources and further 1 1 studies units. improve civil rights and oral history -Partner with Wilson Library,various curricula for Orange County Schools. historic societies,and Orange County Provide a range of multimedia Human Resources office to review and resources(photographs,video,oral l improve our civil rights curriculum for history interviews,music,and physical i Orange County schools, 1 artifacts)to strengthen both -Develop a resource packet for teachers 1 preparation and follow-up workshops. i and staff to enable sustained follow-up to -Utilize community-based public our workshops. history taskforce to review and Utilize our community-based public mon€tor all progress. [III history taskforce to review and monitor all Involve local elder citizens of color in progress. I all aspects of our civil rights Involve local elder citizens of color in all I workshops,especially local leaders aspects of our civil rights workshops, with schools with familial or historic especially connecting local leaders with connections. I schools with familial or historic incoeporate student volunteers where connection. necessary to further build the capacity ] -Showcase student work whenever of the programs. j possible to share with Northside -Showcase student work whenever community the outcomes of the possible to share with Northside j education programs. community the outcomes of the education programs- Program Goal Education I Education 1 Education Expand civil rights Deepen civil rights curriculum,sustain a Sustain a fourth year of support for curriculum to reach 3rd year of support for schools reached schools reached already,providing a additional school already,and provide full support and consistent and versatile curricula that partners i resources for school teachers and staff to grows student knowledge and j 1 sustain education work beyond our experience incrementally,and fully workshops. supports local history and social studies units. Performance «school partners -Engage in early planning meetings that -Using exit surveys and teacher DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's Outside Agency Application Measures provide the opportunity for evaluation feedback as a guide,engage in collaborative planning,and full integration planning meetings that further develop of Jackson Center curricula into social curricula,and provide opportunities studies and history units. for deeper student engagement -provide exit surveys upon completion of j through Civil Rights and Oral History i programs that gauge student programming. engagement,presentation and clarity of -Provide exit surveys upon completion I i materials,and effectiveness of program. of programs that gauge student A teacher and staff working group and engagement,presentation and clarity our Public History Task Force will monitor 3 of materials,and effectiveness of I the development of the resource packet. programs. A teacher and staff working group and our Public History Task f=orce will monitor the continuous development i I I of program materials and resources. I Program Results Two new school Complete Civil Rights in Chapel Hill I -Complete Civil Rights in Chapel Hill partners developed& curriculum and partner with a pilot school i curriculum and partner with j over 800 total 1 to reach at least 300 additional students. community schools to reach at least students reached [ -In close coordination with partner 500 students. throughout year i school,complete a 2nd year of vertical I -in close coordination with partner j curriculum for local civil rights and oral school,complete P year of vertical history with positive reviews and curriculum for local civil rights and oral educational outcomes, history with positive reviews and School partners will report in exit surveys educational outcomes. a marked increase in support from the -Through both initial planning resource handbooks. meetings and exist surveys,school i -24 senior citizens will be engaged actively partners will report a marked increase in our education efforts as school in support from the resources i i mentors,and teachers will report an provided,as well as a deeper level of improvement in school engagement,from engagement in Social Studies and youth of color. History units. -24 senior citizens will be engaged actively in our education efforts as i school mentors,and teachers will j report an improvement in school engagement from youth of color. -3 new senior citizens from the j community will be added to our j 1 community mentor team. Program N/A -Leverage connections within school -in close coordination with new Activity 3 administration,foundations,and current partners,complete 2"'year of new partner teachers to share the successes of i civil rights and oral history programs the Civil Rights and Oral History curricula, j with positive reviews and educational and forge new connections for further outcomes. programming. -Through both initial planning Schedule planning meetings with all new meetings and exit surveys,partners partners,establishing pilot programming I will report a marked increase in that supports fully History and Social support from the resources provided, Studies classes,and oral history projects, as well as a deeper level of -Provide a resource packet that enables engagement in social studies and both preparation for Civil Rights and Oral ? history units. DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's Outside Agency Application j i History programming,and enables follow- _ -our community mentor team will be j up work upon completion of workshops. fully involved in our educational efforts I Provide opportunities for feedback and as mentors,and teachers will report an analysis to grow programs for future improvement in school engagement I years. I from youth of color. i -New partners will be engaged fully in ! i the work of the Jackson Center,and i through initial education partnership will take part in other community i engagement events. i Program Goal N/A Education 1 Education Grow school partnerships to reach at least Sustain partnerships with four four new educational programs in the additional partnerships established in 2015-2016 year,a total of 200 students, the 2015-2016 year,adding one to two focusing specifically on county schools, additional par Hers in 2016-2017, low-income youth,and students from high-need communities. I Performance N/A -Engage in early planning meetings that Using exit surveys and teacher Measures provide the opport unity for evaluation, feedback as a guide,engage in I collaborative planning,and full integration 3 planning meetings that further develop of Jackson Center curricula into social j curricula,and provide opportunities studies and history units. for deeper student engagement -Provide exit surveys upon completion of through Civil Rights and Oral History programs that gauge student programming. engagement,presentation and clarity of 1 -Provide exit surveys upon completion materials,and effectiveness of program. of programs that gauge student A teacher and staff working group and engagement,presentation and clarity our Public History Task Force will monitor of materials,and effectiveness of the development of the resource packet. programs. -A teacher and staff working group and our Public History Task Force will I monitor the continuous development of program materials and resources. Program Results i N/A -Develop 4 new sustainable partnerships -This year will have firmly established that strengthen and grow the reach of at least 8 school and educational i Civil Rights and Oral History curricula, i partnerships benefiting from the -Through these additional partnerships, i Jackson Center Civil Rights and Oral grow the resources and program materials History curricula. available for all existing partnerships. An array of materials,resources,and iprograms will be available to all community partners. Program 3 NIA -in the fall of 2015,partner with teachers { -Building upon the planning work of Activity 4 i to evaluate and explore Social Studies and 1 previous years,explore further ways to History units,taking into consideration i incorporate appropriate learning I Common Core standards,skill mastery, standards into the Civil Rights and Ora) and student achievement levels. History curricula,helping to grow skill -Work with teachers to establish which mastery,and student achievement skills and materials they hope to master levels. through civil rights and oral history -Work with teachers to further focus j workshops. the design of workshops to increase -Create challenging programs that address ' student mastery. DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's Outside Agency Application these standards and learning outcomes, Design assessment tools to gauge the I i and utilize community support and effectiveness of programs in achieving volunteers to fully execute these established learning goals, programs in classes. Update program materials as -Offer intake and exit surveys that allow i necessary to address these standards E teachers to gauge workshop effectiveness, and learning outcomes,further and provide suggestions for future incorporating community teachers and growth. volunteers to execute programs I successfully, I € -Offer intake and exit surveys that allow teachers to evaluate workshops, and provide suggestions for growth. Program Goal I N/A Education Education Increase level of reported student Continue to increase student's engagement in Social Studies and History = engagement in Social Studies,History, I classes after experiencing Jackson Center and Literacy by incorporating 6 programs,and incorporate 4-6 i appropriate Common Core standards appropriate Common Core standards and and skills into the design of grade level skills into the design of grade level workshops,and setting clear learning workshops. objectives for students to work towards. Performance N/A i -Early planning meetings that allow i -Early planning meetings that allow Measures teachers to set clear goals in collaboration teachers to set clear goals in with Jackson Center staff. collaboration with Jackson Center -intake and exit surveys that provide staff. numerous opportunities for feedback, -Intake and exit surveys that provide suggestions,and analysis of strengths, numerous opportunities for feedback, suggestions,and analysis of strengths. Program Results N/A j -Teachers report 75%greater engagement -Teachers report 751 greater with social studies and history units. engagement with Social Studies and Increased attention to North Carolina 3 History Units, education standards and Common Core I -increased attention to North Carolina strengthens education programs,and I education standards and Common increases relevancy to student growth and Core strengthens education programs, development and increases relevancy to student growth and development. Program N/A -Strengthen partnership with WYYC- p{ Continue to grow partnerships with Activity S i Chapel Hill by recruiting 4 student DJ's to [ WXYC-Chapel Hill by permanently serve as mentors for Fusion Youth Radio. establishing staff presence on the Recruit 20 UNC student volunteers to Fusion Youth Radio mentor team. i serve as tour guide assistants for field -Develop and update orientation trips,and to help process oral history materials for student volunteers, i interviews. ncluding creating a manual for Oral j -involve at least 24 elderly neighbors in History processing,teaching the civil the education efforts,and participate in ; rights curricula,and suggested school interviews, readings. -Develop a volunteer orientation for both ; -Further incorporate Northside student volunteers and elderly neighbors neighbors into education efforts that allows participants to share through tours,interviews,and j experiences,collaborate,and establish workshops,and add 3 new members i intergene rational connections. to the community mentor team. DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's Outside Agency Application -Sustain connections with current student and community volunteers, and recruit new participants as necessary. Program Goal N/A Education/Fusion Youth Radio/Oral Education/Fusion Youth Radio/Oral History Trust History Trust I Increase University and community Incorporate volunteers into all aspects support and engagement by building a of education programs,training 1 sustainable volunteer base to help volunteers to help facilitate I facilitate civil rights and oral history workshops,and providing education programs,as well as Fusion opportunities for WXYC staff to Youth Radio. facilitate audio production work shops in Fusion Youth Radio sessions. Performance N/A -Student volunteers complete intake and -Ali students receive orientation Measures exit surveys about program interests, materials,and complete volunteer experience,and availability. orientation. -All student volunteers participate in -Student volunteers complete intake volunteer orientation. and exit surveys about program interest,experience,and availability. Program Results N/A -Out of 14 new student volunteers -24 community members remain recruited and eight commit to regular involved in education efforts,3 new participation in Jackson Center education partnerships are added. programming. At 4 WXYC staff remain involved -Elderly neighbors continuously eng pge in on, a permanent basis throughout education programs as able,and report Fusion Youth Radio. improved quality of lif e asa result of -Orientation materials are complete. participation, I Program Develop a I -Develop a neighborhood tour team in -Continue to grow the neighborhood Activity 6 i neighborhood tour I Northside to Participate in all education tour team in Northside to participate team in Northside to workshop tours that are carried out I in all education workshop tours that participate in all Partner with Lincoln High Alumni are carried out, workshop tours that Association,the Senior Center,and RENA -include current volunteers in are carried out to reach new partners connected to the I recruitment efforts for neighborhood Partner with Lincoln civil rights struggle,growing the resources tour team, i High Alumni available for education programs. Engage Bonner Leaders and student Association,the -Conduct an additional dozen intervie ws' volunteers I from the UNC NAACP and ' Senior Center,and I connecting aging resident leaders with other activist organizations to grow RENA to reach new student learners, both the Civil Rights in Chapel Hill and pa tners connected to Black Lives Matter oral history series, ; the civil rights struggle i Providing opportunities to connect I Civil Rights struggles of the past with events today in school workshops. Program Goal Engage 30 unreoched I Oral History Trust Oral History Trust senior citizens in their Engage 30 unreached senior ris in Continue inue to expand the Jackson histories and role in their histories and role in educating future 'Center's Oral History Trust by educating future generations,Finish processing 15 new oral performing at least 5 new interviews generations histories. i I that grow the Civil Rights in Chapel Hill and Black Lives Matter series,continue to involve 30 reached senior citizens in education efforts,and engage 3 new elderly neighbors in educating future� DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's Outside Agency Application generations, Performance #seniors actively Quality of life interviews will be nterviews will be processed and Measures I engaged in conducted with elder leaders who are included as part of the Jackson Center ntergenerational involved in our various efforts. oral History Trust. education iniatives -Interviews will be processed and included Quality of life interviews will be as part of the Jackson Center Oral History conducted with elder leaders who are i Trust, involved in our various efforts. Program 36 unreached seniors -out of 30 reached,at least 20 will report -Out of 38 reached,at least 28 will Outcome involved in ongoing quality of life improvement as a result of 1 report quality of life improvement as a j education work various education and history efforts. result of various education and history ��� _- efforts. oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's plic8tion 4. FINANCIAL INFORMATION FOR SERVICE PROGRAMS a.) Program Budget Please oom p�ta 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 tho pnogram'afinencoo experienced significant changes that you would like to oxp|ain, please use the space below. It is required that your Excel budget worksheet be embedded on the next page- You must also submit an e|en|nnn|o copy of the KHG Excel file with your application. as o separate 0e. Main Application 1124/2016 5:04:30 PM DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's qyAMH-p Aqf�a%Mkppl i cation Program Budget AgencyiProgram; Learning Across Generations; Youth Leadership&Civil Rights Frif—finn 1 Actual I Estimated Projected Percent i I AGENCY REVENUE 1 2014-15 2015-16 2016-17 Change Private Donations S C,600 S 7 6'; Agency Generated Revenue(fees) i S 3,475 000C $ 2.Cti0 20% Local Government Grants: - Orange County S 6,0001 1 $ 8.000 _ � Oco 1 25%1 Town ol Chapef H 1j S ury i 4 0 S -A jC0 1 300%1 S S 2,50-0 5 3om 1 Town of CaP Dora 750, Other vocal: r o I Other 0, r O-kher r i-i—th- Plea-p7c_e S�Parat&lisi, Non-Local Government Grants Tnande Uni Cd'Vay Stale Go ve,.ent C Fecera!Govemrren, Cl Othe,Gran!s, FOUrd2l.-IOr'.Gre-MIS n- 2-5-A-000 1 iu;Z�IW 1 S 22.5-00 O„her Gmnts: NC Humanities Courict! 2 000 5�000 S 2M0 -6:-1%1 Miscellaneouslother Revenue Total Agency Revenue 44.422$ S 49,600 $060,500 2 2—'%,-, AGENCY EXPENSES low I Compensation S `t7.2 0 1 _5 32.550 14�� Rent&Utilities 4�976 1 5 5�51-! S 5.95? Supplies&Equipment S 1,554 S 4.038 i $ 5,500 3C',, Travel&Training $ 3.84e. s 2,500 S 4.500 Other Expenses: 31610 S 1500, 111 5 2. 0 3= _% f5" P,ni n g a n d Copying somvs,e Total Agency Expenses $ 49,275 S 50,799 S 60,500 SURPLUSI(DEFICIT)FOR PERIOD: L-L__(4-852) $ 100% DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's AqWMN4ppi ication Main Application 1/24,2016 5:04:30 PM 9 o- DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued ProviderOAIRLOO Aq8ncy Application tA b.) Program Budget Detail What is the cost to deliver your projectiprogram? Lis"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 dost OY subtotal P, 1,1�0,st F quaM1ty1Un*o1fM"$U Credit Counseling Teacher—in class $25 96 hours(6 hrslmth x f2 months) i $2,400 Credit Counseling Teacher--class prep $25 48 hours(4hrslr7th x 12 mths) 7 z Uu Credit Counselor--cane-on-one 520 120 hours 110 firs/inth x12 mths $2,409 Materials $25 f20 course packets1credit reports $37000 Total j $9,000 Program: Learning Across Generations: Youth Leadership & Civil Rights Education t-ost F_w�l,44 Quantiltviunit uire" Assistant Director of Youth&Education I $131hour 75 time at S1 31hr $22.754 Coordinator of Youth&Education(VISTA) 55,700(fee) 2.000 coordination hours $5.700 Additional staff pro2ram time S1311hr 700 staff hours for mentors 59,100 Youth Conferences&Training $4,500 Cost of AMC for FYFR Youth $4.500 Program materials:audio&tech equipment 55,500 Cost of equipment $5.500 Printing.Software,Miscellaneous $2,000 Education materials software 52.000 Shared cost allocation % total 1 rent,payroll,admin 510,950 Total $601500 c.) Cost per Unit, "Please note:we have removed estimated numbers for Northside News&community events,which were previously included in our breakdowns in this application, 'V'Ve have done this to better track progress on youth and education in-depth Dth services. This makes our numbers significantly lower than in previous applications,but not because of a lower reach or inaccuracy of reporting.but a more focused impact analysis on this program. AVtuOJ,201471$- J_ESt1 tit 0d,9O1616 I PrOJOCWO, -17 Total Cost of Program 1 $49,275 1 $50,799 I l $60,500 Total#of Units 1 847 1272 i 1584 Cost Per Unit 1 $58.17 J $39.94 1 $38.19 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 vilith report submittals from previous years (if applicable). go Main Application 1t2412016 5:04:30 PM oocunignsnvelopo 0:oeoee1a4'one7-4aca*nrA-CmnAcocoeeco Exhibit /\ - continued Provider's �«pplication d.) Agency Operating Budget Please show all nounma and amounts of funding for your entire current fiaoa| year. What is your agency's fiscal year? Example: July 1.2o16 through June OO.2O17 July 1.ou15-June3o. 2015 It is required that your Excel budget worksheet be embedded onthe next page. You must also submit an electronic copy ufthe MS Excel file with your application. as o separate fi|e- ~~p}mano note: Our budget this year is higher than next years due to several specific sources of income/expenses that likely will not berepeated. We received a grant($40.000)to purchase van for Heavenly Groceries. the ropu Justice pnogram at St. Joseph that we support. We also opntemod with an agency fora $90,000 community planning effort, much of which was additional staff capacity and contract services for a limited period of time (completed this year). Finally, we have a S75,000 grant frorn the Town of Chapel Hill, 100%of which is invested into home repairs. Main Application 1/24/2018 5:04:30 PM F egs 3 1 of 2 � DocuSign Envelope ID:C8D98134-3597-4323-98FA-COCA282OB225 Exhibit A - continued Provider's Rmf�wpew%m Application Semon VL Fmancial Data Comparative Budget for EmCm AGency AGENCY NAME- The Maran Check Jackson Ce-ter fo;Savin u and Making History Act—W EshmWled Pmjazzed AGENCY REVENU E 2014-15 2011.17 16 T5C, 5 21 1, Z; .age-:.._ Rvyer-je ftew Loczi Go-emme�t Grar-!f-, S 0 C U S 1,cCo S 7t zcu r N�n-Lo,zl Sowcfnm�M Grams W ing e�n ily - W A S� T- ZW r Thtal Age-.,�-y Revenue 'S 197,M 444 M 35'.500 AGENCY EXPONSES Cpmrermalivn 2 t I S ��U 25;) Rem&Ubfibe. Z Sur, Hes Eaulment S 15 n,- pl —696 a Tfa.e'&Training $ 3,t45 i S t 5CU, i r Chher Expenses- < 539 -41, MEN I Su', i 21-,,11QK Totaw Agency Expimsss S Z5t amt -21% -SURPI USAD-EF9CM FOR FERRO V- Main Application 112412016 5:04:30 PM DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Marian Cheek Jackson Center for Saving and Making History Funding Award: $10,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Salaries—Program Support Expenses 10,000 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. • Measurably improve student performance, engagement, and career readiness by connecting students with a knowledgeable and consistent network of elder mentors,providing trainings in history, writing, and social justice,and producing a cohesive portfolio of work that showcases student talent. • Sustain a fourth year of support for schools reached already,providing a consistent and versatile curricula that grows student knowledge and experience incrementally, and fully supports local history and social studies units. • Continue to increase student's engagement in Social Studies, History, and Literacy by incorporating 6 appropriate Common Core standards and skills into the design of grade level workshops, and setting clear learning objectives for students to work towards. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Youth participants will show measureable increase in civic media skills and confidence in their 75 % voices. Strong audio production skills,radio journalism job training,increased confidence and social 15 Youth justice consciousness along with a deeper belief in the power of their own voices. Teachers report greater engagement with Social Studies and History Units. 75 % Community memebers remain involved in education efforts 24 #school and educational partnerships receiving oral history&civil rights education workshops 8 partners �1DocuSigned by: 7� tht SbbL U4 Senior Director 11/2/2016 Certified by: nR,Q,RCIR, Title: Date: (Provider's Signature) DocuSign Envelope ID:C8D98134-3597-4323-98FA-C0CA2820B225 MARICHE OP ID: DR CCARJ:)' ATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE D08/18/2016 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 Phone: 919-682-4814 CONTACT Lee Hammond The Sorgi Insurance Agency Fax: 919-682-4906 PHONE g19-682-4814 FAX 16 Consultant Place Suite 102 (A/C,No,Ext): (A/C,No): 919-682-4906 Durham, NC 27707 E-MAIL lee@sorgiinsurance.com James E.Sorgi,CIC ADDRESS: g INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Erie Insurance Exchange 26271 INSURED Marian Cheek Jackson Center INSURER B:Westchester Fire Insurance Co for Saving and Making History 512 West Rosemary St INSURER C: Chapel Hill,NC 27510 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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 I SR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X Q970503239 08/15/2016 08/15/2017 DAMAGES( RENTED 1,000,000 PREMISES(Ea occurrence) $ CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) A ANY AUTO X Q970503239 08/15/2016 08/15/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE Q921501020 08/15/2016 08/15/2017 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 B Professional Liab. G27096566001 11/05/2015 11/05/2016 Prof Liab 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Town of Chapel Hill and Orange County are named as additional insured in regard to General Liability CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Risk Manager ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD