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2016-656-E Finance - OC Partnership for Young Children - Outside Agency Performance Agreement
DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 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 Orange County Partnership for Young Children, a not-for-profit corporation, located at 120 Providence Rd, Suite 101, Chapel Hill,NC 27514 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Orange County Partnership for Young Children 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 3500. 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 $ 875. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (Orange County Partnership for Young Children) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 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. (Orange County Partnership for Young Children) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 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. (Orange County Partnership for Young Children) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 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 Orange County Partnership for Young Children 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: (Orange County Partnership for Young Children) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 County: Finance&Administrative Services Provider: Orange County Partnership for Orange County Young Children Post Office Box 8181 120 Providence Rd, Suite 101 Hillsborough,NC 27278 Chapel Hill,NC 27514 16. E ntire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For I' p �i4ihelf of the Provider ��p rbllt/t eviNktr 11/3/2016 91 ARF4n47nn944R Date For an Robehn of Orange County Government 1561A,LAAt, AAAtwtLV'StUi 11/15/2016 0637994B755E477... Bonnie Hammersley, County Manager Date (Orange County Partnership for Young Children) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 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: ��pp r66, PVINktr 11/3/2016 Certified by: 91A8F404700944B Title: Executive Di rector Date: (Provider's Signature) (Orange County Partnership for Young Children) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 Exhibit A Provider's Outside Agency Application A. APPLICATION SU MITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Orange County Partnership for Young Children Date/Time Program(s) Transplanting Traditions Community Farm Section For CDBG & HOME - Subsection HUD Regulations 1. Cover Page a. Applicant Contact Information b. 1 Project/Program Contact Information C. 4 Funding Requests Identified d. i4 Signed Application Cover Page 2. Agency a. Z Agency's Years In operation 24 CFR 570,506, Information - b. L Agency's Purpose/Mission 570.507, 570.610 24 CFR Parts 84 or 85 c. 4 Agency's Types of Services Provided d. 4 Agency's Experience e. Z Other Pertinent Information 3. Program/ a. Type of Application and Program Identified 24 CFR 570.200(a), Project b. Summary of Program 570.201-570 208, Information - c. Description of Identified Need (for each d. I1 Description of Population to be Served program/ e. M Activity Manager and Location Description project for which funding f. Z Activity Implementation Timeline is requested) g' Agency Collaboration h. Z Describe Impact of Reduced/No Allocation i. Other Pertinent Information j. D:j Complete Target Population/Beneficiary Chart k. Z Complete Schedule of Positions I. Z Signed Conflict of interest Disclosure m. 4 Complete Work Statement i I I 3 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION 24 CFR 570.200(a), 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, each expenses for the entire program and ALL sources of 507.503 program/ funding. 24 CFR 570.506, project for 570.507, 570.601, which funding a. Program Budget Worksheet 570.602, 570.607(b), is requested) b. IA Program Budget Detail 570.611 24 CFR c. I Cost Per Unit 570.502-570.504, d. Agency Operating Budget Worksheet 570.506, 570.507, 570.610; 24 CFR Parts 84 or 85, and OMB Circulars A-87 or A- 122; Treasury Circular 1075 5. Supplemental A. E Part A: CDBG & HOME Sections (as B. H Part B: Construction/Rehab applicable) 6. Attachments a. I i 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. Z IRS Federal Form 990 c. ' NC Solicitation License d. 1 4 IRS Federal Tax-Exemption Letter e. Certificate of Insurance f. P4 List of Board of Directors 24 CFR Parts 84 or 85 g. Articles of Incorporation/Bylaws 24 CFR 570.208, h. ' Authorization to Request Funds 570.500(c), 570.611 i. EZI Authorized official designation j. I Solid Waste Program Fee (SWPF) Verification Main Application 1/25/2016 10:25:47 AM DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 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: Orange County Partnership for Young Children Applicant Organization's Physical Address: 120 Providence Road, Suite 101,, Chapel Hill, NC 27514 Applicant Organization's Mailing Address: 120 Providence Road, Suite 101, Chapel Hill, NC 27514 Applicant Organization's Web Address: www,orangesmartstarLorg Executive Director: Robin Pulver Telephone Number: 919967-9091 E-Mail: r_pulver@grangesmartstart,orq DUNS Number: 007892730 (Dun & Bradstreet, Inc provides this number at no charge, and it is required for Federal funding recipients.) b) Project/Proqram Contact Information Project/Program Name: Transplanting Traditions Community Farm Project/Program Primary Contact and Title: Kelly Owensby, Project Director Telephone Number: 919-967-9091 E-Mail: kowensbyAorangesmartstart.orq c) Funding Request Identification Total Project/Program Cost: $171,592 Total Amount of Funds Requested: $15,000 Proposed Use of Funds Requested (2-3 Line Maximum): Funds will be used to support costs associated with staffing and contractual services to serve the Transplanting Traditions Community Farm for Burmese refu.ees, Contractual services include a native Burmese translator. 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) $ Grant Ej Loan El] CDBG Construction (CH) 1:1 Grant Loan E] HOME CHDO (OC) E Grant 11 Loan 1:1 HOME Other (OC) E Grant E Loan Z Human Services: r Carrboro $5,000 Z Chapel Hill $5,000 Z Orange County $5,000 d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: 1/25/16 Executive Director Date Signature: 1/25/16 Board Chairperson Date Main Application 1/25/2016 10:25:47 AM DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 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: 22 years Date of Incorporation: August 1993 b) Agency's Purpose/Mission The mission of the Orange County Partnership for Children (OCPYC) is to ensure that all young children arrive at school healthy and ready to succeed. c) Types of Services the Agency Provides The Partnership has served as the administrator for the Smart Start Early Childhood Initiative and the NC Pre-K program in Orange County since 1993. Our programs concentrate on early childhood education, children's health, early intervention, parenting education, and family support, The TTC Farm focuses on serving low-income families in the refugee and immigrant community by providing refugee adults and youth access to land, healthy food and agricultural and entrepreneurial opportunities. The farm provides a cultural community space for families to come together, build healthy communities and continue agricultural traditions in the Piedmont of N.C. According to 2015 data, 75% of families served by TTC Farm are considered low income based on the U.S. Federal Poverty Guidelines. The Farm is designed to collaboratively and comprehensively address the issues of obesity, economic instability and food insecurity. The TTC Farm is located outside of Chapel Hill and Carrboro just 4 miles from the largest refugee neighborhood in the county. d) Agency's Experience with Similar Programs as the Funding Request In Spring 2007, OCPYC, concerned with issues of childhood obesity and food insecurity, launched the Healthy Kids Campaign with the start of 3 community gardens that provided gardening, nutrition and outdoor education programming to low-income families, with 90 percent refugee and immigrant families. These became known as the Growing Healthy Kids Community Gardens. In 2010, OCPYC received the Refugee Agricultural Partnership Grant from the Office of Refugee Resettlement allowing 14 refugee families to move from the Growing Healthy Kids community gardens to Triangle Land Conservancy land, forming Transplanting Traditions Community Farm (TTCF). TTCF is entering its sixth year of operation on 5 acres, directly supporting 28 refugee families or 119 individuals and 1,141 additional refugee individuals who receive fresh traditional produce grown by TTCF farmers on a regular basis. e) Other Pertinent Agency Information The Orange County Partnership for Children was founded as a nonprofit agency in 1993 and was the first Smart Start agency in the state. OCPYC has been operating for 22 years with the mission to ensure that all young children arrive at school healthy and ready to succeed. We accomplish this mission through developing programs, funding evidence-based programs within the community, and providing information to our community. We have been involved with health-related initiatives, including the community gardens mentioned above. The Healthy Kids Campaign sought to ensure that children were provided with opportunities for healthy eating and exercise through working with child care providers and caregivers to develop strategies for better nutrition and active play. We have been a partner with the North Carolina Partnership for Children and the Blue Cross Blue Shield Foundation of North Carolina for over 3 years in implementing SHAPE NC, a program that works with child care providers to improve nutritional offerings, exercise through active play, and Main Application 1/25/2016 10:25:47 AM H 4 , DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION enriching activity through building outdoor learning environments. We have expanded this program to serve 9 centers, and we plan to add several centers for 2016, Main Application 1/25/2016 10:25:47 AM P 9 5 0 2 1 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION . . 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Orange County Partnership for Young Children—Transplanting Traditions Community Farm As you complete your application, complete only those sections that pertain to the type of application you are submitting. The application is divided into several sections and not all sections apply to every project. Every applicant MUST complete the main application. a) Check the type of funding request for this application package submittal and complete the required application and required supplemental sections (Parts) as specified below: Human Services (Main Application Only) E CDBG Non-Construction — (Main Application AND Part A) E CDBG Construction — (Main Application AND Part A AND Part B) ii HOME CHDO Set-aside — (Main Application AND Part A) L HOME Other — (Main Application AND Part A AND Part B) Indicate the type of program for which you are requesting funding: Program Category Youth Adult Elderly Disabled Public Housing (not elderly) Neighborhoods/Residents Education Health and Nutrition x Job Training Sports and Arts Activities Pre-School Activities x After-School Activities Mentoring Transportation Housing —Other: Leadership and Conflict Training x Program/Project Descriptin_(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? Funding for this program would support initiatives that address childhood obesity, food insecurity, and economic instability in Orange County. These issues adversely affect the refugee and immigrant communities in Orange County, specifically in Chapel Hill and Carrboro, North Carolina resettles some of the highest numbers of refugees each year. Although the population of Chapel Hill/Carrboro makes up less than 1% of the total population of N.C,, over Main Application 1/25/2016 10:25:47 AM DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION 10% of the total refugee population from Burma lives in this area. The TTC Farm focuses on serving low-income families in the refugee and immigrant community. Services proposed include the continued access to land to grow healthy traditional foods, weekly translated workshops focused on agricultural topics and small farm business development and youth programming focused on nutrition, active living and leadership development. In addition services include "Share a Share" program in collaboration with PORCH, which provides traditional vegetables for 114 refugee families in need on a monthly basis while providing economic support for TTCF farmers, 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. Funding priorities of the Board in 2016-2017 include safety-net services for disadvantaged residents; education, mentorship, and afterschool programming for youth facing a variety of challenges and programs aimed at improving health and nutrition of needy residents. OCPYC is requesting funding specifically aimed at improving the health and nutrition of refugee residents in need. OCPYC has provided and expanded these services since the farm's inception in 2011. Studies of other refugee and immigrant communities in the U.S, have shown high rates of obesity in resettled refugee children which may be based on stress, food insecurity, caregivers' unfamiliarity with local food culture, poverty and lack of access to familiar food items. The earlier families can be reached, and these barriers addressed, the more successful and healthier families will be. Childhood obesity and weight continue to be prevalent issues in Orange County, statewide and nationally. According to the 2012 North Carolina Nutrition and Physical Activity Surveillance System (NC-NPASS), Orange County had an overweight/obesity rate of 30.1% for children 2-4 years of age. This puts the county 61st overall in overweight percentage and 47th in obesity out of 100 counties. Research shows that weight gain begins within ten years of immigration. (Obesity Among US Immigrant Subgroups Duration of Residence, Goal, McCarthy, Phillips, Wee, JAMA, 12/15/04-V01 292, No. 23) Transplanting Traditions Community (TTC) Farm strives to address the needs of the entire family through providing a space to grow healthy, culturally appropriate foods and provide educational workshops on nutrition and healthy eating. Access to culturally appropriate fresh food directly impacts the daily diets and health of those involved with the project. Based on data collected in 2013, 95% of refugee farmers with TTC Farm reported their families were able to eat "a lot" more fresh fruits and vegetables as a result of farming with TTC Farm. This is also specifically due to families able to grow culturally appropriate and familiar vegetables that are otherwise hard to find in NC. According the U.S. Census, North Carolina has significantly higher food insecurity rates (17.1%) than the national average (14,7%). Over a quarter of minorities, which include refugees and immigrants, are classified as food insecure by the USDA making the work of the TTC Farm crucial. Refugee farmers with TTC Farm are able to both increase supplemental income through selling produce as well as increase fresh fruits and vegetable intake by growing food for their families to consume. In order to make the fruits and vegetables grown on the farm more accessible to the greater refugee and immigrant community farmers market produce within in their own community, sales of traditional produce in 2015 reached $10,000. In addition TTCF formed the Share a Share program in collaboration with hunger relief agency PORCH in order to get more fresh traditional produce to refugee families in need. The program donated 1,200 pounds of traditional produce to PORCH and supported 114 refugee families. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. Main Application 1/25/2016 10:25:47 AM H DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION The TTC Farm focuses on serving low-income families in the refugee and immigrant community. The Farm is designed to collaboratively and comprehensively address the issues of obesity, economic instability and food insecurity. The TTC Farm is located outside of Chapel Hill and Carrboro just 4 miles from the largest refugee neighborhood in the county. The location of the farm allows for increased accessibility and regular attendance to programming directly, correlated to the success of the program and significant program growth each year. Beneficiaries are identified through referrals within the refugee community and from refugee support agencies. Data is collected through intake interviews and end of year evaluations with each family. e) Who specifically will carry out the activities and in what location will they be carried out OCPYC supports the TTCF program with 2 full time and 1 part time staff, as well as a contracted cultural liaison and interpreter. A majority of the activities will be carried out at the Transplanting Traditions Community Farm on Jones Ferry Rd and in Carrboro and Chapel Hill at various training spaces and area farmers markets. f) Describe specifically the period over which the activities will be carried out, the frequency with which the activities will be carried out, and the frequency with which services will be delivered. Include an implementation timeline, Activities and services are carried out year round. Translated classroom workshops focused on agricultural topics, finance, business planning, conflict resolution and leadership occur Jan-Feb twice a week, Hands-on, on-farm workshops occur March-November twice a week. Share a Share program food distribution occurs monthly during the farming season. Referrals and connections to service providing agencies occur year round. Youth programming for young children occurs weekly during summer months. Teen programming occurs on an event basis one to two times per month during the school year and weekly during summer break. 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. • Triangle Land Conservancy (TLC): Provides land, infrastructure, and support in expansion. A unique collaboration, the only of its kind between a land conservancy agency and a non-profit educational farm in the state. • KCNC (Karen Communities of North Carolina): Helping to connect with local refugee families. • PORCH (People Offering Relief for Chapel Hill and Carrboro Homes): TTC Farm both donates and sells produce from the farm to PORCH. PORCH provides service opportunities to teen program • Art Therapy Institute: Event collaboration and client services overlap • Conservation Fund and Resourceful Communities: Provides strategic planning and fundraising support to TTCF. • Carrboro Farmers Market: Support for teen program and marketing education • Chapel Hill Farmers Market: Support for farm marketing • Chapel Hill Carrboro Youth Forward: Resource and network for other youth orgs • CEFS (Center for Environmental Farming Systems): Resource and network for racial equity training and agricultural support • NC FYI (North Carolina Food Youth Initiative). Teen program support • CFSA (Carolina Farm Stewardship Association): Farm tour and public outreach support Main Application 1/25/2016 10:25:47 AM DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION • RAFI (Rural Advancement Foundation International): Promotion and support of new farmers • UNC Chapel Hill: School of Social Work field placement intern and School of Public. Health and APPLES intern program • Chapel Hill Service League: Volunteer and funding support • Chapel Hill/Carrboro Sunrise Rotary Club: Volunteer and advocacy support • PORCH (People Offering Relief for Chapel Hill and Carrboro Homes): TTC Farm both donates and sells produce from the farm to PORCH. PORCH provides service opportunities to teen program • Conservation Fund and Resourceful Communities; Provides strategic planning and fundraising support to TTCF, • Carrboro Farmers Market: Support for teen program and marketing education • Lantern Restaurant— Fundraising, marketing collaboration and cooking classes h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. This funding helps to ensure that our staffing is supported and that we can retain our translator/interpreter. The translator is critical to the operation and function of the farm. With a reduced allocation, we would steer human services funding toward supporting the translator/interpreter and seek other sources of funding for other personnel. i) Include any other pertinent information. Program/Prolect 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 performed, and be sure to attach copies of all data collection tools that will be used to verify achievement of program goals and objectives. Describe who will be responsible for monitoring progress. Information to Complete j.) Target Population Complete the following tables to the best of your ability, Show numbers of participants and percentages, as applicable, in each category. Please indicate whether this project/program will serve: A Persons LIJ Households E Units Program: Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 491 496 501 Female 490 495 500 Total 981 991 1,001 Of the females, how many are single- female Head of Households (Omit for Human Services) Main Application 1/25/2016 10:25:47 AM ' DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 i /\ - continued Provider's Outside Agency Application MAIN APPLICATION Ethnicity African-American American Indian or A}aska Native Asian 981 991 1001 Caucasian Native Hawaiian or other Pacific Islander Other Total 981 j 981 / 1081 ' Of the above, how many ' � ' ' � � � � � Hispanic/Latino - Of the above, how many non- Hispanic/Lnbno Total 0 0 0 Age 0-5 years 98 100 102 6-18 years 415 417 419 19-50 years 361 363 365 51-61 years 78 80 82 62+ years 29 31 33 � � | Total 981 991 1001 Geographic Location Durham City Durham County | Canboro 384 387 390 Chapel Hill 529 534 539 Chapel Hill Public Housing Residents ? ? ? Orange County 68 70 72 Raleigh Wake County Total . 381 991 1,001 Income Level—See following chart (Omit for HS) < 30% Area Median Income 31-50% Area Median Income 51-80% Area Median Income > 80% Area Median Income Total 0 � 0 Special Needs (Omit for HS) Elderly (Over 62) Disabled (not elderly) Homeless People with HIV/Aids � Total � 0 0 0 Main Application 1/25/2016 10:25:47 AM DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 i /\ - continued Provider's Outside Agency Application MAIN APPLICATION * This increased number is based on two additional pieces of data. 1) TT[ Farm's participating farmers regularly sharing produce (1x week), during the growing season, with extended family, friends and neighbors in the refugee community. 2.) Number from a new hunger relief program "Share a Share" in partnership with PORCH. , an all-votunteer, grassroots hunger relief organization whose mission is to collect and distribute food for families going hungry in the Chapel Hill and Carrboro, in order to serve more refugee families experiencing food insecurity in our local community.The program was piloted July November with great success, with $3,320 in donations from 36 community members. These funds were then used to purchase fresh, traditional produce from TTCF farmers. Over 1,200 lbs. of traditional produce grown by TTCF farmers such as rosette, water spinach, pennywort, water gourd and pumpkin was then donated to PORCH to feed 118 refugee families (1 x month). Numbers are significantly higher than the numbers reported in the funding application in January 2015 Main Application 1/25/2016 10:25:47 AM DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION CDBG & HOME ONLY - Area Benefit Activities (Infrastructure and Public Facilities) Street Census Tract Block Group Total Persons #LMI Persons 2015 Area Median Family income Limits U.S. Department of Housing & Urban Development (HUD) 2015 Area Median Family Income Limits Effective March 15, 2015 Income 1 2 3 4 5 6 7 8 Level person people people people people people people people 30% AMI $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 50% AMI $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 80% AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 100% AMI $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115°/0 AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www.huduser.orp/portal/datasets/i1/01 51FY201 5 IL nc.pdf Main Application 1/25/2016 10:25:47 AM ( , DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION k.) Schedule of Positions Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). If provided, indicate: Position Titles FTE* % (R) Actual Estimated Projected % Total * = Position Program Retirement 2014-15 2015-16 2016-17 Budget Vacant Staff+ Plan (H) Health in Executive Director 1.0 0% 93,521 95,391 97,299 3,00% R H Program Director 10 0% 76,332 77859 79,416 2,63% (_F,Z) (t Senior Program Coordinator 1.0 0% 36,192 73,832 75,309 1.24% (R) (H) Office Manager 1.0 0% 55,704 56,818 57,954 1:92% (R) (H) Research Assistant :50 0% 14,782 0 0 0.50% (R) Agricultural Program Director 1.0 85% 58,263 59 428 60,617 2,00% jR) Agricultural Program Assistant 1.0 85% 41,420 42,248 43,093 1.43% R H Health Check Program Coordinator 1.0 0% 37,032 0 0 1.28% (Ft) (H) Marketing Coordinator TTCF .64 100% 0 12,240 23,664 .80% (R) 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 1/25/2016 10:25:47 AM f DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? LII b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? 110 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. 1. Colleen Bridger and her designee, Meredith Stewart, are employees of the Orange County Health Department, 2, Mark Dorosin is a county commissioner designated by the Board of County Commissioners to serve on our Board of Directors. 3, Tom Forcella is superintendent of Chapel Hill/Carrboro City Schools. His designee, Kerry Moore, director of Head Start and Pre-K, serves in his absence, 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 qrant awarded. ,/ Signature: 1/25/16 Executive Director Date Signature: 1/25/16 Board Chairperson Date Main Application 1/25/2016 10:25:47 AM H ; 1 4 c 2 1 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION Performance Measures At least 7 brothers wei AL feat 5 fedirters war At beast S farmers wit partopate et the Cilia participate ar the CSA Inarficipate cro the COO program,conteding to at program,connecting to at program,connecting to at m.) Work Statement leaqd 90 customers Wart 90 nasturtium to 000 customers Farirmur will(1400*00 Farmers wilt tarn 100e, Farmers wit nom over 750,000!ri witplerupigal $60000 in sithereementer 860,000M suppler metal income through the,sate of inoome trarough the ado or income through the sale de This form is used to document to e Er cuto ea produce . .. Program Results 7rtrenetrit parbArdretTeawesA 5 farmers partdliadierti dr CSA 5 laroners parnetTiZilereSA program activities, program goals, oantem proem lordegart Chong the growing veason, During Me growing reason,. Dwane die growing kintait performance measures, and ma'provided rethriers 25 'nu provided latilf vets 25 ricF provided Embed 25 NAM of classroom h ours of classroom tlICKIrS of classroom actual results. (Add more rows as !workshops,72 howl al. vex kshom 72 MAPS CA 'WettrailtfaS,72 hours of i needed) If this s a new program, hands ion farm workshop 1 hendoron farm workshop. 'handgun farm workshop . 502,270 earned through COO i 43,000 named thcaregi(50 43055 earned through Cdt you will only document the 551d80 earned it totar i salts sakts produce sales '570,l810 earned rn total 5700000 earned or total ! projected information. y imitate sales 1.droduce Wien Program Activity 3 i impledi;rt atturarroot — implierre;IllessuZ7— dropicrtent aft7drechoP5 programming;Ohm youth prddrovist nay artrat youth programming dip youth Program Activities should I I I commoh"hty p a a t ale 11 to with carmatungy partneri for I not trommort Ito partners for outline major activities the agency spend pribects sonnet Protect, spent prororts Program Otto II increase commomeabowtoh I increase commundeboa,,gob increase commundation,lot implements to accomplish its and leadership skr118 for I and readership obits for and leadership skills for :refugee and unmet ant teethe:re fuggier and twerierant rump refugee and interberana teens program goals, , ......_._ .......„„„_,„,„„.........„,„,__.,_, ___.„.„.........____„. Perthaterthe Meguites!,4,13eYrdame otcfarcees„ nocudenere Ve“,,,d5,, Attendance retords, • Program Goal should explain program umpromentation program amthementator program impeemontetion schedules 'schedules schedules what the program is trying to Program Results 8 refugee teens received 10 refugee teem received 10 relapse them receded commurecation,Joh md rommoncation,fr dad cemmumeation Into and achieve/accomplish. Goals are Leadership skills through ivadeashcri Its through Athelerseup Wins through statements about what the teen program teen prograrn iteun grogram program should accomplish. ---1„voz,717,7,:mw----wwwwriz7;;;;r--- UWW;;Wi7G17,7Mi Program Activity 4 week110 simiter&igloo's weekly summer 8bidren's weeldy WITIMer chddren's SMART Goals .... program focused on program Metered on Iprograre too tool on eavemunantal education environmental educator !orddenstentat education Performance Measures describe I cmd science ,and science and snout how you will evaluate the degree favgrom Goat I Provide hantlaron ocitcloor 'Provide tiring/UM outdoor I leacmde hartaiion outdoor actim teat ing and(Sty active learning and lerb, 'active teaming and ESL in which you achieved the stated support for refugee and soupeat for refugee and Immured fax refugee and , ornarieraot choheren orrinlieritut entidir en anntgrant children goals. Perforrearien Mealtire$I Anemia thrtheror de, Abundance actordry attendaritre recordat ET*tr,,,..."4".**"' 21222Effg**.? ..._.„..,„*.2,°:1=****"' • Actual Program Results use Program Results I etwerake 00 11,efnee voting Average iiWkir r coupe Poem overage orku refugee young chiteren me nthog handsbat children reCtIvong hotrods:Mt eadhlrect cenerwor,headman program results to indicate the outdoor active learning and 'outdoor active reaming and outdoor extern teaming and 1E51 toothed I tal W,POC101 .ESL mood actual measureable achievement of goals. If goals were not met, iwAwo,,,,,,,-.5i- Prowde tours,.conduct 754 Prouder touth conduct Clerk Provide Muth coridurt ESA AttlivuOn, orCUWMIn ratliVItier, please explain. ---1,147;i7gii Maude education and Provide education and Provide edsmitoith and outreach to the peeler outback',to the greater outreach to the greater Orange County conmundy Oat dre County ecommunCy Orange County conutturtv PriCribrmaure Measures tour low CSO remenutien tour tug;C50 negratration 'Tour logy MA cogrotrados Meath a.owed% 'refunds —"W47;07FttStatt$COM Wed ith VMS moiling Condor 1010 70 WW1 re'dt Nag:Comthard 20 tam Ped,Jung over 5tt11 1 nthervitadis par 5:00 individuals over 500 individuals 7 farottits supwied produce S fainters supplied produce '5 farmers supprited produce ito SZ CEA members to 92 rtilLA members to KO CSA members Main Application 1/25/2016 10:25:47 AM DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION 4. FINANCIAL INFORMATION FOR SERVICE PROGRAMS a.) Program Budget Please complete a Program Budget Excel Form for each requested program. The Program Budget should reflect only figures and amounts associated with the Program(s) for which you are seeking funding and not the total agency budget. If the program's finances experienced significant changes that you would like to explain, please use the space below. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. For 2016-2017, the budget reflects an addition of a part-time market coordinator to facilitate the development of the CSA and Share a Share activities. Main Application 1/25/2016 10:25:47 AM 1 ' ,x DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION Section III. Program Information Program Budget Worksheet AGENCY NAME: Orange County Partnership for Young Children Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 1 2015-16 2016-17 Change Private Donations $ 162,980 $ 164,610 $ 155,000 -6% Program Generated Revenue(fees) $ 3,719 $ 3,756 $ 3,756 0% Local Government Grants: Orange County $ 2,000 $ 5,000 150% Town of Chapel Hill $ 3,000 1 $ 3000 $ 5,000 67%1 Town of Carrboro $ 2,500 $ 2,500 $ 5,000 100% Other Local: IIIIIIIIIIIIIIIIIII 0 Other Local: IIIMMEI 0 Other Local: IIIIIIIIIIIIIIIIIIIIIIIIIIII 0 If more than 3 sources,please provide a separate list, Non-Local Government Grants Triangle United Way 1111111111111111.11111111111111111 0 State Government IIMIIIIIIIIIIIIMII 0 Federal Government IIIIIIIIIIIIIIIIIIIIIIIIIIIIII 0 Other Grants: 111111111111111.111M1111111M Other Grants: . IIIIIIIIIMIINIIIIIII 0 Miscellaneous/Other Revenue =MMIUIIIIIIIIIIIIE Please it 3 largest Mrscellanous sources $ $ . $ _ Total Program Revenue $ 172 199 % 175 866 $ 173 756 IOW PROGRAM EXPENSES Compensation $ 57,656 $ 71,994 $ 110,425 Rent& Utilities $ 2,978 $ 3,008 I $ 3,008 0% Supplies&Equipment $ 21,578 ' $ 72,225 Mil 0% Travel&Training $ '1,481 Mil $ 1,511 0% Other Expenses: $ 33,748 $ 34,423 $ 34,423 0% Please lost 3 largest'Other Expenses' Contracted Services $ 27,918,00 Land Use and Insurance $ 3,640,00 Equipment Rental $ 2,190,00 Total Program Expenses ' % 133 160 $ 171 592 29% HI, SURPLUS/(DEFICIT)FOR PERIOD: $ 54,758 I$ 42,706 1 $ 2,164-1- -650/t1 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment, Example Program: Credit Counseling Class Cost Elements Cost ($) Quantity/Unit of Measure Subtotal ($) Credit Counseling Teacher-in class $25 96 hours (8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours (4hrs/mth x 12 mths) $1,200 Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the project/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: Transplanting Traditions Community Farm Cost Elements Cost ($) Quantity/Unit of measure Subtotal ($) Project Director/Coordinator $2617 avg 3,315 hrs (3950 hrs/yr x .85) 86,761 Marketin. Coordinator $18 96 1248 hrs24 hrs/wk x 52 wks). 23,664 Translator(Contracted Services) $25,00 807 hrs (1552 hrs/wk x 52 wks) 20,175 Contracted Services (Other—maint) $25.00 336/2 hrs. variable 8,418 supplies/Equipment Varies Varies for seeds, •lantines, etc., 22,225 Travel and Trainini (2 trg x 200) + DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 t A - continued Provider's Outside Agency Application MAIN APPLICATION d.) Agency Operating Budget Please show all sources and amounts of funding for your entire current fiscal year. What is your agency's fiscal year? Example: July 1, 2016 through June 30, 2017. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/25/2016 10:25:47 AM P 1 21 DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 A - continued Provider's Outside Agency Application MAIN APPLICATION Section VI. Financial Data Comparative Budget for Entire Agency AGENCY NAME: Orange County Partnership for Young Children Actual Estimated ' Projected Percent I AGENCY REVENUE 2014-15 201546 201647 Chant,,e Private Donations (Contributions) $ 193,650 $ 195,587 $ 185,977 -5% Agency Generated Revenue(fees) Local Government Grants: Orange County $ 2,000 $ 5,000 150% town of Chapel Hill 3,000 $ 3,000 $ 5,000 67% Town of Carrboro 2 500 $ 2,500 $ 5,000 MBE Other Local: Other Local: 0 Other Local: _ If more fhan 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way 0 State Government $ 2,802,363 $ 2,802,363 $ 2,802,363 Federal Government $ Other Grants: 0 Other Grants: 11110E1 0 Miscellaneous/Other Revenue 8,455 $ 8,455 0% Please list 3 largest Miscellartous sources. Special fundraising events $ 3,719,00 Sales Tax Refunds 1,134,00 Other Income $ 3,518„00 Total Agency Revenue $ 3 009 884 $ 3 013 904 $ 3 011 795 0% AGENCY EXPENSES Compensation $ 413,246 $ 483,905 1.111 Rent& Utilities $ 42,086 $ 42,507 $ 42,932 1% Supplies&Equipment $ 33,431 $ 34,100 $ 34,100 0% Travel&Training 7,473 $ 8,070 $ 8,070 0% Other Expenses: $ 2,447,766 I $ 2,451,237 $ 2,441,237 0% Please hst 3 largest"Other Expenses"' Contracts and Grants $ 2,230,693,00 Contracted Services $ 173,551,00 Other Operating Expenses $ 43,522,00 Total Agency Expenses $ 2 944 002 2 972 425 3 010 244 EMI SURPLUSADEFICIT).FOR PERIOD: $ 65,883 $ 41,479 $ 1,550 1 -96% DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Orange County Partnership for Young Children Funding Award: $3,500 Outline how the agency will spend Orange County's funding award. Expense Description Amount Programmatic Expenses 3,500 Personnel—Salaries Program Services For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes below,by June 30,2016. • Business Technical: Provide agricultural,business planning and market education • Business Technical: Provide technical assistance focusing on risk mangement, farm production costs, and developing markets. 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 Refugee families served through Share a Share program 118 refugee families Numbers of farmers participating in CSA 5 farmers Percentage of participants reporting a decrease in food insecurity 80% �v DocuSigned by: rbklA, plAtvtr Executive Di 11/3/2016 Certified by: 91A8F404700944B Title: Date: (Provider's Signature) DocuSign Envelope ID: DD554565-B9BA-4128-863D-805D6BC56619 ORANCOU-04 MROBERTS A RO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `••---� 9/21/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Summers Thompson Lowry,Inc. PHONE 919 968-4472 FAX 919 942-4221 100 Europa Drive (A/c,No,Ext):( ) (a/c,No): ( ) Suite 571 E-MAIL info @STLinsure.com Chapel Hill,NC 27517-2393 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Alliance for Non-Profits for Insurance Risk Retention Group INSURED INSURER B:Hartford Casualty Ins. Co. Orange County Partnership for INSURER C:Carolina Casualty Insurance Young Children 120 Providence Rd Ste 101 INSURER D: Chapel Hill,NC 27514 INSURERE: 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 INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 201636915 08/10/2016 08/10/2017 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 500,000 MED EXP(Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY PRO- JECT PRODUCTS-COMP/OP AGG $ 3,000 000 JECT � OTHER: $ 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 (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 201636915UMB 08/10/2016 08/10/2017 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE 22WECIT8297 10/01/2016 10/01/2017 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 C D&O/Employment Pract 1486787 08/10/2016 08/10/2017 D&O Coverage 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) For Information Purposes CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN O O a S.Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough,NC 27278 AUTHORIZED REPRESE NNTATI V E tj" j/694 © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD