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2016-673-E Finance - Inter-Faith Council for Social Service - Outside Agency Performance Agreement
DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB 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 Inter-Faith Council for Social Service, a not-for-profit corporation, located at 110 West Main Street, Carrboro,NC 27510 ("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 Inter-Faith Council for Social Service 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 50000. 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$12,500. 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. 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. (Inter-Faith Council for Social Service) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB 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. (Inter-Faith Council for Social Service) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB 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. (Inter-Faith Council for Social Service) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB 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 Inter-Faith Council for Social Service 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: (Inter-Faith Council for Social Service) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB County: Finance&Administrative Services Provider: Inter-Faith Council for Social Orange County Service Post Office Box 8181 110 West Main Street Hillsborough,NC 27278 Carrboro,NC 27510 16. E ntire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and 11,, tageu he Provider ( `u' 11/21/2016 •t367-4:E-1-D D446... Date For and o afn9range County Government 1561A tAt, tk Ak tY$t 11/28/2016 a®-`Hrsfs5E4n... Bonnie Hammersley, County Manager Date (Inter-Faith Council for Social Service) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB 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. 4DocuSigned by: p,��� s w 4 Co-Di 11/21/2016 Certified by: 2fi67,1€F51DAD Title: Date: (Provider's Signature) (Inter-Faith Council for Social Service) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Inter-Faith Council for Social Service Date/Time / Complete Y N Program(s) Community House, HomeStart, Community Services Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. 0 Applicant Contact Information b. [..3 Project/Program Contact Information c. Funding Requests Identified d1 0 Signed Application Cover Page 2. Agency a. E 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. E Agency's Types of Services Provided d. L Agency's Experience e. E Other Pertinent Information 3. Program/ a. E Type of Application and Program Identified 24 CFR 570.200(a), Project b. E Summary of Program 570.201-570. 208, Information - 507.503 c. fl Description of Identified Need (for each -- d. Description of Population to be Served program/ e. E Activity Manager and Location Description project for which funding C Activity Implementation Timeline is requested) g. T. Agency Collaboration h. C Describe Impact of Reduced/No Allocation I. C Other Pertinent Information j. C Complete Target Population/Beneficiary Chart k. C Complete Schedule of Positions Signed Conflict of Interest Disclosure m. C Complete Work Statement ilPage DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProviderViaibAmf ••lication 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. El Program Budget Worksheet 570.602, 570.607(b), is requested) b. E Program Budget Detail 570.611 24 CFR c. E Cost Per Unit 570.502-570.504, d. 0 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. 11 Part A: CDBG & HOME Sections (as B. 1-1 Part B: Construction/Rehab applicable) 6. Attachments a. Li 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. El IRS Federal Form 990 c. [1:1 NC Solicitation License d. El IRS Federal Tax-Exemption Letter e. El Certificate of Insurance f. E List of Board of Directors 24 CFR Parts 84 or 85 g. E Articles of Incorporation/Bylaws 24 CFR 570.208, h. T Authorization to Request Funds 570.500(c), 570.611 Authorized official designation j. Li Solid Waste Program Fee (SWPF) Verification Main Application 1/25/2016 12:58:53 PM Page 2 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProvidersaibkratNlication 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Inter-Faith Council for Social Service Applicant Organization's Physical Address: 110 West Main Street, Carrboro, NC 27510 Applicant Organization's Mailing Address: 110 West Main Street, Carrboro, NC 27510 Applicant Organization's Web Address: www.ifcweb.org Executive Director: Michael Reinke Telephone Number: 919.929.6380 E-Mail: mreinkeifcmailbox.org DUNS Number: 171570906 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) Project/Program Contact Information Project/Program Name: Residential Services - Community House and Home Start; Community Services - Food Programs, Support Circles Project/Program Primary Contact and Title: Stephani Kilpatrick, Residential Services Director and Kristin Lavergne, Community Services Director Telephone Number: Stephani Kilpatrick 919.967.1086 Kristin Lavergne 919.929.6380 E-Mail: Stephani Kilpatrick: skilpatrickifcmailbox.orq: Kristin Lavergne: klavergneifcmailbox.org c) Funding Request Identification Total Project/Program Cost: $1,338,838 Total Amount of Funds Requested: $89,000 Proposed Use of Funds Requested (2-3 Line Maximum): To renew funding of IFC food and shelter programs serving Orange County's citizens in need, to fund a 15 hour per week Case Manager for HomeStart residential program, and to help fund half of the salary costs of a half-time staff person to coordinate the Orange County Partnership to End Homelessness Support Circles Program. 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. X CDBG Non-Construction (CH) $ X Grant 0 Loan CDBG Construction (CH) 0 Grant Loan 111 HOME CHDO (OC) 0 Grant E Loan fl HOME Other (OC) El Grant —I Loan X Human Services: X Carrboro $14,000 X Chapel Hill $25,000 X Orange County $50,000 Main Application 1/25/2016 12:58:53 PM Page 3 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider's OktORAcinacy_AQpiication UA I KIN 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. zy -7-7/4"W Signature: 6 / / Executive Director Signature: :oard Chairperson Date Main Application 1/21/2016 3:50:16 PM Page 4 of 24 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProvidersaMibkrem_ ••lication 2. AGENCY INFORMATION Please provide the following information about your agency(Limit of 2 pages total): a) Years in Operation, Date of Incorporation (Month/Year) In Operation for 52 years, incorporated since June 1966 b) Agency's Purpose/Mission The Inter-Faith Council for Social Service meets basic needs and helps individuals and families achieve their goals. We provide shelter, food, direct services, referrals and information to people in need. We accomplish this through strong partnerships with volunteers, staff and those we serve. We rely on the active involvement of caring individuals, congregations and other community organizations. c) Types of Services the Agency Provides Program 1, Food Programs The IFC provides around 75,000 meals to hungry persons every year. Meals are free of charge and are provided to anyone who is hungry as well as to the residents of Community House and HomeStart. Community volunteers and volunteer groups representing congregations, businesses, neighborhoods and the University provide nutritious, hot meals 365 days a year. The Kitchen Coordinator schedules and trains volunteers to prepare and serve meals. Nearly all of the food that is served is donated by local restaurants, food services, campus groups, farmers, congregations and businesses. The IFC partners with Farmer Foodshare and other local groups to provide fresh, locally-grown produce for the Community Kitchen. The Community Kitchen relies heavily on volunteers to prepare and serve meals and clean up afterwards. Meal monitors provide support to volunteer groups and address client needs during the meal. Volunteers also help pick up, receive, sort and store food donations. The Food Pantry provides around 1,300 bags of groceries to those in need every month. Households in Chapel Hill or Carrboro, or in which an adult works in those communities, may become members of the Pantry who are welcome to receive groceries once a month. Grocery quantities offered are based on the number of people in the household. Food Pantry members may be eligible for other services. Staff, student interns and community volunteers receive, sort and stock food, interview clients and greet visitors at the reception desk. Evening hours are provided through a special collaboration with Project Rushhour, a service of the North Carolina Hillel. The IFC relies on donations from individuals, congregations, community food drives, grocery stores, UNC campus, the Inter-Faith Food Shuttle and the Food Bank of Central and Eastern North Carolina. The Pantry also partners with Farmer Foodshare to receive fresh locally-grown produce that is distributed with non- perishables. With community donations and hands-on help, holiday dinners are distributed at the end of November and December to member households that have pre-enrolled. Program 2, Residential Programs Community House offers safe living accommodations, meals, showers and laundry facilities. Community House guests also receive an array of services: referrals to substance abuse education and counseling; medical, mental health and dental treatment; social worker support; job coaching; and referrals to community agencies. Residents are encouraged to identify and address personal challenges, seek employment opportunities, and establish a plan with short Main Application 1/25/2016 12:58:53 PM Page 5 0 f 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider'sai,M,AErat • lication and long-term goals. IFC partners with Piedmont Health Services (PHS) to provide a PHS Satellite Clinic inside Community House to provide health care services to respond to the various needs of homeless men and women. Staff and volunteers strive to empower, educate and support homeless men to take important steps towards a successful transition out of homelessness. There are a variety of volunteer opportunities for individuals and groups available at Community House, which include; evening volunteers, receptionists, building monitors and clinic staff. Community House serves as Orange County's only shelter for homeless men. It also provides 17 emergency shelter cots during inclement weather. Home Start provides 24-hour emergency and longer-term housing and services to homeless women and children. Home Start's mission is to provide "a safe, structured home for homeless women and children, helping them to access community resources and offering everyone on- going support to break the cycle of poverty and homelessness." Domestic violence, eviction, unemployment, low-paying jobs, mental illness, lack of support services, family break up and substance abuse are just some of the reasons Home Start residents find themselves homeless. A range of services including meals, social work,job coaching, health and mental health care are provided. Intensive case management serves as the key tool for helping families to achieve their goals of earning their own income and finding affordable childcare and housing. It is our hope that with additional funding from CDBG we will be able to double the amount of Case Management we provide. Home Start, located on land provided by Orange County, began as a transitional housing program for homeless families that was a direct outcome of a 1994 Orange County Emergency Family Shelter Task Force. Program 3, Support Circles Support Circle Teams comprise 8-10 volunteers that partner with individuals and families who are experiencing - or at risk of- homelessness and who are transitioning into permanent housing. Teams provide Partners assistance with: • Material support such as furniture and other household goods (often gathered from congregations and family) • Practical support including taking partners grocery shopping or to appointments, helping them work out budgets, tutoring them for GED classes or other assistance their partners may need • Financial support: each team contributes $2,500; $2,000 goes for their Partner's needs associated with moving in to permanent housing such as security deposit, furnishings, etc., $500 goes toward program administration. • Relational support: most importantly, team members meet regularly with the individual or family they're partnered with to share information, build relationships, and function as a support system for their Partners. d) Agency's Experience with Similar Programs as the Funding Request IFC has been providing basic needs programs for the past 52 years and have a demonstrated track record of success. Our Community Services Director Kristin Lavergne has a Master of Social Work degree from the University of North Carolina and has been with IFC for over 20 years, Our Residential Services Program Director has a Master of Social Work degree from the University of North Carolina and has been with IFC for 14 years. e) Other Pertinent Agency Information IFC has extensive and long-standing partnerships with a wide array of community partners, ranging from local government agencies, other nonprofit agencies, to private businesses. IFC has 56 member congregations who contribute time, talent and treasure to our success. Main Application 1/25/2016 12:58:53 PM Page 6 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider's 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Inter-Faith Council for Social Service: Community House, Home Start, Community Services As you complete your application, complete only those sections that pertain to the type of application you are submitting. The application is divided into several sections and not all sections apply to every project. Every applicant MUST complete the main application. a) Check the type of funding request for this application package submittal and complete the required application and required supplemental sections (Parts) as specified below: X Human Services (Main Application Only) X CDBG Non-Construction—(Main Application AND Part A) CDBG Construction —(Main Application AND Part A AND Part B) E HOME CHDO Set-aside —(Main Application AND Part A) El HOME Other—(Main Application AND Part A AND Part B) Indicate the type of program for which you are requesting funding: D Public Housing Program Category Youth Adult Elderly (nis ot elabled derly) Neighborhoods/FResidents Education Health and Nutrition X X X X X Job Training Sports and Arts Activities Pre-School Activities After-School Activities Mentoring X X X X X Transportation Housing X X X X Other: Please specify Proaram/Proiect Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: b) Summarize the program services proposed and how the program will address the chosen Town/County priority? Food Programs The Food Pantry will meet the Town/County priority for health and nutrition to needy residents and safety-net services to disadvantaged residents by collecting or purchasing enough non-perishable food items to provide groceries as often as once per month to member households. Staff and volunteers of the Food Pantry will distribute monthly Main Application 1/25/2016 12:58:53 PM Page 7 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider's_Outide_Agepcy_A_pplication MAIN APPLICATION grocery allotments of essential food items to thousands of eligible members; quantities are based on the number of people in the household. A hot, nutritious meal will be served to homeless residents and any hungry person who shows up at mealtimes at the Community Kitchen. 1FC's Kitchen Coordinator and 500+ community volunteers will serve some 75,000 hot, nutritious meals during the program year. Residential Programs Both Community House and Home Start will meet the Town/County priority for safety-net services by providing emergency shelter and transitional housing for up to 52 men, 24 women, and 30 children at a time. Some 400 homeless persons who lack a fixed, regular, and adequate nighttime residence will receive emergency/transitional shelter, as well as laundry and shower services, and basic needs such as clothing and personal care items, during the program year. Community House also offers 17 cots during inclement weather. With CDBG funding, Home Start families will have access to Case Management services from a 30-hour per week Case Manager, to assist in securing resources necessary to become self-sufficient and prevent relapses into homelessness. Support Circles Support Circles will meet the community need for safety-net services by functioning as a support system for a formerly homeless individual or family transitioning into permanent housing. Support Circles comprised of 8-10 volunteers will function as a support system for their partners, i.e. helping them work out budgets, sharing information, providing furniture and household items, helping partners fill out and submit job applications, providing transportation, tutoring, thus empowering their partner to remain independent and securely housed. 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. Program 1, Food Programs According to the latest data available from Feeding America, Orange County had an overall food insecurity rate of 15.4 percent and 20,900 food insecure people. In the Chapel Hill- Carrboro City Schools, 60% of preschool children, 30% of elementary school children and 24% of middle school students receive free and reduced price meals. We currently have thousands of households who are card carrying members of the food pantry and are eligible to come in for groceries once a month. We believe that between our pantry, community kitchen and holidays dinners program the IFC helps to feed more people in Orange County, Chapel Hill and Carrboro than any other agency in the County. Program 2, Residential Programs In accordance with the Consolidated Plan's Goal #2 Providing Housing and Services for Homeless Populations, IFC provides service-enriched transitional housing for homeless persons at Community House and Home Start. The Point-in-Time Count in January 2015 found 129 homeless individuals in Orange County and 70% of them were staying at one of our two shelters. The IFC provided shelter to 323 men, 129 women, and 43 children last year (unduplicated individuals). Our shelters sleep some 50 people per night at each facility and we constantly have more requests than we can meet. We have found that intensive case management is key to families overcoming homelessness. In the past, HomeStart had 1 full-time Social Worker to provide Case Management Services for 10 families. A dramatic cut in funding from the North Carolina Partnership for Young Children (Smart Start) has resulted in a reduction in case management support to 15 hours a week for all of the women and families. This CDBG Main Application 1/25/2016 12:58:53 PM Page 3 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProvidersaithiAAyegyiNkilication request will allow IFC to double the amount of case management and reduce the time single women and women with children need to live in a shelter. Each resident currently receives case management about every two weeks in order to set goals and review her progress in working towards her goals. We would like to increase the frequency that a resident has access to the case manager, as a great deal can happen in the lives of mothers and children during a two-week period. Sometimes not making timely connections to resources such as mental health services or school resources can derail a family's entire plan for becoming self-sufficient. During a case management meeting the case manager and resident look at many different areas such as identifying/contacting local services, job search,job training or schooling, mental health, and housing, etc. They prioritize together how to navigate the confusing/frustrating situation of being homeless. Each resident identifies the next steps that would help her and her children become more stable and end their homelessness. Case notes are written after each session. Once goals have been set, the case manager supports the women's work towards those goals by identifying and making contact with outside service providers such as DSS (Work First, Rapid Rehousing, etc.), Vocational Rehabilitation, Freedom House, UNC Horizon's program , Durham Tech, and Community Empowerment Fund to name a few. The case manager advocates for the women when it seems they need extra assistance at these organizations. Program 3, Support Circles In accordance with the Consolidated Plan's Goal #2 Providing Housing and Services for Homeless Populations IFC coordinates Support Circles to Reduce Chronic Homelessness by providing the support formerly homeless individuals need in order to prevent a relapse into homelessness. Research shows that as homeless individuals and families transition out of shelters and other emergency housing into more independent living in the community, having support services is an essential component of successful stabilization. A much higher percentage of those who receive wrap-around services remain housed on a more permanent basis. In collaboration with social service agencies, the Support Circles Program contributes to breaking the cycle of poverty and homelessness in Orange County by training and supporting community members (volunteers) to provide material, practical, financial and relational support to those who are transitioning. Each individual or family (called a Partner) is matched with a Support Circle for 12 months. Modeled in large part after the Raleigh/Wake Support Circles Program for Homeless Families. OCPEH Support Circles provides volunteers essential training to be able to foster relationships that are empowering and offer support with the end goal of enhancing the likelihood that the Partners will be able to sustain the positive changes in their lives, both on an individual level (addressing domestic violence, mental illness and addiction issues) and in facing the structural and systemic challenges that contributed to their homelessness (such as lack of affordable housing, poverty and lack of affordable health care). IFC has 7 Support Circles functioning this year so far. This program has grown large enough that an all-volunteer effort is no longer practical. Their success is encouraging other volunteers to come forward and want to form circles, but there is a great deal of training and coordinating that must happen in order to increase the number of circles going at the same time. We have a half-time Support Circles Coordinator position, which is partially funded by the Human Services grant. d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. Main Application 1/25/2016 12:58:53 PM Page 9 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProviderVaiWEEktrMication We serve the area's homeless, formerly homeless, and hungry. These are individuals living at less than 30% of the poverty level. Some of the challenges they face include loss of jobs, significant health-related expenses, loss of housing, disrupted family units and lack of social support. We allow individuals to self-refer, and we accept referrals from community agencies, including the Orange County Department of Social Services. e) Who specifically will carry out the activities and in what location will they be carried out? Food Programs We have a Program Director, Kitchen Coordinator, and multiple front-line staff to carry out the program activities at 110 West Main Street Carrboro and 100 West Rosemary Street Chapel Hill. Residential Programs We have a Residential Services Director, Social Workers, and multiple Residential Staff to carry out the program activities at 2505 Homestead Road Chapel Hill and 1315 Martin Luther King Jr Boulevard Chapel Hill, Support Circles We have a Client Services Coordinator, half of whose time is devoted to carrying out program activities at 110 West Main Street Carrboro. We rely on over 42,000 volunteer hours per year to provide direct services in all of our programs. 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. The activities will be carried out over the next fiscal year, Food Program The Food Pantry is open from 9am to 5pm on weekdays. On most Tuesdays and Wednesday the pantry stays open until 7pm. The Community Kitchen serves lunch Monday through Saturday 11:15am-12:30pm, Sunday 12:15pm-1:30pm, and dinner Monday through Friday 6:15pm-7:00pm. Residential Programs Our residential facilities are 24-hour facilities, open 365 days per year; We plan to have an additional 15 hours per week of case management services available to HomeStart families. Support Circles A family is supported for up to a one year period. 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. • Active participation on Orange County's Family Success Alliance leadership council. The Alliance seeks to improve the lives and opportunities for long term success for children and families struggling to make ends meet. This is done through developing a "pipeline" of coordinated community resources that will ensure the successful passage of children from cradle to career or college; • IFC works closely with Farmer Foodshare, TABLE, St. Joseph's Food Ministry, Inter-Faith Food Shuttle, Food Bank of Central and Eastern North Carolina, local grocery stores, restaurants, congregations, UNC at CH dining services and other food programs to gather and distribute the needed food resources; • In an effort to help keep people in independent housing and have the money to buy groceries on their own, we have been partnering for the last year with the Jackson Center. We received a special grant from Duke Energy that allows us to pay for replacing electrical Main Application 1/25/2016 12:58:53 PM Page 110 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Providers_Quts.ide Aciency_Application MAIN APPLICATION appliances that no longer work or are no longer efficient. Working with the Jackson Center we have replaced many different appliances and HVAC systems for residents of the Northside and Rogers Road Communities. Many of these homeowners/families have been residents of these neighborhoods for generations, but the homes they live in are in need of repairs to provide basics like heat. We also worked with several families in the Rocky Brook trailer park in Carrboro after the June 2013 flood. • Participation on the Orange County Partnership To End Homelessness executive council and the Support Circles Program; • Collaboration with liaisons representing some 35 congregations who meet regularly for IFC updates, trainings, sharing of information, organizing food collections and mobilizing volunteers and financial resources; • The IFC recruits and maintains cooking groups from congregations, neighborhoods, the university and businesses to prepare and serve meals at the Community Kitchen, at Home Start and the new Community House; • We rely heavily on in-kind donations from local businesses and community volunteers. • Partnership with Orange County that provides a no-cost 25-year lease of three acres of land where the IFC's Home Start facility sits. We also collaborate with the County on the Emergency Solutions Grant and rapid rehousing; • 50-year lease arrangement with the University of North Carolina at Chapel Hill for the IFC @ SECU Community House transitional housing facility for homeless men in partnership with the Town of Chapel Hill and numerous social service agencies; • Partnership with UNC Hospitals and SHAC Clinic; Partnership with Piedmont Health Services to provide medical, mental health and dental clinics in an onsite satellite clinic of PHS at IFC @ SECU Community House, that is having a huge impact on the long-term sustainability of health care for all of our residents; • Ongoing collaboration with Housing for New Hope PATH workers who offer outreach services to homeless persons who are street persons or unsheltered; • Orange Literacy and UNC students' Talking Sidewalks and Home and Homeless Project provide cultural, educational, writing and literacy programs to both male and female shelter residents; • IFC works closely with the Community Empowerment Fund who offer financial education, matching funds savings accounts and job search help to many of our residents and Support Circle participants; • IFC works with the Veterans Administration to assist our homeless vets with services; • Longstanding collaborative relationships between Freedom House, The Horizons Program at UNC-CH and AA/NA groups to respond to addiction and substance abuse issues experienced by clients; • Partnership with the Compass Center who provide domestic violence workshops geared toward both women and children at Home Start. We also work closely with the Center to provide a safe space for survivors to be housed, when appropriate; • Partnership with The Furniture Project, organized by St. Thomas More volunteers and supported by the IFC since its inception, which helps furnish homes for graduates of IFC residential services and others throughout the community who might not otherwise have furniture; • Partnership with the PTA Thrift Shop, which provides clothing vouchers for IFC clients. This long-standing partnership is a huge help to our many clients who find themselves in need of clothing. h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. IFC would need to consider reducing hours of service, number of meals provided, or number of clients served. The worst case scenario would be that IFC would have to close one program completely. Main Application 1/25/2016 12:58:53 PM Page II of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider's RxiNcA4comdit9Rilication I) Include any other pertinent information, Program/Project Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff I) Disclosure of Potential Conflicts of Interested must be signed m) Complete the Work Statement Chart to describe the work to be 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: X Persons X Households El Units Program: Community House, Home Start Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 346 132 130 Female 149 176 170 Total 495 308 300 Of the females, how many are single- 129 176 170 female Head of Households(Omit for Human Services) Ethnicity African-American 302 144 141 American Indian or Alaska Native Asian Caucasian 149 152 147 Native Hawaiian or other Pacific Islander Other 44 12 12 Total 495 308 300 Of the above, how many 30 0 10 Hispanic/Latino Of the above, how many non- 465 308 290 Hispanic/Latino Total 495 308 300 Age 0-5 years 40 39 6-18 years 28 27 Main Application 1/2512016 12:58:53 PM Page 12 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider'siQuiAT5E * Iication 19-50 years 152 147 51-61 years 78 77 62+years 10 10 Total 0 308 300 Geographic Location Durham City 50 48 Durham County 2 2 Carrboro 46 12 12 Chapel Hill 86 134 129 Chapel Hill Public Housing Residents Orange County 76 38 36 Raleigh 12 12 Wake County 2 1 Total 208 250 240 *Does not *Does not *Does not equal 495 equal 308 equal 308 because because because some are some are some are from other from other from other counties; Did counties counties riot count Durham and Wake in 2014-15 Income Level--See following chart (Omit for HS) .. <30%Area Median Income 234 300 31-50% Area Median Income 6 51-80%Area Median Income 0 >80%Area Median Income 0 Total 0 240 300 *Does not equal 308 because some are dependents Special Needs(Omit for HS) Elderly (Over 62) 10 10 Disabled (not elderly) Homeless 308 300 People with HIV/Aids Total 0 318 318 Program: Community Services, Support Circles Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Main Application 1/25/2016 12:58:53 PM Page 1 3 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider's 6NtRi 8 hlication Male 1 2,150 1,950 1,950 Female 3,362 3,050 3,050 Total 5,512 5,000 5,000 Of the females, how many are single- female Head of Households(Omit for Human Services) Ethnicity African-American 3,196 2,900 2,900 American Indian or Alaska Native Asian Caucasian 1,322 -1,200 1,200 Native Hawaiian or other Pacific Islander Other 332 300 300 Total 5,000 5,000 Of the above, how many 662 _ 600 600 Hispanic/Latino Of the above, how many non- 4850 4,400 4,400 Hispanic/Latino Total 5,000 5,000 Age 0-5 years 0 0 . 0 6-18 years 50 50 19-50 years 2,700 2,700 51-61 years 2,250 2,250 62+years 0 0 0 Total 5,000 5,000 Geographic Location Durham City 55 50 50 Durham County 55 50 . 50 Carrboro 1,434 3,300 3,300 Chapel Hill 3,638 1,300 1,300 Chapel Hill Public Housing Residents Orange County 5,126 4,650 4,650 (includes (includes (includes Chapel Hill Chapel Hill Chapel Hill and Carrboro) and Carrboro) and Carrboro) Raleigh 55 50 50 Wake County 55 50 50 Total 220 200 200 Income Level-See following chart (Omit for H8) < 30%Area Median Income 5,512 5,000 5,000 31-50%Area Median Income 51-80% Area Median Income Main Application 1/2512016 12:58:53 PM Page 1 4 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider'saitrliM4Er6k&rvlication > 80%Area Median Income Total 5,512 5,000 5,000 Special Needs(Omit for HS) Elderly(Over 62) Disabled (not elderly) Homeless People with HIV/Aids Total Main Application 1/25/2016 12:58:53 PM Page 15 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider'satfli,kopy8xyr Nqlication CDBG & HOME ONLY- Area Benefit Activities (Infrastructure and Public Facilities) Street Census Tract Block Group Total Persons #LMI Persons 2505 118 2505 Homestead 130 130 Homestead Road block Road Chapel Hill NC 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%AM! $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115% AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 hftp://www.huduser.orq/portalidatasets/i1/1115/FY2015 IL nc.pdf Main Application 1/25/2016 12:58:53 PM Page 'I S a f 3 3 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provider' liiT,O,EgligyMlication k) Schedule of Positions Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). If provided, indicate; Position Titles % - (R) - FTE* Actual Estimated Projected %Total *- P srtion Program Retirement = ° * - 2014-15 201546 2016-17 Budget Vacant Staff+ Plan (H) Health Plan .098, .108, Executive Director 1,1,1 100 97,997 97,997 97,997 .108 R&H .055,.06, Finance Director 1,1,1 100 55,000 55,000 55,000 .06 R&H .044„04 Executive Assistant 1,1,1 100 44,000 44,000 44,000 8,.048 R&H Community 50,000 .05..055. Services Director 1,1,1 100 50,000 50,000 055 R&H Kitchen Coordinator .033,.03 -FT 1,1,1 100 32,576 32,576 32,576 6,.036 R&H Part-time Kitchen 0,1.2, 0,.033.0 Staff 1.2 100 0 30,048 30,048 33 R Support Circles .44,.4 .015,.01 Coordinator 4,.44 100 14,677 14,677 14,677 6,.016 R&H Client Services 1.8,2. .058,.07, Representatives 1,2.1 100 57,760 64,145 64,145 .07 R&H Residential .047,.05 Services Director 1,1,1 100 47,000 47,000 47,000 2,.052 R&H .039„.04 CH Social Worker 1,1,1 100 39,000 39,000 39,000 3,.043 R&H CH Residential .129,.14 Staff 4,4,4 100 128,182 128,182 128,182 1,.141 R&H Social Work 0,.035,.0 Assistant 0,1,1 _ 100 0 32,000 32,000 35 R&H Medical 1,.17, Coordinator 0 100 60,000 10,200 0 .06,.01,0 R&H .37,.3 .02,.021, HS Case Manager 7,.37 100 19.500 19,500 19,500 .021 R HS Residential .15,.166, Staff 5,5,5 100 150,498 150,498 150,498 .166 R&H Kitchen Coordinator 0,.7,. 0,.024„0 -PT 7 100 0 21,696 21,696 24 R .046,.05, Project Manager 1,1,1 100 45,900 45,900 45,900 .05 , R&H Construction 1,.17, .07,.013, Manager 0 100 69,120 11.520 0 0 R&H • Facilities .034,.03 Coordinator , 1,1,1 100 34,360 34,360 34,360 8,.038 R&H 22, 19, Volunteer Hours 19 100 _ 44,500 38,500 38,500 N/A Main Application 1/25/2016 12:58:53 PM Page 17 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB i /\ - continued Provider's i Application MAIN APPLICATION Notes: o Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. o °° Full Time Equivalent staff will be noted as 1.00; half time aa .5D; quarter time aa .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 12:58:53 PM Page 18 of 3 3 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued . . ProvidersradAitAyrkffilication I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO X Ej a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? EI X b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? X El c) Current beneficiaries of the project/program for which funds are requested? X Ej 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. • One of our Board Members is a part-time Town of Carrboro Parks & Recreation Dept. employee, with a sister who works part-time for the Town of Carrboro and a daughter who works for the Chapel Hill Carrboro City Schools. • We have another Board Member whose husband works for the Town of Carrboro. • One of our Board Members has a daughter who receives services from Vocational Rehabilitation. • Two of our Board Members work for Piedmont Health Services, one of our partner agencies located within our residential facility. 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 the termination of any grant awarded. ) Th ( _, .2 2 -;,?, 0(/ Signaturgi : ,),`,.471,1 'lb I:ExeCutivef Director Date . . . , Sign ature: :oard Chairperson Date Main Application 1/25/2016 12:58:53 PM Page 19 of 3 3 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProvidersOutside_Aciepaalication MAIN APPLIC m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Program Activity 1 17,000 bags of Staff and volunteers of Staff and volunteers of groceries and 800 the Food Pantry will the Food Pantry will holiday dinners will be distribute monthly distribute monthly distributed during the grocery allotments of grocery allotments of program year essential food items to essential food items to eligible members; eligible members; quantities are based on quantities are based on the number of people the number of people in the household in the household Program Goal IFC Food Programs are The Food Pantry will The Food Pantry will designed to alleviate collect or purchase collect or purchase hunger primarily by enough non-perishable enough non-perishable collecting food food items to provide food items to provide donations from the groceries as often as groceries as often as community and once per month to once per month to distributing them to member households member households households and persons in need Performance Measures Community Services Community Services Community Services Director and Client Director and Client Director and Client Services Reps track Services Reps track Services Reps track number of bags of number of bags of number of bags of groceries distributed groceries and holiday groceries and holiday dinners distributed dinners distributed Main Application 1125/2016 12:58:53 PM Page 20 of 33 DocuSign Envelope ID 82431AC8-7r03-4084-815E-A2Ero34C82oo [ /\ - continued [»[OViderS [ln��i liC@tiOn ��� �� .`~ .... . . �.~. .. .~~,^ Program Results 15,338 bags of 13,624 bags of groceries and 796 groceries and 783 holiday dinners holidays dinners Program Activity 2 IFC's Kitchen IFC's Kitchen IFC's Kitchen Coordinator and 500+ Coordinator and 500+ Coordinator and 500+ community volunteers community volunteers community volunteers will serve 75,000 meals will serve 75,000 hot, will serve 75,000 hot, during the program nutritious meals during nutritious meals during year the program year the program year Program Goal A hot, nutritious meal A hot, nutritious meal A hot, nutritious meal will be served to will be served to will be served to homeless residents and homeless residents and homeless residents and any hungry person who any hungry person who any hungry person who shows up at mealtimes shows up at mealtimes shows up at mealtimes at the Community at the Community at the Community Kitchen Kitchen Kitchen Performance Measures Kitchen Coordinator Kitchen Coordinator Kitchen Coordinator determines number of determines number of determines number of meals served by meals served by meals served by counting trays at the counting trays at the counting trays at the end of each meal end of each meal end of each meal service service service Program Results 85,560 meals 65,000 meals 65,000 meals Program Activity 3 500 homeless persons Some 500 homeless Some 400 homeless who lack a fixed, persons who lack a persons who lack a regular, and adequate fixed, regular,and fixed, regular,and nighttime residence will adequate nighttime adequate nighttime receive residence will receive residence will receive emergency/transitional emergency/transitional emergency/transitional shelter shelter during the shelter during the program year program year, as well as access to Case Management Services Program Goal IFC Residential Both Community House Community House and Programs are designed and HomeStart will HomeStart will provide to provide safe, operate at capacity (all safe,emergency shelter emergency shelter and available beds will be and transitional transitional services to filled) housing,as well as Case homeless individuals Management to reduce obstacles to overcoming homelessness Main Application 1/25/2016 12:58:53 PM Page 21 of 33 - ' ' - 000wSWn Envelope ID:8u431AC8-7r03-4084-815E-AuEro34C8uoo [ /\ - continued [»[OVider i liC@tiOn MAIN AVPLIU'A Performance Measures Information was logged Information logged into information logged into into the Carolina the Homeless the HMIS and an in- Homeless Information Management house data collection Network(CHIN)and an Information System system in-house data collection (formerly CHIN) and an system in-house data collection system Program Results 495 homeless persons 376 homeless persons 400 homeless persons received shelter to receive shelter receive shelter,with access to a 30-hour per week Case Manager Program Activity 4 IFC did not operate Support Circles Support Circles Support Circles in 2014- comprised of 8-10 comprised of 8-10 15 volunteers will function volunteers will function as a support system for as a support system for their partners,thus their partners,thus empowering their empowering their partner to remain partner to remain independent and independent and securely housed securely housed Program Goal Support Circles will Support Circles will function as a support function as a support system for a formerly system for a formerly homeless individual or homeless individual or family transitioning into family transitioning into permanent housing permanent housing Performance Measures IFC did not operate Support Circle Support Circle Support Circles in 2014- Coordinator will collect Coordinator will collect 15 data on demographics, data on demographics, assistance rendered assistance rendered and final outcomes and final outcomes Program Results IFC did not operate There are 7 Support 8-10 functioning Support Circles in 2014- Circles functioning in Support Circles 15 2015-16 so far Main Application 1/2512816 12:58:53 PM Page 2 2 cf 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provid er'srai,1\epfeayral i cation 4. FINANCIAL INFORMATION FOR SERVICE PROGRAMS a.) Program Budget Please complete a Program Budget Excel Form for each requested program. The Program Budget should reflect only figures and amounts associated with the Program(s) for which you are seeking funding and not the total agency budget. If the program's finances experienced significant changes that you would like to explain, please use the space below. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/25/2016 12:58:53 PM Page 23 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB A - continued ProvigrAi&CAOrciXFem Application AGENCY NAME: Inter-Faith Council for Social Service - Community House Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 243,630 $ 277,530 $ 277,530 0% Program Generated Revenue (fees) $ 30,189 $ 23,680 $ 23,680 0% Local Government Grants: Orange County $ 13,120 $ 14,080 $ 17,887 27% Town of Chapel Hill 5,760 $ 6,080 $ 7,861 29% Town of Carrboro 3,200 $ 3,200 $ 4,412 38% Other Local: 0 Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way $ 43,757 $ 49,780 $ 49,780 0% State Go■remment $ 31,652 $ 29,808 $ 29,808 0% Federal Gmemment 0 Other Grants:Foundations $ 77,603 $ 126,363 $ 119,563 -5% Other Grants: 0 MiscellaneousiOther Revenue $ 139,480 $ 5,000 $ 5,000 0% Reese list 3 largest IViscellanous sources: UNC Men's Basketball - Transfer from Capital fund $ - $ Total Program Revenue $ 588,391 IIIMIFEEI 0% PROGRAM EXPENSES Compensation $ 397,857 $ 346,600 $ 346,600 0% Rent&Utilities $ 23,427 $ 44,537 $ 44,537 0% Supplies&Equipment $ 31,194 $ 21,568 $ 21,568 0% Travel &Training $ 125 $ 125 0% Other Expenses: $ 135,913 $ 122,691 $ 122,691 0% Reese list 3 largest"Other Expenses": Allocation of agency overhead $ - $ Total Program Expenses $ 588,391 $ 535,521 $ 535,521 0% SURPLUS/(DEFICIT) FOR PERIOD: I $ 0 J $ 0 I $ 0 Main Application 1/25/2016 12:58:53 PM Page 24 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProviggiWONEPAF8v Application AGENCY NAME: Inter-Faith Council for Social Service -Community Kitchen Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 2016-16 2016-17 Change Private Donations $ 135,358 $ 124,352 $ 124,352 0% Program Generated Revenue (fees) $ 36,909 $ 29,000 $ 29,000 0% Local Government Grants: Orange County 4,920 $ 5,720 $ 7,267 27% Town of Chapel Hill 2,160 $ 2,470 $ 3,193 29% Town of Carrboro 1,200 $ 1,200 $ 1,792 49% Other Local: 0 Other Local: 0 Other Local: 0 If more than 3 sources, please provide a separate list. Non-Local Government Grants Triangle United Way $ 16,409 $ 20,223 $ 20,223 0% State Gmemment 0 Federal Government 0 Other Grants:Foundations $ 30,612 $ 33,488 $ 30,625 -9% Other Grants: 0 Miscellaneous/Other Revenue ill1111 0 Please list 3 largest Miscellanous sources: $ Total Program Revenue $ 227,568 $ 216,453 $ 216,453 0% PROGRAM EXPENSES Compensation $ 132,619 $ 115,533 $ 115,533 0% Rent& Utilities $ 17,230 $ 28,470 $ 28,470 0% Supplies& Equipment $ 26,752 $ 22,607 $ 22,607 0% Travel &Training - $ - $ 0 Other Expenses: $ 50,967 $ 49,843 $ 49,843 0% Please list 3 largest"Other Expenses": Allocation of agency overhead $ - $ - Total Program Expenses $ 227,568 $ 216,453 $ 216,453 0% Main Application 1/25/2016 12:58:53 PM Page 25 of 33 SURPLUS/(DEFICIT) FOR PERIOD: 0 1 $ 0 1 $ (0)1 -216% DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued Provifir' rAIRRILINEAF8V A Application AGENCY NAME: Inter-Faith Council for Social Service - Emergency Pantry Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 82,830 $ 65,704 $ 65,704 0% Program Generated Revenue (fees) $ 29,261 $ 19,000 $ 19,000 0% Local Government Grants: Orange County 3,690 $ 3,520 $ 4,472 27% Town of Chapel Hill 1,620 $ 1,520 $ 1,965 29% Town of Carrboro 900 $ 800 $ 1,103 38% Other Local: 0 Other Local: 0 Other Local: 0 If more than 3 sources, please provide a separate list Non-Local Government Grants Triangle United Way $ 12,307 $ 12,445 $ 12,445 0% State Gokemment Federal Gmernment 0 Other Grants:Foundations $ 27,539 $ 38,608 $ 36,998 -4% Other Grants: 0 Miscellaneous/Other Revenue $ 10,000 $ 10,000 $ 10,000 0% Please list 3 largest Miscellanous sources: Smith/Monk Fund - $ Total Program Revenue $ 168 147 $ 151,687 0% PROGRAM EXPENSES Compensation $ 80,800 $ 83,280 $ 83,280 0% Rent&Utilities 4,927 $ 4,339 $ 4,339 0% Supplies& Equipment $ 44,194 $ 33,305 $ 33,305 0% Travel &Training $ - $ 0 Other Expenses: $ 38,226 $ 30,673 $ 30,763 0% Please list 3 largest"Other Expenses": Allocation of agency overhead $ $ - Total Program Expenses $ 168,147 $ 151,597 $ 151,687 0% Main Application 1/25/2016 12:58:53 PM Page 26 of 33 SURPLUS/(DEFICIT) FOR PERIOD: - I $ 0 $ 01 _33% DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProvigrANCALOOgrdffiem Application AGENCY NAME: Inter-Faith Council for Social Service - Home Start Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 273,581 $ 236,368 $ 231,480 -2% Program Generated Revenue (fees) $ 23,585 $ 17,020 $ 17,020 0% Local Government Grants: Orange County $ 10,250 $ 10,120 $ 12,857 27% Town of Chapel Hill 4,500 $ 4,370 $ 5,650 29% Town of Carrboro 2,500 $ 2,300 $ 3,171 38% Other Local: Other Local: 0 Other Local: 0 If more than 3 sources, please provide a separate list. Non-Local Government Grants Triangle United Way $ 34,186 $ 35,780 $ 35,780 0% State Government $ 40,495 $ 29,808 $ 29,808 0% Federal Government 0' Other Grants:Foundations $ 70,775 $ 66,248 $ 66,248 0% Other Grants: 0 Miscellaneous/Other Revenue 5,000 $ 5,000 $ 5,000 0% Reese list 3 largest Miscellanous sources: UNC Men's Basketball - $ Total Program Revenue $ 464,872 $ 407,014 $ 407,014 0% PROGRAM EXPENSES Compensation $ 267,205 $ 231,535 $ 231,535 0% Rent& Utilities $ 69,932 $ 68,936 $ 68,936 0% Supplies& Equipment $ 21,553 $ 18,234 $ 18,234 0%. Travel &Training - $ 125 $ 125 0% Other Expenses: $ 106,182 $ 88,184 $ 88,184 0% Please list 3 largest"Other Expenses": Allocation of agency overhead $ - $ - Total Program Expenses $ 464,872 $ 407,014 $ 407,014 0% Main Application 1/25/2016 12:58:53 PM Page 27 of 33 SURPLUS/(DEFICIT) FOR PERIOD: - I $ $ (0)1 4% DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB A - continued ProviggVAE100149/5w Application AGENCY NAME: Inter-Faith Council for Social Service - Support Circles Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 19,755 $ 18,530 $ 18,105 -2% Program Generated Revenue (fees) 0 Local Government Grants: Orange County 820 $ 880 $ 1,118 27% Town of Chapel Hill 360 $ 380 $ 491 29% Town of Carrboro 200 $ 200 $ 276 38% Other Local: 0 Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way 2,735 $ 3,111 $ 3,111 0% State Govemment 0 Federal Government 0 Other Grants:Foundations 5,102 $ 5,152 $ 5,152 0% Other Grants: 0 Miscellaneous/Other Revenue MIME= 0 Please list 3 largestMscellanous sources: - $ - Total Program Revenue $ 28,972 MUM 0% PROGRAM EXPENSES Compensation $ 19,973 $ 20,585 $ 20,585 0%, Rent& Utilities 0 Supplies& Equipment 0 Travel &Training 0 Other Expenses: 8,999 $ 7,668 $ 7,668 0% Flease list 3 largest"Other Expenses": Allocation of agency merhead $ - Miscellaneous $ Total Program Expenses $ 28,972 $ 28,253 $ 28,253 0% maiRIMAISARFICIT) FOR PERIOD: 1/25/2016 1).ScR.c1 Pm I $ 01SID ,-, 4,. GAR 1931 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProvikrA'fi9\iftqydgabi,ci Application 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 hrstmth 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 hrstmth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the project/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: Cost Elements Cost($) Quantity/Unit of measure Subtotal ($) One grocery bag of essential food items $10.11 15,000 $ 151,597 One nutritious meal at Community Kitchen $ 3.56 60,312 $ 216,453 One night of safe shelter at Community House $33.47 16,000 $535,521 One night of safe shelter at HomeStart $37.00 11,000 $407,014 Support Circle for one household $2,825.30 10 $28,253 Total $1,338,838 b.) Cost per Unit—emergency pantry , 1 Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $ 168,147 $ 151,597 $ 151,597 Total # of Units 15,338 15,000 15,000 Cost Per Unit $ 10.96 $10.11 $ 10.11 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/25/2016 12:58:53 PM Page 29 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProvigrAVALAKOffies Application c.) Cost per Unit—community kitchen gSMt'6A514*-191141sgiolciASM4041P141t,.0g'''A'4"401600.#40f6;17': Total Cost of Program $ 227,568 $ 216,453 $ 216,453 Total # of Units 85,560 60,312 60,312 Cost Per Unit $ 2.66 $ 3.56 $ 3.56 d.) Cost per Unit—community house 4.'Akftl:*41#01:0 ,15,0***000104,104 7:;',AY0:**100:ed104i6417',' Total Cost of Program $ 588,391 $ 535,521 $ 535,521 Total # of Units 19,140 16,000 16,000 Cost Per Unit $ 30.74 $ 33.47 $ 33.47 e.) Cost per Unit - homestart Actual 2014-15 Estimated2M5-16 ,V001010:000;70164,11 Total Cost of Program $ 464,872 $ 407,014 $ 407,014 Total #of Units 14,685 11,000 11,000 Cost Per Unit $ 31.66 $ 37.00 $ 37.00 f.) Cost per Unit—support circle for one household '..'::Pi6100;i10:1010.4 Total Cost of Program $ 28,972 $ 28,253 $ 28,253 Total # of Units 5 8 10 Cost Per Unit $ 5,794.40 $ 3,531.63 $ 2,825.30 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 1/25/2016 12:58:53 PM Page 30 of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB t A - continued ProviderivaqliONEffhNlication g.) Agency Operating Budget Please show all sources and amounts of funding for your entire current fiscal year. What is your agency's fiscal year? Example: July 1, 2016 through June 30, 2017. Submit operating budget in your own format. Do not include funds that have been applied for but not yet awarded: If the total revenue is not the same amount as the budget for any fiscal year, please attach a statement explaining the deficit or surplus. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 1/25/2016 12:58:53 PM Page 3 / of 33 DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB A - continued Providec's Qutsi0?)Agency_Vplication mAIN A LICA I ru AGENCY NAME: Inter-Faith Council for Social Service Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 920,335 $ 745,000 $ 745,000 0% Agency Generated Revenue (fees) $ 140,699 $ 122,000 $ 122,000 0% Local Government Grants: Orange County $ 41,000 $ 44,000 $ 55,898 27% Town of Chapel Hill $ 18,000 $ 19,000 $ 24,565 29% Town of Carrboro $ 10,000 $ 10,000 $ 13,788 38% Other Local: CDBG - $ - $ 20,000 0 Other Local: 0 Other Local: 0 If more than 3 sources,please provide a separate list. Non-Local Government Grants Triangle United Way $ 136,742 $ 155,564 $ 155,564 0% State Govemment $ 72,147 $ 59,616 $ 59,616 0% Federal Gmemment 0 Other Grants:Foundations $ 255,100 $ 297,600 $ 297,600 0% Other Grants:Various $ 26,527 $ 118,650 $ 118,650 0% MiscellaneouslOther Revenue $ 216,193 $ 133,614 $ 133,614 0% Please list 3 largest Mscellanous sources: Interest - Rents - Transfer from Capital Fund $ - Total Agency Revenue $ 1,836,743 $ 1,705,044 2% AGENCY EXPENSES Compensation $ 1,228,719 $ 1,144,915 $ 1,186,166 4% Rent& Utilities $ 213,877 $ 198,381 $ 198,381 0%. Supplies& Equipment $ 153,667 $ 102,374 $ 102,374 0%. Travel &Training - $ 500 $ 500 0% Other Expenses: $ 261,321 $ 258,874 $ 258,874 0% Please list 3 largest"Other Expenses": Specific Individual Assistance $ - Professional Fees - Miscellaneous - Total Agency Expenses $ 1,857,584 $ 1,705,044 $ 1,746,295 2% mSaIIRPAffligfralT) FOR PERIOD: 1/25/2016 12:d8/.53 R184111 $ r 2 cf t" ol DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: Inter-Faith Council for Social Service Funding Award: $50,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Programmatic Expenses—Food and Residential Programs, Support Circles 50,000 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. • Staff and volunteers of the Food Pantry will distribute monthly grocery allotments of essential food items to eligible members; quantities are based on the number of people in the household • IFC's Kitchen Coordinator and 500+ community volunteers will serve 75,000 hot, nutritious meals during the program year • Some 400 homeless persons who lack a fixed, regular, and adequate nighttime residence will receive emergency/transitional shelter during the program year, as well as access to Case Management Services 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 Bags of Groceries 17,000 bags Homeless to Receive Shelter 400 people Support Circles 8-10 circles Meals Served 65,000 meals DocuSigned by: E6SfilA, tAkAt /A,t, Certified by: Title: co-Di rector Date: 11/21/2016 y• . (Provider's Signature) DocuSign Envelope ID:82431AC9-7F03-4084-815E-A2EFB34C92BB INTECOU-01 KDAVIS ,4c0R1fJ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/23/2016 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 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Alliance for Non-Profits for Insurance Risk Retention Group INSURED INSURER B:Association Insurance Company Inter-Faith Council for Social INSURER C:Hartford Fire Ins. Co. Service Inc. 110 W.Main Street INSURER D:The Hanover Ins Co Carrboro,NC 27510 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. R TYPE OF INSURANCE ADDL WVD POLICY NUMBER POLICY EFF POLICY EXP T LIMITS (MM/DDIYYYY) (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR X 201517838 07/01/2016 07/01/2017 DAMAGE TO RENTED 500 000 PREMISES(Ea occurrence) $ X Professional 1 M/2M MED EXP(Any one person) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000 000 JECT � OTHER: Employee Ben $ Included AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 (Ea accident) > > A X ANY AUTO 201517838 07/01/2016 07/01/2017 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 X 201517838UMB 07/01/2016 07/01/2017 AGGREGATE $ 1,000,000 DED X RETENTION$ 1 0,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N B ANY PROPRIETOR/PARTNER/EXECUTIVE WC522-000320-115 07/01/2016 07/01/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Crime/ERISA 22BDDHK5511 07/01/2016 07/01/2017 100,000 D D&O/EPLI LHR8785106 07/01/2016 07/01/2017 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) It is understood and agreed that the certificate holder is included as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE csac i F 5,.vvr$rw,,e,g ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD