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HomeMy WebLinkAbout2017-160-E Health - El Centro Hispano - Outside Agency Performance Agreement DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DDO5E1503A51 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the fourth day of April 2017, ("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 El Centro Hispano, a not-for-profit corporation,located at 2000 Chapel Hill Road, Suite 26A, Durham,NC 27707 ("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 El Centro Hispano agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning April 4, 2017 to June 30, 2018. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Funding Requests 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 request 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$54,168.00. 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 one lump sum in the amount of $54,168.00. The payment is contingent upon receipt of the agency's performance agreement. d. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. Orange County Outside Agency Performance Agreement—Social Justice Funds April 2017 Page 1 of 7 DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DDO5E1503A51 a. Provider will provide Orange County a quarterly 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 11,April 15, and July 8 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. 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. Orange County Outside Agency Performance Agreement—Social Justice Funds Page 2 of 7 April 2017 DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DDO5E1503A51 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. 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 Orange County Outside Agency Performance Agreement—Social Justice Funds Page 3 of 7 April 2017 DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DDO5E1503A51 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 El Centro Hispano 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: County: Orange County Health Department Provider: El Centro Hispano ATTN: Kimberlee Quatrone 2000 Chapel Hill Rd. Ste. 26A Post Office Box 8181 Durham,NC Hillsborough,NC 27278 27707 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of Orange County Outside Agency Performance Agreement—Social Justice Funds Page 4 of 7 April 2017 DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DDO5E1503A51 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 1 1 A 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. Cou�w r ii,behalf of the Provider P Rod4-Guy 4/30/2017 22BDDB39CI74.101.. Pilar Rocha-Goldberg,President/CEO Date Bcaffifinvithbehalf of Orange County Government NIAAA t, lkamovt -rSt 5/11/2017 n5179A4B7f SF477 Bonnie Hammersley, County Manager Date Orange County Outside Agency Performance Agreement—Social Justice Funds Page 5 of 7 April 2017 DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DDO5E1503A51 ATTACHMENT "A" Orange County Certifications—FY 2015-16 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: ee Certified by: „erns q ,, �� Title: President&CEO Date: 4/30/2017 (Provider's Signature) Orange County Outside Agency Performance Agreement—Social Justice Funds Page 7 of 7 April 2017 DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DD05E1503A51 Exhibit "A" El Centro Hispano: GC Funding Reuet-- arch 2017 IMMIGRATION LEGAL ASSISTANCE Intervention Area; Community Support Services- Immigration Legal Assistance Identified Need There is growing concern among the Hispanic/Latino population nationwide of the climate and policies that the new Administration of the United States is setting forth; particularly those targeting non-citizens. The Pew Research Center reported on recent at February 23, 2017 that there is growing concern and fear of deportation among green card holders and undocumented residents because of"new immigration enforcement policies that widen the pool of unauthorized immigrants prioritized for deportation to include those who have committed an act that will result in criminal charges." (Pew Research Center) Legal Recent policy changes have accelerated detention and deportation activities, deepened immigration enforcement authority to sheriffs and police officers, expanded those targeted for deportation, and prioritized for deportation anyone convicted of a crime, even minor offenses. One safeguarded group are DACA recipients, however, their future standing is still unknown. In addition, verbal attacks by the new Administration Latinos and the depiction of ALL as criminals and potential terrorists affect citizens and non-citizens alike, giving way to further isolation, distrust of law enforcement and government officials, and harassment by anti- immigrant/anti-Latino groups. These findings have been echoed by HispaniclLatino residents in the Triangle area of North Carolina. Attendees of community forums and Faith ID held by El Centro Hispano have voiced concern and confusion over recent changes, not knowing the immediate impact the changes will have on them and their family members, their resident status, and opportunity to achieve citizenship. Proposed Intervention In response to these growing concerns, the leadership of the organization is restructuring its community support services to establish an immigration legal team and approach that assists Latinos in their pathway toward citizenship and advance immigrant rights. Program Title: Immigration Legal Assistance Population to be Served: - Undocumented Immigrants of Hispanic/Latino origins - Youth eligible for and/or recipients of DACA - Domestic Violence Victims I Victims of Crimes - Lesbian, Gay, Bisexual &Transgender - Permanent Residents seeking citizenship Areas of Legal Assistance - Adjustment of Status Screening - Family Based Petitions - Naturalization and Citizenship - Deferred Action of Childhood Arrivals (DACA) - Asylum Petitions - U-Visas and Violence Against Women Act(VAWA) petitions - Limited deportation assistance DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DD05E1503A51 Type of Legal Services - Adjustment status consultation and screening - Assistance with completing forms - Filing with USCIS - Representation before Board of Immigration Appeals (BIA) - Representation before immigration courts - Legal assistance with removal hearings (limited) - Power of Attorney Type of Non-Legal Services - Community Education Forums (i.e. Know Your Rights Forums) - Faith ID Drives - Citizenship/ Civic Classes - English as a Second Language (ESL) Classes - Interpretation and Translation • - Advocacy and community mobilization Program Goals and Expected Outcomes 1) By the end of 2017, establish Immigration Legal Assistance as part of the Community Support Services Section of El Centro Hispano a. By July 2097, o Complete BIA recognition and accreditation process o Secure additional funds to expand services and hire staff o Hire and/or reassign staff to provide services, to include: - 1 FT Lawyer(to provide legal counsel and representation and oversight over BIAS) - 1 FT Paralegal (to respond to calls, set up appointments,prepare paperwork and assist lawyer with building cases) - 1 FT BIA certified (1 full-time or 2 part-time staff to assist with intake, conduct screenings, and help complete and assist forms to USCIS,and - 1 FT Coordinator of Education& Outreach (to coordinate No Operator Civic Classes,. forums, Faith ID drives, conduct presentations in the community, recruit and manage volunteers, provide outreach to the community using a variety of channels to include social media, radio,TV, print, etc) o Set service policies, schedule of services, case load limits, and fees b. August to December 2017 o Launch, monitor, and evaluation services rendered o Work with partners and community volunteers to hold the following community education and outreach events - Ten(10) community forums(April to December 2017) - 10 Faith ID Drives - Four(4) No Operator Civic Classes DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DD05E1503A51 Progress to Date El Centro Hispano has been working in the past year to respond to the needs of our immigrant Latino community by providing immigration legal assistance and due to heightening concerns and changing policies, have expedited its efforts To date, • Completed BIA Recognition and Accreditation Application • Engaged staff in BIA recognition training • Secured $45,000 toward hiring of legal team • Established Faith ID recognition in Durham and Orange County • Held 12 Faith ID drives since February 2016 and Issued over 1859 Faith lDs • Held 3"Know Your Rights" Forums and assisted community members with establishing Power of Attorney documents • Held 6 citizenship classes with the result in 15 new US citizens • Two citizenship clinics in collaboration with NALEO and The Latin American Coalition Proposed Budget for Orange County Costs for Affordable immigration services for Orange County 100 people for screening/legal services 100 People/4 sessions a year/25 per session for No Operator License Civics Classes(NOLC) 150 people/6 Faith ID drives a year $155/person served Description $ Unit Total Explanation Part time to coordinate the No Operator Civic Classes, forums, Faith ID drives, conduct presentations in the community, Project Coordinator $13 $13,520 recruit and manage volunteers, provide outreach to the community using a variety of channels to include social media, radio, TV, print, etc. Full time to assist with intake, conduct BIA Certified $13 $27,040 screenings, and help complete and assist forms to USCIS personnel 22% FT Benefits for P 11% PT $7,436 Health insurance, Denta Insurance, etc. Faith ID drives $4 $3,600 Extra cost no covered by the individual payment Interpretation& $40 $640 1 interpreter per session for the NOLC Translation Classes Childcare $13 $832 4 childcare people/session • DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DD05E1503A51 • Printing &Copying $010 $800 20 copies per person Snacks for the NOLC classes $2 $30[ Participants and their children TOTAL $54,168 • DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DDO5E1503A51 EXHIBIT `B" Scope of Services—FY 2016-17 &2017-2018 (4/4/2017-6/30/2018) Outside Agency Social Justice Funds Performance Agreement Agency Name: El Centro Hispano (ECH) Funding Award: $54,168 Outline how the agency will spend Orange County's funding award. Expense Description Amount Project Coordinator Salary Support @art-time—PT) $13,520 BIA Certified Staff Salary Support(full-time—FT) $27,040 Benefits for Personnel(22%FT, 11%PT) $7,436 Faith ID Drive expenses not covered by individual payment $3,600 Interpretation and Translation for No Operator License/Civics(NOLC)classes $640 Child Care for NOLC classes $832 Printing and Copying $800 Snacks for NOLC classes $300 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 30,2018. • Provide legal assistance in various areas, including: Adjustment of status screening, family-based petitions, naturalization and citizenship, Deferred Action for Childhood Arrivals (DACA), asylum petitions, U visas and Violence Against Women Act (VAMA) petitions, limited deportation assistance, and Power of Attorney. • Coordinate community education (Know Your Rights) forums; Faith ID drives; No Operator License/Civics, ESL, and Citizenship classes; interpretation/translation; and advocacy 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 Number of clients who receive immigration legal services/screening 100 Number of clients who participate in No Operator License/Civics classes 100 Number of clients who participate in the Faith ID program 150 DocuSigned by: P" ' ko 4-40 President&cEO 4/30/2017 Certified by: 22gno.39c Title: Date:ni 7nn(Provider's Signature) DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DD05E1503A51 ELCENTR-04 SPIKE ,4 G'ORC1" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `..•- 4/18/2017 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 have ADDITIONAL INSURED provisions or 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: Hub International Southeast PHONE 919 337-0000 FAX 866 553-5124 4000 CentreGreen Way (A/C,No,Ext):( ) (NC,No):( ) Suite 140 ADDRESS: Cary, NC 27513 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: El Centro Hispano,Inc. INSURER C: 2000 Chapel Hill Road,Ste 26A INSURER D: Durham,NC 27707 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR W POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD VD (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK1612489 04/06/2017 04/06/2018 DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) ANY AUTO PHPK1612489 04/06/2017 04/06/2018 BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PHUB573161 04/06/2017 04/06/2018 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Crime PHPK1612489 04/06/2017 04/06/2018 Employee Dishonesty 120,000 A Professional Liabili PHPK1612489 04/06/2017 04/06/2018 Each Incident 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Professional Liab Aggregate$3,000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Health Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y p ACCORDANCE WITH THE POLICY PROVISIONS. 300 W Tryon St Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:917E7596-F2F2-4BF8-B6C3-DD05E1503A51 I _.F CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/18/17 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 have ADDITIONAL INSURED provisions or 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 Aon Risk Services,Inc of Florida NAME: Aon Risk Services,Inc of Florida 1001 Brickell Bay Drive,Suite#1100 PHONE FAX Miami,FL 33131-4937 (A/C,No,Ext):800-743-8130 (A/C,No):800-522-7514 EMAIL ADDRESS: ADP.COI.Center @Aon.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: New Hampshire Ins Co 23841 INSURED INSURER B: ADP TotalSource FL XVI,Inc. 10200 Sunset Drive INSURER C: Miami,FL 33173 L/C/F INSURER D: El Centro Hispano Inc. 600 East Main Street INSURER E Durham,NC 27701 INSURER F: COVERAGES CERTIFICATE NUMBER: 1554631 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. LIMITS SHOWN ARE AS REQUESTED. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE COMBINED SINGLE LIMIT UTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY _AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEC RETENTION$ WORKERS COMPENSATION X PER OTH- A AND EMPLOYERS'LIABILITY Y/N WC 061145842 NC 07/01/16 07/01/17 STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 2,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) All worksite employees working for EL CENTRO HISPANO INC.,paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION Orange County Health Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 300 W Tryon St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Hillsborough,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE on,or(2:61c detvice6, % a of cRoticla ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD