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2017-430-E Health - Boomerang Youth, Inc. - Outside Agency Performance Agreement
DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 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 Boomerang Youth, Inc., a not-for-profit corporation, located at 825A N. Estes Drive, Chapel Hill,NC 27514 ("Provider"). WITNES SETH: 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 Boomerang Youth, Inc. agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2017 to June 30, 2018. 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 B, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of 11725 b. All funds appropriated shall be used for purposes described in Exhibit B. 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 2931.25. 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. (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 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 12, April 13, and July 13 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. (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 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. (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 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 Non-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 $ 13.75 per hour. To the extent possible, Orange County recommends that Boomerang Youth, Inc.provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 County: Finance &Administrative Services Provider: Boomerang Youth, Inc. Orange County 825A N. Estes Drive Post Office Box 8181 Chapel Hill,NC 27514 Hillsborough,NC 27278 16. Entire Agreement. This Agreement,including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable,it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. 18. 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. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of the Agreement and County may immediately terminate this Agreement without further obligation on part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. 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. 19. 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 a)[127tAli pocusigned by: r e Provider 19 8/31/2017 B35AF5C2C51431... Date (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 For DocuSigned by: 7ounty Government beet' ecbuk xs ,ti 8/31/2017 06379948755E477... Bonnie Hammersley, County Manager Date (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FOR OFFICE USE ONLY Agency Boomerang Youth, Inc. Received By Program(s) Boomerang Date/Time / Section Subsection 1. Cover Page a. ❑ Applicant Contact Information b. ® Funding Requests c. ❑ Signed Application Cover Page d. Signed Disclosure of Conflicts of Interest and Clause 2. Agency Information a. ® Agency's Years in operation b. ® Agency's Purpose/Mission c. ❑ Agency's Types of Services Provided d. ❑ Agency's Experience with Programs e. ❑ Other Pertinent Agency Information f. ❑ Schedule of Positions g. ® Living Wage h. ® Agency Budget 3. Program Information a. ® Human Services Needs Priority b. ® Type of Program A separate Section 3 is c. ❑ Agency Collaboration required for each program. d. ® Summary of Program e. ® Description of Identified Need f. ❑ Description of Population to be Served g. ❑ Program Staffing, Capacity, & Expertise h. ® Program Implementation Timeline i. ® Value of Investment j. ® Impact of Reduced/No Allocation k. [' Other Pertinent Information I. ❑ Target Population/Beneficiary Chart m. ® Work Statement n. ® Program Budget, Detail, & Cost per Individual 4. Attachments a. ® Audit: Organizations receiving $300,000 or more in Federal financial assistance, and/or organizations with more than $500,000 NOTE:Audit and Form 990 are for the YMCA of the Triangle of receipts and expenditures in a fiscal year, must secure an audit. b. ❑ IRS Federal Form 990 NC Solicitation License:YMCA and c. ❑ NC Solicitation License Boomerang Youth exemptions attached d. ® IRS Federal Tax-Exemption Letter e. ❑ Certificate of Insurance SWPF: Boomerang leases program f. ❑ List of Board of Directors space from Amity Church in Chapel Hill g. ® Solid Waste Program Fee (SWPF)Verification Pago 1 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Boomerang Youth, Inc. Applicant Organization's Physical Address: 825A N. Estes Drive,Chapel Hill NC 27514 Applicant Organization's Mailing Address: 825A N. Estes Drive Chapel Hill, NC 27514 Applicant Organization's Web Address: boomerangyouth.orq Executive Director: Tami Pfeifer Telephone Number: (919) 968-2146 E-Mail: tamipfeiferAboomerandyouth.org Tax ID Number: b) Funding Request Program Carrboro -HS Chapel Hifi-HS Orange County-HS Total] Program Manager(s)salary 3,900 7,800 11,700 23,400 Psycho-educational skill building 0 1,750 1,750 3,500 groups:. conflict resolution, healthy relations„ substance use, 1 communication and self-expression, personal growth (contractors) 1 1 Materials for after school community 0 450 0 450 service/service learning projects Totals 3,900 10,000 13,460 27,350 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant Signature: T i Pfeifer, Executi ir- or la '.i 1 Di te li I ' ':2)C - I ''''t Signaturell: -''' _ ',,,) 2 ,/ ,„2,; ', ,ti--',...,___ Isabel Geffn-r, Boa d ,g jlla i r p e r s o n Date DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency, which will be carrying out this program or members of their immediate families, or their business associates... YES NO El a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? El c) Current beneficiaries of the program for which funds are being requested? D 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. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to 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, gender identity/expression, 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. 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 program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: \ Executive Dire ttg\ \\ ( Date Signature:c: Board Chairp rson/ Date 1 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation *, Date of Incorporation (Month/Year): August 24, 2015 * Boomerang was a program of the Chapel Hill-Carrboro YMCA from January 2006 to June 2016. Boomerang Youth, Inc., was incorporated on August 24, 2015 (Articles of Incorporation accepted by NC Secretary of State), but operated under the YMCA until July 1, 2016. On July 1, 2016, Boomerang officially separated from the YMCA to begin operations as Boomerang Youth, Inc., an independent 501(c)3 organization. b) Agency's Purpose/Mission (no more than a few sentences): Boomerang inspires youth to bounce back from challenges and move towards positive change. We provide youth with the support they need in times of crisis and beyond, to manage their challenges, cope with adversity and become resilient, independent young people. We strive to disrupt the school-to-prison pipeline by providing alternative-to- suspension and after school programming for middle and high school students in Chapel Hill-Carrboro City Schools and Orange County Schools. Services are provided at no cost to students/families. To date, Boomerang has served over 2500 students through its programs. c) Types of Services the Agency Provides (bullet format): • Alternative to Suspension • Continuing Connections After School o What's Next? skill-building workshops for middle and high school students o Homework Help & Tutoring o Support on Demand: brief counseling, intervention and support for students o Community Service & Service Learning projects d) Agency's History with Providing These Services: 2006: Boomerang is launched as a pilot alternative to suspension program in January, serving one CHCCS middle and one high school 2006: District Court Judge mandates that all CHCCS court-involved youth attend Boomerang when short-term suspended from school 2007: Boomerang expands services to all CHCCS middle and high schools 2008: Boomerang expands services to court-involved youth in Orange County 2008: Boomerang becomes an approved adult community service site 2008: Boomerang and Volunteers for Youth enter an agreement for court- involved Orange County youth aged 16 and younger to complete court-ordered community service hours at Boomerang 2009: Boomerang offers after school hours on Wednesdays-Fridays 2010: Boomerang offers community service hours during the summer break 2011: Boomerang expands services to Orange County Schools 2011: Boomerang expands to a 5-day program in September, including afterschool programming (Tues-Thurs) and summer programming I ' ago 1 o of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 2016: Boomerang separates from the YMCA and begins operations as an independent non-profit e) Other Pertinent Agency Information As of July 1, 2016, Boomerang separated from the YMCA to begin operations as an independent non-profit organization. f) Schedule of Positions # of FTE - Full-Time Paid Positions: 5 # of FTE - Paid Part-Time Positions: 0 # of Volunteers*: 25 # of FTE -Volunteers: 1 *Includes MSW intern, 2 Bonner interns (0.5FTE) g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/No) YES If yes, is this agency an Orange County Living Wage Certified Employer? YES ll ' ago 5 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget i. Is your agency currently receiving and/or requesting other(non-Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes/No) Yes If yes, please list below: Program FY16-17 Award FY17-18 Source Request Boomerang $27,312 + $8,194 = 35 500 Juvenile Crime Prevention $35,506 Council + County Match ii. Submit your agency's budget. ATTACHED iii. Does your agency budget show a Surplus or Deficit? Deficit Is there a significant change? Yes/No No Please provide a brief explanation for Surplus or Deficit, and significant changes. A deficit of$6,037 is projected for FY 2017-18. This should be offset by the projected surplus shown for FY 2016-17. iv. What is your agency's fiscal year? July 1, 2017 — June 30, 2018 6 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Boomerang -Alternative to Suspension & Continuing Connections After School Program Primary Contact and Title: Sonia Frischemeier, Director of Operations Telephone Number: (919) 968-2146 E-Mail: Sonia.Frischemeier©BoomerangYouth.org a) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #1: safety-net services for disadvantaged residents ® Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare Education X Family Resources Jobs/Jobs Training Food Transportation Other: After School X c) 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, briefly describe the coordinated/collaborative efforts. • School districts - Chapel Hill-Carrboro City Schools and Orange County schools — are core partners in coordinating services provided to suspended students and transitioning them back to school. • Department of Juvenile Justice is a core partner in coordinating services and follow-up with court-involved students. • UNC Outpatient Substance Abuse Clinic provides weekly workshops on substance use to supplement Boomerang's assessments and psycho-educational skill-building activities; an important service as substance use has been the most common reason for suspension over the last 2 years. • Dispute Settlement Center provides bi-monthly skills-building sessions in conflict resolution to supplement Boomerang's conflict and communication skill-building II:' g of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION activities; an important service as fighting is the second most common reason for suspension. • Orange County Rape Crisis Center provides weekly workshops on healthy relations and sexual health to supplement Boomerang's self-care and communication skill-building activities. • Partnerships: o Volunteers for Youth and the Adult Community Service to provide approved community service programming for juvenile and adult court-involved youth during after school hours. o The ARC of Orange County and Eyes Ears Nose and Paws (EENP) provide expanded opportunities for youth to engage in meaningful service in the community. o UNC School of Social Work provides a MSW intern each year. The intern functions as staff and provides additional support during alternative to suspension and afterschool programming. o Campus Y provides Bonner interns each year; each intern stays with Boomerang for 4 years. o UNC's APPLES Service Learning program volunteers provide academic support to students, including 1:1 tutoring, as well as after school support. • Boomerang works with partner agencies to refer students and families for follow-up services, including: o Mental health (e.g. Carolina Outreach, El Futuro) o Family support to provide critical assistance to parents raising school-age children with emotional/behavioral issues, mental illness, learning differences, substance abuse problems and other challenges (Freedom House, Youth Villages), and substance use (UNC-ASAP). • Boomerang is a community impact partner of Orange County Family Success Alliance, contributing to the development of activities and services for youth on the cradle to college/career continuum. • Boomerang is a community partner in Orange County Misdemeanor Diversion Program: rather than face arrest and prosecution in adult criminal court, 16 and 17 year old first-time offenders with eligible misdemeanor offenses are placed on a 90-day diversion plan that focuses on addressing individual therapeutic needs or the completion of community service hours. • Boomerang is a member of the Third Sector Alliance, a community organization that seeks to address community needs and support collaborations to improve the quality of life of all who live and work in Orange County. PROGRAM DESCRIPTION (3 pages OR LESS) d) Program Services Proposed At Boomerang, students participate in structured programming which emphasizes positive behavioral-change outcomes, and which is an opportunity to re-engage students in school and community. We do this through two central program services: Positive Alternative to Suspension Boomerang's Alternative to Suspension program provides a structured and supervised environment for 6th to 12th grade students who have been short-term suspended from I ' ago of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION school. Students: • Engage in 1:1 sessions with licensed staff to discuss underlying issues that led to the suspension, identify their strengths and learn about alternative, positive behaviors/skills and coping strategies. • Receive academic support and tutoring to stay on task with schoolwork. • Build social skills and identify core values during structured group discussions. • Participate in psycho-education groups: conflict resolution; self-expression; healthy relationships; and substance use prevention & education. • Lead a wrap-up meeting with family and school representatives (and court counselor if applicable) to support their re-entry back to school. Boomerang is the only organization that offers an alternative to short-term suspension for youth in Orange County. Our principal partners for student referrals are Chapel Hill- Carrboro City Schools, Orange County Schools and the Department of Juvenile Justice Continuing Connections After School During the critical hours after school and over the summer, Boomerang provides youth with additional learning opportunities and support, as well as recreational opportunities, to help them: • Build skills that support academic achievement. • Gain confidence and cultivate leadership skills through service learning, community service and other civic engagement opportunities. • Learn independent living and leadership skills. • Develop conflict and communication skills. Weekly: Tuesday through Thursday, 4-6pm - Service learning - Community service - Tutoring - Individual brief counseling Weekly/Quarterly: What's Next?: life skills workshops for middle and high school students. Monthly: Reunions for youth to reconnect with Boomerang in a recreational setting. Summer: Weekly life skills workshops for youth participating in summer employment programs and internships, such as EmPowerment's Career Explorers, and for youth in Orange County Misdemeanor Diversion Program. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. Community Need Most young people in Orange County navigate their teen years successfully. Surrounded by supportive families and communities, students do well in school and avoid risky behaviors that can lead to negative outcomes. These youth have hope for the future and work hard to make their aspirations a reality. Their dreams and plans include further education, I ' ago 9 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION meaningful careers, involvement in their communities, and healthy relationships with family and friends. But some young people in our community find the road to adulthood much harder to navigate and face more challenges than their peers. For these youth, the journey is filled with external and internal obstacles and stressors that can derail healthy development. In Orange County, 1 in 20 youth (Measure of America) are disconnected from the typical pathways of education, college and career. This number does not capture the number of youth at high risk for disconnection: • Students suspended from school are up to ten times more likely to drop out of school or repeat a grade • Youth in the juvenile justice system • Young people with limited means and access to opportunities Most young people we see at Boomerang are at the intersection of multiple types of social and economic disadvantage: poverty, racialization, undocumented status, and/or underserved families (education, employment). Many have experienced trauma that is beyond the range of typical human experience. These stressors can cause the disruptive, risky behaviors that interfere with a young person's daily functioning. They affect school performance, and can lead to dropping out of school, homelessness, substance use, other health-compromising behaviors, and/or involvement with the justice system. Boomerang seeks to empower these vulnerable youth to have crisis-free lives, and build strong connections to family, school and positive peers in a supportive environment during out of school time. Boomerang's programming thus aligns with the following community goals: • Chapel Hill Human Services Needs Assessment Education & Family Resources are identified as an important community need. Within this category, Youth Support and Activities are highlighted with many participants agreeing "Chapel Hill lacks sufficient low-cost/free activities that positively engage children and youth, especially those from at-risk and low-income households". Among the responses to this Assessment, participants specifically cited the need to support [for] at-risk children and teens. • Town of Chapel Hill Council Goals, 2016-18 Community Prosperity: Develop a strategy for creating vocational classes and career development for youth with the school system, Durham Tech and other non-profit organizations. This builds on the 2016 Council Goal (2014-2016 Council Goals Status Report), under Nurture Our Community: Create a strategy to impact out of school time, ESL, and vocational classes for youth with non-profit organizations (2016 Goal) • Chapel Hill 2020 - Theme 1: A Place for Everyone states "Chapel Hill is a place for youth, students, singles, families, retirees, and people at every life stage." • Orange County BOCC Goals and Priorities Applies to all goals: Pago 10 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Social Justice Values: o Foster a community culture that rejects oppression and inequity. o Ensure economic self-sufficiency. o Create a safe community. o Enable full civic participation. Goal 1: Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents. Boomerang is a community member of Family Success Alliance (FSA); our work falls under the following goals of FSA's Strategic Plan 2016-2018: - Goal 2: Children and youth are healthy and succeed in school - Goal 3: Youth graduate from high school and college. Goal 6: Ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare. Specifically, EDUCATION: AT-RISK CHILDREN Continue to close the achievement gaps and end the school to prison pipeline. • Carrboro Board Priorities: E. Enhance and sustain quality of life/place issues for everyone 7. Help citizens develop a human environment that promotes trust, mutual respect, acceptance, happiness and well being. (Planning) f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Boomerang primarily serves youth ages 11-19 in Orange County. Please note, we continue to provide support to a small cohort of young people who are now beyond this age range, but who return to us after middle and/or high school for support and mentorship. Youth are referred by the two school districts, juvenile justice system and other non-profits whose work supports at risk youth including Family Success Alliance and Orange County Misdemeanor Diversion Program. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Direct Support Staff Administration Executive Director (LCSW) Executive Director Program Manager (LCSW-A) Director of Operations Program Manager (vacant) Office Manager MSW Intern Direct services are provided by licensed staff (LCSW, LCSW-A or MSW) with graduate degrees in Social Work or Counseling, or equivalent experience working with vulnerable youth. Direct support staff is assisted by an MSW intern (UNC-Chapel Hill School of Social Work). Licensed staff participates in Continuing Education throughout the year to keep in Page 11 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION good standing (e.g. Ethics & Trauma). In addition, Boomerang has two interns from the UNC-CH Bonner Leaders Program who help with student supervision, 1:1 tutoring, and program evaluation, among other duties. All staff members, including our MSW Intern, participate in an annual 2-day training retreat before the start of a new school year conducted by the Executive Director. All volunteers participate in a half-day orientation conducted by the Program Managers. All staff and volunteers carefully review and sign Boomerang's Code of Conduct and Confidentiality Agreement and go through a comprehensive background check. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Activities will be carried out from July 1, 2017 to June 30, 2018. Alternative to Suspension Traditional school calendar for CHCCS and OCS; community service opportunities are provided on teacher workdays; Monday-Friday, 9am-2pm. Continuing Connections After School During the school year: Tuesday to Thursday, 4-6pm Summer schedule is posted in June i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) • Boomerang contributes to safer schools and community. As the only organization that offers an alternative to short-term suspension for youth in Orange County, youth are supervised in a safe, positive environment, get the support they need at a time of crisis, learn and build on skills that will help them be successful, and keep up or catch up with schoolwork. A recent quote from a parent: "It gave my son a chance to stay in a routine in a less stressful environment, with staff who broke the wall between my son and school personnel, which allowed for a nice wrap-up meeting with school personnel and nice transition back to school." • Our after school programming continues the important work of skill-building and support. It is critical to provide a safe space — for learning, support and recreation - to young people who often have limited access to after school activities. • Investing in all our youth is vital for the social and economic wellbeing of our community. We believe that empowering underserved youth is key to achieving greater equity of opportunity and outcomes for all Orange County residents. Boomerang programs work with vulnerable youth to address some of the barriers they face so they can be successful in school and in life. We do this in concert with other local partners to build and maintain a network of services and activities that lift young people up. Pago 12 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Our vision for our community is one where all youth view themselves — and others view them — as whole and worthy community members. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If the requested funding is not awarded or is at a reduced level, Boomerang would need to reconsider the number of youth served, and potentially reduce after school programming. Additional Program Information k) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics—ALTERNATIVE TO SUSPENSION Actual Estimated Projected 2015-16 2016-17 2017-18 Gender Male 120 105 105 Female 47 45 45 Total 167 150 150 Ethnicity African-American 82 65 65 American Indian or Alaska Native 0 0 0 Asian 0 0 0 Caucasian 69 75 75 Native Hawaiian or other Pacific Islander 0 0 0 Other: Multi-Racial 16 10 10 Total 167 150 150 Of the above, how many Hispanic/Latino 37 45 45 Of the above, how many non-Hispanic/Latino 130 105 105 Total 167 150 150 Age 0-5 years 0 0 0 6-18 years 162 145 145 19-50 years 5 5 5 51+years 0 0 0 Total 0 150 150 Geographic Location Orange County Breakdown Chapel Hill (27514, 27516, 27517) 80 75 75 Carrboro (27510) 31 30 30 Other Orange County 56 45 45 Total 167 150 150 Pago 13 f 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement I) Complete the Work Statement Chart to describe the work to be performed. Work Statement Chart for Program Boomerang 1. Program Activity Name Alternative to Suspension Program Goal 85%of students will successfully complete the alternative to suspension component Performance Measures School referral, daily attendance, qualitative notes on student participation and behavior, student External Service Note to schools/courts, internal service notes Previous Year Program Results 96% - 160 students out of 167 Current Year Estimated Results 85%- 128 out of 150 Next Year Projected Results 85% - 128 out of 150 2. Program Activity Name Community Service Program Goal 50% (15/30)of youth will self-report learning/improving skills and will actively participate in Community Service projects Performance Measures Community service referral forms, daily timesheets, reports to Volunteers for Youth and Adult Community Service, youth surveys Previous Year Program Results 72% (#of youth completing at least 5 hours of community service in 2015-16); goal has since been revised. 1 2015-16, youth completed 720 hours of service. Current Year Estimated Results 50% Next Year Projected Results 50% 3. Program Activity Name What's Next? Program Goal 75%of youth attending What's Next?life skills workshops will report having significantly improved knowledge of subject area Performance Measures Post-session surveys Previous Year Program Results 86% (percentage of youth attending Boomerang's "What's Next?" workshops will complete at least 2 group sessions); goal has since been revised. In addition,16 individual youth participated in an 8- week What's Next? Entrepreneurship Development Workshop, provided by Boomerang for summer interns registered with EmPowerment's Career Explorers program; this was an in-kind contribution to an FSA partner. Current Year Estimated Results 75% Next Year Projected Results 75% 4. Program Activity Name Intensive Follow Up Program Goal 50%of youth (6/12) identified for intensive follow up services will show an increase in social connectedness (positive peers, family, school, community) by the end of the school year Performance Measures Readiness to Change scale, post-surveys, school/family feedback, decreased recidivism Previous Year Program Results 50% Current Year Estimated Results 50% Next Year Projected Results 50% P g 11 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION m) Program Budget -ATTACHED 1. Program Budget Detail — Provide description of"other" budget items, not defined. Other Expenses 2017-18 Workers Compensation $2,000.00 Payroll Service $1,500.00 Background Checks $500.00 Bookkeeping $1,920.00 Contract Services $12,110.00 Bank Service Charges $100.00 Insurance— General liability, property, D&O, professional liability $3,300.00 Membership & Professional Dues $500.00 Marketing & Development $2,000.00 Translation/Interpretation (20 hours) $550.00 Total "other expenses" $24,480.00 2. This program budget represents what percent of the agency budget? 100% 3. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2015-16 Estimated 2016-17 Projected 2017-18 Total Cost of Program 249,841 291,544 297,187 Total # of Individuals 1072 1200 1200 Cost Per Individual 233 243 248 We define "# of individuals" in terms of weighted Units of Service. UNIT OF SERVICE: reflects the services each student receives in terms of 1:1 time with the licensed clinical staff, `dosage' of services they receive with guest speakers, group sessions and academic engagement (tutoring, communicating with teachers, follow-up support), as well as after school programming (community service, service learning, What's Next?, drop- in brief crisis counseling, schoolwork help). 2015-16 1 Student 2-4 day ATS = 1 unit of service = 96 units 1 Students -7 day ATS = 2 units of service = 43x2 = 86 units 1 Student 8-10+ day ATS = 3 units of service = 28x3 = 84 units 1 Student Instance CS/SL = 1 unit of service = 382 units 1 Student receiving intensive follow-up services = 3 units of service = 12x3 = 36 units 1 Student instance attending What's Next? = 1 unit of service = 102 units 1 Student instance receiving after school tutoring = 2 units of service = 24x2 = 48 units 1 Student attending Open Doors (drop in, brief crisis counseling) = 1 unit of service = 238 units Page 15 of 15 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Boomerang Youth, Inc. Actual Estimated Projected Percent AGENCY REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ - $ 30,000 $ 45,000 50% Agency Generated Revenue (fees) $ - $ - $ - 0 Local Government Grants: Human Services -Town of Carrboro $ 1,600 $ 2,500 $ 3,900 56% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 2,500 $ 7,000 $ 10,000 43% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services -Orange County $ 5,000 $ 10,000 $ 13,450 35% Other- Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ 3,977 $ - $ - $ - UWGT/Family Success Alliance $ 4,000.00 $ 6,950.00 $ 7,500.00 $ 0.08 Juvenile Crime Prevention Council $ 32,850.00 $ 35,506.00 $ 35,500.00 $ (0.00) Family Success Alliance $ 10,000.00 $ - $ - 0 School Districts $ 55,000.00 $ 55,000.00 $ 55,000.00 $ - Private Foundation Grants $ 181,150.00 $ 178,468.00 $ 118,000.00 $ - Other Revenue $ - $ 6,067 $ 2,800 $ (0.54) Total Agency Revenue $ 296,077 $ 331,491 $ 291,150 -12% AGENCY EXPENSES Compensation $ 203,491 $ 234,903 $ 240,157 2% Rent& Utilities $ 21,620 $ 22,680 $ 23,200 2% Supplies & Equipment $ 6,759 $ 7,850 $ 8,950 14% Travel & Training $ 2,244 $ 100 $ 400 300% Other Expenses: $ 15,727 $ 26,011 $ 24,480 -6% Total Agency Expenses $ 249,841 $ 291,544 $ 297,187 2% SURPLUS/(DEFICIT) FOR PERIOD: $ 46,236 I $ 39,947 I $ (6,037)1 -115% FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 EXHIBIT "B" Scope of Services— FY 2017-18 Outside Agency Performance Agreement Agency Name: Boomerang Youth, Inc: Program Name: Boomerang Funding Award: $1 1,725 outline how the agency will spend Orange County's articling award. Expense Description Amount Program Manager(s)salary 11 a000 ........:_ Psycho-educational skill building groups: conflict resolution,healthy relations,substance use, 725 communication and self-expression„personal growth(contractors) Program Services Outline the critical services(acti vines)the agency will employ to attain the Anticipated Outcomes below,by RIM:30.2018. • Alternative to Suspension: structured day program for short-term suspended middle and high school students attending Orange County Schools and Chapel Hill-Carrboro City Schools • Continuing Connections After School o What'57 Next?skill-building workshops for middle and high school students, and summer interns o Homework Help& Tutoring o Support on Demand: brief counseling,intervention and support for students o Community Service & Service Learning projects 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. — , Anticipated Performance Measures Results _ ' 85%of students referred to Boomerang will successfully complete the alternative to suspension . , 12S out of coin orient 150 students 50%of youth will self-report teaming/improving skills and will actively participate in 15 out of 3() Communit Service ro ects youth ... 75%of youth attending,What's Next'? life skills workshops will report having significantly : 30 out of 40 im roved knowledze of subject arca youth 50%of youth identified for intensive follow up services will show an increase in social 6 out of 12 connectedness ositive eers,famil :, school,community)by the end of the school year youth --0 ocuSigned by: [ 1'0111 Ptr Executive Di rector 8/31/2017 6B35AF5C2C51431. j '---9 . i I n Certified by , Title: estr=Q___(-01e--- :. vSe...()0 Date -1 - ' k i : i t (Provider's Si i tur DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 ATTACHMENT "A" Orange County Certifications—FY 2017-18 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. °=°{-D.ocuSived by: lt Executive Director 8/31/2017 Certified by: 6B35AF5C2C51431... Title: Date: (Provider's Signature) (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID: 5F353138-C664-4703-97A3-A28BCE0500B7 AC J DATE(MM/DD/YYW)CERTIFICATE OF LIABILITY INSURANCE 7/14/2017 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 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 Kelley Loso NAME: y Business Insurers of Carolinas (A//C,NNo,Ext): (91 9)968-4611 FAX No): (919)968-8991 800 Eastowne Drive, Suite 208 AE-MDDAIL PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA:Western World Ins Co INSURED INSURER B Amguard Insurance company Boomerang Youth Inc INSURER C: 825-A North Estes Dr INSURERD: INSURER E: Chapel Hill NC 27514 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1771419128 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ NPP8393528 7/1/2017 7/1/2018 MED EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 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: NonOwn Auto Liab Ul UIM $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? 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