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HomeMy WebLinkAbout2017-482-E Finance - Habitat for Humanity, Orange County, NC - Outside Agency Performance Agreement DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A 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 Habitat for Humanity, Orange County, NC, Inc., a not-for-profit corporation, located at 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Habitat for Humanity, Orange County,NC, 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 37500 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 9375. 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. (Habitat for Humanity, Orange County, NC,Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31; January 1 —March 31 and April 1 - June 30. Reports are due on January 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 (Habitat for Humanity, Orange County,NC,Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement,insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury,including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance,including hired and non-owned vehicles,if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A - Statutory State NC& Coverage B -Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 (Habitat for Humanity, Orange County,NC,Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender,national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County 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 Habitat for Humanity, Orange County,NC, 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 (Habitat for Humanity, Orange County,NC,Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance &Administrative Services Provider: Habitat for Humanity, Orange Orange County County,NC, Inc. Post Office Box 8181 88 Vilcom Center Drive, Suite Hillsborough,NC 27278 L110 Chapel Hill,NC 27514 16. E ntire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable,it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. 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 and on behalf of the Provider (Habitat for Humanity, Orange County,NC,Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A [' DocuSigned by: sal,t, V-- ( 8/31/2017 68R7fRCO27AA4FC Date For Sangho/gulf of Orange County Government botA lU1. A-cum144 "S 9/5/2017 0637-994D7:f 0477... Bonnie Hammersley, County Manager Date (Habitat for Humanity, Orange County,NC,Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FY 2017-2018 Outside Agency Funding Application HUMAN SERVICES • ORANGE COUNTY • TOWN OF CARRBORO • TOWN OF CHAPEL HILL Orange County (OC) Town of Carrboro (CA) Town of Chapel Hill (CH) 200 S. Cameron Street 301 W. Main Street 405 Martin Luther King, Jr. Blvd. Hillsborough, NC 27278 Carrboro, NC 27510 Chapel Hill, NC 27514 ,--".'cr,'o � 1o0o01 ' ""%o•••o III �l» .` li &VII � 0�}' m 1011 IIIIi�IIVII�����1��������� �������������go ��� VIIIII ''1 '4‘'°' 111111100011000011111111111111111110111000011110 414:„. II‘ IIVIVIVIVI VON ' sHIS)tHhill 'Vii 1 10 '' l&Z�O� 1 � � I1 IL NO 1 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION INFORMATION Each year, Orange County Government, the Town of Carrboro and the Town of Chapel Hill invite program funding requests from non-profit providers that support the delivery of vital community services. The application process is very competitive and not all applicants will be awarded funding. Recommendations for funding may be for an award amount less than that requested by the applicant. Agencies that are currently receiving funds from Orange County, the Town of Carrboro, or the Town of Chapel Hill local governments, and are also applying for new funds, must be in compliance with all terms of their current agreement(s) and must not have any outstanding audit findings, monitoring findings or concerns as determined by the municipality. Recipients are required to submit written progress reports on their SMART Measures that include: goals, description of activities/challenges, revisions of timelines/budgets, and other relevant information Funded projects will be monitored for progress and performance, financial and administrative management, and compliance with the terms of Performance/Development Agreement(s). Monitoring may involve site and/or office visit(s). Once applications are received, they are reviewed by staff for completeness and eligibility. The applications are presented to a specific application review group, depending on the funding source. The review group will make a recommendation, based on available funding and the priorities identified by the participating jurisdiction. The recommendation is presented to the appropriate Board/Council for consideration and approval. The Board/Council approves/adopts the final allocations. TIMELINE November 15 Funding Application Posted on Websites November 29 Funding Application Workshop Held October 18-January 23 Agency Prepares Application January 10 Q&A Session Held J r uua ry 31 A Suuabiiii° r 101)1i March - May Application Review & Agency Presentations June Agency Funding Approval by Board/Council July Contracts Executed & Programs Begin DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM P a g e 2 of 1 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION SUBMITTAL INFORMATION Welcome to the Outside Agency Common Funding application for local/general funds, which will be distributed through this competitive application process. All entities or organizations requesting funds must complete and submit this application prior to the deadline to be considered for FY 2017-2018 funding. The Application Submittal Deadline is: Tuesday, January 31, 2017 5:00 PM In the event of inclement weather, check the website for each Town/County you are applying to, for further instructions. Please note that late, handwritten, or incomplete applications will not be accepted. (Applications not signed by the Chair or President of the Board of Directors, are considered incomplete.) An application orientation workshop will tentatively be held on Tuesday, November 29, 2016 at 9 AM to Noon to review the application and submittal requirements. SUBMITTAL REQUIREMENTS FOR EACH MUNICIPALITY Human Services— Town Of Carrboro Applications are accepted once a year and reviewed by the Town's Human Services Advisory Commission, which makes a recommendation for funding to the Board of Aldermen for final approval. For more information about the Town of Carrboro Human Services program, see here. Questions and submittals should be directed to: Annette Stone, 301 W. Main Street Carrboro, NC 27510 919-918-7319 astone(a townofcarrboro.org Submission: ➢ We strongly encourage applications to be single-spaced, with 12-point arial font and normal margins. ➢ Application: One (1) original plus Two (2) paper copies of the application must be hand delivered or mailed to Annette Stone, 301 West Main Street, Carrboro, NC 27510; AND ➢ One Application and Attachments files must be submitted by email. Any .pdf files must be accompanied by the original file format of .doc, .xls, etc. DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM P a g e 3 of °t DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Human Services —Town Of Chapel Hill In 1982, the Town established local funding to support local nonprofit organizations that carry out human service work throughout the community. Applications are accepted once a year and reviewed by the Town's Human Services Advisory Board, which makes a recommendation for funding to the Town Council for final approval. For more information about the Town of Chapel Hill Human Services program, see here. Questions and submittals should be directed to: Jackie Thompson 405 Martin Luther King Jr. Blvd. Chapel Hill, NC 27514 919-969-5081 ihompsonPtownofchapelhill.org Submission: ➢ We strongly encourage applications to be single-spaced, with 12-point arial font and normal margins. ➢ Application: Two (2) paper copies of the application with ORIGINAL signatures must be hand delivered or mailed to Jackie Thompson, 405 Martin Luther King, Jr. Blvd., Chapel Hill, NC 27514; AND ➢ Attachments: The application submittal must be accompanied by a flash drive with the application and all attachment files in electronic format. Any .pdf files must be accompanied by the original file format of .doc, .xls, etc. Human Services— Orange County For more information about the Orange County Human Services program, see here. Questions and submittals should be directed to: Allen Coleman PO Box 8181 Hillsborough, NC 27278 (919) 245-2151 acolemanCa orangecountync.gov Submission: ➢ Email application and ALL Attachments prior to the deadline. Any .pdf files must be accompanied by the original file format of .doc, .xls, etc. Please request a delivery receipt of email with application and attachments. DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM P a g e of °t DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FOR OFFICE USE ONLY Agency Habitat for Humanity of Orange County Received By Pro rams Home Preservation 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 of receipts and expenditures in a fiscal year, must secure an audit. b. ® IRS Federal Form 990 c. ® NC Solicitation License d. ® IRS Federal Tax-Exemption Letter e. ® Certificate of Insurance f. ® List of Board of Directors g. ® Solid Waste Program Fee (SWPF)Verification Application Submittal Checklist 1/31/2017 2:31 :06 PM Pago 5 of I DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Habitat for Humanity of Orange County Applicant Organization's Physical Address: 88 Vilcom Center Dr. #L110, Chapel Hill, NC 27514 Applicant Organization's Mailing Address: 88 Vilcom Center Dr. #L110, Chapel Hill, NC 27514 Applicant Organization's Web Address: www.orangehabitat.org Executive Director: Susan Levy Telephone Number: (919) 932-7077 ext. 211 E-Mail: slevy @orangehabitat.org Tax ID Number: b) Funding Request List all FY17-18 Human Services (HS) Funding Being Requested — For All Programs) and the Proposed Use of Funds (2-3 lines or less) Program Carrboro Chapel Orange Total - HS Hill - HS Countv-HS Home Preservation $0 $0 $50,000 $50,000 Totals $0 $0 $50,000 $50,000 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: 1/31/2017 Executive Director Date Signature: Gam- ! 1/31/2017 Board Chairperson Date 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 ❑ ® 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? DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page 6 of 1 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION ❑ ® c) Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. 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: 1/31/2017 Executive Director Date Signature: . {(A/4GbvL- lT 1/31/2017 Board Chairperson Date 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): Habitat was incorporated on April 13, 1984. It has been in operation for 32 years. b) Agency's Purpose/Mission (no more than a few sentences): Habitat for Humanity of Orange County changes lives by bringing together God's people and resources to help families in need build and own quality affordable homes in safe and supportive communities. Habitat's vision is an Orange County where everyone has a decent place to live. c) Types of Services the Agency Provides (bullet format): • Habitat for Humanity of Orange County is a local nonprofit organization affiliated with Habitat for Humanity International (HFHI). Habitat provides affordable homeownership opportunities for families who live and/or work in Orange County, earn between 30% and 60% of the area DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page f of 1 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION median income (AMI), and live in substandard housing. Habitat was incorporated in 1984, and completed its first home in 1987. Since that first home, Habitat has built more than 260 affordable homes throughout the County. Through its New Home Construction program, Habitat uses donations and volunteer labor to construct energy-efficient, green-certified, high- quality homes, and then sells those homes to qualifying families. The buyers receive an affordable mortgage, and mortgage payments are recycled to build future homes. Homebuyers are required to contribute 325 hours of sweat equity toward the construction of their own and other Habitat homes. Habitat retains the right of first refusal to repurchase a Habitat home if the owner wishes to sell. Habitat uses deferred-payment second mortgages and equity sharing to ensure that the community's investment of funds and labor will continue to benefit low-income families if the original buyer sells the home. • Since 2010, Habitat has also provided home repairs to low-wealth homeowners. To date, Habitat has completed 88 repair projects. Through these projects, Habitat recognizes and seeks to address the ongoing need for affordable work on existing homes in the communities where it builds. Repairs are an important aspect of Habitat's affordable housing strategy because they offer low-cost assistance to homeowners living in deteriorating or unsafe homes, which improves their quality of life as well as the quality of life of other neighborhood residents. Habitat is also committed to strengthening the neighborhoods where it builds by developing relationships and supporting other neighborhood improvement initiatives identified by neighborhood residents. • In carrying out its affordable housing and community strengthening activities, Habitat seeks to educate and empower its homebuyers through a series of relevant workshops and one-on- one trainings. Habitat also strives to educate the broader community about the crisis in affordable housing by introducing and involving hundreds of new volunteers from all walks of life into its work each year. Habitat promotes the positive value of diversity by uniting people of varied economic, religious, social, and racial backgrounds to work together toward a common goal — building and repairing decent homes in partnership with families in need. d) Agency's History with Providing These Services: Habitat is requesting funding for its Home Preservation program. Habitat first began completing exterior home repairs in 2010, and has since successfully completed 76 projects. Habitat has received government funding for these projects in the past, and has proven its ability to successfully complete and report the agreed upon work. In addition, during the fall of 2016 Habitat piloted providing critical repairs to homeowners in Northside and Pine Knolls. These repairs were also subject to grant funding restrictions and reporting. Habitat successfully completed 12 critical repairs. e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes in the past year?Is there a new Executive Director?Are there new initiatives?) At its meeting on January 21, 2017, Habitat's Board of Directors approved a motion to pursue long- term funding for critical repairs, following a successful pilot program during the fall of 2016. f) Schedule of Positions (For Entire Agency) • Full Time Equivalent(FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 2,080 #of FTE - Full-Time Paid Positions: 15.6 #of FTE - Paid Part-Time Positions: 0.5 DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION #of Volunteers: 2,049 # of FTE - Volunteers: 10 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 a rtifi Employer? Yes If no, please explain. 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: Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill, and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY16-17 FY17-18 Source Award Request Northside Homebuyer Support $105,000 $0 Chapel Hill Affordable Housing - Second Mortgage Assistance Reserve Fund Impact Fee Reimbursements $96,476 $103,000 Orange County Land Purchase - Northside $55,000 $0 Chapel Hill Affordable Housing Reserve Fund Senior Housing at Waterstone $0 $500,000 Orange County/Hillsborough Infrastructure Costs *Add rows or attach additional page, if needed. ii. Submit your agency's budget. You may complete the provided template (separate xis file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues o Private Donations o Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG/HOME/etc.) DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Private Foundation Grants o Other Revenue • Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel & Training o Other Expenses iii. Does your agency budget show a Surplus or Deficit? Our budget for FY17 shows a surplus of $15,659. Is there a significant change? Yes/No No. Please provide a brief explanation for Surplus or Deficit, and significant changes. The surplus is due to revenue being budgeted slightly higher than expenditures this year. iv. What is your agency's fiscal year? July 1, 2016 through June 30, 2017 (Example: July 1, 2016 through June 30, 2017) 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Home Preservation Program Primary Contact and Title: Adwoa Asare, Associate Director of Community Development and Engagement Telephone Number: (919) 932-7077 ext. 233 E-Mail: aasare @orangehabitat.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 X X X Affordable Healthcare Education Family Resources Jobs/Jobs Training Food Transportation Other: Please specify DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM page it f 'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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. Each month the Jackson Center, Habitat, and Rebuilding Together of the Triangle (RTT) staff gather for a critical repair meeting to discuss applicants and homeowner needs in the Northside and Pine Knolls communities. Each agency takes on portions of an individual homeowner's repair requests so that we can provide the greatest impact across a broad base of residents. Through this new coalition, over a dozen homeowners benefited from home repairs in 2016. • The Jackson Center staff helps market Habitat repair programs to families in Northside and Pine Knolls. They spearheaded the creation of a common application that meets the needs of multiple repair agencies to determine homeowner need and eligibility. The Jackson Center participates in Habitat home repairs and new construction by providing volunteer labor, and they perform their own critical repairs in Northside through the Promise of Homes program. • RTT uses both volunteers and subcontractors to perform repairs in Orange, Durham, and Wake Counties. The RTT program director provided invaluable assistance to the Habitat program director in establishing a successful repair program. RTT and Habitat collaborate on repairs for individual households in Orange County by sharing resources. • Orange County Urgent Repair performs minor and major repairs throughout Orange County. Urgent Repair and Habitat have provided informal referrals to one another since the inception of Habitat's repair program. With funding to expand our repair program we plan to be more intentional in collaborating and developing a repair coalition that benefits residents countywide. • Habitat coordinates with the Blue Ribbon Youth Leadership Institute to provide volunteer opportunities for high school students who can then apply for a scholarship to assist with higher education if they complete 30 hours of service with Habitat, primarily on repair projects. The funding for the scholarship program is provided by an anonymous donor. • Habitat is a member of the Orange County Affordable Housing Coalition, a group of housing providers and advocates who are working together to increase resources for the full range of housing needs in Orange County, including home repair. Habitat's Executive Director currently chairs the Coalition. • Habitat staff and volunteers work with established leaders in the neighborhoods they serve, and also strive to identify and nurture new leaders, providing support and training as needed. Habitat's commitment to strengthening neighborhoods includes a variety of trainings and workshops that promote leadership specifically for the youth and adults who reside there. Collaborative efforts that began several years ago with both the Rogers-Eubanks Neighborhood Association (RENA) and the Fairview Community Watch enhance the overall quality of life in each neighborhood, and also serve to spread the word about Home Preservation and ensure that residents who could benefit from the program are identified and referred. Collaborative efforts in the Rogers Road community have engaged representatives from the Department on Aging, Piedmont Health Services, St. Paul AME Church, RENA, Justice United, Habitat's Youth United program, Blue Ribbon Mentor Advocates, and the UNC Campus Chapter of Habitat for Humanity. • Habitat's Executive Director and Associate Director of Community Development and Engagement are currently serving on the Orange County Department on Aging's Master Aging Plan Housing Work Group, which addresses housing options and aging in place for seniors. • Habitat's Executive Director, Construction Director, and Associate Director of Community Development and Engagement recently met with the leaders of the Orange County Rural Alliance (OCRA) to discuss collaboration on home repairs for residents in Orange County (specifically rural northern Orange). OCRA has built strong relationships with rural residents and a strong base of volunteer support to assist with repairs. A partnership with OCRA would DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page f °'f of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION provide an opportunity for Habitat to increase its assistance to families (primarily elderly and/or disabled) in rural areas who have been waiting a long time for desperately needed home repairs. Program Description (3 pages OR LESS) Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a Town/County priority/goal? Habitat will continue to address the County's priority need for affordable homeownership for low- and very low-income renters through its new home construction program. However, Habitat's experience working with residents in the communities where it builds new homes has helped to identify an underserved need among low-income homeowners, especially those who are elderly or disabled. Habitat has had direct experience with low-income families in Orange County who are struggling to maintain the exterior and interior of their homes, and who need modifications to their homes so that they may continue to live in and enjoy them. Rot, peeling paint, sagging gutters, broken doors, unsafe porches, roof leaks, plumbing damage, holes in floors, and lack of accessibility impact the safety, livability, and value of individual homes in neighborhoods like Fairview, Rogers Road, Northside, and Pine Knolls, as well as in more rural areas of the county like Efland, Mebane, and Cedar Grove. Our increased capacity to take on critical repair projects will allow us to serve 15 more families than last year. When combined with new home construction, these home preservation repairs allow Habitat to impact nearly 45 new families each year. 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 goals, 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. Affordable housing was selected as the number one human services need in Chapel Hill in the long-range needs assessment. Affordable housing was the number one priority selected by the Orange County Commissioners in 2016. The Chapel Hill Town Council has established the overarching goal of creating a place for everyone in 2016-2018. Under that goal, the Council pledges to adopt and support affordable housing programs and to sustain the momentum of the Northside Neighborhood Initiative. Habitat's Home Preservation program assists with all of the aforementioned priorities. Habitat launched A Brush with Kindness (ABWK) as a pilot program in 2009 with two projects in Hillsborough. When Habitat formalized the program in 2010, it also created an informal Advisory Committee, inviting other repair program providers to meet to share information and referrals for repairs within the county. The services Habitat provided through ABWK complemented those provided by JOCCA, Rebuilding Together of the Triangle, and Orange County's Urgent Repair and Rehab programs. All of these agencies provide referrals to Habitat's ABWK program, and Habitat refers clients to them. Moving forward, Habitat plans to merge its ABWK and critical repair programs into the comprehensive, countywide Home Preservation program. This program will allow us to contribute even more to the combined efforts to meet the growing need for home repairs. To date, Habitat has received over 200 applications for home repair. In 2016, over 80% of the Orange County residents who applied for the program were elderly and/or disabled. Overall, 30% of applicants come through agency referrals, and the remaining 70% come through targeted DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page 12 of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION neighborhood marketing and word of mouth. In 2012, Habitat was asked by the Town of Chapel Hill to implement ABWK in the Northside/Pine Knolls neighborhood on a pilot basis. Since that time, Habitat has completed a total of 33 repairs in both neighborhoods. In the fall of 2016, Habitat piloted a critical repair initiative in Northside/Pine Knolls with one-time funding from Lowe's Home Improvement and Habitat for Humanity International. With this funding, 10 families were served through 12 major critical repairs. This is part of an ongoing retention strategy to help existing homeowners stay in their homes, while also increasing the attractiveness of the neighborhood. Habitat will continue to market the program and complete Home Preservation projects in these neighborhoods and beyond in FY17-18. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The targeted population for Home Preservation is senior homeowners in Hillsborough, Efland, and Chapel Hill. This population has self-identified as having the highest physical and financial need. In the past five years, Habitat has received numerous requests for interior critical repairs and roof replacements. We will begin by contacting those 20 households at the top of our waitlist, the majority of which are very low-income households. We will market the program through the social services department, Orange County aging resource guide, community meetings, and faith group bulletins. Home Preservation recipients must own their home and be current on their mortgage, homeowners insurance, and property taxes. Recipients must earn 80% or less of the area median income. In 2016, nearly 70% of the Orange County residents who participated in the program were elderly and/or disabled. The average recipient income was less than 45% of the area median income (this includes both County and Town residents). Habitat does not consider age, race, gender, religion, or any other protected status when evaluating applications. Habitat receives referrals from and partners with local senior support organizations and other low-income service providers. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) The activities of Habitat's Home Preservation program will be carried out primarily by Adwoa Asare, Associate Director of Community Development and Engagement, and Tate Hamlet, ABWK/Critical Repair Supervisor. Ms. Asare is responsible for marketing the program, processing program applications, meeting with homeowners, and recruiting volunteers, while Mr. Hamlet is responsible for assessing the scope of the project, purchasing supplies, and supervising volunteer work. The program activities will be carried out primarily at the Habitat office and on the project site, which could be the home of any qualifying family in Orange County. Ms. Asare and Mr. Hamlet have led the repair program since 2012. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Home Preservation is an ongoing program. Projects are completed throughout the year. At all times, there will be projects at different stages in the process, such as application, approval, assessment of repairs needed, volunteer and funder recruitment, work days, and evaluation. There is an abundant need for home repairs in Orange County. On average, Habitat repairs 2.5 homes each month. Construction work typically occurs on weekends with volunteers, while staff works throughout the week on program administration. For an exterior repair completed primarily by volunteers, the average timeline is seven months from the time of DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page 13 of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION application to the time of the repairs being completed, final payment being made, and the homeowner signing off that they are satisfied with the work. For a critical repair completed primarily by subcontractors, the average timeline is three months. We anticipate the following timeline, as in previous years: July 2017 August 2017 Market Home Preservation program and touch base with applicants on waiting list August 2017 Annual youth paint blitz September 2017 December 2017 Perform home repairs with volunteers and subcontracted labor October 2017 March 2018 Attend community meetings to market program to community members January 2018 June 2018 Perform home repairs with volunteers and subcontracted labor 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) The Home Preservation program directly targets the need to maintain the existing stock of affordable homes in Orange County. This program meets a long-term demonstrated need from community residents and meets a countywide affordable housing goal. For over 30 years, Habitat for Humanity has successfully stewarded its resources to provide safe, decent new homes for more than 260 families, and repair projects for more than 70 homeowners. Our organizational vision is for everyone in Orange County to have a decent place to live. Habitat mobilizes volunteers and subcontractors who are mission-oriented to assist with home repair in order to 1) meet the physical need, 2) keep costs low, and 3) provide much- needed interaction between Orange County residents of varying socioeconomic status, age, religious practices, political affiliations, etc. Habitat's model of collaboration and a hand up, not a handout engages homeowners and other housing agencies to provide the greatest impact on residents. On its own, Habitat does great affordable housing work, but in combination with local government and community advocates we are able to accomplish far more. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. We arrived at this project design through a comprehensive strategic planning process and by identifying the critical actions necessary to achieve our mission and vision. Our fall 2016 pilot of volunteer-led repairs and subcontractor-led repairs gave us a great framework for expenses and timeline to perform repairs. Funding support from Orange County is critical to the transition of Home Preservation from exterior-only to both interior/exterior repairs. Our Board of Directors identified Home Preservation as a strong and growing program that fulfills the mission and vision of Habitat. They also identified the strength of this program in connecting new donors, volunteers, and sponsors with the need for affordable housing solutions in Orange County. Funding for this project will enhance the quality and quantity of the services we provide. Our commitment to communities has been that we will partner with individuals, associations, government, and funders to carry out our mission to the best of our ability and provide safe, decent, affordable housing in Orange County to as many people as possible. If the requested funding is not awarded at all, we will be unable to repair homes this year. If a reduced allocation is recommended, the core activities described in this proposal will be carried out to a lesser degree commensurate to the funding allocation. DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page f of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION k) Include any other pertinent information. n/a Additional Program Information I) 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 Actual Estimated Projected 2015-16 2016-17 2017-18 Gender Male 15 15 15 Female 17 34 34 Total 32 49 49 Ethnicity African-American 29 38 43 American Indian or Alaska Native 0 0 0 Asian 0 8 4 Caucasian 2 2 2 Native Hawaiian or other Pacific Islander 1 1 0 Other: specify 0 0 0 Total 32 49 49 Of the above, how many Hispanic/Latino 0 0 0 Of the above, how many non-Hispanic/Latino 32 49 49 Total 32 49 49 Age 0-5 years 2 0 0 6-18 years 3 9 9 19-50 years 5 7 7 51+years 22 33 33 Total 32 49 49 Geographic Location Alamance County 0 0 0 Chatham County 0 0 0 Durham County 0 0 0 Wake County 0 0 0 Orange County Breakdown Chapel Hill Public Housing 0 0 0 Town of Chapel Hill (Non-Public Housing) 14 38 15 Town of Carrboro 7 6 6 Town of Hillsborough 7 4 13 City of Mebane (Orange County) 4 1 10 Orange County(Outside Municipalities) 0 0 5 Total 32 49 49 Work Statement m) Complete the Work Statement Chart to describe the work to be performed. This chart 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 DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page 15 of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time- bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday-Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program Home Preservation 1. Program Activity Name Home Preservation Program Goal Provide 30 interior/exterior home repairs for low- and moderate- income homeowners in Orange County. Performance Measures By June 30, 2018, complete 30 interior/exterior repair projects for low- and moderate-income homeowners in Orange County. Previous Year Program Results 17 exterior home repairs completed Current Year Estimated Results 26 interior/exterior home repairs completed Next Year Projected Results 30 interior/exterior home repairs completed n) Program Budget 1. Submit your program budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues o Private Donations o Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG/HOME/etc.) • Private Foundation Grants o Other Revenue • Expenditures o Compensation o Rent & Utilities DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page f 6 of °'f DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION O Supplies & Equipment O Travel & Training O Other Expenses 2. Program Budget Detail — Provide description of "other" budget items, not defined. Other Revenue: Loan payments from homeowners. Other Expenses: Materials and subcontracted labor. 3. This program budget represents what percent of the agency budget? 5.8% FY17 4. 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 $127,604 $188,446 $211,080 Total # of Individuals 17 26 30 Cost Per Individual $7,506 $7,245 $7,036 4. ATTACHMENTS Description of Required Attachments a) Financial Audit A recent financial audit that should cover CY 2015, for calendar year agencies, and FY 2015-16, for fiscal year agencies. For agencies with prior year revenues totaling $500,000 or more a financial audit, prepared by a certified public accountant is required. Agencies with prior year revenues of less than $500,000 may submit a completed Schedule of Receipts and Expenditures form (see application materials), in lieu of an audit/report. Agencies with a certified audit/report should not complete the form. b) IRS Federal Form 990 A copy of the agency's 2014 Form 990 is required. The specific form depends upon the agency's financial activity. Review the IRS' table guide, for more details. For Form 990-N (e- postcard) filers, include a copy of the postcard, with the agency's application materials. c) NC Solicitation License A copy of the agency's current solicitation license is required. Organizations that solicit contributions in North Carolina, directly or through a third party, must renew their licenses annually. For more details, refer to the NC Secretary of State's licensing website and its Frequently Asked Questions Guide (P F), about exemptions. If exempt per N.C.G.S. § 131 F-3, include a copy of the exemption letter with the agency's application materials. d) IRS Federal Tax-Exemption Letter A copy of the agency's IRS tax-exempt letter that confirms its nonprofit status is required. An agency can request a copy of its letter from the IRS' Customer Account Services. e) Certificate of Liability Insurance DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page "'e of 1 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION A copy of the agency's current certificate, from the agency's insurance carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker's Compensation compliance, include a statement explaining why, with the agency's application materials. *Note: If Approved for Funding: Approved agencies must provide an updated insurance certificate. The update should reflect the funding jurisdiction as an additional insured party and certificate holder and provide coverage for the duration of the funding period (July 1 — June 30). Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any stipulated insurance coverage. Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required INSURANCE TOWN OF CARRBORO TOWN OF CHAPEL HILL ORANGE COUNTY3 Worker's Limits for Coverage Compensation' A - Statutory State Limits for Coverage A - Limits for Coverage A - NC, for each Statutory State NC, for Statutory State NC, for employee each employee each employee Limits for Coverage Limits for Coverage B - Limits for Coverage B - B - Employers Employers Liability of: Employers Liability of: Liability of: $100,000 Each Occurrence $500,000 each $1 million Each $100,000 BID for each accident, $500,000 Occurrence employee BID for each employee $1 ,000,000 BID2 $500,000 BID limit $500,000 for BID limit limit Commercial $100,000 Property General Damage Liability $1 million Each Liability $1 ,000,000 Bodily $1 million Each Occurrence Occurrence $2 million Aggregate and Property $2 million Aggregate Damage Limit Automobile Not Applicable $1 million Each Occurrence $500,000 Each Liability Occurrence Professional $1 million Each Liability Not Applicable Not Applicable Occurrence $2 million Aggregate 1 . Visit the NC Industrial Commission's website for more information regarding Coverage A. Also, note that if an agency uses subcontractors, it must require subcontractors to have workmen's compensation insurance. 2. Bodily Injury by Disease (BID) 3. Please visit Orange County's contracts webpage for more information about the County's risk assessment procedures. f) List of Board of Directors Provide the following information about each board of director's member: name, telephone number, address, occupation or affiliation of each member and the list must identify the principal officers of the governing body, and length of term. DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page I of °'I DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION g) Solid Waste Program Fee (SWPF) Verification This fee finances Orange County's recycling and waste reduction program. Submit either a.) proof of payment of the agency's FY 2016-17 Solid Waste Program Fee, OR b.) a statement on agency letter head indicating exemption and specify the person(s), business, etc. that is responsible for paying this fee. DO NOT SUBMIT THIS PAGE 1/31/2017 2:31 :06 PM Page 1 of DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Habitat for Humanity of Orange County Actual Estimated Projected Percent AGENCY REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ - $ - $ - 0 Agency Generated Revenue(fees) $ 1,009,925 $ 1,098,500 $ 1,118,000 2% Local Government Grants: Human Services-Town of Carrboro $ 2,000 $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 1,500 $ - $ - 0 Other-Town of Chapel Hill $ 216,965 $ 155,000 $ 50,000 -68% Human Services-Orange County $ 20,000 $ 22,500 $ 50,000 122% Other-Orange County $ 84,345 $ 96,476 $ 428,000 344% Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ 2,193 $ 2,000 $ 2,000 0% State Government $ - $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ 191,378 $ 262,777 $ 250,000 -5% Private Foundation Grants $ 177,500 $ 272,500 $ 187,500 -31% Other Revenue:Top 3 201 7-201 8 $ 1,215,837 $ 1,336,000 $ 1,308,000 -2% Mortgage payments 580,000 NCHFA payments 390,000 ReStore proceeds 240,000 Total Agency Revenue $ 2,921,643 $ 3,245,753 $ 3,393,500 5% AGENCY EXPENSES Compensation (incl. Benefits) $ 1,123,646 $ 1,199,250 $ 1,219,600 2% Rent&Utilities $ 88,993 $ 95,868 $ 98,700 3% Supplies &Equipment $ 75,980 $ 74,000 $ 76,200 3% Travel &Training $ 31,291 $ 36,500 $ 32,000 -12% Other Expenses:Top 3 201 7-201 8 $ 1,798,808 $ 1,824,476 $ 2,373,000 30% Construction and land costs 1,971,000 NCHFA payments 125,000 Workers comp, liability,other insurance 54,000 Total Agency Expenses $ 3,118,718 $ 3,230,094 $ 3,799,500 18% SURPLUS/(DEFICIT) FOR PERIOD: $ (197,075)1 $ 15,659 I $ (406,000)1 -2693% FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME: Home Preservation Actual Estimated Projected Percent PROGRAM REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ - $ - $ - 0 Program Generated Revenue $ 78,679 $ 135,446 $ 103,080 -24% Local Government Grants: Human Services-Town of Carrboro $ 2,000 $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 1,500 $ - $ - 0 Other-Town of Chapel Hill $ 21,965 $ 25,000 $ 50,000 100% Human Services- Orange County $ 20,000 $ 25,000 $ 50,000 100% Other- Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government (CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ - $ - $ - 0 Other Revenue $ 3,460 $ 3,000 $ 8,000 167% Total Program Revenue $ 127,604 $ 188,446 $ 211,080 12% PROGRAM EXPENSES Compensation $ 95,755 $ 101,446 $ 1 09,880 8% Rent& Utilities $ 7,600 $ 8,100 $ 8,900 10% Supplies & Equipment $ 6,500 $ 6,300 $ 6,900 10% Travel & Training $ 2,700 $ 3,100 $ 2,900 -6% Other Expenses: (Materials & subcontractors) $ 15,049 $ 69,500 $ 82,500 19% Total Program Expenses $ 127,604 $ 188,446 $ 211,080 12% SURPLUS/(DEFICIT) FOR PERIOD: $ - I $ - I $ - I 0 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A EXHIBIT`B" Scope of Services—FY 2017-18 Outside Agency Performance Agreement Agency Name: Habitat for Humanity of Orange County Program Name: Home Preservation Program Funding Award: $37,500 Outline how the agency will spend Orange County's funding award. Expense Description Amount Home Preservation Program Support—Personnel Expenses—Salaries and Benefits $37,500 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Provide 30 interior/exterior home repairs for low- and moderate-income homeowners in Orange County. 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 By June 30,2018,complete 30 interior/exterior repair projects for low-and moderate-income 30 homeowners in Orange County. DocuSigned by: SMed Executive Director 8/31/2017 Certified by: aggZnnrn?w_vn FC. Title: Date: .. T1 (Provider's Signature) DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A 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. DocuSigned by: SUSGU�L bu ( 8/31/2017 Certified by: 6887D8CO27AA4FC... Title: Executive Di rector Date: (Provider's Signature) (Habitat for Humanity, Orange County,NC,Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID: B67A2C26-3304-4095-BB1C-73A2BC4A569A �® AC DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/19/2017 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 Lori Short NAME: Summit Insurance Group, Inc. (a//C,NNo,Ext): (704)659-2141 (p/C,No): (704)659-2148 PO Box 2485 ADDRE-MAIL ESS:lori @sumins.com INSURER(S)AFFORDING COVERAGE NAIC# Huntersville NC 28070 INSURERA:Builders Mutual Insurance Company - 10844 INSURED INSURER B:QBE Insurance Corporation 39217 Habitat For Humanity Of Orange County, NC, Inc. INSURER C: 88 Vilcom Center Dr. Ste L110 INSURERD: INSURER E: Chapel Hill NC 27514 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1732003047 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 W LIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 500,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ CPP0058155 4/1/2017 4/1/2018 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: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED AUTOS AUTOS PCA0009233 4/1/2017 4/1/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS (Per accident) $ Medical payments $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED X RETENTION$ 10,000 MUB0001005 4/1/2017 4/1/2018 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) PWC1011231 4/1/2017 4/1/2018 E.L.DISEASE-EA EMPLOYEE$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Volunteer/Accident DI NHH000489 4/1/2017 4/1/2018 $250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Lori Short/LORI <' , ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011