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2017-488-E Finance - Movement of Youth Inc. - Outside Agency Performance Agreement
DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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 Movement of Youth Inc., a not-for-profit corporation, located at 406 Blackwell Street B030, Durham,NC 27701 ("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 Movement of 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 20213 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 5053.25. 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. (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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. (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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. (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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 Movement of 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: (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D County: Finance &Administrative Services Provider: Movement of Youth Inc. Orange County 406 Blackwell Street B030 Post Office Box 8181 Durham,NC 27701 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.EttP For sf f o the Provider f vA.yUS L70b 9/5/2017 8D897F1 C9FB34A5... Date (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D E F t epee half of Orange County Government botA lt,tf, A-OV %U"SL 9/5/2017 () 79Q4az55E47_z Bonnie Hammersley, County Manager Date (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FY 201 Outside Agency Funding A • 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 h r' I� y I y, 1111,1111 111 11 01 111111 „,0J1111 j r,^I MA d1�4,.r. R 70'7 G6 I; III f DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) A. •licant Contact Information Applicant Organization's Legal Name: Movement of Youth, Incorporated Applicant Organization's Physical Address: 406 Nac well Street, Suite B030, Durham, NC 27701 Applicant Organization's Mailing Address: Same as above Applicant Organization's Web Address: www.movementof outh.or•. Executive Director: Atrayus Goode Telephone Number: (800) 956-3820 E-Mail: a,000de move entofvouth.orq Tax ID Number: b) Funding Request List all FY17-18 Human Services (HS) Funding Being Requested — For All Pro•ram ) and the Proposed Use of Funds (2-3 lines or less) M Brother's Keeper(MBK) gunge County, Carrboro Cha al Orange Total -HS Hill-HS County-HS Admit.Me. Online support system where students get 250.00 250.00 expert support on how to represent their academic background, activities, goals, and interests for schools College Tour. Travel and Lodging for 50 students 26,250.00 26,250.00 from MBK-related agencies Institute for Civic Engagement for WEmerging ...... ...... . _. 25,000.00 25,000.00 Leaders. Cost for supplies, food, presenters, and instruction during two-week intensive summer enrichment academy for 50 students from MBK- related agencies Racial Equity Institute. Cost for 50 students nITIT ts....._ _..... ..... _ __..__...0 from 11,250.00 11,250.00 MBK-related agencies to attend REI training MBK Director of Programs. Cost for technical 40,000.00 40,000.00 assistance and staff support to direct MBK Orange County. AmeriCorps VISTA. Cost share for 3 full time 12,000.00 12,000.00 AmeriCorps members to support and manage project. MBK Opportunity Summits. Cost for supplies, food, 10,000.00 10,000.00 presenters, and materials for two (2) MBK Opportunity Summits for high school students, college students, K- 12 educators, and community and business leaders. Summits will focus on student achievement, career/personal/professional development, social .ustice and en.a.ement, and mentorship. AGENCY INFORMATION 1/31/2017 3:24:15 PM P a 0 0 il 0 t 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Marketing. Costs associated with web design, 10,000.00 10,000.00 photography, videography, and general promotion of MBK Orange County. Totals 134,750.00 134,750.00 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: Executive Direc r Dat 7 Signature: 60/1" I Board hairperson Date AGENCY INFORMATION 1/31/2017 3:24:15 PM Page 8 of 29 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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 ❑ ® 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? ❑ ® 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: / Exec ive elector Dat Signature: Boa d 1 Chairperson Date AGENCY INFORMATION 1/31/2017 3:24:15 PM Page 9 of 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION AGENCY INFORMATION 1/31/2017 3:24:15 PM P age 10 of' DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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): 10 ears„ incorporated in 2008 b) Agency's Purpose/Mission (no more than a few sentences): Movement of Youth (MOY) prepares diverse youth to lead and succeed in the 21st Century through mentoring and targeted enrichment activities led by college students. MOY aspires to be the nation's leading movement for young people to disrupt the status quo and build a safer, smarter, more socially conscious world. c) Types of Services the Agency Provides (bullet format): • Leadership Academy • Team Mentoring • College Tours • Summer Enrichment Academy • International travel via the J.U.S.T Global Fellowship • College scholarships through the Tyreic E. Hemphill Memorial Scholarship Fund d) Agency's History with Providing These Services: Targeting only 11 students in 2006, MOY has grown to impact hundreds of middle and high school students annually and is in the process of scaling nationally through the 20 by 2020 Expansion Plan, with the goal of being in 20 states by the year 2020. Student Polo ulation • 6th — 12th grade students • 95% African American • 4% Latino Achievement • 100% of MOY students complete at least eight (8) hours of community service per year, amounting to 10,000+ hours since 2006 • 100% of MOY high school students are enrolled in at least one (1) honors or Advanced Placement Course • 100% of MOY students graduate from high school • 99% of MOY graduating seniors enroll in college 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?) In December 2016, the William R. Kenan Charitable Trust funded Phase II of the 20 by 2020 Expansion Plan, which will focus on operationalizing the Carolinas Mentoring Partnership and My Brother's Keeper(MBK) Orange County, two strategic programmatic thrusts that will expand our impact statewide and nationally. Agency Information 1/31/2017 3:24:15 PM Page 1 1 of 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION The Carolinas Mentoring Partnership will significantly increase the number of youth in quality mentoring relationships in North Carolina; multiply and leverage the human, financial, and in-kind resources dedicated to mentoring initiatives; ensure quality standards in all mentoring efforts; and expand the number and types of organizations that are equipped to start, manage and expand a mentoring initiative. This initiative will be supported by innovation Research & Training (iRT), a multidisciplinary team of scientists, educators, and technical assistance coaches that support youth mentoring programs internationally. In February 2014, President Barack Obama launched the My Brother's Keeper(MBK) Community Challenge, and issued a challenge to counties, cities, towns and tribal nations to become MBK communities. This initiative is a call to action for communities across the US "to build and execute robust plans to ensure that all young people—no matter who they are, where they come from, or the circumstances into which they are born—can achieve their full potential." MOY has been named as the lead agency for MBK Orange County and will leverage stakeholders, manage workflow, and capture outcomes to ensure progress towards the following goals in Orange County: (1) youth graduate from high school, (2) youth complete post-secondary education or training, and (3) youth out of school are employed. 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: 2 # of FTE - Paid Part-Time Positions: 1 #of Volunteers:220 # of FTE -Volunteers:0 g) Living Wage Does this agency pay permanent employees a minimum livin a? (Yes/No) Yes If yes, is this agency an Oran!eCountA Livin , a,a Certified Ems to r qf? No If no, please explain. MOY is based in Durham County. Agency Information 1/31/2017 3:24:15 PM I''' age 12 " 29 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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) No If yes, please list below: Include all programs that have funding requests/awards/totals from Carrboro Clra el 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........_._....W Ex: Affordable Rental I 0 $20,000 Carrboro -Affordable Housing Rehabilitation Ex: Agency Administration $15,000 $15,000 Carrboro—Other Ex. Total $15,000 $35,000 Carrboro Total Funding Add rows or attach additional ,a e p if needed H. Submit your agency's 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, 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 Agency Information 1/31/2017 3:24:15 PM P q a 13 or DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • 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 o Supplies & Equipment o Travel &Training o Other Expenses iii. Does your agency budget show a Surplus or Deficit? Surplus Is there a significant change? Yes/No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes,. There is a small surplus due to revenue slightly exceeded expenses. The William R. Kenan, Jr. Charitable Trust challenge grant and AmeriCorps State Funding will mark a significant increase in funding from previous years, increasing our staff and internal capacity. iv. What is your agency's fiscal year? Janua 1 through December 31 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/31/2017 3:24:15 PM P a g pH 29 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: IMyBr, ther`s Keeser MBK Oran*ecounty Program Primary Contact and Title: Atrayus Goode, President & CEO, Movement of Youth Telephone Number: X600) 956-3820 E-Mail: a'oode • movemgntof outh.or. • 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 • 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 Housin• Affordable Healthcare Education ... .. ........ ... �.. n x Famil Resources x Jobs/Jobs Traininc x Food _ _......... ... _.._. .._.. ..................... Trans•ortation Other: Please specify • 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. • Beyond Expectations is dedicated to mentoring adolescents in grades 6 through 12 in Orange County, NC. On two Saturdays each month, youth participate in a variety of activities to support them academically, emotionally, and socially. Jeff and Charlene Campbell, Program Directors, have actively supported MBK Orange County activities for the past two years, through coordination of community summits. They will continue serving MBK Orange County through work on the inaugural Board of Advisors. • Fathers on the Move provides transitional services to males over the age of 16 who are involved in the criminal justice system and have children. The program is also open to all males needing support, guidance and mentorship. Victor Glover, leader of Fathers on the Move, has supported MBK Orange County as a member of the Board of Advisors. PROGRAM INFORMATION 1/31/2017 3:24:15 PM I ig c 1 5 o f 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • North Carolina Scholars Latino Initiative (N.C. Sli) seeks to create pathways to educational, professional, and civic engagement opportunities for a new generation of Latinx leaders in North Carolina. In 2015, N.C. Sli was named a "Bright Spot in Hispanic Education" by the White House Initiative on Educational Excellence for Hispanics. In Orange County, N.C. Sli currently works with students from Carrboro High School and Chapel Hill High School. MOY President & CEO Atrayus Goode serves on their Board of Directors, and MOY and N.C. Sli work together through sharing of best practices and collaboration on funding proposals to expand the capacity of both organizations. • Dismantling Racism Works (dRworks) provides tailored workshops and long-term support focused on helping organizations and communities live into race equity and racial justice commitments. MBK will engage dRworks to provide racial equity training for youth from MBK-related agencies. Program Description (3 pages OR LESS) Please provide the following information about the proposed program: • Summarize the program services proposed and how the program will address a Town/County priority/goal? Per Orange County BOCC priorities to foster a community that rejects oppression and inequity, ensure economic self-sufficiency, and close the achievement gap and end the school to prison pipeline, MBK Orange County will ensure that participating youth (1) meet the requirements to graduate from high school to enter careers or to pursue higher education; (2) have access to post-secondary educational options or work-based learning options that lead towards job placement; and (3) have access to jobs that provide a livable wage. The following strategies will be employed to accomplish this goal: 1. Identifying career clusters and specific job pathways to identify key knowledge and skills that students need to perform in defined career areas. 2. Expanding the capacity of organizations and programs that support the development of 21st Century Skills (also referred to as the New Basic Skills). 3. Developing a youth one-stop-shop to provide young people with information about how to access relevant services. 4. Increase local business and nonprofit participation to expand work-based learning programs (e.g. Institute of Civic Engagement for Emerging Leaders, AmeriCorps) to serve greater numbers of Orange County Youth. 5. Expand the capacity of organizations and programs that support college access and readiness. 6. Refine NCWorks Online job matching system and ensure its usability and access to employers and job-seeking youth. 7. Increase annually the number of employers who adopt `ban the box' practices. 8. Provide ongoing Racial Equity Training to Orange County employers and youth. • Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orani;e Count BOCC Goals and Priorities, Town of Ctapill 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. PROGRAM INFORMATION 1/31/2017 3:24:15 PM II ' ago n d 29 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION The stakes are high for society as a whole, but especially for disadvantaged youth. If they do not graduate from high school, they are less likely to be prepared to raise a family, become civically engaged, or be able to compete in the workforce. Locally, outcomes within the Chapel Hill-Carrboro City Schools System can still be predicted by race, with white students' outcomes in every area always above those of black and brown students. For example, in 2013-2014, only 20-30% of African American children meet standard achievement requirements for their grade level. Recent data reveal that 85% of black male students in 8th grade were unable to pass the end-of-grade reading test. The Board of Orange County Commissioners in its 2016 annual retreat committed to social justice values as well as enhancing education for at-risk children; MBK Orange County represents a focused, coordinated initiative that is organized to identify and support opportunity youth—in particular boys and young men of color—who can be successful when given the opportunity to pursue the best lives possible. • Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? MBK Orange County will work with diverse youth—in particular boys and young men of color—that need access the knowledge, skills, and resources needed to be engaged, productive 21st century citizens. Youth will be identified by community organizations, Chapel Hill Carrboro-City Schools, and Orange County Schools, all of which are represented on the MBK Advisory Board and both school systems currently work with Movement of Youth. • Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Project Lead –Atrayus Goode, President & CEO, Movement of Youth Seeing such a need to address the educational and social needs of underrepresented populations, Atrayus founded Movement of Youth (MOY) in 2006 as a junior at the University of North Carolina at Chapel Hill. Targeting only 11 students in 2006, MOY has grown to impact hundreds of middle and high school students annually and is in the process of scaling nationally. Atrayus has received numerous awards and accolades for his work, including the Triangle Business Journal's 40 Under 40 Leadership Award and the North Carolina Governor's Medallion Award for Volunteer Service, the state's highest award for volunteer service. Atrayus will oversee overall strategic and operational responsibility for MBK Orange County staff, programs, expansion, and execution of its mission. Education • Duke University Divinity School, Master of Arts, Christian Practice (expected 2018) • American University - School of Public Affairs, Master of Science, Organization Development (2015), Cohort 69 Representative • Duke University, Certificate, Non-Profit Management (2013) • The University of North Carolina at Chapel Hill, Bachelor of Arts, Communication Studies (Interpersonal and Organizational Concentration), (2007), Order of the PROGRAM INFORMATION 1/31/2017 3:24:15 PM N::' a 2 t. 29 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Golden Fleece Honor Society, 100 Black Men of America Merit Scholarship Recipient Director of Programs, MBK Orange County—TBD The Director of Programs will be tasked with convening various groups to ensure community support towards the MBK initiative. The Director will do the following: • Increase community engagement • Increase Service Provider/Non-Profit/Government Agencies Engagement • Increase engagement of funding community • Research and develop comprehensive list of organizations that impact males of color • Plan and organize targeted outreach events to these organizations • Attend community events to provide information on MBK • Research best practices to increase website traffic, social media engagement, and other communication outlets • Develop and analyze custom data reports to illustrate the impact of MBK and recommend how to integrate results into sustainable efforts AmeriCorps VISTA Members (3) —TBD MBK Orange County VISTAs will advance the MBK agenda in Orange County in partnership with Movement of Youth (host agency) and various stakeholders. VISTAs will support execution of the MBK Orange County Community Challenge Action Plan, which calls for individuals to work on key initiatives to support boys and men of color in Orange County through activities such as: • Engaging key stakeholders in advancing the local MBK strategy; • Raising money and/or developing resources to implement communities' local MBK strategy; • Developing and implementing a public service campaign to raise awareness of communities' local MBK initiative; and • Evaluating the impact of the local MBK initiatives. • Describe the specific period over which the activities will be carried out and include an implementation timeline. Implementation Timeline (Jul 2017—Jul 201 8) • Host Leadership Summit to build a program and policy agenda (Aug 2017) • Hire MBK Director and AmeriCorps VISTA members (Aug 2017) • Begin rollout of program and policy agenda (Sept 2017) • Establish shared measurement practices (Sept 2017) • Scan of current youth-serving and mentoring organizations completed (Dec 2017) • MBK Mentor recruitment, training, and screening (Jul 2017—Sept 2017) • MBK Mentee recruitment, orientation, and screening (Jul 2017—Sept 2017) • Saturday Leadership Academy and Team Mentoring (Sept 2017 —Apr 2018) • Step to the Future Spring Break College Tour (Apr 2018) • Summer Enrichment Academy (Jul 2018) • Parent Engagement Sessions (Jul 2017, Sept 2017, Nov 2017, Jan 2018, Mar 2018, May 2018) PROGRAM INFORMATION 1/31/2017 3:24:15 PM C:) 111 or 2 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXH IBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Host Opportunity Summits to engage public, private, and nonprofit leaders, provide technical assistance and training, and to track progress on goals (Nov 2017, Apr 2018) • 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) Investment is needed in these types of initiatives. Poor students and students of color are more likely to drop out of school than any other group of Americans and end up underemployed, reliant on government assistance, and facing a lifetime of health problems as a result. Funding MBK Orange County adds value to the community because it will augment or intensify the work in progress, as opposed to starting a new program, based on data and findings. Movement of Youth, the backbone organization, will leverage stakeholders, manage workflow, and capture outcomes to ensure progress towards goals. • Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Movement of Youth (MOY) engages in similar work locally with Chapel HiII-Carrboro City Schools, Orange County Schools and in other communities and school systems, including Guilford County Schools, Wake County Public Schools System, Durham Public Schools, and DC Public Schools. If MBK Orange County is not funded, the capacity to deliver these services will be limited, as MOY needs the additional funds to expand its work in Orange County. • Include any other pertinent information. PROGRAM INFORMATION 1/31/2017 3:24:15 PM l:"^ 2 I 9 9 t 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information 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 50 250 Female 50 250 Total N/A 100 500 Ethnicity African-American 111111111= 100 500 - American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Total N/A 100 500 Of the above, how many Hispanic/Latino 10 100 Of the above, how many non-Hispanic/Latino 90 400 Total N/A 100 500 Age 0-5 years 6-18 years 10OI ........500.. 19-50 years IM 51+ years Total N/A 100 500 Geographic Location Alamance County Chatham County Durham County Wake County Orange County Breakdown Chapel Hill Public Housing MEd 50 Town of Chapel Hill (Non-Public Housing) 50 200 Town of Carrboro 100 Town of Hillsborough 50 150 City of Mebane (Orange County) Orange County (Outside Municipalities) PROGRAM INFORMATION 1/31/2017 3:24:15 PM P aqP 20 2 f 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Total N/A 100 500 Work Statement • 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 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 My Brother's Keeper(MBK) Orange County Program Activity Name Leadership Summit Program Goal 1 To build a program and policy agenda Performance Measures 1. #of partners that accurately describe common agenda 2. #of partners that publicly discuss/advocate for common agendaAoals Previous Year Program Results I N/A Current Year Estimated Results N/A Next Year Projected Results 1. 20 partners accurately describe common agenda 2. 20 partners publicly discuss/advocate for common agenda oa's Program Activity Name Establish shared measurement practices Program Goal j To develop shared data system Performance Measures 1. #of partners that understand the value of shared data 2. #of partners that have robust/shared data capacity 3. #of partners that make decisions based on data 4. #of partners that utilize data in a meaningful way rent YYear Program Results N/A Cur .... �� .... . ..� Previous ear Estimated Results j N/A Next Year Projected Results 1. 20 partners n__. the value WoW shared p understand the value of shared data 2. 20 partners have robust/shared data capacity 3. 20 partners make decisions based on data 4. 20 Sartners utilize data in a meaniniful wa Program Activity Name Scan of current youth-serving and mentoring organizations Program Goal To increase#of relevant stakeholders engaged in the initiative Performance Measures 1. of stakeholders engaged in the initiative Previous Year Pro g ram Results N/A mmmm PROGRAM INFORMATION 1/31/2017 3:24:15 PM i) ago 21 o l'' 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Current Year Estimated Results N/A Next Year Projected Results 1. At least 20 relevant stakeholders engaged in the initiative Program Activity Name MBK Mentor and Mentee recruitment, training, and screening Program Goal To increase#of mentors and mentees participating in MBK related activities Performance Measures 1. � ���...._ .....�. #of mentors and mentees participating in MBK related activities Previous Year Program Results N/ _....................__......_, Current Year Estimated Results N/A Next Year Projected Results 1. At least 100 mentors and 100 mmmITITIT mentees participating in MBK related activities Program Activity Name Saturday Leadership Academy and Team Mentoring Program Goal To increase#of mentees participating in MBK related activities Performance Measures 1. % increase of students that enroll in at least one college-level course(when eligible) 2. °A° increase of students that have satisfactory school behavior (good attendance records, no suspensions, etc.) 3. % increase of students that improve in problem subjects 4. % increase of students that seek leadership roles in their extracurricular activities 5. % increase of students that complete at least 8 hours of community service per school year 6. % increase of students that are aware of the importance of academics and good decision making 7. % increase of students that are aware of 21st Century skills and how they connect with success 8. % increase of mentors that report satisfactory relationships in monthly contact reports 9. % increase of mentors that gain a better understanding of their individual student's needs and tailors support based on needs Previous Year Program Results N/A Current Year Estimated Results N/A Next Year Projected Results 1. 10% increase of students that enroll in at least one college- level course (when eligible) 2. 10% increase of students that have satisfactory school behavior(good attendance records, no suspensions, etc.) 3. 10% increase of students that improve in problem subjects 4. 10% increase of students that seek leadership roles in their extracurricular activities 5. 10% increase of students that complete at least 8 hours of community service per school year 6. 10% increase of students that are aware of the importance of academics and good decision making 7. 10% increase of students that are aware of 21st Century skills and how they connect with success 8. 10% increase of mentors that report satisfactory relationships in monthly contact reports 9. 10% increase of mentors that gain a better understanding of their individual student's needs and tailors support based on needs ty Tour Program Activity Name �Step to the Future Spring Break College ToM --µIT- mmmmITITITIT mmmIT-IT�ITm Program Goal To increase#of students that visit at least one college campus annual) Performance Measures 1. #of students that visit at least one college campus annually PROGRAM INFORMATION 1/31/2017 3:24:15 PM Prigo 1°:, 1m DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Previous Year Program Results N/A Current Year Estimated Results N/A Next Year Projected Results 12. At least 50 students visit at least one college campus annually Program Activity Name Summer Enrichment Academy Program Goal To increase#of mentees participating in summer enrichment activities Performance Measures 1. #of mentees participating in summer enrichment activities Previous Year Program Results ' N/A Current Year Estimated Results N/A Next Year Projected Results 1. At least 50 mentees participate in summer enrichment activities Program Activity Name Parent Engagement Sessions Program Goal To increase#of parent(s)/guardian(s) that are aware of MBK resources available to assist their child's academic and personal goals Performance Measures 1. #of parent(s)/guardian(s)that report awareness of MBK resources available to assist their child's academic and personal goals 2. #of parent(s)/guardian(s) that report program satisfaction g �.. and annual surve s Burin chat sessions and annual surve Previous Year Program Results N/A Current Year Estimated Results N/A Next Year Projected Results 1..... At least 50 parent(s)/guardian(s) report awareness of MBK ............. resources available to assist their child's academic and personal goals 2. At least 50 parent(s)/guardian(s) report program satisfaction durin , chat sessions and annual surve s Program Activity Name Opportunity Summits Program Goal To engage public, private, and nonprofit leaders, provide technical assistance and training, and to track progress on goals .. .. Performance Measures 1. #of partners that engage in collaborative work 2. #of partners that improve the quality and efficiency of their work 3. #of community members that are aware of the initiative 4. #of community members that support the initiative (through finances, volunteerism, etc.) 5 #of funders that direct funds to support initiative goals Previous Year Program Results N/A Current Year Estimated Results_. / W........... Next Year Projected Results e, wor ... � 1. At least 20 partners engage in collaborative work 2. At least 10 partners improve the quality and efficiency of their work 3. At least 100 community members are aware of the initiative 4. At least 50 community members support the initiative (through finances, volunteerism, etc.) 5. At least 10 funders direct funds to support initiative •oals PROGRAM INFORMATION 1/31/2017 3:24:15 PM ago 23 n if 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • 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 o Supplies & Equipment o Travel &Training o Other Expenses 2. Program Budget Detail — Provide description of"other" budget items, not defined. • Admit.Me. Online support system where students get expert support on how to represent their academic background, activities, goals, and interests for schools. • Institute for Civic Engagement for Emerging Leaders. Cost for food, presenters, and instruction during two-week intensive summer enrichment academy for 50 students from MBK-related agencies. • MBK Opportunity Summits. Cost for food and presenters for two (2) MBK Opportunity Summits for high school students, college students, K-12 educators, and community and business leaders. Summits will focus on student achievement, career/personal/professional development, social justice and engagement, and mentorship. • Marketing. Costs associated with web design, photography, videography, and general promotion of MBK Orange County. 3. This program budget represents what percent of the agency budget? 12% °„ wpMl PROGRAM INFORMATION 1/31/2017 3:24:15 M IC: �� � o f 2 9 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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 201646 Estimated 2 47 ? Projected 2017-18 Total Cost of Program N/A $4000.00 $134,750.00 Total #of Individuals.......... .. . ....._......m ._..._.........N/A.. _. 100 500 Cost Per Individual N/A $40.00 $269.50 PROGRAM INFORMATION 1/31/2017 3:24:15 PM 99292 25 of 29 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Movement of Youth Actual Estimated Projected Percent AGENCY REVENUE 2015 2016 2017 Change Private Donations $ 4,685 $ 5,624 $ 20,000 256% Agency Generated Revenue (fees) $ 37,617 $ 76,502 $ 150,000 96% Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ - $ - $ - 0 Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ - $ - $ 134,750 0 Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ 500,000.00 0 Federal Government (CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ 110,045.06 $ 50,000.02 $ 320,000.00 $ 5.40 Other Revenue $ - $ - $ - 0 Total Agency Revenue $ 152,347 $ 132,126 $ 1,124,750 751% AGENCY EXPENSES Compensation $ 32,924 $ 13,047 $ 343,863 2536% Rent& Utilities $ 3,810 $ 3,113 $ 4,130 33% Supplies & Equipment $ 19,860 $ 9,556 $ 16,540 73% Travel &Training $ 14,614 $ 5,363 $ 84,102 1468% Other Expenses: $ 99,424 $ 104,825 $ 674,512 543% Total Agency Expenses $ 170,632 $ 135,903 $ 1,123,147 726% SURPLUS/(DEFICIT) FOR PERIOD: $ (18,286)1 $ (3,778)1 $ 1,603 I 142% FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME My Brother's Keeper(MBK) Orange County Actual Estimated Projected Percent PROGRAM REVENUE 2015-16 2016-2017 2017-2018 Change Private Donations $ - $ - $ - 0 Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ - $ - $ - 0 Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ - $ 4,000 $ 134,750 3269% 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 $ - $ - $ - 0 Total Program Revenue $ - $ 4,000 $ 134,750 3269% PROGRAM EXPENSES Compensation $ - $ - $ 52,000 0 Rent& Utilities $ - $ - $ - 0 Supplies & Equipment $ - $ - $ 4,000 0 Travel &Training $ - $ - $ 37,500 0 Other Expenses: $ - $ 4,000 $ 41,250 931% Total Program Expenses $ - $ 4,000 $ 134,750 3269% SURPLUS/(DEFICIT) FOR PERIOD: $ - I $ - I $ - I 0 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D EXHIBIT "B" Scope of Services—FY 2017-18 Outside Agency Performance Agreement Agency Name: Movement of Youth Program Name: My Brother's Keeper (MBK) Orange County Funding Award: $20,213.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount AmeriCorps VISTA.Cost share for 1 full time AmeriCorps member to support and manage $5,500.00 project. MBK Leadership Summit.Cost for supplies,food,presenters,and materials for a MBK $1,500.00 Leadership Summit for advisory board members to build a program and policy agenda. MBK Opportunity Summit,Saturday Leadership Academy,and Team Mentoring.Cost for $8,500.00 supplies,food,presenters,and materials for up MBK Opportunity Summits, Saturday Leadership Academy,and Team Mentoring. Summits will focus on student achievement, career/personal/professional development,social justice and engagement,and mentorship. Saturday Leadership Academy will focus on mastery of 21st Century Skills.Team Mentoring will focus on life skills and character development. Step to the Future Spring Break College Tour.Travel and Lodging for 10 students from MBK- $4,713.00 related agencies. Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • MBK Leadership Summit.Movement of Youth will build a program and policy agenda for MBK Orange County • MBK Opportunity Summit, Saturday Leadership Academy, and Team Mentoring. Movement of Youth will increase the number of mentors and mentees participating in MBK related activities • Step to the Future Spring Break College Tour.Movement of Youth will increase the number of students that visit at least one college campus annually 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. DocuSigned by: Q{1�ayUS Gbb�,t, 8D897F1 4A5... 9/5/2017 President & CEO Certified by: Title: President& CEO Date: July 24, 2017 (Provider's Signature) DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D Performance Measures Anticipated Results MBK Leadership Summit-#of partners that accurately describe common agenda 20 MBK Leadership Summit-#of partners that publicly discuss/advocate for common agenda goals 20 MBK Opportunity Summit,Saturday Leadership Academy,and Team Mentoring-#of mentors 100 and mentees participating in MBK related activities MBK Opportunity Summit,Saturday Leadership Academy,and Team Mentoring-#of students 50 that complete at least 8 hours of community service per school year MBK Opportunity Summit,Saturday Leadership Academy,and Team Mentoring-%of students 50 that report satisfactory mentoring relationships in monthly contact reports MBK Opportunity Summit,Saturday Leadership Academy,and Team Mentoring-#of 100 stakeholders that attend MBK Opportunity Summit Step to the Future Spring Break College Tour.#of students that participate in Step to the Future 10 Spring Break College Tour. DocuSigned by: Q{1�ayUS Gbb�,t, 8D897F "'-B34A5... President & CEO 9/5/2017 Certified by: Title: President& CEO Date: July 24, 2017 (Provider's Signature) DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D 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. ��Doo"cuSigned by: QtvAyUS Ot■ President & CEO 9/5/2017 Certified by: 8D897F1C9FB34A5_. Title: Date: (Provider's Signature) (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID: E546BA93-2CAA-4121-B91A-3F2107563B4D MOVEM-1 OP ID: C2 ACORCr CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �►. 01/31/2017 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). CONT PRODUCER NAMEACT Codruta E. Roberts The Insurance Center of Durham 1920 Front St,Suite 710 PHONE 919-471-2541 Ext):919-471-2541 FAX No): 919-471-2132 P.O.Box 15369 E-MAIL codruta@insurancecenterofdurham.com Durham,NC 27704- ADDRESS: Codruta E. Roberts INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:The Cincinnati Insurance Co. 10677 INSURED Movement Of Youth Inc. INSURER B: 406 Blackwell St Ste B030 Durham, NC 27701 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR ETD0372692 02/05/2017 02/05/2018 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT PRODUCTS-COMP/OPAGG $ 2,000,000 JECT � OTHER: Physical/ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A ANY AUTO ETD0372692 02/05/2017 02/05/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X AUUTOSWNED (Para cdent)AMAGE X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE ETD0372692 02/05/2017 02/05/2018 AGGREGATE $ DED RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE X ER Y A ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A EWC037269300 02/05/2017 02/05/2018 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Physical/Sexual ETD0372692 02/05/2017 02/05/2018 Phy/Sex 1,000,000 A Professional Liab. ETD0372692 02/05/2017 02/05/2018 Professio 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ORAN005 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g y ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron St Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE . �a ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD