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2017-496-E Finance - Pathways to Change Inc. - Outside Agency Performance Agreement
DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D 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 Pathways to Change Inc., a not-for-profit corporation, located at 960 Corporate Drive, Hillsborough,NC 27278 ("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 Pathways to Change 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 9400 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 2350. 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. (Pathways to Change Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D 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. (Pathways to Change Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D 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. (Pathways to Change Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D 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 Pathways to Change 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: (Pathways to Change Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D County: Finance &Administrative Services Provider: Pathways to Change Inc. Orange County 960 Corporate Drive Post Office Box 8181 Hillsborough,NC 27278 Hillsborough,NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable,it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. 18. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of the Agreement and County may immediately terminate this Agreement without further obligation on part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 19. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For an ,�A0 'if the Provider �� � a� 9/1/2017 5543F7SCQR5345n Date (Pathways to Change Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D For an P iwr f f Orange County Government bov,v,tt, holoku(sLui 9/8/2017 06379949755E477... Bonnie Hammersley, County Manager Date (Pathways to Change Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION -_ FOR OFFICE USE ONLY Received By Agency Behavioral Insights, Inc. Date/Time Program(s): Programming to Fulfill Court & CPS ���� w,. �x un � � �u_ �__.wA, - Mandates 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 1/30/2017 10:59:14 AM Page 5 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Behavioral Insights, Inc. Applicant Organization's Physical Address: 100 N. Churton Street, Suite 207, Hillsborough Applicant Organization's Mailing Address: 100 N. Churton Street, Suite 207, Hillsborough Applicant Organization's Web Address: www.behavioralinsightsorangenc.com Executive Director: Kathryn Bauman, LCSW Telephone Number (919) 391-0365 E-Mail: kathrygbaurnan@gmall corn 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 County-HS Ex.Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 Afterschool Program Coordinator salary and materials for youth activities and projects Programs to Fulfill Court and CPS $11,000 $35,000 $40,000 $86,000 Mandates Totals c) To the pest 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 irector Date Signature: J + , Board Chairperson Date 4' AGENCY INFORMATION 1/29/2017 9:40:56 PM Cage 3 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D 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 beat of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: -.. Executive Director Date Signature:, 6 Board Chairperson Date AGENCY INFORMATION 1/29/2017 9:40:56 PM Page 7 o f 2 1 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D 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): 23 years, October 1993 b) Agency's Purpose/Mission (no more than a few sentences): Behavioral Insights, Inc. provides classes to meet the needs of those required by a North Carolina mandate to participate in a state certified domestic violence Batterer Intervention Program. Additionally, Behavioral Insights intends to provide other services to identify client needs and link clients to needed services. c) Types of Services the Agency Provides (bullet format): • Certified Batterer Intervention Program — providing 26-week curriculum and notifying court officials of compliance by the participant • Anger Management classes • Strong Fathers Program — a strengths-based intervention for fathers overcoming cycles of family violence referred by child protective services or court personnel d) Agency's History with Providing These Services: Behavioral Insights has prepared risk needs assessments and individualized recommendations for psycho-social issues interfering with pro-social living for more than twenty years. Current Executive Director, Kathryn Bauman, co-wrote the Strong Fathers Program in 2009 and has directed the program's operations in Durham since 2013. 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?) Behavioral Insights, Inc. received state certification to provide Batterer Intervention Programming in November of 2016. Kathryn Bauman replaced Joyce Kuhn as Executive Director on January 17, 2017. Provision of the Strong Fathers Program will be a new initiative offered by Behavioral Insights beginning July 1, 2017; however, Kathryn Bauman has been running this program in Durham since October 2013. 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: # of FTE - Paid Part-Time Positions: 1 # of Volunteers: # of FTE -Volunteers: g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/No) Yes If yes, is this agency an Orange County Living Wage Certified Employer? No Agency Information 1/30/2017 10:59:56 AM Page 8 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION If no, please explain. Behavioral Insights, Inc. has just learned of this certification. We have submitted an a application but not yet received certification. 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, 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 Ex:Affordable Rental 0 + $20,000 Carrboro-Affordable Housing Rehabilitation Ex: Agency Administration $1$,000 $15,000 Carrboro-Other. Ex. Total $15,000 .x$35000. Carrboro Total Funding *Add rows or attach additional page, if needed. ii. 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 • 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 Agency Information 1/30/2017 10:59:56 AM Page 9 o f 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION o Travel &Training o Other Expenses iii. Does your agency budget show a Surplus or Deficit? Balanced budget Is there a significant change? Yes/No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes. Behavioral Insights is launching two new services in 2016-17, the Batterer Intervention Program and Strong Fathers Program. The Strong Fathers Program, which is often required of fathers involved with Child Protective Service, features no fee for participants. iv. What is your agency's fiscal year? July 1, 2017 —June 30, 2018 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/30/2017 10:59:56 AM Page 1 0 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Behavioral Insights, Inc. Actual Estimated Projected Percent AGENCY REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ - $ - $ 5,000 0 Agency Generated Revenue $ 21,000 $ 3,000 $ 12,000 300% Local GoverpFment Grants: Human Services-Town of Carrboro $ 5,600 $ 5,000 $ 11,000 120% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 7,500 $ 14,500 $ 35,000 141% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 71,250 $ 4,000 $ 40,000 900% Other-Orange County $ - $ - 0 Other-Town of Hillsborough $ 320 $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ - $ - $ - 0 Other Revenue fund.bal-15/16 $ 16,402 $ 26,241 $ 1,500 $ 0.94 Total Agency Revenue $ 122,072 $ 52,741 $ 104,500 98% AGENCY EXPENSES Compensation $ 84,000 $ 31,241 $ 39,500 26% Rent&Utilities $ 18,150 $ 8,808 $ 8,800 0% Supplies&Equipment $ 3,520 $ 1,200 $ 6,730 461% Travel&Training $ 1,552 $ 1,200 $ 2,450 104% Other Expenses: insurance, co-facil., bookkeeping. $ 14,850 $ 10,292 $ 47,020 357% Total Agency Expenses $ 122,072 $ 52,741 $ 104,500 98% SURPLUS/(DEFICIT) FOR PERIOD: I $ - 1 $ - ( $ - J 01 FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Behavioral Insights: Programming to Fulfill Court and CPS Mandates (All class offerings are grouped together because we cannot predict to which program participants will be referred). Program Primary Contact and Title: Kathryn Bauman, Executive Director Telephone Number: (919) 391-0365 E-Mail: kathrvnibaumanna gmail.com 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 X Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare Education X X X X Family Resources X X X X Jobs/Jobs Training Food Transportation Other: Please specify: Court and CPS- mandated programming X X X X c) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated/collaborative efforts. • Department of Social Services — Our staff provides presentations and liaises with DSS staff to enroll participants and support their case management needs ® Community Corrections (Probation) —We liaise with staff to receive referrals and provide/receive updates regarding participant progress PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 1 1 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Freedom House Recovery Center—We refer participants with substance abuse needs and accept referrals of their participants. • Cardinal Innovations —We refer participants with substance abuse and mental health treatment needs • ADATC —When active substance abuse is evidenced, a referral for detox will be made when warranted • The Compass Center— collaboration for victim safety and services with Memorandum of Understanding • El Futuro —we receive and make referrals for Spanish-speaking participants • Student Health Action Coalition (SHAC) —We refer clients with medical needs who are unable to pay for traditional care • Linkages with these agencies and others will be made during intake appointments and throughout work with participants to increase the likelihood of long-term behavior change. Such linkages are intended to reduce barriers and satisfy basic needs so that participants can focus on changing behavior. 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? All services offered by Behavioral Insights address the priority of improving the health of needy residents. Batterer Intervention Programming, which is court- mandated for individuals convicted of domestic violence crimes, helps participants understand how their behavior constitutes domestic violence and how their abuse negatively affects victims, themselves, and their families. Anger Management classes equip participants with tools for recognizing triggers for their anger and learning constructive ways to express emotions and resolve conflicts. Strong Fathers empowers fathers to end cycles of family violence and begin restoring physical and psychological safety for children exposed to violence in the home. These services benefit all Orange County residents by offering alternative life pathways for those working to overcome antisocial behavior and preventing the future victimization of participants' partners, children, and others in the community. Services are available in English and Spanish. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. Council/Board Goals). One of the Orange County BOCC's overarching goals is to promote values of social justice, including ensuring economic self-sufficiency and creating a safe community. Behavioral Insights furthers this goal by decreasing violence in families. Approximately 21% of children in the U.S. are exposed to family violence each year. Assuming these statistics are representative of Orange County, the number of PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 12 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Orange County children exposed to domestic violence annually is approximately 6,025. Children exposed to violence exhibit significantly higher levels of emotional and behavioral problems than their peers, and research indicates that these adverse effects carry over into adulthood, leaving violence-exposed children at greater risk for negative physical and mental health outcomes, including heart disease, stroke, depression, suicide attempts, sexually transmitted infections, and substance abuse. All of these consequences contribute to social inequity in that they hinder the ability of individuals to live productive, satisfying, and self-sufficient lives. In this way, children's exposure to violence is indisputably a social justice issue. Evidence for the local need for the Strong Fathers Program can be gleaned from referral data provided by the Strong Fathers Program based out of Durham. Over the last year, 20 fathers were referred by Orange County Child Protective Services workers to the Strong Fathers Program in Durham. This represents concrete evidence of the need for this program here in the Orange County community. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Individuals who stand to benefit from our programs include those mandated to participate as well as their family members and other contacts in the community. Participants will be identified and referred primarily by court personnel and child protective services social workers. Because Behavioral Insights cannot predict to which program an individual will be referred, we are requesting financial support for all three class offerings combined. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Executive Director, Kathryn "Katie" Bauman is a licensed clinical social worker with 9 years of experience working with children and families impacted by trauma. She co-wrote the Strong Fathers curriculum in 2009, began facilitating groups in 2012, and assumed directorship of the Strong Fathers Program's operations in Durham in 2013. Through her work with Strong Fathers, she has developed a skill and passion for working with men overcoming cycles of family violence. As a licensed clinical social worker, she is experienced at conducting bio-psycho-social assessments and using evidence-based treatment modalities to motivate behavior change. While transitioning to the role of Behavioral Insights Executive Director, Kathryn received training on Behavioral Insights' Batterer Intervention Program from outgoing director Joyce Kuhn. Ms. Bauman will attend a more comprehensive training for facilitators of certified Batterer Intervention programming later this year. Ms. Bauman can provide services in English and Spanish. All facilitators hired to conduct Batterer Intervention, Anger Management, and Strong Fathers groups will be trained at least to the extent required by state and programmatic certifications. All will be expected to complete continuing education annually to stay abreast of the latest research regarding work with our clients. All PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 13 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION will additionally be required to participate in Racial Equity training to help ensure that we maintain an equity focus in the delivery of all our programming. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. All services will be offered throughout the year. At least one Batterer Intervention class (26 weeks) and one Anger Management class (12 weeks) will be provided each week with rolling enrollment. The number of groups running simultaneously will depend on number and geographic location of referred participants. Strong Fathers groups will run for 20 weeks and operate on a closed-group model. (No new participants admitted after 3rd session.) Number and location of these groups is also dependent on number and geographic proximity of participants referred. Community education presentations regarding domestic violence and its impact on children will be available as requested throughout the year. Behavioral Insights staff will continue participating on the Orange County Domestic Violence Task Force throughout the year in addition to assisting in other collaborative efforts to address domestic violence in the community. 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) As previously explained, domestic violence and children's exposure to domestic violence are serious community health problems. Both have significant ramifications across multiple areas of life satisfaction and wellbeing and produce burdensome costs for the social service and criminal justice systems. The need for the Strong Fathers Program, an innovative strengths-based intervention that combines parenting and anti-violence education, has been demonstrated over the last several years by a steady stream of Orange County residents being referred to the Durham Strong Fathers Program. Availability of Strong Fathers locally would increase accessibility of the program as well as ensure ongoing capacity to serve Orange County participants. This stands to reduce both social and economic costs by helping reunite children with their families and curbing the intergenerational transmission of violence. As the only agency in Orange County certified to provide Batterer Intervention, Behavioral Insights meets a long-standing need and increases accessibility of this vital programming to residents in the community. Recent statistics from the Orange County Sherriffs office indicate that hundreds of victims sought Domestic Violence Protective Orders in the last year. As part of a community collaborative effort to address domestic violence, Behavioral Insights' Batterer Intervention Program stands to increase safety for all in the community by holding offenders accountable and teaching them how to relate in equitable and non-coercive ways with their partners and others. District Court Judges in Orange County often mandate anger management programming in landlord-tenant disputes and various types of neighbor and consumer disputes. For some years, the need for anger management classes has PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 14 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION gone unmet. Community support of this offering ensures the ongoing availability and affordability of this offering. More than half of the referrals to Behavioral Insights' programs will be generated by the court system as sanctions handed down in lieu of active jail time. Availability of these services, therefore, stands to offset jail costs that often go unpaid due to the indigent status of participants. Furthermore, participation in programming that provides pro-social tools for managing stress and conflict will reduce recidivism, further reducing jail bed costs and facilitating intact family time, thereby unburdening over-strained government support systems. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If requested funding is not awarded, the Behavioral Insights board will meet with stakeholders to determine how best to allocate the funding available. Likely, this would result in a reduced capacity to provide the outlined services. k) Include any other pertinent information. The Strong Fathers Program was evaluated by Dr. Joan Pennell at NC State's Center for Family and Community Engagement. Findings published in a 2015 report indicated statistically significant reductions in the following child protection outcomes for families of 177 fathers who participated in the program: 1) Number of families with investigated child welfare reports, 2) Median level of highest family risk assessed during investigations, 3) Number of families with child protection findings (substantiations, services needed), and 4) Number of families with household domestic violence as contributory to child maltreatment. For more information, please see full report at http://cfface.chass.ncsu.edu/documents/Stronq Fathers Evaluation Report 2015.p df PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 15 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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 (6 months) (12 mos.) Male 5 110 Female 3 12 Total 0 8 122 Ethnicity _ African-American 2 48 American Indian or Alaska Native Asian 9 Caucasian 6 65 Native Hawaiian or other Pacific Islander Other: specify Total 0 8 122 Of the above, how many Hispanic/Latino 2 15 Of the above, how many non-Hispanic/Latino 6 107 Total 0 8 122 Age.. 0-5 years 6-18 years 2 7 19-50 years 5 103 51+ years 1 12 Total 0 8 122 Geographic Location Alamance County Chatham County Durham County Wake County Orange County Breakdown Chapel Hill Public Housing 1 31 Town of Chapel Hill (Non-Public Housing) 2 34 Town of Carrboro 1 5 Town of Hillsborough 2 14 City of Mebane (Orange County) 0 6 Orange County(Outside Municipalities) 2 32 Total 0 8 122 PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 16 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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 document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART(Specific, Measurable, Achievable, Re levant, 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: _Behavioral Insights: Programming to Fulfill Court and CPS Mandates_ 1.. Program Activity Name Assess referred participants to determine suitability for BI's interventions (Assessment to include lethality screening) Program Goal Conduct assessment of 80% of referred participants Performance Measures Will maintain database of referred participants Previous Year Program Results N/A Current Year Estimated Results Will conduct assessment of 7 participants Next Year Projected Results Will conduct assessment of 122 participants 2. Program Activity Name , Provide referrals to address barriers to participant success Program Goal Provide referrals to 90% of participants assessed Performance Measures Will maintain database of referrals made to assessed participants Previous Year Program Results N/A Current Year Estimated Results Will provide referrals to 5 participants Next Year Projected Results Will provide referrals to 110 participants 3. Program Activity Name. Provide Anger Management, Batterer Intervention, and Strong Fathers interventions Program Goal 80% of enrolled participants will complete assigned program Performance Measures Will maintain records of attendance and program completion Previous Year Program Results N/A Current Year Estimated Results 7 participants will complete Batterer Intervention or Anger Management Next Year Projected Results 98 participants will complete Anger Management, Batterer Intervention, or Stron• Fathers 4. Program Activity Name Interface with local domestic violence, child protection, and criminal justice personnel and organizations Program Goal Conduct/attend at least 3 meetings or presentations/month for/with local domestic violence, child protection, or criminal justice PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 17 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION personnel or organizations Performance Measures Will maintain records of meetings/presentations Previous Year Program Results N/A Current Year Estimated Results Will conduct/attend at least 8 presentations/meetings Next Year Projected Results Will conduct/attend at least 36 presentations/meetings PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 18 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION n) Program Budget 1. Submit your program 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, 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. • Liability insurance • Contract facilitators— Facilitators of all three programs are paid hourly on a contractual basis • Contract bookkeeper—Maintains financial records, provides financial reports, etc. 3. This program budget represents what percent of the agency budget? 100% 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. ��I�It ININIIp 1111,1.„III II N I ,,J I I ,,i V hI'I��Ip,�I•li.' 1!"�MINI I. nq.u11��,., � I INI,'+9!Ni1If f i'y...l II p.�.r�im�1. :1 III9.I;I:,,� �I II�IIIt'I�II.�I11��1�11 1 I�1 11111.1!Illl�l �IIIIIIIII,�1IIrI�I,�IryryI I�II�� �11,, 11 III III,; II...II� 1 �.� m'"� ":,F1.,.I .III It I I: q 1 ����I16.,.��.1y111 II 1 I� II I1� 'IIV u 1 Ih�RIIII I{III i1:II;i11 u p I .. 1 1I 111611 III Il 1�i�ll6l„ II 119 ,..: 1 1 ,.1 I, L 1 "`,II 21 1 I �j1 1 I I�i.:.1�r111 11. 8 )�I661N,II,III1111i1 11!,x.111I III !IIII II II IIII II IFFIIIII�I�iI111�lUII III�1 � (� Illlf� ��lli�ifli't, (Ih�l� "I uy X11111 IIII��IIIII I � 11 11 h II I, Total Cost of Program 0 $52,741 $104,500 Total # of Individuals 0 8 122 Cost Per Individual 0 $6,593 $857 PROGRAM INFORMATION 1/30/2017 10:59:56 AM Page 19 of 21 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME: Behavioral Insights: Programming to Fulfill Court and CPS Mandates Actual Estimated Projected Percent PROGRAM REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ - $ - $ 5,000 0 Program Generated Revenue $ - $ 3,500 $ 12,000 243% Local Government Grants: Human Services-Town of Carrboro $ - $ 5,000 $ 11,000 120% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ - $ 14,500 $ 35,000 141% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ - $ 4,000 $ 40,000 900% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBG/HOMEIetc.) $ - $ - $ - 0 Private Foundation Grants $ - $ - 0 Other Revenue agency balance $ - $ 26 241 $ 1,500 $ 0.94 Total Program Revenue $ $ 53,241 $ 104,500 96% PROGRAM EXPENSES Compensation $ - $ 31,241 $ 39,500 26% Rent&Utilities $ - $ 8,808 $ 8,800 0% Supplies&Equipment $ - $ 1,700 $ 6,730 296% Travel&Training $ - $ 1,200 $ 2,450 104% Other Expenses:insurance,co-facil.,bookkeeping $ - $ 10,292 $ 47,020 357% Total Program Expenses $ $ 53,241 $ 104,500 96% SURPLUS/(DEFICIT)FOR PERIOD: $ - ( $ - I $ - I 0 000uSign Envelope ID:sn1euuna'oFAn-4Ena-9uncoznenF000ero EXHIBIT "B" Scope of Services—FY2Ol7-lQ Outside Agency Performance Agreement Agency Name: iathways to Change(formerly Behavioral Insights) Program Name: Programs toFulfill Court and CPS Mandates Funding Award: $9,400 Outline how the agency wil sperd Orange County's funding a�wd� ---� � �zpemoc0emoNption --' _ Amount Reut& Uti]ibex -- -- --� — - -- _ __� __ __ __ __. __. $3500 Lur�8�munoQca copies etc.) -- -- -- - - --- �� - =- — ��- ��00 Contract t au��mtor�m� --- -- | -- -- -- - - $5600 ________ _- ___ Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,hy June 30.2Ul8. • Partner Abuse Intervention: Twenty-six-week rolling admission program for those referred for concerns related to domestic violence. Self-referrals accepted. • Anger Management: Ten-week rolling admission program for those court or CPS-ordered to complete Anger Management programming. Self-referrals accepted. • Strong Fathers: Twenty-week strengths-based intervention for fathers overcoming cycles of family violence, combines parenting education with anti-violence education. Free to CPS-referred fathers � Sentence Planning: Comprehensive bio-psycho-social-lega! assessment, short-term intensive case management, and production of report outlining alternatives to jail boze. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number ef persons/units served within Qrance County, only (all Towns and municipalities), if you use percentages, you must also provide the tota] number of priicipant,s within that omeusam'odesoriyd000r for uoomrWc,performance nmomxurc. Performance Measures Anticipated Results BoroUmeuimPu�oor,�bus�Int��voou|ma�poArrm --�i --' program 68 Complotinuof---Partner Abuse--- {mt `°°�ot�o'"---program--- --- --- ---' --- --�' --- --] "^ , 80%(48) Enrollment in An ~ 8�/ �upro&oam ---� | - -- - � 36 \ Completion of Anger --- Management 8O96(2y) Enrollment in Strong Fathers program --'------ ' 20 of8�mo�- ---- -- --- ---- --�— ----� -- — / —'— -- r �� ___ ^="�^�v`"e"°' 8OY�(l6) _� __' Number of completed 5 | -` '~ '' r'~ '' � ---' ---------- ---- � --- ---- Executive Di rector _ | 9/1/2017 Certified by:/-(,-- Title' ,ikkf 7/14j, (Provi4e -Signature) ___ � ' DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D 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: 1`AI(I�'yln Executive Di rector 9/1/2017 Title: Date: by: 5543F25C9B5345D_. itle: Date. (Provider's Signature) (Pathways to Change Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID:60192208-BFA3-4E38-9277-B2390FDDC97D ACC30RD® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/6/2017 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 Amber Cur lee NAME: Business Insurers of Carolinas (a//C,NNE,Ext): (919)968-4611 FAX No): (919)968-8991 800 Eastowne Drive, Suite 208 aoDRless:acurlee @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INsuRERA:American Casualty Company of 20427 INSURED INSURER B:Lloyds of London 00432 Pathways to Change INSURER C: 960 Corporate Drive INSURER D: Suite 408 INSURERE: Hillsborough NC 27278 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1761918902 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 300,000 A CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ X 6021140912 7/1/2017 7/1/2018 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: BAIL $ 1,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Professional Liability MPL148440816 8/25/2016 8/25/2017 LIMIT 1,000,000 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is an additional insured with respect to general liability per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 S. Cameron Street ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE Amber Curlee/AMBER ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014011