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2017-498-E Finance - Big Brothers Big Sisters of the Triangle, Inc. - Outside Agency Performance Agreement
DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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 Big Brothers Big Sisters of the Triangle, Inc., a not- for-profit corporation,located at 808 Aviation Parkway, Suite 900,Morrisville,NC 27560 ("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 Big Brothers Big Sisters of the Triangle,Inc. agree as follows: 1. Term of the Agreement. The tenn 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 5800 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 1450. 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. (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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. (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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. (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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 Big Brothers Big Sisters of the Triangle, 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: (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 County: Finance &Administrative Services Provider: Big Brothers Big Sisters of the Orange County Triangle, Inc. Post Office Box 8181 808 Aviation Parkway, Suite 900 Hillsborough,NC 27278 Morrisville,NC 27560 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 and Plifflpfligrovider KA net A, 9/6/2017 5E4774DA5B354D3... , Date (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 For a AV':D'tf of Orange County Government jOUtuut, ikalmviit-Y'Stui 9/8/2017 0637994B755E477... Bonnie Hammersley, County Manager Date (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FOR OFFICE USE ONLY Agency: Big Brothers Big Sisters I of the Triangle, Inc. Received By Date/Time Program(s): Community and School-Based Mentoring 1. Cover Page a. El Applicant Contact Information b. El Funding Requests C. El Signed Application Cover Page d. illiSigned Disclosure of Conflicts of Interest and Clause 2. Agency Information a. El Agency's Years in operation b. E] Agency's Purpose/Mission c. E] Agency's Types of Services Provided d. El Agency's Experience with Programs e. El Other Pertinent Agency Information f. El Schedule of Positions g. El Living Wage h. [I] Agency Budget 3. Program Information a. El Human Services Needs Priority b. ID Type of Program A separate Section 3 is c. (11 Agency Collaboration required for each program. d. El Summary of Program e. El Description of Identified Need f. El Description of Population to be Served g. El Program Staffing, Capacity, & Expertise h. El Program Implementation Timeline i. [1] Value of Investment j. El Impact of Reduced/No Allocation k. El Other Pertinent Information I. El Target Population/Beneficiary Chart m. 1:1 Work Statement n. El Program Budget, Detail, &Cost per Individual Application Submittal Checklist 1/27/2017 1:43:18 PM Page 5 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 4. Attachments a. El 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. E] IRS Federal Form 990 c. LI NC Solicitation License d. El IRS Federal Tax-Exemption Letter e. El Certificate of Insurance f. El List of Board of Directors g. El Solid Waste Program Fee (SWPF)Verification Application Submittal Checklist 1/27/2017 1 :43:18 PM Page 6 of 2 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Big Brothers Big Sisters of the Triangle, Inc. Applicant Organization's Physical Address: 808 Aviation Parkway, Suite 900 Morrisville, NC 27560 Applicant Organization's Mailing Address: same Applicant Organization's Web Address: www.bbbstriangle.org Executive Director: Kim Breeden Telephone Number: 919-850-9772 E-Mail: kbreeden(@,bbbstri.org Tax ID Number: b) Funding Request List all FY17-18 Human Services (HS) Funding Being Requested — For All Programs) and the Proposed Use of Funds (2-3 lines or less) Program Carrboro Chapel Orange Total - HS Hill - HS County-HS_ We are requesting funds to continue to support our $5,000 $10,000 $10,000 $25,000 Community and School-Based Mentoring Programs in Carrboro, Chapel Hill, and all of Orange County for at- risk children ages six to 14. Totals $5,000 $10,000 $10,000 - $25,000 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. )t) Signature -7` 1/27/17 Executiv Directo Date Signature: /‘1,4 1/27/17 Board C 'rpers Date AGENCY INFORMATION 1/26/2017 9:39:14 AM Page 7 of 23 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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 E X a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? 11 X 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? LI X c) Current beneficiaries of the program for which funds are being requested? E X 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. n/a 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. I Signature: 11 1/27/17 Exvcuiiv, Director 72 Date Signature: , ° 1/27/17 Board • airperAPF. Date AGENCY INFORMATION 1/26/2017 9:39:14 AM Page 9 of 23 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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): 10/26/1998. A Big Brothers Big Sisters agency has operated in our area for 18 years. Big Brothers Big Sisters of the Triangle, which is the result of a merger between two BBBS agencies, has been in operation here for over 11 years. b) Agency's Purpose/Mission (no more than a few sentences): Our mission is to provide children facing adversity with strong and enduring, professionally supported, one-to-one relationships that change their lives for the better forever. c) Types of Services the Agency Provides (bullet format): • Community-Based Mentoring provides children from single-parent homes or other children in need of an adult role model with a one-to-one mentor relationship with a volunteer from the community. These volunteers receive extensive screening and training from our Enrollment Specialists and our Match Support Personnel. A careful process is followed to make a quality match between the child and the appropriate volunteer in order to promote a long-term relationship. The Community-Based "Bigs" routinely provide eight to 10 hours a month of quality one-to-one time for each child. This particular program allows us to reach children throughout our service area who may not otherwise have access to services. These Bigs play an integral role in the lives of their "Littles" as stable, adult role models to help guide these children in the right direction. • School-Based Mentoring provides children in need of an adult role model with mentors who visit the Little's school campus during and after school. Our partnerships with many local schools allow school counselors and teachers to refer children who are struggling with class work or need extra attention to build better social skills and improve classroom behavior. Our School-Based matches meet for one to two hours each week. They read together, do homework, or play educational games, among other activities. School-Based Bigs work to improve their Littles' school attendance and academic performance and help them understand the importance of staying in school, graduating, and achieving higher education. They also tend to have more direct conversations about school performance and get access to more information regarding grades and homework through interaction with their Little's teachers. • We provide a variety of supplemental activities as well — STEM Smart Saturday Academy programming; book clubs; college and career readiness; yoga; and our Healthy Child Initiative, to name a few. We also work with corporate sponsors and local donors to provide opportunities for the matches to attend sporting events, movies, museums, and many other activities. d) Agency's History with Providing These Services: For 111 years, Big Brothers Big Sisters of America remains true to its founders' vision of bringing caring role models into the lives of children. We are the oldest and most respected mentoring agency in the country. With that, our core programming - Community and School-Based Mentoring — is the cornerstone of our agency. We have the hard data to prove that our mentoring helps children increase self- esteem, overcome adversity, improve school behavior and academic performance, and avoid risky behaviors, like drug use and truancy. Agency Information 1/27/2017 1:43:18 PM Page 1 # of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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 August 2016, we hired Meri Mitchell as our new Development Director. She has been a wonderful asset to our team, and with her lead, we hope to grow our community engagement, marketing, and fundraising in 2017 and for years to come. f) Schedule of Positions (For Entire Agency) O Full Time Equivalent (FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc. O 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: 12 # of FTE - Paid Part-Time Positions: 3 # of Volunteers: 600 # of FTE - Volunteers: 27 g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/No) YES If yes, is this agency an Orange County Living Wage Certified Employer? YES If no, please explain. Agency Information 1/27/2017 1:43:18 PM Page 11 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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, Chapel and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY16-17 FYI 7-18 Source Award Request Ex: Affordable Rental 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 page, if needed, ii. Submit your agency's budget. You may complete the provided template (separate xis file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). SEE ATTACHED 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 Agency Information 1/27/2017 1 :43:18 PM Page 12 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • 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 NO The past four years have been challenging for us. Our small surplus is the result of us budgeting to start building up a cash reserve. iv. What is your agency's fiscal year? 1/1/17 to 12/31/17 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/27/2017 1:43:18 PM Page 13 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Community and School-Based Mentorinq Program Primary Contact and Title: Andie Thomas-Young, VP of Programs Telephone Number: 919-850-9772 E-Mail: ayoungbbbstri.org a) Indicate the type of Human Service Needs Priority, if program applicable: I I Priority Area #1: safety-net services for disadvantaged residents X Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges r Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare Education X Family Resources X Jobs/Jobs Training Food Transportation Other: Please specify —Mentoring 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. • Wake and Durham County Departments of Social Services–We have received referrals from them in the past and have current relationships in which they are assigned as the legal guardian. • North Carolina Department of Public Instruction – They endorse our programs every year by supporting our efforts to help at-risk children. • North Carolina Department of Juvenile Justice – We get referrals from them to mentor children. • Durham Housing Authority and the Housing Authority of Wake Counties– We get referrals from them to mentor children they determine are in need of our services. • JD Lewis Community Center in Raleigh PROGRAM INFORMATION 1/27/2017 1:43:18 PM Page 14 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Passage Home in Raleigh • YMCA of the Triangle, including the Chapel Hill/Carrboro YMCA • Area Boys & Girls Clubs - We get referrals from them to mentor children they determine are in need of our services. Through United Way, we are in a two-year collaboration with Boys & Girls Clubs and six other youth serving agencies. • Communities in Schools - We get referrals from them to mentor children they determine are in need of our services. Through United Way, we are in a two-year collaboration with Boys & Girls Clubs and six other youth serving agencies. • School Districts of Orange, Durham, and Wake Counties—We work directly with guidance counselors and social workers in schools where we have official mentoring sites, and we get referrals from schools to mentor children they determine are in need of our services. • Leadership and staff of Orange, Durham, and Wake Counties • Leadership, staff, and students at NCCU, Duke University, UNC-CH, and NCSU • Numerous African-American and Multi-Ethnic Churches in the community • National African-American fraternities: Kappa Alpha Psi, Alpha Phi Alpha, Omega Psi Phi • Haven House in Raleigh - We get referrals from them to mentor children. • StepUp Ministries - We get referrals from them to mentor children they determine are in need of our services. Through United Way, we are in a two-year collaboration with Boys & Girls Clubs and six other youth serving agencies 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? Our Community-Based Program allows us to reach children throughout Orange County, Chapel Hill, and Carrboro who need an adult role model in their lives. Community-Based Bigs routinely provide two hours a week of quality one-to-one time for their Littles for at least one year, These Bigs play an integral role in the lives of their Littles by being good listeners, by giving the Littles a stable adult role model to help guide them in the right direction, and by exposing the Littles to a variety of cultural, community, and sporting activities. Our School-Based program allows school counselors and teachers to refer children who are struggling with class work or need extra attention to build better social skills and improve classroom behavior. Many of the children referred to our School-Based Mentoring Program are academically at risk — struggling with negative perceptions of school and teachers, time management, focusing, and test preparation. School-Based mentors are trained to work with their Littles to offer a positive perspective on school, model productive study habits, and encourage improved relationships with teachers and other adults. In 2016, 14% of our Littles and 15% of our Bigs were located in Orange County. Results of our 2016 Youth Outcomes Survey show that social acceptance, risk attitudes, scholastic competency, and parental trust, among others, are markedly improved in our Littles after just one year in our program. This is proof that our program helps to prevent young people from going down the wrong path, making our community safer and more successful. PROGRAM INFORMATION 1/27/2017 1:43:18 PM Page 15 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. There are more than 75,000 children who qualify for free and reduced lunch that live in our service area. Most of these kids are minorities from single-parent households. They often live in our highest crime-ridden neighborhoods, attend our most struggling schools, and/ or become victims of violence and abuse. Many of them have at least one incarcerated parent. As a result, increases in juvenile crime, school dropout rates, childhood obesity, and other health and social problems occur. An investment in this vulnerable population is an investment in our community. We believe that inherent in every child is the ability to succeed and thrive in life. These children need positive role models to show them hope for a brighter future, and our mentors and supplemental programs help them achieve just this. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Fifty-two percent of children in our program are male, while 48% are female. The majority (75%) of kids we serve are African-American; 10% are Caucasian; five percent are Hispanic; nine percent are multi- race; and one percent is Asian. Eighty-one percent quality for free/reduced lunch, and 27% have at least one parent in prison. Eighty-four percent come from single-parent homes, and the vast majority of those households are headed by single mothers. Our programs target the children who need us the most. Any child aged six to 14 with an identified need can be enrolled in our program at no cost. Parents and guardians are the most important connection to our program. They recognize the potential of their children better than anyone. By starting a child in our program, parents are introducing a path that is brighter and more promising. g) Describe the credentials of the program manager and other key staff. Our Vice President of Programs, Andie Thomas-Young, has a B.A. in Psychology and Sociology from Sweet Briar College. She also has a M.S. in Sociology, with a concentration in criminal justice. For seven years, she worked with Big Brothers Big Sisters of Central Virginia, and she has been with Big Brothers Big Sisters of the Triangle since 2001. All of our program staff have social work backgrounds and participate in regular staff trainings to continue to grow and learn in their positions. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Our activities take place all during the year. Community- Based matches spend eight to 10 hours per month together, while School-Based matches spend at least one hour a week together during the school year. Our Match Support Specialists provide on-going monthly support to each and every match. After the initial match process, volunteers, parents, and children are contacted each month to ensure the effectiveness of our service delivery model. Every day, our program staff is on the phone with Bigs, Littles, and parents/guardians about their match experience, securing anecdotal evidence on the impact of the match. PROGRAM INFORMATION 1/2712017 1 :43:18 PM Page 16 of 24 DocuSign Envelope ID: oC/+8002FA0o789204A6 EXHIBIT PROVIDERS OUTSIDE AGENCY APPLICATION 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 an agency of Big Brothers Big Sisters of America, we have national data to demonstrate how well our methods work. Our programs have been recognized for reducing the dropout [Gte, curbing vio|enCe, minimizing tru8Ocy, and decreasing crime rates. Independent studies prove that our ongoing evaluation and support helps families increase the odds that Littles will perform better in school and life. Mentoring is a recognized cost-saving method for investing in the Triangle's economic and social future. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Your continuous support is instrumental in helping us cover our program costs. It costs approximately $1,500 to create and support a match, and that $1.500 is derived from: cost of our well-trained staff to enro||, interview, match, and support mentoring relationships; trainings provided to parents and mentors; liability and property insurance; program activities; BBBSA affiliation dues; AIM fees; and criminal background checks for our volunteers and mentors. Without your generous support, we would not be able to support as many matches, which means that even more at-risk youth in our community would "fall through the cracks." These children need positive role models to show them hope for a brighter future. Without grant funding, they simply will not have the opportunity to have one of our mentors — which means they will miss out on the deep, impactful, meaningful relationship that goes along with that. Our agency's mere existence hinges on the support of entities like yours. We deeply appreciate your continued Gupport, and we look forward to a close working relationship for years to come! k) Include any other pertinent information. PROGRAM INFORMATION 1/27/2017 1 :43:18 PM Page 17 of DocuSign Envelope ID: oC/+8002FA0o789204A6 EXHIBIT A PROVIDERS OUTSIDE AGENCY APPLICATION Additional Program Information I) Target Population - Complete the following ta@eS, 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 514 494 528 Female 554 536 572 Total 1068 1030 1100 Ethnicity African-American 787 762 814 American Indian or Alaska Native 0 Asian 4 4 4 Caucasian 102 103 110 Native Hawaiian or other Pacific Islander 0 0 0 Other: specify Multi-race 175 165 176 Total 1088 1030 1100 Of the above, how many Hispanic/Latino *I calculated these from the"other"category-not from the grand total 9 8 9 Of the above, how many non'Hiapanin/LeMnn* 106 157 167 Total 175 165 176 Age 0-5 years 0 6-18 years 1061 1020 1088 19-50 years 7 10 11 � 51+ years Total 1068 1030 1100 Geographic Location Alamance County 0 Chatham County 0 Durham County 376 361 385 Wake County 551 536 572 _ Orange County Breakdown Chapel Hill Public Housing 0 Town of Chapel Hill (Non-Public Housing) 103 101 108 Town of Carrboro 1111 19 22 Town of Hillsborough ISM= 10 9 City of Mebane (Orange County) 1 ME= 1 (]range County(Outside Municipalities) 4 2 3 Total 1068 1030 1100 , PROGRAM INFORMATION 1/27/2017 1 :43:18 PM Page 18 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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, 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 Community and School-Based Mentorinq 1. Program Activity Name Match at-risk children, ages six to 14, who reside in Durham, Wake, or Orange Counties, with professionally screened and trained adult mentors who will provide a positive role model in their lives. Program Goal We are trying to make more matches between Bigs and Littles. We are also working hard to continue to increase the length of those matches. Performance Measures We focus on creating and sustaining long, strong relationships with measurable impact. Once the match is made, our program staff members call or meet monthly with Bigs, Littles, and their parents and track information about the match in our Agency Information Management (AIM) system, producing a written record of the relationship. We also request that parents give us a copy of their child's report card —this allows us to track grades, attendance, and classroom behavior. Additionally, we give pre- and post- surveys to Littles in both of our main programs to help evaluate the effectiveness of our work with the children. We enter this information into AIM as well to produce hard data to demonstrate that our mentoring helps children succeed in school and in life. Previous Year Program Results We served 1068 children in our service area. Our Average Match Length (AML) was 28.5 months for Community-Based Matches and 21.9 months for School-Based Matches. Current Year Estimated Results We are serving 1030 children in our service area. Our AML was 29.8 months for Community-Based Matches and 22.1 months for School-Based Matches. PROGRAM INFORMATION 1/27/2017 1 :43:18 PM Page 19 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Next Year Projected Results We have a goal of serving 1100 children in our service area. Our AML will be 32 months for Community-Based Matches and 24 months for School-Based Matches. 2. Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results 10111 10110111 110111 I'll, 111111111 111111 guidon 1,11 1111111111111111.111,111witoolloolliiiiiimilivioullinummuolohill 1111111111 1111111d 11111,11, imioH111111 11111 IT 3, Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results 11,11'111111111iikilii0410%11111111111111111111111fiplphl'h11111111111'11'1111111111°101,,a,,/71(Atigg0410004104/joiti 1,1111 ilhoolisol?1,0110,111101111101 NH 111,11111111111111,101111111,111,111,1111,11101111,111, 1,111 1111,111111111l11111111,0011111111111111111110101011111101111111, 4. Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results PROGRAM INFORMATION 1/27/2017 1 :43:18 PM Page 20 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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: 0 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. Other budget items include membership fees to our national database management system; fundraising costs; agency insurance; and background checks. 3. This program budget represents what percent of the agency budget? 72% 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. l',/,Y/;*:.4*/167/;1,6,; /414001//g01047'ZIOii**040:1:744 Total Cost of Program $675,350 $748,000 $768,000 Total # of Individuals 1068 1030 1100 Cost Per Individual $632 $726 $698 PROGRAM INFORMATION 1/27/2017 1:43:18 PM Page 21 of 24 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Big Brothers Big Sisters of the Triangle, Inc. Actual Projected 2017- Percent AGENCY REVENUE 2015-16 Estimated 2016-17 18 Change Private Donations $ 263,080 $ 276,626 $ 318,000 15% Agency Generated Revenue(fees) $ $ 0 Local Government Grants: Human Services-Town of Carrboro $ 1,350 $ 3,000 $ 5,000 67% Other-Town of Carrboro $ - $ $ Human Services-Town of Chapel Hill $ 2,000 $ 2,000 $ 10,000 400% Other-Town of Chapel Hill $ $ - $ Human Services-Orange County $ 2,000 $ 6,000 I $ 10,000 67% Other Orange County $ - $ - $ 0 Other-Town of Hillsborough $ - $ $ - 0 Other Government Grants .1::1111111N1,11'111'1'1'1'1'111111\\\\\'11111111111111111111""""' Triangle United Way $ 56,093.00 $ 50,647.54 $ 60,000.00 $ 0.18 State Government $ 18,754.00 $ 19,256.25 $ 34,000,00 $ 0.77 Federal Government(CDBG/HOME/etc„) $ - $ 56,433.14 $ 75,000.00 $ 0.33 Private Foundation Grants $ 203,000.00 $ 294,225.00 $ 300,000.00 $ 0.02 1111 Other Revenue $ 249,498 $ 246,968 $ 272,500 $ 0,10 Total Agency Revenue $ 795,775 $ 955,156 $ 1,084,500 14% 11 ,ifimmh 1.1.1111,4,11,11,',11:1;11111,i11,11111indl.11110111'01111,11,1' 111 momill,111,11111,1111111111111111111111111111111111 „„„„„, AGENCY EXPENSES Compensation $ 633,781 $ 613,382 $ 746,616 22% Rent& Utilities $ 95,097 $ 103,028 $ 105,256 2% Supplies&Equipment $ 12,770 $ 14,534 $ 26,228 80% Travel&Training $ 6,714 $ 6,295 $ 17,600 180% Other Expenses: $ 90,016 $ 174,048 ' $ 170,000 -2% ;I cII Total Agency Expenses $ 838,378 $ 911,287 1 $ 1,065,700 17% SURPLUS/(DEFICIT) FOR PERIOD: $ (42,603)1 $ 43,869 1 $ 18,800 1 -57% FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAMECommunity and School-Based Mentoring - Big Brothers Big Sisters of the Triangle, Actual Estimated Projected Percent PROGRAM REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ 235,000 $ 255,000 1 $ 255,000 0% Program Generated Revenue $ - $ $ - 0 Local Government Grants: 11111111,111111111111111111111111111hIllihowiuhli Human Services-Town of Carrboro $ 1,350 $ 3,000 $ 5,000 67% Other-Town of Carrboro $ $ $ - 0 Human Services-Town of Chapel Hill $ 2,000 $ 2,000 $ 10,000 400% Other-Town of Chapel Hill $ - $ $ - 0 Human Services-Orange County $ 2,000 $ 6,000 $ 10,000 I 67% Other-Orange County $ - $ $ - Other-Town of Hillsborough $ - $ $ - 0 Other Government Grants 011111111111111,1111171111111111111111111111111111611111111411111'11111111111117111111110,111111111F11111 ffilhommom 11111 Triangle United Way $ 35,000.00 $ 46,000.00 1 $ 46,000.00 $ - State Government $ $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ 200,000.00 $ 200,000.00 $ 200,000.00 $ 111,11.1111111111111111l1111111111111111111„1111111,111111111111111111111111100.1111111 Other Revenue $ 200,000 $ 236,500 $ 242,000 $ 0.02 hhIIIIPH„.11„11,1111,111„1111111111111,111111111111111,1111,111.1111,11 "11. 111114 11 Total Program Revenue $ 675,350 $ 748,000 $ 768,000 3% 11111,11110111,111,111,111,11,1111;111111111,11,11,1111,1111,11111,1111111011 11.11111111111dohl 111,1111111,111' 1.11111111111Ermh111111111111 PROGRAM EXPENSES 1111-111 Compensation $ 570,000 $ 620,000 $ 640,000 3% Rent& Utilities $ 60,000 $ 65,000 $ 65,000 0% Supplies & Equipment $ 10,000 $ 10,000 $ 10,000 0% Travel &Training $ 10,000 $ 10,000 $ 10,000 0% Other Expenses: I $ 25,350 $ 43,000 $ 43,000 0% Total Program Expenses $ 675,350 $ 748,000 $ 768,000 3% SURPLUS/(DEFICIT) FOR PERIOD: I $ 01 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 EXHIBIT `B" Scope of Services—FY 2017-18 Outside Agency Performance Agreement Agency Name: Big Brothers Big Sisters of the Triangle,Inc. Program Name: Community-Based and Site-Based Mentoring Funding Award: $5,800 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel salaries,FICA,and Fringe $5,800 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Continue to carefully screen, train, match, and support Bigs to ensure appropriate pairing of Bigs and Littles • Establish match goals based on self-reported information from the program participants and any relevant external resources(e.g., counselor/therapist,references, former volunteer experience) • Staff will continue to provide supplemental activities, trainings, and opportunities for all program participants Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results BBBST will serve children in Orange County through mentoring and supplemental programming 143 BBBST will continue to increase the Average Match Length in their Community-Based 32 months mentoring program BBBST will continue to increase the Average Match Length in their Site-Based mentoring 24 months program DocuSigneyd eby: 15I(W 5E4774DA5B354D3... CEO 9/6/2017 Certified by: Title: CEO Date: 7/6/17 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FA0D789204A6 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:::�/I 15rt- t.l& CEO 9/6/2017 Certified by: 5E4774DA5B354D3... Title: Date: (Provider's Signature) (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID:2A83AE93-E43A-4DCA-8002-FADD789204A6 ACORL) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4110■, 10/17/2016 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 NAMEACT Debbie Callahan Moore and Johnson Agency PHONE 919-582-1977 FAX 919-719-8806 3809 Computer Drive (A/C,No,Ext): (NC,No): Raleigh NC 27609 ADDRESS:dcallahan @mooreandjohnson.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Berkshire Hathaway INSURED BIGBR-1 INSURERB:SUmmit Holdings Big Brothers Big Sisters of the INSURER C: Triangle, Inc. 808 Aviation Pkwy Ste 900 INSURER D: Morrisville NC 27560 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:884394368 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 /Y LIMITS LTR INSD VD POLICY NUMBER (MM/DDYYY) (MM/DD/YYYY) A x COMMERCIAL GENERAL LIABILITY 47-SPK-255375-01 9/28/2016 9/28/2017 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES( SES(Ea occurrence) $1,000,000 X Employee Benefit MED EXP(Any one person) $20,000 X D&O Liability PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $3,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: Empl.Benefits $1,000,000 A AUTOMOBILE LIABILITY 47-RWS-255376-01 9/28/2016 9/28/2017 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS )( NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 0521063508 9/8/2016 9/8/2017 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N/A (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 Property 47-SPK-255375-01 9/28/2016 9/28/2017 Blkt BPP $200,000 Crime Fidelity $100,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Professional Liability #47-SPK-255375-01 9/28/16 to 9/28/17 Limits $1, 000, 000/$3,000,000 Aggregate Abuse and Molestation $1,000,00 Each Incident/ $1, 000, 000 Aggregate CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Government Finance&Admin Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD