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HomeMy WebLinkAbout2017-513-E Finance - EmPOWERment, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 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 EmPOWERment, Inc., a not-for-profit corporation, located at 109 N. Graham Street, Suite 200, Chapel Hill,NC 27516("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 EmPOWERment, 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 27500 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 6875. 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. (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 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. (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 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. (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 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 EmPOWERment, 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: (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 County: Finance &Administrative Services Provider: EmPOWERment,Inc. Orange County 109 N. Graham Street, Suite 200 Post Office Box 8181 Chapel Hill,NC 27516 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 T ' h7tlf of the Provider ahVt S 15 614 9/13/2017 BCE548CED19F4OF... , Date (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 EFt�' of Orange County Government NIA,lA , ikav Mt,V'SLu 9/14/2017 06379946755E477... Bonnie Hammersley, County Manager Date (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID.72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FOR OFFICE USE ONLY Agency EmPOWERment Received By Program(s) Rental Property Management Date/Time Section Subsection 1. Cover Page a, Applicant Contact Information b. II 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. 1,1 Agency's Types of Services Provided d. 19 Agency's Experience with Programs e. Other Pertinent Agency Information f. ■ Schedule of Positions g. Living Wage h. Agency Budget 3. Program Information a. l■ Human Services Needs Priority b. Type of Program A separate Section 3 is c. IA Agency Collaboration required for each program. d. F9 Summary of Program e. ■ Description of Identified Need f. a Description of Population to be Served g. Program Staffing, Capacity, & Expertise h. E Program Implementation Timeline i. I Value of Investment j. Impact of Reduced/No Allocation k. i4 Other Pertinent Information I. ■ Target Population/Beneficiary Chart m. ■ Work Statement n. A 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. IA Certificate of Insurance f. I List of Board of Directors g. II Solid Waste Program Fee (SWPF)Verification Application Submittal Checklist 1/25/2017 4:42:59 PM P 5 5 o 2 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: EmPOWERment, Inc Applicant Organization's Physical Address: 109 N. Graham Street, Suite 200, Chapel Hill, NC 27516 Applicant Organization's Mailing Address: 109 N. Graham Street, Suite 200, Chapel Hill, NC 27516 Applicant Organization's Web Address: www.empowermentinc-nc.orq Executive Director: Delores Bailey Telephone Number: 919-967-8779 E-Mail: empowermentincncgmail.com 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 Rental Property Management Program $15,000 $20,000 $30,000 $65,000 Services, Support, materials and salary for the Property Manager and Property Manager Assistant Totals $15,000 $20,000 $30,000 $65,000 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. (e(Signature: /— -/?' Executive Director Date Signature: ( S 7(7 BoarO/Chairperson Date AGENCY INFORMATION 1/25/2017 9:41:22 AM P It onnunign Envelope ID:r2cnooEs+DFsA-471E-so71-CCon000nnne1 EXHIBIT PROVIDERS 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 }( 0 a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? [� �� C 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? E�_ 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, Jabe Hunter is a member of the Chapel Hill Police Department, but he does not receive any benefit from these grant funds. His job as a police officer does not pose a conflict of interest with El providing affordable rental housing. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themGe|vao, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, gender, national origin, ago, h@ndic8p, r8}igion, sexual oriHntoUon, gender identitv/expneoai0n, familial status or veteran status with reference to any activities carried out by the gnantee, 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 arnended, and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific perfornnonoe, 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 curment' 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 qrant awarded. k ~~�� /' �J �- / �7 Signature { / '~ ~` -~ - / 7^ c xGout|ve Director Date Signature: - ( t) ( / -7 Unoc Chairperson Date AGENCY INFORMATION 1/25/2017 9:41:22 AM r' a g e. 7 0f 7 :,:, DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 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): 21, 03/1996 b) Agency's Purpose/Mission (no more than a few sentences): The mission of EmPOWERment, Inc. is to empower people and communities to determine their own destinies through affordable housing, community organizing and grassroots economic development. c) Types of Services the Agency Provides (bullet format): • Community Organizing • Provide safe affordable rental units • Rental counseling (HUD approved Housing Counseling Agency) • Provide summer employment for youth • Operate and manage small business incubator d) Agency's History with Providing These Services: With funding provided through the Human Services Grant, EmPOWERment, Inc. has created a one-stop shop for affordable rental management programs and services that serves the Orange County population. EmPOWERment, Inc. is the primary provider of much needed affordable rentals in Orange County. Local agencies such as Social Services, the Interfaith Council, Community Empowerment Fund, Housing for New Hope and area churches are able to refer individuals and families that are in need of a safe, clean, and affordable place to live. EmPOWERment will continue to tailor the services of the affordable rental program to include more Housing Choice voucher holders, veterans, individuals transitioning from homelessness, seniors and disabled populations. The property manager position is responsible for the management of 47 rental units throughout Orange County. These units are made available for families and individuals at income levels that range from 30- 80% Area Media Income. • El has been one of the largest property managers for affordable rentals for more than 15 years. It continues to address the affordable rental demand for households at the moderate to low, low income range. More than 50% of our tenants are Housing Choice Voucher holders, 25% are seniors and 30% have a disability. • EmPOWERment Inc. collaborates with Social Services, Habitat for Humanity, Community Home Trust, Interfaith Council, Housing for New Hope, Club Nova, UNC Chapel Hill School of Medicine Department of Psychiatry and Community Empowerment Fund to help place qualified residents in affordable rental units. We provide a range of services that include: assisting with acquiring rental housing, securing utility services and transitioning into home ownership. • Rental counseling, acquiring rental housing, security utility service and transitioning to home ownership. Agency Information 1/25/2017 4:42:59 PM P a g a 8 a f 22 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • EmPOWERment, Inc. continues to assist families in transitioning from various states of homelessness into permanent housing. In this effort we worked closely with Housing for New Hope and Social Services on projects such as the Rapid Re- Housing Program and Orange County Partnership. El transitioned two families from homelessness to permanent. • We work constantly with the area Police Departments, our neighborhood Watch Program, and with UNC students and administrators to address the needs of underserved individuals in our community through program assistance and information sharing. • EmPOWERment actively collaborates of Justice United to bring light to neighborhood issues that may require Orange County attention. In conjunction with Justice United and the UNC Chapel Hill School of Public Policy Department we have conducted surveys with tenants about the condition of their units and updated Tenant Bill of Rights we helped author in 2014. • EmPOWERment, Inc. continues to collaborate with Chapel of the Cross Church and local developers to provide free gently used furniture and appliances to low income families. • We have partnerships with local churches and faith based organizations to provide temporary financial assistance to residents in need. EmPOWERment Inc. continues to search out funding sources for emergency assistance programs that were established in 2015. The fund provides assistance with rent and utilities when tenants are experiencing financial hardships. • We continue to partner with Community Empowerment Fund to transition homeless individuals into permanent housing through "home sharing" as housemates when possible. 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?) Our new initiative has expanded our target demographic to include our members of the Burmese and Latino communities as well as individuals transitioning from public housing units. f) Schedule of Positions (For Entire Agency) • Full Time Equivalent (FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 2,080 # of FTE - Full-Time Paid Positions: 2 # of FTE - Paid Part-Time Positions: 1.55 Agency Information 1/25/2017 4:42:59 PM Page 01 22 _ _ _ DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION # of Volunteers: 153 # of FTE - Volunteers:3 g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/No) yes If yes, is this agency an Oran.e Count Livin• Was e Certified Em•lo er? yes If no, please explain. We have not received our certificate but we have applied and according to the definition we meet the guidelines. Agency Information 1/25/2017 4:42:59 PM P a j a I 0 r, f 22 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget i. Is your agency currently receiving and/or requesting other (non-Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes/No) Yes If yes, please list below: 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 $15,000 $15,000 Carrboro— Other Ex. Total $15,000 $35,000 Carrboro Total Funding Affordable Housing Develop- 0 $54,128 Chapel Hill Mental Reserve, for property acquisition HOME funds property 0 $85,000 Orange County acquisition Total 0 $139,128 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). 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 Agency Information 1/25/2017 4:42:59 PM P g e I 1 cf 22 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • 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 iii. Does your agency budget show a Surplus or Deficit? Surplus Is there a significant change? Yes/No No Please provide a brief explanation for Surplus or Deficit, and significant changes. We have recorded a slight surplus this fiscal year due to the fact that the rental units have not needed as many repairs. Many of EmPOWERment's rental units are older and the surplus will be carried over for any unexpected repairs in the next fiscal year. iv. What is your agency's fiscal year? January 1 through December 31 (Example: July 1, 2016 through June 30, 2017) For the purposes of this report we have calculated the Agency and Program Budget on a July to June fiscal year. Agency Information 1/25/2017 4:42:59 PM P e 1 2 of 2 2 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: EmPOWERment, Inc. Actual Estimated Projected Percent AGENCY REVENUE 2015.46 2016-17 2017-18 chan.e Private Donations $ 12,584 $ 9,884 $ 10,181 3% Agency Generated Revenue(fees) $ 19,543 $ 19,351 $ 19,932 3% Local Government Grants: Human Services-Town of Carrboro $ 9,500 $ 10,000 $ 10,300 3% Other-Town of Carrboro $ - $ - $ _ 0 Human Services-Town of Chapel Hill $ 40,500 $ 47,000 $ 48,410 3% _ $ _ Other-Town of Chapel Hill $ 16,225 $ 0 Human Services-Orange County $ 20,000 $ 25,000 $ 25,750 3% Other-Orange County $ 49,076 $ 50,231 $ _ 51,738 °/ 38 300 Other-Town of Hillsborough $ - $ - Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ 12,509.00 $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ 5,000.00 $ 31,000.00 $ 31,930.00 3% Other Revenue 392,131 $ 418,434 $ 430,987 3% Total Agency Revenue $ 577,068 $ 610,900 $ 629,227 3% 1 AGENCY EXPENSES Compensation $ 216,290 $ 211,654 $ 218,004 3% Rent& Utilities $ 160,387 $ 197,406 $ 203,328 3% Supplies & Equipment $ 38,106 $ 28,509 $ 29,364 , 3% Travel &Training $ 3,613 $ 3,635 $ 3,744 3% Other Expenses: $ 153,489 $ 163,062 $ 167,954 3% Total Agency Expenses $ 571,885 $ 804,266 $ 622,394 3% SURPLUS/(DEFICIT) FOR PERIOD: 1 $ 5,183 I $ 6,634 I $ 6,8331 3%1 FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Rental Property Management Program Primary Contact and Title: LaTanya Davis, Property Manager Telephone Number: 919-967-8779 E-Mail: latanyaempowermentinc-nc.orq a) Indicate the type of Human Service Needs Priority, if program applicable: Priority Area #1: safety-net services for disadvantaged residents E Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges — Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Public Housing Program Category Youth Adult Elderly Disabled . . Neighborhoods/Residents Affordable Housing X X X X Affordable Healthcare Education (Counseling) X X X X Family Resources Jobs/Jobs Training Food Transportation Other: Please specify 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. 1. Provide Housing and counseling for individuals that come through their programs in collaboration with: Department of Social Services Rapid Rehousing Community EmPOWERment Fund Housing Choice Community Home Trust Housing for New Hope Freedom House Oxford House UNC Horizons Cardinal Innovations Health Care Solutions UNC School of Medicine Department of Psychiatry PROGRAM INFORMATION 1/25/2017 4:42:59 PM P a g a 1 $ a f 22 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 2. We work closely with the following agencies to provide Emergency funding sources to prevent evictions and utility disconnections: The Interfaith Council Local Churches JOCCA DSS 3. Collaborate to find resources for financial planning to ensure property budgeting and to provide emergency financial assistance when needed: Community Empowerment Fund 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? We address the affordable housing renal program outlined in the goals for the Town of Chapel Hill by using the following process: Process for filling vacancies includes the following services Unit Turnover Cleaning and repairs Receiving Applications Through online submission and in office visits Application Processing Income and Rental Verifications and Reference Check Pre-counseling Selection from verified applications on the wait list; Most recent verifications reviewed Lease Signing/ Document signing/ Deposit Move In Procedure and Check list Walk through, utilities transferred to tenant Collection/ Deposit of Rent Payments Late Notices and Evictions Generating Monthly Rent Rolls, Board Reports and Quarterly Reports to grantors, government 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 PROGRAM INFORMATION 1/25/2017 4:42:59 PM Pape 14 at 22 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Human Services Needs Assessment) to support the need for this program. The Orange County 5 Year consolidated plan has Housing as a "High Priority" item that includes providing safe and affordable rental units for low to moderate income families. Town/Council goal - Adopt and implement affordable housing strategies. Town/Council Programs - Housing and Community: Rental Housing for Low- Income Families; Maintenance Services: Resident Services EmPOWERment's rental program fully embodies these objectives. It is the largest residential landlord that accepts Housing Choice Vouchers when other landlords refuse to accept. There is a critical need for affordable rental. EmPOWERment Inc. continues to purchase units to fill and create inventory to address the need. The EmPOWERment, Inc., rental program has a proven track record of implementing safe, clean and affordable places for low to moderate income families to live. We have provided these services for the past 16 years. Our inventory of units has increased to 40 owned by the organization and 7 that we manage for private landlords. EmPOWERment uses a tracking log to keep account of the number of telephone calls, in office visits, and applications submitted for requested housing. In 2016 we fielded approximately 613 inquiries for rental homes. Many of the individuals seeking housing are below the poverty level and were referred to us through our collaborative efforts with other social service agencies. Seventy-seven percent of the inquiries and applications submitted were from minority populations and 100% were below the 80% level. We have found that approximately 58% of our inquiries are from female heads of households that include young children. The major property management companies in the area are no longer accepting Housing Choice Vouchers. EmPOWERment gives these individuals priority because those individuals have a limited amount of time to use their vouchers. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Our target population is Orange County residents' looking for affordable rentals whose income falls below the 80% area median income. Our typical residents are Housing Choice Voucher holders, seniors, disabled or homeless. We give priority to these individuals. They are identified through the application and verification process and other agencies. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) EmPOWERment, Inc. has been in the property management business for 16 years. The Property Manager and her team carry out all program activities. They operate out of the EmPOWERment Office located in the Midway Business Center, Chapel Hill, NC. All of the EmPOWERment staff, UNC Bonner students (4) and volunteers PROGRAM INFORMATION 1/25/2017 4:42:59 PM Fag a 15 of 22 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION are trained to help with the Rental Program. Our current property manager, LaTanya Davis, is a Broker-in-Charge with over twenty years of experience that allows her to manage units that do not belong to EmPOWERment. She manages 7 rental properties that are privately owned along with the 40 units that we currently own. Ms. Davis has been the Property Manager for nine years, overseeing the Rental Property management program including but not limited to: rental counseling, apartment turnovers, maintenance, negotiating with vendors and rent collection. Reporting to the Property Manager is the Assistant Property Manager, Valencia Thompson who is also a Real Estate Broker. This role works with tenants, handles administrative rental duties, data collection and Website management of the Rental Program. Santa Nwachukwu, the Director of Community Programs, has a BS in Business Management and spends 30% of her time supporting the Rental Program. She manages registration of clients, phone calls and receives maintenance requests. Volunteers assist with administrative duties and apartment turn-overs. The four Bonner students are UNC students who spend four years with EmPOWERment to complete their work-study hours. They are trained to work on many aspects of the Rental Program with Ms. Davis and provide tremendous support. The Executive Director, Delores Bailey, has 14 years of rental property management experience with EmPOWERment, Inc. With the approval of the Board, Ms. Bailey researches and negotiates potential affordable rental projects. These units will be included in EmPOWERment's affordable rental inventory. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. EmPOWERment Inc. holds two tenant association meetings each year. We bring in speakers to discuss relative topics to educate the tenants on any challenges they may be facing. We also conduct annual HQS inspections and recertification. EmPOWERment also gives each tenant a survey to complete to document any concerns tenants may have. The typical yearly timeline resembles this: Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Tenant HQS Inspections Tenant Association and Recertification Surveys Meeting and Tenant Association Meeting i) Why is funding this program a good investment for the community? How does funding this PROGRAM INFORMATION 1/25/2017 4:42:59 PM pa ,,1E 16 oi DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION program add value to the community? (250 words OR LESS) The need for safe, livable, and affordable housing for people earning less than 80% of the Area Median Income in our community is so great that it cannot be met by any one government or non-governmental organization. Since its inception in 1996, EmPOWERment has had affordable housing as a primary mission. Our mission in this regard matches the expressed concerns and goals of town and county governments. We have become the leading non-governmental agency for affordable rental housing in Orange County and continue to grow through property acquisition and management of privately owned properties. We also seek growth through public-private partnerships with developers and feel that we can play an important role in that area. Properties we own may qualify for redevelopment to increase our inventory. All of these activities require a strong and well-qualified staff. This funding is essential to supporting that staff. In turn, a strong EmPOWERment staff complements the efforts of town and county programs and staff. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If funding for this position were reduced or eliminated the services provided would be greatly diminished. Also, there would not be sufficient resources to support a full time property manager, resulting in an increased response time to tenant issues, reporting, unit turnover and marketing of available unit. A reduction in funding or funding elimination would impact the number of people that can be assisted, because currently the office handles approximately 613 inquiries during a calendar year, without the funding for a full time staff person we could not help as many individuals as we are able to now. Because EmPOWERment, Inc. is one of the few organizations in Chapel Hill that works primarily with Affordable Rental a full time property manager is essential to continued quality service. k) Include any other pertinent information. Unfortunately the waiting list for affordable rentals moves very slow. Families are forced to live in expensive units they can't really afford or substandard apartments with little recourse. The EmPOWERment Inc. Rental Property Management Program is intentional about our units and the families we try to serve. PROGRAM INFORMATION 1/25/2017 4:42:59 PM Fag e 17 a f 22 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 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 Male 259 240 272 Female 354 363 372 Total 613 603 644 Ethnicity African-American 374 406 393 American Indian or Alaska Native 1 0 1 Asian 8 3 8 Caucasian 211 179 222 Native Hawaiian or other Pacific Islander 0 0 0 Other: specify Hispanic 19 15 20 Total 613 603 644 Of the above, how many Hispanic/Latino 16 15 17 Of the above, how many non-Hispanic/Latino 597 588 627 Total 613 603 644 Age 0-5 years 63 69 66 6-18 years 52 62 55 19-50 years 297 267 312 51+ years 201 205 211 Total 613 603 644 Geographic Location Alamance County Chatham County Durham County Wake County Orange County Breakdown, Chapel Hill Public Housing Town of Chapel Hill(Non-Public Housing) 276 251 290 Town of Carrboro 337 352 354 Town of Hillsborough City of Mebane (Orange County) Orange County(Outside Municipalities) 0 0 0 Total 613 603 644 PROGRAM INFORMATION 1/25/2017 4:42:59 PM P -Lc;;i a 18 oi 2 2 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 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( pecific, 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 Rental Property Management 1. Program Activity Name Increase number of rental units (currently have 40 units) Program Goal Increase by one unit Performance Measures Document new rental units on spreadsheet Previous Year Program Results 2 Current Year Estimated Results 2 Next Year Projected Results 2. Program Activity Name Housing for homeless, disabled, and veteran population Program Goal Performance Measures Collaborations with other agencies to reach this population Previous Year Program Results 2 Current Year Estimated Results Next Year Projected Results 3. Program Activity Name Unit turnover Program Goal Maintain 5% vacanc or less Performance Measures Chart monthly vacancies Previous Year Program Results 98.5% Current Year Estimated Results 95% or less Next Year Projected Results 95% or less 4. Program Activity Name Complete annual housing inspections Program Goal Complete 90% of inspections Performance Measures Document on HQS Previous Year Program Results 100% Current Year Estimated Results 95% Next Year Projected Results 95% PROGRAM INFORMATION 1/25/2017 4:42:59 PM Pa . ,..-3 1 9 t„, i 22 DocuSign Envelope I D:72266CE5-DF5A-471E-B671-CC65C8960691 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 e 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. 3. This program budget represents what percent of the agency budget? 60% 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2015-16 Estimated 2016-17 Projected 2017-18 Total Cost of Program $192,775.00 $209,158.00 $202,414 Total # of Individuals 613 603 644 Cost Per Individual $314.00 $346.86 $330.00 PROGRAM INFORMATION 1/25/2017 4:42:59 PM 0002 20 of 22 DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME: EmPOWERment,Inc.-Rentals Actual Estimated Projected Percent PROGRAM REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ - $ - $ - 0 Program Generated Revenue $ 305,469 $ 320,213 $ 329,820 3% Local Government Grants: Human Services-Town of Carrboro $ 9,500 $ 10,000 $ 10,300 3% Other-Town of Carrboro $ - $ - $ 0 Human Services-Town of Chapel Hill $ 13,500 $ 20,000 $ 20,600 3% Other-Town of Chapel $ $ - $ - 0 Human Services-Orange County $ 20,000 $ 25,000 $ 25,750 3% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way 0 : State Government 0 Federal Government(CDBG/HOME/etc.) $ - $ 0 Private Foundation Grants $ - $ - 0 Other Revenue E11111111111111111 $ - $ 0 Total Program Revenue $ 386,470 1111111111 PROGRAM EXPENSES Compensation $ 61,294 $ 62,282 $ 64,150 3% Rent&Utilities $ 19,472 $ 28,068 $ 28,910 3% Supplies&Equipment $ 41,523 $ 43,738 $ 45,050 3% Travel&Training $ - $ - $ - 0 Other Expenses: $ 70,486 $ 62266 $ 64,134 3% Total Program Expenses MEI $ 196,364 $ 202,245 111111I! SURPLUS/(DEFICIT)FOR PERIOD: $ 156,694 I$ 178,859 I$ 184,225 I 3% DocuSign Envelope ID:72266CE5-DF5A-471E-B671-CC65C8960691 E IBIT"B" Scope of Services—FY 2017-1 Outside Agency Performance A reement Agency Name: EmPOWERme t, Inc. Program Name: Rental Propel Management Funding Award: $27,500 Outline how the agency will spend Or.ige County's funding award. Expense Description Amount Rental Property Management Pri gram Services, Support,materials and salary for the Property $27,500 Manager and Property Manager ssistant Program Services Outline the critical services(activities) t e agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Increase affordable rent:1 inventory • Provide counseling for ip otential and current rental clients • Work closely with loc.1 churches, non-profits and housing agencies (DSS, IFC, CEF) to find affordable housing opti• s for Orange County residents Anticipated Outco es The Anticipated Results column must i elude quantifiable results in the form of number of persons/units served within Orange County,only(all Towns and municipal ities).If you use percentages,you must also provide the total number of participants within that measure's description or for an earloer performance measure. Anticipated Performance Measures esults Increase affordable rental inventory by two 2 Provide housing for 2 homeless, isabled,or veteran individuals/families 2 Monitor unit turnover by mainta•D ing five percent(5%)vacancy or less 95% Complete HQS annual housing illlIspections on all units(40 units) 100% UocuSigned VabiftS Executive Di rector 9/13/2017 BCE54: 14F40F/ Certified by: _44 A!, Title E x e„el,c17 v re dor Date: 7- / - (Provider's Sign1 tire) ' DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 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. VaDocuSigned¢by: I1 J,, bV't S vim"""I 9/13/2017 Certified by: BCE548CED19F4OF_. Title: Executive Di rector Date: (Provider's Signature) (EmPOWERment,Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID:72266CE5-DF5A-471 E-B671-CC65C8960691 �.-� EMPOINC-01 DMASON `4��° CERT FICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/18/2017 ll THIS CERTIFICATE IS ISSUED AS A MATT - OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY R NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANC, DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE + ERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an Al 11 DITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to th.111 terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the ce j ificate holder in lieu of such endorsement(s). PRODUCER [CONTACT Summers l NAME:----......._ ------ PHONE 100 Europa Drive Lowry,Inc. (A/C,No,Ext):(919)968-4472 aC,No):(919 9424221 P rY, Suite 571 I E-MAIL info STLinsure.com Chapel Hill,NC 27517-2393 INSURER(S)AFFORDING COVERAGE _._..................___ I NAIC# INSURER a_Technology Insurance Company Inc [42376 INSURED INSURER B: Empowerment,Inc. INSURER C: Delores Bailey 109 N.Graham St.#200 INSURER D Chapel Hill,NC 27516-2328 INSURER E: L uu INSURER F: , COVERAGES CERTIFICA II' NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF I 'ENT, LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRE 'ENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAI THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIE'y.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR --- [ADDL,SUB, POLICY EFF POLICY EXP LTR TYPE OF INSURANCE !INSD I WV iu' POLICY NUMBER (MM/DD LIMITS /YYYYL(MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED X ', NPP1005089 06/16/2017 06/16/2018 PREMISES(Ea occurrences $.- MED EXP(Any one person). $ 10'000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY 1 PRO- F JECT L__J LOC PRODUCTS-COMP/OP AGG $ OTHER: Sex Abuse $ 1,000,000 AUTOMOBILE LIABILITY [ ' COMBINED SINGLE LIMIT 1,000,000 (E.daccident) $ ■ ANY AUTO _ NPP1005089 06/16/2017 06/16/2018 BODILY INJURYJPerperson_ $ OWNED SCHEDULED Ili AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ L X_ AUTOS ONLY _X....... AUTOS ONLY PROPERTY (Per accident) $ $ UMBRELLALIAB OCCUR I EACH OCCURRENCE $ XC RETENTION$ESSLIIA CLAIMS-MADE AGGREGATE $ E $ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER_ ANY PROPRIETOR/PARTNER/EXECUTIVE TWC3634138 06/16/2017 06/16/2018 E.L.EACH ACCIDENT J$ 500,000 OFFICER/MEMBER EXCLUDED? N/A ■ .....__.___ (Mandatory in NH) 500,000 DESCRIPTION OF OPERATIONS below _E.L.DI$EASE__EA EMPLOYEE $ DES RIPTION under ', !�I E.L.DISEASE-POLICY LIMIT $ 500'000 Prof Liability NPP1005089 06/16/2017 06/16/2018 Occurrence 1,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACO 11,11.101,Additional Remarks Schedule,may be attached if more space Is required) UniFi Equipment Finance,Inc.and its assignors&assignees are additional insured as respects written contract.Contract Number 175024-0002;Xerox WorkCenre 7225 Trade up for Lease 175024-01 valu I d$18,015.15 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE UniFi Equipment Finance,Inc.ISAO'll ATIMA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o American Lease Insurance 654 Amherst Road Sunderland,MA 01375 AUTHORIZED REPRESENTATIVE JJ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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