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2017-523-E Finance - Historic Hillsborough Commission - Outside Agency Performance Agreement
DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 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 Historic Hillsborough Commission, a not-for-profit corporation, located at 319 N. Churton Street, Hillsborough,NC 27278 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Historic Hillsborough Commission 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 9028 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 2257. 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. (Historic Hillsborough Commission) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 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. (Historic Hillsborough Commission) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 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. (Historic Hillsborough Commission) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 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 Historic Hillsborough Commission 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: (Historic Hillsborough Commission) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 County: Finance &Administrative Services Provider: Historic Hillsborough Orange County Commission Post Office Box 8181 319 N. Churton Street Hillsborough,NC 27278 Hillsborough,NC 27278 16. Entire Agreement. This Agreement,including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. 18. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of the Agreement and County may immediately terminate this Agreement without further obligation on part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 19. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For ,t , off. the Provider ra^^ 1L 9/21/2017 P QFU97231.3.FC... , Date (Historic Hillsborough Commission) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 For a , J o *rnyof Oran e County Government bikuut, ikalmwtt,V' 9/21/2017 06379946755E477... Bonnie Hammersley, County Manager Date (Historic Hillsborough Commission) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FOR OFFICE USE ONLY The Historic Hillsborough Commission Received By Visitor Services at: Date/Time The Burwell School Historic Site Section Subsection 1. Cover Page a. Applicant Contact Information b. A, Funding Requests C. Ul Signed Application Cover Page d. 71Signed Disclosure of Conflicts of Interest and Clause 2. Agency Information a. 2)Agency's Years in operation b. 0Agency's Purpose/Mission c. Da:Agency's Types of Services Provided d. [atAgency's Experience with Programs e. f Other Pertinent Agency Information f. 1M Schedule of Positions g. I! Living Wage h. li:i,Agency Budget 3. Program Information a. 4E1 Human Services Needs Priority b. SI,Type of Program A separate Section 3 is c. 'Agency Collaboration required for each program. d. Summary of Program e. es c ript ion of identified Need f. sescription of Population to be Served g. eProgram Staffing, Capacity, & Expertise Program Implementation Timeline i. --0Value of Investment j.,./Ne Impact of Reduced/No Allocation k.)jal Other Pertinent Information 1. r Target Population/Beneficiary Chart m.,Ia Work Statement n. g.Program :udget, 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. MI IRS Federal Form 990 C. C Solicitation License d. J Federal Tax-Exemption Letter e. ertificate of Insurance f. 11!s, ist of Board of Directors g Ike.lid Waste Program Fee (SWPF)Verification Application Submittal Checklist 1/31/2017 4:15:48 PM r f 2 ? DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: The Historic Hillsborough Commission, Inc. Applicant Organization's Physical Address: 319 N Churton Street Hillsborough, NC 27278 Applicant Organization's Mailing Address: PO Box 922 Hillsborough, NC 27278 Applicant Organization's Web Address: vvvvvv.burvvellschool.or• Executive Director: Kate Fahert Telephone Number: 9197327451 E-Mail: directorRburwellschool.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 The HCC proposes to strengthen & expand visitor services at the Burwell School Historic Site, providing historical and cultural service for Orange County residents and visitors from all parts of the state and beyond. Three major components 1. Program planning and 5,000 implementation 2. Site maintenance and restoration 4,000 of deteriorating materials 3. Year-long observance of the life of 1,000 Elizabeth Hobbs Keckly, bicentennial year 2018, with educational programming and expanded exhibit. Totals for all 3 Programs listed above $10,000 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: Executive Direc r Date Signature: I IPA" 1 e —3 1 Board Chairpers1.1 Date AGENCY INFORMATION 1/31/2017 4:15:48 PM q c, 6 oi t 7 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT 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 I a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? LII 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? E X c) Current beneficiaries of the program for which funds are being requested? E] 11 d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be blinding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: ecutive iiirector Date Signature: A , b • -3 Board Chairperso Date AGENCY INFORMATION 1/31/2017 4:15:48 PM Pa g ir,„ 7 a f 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT 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): • Years in Operation, Date of Incorporation (Month/Year): The HHC is a statutory commission established in 1963 by the NC General Assembly and incorporated in January 1964. • Agency's Purpose/Mission: The mission of the HHC, as stated in its bylaws, is "To maintain and preserve the Burwell School Historic Site; to interpret the history of 19th Century Hillsborough for the enrichment of the public; and to celebrate and promote the culture and heritage of Hillsborough and Orange County." • Types of Services the Agency Provides (bullet format): • Visitor Services: showcasing the historic importance of the property, its residents, its role in women's education, and the lives of the Burwell School's students and residents – Burwells, Elizabeth , the Collins family, and 200+ young women who attended the School. • Operation and maintenance of the 200 year old property • Events management in cooperation with local agencies and organizations • Volunteer opportunities and community cooperation to bring underserved populations into the site. • • Agency's History with Providing These Services: The Burwell School has provided unique cultural, historic and educational services to the citizens of Hillsborough and Orange County since 1974. Over those years the extent and depth of the programming has increased as have the numbers of visitors and participants, now averaging about 5,000 per year. The Historic Hillsborough Commission has conducted its business as a non-profit agency with uninterrupted and impeccable dedication to the stewardship of the property and the role that this historic place has in the life of the community, and seeks always to serve all populations and bring the important history of 199' century Hillsborough and Orange County alive to all. • 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?) • There have not been major changes in the past year, apart from increasing visitor counts and the expansion of programming and, important maintenance to the property. However, planning is beginning for an important major NEW initiative in 2018— an observance of the bicentennial of the birth of Elizabeth Hobbs . The Burwell School is one of the only places remaining intact where this important historical figure lived, and our goal is to create events and exhibits that will bring widespread attention to her story as well as increase the number of visitors to Orange County. We expect this to enrich the overall narrative of African American life and history in the area and the nation* Publicity will be nationwide. • Schedule of Positions (For Entire Agency) Executive Director (.375 FTE), Kathleen Faherty, MS Site Manager (.625 FTE) Ronda Tucker • 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 Agency Information 1/31/2017 4:15:48 PM Page 8 of 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION # of FTE - Full-Time Paid Positions: 0 # of FTE - Paid Part-Time Positions: 2 PT positions, (total of I FTE) # of Volunteers:42 # of FTE - Volunteers: 1.2 • 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 • 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 fist below: Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hilt 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 Reqqest 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 ( The Burwell School Historic 8857 10,000 Orange County Human Services Site Visitor Services • Program planning 5,000 and support • Site Operations 4,000 • Elizabeth 1000 Bicentennial program planning *Add rows or attach additional page, if needed. Agency Information 1/31/2017 4:15:48 PM P 'aqe 9 of 22 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Does your agency budget show a Surplus or Deficit? Deficit We budget low and try and cut cost at end of year and work hard around fundraising seasons, etc. to boost agency generated income. We didn't have paid staff for half of 2015-16 so that helped with the deficit. Please provide a brief explanation for Surplus or Deficit, and significant changes. iii. What is your agency's fiscal year? July 1, 2016 to June 30, 2017 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/31/2017 4:15:48 PM DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: The Burwell School Historic. Site Visitor Services Program Primary Contact and Title: Kate Faherty Telephone Number: 919-732-7451 E-Mail, directoraburwellschool,orq a) Indicate the type of Human Service Needs Priority, if program applicable: O Priority Area#1: safety-net services for disadvantaged residents 12 Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges O 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) I 1 Public Housing 1 Program Category Youth Adult Elderly Disabled I . . I 1 1 Neighborhoods/Residents Education X X X 1 X X Affordable Healthcare Art Activities X X X X I X I Family Resources Jobs/Jobs Training X X X 1 X X I 1 Food 1 1 1 Transportation Other: local history & X X X X X culture I I 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 • Alliance for Historic Hillsborough& Hillsborough Visitor Services: The Burwell School and the HHC are founding members and partners of the Alliance and work throughout the year with staff at the Visitor Center to carry out a variety of programs for visitors: Living History Days, School Groups, Revolutionary War History Days, Visitor Services, Walking Tours • Hillsborough Arts Council. Last Fridays, collaboration on events • Orange County Historical Museum: Living History and walking tours • CH/Orange Co. Visitors Bureau: Interagency cooperation and support, information sharing throughout the year PROGRAM INFORMATION 1/31/2017 4:15:48 PM P a y f„, 1 1 a 1 22 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Description (3 pages OR LESS) d) Summarize the program services proposed and how the program will address a Town/County priority/goal? Commissioners of the Historic Hillsborough Commission work diligently to maintain and preserve the Burwell School Historic Site. Stewardship of this historic place is a top priority and great pains are taken to care for the buildings and grounds, the furnishings, and the important historic documents and items maintained in the Research/Records Room. This stewardship partners with service to the greater community through the operation of the site as a historic house museum, welcoming visitors to tour and learn about: (1) the story of the landmark school for girls (1837 – 1857) operated by the Rev. Robert Burwell and his wife, Anna; (2) the story of former slave – later renowned businesswoman, dressmaker for Mary Todd Lincoln, and author Elizabeth Hobbs , and (3) the story of the property as a refuge during the Civil War of the Josiah Collins family of Washington Co. NC.—the "Beehive Years." In addition to a wide range of programs and generous free tours , the HHC and the Burwell' School provide rewarding volunteer opportunities to local residents and students of Orange County. All of the operations of the Commission and the site are dedicated to preserving the unique and irreplaceable history of the County and enriching the lives of all citizens by connecting them to the places and stories of Orange County's rich past. Importantly, this is done with a clear intent of encouraging educational, cultural, and economic growth by bringing visitors to Orange County. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County_BQCC Goals and Priorities, Town of Criggel Hill Council Goals,Carrboro goals,or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment)to support the need for this program. The Orange County Master Aging Plan for 2012- 2017, Goal 5, states: "Empower older adults to engage in the community through volunteerism, lifelong learning, and civic activities; promote lifelong learning of older adults through increased access to continuing education classes and programs throughout the community." Every proposed project element in this application supports this goal. The Orange County Board of Commissioners Statement of Goals and Priorities, adopted in 2009, states as goal #6: "Ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare." Every project component in this application supports this goal. Historical and cultural literacy for all is at the forefront of the mission of the Historic Hillsborough Commission, along with a more in-depth understanding of the complexities of antebellum life and the corrosive effects of slavery that echo through our history. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? • Local Residents – marketing, media outreach (email list of 780 contacts and growing); social media • Students –extensive outreach through the schools and the Visitor Center • Elderly – outreach to senior centers and retirement communities PROGRAM INFORMATION 1/31/2017 4:15:48 PM I ' 0 t 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION g) Describe the credentials of the program manager and other key staff. (Ex, Identify Program Manager and credentials, describe training provided to volunteers, etc.) Executive Director — Kate Faherty. MS in Special Education; Educational Administrator for NC AHEC Program; Assistant Professor, Atlantic Christian College.; Member, Chair, Vice Chair and Secretary, Historic Hillsborough Commission 2004—2016. Site Manager- Ronda L. Tucker: Extensive experience in business management and administration. Program planning and implementation: Staff and committees of the HHC carry out the following: - Provision of in- depth, age appropriate educational programs for school groups - Free tours to visitors available five days per week - Development of additional program components - New exhibits related to the site, its people and history with emphasis on the Burwell Family and Elizabeth Throughout the year the HCC and Burwell School partner with local agencies servicing Orange County and surrounding areas. Our paid staff as well as various commissioners and volunteers operate to maintain the Burwell School Historic Site. The Burwell School is open to the public and partner with local agencies to service residents and visitors. The ;urwell School offers education and cultural experiences that are made available and are utilized by residents and visitors of the elderly population, families of all incomes and of all ages and disabilities visit our site each year Our organization provides education and cultural experiences to visitors. Our staff and volunteers are educated and become teachers and guides to visitors and provide opportunities to learn about history from the 19'th Century in Hillsborough, history and education about The Burwell School and many students who lived in the town and surrounding areas and as far as Florida and New York. They learn about Elizabeth Keck ly who lived at the Burwell School then later became a famous dressmaker to Mary Todd Lincoln after buying her freedom. In our last 2 quarters we welcomed nearly 3,000 visitors — we welcomed school aged students - field trips, home schooled groups, girl scout troops, elderly visitors and residents including assisted living facility groups we host throughout the year, underprivileged residents and children of all incomes and ages. Site opens in coordination with town events held by local organizations such as the Hillsborough Chamber of Commerce, Orange Co. Museum, Hillsborough Arts Council, Visitor Services, and provide visitors with education, activities, experiences and events such as Hillsborough History Days, Living History Day, Colonial Kids Day, Art Walk/Last Fridays, Sundays in Hillsborough, Hillsborough Parade. The Burwell School is also open to the public and offers tours and experiences 5 days a week. h) Why is funding this program a good investment for the community? How does funding this program add value to the community?(250 words OR LESS) The Burwell School is a precious historic resource for Orange County, one of only two historic house museums I the county and the ONLY one offering free tours five days a week. In the first two quarters of the current fiscal year, the site welcomed nearly 3,0nd 00 visitors including hundreds of Orange County schoolchildren, as well as elderly residents, students participating in cultural enrichment projects, and teachers. The site is open in PROGRAM INFORMATION 1/31/2017 4:15:48 PM P e 3 of 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION coordination with town events held by Hillsborough Visitor Services, etc. to provide visitors with education, activities and experiences while in Hillsborough attending: Hillsborough History Days, Living History Day, Colonial Kids Day, Art Walk/Last Fridays, Sundays in Hillsborough, and the Hillsborough Christmas Parade and Holiday Home Tour, The Burwell School is open to the public five days a week, and offers free tours daily. Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Funds are utilized to support all programming, to ensure that the site is appropriately safe and comfortable for visitors and and to ensure an educational, inspiring, and accurate historical portrayal. The site operates currently on a total of 1 (one) FTE staff component. IF funding is reduced the staff FTE component would be reduced accordingly, affecting site care, programming, and the availability of staff to conduct school programs. It would be difficult to expand exhibit offerings and such exhibits would be curtailed. PROGRAM INFORMATION 1/31/2017 4:15:48 PM P 4 o fl 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT 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, LProgram Target Population Demographics Actual Estimated Projected 2015-16 2016-17 2017-18 Gender Male 45% 45% t 45% Female 55% 55% 55% Total El 00% 100% 100% Ethnicity African-American 1 40 30 40 American Indian or Alaska Native 10 15 10 Asian 5 10 5 Caucasian 40 40 40 I 5 Native Hawaiian or other Pacific Islander 1 5 5 Other: specify 1 Total 100 I 100 100 Of the above, how many Hispanic/Latino unknown unknown unknown Of the above, how many non-Hispanic/Latino unknown unknown unknown Total 5,000 6,500 8,000 _ Age 0-5 years unknown 500 1,000 6-18 years unknown 2,500 2,500 19-50 years unknown 1,500 2,000 51+ years unknown 2,000 2,500 Total 0 6,500 8,000 PROGRAM INFORMATION 1/31/2017 4:15:48 PM P a q a 15 o f 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement j) 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- To provide staff and upkeep for the Burwell School Historic Site and offer experiences and opportunity for visitors and provide them with safe conditions and the site be open and available for visitors and residents to learn about history and participate in hands on experiences and enrich themselves with cultural history and ways of life for residents in Hillsborough and students who attended the Burwell School in earl vs to mid 1800s. We provide inspiration to visitors who learn about individuals such as The Burwell Family and students of the Burwell School including slave girl Elizabeth Keck ly and the Collins Family. PROGRAM INFORMATION 1/31/2017 4:15:48 PM q e 1 6 o f 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. Program Activity Name | Program f»lamn/ Implementation ---- �-- --- --- ---� ~'^ba"°- Program Goal Develop, refine and provide educational me---' ^ � �^ �//w cultural programs year round to all populations Performance Measures Visitor counts, evaluations and feedback ---------- Previous Year Program Results 5008+ v|o8om, over md ms, 400 + school students Current Year Estimated Results 5000+ visitors, over 20 events and ms, 700+ school students Next Year Projected Results 6008+ visitors, u-� mch ---' 20 events od ---- ----700+ school � o programs, Keckly observance Isno•ram. 2. Program Activity Name operations Program Goal To ensure the safety, integrity, and maintenance --- e Burwell School Historic Site and its contents for the-- -- - -- e 'oyment of the public and the preservation of Orange County History.Per�nmmnce & emmurms Maintenance and upneopo/ site (buno/ngo' groun d s, furnishings) and /�| operations to remain open to the pub|io, protect the property, and enrich visitor experiences to the fullest. In particular: replace all tattered white muslin reproduction curtains (more than 40 years old) to increase protection from sun damage to interior furnishings and improve exterior appearance; replace Union St. sign which has rotting post. Previous Year P.°y.�. Results Goal Met; property maintained , repair s accom plishe damneeded Current ear Estimat sults On target to meet goal----f increased li tran ---� safer access to front steps. n ��*��e�r� ��c�edF�e�u|tm Buildings maintained replacement created for protection against light damage to interior furnishings. Re s1aoe,nentofei~non Union Street whose au w sort woStn are rottins, 3. Program Activity Name Bicentennial O se wse201E. Elizabeth /9mJbs Program Goal | P|�ne �np|oc� �ndimp|�men#e' for --�ot--- ven---nexpanded--- w m� ,� uwuu events, an exhibit dedicated to . a walking boor, and educational materials available to teachers and students, Initial mnarketing, publicity, and | nationwide information underway 17� Performance Measures At least two ---- --- --�— ---- ---- o �vmnts' a walking tour, expanded permanent on-site / | exhibit, and curricula materials available to school groups and teachers, with 50% accomplished by June 30, 2018. Publicity initiated | byNovember2017. Previous Year Pnmgranm Results m/a--- --- --- --- ---- ---- ---- -- _---____ Current Year Estimated Results nia ��� --- ---- ---- ---- --- ---- +-- Next Year Projected Results All planning accomplished for events, programs, and curricula related to the life nf . appropriate to both adults and children. By June 30, at least two events will have taken lace. � � k) Program Budget � � PROGRAM INFORMATION 1/31/2017 4:15:48 PM p 1 7 of 2 2 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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). Agency Budget Operating Budget for Entire ency AGENCY NAME: Historic Hillsborough Commission 11 Actual Estimated Projected Percent AGENCY REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ 8,000 $ 10.000 $ 11,000 10% Agency Generated Revenue(fees) $ 20,078 $ 25.000 $ 25.000 0% Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ - $ - $ - 0 Other-Town of Chapel Hill $ $ $ . 0 Human Services-Orange County $ 7,000 $ 8.857 $ 10.000 13% Other-Orange County $ - $ - $ 0 Other-Town of Hillsborough $ 16.000 $ 20.787 $ 20,787 0% Other Government Grants Triangle United Way - $ - $ - 0 State Government - $ - $ - 0 Federal Government (COBG/HOMIEletc.) $ - $ - $ 0 Private Foundation Grants Kirby $ 7500,00 $ 10,000,00 $ - $ 1,00)1 Other Revenue 0 Total Agency Revenue $ 66,950 $ 69,000 $ 69,500 1% AGENCY EXPENSES Compensation $ 34.000 $ 45,000 11 $ 46.650 4% Rent&Utilities $ 6.350 $ 6,000 $ 6.100 2% Supplies&Equipment $ 3,500 $ 3,500 $ 3.500 0% Travel& Training $ - $ - $ 01 Other Expenses: $ 24,500 $ 23 500 $ 22,000 I -6% Total Agency Expenses $ 68,350 $ 76,500 $ 78,250 2% SURPLUS/(DEFICIT)FOR PERIOD: $ (1,400)1 $ (7,5001$ (8,750)1 -17% 1 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 a Local Government Grants • Carrboro Human Services • Carrboro Other PROGRAM INFORMATION 1/31/2017 4:15:48 PM I°' a q e 8 c) 1 22 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) O Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG/HOMEletc,) • Private Foundation Grants O Other Revenue • Expenditures O Compensation O Rent & Utilities O Supplies & Equipment O Travel & Training a Other Expenses This program budget represents what percent of the agency budget? 100 2. 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 nia Program Total # of Individuals Cost Per Individual PROGRAM INFORMATION 1/31/2017 4:15:48 PM P a g e 19 of 22 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Approved 9.1.2016 2nd Total Annual 1st Quarter Quarter 3rd Quarter 4th Quarter Budget Expense Acquisions 25.00 25.00 25.00 25,00 100.00 Website and Advertising 275.00 275.00 275.00 275.00 1,100.00 Book Purchase 75.00 75.00 75.00 75.00 300.00 Building Preservation&Maint 825,00 1,425.00 825.00 1,785.00 4,860.001 Contract Labor Accounting - 1,500.00 - - 1,500.00 Research/Data Entry - 100.00 200.00 200.00 500.00 Spurgeon Garden&Grounds - 550.00 550.00 1,100,00 Shutter Restoration&Repair 7,000.00 7,000.00 Keck ley Exhibit Materials(grant) 875,00 875,00 Total Contract Labor - 1,600 00 750,00 8,625.00 10,975.00 Fundraising Expense - Auction Expense 1,000.00 4,000 00 5,000.00 Other Event Expense - 700.00 700.00 - 1,400,00 Total Fundraising Expense - 700.00 1,700.00 4,000,00 6,400.00 Insurance Property&Liability 5,800.00 5,800.00 Directors&Officers 700.00 700.00 Workman's Comp 200.00 200.00 200.00 200.00 800.00 Total Insurance 200.00 6,700.00 200.00 200.00 7,300.00 Miscellaneous Expense Burgler Alarm 150.00 150.00 150.00 150.00 600.00 Credit Card Processing 500.00 500.00 Safe Deposit&PO Box Rental 65.00 135.00 200.00 Subscriptions 150.00 150.00 Other 250.00 250.00' 250.00 250.00 1,000,00 Total Miscellaneous Expense 400.00 615.00 535.00 900.00 2,450.00 NC Sales Tax 15.00 15.00 15.00 15.00 60.00 Office Expense Office Supplies 300.00 300,00 300.00 300.00 1,200.00 Postage 100.00 100.00 100.00 100.00 400.00 Total Office Expense 400.00 400.00 400.00 400.00 1,600.00 Payroll Docent 1,000.00 1,000.00 1,000.00 1,000.00 4,000.00 Site Manager 4,800.00 6,000.00 6,000.00 6,000.00 22,800,00 Executive Director 2,400.00 3,600.00 3,600.00 3,600.00 13,200.00 Employer Pd Tax-SS,Medicare,FUTA 700.00 900.00 900.00 900.00 3,400.00 Total Payroll 8,900.00 11,500.00 11,500.00 11,500.00 43,400,00 Utilities Electricity 900.00 750.00 750.00 900.00 3,300.00 Gas 475.00 475.00 475.00 475.00 1,900.00 Telephone&Internet 500.00 500.00 500.00 500.00 2,000,00 Water 159.00 159.00 159.00 159.00 636.00 Total Utilities 2034.00 1,884.00 1,884.00 2,034.00 7,836,00 .... Total Expense 13,149.00 25,214.00 18,184.00 29,834.00 86,381.00 Net Income (3,213.00) (9,428.00) (8,248,00) 15,102.00 (5,787,00) DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Approved 9.1.2016 2nd Total Annual HHC Approved Budget 2016-2017 1st Quarter Quarter 3rd Quarter 4th Quarter Budget Income Book Sales 150 00 150.00 150.00 150.00 600.00 Contributions 150,00 6,000,00 150,00 150,00 6,450 00 Auction 35,000 00 3500000 Program Fees 150.00 150.00 150.00 150.00 600.00 Other Income 200.00 200.00 200.00 200.00 800.00 Total Non-Grant Income 650.00 6,500 00 650.00 35,650 00 43,450.00 Grant Income FM Kirby Foundation 1,875.00' 1,875 00 1,875.00 1,875 00 7,500.00 Orange County Human Services 2,214 25 2,214.25 2,214 25 2,214 25 8,857.00 Town of Hboro Tourism Bd 5,196 75 5,196.75 5,196 75 5,196 75 20,787.00 Other Grant Income Total Grant Income 9,286.00 9,286 00 9,286.00 9,286 00 37.144 00 Total home 9,936 00 15,786 00 9,936 00 44,936.00 80,594 00 01 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 EXHIBIT"B" Scope of Services FY 2017-18 Outside Agency Performance Agreement Agency Name: Ifistotle Hillsborou_h Commis'sion inc dba The Burwell.Schgol Historic Site Program Name: The Burwell School istoric Site Visitor Services Funding Award: $9,028 Outline how the agency will spend Orange County's funding award. Expense Description Amount Wages&FICA costs for staff to operate site including but not limited to program planning and 5,000 implementing programs througout the year. Visitor Safety,Site Maintenance and restoration of deteriorating materials 4,028 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Maintain/Increase Visitors to Orange County/Town of Hillsborough. • Provide Free tours and educational events for visitors including students and residents. • Operation, maintenance & upkeep of the 200 year old property Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orangg Qounty, 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. Anticipated Performance Measures Results Visitor Count(including Students) 6,700 Events 20 DocuSigned by: Executive Di rector 9/21/2017 A 41 1: ( Certifi b3C..i.o/ II A 164 I a ITC,- Date: 1(4°::;) / 31 6 Ul — 1 Provider's ignature) (1- DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 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. � DDoccuSigneddby,: , G F"""'v'`ti 9/21/2017 Certified by: Title: Executive Di rector Date: y' -E396827231534FC... (Provider's Signature) (Historic Hillsborough Commission) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 IIIMIII DocuSi n Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 N tire CERTIFICATE OF INSURANCE DATE ISSUED(MIV1/DD/YY) 1 , . 7/ ■e Insurance' _THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY— 27717 Home Office • 100 Erie Insurance Place . Erie,Pennsylvania 16530 • 814 870 2000 Toll free 1 800 458 0811 • Fax 814 870 3126 • ,,,ww/enernsurance corn NAME AND ADDRESS OF AGENCY THE BALLARD AGENCY AGENT'S NO. _ ItaigniV14011 UM IIIIIIII,YAM 1 — _ ___ _ 105 W KING ST J.I1010 D „ ça.:_ TACINS.OBAVI PRO•_EATTr&CASuAtil:y Mm PAN Y HILLSBOROUGH, NC 27278-2543 Co.:E ERIE INSURANC_E EXCHANGE lot Applicable\ Ene Indemn0 Uo,,,Attorney-in-Fact in_NY / (91 9)732-2 1 58 -"cfla._ENEATURAtic_E_CPMPft QF f■IVV 9 RK uo.:G i-LALibmP CI1Y INSui-IANCLA,OM-1-ANY .... .,This certificate is issued for Information purposes only and confers ______ _ NAME AND ADDRESS OF NAMED INSURED no rights on the certificate holder. It does not affirmatively or Inegatively amend,extend,or otherwise alter the terms, exclusions HISTORIC HILLSBORO(JGH and conditions of insurance coverage contained in the policy(ies) '.,O?' indicated below,The terms and conditions of the policy(ies)govern the insurance coverage as applied to any given situation, Limits PO BOX 922 'shown may have been reduced by claims paid.This certificate of insurance does not constitute a contract between the issuing H1L.LSBOROUG1I,NC 27278 insurer(s), authorized representative or producer and the certificate holder. .,..i This is to certify that policies as indicated by the Policy Number below,are In force for the Named Insured at the time that the Certificate is beta issued, CD Mal ' 1 1 •N ; 111 :4h'; 4 __, LIMITS TYPE OF INSURANCE POLICY NUMBER D. 1GENERAL LIABILITY EACH OCCURRENCE $ Cl COMMERCIAL GENERAL LIABILITY1 FIRE DAMAGE(Anne FIN) $ [1]CLAIMS MADE H OCCUR, MED EXP(Any One Pesos) E I PERSONAL&ADV.INJURY, Li ,. __ GENERAL AGGREGATE $ GEM_AGGREGATE LIMIT APPLIES PER:, PRODUCTS-COMP/OP AGGI$ Li.., Li POUCT PROJECT LIII LOCI pi AUTOMOBILE LIABILITY i 1 BODILY INJURY [7] "ANY AUTO"(PtIgERNIP I (EACH PERSON) , S I I BODILY INJURY [—._.I OWNED (EACH ACCIDENT) $ ET HIRED PROPERTY DAMAGE $ E NON-OWNED BODILY INJURY AND ,_, GARAGE PROPERTY DAMAGE Li $ COMBINED EXCESS LIABILITY EACH OCCURRENCE $ E OCCURRENCE AGGREGATE $ r_ , ■ _ L,,I RETENTION S $ 1 , E. _, , WORKERS COMPENSATION& EMPLOYERS LIABILITY Q86 0600392 2/ SrAttgORY 6/17 2/6/18 1 BODILY1 ACCIDENT $ 500,000 EACH ACCIDENT I NJURY1 DISEASE $ 300,000 POLICY LIMIT 1 1 1 I BY DISEASE $ 500,000[Acii INELOYEC OTHER I , 1 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIV ERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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). NAME AND ADDRESS OF CERTIFICATE HOLDER ORANGE(DUN-FY HUMAN SERVICES AUTHORIZED REPRESENTATIVE AGENCY PO BOX 8181 HILLSBOROUGH, N(' 27278 /1 I - ,2 „,....//2 A )) //, , / ,. / . .-,7- ...,-,1..... 4,e / E1G6230 8/11 // Ruin 1 nf 1 DocuSign Envelope ID: 1632E805-38D3-49DF-9836-981006B20F64 �,� �ri�H i c. Li LIAL ILITY INSURANCE 7/27/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(Nes)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 Ileu of such endorsement(s). PHONE 919) 7 3 asc Na:(919)732-'4636 SAL _ ENCY INC acD�©.�Ext). �. 2 A2Ll�D I I�A�_...w PRODUCER LARD AGENCY Box 1559 NA ,bahaxd �alWl 1( I .... ...,..w Hillsborough, NC 27278 AllaRss_ _ @ ardagencync,coarn INSURERIB} AFFORDING COVERAGE HA,ICV GREAT AN INSURANCE CO HISTORIC2HILLSB©ROU.... .m GREAT AMERICAN INSURANCE CO INSURED HILLSBOROUGH COMMISSION INSURERS:A AMERICAN INSURER INSURER c INSURANCE CO t R NC 27278 R INSURE ........m.. e__ ......,._ ..... ........_. ..._. ....,...... ........... _..._,... .�... HILLSBOROUGH D; INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN„ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD ww0 ,...' _......_.... ...�.....,. !-!OUCY °CIS'-EXP ,�. ...._...� ..r. ...... ...............� COMMERCIAL GENERAL.LIABILITY POLICY NUMBER EACH OCCURRENCE LIMITS S ...1 Q Q 0,Q 0.. CLAIMS-MADE „X OCCUR PREMISES(Ea occurrence)(MMQ©IYYYY) ..EA�RENCE J. ©. enenoeJ $ 100,000 _. .,... PAC4816275 12/11/16 12/11/17 eMEDEXP[Anyonepersenl $ 5000 A GEN L AGGREGATE LIMIT APPLIES PER: X GENERA'PERSONAL AGGREGATE Y $ j,000,01)-,0 0 0,0 0 Q._f X POLICY� PRO- 00 PRODUCTS COMPIOP AGG $ 3,000,000 .1 � ......., JECT LOC OTHER S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a acClcer BODILY INJURY(Per person) $ANYAUTO , mm — ALL OWNED SCHEDULED AU7OS AUTOS BODILY INJURY{Peer accident} $ i NON-OWNED "'PRCSPERTY DAGIA.C`r $ HIRED AUTOS AUTOS iffier accider II UMBRELLA LIAB UMB4816276 12/11/16 12/11/17 $ X_ OCCUR EACH OCCURRENCE $ 1,000,000 I B EXCESS LIAB mm CLAIMS-MADE X AGGREGATE QO ©Q PER TE $ 1 ©,... _. Q DED .RETENTION$101000 WORKERS COMPENSATION 10TH — AND EMPLOYERS'LIABILITY YIN ) STATUTE I I ER ANY PROPRIETOR/PARTNERIEXECU"I'VVE - E.L EACH ACCIDENT OFFiCERIMEPABER EXCLUDED?(Mandatory In NH} If describe r©�©rERATNONs Wow �NIlA ,E L DISEASE EA EMPLOYE $ E IL DISEASE POLICY ILIMIII C DIRECTORS & OFFICERS EPP4917808 1/21/171/'2'1/18; { LIABILITY DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101 Additional Remarks Schedule may be etleched if more space is required) DIRECTORS & OFFICERS LIABILITY LIMITS $1,000,000 OTHER THAN EMPLOYMENT PRACTICES WRONGFUL ACTS $10,000 DONOR DATA LOSS CRISIS FUND SUBLIMIT $1,000,000 EMPLOYMENT PRACTICES WRONGFUL ACTS $150,000 ELSA DEFENSE SUBLIMIT rCERTIFICATE HOLDER CANCELLATION i ORANGE COUNTY HUMAN SEVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE AGENCY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PD BOX 8181 HILLSB©R©UGH,NC 27278 ~AUTHOR) ED REPRESENTATIVE I ACORD25 2014/01 The ACORD name and logo are reg sI ter 198CORD RC�� J ed marks ORD CORPORATION. All rights reserved. ! of ACORD