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HomeMy WebLinkAbout2017-562-E Finance - El Centro Hispano, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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 El Centro Hispano, Inc., a not-for-profit corporation, located at 2000 Chapel Hill Road, Suite 26A, Durham,NC 27707 ("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 El Centro Hispano,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 31905 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 7976.25. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (El Centro Hispano, Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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. (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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. (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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 El Centro Hispano, 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: (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 County: Finance &Administrative Services Provider: El Centro Hispano, Inc. Orange County 2000 Chapel Hill Road, Suite 26A Post Office Box 8181 Durham,NC 27707 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. 7 P F ankt§ lhalf of the Provider Rod4-C1ta 10/10/2017 22BDDB39C1744D1... , Date (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 For an Eff to Orange County Government NIAA/ut, avoit,V'Stt,(1 10/12/2017 06379946755E477... Bonnie Hammersley, County Manager Date (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FY 20°17=2018 Outside Agency Funding Application r HUMAN SERVICES, • ORANGE COUNTY • TOWN OF O �r TOWN OF CHAPEL I Orange County (0C) Town of Carrboro (CA) Town of Chapel Hill (CH) 200 S. Cameron Street 301 W. Main Street 405 Martin Luther King, Jr. Blvd. Hillsborough, NC 27278 Carrboro, NC 27510 Chapel Hill, NC 27514 1" :ri" DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FOR OFFICE USE ONLY Agency El Centro Hispano Received By Program(s): ECH-Carrboro Community Services Date/Time Section Subsection 1. Cover Page a. 4 Applicant Contact Information b. i1 Funding Requests c. I Signed Application Cover Page d. ■Signed Disclosure of Conflicts of Interest and Clause 2. Agency Information a. AL Agency's Years in operation b. Agency's Purpose/Mission c. Agency's Types of Services Provided d. Agency's Experience with Programs e. Other Pertinent Agency Information f. Schedule of Positions g. I Living Wage h. I4 Agency Budget 3. Program Information a. OA Human Services Needs Priority b. ■ Type of Program A separate Section 3 is C. A, Agency Collaboration required for each program. d. J Summary of Program e. Description of Identified Need f. 2 Description of Population to be Served g. ' Program Staffing, Capacity, & Expertise h. i4 Program Implementation Timeline i. Fr Value of Investment j. Impact of Reduced/No Allocation k. Other Pertinent Information I. Target Population/Beneficiary Chart m. Work Statement n. L 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. Z IRS Federal Form 990 c. L NC Solicitation License d. IRS Federal Tax-Exemption Letter e, Z Certificate of Insurance f. i4 List of Board of Directors g. 4 Solid Waste Program Fee (SWPF) Verification Application Submittal Checklist 1/31/2017 3:16:25 PM Page 2 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: El Centro Hispano Applicant Organization's Physical Address:201 West Weaver Street, Carrboro NC 27510 Applicant Organization's Mailing Address: 2000 Chapel Hill Road, Suite 26A Durham NC 27707 Applicant Organization's Web Address: www.elcentronc.orq Executive Director: Pilar Rocha-Goldberg Telephone Number: (919) 687-4635 Ext. 43 E-Mail: prochaelcentronc.orq 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 Community Support Services (salaries, rent& utilities, 5,000 15,000 20,000 40,000 communications, supplies, equipment, forums) Center for Employment and Leadership (salaries, rent 5,000 10,000 15,000 25,000 & utilities, supplies, program expenses) • Education Services: PreK-Adult(staff salaries, 10,000 5,000 15,000 supplies, program expenses, Totals J 20,000 30,000 35,000 85,000 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. (Jr, . t'i Q Signature: (A o(( Executive Director Date Signature: 04‘■,,. ! 1/ 7 S=oard Chair.-rson Date AGENCY INFORMATION 1/30/2017 4:37:40 PM Page 3 of 3& DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO ❑ ® a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ ® b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ ® c) Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: Cle (W 01/301/9 Executive Director Date Signature: � 1/30/ 17 CBoard Chairpe son Date AGENCY INFORMATION 1/30/2017 2:43:20 PM Page 4 of 34k DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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): 1/1998 b) Agency's Purpose/Mission (no more than a few sentences): El Centro Hispano works to strengthen the community, build bridges, and serve as advocates for equity and inclusion of Hispanics /Latinos in the Triangle area of North Carolina. We achieve these purposes by making advancements in Education, Economic Development, and Health & Well-being. c) Types of Services the Agency Provides (bullet format): El Centro Hispano has three main focus areas and delivers the following programs and services under each: Education - Child Enrichment (Preschool), K-12 tutoring, College preparation, Work Skill, Life skills, Leadership Development - Adult Literacy, Adult elementary & secondary education (Plaza Comunitaria), Language Classes (ESOL, Spanish as Second Language, etc., computer classes, citizenship, Reading as a Family, Circle of Parents Economic Development (under Center for Employment and Leadership) - Workforce Training and Development - Income and Job Security, Self-Employment - Worker Protection & Safety - Financial Literacy & Asset Building Health and Well-being - Community Support Services Walk-in Office (Information, Referral, & Connections to area resources, Translation/Interpretation, Legal Clinic, Domestic Violence, Community Service, Faith ID) - Health Promotion & Disease Prevention (Ventanilla de Salud- Health Booth, HIV Prevention & Outreach) - Access to Healthcare (Navigation services, LATCH, Annual Health Fair) d) Agency's History with Providing These Services: The organization has been providing education, outreach, direct support, and human services referrals since its inception and has partnered with community and government organizations to provide services that benefit the community in general, particularly to address community needs. About 18 months ago it took on the Day Laborers & Domestic Worker's Project and started the Center for Employment and Leadership to better focus economic development efforts. Agency Information 1/31/2017 3:16:25 PM Page 5 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes in the past year? Is there a new Executive Director?Are there new initiatives?) In the past year, the organization went through an internal strategic refresh and reorganization process the resulted in reassignment of staff and the creation of the Community Engagement and Advocacy section within the organization. This section was established to further focus and improve the organization's leadership role in the area of advocacy and community mobilization and to strengthen partnerships with area agencies, organization, and constituents. In addition, the organization's economic development initiative has been revisited to focus more on the elimination of poverty and on building financial literacy and asset-building capacity 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: 12 # of FTE - Paid Part-Time Positions: .5 # of Volunteers: 65 # of FTE -Volunteers: 38.75 # of Volunteer hours: 1951.5 g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/No) Yes If yes, is this agency an Orange County Living Wage Certified Employer? No If no, please explain. We submitted online application on 1/25/2017. Please see attached. Agency Information 1/31/2017 3:16:25 PM Page 6 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget Is your agency currently receiving and/or requesting other(non-Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes/No) No If yes, please list below: Include all programs that have funding requests/awards/totals from Carrboro, Chapel 11111, 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 Res uest 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 N/A *Add rows or attach additional page, if needed. Agency Information 1/31/2017 3:16:25 PM Page 7 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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 • 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? n/a Is there a significant change? Yes/No n/a Please provide a brief explanation for Surplus or Deficit, and significant changes. iv. What is your agency's fiscal year? July 1 — June 30 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/31/2017 3:16:25 PM Page 8 of 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: ECH-Carrboro Community Support Services Program Primary Contact and Title: Pilar Rocha Goldberg Telephone Number: (919) 687-4635 Ext. 43 E-Mail: prochaelcentronc.orq a) Indicate the type of Human Service Needs Priority, if program applicable: Z Priority Area #1: safety-net services for disadvantaged residents Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges Z 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 I Disabled . Neighborhoods/Residents Affordable Housing Affordable Healthcare Education Family Resources x x x Jobs/Jobs Training Food Transportation Other: Please specify: information & referral, legal assistance, case management, communit outreach 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. • Compass Center: Partner to share some resources for support services and also refer directly to them. We assist them with some case management and legal assistance • Orange County Rape Crisis Center: We refer individuals to them and provide our space for one of OCRRC's staff to attend cases directly in Spanish on site. They provide workshops on sexual violence to our community. • El Futuro, Inc.: Accepts referrals for mental health and substance abuse treatment from us • Inter- Faith Council (IFC): Accept referrals for financial help or food from ECH. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 9 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • UNC CAMPOS Adelman Program: We collaborate with a group of students from UNC School of Medicine to give a series of workshops in health and safety to the community, specifically to our tutoring program parents. They take blood pressure and recommend tips to the community on care. • UNC Chapel Hill: We work with the school to integrate students into the volunteer program of the organization and help develop their abilities. In February, we will be staring a new collaboration with UNC Eshelman School Pharmacy students and their supervisor associated with SHAC (Student Health Action Coalition) to promote healthy lifestyle changes in the hopes of reducing the risk of high blood pressure among the participants. They will take patients' blood pressures, counsel about the results, and provide lifestyle modification tips by text. • OWASA to develop a video and new brochure for the Latino community. They receive some referrals from ECH and tend to some particular cases from ECH. • Lawyers: Volunteer lawyers provide free legal services on immigration, civil, family and support child and traffic cased to the community. • NC Diaper Bank: They provide diapers as donation for the community and we distribute to them directly • Table: We partner with them to receive food. Bags are provided to our kids and parents in the tutoring's program every week. We work together to educate kids and parents in health and nutrition. Also, Hispanic kids have workshops on nutrition two or three times per month. • Court of Chapel Hill: ECH collaborates with the courts to receive referrals of people who need to complete their community service hours. • Family Successful: Accepts referrals for specific support services cases to help families and their kids. • Orange County Department of Housing, Human Rights, & Community Development: Partner to provide workshops on housing rights. We refer to the Community Specialist when we receive some cases through our community support services and follow its progress. • Orange County Health Department: Partner to provide some talks in our office. We also assist in helping them to get to know the needs of the community in Orange County and create a space where they can express their thoughts directly with them. • Cooperativa Latina: We refer for banking services and they assist with notarizations and other banking related services • Orange ABC- ECH is a partner to provide alcohol and substance abuse prevention education and outreach. Orange ABC provide support to acquire educational materials and train staff. • Orange County Arts Commission: Last year was the first year the Arts Commission provided support to local Latino artists participating in the festival PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 10 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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? El Centro Hispano seeks funding to sustain its Community Support and Engagement Services delivered through our Carrboro-Chapel Hill Office. This intervention aligns with the Board of County Commissioner Goal #1; to ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents. It also supports the Town of Chapel Hill Council Goals of Creating a Place for Everyone, Supporting Community Prosperity, and Nurturing Our Community. Community Support Services include information, referral, and facilitation of linkage to area resources (i.e. housing, healthcare, academic, human services, etc.). Staff and volunteers also assist with case management, legal services, interpretation, immigrant assistance (i.e. DACA/DAPA, Faith ID program), citizenship classes, and any other direct support that responds to community need. Community Engagement include forums, outreach, educational campaigns, support groups, leadership development, and other activities that assist Latinos and other populations to better participate in the community and enjoy optimal quality of life. By providing these services, staff is able to connect individuals to area resources and also gather data on issues and service barriers to subsequently work with area resources and make improvements. 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 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. El Centro Hispano applauds and aligns with the Board of County Commissioners values of diversity and social justice. Investments made in El Centro Hispano help address Human Service Needs of the County and help to 1) Increase Access to Services through Coordination and Communication and 2) Increasing Community Engagement. Orange County is a diverse community with 13% of the population reported as foreign-born; higher than the State's percentage of 7.7%. Both the Town of Chapel Hill and Carrboro, each exceed those numbers for both the State and the County with 17.9% and 17% reported as foreign born, respectively. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 11 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION The 2014 US Census State & County Quick Facts reports that North Carolina experienced great population growth, 111% change. This growth is attributed to new births and migration from other states and countries. Latinos alone make up 9.2% of Orange County, 13.8% of Carrboro, 6.4% of Chapel Hill, and 6.6% of Hillsborough. The Latino population is very young and still establishing themselves within social structures. The median age of all NC Latinos is 23. In North Carolina, 69.4% of foreign born Spanish speakers older than age 5 have Limited English Proficiency (LEP). Thirty-one percent of NC Spanish-speaking households are linguistically isolated, meaning all persons ages 14 and over in the household are LEP, which is higher than other immigrant groups (Migration Policy Institute, 2010). In the U.S., 23.5% of all Latinos and 34% of foreign-born Latinos have less than a 9th grade education (Pew Hispanic Center), and research shows that low literacy and education levels in Spanish also make it difficult for Spanish speakers to fully participate in society and utilize its resources. Individuals who utilize El Centro Hispano's Community Engagement & Support Services are individuals who may not know about community resources, experience barriers whether it be due to limited English proficiency, cultural differences, and/or do not meet eligibility requirements, who may not understand wordy applications or agency processes, who are just new to the area and are becoming familiar with what is around or are needing a sense of community. Some fear individuals in certain positions of authority and others just have multiple layers of need that some agencies are not willing to take the time to work through. Some are victims of discrimination and other injustices. El Centro Hispano serves as a resource to them for information, for linkage to services, for advocacy, for cultural affirmation/affinity, and for help in integrating into the greater community. It provides space for members of the community to get involved through volunteerism. This allows for cross-cultural interactions, builds awareness of needs/experiences, and nurtures a sense of community. Through services rendered staff learn of access barriers, issues, concerns, and work with other partners and allies to share information, design interventions, and advocate for improvements, as needed. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? El Centro Hispano serves primarily the Latino population of all ages residing in Orange County, its municipalities, and surrounding areas. Community members learn about El Centro Hispano and its services through word of mouth, outreach efforts, partner agencies, government agency referrals, and social, broadcast, and print media. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 12 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT 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.) Linda Esquivel, Community Specialist, received her B.A in Spanish Teacher from Distrital Francisco Jose de Caldas University in Colombia. She worked for ICFES- Colombian Institute for Higher Education as an exam and essay reader. She worked as Spanish and Literature teacher for high school students and adults. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Services are delivered year-round. Office hours are gam — 5pm with some evening and weekend hours available for some services. Outreach is conducted during day, evenings, and weekend hours i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) Investing in this program is a direct investment in the all residents of Orange County and its municipalities. It expands the capacity of the organization to address the human service needs of the community. Individuals, families, and service providers have a place to get information and assistance in accessing area resources. It helps eliminate service gaps and disparities, builds inclusion, facilitates communication (particularly of those with Limited English Proficiency), and utilization of resources by community members. It contributes to building an informed, resilient, and engaged community of Orange County residents. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. It would impact the amount of services rendered and/or hours of operation k) Include any other pertinent information. With new political environments and changing administrations locally and nationally, El Centro Hispano is taking a more active approach in engaging and mobilizing community in an effort to increase awareness of issues, legislations and policies as well as identify community leaders, build alliances with area agencies, and foster social action to eliminate inequity and build community. This past year we have been more active in holding community forums under the FAITH ID Initiative to build trust between the community and law enforcement and provide immigrants a form of identification the can help them better provide for themselves and their loved ones and fully contribute to the local community. These forums have been very successful to date, building awareness of law enforcement, community members, and community agencies. We hope to continue conducting these forums in an effort to continue building a safe, unified, culturally conscious community. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 1 3 of 32 onouaign Envelope ID:42FCuoE4*ano-4rF4+2n1-0AoAo7onnAnn EXHIBIT A PROVIDERS OUTSIDE AGENCY APPLICATION Additional Program Information I) Target Population Complete the following t8bl8S, 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 348 132 348 Female 531 283 567 - Other 20 1 __ Total 899 416 915 . Ethnicity African-American 6 0 American Indian or Alaska Native 0 0 Asian 16 23 45 _— Caucasian 45 18 45 Native Hawaiian or other Pacific s�aoi� Islander d 0 O an er � Other: specify Hispanics, Middle Eastern, European, Ukrainian 832 375 850 Total 809 416 915 Of the abovo, how many Hispanic/Latino 70G 375 825 � � Of the above, how many non-Hispanic/Latino 103 41 90 . Total 896 416 915 . Age 0-5 years n/a 6-18 years 1 n/u 19-50 years I mu = I 51+ Years Total 0 O 0 Geographic Location Alamance County 17 8 Chatham County 13 5 Durham County 54 21 Wake County 13 5 Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non-Public Housing) 337 156 350 Town of Carrboro 360 179 375 ! / Town of Hillsborough . 33 | 16 35 City of Mebane (Orange County) 7 4 8 Orange County (Outside Municipalities) 24 0 25 Other: 138 61 122 i | Total | 899 416 0 PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 1 4 of 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement m) Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART(specific, Measurable, Achievable, Relevant, and Time-bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday-Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program ECH Community Support and Engagement Services 1. Program Activity Name Information, Referral, and Support Services Program Goal 1,200 referrals and support services rendered to Latinos and other community members in the Orange County, Chapel Hill, and Carrboro areas Performance Measures #of referrals and support services provided; #of new users Previous Year Program Results 1403 services provided; 889 new users Current Year Estimated Results 1,000 Goal for year; 661 people served as of 12/31/16 Next Year Projected Results I At least 1,200 2. program Activity Name Legal Assistance Program Goal 150 appointments made for individuals in need of legal services Performance Measures #of appointments made; #of appointments kept Previous Year Program Results 153 appts made; 93 appts kept Current Year Estimated Results 100 Goal for year; 90 appts made as of 12/31/16; Next Year Projected Results At least 150 3. Program Activity Name Community Education and Outreach Program Goal 7 Community Events will be held (such as the Forums, Faith ID Drives & the Latin-American Festival) to improve communication, engagement, and access to area resources by Latino community members as well as to foster cross-cultural appreciation and understandin. Performance Measures #of events held;#of participants Previous Year Program Results n/a Current Year Estimated Results 2 Community-Law Enforcement Forums; 4 Faith ID Drives; 1 Latin- American Festival Next Year Projected Results At least 7 community events PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 15 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION n) Program Budget 1. Submit your program budget. Submit your program budget. See attached 2. Program Budget Detail — Provide description of "other" budget items, not defined. Other Line items include contracted services, communications, printing and copying, community training, dues and subscriptions, participant incentives 3. This program budget represents what percent of the agency budget? 38% 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. Total Cost of Program $196,080 $216,730 $389,957 Total # of Individuals 1350 1350 1350 Cost Per Individual $145 $161 $289 PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 1 6 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) • Program Name: ECH-Center for Employment and Leadership Program Primary Contact and Title: Pilar Rocha Goldberg Telephone Number: (919) 687-4635 Ext. 43 E-Mail: procha@elcentronc.orq a) Indicate the type of Human Service Needs Priority, if program applicable: E Priority Area #1: safety-net services for disadvantaged residents — Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges — Priority Area #3: programs aimed at improving health and nutrition of needy residents 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 Housin. Affordable Healthcare Education Family Resources X x Jobs/Jobs Trainin. x x x Food Transportation Other: Please specify: I x job placement, worker rights & safety, communication, & outreach 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. • Day Laborer Task Force: ECH is very active in the Carrboro Day Laborer Task force, which includes representatives from the Carrboro Mayor's office, the Chapel Hill-Carrboro Chamber of Commerce, Justice United, Carrboro Day Laborers, the Human Rights Center and El Centro Hispano. • Chapel Hill-Carrboro Chamber of Commerce: ECH is a member of the Chapel Hill-Carrboro Chamber of Commerce. The Chamber participates in the Carrboro Day Laborer Task Force. • Human Rights Center: ECH partners with the Human Rights Center to develop initiatives for Carrboro day laborers. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 17 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • National Day Laborer Organizing Network — ECH has joined this network which has at least 30 centers nationwide and helps identify funding options and strategies to further engage workers • UNC A.P.P.L.E.S: Coming February 2017, students in the APPLES course will serve a minimum of 30 hours with a community partner during the semester. • Latino Migration Project: In April 2017, we will be collaborating with the Latino oral history archive "New Roots/Nuevas Raices" to capture Carrboro/Chapel Hill day laborer stories as a form of building community awareness. • Town of Carrboro Chief of Police: Collaborate on neighborhood safety and crime reduction efforts; particularly to address violence, loitering, drug prevention PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 1 8 of 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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? El Centro Hispano seeks funding to strengthen services rendered through the Center for Employment and Leadership (CEL) located at the Carrboro-Chapel Hill Office. CEL's programs and services align with the Board of County Commissioners' values of diversity and social justice and help address Goal #3; to implement planning and economic development policies which create a balanced, dynamic local economy, and which promote diversity, sustainable growth, and enhanced revenue while embracing community values. It also supports the Town of Chapel Hill priorities of Supporting Community Prosperity, Nurturing Our Community, and Growing Town, UNC and UNC Healthcare Collaborations. CEL helps connect job seekers with employment, particularly day laborers and domestic workers. It provides worker training, job placement services, financial literacy education, community outreach, and grassroots mobilization. Staff work with area employers to connect with a strong, ready workforce and to assure a safe workplace and fair wages. CEL works closely with staff of ECH's Community Support Services to refer to and address additional worker needs, such as housing, food access, healthcare, etc. They also collaborate with the Adult Education staff to provide elementary/secondary education through Plaza Comunitaria and ESL classes to workers. 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 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. Investments made in and through El Centro Hispano's Center for Employment and Leadership help address the Jobs and Jobs Training and Community Engagement priorities of the 2012 Human Services Report. Between 1995 and 2005, the number of Hispanic/Latino workers in North Carolina increased 431%, which accounted for 35% of the state's total workforce.1 By the end of 2005, three out of four Latinos residing in North Carolina were employed in construction, wholesale, manufacturing, and the retail industries.2 Given the dramatic growth of Latinos residing in North Carolina over the years and unstable economies, men were gathering daily at the corner of Jones Ferry Road Kasarda, J. 1), & Johnson, J. H. (2006). The Economic Impact of the Hispanic Population on the State of North Carolina, Chapel Hill, NC: Frank Hawkins Kenan Institute of Private Enterprise. 2 Ibid. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 19 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION and Davie Road in Carrboro to obtain work. The majority of the workers gathering at the Carrboro site are from Mexico, Guatemala, Honduras and El Salvador; however, Caucasian and African American day laborers also frequent the site. While Orange County was holding its own with a 3.5% unemployment rate, there was an upsurge in that rate, 4.20%, toward the end of 2015. This site has become an informal Day Laborer hiring site (also known as "the corner"). People who stand there are sought out to do work in construction, landscaping, painting, housekeeping, food, moving and service industries in Carrboro, Chapel Hill and other areas throughout Orange County and the Triangle. Some workers reported being victimized by presumed employers; others were promised a day's wage that was never paid; others were paid less than promised, and so on. Neighbors and police have cited problems at the corner given the diversity of the men standing there for work, such as loitering, violence, alcohol use. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? El Centro Hispano serves primarily the Latino population of all ages residing in Orange County, its municipalities, and surrounding areas. Through CEL it particularly focuses its efforts on Day Laborers, Domestic Workers, and Unemployed individuals to include all races and ethnicities, veterans, and homeless individuals. Community members learn about El Centro Hispano and its services through word of mouth, outreach efforts, partner agencies, government agency referrals, and social, broadcast, and print media. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Constanza Johnson, the Program Coordinator of the Center for Employment & Leadership (CEL), received her MA in Social Work from North Carolina State University in May 2016. Daniel Moore, Lead Organizer at the Center for Employment and Leadership as an Americorps Service Member, received his B.A. in Spanish from Duke University. He has experience with social justice and community mobilization through his work to support a domestic violence shelter in Siuna, Nicaragua with GlobeMed and Salud Sin Limites. CEL volunteers have undergone a general orientation by El Centro Hispano staff. There are 2-3 orientations planned each month for volunteers to attend. During the one-hour orientation, volunteers are given a quick overview of ECH's history, background, and core areas they can be engaged in. Specific assignments are explained by the Program Coordinator PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 20 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION h) Describe the specific period over which the activities will be carried out and include an implementation timeline. CEL operates year round with the following office hours Monday-Saturdays 6am- 2pm (summer hours); Monday-Friday 7AM-noon and Saturday 7AM-10AM (winter hours). Outreach is conducted during day, evenings, and weekend hours. i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) This initiative is a direct response to an identified community need related to public safety, employment, and securing fair wages. Funds support ECH Center of Employment and Leadership's growing role as a contributor to economic development in the Carrboro-Chapel Hill area. It creates jobs, accountability of employers, protection of workers, assurance of payment of fair wages, and builds collaboration between workers and employers, neighborhoods and law enforcement, and organization working to build wealth in low-income communities. The added value is that it invests in economic prosperity for the community; working to eliminate poverty. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. It would impact the amount of services rendered and/or hours of operation k) Include any other pertinent information. ECH's Center for Employment and Leadership (CEL) opened its doors April 2015 in response to a need identified by the Day Laborer Task Force in Carrboro-Chapel Hill to develop a Workers' center in hopes to minimize loitering and ease tensions with neighborhoods surrounding an informal hiring location on the corner of Jones Ferry Road and Davie Road in Carrboro. CEL's Worker Center Project was successful in its first year registering workers and potential employers, however, it quickly found itself addressing additional community needs and now also provides job skills training, employment placement, worker protection education, and advocacy for worksite safety and fair wages. The population served has also grown to include domestics workers and other racial/ethnic populations such as African-Americans and Whites hat are seeking employment. Because of this shift in population and needed services, CEL will engage in a strategic realignment process to better define its future work. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 21 of 32 onouaign Envelope ID:42FCuoE4*ano-4rF4+2n1-0AoAo7onnAnn EXHIBIT PROVIDERS OUTSIDE AGENCY APPLICATION Additional Proqram 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 � ���:�'�,��`- ��( �� � �' `` _^ Actual Estimated Projected ' 2015-16 201E-17 2017-18 Gender ~ ` ---- - Male 224 250 250 Female 30 75 1 75 Total 314 325 325 Ethnicity ��'` ����;' ' African-American 46 50 50 American Indian or Alaska Native 0 0 0 I Asian 2 5_^ 5 Caucaniam �5 20 20 - _ Native Hawaiian or other Pacific Islander 0 0 0 Other: upeo�yAf�oa (COB not given), Hispanic ------- ---- 241 250 250 Total 314 325__ 325 Of the above, how many Hispanic/Latino 241 250 250� Of the above, how many non-I-tispanic/Latino 73 75 75 Total 314 325 325 | Age 0-5 years n/a 6-18 years 19-50 years _ 51+ years Total 0 0 0 phic Location Alamance County 2 2 2 Chatham Count 3 2 2 Durham County 30 30 20 Wake County 1 1 1 Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non-Public Housing) __ 139 140 , 140 Town of Carrboro 110 110 110 . Town of Hillsborough 8 0 0 City of Mebane (Orange County) 6 0 0 Orange County (Outside K4unioipa|ides) 1, 7 25 25 Other: Unknown 8 25 25 Total ( 314 0 0 PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 2 2 of 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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(lpecific, 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. (Le. 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: ECH Center for Employment and Leadership 1. Program Activity Name Day Laborer Project Program Goal 325 individuals will seek CEL for work-related services/assistance Performance Measures #of workers registered; #of employers registered; Previous Year Program Results 264 total individuals registered; 101 workers and 161 Employers Current Year Estimated Results 325 Goal; 145 total persons registered; 68 workers & 77 employers as of 12/31/16 Next Year Projected Results At least 325 2. Program Activity Name Worker Education and Training Program Goal 100 individuals served Performance Measures # of individuals educated/trained; # of ind securing employment; # of ind reporting no loss in wages; # of ind reporting improved wages Previous Year Program Results 74 workers attended training Current Year Estimated Results 150 Goal Next Year Projected Results At least 100 3. Program Activity Name Financial Literacy and Asset-Building Initiative Program Goal 75 individuals will receive financial literacy counseling Performance Measures #of individuals served Previous Year Program Results n/s; new goal Current Year Estimated Results 75 Goal Next Year Projected Results At least 75 4. Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 23 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION n) Program Budget 5. Submit your program budget. See attached 6. Program Budget Detail — Provide description of"other" budget items, not defined. Other Line items include contracted services, communications, printing and copying, community training, dues and subscriptions, participant incentives 7. This program budget represents what percent of the agency budget? 38% 8. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. N Total Cost of Program $196,080 $216,730 $389,957 Total # of Individuals 314 400 400 Cost Per Individual $624 $542 $975 PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 2 4 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: ECH-Education Services Program Primary Contact and Title: Pilar Rocha Goldberg Telephone Number: (919) 687-4635 Ext. 43 E-Mail: prochaelcentronc.org a) Indicate the type of Human Service Needs Priority, if program applicable: Priority Area #1: safety-net services for disadvantaged residents Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges Z 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) Pliblic Housing Program Category Youth Adult Elderly Disabled . . Neighborhoods/Residents Affordable Housing Affordable Healthcare Education x x Family Resources x x Jobs/Jobs Training Food Transportation Other: Please specify: ESL, elementary & secondary education, computer training, etc, 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. • Durham Tech: ECH provides space to host ESL classes for low and intermediate levels. They use an appropriate curriculum for our community. • Orange Literacy Council: ECH lends space for ESL classes to parents and have children participate in preschool classroom. Orange Literacy and ECH partner to improve the development of our children and increase the English language skills for parents. • Sophomore & Junior High School Students: ECH collaborates with area high school students to help tutor elementary and middle school kids. Their service helps them complete the community service hours requited by their school. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 25 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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? El Centro Hispano seeks funding to support Education services offered at the Carrboro-Chapel Hill Office to children, youth, and adults. ECH's Education Initiatives align with the Board of County Commissioners' values of diversity and social justice and help address the Education component of Goal 6: to ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare. It also supports the Town of Chapel Hill priorities of Supporting Community Prosperity, Nurturing Our Community, and Growing Town, UNC and UNC Healthcare Collaborations. Education interventions include school readiness and academic achievement interventions such as Pre-K preparation, K-12 tutoring, parent education and support, adult literacy and ESOL, and adult elementary education through Plaza Comunitaria (a collaboration with the Mexican National Institute of Adult Education). e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County :OCC Goals and Priorities, Town of Chapel 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. Education Initiatives at El Centro Hispano Carrboro-Chapel Hill office addressed the Education & Family Resources priorities of the 2012 Human Services Report. In North Carolina, 69.4% of foreign born Spanish speakers older than age 5 have Limited English Proficiency (LEP). Thirty-one percent of NC Spanish-speaking households are linguistically isolated, meaning all persons ages 14 and over in the household are LEP, which is higher than other immigrant groups (Migration Policy Institute, 2010). In the U.S., 23.5% of all Latinos and 34% of foreign-born Latinos have less than a 9th grade education (Pew Hispanic Center), and research shows that low literacy and education levels in Spanish also make it difficult for Spanish speakers to fully participate in society and utilize its resources. In Chapel Hill-Carrboro City Schools, only 66.2% of Latino youth graduated from high school in 4 years in 2010, as compared to 92.5% for white students. Research shows that low literacy and education levels make it difficult to get a job, access resources, and assist with children's education or literacy development. Furthermore, low literacy levels in Spanish make it more difficult for native Spanish speakers to learn English. Developing English proficiency is an important pathway to improving employability and economic success in the United States for immigrant families. In North Carolina, only 25% of Latina mothers read to their children at least once a day in 2005, compared to more than 50% of mothers in the general state population. Latino parents in North Carolina are more likely to report that their children have fair or poor health and have had no health insurance in the past year PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 2 6 of 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION than White parents. Moreover, national evidence shows that Latinos are less likely than children of any other racial or ethnic group to be enrolled in an early childhood program or to receive early intervention services. In 2005-06, 27% of Latino four-year-olds lacked regular, non-parental arrangements for child care, compared with 18% of white preschoolers and 16% of black preschoolers. Thus, many Latino children reach school age without having been exposed to developmentally appropriate preschool settings. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? El Centro Hispano serves primarily the Latino population of all ages residing in Orange County, its municipalities, and surrounding areas. Education Initiatives focus efforts on children 0-5 and their parents/caretakers through its preschool preparation program and grades K-8 for its tutoring program. They also work with adults who do not know how to read or write, have not completed any formal education, and/or who experience Limited English Proficiency. The program also works with educators, literacy programs, and school officials to increase communication and engagement of children and their family in learning. Community members learn about El Centro Hispano and its services through word of mouth, outreach efforts, partner agencies referrals, government agency referrals, and social, broadcast, and print media. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Tana Hoffman, School Readiness PreK-8 Program Coordinator, has a degree in Psychology from Mexico and 15 years of experience in Education. Fanny Fragosa, Adult Education and Literacy Coordinator, has a Bachelor's degree in Education and over 17 years of experience in Adult Education. Sor Angela Gonzalez, Preschool Lead Teacher, has more than ten years of experience working with children 6 wks to 5 yrs as teacher or childcare provider. Antonio Alanis, Child Education & Literacy AmeriCorps Service Member, received a B.A in Spanish from the University of North Carolina at Chapel Hill and a Masters in Arts in Education from Wake Forest University. Antonio has experience in educational research including implementing best practices to identify problems and better students' learning problems within the school classroom, developing K-12 curriculum. Education volunteers (particularly for the tutoring program) participate in a general orientation by El Centro Hispano staff. Four orientation's sessions are held during the Fall and Spring Season. Volunteers are given an overview of ECH's history, background, and core areas they can be engaged in. Specific assignments are explained by the Program Coordinator PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 27 of 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION h) Describe the specific period over which the activities will be carried out and include an implementation timeline. The Preschool Classroom and Circle of Parent Sessions are offered in two 14-week series; the first is offered September to December and the second is offered February to May. Classes are held in the morning from 11:30am to 12:30am. Tutoring is made available to children and youth during the school year on Mondays and Thursdays from 5:30pm to 7pm. Summer Camps are held during the summer months. English Classes are offered in collaboration with Orange Literacy Council and Durham Tech as follows: • ESL classes on Mondays & Thursdays10:00am-11:30am for Burmese, Korean, and Hispanic mothers of children 0-5 year of age who attend the preschool classroom program • ESL PACT Classes on Mondays & Thursdays 11:30am-12:30pm as a joint parent and children class. • ESL Durham Tech Mondays & Wednesday 6:OOpm-8:00 pm and Tuesdays & Thursdays 7:00pm-9:00 pm. I) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) Investing in Education is an investment in j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. It would impact the amount of services rendered and/or hours of operation k) Include any other pertinent information. The Education program is still being strengthened at the Carrboro-Chapel Hill office. It seeks to build literacy, academic excellence, and build language/work skills of Latinos and other minority populations in order to assist them in assuring a better quality of life and participation in society. Staff is working to replicate interventions that have been successful at our Durham location and meet a request from community members to have such programs in Orange County. ESL classes continue to be offered to day laborers and others that attend the Chapel Hill- Carrboro office. The tutoring program has been successful in recruiting and maintaining participation of area kids need homework assistance as well as securing tutors from area high schools. Parent education focuses on how families can support learning at home and on how to prevent child abuse. Families identified with basic needs are referred to and assisted through our Community Support staff that referred to area resources or help meet the need. PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 28 of 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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 78 80 80 Female 100 110 110 Total 178 _ 190 _ 190 Ethnicity African-American American Indian or Alaska Native Asian 28 30 30 Caucasian Native Hawaiian or other Pacific Islander Other: specify Hispaicn 150 160 160 Total 178 190 190 Of the above, how many Hispanic/Latino 150 160 160 Of the above, how many non-Hispanic/Latino 28 30 30 Total 178 190 190 Age 0-5 years 34 34 34 6-18 years MEMMI 19-50 years 144 156 156 51+ years Total 178 190 190 Geographic Location Alamance County Chatham County Durham County 5 5 5 Wake County Orange County Breakdown Chapel Hill Public Housing 32 32 32 Town of Chapel Hill (Non-Public Housing) Town of Carrboro 18 18 18 Town of Hillsborough 2 2 2 City of Mebane (Orange County) 2 2 2 Orange County(Outside Municipalities) 116 131 131 Total 178 190 190 PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 29 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 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(S_fiecific, 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 ECH Education Services 1, Program Activity Name School Readiness- Preschool Classroom Program Goal 30 children 0-5 will participate in the pre-school classroom Performance Measures #of children participating Previous Year Program Results 62 children participated Current Year Estimated Results 25 Goal; 27 have participated as of 12/31/2016 Next Year Projected Results At least 30 children 2. Program Activity Name School Achievement- K-8 Tutoring Program Goal 30 children in K-8 will receive tutoring for homework (4hrs per week Performance Measures #of children participating Previous Year Program Results 37 children participated current Year Estimated Results 25 Goal; 24 children have been tutored since 12/31/2917 Next Year Projected Results At least 30 children 3. Program Activity Name Circle of Parents Program Goal 30 parents/caretakers of children 0-5 will participate in Circle of Parent sessions Performance Measures #of parents attending; #of parents that complete the program Previous Year Program Results 38 parents attended Current Year Estimated Results 14 parents have attended as of 12/31/16 Next Year Projected Results At least 30 parents 4. Program Activity Name Adult Literacy- ESL Program Goal 100 will participate in literacy and/or ESL classes Performance Measures #of participants in classes Previous Year Program Results 38 individuals attended Current Year Estimated Results 100 Goal; 24 attended as of 12/31/16 Next Year Projected Results At least 100 PROGRAM INFORMATION 1/31/2017 3;16:25 PM Page 31 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION n) Program Budget 1. Submit your program budget. See attached 2. Program Budget Detail — Provide description of "other" budget items, not defined. Other Line items include contracted services, communications, printing and copying, community training, dues and subscriptions, participant incentives 3. This program budget represents what percent of the agency budget? 38% 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. n,r Total Cost of Program $196,080 $216,730 $389,957 Total # of Individuals 190 190 190 Cost Per Individual $1032 $1141 $2052 PROGRAM INFORMATION 1/31/2017 3:16:25 PM Page 31 o f 3 2 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: El Centro Hispano, Inc Actual 2015- Estimated 2016• Projected 2017- Percent AGENCY REVENUE 16 17 18 Change Private Donations $ 38,052 $ 43,808 $ 45,000 3% Agency Generated Revenue(fees) $ 177,164 $ 184,678 $ 185,000 0% Local Government Grants: Human Services-Town of Carrboro $ 9,500 $ 14,800 $ 20,000 35% Other-Town of Carrboro $ 36,970 $ 36,980 $ 36,980 0% Human Services-Town of Chapel Hill $ 14,910 $ 18,000 $ 30,000 67% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 20,000 $ 28,810 $ 35,000 21% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ 78,828.00 $ 36,194.00 $ - $ (1.00) Federal Government(CDBG/HOME/etc.) $ - $ - $ 20,000.00 0 Private Foundation Grants $ 233,428.00 $ 108,134.00 $ 143,134.00 $ 0.32 Other Revenue $ 289,153 $ 337,951 $ 506,605 $ 0.50 Total Agency Revenue $ 898,005 $ 809,355 $ 1,021,719 26% AGENCY EXPENSES Compensation $ 392,228 $ 407,588 $ 501,867 23% Rent&Utilities $ 74,660 $ 89,940 $ 99,845 11% Supplies &Equipment $ 18,509 $ 11,507 $ 20,173 75% Travel &Training $ 19,361 $ 23,685 $ 23,846 1% Other Expenses: $ 393,247 $ 308,963 $ 375,988 22% Total Agency Expenses $ 898,005 $ 841,683 $ 1,021,719 21% SURPLUS/(DEFICIT) FOR PERIOD: $ - I $ (32,328)1 $ - I 100% FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME ECH- Carroboro Office Community Services Actual Estimated Projected Percent PROGRAM REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ 7,177 $ 10,000 $ 10,000 0% Program Generated Revenue $ 12,991 $ 55,403 $ 55,403 0% Local Government Grants: Human Services-Town of Carrboro $ 9,500 $ 14,800 $ 20,000 35% Other-Town of Carrboro $ 36,970 $ 36,970 $ 36,970 0% Human Services-Town of Chapel Hill $ 14,910 $ 18,000 $ 30,000 67% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services- Orange County $ 20,000 $ 28,810 $ 35,000 21% Other- Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ - $ 20,000.00 0 Private Foundation Grants $ - $ 32,440.00 $ 32,440.00 $ - Other Revenue $ 94,532 $ 20,307 $ 150,144 $ 6.39 Total Program Revenue $ 196,080 $ 216,730 $ 389,957 80% PROGRAM EXPENSES Compensation $ 112,113 $ 96,695 $ 218,271 126% Rent&Utilities $ 29,545 $ 44,848 $ 44,848 0% Supplies & Equipment $ 1,715 $ 1,500 $ 8,179 445% Travel &Training $ 6,286 $ 6,300 $ 8,803 40% Other Expenses: $ 46,421 $ 67,387 $ 109,856 63% Total Program Expenses $ 196,080 $ 216,730 $ 389,957 80% SURPLUS/(DEFICIT) FOR PERIOD: $ - I $ - I $ - I 0 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 4. ATTACHMENTS Description of Required Attachments a) Financial Audit A recent financial audit that should cover CY 2015, for calendar year agencies, and FY 2015-16, for fiscal year agencies. b) IRS Federal Form 990 A copy of the agency's 2014 Form 990 is required. c) NC Solicitation License A copy of the agency's current solicitation license is required. d) IRS Federal Tax-Exemption Letter A copy of the agency's IRS tax-exempt letter that confirms its nonprofit status is required. e) Certificate of Liability Insurance f) List of Board of Directors Provide the following information about each board of director's member: name, telephone number, address, occupation or affiliation of each member and the list must identify the principal officers of the governing body, and length of term. g) Solid Waste Program Fee (SWPF) Verification This fee finances Orange County's recycling and waste reduction program. Submit either a.) proof of payment of the agency's FY 2016-17 Solid Waste Program Fee, OR b.) a statement on agency letter head indicating exemption and specify the person(s), business, etc. that is responsible for paying this fee. DO NOT SUBMIT THIS PAGE 1/31/2017 3:16:25 PM Page 32 of 32 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 EXHIBIT`B" Scope of Services-FY 2017-18 Outside Agency Performance Agreement Agency Name: El Centro Hispano,Inc Program Name: ECH- Community Services Funding Award: $31,905 Outline how the agency will spend Orange County's funding award. Expense Description Amount Community Support&CEL Salaries&Fringe $20,146 Program Expenses(rent, communications,supplies,travel, community training/forums, etc) $11,759 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Community(direct) support servcies • Community Education, Outreach, and Engagement • Workforce Training/Placement Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results #of referrals and support services provided 1,200 #of legal assistance appointments made 150 #of community education and outreach events held 7 #of workers and employers registered 325 #of individuals served through work related services 100 #of individuals receiving financial literacy education/counseling 75 c3i DocuSigned by: Gam k 4 -G Presiiddent&CEO 10/10/2017 D s aaD,..* Certified b : a 'r /`� Title: 0M-C-444' 64.CeD Date: 09-7a 6( 0- (Provider's Signature) DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 ATTACHMENT "A" Orange County Certifications—FY 2017-18 Outside Agency Performance Agreement Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name,title,residential address;phone and email address and if possible,fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name, physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DocuSigned by: Pa44 koc44-4 yk President&CE0 10/10/2017 Certified by: 99RnnRRQC1744D1 Title: Date: (Provider's Signature) (El Centro Hispano,Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID:42FC26E4-086D-47F4-A291-0A9A8706CA60 ELCENTR-04 _ SPIKE ACORar DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 4/5/2017 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hub International Southeast PHONE FAX 4000 CentreGreen Way (Arc,No,Ext): (919)337-0000 (wc,No):(865)553-5124 Suite 140 ADDRESS: Cary,NC 27513 INSURERIS)AFFORDING COVERAGE NAIC# _ INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: El Centro Hispano,Inc. INSURER C: 600 East Main Street INSURER D: Durham,NC 27701 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. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD 4WD POLICY NUMBER IMM/DO/YYYYI LMM/DD/YYYYS LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK1612489' 04/06/2017 04106/2018 PREMISESO R NTEDnces $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EGT $ A COMBINED SINGLE LIMIT AU LIABILITY (Ea accident) $ _ ANY AUTO BODILY INJURY(Per person) $ OWNED TOSS ONLY SCHEDULED AUTOS pBOODILY INJURY(Per accident) $ AUTOS ONLY AUTOS ONLY (Perr accident)AMAGE $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PHUB573161 04/06/2017 04/06/2018 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y!N STATUTE ER ANY YIGEWM�MggO�R/�EXCLUDED?ECUTIVE N!A E.L.EACH ACCIDENT $ (Mandatory m NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Crime PHPK1612489' 04/06/2017 04/06/2018 Employee Dishonesty 120,000 A Professional Liabili PHPK1612489' 04/06/2017 04/06/2018 Each Incident 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached IF more space Is requIred) Professional Liab Aggregate$3,000,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County Government ACCORDANCE WITH THE POL CY PROVISI0 SCE WILL BE DELIVERED IN 200 S Cameron St PO Box 8181 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. 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