Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
2017-614-E Finance - Planned Parenthood South Atlantic - Outside Agency Performance Agreement
DocuSign Envelope ID:D13694BA-66F1-4441-9114-5334F2B6AC3D 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 Planned Parenthood South Atlantic, a not-for-profit corporation, located at 100 S Boylan Ave, Raleigh,NC 27603 ("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 Planned Parenthood South Atlantic 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 20000 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 5000. 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. (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID:D13694BA-66F1-4441-9114-5334F2B6AC3D 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. (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID:D13694BA-66F1-4441-9114-5334F2B6AC3D 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. (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID:D13694BA-66F1-4441-9114-5334F2B6AC3D 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 Planned Parenthood South Atlantic 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: (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID:D13694BA-66F1-4441-9114-5334F2B6AC3D County: Finance &Administrative Services Provider: Planned Parenthood South Orange County Atlantic Post Office Box 8181 100 S Boylan Ave Hillsborough,NC 27278 Raleigh,NC 27603 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. F nd beh�a f of the Provider s)GIAlU? f 7(2L t 10/10/2017 -DGFE-236904274.0... , Date (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID:D13694BA-66F1-4441-9114-5334F2B6AC3D 7 F 9t�1' �ebHtalf of Orange County Government �jbtbut, l'a.wtwtt,V'Stt 11/13/2017 0637994B755E477... Bonnie Hammersley, County Manager Date (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Planned Parenthood South Atlantic Applicant Organization's Physical Address: 1765 Dobbins Drive, Chapel Hill, NC 27514 Applicant Organization's Mailing Address: 1765 Dobbins Drive, Chapel Hill, NC 27514 Applicant Organization's Web Address: www.ppsat.orq Executive Director: Jenny Black Telephone Number: 919-833-7526, ext. 6140 E-Mail: jenny.blackppsat.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) Proqram I Carrboro 1 Chapel Orange Total -HS Hill -HS Coun -HS Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 Afterschool Program Coordinator salary and materials for outh activities anstprojects Sexual Health Education and Outreach $1,000 $2,500 $20 000 I 23,500 I Totals 1 I 1 1 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. II 7 ,, ( ( I II ,,,, 1 h o I i- Signature: _0 2 70./ ...._.... ....._,... ...........______ 6(ecutive l irector Date Signature: -,.._-F -.., - 17 Bo / ),.. , 5,0 ,Chairperson Date AGENCY INFORMATION 1/26/2017 1:47:36 PM p , g II, 6 o f 27 DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D 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 LI a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? LI 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? LI 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: I - Executive Director Date Signature: ' /. 3,1 /7 Boa Chairperson Date AGENCY INFORMATION 1/26/2017 1:47:36 PM , r DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following info ation about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): 36 years, incorporated in 1980 b) Agency's Purpose/Mission (no more than a few sentences): Planned Parenthood South Atlantic proactively ensures comprehensive reproductive health care by: providing services in settings that preserve and protect the individual's right to privacy and reproductive choice; by advocating public policies that advance these rights and expand access to such services; by providing educational programming that fosters a culture of healthy sexuality; by working with and meeting the needs of diverse communities and the under-served; and by leading broad-based strategies that further these fundamental rights. c) Types of Services the Agency Provides (bullet format): • Reproductive health care • Contraceptives • Cancer Screenings • Testing and treatment for sexually transmitted infections • HIV/AIDS testing • Abortion care • Evidence-based education programs for teens and their parents or caregivers • Community-based sexuality education programs d) Agency's History with Providing These Services: For more than 36 years, PPSAT has provided high-quality education that reflects the needs of young people, their families, our patients and the communities we serve. Last year, more than 25,000 young people benefited from our education programs within our affiliate area. Programming ranges from health center-based projects like enrolling patients in health care coverage through the Affordable Care Act; to delivering model, Planned Parenthood South Atlantic branded sex education programs; to offering professional training in the affiliate and in partnership with other nonprofit organizations; to teaching healthy living curricula in local schools. We place an emphasis on multi-session sex education programs that are evidence- based and proven to meet the needs of the participants. We have offered the Teen Connections and programs in Orange County for the past 4 years. 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?) The Agency Information 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION organization has faced an increase in hateful rhetoric and unnecessary scrutiny since the 2015 release of a series of deceptively edited videos intended to mislead the public and discredit Planned Parenthood. Nationwide and within our own affiliate, investigations have shown that Planned Parenthood did nothing wrong and instead, the head of the group releasing the videos was indicted for misconduct. Despite this, Planned Parenthood continues to be the target of anti-women's health politicians and millions of tax payer dollars have been spent on these politically- motivated investigations. A call for defunding of the organization seems likely in the new administration and our programs and services are at increased risk in the coming year. Despite these external challenges, Planned Parenthood remains committed to its mission and the patients we serve. 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: 168 # of FTE -Paid Part-Time Positions: 91 # of Volunteers:40 #of FTE -Volunteers:2.8 g) Living Wage Does this agency pay permanent employees a minimum livin a e? (Yes/No) Yes If yes, is this agency an Oran me C lunty_Living ' e Certifiem II i?El 111 P 111111 r No If no, please explain. We have applied and our approval is pending. Agency Information 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Planned Parenthood South Atlantic Actual 2015- Projected 2017- Percent AGENCY REVENUE 16 Estimated 2016-17 18 Change , Private Donations $ 5,368,208 $ 6,053,446 $ 6,235,049 3% Agency Generated Revenue(fees) $ 8,967,011 $ 10,240,850 $ 10,548,076 3% Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ 1,000 $ 1,000 $ 1,000 0% Human Services-Town of Chapel Hill $ - $ - $ - 0 Other-Town of Chapel Hill $ 2,500 $ 2,500 $ 2,500 0% Human Services-Orange County $ - $ - $ - 0 Other-Orange County $ 20,000 $ 20,000 $ 20,000 0% Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants MIIMMIIM Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ 0 Federal Government(CDBG/HOME/etc.) $ 2,909,600 $ 2,986,000 $ 2,986,000 0% Private Foundation Grants $ 1,902,893 $ 1,288,054 $ 1,326,696 3% Other Revenue $ 1,529,216 $ 330,573 $ 330,573 0% Total Agency Revenue $ 20,700,428 $ 20,922,423 $ 21,449,894 3% AGENCY EXPENSES Compensation $ 11,336,351 $ 12,668,595 $ 13,048,653 3% Rent&Utilities $ 979,768 $ 726,583 $ 726,583 0% Supplies&Equipment $ 2,983,624 $ 3,255,253 $ 3,320,358 2% Travel&Training $ 635,030 $ 854,351 $ 871,438 2% Other Expenses: $ 4,646,191 $ 4,329,331 $ 4,415,918 2% Depreciation 575,454 Facilities Maintenance 593,223 Contract Services 606,853 Marketing 407,470 Total Agency Expenses $ 20,580,964 $ 21,834,113 $ 22,382,950 3% SURPLUS/(DEFICIT) FOR PERIOD: $ 119,4641 $ (911,690)1 $ (933,056) -2% FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget i. Is your agency currently receiving and/or requesting other(non-Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes/No) No If yes, please list below: Include all programs that have funding requests/awards/totals from Carrboro Cha I el Hill and Orange County governments (other than Human Services), DO NOT include federal funding sources, such as CDBG and HOME, Program FYI6-17 FY17-18 Source Award Re.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 =I=111.1.IIIIIIIIIIIMIIII.MIIMMIIIIIMIIII 111111111111 11111111111111111= 11.11111 IlMilli IIMMIIIIIIINMIIIIIIIIIIIMIMIMIIIMMM IIIIIIIIIIIllMINIIIIIIIIIIII 1111111M 11111111111M11 = MEMIIMIIIIIMIIIMINIIMIMINIMIMIllilMEIMII NIIIIIIIIIIIIIMIIIIIIIIIIIIII MIIIIIIIMIIIIIIIIIIIIIIIIIIIIIIII 11111111111111111111111111111111111111 = 111101=11111.11111.1111111.111.1= IM1111111111111111111111111111111111111111111111111111111111111111111 1111111110111111111111111111111111 MIIIIIIIIIIIIIIIIIIIIIIIMI 1. 111111111111111111111111111111 I *Add rows or attach additional page, if needed. ii. Submit your agency's budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues o Private Donations o Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other(DO NOT include CDBG funding here) Agency Information 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • 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?Yes Is there a significant change? Yes/No No Please provide a brief explanation for Surplus or Deficit, and significant changes. iv. What is your agency's fiscal year? July 1, 2016-June 30, 2017 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Sexuality Health Education and Outreach Program Primary Contact and Title: Molly Laing Telephone Number: 919 286-2872 Ext. 5417 E-Mail: molly.laina ppsat.orq 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 ❑ Priority Area#3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare X X Education X X Family Resources Jobs/Jobs Training Food Transportation Other: Please specify c) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated/collaborative efforts. Program Description (3 pages OR LESS) Please provide the following info ation about the proposed program: d) Summarize the program services proposed and how the program will address a Town/County priority/goal? In the coming year, our education department will provide Orange County teens and young adults with medically accurate, intensive, and balanced sexuality education programs that promote positive sexuality, healthy behavior, and responsible choices —with the goal of reducing the rates of unintended pregnancy and sexually transmitted infection. In doing so, we are addressing the Town of Chapel Hill's budgeting priority to fund education, mentorship, and afterschool PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION programming for youth facing a variety of challenges. PPSAT will provide Teen Connections, a sexual education program for teens that uses the evidence-based Becoming a Responsible Teen (BART) BART is a comprehensive curriculum specifically designed to increase many of the knowledge and skill-based protective factors about contraception use and negotiation skills. PPSAT will also offer Smart Girls, a science-based, intensive adolescent pregnancy prevention program for middle school girls. The goal of both programs is to build self-esteem and healthy decision-making to delay initiation of sex, increase condom use of sexually active teens, and reduce the number of sexual partners for those teens. In addition, we will be using the Making Proud Choices! Program and Making Proud Choices! Plus which stress making proud and responsible choices. While recognizing the geographic and cultural diversity among U.S. youth, the curriculum addresses beliefs associated with sexual risk behavior. It was proven effective at increasing knowledge about HIV, other STDs and pregnancy, strengthening negotiation skills, and lowering incidence of HIV/STD risk-associated behavior. (9 sessions) Making Proud Choices uses a combination of lectures, videos and activities to motivate students to become responsible and proud decision makers. Making Proud Choices! Plus is identical to that of Making Proud Choices! However, this curriculum is specifically geared toward youth in out-of-home care and addresses the needs and challenges of this population. It is also a great program for LBGQT youth. We will invite graduates of our teen education programs to participate in our alumni group. Through the alumni group, we will look at the larger community to identify other needs and design and implement appropriate service projects. This service- learning component will work to increase community involvement. Parent workshops will improve parents' confidence in talking to their children about sex and will increase parent-child communication about sex and contraception. Alumni will lead workshop sessions so that parents have the opportunity to practice talking to teens about these sensitive topics. Our program will also include a series of chats aimed at young women (aged 19— 25) who do not qualify to participate in our after-school program. These workshops will engage them in a dialogue about family planning and pregnancy prevention. e) Describe the community need or problem to be addressed in relation to the Chhel Hull Human Sem sicgs O Je cr',s l-,ssessH gent, than'e C OCC Goals and II'riorities, Town of Cha+el Hill Coa rkolil Go Ws, 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. PROGRAM INFORMATION 1/27/2017 3:1 0:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION The consequences of adolescent pregnancy and childbearing are serious and numerous. Teen mothers are less likely to graduate from high school and more likely to live in poverty and to rely on welfare. The children of teenage mothers are often born at low birth weight, experience health and developmental problems, and are likely to be poor, abused, and/or neglected The educational programs PPSAT offers influence specific behaviors related to sexual risk-taking and reinforce protective factors to prevent teen pregnancy. In 2015, the most recent year for which data is available, North Carolina's teen pregnancy rate fell 9% to 35.2 out of every 1,000 15-19 year old girls, which is a record low in the state's history. Orange County's teen pregnancy rate dropped 35% from 2012 - from 9.6 that year to 4.4 in 2014. The number of teen pregnancies fell from 102 in 2012 to 69 in 2014, the most recent year in which county data is available. Orange County has historically had one of the lowest rates in the state, but this large reduction year-to-year is notable and a positive step. Even with this lowest and dropping overall rate, rate disparities exist by race and ethnicity. Orange County demonstrates a greater racial and ethnic disparity when it comes to teen pregnancy rates than the state as a whole. In our community, 4.3 out of every 1,000 White teens experience teen pregnancy, whereas 31.9 out of 1,000 African American and 41.3 out of 1,000 Hispanic teens are faced with this challenge. According to the 2015 Youth Risk Behavior Survey (YRBS) for North Carolina, over 43.5% of high school students report having had sexual intercourse. That includes 57.5% of juniors and 63.9% of seniors. This demonstrates that many adolescents are confronted at some point during their teen years with choices about whether or not to have sex and, if they do, whether or not to use condoms and/or other contraceptives. Research shows that teens who begin having sex at an earlier age are less likely to use contraception and more likely to become pregnant and to become a parent. They are also more likely to accumulate a greater number of lifetime sexual partners. Of those that reported having had sex, only 60.8% used a condom the last time they had sex. In addition, 21.2% reported using drugs or alcohol before sex. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? This project will primarily serve middle and high school aged teens living in Orange County, Chapel Hill and Carrboro. Our Community Health Educator works with social workers and counselors in the schools and community partners to promote the program and receive direct referrals. Teen Connections and Smart Girls are available to any teen that meets the age requirements for the curricula. Interested teens complete an application and interview with the educator to demonstrate their interest in the program. When there are more applicants than spaces available, the educator gives priority to older teens that many age out of the program sooner and reserves a space the following year for teens that she cannot accommodate. PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION In addition, we will implement parent workshops to benefit parents of teens, promoting this project with our community partners and among our teen program participants. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Our program is conducted by Molly Laing, a full-time community educator serving Orange and Durham Counties. Molly is an experienced educator whose resume includes assisting in designing and leading video trainings for Ugandan HIV/AIDS and LGBTQ activists. She has a Bachelor of Arts in Anthropology and Social Psychology with a Special Project: Community Health: Public Health Strategies The program is overseen by Monika Thigpen, Sr. Director of Education. Ms. Thigpen has more than 20 years of experience developing and implementing successful community education programs. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Sept-Nov 2016- Begin preparation for program January 2017 Set up dates/time for spring health fair, workshops, other activities February 2017 Begin recruitment process through guidance counselors, Teen Center, social workers, and referrals for Smart Girls and Teen Connections March 2017 Teen Connections start- 12 weeks, 12 sessions April 2017 Smart Girls start- 10 weeks, 10 sessions March-April 2017 Parent session in between the program dates for both Teen Connections and Smart Girls (Other parents are allowed to attend) May/June 2017 Graduation for Smart Girls and Teen Connections Throughout the year - workshops, health fairs, Teen Connections Alumni meets once a month i) Why is funding this program a good investment for the community? Our programs help participants to increase self-esteem and delay sexual activity. This is especially important because teens who begin having sex at an earlier age are less likely to use contraception and more likely to become pregnant and to become a parent. Lifetime achievement for teen parents is significantly less than for their peers who are able to pursue their education or career training. They are more likely to live in poverty and require assistance from their communities. Investing in our teens today provides a solid knowledge base that will assist them as they navigate their teen years and will positively impact their future success. PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION j) Describe what Would happen if requested funding is not awarded at all or if a reduced allocation is recommended. PPSAT is committed to maintaining these education programs in Orange County. In addition to County and Town support, PPSAT receives funding for its educational programs from a number of private foundations. All of these foundations have a long history of supporting our programs and we anticipate their renewed support for FY16. If requested funding is not awarded, we will have to make a larger institutional investment in the programs - designating funds raised for general operating support. That said, we deeply value our partnership with Orange County and the towns of Chapel Hill and Carrboro. k) Include any other pertinent information. We have added an additional program to our array of parenting programs. We will utilize the Parent Matters curriculum with 10 additional parents. To reinforce information and knowledge, we will also be distributing a parent newsletter. PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Info ation 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 136 94 94 Female 389 269 269 Total 525 373 373 Ethnicity African-American 117 82 82 American Indian or Alaska Native Asian Caucasian 172 123 123 Native Hawaiian or other Pacific Islander Other: specify 236 168 168 Total 525 373 373 Of the above, how many Hispanic/Latino 92 65 65 Of the above, how many non-Hispanic/Latino 263 308 308 Total 525 373 373 Age 0-5 years 6-18 years 336 238 238 19-50 years 189 134 134 51+ years Total 525 373 _ 373 Geographic Location Alamance County Chatham County Durham County _ Wake County Orange County Breakdown Chapel Hill Public Housing N1111111111111111=11111 Town of Chapel Hill (Non-Public Housing) 155 110 110 Town of Carr oro 150 106 106 Town of Hillsborough 1111111111111111 City of Mebane (Orange County) Orange County (Outside Municipalities) 220 Other Total 525* _ 373 373 PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION **Please note that the actuals reported for 2015-2016 reflect all participant contacts through the program, The projected numbers reflect only those participants outlined in the program goals, however,we anticipate that we will meet or exceed the 2015-2015 figures in both 2015-2017 and 2017-2018. Work t m) Complete the Work Statement Chart to describe the work to e or . This chart is used to document program activities, program oals, performance measures, and actual results. more rows as needed) If this is new ra , you ill only document the projected information. Every program is required to have AT LEAST Program ctivity, which should SMART(Ssecific, Measurable, Achievable, Relevant, and Time-bound". Click on SMART Goad§to learn more. • Program iii should outline major activities the ency implements to accomplish its program oals. (Le. Deliver meals to elderly/disabled residents) O Program l should explain h t the program is hying to chi v / acco lis Goals are statements about h t the program should cco lis . (La Deliver 100 meals per day, Monday-Friday.) * Performance Measures escri a how you ill evaluate the degree in which you achieved the stated oals. (Le. Will track the number of meals delivered each clay.) • Actual r use program results to indicate the actual measureable achievement of o ls. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day) Work Statement Chart for Program Sexual 1 Education r c 1. Program ctivi Using the i ng a Responsible Tea curriculum, provide a dive group of teens with training aro issues of sexuality, a y relationships, a stM e contraceptive options, communication and ecisi - ki sills and goal setting. Program Goal Recruit at least 15 teens (ages 14— 16). All participants will demonstrate at least a 1 % increase in o 1 e about preventing r c Sib. Performance e res PPSAT will measure the competency vela of participants through pre- and post-program tests. The pre-test i t be administered at the beginning of the first session, the post-test will be administered immediately fo to r the conclusion of the program. Measurable outcomes include change in n le , attitudes, and behaviors. Previous r r Results ici is demonstrated a 10% increase i knowledge using pre ost testinameasurements. current Year Estimated Results All participants will demonstrate at least a 10% increase in knowledge about preventing pregnancy ls. Next Year Projected Results All a ici will str t. at least a 10% increase in le . about *r ve tin• .reline= and STIs. 2. Program ctiv Name Peer-educators ill work within their schools and PROGRAM INFORMATION 1/27/2017 3: DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION communities to disseminate to others information they have learned. Program a' Each peer-educator will make 20 contacts in eir co un` Performance r es Peer-educators will maintain contact logs so that the Community r can review them for accuracy completeness. Previous Y r Program ResultsEach r educator contacts for a total of 300 contacts. Current r Estimated Results peer-educator will make 20 contacts in it " .. . Next r Projected a Each community peer-educator will make 20 contacts. in their 3. Program ctiv Using the Smart Girls curriculum, provide a diverse group of middle school girls with training r issues of sexuality, healthy relationships, absti e c e and contraceptive optr n , communication and decision- making skills and goal setting. Program. . will r._.cr it at least 10 irl (ages 1 . .... All participants ill demonstrate at least a 10% increase in knowledge about preventing and TI . Performance Mea r . .__ will measure... the competency levels f PPSAT participants through r and ost- ro r pre-test will be administered at the innin t he first session, the t-test will be administered immediately following the conclusio of the program. Measurable outcomes include change in o le , attitudes, and behaviors. ... Previous r Program nesuits Participants demonstrated 18% increase in knowledge i r post testing measurements current Year Estimated Results All participants will demonstrate at least a 10% increase in about preventing pregnancy I . Next Year Projected All participants will demonstrate at least a 10% increase in o le lie about o reventins re,nano and I . 4. Program tivi Name Create an alumni group graduates of education programs o will conduct annual service-learnin activities. Program al At least 8 graduates it ici C in the alumni group, and conduct an annual student-led ice-le r project. Performance measures PPSAT will seek out feedback fr the ro that the alumni group works with urin their service learning activity to cce the value of the participants' contribution. Previous ar Program Results alumni participated in a service-learning pr "ect and activities Current r Estimated Results At least 8 graduates will participate in the alumni group, PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION and conduct an annual student-led service-learning project. Next Year Projected Results At least 8 graduates will participate in the alumni group, and conduct an annual student-led service-learning •re'ect. 5. Program Activity Name At least 15 parents of middle and high school students will •artici•ate in "arent worksho•s. Program Goal At least 75% of parents will report increased comfort in talking with their kids about sexuality issues and intend to talk with their children about sex Performance Measures Participants will provide feedback on the quality of the program by completing surveys. Previous Year Program Results 88% of parents reported that they have an increased comfort in talking with their kids about sexuality issues and intend to talk with their children about sex. Current Year Estimated Results At least 75% of parents will report increased comfort in talking with their kids about sexuality issues and intend to talk with their children about sex Next Year Projected Results At least 75% of parents will report increased comfort in talking with their kids about sexuality issues and intend to talk with their children about sex. 6. Program Activity Name Host a series of workshops to help women of reproductive age assess their risk of pregnancy. Program Goal Teach at least 15 women of reproductive age about the benefits and availability of various contraceptive methods with 75% of participants reporting an increased understanding of their risk of pregnancy and have a plan for preventing unintended re nancies. Performance Measures Participants will provide feedback on the quality of the 'roe ram b corR•letin• surve s. Previous Year Program Results Conducted 8 workshops and 2 health fairs with women of reproductive age. 75% of those participating indicated a greater understanding of pregnancy risk and created a plan to prevent unintended pregnancy. Current Year Estimated Results Teach at least 15 women of reproductive age about the benefits and availability of various contraceptive methods with 75% of participants reporting an increased understanding of their risk of pregnancy and have a plan for preventin• unintended •resnancies. Next Year Projected Results Teach at least 15 women of reproductive age about the benefits and availability of various contraceptive methods with 75% of participants reporting an increased understanding of their risk of pregnancy and have a plan for •reventin• unintended pregnancies. PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 7. Program Activity Name Equip parents with information through Parent Matters Program Goal training and quarterly newsletters 10 parents will participate in Parent Matters training All parents will receive a quarterly newsletter Performance Measures ' Parents will complete an annual survey indicating the benefit of the training and information they receive via , the newsletter. Previous Year Program Results 1 This is a new goal that was not reflected in the previous year. Current Year Estimated Results 10 parents will participate in Parent Matters training and will utilize information from the training and newsletter to increase their knowledge base when talking with their children about sexuality. Next Year Projected Results 10 parents will participate in Parent Matters training and will utilize information from the training and newsletter to increase their knowledge base when talking with their children about sexualit c. PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME Actual Estimated Projected ' Percent PROGRAM REVENUE 2015-16 2016-17 , 2017-18 Change Private Donations $ - $ - $ - 0 Program Generated Revenue $ - $ - $ - 0 Local Government Grants: EMIIIIIMIll Human Services-Town of Carrboro $ 1,000 $ 1,000 $ 1,000 0% Other-Town of Carrboro - 0 Human Services-Town of Chapel Hill $ 2,500 . $ 2,500 $ 2,500 : 0% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County ,$ 20,000 $ 20,000 $ 20,000 0% Other-Orange County $ - $ - $ - , 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBG/HOMEJetc.) $ - $ $ - 0 Private Foundation Grants $ 5,000.00 $ 12,500.00 $ 12,500.00 $ - Other Revenue $ - $ - $ - 0 IIIIIMINI Total Program Revenue $ 28,500 $ 36,000 $ 36,000 0% PROGRAM EXPENSES Compensation $ 21,573 $ 21,543 $ 22,495 4% Rent&Utilities $ 1,150 $ 1,150 $ 1,150 0% Supplies& Equipment $ - $ 2,934 $ 2,240 -24% Travel&Training $ - $ 3,049 $ 3,029 -1% Other Expenses: $ 9,210 $ 9,210 $ 10,160 10% MIIIM Total Program Expenses $ 31,933 $ 37,886 $ 39,074 3% SURPLUS/(DEFICIT) FOR PERIOD: $ (3,433)1 $ (1,886)1 $ (3,074)1 -63% DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program: Sexual Health Education and Outreach Cost Elements Cost (_,$) Quantity/Unit of measure Subtotal($) Refreshments Teen Voices(TV),Smart Girls, $7 'TV- 15 participants x 12 sessions $3,132 Alumni Smart Girls - 10 participants x 10 sessions Alumni--8 participants x 12 sessions, 1 Graduations-TC$200,SG,$150,PM$150 Refreshments- Parents,chats $7 5-15 participants per workshop x 2 parent ' $280 workshops and 2 chats Incentives . Gift Cards $300+$2 fee TV- 15 participants $4,530 $100+$2 fee Smart Girls- 10 participants $1,020 $50 1 drawing per workshop x 2 nt $200 workshops and 2/chats Parent Matters incentives$15x5 sessions $750 x10,parents Incentives-T-shirts $7.50 TV-- 15 participants $247.50 Smart Girls—10 participants Alumni-8 participants Rental Variable , TV and Smart Girls-$300 each $1,150 . nts and chats-$200 each Alumni-$150 Mileage- Community Educator $0.54 175 miles per month x 12 $1,134 1, Training-New Educator on curriculum $995 1 participant $995 I Copies : ', $0,50 800 copies for worksheets,promotional fliers $400 Office Supplies $40 Per month x 12 $480 Brochures $40 Per 100 x 10 topics $400 , Promotional materials-swag $2 3 promotional items(keychains,pens, $ I carbineers,etc) x 150 of each Guest Trainers- TV $100 2 speakers $200 Peer Assistant - TV $100 1 assistant $100 Supplies for Child Care $40 I Per workshop,2 nt workshops and 2 $160 chats Field Trip--Bus rental for Youth Advocacy Day $420 1 day $420 A PPCNC Conference $250 2 registrants $500 Education Materials- TV $20 Worksheets x 15 participants $300 Postage $0.49 50 stamps per month x 12 $294 Salary -Community Health Educator 2 educators x 50%of time each Salary Sr. Director of Education 1 director x 5%of time Benefits--25% 2 staff salary x 25% Total $39,074 3. This program budget represents what percent of the agency budget? 002% ,C COST PER INDIVIDUAL PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID: D13694BA-66F1-4441-9114-5334F2B6AC3D XHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 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 Projected2017-18 Total Cost of Program $34,241 $38,836 $39,074 Total #of Individuals 363 373 373 Cost Per Individual $106.72 $104.11 $104.75 PROGRAM INFORMATION 1/27/2017 3:10:56 PM DocuSign Envelope ID:Dl3694BA-66F1-4441-9114-5334F2B6AC3D EXHIBIT `B" Scope of Services—FY 2017-18 Outside Agency Performance Agreement Agency Name: Planned Parenthood South Atlantic Program Name: Sexual Health Education and Outreach Funding Award: $20,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel—Salaries $20,000 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Using an evidence-based curriculum, provide a diverse group of highschool teens with training around issues of sexuality. • Peer-educators will work within their schools and communities to disseminate to others the information they have learned. • Using an evidence-based curriculum, provide a diverse group of middle school girls with training around issues of sexuality. • Provide parent workshops • Host workshops to help women of reproductive age assess their risk of pregnancy. 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 Recruit at teens(ages 14-18)for evidence-based sexuality program. 15 Recruit girls(10-14)for middle-school science-based sexuality program. 10 Participants of multi-session programs will demonstrate an increase in knowledge about 10%increase preventing pregnancy and STIs Peer educators will make contact in their community 20 each Recruit parents of middle and high school students for parent workshops 15 Parents will report increased comfort in talking with their kids about seuxality. 75% Recruit community members for single-session workshops about birth control,reproductive 15 health,and sexual Docusjgned by: Jam' HAtk. President and CEO 10/10/2017 Certified by: �DrEP9qP1,90A27A90 Title: Date: (Provider's Signature) DocuSign Envelope ID:D13694BA-66F1-4441-9114-5334F2B6AC3D 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: President and CEO 10/10/2017 Certified by: DCFE23890427490... Title: Date: (Provider's Signature) (Planned Parenthood South Atlantic) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID:Dal 3694BA-66F 1-4441-91 14-5334F2B6AC3D ,4cOz° DATE(MM/DD/YYYY)® CERTIFICATE OF LIABILITY INSURANCE 07/20/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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 Marsh USA,Inc. NAME: PHONE FAX 1166 Avenue of the Americas (A/c,No,Ext): (NC,No): New York,NY 10036 E-MAIL Attn:healthcare.accountscss @marsh.com Fax:212-948-1307 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# 109210-NIP-CAS-17-18 CHA,N GL INSURERA:New Hampshire Insurance Company 23841 INSURED LANNED PARENTHOOD SOUTH ATLANTIC INSURER B:NIA N/A AN AFFILIATE OF PLANNED INSURER C: PARENTHOOD FEDERATION OF AMERICA,INC INSURER D 1765 DOBBINS DRIVE CHAPEL HILL,NC 27514 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-010043195-01 REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY 082695195 01/01/2017 01/01/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO CLAIMS-MADE X OCCUR PREMISES Ea occur ence ) $ 500,000 X SIR:$100,000 MED EXP(Any one person) $ Included PERSONAL&ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT X LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:SEXUAL HEALTH EDUCATION PROGRAMS ORANGE COUNTY GOVERNMENT IS INCLUDED AS ADDITIONAL INSURED AS THEIR INTERESTS MAY APPEAR. CERTIFICATE HOLDER CANCELLATION ORANGE COUNTY GOVERNMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 SOUTH CAMERON STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HILLSBOROUGH,NC 27278 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Ricki Fitzsimmons ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD