HomeMy WebLinkAboutAgenda - 11-20-2017-12-2 - Information Item - Transmittal of the FY 2018-19 Human Services Funding Application
FINANCE AND ADMINISTRATIVE SERVICES
An Equal Opportunity/Affirmative Action Employer
www.orangecountync.gov
MEMORANDUM
TO: Orange County Board of County Commissioners FROM: Allen Coleman, Orange County Government Jackie Thompson, Town of Chapel Hill Annette Lafferty, Town of Carrboro DATE: November 3, 2017 RE: Transmittal of the FY 2018-19 Human Services Funding Application Each fiscal year, non-profit organizations that deliver vital community services have the ability to apply for program funding from Orange County, the Town of Chapel Hill, and the Town of Carrboro. The FY 2017-18 application presented three types of available funding sources: Human Services (Outside Agencies), Community Development Block Grant (CDBG), and Home Investment Partnership Programs (HOME). A variety of positive feedback was received from: representatives of the third sector alliance, various town and advisory board members, and executive directors of non-profits related to the FY 2017-18 application as a result of our revisions from the previous FY 2016-17 funding cycle. A meeting was held in September of 2017 with both municipal and county staff to discuss any feedback and revisions related to the FY 2017-18 funding application. Each section of the application was reviewed thoroughly. Questions within each section were discussed and restructured, allowing agencies to be clear and concise in their responses, while still providing vital information to application reviewers. We are pleased to present to you the attached FY 2018-19 Human Services funding application. The municipal and county staff would like to thank each of the local agencies for their hard work each and every day which makes Orange County a great place to live, work and play!
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FY 2018-2019
Outside Agency
Funding Application
HUMAN SERVICES
• ORANGE COUNTY
• TOWN OF CARRBORO
• TOWN OF CHAPEL HILL
Orange County (OC)
200 S. Cameron Street
Hillsborough, NC 27278
Town of Carrboro (CA)
301 W. Main Street
Carrboro, NC 27510
Town of Chapel Hill (CH)
405 Martin Luther King, Jr. Blvd.
Chapel Hill, NC 27514
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INFORMATION
Each year, Orange County Government, the Town of Carrboro and the Town of Chapel Hill
invite program funding requests from non-profit providers that support the delivery of vital
community services.
The application process is very competitive and not all applicants will be awarded funding.
Recommendations for funding may be for an award amount less than that requested by the
applicant.
Agencies that are currently receiving funds from Orange County, the Town of Carrboro, or
the Town of Chapel Hill local governments, and are also applying for new funds, must be in
compliance with all terms of their current agreement(s) and must not have any outstanding
audit findings, monitoring findings or concerns as determined by the municipality.
Recipients are required to submit written progress reports on their SMART Measures that
include: goals, description of activities/challenges, revisions of timelines/budgets, and other
relevant information
Funded projects will be monitored for progress and performance, financial and
administrative management, and compliance with the terms of Performance/Development
Agreement(s). Monitoring may involve site and/or office visit(s).
Once applications are received, they are reviewed by staff for completeness and eligibility.
The applications are presented to a specific application review group, depending on the
funding source. The review group will make a recommendation, based on available funding
and the priorities identified by the participating jurisdiction. The recommendation is
presented to the appropriate Board/Council for consideration and approval. The
Board/Council approves/adopts the final allocations.
TIMELINE
November 7 Funding Application Posted on Websites
November 28 (9:00am-noon) Funding Application Orientation Workshop
November 7-January 22 Agency Prepares Application
December 5 (9:00am – noon)
December 12 Inclement Weather Date
January 9 (9:00am-noon)
January 12 Inclement Weather Date
Q&A Sessions Held-Chapel Hill Public Library
Meeting Room A
Meeting Room A
Meeting Room A
Meeting Room B
January 23 Applications Due 5:00pm
March - May Application Review & Agency Presentations
June Agency Funding Approval by Board/Council
July Contracts Executed & Programs Begin
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SUBMITTAL INFORMATION
Welcome to the Outside Agency Common Funding application for local/general funds,
which will be distributed through this competitive application process. All entities or
organizations requesting funds must complete and submit this application prior to
the deadline to be considered for FY 2018-2019 funding.
The Application Submittal Deadline is: Tuesday, January 23, 2018 5:00 PM
In the event of inclement weather, check the website for each Town/County you are
applying to, for further instructions.
Please note that late, handwritten, or incomplete applications will not be accepted.
(Applications not signed by the Chair or President of the Board of Directors, are considered
incomplete.)
An application orientation workshop will tentatively be held on Tuesday, November 28,
2017 at 9 AM to Noon to review the application and submittal requirements.
SUBMITTAL REQUIRMENTS FOR ALL MUNCIPALITIES
Application should be submitted in the following format and labeled with the following file
names.
Application (Agency Cover Sheet, Agency Information, Program Information)
A. Financial Audit
B. IRS Federal Form 990
C. NC Solicitation License
D. IRS Federal Tax-Exemption Letter
E. Certificate of Insurance
F. List of Board of Directors
G. Solid Waste Program Fee (SWPF) Verifications
SUBMITTAL REQUIREMENTS FOR EACH MUNICIPALITY
Human Services– Town Of Carrboro
Applications are accepted once a year and reviewed by the Town’s Human Services
Advisory Commission, which makes a recommendation for funding to the Board of
Aldermen for final approval.
For more information about the Town of Carrboro Human Services program, see here.
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Questions and submittals should be directed to:
Annette Stone,
301 W. Main Street
Carrboro, NC 27510
919-918-7319
astone@townofcarrboro.org
Submission:
We strongly encourage applications to be single-spaced, with 12-point arial
font and normal margins.
Application: One (1) original plus Two (2) paper copies of the application
must be hand delivered or mailed to Annette Stone, 301 West Main
Street, Carrboro, NC 27510; AND
One Application and Attachments files must be submitted by email in pdf
format.
Human Services – Town Of Chapel Hill
In 1982, the Town established local funding to support local nonprofit organizations that
carry out human service work throughout the community.
Applications are accepted once a year and reviewed by the Town’s Human Services
Advisory Board, which makes a recommendation for funding to the Town Council for final
approval.
For more information about the Town of Chapel Hill Human Services program, see here.
Questions and submittals should be directed to:
Jackie Thompson
405 Martin Luther King Jr. Blvd.
Chapel Hill, NC 27514
919-969-5081
jthompson@townofchapelhill.org
Submission:
We strongly encourage applications to be single-spaced, with 12-point arial
font and normal margins.
Application: Two (2) paper copies of the application with ORIGINAL
signatures must be hand delivered or mailed to Jackie Thompson, 405
Martin Luther King, Jr. Blvd., Chapel Hill, NC 27514; AND
Attachments: The application submittal must be accompanied by a flash
drive with the application and all attachment files in electronic format. PDF
files must be accompanied by the original file format of .doc, .xls, etc.
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Human Services– Orange County
For more information about the Orange County Human Services program, see here.
Questions and submittals should be directed to:
Allen Coleman
PO Box 8181
Hillsborough, NC 27278
(919) 245-2151
acoleman@orangecountync.gov
Submission:
Email application and ALL Attachments prior to the deadline in pdf
format only. Please request a delivery receipt of email with application
and attachments.
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Agency ______________________________
Program(s) ______________________________
Section Subsection
1. Cover Page
a. Applicant Contact Information
b. Funding Requests
c. Signed Application Cover Page
d. Signed Disclosure of Conflicts of Interest and Clause
2. Agency Information a. Agency’s Years in operation
b. Agency’s Purpose/Mission
c. Agency’s Types of Services Provided
d. Agency’s Experience with Programs
e. Other Pertinent Agency Information
f. Schedule of Positions
g. Living Wage
h. Agency Budget
3. Program Information
A separate Section 3 is
required for each program.
a. Human Services Needs Priority
b. Type of Program
c. Agency Collaboration
d. Summary of Program
e. Description of Identified Need
f. Description of Population to be Served
g. Program Staffing, Capacity, & Expertise
h. Program Implementation Timeline
i. Value of Investment
j. Impact of Reduced/No Allocation
k. Other Pertinent Information
l. Target Population/Beneficiary Chart
m. Work Statement
n. Program Budget, Detail, & Cost per Individual
FOR OFFICE USE ONLY
Received By ________
Date/Time ___________/_________
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4. Attachments
a. Audit: Organizations receiving $300,000 or more in Federal
financial assistance, and/or organizations with more than $500,000
of receipts and expenditures in a fiscal year, must secure an audit.
b. IRS Federal Form 990
c. NC Solicitation License
d. IRS Federal Tax-Exemption Letter
e. Certificate of Insurance
f. List of Board of Directors
g. Solid Waste Program Fee (SWPF) Verification
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1. COVER PAGE
a) Applicant Contact Information
Applicant Organization’s Legal Name:
Applicant Organization’s Physical Address:
Applicant Organization’s Mailing Address:
Applicant Organization’s Web Address:
Executive Director:
Telephone Number: E-Mail:
Tax ID Number:
b) Funding Request
List all FY18-19 Human Services (HS) Funding Being Requested –
For All Programs) and the Proposed Use of Funds (2-3 lines or less)
Program Carrboro
- HS
Chapel
Hill - HS
Orange
County-HS
Total
Ex. Youth Afterschool Program
Afterschool Program Coordinator salary and materials
for youth activities and projects
$10,000 $15,000 $5,000 $30,000
Totals
c) To the best of my knowledge and belief all information and data in this application is
true and current. The document has been duly authorized by the governing board of the
applicant.
Signature:
Executive Director Date
Signature:
Board Chairperson Date
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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:
Executive Director Date
Signature:
Board Chairperson Date
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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):
b) Agency’s Purpose/Mission (no more than a few sentences):
c) Types of Services the Agency Provides (bullet format):
d) Agency’s History with Providing These Services:
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?)
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:
# of FTE - Paid Part-Time Positions:
# of Volunteers: # of FTE - Volunteers:
g) Living Wage
Does this agency pay permanent employees a minimum living wage? (Yes / No)
If yes, is this agency an Orange County Living Wage Certified Employer?
If no, please explain.
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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)
If yes, please list below:
Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill,
and Orange County governments (other than Human Services). DO NOT include federal
funding sources, such as CDBG and HOME.
Program FY17-18
Award
FY18-19
Request
Source
Ex: Affordable Rental
Rehabilitation
0 $20,000 Carrboro - Affordable Housing
Ex: Agency Administration $15,000 $15,000 Carrboro – Other
Ex. Total $15,000 $35,000 Carrboro Total Funding
*Add rows or attach additional page, if needed.
ii. Submit your agency’s budget. You may complete the provided template (separate
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)
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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?
Is there a significant change? Yes/No
Please provide a brief explanation for Surplus or Deficit, and significant changes.
iv. What is your agency’s fiscal year?
(Example: July 1, 2016 through June 30, 2017)
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3. PROGRAM INFORMATION (Submit a separate Section 3 for each program)
Program Name:
Program Primary Contact and Title:
Telephone Number: E-Mail:
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)
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 information about the proposed program:
d) Summarize the program services proposed and how the program will address a
Town/County priority/goal?
e) Describe the community need or problem to be addressed in relation to the Chapel Hill
Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of
Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e.
Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill
Human Services Needs Assessment) to support the need for this program.
Program Category Youth Adult Elderly Disabled Public Housing
Neighborhoods/Residents
Affordable Housing
Affordable Healthcare
Education
Family Resources
Jobs/Jobs Training
Food
Transportation
Other: Please specify
_________________
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f) Who is your target population of individuals to benefit from this program and how will they
be identified and connected with the program?
g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program
Manager and credentials, describe training provided to volunteers, etc.)
h) Describe the specific period over which the activities will be carried out and include an
implementation timeline.
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)
j) Describe what would happen if requested funding is not awarded at all or if a reduced
allocation is recommended.
k) What percentage of your target population is low-moderate income?
l) What efforts do you make to seek feedback about your program from your target population
(e.g. survey, evaluations, etc.?)
m) Include any other pertinent information.
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Additional Program Information
n) 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
2016-17
Estimated
2017-18
Projected
2018-19
Gender
Male
Female
Total 0 0 0
Ethnicity
African-American
American Indian or Alaska Native
Asian
Caucasian
Native Hawaiian or other Pacific Islander
Other: specify __________________
Total 0 0 0
Of the above, how many Hispanic/Latino
Of the above, how many non-Hispanic/Latino
Total 0 0 0
Age
0-5 years
6-18 years
19-50 years
51+ years
Total 0 0 0
Geographic Location
Alamance County
Chatham County
Durham County
Wake County
Orange County Breakdown
Chapel Hill Public Housing
Town of Chapel Hill (Non-Public Housing)
Town of Carrboro
Town of Hillsborough
City of Mebane (Orange County)
Orange County (Outside Municipalities)
Total 0 0 0
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Work Statement
o) 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 ___________________________________________
1. Program Activity Name
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
2. Program Activity Name
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
3. Program Activity Name
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
4. Program Activity Name
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
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p) Program Budget
1. Submit your program 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,
in the same format, as requested in the provided template).
Program Budgets are required to define budget amounts for the previous program
year, current program year, and next program year for the following categories:
• Revenues
o Private Donations
o Program Generated Revenue
o Local Government Grants
Carrboro Human Services
Carrboro Other
Chapel Hill Human Services
Chapel Hill Other (DO NOT include CDBG funding here)
Orange County Human Services
Orange County Other (DO NOT Include HOME funding here)
o Other Government Grants
Triangle United Way
State Government
Federal Government (CDBG/HOME/etc.)
Private Foundation Grants
o Other Revenue
• Expenditures
o Compensation
o Rent & Utilities
o Supplies & Equipment
o Travel & Training
o Other Expenses
2. Program Budget Detail – Provide description of “other” budget items, not defined.
3. This program budget represents what percent of the agency budget? %
4. COST PER INDIVIDUAL
This Cost per Individual must reflect the total program budget divided by the total number of
program individuals in this application.
Actual 2016-17 Estimated 2017-18 Projected 2018-19
Total Cost of Program
Total # of Individuals
Cost Per Individual
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4. ATTACHMENTS
Description of Required Attachments
a) Financial Audit
A recent financial audit that should cover CY 2016, for calendar year agencies, and FY
2016-17, for fiscal year agencies. For agencies with prior year revenues totaling $500,000 or
more a financial audit, prepared by a certified public accountant is required. Agencies with
prior year revenues of less than $500,000 may submit a completed Schedule of Receipts
and Expenditures form (see application materials), in lieu of an audit/report. Agencies with a
certified audit/report should not complete the form.
b) IRS Federal Form 990
A copy of the agency’s 2014 Form 990 is required. The specific form depends upon the
agency’s financial activity. Review the IRS’ table guide, for more details. For Form 990-N (e-
postcard) filers, include a copy of the postcard, with the agency’s application materials.
c) NC Solicitation License
A copy of the agency’s current solicitation license is required. Organizations that solicit
contributions in North Carolina, directly or through a third party, must renew their licenses
annually. For more details, refer to the NC Secretary of State’s licensing website and its
Frequently Asked Questions Guide (PDF), about exemptions. If exempt per N.C.G.S. §
131F-3, include a copy of the exemption letter with the agency’s application materials.
d) IRS Federal Tax-Exemption Letter
A copy of the agency’s IRS tax-exempt letter that confirms its nonprofit status is required. An
agency can request a copy of its letter from the IRS’ Customer Account Services.
e) Certificate of Liability Insurance
A copy of the agency’s current certificate, from the agency’s insurance carrier. Table 1
below outlines insurance types and minimums required, for each jurisdiction. If exempt from
Worker’s Compensation compliance, include a statement explaining why, with the agency’s
application materials. *Note: If Approved for Funding: Approved agencies must provide an
updated insurance certificate. The update should reflect the funding jurisdiction as an
additional insured party and certificate holder and provide coverage for the duration of the
funding period (July 1 – June 30). Renewal certificates must be sent to the jurisdiction 30
days prior to any expiration date, cancellation or modification of any stipulated insurance
coverage.
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Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required
INSURANCE TOWN OF CARRBORO TOWN OF CHAPEL HILL ORANGE COUNTY3
Worker's
Compensation1
Limits for Coverage
A - Statutory State
NC, for each
employee
Limits for Coverage
B - Employers
Liability of:
$1 million Each
Occurrence
$1,000,000 BID2
limit
Limits for Coverage A -
Statutory State NC, for
each employee
Limits for Coverage B -
Employers Liability of:
$100,000 Each Occurrence
$100,000 BID for each
employee
$500,000 BID limit
Limits for Coverage A -
Statutory State NC, for
each employee
Limits for Coverage B -
Employers Liability of:
$500,000 each
accident, $500,000
BID for each employee
$500,000 for BID limit
Commercial
General
Liability
$100,000 Property
Damage Liability
$1,000,000 Bodily
Injury and Property
Damage Limit
$1 million Each Occurrence
$2 million Aggregate
$1 million Each
Occurrence
$2 million Aggregate
Automobile
Liability Not Applicable $1 million Each Occurrence $1 million Each
Occurrence
Professional
Liability Not Applicable $1 million Each Occurrence
$2 million Aggregate
$1 million Each
Occurrence
$2 million Aggregate
Sexual Abuse &
Molestation Not Applicable $1 million Each Occurrence
$2 million Aggregate
$1 million Each
Occurrence
$2 million Aggregate
Cyber Liability
Not Applicable $1 million Each Occurrence
$2 million Aggregate
$1 million Each
Occurrence
$2 million Aggregate
1. Visit the NC Industrial Commission’s website for more information regarding Coverage A.
Also, note that if an agency uses subcontractors, it must require subcontractors to have
workmen’s compensation insurance.
2. Bodily Injury by Disease (BID)
3. Please visit Orange County’s Risk Management page for more information about the
County’s Minimum Insurance Requirements.
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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 2017-18 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.
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