HomeMy WebLinkAbout2018-018-E Finance - Senior Care of Orange County performance agreementDocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D
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 Senior Care of Orange County, Inc, a not- for - profit
corporation, located at 105 Meadowland Drive, Hillsborough, NC 27278 ( "Provider ").
WITNESSETH:
WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby
enhance its availability to residents of the County, and said program addresses an important community
human services need, as identified by the Board of Commissioners;
NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set
forth, the County and Senior Care of Orange County, Inc agree as follows:
1. Term of the Agreement. The term 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 35000
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.
The Provider shall be paid in four equal installments in the amount of 8750. 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.
(Senior Care of Orange County, Inc)
Orange County Outside Agency Performance Agreement
Revised 712017 Page I of 7
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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.
Orange County Outside Agency Performance Agreement Page 2 of 10
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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
• Commercial General
Liability
• Automobile Liability
• Professional Liability
Limits for Coverage A - Statutory State
NC & Coverage B - Employers Liability
$500,000 each accident, disease policy limit and
disease each employee
$1,000,000 Each Occurrence
$2,000,000 Aggregate
$500,000 Combined Single Limit
$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.
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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 Senior Care of Orange County,
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:
Orange County Outside Agency Performance Agreement Page 4 of 10
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DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D
County: Finance & Administrative Services
Orange County
Post Office Box 8181
Hillsborough, NC 27278
Provider: Senior Care of Orange County,
Inc
105 Meadowland Drive
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 I IA 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.
Fora der
C5655FF72C3C602.
Orange County Outside Agency Performance Agreement
Rev. 7117
1/22/2018
Date
Page S of 10
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D
For and on ldf b: P inge County Government
6V�.IA.it, h;404t yV'
r15e '
9637994 E375SE477
Bonnie Hammersley, County Manager
Orange County Outside Agency Performance Agreement
Rev. 7117
Date
1/24/2018
Page 6 of 10
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
1. COVER PAGE
a) Applicant Contact Information
Applicant Organization's Legal Name: Senior Care of Orange County, Inc.
Applicant Organization's Physical Address: 105 Meadowland Drive
,Hillsborough, NC 27278
Applicant Organization's Mailing Address: 105 Meadowland Drive, Hillsborough, NC 27278
Applicant Organization's Web Address: www.soltysdayhealth.org
Executive Director: Alvonia Baldwin
Telephone Number: 919- 245 -2017
Tax ID Number: 56- 2460614
E -Mail: albaldwin @oranc�ecountync.gov
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 .
Hill - HS
Oran a
Coun -HS'
Total
- Hs
TheAdf�lt day Health Program, Opelatlons,
progxamrnt sppl[es anal days ofetvice fQT the;
"" z" 2 ✓ z-`'5 .
$'l 500
�r ✓
$2,500
$40400
Totals
$1,500
$2,500
$40100.0
$44,000
c) To the best of my knowledge and belief all information and data in this application is
true and current. The document has been duly authorized by the governing board of the
applicant.
Signature:
Executive Director
Signature: W. � —
Board Chail erson
IJ2 :Z
Date
11-:17 %
Date
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D 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
❑ X❑ a) Employees of or closely related to employees of the Town of Carrboro, the Town
of Chapel Hill, or Orange County?
❑ X❑ 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?
❑ X❑ c) Current beneficiaries of the program for which funds are being requested?
❑ X❑ 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.
NONDISCRIMINATION
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 anv arant awarded.
Signature: 112--1111
Executive Director Date
Signature: 1/ ,27/�b1]
Board Ch irperson Date
AGENCY INFORMATION 1/23/2017 5:02:47 PM Page 9 of 27
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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): Senior Care of Orange
County was incorporated in March of 2004 with 13 Vears of operation.
b) Agency's Purpose /Mission (no more than a few sentences): The mission of the Florence Gray
Soltys Adult Day Health Program is to provide social and health services to frail, disabled
and isolated adults 18 years and older with special needs that will benefit from Adult Day
Health programs. Stimulating activities, enriching programs, provision of nutritious meals
and snacks as well as rehabilitative services are offered. The program also provides
respite and education for family members and caregivers. The primary goal is to prevent or
delay the onset of institutionalization of participants.
The vision of Senior Care of Orange County, Inc. is to advocate, establish and operate
programs that provide services for frail or disabled older adults to remain in their homes
with their family as long as possible. The 65 and older adult is the fastest growing
population segment.
c) Types of Services the Agency Provides (bullet format):
• A safe & friendly environment
• Qualified Nurses and Therapist for Health Monitoring
• Socialization to prevent isolation
• Caregiver Respite
• Therapeutic Programming
• Safe & Stimulating Environment
• Quality of Life and meaningful /purposeful programs
d) Agency's History with Providing These Services: Over the past 14 years the need for
Adult Day Health services continues to increase. The continued growth of the area and
cost of healthcare for seniors to attend our program remains a challenge. Through the
years, we have made great efforts and will continue to collaborate with the recruitment
process to assist participants from the Department of Social Services (Medicaid
CAP /DA) and the Veteran's Administration who will financially support the participants
with low incomes and/or medical needs to utilize the Day Health Program as an option
to in -home care services. This option may also help with the social interaction of each
and every participant enrolled in the program. We will reapply for the Home Community
Care Block Grant from Triangle J Council of Governments for continued funding to help
support days of coverage for Adult Day Care and Health funding options.
e) Other Pertinent Agency Information (Ex. Has the agency experienced any major in the
past year? Is there a new Executive Director? Are there new initiatives ?) Over the past
year their has been an increase in the health component of the program as the
acuity levels of the participants requires more staffing to ensure their needs are
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safety being met. With this increase, it has impacted more 1:1 assistance which
effects the pay scale supported by the revenue.
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: 5
# of FTE - Paid Part -Time Positions: 15
# of Volunteers: 4 # of FTE - Volunteers: 0
g) Living Wage
Does this agency pay permanent employees a minimum living wage? No
If yes, is this agency an Orange County Living Wage Certified mEmployer?
If no, please explain.
Due to the new increase of the living wage, and limited budget resources, Senior Care
of Orange County; Inc, is unable to provide to our Part-time and per diem employees
the new wage increase. Our goal beginning, mid February 2017, is to ensure that all
full -time and regularly scheduled employees are at the minimum living wage.
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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? 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. NIA
Program . IFY16-17 I 1= Y97 -98 I Source
Award Request
*Add rows or attach additional page, if needed.
ii. Submit your agency's budget. You may complete the provided template (separate
As 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:
(See Attached Operating Budget for the Agency)
Revenues
• Private Donations
• Program Generated Revenue
• Local Government Grants
• Carrboro Human Services
• Carrboro Other
• Chapel Hill Human Services
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• Chapel Hill Other (DO NOT include CDBG funding here)
• Orange County Human Services
• Orange County Other (DO NOT Include HOME funding here)
• Other Government Grants
• Triangle United Way
• State Government
• Federal Government (CDBGIHOMEIetc.)
IN Private Foundation Grants
• Other Revenue
Expenditures
• Compensation
• Rent & Utilities
• Supplies & Equipment
• Travel & Training
• Other Expenses
iii. Does your agency budget show a Surplus or Deficit? Deficit
Is there a significant change? Yes /No Yes
A significant change for Senior Care of Orange County has been a challenge over the past
fiscal year. The Florence Gray Soltys Adult Day Health Program has various third party
payer sources and due one; the Veterans Administration is currently providing limited
funding days of service for approved Veterans. In the past; Veterans would qualify for
attendance in the program for up to five days per week, where now its three days. The
increase in the cost of living wage, where the program cost per day of service has
remained the same. The staffing changes due to limited wages and employees needing
benefits. (Staffing Turnover)
iv. What is your agency's fiscal year? July 1, 2016 —June 30, 2017
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3. PROGRAM INFORMATION {Submit a separate Section .3 for each program}
Program Name: Florence Gray Soft Vs Adult DaV Health Program
Program Primary Contact and Title: Alvonia Baldwin Director
Telephone Number:
919- 245 -2017
E -Mail: albaldwin(cDorangecountync.gov
a) Indicate the type of Human Service Needs Priority, if program applicable:
X Priority Area #1: safety -net services for disadvantaged residents
❑ Priority Area #2: education, mentorship, and afterschool programming for
youth facing a variety of challenges
X 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 Cafiegory`
Youth
Adult
Elderly
Disabled
Publ4c Ho�s�ng
,
NeighbbrhaadslRestdents
Affordable Housing
Affordable Healthcare
Education
Family Resources
X
X
Jobs /Jobs Training
Food
Transportation
Other: Please specify
Adult Day Health
Program
X
X
X
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.
• Orange County Department on Aging- Referrals to our program from OC
Cares, Caregiver Respite Support, $25,000 in -kind donation for meals.
• Orange County Department of Social Services- Referrals from the adult
division of DSS
• Triangle J Council of Governments- ( HCCBG) Home Community Care Block
Grant Funding annually for adult day health and social participants.
• The Veterans Administration Services; maintains a federal contract for Adult
Day Health qualified Veterans.
Program Description (3 pages OR LESS)
Please provide the following information about the proposed program:
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d) Summarize the program services proposed and how the program will address a
Town /County priority /goal? This is a request to continue with the financial support
provided to the Florence Gray Soltys Adult Day Health Program under the auspices of
Senior Care of Orange County, Inc. This program originally started by the County
Department on Aging as a major Master Aging Plan funded initiative. County and Town
funds are critical for the continuation of this one of a kind program that serves the
severely frail elderly and adults with special needs in Orange County. We have seen
growth from residents of Chapel Hill and Carrboro needing Adult Day Health services
since 2014. The program expanded on February 4, 2009 as a partnership with the
county to continue to work towards meeting the goals of the Master Aging Plan of
Orange County. The request for funding from each participating jurisdiction is a huge
priority with helping to prolong and/or prevent institutionalization. This would allow the
individual to age in place within their home and community as statistics show that adults
are living longer. This program will continue to provide quality of care; with dignity and
respect to all individuals in which we serve ages 18 and up. (Please note that the
average age is 80 years old.)
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. The Florence Gray Soltys Adult Day Health Program is a
therapeutic, health - focused program for adults and seniors that offer a variety of services in
a home -like setting that is open from 7:30am to 5:30pm, Monday - Friday.
The significant need for this program is growing rapidly as more seniors age in place with
various diagnosis ranging from, but not limited to dementia, Parkinson's and diabetes. The
program allows more opportunities for families to feel reassured of the care and safety that
their loved one receives. From year to year, the number of participants enrolled in program
continues to grow. Currently the program is averaging 23 participants per day, with a
capacity for up to 29 per day. The support from the Towns and County would continue to
provide day health services for the individual in the community.
f) Who is your target population of individuals to benefit from this program and how will they be
identified and connected with the program? Our targeted population is individuals 65 years of
age and older. The need of this program is growing rapidly as more seniors age in place
with various diagnosis ranging from, but not limited to dementia, Parkinson's disease,
CVA and Diabetes (physical & cognitive related diagnoses) Identifying and connecting
this populations' needs would remain through the outside collaboration efforts with The
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Department on Aging, Triangle J Council of Governments, The local Veteran's Affairs
Officer, Physician /Provider Offices, Civic Groups, Churches Senior Advisory Committees,
Social Media efforts and continued word of mouth through the community.
g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program
Manager and credentials, describe training provided to volunteers, etc.) The credentials of
the Program Director and other key staff must hold at minimum, a Bachelors Degree
from an accredited University. The current Director has over twenty -five years of
experience working within the senior population. As the Director of the Florence Gray
Soltys Adult Day Health Program, the current director remains and has nine years of
experience in managing and operating the program. The support of other key staff is
pertinent to the continue success of operations which includes a program coordinator,
social worker, recreational therapist and healthcare coordinators in which this position
is held by registered nurses.
h) Describe the specific period over which the activities will be carried out and include an
implementation timeline. The activities carried out for providing funding for adult day
health services and continued program operations is ongoing and will continue through
the July 1, 2017 -June 30, 2018 fiscal year. The funding will help the continuation of
services for families in need of Adult Day Health programming and additional days as
needed along with program operations that would include but not limited to medical,
office and activity supplies, some food cost with am and pm snacks, training (i.e. staff
development on a quarterly basis and new staff orientation.) The services for the
participants would vary on each individual's need base. (i.e. one —two days per week,
short -term and /or long- term.)
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 is a request to
continue with the funding support provided to the Florence Gray Soltys Adult Day Health
Program under the auspices of Senior Care of Orange County, Inc. Continuation of the
funding support remains a good and valued investment. This program originally started
by the County Department on Aging as a major Master Aging Plan funded initiative.
County and Town funds are critical for the continuation of this one of a kind program
that serves the severely frail elderly and adults with special needs in Orange County.
We have seen growth from residents of Chapel Hill and Carrboro needing Adult Day
Health services since 2014. The program expanded on February 4, 2009 as a
partnership with the county to continue to work towards meeting the goals of the Master
Aging Plan of Orange County. The request for funding from each participating
jurisdiction is a huge priority with helping to prolong and/or prevent institutionalization.
The value of this program helps to increase awareness of the need of services and
would allow the individual to age in place within their home and community as statistics
show that adults are living longer and healthier lives. This program will continue to
Page 16 of 26
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
provide quality of care; with dignity and respect to all individuals in which we serve ages
18 and up.
j) Describe what would happen if requested funding is not awarded at all or if a reduced
allocation is recommended. If funding was a reduced allocation; hopefully the program
would continue to sere as many participants and their families as possible which may
reduce the daily average of individuals enrolled in the program due to limited funding
sources. We would hate to fathom if funding was not awarded. If this scenario were to
happen to Orange County's one of a kind Adult Day Health model; this would be a
huge impact for all the families that we serve. This unique program is committed to the
health and well being of adults with physical and mental impairments that come along
with the aging process. As Orange County continues to grow, with the new UNC
hospital and new residential communities this shows a need of Adult Day Health
services. Again, this program is able to provide a safe, stimulating, friendly
environment to meet the quality of life for frail individuals that may need a bit more of
structure in their day to day activities along with health care monitoring. Funding not
awarded would also impact working caregivers and veterans of Orange County.
Working caregivers may need to retire early or leave a position to care for their loved
ones and with the Veterans, unable to provide the contracted services for the men and
women that have served our country due to the lack of financial sustainability. Our
program fees are based on a sliding scale of the individual in need of our program.
This program was designed to meet the needs of all families that we serve. Majority of
our population about 90% have at least a dementia diagnosis which is growing rapidly
in this age group and the need for Adult Day Health services. Without the towns and
County support, our sustainability of the program would be very difficult for the program
to continue for more than one or possibly two years. Please consider the continuation
of funding to help out our Orange County Residents.
k.) Include any other pertinent information.
In 2003, Central Orange Adult Day Health Program (formally) was under the auspicious of
the Orange County Department on Aging. In 2004, the program assumed a non- profit
501c -3 status under the Governing Board of Senior Care of Orange County; Inc. Through
the years the operation remained adjacent to the Central Orange Senior Center and was
licensed for 10 participants per day. As the need in the county continued to grow, the
program later expanded to hold a license of 29 participants per day on February 4, 2009 as
a partnership with the county to continue to work towards meeting the goals of the Master
Aging Plan of Orange County.
The Senior Care Board continues to work toward building stronger relationships with the
Veteran's Administration Community referral program, and establishing a partnership with
the local Veterans Affairs Office, Discharge Planners at the local Hospitals to aid in the
referral program. Additional In -kind support still remains from Carol Woods Retirement
Community with a representative which serves on the Senior Care Board of Directors.
Page 17 of 26
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
Additional In -kind support still remains from Carol Woods Retirement Community with a
representative which serves on the Senior Care Board of Directors. Efforts continue to
recruit participants from the Department of Social Services (Medicaid CAP /DA) and the
Veteran's Administration who will financially support the participants with low incomes and
to encourage them to utilize the Day Health Program as an option to home care. The
program will reapply for the Home Community Care Block Grant from Triangle J Council of
Governments.
We have established the Florence Gray Soltys Memorial Scholarship fund where
individuals can donate throughout the year. The way we generate this fund is through
newsletters, postings on our website, direct mail lists, e-mail lists, phone lists, etc. We will
also seek in kind gifts and work diligently on fundraising, which will help develop these
funding sources into a long -term support of the programs.
Page 18 of 26
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
Additional Pro ram Information
1) Target Population
Complete the following tables, with numbers (not percentages) of individuals served and to be
served, to the best of your ability,
Page 19 of 26
Actual
Estimated
Projected
2015 -16
2016 -17
2017 -18
Gender
Male
48
50
52
Female
38
42
44
Total
86
92
96
African - American
25
30
32
American Indian or Alaska Native
1
3
4
Asian
4
5
5
Caucasian
54
50
49
Native Hawaiian or other Pacific Islander
0
1
1
Other: specify Latino
2
3
5
Total
86
92
96
Of the above, how many Hispanic /Latino
2
3
7
Of the above, how many non - Hispanic /Latino
84
89
89
Total
86
92
96
{yJ
0 -5 years
6 -18 years
19 -50 years
1
1
3
51+ years
85
91
93
Total
86
92
96
Alamance County
3
4
5
Chatham County
1
2
3
Durham County
8
7
6
Wake County
1
1
1
Page 19 of 26
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
"total 86 1 92 96
Work Statement
m3 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 9
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 900 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
905 meals per day.)
Work Statement Chart for Program: Florence Gray Solty Adult Day Health Program
..........
Program Goal Maintain Adult Day Health Enrollment Census
Performance Measures Increase marketing strategies and program awareness
Previous Year Program Results 86 participants were enrolled
Current Year Estimated Results 92 expected enrollment
Next Year Projected Results 1 96 projected enrollment
Program Goal Prevent and/or delay Institutionalization
Performance Measures To provide financial community resources to 80% of participants
Previous Year Program Results Assist with supplemental funding for families in need - Provided 80% and
prevented or delayed institutionalization
Current Year Estimated Results Continue to meet the 80%
Next Year Projected Results I Continue to meet 80%
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
Page 20 of 26
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
This Page Leff Blank Intentionally
Page 21 of 26
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
n) Program Budget
1. Submit your program budget. You may complete the provided template (separate As
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
• Private Donations
• Program Generated Revenue
• Local Government Grants
KI 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)
• Other Government Grants
• Triangle United Way
• State Government
• Federal Government (CDBGIHOME /etc.)
• Private Foundation Grants
o Other Revenue
Expenditures
• Compensation
• Rent & Utilities
• Supplies & Equipment
• Travel & Training
• 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? 100%
4. COST PER INDIVIDUAL — Average $58.00 per participant/day
This Cost per Individual must reflect the total program budget divided by the total number of
program individuals in this application. (number of individuals served times 245 days/ year)
Page 22 of 26
Total Cost of Program
$3747546
$374,460
393,460
Total # of Individuals
21070
22540
23520
Cost Per Individual
$56.00
$60.00
$59.00
Page 22 of 26
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A
PROVIDER'S OUTSIDE AGENCY APPLICATION
Agency Budget
Operating Budget for Entire Agency
AGENCY NAME: Senior Care of Orange County; Inc.
AGENCY REVENUE
Private Donations
Agency Generated Revenue (fees)
Local Government Grants:
Human Services - Town of Carrboro
Other - Town of Carrboro
Human Services - Town of Chapel Hill
Other - Town of Chapel Hill
Human Services - Orange County
Other - Orange County
Other - Town of Hillsborough
Other Government Grants
Triangle United Way
State Government
Federal Government (CDBG /HOME /etc.)
Private Foundation Grants
Other Revenue
Total Agency Revenue
AGENCY EXPENSES
Compensation
Rent & Utilities
Supplies & Equipment
Travel & Training
Other Expenses: Insurances
SURPLUS /(DEFICIT) FOR PERIOD: 1 $ (27,027) $ (14,960)1 $ 5,540 137%
FY 2015 -16 Comparative Agency Budget
Revised 9/29/2014
Actual
2015 -16
Estimated
2016 -17
Projected
2017 -18
Percent
Change
$
740
$
500
$
500
0%
$
257,433
$
265,000
$
275,000
4%
$
1,000
$
1,250
$
1,500
20%
$
-
$
-
$
-
0
$
1,500
$
2,000
$
2,500
25%
$
-
$
-
$
-
0
$
25,000
$
28,750
$
37,500
30%
$
-
$
-
$
-
0
$
-
$
-
$
-
0
$
-
$
-
$
-
0
$
-
$
-
$
-
0
$
61,843
$
62,000
$
62,000
$ -
$
-
$
-
$
20,000
0
$
t
3
$
-
0
$
$
347,519
326,925
$
$
359,500'>
327,000
$
$
399,000
345,000
11%
6%
$
780
$
1,560
$
1,560
0%
$
24,797
$
26,500
$
27,000
2%
$
1,781
$
1,900
$
1,900
0%
$
20,263
$
17,500
1 $
18,000
3%
MOM
374,546
1 $
374,460
$
393,460
5%
SURPLUS /(DEFICIT) FOR PERIOD: 1 $ (27,027) $ (14,960)1 $ 5,540 137%
FY 2015 -16 Comparative Agency Budget
Revised 9/29/2014
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D
1-
r
r
EXHIBIT "B"
Scope of Services -- FY 2017 -18
Outside Agency Performance Agreement
Agency Name,<;--n li 'CiC Ckr'- (b -P 0(O-X)je 6xc-A *
Program Name: I -:) 1
Funding Award:
Outline how the agency will spend Orange County's funding award.
Expense Description
Amount
fle -'s l-, V1 ,o- ( ri t
17 '731 1.6YL
s
0/c
ON E t)4 1 l i e
°►°
If
IV + P°' CU L e4 l d 02
75- Vzu
Program Services
Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2018.
• � rLtl� .Tv �l'tcJrJlc "��.. Tl��i4 -'�c�'iC. ��'�., -t"�7i �Y1� ?�� �ci f�2��� Cz- -�-�"S :' r"1 ,��€/3767 }�"��i �y
1 '' ? 3e6�ZAp�CC'..J C.Oe'e"ecae I s v- Ct, 1'uyL_, S64 L �< /i{li �i S� �JC�� CJ ! � ZG 1 L V�1 ap oat fj �' h j
• � rvcf,c(C_ St,.W[tlt4° eJ &m O- jt &VI help, �C- ! tb J b 'f Si-, -Uj, e 5 e.. a
T� l -, Q�s S�°ezl ` rite.. 0 £m *6� sv-�Oiz ra-1 4 4 c f
si� 70,f Cc 4 -i r- GU C!k'�'i'D -e\, 0,P t.- C:'i�i'.} -,, �,��� �
Anticipa a 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 perfoiTnance measure.
Performance Measures
U
Anticipated
Y� U�� t-} i
r9rr t C to 40-04 a*
e��f
ON E t)4 1 l i e
°►°
If
IV + P°' CU L e4 l d 02
75- Vzu
P� d -h / 0 /l am
DocuSigned by:
Wot��iGin! S�G� Executive Director
C5B55FF72C3C
by: �d: s�
Provi 01N Signature}
1/22/2018
Date: ,09/9 P11,7
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D
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:
SWArtAA ' NSta Executive Director 1/22/2018
Certified by: C5655FFT2C3C4D2. Title:
(Provider's Signature)
Orange County Outside Agency Performance Agreement
Rev. 7117
Date:
Page 10 of 10
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D
Client#: 955852
04SENIOCARI
AC ®R ®T,. CERTIFICATE OF LIABILITY INSURANCE
r ATE(MMJD13NYYY)
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
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 INSURERS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME:
i3B &T Insurance Services, Inc.
PuHCG Ne Eld :888 743 -2217 No; 8888279861
414 Gallimore Dairy Road
E -MAIL
Suite F
ADDRESS:
07/13/201
Greensboro, NC 27409
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURER A: Evanston Insurance Company
35378
MEDFXP (Any one person)
INSURED
INSURER B: Markel Insurance Company
38970
Senior Care of Orange County Inc
Attn Day Health Center
INSURER c
PERSONAL $ AOV INJURY
105 Meadowlands Dr
INSURER D
Hillsborough, NC 27278 -8181
INSURER E:
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO -
POLICY JECT El LOG
GENERAL AGGREGATE
$3,000,000
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 CONTRACTOR 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,
LTR
TYPE OF INSURANCE
tNgDL
SU D
POLICY NUMBER
POLICY 0fYYY
POLICY flNYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
X CLAIMS•MAOE OCCUR
X
SM921051
7/13/2017
07/13/201
$1,0,(0,0 00
❑EAACyHpOCCURRENCE
PREMISES EaoNccTu ante
$50000
X
MEDFXP (Any one person)
$5,000
1311PD Ded:5,000
PERSONAL $ AOV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRO -
POLICY JECT El LOG
GENERAL AGGREGATE
$3,000,000
PRODUCTS • COMP /OP AGG
$
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
1
BODILY INJURY Per accident
( )
$
NON -OWNED
HIRED AUTOS AUTOS
k
PROPERTY DAMAGE
Per accident
$
$
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
DEO RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED?
N 1 A
MWC010610201
2/0812017
02/0812018
X 1psTEARTLITE I IOTH-
E.L. EACH ACCIDENT
$500,000
E.L. DISEASE - EA EMPLOYEE
$500 000
(Mandatory In NH)
If Dyes, IPTIONunder
DESCRIPTION OF OPERAT €DNS Below
E.L. DISEASE - POL €CYLIMIT
$500,000
A
Professional
SM921051
7113/2017
0711312018
$1,000,000 each claim
Liability
$3,000,000 aggregate
$5,000 deductible
DESCRIPT€ON OF OPERATIONS 1 LOCATIONS f VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
Policy includes endorsement that provides Additional Insured status for any Landlord, Owner, or Property
Manager of the Designated Premises or any Tradeshow or Convention Sponsor or operator or any lessor of
equipment.
Professional Liability - Pol.# SM921051
(See Attached Descriptions)
Orange County Government
200 S Cameron Street
Hillsborough, NC 27278
ACORD 25 (2014101) 1 of 2
#S18510696IM18508092
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Uk'
O 1988 -2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
JUSC
DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501 D
Professional Liability Limit #1: 1,000,000 Ded. #1: $5,000.00
Limit #2: 3,000,000
Retroactive Dato: July 13, 2005 for GL and PRO
Sexual Acts Liability Endorsement Limit #1: 1,000,000 Limit #2: 2,000,000
** Workers Comp Information **
Other States Coverage
Prop rietors /PartnerslExecutive OfficerslMembers Excluded:
Nancy Espersen, Officer
Ann Burton, Officer
Dave Wilkerson, Officer
bAU] I I A Lb.J (L404101) 2 Of Z
#S185106961M18508092