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2018-241-E Health - OCIM Navigators
DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C ORANGE COUNTY HEALTH DEPARTMENT FAMILY SUCCESS ALLIANCE OUTSIDE AGENCY PERFORMANCE AGREEMENT ORANGE CONGREGATIONS IN MISSION FY 2018 -19 THIS AGREEMENT, made and entered into the first day of July 2018, ( "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, on behalf of the Orange County Health Department ( "County ") and Orange Congregations in Mission, located at 300 Millstone 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 Orange Congregations in Mission agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2018 to June 30, 2019. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application Scope of Services 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 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. 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 A, Scope of Services and more particularly described in the Program Budget, the maximum sum of two hundred thirteen thousand six hundred one dollars ($213,601). b. All funds appropriated shall be used for purposes described in Exhibit A. 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 thirty four thousand dollars ($34,000) upon receipt of the fully executed agency's performance agreement. The Provider shall properly submit to County an accounting of expenditures within fifteen (15) days of each month's end. The remainder of the maximum amount appropriated by the County as provided in (a) will be paid in Revised 512016 Page I of 6 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C monthly installments, based upon Provider's actual expenditures, within thirty (30) days of receipt of an invoice and accounting of Provider's actual expenditures properly submitted to County. d. The County's obligation to make additional payments is contingent upon receipt of quarterly Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) final payment will be made within 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 by 10/15/18, 1/15/19, and 4/15/19 that includes a summary of satisfactory progress toward completion of performance measures. Provider will also provide a Final Report by 7/15/19 that includes a fiscal report and final evaluation and performance measures as outlined in Exhibit A. 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. Page 2 of 6 Revised 412018 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C 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. 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 b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION • Worker's Compensation • Commercial General Liability • Automobile Liability MINIMUM REQUIRED COVERAGE 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 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 Page 3 of 6 Revised 412018 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C Post Office Box 8181 Hillsborough, NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. e. If County's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of Sexual Abuse and Molestation Rider. Provider shall not commence work until such insurance is in effect and certification thereof has been received by the County's Risk Manager. 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 parry without the prior written consent of the County. 11. Indemnification. Each party shall hold the other harmless from all loss, liability, claims or expense arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by its own employees functioning under this Memorandum of Agreement and shall bear responsibility for liability, claims or expenses arising from the acts or omissions of the party's own personnel to the extent provided by North Carolina law. Nothing in this section is intended to affect or abrogate the either Party'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. 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. Page 4 of 6 Revised 412018 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C 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 Orange County Schools 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 parry addressed as follows: County: Orange County Health Department ATTN: Kimberlee Quatrone Post Office Box 8181 Hillsborough, NC 27278 Provider: Orange Congregations in Mission 300 Millstone 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. The laws of the State of North Carolina shall govern all aspects of this Agreement. In the event that it is necessary for either party to initiate legal action regarding this Agreement, venue shall lie in Orange County, North Carolina. The parties hereby waive their right to trial by jury in any action, proceeding or claim, arising out of this Agreement, which may be brought by either of the parties. 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, 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. - aaad "b,behalf of the Provider Sharon Freeland Page 5 of 6 Revised 412018 6/21/2018 Date DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C Aara,hehalf of Orange County Government f jbl�,but, �iA.tMUkW'S� Bonnie Hammersley, County Manager Page 6 of 6 Revised 412018 6/25/2018 Date DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C BUSINESS ASSOCIATE AGREEMENT This Business Associate Agreement ( "Agreement ") is made effective the first day of July, 2018, by and between Orange County Government through its Orange County Health Department ( "Covered Entity "), and Empowerment, Inc., ( "Business Associate "). Covered Entity and Business Associate may be referred herein individually as a "Party" or collectively as the "Parties ". This Agreement supersedes any previously executed Business Associate Agreement between the Parties. WITNESSETH: WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability and Accountability Act of 1996 ( "HIPAA "), Public Law 104 -191, as modified by the Health Information Technology for Economic and Clinical Health Act ( "HITECH "), Public Law 111 -5, known as "the Administrative Simplification provisions," direct the Department of Health and Human Services to develop standards to protect the security, confidentiality and integrity of health information; and WHEREAS, pursuant to the Administrative Simplification provisions, the Secretary of Health and Human Services ( "Secretary ") has issued regulations modifying the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Parts 160 and 164, as the same may be amended from time to time (the " HIPAA Security and Privacy Rule "); and WHEREAS, the Parties wish to enter into or have entered into an arrangement whereby Business Associate will provide certain services to Covered Entity, and, pursuant to such arrangements, Business Associate may be considered a "Business Associate" of Covered Entity as defined in the HIPAA Security and Privacy Rule (the agreement evidencing such arrangement is detailed below and hereinafter referred to as the "Service Agreement(s)"); and WHEREAS, Business Associate may have access to Protected Health Information (as defined below) in fulfilling its responsibilities under such arrangement; THEREFORE, in consideration of the Parties' continuing obligations under the Service Agreement, compliance with the HIPAA Security and Privacy Rule, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties agree to the provisions of this Agreement in order to address the requirements of the HIPAA Security and Privacy Rule and to protect the interests of both Parties. I. DEFINITIONS (a) Service Agreement. Agreement(s) for services affected by this HIPAA Business Associate Agreement, which this Business Associate Agreement shall be attached to, and is (are) hereby incorporated by reference, and which shall be taken and considered as a part of this document the same as if fully set out herein: Family Success Alliance Zone Navigators Agreement (b) Catch -all Provision. Except as otherwise defined herein, any and all capitalized terms in this Agreement shall have the definitions set forth in the HIPAA Security and Privacy Rule, 45 CFR Parts 160 and 164, subparts A and E. In the event of an inconsistency between the provisions of this Agreement and mandatory provisions of the HIPAA Security and Privacy Rule, as amended, the HIPAA Security and Privacy Rule shall control. Where provisions of this Agreement are different than those mandated in the HIPAA Security and Privacy Rule, but are nonetheless permitted by the HIPAA Security and Privacy Rule, the provisions of this Agreement shall control. October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C (c) Electronic Protected Health Information. Protected Health Information that is transmitted by or maintained in Electronic Media (as defined in the HIPAA Security and Privacy Rule). (d) Protected Health Information. "Protected Health Information" shall have the same meaning as the term in 45 CFR § 160.103, limited to the information created or received by Business Associate from or on behalf of Covered Entity and includes without limitation "Electronic Protected Health Information." Business Associate acknowledges and agrees that all Protected Health Information that is created or received by Covered Entity and disclosed or made available in any form, including paper record, oral communication, audio recording, and electronic display by Covered Entity or its operating units to Business Associate or is created or received by Business Associate on Covered Entity's behalf shall be subject to this Agreement. (e) Required by Law. "Required by Law" shall have the same meaning as the term in 45 CFR § 164.103. IL OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE (a) Use and Disclosure. Business Associate agrees to fully comply with the requirements under the HIPPA Security and Privacy Rule applicable to Business Associates and not to use or disclose Protected Health Information other than as permitted or required by this Agreement, the Service Agreement or as Required by Law. To the extent Business Associate carries out obligations of Covered Entity under the HIPAA Security and Privacy Rule, Business Associate shall comply with the applicable provisions of the HIPAA Security and Privacy Rule as if such use or disclosure were made by Covered Entity. Business Associate agrees to comply with Covered Entity's policies regarding the minimum necessary use or disclosure of Protected Health Information. (b) Appropriate Safeguards. Business Associate agrees to use appropriate safeguards to prevent use or disclosure of Protected Health Information other than as provided for by this Service Agreement(s), this Agreement or as Required by Law. This includes the implementation physical, technical and administrative safeguards to prevent use or disclosure of Protected Health Information other than as permitted in this Agreement or Required by Law and reasonably and appropriately protect the confidentiality, integrity, and availability of any Electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of Covered Entity as required by the HIPAA Security and Privacy Rule. The Business Associate shall maintain appropriate documentation of its compliance with the HIPPA Security and Privacy Rule, including, but not limited to, its policies, procedures, records of training and sanctions of members in its workforce. (c) Assurances. Business Associate agrees to provide Covered Entity with written assurances that any Protected Health Information placed on any type of mobile media, including, but by no means limited to, lap top computers, Ipads and mobile phones, is encrypted in accordance with guidance issued by the Secretary. (d) Agents and Subcontractors. Business Associate shall require any agents, including any subcontractors, to whom it provides Protected Health Information from Covered Entity that is created, received, maintained or transmitted on behalf of Business Associate to agree by written contract with Business Associate to the same (or greater) restrictions, conditions and requirements that apply to Business Associate with respect to such information, and to agree to implement reasonable and appropriate safeguards to protect any of such information that is Electronic Protected Health Information. In addition, Business Associate agrees to take reasonable steps to ensure that its employees' actions or omissions do not cause Business Associate to breach the terms of this Agreement. (e) Mitigation of Breach. Business Associate agrees to mitigate, to the extent practicable, any harmful effect that is known to Business Associate of a use or disclosure of Protected Health 2 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C Information by Business Associate in violation of the requirements of this Agreement, as well as to provide complete cooperation to Covered Entity should Covered Entity elect to review or investigate such noncompliance or Security Incident. Business Associate shall cooperate in Covered Entity's breach analysis and/or risk assessment, if requested. Furthermore, Business Associate shall cooperate with Covered Entity in the event that Covered Entity determines that any third parties must be notified of a Breach, provided that Business Associate shall not provide any such notification except at the direction of Covered Entity. (f) Breach Reporting. Business Associate shall report in writing to Covered Entity's Privacy Officer (see Exhibit A), any use or disclosure of Protected Health Information that is not in compliance with the terms of this Agreement, as well as any Security Incident and any actual or suspected Breach, of which it becomes aware, without unreasonable delay, and in no event later than forty-eight (48) hours of such discovery. For purposes of this Agreement, "Security Incident" means the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with system operations in an information system. Such notification shall contain the elements required by 45 C.F.R. § 164.410. (g) Compliance. To the extent applicable, Business Associate will comply with (i) Covered Entity's Notice of Privacy Practices; (ii) any limitations to which Covered Entity has agreed in regard to an Individual's permission to use or disclose his or her Protected Health Information; and (iii) any restrictions to the use or disclosure of Protected Health Information to which Covered Entity has agreed or is required to agree. (h) Government Access. Business Associate will make its internal practices, books and records available to the Secretary of the Department of Health and Human Services for purposes of determining compliance with the terms of the HIPAA Security and Privacy Rule, and, at the request of the Secretary, will comply with any investigations and compliance reviews, permit access to information, and cooperate with any complaints, as Required by Law. Without unreasonable delay and, in any event, no more than 48 hours of receipt of the request or notification, Business Associate will notify Covered Entity in writing of any request by any governmental entity, or its designee, to review Business assessment of any kind. (i) Electronic Transactions. If Business Associate conducts any Standard Transactions for or on behalf of Covered Entity, Business Associate shall comply with the requirements under the Electronic Transaction Rule. 0) Audit. Business Associate shall permit Covered Entity, in its discretion, to conduct an audit of Business Associate's compliance with this Agreement, HIPAA, and HITECH. Such audit may consist of an onsite visit, a series of inquiries that require written responses, or both. Business Associate shall promptly and completely respond to Covered Entity's requests for information in support of the audit, which shall not be conducted more than once annually except in cases of an actual or reasonably suspected Security Incident or reasonably suspected noncompliance with this Agreement, HIPAA or HITECH. Each Party shall bear its own costs associated with the audit. (k) Identity Theft. Business Associate shall implement Identity Theft Monitoring Policies and Procedures to protect any patient information that may be breached by the Business Associate to the extent applicable under the Federal Trade Commission's Red Flag Rules. (1) HITECH Compliance. Business Associate shall: A. Not receive, directly or indirectly, any impermissible remuneration in exchange for Protected Health Information or Electronic Protected Health Information, except as permitted by HITECH § 13405(d) or the HIPPA Regulations; 3 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C B. Comply with the marketing and other restrictions applicable to Business Associates contained in HITECH § 13406 and the HIPPA Regulations; C. To the extent required under HITECH § 13404, fully comply with the applicable requirements of 45 CFR 164.502(e)(2) for each use and disclosure of Protected Health Information; D. To the extent required under HITECH § 13401, fully comply with 45 CFR §§ 164.308, 164.310, 164.312, and 164.316; E. To the extent required under HITECH §§13401 and 13404, comply with the additional privacy and security requirements that apply to Covered Entities in the same manner and to the same extent as Covered Entity is required to do so; and F. To the extent required under the HIPPA Regulations, comply with the privacy and security requirements that apply to Business Associates. (m) State Privacy Laws. Business Associate shall understand and comply with state privacy laws to the extent that such privacy laws are not preempted by HIPPA or HITECH. III. PERMITTED USES AND DISCLOSURES BY BUSINESS ASSOCIATE (a) Use of Protected Health Information on Behalf of Covered Entity. Except as otherwise limited in this Agreement, Business Associate may use or disclose Protected Health Information to perform functions, activities or services for, or on behalf of, Covered Entity described in the Service Agreement, provided that such use or disclosure would not violate the HIPPA Security and Privacy Rule if it were made by Covered Entity or would not violate the Covered Entities minimum necessary policies. (b) Other Uses of Protected Health Information. Except as otherwise limited in this Agreement, Business Associate may use Protected Health Information within its workforce for the proper management and administration of Business Associate not to include Marketing or Commercial Use and to carry out the legal responsibilities of Business Associate; and (c) Third Parry Confidentiality. Except as otherwise limited in this Agreement, Business Associate may disclose Protected Health Information for the proper management and administration of Business Associate or to carry out the legal responsibilities of Business Associate, provided that if Business Associate discloses any Protected Health Information to a third party for such purpose, the Business Associate shall enter into a written agreement with such third parry requiring the following: A. Disclosure only as Required by Law; or B. Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and will be used or further disclosed only as Required by Law or for the purpose for which it was disclosed to the person, and the person notifies Business Associate of any instances of which it is aware in which the confidentiality, integrity, and or availability of the Protected Health Information has been breached immediately upon becoming aware. (d) Business Associate may provide data aggregation services relating to the health care operations of Covered Entity pursuant to any agreements between the Parties evidencing their business relationship as permitted by 45 CFR § 164.504(e)(2)(i)(B). (e) Other Uses Strictly Limited. Nothing in this Agreement shall permit the Business Associate to share Protected Health Information with Business Associate's affiliates or contractors except 4 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C for the purposes of the Service Agreement(s) between the Covered Entity and Business Associate(s) identified in Section I (a) of this Agreement. (f) Covered Entity Authorization for Additional Uses. Any use of Protected Health Information by Business Associate, its affiliate or Contractor, other than those purposes of this Agreement, shall require express written authorization by the Covered Entity, and a Business Associate Agreement or amendment as necessary. Activities which are prohibited include, but are not limited to, Marketing, as defined by 45 CFR § 164.503 or the sharing for Commercial Use or any purpose construed by Covered Entity as Marketing or Commercial Use, even if such sharing would be permitted by federal or state laws. (g) Business Associate may de- identify Protected Health Information only at the specific direction of and only for the use of Covered Entity. Business Associate may not sell Protected Health Information except at the direction of Covered Entity and in compliance with the requirements of the HIPAA Security and Privacy Rule. IV. AVAILABILITY OF PHI (a) Access to Protected Health Information. Business Associate agrees, in the event the Business Associate maintains protected health information in a Designated Record Set, to make available, within ten (10) days of a request by Covered Entity in a time and manner designated by Covered Entity, Protected Health Information in a Designated Record Set, to Covered Entity or as directed by Covered Entity, to an individual in order to meet the requirements of 45 CFR § 164.524 of the HIPAA Security and Privacy Rule. (b) Amendments to Protected Health Information. In the event that the Business Associate maintains Protected Health Information in a Designated Record Set, Business Associate agrees to make any amendment(s) to Protected Health Information in a designated record set that the Covered Entity directs or agrees to pursuant to the HIPAA Security and Privacy Rule at the request of Covered Entity of an individual, within ten (10) days of receipt of a request from Covered Entity and in the time and manner designated by Covered Entity. (c) Accounting of Disclosures. Business Associate agrees to maintain and make available the information required to provide an accounting of disclosures, as required by 45 CFR § 164.528 of the HIPAA Security and Privacy Rule. Business Associate will comply with Covered Entity's policy regarding accounting of disclosures. (d) Document Disclosures. In the event an Individual makes a request under this Section of the Agreement directly to Business Associate, Business Associate will notify Covered Entity of such request within three (3) business days and shall cooperate with, and act only at the direction of Covered Entity in responding to such request. V. OBLIGATIONS OF COVERED ENTITY (a) Notice of Privacy Practices. Covered Entity shall provide Business Associate with the notice of privacy practice that Covered Entity produces in accordance with 45 CFR § 164.520, as well as any changes to that notice. (b) Notice of Changes in Individual's Access or Protected Health Information. Covered Entity shall provide Business Associate with any changes in, or revocation of, permission by an Individual to use or disclose Protected Health Information, is such changes affect Business Associate's permitted or required uses. 5 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C (c) Notice of Restriction in Individual's Access to Protected Health Information. Covered Entity shall notify Business Associate of any restrictions to the use or disclosure of Protected Health Information that Covered Entity has agreed in accordance with 45 CFR § 164.522 to the extent that such restriction may affect Business Associate's use of Protected Health Information. VL PERMISSABLE REQUESTS BY COVERED ENTITY Requests Permissible Under HIPAA. Covered Entity shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy or Security Rule. VII. TERMINATION (a) Term. This Agreement shall be effective as of the date first set forth above and shall terminate upon the earlier of (i) the termination of all agreements between the parties, and (ii) the termination by Covered Entity for cause as provided herein. (b) Termination for Cause. Notwithstanding anything in this Agreement to the contrary, Covered Entity shall have the right to terminate this Agreement and the Service Agreement immediately if Covered Entity determines that Business Associate has or will violated any material term of this Agreement. Upon Covered Entity's knowledge of a material breach by Business Associate, Covered Entity shall provide an opportunity for Business Associate to cure the breach or end the violation. Covered Entity may terminate this Agreement if Business Associate does not cure the breach or end the violation within the time period specified by Covered Entity. If termination, cure or end of the violation is not feasible, Covered Entity may report the violation to the Secretary. (c) Obligation of Business Associate Upon Termination. At termination of this Agreement, the Service Agreement (or any similar documentation of the business relationship of the Parties), or upon request of Covered Entity, whichever occurs first, Business Associate, shall: A. if feasible, return (in a manner or process approved by the Covered Entity) or destroy all Protected Health Information, regardless of form, including but not limited to paper or electronic format, received from Covered Entity, or created, maintained or received by Business Associate on behalf of Covered Entity. Business Associate shall retain no copies of the Protected Health Information. This provision shall also apply to Protected Health Information and other confidential information in the possession of sub - contractors or agents of Business Associate. B. If such return or destruction is not feasible, Business Associate shall (i) retain only that Protected Health Information necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; (ii) return or destroy the remaining Protected Health Information that the Business Associate still maintains in any form; (iii) extend the protections of this Agreement to the retained Protected Health Information; (iv) limit further uses and disclosures to those purposes that make the return or destruction of the Protected Health Information not feasible; and (v) return or destroy the retained Protected Health Information when it is no longer needed by Business Associate. (d) Survival. This paragraph shall survive the termination of this Agreement and shall apply to Protected Health Information created, maintained, or received by Business Associate and any of its subcontractors. VIII. MISCELLANEOUS 6 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C (a) Indemnification. Business Associate agrees to indemnify, defend, and hold harmless Covered Entity, its officers, agents, contractors and agents, against, and in respect of, any and all claims, losses, expenses, costs, damages, obligations, penalties, and liabilities which Covered Entity may incur by reason of Business Associate's breach of or failure to perform any its obligations pursuant to this Agreement, including but not limited to any injury or damages arising from any noncompliance with this Agreement or any Security Incident attributable to the negligence of Business Associate, including failure to execute the terms of this Agreement. Further, Business Associate agrees to indemnify, defend, and hold harmless Covered Entity, its officers, employees, contractors and agents, against all costs and expenses, including but not limited to, reasonable legal expenses, which are incurred by or on behalf of Business Associate in connection with the defense of such claims. (b) Disclaimer. Covered Entity makes no warranty or representation that compliance by Business Associate with this Agreement, HIPAA, HITECH, or the HIPAA Regulations will be adequate or satisfactory for Business Associate's own purposes. Business Associate is solely responsible for all decisions made by Business Associate regarding the safeguarding of Protected Health Information. (c) Assistance in Litigation or Administrative Proceedings. Business Associate shall make itself, and any subcontractors, employees, affiliates or agents assisting Business Associate in the performance of its obligations under this Agreement, available to Covered Entity, at no cost to Covered Entity, to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being commenced against Covered Entity, its directors, officers or employees based upon a claimed violation of HIPAA, HITECH, the HIPAA Regulations, or other laws relating to security and privacy, except where Business Associate or its subcontractor, employee or agent is named adverse party. (d) Survival. The obligations of Business Associate under this Agreement shall survive the expiration, termination, or cancellation of this Agreement, the Service Agreement and/or the business relationship of the parties, and shall continue to bind Business Associate, its agents, employees, contractors, successors, and assigns as set forth herein. (e) Ownership of Information. Covered Entity holds all right, title, and interest in and to the Protected Health Information and Business Associate does not hold and will not acquire by virtue of this Agreement or by virtue of providing goods or services to Covered Entity, any right, title, or interest in or to the PHI or any portion thereof. (f) Right to Injunctive Relief. Business Associate expressly acknowledges and agrees that the breach, or threatened breach, by it of any provision of this Agreement may cause Covered Entity to be irreparably harmed and that Covered Entity may not have an adequate remedy at law. Therefore, Business Associate agrees that upon such breach, or threatened breach, Covered Entity will be entitled to seek injunctive relief to prevent Business Associate from commencing or continuing any action constituting such breach without having to post a bond or other security and without having to prove the inadequacy of any other available remedies. Nothing in this paragraph will be deemed to limit or abridge any other remedy available to Covered Entity at law or in equity. Except as expressly stated herein or in the HIPAA Security and Privacy Rule, the parties to this Agreement do not intend to create any rights in any third parties. (g) Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the HIPSS Regulations. In addition, this Agreement may be amended or modified by the Parties only in writing. (h) Assignment. No Party may assign its respective rights and obligations under this Agreement without the prior written consent of the other Party. 7 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C (i) Independent Contractor. None of the provisions of this Agreement are intended to create, nor will they be deemed to create any relationship between the Parties other than that of independent parties contracting with each other solely for the purposes of effecting the provisions of this Agreement and any other agreements between the Parties evidencing their business relationship. This Agreement will be governed by the laws of the State of North Carolina. No change, waiver or discharge of any liability or obligation hereunder on any one or more occasions shall be deemed a waiver of performance of any continuing or other obligation, or shall prohibit enforcement of any obligation, on any other occasion. 0) Regulatory References. A reference in this Agreement to a section in HIPAA, HITECH or the HIPAA Regulations means the section as it currently is in effect or as amended. (k) Interpretation. Any ambiguity in this Agreement shall be resolved in favor of a meaning that permits Covered Entity to comply with the HIPAA Regulations. The parties agree that, in the event that any documentation of the arrangement pursuant to which Business Associate provides services to Covered Entity contains provisions relating to the use or disclosure of Protected Health Information that are more restrictive than the provisions of this Agreement, the more restrictive provisions will control. The provisions of this Agreement are intended to establish the minimum requirements regarding Business Associate's use and disclosure of Protected Health Information. (1) Severability. In the event any part or parts of this Agreement are held to be unenforceable, the remainder of this Agreement will continue in effect. In addition, in the event a party believes in good faith that any provision of this Agreement fails to comply with the then - current requirements of the HIPAA Security and Privacy Rule, such party shall notify the other party in writing. For a period of up to (30) thirty days, the parties shall address in good faith such concern and amend the terms of this Agreement, if necessary to bring it into compliance. If, after such thirty -day period, a party believes in good faith that the Agreement fails to comply with the HIPAA Security and Privacy Rule, then either party has the right to terminate upon written notice to the other party. (m) Notices and Communications. All instructions, notices, consents, demands, or other communications required or contemplated by this Agreement shall be in writing and shall be delivered to the Party at the address below: For Covered Entity: For Business Associate Orange County Health Department Orange Congregations in Mission 300 W. Tryon Street 300 Millstone Drive Hillsborough, NC 27278 Hillsborough, NC 27278 (n) Strict compliance. No failure by any Party to insist upon strict compliance with any terms or provisions of this Agreement, to exercise any option, to enforce any right, or to seek any remedy upon any default of any other Party shall affect, or constitute a waiver of, any Party's right to insist upon such strict compliance, exercise that option, enforce that right, or seek that remedy with respect to that default or any prior, or contemporaneous, or subsequent default. No custom or practice of the Parties at variance with any provisions of this Agreement shall affect, or constitute a waiver of, any Party's right to demand strict compliance with all provisions of this Agreement. (o) Governing Law. This Agreement shall be governed and construed in accordance with the laws of the State of North Carolina except to the extent that North Carolina laws have been pre - empted by HIPAA and without giving effect to principals of conflicts of law. Jurisdiction shall be Orange County, North Carolina, for purposes of litigation resulting from disagreements of the Parties for purposes of this Agreement and the Service Agreement(s). (p) E- Verify. Employers and their subcontractors with 25 or more employees as defined in Article 2 of Chapter 64 of the NC General Statutes must comply with E -Verify requirements to contract with governmental units. E- Verify is a Federal program operated by the United States Department of 8 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C Homeland Security and other federal agencies, or any successor or equivalent program used to verify the work authorization of newly hired employees pursuant to federal law. Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes shall constitute breach of this Agreement. If applicable, by executing this Agreement, Business Associate affirms that they are in compliance with Article 3 of Chapter 64 if the North Carolina General Statutes. IN WITNESS WHEREOF, the Parties have executed this Agreement as of the day and year written above. CO RE Q9NTITY: ( iIa.�A.. skwaV'f By Title: Orange county Health Director 9 October 2013 e i M�_,z _ Title: Executive Director DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C EXHIBIT A COVERED ENTITY PRIVACY OFFICER CONTACT INFORMATION To report to Covered Entity any use or disclosure of Protected Health Information not in compliance with the terms of this Agreement that might be considered a privacy breach, Business Associate should contact the Privacy Officer at the applicable entity. To report to Covered Entity any Security Incident (as defined in the Agreement), Business Associate should contact Carla Julian (919) 245 -2434, or the Security Officer at The Orange County Health Department. 10 October 2013 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C EXHIBIT A Ref: Family Success Alliance Zone 4 Navigators Purpose: To provide Navigator services for the Family Success Alliance in Zone 4 as outlined in detail below and described in Exhibit B, Navigator Job Description. Protect Scope: Provider will: 1. Coordinate logistics to allow navigators to operate out of provider office. a. Provide Wi -Fi internet connection. b. Provide access to photocopier for small print jobs (less than 10 copies). Larger print jobs can be done at Orange County Health Department (OCHD). c. Provide key or other procedures to allow navigator access to the office during regularly scheduled hours. d. Provide a work space for each navigator that includes a desk, chair and access to basic office supplies (pens, notebooks, stapler, etc.). e. Offer an orientation to review office procedures and locations for supplies, printing, meeting space, and payroll procedures and reporting weekly hours. Use an orientation protocol to track topics and completion dates. f. Include navigator in agency meetings, as relevant and appropriate. g. Provide a locked location to store paper documents that only navigators are able to access. 2. Provide program support to the navigators. a. Either the Executive Director or other program staff is available to answer questions about the services of the organization or other related community -based services. b. Either the Executive Director or other program staff will provide guidance on how to assist zone families with service referrals and issues of confidentiality. c. Either the Executive Director or other program staff will work with navigators to identify areas of collaboration and partnership between provider and FSA to include client referrals, co- sponsoring of community and outreach events, and other options. d. Either the Executive Director or other program staff will be available to provide job shadowing to increase navigator understanding of the provider agency and to increase community contacts and network. e. Either the Executive Director or other program staff will provide support and guidance as needed in other unspecified areas. 3. Orientation /Training. a. OCHD and provider will discuss training needs and requirements and develop a mutually agreed upon schedule to meet the requirements. Training must include review of the Navigator Manual and its associated policies and procedures. b. Training and orientation may cause the normal work schedule to vary. 1 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C EXHIBIT A c. Navigators will attend FSA Project Team meetings, held at OCHD in Hillsborough, every two weeks, a monthly partner meeting, bimonthly Advisory Council meetings and other FSA related meetings as needed. d. OCHD may request that Navigators attend additional trainings or meetings to meet the skills and knowledge required for their duties. 4. Working with the OCHD program manager, provide support for navigator performance measures outlined below. a. Community Engagement and Outreach: Navigator will be assigned 1 -2 community based organizations (ex. service providers, faith groups, neighborhood associations) to regularly attend meetings and represent the FSA project and identify opportunities for mutual support and objectives. Updates from these meetings should be shared in weekly reports and at biweekly FSA Project Team meetings. Permission to attend additional meetings or events must come from OCHD Program Manager. b. Family Engagement: Navigator team will meet performance goals as follows: • Contact 100% (n =40) of the 2018 Zone 4 Kindergarten Readiness Cohort to offer Zone Navigator support. Follow -up with those not enrolled again by January 31ST, 2019. • Enroll at least 37.5% (n =15) of the 2018 Zone 4 Kindergarten Readiness Cohort • Meet monthly with enrolled families from all Cohort groups. c. Family Goals: • Ensure that 50% of enrolled cohort families with children 0 -5 years old have early childhood goals. • Ensure that 80% of enrolled cohort families have completed an Education Goal Checklist for each five to eighteen year old in enrolled families. d. Resource Referrals: • Navigator will identify and connect zone families to needed resources with a goal of 8 -10 referrals per month. Referrals should be documented weekly in the Efforts to Outcomes system. i. Ensure that 80% of families with children 0 -5 years old are actively enrolled in a high quality (3 -5 star) early learning center or a parenting support class or program (e.g. Incredible Years, Orange Literacy). ii. Work to connect enrolled families with children 8 -18 years old to an adult mentor. iii. Ensure that 50% of children age 5 -18 years old in enrolled families have a structured summer activity that includes academic components. iv. Ensure that 50% of children age 5 -18 years old in enrolled families have a structured after school activity that includes academic components. e. School -based Support: Navigator will be available to zone schools on an as needed basis to support FSA - related activities. Navigator will document hours and activities in the weekly reports as a way to formalize this component of the position. 2 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C EXHIBIT A f. Data Collection and forms: Navigators will use intake and other client forms created and updated by FSA program manager. Navigators will receive instruction from OCHD staff on methods for conducting ongoing needs assessment data and incorporating local knowledge and conditions into evaluation of FSA. 5. Conduct supervision of the navigators. a. Provider will review weekly activities reports and conduct a brief weekly check in with each navigator located at the agency. Provider should refer any issues that cannot be addressed internally to FSA Project Program Manager in a timely manner. b. Conduct formal 6 month and one year performance reviews for each Navigator located at the agency with the FSA Program Manager. 6. Provisional status and monitoring of agreement a. Hiring: Provider will coordinate with OCHD to recruit, interview and select appropriate candidates. b. Probationary period: Provider will follow internally established protocols for employee probationary period. c. Disciplinary action: Provider will follow internally established protocols for monitoring any activity or behavior that requires disciplinary action and report that to OCHD. d. Termination: Provider will follow internally established protocols for termination and will notify OCHD. Any final termination decision will be made after a meeting with OCHD program staff. e. Position Open: Should the position become open due to termination or attrition, provider and OCHD will re -open the position and re -start the hiring process outlined above with an expectation of filling the position in a 30 -day time period. New hire will start as an OCHD temp for the first 4 -6 weeks for training and orientation purposes. f. Navigator reporting: Navigator will provide written feedback to OCHD regarding any perceived violation of the agreement and OCHD will provide guidance to develop solutions amenable to all parties. OCHD Program Manager will: 1. Serve as a liaison between Provider and zone navigators. Conduct co- working sessions on site on a weekly basis. Schedule to be determined with OCHD and site supervisor. 2. Meet monthly with each navigator to review performance measures and family progress. 3. Provide assistance with logistics for monitoring navigator activities and performance, including identification of priority programs and recruitment /referrals and information for Navigators to share with families. 4. Compile program, service, and other opportunities for Zone families from community partners and send to Provider to share with Navigators. S. Provide supplies for navigators as needed for community events and outreach. 3 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C EXHIBIT A 6. Provide initial training and orientation for new navigators at the Health Department and distribute equipment (laptop computer, cell phone, client file bag and lock). Training will include use and ongoing support for the Efforts to Outcomes client database system. 7. Identify ongoing learning and training opportunities for zone navigators and send to Provider. Personnel: 3.75 FTE zone navigators Cost: Payment schedule is outlined in the contract. Budget Categories: (Exhibit C includes detailed budget) 1. Salaries: Will range from $15.00 - $18.36 per navigator salary schedule. 2. Payroll Taxes: Estimated at 6.2% Social Security, 1.45% Medicare, 1.07% SUTA 3. Fringe Benefits, including health insurance and workers compensation: Estimated based on 2.03% workers comp, $648 /month for health insurance, $55.25 /month per person for life insurance 4. Overhead: Calculated at 15% of salary, benefits and payroll taxes 5. Mileage: Calculated at.545/mile for up to 250 miles per month per full time navigator and pro -rated for navigators working less than full time 6. Training: Calculated at $500 per navigator, per year 7. Payroll processing: Estimated at $13 per month, per navigator 8. Office Supplies: $500 (can be used for furniture and other basic office supplies) 9. Supervision: $2,500 10. Neglect and Abuse Insurance: $1,500 Provider Deliverables: 1. Complete a site orientation protocol for each navigator within the first month of navigator employment with agency. 2. Review weekly activity reports from each Zone 4 Navigator. Report any concerns with navigator performance to FSA Program Manager. 3. Meet monthly with FSA Project Manager to check in and review priorities and challenges. 4. Provide timely monthly invoices. Payment will be processed within 2 -3 weeks of receipt of invoice. 5. Provide a quarterly expense and performance report (no later than October 15, January 15, April 15, and July 15) that documents each budget category and includes receipts as appropriate to FSA Project Program Manager. FSA Project Manager will provide the template to be used. 6. Conduct a formal 6 month performance review with new hires and an annual review at one year for all navigators with the FSA Program Manager. 4 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C Exhibit B FAMILY SUCCESS ALLIANCE '10/0 Zone Navigator Job Announcement Salary: Salary based on education and experience Description: This is an invitation to join a strong team of dedicated professionals working to dramatically improve student achievement and family success for families struggling to make ends meet in New Hope area south of Hillsborough, known as Zone 4, of the Family Success Alliance. The position will serve as a "navigator" for families living in Zone 4 as part of the work of the Family Success Alliance. This position will be a dynamic one, responding to the needs of the community and zone partners to assist the work. Much of the work will be done in neighborhood, schools and community settings with families. We are looking for someone who knows the community and public schools well and understands the challenges faced by families living in poverty. This versatile, on the ground position, will connect with families to make program and resource referrals in areas such as housing, mental health, mentoring, health and wellness and career training and financial education while reporting on needs and obstacles to child and family success. We are looking for someone who can work independently and passionately while partnering with school staff, service providers, faith -based and community groups and neighborhood organizers and activists to develop a culture of achievement and success among all children and families in the zone. This position will be located at a local nonprofit organization. Support and supervision will be in coordination with the Family Success Alliance Program Manager located at the Orange County Health Department. Examples of Duties This position will be responsible for the long -term strategy and day to day activities required to support child and family success in Zone 4. Duties include but are not limited to: • Assist in recruiting and supporting a caseload of up to 20 families enrolled in the navigator program through monthly meetings, goal setting, resource referrals and peer support. • Act as a coach for families to model skills for parents to be their child's first teacher. • Utilize program forms to document progress in a timely, accurate manner with assigned families using a data tracking system. Training on use of the database will be provided. • Assist in recruiting and supporting families participating in summer kindergarten readiness program. • Be the go- between and "connector" between families and service providers to tailor programs to meet family needs and goals. • Support families to access needed programs and assist them in signing up and participating in programs. • Attend community meetings such as neighborhood association meetings, related local task force and /or coalition meetings to promote FSA, build relationships with other advocates and stay current on community changes, challenges and opportunities. • Document and celebrate project successes in the zone and contribute to the overall community -based identity of FSA. DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C • Attend FSA project, partner, Advisory Council and navigator group supervision meetings and participate in overall project planning and decision - making. Typical Qualifications • Prefer candidates that are from the community with children that attend a zone school and can identify with families struggling to make ends meet. • Must possess strong people skills. • Ideal candidates are bilingual (Spanish) and bicultural applicants. [when applicable] • Requires a minimum combination of education and experience equivalent to a high school diploma or a GED with a preference for candidates that are enrolled in or have goals for higher education. Skills /Abilities • Ability to connect with and build trusting relationships with families struggling to make ends meet. • An excitement and passion for identifying and connecting with students and families who can benefit from program participation. • Demonstrate cultural sensitivity and the ability to work with diverse groups. • Possess a range of communication skills that can be employed in various settings and with families that are the most in need. • Uses personal experiences of overcoming obstacles as a tool for helping others build success while also maintaining professional boundaries and confidentiality. Knowledge • Candidates should be resourceful and knowledgeable of community resources, with a working knowledge of county /municipal systems and agencies that support children and families. • An understanding of the role that structural barriers play in health and academic disparities is preferable. • Knowledge of the history of the community and the ways that may shape local culture, and individual behavior and identity. • Knowledge of neighborhoods located near New Hope Elementary and A.L. Stanback Middle school. Requirements • This position requires transportation and some night and weekend hours. DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C OCIM Family Success Alliance Salary Bi- weekly Monthly Subtotal Taxes Social Security - Co Paid Medicare - Co Paid SUTA Tax - Co Paid Monthly Subtotal Benefits Worker's Compensation Company Paid Health Ins Life Insruance Number of Hours FT E # months Rate of Pay Rate of Pay per Month Navigator PT (30 0.75 hours) 30 PT Hourly 0.75 FTE 11 $ 16.00 $24,960.00 $2,080.00 2,080.00 2,080.00 6.2% of S &W Navigator FT (40 197.31 Navigator FT (40 1 hours) 2 hours) 40 FT Hourly 40 FT Hourly 1.0 FTE 1.0 FTE 12 1.070% 12 1.070% $ 18.36 $38,188.80 $ 16.32 $33,945.60 $3,182.40 3,182.40 $2,828.80 2,828.80 Training $500 per Navigator (annual) 3,182.40 500.00 2,828.80 Navigator PT (30 0.75 hours) 30 PT Hourly 0.75 FTE 11 $ 16.00 $24,960.00 $2,080.00 2,080.00 2,080.00 6.2% of S &W 6.20% 197.31 6.20% 175.39 6.20% 128.96 1.45% of S &W 1.45% 46.14 1.45% 41.02 1.45% 30.16 1.07% of S &W 1.070% 34.05 1.070% 30.27 1.070% 22.26 $ 50,733.10 $ 92,067.50 277.51 15% Overhead (annual) 246.67 13,810.13 181.38 Training $500 per Navigator (annual) 500.00 500.00 500.00 Mileage per Navigator (.545/m x 250 m /mo) per FTE 2.03% of S &W 2.03% 64.60 2.03% 57.42 2.03 % 42.22 $648/mo ER 648.00 648.00 648.00 648.00 648.00 648.00 $55.25 per person 55.25 55.25 55.25 55.25 55.25 55.25 Monthly Subtotal 767.85 760.67 745.47 Payroll Processing $13 /mo 13.00 13.00 13.00 13.00 13.00 13.00 Monthly subtotal 13.00 13.00 13.00 Total Monthly Cost 4,240.76 3,849.15 3,019.85 Total Annual Salary, Taxes, Benefits & Payroll per Navigator 50,889.10 46,189.75 36,238.20 Total Salary, Benefits & Taxes (annual) $ 50,733.10 $ 92,067.50 $ 33,075.35 15% Overhead (annual) 7,609.96 13,810.13 4,961.30 Training $500 per Navigator (annual) 500.00 500.00 500.00 Mileage per Navigator (.545/m x 250 m /mo) per FTE 1,635.00 1,635.00 963.00 Total Annual Cost Per Navigator 60,634.06 62,134.88 42,662.50 Number of Navigators 1 2 1 # Full Time # Full Time # Part Time Total Projected Annual Cost - based on # of Navigators 60,634.06 124,269.76 42,662.50 Navigator Supervision ($2500) Neglect & Abuse Insurance Policy (flat amount) Office Supplies 4 addl mo Annual Budget Total 128,960.00 Salary Subtotal 11,245.31 Taxes Subtotal 35,670.64 Benefits Subtotal 611.00 Payroll Subtotal Salary, Taxes, Benefits, Payroll 179,506.80 Subtotal 178,895.80 Salary, Taxes, Benefits Subtotal 26,381.39 Overhead Subtotal 2,000.00 Training Subtotal 4,233.00 Mileage Subtotal 2,500.00 Supervision Subtotal 1,500.00 Insurance Subtotal 500.00 Office Supplies Subtotal Total Project Cost 213,601.34 DocuSign Envelope ID: B6268174 -A19D- 4873- 8AEC- OB7ECE2FAF4C OP ID: LP ,d►��R° CERTIFICATE OF LIABILITY INSURANCE DATE 05//02/2018 02/2018 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 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 High & Rubish Insurance Agency P.O. Box 3040 NAME: Jeff Rubish PHONE FAX A/C No, : 919- 913 -1144 Alc No): 919- 913 -1155 E -MAIL natalie ^hi handrubish.com v g 6015 Farrington Rd. Ste 101 Chapel Hill, NC 27517 Jeffrey A. Rubish PRODUCER CUSTOMER ID #:OCIM - -1 INSURER(S) AFFORDING COVERAGE NAIC # $ 2,000,000 INSURED Orange Congregations In INSURER A: Cincinnati Insurance Company 10677 Missions, Inc. 300 Millstone Drive INSURER B: Hartford Underwriters Ins. 30104 Hillsborough, INC 27278 INSURER C, GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT PRODUCTS - COMP /OP AGG $ 4,000,000 INSURER D A INSURER E LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS INSURER F: EBA0349072 10/15/2015 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DDL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDD /YYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE L OCCUR X Hillsborough, INC 27278 ECP0349072 10/15/2015 10115/2018 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 2 000 000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT PRODUCTS - COMP /OP AGG $ 4,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS EBA0349072 10/15/2015 10/15/2018 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (PERACCIDENT) $ X X $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 22WECBV6360 08/18/2017 08/18/2018 X WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYEE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 A Sexual Misconduct ECP0349072 05/02/2018 10115/2018 Occurence 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES Attach ACORD 101, Additional Remarks Schedule, if more space is required) Additional Insured Status Applies to Holder CERTIFICATE HOLDER CANCELLATION ORANG -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ORANGE COUNTY COUNTY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WITH THE POLICY PROVISIONS. P O Box 302 W. Tryon St. Hillsborough, INC 27278 AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD