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Home My WebLink About2018-318-E DSS - Diaper Bank of NCDocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF OUTSIDE AGENCY PERFORMANCE AGREEMENT 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, ( "County ") and Diaper Bank of North Carolina, a not - for - profit corporation, located at 1311 E. Club Boulevard, Durham, North Carolina 27704. ( "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 Provider 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 to the residents of Orange County, as outlined in the Outside Agency Funding Application and any amendments or revision. thereto (Exhibit "A ") which is attached and hereby incorporated into this document as if set out herein. The Scope of Services in Exhibit A 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 A and B, Scope of Services and more particularly described in the Revised Program Budget (Exhibit "C "), the maximum sum of Ten Thousand dollars ($10,000). b. All funds appropriated shall be used for purposes described in Exhibit A and B. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of Two Thousand Five Hundred dollars ($2,500). 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. Diaper Bank of North Carolina Orange County Outside .agency Performance Agreement Revised 612018 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF 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. 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 11, April 15, and July 8 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. S. 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: L 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 ra DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF 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. b. 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 MINIMI_TM 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 Sox 8181 Hillsborough, NC 27278 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 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 Grange 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 $ 14.25 per hour. To the extent possible, Change County recommends that Provider 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 C! DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF 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: , County. Nancy Coston Orange County Department of Social Services Post Office Box 8181 Hillsborough, North Carolina 27278 Provider: Executive Director Diaper Bank of North Carolina 1311 E. Club Blvd Durham, North Carolina 27704 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. Severahility. 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.orangecountyne.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 1 IA and Article 40 of North Carolina General Statute Chapter fib. 5 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF 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, T OocuSigned by., l of the Provider �i(" V 197D6380FECF4BD... Michelle Old, Executive Director 7/24/2018 �._- __ ig ___ r _,_ ,X DocuSigned by: nge County Government E66K,tAj(, f%MKAtVSt" 7/25/2018 0637994B755E477... Isannie Hammersley, Uounty Manager Date Date no DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF Exhibit A Outside Agency Application and Scope of Services DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF 1. GONER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Diaper Bank of North Caroline Applicant Organization's Physical Address: 1311 E. Club Blvd. Durham, 27704 Applicant Organization's Mailing Address: 1311 E. Club Blvd. Durham, 27704 Applicant Organization's Web Address: www.ncdiaperbank.org Executive Director: Michelle Old Telephone Number: 919 -886 -8085 Tax ID Number: 32- 0401621 E -Mail: michelle{a)ncdialperbank.org b) Funding Request List all FYI 8-19 Human Services HS Funding Being Requested — For All Programs) and the Proposed Use of Funds (2 -3 lines or less) Program — -- Ex. Youth Afterschool Program -- — Afterschool Program Coordinator salary and materials for youth activities and pr2jects CgrrhgL2 Cha rel Hill - HS Orange County-HS Total $10,000 $15,000 $5,000 $30,000 Outcome Based Diaper Distribution Program: Diaper and Diapering supplies, wrapping supplies, and program management (Distribution Coordinator) salary. Totals $5,000 $5,000 $10,000 $20,000 $5,000 $5,000 $10,000 $20,000 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duty authorized by the governing board of the applicant. Signature: �J_ "_LL Executive Director Signature: (- IVA Board Chairperson Date January 23, 2018 Date AGENCY INFORMATION 2/12/2018 7:53:03 PM Page 8 of 28 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates.., YES NO ❑ ® a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Change County? ❑ ® c) Current beneficiaries of the program for which funds are being requested? ❑ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON - DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity /expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Change County Anti - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: UILA_Clt=9� Jl Executive Director Signature: J& r �k Board Chairperson — 2_� Date January 23, 2018 Date AGENCY INFORMATION 2/12/2018 7:53:03 PM Page 10 of 28 DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF 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 (MonthJYear): 01113 Diaper Bank of North Carolina was incorporated January loth , 2013 and has been in operation 5 years. b) Agency's Purpose /Mission (no more than a few sentences): The mission of Diaper Bank of North Carolina is to promote and protect the dignity of each resident by improving access to personal hygiene products and other basic necessities, thereby removing barriers to education, employment, and personal fulfillment. Our cornerstone purpose is to ensure that families living with poverty have an adequate supply of diapers, and we have expanded to include feminine hygiene and adult incontinence products. We distribute these basic needs through community partners in order to encourage access to their services and programs, which empower people to become self - sustaining and develop their full potential. c) Types of Services the Agency Provides (bullet format): • Diapers and related sup 1p ies: Diaper Bank of North Carolina (DBNC) provides diapers and diapering supplies to families living with poverty. Public safety -net programs such as The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) do not cover the purchase of diapers, often leaving families with a difficult decision between buying diapers and other necessities with their limited funds. A study in the journal Pediatrics by Smith, Kruse, Weir and Goldblum (2013) examined how diaper need contributes to parental stress, which is an important factor in a child's health and development. • Feminine hygiene roducts: The same barriers to accessing diapers exist for feminine hygiene products (FHP). With this realization, we launched the Helping Moms Helps Babies campaign in Summer 2015 to distribute FHP to women through our community partner organizations. This campaign has since grown to include Can the Spot, an initiative with Durham Public middle and high schools to minimize girls missing school because they lack FHP. • Adult incontinence supplies: According to the Center for Disease Control, over half of adults over 65 have experienced incontinence. By providing seniors living in poverty with incontinence supplies, DBNC helps older adults maintain dignity and the ability to remain engaged in daily activities. d) Agency's History with Providing These Services: DBNC has been distributing products through partner agencies since 2013, working to fill a gap that has long been ignored: providing diapers for children living in poverty. Statewide, we distribute 280,000 diapers each month. Our real work, however, involves leveraging diapers as a gateway to other services. Our Branches use an outcome -based model, showing that diapers help to engage families with partner agencies. Partners report that families seeking diapers are able to be connected to other support services such as assistance with food and utilities, job training, and case management. We have a growing number of partners who use Agency Information 211212018 7 :53 :03 PM i F 11 of 28 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF diapers as an incentive to decrease no -show rates for home visits for postpartum depression counseling or early childhood intervention services. Diaper Bank of North Carolina is committed to not only providing diapers to families in need, but also to producing broader outcomes for families and children. e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes in the past year? is there a new Executive Director? Are there new initiatives?) • In the past year, our agency has added three part -time employees and an AmeriCorps Volunteer to our staff. Our Executive Director has been with the agency since she founded it in 2013. • In 2017, we launched our Truckload of Hope initiative. The Truckload of Hope is our mobile diaper bank that travels to Fayetteville, NC monthly to distribute diapers and related products to over 600 military families. 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: 1.0 # of FTE - Paid Part -Time Positions: 1.75 # of Volunteers: 450 per month g) Living Wage # of FTE - Volunteers: 2.5 Does this agency pay permanent employees a minimum living wage? (Yes 1 No) No If yes, is this agency an Orange County Living Wage Certified Employer? If no, please explain. We have a very small staff budget with the majority of our budget going towards program costs. Agency Information 2/12/2018 7 :53:03 PM P a g e 1 2 o f 2 8 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF h) Agency Budget i. Is your agency currently receiving and/or requesting other (non -Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes/No) No If yes, please list below: Include all programs that have funding requestslawardsltotais from Carrboro, ChaQel hf /11. and Orange Cogn!y governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME, Program - FY17 -18 FY18 -19 I Source - — - Award Request Ex: Affordable Rental a $20.000 Carrboro - Affordabl Housi Rehabilitation Ex: Agency Administration $15,000 $15,0010 Carrboro - Other Ex. Total $15,000 $35,000 Carrboro Total Fundina *Add rows or attach additional page, if needed. ii. Submit your agency's budget. You may complete the provided template (separate xis file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues Q Private Donations 0 Program Generated Revenue Q Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) Agency Information 2/1212018 7:53:03 PM Page 13 of 28 DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF ■ Orange County Human Services ■ Orange County Other (DO NOT Include HOME funding here) * Other Government Grants ■ Triangle United Way ■ State Government • Federal Government (CDBG /HOME /etc.) ■ Private Foundation Grants * Other Revenue Expenditures o Compensation * Rent 8 Utilities o Supplies & Equipment a Travel & Training v Other Expenses Ill. Does your agency budget show a Surplus or Deficit? No Is there a significant change? Yes /Ho No Please provide a brief explanation for Surplus or Deficit, and significant changes. Iv. What Is your agency's fiscal year? Janua 1 2018 through December 31st 2018 (Example: July 1, 2016 through June 30, 2017) Agency Information 2/1212018 7:53:03 PM Page 14 of 28 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Outcome Based Diaper Distribution Program Primary Contact and Title: Michelle Old, Executive Director Telephone Number: 919 -886 -8085 E -Mail: michelleCcDncdiaperbank.org aj Indicate the type of Human Service Needs Priority, if program applicable: ® Priority Area #1: safety -net services for disadvantaged residents Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges Z Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly - x Disabled x Public Housing NeighborhoodslResidents Affordable Housing Affordable Healthcare Education - -� -- Family Resources x x Jobs /Jobs Trainin Food _ Transportation_ Other: Please specify c) Provide a bulleted list of other agencies, if any, with which your agency coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. • Compass Center for Women and Families (CCWF) CCWF is our open distribution program which means that anyone who lives in Town of Carrboro, Town of Chapel Hill, and Orange County and are in diaper need can get the items they need from CCWF. We feel having an open source is vital for every community we serve. Based on our research, 78 % of families that receive our diapers are working 1 -3 jobs. We want all families to have access to the diapers they need for their children. CCWF has reported wonderful outcomes since our partnership; increased awareness of services, expanded outreach, and increased class participation. PROGRAM INFORMATION 2112/2018 7:53:03 PM P a g e 1 5 o f 2 8 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF • Orange County Health Department (OCHD) OCHD distributes our products to pregnant and postpartum woman and infants participating in the PCM, PPNB, BF Support, WIC, and HBI programs. Since introducing diapers, they have seen a 78% increase in home visits and client interaction. • Orange County DSS (OCDSS) Diapers are distributed through their Community Response Program, CPS, and Adolescent Parenting Program. They have reported increased participation in their prevention parenting classes. CPS has shared that before, when entering a home, they were seen as a threat but now that they come with a tangible, basic need, they are seen as helpers and it increased trust with the families and case workers • El Centro Hispano Carrboro — Chapel Hill (El Centro) Poverty among Hispanic Families in Carrboro - Chapel Hill is 49 %, El Centro has reported an increased participation in their Circle of Friends Parenting classes and increased outreach to Hispanic Families as well as families from Burma. Program Description (3 pages OR LESS) Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a Town /County priority /goal? Diaper Bank of North Carolina is committed to not only providing diapers to families in need, but also to producing broader outcomes for families and children. Within Orange County, Town of Carrboro, and Town of Chapel Hill, Diaper Bank of North Carolina partners with organizations that offer services focused on children health and wellbeing. Through these organizations, diapers are provided directly to families and also serve as a gateway to other services such as home visits, health screenings, and job training. We aim to distribute 85,000 diapers over the course of 1 year, serving roughly 1,500 --- 1,700 children in Orange County, Town of Carrboro, and Town of Chapel Hill. We will be developing specific outcomes with each community partner agency but our overarching goal is to help agencies improve their connection to families with young children. For example, an outcome of our work may be helping a partner agency to experience a 25% increase in program retention or completion rates, or a 25% decrease in missed appointments. While our focus will be outcome -based programs, we will also continue our already established output programs which are vital for families who are not enrolled with one of our partner agencies. e) Describe the community need or problem to be addressed in relation to the Chapel Hill PROGRAM INFORMATION 2/12/2018 7:53:03 PM P a g e 1 6 o f 2 8 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF 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. Poverty among North Carolina parents has persisted despite the national economic recovery, with Orange County, Chapel Hill and Carrboro as no exception. In 2015 Orange County Health Department reported over 4,500 children living in poverty, an increase of over 7.4% in 3 years. Specifically, within Chapel Hill and Carrboro, the Chapel Hill- Carrboro Chamber of Commerce reporter} the percentage of "economically disadvantaged" children is at 26.5 percent —the highest since 2006. Many of these children are likely to be diaper users without access to an adequate supply of clean, dry diapers. There is currently no other agency working in Orange County dedicated to addressing the problem of diaper need for these thousands of children living in poverty, making the Diaper Bank of North Carolina a unique service for the community. DBNC's work directly impacts healthcare and family resources, two areas referenced by the Chapel Hill Human Services Needs Assessment. Diapers can cost families $100 per child each month, a substantial cost for low - income families. When families are unable to change a child's diaper as often as recommended, children are more susceptible to skin and urinary tract infections. Children uncomfortable from wearing a soiled diaper for as long as an entire day cry more often, are fussier, and wake more frequently at night, disrupting healthy sleep patterns and increasing parental stress. This additional stress presents one more challenge for parents struggling to make ends meet. The success of our program is measured not only by the number of diapers we distribute to families in need each month, but also by outcomes families experience from receiving diapers. We surveyed 246 diaper recipient families this winter and learned that due to assistance received from the diaper bank, children were happier (33 %) and healthier (33%) and parents experienced a reduction in their own stress (44 %). In addition to physical and emotional health benefits, having diapers enabled families to utilize daycare (18 %), attend work (10%), purchase food (45 %), look for work (8 %), attend school or job training (6 %), pay bills (39 %), purchase other nonfood essential items such as soap, toothpaste, or toilet paper (31 %), and save money for future expenses (32%). According to the Orange County BOCC, a top goal is to ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well -being of all county residents. Similarly, the Chapel Hill Human Services Needs Assessment identified the need for integrated coordination and communication. DBNC's work fits solidly within this goal, not only in providing a basic human need, but also in using diapers as a gateway to families receiving other support services. Our 2017 paper published in the peer - reviewed journal Child and Youth Services Review, documents the benefits our partner agencies experience as a result of distributing products from the diaper bank. Our findings revealed that before their partnerships with us, agencies had limited means for providing hygiene products for their clients. Some agencies could provide products only when they were donated, others had to divert limited program funds to purchase diapers at the expense of another need, and others were not able to provide products at all. Multiple agency staff members reported using money from their own pockets to buy PROGRAM INFORMATION 2/1212018 7:53:03 PM Page 17 of 28 DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF products for families with the most desperate needs. Partnering with the diaper bank allows organizations to consistently provide their clients with diapers and saves them the time and funding previously spent trying to acquire hygiene products for their families. In a recent survey, 56% of our partner organizations reported that distributing diapers extended the average length of a relationship with clients, 66% of partner organizations reported that distributing diapers reduced missed visits, and 41 % of partner organizations reported that distributing diapers improved communication with clients. Furthermore, within our successful programs, DBNC acts as a hub, not only connecting families to diapers and services, but also connecting partner agencies to each other. We host an annual "We've Got You Covered" networking brunch to share updates about DBNC and allow partner agencies to deepen their relationships and identify opportunities to more efficiently meet the community's needs. fl Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The Diaper Bank of North Carolina serves low income Orange County, Town of Chapel Hill, and Carrboro families by providing free diapers, diaper wipes, and diaper rash cream. Most families we serve are eligible for federal safety net programs including: Medicaid (94 %), WIC (94 %), and SNAP (78 %n), however none of these programs provide diapers. In addition, 45 % of families qualify for the NC subsidized childcare program. Our distribution model leverages existing relationships between families and support organizations. Because families that experience diaper need also experience other basic needs, we provide diapers to Grange County, Town of Chapel Hill, and Carrboro organizations already working with families in areas such as job training, health, food, and housing. Families already enrolled in programs offered by our partner agencies are eligible to receive diapers. We are the first diaper bank in the country to publish our research findings in peer - reviewed scientific literature. Our 2017 paper published in Maternal & Child Health Journal documents the many challenges of daily living that diaper recipient families experience including: transportation to places they need to go, affording food, paying bills, and meeting educational goals. We also maintain open distribution partnerships in each of the communities we serve, allowing families that are not enrolled with a partner organization to get supplemental supplies of diapers. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) • DBNC Founder & Executive Director - Michelle Old, BSW (Ms. Old provides program oversight, build relationships with our partner agencies in Orange County, and oversees the project budget.) • DBNC Distribution Manager - Debbie Hauck (Ms. Hauck oversees project inventory and fills agency orders.) PROGRAM INFORMATION 2/1212018 7:53:03 PM Page 18 of 28 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF • DBNC Director of Research and Evaluation - Kelley Massengale, Ph.D. (Dr, Massengale is responsible for evaluation activities including dissemination of results.) h) Describe the specific period over which the activities will be carried out and include an implementation timeline. If funded, we will distribute products to our Orange County, Town of Chapel Hill, and Carrboro partner agencies from July 2018 - June 2019. Partner agencies are eligible to place orders for diapers and related products weekly, although some choose to order biweekly or monthly based on their client needs and storage capabilities. 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) The average Diaper Bank of North Carolina recipient family includes 2.2 adults and 2.7 children. Therefore, the outcomes experienced as a result of receiving diapers can benefit a few thousand low - income household members, in addition to the children wearing diapers. The diapers received allow families to divert income towards other necessities such as food, soap, toilet paper, clothing, and healthcare that benefit the entire household. Our entire community benefits when families can fully participate in society. When families have enough diapers to keep their children clean, dry, and healthy, adults can participate in the workforce and children can attend early childhood education. When children experience fewer infections related to prolonged diaper changes, healthcare spending on diaper-related infections is reduced. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Diaper Bann of North Carolina's mission is to support families living in poverty with the diapers their children need to stay clean, dry and healthy while connecting them to services that will help them to become self- sustaining. If funding is not awarded, we will continue to strive to do that even if in a much smaller way. k) What percentage of your target population is low - moderate income? 100% 1) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) Each time that families receive diapers, they are asked to complete a brief survey documenting any outcomes or positive benefits they may have experienced as a result of receiving products from the diaper bank. In addition, we host an annual breakfast for our partner agencies in which we solicit program feedback. PROGRAM INFORMATION 2/12/2018 7:53:03 PM ; DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF m) Include any other pertinent information. The Diaper Bank of North Carolina is the only diaper bank in the country to have a PhD - trained researcher on staff. All of our programs are evaluated to ensure that we are meeting families' needs for hygiene products. We are the first diaper bank in the country to publish peer - reviewed literature about our work, documenting both the outcomes received by families who receive diapers and the outcomes experienced by our community -based partner organizations who provide distribute diapers on our behalf. As such, we are seen as the leader among diaper banks across the country. Diaper banks around the country and legislators advocating on behalf of policies that address diaper need use our research when writing grants, drafting legislation, and when speaking with donors and the media in their own communities. We published the first peer - reviewed study in the scientific literature about diaper need the spring of 2017. We surveyed our community partners (the organizations distributing diaper bank products directly to families in need) about benefits they had received since they started providing diapers from the Diaper Bank of North Carolina: 41 % indicated that their clients were more likely to communicate with them or their agencies between scheduled appointments or visits. 56% reported that families were more likely to extend the length of their relationships with the organization beyond the average length of a typical relationship they would have with a family. 66% specified that clients were more likely to keep scheduled appointments. 44% documented that clients were more likely to participate in other programs offered their agency. The success of our program is measured not only by the number of diapers we distribute to families in need each month, but also by outcomes families experience from receiving diapers. This summer we published the first peer - reviewed study that documents the benefits that diaper recipient families received. Here are some of the quantitative highlights from our article on the positive benefits families experience when they receive something as small as a diaper: Due to assistance received from the diaper bank: children were happier (43 %) and healthier (28 %), and could attend daycare (18 %). Receiving diapers allowed parents to: experience a reduction in their own stress (62 %), attend work (15 %), purchase food (61 %), attend school or job training (15 %), pay a nonmedical bill such as a utility bill (17 %), or pay a medical bill (5 %). PROGRAM INFORMATION 2112/2018 7:53:03 PM Page 2 0 of 28 DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF Additional Program Information n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, ram Target Population Gender Male Female Total Ethnicity African - American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other. specify Total Of the above, how many Hispanic/Latino Of the above, how many non-Hispanic/Latino Total Age 0 -5 years 6 -18 years 19 -50 years 51 + years Total Geographic Location Actual Estimated Projected 2016 -17 1 2017 -18 1 2018 -19 700 990 800 700 990 800 1,400 1,980 1,600 280 396 320 973 1376 1492 84 119 96 1,001 1,416 1144 0 01 0 35 49 40 1,400 1,980 1,600 427 604 488 973 1376 1492 1,400 1,980 1,600 1,400 1 980 1,600 0 01 0 Alamance County Chatham County Durham County Wake County Orange County Breakdown Chapel Hill Public Housing we do not track Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) PROGRAM INFORMATION 2112/2018 7:53:03 PM Page 21 of 28 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF Total 1 1,400 1 1,980 1 1 ,600 Work Statement o) Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 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 elderlyldisabled residents.) • Program Goal should explain what the program is trying to achieve /accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday - Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e, Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goats. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program: Outcome Based Diaper Distribution 1, Program Activity Name Distribute diapers and related products to low- income families with young children in Orange County, Town of Chapel Hill, and Carrboro. _ Program Goal Distribute 85,000 diapers per year. Performance Measures We will track the percentage of families reporting that receiving diapers allows them to experience the outcomes of: reduced parental stress; increased ability to afford food, pay bills, or purchase other nonfood hygiene products; increase child health and happiness; and increased work and childcare attendance. Previous Year Program Results 28 %fl households report that receiving diapers from DNBC allows children to be healthier. 62 %® of households that receiving diapers from DNBC reduces parental stress. 61% households reporting that receiving diapers allows them to purchase food. Current Year Estimated Results 33% households reported that receiving diapers from DNBC allows children to be healthier. 44 % of households reported that receiving diapers from DNBC reduces parental stress. 45 % households reported that receiving diapers allows them to purchase food. PROGRAM INFORMATION 2/12/2018 7:53:03 PM Page 22 o f 28 DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF Next Year Projected Results 30% households will report that receiving diapers from DNBC allows children to be healthier. 53% of households will report that receiving diapers from DNBC reduces parental stress. 53% households will report that receiving diapers allows them to purchase food. 2, Program Activity Nome Partner with Orange County, Town of Chapel Hili, and Carrboro agencies who will distribute DBNC products to their clients in need. Program Goal Distribute products to 6 agencies in Orange County, Town of Chapel Hill and Carrboro per year. Performance Measures We will track the percentage of partner agencies reporting that distributing diapers: extends the average length of a relationship with clients, reduces missed visits and im roves communication with clients. Previous Year Program Results 56% partner organizations reported that distributing diapers extends the average length of a relationship with clients. 66% of partner organizations reported that distributing diapers reduces missed visits. 41% partner organizations reported that distributing dia ers improves communication with clients. Current Year Estimated Rasul'ts 56'/4 partner organizations well report that distributing diapers extends the average length of a relationship with clients. 66% of partner organizations will report that distributing diapers reduces missed visits. 41% partner organizations will report that distributing diapers improves communication with clients, Next Year Projected Results 56/4 partner organizations will report that distributing diapers extends the average length of a relationship with clients. 66% of partner organizations will report that distributing diapers reduces missed visits. 41 % partner organizations will report that distributing diapers improves communication with clients. 3. Program Activfty Nome Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results 4. Program Activity Name PROGRAM INFORMATION 2112/2018 7:53:03 PM Page 23 of 28 DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results PROGRAM INFORMATION 2/12/2018 7 :53:03 PM Page 2 4 of 28 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF p) 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 o Private Donations o Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other ■ Chapel Hill Human Services ■ Chapel Hill Other (DO NOT include CDBG funding here) Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) 0 Other Government Grants ■ Triangle United Way • State Government ■ Federal Government (CDBGIHOME /etc -) ■ Private Foundation Grants 0 Other Revenue Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel & Training t) 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? 5% 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 2112/2018 7:53:03 PM Page 2 5 of 28 Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Total Cost of Program 20,000 Total # of Individuals 1,600 12.50 Cost Per Individual PROGRAM INFORMATION 2112/2018 7:53:03 PM Page 2 5 of 28 DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF AGENCY NAME: AGENCY REVENUE Private Donations Agency Budget Operating Budget for Entire Agency DIAPER BAND OF NORTH CAROLINA 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 (COBGIHOMEletc.) Private Foundation Grants Other Revenue Total Agency Revenue AGENCY EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Agency Expenses SURPLUSI(DEFICIT) FOR PERIOD: FY 2018 -13 Comparative Agency Budget Revised 9121/2017 $ 26,198 1 $ 64,056 1 $ 523 -99% Actual 2016 Actual 2017 Projected 2018 Percent Change $ 28,880 $ 61,506 $ 101,000 64% $ - $ - $ 0 $ - $ - $ 5,0001 0 $ - $ - $ - 0 4,000 $ - $ 5,000 0 $ _ $ - 0 $ - $ - $ 10, 040 0 $ - $ - $ 0 $ - $ - $ - 0 $ - $ 2,000.00 $ - - 100% $ _ $ _ $ _ 0 $ $ - $ - 1 0 $ 70 0o0.00 $ 75 004.00 $ 40,000.00 -47% $ 79,571 $ 122,158 $ 141,440 $ 0.16 $ '182,451 $ 86,734 $ 260,674 $ 83,759 $ $ 302,440 138,352 16% 65°/0 $ 421 $ 22,255 $ 75,604 240% $ 10,113 $ 19,188 $ 39,261 105% $ 4,364 $ 3,888 $ 8,000 106% $ 54,621 $ 67,528 $ 40,700 -40% $ 156,253 $ 196,618 $ 301,917 5411, $ 26,198 1 $ 64,056 1 $ 523 -99% DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF Program Budget Operating Budget for Program PROGRAM NAME Outcome Based Diaper Distribution PROGRAM REVENUE Private Donations Program Generated Revenue 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 Program Revenue PROGRAM E=XPENSES Compensation Rent & Utilities Supplies & Equipment. Travel & Training Other Expenses: Total Program Expenses Actual 2016 -2017 Estimated 2017 -2018 Projected 2018 -2019 Percent Change $ - $ - $ 15,000 0 $ - $ - $ - 0 - $ $ 5,000 0 - $ - $ - 0 $ - $ - $ 5,000 0 $ - $ - $ - 0 $ - $ - $ 10,000 0 $ $ - $ - 0 $ - $ - $ - 0 $ $ - $ - 0 $ $ - $ - 0 $ $ - $ 0 $ $ - $ 5,000.00 0 $ $ - $ 10,000 0 $ - $ - $ - $ $ 50,000 $ 16,000 0 0 $ $ $ 15,600 0 $ $ $ 18,400 0 $ - $ $ - 0 $ - $ $ r 0 $ - $ - $ 50,000 0 SURPLUS / (DEFICIT) FOR PERIOD: 1 $ - 1 $ - 1 $ - 1 0 In -Kind Donations Not included above: In -Kind Revenue: $842,259 In -Kind Expenses: $443,582 Program Budget DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF Exhibit B Scope of Services Federal Tax Id. or SSN Contract # A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Diaper Bank of North Carolina 2. If different from Contract Administrator Information in General Contract: Address Telephone Number: _ Fax Number: Email: 3. Name of Program (s): Diaper Distribution Program 4. Status: ( ) Public (X) Private, Not for Profit ( ) Private, For Profit S. Contractor's Financial Reporting Year July 1, 2018 through June 30, 2019 B. Explanation of Services to be provided and to whom: The Outcome Based Diaper Distribution Program aims to distribute diapers and related products to low - income families with young children in Orange Coup through community partnerships, The Provider will provide up to fifty diapers per child per month sizes newborn -five only) or thiniy pull-ups per child per month for up to one hundred participants pe r month. Dig ers will be picked up at the Provider's location by the Count, for use by artier ants en a ed in Social Services' orogmmming—including, but not limited to the Communijy Response Program, the Adolescent Parenting Program, and Child Protective Services. As available the Provider will provide diapers of other sizes adult incontinence supplies, and feminine hygiene .products. As available, the Provider's toddler toilet classes will be open to Social Services' participants. The Provider will track percentages of families reporting that receiving diapers allows them to experience the outcomes of- reduced parental stress' increased ability to afford food, pa bills, or purchase other nonfood hygiene products, child health and ha mess- and increased work and childcare attendance. The Coun will publish a press release announcing this community partnership upon execution of this contract C. Funding reimbursement limits by category: The Coup ty will reimburse the Provider for administrative costs required to pLovide the services described in this contract pp to the bud"Ey limits of the contract allotment. Costs include compensation. rent utilities, supplies, and equipment, D. Number of units to be provided: NA E. Area to be served/Delivery site(s): Oran a Caun �j DocuSign Envelope ID: C4A8ABA9- 961E- 4297- 82F0- 5B1739260CFF EXIMIT "C" Scope of Services — FY 2018 -19 Outside Agency Performance Agreement Agency Name: Diaper Bank of North Carolina Program Name: Outcome Based Diaper Distribution Program Funding Award: $10,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Compensation $3000 Rent - $3,000 utilities $500 Supplies $3,500 Equipment $0 (451/850) Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 34, 2019. • Distribute diapers and related products to low - income families that are actively participating in programs through the Orange County Department of Social Services. • Distribute products to the Orange County Department of Social Services. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Urance County, only (all Towns and municipalities), If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Dom Signed by; X� Certified by: 997DB380FECF4BD... (Provider's Signature) Title: Executive Director Date: 7/24/2018 Orange County outside Agency Performance Agreement Revised 612038 Anticipated Performance Measures Results Number of diapers distributed yearly 42,500 Households reporting that receiving diapers from DNBC allows children to be healthier 30% 255/850 Households reporting that receiving diapers from DNBC reduces parental stress 53% (451/850) Households reporting that receiving diapers allows them to purchase food 53% (451/850) Partner organizations reporting that distributing diapers extends the average length of a 56% relationship with clients. 2.24/4 Partner organizations reporting that distributing diapers reduces missed visits. 66% 2.64/4 Partner organizations reporting that distributing diapers improves communication with 41% clients. 1.64/4 Dom Signed by; X� Certified by: 997DB380FECF4BD... (Provider's Signature) Title: Executive Director Date: 7/24/2018 Orange County outside Agency Performance Agreement Revised 612038 DocuSign Envelope ID: C4A8ABA9 -961E- 4297- 82F0- 5131739260CFF DIAPERB OP ID: S8 CERTIFICATE OF LIABILITY INSURANCE DATE 0212212018Y) D2iz2r2D18 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 Phone: 919- 286 -7473 Dominick Huckabee Noblin Trent Insurance Agency Fax: 919 -286 -5170 PDBo% 52239 Durham, NC: 27717-2239 CONTACT NAME: {AIC No Ext , FAX No l: E -MAIL ADDRESS: _ BPS 0705663 Steve Booth INSURERS) AFFORDING COVERAGE NAIC a INSURER A: Penn National Insurance 14990 $ 50,000 INSURED Diaper Bank of NC, Inc Michelle Old, ED do 1311 E Club Blvd INSURER B :AmTrust North America PERSONAL & ADV INJURY INSURER c GENERAL AGGREGATE Durham, INC 27704 INSURER D: PRODUCTS - COMPIOPAGG INSURER F; $ INSURER F; I COVERAGFS 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 MICH 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. fR LT TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 8181 POLICY NUMBER POLICY MYYYY POLICY IDDIYYYY LIMITS A GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1 •- i OCCUR X Business Owners X BPS 0705663 0210112018 0210112019 EACH OCCURRENCE $ 1,000,00 DAMAGE 10 HFN I LEY— PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ §,40 PERSONAL & ADV INJURY $ 1,006,00 GENERAL AGGREGATE $ 2,000,00 GEN'LAGGREGATE LIMIT APPLIES PER x I POLICY PRQ LOG PRODUCTS - COMPIOPAGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accltlanl BODILY INJURY (Per person) $ BODILY INJURY (Per accidenl) $ - PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPR I ETORIPARTNEWEXECUTIVE Yn OFFICERIMEMBER EXCLUDED? F-1 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA _ C3619574 04101/2017 0410112018 v, I WC STATU- I 10TH- R LIMITS E E.L. EACH ACCIDENT $ 100,00 E,L. DISEASE - EA EMPLOYE $ 100,00 E.L DISEASE - POLICY LIMIT S 500,00 I I DESCRIPTION OF OPERATIONS I LOCATION 5I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mare space Is required) non - profit diaper provider to needy families - distribution services for Orange County are covered rFRTIFICATF HnI DER CANCELLATION Q 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Co Government g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 8181 Hillsborough, INC 27278 AUTHORIZED REPRESENTATIVE Q 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD