Loading...
HomeMy WebLinkAbout2018-410-E Finance - Big Brothers Big Sisters of the Triangle Inc outside agency agreementDocuSign Envelope ID: 1381F24A- F27B- 438F- AC45- 7A16015EA606 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 Big Brothers Big Sisters of the Triangle, Inc., a not- for -profit corporation, located at 808 Aviation Parkway, Suite 900, Morrisville, NC 27560 ( "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 Big Brothers Big Sisters of the Triangle, Inc. 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 and any amendments or revision thereto which is attached as Exhibit "A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of $6,430. 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 in four equal installments in the amount of $1,607.50. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: 1381F24A- F27B- 438F- AC45- 7A16015EA606 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. £ 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 12, and July 12 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default "), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten (10) business days from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: 1381F24A- F27B- 438F- AC45- 7A16015EA606 c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof, iii. Comprehensive Automobile Liability Insurance, including hired and non -owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION • Worker's Compensation • Commercial General Liability • Automobile Liability • Professional 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 $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: 1381F24A- F27B- 438F- AC45- 7A16015EA606 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non - Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non - Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 14.25 per hour. To the extent possible, Orange County recommends that Big Brothers Big Sisters of the Triangle, Inc. provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: 1381F24A- F27B- 438F- AC45- 7A16015EA606 County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Big Brothers Big Sisters of the Triangle, Inc. 808 Aviation Parkway, Suite 900 Morrisville, NC 27560 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. a. 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. 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. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For OocuSigned by:'r Provider f'6& (A" A(A" C9C31158451E4EB... For E6Q cuSigned by: r County Government Nwm v�C G3799d6755E477... Bonnie Hammersley, County Manager (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Rev. 7118 8/14/2018 Date 8/14/2018 Date Page S of 9 DocuSign Envelope ID: 1381F24A- F27B- 438F- AC45- 7A16015EA606 = xhlblt A: Provider's Outside Agency Application 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Big Brothers Big Sisters of the Triangle, Inc. Applicant Organization's Physical Address: 808 Aviation Parkway, Suite 900 Morrisville. NC 27560 Applicant Organization's Mailing Address: SAME AS ABOVE Applicant Organization's Web Address: www.bigstri.org Executive Director: Erin Callahan Telephone Number: 919 - 850 -9772 E -Mail: ecallahan @bbbstri.org Tax ID Number: 56- 2109717 b) Funding Request List all FY18 -19 Human Services (HS) Funding Being Requested — For All Programs) and the Proposed Use of Funds (2 -3 lines or less) Program Carrboro Chapel Orange County - Total - HS Hill - HS HS The funds we are requesting are in support of our two core mentoring programs — Community -Based and Site -Based Mentoring. These programs serve at -risk children ages six to 14 throughout Chapel Hill, Carrboro, and all of Orange County. $5,000 $10,000 $10,000 $25,000 Totals $5,000 $10,000 $10,000 $25,000 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. AGENCY INFORMATION 1/18/2018 7:54:45 PM Page 8 of 29 DocuSign Envelope ID: 1381 F24A-F27B-438F-AC45-7A1 6015EA606 _Xhibit A: Provider's Outside Agency Application Signature: 9 � ExOdtive Director Date Signatur . Board Chai d/ Q� 2�1� Date AGENCY INFORMATION 1/8/2018 10:00:15 AM Page 8 of 25 DocuSign Envelope ID: 1381F24A- F27B- 438F- AC45- 7A16015EA606 :xhlblt A: Provider's Outside Agency Application d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO ❑ X a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ X b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ X c) Current beneficiaries of the program for which funds are being requested? ❑ X d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON - DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity /expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. AGENCY INFORMATION 1/18/2018 7:54:45 PM Page 10 of 29 DocuSign Envelope ID: 1381 F24A-F27B-438F-AC45-7A1 6015EA606 _xhibit A: Provider's Outside Agency Application 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: Signature: AGENCY INFORMATION Date oil Date 1/8/2018 10:00:15 AM Page 10 of 25 DocuSign Envelope ID: 1381 F24A-F27l3-438F-AC45-7A1 6015EA606 = xhibit A: Provider's Outside Agency Application 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): 10/26/1998. A BBBS agency has operated in our area for 19 years. BBBST, which is the result of a merger between two BBBS agencies, has been in operation for over 12 years. b) Agency's Purpose /Mission (no more than a few sentences): Our mission is to provide children facing adversity with strong and enduring, professionally supported, one -to -one relationships that change their lives for the better, forever. c) Types of Services the Agency Provides (bullet format): Community -based mentoring provides children in need of adult role models with a one -to -one mentor relationship with a volunteer from the community. These volunteers receive extensive screening and training from our Enrollment Specialists and our Match Support Personnel. We follow a careful process to make a quality match between youth and the appropriate volunteer in order to promote long -term relationships. The Community -based "Bigs" routinely provide eight to 10 hours a month of quality one -to -one time for each child. These Bigs play an integral role of the lives of their "Littles" by providing a stable adult role model to help guide these children in the right direction. Site -based mentoring provides mentors to children during and after school on their school's campus. Our partnerships with many local schools allow teachers or key school personnel to refer children who may need extra attention to build better social skills or those who may be lacking in a particular area of schoolwork. Although it takes place at schools, our Site - Based Mentoring program isn't limited to the classroom. Of course, some Littles do talk with their Bigs about class, do homework, or read together, but it's perfectly fine to shoot hoops in the gym or play on the playground. At the end of the day, it's really all about starting a friendship, providing guidance, and inspiring them to reach their potential. Site -based volunteers are oriented, screened, and trained to assist this population of children with the same care and detail as our Community -Based volunteers. Matches in Site -Based programs last for one school year and may continue into the next at the request of the parent, child, teacher, and volunteer. As an initiative within our Site -Based program, we launched the first Beyond School WallsSM site in Wake County in November 2017. It is a version of our Site -Based mentoring program whereby a group of students from local elementary and middle schools meet with their Bigs at the workplace instead of the school. These meetings happen once or twice a month over the course of a school year. This allows a company to provide a captive and consistent volunteer team of new adult friends and role models to kids who need it the most. Beyond School Walls enriches both the lives of the employees and the children served by Big Brothers Big Sisters of the Triangle. Agency Information 1/18/2018 7:54:45 PM Page 12 of 29 Agency Information 1/18/2018 7:54:45 PM Page 13 of 29  • We provide a variety of supplemental activities as well – STEM Smart Saturday Academy programming; book clubs; college and career readiness; yoga; and our Healthy Child Initiative, to name a few. We also work closely with corporate sponsors and local donors to provide opportunities for the matches to attend sporting events, movies, museums, and many other activities. d) Agency’s History with Providing These Services: For more than 100 years, our national organization has remained true to its founders’ vision of bringing caring role models into the lives of children. We are the oldest and most respected mentoring agency in the country. We have the hard data to prove that our Community-Based and Site-Based mentoring models help children increase self-esteem, overcome adversity, improve school behavior and academic performance, and avoid risky behaviors, like drug use. 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?) On November 1, 2017, Erin Callahan became our new CEO. Erin has been with BBBST for over 11 years in various roles within our agency, most recently as Director of Programs. She is building on the solid foundation and momentum that is in place, thanks to our longtime CEO Kim Breeden. The transition has been smooth, and Erin has been a strong and amazing leader thus far! 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: 12 # of FTE - Paid Part-Time Positions: 2 # of Volunteers: 504 # of FTE - Volunteers: 23 Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 Agency Information 1/18/2018 7:54:45 PM Page 14 of 29 g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes / No) YES If yes, is this agency an Orange County Living Wage Certified Employer? YES If no, please explain. Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 Agency Information 1/18/2018 7:54:45 PM Page 15 of 29 h) Agency Budget i. Is your agency currently receiving and/or requesting other (non-Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes/No) NO If yes, please list below: Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill, and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. I deleted this table as it did not pertain to our agency. ii. Submit your agency’s budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). THIS IS INCLUDED WITH OUR ATTACHMENTS. Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues o Private Donations o Program Generated Revenue o Local Government Grants Carrboro Human Services Carrboro Other Chapel Hill Human Services Chapel Hill Other (DO NOT include CDBG funding here) Orange County Human Services Orange County Other (DO NOT Include HOME funding here) o Other Government Grants Triangle United Way State Government Federal Government (CDBG/HOME/etc.) Private Foundation Grants o Other Revenue • Expenditures o Compensation o Rent & Utilities o Supplies & Equipment Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 Agency Information 1/18/2018 7:54:45 PM Page 16 of 29 o Travel & Training o Other Expenses iii. Does your agency budget show a Surplus or Deficit? Surplus Is there a significant change? Yes/No No Please provide a brief explanation for Surplus or Deficit, and significant changes. We are continuing to work hard to build up our cash reserve. iv. What is your agency’s fiscal year? 1/1/18 to 12/31/18 (Example: July 1, 2016 through June 30, 2017) Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 17 of 29 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Community-Based and Site-Based Mentoring Program Primary Contact and Title: Andie Thomas-Young, VP of Programs Telephone Number: 919-850-9772 E-Mail: ayoung@bbbstri.org a) Indicate the type of Human Service Needs Priority, if program applicable: Priority Area #1: safety-net services for disadvantaged residents X Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) c) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated/collaborative efforts. • Wake and Durham County Departments of Social Services – These DSS agencies refer children to us and also serve as the legal guardian for some of our clients. • North Carolina Department of Juvenile Justice – This department refers children to our agency. • Durham Housing Authority and the Housing Authority of Wake Counties – These groups refer children to us that they determine are in need of our services. • JD Lewis Community Center in Raleigh Program Category Yout h Adult Elderl y Disabled Public Housing Neighborhoods/Resident s Affordable Housing Affordable Healthcare Education X Family Resources X Jobs/Jobs Training Food Transportation Other: Please specify ____Mentoring_____ _ X Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 18 of 29 • Passage Home in Raleigh • YMCA of the Triangle, including the Chapel Hill/Carrboro YMCA • Area Boys & Girls Clubs – They refer children to us that they determine need our services. • School Districts in Wake, Durham, and Orange Counties – With this partnership, we work directly with guidance counselors and social workers in schools where we have Site-Based Mentoring programming. We receive referrals from these school districts as well. • Leadership and staff of Orange, Durham, and Wake Counties • Leadership, staff, and students at NCCU, Duke University, UNC-CH, and NCSU • Numerous African-American and Multi-Ethnic Churches in the community • National African-American fraternities: Kappa Alpha Psi, Alpha Phi Alpha, Omega Psi Phi • North Carolina Department of Public Instruction – They endorse our programs every year. • StepUp Ministries – We get referrals from this organization. In addition, through United Way, we are in a two-year collaboration with StepUp, Boys & Girls Clubs, and six other local youth service agencies. • Captrust – They are our partner in our brand new Beyond School Walls program. In this, mentees visit Captrust twice a month over the course of a school year to meet with their mentors in a professional work environment. • Youth Thrive - We are one of the agencies working with a collaborative here comprised of over 100 community members from 40 organizations to create the Wake County Strategic Planning Blueprint. • Triangle Land Conservancy – TLC has provided various recreational/agricultural opportunities for the youth in our program to not only commune with nature, but to increase their knowledge of and care for local natural resources. • Project 366 – This group has facilitated art sessions, helped fundraise for us via the selling of craft items, and sponsored an interactive art/outdoors experiment at our annual Holiday party. • The First Tee – We partnered in the fall of 2017 to deliver this group’s six-week character development program to our youth participants. • Morrisville Fire Department – They provided a fire engine and several fire fighters to our agency’s Annual Back to School Picnic. • Caron Treatment Center – We have partnered with Caron to provide professional training for staff to strengthen our approach to family engagement and building resiliency in youth. 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? Our Community-Based mentoring program allows us to reach children throughout Orange County, Chapel Hill, and Carrboro who need an adult role model in their lives. These adult volunteers routinely provide a minimum of two hours a week of quality one-to-one time for their Littles for at least one year. These Bigs play an integral role in the lives of their Littles by being good Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 19 of 29 listeners; by giving the Littles a stable adult role model to help guide them in the right direction; and by exposing the Littles to a plethora of cultural, community, and sporting activities. Our Site-Based mentoring program allows school counselors and teachers to refer children who are struggling with class work or need extra attention to help them with social skills and/or classroom behavior. Many of the children referred to this program are academically at risk – struggling with negative perceptions of school and teachers, time management, focusing, and test preparation. Site-based mentors are trained to work with their Littles to offer a positive perspective on school, model productive study habits, and encourage improved relationships with teachers and adults in general. In 2017, 14% of our Littles and 13% of our Bigs were located in Orange County. Results of our most recent Youth Outcomes Survey (YOS) show that scholastic competency, parental trust, risk attitudes, and social acceptance, among other measures, are vastly improved in our Littles after only one year in our program. This is proof that our program helps to prevent young people from going down the wrong path, making our community safer and more successful. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. Of the six Human Services needs, the one that is most applicable to us is the Education and Family Resources need, specifically focusing on youth support and activities. Most of our kids are minorities from single-parent households. They live in our highest crime-ridden neighborhoods, attend our most struggling schools, and/or become victims of violence and abuse. Many of them have at least one incarcerated parent. As a result, increases in juvenile crime, school dropout rates, childhood obesity, and other health and social problems occur. An investment in this vulnerable population is an investment in our community. We believe that inherent in every child is the ability to succeed and thrive in life. These children need positive role models to show them hope for a brighter future. Our mentors and supplemental programs help them achieve this very thing. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? 50% of the children we served in 2017 were male; the other 50% were female. Most (72%) are African-American; 8% are Caucasian; 5% are Hispanic; 11% are Multi-race; 1% is Asian; and 1% is American Indian. Eighty-one percent qualify for free/reduced lunch, and 27% have at least one parent in prison. Eighty-two percent come from single-parent homes, with over 90% households headed by single mothers. Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 20 of 29 Our programs target the children who need us the most. Any child aged six to 14 with an identified need can enroll in our program at no cost. Parents and guardians are the most important connection to our program. They recognize the potential of their children better than anyone. By enrolling a child in our program, parents are introducing a path that is brighter and more promising. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Our VP of Programs, Andie Thomas-Young, has a B.A. in Psychology and Sociology from Sweet Briar College in Sweet Briar, VA. She also has a M.S. in Sociology, with a concentration in criminal justice. She worked with BBBS of Central Virginia before moving to BBBST in 2001. All of our program staff have social work backgrounds and are required to participate in regular staff trainings to continue to grow professionally. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Our activities occur all throughout the year. Community-Based matches spend at least eight to 10 hours together each month, while Site-Based matches spend at least one hour a week together during a typical school year. Our Match Support Specialists provide ongoing monthly support to each and every match. After the initial match process, volunteers, parents, and children are contacted on a regular basis to ensure the effectiveness of our service delivery model. Every day, our program staff is on the phone with volunteers and clients, securing anecdotal evidence on the impact of the match. 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) There are several ways that our mentoring programs are a good investment for the community. Studies show that children who have role models are more likely to improve in school and in their relationships with their friends and family members. They are also less likely to skip school, commit crimes, and abuse drugs and alcohol. What is especially valuable is that our impact is felt long after Littles graduate from our program. In 2009, Harris Interactive surveyed alumni Littles and gathered some compelling data. According to this survey, 90% said their relationship with their Big helped them make better choices throughout their childhood. Eighty-six percent said their relationship with their Big helped them make better choices throughout their adult life. And 76% said they learned right from wrong from their Big. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Because all of our services are offered free of charge, we must fundraise to cover all program costs. Your support over the years has been instrumental in helping us work towards our mission of changing Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 21 of 29 kids’ lives for the better, forever. Without grant funding, at-risk youth in our service area, simply put, will not have the opportunity to be matched with a Big – which means they will miss out on the deep, impactful, meaningful relationship that comes with that. It costs approximately $1,500 to create and support a match, and that $1,500 is derived from: cost of staff to enroll, interview, match, and support mentoring relationships; trainings provided to parents and mentors; liability and property insurance; program activities; BBBSA affiliation dues; AIM fees; and criminal background checks for all volunteers. Support like yours means that the at-risk youth in our community are less likely to fall through the cracks. Our agency’s mere existence hinges on help from our generous funders. We deeply appreciate your continued support, and we hope to have a close working relationship for years to come! k) What percentage of your target population is low-moderate income? Eighty- one percent of the children we serve qualify for free/reduced lunch, which is how we measure income level. l) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc.?) Our Match Support Specialist (MSS) Team makes monthly match support calls to the parents and families that we serve. These calls give us feedback from our target population about how the match is going, how we as an agency can improve, and what may or may not be working for our Littles and families. m) Include any other pertinent information. Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 22 of 29 Additional Program Information n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics Actual 2016-17 Estimated 2017-18 Projected 2018-19 Gender Male 494 528 570 Female 536 572 571 Total 1030 1100 1141 Ethnicity African-American 762 814 822 American Indian or Alaska Native 1 Asian 4 4 11 Caucasian 103 110 101 Native Hawaiian or other Pacific Islander Other: specify __________________ 165 176 206 Total 1030 1100 1141 Of the above, how many Hispanic/Latino 8 9 57 Of the above, how many non-Hispanic/Latino 157 167 149 Total 165 176 206 Age 0-5 years 6-18 years 1020 1089 1130 19-50 years 10 11 11 51+ years Total 1030 1100 1141 Geographic Location Alamance County Chatham County Durham County 361 385 354 Wake County 536 572 628 Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non-Public Housing) 101 108 119 Town of Carrboro 19 22 24 Town of Hillsborough 10 9 10 City of Mebane (Orange County) 1 1 Orange County (Outside Municipalities) 2 3 6 Total 1030 1100 1141 Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 Work Statement a)Complete the Work Statement Chart to describe theworktobeperformed. This chart is usedto document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time-bound. Click on SMART Goals to learn more. x Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) x 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.) x 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.) x Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chartfor Program Community AndSite-Based Mentoring 1.Program Activity Name Match-Making –we match at-risk children, ages six to 14, with professionally screened and trained adult mentors who will serve as positive role models in their lives. Program Goal We have two main goals: to increase the number of matches we make; and to continue to increase the length of our matches. Studies show that relationships that last 12 months or longer show the most dramatic impact on children both academically and socially. Performance Measures Wetake great care in evaluating our measurable impact. Once a match is made, program staff members call or meet monthly with Bigs, Littles, and their parents. All information is tracked in our Agency Information Management (AIM) system, producing a written record of the relationship. We give pre-and post-surveys to Littles in both Community-and Site-Based matches to help evaluate the effectiveness of our work. We enter this into AIM as well. We are quickly able to pull reports that Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 demonstrate that our mentoring helps children succeed in school and life. Previous Year Program Results We served 62children in our service area. Our AML was 28.5 months for Community-Based matches and 21.9 months for Site-Based Matches. Current Year Estimated Results We are serving 73children in our service area. Our AML is 27.5 months for Community-Based matches and 19.2 months for Site-Based Matches . Next Year Projected Results Our goal is to serve 73children in our service area. Our Community-Based AML will be 30 months, and our Site- Based AML will be 22 months. Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 25 of 29 p) Program Budget 1. Submit your program budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). THIS IS INCLUDED WITH OUR ATTACHMENTS. Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues o Private Donations o Program Generated Revenue o Local Government Grants Carrboro Human Services Carrboro Other Chapel Hill Human Services Chapel Hill Other (DO NOT include CDBG funding here) Orange County Human Services Orange County Other (DO NOT Include HOME funding here) o Other Government Grants Triangle United Way State Government Federal Government (CDBG/HOME/etc.) Private Foundation Grants o Other Revenue • Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel & Training o Other Expenses 2. Program Budget Detail – Provide description of “other” budget items, not defined. Other budget items include fundraising costs; agency insurance; background checks; and membership fees to our national database management system. 3. This program budget represents what percent of the agency budget? 79%     Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 PROGRAM INFORMATION 1/18/2018 7:54:45 PM Page 26 of 29 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2016- 17 Estimated 2017- 18 Projected 2018- 19 Total Cost of Program $748,000 $768,000 $840,500 Total # of Individuals 1030 1100 1141 Cost Per Individual $726 $698 $737 Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 FY 2018-19 Agency Budget Agency Budget Operating Budget for Entire Agency Actual 2016-17 Estimated 2017- 18 Projected 2018-19 Percent Change 276,626$193,787$303,000$56% -$-$-$0 3,000$4,000$5,000$25% -$-$-$0 2,000$4,000$10,000$150% -$-$-$0 6,000$5,800$10,000$72% -$-$-$0 -$-$-$0 50,647.54$4,219.00$-$(1.00)$ 19,526.25$21,000.00$84,000.00$3.00$ 56,433.14$123,513.00$86,500.00$(0.30)$ Private Foundation Grants294,225.00$265,250.00$300,000.00$0.13$ 246,968$283,215$261,000$(0.08)$ 955,426$ 904,784$1,059,500$17% 613,382$574,121$627,000$9% 103,028$92,720$96,360$4% 14,534$11,368$16,900$49% 6,295$11,764$21,187$80% 174,048$207,463$283,053$36% 911,287$ 897,436$1,044,500$16% 44,139$7,348$15,000$104% Total Agency Revenue Agency Generated Revenue (fees) AGENCY NAME: Other Revenue SURPLUS/(DEFICIT) FOR PERIOD: Other Government Grants Triangle United Way State Government Federal Government (CDBG/HOME/etc.) Compensation Rent & Utilities Other Expenses: Total Agency Expenses Supplies & Equipment Travel & Training AGENCY EXPENSES AGENCY REVENUE Private Donations Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Big Brothers Big Sisters of the Triangle, Inc. Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 FY 2018-19 Program Budget Program Budget Operating Budget for Program Actual 2016-17 Estimated 2017-18 Projected 2018- 19 Percent Change 255,000$193,787$200,000$3% -$-$-$0 3,000$4,000$5,000$25% -$-$-$0 2,000$4,000$10,000$150% -$-$-$0 6,000$5,800$10,000$72% -$-$-$0 -$-$-$0 46,000.00$4,220.00$-$(1.00)$ -$21,000.00$84,000.00$3.00$ -$123,513.00$ 86,500.00$(0.30)$ Private Foundation Grants200,000.00$ 265,250.00$ 300,000.00$0.13$ 236,000$113,553$145,000$0.28$ 748,000$ 735,123$ 840,500$14% 620,000$574,121$627,000$9% 65,000$81,020$85,200$5% 10,000$10,000$21,000$110% 10,000$5,177$12,000$132% 43,000$64,805$95,300$47% 748,000$ 735,123$ 840,500$14% -$-$ -$ 0 PROGRAM REVENUE PROGRAM NAME Big Brothers Big Sisters of the Triangle, Inc. 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 Travel & Training Other Expenses: Federal Government (CDBG/HOME/etc.) Supplies & Equipment Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities SURPLUS/(DEFICIT) FOR PERIOD: Total Program Expenses Exhibit A: Provider's Outside Agency Application DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606 Certified by: Title: CEO Date: 8/6/2018 (Provider’s Signature) EXHIBIT “B” Scope of Services –FY 2018-19 Outside Agency Performance Agreement Agency Name:Big Brothers Big Sisters of the Triangle, Inc. Program Name: Community-Based and Site-Based Mentoring Funding Award:$6,430 Outline how the agency will spend Orange County’s funding award. Program Services Outline the critical services (activities)the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. x Continueto carefully screen, train, match, and support Bigs to ensure appropriate pairing of mentors with mentees x Establish match goals based on information reported fromthe program participants and any relevant external resources (i.e. therapists, counselors, or references) x Work hard to continue offering supplemental activities, trainings, and opportunities for all program participants Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure’s description or for an earlier performance measure. Performance Measures Anticipated Results BBBST will serve children in Orange County through mentoring and supplemental programming.159 BBBST will continue to increase the Average Match Length in the Community-Based Mentoring program. 30 months BBBSTwill continue to increase the Average Match Length in the Site-Based Mentoring program. 22 months BBBST will serve children in Orange County through Community-Based Mentoring.73 BBBST will serve children in Orange County through Site-Based Mentoring. 73 Expense Description Amount Personnel Costs –salaries, FICA, and fringe$6,430 DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606  (Big Brothers Big Sisters of the Triangle, Inc.) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7/18 ATTACHMENT “A” Orange County Certifications – FY 2018-19 Outside Agency Performance Agreement Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, residential address; phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization’s Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. Certified by: _______________________ Title: __________________________ Date: ___________ (Provider’s Signature) DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606   The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE$ MED EXP (Any one person)$ PERSONAL & ADV INJURY$ GENERAL AGGREGATE$ PRODUCTS - COMP/OP AGG$ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE$ EACH OCCURRENCE$UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.  $VVXUHG3DUWQHUVRI1RUWK&DUROLQD )DOOVRI1HXVH5RDG6XLWH 5DOHLJK1& 6HOHFW%XVLQHVV8QLW  VEXVHUYLFHQF#DVVXUHGSDUWQHUVFRP %HUNVKLUH+DWKDZD\,QVXUDQFH*URXS %,*%527%XVLQHVV)LUVW,QVXUDQFH&R %LJ%URWKHUV%LJ6LVWHUVRIWK $YLDWLRQ3NZ\6WH 0RUULVYLOOH1& %HUNVKLUH+DWKDZD\6SHFLDOW\,QVXUDQFH&RPSDQ\  $; ;    ; 63.  & ;; 5:6 %;    $3URSHUW\ &ULPH 63.%33 )LGHOLW\   3URIHVVLRQDO/LDELOLW\63. $JJUHJDWH $EXVHDQG0ROHVWDWLRQ(DFK,QFLGHQW$JJUHJDWH 2UDQJH&RXQW\*RYHUQPHQW)LQDQFH $GPLQ6HUYLFHV 32%R[ +LOOVERURXJK1& DocuSign Envelope ID: 1381F24A-F27B-438F-AC45-7A16015EA606