HomeMy WebLinkAbout2018-412-E Finance - Dispute Settlement Center outside agency agreementDocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
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 Dispute Settlement Center, Inc., a not - for - profit
corporation, located at 302 Weaver Street, Carrboro, NC 27510 ( "Provider ").
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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 Dispute Settlement Center, 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 $81,850.
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 $20,462.50. 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.
(Dispute Settlement Center, Inc.)
Orange County Outside Agency Performance Agreement
Revised 712018 Page I of 9
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
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.
(Dispute Settlement Center, Inc.)
Orange County Outside Agency Performance Agreement Page 2 of 9
Rev. 7118
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
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
parry 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.
(Dispute Settlement Center, Inc.)
Orange County Outside Agency Performance Agreement Page 3 of 9
Rev. 7118
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
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 Dispute Settlement Center, 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:
(Dispute Settlement Center, Inc.)
Orange County Outside Agency Performance Agreement Page 4 of 9
Rev. 7118
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
County: Finance & Administrative Services
Orange County
Post Office Box 8181
Hillsborough, NC 27278
Provider: Dispute Settlement Center, Inc.
302 Weaver Street
Carrboro, NC 27510
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 at oocusignei a,,: r
V'ciln G1.5 KJA �t 16VL
35C63Ad62C124C8... —
For e oocu$ignedby, `7ounty Government
0637994B755E477...
Bonnie Hammersley, County Manager
(Dispute Settlement Center, Inc.)
Orange County Outside Agency Performance Agreement
Rev. 7118
8/14/2018
Date
8/16/2018
Date
Page S of 9
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
COEI PkCE.t
a) Applicant Contact Information
Applicant Organization's Legal Name: Dispute Settlement Center
Applicant Organization's Physical Address: 302 Weaver Street Carrboro NC 27510
Applicant Organization's Mailing Address: same
Applicant Organization's Web Address: www.dis utesettlement.or
Executive Director: Frances Henderson
Telephone Number: 919 929 -8800
Tax ID Number: 56- 1216584
E -Mail: fenderson dis utesettlement_or
b) Funding Request
List all FY18 -19 Human Services HS Funding Being Requested —
For All Proarams] and the Proposed Use of Funds (2 -3 lines or less)
Program
Ch7_p 'el ' ;
0rarrge.. +
Total
-� T
`- HS
County-HS.
$85,000
Mediation
x
$85;U00
PY r fib f6 f�gP� i_
�
Totals
$1404
$18;000 -
$85,`000
$117,000
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.
i
Signature: r�ti
E/ cutive Director
J
Signature:
Board Chairperson
/ -2- 2 if
Date
/- 2,2--It
Date
AGENCY INFORMATION 1 /12/2018 12:41:41 PM Page 8 of 27
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT 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.
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: ag4.e4.—
xecutive Director
Signature:
Board Chairperson
Date
Date
AGENCY INFORMATION 1/19/2018 1:33:24 PM Page 9 of 27
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT 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): September 1978
We will celebrate our 40th anniversary this year, as the founding community mediation
center in North Carolina!
b) Agency's Purpose /Mission (no more than a few sentences):
Mission: "To promote and bring about the peaceful settlement of disputes and
prevent the escalation of conflict through mediation, conciliation, facilitation, and
training."
We assist individuals and groups to work through interpersonal conflicts, or to reach
mutually agreeable decisions in constructive ways.
We help organizations and schools make systemic change in how members work
together, solve issues, and deal with infractions or breaches within the organization
or school, using conflict resolution and Restorative Practices techniques.
c) Types of Services the Agency Provides (bullet format):
o Mediation for court - referred and community- referred interpersonal disputes
including family, business, neighborhood, Medicaid Appeals, and eldercare;
o Training for adults in conflict resolution, mediation, and facilitation, as well as
interventions in disputes;
o Facilitation, mediation and consensus - building for groups, organizations, and
governmental units; and
o Training, mediation and development of Restorative Practices for youth in
school, community, and juvenile court settings.
d) Agency's History with Providing These Services:
Court Mediation: We have provided mediation services since 1978. DSC relieves
the Orange County Criminal District of cases best settled through mediation -
thereby freeing up judges and court staff for other issues, and providing a more
humane and effective forum for interpersonal disputes between neighbors, co-
workers, family members and others.
Community Mediation: We offer sliding scale separation and divorce mediation
sessions on issues including parenting arrangements, financial divisions, alimony
and custody.
We also help families with eldercare issues and neighbors and small business
people with disputes. In 2012 we began assisting Orange County Medicaid
Agency Information 1/22/2018 4:11:17 PM Page 10 of 27
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
recipients, the very poor and disabled, with their service provision appeals, by
facilitating conversations with providers.
Youth Services: We have provided Youth Services since 1984. Our youth services
have evolved over time to include Restorative Justice (or Restorative Practices.)
Public Disputes: Since 1986 we have provided Public Disputes (facilitation)
services including training for people who want to facilitate better meetings, or that
need assistance in process design or consensus building for important issues.
Training and Intervention: Individuals, groups, and organizations seeking better
skills in conflict management may take training from DSC, or ask us to intervene in
an active dispute.
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 ?)
Our staff is very stable. Knowing that we are understaffed, and knowing that we can do
more with providing training for systemic change, our board is planning a fundraising
initiative for FY19 related to our 40th anniversary. We are planning expanding some
services outside of this community, while preserving (and enhancing) services here. We
need a Community Engagement/Communications staff person — we currently have no
designated development staff. We hope to add an additional Youth Program staff member
in order to keep up with the demand for the Restorative Practices work.
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
Executive Director 40 hrs
Public Disputes Program Coordinator 40hrs
Mediation Coordinator 36 hrs
Training Coordinator 40
Restorative Practices for Youth Coordinator 36 hrs
Assistant to Director /Family Mediation Intake 30 hrs (reduced to 16 in November 2017)
Proposed for FY 19:
Youth Program 30 hours
Development/ Engagement staff 40 hours
# of FTE - Full -Time Paid Positions: 5 -7
# of FTE - Paid Part -Time Positions: 1
Agency Information 1/22/2018 4:11:17 PM
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
# of Volunteers: 40 # of FTE - Volunteers:5
g) Living Wage
Does this agency pay permanent employees a minimum living wage? (Yes/ No) Yes
We were proud to be in the first round of living wage employers!
If yes, is this agency an Orange County Living Wage Certified Employer? Yes
If no, please explain.
Agency Information 1/22/2018 4:11:17 PM Page 12 of 27
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
h) Agency Budget
Is your agency currently receiving and /or requesting other (non -Human Services)
local (Town of Carrboro, Town of Chapel Hill, Orange County) government
funding? (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.
Program FY17 -18 FY18 -19 Source
Award Request
*Add rows or attach additional page, if needed.
ii. Submit your agency's budget. You may complete the provided template (separate
As file) or you may submit your own budget file (as long as it contains the same
information, and in a similar format, as requested in the provided template).
Agency Budgets are required to define budget amounts for the previous program
year, current program year, and next program year for the following categories:
Revenues
• Private Donations
• Program Generated Revenue
• 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
Agency Information 1/22/2018 4:11:17 PM --3 g e 1 3 o f 2
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
■ 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
o Rent & Utilities
• Supplies & Equipment
• Travel & Training
• Other Expenses
iii. Does your agency budget show a Surplus or Deficit?
There is a small deficit for FY17.
Is there a significant change? Yes /No No
Please provide a brief explanation for Surplus or Deficit, and significant changes.
The board has reviewed the deficit, which was caused by some initiatives that
were unpaid. As the deficit was a low percentage of the budget, and we have
reserve funds, the board was comfortable with it.
iv. What is your agency's fiscal year? June 30
(Example: July 1, 2016 through June 30, 2017)
Agency Information 1/22/2018 4:11:17 PM
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Agency Budget
Operating Budget for Entire Agency
AGENCY NAME:
AGENCY REVENUE
Private Donations
DISPUTE SETTLEMENT CENTER
Agency Generated Revenue (fees)
Local Government Grants:
Human Services - Town of Carrboro
Other - Town of Carrboro
Human Services - Town of Chapel Hill
Other - Town of Chapel Hill
Human Services - Orange County
Other - Orange County
Other - Town of Hillsborough
Other Government Grants
Triangle United Way
State Government
Federal Government (CDBG /HOME /etc.)
Private Foundation Grants
Other Revenue
Total Agency Revenue
AGENCY EXPENSES
Compensation
Rent & Utilities
Supplies & Equipment
Travel & Training
Other Expenses:
Total Agency Expenses
SURPLUS /(DEFICIT) FOR PERIOD:
FY 2018 -19 Agency Budget
$ (11,052) $ - 1 $ - 1 0
Actual
2016 -17
Estimated
2017 -18
Projected
2018 -19
Percent
Change
$
51,803
$
26,000
$
65,000
150%
$
195,772
$
254,000
$
270,000
6%
$
9,000
$
10,000
$
14,000
40%
$
-
$
-
$
-
0
$
12,000
$
14,000
$
18,000
29%
$
-
$
-
$
-
0
$
80,000
$
81,500
$
85,000
4%
$
8,118
$
8,315
j $
9,146
10%
$
-
$
-
$
-
0
0
$
27,061.00
$
27,718.00
$
30,489.00
$ 0.10
$
-
$
-
$
-
0
$
64,048.00
$
45,000.00
$
70,000.00
$ 0.56
$
2,042
$
500
$
400
$ (0.20)
$
$
449,844
418,007
$
$
467,033
413,793
$
$
562,035
502,702
20%
21%
$
7,285
$
8,000
$
9,000
13%
$
5,107
$
5,500
$
14,500
164%
$
8,895
$
9,800
$
12,000
22%
$
21,602
$
29,940
1 $
23,833
1 -20%
$
460,896
$
467,033
1 $
562,035
1 20%
$ (11,052) $ - 1 $ - 1 0
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
3. PROGRAM INFORMATION (Submit a separate Section 3 for each program)
Program Name: Mediation — in court and in the community
Program Primary Contact and Title: Jenifer Yarnelle, Mediation Coordinator
Telephone Number: 919 929 -8800
E -Mail: jarnelle(a)disputesettlement.org
a) Indicate the type of Human Service Needs Priority, if program applicable:
X❑ Priority Area #1: safety -net services for disadvantaged residents
❑ Priority Area #2: education, mentorship, and afterschool programming for
youth facing a variety of challenges
❑ 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
Disabled
Public Housing
Neighborhoods /Residents
Affordable Housing
Affordable Healthcare
Education
Family Resources
Jobs /Jobs Training
Food
Transportation
Other: Please specify
conflict resolution and
mediation
x
x
x
x
x
c) Provide a bulleted list of other agencies, if any, with which your agency
coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s)
to be funded. For each, briefly describe the coordinated /collaborative efforts.
We receive case referrals from these entities, among others:
Orange County Criminal District Court;
Orange County Civil District Court (50 -C cases)
Orange County Magistrates;
Orange County Small Claims Court;
Orange County Animal Control;
Orange County Senior Centers;
Orange County Clerk of Court;
Orange County Department on Aging:
Homeowners' Associations (HOAs):
Chapel Hill Police Department Crisis Unit;
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DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Orange County DSS;
Town of Chapel Hill Ombuds Office;
Town of Chapel Hill Human Resources;
Town of Carrboro;
Chapel Hill- Carrboro City Schools;
Orange County Schools;
Family law attorneys;
Family therapists;
NC Office of Administrative Hearings (Medicaid Appeals)
Compass Center;
Congregations, nonprofits and businesses;
Senior Care providers.
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?
Court Mediation In Orange County Criminal District Court, the judges and assistant
district attorneys refer cases to us and we then screen for appropriateness and
voluntariness. An appropriate case involves an interpersonal dispute (leading to, for
example, charges of harassment, communicating a threat, injury to personal
property, etc.) without domestic violence, in which the parties agree to mediate.
Most court clients have very few resources and often need to get back to their jobs.
They also need real resolution of the problem between themselves and their
neighbor, co- worker, or family member.
Family Mediation In the case of family mediation, clients are referred to Dispute
Settlement Center through attorneys, therapists, or social services agencies, or self -
referred. Our sliding scale fee structure enables people of all income levels to have
access to high quality mediation.
Likewise, business, neighborhood, and employment cases come to us through
attorney, law enforcement, or agency referrals, or self - referrals.
Medicaid Appeals These cases are referred to us through a program through
Office of Administrative Hearings. This program serves the very poor and disabled
in Orange County who have been denied Medicaid services or support and have
appealed the denial.
The Orange County Board of County Commissioners' goals include to "Create a
Safe Community" and to "Foster a community culture that rejects oppression and
inequity."
Dispute Settlement Center helps people in conflict work through their
differences in safe environments so that they can move on with their lives with less
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DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
stress and perhaps improved relationships. Through the mediation process, they
may learn skills that help them speak up for themselves more effectively. This, we
believe, is a building block for democracy and inclusiveness.
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.
"Ending the overuse of jail will reduce economic and racial inequalities and is an essential
part of advancing civil rights in the 21st century." Nicholas Turner, President and Director,
Vera Institute of Justice.
We are proud that Orange County (to the best of our knowledge) is the only county in NC
which provides mediation without cost in Criminal District Court, due to the funding of
Dispute Settlement Center through this grant. A recent report "Court Fines and fees:
Criminalizing Poverty in NC" www.ncpolicywatch.com /2018/01/03 details the legislature's
increasing reliance on court fees that millions cannot afford. Court fees can constitute an
on -going "poverty trap." We can help get cases settled, and people back to their jobs..
As quoted above on the County's website, the BOCC recognizes that smooth and equitable
functioning of the court system is a part of its larger goals. Any of the 135,000 Orange
County residents may in fact be in Criminal District Court, but many are low- resource
individuals working in hourly positions. Court may have been a last resort for them in a
conflict with their friend, neighbor, family member or colleague. While they have a right to
use court, it may not be the best route to resolution for them. We give them an option of
mediation, which can mean a quicker return to work, as well as a much better resolution.
(Note that some court clients may live in Chatham, Durham, Alamance or Wake and be
involved in an Orange County Court case.)
We cannot claim to prevent violence or that we advance civil rights. But, contributing to the
efficiency of the court system AND helping people take more control over their lives
contributes to both of these BOCC goals. As we encourage mediation and conciliation in
the community (out of court) we also hope to contribute to the County goals of full civic
participation, in a safe community, and promoting the well -being of all citizens.
Conflict avoidance (or fighting) is stressful. In the case of family mediation, there is strong
research showing that mediation is better for the long -term relationships between parents
and children. (see Robert Emery, PhD. at the University of Virginia's Center for Children,
Families and the Law.) Likewise in eldercare mediation, or other family situations,
relationships can salvaged, or improved, in mediation.
f) Who is your target population of individuals to benefit from this program and how will they
be identified and connected with the program?
Court: Anyone in Criminal District Court as a result of a civilian- generated warrant
may be referred to us by the court (we screen for violence) and have an option to
mediate. Also, we can receive referrals from Small Claims Court, 50 -C, and Truancy
Court.
PROGRAM INFORMATION 1/22/2018 4:11:17 PM
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Family cases: Lawyers, therapists, family service providers and others in the
community refer people to us. People know of us and self- refer. Senior care
providers and the Orange County Clerk of Court may send us eldercare disputes.
Medicaid Recipients: The Office of Administrative Hearings sends these poor and
disabled citizens (or their advocates) to us for facilitation of disputes over Medicaid -
funded services.
g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program
Manager and credentials, describe training provided to volunteers, etc.)
The Executive Director has a JD and 26 years of mediation experience. She is an adjunct
professor at the UNC School of Government, teaching Non - Profit Management. The
Mediation Coordinator has 23 years of experience in mediation. Assisting in court is the
Restorative Practices Coordinator, with a JD and 6 years of experience in mediation.
h) Describe the specific period over which the activities will be carried out and include an
implementation timeline.
July 1, 2018 through June 30, 2019 we will attend Criminal District Court "People's
Court" sessions regularly for referral, interviewing, and mediation. This means
Mondays and Thursdays, with a team of mediators attending on the People's Court
days.
In addition, we receive referrals, do intake, and mediate family, community and
eldercare cases throughout the year.
We are available for consultations throughout business hours on the phone or ny
people coming by the office: this is a lot of our work, as people in conflict need to
vent, tell their story, and learn about mediation. Many times mediation is not
appropriate for their situation. It may be too late in the drama, there may be violence
or the threat of violence, or one party may be unwilling. This is not reflected in the
numbers, but is a service we provide. Even when situations do not come to
mediation, it can be helpful for people to talk to us, be heard, and get some ideas for
conciliation or moving forward, short of mediation.
Medicaid Appeals are referred to us when initiated, and we have 25 days in which to
hold a mediation and report.
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)
Orange County has a role to play in making sure that the court system functions
effectively. A crowded docket strains resources and lack of efficiency in case management
could also mean increased crowding and liability in the local jail.
As mentioned above, our service as funded by the BOCC means low- resource clients can
get mediation and return to their jobs without paying fees, leading to the "poverty trap."
PROGRAM INFORMATION 1/22/2018 4:11:17 PM Page 18 of 27
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Chief District Court Judge Joseph Buckner has said that his courthouse would "be in lock -
down" without the assistance of Dispute Settlement Center mediators relieving the courts.
Most important, offering disputants a chance to sit down with mediators helps them reach
lasting resolutions so that behaviors leading to warrants are less likely to be repeated.
These are public safety issues.
Families in Orange County need affordable mediation services when faced with separation
and divorce. While there are private mediators, we are the only mediators with a sliding
scale fee structure. Low to moderate income couples — and those unemployed- need this
support. In addition, as the population ages, more families struggle with transitions around
care of elders. We offer a different way, beyond fighting, litigation, or suffering in silence.
This includes assisting the Orange County Clerk of Court with family situations at his
request.
Finally, having a place to contact for help and support with neighborhood or other conflicts
means we can be a gentler community — where people try to talk to each other over
differences, rather than litigating, fighting, or avoiding each other.
j) Describe what would happen if requested funding is not awarded at all or if a reduced
allocation is recommended.
Without funding, we could not attend Criminal District Court. After the NC Legislature de-
funded mediation throughout the state for FY11, Orange County picked up support for this
needed service.
Note that in FY02, the NC Legislature was providing $84,530 in support for this program.
Over time, we have found some general support for mediation. We believe that it can be
agreed that court mediation, however, is properly supported by government.
Our expenses have continued to go up with this program, while we receive less than we did
17 years ago in government support, due to the state budget pullbacks.
We are so grateful for Orange County's leadership (the only County in NC to support court
mediation in this way) but we do struggle to keep up with our costs.
k) What percentage of your target population is low- moderate income?
Court: We understand most of our clients to be hourly workers who are missing work to be
in court. We do not have absolute data to support this, but this is our experience.
Family: Divorce mediation is open to all income levels, but the reality is that our clients
tend to be moderate income, with about one - quarter being low- income or unemployed
(paying the minimal on our sliding scale.)
Medicaid: All clients are either disabled or very low- income.
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DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
1) What efforts do you make to seek feedback about your program from your target population
(e.g. survey, evaluations, etc. ?)
We do post mediation evaluation with family mediation clients.
We have found that it is nearly impossible to survey court clients, given the fast -paced
court environment.
Recently we have done a major survey effort with the 20 -40 year -old age group, to assess
their needs.
m) Include any other pertinent information.
We would like to note that mediation is a practice which does not lend itself to easy
evaluation. We maintain demographic information on clients and resolution rates, but this
does not tell the whole story.
In many cases, we talk the parties separately through the conflict, encourage ways of
conciliation, and then they may not mediate, or one side refuses. In other cases, there may
be a long mediation but no resolution — nonetheless progress has been made. Mediators
are trained to not focus on resolutions but on first, doing no harm, and second, empowering
the parties to communicate and negotiate for themselves. Of course, resolutions can be
great things, and we note that in over 80% of mediations held, there is a resolution.
In Criminal District Court, the cases can be very involved and take a few hours of
mediation, or be short. Orange County support enables us to give each case the attention
that is needed.
We are trying to be realistic in setting number goals. It all depends on the number of
appropriate cases that are referred to us, and this may vary widely. The agency must
maintain trained available personnel no matter how many cases there are.
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DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
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
Gender
Male
Female
Total
Ethnicity
African - American
American Indian or Alaska Native
Asian
Caucasian
Native Hawaiian or other Pacific Islander
Other: specify latino
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
Alamance County
Chatham County
Durham County
Wake County
Orange County Breakdown
Chapel Hill Public Housing
Town of Chapel Hill (Non - Public Housing)
Town of Carrboro
Town of Hillsborough
City of Mebane (Orange County)
Orange County (Outside Municipalities)
Actual Estimated Projected
2016 -17 2017 -18 2018 -19
259
236
275
347
414
375
606
640
650
143
152
160
574
616
30
33
22
40
398
442
420
32
24
30
606
640
650
32
24
30
574
616
30
606
640
650
none none
606 640 650
41
30
30
33
30
30
12
15
15
35
25
25
unk
256
280
285
56
70
75
107
110
110
66
80
80
Total 1 606 640 1 650
PROGRAM INFORMATION 1/22/2018 4:11:17 PM Page 21 of 27
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Work Statement
o) Complete the Work Statement Chart to describe the work to be performed.
This chart is used to document program activities, program goals, performance measures,
and actual results. (Add more rows as needed) If this is a new program, you will only
document the projected information. Every program is required to have AT LEAST 1
Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and
Time- bound. Click on SMART Goals to learn more.
• Program Activities should outline major activities the agency implements to accomplish its
program goals. (i.e. Deliver meals to elderly /disabled residents.)
• Program Goal should explain what the program is trying to achieve /accomplish. Goals are
statements about what the program should accomplish. (i.e. Deliver 100 meals per day,
Monday - Friday.)
• Performance Measures describe how you will evaluate the degree in which you achieved
the stated goals. (i.e. Will track the number of meals delivered each day,)
• Actual Program Results use program results to indicate the actual measureable
achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of
105 meals per day.)
Work Statement Chart for Program MEDIATION
I. Program Activity Name.
Court Mediation
Program Goal
Offer mediation in Orange County Criminal District Court
Performance Measures
Numbers of people assisted with conflict and resolution rate for
cases mediated.
Previous Year Program Results
247 assisted with an 82 % resolution rate for cases mediated.
Current Year Estimated Results
250 assisted with an 80% resolution rate for cases mediated
Next Year Projected Results
250 people with 80% resolution rate for cases mediated
2. Program Activity Name..
Community mediation
Program Goal
Assist people with family, neighborhood, business, Medicaid
services and other conflicts
Performance Measures
Numbers of people assisted and resolution rate of cases mediated
Previous Year Program Results
359 people assisted; resolution rate 78%
Current Year Estimated Results
390 people assisted; resolution rate 80%
Next Year Projected Results
400 people assisted; resolution rate 80%
3. Program Activity Name;
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
4; Program Actiivity'Name ,
Program Goal
Performance Measures
Previous Year Program Results
Current Year Estimated Results
Next Year Projected Results
PROGRAM INFORMATION 2/28/2018 12.51:40 PM Page 2 2 of 27
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
p) Program Budget
1. Submit your program budget. You may complete the provided template (separate xls
file) or you may submit your own budget file (as long as it contains the same information,
in the same format, as requested in the provided template).
Program Budgets are required to define budget amounts for the previous program
year, current program year, and next program year for the following categories:
Revenues
• Private Donations
• Program Generated Revenue
• 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)
• Other Government Grants
• Triangle United Way
• State Government
• Federal Government (CDBG /HOME /etc.)
• Private Foundation Grants
• Other Revenue
Expenditures
• Compensation
• Rent & Utilities
• Supplies & Equipment
• Travel & Training
• Other Expenses
2. Program Budget Detail — Provide description of "other" budget items, not defined.
These would include insurance, printing, and the costs of our audit, as allocated
to this budget.
3. This program budget represents what percent of the agency budget? 32%
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 1/22/2018 4:11:17 PM
Actual 2016 -17
Estimated 2017 -18
Projected 2018 -19
Total Cost of Program
152,075
153,190
158,000
Total # of Individuals
606
640
650
Cost Per Individual
250
239
243
PROGRAM INFORMATION 1/22/2018 4:11:17 PM
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Program Budget
Operating Budget for Program
PROGRAM NAME
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 EXPENSES
Compensation
Rent & Utilities
Supplies & Equipment
Travel & Training
Other Expenses:
Total Program Expenses
SURPLUS /(DEFICIT) FOR PERIOD:
FY 2018 -19 Program Budget
MEDIATION
$ (8,488) $ (4,690) $ - 1 100%
Actual
2016 -17
Estimated
2017 -18
Projected
2018 -19
Percent
Change
$
20,000
$
20,000
$
37,500
88%
$
18,587
$
27,000
$
26,000
-4%
$
-
$
-
$
-
0
$
-
$
-
$
-
0
$
-
$
-
$
-
0
$
-
$
-
$
-
0
1
80,000
$
81,500
$
85,000
4%
$
-
1 $
-
1 $
-
0
6$
$
-
$
-
0
$
=0l-
-
$
-
$
-
0
$
-
$
-
$
-
0
$
-
$
-
$
-
0
$
25,000.00
$
20,000.00
$
10,000.00
$ (0.50)
$
-
$
-
$
-
0
$
$
143,587
129,500
$
$
148,500
132,090
$
$
158,500
134,750
7%
2%
$
2,650
$
2,900
$
3,400
17%
$
3,875
$
3,000
$
3,250
8%
$
3,175
$
2,800
$
3,200
14%
$
12,875
$
12,400
$
13,900
12%
$
152,075
$
153,190
$
158,500
3%
$ (8,488) $ (4,690) $ - 1 100%
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
131:x;11: t
Scope of Services — FY 2018 -19
Outside Agency Performance Agreement
Agency Name: Dispute Settlement Center
Program Name: Mediation
Funding Award: $81,850
Outline how the agency will wend Orange Countv's funding award.
Expense Description
Amount
The agency will spend Orange County funding on personnel costs for mediation staff. For the
agency, personnel costs are over 80% of the budget, including salaries, retirement, and payroll
taxes.
240 people
served
2. Assist 384 people with interpersonal disputes related to divorce, neighborhood,
business, and Medicaid services with an above 80% resolution rate.
384 people
served
(from application, projecting 4% fewer, passed on 4% fewer dollars allocated than requested.)
$81,850
Program Services
Outline the critical services (activities) the agency will employ to attain the .Anticipated Outcomes below, by June 30, 2019.
• Provide mediators in Orange County Criminal District Court for resolution of interpersonal
disputes
• Provide mediators for assistance with family, business, neighborhood, and Medicaid disputes.
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
1. Assist 240 people in court with interpersonal disputes, with an above 80%
resolution rate.
240 people
served
2. Assist 384 people with interpersonal disputes related to divorce, neighborhood,
business, and Medicaid services with an above 80% resolution rate.
384 people
served
(from application, projecting 4% fewer, passed on 4% fewer dollars allocated than requested.)
rDoc uSigned by: 624
FMAA. 5 k.IRJW56VU Execu i ve Director 8/14/018 /
Certified by: Tn --�" �' ........ title: Date: 7127 _3
(Provider's Signature)
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
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.
UceuSIgned by:
FrXV,U,S
Certified by: _If
s�ensaae2czac8... Title:
(Provider's Signature)
Executive Director 8/14/2018
Date:
(Dispute Settlement Center, Inc.)
Orange County Outside Agency Performance Agreement Page 9 of 9
Rev. 7118
DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1
s�C t�® CERTIFICATE OF LIABILITY INSURANCE
DATE(MUMDIYYYY)
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
0 511 61201 8
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND 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 have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT Diane Nadeau
NAME
Business Insurers of Carolinas
PHONE Ext: N. 968 -4611 Nn : (919) 968 -8991
800 Eastowne Drive, Suite 208
1=40AIL dnadeau @businessAnsurers.com
ADDRESS:
PO Box 2536
EACH OCCURRENCE
$ 1,000,000
INSURER(S) AFFORDING COVERAGE
NAIC #
Chapel Hill NC 27515 -2536
1111RERA: American Liberty Insurance Co
25186
INSURED
Emplo e
INSURER B : Employers Mutual Casualty
21415
DISPUTE SETTLEMENT CENTER INC
INSURER C
302 W WEAVER ST STF A
INSURER D :
INSURER E:
$
A
CARRBORO NC 27510 -6004
INSURER F :
4W54487
UVV1zKAGtc5 CERTIFICATE NUMRERt L:LItS01bZZZ6b PF=VIQlnfd iW IUIZF17-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ALIUL
INSD
WVD
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MWDDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO
PREMISES FR =n ce
$ 300'000
MED EXP (Any one person)
$ 5,000
PERSONAL &ADV INJURY
$
A
4W54487
06/17/2018
06/17/2019
GEN'LAGGREGATE LlMITAPPLIES PER
POLICY ❑ PECT_ ❑ LOC
GENERAL AGGREGATE
$ 2.000,000
PRODUCTS - COMPIOPAGO
$ 2,000,000
Hirediborrowed
$ 1,000,000
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea acciderrt
$
BODILY INJURY (Per person)
$
ANYAUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per aoc?dent
$
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED I I RETENTION $
$
WORKERS COMPENSATION
PER
B
AND EMPLOYERS LIABILITY
D? ANY PROPRIETORIPARTNER(EXECUTIVE Y❑
OFFJCERfMEMBER EXCLUDE
NIA
4H54487
06/17/2018
06/17/2019
STATUTE ER
E.L. EACH ACCIDENT
$ 100,000
E.L. DISEASE -EA EMPLOYEE
$ 100,000
(Mandatory in NH)
If yes, describe under
❑ ESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY UM1T
$ 500'000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES {ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Orange County Government
PO Box 8181
Hillsborough
NC 27278
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD