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Home My WebLink About2018-439-E Finance - Boys and Girls Club of Durham and Orange Counties outside agency agreementDocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA 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 Boys & Girls Club of Durham & Orange Counties, a not - for - profit corporation, located at 808 East Pettigrew Street; PO BOX 446, Durham, NC 27702 ( "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 Boys & Girls Club of Durham & Orange Counties 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 $5,000. 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. The Provider shall be paid in four equal installments in the amount of $1,250. 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. (Boys & Girls Club of Durham & Orange Counties) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 — December 31; January 1 — March 31 and April 1 - June 30. Reports are due on January 11, April 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 (Boys & Girls Club of Durham & Orange Counties) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance, including hired and non -owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation • Commercial General Liability • Automobile Liability • Professional Liability Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee $1,000,000 Each Occurrence $2,000,000 Aggregate $500,000 Combined Single Limit $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 (Boys & Girls Club of Durham & Orange Counties) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non - Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non - Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of 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 Boys & Girls Club of Durham & Orange Counties 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 (Boys & Girls Club of Durham & Orange Counties) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance & Administrative Services Provider: Boys & Girls Club of Durham & Orange County Orange Counties Post Office Box 8181 808 East Pettigrew Street; PO Hillsborough, NC 27278 BOX 446 Durham, NC 27702 16. E ntire 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 11 A 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 t h'Uocu Sig ned by: B7flB580G91 ND9... J C z CI UIII LCv I y Provider CEO 8/16/2018 Date Form 1 DocuSignedby, P� �)untyGovernment 661A n.1(, N *KALY' 8/18/2018 {]637994B755E477... (Boys & Girls Club of Durham & Orange Counties) Orange County Outside Agency Performance Agreement Page S of 9 Rev. 7118 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA Bonnie Hammersley, County Manager Date (Boys & Girls Club of Durham & Orange Counties) Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 7118 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE Applicant Organization's Legal Name: Boys & Girls Clubs of Durham and Orange Counties Applicant Organization's Physical Address: 808 E Pettigrew St; Durham, NC 27701 Applicant Organization's Mailing Address: P.O. Box 446 Durham, NC 27702 Applicant Organization's Web Address: ynw.bggdop.grg Executive Director: Jerome Levis) Telephone Number: (919)- 687 -4517 E -Mail: _i[evisvCcDbacdoc.czrcJ Tax ID Number: 56- 6001906 b) Funding Request List all FY18 -19 Human Services (H$) Funding Being Requested — For All Programs) and the Proposed Use of Funds (2 -3 lines or less) Prrogmm Carrboro Chapel -H Orange -County- Total - HS Youth After School IMPACT Program After School Program Coordinator salary and materials for youth activities and projects $15,000 $10,000 $5,000 $30,000 Totals $15,000 $10,000 $5,000 $30,000 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: 1 19 �g xecutive Director Date j s Signature: k - 4::7� /jqjw B a`d Chaimerson Date DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA 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 ❑ m a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ ® b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ o c) Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON - DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the 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 Q an undisclosed conflict may result in the termination of any grant awarded. w Signature: Executive Director Date Signature: J l y Boar Chairperson Date DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA 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): 78 years in operation; incorporated in 1942 b) Agency's Purpose /Mission (no more than a few sentences): Mission: The Boys & Girls Clubs of Durham and Orange Counties mission is to inspire and enable all young people, particularly those who need us most, to reach their full potential as productive, caring and responsible citizens. Purpose: To instill a sense of competence, a sense of belonging and a sense of having power and influence, especially over their own lives as well as in the community. c) Types of Services the Agency Provides (bullet format): • Assistance with homework with goal of academic success and graduation from high school • Character and leadership development through volunteer programs, healthy interaction with peers and adults, and opportunities to get involved in the community • Health education (both mental and physical) that incorporates age - appropriate lessons to ensure that Club members develop the capacity to engage in positive behaviors and set goals. Programs include: Smart Moves, Healthy Habits, Smart Girls, and Passport to Manhood • Summer camp that helps children continue to engage in educational activities throughout the summer, decreasing the educational gap between spring and fall • Exposure to various opportunities that allow members to explore career paths, the arts, the environment and technology d) Agency's History with Providing These Services: The Durham and Chapel Hill Clubs have been successfully operating for 78 years and the Chapel Hill Impact Program has been successfully operating for 4 years. 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 ?) After the merger, the name Boys & Girls Clubs of Durham and Orange Counties has been legally changed. A new Board Chair was also recently appointed; Lynda Curtis now serves as the Chair. 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 = VVolunIter FTE 2,080 # of FTE - Full Time Paid Positions: 4 # of FTE - Paid Part Time Positions: 6.5 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION # of Volunteers: 50 # of FTE - Voldnteers: 1.040 g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/ No) NQ If yes, is this agency an Orange CQjjnjy Living if' Employer? If no, please explain. The Boys & Girls Club of Durham and Orange Counties has not gone through the certification process as there has been some staff transition and new hires to support the Orange County program. 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 p11 programs that have funding requesfs/awards4otals from Carrboro. Chapel Hill. and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. "Add rows or attach additional page, if needed. DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 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 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 (CDBGIHOMEIetc.) • Private Foundation Grants o Other Revenue • Expenditures • Compensation • Rent & Utilities • Supplies & Equipment • Travel & Training • 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. The surplus in the annual budget is nominal. The organization is fiscally sound and operates with limited surplus. iv. What is your agency's fiscal year? nua 1 2018- D cember 31 2018 (Example: July 1, 2016 through June 30, 2017) DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION z z N r A Z 0 'ii W V V r un r N Gl T O N `n N `O r r A Q O W N g o Q ul ul N O ' W W y O1 �. 00 v w C m 0 O w M v m < ro O 0 w-V G1 47 v ICC 4 0 G 0 L" Is Q O G O O O V 1 ~ m O W N k ro N m N G t 'I' ro ' �, m Li VI R Iron ro aX� A �v nm a c'N p �m 7 m3 zp ro a N r� N n 2 ; w m m N a m mo M ro H { Oti 00 �' O I A A A O Z.0 O O O W N O O I r(D y m O Q G C ro a 3 *+ r m N m o to C } N _t to 4 m rL 8 cm 0 0 0 0 $0 2 A V v N Ln Owo w w N r A A 'ii W V V r un r N Gl T O N `n N `O r r A Q O W N g o Q ul ul N O ' W W y O1 op W QOO 1i pQ , C p 8 Il W I O O N N O N 4 0 G 0 L" Is Q O G O O O lO N IAD N F+ F+ N W N A N VSWi N O O `ta 14 J4 `Owl L. 000 ' I ppO I pp� II6�e ro Q m N CISS�S 000 �toO G S O 0 V 1 ~ N a% N QI O W N O5 r M M r A N V 14 M N 0 A N V V W ll �J1 O 11 UI pGp p S GG Q r 00 O O Q 0 0 p OG8p O W V 0 0 0 O 0 0 0 0 N W O { Oti 00 00 Y N N N Qt O W �LQ I A A A O Z.0 O O O W N O O I GI O Q G p p p p 0 0 0 O O O *+ r _t to 4 �wit i l a 8 0 0 0 0 $0 A V v N Ln Owo w A twrt l N N V n W • ` t 0G 5 p p QQ � j O O a hi Ln 0 O C O O G 0 825 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: The Chapel ffdl Impact Program under the auspices 2f t& am A fawE Clvbs g:{ Durham and Orange Counties (BGCDOC) Program Primary Contact and Title: Jerome Levisy, CEO Telephone Number: 919 - 687 -4517. ext 20 E -Mail: ie y0bacdoc.org a) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #7: safety -net services for disadvantaged residents r 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 Yout Adult Elderly Disabled Public Housing h NeighborhoodslResidents Affordable Housing Affordable Healthcare focus on those who need Education !t us most Family Resources Jobs /Jobs Training Food Transportation Other. Please specify focus on those who need character us most development, good citizenship and healthy lifestyles 1 19 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. • East Cares- A program at East Chapel Hill High School that provides mentors for young people. We work with them to pair high school students with younger children. • Carolina Outreach- This program provides mental health and family crisis services for our Club members and their families. We sought collaboration with the Chapel Hill- Car-boro City Schools in late 2094 and secured space for one classroom to serve 17 youth beginning on January 5, 2015 in Northside Elementary School. The Northside School officials said they were "delighted" to have our DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION program back in Fall 2015 in two large, sunny classrooms with 32 children enrolled (K -5) for the school year of 2015 -16. With the continuing success of the BGC Community Impact Program, the Northside School has offered three rooms in 2016 -17 for the program to expand to 50 children enrolled. This continued for the 2017 -2018 year. Referrals to the program are primarily through the school social worker and teachers. The CEO, staff, and board are working to continue to expand the program throughout Orange County. We now have two classrooms in Smith Middle School that are equipped to serve 50 additional middle school youth. • Power Crunch- We have a partnership with Power Crunch, in which they offer protein bars and nutritional services at our Club. • Bridge Builders- In January 2016, Ron Reeves of Bridge Builders at UNC, which focuses on work with at risk children in grades 3-6, started work with our program. This is a group of 20 -30 African American men who are employees of UNC in departments associated with athletics and in professions including graphic design, training, business, fundraising, ticket sales and coaching. They desire to serve as role models and build bridges to adulthood, provide field trips to the UNC campus to encourage kids to see themselves as future students on campus. They tutor and help kids with their homework, as well. This program continues this year. • The Walking Classroom- The Program for impact engaged the Walking Classroom tapes during the summer 2016 program. This partnership has continued successfully. • UNC Jump Rope Team- The Jump Rope Team came to the Club and taught kids jump roping techniques. This introduced them to a fun way to exercise. • Healthy Kids Healthy Lives UNC- Through visits to the Club each semester, this program addresses self - esteem and promotes body positivity. This partnership is important for our efforts to improve the healthy habits of our Club members. • Duke Energy- Duke Energy has made a big impact on our STEM programming, supporting STEM Fridays, during which Club members participate in various activities that make learning about STEM captivating and fun for all. • School Reading Partners- A program through the CHCCS district that helps children with literacy issues improve their reading skills and their reading comprehension. Trained volunteer reading tutors help students and Club members become confident in their learning and ready for success. 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? The Community Impact Program provides affordable childcare, family support, and resources for the youth of Orange County. This supports the Chapel Hill goal of ensuring a community network of basic human services and infrastructure that maintains, protects, and promotes the well -being of all county residents. The Boys & Girls Clubs allows for children to receive quality after - school DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION programming, regardless of income, which also contributes to Chapel Hill's goal of continuing to decrease the achievement gap. At -risk youth from kindergarten through eighth grade have access to development programs focused on three main goals or outcomes as follows: The PRIORITY OUTCOMES are: 1. Academic success in school with end -goal to graduate from high school ready for college, trade school, military or employment; 2. Good character and citizenship- to become an engaged citizen involved in the community, register to vote and model strong, positive character; 3. Healthy lifestyle- to adopt a healthy diet, practice good lifestyle choices and make a lifelong commitment to fitness. While all children are eligible to join, the Club focuses on the population who "needs us most," those unable to access other Chapel Hill - Carrboro after - school programs, even on scholarship, which often have waiting lists and which present transportation problems. Providing after school academic enrichment and development to children who currently are poorly served or not served at all, centrally fills the stated goal of maintaining, protecting and promoting the well -being of all of our county residents with this'safety net' program. e) Describe the community need or problem to be addressed in relation to the Chagel Hill Human Services Needs Assessment, Orancie Counly BOCC Goals &nA Priorities, Town pff Chapel Hill Council Goals, Carrboro guard 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. A needs survey found that, although there are many activities for children in the Chapel Hill - Carrboro area, most of them have waiting lists, have costs that prohibit low income children from taking part and are not open long enough or often enough to be helpful to and useful for our target population, to achieve and maintain the goals of the program for the youth enrolled. In 2015-2016, 44.2% of the student population in the Orange County Schools qualified for free or reduced lunch. In Orange County, 14% of people live in poverty and children in these families cannot afford any of the programs offered after school, even on scholarship. After - school programs have consistent waiting lists and also pose transportation difficulties. These kids are left to wander the streets during the most dangerous hours for kids (3pm -7pm) when either they commit crimes or crimes are committed against them. The goal to 'nurture our community' or 'provide high quality life' is described in all the governmental needs assessment documents. Orange County's Goal, "High Quality of Life," describes two education goals: close the achievement gap and end school to prison pipeline. The Chapel Hill - Carrboro City Schools have been struggling for years to close the achievement gap. A Boys & Girls Club, with its emphasis on school success, can be instrumental in helping to close that gap. In addition, because the club program continues through the summer months, children will not lose the gains they have made in the past year as they often do if they have no enrichment over the summer. Because of the strong attention the Club gives to understanding DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION and finishing homework each day, with the goal of success in school, it is expected that the Community Impact Program will have a positive effect on the achievement gap. Over 70% of adults who attended Boys & Girls Clubs say that the Club saved their lives. Studies show that Boys & Girls Clubs work to reduce drug, gang and early sexual involvement, and to increase the likelihood of graduating from high school. The program will end the school to prison pipeline for those who attend. A father of twins who attend the program starting from January 2015 said that he saw a difference in his boys immediately and that they are now "interested in math! Of all things!" As District Court Judge Joe Buckner says, regarding the Boys & Girls Club in Chapel Hill, 'There is no greater need." It is clear that the Impact of the BGC Program corresponds closely with many of the goals set forth by governments and will greatly enhance the quality of life in Chapel Hill. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The population we will serve encompasses all children from K -8 in Orange County who wish to belong. The program at this time can only accommodate 75 children at any one time at the Northside Elementary School, from kindergarten- fifth grade. We do not discriminate, while at the same time our target population is youth "who need us most." At the present time, all of our Club members are from the Northside School and are referred into the program by the school Social Worker and teachers. Our long term plans are to expand to other schools, especially middle schools, so that the youth who graduate from 8th grade will not be deprived of continuing Club membership through high school. 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 management team comprises four educated and experienced individuals. The CEO, Jerome Levisy, has worked with Boys & Girls Clubs for nearly two decades. The Director of Operations, Benay Hicks, has her master's degree from Boston University and a Certificate in Nonprofit Management from Duke. The Program Director, Regina Lindsay, has her degree in criminal justice, speaks Spanish fluently, and has worked with BGC programming for several years. In addition, the program coordinator in Chapel Hill, Charlotte Makoyo, has a college degree in Early Childhood Education from North Carolina Central University and has worked as Chapel Hill Outreach Afterschool Youth Leader for two years. The three program leaders in Chapel Hill are full time teachers in the Chapel Hill Carrboro City Schools and have worked in the program for three years, since it opened. All program leaders and management staff undergo consistent training with the Boys & Girls Clubs of America. This includes webinars, in- person trainings, and conferences. Volunteers go through an orientation, background check, and placement process. They are reviewed and managed accordingly. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. The Chapel Hill program is an after - school and summer camp program, and is currently being carried out at the Northside School and Smith Middle School from 2:30- 6pm, Monday through Friday during DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION the school year. A summer program was provided in 2016 and 2017, and will be continued in the summer of 2018. The rate of educational programs has been steadily increasing, and will continue to increase throughout 2018. The management team will oversee new program implementation, ensuring that children in Orange County are getting the most out of their education throughout the school year and during the summer. i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) The Boys & Girls Club helps at -risk children in Orange County reach their potential through academic and life - skills programming. These kids do better in school, behave well at home, and are able to plan for their future. Each child has a ripple effect within the community as they become leaders among their peers and in their families. Teach them to read, and they will teach their siblings and cousins to read. Teach them about healthy lifestyles and they will encourage their parents /guardians to buy healthier food and stop smoking. Each individual child the Boys & Girls Club helps will contribute to a more positive Orange County. A Florida study shows that BGCs even help enhance the tax base since these youth grow up to be gainfully employed, tax - paying citizens who do not need juvenile justice services in their youth. Because we do not charge a membership fee at our Northside and Smith programs, now ALL children in our community will have a safe and nurturing place to be after school, regardless of income. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If funding is not awarded, we will find additional sources for support. In the Durham Club's 78 years, the doors have never been closed. This will be the case for Orange County as we do whatever we can to continue to provide the excellent programming we offer. The program, both in Chapel Hill and Durham, is currently supported by ongoing individual donors, corporate donations, and grants. However, the funds that come through the Outside Agency Grant will enable our programs to be stronger and more fulfilling and we hope for increased support in future as we extend our excellent record of accomplishment. k) What percentage of your target population is low-moderate income? In Orange County, 14% of people live in poverty. Our target population is 100 % low to moderate income. 1) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) Our Club evaluates the progress of our children and our programs by administering pre and post tests to our Club members. We measure the success of our programs by tracking attendance numbers and engagement with activities. We are always aiming to provide programming that is most beneficial and effective in educating our members. DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION m) Include any other pertinent information. Funding from this grant would go specifically to the program in Chapel Hill. The organizational budget lists both Durham and Orange County programs - many are combined, but funding remains separate when necessary. 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 Estimated Projected 2016 -17 1 2017 -18 2018 -19 Gender Male Female Total Ethnicity African- American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify _hispanic Total Of the above, how many HispanictLatino Of the above, how many non- Hispanic/Latino Age Geographic Location Total 0 -5 years 6 -18 years 19 -50 years 51+ years Total Alamance County Chatham County Durham County 382 400 Wake County Orange County Breakdown 71 100 Chapel Hill Public Housing 146 50 290 300 200 200 0 490 500 Alamance County Chatham County Durham County 382 400 Wake County Orange County Breakdown 71 100 Chapel Hill Public Housing 146 50 386 440 403 455 0 1 5 6 10 0 453 485 1 30 0 453 485 Alamance County Chatham County Durham County 382 400 Wake County Orange County Breakdown 71 100 Chapel Hill Public Housing 146 50 50 30 403 455 0 453 485 Alamance County Chatham County Durham County 382 400 Wake County Orange County Breakdown 71 100 Chapel Hill Public Housing 146 50 0 453 485 0 0 0 453 485 Alamance County Chatham County Durham County 382 400 Wake County Orange County Breakdown 71 100 Chapel Hill Public Housing 146 50 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) Work Statement Total 1 0 1 453 1 485 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 (Apecific, Measurable, Achievable, Relevant, and Time - bound. Click on SINART 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 measurable 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 _Chapel Hill Impact Program I. Program Activity Name Homework Assistance and Tutoring Program Goal To ihcrease grades in reading and/or math by 1 point (scale 1-4) for 20% of youth members. Performance Measures Report card measurement Previous Year Program Results Met goal Current Year Estimated Results Already exceeded by 20°% over goal Next Year Projected Results Expect to reach or exceed goal. 2. Program Activity Name Improve interpersonal and social skills of youth members Program Goal 75°% of youth members will meet standards set by school in four categories. Report card indicators: 1. Follows classroom rules. 2. Takes responsibility for behaviors and actions. 3. Respects and cooperates with others, 4. Follows directions. DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement Chart for Program _Chapel Hill Impact Program 1. Program Activity Name Homework Assistance and Tutoring Program Goal To increase grades in reading and /or math by 1 point (scale 1 -4) for 20% of regularly attending youth members (for the 2017 -2018 school year, that will be approximately 10 students at Northside and Smith Middle). Performance Measures Report card measurement Previous Year Program Met goal Results Current Year Estimated Already exceeded by 20% over goal for the 2017 -2018 school Results year. Next Year Projected Results Expect to reach or exceed goal. 1 imm 2. Program Activity Name Improve interpersonal and social skills of youth members Program Goal 75% of youth members will meet standards set by school in all four categories (approximately 35 youth at Northside and Smith). Report card indicators: 1. Follows classroom rules 2. Takes responsibility for behaviors and actions. 3. Respects and cooperates with others. 4. Follows directions. Performance Measures Report card measurement Previous Year Program 92% success in reaching goal so far and expect goal will be Results fully met. Current Year Estimated On pace to exceed 75% goal Results Next Year Projected Results Expect to reach or exceed goal DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 2. Program Budget Detail — Provide description of "other" budget items, not defined. Other budget items include event revenues and expenses, fees and grants associated with our affiliation with Boys & Girls Clubs of America, and professional fees (audit and consulting). 3. This program budget represents what percent of the agency budget? -L-216 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. 'Agency management salaries are not included in the program budget, resulting in a decrease in the cost of the program. Actual 2018 -17 Estimated 2017 -18 Projected 2018 -19 Total Cost of Program $130,499 $91,000 $86,152 Total # of Individuals 40 70 75 Cost Per Individual $3,262 $1,300 $1,148 'Agency management salaries are not included in the program budget, resulting in a decrease in the cost of the program. DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA EXHIBIT "B" Scope of Services — FY 2018-19 Outside Agency Performance Agreement Agency Name: Boys & Girls Clubs of Durham and Orange Counties Program Name: Youth After School IMPACT Program Funding Award: $5,000 Outline how the agency will spend Orange County's funding award. Ex ense Description Amount Salary for Program Coordinator $3,500 Materials for youth activities $800 Transportation for off -site events $700 i Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. • Provide homework and tutoring assistance for at -risk youth. • Introduce healthy lifestyle programs and activities to youth to avoid illness, which leads to missed school attendance. • Monitor personal and social skills of youth members and implement BGCA and school approved measures to guide the youth in positive behaviors. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of personslunits 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 Academic improvement will increase in reading and/or math by one letter grade 18 out of 65 Increase in average daily attendance during the school year and reduce in- school suspensions and behavior referrals of club members. (we obtain school report cards and monitor the absences 25 out of 65 i Docu Sign edrr by,: A' +� W, tk "Sq - �B70D580C401D4D9..! CEOr 8/16/20 Certified by: �e { �T Title: Date: vsrovider igna ) DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA 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. DOCUSigned by: Certified by: _ E a�ao�sflcaeioaos _ (Provider's Signature) Title: CEO Date: 8/16/2018 (Boys & Girls Club of Durham & Orange Counties) Orange County Outside Agency Performance Agreement Page 10 of 9 Rev. 7118 DocuSign Envelope ID: 42882613- 58E8 -4BA1- 9376- A348D7FC56CA 20BOYSGIR2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 7/25/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER BB &T Insurance Services, Inc. Post Office Box 13941 CONTACT NAME: Terrie G. Roberts PHONE 919 281 -4500 FAX 8887468761 A/C, No, Ext : A/C ): , No E -MAIL ADDRESS: t g roberts bbandt.com Durham, NC 27709 919 281 -4500 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: United States Flre Insurance Co 21113 INSURED Boys & Girls Club of Durham & Orange Counties INSURER B • North River Insurance Company . 21105 INSURER G MED EXP (Any one person) $10,000 PO Box 446 INSURER D: PERSONAL & ADV INJURY $1,000,000 GEN'L Durham, INC 27702 -0446 INSURER E: $3,000,000 INSURER F : PRODUCTS - COMP /OPAGG COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. 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INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR 13736884 9/09/2017 09/09/2018 EACH OCCURRENCE $1,000,000 PREMISES Ea RENTED $100,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FI JECT LOC OTHER: GENERAL AGGREGATE $3,000,000 PRODUCTS - COMP /OPAGG $3,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 13736884. 13736886 09/09/2017 09/09/201 MBINED Ea a.,d.n SINGLE LIMIT $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ A UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE 9/09/2017 09/09/2018 EACH OCCURRENCE $1,000,000 X( X AGGREGATE $1,000,000 DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE YIN N OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 13736890 09/09/2017 09/09/2018 X STATUTE EORH E.L. 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