HomeMy WebLinkAbout2018-440-E Finance - Chapel Hill Carrboro Meals on Wheels outside agency agreementDocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
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 Chapel Hill - Carrboro Meals on Wheels, a not -for-
profit corporation, located at 1712 Willow Drive, Chapel Hill, NC 27514 ( "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 Chapel Hill - Carrboro Meals on Wheels 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 $23,167.
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 $5,791.75. 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.
(Chapel Hill- Carrboro Meals on Wheels)
Orange County Outside Agency Performance Agreement
Revised 712018 Page 1 of 9
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
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.
(Chapel Hill- Carrboro Meals on Wheels)
Orange County Outside Agency Performance Agreement Page 2 of 9
Rev. 7118
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
c. Notwithstanding the foregoing, either party may terminate the agreement at any time
without penalty; provided that written notice of such termination is furnished to the other
party at least 30 days prior to termination. In the event of such termination, any payment
due shall be prorated to the date of termination and any unused funds shall be returned to
the County within 10 days of termination.
d. Any termination of this Agreement for default under this section that is later deemed to be
unjustified shall be deemed a termination for convenience.
6. Insurance.
a. General Requirements. The Provider shall purchase and maintain, during the period of
performance of this Agreement, insurance:
i. Worker's Compensation. For protection from claims under workers' or workmen's
compensation acts;
ii. Comprehensive General Liability Insurance covering claims arising out of or
relating to bodily injury, including bodily injury, sickness, disease or death of any
of the Consultant's employees or any other person and to real and personal property
including loss of use resulting thereof,
iii. Comprehensive Automobile Liability Insurance, including hired and non -owned
vehicles, if any, covering personal injury or death, and property damage; and
iv. Professional Liability Insurance, covering personal injury, bodily injury and
property damage and claims arising out of or related to the performance under this
Agreement by the Consultant or his agents, consultants and employees.
b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows:
INSURANCE DESCRIPTION
• Worker's Compensation
• Commercial General
Liability
• Automobile Liability
• Professional Liability
MINIMUM REQUIRED COVERAGE
Limits for Coverage A - Statutory State
NC & Coverage B - Employers Liability
$500,000 each accident, disease policy limit and
disease each employee
$1,000,000 Each Occurrence
$2,000,000 Aggregate
$500,000 Combined Single Limit
$1,000,000 Each Occurrence
$2,000,000 Aggregate
c. All insurance policies (with the exception of Worker's Compensation and Professional
Liability) required under this Agreement shall name the County as an additional insured
party and as a certificate holder. Evidence of such insurance and all correspondence shall
be sent to:
Orange County Risk Manager
Post Office Box 8181
Hillsborough, NC 27278
d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity
defenses.
(Chapel Hill- Carrboro Meals on Wheels)
Orange County Outside Agency Performance Agreement Page 3 of 9
Rev. 7118
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
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 Chapel Hill - Carrboro Meals on
Wheels 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:
(Chapel Hill- Carrboro Meals on Wheels)
Orange County Outside Agency Performance Agreement Page 4 of 9
Rev. 7118
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
County: Finance & Administrative Services
Orange County
Post Office Box 8181
Hillsborough, NC 27278
Provider: Chapel Hill - Carrboro Meals on
Wheels
1712 Willow Drive
Chapel Hill, NC 27514
16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire
Agreement between the parties and shall supersede, replace or nullify any and all prior
Agreements of understandings; written or oral, relating to the matters set forth herein, and any
such prior Agreements or understandings shall have no force or affect whatsoever on this
Agreement. The County and Provider have read this Agreement and agree to be bound by all of
its terms, and further agree that this Agreement constitutes the complete and exclusive statement
of the Agreement between the County and Provider.
17. Severability. All clauses found herein shall act independently of each other. If a clause is found
to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It
is understood by the parties hereto that if any part, term or provision of this Agreement is by the
Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United
States, the validity of the remaining portions or provisions shall not be affected, and the rights
and obligations of the parties shall be construed and enforced as if the Agreement did not contain
the particular part, term or provision held to be invalid.
a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of
respective parties hereunder shall be governed by the laws of the State of North Carolina. By
executing this Agreement Provider affirms that Provider and any subcontractors of Provider are
and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General
Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and
has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer
pursuant to G.S. 147 - 86.58.
18. Signatures. This Agreement together with any amendments or modifications may be executed
electronically. All electronic signatures affixed hereto evidence the intent of the Parties to
comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66.
IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on
the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures
below.
For OocuSigned by:' _
S6kt
24BA22F68
70A4A5... —
For oocusigned try:" County Government
bin Vi tf, RA*mtY sL"
OG3799d6755E477...
Bonnie Hammersley, County Manager
(Chapel Hill- Carrboro Meals on Wheels)
Orange County Outside Agency Performance Agreement
Rev. 7118
8/16/2018
Date
8/18/2018
Date
Page S of 9
DocuSign Envelope ID: El 573D55-1 DCO -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
1. COVER PAGE
a) Applicant _Contact Information
Applicant Organization's Legal Name: Chapel_ Hill Carrboro Meals on Wheels
Applicant Organization's Physical Address: 1712 Willow Drive Suite 1 Chapel Hill NC 27514
Applicant Organization's Mailing Address: PO Box 2102 Chapel Hill NC 27515
Applicant Organization's Web Address: www.chcmow.org
Executive Director: Rachel Sobel Bearman
Telephone Number 919 -942 -2948
Tax ID Number: 59- 1721954
E -Mail: Rachel. bearman[_ehcmow.org
b) Funding Request
List all FY18 -19 Human Services (HS) Funding Being Requested —
For All Programs] and the Proposed Use of Funds (2 -3 lines or less)
Program
Carrboro
Chapel
Hill - HS
Orange
County-HS
Total
- HS
Ex. Youth Afterschool Program
Afterschool Program Coordinator salary and materials
for youth activities and pLojects
$10,000
$15,000
$5,000
$30,000
Funds requested to subsidize the delivery of lunches
every Monday -Friday to the homebound and elderly
who cannot afford to cover the cost of the meals.
$18,000
$23,000
$18,000
$59,000
Totals
$18,000
$23,000
$18,000
$59,000
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
Signature
1`x2 -.11
Date
Date
AGENCY INFORMATION 1/2212018 8:21:25 AM Page 8 of 26
II1ml— .^ -.A
DocuSign Envelope ID: El 573D55-1 DCO -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NONDISCRIMINATION
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:
Signature:
Director
Board Chai
I - ZZ•L
Date
Date
AGENCY INFORMATION 1/22/2018 8:09:04 AM Page 9 of 26
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
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):
41 years in operation, October 1976
b) Agency's Purpose /Mission (no more than a few sentences):
We nourish the bodies and spirits of the homebound with a balanced meal and the
human connection they need to help them live independently. We provide a hot meal
delivered to the home every weekday by a corps of volunteers. Resource and
referral services as needed.
c) Types of Services the Agency Provides (bullet format):
• M -F lunch delivery,
• social visit,
• wellness check -in,
• monthly porch bag delivery (shelf stable food),
• deliver birthday cards, pet food, holiday gifts, birthday flowers, and letters, art
projects and gifts from local children & community members.
d) Agency's History with Providing These Services:
For 41 years, Chapel Hill Carrboro Meals on Wheels has provided daily weekday
meals and a social visit to the homebound, elderly, those convalescing and to the
physically or mentally handicapped in need of our services. Service is provided out
of Binkley Baptist Church which has generously donated its space to ensure our
funds can serve those in need. Over the past ten years we have steadily increased
the numbers of clients served to approximately 280, and have expanded our delivery
area to meet the growing need of the underserved populations in the county. We are
committed to serve our clients in the most meaningful and efficient way possible and
thus continually strive for improvement through feedback from our clients and
stakeholders. We distribute an annual client satisfaction survey which consistently
receives overwhelmingly positive results and this past year we conducted a
stakeholder planning survey to gather input which could help us improve. We are
members of both the statewide and national Meals on Wheels associations and
consistently partner with our peers in neighboring counties to better serve our
clientele. We are currently working together to find alternate sources of funding to
help with the cost of providing services to increasing numbers of clients requesting
services.
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 ?)
CHCMOW directly impacts the lives of those who are frail, disabled, and or
homebound by providing food assistance, social and emotional support and
information about other area services to those who are often also in economic
distress. In 2017, thanks to the hard work of our more than 250 dedicated volunteer
drivers and bakers, CHCMOW provided over 46,000 meals. We serve a diverse
client base that is 43% minority, 66% female, and increasingly more elderly. 29% of
our clients last year were 85 years of age or older. Our dedicated volunteers now
deliver on 14 routes Monday through Friday all the way west to the Alamance
border, east to Durham, south to Chatham and north to Mount Sinai Road with a
"buffer area" where we call OCIM to determine which program has a route that is
Agency Information 1/22/2018 9:22:00 AM Page 10 of 26
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
closest to the potential new recipient. In October of 2017 CHCMOW hired a new
Executive Director.
f) Schedule of Positions (For Entire Agency)
• Full Time Equivalent (FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc.
• Calculate a Full Time Equivalent for all recorded volunteer hours using the following:
Total Volunteer Hours = Volunteer FTE
2,080
# of FTE - Full -Time Paid Positions: 0
# of FTE - Paid Part -Time Positions: 4 [.75 Executive Director; .50 Operations Manager;
.25 Bookkeeper; .25 Volunteer Coordinator]
# of Volunteers: 450 # of FTE - Volunteers: - 30,160 (total volunteer hours, deliverers and
bakers
g) Living Wage
Does this agency pay permanent employees a minimum living wage? (Yes/ No) Yes
If yes, is this agency an Orange County Living Wage Certified Employer? Yes
If no, please explain.
Agency Information 1/22/2018 9:22:00 AM Page 11 of 26
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
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
Award
FY18 -19
Request
Source
Ex: Affordable Rental
Rehabilitation
0
$20,000
Carrboro - Affordable Housing
Ex: Agency Administration
$15,000
$15,000
Carrboro — Other
Ex. Total
$15,000
$35,000
Carrboro Total Funding
*Add rows or attach additional page, if needed.
ii. Submit your agency's budget. You may complete the provided template (separate
xls file) or you may submit your own budget file (as long as it contains the same
information, and in a similar format, as requested in the provided template).
Agency Budgets are required to define budget amounts for the previous program
year, current program year, and next program year for the following categories:
Agency Information 1/22/2018 9:22:00 AM P a g e 1 2 o f 2 6
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Chapel Hill Carrboro Meals on Wheels 2016 -2018
2016
2017
2018
Notes
Revenues
Private Donations
134,032.64
273,187.98
140,800.00
Program Generated Revenue
36,717.00
44,131.70
42,500.00
Client payments
Local Government Grants
Carrboro Human Services
11,950.00
14,000.00
15,000.00
Carrboro Other
Chapel Hill Human Services
10,000.00
15,000.00
15,000.00
Chapel Hill Other
Orange County Human Services
10,000.00
15,000.00
15,000.00
Orange County Other
Other Government Grants
Triangle United Way
23,530.00
10,929.10
7,000.00
Designated and Allocated
[Donations decreasing - Change in
UW focus. Expectation to Zero]
State Government
-
-
Federal Government
-
-
Private Foundation Grants
22,500.00
20,113.66
35,000.00
Subaru, MOWA, Whole Foods,
Carol Woods, Strowd
Other Revenue
89,375.51
79,733.83
106,700.00
Events & Investment income
Total Revenue
338,105.15
472,096.27
377,000.00
Expenditures
Compensation
42,766.09
67,208.82
89,000.00
Rent & Utilities
2,093.34
77,261.60
102,300.00
Moving expenses.
Supplies & Equipment
212,071.82
211,095.90
221,750.00
Food Cost, Supplies,Depreciation
Travel &Training
27.37
991.97
4,000.00
Other Expenses
36,586.65
32,877.07
34,950.00
Total Expenditures
293,545.27
389,435.36
452,000.00
Net
44,559.88
82,660.91
(75,000.00)
iii. Does your agency budget show a Surplus or Deficit? Deficit
Is there a significant change? Yes /No Yes
Please provide a brief explanation for Surplus or Deficit, and significant changes.
The budget history for CHCMOW is a volatile one. We have no guaranteed funding
each year. Every year we must apply for available grant funding and run an annual fund
and fundraisers to raise the appropriate funds to enable our delivery of 170 -185 meals
per day to the elderly and homebound. Our only source of income beyond grants and
individual or corporate donors are client fees, which have drastically reduced over the
years (relative to the number of clients served). Over the past 8 years we have tracked
a significant decrease in client fees, leaving CHCMOW to meet the expense of the
majority of our clients. Each year the grants we apply for, the events we run, the
individual contributions we collect are entirely driven by the energy and vision of the
Board and Executive Director. We are not a line item in anyone's annual budget. Even
our United Way funding is diminishing each year and is the result of a rigorous
application process. Some years we write 15 or more grant requests. In a good year we
are successful with half or fewer and some years we may receive only a handful. To
help smooth this wild up and down roller- coaster, CHCMOW has instituted the following
annual fundraising campaign:
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DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
1. A Spring Fundraiser - Dining for Dollars, that currently brings in approximately
$50,000 per year,
2. A Fall Fundraiser - Airline Ticket Raffle that can raise a total of $10,000,
3. March Madness — a restaurant eat -out night that supports CHCMOW,
4. And an expanded annual fund campaign that reaches out to an increasing
number of potential donors each year.
Income Sources
2%
6%
7% 0 Individuals
31'9�0�
0 Events
19 Grants
— Program fees
United Way
Corporations
18%
Congregations
This past year CHCMOW received a significant one -time donation that was set aside to
help pay for expanded space to meet the growing demands for our services. In mid to
late 2018 CHCMOW will be moving to St Thomas More in the new space that is
currently Aldersgate Church. In support of this move a significant amount was allocated
toward STM's campaign to help purchase and renovate the space that we will then be
able to use free of charge. Surpluses accrued over 2016 and 2017 were part of long
range planning to expand the professional capacity of CHCMOW as well as our office
and distribution space so that we could continue to meet the growing need for our
services. The deficit projected in 2018 encompasses the expenses associated with our
move as well as the increased demand as projected by current demographic
information.
iv. What is your agency's fiscal year? January 1 through December 31
V. (Example: July 1, 2016 through June 30, 2017)
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DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
3. PROGRAM INFORMATION (Submit a separate Section 3 for each program)
Program Name: Meals for the Elderly and Homebound
Program Primary Contact and Title: Rachel Sobel Bearman, Executive Director
Telephone Number: 919 - 942 -2948 E -Mail: Rachel.bearman @chcmow.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
X 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
X
X
X
X
Transportation
Other: Please specify
c) Provide a bulleted list of other agencies, if any, with which your agency
coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s)
to be funded. For each, briefly describe the coordinated /collaborative efforts.
Provide a bulleted list of other agencies,
• OCRA, Orange County Rural Alliance — information and process sharing; joint shelf - stable
meal purchasing, joint administrative tasks such as volunteer verification, etc.
• Arc of Orange County, RSI, CHCCS special needs programs — we provide volunteer
placements for those with challenges. They help set up, count out meals, and deliver.
• Porch — partner to deliver monthly senior snack bags which are shelf stable and augment
the clients' pantries
• Inter Faith Council (IFC) — we refer clients who may be eligible for additional services
(vision care, Sec 8 housing challenges)
• Farmer Foodshare — we purchase fruit on Tuesday in the spring and summer months
• Book Harvest NC — deliver books that are like new (they serve children, so we take
donations that are suitable for adults)
PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 15 of 26
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
• HomeStart, Ronald McDonald House, SECU — we donate extra food that we can't
distribute ourselves in a timely fashion.
• Department on Aging — we distribute the Senior Times quarterly and refer those who need
more services
• Chapel Hill - Carrboro City Schools(CHCCS) - we provide service hour opportunities for
high school students.
• Harris Teeter and Starbucks at University Mall, Whole Foods, Trader Joe's, Panera —
we "glean" food that is pulled from the shelves because of sell by date and deliver it the
same day for our clients benefit
• UNC Cancer Support Services- we are accepting referrals for clients who are staying at
the Quality Inn for treatment at the UNC Cancer Center. The come alone for treatment from
all over the state and often have no access to food other than the complimentary breakfast
served at the motel
PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 16 of 26
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Program Description (3 pages OR LESS)
Please provide the following information about the proposed program:
d) Summarize the program services proposed and how the program will address a
Town /County priority /goal?
Our goals are threefold; 1. Provide affordable, nutritious and flavorful meals to the
homebound and elderly. 2. Reduce isolation, support independence and enhance
recipient's quality of life. 3. Engage in partnerships that benefit volunteers and recipients.
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.
CHCMOW addresses the need for Senior Housing options, particularly options for aging -
in -place and provision of meals and other services that meet the unique needs of the
elderly as well as Food Insecurity, enabling access to affordable and healthy food for
those who have an inability to freely access grocery stores or prepare food for themselves.
Moreover, Meals on Wheels programs significantly reduce health care costs through
decreased emergency room visits and dependence on institutionalized care. In addition,
CHCMOW actively works towards increasing collaboration with UNC Healthcare so that
those discharged that are eligible for MOW are informed of and connected to CHCMOW,
working together to improve the health and well -being of the elderly in our community.
Overall, CHCMOW plays an important role in ensuring a community network of basic
human services and infrastructure that maintains, protects, and promotes the well-
being of all county residents by focusing on the basic needs of one of the most
vulnerable and often overlooked populations in our community. CHCMOW also helps
citizens develop a human environment that promotes trust, mutual respect,
acceptance, happiness and well- being, not only by improving the daily life of elderly and
homebound residents but through our robust volunteer program which connects a diverse
community of volunteers with a diverse community of clients, creating connections across
social, class and racial groups, creating a stronger more connected community as a
whole.
state figures are in grassy green, county figures in lighter green
Poverty rate increases with age
M N ■ NC
2
14.9% 2.9%
6.2%
65 -74 Below 65 -74 in 100 % - 75+ below 100 % poverty 75+ in 100 % -199%
100% 199%
26
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Projected change of population 65 +, by age group (2014 -2034)
* Of the population 65 +, the
Ages 65 -74 75 -84 85+ age group 75 -84 will grow more
County 67% 190% 167% rapidly in the next decades.
Beyond 2030, the growth will
shift into the ages 85 +, as the
State 48% 103% 92%
baby boomers move into this
age group.
However, 44 counties in the
state are already projected to
*As % of age group
have more growth in the 85+
population (2014 - 2034).
Source: NC Office of State Budget and Management, Oct 2015
As seniors age, the numbers living in poverty increases and CHCMOW works to meet the
increasing need of our seniors and homebound regardless of their ability to pay.
f) Who is your target population of individuals to benefit from this program and how will they
be identified and connected with the program?
Our target population is any elderly, disabled or convalescing person who cannot prepare
their own meals who lives in Chapel Hill, Carrboro or Southern Orange County. We accept
referrals from all sources — individuals, family members, neighbors, health professionals,
social service agencies. We encourage identification and connection through our website
and by distributing brochures in prominent spots within the community — the public library,
UNC Hospital system, etc. We also connect with discharge nurses and other non - profits
and practitioners serving seniors so they can easily refer CHCMOW to potentially eligible
clients. We are listed in a national Meals on Wheels search engine as well as being in the
local phone directory. We periodically have PSAs on WCHL and advertise in local media.
g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program
Manager and credentials, describe training provided to volunteers, etc.)
Executive Director has a BA in Political Science from Tulane University and an MA in
International Service from American University of Washington DC. Since moving to NC
in 1995 she has been involved in non - profit work as both a professional and volunteer
with experience in strategic planning, development and community engagement. She is
currently enrolled in the certification in program leadership from the Meals on Wheels
America organization.
Operations Manager attended UNC- Greensboro and has a wide range of experience
with local agencies, including IFC, Take and Eat Food Pantry, Habitat for Humanity and
Cornucopia House, and she also volunteers as a Guardian ad Litem.
Volunteer Coordinator has a BA in Anthropology and Studio Arts from UNC -CH and
has experience working with elderly populations through Carol Woods Retirement
Community.
h) Describe the specific period over which the activities will be carried out and include an
implementation timeline.
PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 18 of 26
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Services are ongoing — Every M -F with the exception of a few Federal Holidays. When not
able to deliver (whether a holiday or inclement weather) we plan ahead and deliver a
shelf - stable meal to ensure there is food in the client's pantry.
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)
No other agency delivers a hot ready -to -eat meal to the home of the person in need. If
CHCMOW ceased operation, the vital safety net service we provide would be
discontinued. The simple act of a delivery of a hot, nutritious meal and a friendly check -in
saves an estimated $109 million dollars nationally, by reducing dependence on
institutionalized care and emergency room visits. The assurance of a daily weekday meal
and a check -in enables the elderly and homebound to age in place with dignity. For many
of our clients, the volunteer is the only human contact they will have that day. Beyond the
positive impact we have on the health and safety of our clients as well as the cost savings
we enable, CHCMOW offers a warm, enriching, and satisfying volunteer opportunity to
our community bringing together a diverse group of people with varying backgrounds,
careers, and mental and physical abilities. CHCMOW both serves and strengthens our
community.
j) Describe what would happen if requested funding is not awarded at all or if a reduced
allocation is recommended.
Services may be curtailed or a waiting list would have to be developed. To date, local
support has enabled CHCMOW to avoid a waitlist.
k) What percentage of your target population is low- moderate income?
Every Meals on Wheels meal is subsidized. Ninety percent of our clients do not pay the
full reduced rate for meals which is $5 /meal. Only 10% pay the reduced rate cost but that
does not necessarily place them outside of the low- moderate income bracket.
1) What efforts do you make to seek feedback about your program from your target population
(e.g. survey, evaluations, etc. ?)
We send an annual client survey that receives very positive results with a few comments.
We take into consideration every comment made and try our best to consistently improve
our services, offerings and efficiency that we can better serve all of those in need. Every
few years we also engage in a broader stakeholder survey so that we may receive
community feedback and determine if we are doing what we do well and how we can
improve to be even better.
m) Include any other pertinent information.
Every year fewer of our clients are able to pay towards the costs of their meals. Ten years
ago, approximately 80% of our clients were able to pay the reduced meal rate charged by
MOW. Today only 20% of our clients are able to do so.
As the CHCMOW organization has grown we have committed to hiring the necessary staff
to meet the growing need for our services. CHCMOW currently serves 170 -185 meals per
day every M -F with approximately 250 volunteer drivers and 250 plus bakers and 4 part -
time employees — an Executive Director, Operations Manager, Volunteer Coordinator and
Bookkeeper.
PROGRAM INFORMATION 1/22/2018 9:22:00 AM P a g e 19 of 2 6
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
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 Hispanic /Latino
Total
Of the above, how many Hispanic /Latino
Of the above, how many non - Hispanic /Latino
Total
Age
Geographic Location
0 -5 years
6 -18 years
19 -50 years
51+ years
Total
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
201( 1 2017 -18 2018 -19
100
111
127
190
210
243
290
320
370
110
120
138
283
306
353
5
8
10
168
178
205
290
320
370
7
14
17
290
320
370
7
14
17
283
306
353
290
320
370
0
0
0
0
0
0
7
9
11
283
311
359
290
320
370
0
0
0
0
0
0
0
0
0
0
0
0
18
20
24
107
117
134
92
102
117
0
0
0
0
0
0
73
81
95
Note: We deliver to Trinity Court, South Estes
PROGRAM INFORMATION 1/22/2018 9:22:00 AM
Page 20 of 26
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Apartments and several section 8 residents but numbers
are approximate
Total 290 320 370
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 Proaram: Meal Delivery
1. Program Activity Name
Deliver hot ready to eat meals and extras each weekday
Program Goal
Provide hot, nutritious and a friendly check -in with every client
Performance Measures
Volunteer log, client delivery records, & annual survey
Previous Year Program Results
46,000 meals delivered plus additional groceries and food
donations
Current Year Estimated Results
47,030 meals delivered plus additional groceries and food
donations
Next Year Projected Results
48,500 meals delivered plus additional groceries and food
donations
2. Program Activity Name
Friendly Visit /Check -In with Client
Program Goal
Provide a personal visit each weekday, relieving isolation and
depression. Check -in on client's health and general well- being.
Quick review of home situation and noting of any problems that
need attention from family or other service providers. The latter are
reported back to Operations Manager and handled with the client,
their emergency contact or through referral to other agencies.
Performance Measures
Notes in client files and incident reports submitted by volunteers
We deliver every weekday, excluding only 5 -6 major holidays and
there are often two volunteers that deliver on each route, When you
aggregate those interactions you get the numbers below which are
estimates.
Previous Year Program Results
110 volunteers, 170 clients daily average (290 clients in a year) if
everyone answers the door it is approximately 45,000 touch points
Current Year Estimated Results
250 volunteers, 178 clients daily average (320 clients per year), if
everyone answers the door it is approximately 46,030 touch points
Next Year Projected Results
265 volunteers, 185 clients daily average (370 clients per year), if
everyone answers the door it's approximately 47,500 touch points
PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 21 of 26
DocuSign Envelope ID: El 573D55-1 DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
p) Program Budget
1. Submit your program budget. You may complete the provided template (separate As
file) or you may submit your own budget file (as long as it contains the same information,
in the same format, as requested in the provided template).
Program Budgets are required to define budget amounts for the previous program
year, current program year, and next program year for the following categories:
Chapel Hill Carrboro Meals on Wheels 2016 -2018
2016
2017
2018
Notes
Revenues
Private Donations
134,032.64
273,187.98
140,800.00
Program Generated Revenue
36,717.00
44,131.70
42,500.00
Client payments
Local Government Grants
Carrboro Human Services
11,950.00
14,000.00
15,000.00
Carrboro Other
Chapel Hill Human Services
10,000.00
15,000.00
15,000.00
Chapel Hill Other
Orange County Human Services
10,000.00
15,000.00
15,000.00
Orange County Other
Other Government Grants
Triangle United Way
23,530.00
10,929.10
7,000.00
Designated and Allocated
[Donations decreasing - Change in
UW focus. Expectation to Zero]
State Government
-
-
Federal Government
-
-
Private Foundation Grants
22,500.00
20,113.66
35,000.00
Subaru, MOWA, Whole Foods,
Carol Woods, Strowd
Other Revenue
89,375.51
79,733.83
106,700.00
Events & Investment income
Total Revenue
338,105.15
472,096.27
377,000.00
Expenditures
Compensation
42,766.09
67,208.82
89,000.00
Rent & Utilities
2,093.34
77,261.60
102,300.00
Moving expenses.
Supplies & Equipment
212,071.82
211,095.90
221,750.00
Food Cost, Supplies,Depreciation
Travel & Training
27.37
991.97
4,000.00
Other Expenses
36,586.65
32,877.07
34,950.00
Total Expenditures
293,545.27
389,435.36
452,000.00
jNetj 1
1 44,559.88
1 82,660.91
(75,000.00)
2. Program Budget Detail — Provide description of "other" budget items, not defined.
The budget surpluses in 2016 and 2017 were the result of strategic planning and
one large on -time corporate gift to prepare for CHCMOW's expanded professional
team and office and distribution space. In 2018 CHCOW will be moving to an
expanded location at the current Aldersagte Church (soon to be a part of St Thomas
More). The planning and accrued funds will support CHCMOW's capacity to meet
increasing needs.
Our biggest expense are food costs which are included under "supplies" The
following expenses are listed under the "other" category:
• Professional fees (990 and financial review fees, website charges)
• Advertising costs
• Insurance
PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 22 of 26
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Bank fees (PayPal costs for credit card transactions)
Dues and subscriptions
3. This program budget represents what percent of the agency budget? 100%
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.
These are estimates and thus our best guesses for 2017 -18 and 2018 -19.
PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 23 of 26
Actual 2016 -17
Estimated 2017 -18
Projected 2018 -19
Total Cost of Program
$341,490
$420,717
$484,000
Total # of Individuals
290 people
320 people
370 people
Cost Per Individual
$1,178 per
person (annual)
$1,315 per person
(annual)
$1308 per person
(annual)
These are estimates and thus our best guesses for 2017 -18 and 2018 -19.
PROGRAM INFORMATION 1/22/2018 9:22:00 AM Page 23 of 26
DocuSign Envelope ID: E1573D55- lDC0 -4F4C- 9784- 749E3E95640B
1 5►:: I 1111"Iu
Scope of Services — FY 2018 -19
Outside Agency Performance Agreement
Agency Name: Chapel Hill Carrboro Meals on Wheels
Program Name:
Funding Award: One -time $7,267
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
Direct Meal Expense $7,267
Program Services
Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019.
• Delivery of a hot, nutritious meal every Monday- Friday.
• Weekday check -in during delivery to ensure health and safety of recipient.
• Outreach to community to inform of our services and so that those in need of our services will
have the information to access the service.
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
Total # of meals delivered
48,500
Total # of recipient check -ins
48,500
Total # of individuals served
370
Dacu5igned by:
Skt be av 40A.
2�BF+.22FB870MA5...
Executive Direc4r6 /2018
Certified by: Title: Executive Director Date: 8 -3 -18
(Provider's Signature)
DocuSign Envelope ID: E1573D55- lDC0 -4F4C- 9784- 749E3E95640B
1 5►:: I 111 1 li Iu
Scope of Services — FY 2018 -19
Outside Agency Performance Agreement
Agency Name: Chapel Hill Carrboro Meals on Wheels
Program Name: Food for the homebound and elderly
Funding Award: $15,900
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
Food Expense $15,900
Program Services
Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019.
• Delivery of a hot, nutritious meal every Monday- Friday.
• Weekday check -in during delivery to ensure health and safety of recipient.
• Outreach to community to inform of our services and so that those in need of our services will
have the information to access the service.
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
Total # of meals delivered
48,500
Total # of recipient check -ins
48,500
Total # of individuals served
370
OocuSigned by:
S6kt buo4ajo.
24BP22FB870.44A5...
Certified by:
(Provider's Signature)
Executive Director 8/16/2018
Title: Executive Director Date: 7 -24 -18
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B
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.
D"USigned by:
�.� �6kt buwvlAot
Certified by: 24BA22F687QMA5 tie:
(Provider's Signature)
Executive Director
Date:
8/16/2018
(Chapel Hill- Carrboro Meals on Wheels)
Orange County Outside Agency Performance Agreement Page 9 of 9
Rev. 7118
DocuSign Envelope ID: E1573D55- 1DC0 -4F4C- 9784- 749E3E95640B NCCHAP7
ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
7/30/2018
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 NAME: Nayab Alam
The CIMA Companies, Inc. PHDNE 703- 778 -7304 Fax 7
2750 Killarney Dr, Suite 202 e a Lo Ext : (A/c, No): 03- 778 -7354
ADDRESS: nalam @cimaworid.com
Woodbridge, VA 22192 -4124 PRODUCER
CUSTOMER ID #:
703 739 -9300
INSURED
Chapel Hill - Carrboro
Meals on Wheels
PO Box 2102
Chapel Hill, NC 27514
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Alliance of Nonprofits for Ins 10023
INSURER B: Hartford Underwriters Insurance 30104
INSURER C: Carolina Casualty Insurance Com 10510
INSURER D:
INSURER E:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
DDL
NSR
UBR
VD
POLICY NUMBER
POLICY EFF
MM/DD/YYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE Fx_] OCCUR
201836882
07/01/2018
07/01/2019
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$500,000
MED EXP (Any one person)
$20,000
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY F7 PRO LOC
PRODUCTS - COMP /OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
201836882
07/01/2018
07/01/2019
COMBINED ) SINGLE LIMIT
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per accident)
$
X
X
$
UMBRELLA LAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DEDUCTIBLE
RETENTION
$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR /PARTNER /EXECUTIVEY
OFFICER /MEMBER EXCLUDED? N
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
"/A`
6S60UBOG11045217
07/01/2018
07/01/2019
X WCSTATU- OTH-
T RY LIMIT ER
E.L. EACH ACCIDENT
$100,000
E.L. DISEASE - EA EMPLOYEE
$100,000
E.L. DISEASE - POLICY LIMIT
$500,000
A
C
Liquor Liab
D &O
201836882
31565480
07/01/2018
07/03/2017
07/01/201
07/03/201
$1,000,000
$1000000
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Certtificate holder is an additional insured but only with respect to the operations and activities of the
named insured. Certificate is subject to all policy conditions, exclusions, limits and terms.
Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Human Services ACCORDANCE WITH THE POLICY PROVISIONS.
200 S Cameron St I PO Box 8181
Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE
tllaGU.l�a- .®- Ems'"
01988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD
#S367884/M359082 NPA