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2018-446-E Finance - OC Rural Alliance outside agency agreement
DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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 Orange County Rural Alliance, a not - for - profit corporation, located at 113 West Hill Ave South, Hillsborough, NC 27278 ( "Provider "). 1.i /11101W1=M 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 Orange County Rural Alliance 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 $28,017. 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 $7,004.25. 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. (Orange County Rural Alliance) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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. (Orange County Rural Alliance) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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. (Orange County Rural Alliance) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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 Orange County Rural Alliance 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: (Orange County Rural Alliance) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Orange County Rural Alliance 113 West Hill Ave South Hillsborough, NC 27278 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 Docusigm'd by': °the Provider Nbl�wia. (P u{t. 34852E93181C459... For z6Q cuSigned by: bounty Government 6,A*MLr5bj �i3799d6755E477... Bonnie Hammersley, County Manager (Orange County Rural Alliance) Orange County Outside Agency Performance Agreement Rev. 7118 8/16/2018 Date 8/18/2018 Date Page S of 9 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Orange County Rural Alliance Applicant Organization's Physical Address: 4901 Schley Road, Hillsborough, NC 27278 Applicant Organization's Mailing Address: PO Box 642, Hillsborough, NC 27278 Applicant Organization's Web Address: www.ocrahub.com Executive Director: Norma White Telephone Number: 919- 732 -8527 Tax iD Number: 81- 4489249 E -Mail: n.b.white0Dembargmail.com 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 Oran a County -HS Total -HS Ex. Youth Afterschool Program Afterschool Program Coordinator salary and materials for youth activities and projects $10,000 $15,000 $5,000 $30,000 Ideal goal is to deliver meals to 120 seniors two times a week by the end of 2018 $40,000 $40,000 Totals $40,000 $40,000 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: Wk,-.t Z- &e." Norma B. White, Executive Director Signature: Os�w,,�e /1" //,p Date Ili 1 /l8 Archie Daniel, Vice President Date AGENCY (NFORMAT(ON 1/11/2018 1 :52:04 PM Page 8 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 W �: l I :3 fi r_w L Z• 01 •] =9 Kell] 1 16y 112FS e i: 10 L f va -A , a I I l b e y ll fi[• d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hili, 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 Grange County? © c) Current beneficiaries of the program for which funds are being requested? ❑ [J d) Paid providers of goods or services to the program or having ether financial interest in the program? If you have answered YES to any question, please provide a full explanation below. Archie Daniel is a part -time employee of the Sheriff's Office, responsible for leading the SALT program. He is a volunteer with OCRA and receives no financial compensation. 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 howl 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 existenr& of an undlscI21A conflict may result in ft termin on of an rant a Signature. / " a A., Norms B. White, Executive Director Date -- Signature: (•''CA � Q i�4X�lc Archie Daniel, Vice President Date AGENCY INFORMATION 1/11/2018 1:52.01 PM Page 9 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 100:I1 :31r_wW:101►•L11121 [ K•111111i•]0 _Te]210141-R_l >>I[O1_r 9 [• 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): 1 yeart 1 month: Incorporated in November of 2016 bj Agency's Purpose /Mission (no more than a few sentences): In alliance with community partners listed below, QCRA builds awareness of the needs of rural seniors and supports them with what they need to live independent and dignified lives access to county services, safe homes, nutritious food, and friendly human contact. OCRNs main mission towards this goal is to provide weekly hot, nutritious meals to rural seniors in underserved areas of rural Grange County, c) Types of Services the Agency Provides (bullet format): • Nutritious meals • Social contact • Liaison with county services d) Agency's History with Providing These Services: QCRA evolved from the SALT /Project EngAGE initiative who discovered that many seniors in rural Orange County were in need of better nutrition and having regular personal contact with someone. Through regular visits over the last 30 months, volunteers have created personal relationships and trust with their "clients ". Through that relationship it was clear that some clients would benefit from nutritious, hot meals on a regular basis. In their beginning months, fOCRA provided meals to 22 of those seniors, QCRA started a formal meal delivery program in November of 2016 with volunteers /caterers donating meals for 40 rural seniors one time per week. As of December 20117 we are serving 82 seniors one hot meal a week, and a pilot second meal is being established. To date, QCRA has served nearly 4,000 meals, including a bonus Thanksgiving meal. Emergency shelf stable meals are now available and have been delivered to 82 people. We are in the process of scaling up, with a long term goal of delivering 5 hot meals a week to seniors in the rural, unincorporated parts of Orange County who are outside the reach of other Meals on Wheels programs and are in need of our help. As QCRA is evolving, our short term goal is to deliver 2 hot meals a week by the end of 2018, e) Other Pertinent Agency information (Ex. Has the agency experienced any major changes in the past year2 is there a new Executive Director? Are there new initiatives ?) This year has seen an increase in partner alliances and collaborations, the start -up of an emergency food pantry, and the distribution of emergency shelf stable meals. CCRA also is participating in the Commodity Surplus Food Program (CSFP) in alliance with the Dept of Aging. This fall we began sharing space with a local church which provides a small office space and meeting rooms and an area to pack meals for distribution. 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 Agency Information 1112/2018 10:05:28 AM P a g e 1 0 o f 2 5 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION # of FTE - Full -Time Paid Positions: 0 # of FTE - Paid Part-Time Positions: 0 # of Volunteers: 43 # of FTE - Volunteers: 4.6 g) Living Wage Does this agency pay permanent employees a minimum living wage? {Yes /No} No If yes, is this agency an Orange County Living Wage Certified Employer? If no, please explain. There are no paid employees. This is an all - volunteer organization at this time. Agency Information 111212018 10:05:28 AM Page 11 o f 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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? (YevNo) No If yes, please list below: Include all programs that have funding requests/awardsftotals from Carrboro, Chapel Hill. and Orange Cour+fy govemments (other than Human Services). DO NOT include federal funding sources, such as CDSG and HOME. Program FYI 7-18 Award FYI 8-19 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 budges. 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 o Private Donations o Program Generated Revenue o Local Government Grants ■ Carrboro Human Services ■ Carrboro Other ■ Chapel Hill Human Services ■ Chapel Hill Other (DO NOT include CDSG funding here) Agency Information 1112/2018 10:05:28 AM Page 12 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 *Z4:u:31r_w- -Z•w1.] =K Kell] &yl 91 aseiz 10 ifVEMWaIfLeLl9IM0I • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government (CDBGIHOME /etc.) • Private Foundation Grants o Other Revenue Expenditures o Compensation o Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses Ill. Does your agency budget show a Surplus or Deficit? Yes Is there a significant change? Yes /No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes, Our ideal plan is to provide two meals a week to 120 people. Our budget reflects increased expenses for these additional meals. This shows a significant increase from the 2017 budget, Because Orange County grant disbursement is made on a quarterly basis, starting in October, a reserve needs to cover the gap from when meals are purchased until such time as the approved County grant allocation is received. iv. What is your agency's fiscal year? January 1 - December 31, 2018 (Example: July 1, 2016 through June 30, 2017) Agency Information 1112/2018 10:05 :28 AM Page 13 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER;q AyT§�,�GENCY APPLICATION Operating Budget for Entire Agency AGENCY NAME: AGENCY REVENUE. Private Donations Orange County Rural Alliance (OCRA) ,$- -'2017 PO4 Agency Generated Revenue (fees) Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - (Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOMEletc.) Private Foundation Grants Other Revenue Total Agency Revenue AGENCY EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Agency Expenses as r4 SURPLUSf(DEFICIT) FOR PERIOD: Actual 2016 -17 Estimated 2017 -2018 16,304 Projected 2018 -19 Percent Change $ 35,924 $ 36,000 $ 36,000 0% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ 12,500 $ 40,000 220% $ - $ - $ - 0 $ _ $ _ $ _ 0 - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ 25,000.00 0 $ - $ - $ - 0 $ $ 35,924 - $ $ 48,500 10,400 $ $ 101,0010 2 0,800 108% 100% $ 600 $ 3,000 $ 3,000 0% $ 3,062 $ 3,000 $ 3,000 0% $ - $ - $ - 0 $ 15,958 1 $ 17,967 1 $ 68,543 1 281% $ 19,620 $ 34,367 $ 95,343 1 177% SURPLUSf(DEFICIT) FOR PERIOD: 1 $ 16,304 $ 14,133 1 $ 5,657 -60% X. Afo©e 13kd yet based e" 041et4 ,seal �e44. �a t /- &.e- 3r. FY 2018 -19 Comparative Agency Budget Revised 9/2112017 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: OCRA (Orange County Rural Alliance)_ Program Primary Contact and Title: Norma B. White, President Telephone Number: 919 -732 -8527 E -Mail: n.b.whiteCeir}embargmail.com a) Indicate the type of Human. Service Needs Priority, if program applicable: ® Priority Area #1: safety -net services for disadvantaged residents Q Priority Area #Z: education, mentorship, and afterschool programming for youth facing a variety of challenges 0 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 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, • SALT (Seniors And Lawmen Together - -a program of the Orange County Sheriffs Department) volunteers coordinate and collaborate with OCRA to identify rural seniors in need and assist with meal delivery • Emergency Medical Services and Fire Departments collaborate to identify vulnerable seniors in the community. • Orange County Department of Aging provides resources and materials about community and county services, and other programs that are pertinent to seniors such as the Handy Helpers Program, a volunteer group that builds ramps, etc., to make the seniors' homes safe. • Project EngAGE (PE, a program of Orange County Dep't of Aging) volunteers coordinate and collaborate with OCRA to visit seniors and to help deliver hot meals. DO NOT SUBMIT THIS PAGE 1/1212018 10 :05:28 AM P a g e 1 4 o f 2 5 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 *ZX no I1: 31r_ wLZ•1• J1.]= K Kell] 1161112FSeiZ 110Lfve_ANaIfLeyll9[• • Commodity Surplus Food Program (CSFP) supplies food surplus items from the Dept of Agriculture to be distributed to eligible seniors through the Dept of Aging and OCRA volunteers. • Department of Social Services (DSS) identifies rural seniors needing assistance. • Chapel HiIUCarrboro Meals on Wheels, in collaboration with OCRA, coordinates the distribution of emergency shelf - stable meals to rural seniors. • Durham Meals on Wheels, Wake Co Meals on Wheels, Chapel HilllCarrboro Meals on Wheels and OCRA Meals on Wheels are joining together to apply for a grant from the AARP. Durham and Chapel Hill have shared information, protocols, and management information to OCRA. • In coordination with a group of women from Salisbury, N.C., OCRAISALT has started an emergency food pantry in rural Orange county • Local churches e St. Matthews Episcopal Church • provides financial assistance • donates food • provides volunteers o Lattisville Grove Missionary Baptist Church, Pleasant Green UMC Women, and Lebanon UMC Women supply food and volunteers o Little River Presbyterian and Efland Faith Collaborative help identify and serve rural seniors and provide volunteers. They have also provided in -kind donations of meals. o New Sharon UM Women, and Hillsborough UM Men have contributed funding. Local Community, Civic and Business Groups • Schley Grange provides a forum for discussion of senior's interests and concerns • Orange County Sheriff's Office provides hot dog meals every other month • Hillsborough Exchange Club provided the kitchen and space to prepare Thanksgiving meals for del iveryldistribution to 82 seniors. • The Hillsborough Kiwanis Club and the Sheriff's Office Citizen's Organization (SOCO) provided funding • Maple View Farm is a sustaining sponsor of OCRA • Hillsborough BBQ provides donated meals once a month • Gillis' Catering Company provides meals at cost Program Description (3 pages OR LESS) Rural Orange County has a growing senior population with many individuals over 65. They face unique issues that are characteristic of rural life: relative isolation and limited community infrastructure— limited availability of healthcare and social services, remote from shopping and food, with no public transportation. In 2015, volunteers from the Orange County's senior leadership program, Project EngAGE (PE), partnered with the Sheriffs visitation program (SALT), and began visiting seniors in rural Orange County. There are over 250 seniors being visited or contacted weekly as of December 7017. The partnership with SALT and PE provided the inspiration for OCRA. Volunteers noticed unmet needs with the seniors they visited, such as empty food pantries, and minor home repairs left undone. The seniors enjoyed the visits and the time spent in DO NOT SUBMIT THIS PAGE 1/1212018 10:05:28 AM Page 15 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION conversation. OCRA was formed to provide a nutritious source of meals for vulnerable seniors. This was of particular importance because neither Chapel Hill - Carrboro or OCIM Meals on Wheels have routes in our remote rural areas. OCRA now delivers meals once a week to 82 seniors, and is securing funds and resources to provide meals two times a week by the end of 2018. Today OCRA provides weekly meals that are purchased from a local business, with desserts provided by churches and individuals. Meal distribution is planned one week in advance. Meals are picked up by volunteers from a commercial kitchen and delivered to our office for distribution to volunteer drivers who then deliver the food to the clients on 10 routes. Once of month a local restaurant donates the meals for our seniors. OCRA clients are located throughout rural Orange County - -in every unincorporated township and in 6 different zip codes. OCRA Volunteers are individually insured for liability and supplemental auto when they are distributing meals. OCRA now has 43 part -time volunteers who work together to organize the tasks, and to prepare and deliver meals every week. With more funding we are prepared to scale up the number of meals and clients served on a weekly basis. Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a Town /County prioritylgoal? The Orange County Commissioners' Goal to "Create a Safe Community" as a Social Justice Value is being done through OCRA and our Alliance members who help build ramps, put up grab bars, and do other small home repairs to allow seniors to feel safe in their own homes as they age in place. These proud seniors have strong connections to their homes, churches, and communities, and do not have the resources for assisted living or affluent senior housing. They are not "asking for help ". Through relationships built with the SALT /PE /OCRA volunteers, these seniors are becoming more connected with their community and to the resources available to them through the county. Seniors who would otherwise be isolated in a remote rural area are building trust and feeling secure with visitation teams, and becoming more receptive to help and support as they as in place. OCRA also supports OC Commissioners' Goal #2 "to promote an interactive and engaging system of governance that reflects community values, mentioning internet access." Many rural seniors do not have computers or skills necessary to interact with the internet. They rely on the old- fashioned way of getting information... personal contact. OCRA, with the help of SALT/PE, shares social connection with the seniors and keeps them informed on community events and of County services available. This connection enables seniors to be part of the County and a valued part of their community. Through our alliances with churches, civic groups, and local businesses, OCRA (with SALT and PE) is creating distinctive community connections that are encouraging pride and camaraderie amongst many rural seniors. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Oran e 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. Food insecurity plagues 15 % of the population of Orange County, with another 47% just DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM page 16 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 I :ZN:If:31W_wW:z•1►•LL721 V Weill 1111•1: I F_Te]21►[4 -N_I>NI[e1_rtlI[•]0 above the poverty level who are unable to qualify for federal assistance or county social services. For rural seniors, there is the complication of transportation, since many of them do not drive anymore. Without transportation, they are unable to participate in meal programs offered through the county's senior centers or community centers. These seniors (and some disabled rural residents) rely solely on charitable food assistance. Local Meals on Wheels agencies serve some of these citizens, but do not reach out into the remote rural areas that are serried by OCRA. Based on the American Community Survey, four thousand seniors live in the unincorporated area of the county (2010 census). The five rural townships (Bingham, Cheeks, Cedar Grove, Kittle River, Eno) have seen a 50% increase in the rate of growth in the seniors over 65+ (US 2010 census) between 2000 and 2010. This number reflects the steady aging of the rural population --not an influx of retirees coming to retirement communities! The growth rate of seniors in rural Orange County far outpaces the rate of growth (21%) in the urban areas. In our short time of operation, SALT/PE identified over 250 seniors for regular visitation and 82 who benefit from meals. The need is much greater, and we are poised to reach further with more funds. 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 target population of individuals is rural homebound or disabled seniors who need help providing nutritious meals for themselves. These seniors are typically identified by SALT /PE volunteers, Department of Social Services, local churches and civic groups, and EMS professionals. g) Describe the credentials of the program manager and other key staff. {Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) OCRA's Leadership Team Norma White, President Founding member OCRA; Volunteer SALT program; Project EngAGE Senior Leader; Volunteer OCIM Meals on Wheels; secretary Orange County Voice (OCV); past Chair Orange County Historic Preservation Committee (1990's); founding member Hillsborough Tree Board; initial member Occoneechi Mountain Park Committee; founder Girl Scout troop — rural northern Orange County; owner N.B. White & Assoc., Inc. Archie Daniel, Vice President Founding member of OCRA; part -time employee of Sheriff's Office— Director of SALT Program; coordinator with Project EngAGE and Handy Helpers; trainer of SALT volunteers; volunteer OCIM Meals on Wheels, former building contractor; retired Captain Orange County Sheriffs Office. Bonnie Hauser, Treasurer Founding member OCRA; organizing member of Project EngAGE; board member Northern Orange NAACP; board member Big Brothers Big Sisters of the Triangle; board member Maple View Agricultural Education Center; Legislative Chair, Schley Grange; founder Orange County Voice; retired partner management consulting firm (P ri cewate rhou se C o op a rs) Karen Barrows, Secretary DO NOT SUBMIT THIS PAGE 1/1212018 10:05-28 AM P a g e 1 7 o f 2 5 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Nurse; Former Peace Corp member; Past Board member Piedmont Health Services; Former Board member Piedmont Electric Membership; Past member Orange County Planning Commission, former Girl Scout leader h) Describe the specific period over which the activities will be carried out and include an implementation timeline. As of the end of 2017, OCRA is serving one meal a week to 82 seniors in rural Orange County. As additional funds and grants are secured, we expect to increase meal frequency to two times a week by the middle of 2018. We recruit and train volunteers regularly, allowing OCRA to scale up our services to serve more clients and increase the frequency of meals as our funding allows. 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) This program provides a much - needed safety net that improves the quality of life for Orange County's rural seniors by helping them continue to live and age in place in their community. Nutritious meals for vulnerable seniors is a proven way to reduce social isolation and depression, reduce emergency visits, and provide countless other healthful benefits. OCRA is the first program to reliably provide meals to underserved rural communities. Through strong alliances and ties to the community, our funds go very far. Many of OCRA's meals are donated or deeply discounted. We are a good fiscal investment and add value to the lives of both our seniors and their communities. Through ongoing contact with seniors, OCRA volunteers can identify or prevent risks facing rural seniors. OCRA extends the reach of Orange County's services for seniors by bringing resources (i.e., Handy Helpers, Fall Prevention) to rural areas. The coalition /alliance of all the partners within the community is strengthened as well when all work together for the common good, and the community thrives. !1 Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. With funds received from the County in the 2017 -18 grant ($12,500) we were only able to sustain 21 people with one meal a week for 50 weeks. Our total delivery was 82 meals per week. The community provided the additional funds that we needed to feed the other 61 people. If funding is reduced from the County and by individuals /businesses because of changes in the tax law, OCRA would have to recalibrate how many meals could be delivered. In either case, vulnerable rural seniors will suffer, as there is no other agency or civic organization who is reliably bringing hot meals to their homes. It is likely that the program would cease entirely as meal acquisition is primarily donor driven at present. The need for our services is also increasing because of the aging population growth in {Orange County.. k) What percentage of your target population is low- moderate income? Of our 82 people currently receiving meals through OCRA, 20 people, or 24 %, qualify for the Commodity Surplus Food Program, which is geared for 130% of poverty level. t} What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) Currently our drivers provide direct feedback from our clients. As meals are delivered, drivers pay attention to their people and look for unusual signs that something may be wrong with them. Clients also relay their thanks and appreciation to the drivers with whom they DO NOT SUBMIT THIS PAGE 1/1712018 10:05:28 AM Page 18 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 ON:IIQ III r:AW:1•1•A1•»ZY K•1l]1 1611 .12F<<ei21ir[y-, ff_1„111LOL`�I Is] .1 have established a relationship. Comments relayed back to OCRAA include our clients feel safer in their homes knowing someone is coming to check on them, their health has improved a little, and they feel less lonely. m) Include any other pertinent information. A recent AARP study shows that isolation increases depression, poor nutrition, susceptibility to falls, and raises health care costs by 300%. According to a study from the UNC Emergency Room, statistics show that 62% of rural elderly people are found to have malnutrition or be at risk for malnutrition. OCRA's program of providing hot meals to the vulnerable rural elderly members in the unincorporated areas of Orange County helps combat all of the issues of being alone and elderly. A program of delivering a hot meal, visiting briefly with a senior, and showing that someone cares, is a simple way to show the older generation that they are not forgotten or alone. This easy step could help keep a senior in their own home and community as they get older and age with dignity. DO NOT SUBMIT THIS PAGE 1/1212018 10:05:28 AM P a g e 1 9 o f 2 5 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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. The following numbers reflect our actual numbers from Jan 1 -Dec 31 of each year.. Program Target Population Demographics Actual Estimated Projected 2017 2018 2019 Gender Male Female Total Ethnicity African- American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Total Of the above, how many HispanicJLatino 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) 22 28 38 60 72 82 82 100 120 28 37 47 82 90 105 0 0 0 54 63 73 82 1 100 1 120 53 1 70 90 82 100 120 0 10 15 82 90 105 0 0 0 Total 1 82 100 1 120 DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM Page 20 of 25 82 100 120 82 1 100 1 120 Total 1 82 100 1 120 DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM Page 20 of 25 28 29 29 1 1 1 1 53 1 70 90 Total 1 82 100 1 120 DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM Page 20 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement o) Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and _Time- bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly /disabled residents.) • Program Goal should explain what the program is trying to achieve /accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday - Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program Orange County Rural Alliance (OCRA) 1. Program Activity Name Meal delivery to elderly /disabled rural residents Program Goal Deliver 120 meals, two times a week Performance Measures Will track the number of meals delivered each week Previous Year Program Results Delivered meals to 82 seniors /disabled once a week Current Year Estimated Results 4000 meals delivered from Jan 1 -Dec 31, 2017 Next Year Projected Results Deliver 12,480 meals to 120 seniors /disabled twice a week 2. Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results 3. Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results 4. Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results DO NOT SUBMIT THIS PAGE 1/12/2018 10:05:28 AM Page 2 1 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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: • Revenues • Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) • Other Government Grants • Triangle United Way • State Government • Federal Government (CDBGIHOMEletc.) • Private Foundation Grants • Other Revenue • Expenditures o Compensation o Rent & Utilities a Supplies & Equipment o Travel & Training n Other Expenses 2. Program Budget Detail — Provide description of "other" budget items, not defined. 3. This program budget represents what percent of the agency budget? 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. y F :n r7.-ry '7 ,Sh,i NO �N Total Cost of Program $18,620 $63,158* $94,950 Total # of Individuals 65 (avg) 120 120 Cost Per Individual 1 $285 $526* $790 ($395/meal) ("increase due to hiring Exec Director) DO NOT SUBMIT THIS PAGE 1/12/2018 10,05:28 AM Page 22 of 25 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME Orange County Rural Alliance �OCRA) Meals on Wheels Program PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG1HOMEletc.) Private Foundation Grants Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Program Expenses SURPLUS/(DEFICIT) FOR PERIOD: 20/7 -3 r-?1, 20/q Actual 2016 -2017 Estimated 2017 -2018 Project d 2018 -2019 Percent Change $ 35,924 $ 36,000 $ 36,000 0% $ - $ - 10 5 - $ - $ 0 $ - $i - 0 s $ - $ 0 S $ - $ 0 5 - $ 12,500 $ 40.000 220% S - $ - $ - 0 $ - $ $ - 0 $ - $ $ - 0 $ - $ $ - 0 $ - $ $ - 0 $ - $ $ 25,000.00 0 Is $ - $ - 0 $ $ 35,924 - $ $ 48,500 10,400 $ $ 101,000 20.8[70 108 %v 100 ° /0 $ 600 $ 3,000 $ 3,000 0% $ 3,062 $ 3,000 $ 3,000 0% $ - $ - $ - 0 $ 15,958 $ 17,967 $ 68,543 281% $ 19,620 $ 34,367 $ 95,343 177 °la $ 16,304 1 $ 14,133 1 $ 5,657 -60/9, IVO7e. -$ cot 4,r_t 6Q$ed an pGi 'A A i j c a I Vier. Jdn r - &e4 31 Program Budget DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBTI` "B" Scope of Services — FY 2018 -19 Outside Agency Performance Agreement Agency blame: Orange County Rural Alliance Program Name: Rural Meal Distribution Funding Award: $20,750 Outline how the agency will spend Orange County's funding award. Expense Description Amount Meal Acquisition $10,000 Salaries for Operations Director $10,750 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. • Acquisistion and distrubtion of meals to vulnerable rural seniors in Orange County • Volunteer recruitment and training • Fundraising • Communications 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 Continue to grow client base by 10 clients a quarter (increase of 40 clients to a total of 140 clients by June 2019 140 Grow volunteer base from 35 to 50 volunteers 50 Docu5igned by: P�vw,a President 8/16/2018 PP f Certified by' 3as\—es�,s�ca�s... Title: 'r f �/�f �'�— Date: l /! (Provider's Signature) DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 EXHIBIT "B" Scope of Services — FY 2018 -19 Outside Agency Performance Agreement Agency Name: Orange County Rural Alliance Program Name: Rural Meal Distribution Funding Award: $7,267 Outline how the agency will spend Orange County's funding award. Expense Description Amount Meal Acquisition $7,267 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. • Meal acquisition and distrubution to vulnerable rural seniors in Orange County Anticipated Outcomes The Anticipated Results column trust include quantifiable results in the form of number of persons /units served within Or anee County, only (all Towns and municipalities). If you use pereentaees, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Provide second weekly meal at least once a month for all OCRA clients (100 -140 additional 100 -140 meals per month) Docu5igned by: N4ia / 8/16/2018 P n 34852E99161C459... Certified by:/` Title: Date: (Provider's Signature) DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 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. Docu5igned by: ovx�a �.ifc. Certified by: E 3as�2essis�ca�s... — (Provider's Signature) Title: President Date: 8/16/2018 (Orange County Rural Alliance) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID: DB2FC63F- 0403 - 4403- BF86- OF5CB206F3F3 NCHILL2 ACORD,, CERTIFICATE OF LIABILITY INSURANCE F DATE (MMD gYYY) 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 CONTACT NAME: The CIMA Companies, Inc. PHONE 703 739 -9300 FAX 7037390761 2750 Killarney Dr, Suite 202 (A/C, Lo, Ezt : (A/c, No): ADDRESS: Woodbridge, VA 22192 -4124 PRODUCER CUSTOMER ID #: 703 739 -9300 INSURED Orange County Rural Alliance (OCRA) 4901 Schley Road Hillsborough, NC 27278 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Alliance of Nonprofits for Ins 10023 INSURER 8: INSURER C : 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 ADDLSUBR NSR D POLICY NUMBER Y EFF MM /DD POLICY EXP MM /DD/YYYY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rx-1 OCCUR 201850439 01/31/2018 01/31/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISE 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 PRO LOC PRODUCTS - COMP /OP AGG $2,000,000 $ • AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 201850439 01/31/2018 01/31/2019 (Ea BIKED) INGLELIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- OTH- TORY LIMIT ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A Abuse /Molestation 201850439 01/31/2018 01/31/2019 $2,000,000/$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Orange County, NC is listed as additional insured under the general liability policy with respects to operations performed by the name insured. Orange County, NC I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S367755/M358958 JXJ