HomeMy WebLinkAbout2018-448-E Finance - Refugee Support Center outside agency agreementDocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
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 Refugee Support Center, a not - for -profit corporation,
located at PO Box 1025, Carrboro, NC 27510 ( "Provider ").
1i.�m►Q.Xy�ly
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 Refugee Support Center agree as follows:
1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1,
2018 to June 30, 2019.
2. Scope of Services.
a. Provider will provide services, as outlined in the attached Outside Agency Funding
Application and any amendments or revision thereto which is attached as Exhibit "A" and
incorporated by reference, to the residents of Orange County. The Scope of Services and
the Program Budget may be different from the original application based on County
appropriation; however, any revisions or amendments to this Agreement must be approved
in writing by the County and attached to this Agreement as Exhibit B.
b. The Provider shall be solely responsible for the means, methods, techniques, sequence,
safety program and procedures necessary to properly and fully complete the work set forth
in the Scope of Services.
3. Funding.
a. The County agrees to appropriate for the provision of services described in Exhibit A,
Scope of Services and more particularly described in the Revised Program Budget, the
maximum sum of $5,000.
b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not
used for the purposes stated shall be returned to the County. Any changes in the use of
funds must be authorized in writing by the County prior to any expenditure of the funds by
the Provider. If the funds are expended not in accordance with the Scope of Services, at the
discretion of the County the Provider may be required to repay the funds to the County.
The Provider shall be paid in four equal installments in the amount of $1,250. The first
payment is contingent upon receipt of the agency's performance agreement; the remaining
payments are contingent upon receipt of the request for reimbursement and related
supporting documentation.
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.
(Refugee Support Center)
Orange County Outside Agency Performance Agreement
Revised 712018 Page 1 of 9
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
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.
(Refugee Support Center)
Orange County Outside Agency Performance Agreement Page 2 of 9
Rev. 7118
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
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.
(Refugee Support Center)
Orange County Outside Agency Performance Agreement Page 3 of 9
Rev. 7118
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
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 Refugee Support Center 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:
(Refugee Support Center)
Orange County Outside Agency Performance Agreement Page 4 of 9
Rev. 7118
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
County: Finance & Administrative Services Provider: Refugee Support Center
Orange County PO Box 1025
Post Office Box 8181 Carrboro, NC 27510
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.
Fo) DocuSigned by'.
FUX bakA ,
BD72F91B382B4C3...
For --- a -c-- L- - '_ _�� _��,_ -____ County Government
Docu5igned by: � �y
66KA&A, � ,MKALY'i
0637994B755E477...
Bonnie tiammersiey, county Manager
(Refugee Support Center)
Orange County Outside Agency Performance Agreement
Rev. 7118
8/16/2018
Date
8/17/2018
Date
Page S of 9
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
1. COVER PAGE
a) Applicant Contact Information
Applicant Organization's Legal Name: Refugee Support Center
Applicant Organization's Physical Address: 401 NC 54 Bypass, E # 16, Carrboro, NC 27510
Applicant Organization's Mailing Address: PO Box 1025, Carrboro, NC 27510
Applicant Organization's Web Address: www.refugeesupportcenter.org
Executive Director: Flicka Bateman
Telephone Number: 919) 423 -1478
Tax ID Number: 46- 3944698
E -Mail: fbatemanrsca)-g mail. corn
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
Agency Administration (rent, utilities, insurance)
$6,000
$6,000
$5,000
$17,000
Projected Estimates: Rent - $10,000; utilities -
$3,000; insurance - $4,000 .
Totals
$6,000
$6,000
$5,000
$17,000
c) To the best of nay 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: �`-',- ti- .._✓___
Executive Director
Signature* i4)
-=- �Boairdl Ch irperson
Date - --
/ / 16 ) -/ C� I � -4
Date
AGENCY INFORMATION 1/18/2018 1:56:21 PM Page 8 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
c) 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 Hill, or Orange County?
❑ ® b) Members of or closely related to members of the governing bodies of the Town of
Carrboro, the Town of Chapel Hill, or Orange County?
❑ ® c) Current beneficiaries of the program for which funds are being requested?
❑ ® d) Paid providers of goods or services to the program or having other financial interest in
the program?
If you have answered YES to any question, please provide a full explanation below.
NON - DISCRIMINATION
Provider agrees as part of consideration of the granting of funds by funding agencies to the
parties hereto for themselves, their agents, officials, employees and servants agree not to
discriminate in any manner of these basis of race, color, gender, national origin, age,
handicap, religion, sexual orientation, gender identity /expression, familial status or veterans
status with reference to any activities carried out by the grantee, no matter how remote. The
parties hereto further agree in all respects to conform to the provision and intent of Orange
County Civil Rights Ordinance, as amended and the Orange County Anti - discrimination
Policy. This provision is enforced by action for specific performance, injunctive relief, or other
remedy as by law provided; this provision shall be binding on the grantees, the successors
To the best of my knowledge and belief all of the above information is true and
currents 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:_.
ive Director
Signature:
B rd'Chairpemrton
Date
Date
and assigns of the parties hereto with reference to the above subject manner.
AGENCY INFORMATION 1/18/2018 1:56:21 PM Page 9 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
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): 07/2012. Incorporated 9/2013
b) Agency's Purpose /Mission (no more than a few sentences):
The Refugee Support Center (RSC) is a volunteer -based organization established to
facilitate the transition of Orange County refugees in their adjustment and integration
into American culture. Our goal is to help refugees develop the skills and access the
tools they need to thrive in their new home and allow them to become self- sufficient,
contributing members of our society.
c) Types of Services the Agency Provides (bullet format):
• Housing
• Employment
• Transportation
• Healthcare access
• Immigration legal assistance (applications for green card, citizenship, and
family reunification)
• ESL and citizenship classes
• After school tutoring
• Food and clothing access
• Enrichment for children
• Interpretation and Translation
• Pro bono legal assistance
d) Agency's History with Providing These Services:
Services scheduled on an ongoing basis at RSC, starting in 2012, included
citizenship and ESL instruction as well as free lunch distribution to school age
refugees during the summer. Other services listed above are on an "as needs"
basis; that is, they are provided when refugees contact us for assistance. In 2015,
our offerings expanded to provide immigration legal services when our organization
became recognized and a staff member certified by the Department of Justice /Board
of Immigration Appeals to provide immigration legal services. This had a significant
impact on the services we could provide and the number of clients we served. In
2016 we were able to expand legal services through pro bono attorneys who assist
in family law, wills, traffic citations, fraudulent transactions, and other legal issues.
Moving into our own space in June of 2017 allowed us to expand what we are able
to offer, as explained below. Please see Attachments 2.d, Graphs of Services for
documentation of services provided in 2015, 2016 and 2017.
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 ?)
Agency Information 1/18/2018 1:56:21 PM Page 11 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
We were located in donated space in the leasing office of a Carrboro apartment
complex from July 2012 until June 2017. At that time, the organization moved to its
own space in the complex, which has opened up opportunities to increase the
quality of our services and the supervision of our volunteers. Having our own free
standing Center has enabled us to: expand our citizenship and ESL programming,
provide confidential office space, maximize opportunities for collaboration with other
organizations serving refugees, provide dedicated space to store donated items and
goods for distribution, and improve volunteer training and support by allocating
training space and a centralized instructional materials library. Maintaining our
location in an area where many refugees live and can access by foot or bus is a
priority.
From 2012 until 2016, we only served refugees from Burma because this constituted
the refugee population in Orange County; this group still comprises approximately 97
percent of the refugees in the County. However, our clientele began to diversify two
years ago when Arabic - speaking and Swahili- speaking refugees started to be
resettled here and sought out the services of RSC. This increased our need to
expand our contract interpreter pool.
Both the move to our own space and the increased client diversification of needed
interpreters has challenged our financial resources.
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: 0
# of Volunteers: 98 # of FTE - Vol unteers:1
g) Living Wage
Does this agency pay permanent employees a minimum living wage? (Yes /No) Yes
Please note that although we have no permanent employees, we pay our contracted
interpreters $15 per hour.
Stipends are given to our volunteer coordinator and employment specialist.
If yes, is this agency an Orange County Living Wage Certified Employer? No
If no, please explain. Since we have no employees, we have not sought certification from
Orange County.
Agency Information 1/18/2018 1:56:21 PM Page 12 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
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) Yes
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
Orange County Social Justice
Funds rent and utilities
$11,340
0
RSC was asked to apply by Orange
County Mana er
$11,340
0
*Add rows or attach additional page, if needed.
ii. Submit your agency's budget. You may complete the provided template (separate
As file) or you may submit your own budget file (as long as it contains the same
information, and in a similar format, as requested in the provided template).
Agency Budgets are required to define budget amounts for the previous program
year, current program year, and next program year for the following categories:
Revenues
o Private Donations
o Program Generated Revenue
o Local Government Grants
• Carrboro Human Services
• Carrboro Other
• Chapel Hill Human Services
• Chapel Hill Other (DO NOT include CDBG funding here)
• Orange County Human Services
Agency Information 1/18/2018 1:56:21 PM Page 13 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
■ Orange County Other (DO NOT Include HOME funding here)
• Other Government Grants
• Triangle United Way
• State Government
• Federal Government (CDBG /HOME /etc.)
• Private Foundation Grants
• Other Revenue
• Expenditures
o Compensation
o Rent & Utilities
• Supplies & Equipment
• Travel & Training
• Other Expenses
iii. Does your agency budget show a Surplus or Deficit? We balance our budget
annually.
Is there a significant change? Yes /No Yes
Please provide a brief explanation for Surplus or Deficit, and significant changes.
Our FY runs Jan 1 — Dec 31. For RSC 's 2017 budget year, we show a surplus of
$5,618.00 because we receive $11,340 from Orange County Social Justice Funds in
June 2017 to cover rent and utilities from July, 2017 — June, 2018.
The significant change is that our budget has grown; this is for two reasons. Due to
our move to own location, we now incur rent, utilities and insurance expenses. Our
need for more interpreters in various languages (Arabic, Burmese, Chin, Karen,
Kinyarwanda, Rohingya and Swahili) has also resulted in budget growth.
iv. What is your agency's fiscal year? January 1, 2018 — December 31,
2018
(Example: July 1, 2016 through June 30, 2017)
Agency Information 1/18/2018 1:56:21 PM Page 14 of 26
DocuSign Envelope ID: 80124B29-E4DA-4BOD-A879-D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Agency Budget
Operating Budget for Entire Agency
AGENCY NAME,
AGENCY REVENUE
Private Donations
Agency Generated Revenue (fees)
Local Government Grants:
Human Services - Toym of Carrboro
Other - Town of Can-lboro
Human Services - Tom of Chapel Hill
Other- Tom of Chapel Hill
Human Services - Orange County
Other - Orange County
Other - Town of Hillsborough
Other Government Grants
Triangle United Way
State Government
Federal Government (CDBG/HOME/etc.)
Private Foundation Grants
Other Revenue
Total Agency Revenue
AGENCY EXPENSES
Compensation
Rent & Utilities
Supplies & Equipment
Travel & Training
Other Expenses:
Total Agency Expenses
SURPI-MI(DEFICIT) FOR PERIOD
FY 2018 -19 Agency Budget
SuDDort Center
I S I S - I S I
Agency Information 1/18/2018 1:56:21 PM Page 15 of 26
Actual
2016-17
Estimated
2017-18
Projected
2018-19
Percent
Change
$
12,600
S
14,260
$
16,000
12%
$
$
$
$
6,000
$
$
$
$
$
6,000
$
$
5,000
-
11,340
-
-100%
$
$
$
0
$
$
$
0
$
5
$
0
$
S
$
-
01
$
12,000.00)
$
15,000.00
$
15,000.00
$
-
$
-
$
0
$
24,600
18,500
$
$
40,600
22,000
$
S
48,000
24,000
18%
9%
-
$
1-1,340
$
13,000
15%
3,600
$
5,000
4:000
-20%
1 S)00:
$
1,000
$
-
-100%
S
1,500
1260
S
7.00G
456%
S
24.600
S
40.600
1 S
48,000
18%1
I S I S - I S I
Agency Information 1/18/2018 1:56:21 PM Page 15 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
3. PROGRAM INFORMATION (Submit a separate Section 3 for each program)
Program Name: Agency Administration: Rent, Utilities, Insurance
Program Primary Contact and Title: Flicka Bateman
Telephone Number: (919) 423 -1478
E -Mail: fbatemanrsc(o-)gmail.com
a) Indicate the type of Human Service Needs Priority, if program applicable:
® Priority Area #1: safety -net services for disadvantaged residents
® Priority Area #2: education, mentorship, and afterschool programming for
youth facing a variety of challenges
® Priority Area #3: programs aimed at improving health and nutrition of needy residents
b) Indicate the type of program for which you are requesting funding
(Check all that apply to this program)
Program Category
Youth
Adult
Elderly
Disabled
Public Housing
Neighborhoods /Residents
Affordable Housing
X
X
X
x
X
Affordable Healthcare
X
X
x
x
X
Education
X
X
x
x
X
Family Resources
x
x
x
x
X
Jobs /Jobs Training
X
x
X
Food
X
X
x
x
X
Transportation
x
x
x
x
X
Other: Immigration
Legal Services
X
X
x
x
X
c) Provide a bulleted list of other agencies, if any, with which your agency
coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s)
to be funded. For each, briefly describe the coordinated /collaborative efforts.
• Orange Literacy: This agency provides funding for teacher and materials for
on -site citizenship class
• Family Reading Partners: Agency volunteers schedule "story time" sessions
on site for refugee parents and children whom we recruit and arrange
interpreters for.
• Carrboro Community Health Clinic: The clinic refers clients to our services
and we assist clients with making medical appointments and medication
refills.
• Orange County Departments of Health and Social Services: We make
appointments, collaborate on completing immunization records for green card
applications, and refer clients when they move from out of state. Receive
referrals for immigration legal services.
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DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
• Chapel Hill Public Housing: We coordinate with CHPH to complete
applications and public housing process; follow up with CHPH for refugee
applicants still on wait list and assist those who have been selected with
move -in requirements
• CHCCS ESL Department: Work with ESL director, teachers, and
interpreters to maximize resources for students and families, including after
school tutoring
• Church World Service (resettlement agency): assist with their refugees
newly resettled in Orange County: provide ESL classes for clients referred to
us; collaborate on job acquisition and immigration legal services
• World Relief (resettlement agency): provide services for their clients upon
referrals
• Learning Outside: provide scholarships for afterschool programs and
summer camps for RSC- designated school -age refugees.
• Furniture Project: provide furniture for refugee apartments.
• UNC Outreach 360: recruits UNC student volunteers to tutor school age
refugees and adults and increases campus awareness of refugees
• Hillsborough Progressives in Action — collaborates with RSC to help some
of the neediest of our families.
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?
Program services proposed: a centralized location (made possible with funding for rent,
utilities and requisite insurance) for refugees to access safety -net services and
assistance related to the following:
Affordable Housing: accessing affordable housing by completing public housing,
Habitat, Home Trust applications and seeing refugees through the process if they are
selected; coordinating furniture for dwelling units.
Affordable Healthcare: navigating the healthcare system by making medical
appointments, accompanying refugees to appointments if requested, completing
applications for ACA and employment -based insurance, UNC Healthcare Charity Care,
Medicaid and SSI /Disability; understanding medical bills and setting up payment plans;
assisting with medication refills and understanding instructions.
Education: navigating educational systems, including preschool, public school,
community college, and adult education; coordinating and supervising volunteer tutors
for school -age and adult refugees; providing ESL and citizenship classes; voter
registration and education; securing scholarships for after - school camp, summer camp
and enrichment programs; holding annual Backpack and School Supplies Give Away.
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 17 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Family Resources: conducting monthly Diaper Day when donated diapers are
distributed; providing donated clothing; assisting with personal finance - budgeting,
understanding bank accounts, writing checks, deadlines for bills; accessing attorneys,
either pro bono or low bono for citations, divorce, custody, domestic violence, SSI
appeals, home purchases; offering "Story Time" for parents and their children.
Jobs /Job Training: applying for jobs, practicing for interviews, advocating with
employers and potential employers, assisting with completion of paperwork related to
hiring process; troubleshooting with supervisor and refugee when issues arise.
Food: completing Food Stamps, Free /Reduced Lunch, PORCH and TABLE
applications; distributing donations of food and grocery store gift cards; distributing Food
for Summer lunches (not done summer of 2017 due to our move).
Transportation: teaching bus usage; driving to appointments; providing instruction to
pass driver's license test (both written and driving components using refugees'
vehicles); assisting with purchasing cars/ insurance /getting repairs /negotiating with
unscrupulous sellers.
Immigration Legal Services — completing and submitting green card, citizenship, family
reunification, and derivative citizenship applications; accompanying refugees to USCIS
when necessary and speaking on their behalf with USCIS officials.
RSC provides a full range of services, many of which utilize or connect clients to
appropriate towns and county services.
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.
Refugees coming to Orange County face numerous challenges. Arriving in a new
country with the loss of support from extended family and established cultural networks,
they encounter significant obstacles. These include securing work and housing,
accessing health care, mastering public transit, raising children in an unfamiliar culture
and educational setting, and navigating the legal system. In addition, cultural and
language barriers pervade every aspect of their lives along with their experiences of
severe trauma and struggle preceding and during the course of their flight. These
barriers are met with a fierce determination to improve their lives and those of their
children. Nonetheless, perseverance and resilience alone cannot offset all obstacles;
and for many situations, refugees need guidance and assistance.
Refugees are assisted with resettlement in their first three months by resettlement
agencies, which have cooperative agreements with the Department of State. After 90
days, these agencies typically phase out to start working with other arrivals. It is
following this 90 -day period that RSC services are most often sought after and
accessed long term. Having a brick - and - mortar office identified, refugees in Orange
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 18 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
County know where to go when assistance is needed. The assistance provided
corresponds to the goals of Carrboro, Chapel Hill and Orange County.
The 2007 Orange County Health Department Assessment: Community Diagnosis in
2007 identified several themes expressed by refugees that hindered their integration
into the community: lack of knowledge of community resources and how to access
them, inconvenient locations and times for Adult Education classes, and language
barriers. Orange County Board of County Commissioners (BOCC) has an overall goal
to ensure economic self - sufficiency and another goal to ensure a community network of
basic human services and infrastructure that maintains, protects, and promotes the well-
being of all county residents. Chapel Hill Town Council has the goal of creating a place
for everyone and to support community prosperity, as well as a sub -goal to support
affordable housing. Goals of the Carrboro Board of Aldermen include to enhance and
sustain the quality of life /place issues for everyone and to maintain ethnic and economic
diversity.
RSC is part of the network of services and infrastructure that helps meet the needs of
refugees in our community. Our location in an apartment complex where refugees live
and which others can access easily addresses the issues of: availability of resources
(donations, assistance in navigating the culture and key agency providers), education
(ESL and citizenship classes on site), language barriers (Arabic, Burmese, Chin, Karen,
Kinyarwanda, and Swahili interpreters available daily) and trust. In addition, these
community goals are supported as RSC assists refugees to: a) complete applications
for benefits, jobs, rentals, school registrations; b) manage and take control of their
personal finances; c) understand the legal system by engaging with RSC pro bono
attorneys when legal issues arise; d) provide after school tutoring for school age
refugees; and e) secure green cards and ultimately citizenship. Support and step by
step instruction helps build refugees' self confidence and their ability to stand on their
own, be less dependent on government resources, and become contributing and
productive members of our community.
f) Who is your target population of individuals to benefit from this program and how
will they be identified and connected with the program?
In 2017 we served 670 refugees, all of whom struggle financially, culturally and
emotionally. The largest number of refugee clients are from Burma and include
Burman, Chin, Karen, Karenni, Mon, and Rohingya ethnic groups. Our target
population also includes in- county refugees from Syria and Congo /Rwanda. Some
refugees are referred to us by resettlement agencies or by social service and health
care providers. However, the vast majority comes to us by "word of mouth ". This
suggests that the refugee communities trust RSC, that they bring their friends and
neighbors to us to be helped just they were helped.
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 19 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
g) Describe the credentials of the program manager and other key staff. (Ex. Identify
Program Manager and credentials, describe training provided to volunteers, etc.)
Flicka Bateman, Director. Dr. Bateman established RSC after over a decade of
volunteering part -time while being employed by the local school system as the principal
of the Hospital School at UNCH. Interfacing with both the local healthcare system and
school district in that role enabled her to cultivate relationships and networks that are
crucial to RSC today. She is also a DOJ (Department of Justice) accredited
representative trained and authorized to provide limited immigration legal services. As a
former Peace Corps volunteer, the director has experience living and interacting with
other cultures.
Sunny Chew,Volunteer Coordinator. The coordinator has a Masters of Education in
English as a Second Language (ESL) and has taught ESL in Asia as well as in the US.
She currently is an ESL tutor at CHICLE and the Augustine Project. Mrs. Chew
manages a volunteer load of over 75 individuals by providing orientation, on -going
consultation, matching volunteers with refugees, keeping the citizenship and ESL
curriculum library current, and maintaining records.
Taylor Billings, Employment Specialist. Our specialist is a second year Master of City
and Regional Planning student. He has professional, teaching and research experience
in city planning, housing, economic development, and public policy. At RSC, Mr.
Billings assists refugees with obtaining and maintaining employment, develops
relationships with employers and supervisors, and troubleshoots when asked to
intervene in employer - employee issues.
Henry Lister, Community Outreach Facilitator. Dr. Lister has experience teaching at
both the public school and university level, as well as prior work writing grants for non-
profit organizations. In his role as facilitator, he interacts with community groups who
reach out to RSC for special projects, organizes fund raisers, and engages and
educates Carrboro, Chapel Hill, and Orange County residents about RSC, its goals and
needs.
h) Describe the specific period over which the activities will be carried out and include
an implementation timeline.
All activities will run from July 1, 2018 —June 30, 2019.
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) (250
words OR LESS)
At an annual cost of $24.29 per refugee, RSC, through reliance on a diverse group of
volunteers, is a cost effective way to assist refugees on their road to self- sufficiency. In
non - monetary ways, value is added to the community when refugees are able to
participate fully in community life. We believe if refugees in our community can become
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 20 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
integrated into and stand on their own in our workplaces, schools, and other spaces of
public life, they are less likely to be perceived as threats and /or burdens and more likely
to experience greater acceptance. Thus, RSC attempts to address a prevailing attitude
fraught with suspicion, fear, and anger toward refugees.
A community always benefits from diversity. Our community benefits when this strand of
diversity —one of the most vulnerable populations in our nation —is informed, involved
and equipped to pursue the American Dream and to be more fully engaged in the life of
Carrboro, Chapel Hill, and Orange County.
j) Describe what would happen if requested funding is not awarded at all or if a
reduced allocation is recommended.
We would realign our funding targets to ensure that direct services to refugees are
maintained as much as possible. For example, we would omit stipends for key
volunteers. We will also seek other sources of funding from foundations and will
increase outreach to potential donors. There is, however, a breaking point where
minimum funding for us to continue —even with reduced services —is critical. Rent,
utilities, and insurance are required no matter how much other program components
are reduced; therefore, not receiving full funding jeopardizes our ability to continue
providing services in the future.
k) What percentage of your target population is low- moderate income?
100%
1) What efforts do you make to seek feedback about your program from your target
population (e.g. survey, evaluations, etc. ?)
As of this writing we have piloted a client feedback survey and will begin its
implementation after it is translated into the necessary languages. Another form of
feedback is our knowledge of how people hear about our services. We do no
advertising or recruiting of clients; instead, refugees tell other refugees about our
services and those, in turn, tell others. This is powerful validation that our program is
respected, trusted, and valued by those we serve.
m) Include any other pertinent information.
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DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Additional Program Information
1) Target Population
Complete the following tables, with numbers (not percentages) of individuals served and to be
served, to the best of y our 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: Congolese, Syrian
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 I Projected
2016 -17 2017 -18 1 2018 -19
322
332
336
348
358
364
670
680
700
72
75
80
670
680
700
596
598
601
82
1 82
82
670
1 680
700
74
82
99
670
680
700
72
75
80
670
680
700
670
680
700
72
75
80
80
82
88
436
441
450
82
1 82
82
670
1 680
700
174
180
190
160
160
162
312
309
320
16
21
18
8
10
10
Total 1 670 680 1 700
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 22 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Work Statement
m) 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 (,2pecific, 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
1. Program Activity Name
Agency Administration
Program Goal
Centralized location to connect refugees to services and resources.
Performance Measures
80% of survey respondents indicate that they received the help
they came for and will return if needed.
Previous Year Program Results
n/a
Current Year Estimated Results
n/a
Next Year Projected Results
80% of survey respondents will indicate that they received the help
they came for and will return if needed
2. Program Activity Name
Agency Administration
Program Goal
Centralized location to store and distribute diapers, clothes, food,
school supplies, and household items
Performance Measures
100% of donated items are distributed to refugees
Previous Year Program Results
n/a
Current Year Estimated Results
100% of donated items are distributed to refugees
Next Year Projected Results
100% of donated items will be distributed to refugees
3. Program Activity Name
Agency Administration
Program Goal
Centralized location to distribute diapers, clothes, food, school
supplies, and household items
Performance Measures
60% of all clients receive at least one donated item
Previous Year Program Results
n/a
Current Year Estimated Results
35% of all clients receive at least one donated item
Next Year Projected Results
60% of all clients will receive at least one donated item
4. Program Activity Name
Agency Administration
Program Goal
Centralized location for immigration legal services
Performance Measures
95% of all green card applicants receive their cards within 10
months
Previous Year Program Results
n/a
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 23 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
Current Year Estimated Results
95% of all green card applicants receive their cards within 10
months
Next Year Projected Results
95% of all green card applicants will receive their cards within 10
months
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 24 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
n) 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)
o Other Government Grants
• Triangle United Way
• State Government
• Federal Government (CDBG /HOME /etc.)
• Private Foundation Grants
o Other Revenue
Expenditures
• Compensation
• Rent & Utilities
• Supplies & Equipment
• Travel & Training
• 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? 35.4%
4. COST PER INDIVIDUAL
This Cost per Individual must reflect the total program budget divided by the total number of
program individuals in this application.
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 25 of 26
Actual 2016 -17
Estimated 2017 -18
Projected 2018 -19
Total Cost of Program
n/a
n/a
$17,000
Total # of Individuals
700
Cost Per Individual
$24.29
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DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
PROGRAM NAME
PROGRAM REVF -NUE
Private Donations
Program Budget
Operating Budget for Program
Refugee Support Center
Program Generated Revenue
Local. Government Grants:
Hinman Services - Town of Carrharo
Other - Town of CanWro
Human Services - Town of Chapel Hill
Other - Town of Chapel Hill
Human Services - Orange County
Other - Orange County
Other - Town of HillsLcrough
Other Government Grants
Triangle United Way
State Government
Federal Government (CDBG /HOMFJetc_)
Private Foundation Grants
Other Revenue
Total Program Revenue
PROGRAM EXPENSES
Compensation
Rent & Utilities
Supplies & Equipment
Travel & Training
Other Expenses: Insurrnre
Total Program Expenses
SURPLUSJ(I]EFICIT} FOR PERIOD
FY 2018 -19 Program Budget
Actual
2016-17
sti hate
2017 -18
relectec
2018 -19
Percern
Change
$ -
h
-
$
0
0
$ -
$
11,340
$
-
- 100%
0
0
0
-
$
-
$
-
0
S -
$
-
$
-
0
0
S -
11,340
S
17,000
500%
$ -
$
11,340
$
13,00D
15%
S -
11 10
S
17.000
50%
PROGRAM INFORMATION 1/18/2018 1:56:21 PM Page 26 of 26
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
151:4: I 1111"Iu
Scope of Services — FY 2018 -19
Outside Agency Performance Agreement
Agency Name: Refugee Support Center
Program Name: Agency Administration
Funding Award: $5,000.00
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
Partial Funding for Rent, Utilities, Insurance $ 5,000.00
Program Services
Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019.
• Provide a centralized location to connect refugees to services and resources
• Provide a centralized location for authorized immigration legal services
• Provide a centralized location to distribute diapers, clothes, food, school supplies, and household
items
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
On Client Satisfaction Survey administered to a sample of refugee clients (25 clients per quarter),
95
95% of respondents will indicate receiving the help they came for and will return. (Total number
of clients is 100 by end of Fiscal Year.)
95% of refugee clients seeking assistance in submitting citizenship applications will receive their
48
citizenship within 12 months of filing. (Total number of clients is 50 by end of Fiscal Year.)
60% of refugee clients will receive at least one donated item annually. (Total number of clients is
420
700 by end of Fiscal Year.)
Dam Signed by:
FU&A b�iAn. Director, Refugee Suppor Cen%46/2018
Certified by: BD72F91B382B4C3... _ Title: late:
(Provider's Signature)
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
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.
DacuSigned by:
Certified by: gD72F91B382MC3... -
(Provider's Signature)
Title: Director, Refugee Support "Ater /16/2018
(Refugee Support Center)
Orange County Outside Agency Performance Agreement Page 9 of 9
Rev. 7118
DocuSign Envelope ID: 80124B29- E4DA- 4BOD- A879- D287FCF3F3CA
REFUSUP -01 VDECAMP
AC�Ri �
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM7❑❑IYYYY)
01/18/2018
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 have ADDITIONAL INSURED provisions or be endorsed,
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in 'lieu of such endorsement(s).
PRODUCER
Summers Thompson Lowry, Inc.
100 Europa Drive
Suite 5716
Chapel Hill, INC 27517 -2393
CONTACT
NAM E•
SA"12 N , E,t; (919) 968 -4472 �q+c, No ):(919) 942 4227
E -Mail
D❑RE ,Info@STLinsure.com
INSURER(5} AFFORDING COVERAC,E
NAIC p
INSURER A : Alliance for Non - Profits for Insurance Risk Retention Group
INSURED
INSURER B :
INSURER c
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Refugee Support Center
INSURER D:
01116/2018
401 NC 54 E -16
INSURER E
DAMAGE TO s NTTE
Carrbaro, NC 27510
INSURER F:
20,000
rrrnvcoence 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
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TYPE OF INSURANCE
ADDL
lNSD.
S.UBR
POLICY NUMBER
POLICY EFF
MM
POLICY EXP
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COMMERCIAL GENERAL LIABILITY
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DAMAGE TO s NTTE
$ 500,000
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PERSONAL & ADV INJURY
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GEN'L AGGREGATE LIMIT APPLIES PER:
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E.L. DISEASE - ER EMPLOYE
$
{M ndato'ryin NH} EXCLUDED? I
NIA
E.L. DISEASE - POLICY LIMIT
S
If yes, desedbL under
OF OPERATIONS below
A
DESCRIPTION
Directors & Officers
2018- 53837DO
01/1612018
01116/2019
D &t7
1,000,000
A
General Liability
2018 -53837
01116/2018
01/16/2019
Sexual Abuse
1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate holder is added as Additional Insured as respects General Liability as required by written contract
C ERT IFICATE H{}LDER CANCELLATION
ACORD 25 (2016103) ®1988 -2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Orange County
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
200 S. Cameron Street
Hillsborough, NC 27278
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016103) ®1988 -2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD