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HomeMy WebLinkAbout2018-469-E Finance - Voices Together outside agency agreementDocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 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 Voices Together, a not - for -profit corporation, located at 5007 Southpark Drive, Suite 230, Durham, NC 27713 ( "Provider "). 1.iIMy►[�l.Xy�lly 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 Voices Together 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 $18,250. 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 $4,562.50. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (Voices Together) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 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. (Voices Together) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 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. (Voices Together) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 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 Voices Together 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: (Voices Together) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Voices Together 5007 Southpark Drive, Suite 230 Durham, NC 27713 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 and oocusigned by. wider �A3401828F37476... For an. ' oocusignedby, � inty Government I6Etilntl.wtt V i d637994B755E477... Bonnie Hammersley, County Manager (Voices Together) Orange County Outside Agency Performance Agreement Rev. 7118 8/17/2018 Date 8/23/2018 Date Page S of 9 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 1. OVER PAGE a) Applicant_ Contact Information Applicant Organization's Legal Name: Voices Together Applicant Organization's Physical Address: 5007 Southpark Drive Ste 230 Durham, NC 27713 Applicant Organization's Mailing Address: 5007 Southpark Dave Ste 230 Durham NC 27713 Applicant Organization's Web Address: www.voicestogether.net E=xecutive Director: Yasmine White Telephone Number: 919- 942 -2714 Tax ID Number: 20- 4612388 E -Mail: jeanne@voicestogether.net b) Funding Request List all FY18 -19 Human Services (HS) Funding Being Requested — For All Programs) and the Proposed Use of Funds (2 -3 lines or less) Program Carrboro Chapel Hill - HS Orange County-HS Total - HS Ex. Youth Afterschool Program Afierschool Program Coordinator salary and materials for youth activities and projects $10,000 $15,000 $5,000 $30,000 VT in Education program in four OC Exceptional Child classrooms; covers board - certified Music Therapist and class materials and equipment $20,000 $20,000 Totals 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. Signatulrw--- ,_ Fx cutive director Date Signature: Board Chairp rson Date,�r AGENCY INFORMATION 1/22/2018 12:53:10 PM Page 8 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NONDISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO E] x a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? [] x b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? 0 x c) Current beneficiaries of the program for which funds are being requested? ❑ x d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NOWDISCRIM[NATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity /expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the beat of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signaturre: — c cutive Director Date f-27_f f�- Signature: i ' � � �� • . Board hair rs-on Date , AGENCY INFORMATION 1/2212018 12:53:10 PM Page 9 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 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 (MonthlYear): March 6, 2007 b) Agency's Purpose /Mission (no more than a few sentences): The mission of Voices Together is to empower individuals with developmental disabilities to transform their lives. Language, social /emotional life skills are developed to enable the students for opportunities in improving their education and making a healthy transition to an independent life that will contribute to their community. c) Types of Services the Agency Provides (bullet format): Using a specialized music -based therapy approach, our board - certified Music Therapists will engage students to assist in improvement of the student's social, cognitive and emotional behaviors. The programs that currently exist are as follows: • Voices Together in the Community: programming for individuals of all ages in the community • Little Voices in the Community: programming for early intervention targeted towards 3 -5 year -olds (pre- school age) • Voices Together in Education: programming for students in special education /exceptional children classrooms • Voices Together Vocational Training: programming for students ages 14 -21 enrolled in traditional /alternative secondary or post - secondary program, targeted towards work readiness, job exploration and self - advocacy skills. Agency's History with Providing These Services: For a decade, Voices Together has been providing weekly programming for students in seven districts in Central North Carolina. Music Therapy is the clinical and evidence -based use of music interventions to accomplish non- musical goals. Public schools and agency administrators and academic partners have all labeled Voices Together a best practice. "I believe that this program is an innovative educational model that can be used in all classrooms. l have seen students in special education classrooms increase vital skills from one session to the next. This is a best practice in education.'" - Jan Riggsbee, Ed. D, Director and chair of Duke's Program in Education Partnerships with the Duke Center for Autism and Brain Development, the Duke Bass Connections research team, and the Duke Social Science Research Institute (SSRI) have yielded outstanding results that establish the Voices Together evidence -based model a "best practice ". The first research project completed by the Duke team in 2014/15 was published in the international journal of Autism Research and Treatment. "A study conducted in Durham Public Schools by Duke researchers in 21175 showed that provision of the Voices Together program resulted in significant increases in communication skills among children with developmental disabilities. The mean improvement reflected a change from one word to phrase speech. "- Dr. Geraldine Dawson, Professor of Psychiatry and Behavioral Sciences, Director Duke Center for Autism and Brain Development_ Agency Information 1/2212018 1 :39:57 PM Page 10 of 25 DocuSign Envelope ID: 1327919D -91391- 4603 - 13056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION An article was published in 2016: "A Preliminary Investigation of a Specialized Music Therapy Model for Children with Disabilities Delivered in a Classroom Setting, " Autism Research and Treatment, vol. 2016, Article ID 1284790, 8 pages, 2016. doi:10.1155/2016/1284790. https:/1 www. hindawi .cDmljournals /aurU2016/1284790/ A new study in 2016 -17 entitled, " The Teacher Toolbox", a pilot completed with the Alamance- Burlington School System, showed significant increase in communication and socialization. d) 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 ?) Voices Together has strengthened and expanded its programming for 2018 in the following ways: • Early intervention programming will be expanded into additional counties for ages 3 -5, through new pre - school partnerships. • A vocational training curriculum program is contracted with a North Carolina state department for a multi -year contract. • Efforts on funding for replication of the Voices Together model continue to be underway for a large future expansion. • Due to new and expanded programming the Voices Together has increased its staff by two full -time board - certified music therapists, full -time program coordinator and a part - time board- certified music therapist. e) Schedule of Positions (Far 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 # of FTE - Full -Time Paid Positions: 8 # of FTE - Paid Part-Time Positions: 2 # of Volunteers: 15 # of FTE - Volunteers:Q f) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes /No) yes If yes, is this agency an Orange County Living Wage Certifier) Employer? no If no, please explain. Voices Together is a Durham based organization and has not applied to be an Orange County Certified Employer. We have always highly valued our staff, offer paid healthcare, paid vacation and sick leave and is competitive with wages for the individual positions. Agency Information 1/2212018 1:39 :57 PM Page 11 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION g) Agency Budget i. Is your agency currently receiving and/or requesting other (non -Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (YeslNo) no If yes, please list below: Include all programs that have funding requests/awards/tota ls from Carrboro, Chapel Hill, and Or "e County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY17 -18 Award FY18 -19 Request Source Ex: Affordable Dental Rehabilitation 0 $20,000 Carrboro - Affordable Housing Ex: Agency Administration $15,000 $15, 000 Carrboro — Other Ex. Total $15,000 $35,000 1 Carrboro Total Funding Human Services $17,500 $20,000 Orange County Add rows or attach additional page, if needed. ii. Subunit your agency's budget. You may complete the provided template (separate xis file) or you may submit your own budget file (as long as it contains the Same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues • Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) Agency Information 1/22/2018 1 :39:57 PM Page 12 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION • Orange County Human Services • Orange County Other (DO NOT Include HOME funding here) • Other Government Grants • Triangle United Way • State Government • Federal Government (CDBGIHOMEIetc.) • Private Foundation Grants • Other Revenue • Expenditures Q Compensation o Rent & Utilities * Supplies & Equipment o Travel & Training o Other Expenses iii. Does your agency budget show a Surplus or Deficit? Surplus Is there a significant change? Yes /No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes. Expansion of programming to additional counties through a state - approved contract has added to our expenses and revenue. iv. What is your agency's fiscal year? October 1, 2018- September 30, 2018 (Example: July 9, 2016 through June 30, 2017) Agency Information 1122/2018 1 :39:57 PM Page 13 of 26 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 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 - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOME /etc.) Private Foundation Grants Other Revenue Total Agency Revenue AGENCY EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Loan Repayment incl. Total Agency Expenses Voices Together SURPLUS /(DEFICIT) FOR PERIOD: 1 $ 88,396 $ 5,692 1 $ 23,192 1 3077/6 Actual Estimated Projected Percent $ 78,090 $ 107,000 $ 107,000 0% $ 28,403 $ 52,000 $ 52,000 0% $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ 15,000 $ 17,500 $ 20,000 14% $ - $ - $ - 0 $ - $ - $ - 0 $ 13,438.00 1 $ 20,000.00 1 $ 20,000.00 $ - $ 108,944.00 $ 70,000.00 $ 85,000.00 21% $ 71,525 $ 605,700 $ 605,700 $ - $ $ 315,400 343,657 $ $ 872,200 558,677 $ $ 889,700 558,677 2% 0% $ 40,449 $ 58,828 $ 58,828 0% $ 4,932 $ 28,651 $ 28,651 0% $ 2,660 $ 47,450 $ 47,450 0% $ 12,098 $ 172,902 $ 172,902 0% $ 403,796 $ 866,508 $ 866,508 02. SURPLUS /(DEFICIT) FOR PERIOD: 1 $ 88,396 $ 5,692 1 $ 23,192 1 3077/6 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION [Submit a separate Section 3 for each program] Program Name: Voices Together in Education Program Primary Contact and Title: Jeanne Johnston- Director of Resources Telephone Number: 919 - 942 -2714 E -Mail: Jeanne voicestogether.net a) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #1: safety -net services for disadvantaged residents K Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods /Residents Affordable Housing Affordable Healthcare Education x x Family Resources Jobs /Jobs Training Food 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. • Voices Together highly values the relationship they have established with the Orange County government, school district, the Director of Exceptional Children and the classroom teachers for almost nine years. N.C. Department of Public Instruction has been an invaluable partner of Voices Together with the Director of Exceptional Children, Bill Hussey, and Chief Digital Learning Officer, Dr. Marie Petri Martin. Expansion of Voices Together programming into new districts and advice on replication of the VT model is an example of the ongoing partnership VT and NC DPI experience. Duke Center for Autism and Brain Development, Duke SSRI and the Bass Connections research teams collaborate on in- classroom research projects and consult on performance measures for program evaluation. PROGRAM INFORMATION 1/2212018 1:39:57 PM Page 14 of 26 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Description (3 pages OR LESS) Families of students with a disability face complex financial challenges. Insufficient financial resources and/or inadequate access to intervention services often prohibit these families from receiving specialized therapy services. The partnership between Voices Together (VT) and the Orange County Schools will help close the achievement gap and help children from these families succeed academically and into adulthood. Schools play a critical role in being the first community resource to identify autism and other developmental challenges that would otherwise go undiagnosed. Studies have shown early intervention assists in getting the proper diagnosis and treatments for a better start to school and life. Data from the Autism and Developmental Disabilities Monitoring (ADDM) Network 2015 Community report, demonstrates the pivotal role school systems play in evaluating and serving children with ASD. The Change County Schools identified approximately 1,186 students with DDS, or 15.7% of the student body, an increase of 12 % over the previous year. (IES, National Center for Education Statistics). This dramatic jump in the number of Exceptional Children's students increased the financial burden on our schools and families without the proportionate increases in federal special education appropriations or state education spending necessary. VT in Education is designed to advance education and student achievement by increasing the development of their social - emotional skills, and building a foundation to improve and expand communication and language capabilities. Social and emotional skills are defined as the ability to understand, manage, and express the social and emotional aspects of one's life in ways that enable the successful management of life tasks such as learning, forming relationships, solving everyday problems, and adapting to the complex demands of growth and development. Numerous research studies have shown that: Students who are more self -aware and confident about their learning capacities try harder and persist in the face of challenges (Durlak et al., 2011). • Students who have self - discipline, motivate themselves, manage stress, and organize their approach to work learn more and get better grades. • Students who use problem - solving skills to overcome obstacles and make responsible decisions about studying and completing homework perform better academically (Durlak et al., 2011). As these students age out of the public schools, their ability to find jobs and keep those jobs can depend on their ability to work with others, express their needs and wants, understand their strengths and challenges and self - manage themselves. Our program addresses all of these areas and gives each student a safe and motivating space to learn and practice these skills ultimately leading to self - advocacy and more independence in their lives. Provide weekly VT music therapy sessions for students in selected Exceptional Children's classrooms resulting in an increase in students' verbal language PROGRAM INFORMATION 1/22/21318 1:39:57 PM Page 15 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION and speech skills. We will administer pre -test and post -tests to teachers to measure the success of the objectives. Voices Together will promote learning in classrooms receiving weekly music therapy sessions by working to increase a student's ability to remain seated and engaged in a group setting, and teach positive coping skills students can use that will decrease the number of emotional or physical outbursts. We will administer pre -test and post -tests to teachers to measure the success of the objectives. o Voices Together will support the development of student's communication and social skills by increasing their ability to initiate conversation, speak so others can understand them, and engage in actively listen. We will administer pre -test and post- tests to teachers to measure the success of the objectives. Because of ongoing Orange County Outside Agency funding, Voices Together has had a very high impact with hundreds of students with developmental challenges from OCS. These students are now able to participate in their community after gaining critical life skills. While offering this program to the students in classrooms this program has also built capacity as our music therapists work closely with teachers. Teachers have learned new strategies, ideas and teaching structures from our weekly sessions that they have carried through to their classroom instruction for maximum outcomes. The proposed funding for 2018 -19 will help bring this program to all classrooms in the Orange County Public School Exceptional Classrooms. It will enable Voices Together to provide our program to those students that desperately need intervention services. Please provide the following information about the proposed program: dj Summarize the program services proposed and how the program will address a Town /County priority /goal? Goal 1: Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well being of all county residents. The Voices Together program aligns with the County's goal of ensuring a high quality of life and lifelong learning that enhances education at all levels. This program is designed for alignment with the Extended Content Standards. It has been such an effective intervention in the school setting precisely because its techniques help teachers and students meet goals established by the state and federal governments. A key part of the Extended Common Core Standards in every subject in the K -12 curriculum is the development of speaking and listening, and language skills. Voices Together's innovative model is based in music therapy that was developed by combining educational and therapeutic techniques for optimal outcomes. Special attention was paid to speech and language areas, basic educational learning techniques and social/ emotional learning techniques. Every Voices Together session offers continual interactive communication techniques that were developed specifically to prompt and cue neural and language response. The Voices PROGRAM INFORMATION 112212018 1 :39:57 PM Page 16 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Together curriculum incorporates the NC Extended Common Core standards because it targets three main core areas of growth: communication, social learning and emotional learning. For these reasons, Voices Together participants acquire life skills that that promote inclusion in the community. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Coals 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. The well -being and quality of life of individuals with developmental challenges depends on opportunities they will have in their classrooms and communities. As they age out of public schools, vocational opportunities will depend on their ability to fully function with others and within a job setting. Without the services to build critical skills this population will be at risk of being isolated from our communities creating more dependent members of our community and more dependency on public funding. Skills such as the ability to tell someone what they think, feel or need at any given time could greatly help them find jobs that will suit them and keep jobs once they have them. This will necessarily lead to more inclusive opportunities, independence and more productive lives. Basic communication and socialization skills are at the core of every person's ability to fully function and thrive. 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 Exceptional Children's Department for Orange County Schools and the VT in Education's Program will select four classrooms with a total of approximately 45 -50 students to participate in the program from September 2 018 thru April 2019. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) All Voices Together Music Therapists have a bachelors or masters degree in Music Therapy, have completed a college - approved practicum and are Board Certified. They also have completed the Voices Together specialized training. The program manager has all of these credentials as well as three to four years experience in program implementation and an understanding of management requirements in the organization. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. The comprehensive Voices Together program consists of two months of program preparation and development, seven (7) months of direct services to students„ followed by two months of assessment and evaluation. The VT program will be capped by a district wide performance. • July & August- Meet with district EC Director to plan and discuss classrooms for the fall and distribute baseline evaluations Voices Together certified therapists and OCS teachers collaborate to set individual student and overall Voices Together goals. Music Therapist and teachers decide on weekly schedule. • September 2018— April 2013- direct student instructional services PROGRAM INFORMATION 1/22/2018 1 :39:57 PM P a g e 17 of 2 5 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION • April- District wide performance • May 2019 — Voices Together will compile data from assessment forms. • May -June — Summary assessment results for the year 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) Our program bridges a critical gap for schools and students. Teachers are struggling to reach children with special needs who have difficulty speaking, expressing and organizing their thoughts, connecting with their peers and identifying their emotions. Resources for educators are dwindling and teachers are searching for innovative ways to help their students learn. With the Voices Together and its scientifically proven method, students in special education classrooms can have a chance at the same opportunities as their peers to live functioning and purposeful lives. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. The goal for Voices Together and for The Exceptional Children's department of OC is to be able to offer this specialized programming to all classrooms in Orange County. Without this funding and support from the Orange County government we would have difficulty reaching that goal. k) What percentage of your target population is low- moderate income? Our VT in Education program is in over 50% of schools with 90% or more free lunch program students. We fundraise for scholarship money to subsidize lower- income families that would like to participate in our VT in the Community programs. 1) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) As presented in our program timeline, we initiate baseline assessments and surveys with the teachers and do post - survey assessments. Our weekly collaboration with teachers allows us to assist them will tools for their students while discussing the needs of the individual student and the entire classroom. m) Include any other pertinent information. We appreciate Orange County's continued support that has made an impact on our ability to serve students with exceptional needs in Orange County since 2012. Last year we were able to offer this program in all of the K -12 Exceptional Children's classrooms in OC and one pre - school classroom. With our success from our pre - school age pilot we are now partnering with a pre - school organization and wouid like to continue in a pre - school classroom in Orange County this fiscal year. We brought in LY's pre- school class through an outside foundation grant. Voices Together strives to procure funding to assist with Orange County classrooms, but foundation funding is not a guaranteed revenue source. PROGRAM INFORMATION 1/2212018 1.39:57 PM Page 18 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information nj Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics Actual Estimated Projected 2016 -17 1 2017 -18 2018 -19 Gender Male Female Total Ethnicity African - American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Total 50 55 55 25 30 30 75 80 80 15 15 15 44 45 45 6 5 5 43 45 45 75 j 80 80 17 20 20 75 80 80 Of the above, how many Hispanic /Latino 14 Of the above, how many non-Hispanic/Latino Total 0 0 19 Age Geographic Location 0 -5 years 6 -18 years 19 -50 years 51+ years Total Alamance County Chatham County Durham County Wake County 25 30 30 44 45 45 6 5 5 15 20 120 75 j 80 80 95 45 65 0 0 0 110 20 45 15 20 120 Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro PROGRAM INFORMATION 112212018 1:39 :57 PM Page 19 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement a) 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- Voices Together 1. Program Activity Name Specialized music -based therapy program that teaches communication and social /emotional skill building Program Goal Communicates thoughts and emotions Performance Measures Increase in language and vocalization (70 -80 students) Previous Year Program +41% Results Current Year Estimated +30% Results Next Year Projected Results +25% 2. Program Activity Name Specialized music -based therapy program that teaches communication and social /emotional skill building Program Goal Increase social communication Performance Measures Percentage of students able to acknowledge others by using appropriate communication skills (70 -80 students) Previous Year Program +50% DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Results Current Year Estimated +30% Results Next Year Projected Results +30% 3. Program Activity Name Specialized music -based therapy program that teaches communication and social /emotional skill building Program Goal Increase engagement /participation Performance Measures Percentage able to remain seated and engaged in a group setting (70 -80 students) Previous Year Program N/A new measure for 18/19 Results Current Year Estimated - Results Next Year Projected Results +25% 4. Program Activity Name Specialized music -based therapy program that teaches communication and social /emotional skill building Program Goal Increase self- advocacy Performance Measures Percentage of children who will ask for help (70 -80 students) Previous Year Program +46% Results Current Year Estimated +46% Results Next Year Projected Results +25% DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 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 fang 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 o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services Chapel Hill Other (DO NOT include CDBG funding here) ■ Orange County Human Services ■ Orange County Other (DO NOT Include HOME funding here) a Other Government Grants • Triangle United Way • State Government • Federal Government (CDBGIHOMEietc.) • Private Foundation Grants Other Revenue • Expenditures o Compensation o 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? 3% 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. Total Cost of Program Total # of Individuals Cost Per Individual Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 $15,000 $17,500 $20,000 26 35 $5'50 $500 50 $400 PROGRAM INFORMATION 1122/2018 1.39:57 PM Page 22 of 25 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budgetfor Program PROGRAM NAME: $ Voices Together $ 25,000 11% $ 14 500 PROGRAM REVENUE 19,750 Actuai Estimated 100t Protected Percent 250 $ 250 2+017 -18 $ 500 2018 -19 Chan e Private Donations F2016-17 $ $ 2,000 $ Program Generated Revenue 25% _ $ $ $ 0 Local Government Grants: $ 16,000 $ 22,5001$ $ - 0 Human Services - Town of Carrboro $ _ $ _ $ Other -Town of Carrboro $ _ $ $ _ 0 Human Services - Town of Chapel Hill $ _ _ $ Other - Town of Chapel Hill $ - $ _ $ 0 Human Services - Orange County $ _ $ _ $ _ 0 Other - Orange County $ 16 400 $ 17.500 1 $ 2D.000 0 14 °% Other - Town of Hillsborough $ - $ - $ Other Government Grants - 0 Triangle United Way $ _ $ State Government $ _ $ $ 4 Federal Government (CDBGIHOMEletc.) $ _ - $ $ 0 Private Foundation Grants Fox Family I $ _ 1 $ 5,000.0C $ 0 Other Revenue $ _ Is n Total Program Revenue Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Program Expenses SURPLUSI(DEFICIT) FOR PERIOD: FY 2018 -19 Program Budget $ 16,000 $ 22,500 $ 25,000 11% $ 14 500 $ 19,750 $ 21 750 100t $ 250 $ 250 $ 250 0% $ 500 $ 500 $ 500 0 °r0 $ 754 $ 2,000 $ 2.500 25% $ - $ - $ - 0 $ 16,000 $ 22,5001$ 25,000 11% $ $ - $ - 0 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 EXHIBIT "B" Scope of Services — FY 2018 -19 Outside Agency Performance Agreement Agency Name: Voices Together Program Name: VOICSSFm In Education Funding Award: $18,250.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Compensation 14,680.00 Rent & Utilities 2,820.00 Supplies & Equipment 400.00 Travel mileage 350.00 18,250.00 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. • Provide weekly VT sessions by board - certified music therapists for stundent in select OCS EC classrooms. • Support the development for student's communication skills by increasing their ability to speak so other's can understand them and in their ability to actively listen. • Promote learning in classrooms so skills acquired in- classroom could be generalized outside of the classroom. 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 (45 -50 students) Goal- Communicates thoughts ad emotions. Measure- Increase in language and vocatlization Projected Results +25% Goal- Increase social communication Measure-Acknowledge others by using appropriate communication skills. Projected Results +30% Goal- Increase engagement /participation Measure -Able to remain seated and engaged in a group setting. Projected Results +25% Goal- Increase advocacy Measure-Ability to ask for help Projected Results +25% uocu5ignea oy: G�A,sv1i/1t " Certified by: -- �A3401826F37476... — (Provider's Signature) ceo 8/17/2018 Title: CEO_ Date: 7/24/18 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 Performance Measures Anticipated Results (45 -50 students) Docu5igned by: G�asy �%ioz �u�t- i DA�401828F374 ?E... Certified by: _ —,,' (Provider's Signature) 8/17/2018 ceo Title: CEO_ Date: 7/24/18 DocuSign Envelope ID: 1327919D -9891- 4603- B056- 5CA1EBBFDF23 ATTACHMENT "A" Orange County Certifications — FY 2018 -19 Outside Agency Performance Agreement Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, residential address; phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DOCUSIgned by: Certified by: _ DAM01826F37476... (Provider's Signature) Title: ceo Date: 8/17/2018 (Voices Together) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID: 1327919D -9B91- 4603- BO56- 5CA1EBBFDF23 'ACaRL7� CERTIFICATE OF LIABILITY INSURANCE rDA7T0E111MM/DDNYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 19/2018 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 CONTACT Amber Brady NAME: Nonprofit Insurance Services (717)630 -1030 FA (717)630 -1188 AICONN. CO. No): Ext : E -MAIL amber @insureanonprofit.com 195 Stock Street, Suite 118 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # P.O. Box 933 INSURERA: ANI -RRG 10023 Hanover PA 17331 INSURED INSURER B: INSURER C : $ 500,000 Voices Together INSURER D: $ 20,000 5007 Southpark Drive INSURER E: Suite 230 INSURER F: Durham NC 27713 COVERAGES CERTIFICATE NUMBER: CL1811927721 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 INSD WVD POLICY NUMBER POLICY EFF MM /DD /YYYY POLICY EXP MM /DD /YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREM SESOEa oNcErDence $ 500,000 MED EXP (Anv one person) $ 20,000 PERSONAL & ADV INJURY $ 1,000,000 A 2017 -35634 10/10/2017 10/10/2018 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO - X POLICY ❑PRO ❑ LOC PRODUCTS - COMP /OPAGG $ 2,000,000 Increased Aggregate $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR /PARTNER/EXECUTIVE ❑ OFFICER /MEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Orange County, its officers, official agents and employees are an additional insured on the General Liability Policy. CERTIFICATE HOLDER CANCELLATION @ 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County, Attn: Risk Management ACCORDANCE WITH THE POLICY PROVISIONS. 200 South Cameron Street AUTHORIZED REPRESENTATIVE PO Box 8181 Hillsborough NC 27278 @ 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 1327919D -9B91- 4603- B056- 5CA1EBBFDF23 ADDITIONAL COVERAGES Ref # Description Improper Sexual Conduct Coverage Code ISC Form No. Edition Date Limit 1 1,000,000 Limit 2 3,000,000 Limit 3 Deductible Amount Deductible Type Premium $1,148.00 Ref # Description Add'] for policy minimum premium Coverage Code APMP Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $581.00 Ref # Description Social Service Prof Liab Coverage Code SSP Form No. Edition Date Limit 1 1,000,000 Limit 2 3,000,000 Limit 3 Deductible Amount Deductible Type Premium $840.00 Ref # Description Liquor Liability Coverage Code LIQUR Form No. Edition Date Limit 1 1,000,000 Limit 2 1,000,000 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium rOFADTLCV Copyright 2001, AMS Services, Inc.