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Home My WebLink About2018-482-E Finance - Human Rights Center DBA Refugee Community Partnership outside agency agreementDocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 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 Human Rights Center of Chapel Hill & Carrboro, a not - for -profit corporation, located at 117 West Main Street, 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 Human Rights Center of Chapel Hill & Carrboro 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 $10,775. 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 $2,693.75. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. (Human Rights Center of Chapel Hill & Carrboro) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 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. (Human Rights Center of Chapel Hill & Carrboro) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 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 parry 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. (Human Rights Center of Chapel Hill & Carrboro) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 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 Human Rights Center of Chapel Hill & Carrboro 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: (Human Rights Center of Chapel Hill & Carrboro) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Human Rights Center of Chapel Hill & Carrboro 117 West Main Street Carrboro, NC 27510 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 a oocu5igned by'. 'rovider 5FA3F096DH8846C... T OocuSigned by, �f f ^ A !ge County Government - 06379946755E477... Bonnie Hammersley, County Manager (Human Rights Center of Chapel Hill & Carrboro) Orange County Outside Agency Performance Agreement Rev. 7118 8/23/2018 Date 8/24/2018 Date Page S of 9 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Chapel Hill - Carrboro Human Rights Center dba Refugee Communijy PPartnership Applicant Organization's Physical Address: 117 W Main St, Carrboro, NC 27510 Applicant Organization's Mailing Address: PO Box 461. Carrboro, 27510 Applicant Organization's Web Address: refugeecommunitypartnership.o[g Executive Director: Madison Haves Telephone Number: 919 - 590 -5910 E -Mail: Madison (Drefugeecommunitypartnership .org Tax ID Number: 26- 3608741 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 Oranae Coun -HS Total - HS Bridge Builders Program staff salary support; insurance coverage; interpreter services; community feedback sessions 31 ear 8,300 7,200 14,500 $30,000 ESL Program staff salary support; volunteer management; bi- annual program evaluation; student progress monitoring; reporting 700 1,000 1,000 $2,700 Totals $9,000 $8,200 $15,500 $32,700 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: VX�JL 12 v Executive D' ector Date Signature: thdW Board Chairperson Date AGENCY INFORMATION 1/22/2018 2:02:18 PM Page 7 of 36 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO ❑ a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ K 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 and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. 1 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: L4 /— 11-10118 Executive Dir ctor Date Signature: Smi kdaa4 112411s, Board Chairpersorf Date AGENCY INFORMATION 1/22/2018 1:10:56 PM P a g e 9 of 37 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 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): 9 years, 09/2008 b) Agency's Purpose /Mission (no more than a few sentences): Through long -term relationship -based support, opportunity development, and cultural stewardship, the Refugee Community Partnership enables and sustains the lifelong process of rebuilding home. Through strategic, cross - sector collaborations, RCP works to enable equitable access to community services and resources, and reshape pathways to opportunities for local refugees in a region with one of the worst economic disparities in North Carolina. c) Types of Services the Agency Provides (bullet format): Bridge Builders is RCP's anchor program, which provides comprehensive, culturally - appropriate support to help refugees find and retain employment and housing; learn English and increase literacy; acquire community navigation skills; improve academic performance among school aged youth; address food insecurity; and build pathways out of poverty. Neighborhood residents and local stakeholders work one -on -one with a refugee family long -term to help them identify and address immediate needs —such as learning the public transit system, improving English, and finding housing - -and develop personalized pathways to long -term goals, like obtaining a GED in order to improve employment opportunities. Volunteers serve as "cultural consultants" and as an on -call emergency contact, helping families navigate crises like natural disasters or police encounters. Bridge Builders families and their volunteers participate in Family Field Days where families, volunteers, staff, and board members go on community outings to public areas like the Farmer's Market, local parks, or downtown. These outings are designed to help families readjust to and gradually dissolve trauma - related fear of public and crowded spaces, and increase participation in civic environments. Refugees are reluctant to see professional service providers for trauma - related psychological distress, despite their eagerness for support. Our Women's Group provides culturally appropriate support to women and girls who are victims of trauma, torture, or abuse who otherwise are unable to access mental health services. Collaborating with UNC Refugee Wellness and the UNC School of Social Work, we draw on the existing kinship ties and social safety networks among refugee communities to create small, intimate support circles. The group meets once /month in a safe environment and focuses on specific themes, like mindfulness -based practices for trauma survivors, self- defense, psychological distress from acculturation and loss of cultural identity, among others. Refugees face food insecurity soon after resettlement and experience significant dietary shock and adverse health disorders due to the financial barriers to accessing fresh, healthy food. In partnership with Farmer Foodshare and the Carrboro Farmer's Market, Bridge Builders provides fresh produce donated by local farmers to over 100 people each week. In 2017 alone, local farmers donated over 9,000 Ibs of fresh food that fed refugee families who otherwise cannot afford it. • ESL Class which provides highly customized one -on -one ESL instruction to students at all levels (beginner, intermediate, and advanced) and role -play scenarios of work, social, or Agency Information 1/23/2018 3:14:24 PM Page 9 o' 3 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION school environments for conversation practice. At the beginning of each semester, students set personal learning goals and work with instructors to create a customized academic plan based on individual priorities. Classes take place outside of typical work hours to increase access for working adults. This class has taught more than 115 local residents over the years, many of who attribute their citizenship exam performance to this program. d) Agency's History with Providing These Services: Started by refugee community leaders and local stakeholders, RCP sprung out of the Chapel Hill Carrboro Human Rights Center in 2011 in response to the Refugee Community Assessment published by the Orange County Health Department and the UNC School of Public Health. The report identified the widening gaps between local refugee populations and the broader Carrboro - Chapel Hill community and the absence of refugee support organizations, producing frightening outcomes like increasing rates of high school dropouts among refugee youth, pervasive trauma - related mental health disorders, under and unemployment, housing insecurity and evictions, and persistent poverty. RCP has spent the last 5 years using a community- driven approach to helping refugees address immediate needs, adjust to their new surroundings, and providing long term support. Our approach draws on strategic partnerships with cross - sector organizations, agencies, and institutions, mobilizing Chapel Hill- Carrboro's existing assets to increase equitable access among refugee communities. Our work is built from the bottom up, producing powerful methods for community collaboration, decision making, and coordinated action, and building a shared sense of ownership and accountability. Mutually transformative relationships are built between volunteers and refugee members, which changes the help giving relationship to one based on reciprocity and mutual benefit. Here, community innovation flourishes, with new initiatives and new partnerships being born out of lived experiences of local refugees. With this relationship- centered approach, RCP strategically and adaptively fills gaps - gaps in access, opportunities, and social support that otherwise keep forcibly displaced people living in the margins. 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 ?) In the past year, RCP has experienced significant and expansive growth. Over the past year, program participation has grown from 158 participants to 260, and from 42 volunteers to over 90. To meet the increased demand, staff capacity has grown, from 1 half -time position to 1 full -time position (Executive Director) and 1 half -time position (Bridge Builders Program Manager), and will grow again at the start of 2018. RCP won the Triangle Community Foundation's 2017 Social Innovation Award, and has acquired 38 new donors. RCP moved its headquarters to the new YouthWorx building in downtown Carrboro —where we collaborate and share resources and knowledge with other area non - profits - -and its operating budget has increased from $22,000 to $82,000. In December 2017, Madison Hayes (ED) was awarded the Roddenberry Fellowship for her work expanding RCP's relationship -based and refugee - governed model for as a regional and national model for refugee support and integration. RCP is being evaluated by Harvard and Duke University's global health program as a model for refugee integration in the Southeast. f) Schedule of Positions (For Entire Agency) • Full Time Equivalent (FTE) staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours = Volunteer FTE 2,080 Agency Information 1/23/2018 3:14:24 PM P a g e 10 of 36 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION # of FTE - Full -Time Paid Positions: 1 # of FTE - Paid Part -Time Positions: .50 (1); .25 (3) # of Volunteers: 82 # of FTE - Volunteers: 16,400 g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/ No) YES If yes, is this agency an Orange County Living Wage Certified Employer? YES If no, please explain. Agency Information 1/23/2018 3:14:24 PM Page 11 of 36 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget Is your agency currently receiving and /or requesting other (non -Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes /No) NO If yes, please list below: Include all programs that have funding requests /awards /totals from Carrboro, Chapel Hill, and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY17 -18 Award FY18 -19 Request Source Ex: Affordable Rental Rehabilitation 0 $20,000 Carrboro - Affordable Housing Ex: Agency Administration $15,000 $15,000 Carrboro — Other Ex. Total $15,000 $35,000 Carrboro Total Funding *Add rows or attach additional page, if needed. Submit your agency's budget. You may complete the provided template (separate As file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: Revenues • Private Donations • Program Generated Revenue • Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other (DO NOT include CDBG funding here) Agency Information 1/23/2018 3:14:24 PM DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION • 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 o Compensation o Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses iii. Does your agency budget show a Surplus or Deficit? Breakeven Is there a significant change? Yes /No No Please provide a brief explanation for Surplus or Deficit, and significant changes. Increase in expenses due to significant increase in program participants, demanding increase in staffing and increase use of interpreter services. Insurance expense more than doubled in 2017 -2018 due to new risk coverage requirements from Orange County. iv. What is your agency's fiscal year? January 1, 2018- December 31, 2018 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/23/2018 3:14:24 PM 1 3 3 6 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 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: Refugee Community Partnership 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 Events Corporate Total Agency Revenue AGENCY EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Interpreters Other Expenses: Insurance Other Expenses: Consulting Fees Total Agency Expenses SURPLUS /(DEFICIT) FOR PERIOD: Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Percent Change $ 20,000 $ 22,486 $ 32,000 42% $ $ - 3,500 $ $ - 6,000 $ $ - 9,000 0 50% $ - $ - $ - 0 $ 1,750 $ 2,000 $ 8,200 310% $ - $ - $ - 0 $ 2,000 $ 8,750 $ 15,500 77% $ 14,120 $ - $ - 0 $ $ - - $ $ - - $ $ - - 0 0 $ - $ - $ - 0 $ - $ - $ - 0 $ 25,000.00 $ - $ 45,000.00 $ 2,460 $ 63,300.00 $ 3,350 41% 36% $ $ 1,000 67,370 $ 25,300 $ 111,996 $ - $ 131,350 - 100% 17% $ 39,348 $ 87,612 $ 110,600 26% $ 7,200 $ 2,796 $ 2,796 0% $ 2,798 $ 3,984 $ 3,700 -7% $ 275 $ 1,750 $ 2,400 37% $ 1,829 $ 3,000 $ 5,500 83% $ 1,200 $ 3,854 $ 3,854 0% $ $ 14,720 67,370 1 $ 9,000 $ 111,996 1 $ 2,500 $ 131,350 -72% 1 17% $ - 1 $ - 1 $ - 1 0 DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program Bridge Builders PROGRAM NAME: PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other -Town of Carrboro Human Services - Town of Chapel Hill Other -Town of Chapel Hill Human Services - Orange County Other - Orange County Other -Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOME /etc Private Foundation Grants Other Revenue Events Corporate Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Interpreters Other Expenses: Insurance Other Expenses: Consulting Fees Total Program Expenses SURPLUS /(DEFICIT) FOR PERIOD: Bridge Builders Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Percent Change $ 12,500 $ 18,000 $ 27,700 54% $ $ - 3,000 $ $ - 5,000 $ $ - 8,300 0 66% $ - $ - $ - 0 $ 1,000 $ 1,000 $ 7,200 620% $ - $ - $ - 0 $ 1,500 $ 8,500 $ 14,500 71% $ - $ - $ - 0 $ $ - - $ $ - - $ $ - - 0 0 $ - $ - $ - 0 $ - $ - $ - 0 $19,128.00 I$E=- $45,000.00 $ 2,460 $ 50,300.00 $ 2,100 12% -15% $ $ 1,000 38,128 $ $ 23,500 79,960 $ - $ 110,100 -100% 38% $ 29,000 $ 58,290 $ 91,625 57% $ 3,600 $ 2,796 $ 2,796 0% $ 2,798 $ 3,220 $ 3,700 15% $ 550 $ 1,000 $ 1,325 33% $ 980 $ 3,000 $ 5,500 83% $ 1,200 $ 2,654 $ 2,654 0% $ - $ 9,000 $ 2,500 -72% $ 38,128 1 $ 79,960 1 $ 110,100 1 389/6 $ - 1 $ - 1 $ - 1 0