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HomeMy WebLinkAbout2018-509-E Finance - El Centro Hispano outside agency agreementDocuSign Envelope ID: A899BE5E- BAEC- 40F3- 91E1- A9D77FC4C488 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 El Centro Hispano, Inc., a not - for - profit corporation, located at 2000 Chapel Hill Road, Suite 26A, Durham, NC 27707 ( "Provider "). WITNESSETH: 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 El Centro Hispano, Inc. 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 $32,834. 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 $8,208.50. 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. (El Centro Hispano, Inc) Orange County Outside Agency Performance Agreement Revised 712018 Page I of 9 DocuSign Envelope ID: A899BE5E- BAEC- 40F3- 91E1- A9D77FC4C488 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. (El Centro Hispano, Inc) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: A899BE5E- BAEC- 40F3- 91E1- A9D77FC4C488 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. (El Centro Hispano, Inc.) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: A899BE5E- BAEC- 40F3- 91E1- A9D77FC4C488 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 El Centro Hispano, Inc. 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: (El Centro Hispano, Inc) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: A899BE5E- BAEC- 40F3- 91E1- A9D77FC4C488 County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: El Centro Hispano, Inc. 2000 Chapel Hill Road, Suite 26A Durham, NC 27707 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 DocuSigned by r wider 1PjA4 P,0d.4-q0U&4g 223DDB39C1744D1... For DocuSigned by, ,ounty Government 0637994B755E477... Bonnie Hammersley, County Manager (El Centro Hispano, Inc) Orange County Outside Agency Performance Agreement Rev. 7118 8/27/2018 Date 8/28/2018 Date Page S of 9 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 1. a) Applicant Contact Information PAGE Applicant Organization's Legal Name: El Centro Hispano Applicant Organization's Physical Address :201 West Weaver Street, Carrboro NC 27510 Applicant Organization's Mailing Address: 2000 Chapel Hill Road, Durham NC 27707 Applicant Organization's Web Address: www.elcentronc.o_rq Executive Director: Pilar Rocha- Goldberq Telephone Number: (919) 687- 4635_ Ext. _43 E -Mail: procha(a_)_elcentronc.orq Tax 1D Number: 56- 2011661 b) Funding Request List all FYI 8-19 Human Services HS Funding Being Requested — For All Programs) and the Proposed Use of Funds (2 -3 lines or less) Pro ram Carrboro Ch. apel Hill -. HS Orange County-HS Total - HS Ex. Youth Afterschool Program Afterschool Program Coordinator salary and materials for youth activities and projects $10,000 $15,000 $5,000 $30,000 Community Support Services (salaries, rent & utilities, communications, supplies, equipment, forums) •5,000 15,000 25,000 45,000 Center for Employment and Leadership (salaries, rent & utilities, supplies, program expenses) 10,000 10,000 10,000 30,000 Education Services: Tutoring /Summer Program (staff salaries, supplies, program expenses) 5,000 5,000 10,000 Totals 20,000 30,000 35,000 85,000 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the apnlicant. Signature: au ;, a"k Executive Director 1/22/2018 Date Signature: i -%�- 1/22/2018 Voard Chairperson Date AGENCY INFORMATION 1122/2018 10:14:21 AM page H of 3 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 FIPTETC C�RLIC�SUOFINTTd) DISCLOSURE ONIAF ERESANVMNTRMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO ❑ ® a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ ® b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ ® c) Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON - DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, aexual orieritation, gerider'ideiititylexpre5sion, familial statds' or veterahs stafias wIt - reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti - discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: �( Executive Director Signature: oard Chairperson 1/22/2018 Date 112212018 Date AGENCY INFORMATION 1122/2018 10:14:21 AM Page 4 of 33 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 2y. i4GENXY ]N PM1111'AMMIJ56W y 8rieF and "C'on6ii 76)' ""' - I Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): 111998 b) Agency's Purpose /Mission (no more than a few sentences): El Centro Hispano works to strengthen the community, build bridges, and serve as advocates for equity and inclusion of Hispanics /Latinos in the Triangle area of North Carolina. We achieve these purposes by making advancements in Education, Economic Development, and Health & Well- being. c) Types of Services the Agency Provides (bullet format): El Centro Hispano has three priority areas that guide its interventions. Education - School Readiness- Kindergarten Preparation, K -12 tutoring, College Readiness, Parent Education & Support - Adult Literacy and Job Skills Training Economic Development (under Center for Employment and Leadership) - Employment & Income Security - Workforce Training and Development - Financial Literacy & Asset Building Health and Well -being Community Support Services (Information, Referral, and case management) - immigrant Services (Immigration Lawyer, Pathway to Citizenship, Forums, etc.) Health Promotion & Disease Prevention (Health Outreach, screenings, education, and linkage to services) Access to Healthcare (Navigation services, LATCH, Annual Health Fair) In addition, ECH works to build community leadership and action through its Community Engagement and Advocacy Initiative. This section of the organization works to increase the capacity of community members to respond to, advocate for, and address issues affecting the lives of Latinos in the area; assuring representation and inclusion of Latinos and their concerns in planning and decision - making. Efforts seek to gather and provide accurate information aboutito the Latino community, assist with community assessments, inform policy, develop leaders, conduct grassroots outreach, foster collaborative action and inspire cross - cultural appreciation. Programs include Youth Leaders in Action (YLA), LGBT Group Meetings (EntreAmigos, EntreNosotras, Mujeres en Accion, and Hola Latino), Voter Registration Drives, and community forums (Faith ID, Know Your Right, Immigration forums, Deferral clinics, etc) . Agency Information 1/22/2018 10:14:21 AM P a g e b o f DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 d) Agency's i_50,99A E'or y,i i' & eTM s:AGENCY APPLICATION The El Centro Hispano has been providing these services for approximately 25 years. Over the years, programs and services have been revised and created to meet the most pressing needs of the community. For example, recent changes in the political and social environments (anti-immigrant/anti-Latino sentiments and policies) has focused the work of the organization in this past year around immigrant issues, advocacy, community mobilization, and leadership development. This resulted in the establishment of an in -house immigration legal team and the regular hosting of information forums and legal clinics for community members. 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 ?) El Centro continues to work on implementation of its strategic plan by evaluating programs and services and making any needed revisions to better meet the need of community members. f) Schedule of Positions (For Entire Agency) • Full Time Equivalent (FTE) staff will be noted as 1.00, half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours = Volunteer FTE 2,080 # of FTE - Pull -Time Paid Positions: 12 # of FTE'- Paid Part -Time Positions: 4 # of Volunteers: 383 # of FTE - Volunteers: 0 g) Living Wage Does this agency pay permanent employees a minimum 11y!9 R&M? (Yes /No) Yes if yes, is this agency an Orange Count .Li vi n Wage Certified — ?Yes If no, please explain. Agency Information 1/22/2018 10:14:211 AM P a g e ° 0 f Z z DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 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? fYes /No) NO If yes, please list below; Include all programs that have funding requests /awards/totals from Carrboro Chapel Hill and Oran e Counf 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 $35,000 Carrboro Total Funding NIA `Add rows or attach additional page, if needed. Agency information 1/22/2018 10:14:21 AM Flags 7 of DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION ii. Submit your agency's budget. You may complete the provided template (separate As file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). See completed Budget Template attached iii. Does your agency budget show a Surplus or Deficit? Surplus in 2016 -2017 budget summaries is there a significant change? Yes /No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes. The surplus amount for the 2016 -2017 budget revenue is due to funders paying out their grant awards early for the 2017 -2018 fiscal year. The 2017 -2018 -year budget includes this revenue. iv. What is your agency's fiscal year? July 1 -- June 30 (Example: July 1, 2096 through June 30, 2097) Agency Information 1122/2018 10:14:21 AM Page 8 of 33 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488� edge# EXHIBIT 46pirW&VIl e$ Ti8f®Fg�&GfyNCY APPLICATION AGENCY NAME: EI Centro Hispano, Inc 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 /HOMEIetc.) Private Foundation Grants Other Revenue Total Agency Expenses SURPL.USI(DEFICIT) FOR PERIOD: FY 2018 -19 Agency Budget 2016 -17 69,910. $ 20117.18 - 90,000 $ 19. 90,000 68,725 14,800 $ $ 90,000 18,000 $ $ 90,000 20,000 36,970 $ 36,970 $ 36,970 18,780 $ 25,000 $ 30,000 - 80,775 $ 1 $ - 31,905 $ 1,$ 35,00C $ $ 54,168 $ 54,16E - $ - $ - $ 1,1 e 0% 0% 0% 20% 0 10% $ 414,00 67,990 $ - $ - $ 900 259,625 516,069 $3,644 $ 348,097 $ 605,371 $1;299,5'11 $ 348,097 $ 605,371 $ 11;299,51'1 e 0% 0% 0% 20% 0 10% $ 414,00 $ 425,000 $ 900 $ 147,900 200 _ $__ _ ._. _25,000 A $ 200 $ 62,900 $ $ 3711 936,983 1 $ 1,299,511 .- $ 5 638,711 1,299;511 0 °/a DocuSign Envelope ID: A8991BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 3. PROG RAM .I.NPORMAMO-W(Submit a se'parat'e' Section 3 for eac'fi' program Program Name: ETCH Communt Support Services Carrboro Office Program Primary Contact and Title: Pilar Rocha Goldber Telephone Number: (919) 687 -4635 Ext. 43 E -Mail: procha@elcentronc.orq a) Indicate the type of Human Service Needs Priority, if program applicable: ® Priority Area #1: safety -net services for disadvantaged residents ❑ Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ® Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods /Residents Affordable Housing x x x Affordable Healthcare Education Family Resources x x x PFood Training Transport ation Other: Please specify: information & referral x x legal assistance,_ case management outreach c) Provide a bulleted list of other agencies, if any, with which your agency coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. ® Orange County Literacy Council and Orange County Partnership for Young Children: Family Literacy Program, ESL, Circle of Parents group ® Chapel Hili Carrboro City Schools: Participation events information nights, like Mc Douglas School, Mary Scroggs Family Fun Nights, and Oak School ® CHCCS Pre -K Head Start: Support to families with applications and registrations PROGRAM INFORMATION 1/22/2018 10:14:21 AM P a g e 9 0 f 3 2, DocuSign Envelope ID: A899BE5E- BAAEC -40IF3 -911 E1- A9D777FC4C488 p '[,� G • OrangeECoulBfy Rapp C�is�s �ente KefeEa] SerNirl�s�PnP�i�lu'TileOeNstaff twice a month. We provide safe space for interviews • Compass Center for Women and Families: Referral and support our women groups as ESL and FLP with information and events. • Interfaith Council: Information and support through community resources. • Orange County Department of Housing and Human Rights and Community Development: Work closely with Marlyn Valeiko on some events about human rights and Faith Id • Orange County Department of Social Services: Support to resources and participation in events. • Child Care Services Association: Workshops and information about applications and registrations • Kidscope Incredible Years: Support programs for children and families. • Shac Dental Clinic and Medical Clinic: Health Information and Workshops • Carrboro Community Health Center Piedmont Health Services: Health outreach and support services in Spanish • Orange County Skills Development and Job Link Center: Partner to deliver ESL classes along with Durham Tech. We provide space • United Church of Chapel Hill: Work together to support LGTBQ Community • Holy Family Catholic Church: Donations • Binkley Baptist Church: Donations • St. Thomas More Catholic Church: Assist with community outreach and support. They also provide space Faith Id and community events • Owasa: Outreach and information • Chapel Hill Public Library: Provide support to promote family literacy. Participants in LatinAmerican Festival • Town of Carrboro Public Works: partner to provide information to community members; participate in LatinAmerican Festival • Orange County Solid Waste Management: partner to provide information to community members; participate in LatinAmerican Festival • Community Empowerment Fund: Provide volunteer time • Orange County Sheriff's Office: Faith Id Drive and Deferral Program • Town of Carrboro: Faith Id Drive and Deferral Program PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 10 of 33 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Description (3 pages OR LESS) Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a Town /County priority /goal? El Centro Hispano seeks continued support for its Community Support and Engagement Services delivered through our Carrboro- Chapel Hill Office. This intervention aligns with the Board of County Commissioner Goal #1; to ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well -being of all county residents. It also supports the Town of Chapel Hill Council Goals of Creating a Place for Everyone, Supporting Community Prosperity, and Nurturing Our Community. Community Support Services include information, referral, and facilitation of linkage to area resources (i.e. housing, healthcare, academic, human services, etc.)_ Staff and volunteers also assist with case management, legal services, interpretation, immigrant assistance (i.e.. Faith ID, DACA, TPA, Know Your Rights), citizenship classes, and any other direct support that responds to community need. Community Engagement include forums, outreach, educational campaigns, support groups, leadership development, and other activities that assist Latinos and other populations to better participate in the community and enjoy optimal quality of life. By providing these services, staff can connect individuals to area resources and also gather information on issues and service barriers to subsequently work with area resources and make improvements. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange Count 13000 Goals and Priorities, Town of Cha el Hill Council Gogis, 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. Orange County is a diverse community with 13% of the population reported as foreign -born; higher than the State's percentage of 7.7 %. Both the Town of Chapel Hill and Carrboro, each exceed those numbers for both the State and the County with 17.9% and 17% reported as foreign born, respectively. However, this population still experiences disconnection, isolation, and gaps in representation and service delivery due to limited English proficiency, low income levels, citizenship status, discrimination, etc. Recent political and social changes have deepened a sense of fear and insecurity for many families, both citizen and new immigrant alike due to anti-Latinolanti- immigrant rhetoric and positions adopted some public entities and community members against Latino residents. PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 11 of 3-- DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT PROVIDER'S OUTSIDE �, ?EI�(Y AG 4� Q9c( For this reason, EC as seen an increase nee ro e o real -time accurate information and services to help them address needs. Individuals who utilize El Centro Hispano's Community Engagement & Support Services are individuals who may not know about community resources, experience barriers whether it be due to limited English proficiency, cultural differences, and/or do not meet eligibility requirements, who may not understand wordy applications or agency processes, who are just new to the area and are becoming familiar with what is around or are needing a sense of community. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? El Centro Hispano serves primarily the Latino population of all ages residing in Orange County, its municipalities, and surrounding areas. While we focus primarily on the Latino community, we serve all community members who find out programs and services beneficial to them. Recently, our Carrboro office has experienced an increase number of Burmese residents accessing services. Community members learn about El Centro Hispano and its services through word of mouth, outreach efforts, partner agencies, government agency referrals, and social, broadcast, and print media. gj Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Sor Gonzalez is the Community Specialist for the Community Support Services at the Carrboro office. She works closely with community organizations and families to connect them with needed services related to their needs or desired goals, Sor is an Educator with a degree in Early Childhood Education and has over 15 years of experience working with families, supporting learning and behavior change, and resolving concerns. She works closely with a team of volunteers to assist community members in Orange County. Eleazar Posada is our Program Manager for the Advocacy and Community Engagement initiative. He holds a Bachelors of Arts Degree with a concentration on Pre -Law from Campbell University. He comes with experience in mobilizing communities, informing policy, developing community leaders, and advocacy. He works closely with staff and volunteers to hold forums, inform on issues, develop new leaders, and build collaborations. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Services are delivered year - round. Office hours are gam — 5pm with some evening and weekend hours available for some services. Outreach is conducted during day, evenings, and weekend hours PROGRAM INFORMATION 1/2212018 1014:21 AM Page 12 of 33 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APP IC%I(I g i) Why is funding this program a good investment for the communit ow oe ndin this program add value to the community? (250 words OR LESS) investing in this program helps expands the capacity of the organization to address the human service needs of the community. Individuals, families, and service providers have a place to get information and assistance in accessing area resources. It helps eliminate service gaps and disparities, builds inclusion, facilitates communication (particularly of those with Limited English Proficiency), and utilization of resources by community members. It contributes to building an informed, resilient, and engaged community of Orange County residents. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. it would impact the amount of services rendered and/or hours of operation k) What percentage of your target population is low-moderate income? 29% of the Hispanic Population in Orange County lives at 125% Below the Federal Poverty Leve 1) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) As part of our Community Support Services and with the help of volunteers, ECH follows within two weeks of providing a service with each person who came to ECH to determine if they were able to have their concerns resolved, whether they experienced any gaps in accessing referral made, and to determine satisfaction with services rendered. In addition, we conduct evaluation of programs and services rendered either at the end of a program session (in the case of workshop) and through random surveys and phone interviews at the end of the year. We also get feedback from community members through outreach efforts like door -to -door canvassing or public forums. m) Include any other pertinent information. Staff have expressed that Latino community member have expressed concerned coming out for services or workshops due to present anti - Latino /anti- immigrant sentiments. Because of this, staff will try to find additional ways to provide information, support, and case management. Since most in our community are not as comfortable using computers, time will be scheduled for more outreach activities to bring services to neighborhoods and /or places communities already gather. We will also explore ways to provide services through other technologies, other than computer based. PROGRAM INFORMATION 1/22/2018 10:14:21 AM P a g e 1 3 of 3 3 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 Additional Program XHoBI TA: PROVIDER'S OUTSIDE AGENCY APPLICATION n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Gender Male Female UnknownlUnreported Total Ethnicity African - American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Hispanic, Burmese, unknown Total Of the above, how many Hispanic/Latino Of the above, how many non-Hispanic/Latino Total Age 0 -5 years 6 -18 years 19 -50 years 51+ years Total Geographic Location Actual Estimated Projected 2016 -17 2017 -1$ 2018 -19 403 500 600 823 850 900 311 1350 1500 1537 1350 1500 24 25 25 459 200 300 1537 1350 1500 29 30 30 0 0 0 1484 1295 1445 1537 1350 1500 1078 1150 11200 459 200 300 1537 1350 1500 nla nla 575 625 nla 600 675 nla 15 20 0 0 0 Alamance County Chatham County Durham County Wake County Unknown /unreported Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non- Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) Total 3 2 174 5 181 PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 1 4 of '_s 515 575 625 534 600 675 13 15 20 6 10 15 104 150 165 1537 1350 1500 PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 1 4 of '_s DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement o) Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART ( §pecific, 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 measurable 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 ECH Community Support and Engagement Services 1. Program Activity Marne Information, Referral, and Support Services Program Goal 1,200 referrals and support services rendered to Latinos and other community members in the Orange County, Chapel Hill, and Carrboro areas Performance Measures # of referrals and support services provided; # of new users Previous Year Program Results 1537 services provided; 781 new users Current Year Estimated Results 1 1,200 Goal for year; 561 served as of 12/31/17 Next Year Projected Results I At least 1,200 2.: Program Activity Maitre Legal Assistance Program Goal 150 appointments made for individuals in need of legal services Performance Measures # of appts made; # of appts kept; #referred to ECH Lawyer Previous Year Program Results 202 appts made Current Year Estimated Results 150 Goa[ for year; 55 appts made as of 12/31/17 Next Year Projected Results At least 150 3... Program Activity Name Community Education and Outreach Program Goal 12 Community Events will be held (such as the Forums, Faith 1D Drives & the Latin - American Festival) to improve communication, engagement, and access to area resources by Latino community members as well as to foster cross - cultural appreciation and understanding Performance Measures # of events held; # of participants Previous Year Program Results 8 events held (Faith ID, Know Your Rights, DACA, International Festival) Current Year Estimated Results 14 events as of 12/31/2017 Next Year Projected Results I At least 12 community events PROGRAM INFORMATION 1122/201810:14.21 AM pa g e '1 8 0 f 3, DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION p) Program Budget 1. Submit your program budget. Submit your program budget. See attached 2. Program Budget Detail - Provide description of "other" budget items, not defined. Other Line items include contracted services, communications, printing and copying, community training, dues and subscriptions, participant incentives 3. This program budget represents what percent of the agency budget? 30% 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 16 of 33 Actual 2016 A7 : Estim,ated 2017-1 8 Pro'ected 201$ -19 _.l Total Cost of Program $240,271 $398,477 $408572 Total # of Individuals (totals for all three initiatives resented in grant application) 1739 +383-144- 2200 1350 +500 +85 = 1935 min 1500 +500 +100= 2900 min Cost Per Individual 1 $106 $205 $195 PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 16 of 33 DocuSign Envelope ID: A89913EK- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S QUTSJDE AGENCY APPLICATION Program Budge Operating Budget for Program PROGRAM NAME El Centro Hispano- Community Services (Carrboro Office) 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 Oth T f Hillsborou h $ $ $ $ $ $ $ $ $ Actual 2016 -17 ... 8,136 12,031 14,800 36,970 18,780 - 80,775 - - Estimated 2017: 18 236,891.1 Projected 2018 -19 .. Percent Change $ 15,000 $ 15,000 0% $ 25,000 $ 18,000 $ 25,000 $ 20,000 0% 11% $ 36,970 $ 36,970 0% $ 25,000 $ 30,000 20% $ - $ - 0 1 $ 31,905 $ 35,000 10% 1 $ 54,168 $ 54,168 0% I T, - $ - 0 er - own o g Other Government Grants Triangle United Way $ State Government r$$ Federal Government (CDBGIHOME/etc.) Private Foundation Grants Other Revenue L$ Total Program Expenses SURPLUS!(DEFICIT) FOR PERIOD: FY 2018 -19 Program Budget $ 256, $ 124,744 '$ 236,891 $ 236,891.1 0% $ 38,168 $ 41,168 $ 41,168 0% $ 5,505 $ 5,500 $ 5.,500 0% $ 8,761 1 $ 13,025 $ 15,000 15% $ 63,093 $ 101,893 $ 101,893 0% $ 240,2711 $ 398,477 1 $ 400,452 1 0% $ 15,752 $ - $ 8,120 =0 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 I 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) j Program Name: ECH- Center for Employment and Leadership Program Primary Contact and Title: Pilar Rocha Goldberg Telephone Number: 919 687 -4635 Ext, 43 E -Mail: procha(cDelcentronc.orq a) Indicate the type of Human Service Needs Priority, if program applicable: ® Priority Area #1: safety -net services for disadvantaged residents ❑ Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ❑ Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods /Residents Affordable Housing Affordable Healthcare Education x Family Resources x x _ x JobslJobs Training x x x Food Transportation Other: Please specify: job x placement, worker rights & safety, outreach, and financial education x x c) Provide a bulleted list of other agencies, if any, with which your agency coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. Day Laborer Task Force: ECH is very active in the Carrboro Day Laborer Task force, which includes representatives from the Carrboro Mayor's office, the Chapel Hill - Carrboro Chamber of Commerce, Justice United, Carrboro Day Laborers, the Human Rights Center and El Centro Hispano. PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 17 of '9 3 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AG Y APPLIC TIO t e Chapel • Chapel Hill- Carrboro Chamber of Commerce: is a member of Hill- Carrboro Chamber of Commerce. The Chamber participates in the Carrboro Day Laborer Task Force. • Human Rights Center: ECH partners with the Human Rights Center to develop initiatives for Carrboro day laborers. • National Day Laborer Organizing Network— ECH has joined this networkwhich has at least 30 centers nationwide and helps identify funding options and strategies to further engage workers • UNC A.P.P.L.E.S: Coming February 2017, students in the APPLES course will serve a minimum of 30 hours with a community partner during the semester. • Latino Migration Project: In April 2017, we will be collaborating with the Latino oral history archive "New Roots /Nuevas Raices" to capture Carrboro /Chapel Hill day laborer stories as a form of building community awareness. • Town of Carrboro Chief of Police: Collaborate on neighborhood safety and crime reduction efforts; particularly to address violence, loitering, drug prevention PROGRAM INFORMATION 1/22/2018 10:14 :21 AM P a g e °1 8 o f 3 3 DocuSign Envelope ID: A89913EK- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDE 'S TSIDE AGENCY APPLICATION Please provide the following information a ou the proposed program. d) Summarize the program services proposed and how the program will address a Town /County priority /goal? El Centro Hispano seeks funding to support services rendered through the Center for Employment and Leadership (CEL) located at the Carrboro - Chapel Hill Office. CEL's programs and services align with the Board of County Commissioners' values of diversity and social justice and help address Goal #3; to implement planning and economic development policies which create a balanced, dynamic local economy, and which promote diversity, sustainable growth, and enhanced revenue while embracing community values. it also supports the Town of Chapel Hill priorities of Supporting Community Prosperity, Nurturing Our Community, and Growing Town, UNC and UNC Healthcare Collaborations. CEL helps connect job seekers with employment, particularly day laborers and domestic workers. It provides worker training, job placement services, financial literacy education, community outreach, and grassroots mobilization. Staff work with area employers to connect with a strong, ready workforce and to assure a safe workplace and fair wages. In addition, through a collaboration with The Financial Clinic and Unidos US, CEL is taking the lead in providing Financial Education and Counseling through a national network of financial coaches of topics related to Budgeting, Banking, Credit, Debt, Taxes, and Building Assets. e) Describe the community need or problem to be addressed in relation to the Chap @l Mill Humao. Servlce5 Need-s Assessment, orangq_ County QQCC P-oals A 1ag,_gQ of Chapel 1-11.I1 Cound Vials, Carrboro goals, or other community priorities (i.e. CouncillBoard Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. El Centro Hispano's Center for Employment and Leadership help address the Jobs and Jobs Training and Community Engagement priorities of the 2012 Human Services Report. Between 1995 and 2005, the number of Hispanic /Latino workers in North Carolina increased 431 %, which accounted for 35% of the state's total workforce. By the end of 2005, three out of four Latinos residing in North Carolina were employed in construction, wholesale, manufacturing, and the retail industries. While Orange County was holding its own with a 3.5% unemployment rate, there was an upsurge in that rate, 4.20 %, toward the end of 2015. Many Latinos, both men and women, are seeking independent work to secure or supplement incomes. We have seen an increase in men seeking assistance from CEL to obtain work or secure wages as day laborers. Women have sought assistance to secure work as Domestic workers. Most of the workers are from Mexico, Guatemala, Honduras and El Salvador; however, Caucasian and African American day laborers have also frequented the Worker's Center. PROGRAM INFORMATION 1/22/2018 10:14:21 AM P a g e 1' 0 f = 3 DocuSign Envelope ID: A8991BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 f] Who is your target pl pulatioR�FiIDEid afsOP ben�fit fromEf�ils pragramla WHoowNwill they be identified and connected with the program? El Centro Hispano serves primarily the Latino population of all ages residing in Orange County, its municipalities, and-surrounding areas. Through CEL it particularly focuses its efforts on Day Laborers, Domestic Workers, and Unemployed individuals to include all races and ethnicities, veterans, and homeless individuals. Community members learn about El Centro Hispano and its services through word of mouth, outreach efforts, partner agencies, government agency referrals, and social, broadcast, and print media. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Luis Rodriguez, our new CEL Coordinator, comes to us with over 10 years' experience in workforce and community development coordinating programs, advocating, coaching and providing technical assistance to immigrant individuals and families in English and Spanish. He holds a degree in International Relations with a Certificate in Project Management from Portland State University and has worked as a business coach and MicroEnterprise Developer since 2012. Vicky Cruz works under the supervision of the CEL Coordinator as the Workforce Specialist working to enhance self- sufficiency and resiliency of Latinos in our service area. She brings over 8 years of experience in management and customer service. CEL volunteers have undergone a general orientation by El Centro Hispano staff. There are 2 -3 orientations planned each month for volunteers to attend. During the one -hour orientation, volunteers are given a quick overview of ECH's history, background, and core areas they can be engaged in. Specific assignments are explained by the Program Coordinator h] Describe the specific period over which the activities will be carried out and include an implementation timeline. CEL operates year -round with the foliowing office hours Monday - Saturdays 6am- 2pm (summer hours); Monday - Friday 7AM -noon and Saturday 7AM -10AM (winter hours). Outreach is conducted during day, evenings, and weekend hours. i) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) This initiative is a direct response to an identified community need related to public safety, employment, and securing fair wages. Funds support ECH's Center of Employment and Leadership's growing role as a contributor to economic development in the Carrboro- Chapel Hill area. It creates jobs, accountability of employers, protection of workers, assurance of payment of fair wages, and builds collaborations, and works to build wealth in low - income communities. The added value is that it invests in economic prosperity for the community; working to eliminate poverty. PROGRAM INFORMATION 1/22/2418 10:14:21 AM Page 2 0 of 33 DocuSign Envelope ID: A89913EK- BAEC- 40F3 -91 E1- A9D77FC4C488 j} Describe what would h PpRO IDgER'st OUfUndDg IAGENCY Wr "ded of alAl IONa reduced allocation is recommended. It would impact the amount of services rendered and/or hours of operation k} What percentage of your target population is low- moderate income? 29% of the Hispanic Population in Orange County lives at 125% Below the Federal Poverty Level 1) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) CEL staff work one -on -one with workers and employers and as part of their service delivery they get feedback daily about their experience with the worksite /workerlemployer. They also conduct surveys and random phone interviews to determine satisfaction with services and any recommended improvements. Forthose that are provided financial education or referrals, staff follow the same process used by the community support services team of calling those service within two weeks of service delivery and through random phone interviews at the end of the year with the help of volunteers. m) Include any other pertinent information. Under the leadership and assistance of the new staff at ECH's Center for Employment and Leadership, laborers and domestic workers have become more engaged in informing possible solutions to improving their employment opportunities. As a result, ECH is formalizing an equipment/tool loan program for day laborers who are unable to secure work because they do not have their own tools. Additionally, the workforce specialist will be holding workshops related to worker safety, worker rights, and other related topics. Domestic workers under the guidance of the CEL Coordinator are designing a cleaning service that will job opportunities for women interested in learning how to start and operate a cleaning services. For those who want to become contractors, staff will coach them on how to incorporate and register their own business, according to the federal, state and local requirements. Staff will also provide financial coaching to those who would like to learn to administer their resources more effectively, PROGRAM INFORMATION 1/2212018 10:14:21 AM Page 21 of 33 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 Additional ProgramnNfioBmTai4bnPROVIDER'S OUTSIDE AGENCY APPLICATION n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Gender Male Female UnknownlUnreported Total Ethnicity African - American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Hispanic, unknown Age Total Of the above, how many Hispanicll -atino Of the above, how many non - Hispanic /Latino Total 0 -5 years 6 -18 years 19 -50 years 51+ years Total Actual Estimated Projected 2016 -17 2017 -18 2018 -19 207 250 350 87 75 150 294 5 10 294 325 500 265 50 60 29 0 0 294 5 10 nla 20 30 0 0 0 294 250 400 294 325 500 265 275 400 29 50 100 294 325 500 nla nla 140 250 nla 140 200 nla 25 30 0 0 0 Geographic Location Alamance County Chatham County Durham County Wake County Unknownlunreported Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non- Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) Total 2 11 25 5 30 PROGRAM INFORMATION 1/2212018 10:14:21 AM Page ? 2' of 3 131 140 250 66 140 200 12 25 30 7 10 10 5 10 10 294 325 500 PROGRAM INFORMATION 1/2212018 10:14:21 AM Page ? 2' of 3 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 Work Statement EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION o) Complete the Work Statement Chart to describe the work to be performed. This chart is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time - bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly /disabled residents.) • Program Goal should explain what the program is trying to achieve /accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday-Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measurable 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: ECH- Center for Employment and Leadership PROGRAM INFORMATION 1122/2018 10 :14:21 AM Page 2� of 3"A DocuSign Envelope ID: A899BE5E- BAAEC- 40F3 -91 E1- A9D77FC4C488 p) Program 13E u "dgeIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 5. Submit your program budget. See attached 6. Program Budget Detail — Provide description of "other" budget items, not defined. Other Line items include contracted services, communications, printing and copying, community training, dues and subscriptions, participant incentives 7. This program budget represents what percent of the agency budget? 30% 8. COST PER INDIVIDUAL This Cost per individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page '24 o f 33 Actual 2016 -'17 Estimated 2017 -18 Projected 2018 -19 _. Total Cost of Program $240,271 $398,477 $408572 Total # of Individuals 1739 X383 +'144 = 1350f500� 85= 1500 500.100= (totals for all three initiatives 2256 1935 min 2100 min resented in grant application) Cost Per Individual $108 $205 $195 PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page '24 o f 33 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROM &EQITISIDE AGENCY APPLICATION operating Budget for Program PROGRAM NAME El Centro Hispano- Community Services (Carrboro Office) $ 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 'intal Arnnram Revenue Actual 2016 -'17 $ 8,136 $ 12,031 $ 14,800 $ 36,970 $ 18,780 $ - $ 50,775 $ - $ - $ - $ - $ - $ - $ 84,531 $ 26,023 236,891 0% l, $ 38,168 $ 41,168 $ Estimated 2017 18 Projected 2018 -19. $ 5,505 Percent Change $ 15,000 $ 15,000 5,500 0% $ 25,000 $ 18,000 $ 25,000 $ 20,000 13,025 0% 11% $ 36,970 $ 36,970 $ 63,093 240,27 0% $ 25,000 $ 30,000 101,893 400,452 20% $ - $ - 0 $ 31,905 $ 35,000_ 10% $ 54,168 $ 54,168 0% $ - $ - $ - $ - 0 0 $ - $ - 0 $ - $ - 0 $ 25,000.00 $ . 25,000.00 $ 167,434 $ 167,434 7$198,477 $ 40$,572 $ $ - - 3% SURPLUSI(DEFICIT) FOR PERIOD: FY 2018 -19 Program Budget $ 124,7441 $ 236,891 $ 236,891 0% l, $ 38,168 $ 41,168 $ 41,168 0 %% $ 5,505 $ 5,500 $ 5,500 0% $ 8,761 $ 13,025 $ 15,000 15% $ 63,093 240,27 $ 101,893 398,477 $ $ 101,893 400,452 0% 0% 15,752 $ - $ 8,'120 0 DocuSign Envelope ID: A8991BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 1 3. PROGRAM INFORMATION (Submit a separate Section 3 for each }grogram) � Program Name: ECH- Education Services Program Primary Contact and Title: Pilar Rocha Goldberg Telephone Number: 919 687 -4635 Ext. 43 E -Mail: procha .elcentronc.orq a) Indicate the type of Human Service Needs Priority, if program applicable: ❑ Priority Area #1: safety -net services for disadvantaged residents ® Priority Area #2: education, mentorship, and afterschooi 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 x x Family Resources x x x Jobs /Jobs Training Food Transportation Other: Please specify: ESL elementary & x x secondary education, computer trainin etc. 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. • Durham Tech & Durham Literacy: ECH provides space to host ESL classes for low and intermediate levels. Durham Tech caters to beginning levels, ENG 1 &2 while Durham Literacy Center provides advanced classes, ENG 3 &4. ® Orange Literacy Council: ECH lends space for ESL classes to parents and have children participate in preschool classroom. Orange Literacy and ECH PROGRAM INFORMATION 11221201810:14:21 AM Page 2, ', of 33 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 partn r HfiffpAr vVQO t�YI+ Ev lb �i�r�t � rl� �i'a i�' i std Ie English language skills for parents. • Sophomore & Junior High School Students: ECH collaborates with area high school students to help tutor elementary and middle school kids. Their service helps them complete the community service hours requited by their school. • TABLE - provide children with free weekly food bags containing healthy, organic vegetables, nonperishables to children whose family may not afford healthy food. • UNC SHAC - invite UNC medical students to give healthy advice to tutoring mothers. Topics range from maintaining a healthy blood pressure, eating healthfully, and exercising. • Orange County Rape Crisis Center- invite the Latino community Liaison to talk to the mothers whose children are in tutoring. Topics include creating healthy sexuality dialogues, talking about sexuality to children, and giving parents a safe space to explore options and answer questions about domestic violence. • Book Harvest: Provide Books free in both languages English and Spanish PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 2 6 o f 33 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 Program DescriptiarXi {(I BITge : 8RTg R'S OUTSIDE AGENCY APPLICATION Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a Town /County priority /goal? El Centro Hispano seeks funding to support Education services offered at the Carrboro - Chapel Hill Office to children, youth, and adults. ECH's Education Initiatives align with the Board of County Commissioners' values of diversity and social justice and help address the Education component of Goal 6: to ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare. It also supports the Town of Chapel Hill priorities of Supporting Community Prosperity, Nurturing Our Community, and Growing Town, UNC and UNC Healthcare Collaborations. Education interventions include school readiness and academic achievement interventions such as Pre -K preparation, K -12 tutoring, parent education and support, adult literacy and ESOL, and adult elementary education through Plaza Comunitaria (a collaboration with the Mexican National Institute of Adult Education). e) Describe the community need or problem to be addressed in relation to the 0- I Dill Hur ikl 50-rvices Ne @ds ,segment, Orange County DQCC G9215 and Priorities, Town of ChaeI Hill Council Carrboro goals, 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. Education Initiatives at El Centro Hispano Carrboro - Chapel Hill office address the Education & Family Resources priorities of the 2012 Human Services Report. In North Carolina, 69.4% of foreign born Spanish speakers older than age 5 have Limited English Proficiency (LEP). Thirty -one percent of NC Spanish - speaking households are linguistically isolated, meaning individuals ages 14 and over in the household are LEP, which is higher than other immigrant groups (Migration Policy Institute, 2010). In the U.S., 23.5% of all Latinos and 34% of foreign -born Latinos have less than a 9th grade education (Pew Hispanic Center), and research shows that low literacy and education levels in Spanish also make it difficult for Spanish speakers to fully participate in society and utilize its resources. In Chapel Hill - Carrboro City Schools, only 66.2% of Latino youth graduated from high school in 4 years in 2010, as compared to 92.5% for white students. Research shows that low literacy and education levels make it difficult to get a job, access resources, and assist with children's education or literacy development. Furthermore, low literacy levels in Spanish make it more difficult for native Spanish speakers to learn English. Developing English proficiency is an important pathway to improving employability and economic success in the United States for immigrant families. In North Carolina, only 25% of Latina mothers read to their children at least once a day in 2005, compared to more than 50% of mothers in the general state population. Latino parents in North Carolina are more likely to report that their children have fair or poor health and have had no health insurance in the past year than White parents. PROGRAM INFORMATION 1/22/2018 10:14:21 A MP agy 2 Y � a of 33 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Moreover, national evidence shows that Latinos are less likely than children of any other racial or ethnic group to be enrolled in an early childhood program or to receive early intervention services. In 2005 -06, 27% of Latino four -year -olds lacked regular, non- parental arrangements for child care, compared with 18% of white preschoolers and 16% of black preschoolers. Thus, many Latino children reach school age without having been exposed to developmentally appropriate preschool settings. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? El Centro Hispano serves primarily the Latino population of all ages residing in Orange County, its municipalities, and surrounding areas. Education Initiatives focus efforts on children 0 -5 and their parents /caretakers through its preschool preparation program and grades K -8 for its tutoring program. They also work with adults who do not know how to read or write, have not completed any formal education, and/or who experience Limited English Proficiency. The program also works with educators, literacy programs, and school officials to increase communication and engagement of children and their family in learning. Community members learn about El Centro Hispano and its services through word of mouth, outreach efforts, partner agencies referrals, government agency referrals, and social, broadcast, and print media. gj Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe .training provided to volunteers, etc.) Antonio Alanis is our new Education - School Readiness Coordinator. He holds a B.A in Spanish from the University of North Carolina at Chapel Hill and a Masters in Arts in Education from Wake Forest University. Antonio has experience in educational research including implementing best practices to identify problems and better students' learning problems within the school classroom, developing K -12 curriculum. Education volunteers (particularly for the tutoring program) participate in a general orientation by El Centro Hispano staff. Four orientation's sessions are held during the Fall and Spring Season. Volunteers are given an overview of ECH's history, background, and core areas they can be engaged in. Specific assignments are explained by the Program Coordinator h) Describe the specific period over which the activities will be carried out and include an implementation timeline. The Preschool Classroom and Circle of Parent Sessions are offered in two 14 -week series; the first is offered September to December and the second is offered February to May. Classes are held in the morning from 11:30am to 12:30am. Tutoring is made available to children and youth during the school year on Mondays and Thursdays from 5:30pm to 7pm. Summer Camps are held during the summer months. ij 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) PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 28 of 32, DocuSign Envelope ID: A8991BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 Investing in Educatiiys IiTn'#rI�i��Ti��ir#`�#�II skills they can be better citizens, secure employment, and have healthier lives. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. It would impact the amount of services rendered andfor hours of operation k) What percentage of your target population is low- moderate income? 29% of the Hispanic Population in Orange County lives at 125% Below the Federal Poverty Level l) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) The Education Coordinator conducts pre- and -post evaluations and maintains daily conversations with program participants. He also receives texted feedback from families about program improvements and /or successes. m) Include any other pertinent information. Staff continue to report progress with children's abilities to communicate and perform in a classroom setting. This year, interventions will focus more on building parent ability to support and guide their child's learning. For this year's summer camp, children will visit a country in Latin American and will explore the country and its culture using reading, writing, and math. PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 2 2, of 33 DocuSign Envelope ID: A8991BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 Additional PrograrEYjWkWTa&RROVIDER'S OUTSIDE AGENCY APPLICATION q) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Gender Male Female Unknown /Unreported Total Ethnicity African- American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Hispanic, unknown Total Of the above, how many Hispanic /Latino Of the above, how many non- HispaniclLatino /unknown Total Age 0 -5 years 6 -18 years 19 -50 years 51+ years Total Geographic Location Actual Estimated Projected 2016 -17 2017 -18 2018 -19 1 60 70 28 25 30 115 18 25 144 85 100 Alamance County Chatham County Durham County Wake County Unknown /unreported Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) Total 11 70 85 133 15 15 16 18 25 1 0 144 1 85 100 127 67 75 144 85 100 Alamance County Chatham County Durham County Wake County Unknown /unreported Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) Total 11 70 85 133 15 15 144 85 100 30 30 30 75 30 45 36 25 25 3 0 144 1 85 100 PROGRAM INFORMATION 112212018 10:14:21 AM Page a r fl f -?'a 0 22 0 1 2 2 0 115 0 PROGRAM INFORMATION 112212018 10:14:21 AM Page a r fl f -?'a 0 22 23 61 75 0 1 0 27 0 144 1 85 100 PROGRAM INFORMATION 112212018 10:14:21 AM Page a r fl f -?'a DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement r) 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 (§,pecific, 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 measurable 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 ECH Education Services 7. Program Activity Name School Readiness- PreK Classroom Program Goal 30 children 0 -5 will participate in the PreK Classroom Performance Measures # of children participating Previous Year Program Results 45 children participated Current Year Estimated Results 30 Goal for the year; 24 have participated as of 12/31/17 Next Year Projected Results At least 30 children School Achievement- K -V grade TutoringlSummerGamp $.: _:,Program.`A7Measures 30 children in K -8 will receive tutoring Performa# of children participating; percentage of improvement; parent pre -and post - survey about tutoring impact on students. Previous Year Pro 75 children participated Current Year Estimated Results 30 Goal for the year; 12 children have been tutored since 12/31/2017 Next Year Projected Results At least 30 children. PROGRAM INFORMATION 1/22/2018 10:14:21 AM Page 31 of 33 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION s} Program Budget 9. Submit your program budget. See attached 10. Program Budget Detail — Provide description of "other" budget items, not defined. Other Line items include contracted services, communications, printing and copying, community training, dues and subscriptions, participant incentives 11. This program budget represents what percent of the agency budget? 30% 12. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 1/22/2018 10:14:21 AM P a cj e 3 2 o f :33 Actua! 2016. =17 Estimated 2017 18 Projected 2018 -19 Total Cost of Program $240,271 $398,477 $408572 Total # of Individuals (totals for all three initiatives presented in grant application) 1739+383 +144= 2266 1350 +500 +85 = 1935 min 1500 +500 +100= 2100 min Cost Per Individual $106 $205 $195 PROGRAM INFORMATION 1/22/2018 10:14:21 AM P a cj e 3 2 o f :33 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT A: PRO`�WtIDE AGENCY APPLICATION Operating Budget for Program PROGRAM NAME El Centro Hispano- Community Services (Carrboro Office) Actual Estimated 2017 Projected Percent PROGRAM REVENUE 2016 -17 18 2018 -19 Change Private Donations $ 8,136 $ 15,000 $ 95,000 0% 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 (CDSGIHOME /etc.) Private Foundation Grants Other Revenue $ $ $ $ 1 $ $ $ $ $ $ $ $ $ 12,031 '14,800 36,970 18,780 - 80,775 - - - - 84,531 $ $ $ $ $ $ $ $ $ $ $ $ $ 25,000 18,000 36,970 25,000 - 31,905 54,168 - - - - 25,000.00 167,434 $ $ 25,000 20,000 41,168 $ 36,970 $ 5,505 $ 30,000 $ $ - $ $ 35,000 15,000 $ 54,168 101,893 $ $ - - $ $ - $ 1 $ 25,000.00 167,4341 $ $ Total Program Expenses SURPLUSI(DEFiCiT) FOR PERIOD: FY 2018 -19 Program Budget $ 250,023 1 $ 39.8,477 1 $ 408,572 $ 124,7441 $ 236,891 $ 236,891 $ 38,168 $ 41,168 $ 41,168 $ 5,505 $ 5,500 $ 5,500 $ 8,761 $ 13,025 $ 15,000 $ 63,093 $ 101,893 $ 101,893 $ 240,271 f $ 398,477 1 $ 400,452 0% 11% 0% 20% 0 10% 0% a 0 0 0 3% 0% 0% 0% 15% 0% 0% $ 15,7521$ $ 8,120 0 DocuSign Envelope ID: A899BEK- BAEC- 40F3 -91 E1- A9D77FC4C488 EXHIBIT `B" Scope of Services – FY 2018 -19 Outside Agency Performance Agreement Agency Name: El Centro Hispano, Inc Program Name: ECH Community Support Services (Carrboro Office Funding Award: $32, 834 Outline how the agency will spend Orange County's funding award Expense Description Amount Personnel $29,409 Rent $2,800 Office Supplies $325 Staff Miles and Parking $200 Advertising $100 # or individuals receiving work related services (training, job placement, improved wages, etc ) 100 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. • Community Support Services to include Information and Referral Assistance, Legal Assistance, and • Community Education and Outreach • Center for Employment and Leadership initiatives such as Day Laborers Project, Worker Education and Training, and Financial Education • Education Interventions focused on School Readiness, K -8 Tutoring /Summer Camp, and Parent /Caretaker Education and Support. 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 # of referrals and support services provided 1,200 # of individuals receiving /referred to legal services 150 # of community events held 12 # of children participating in School Readiness program 30 # of workers and employers registered; 325 # or individuals receiving work related services (training, job placement, improved wages, etc ) 100 # of individuals receiving financial education 75 # of children participating in tutoring /summer camp 30 # of parents attenc+=,,/rmm�ln inn +ho nr„gram DacuSianed bv: 25 Certified by. L c223DDB391744D1... 1 11 t k-! Y--� CAAA (Provider's Signature) President &CEO 8/27/2018 Title: President & CEO Date: 08/14/2018 DocuSign Envelope ID: A899BE5E- BAEC- 40F3- 91E1- A9D77FC4C488 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. OacuSignnedby: �(+�-AII,_ P,0C4 -1G Certified by: — 2239DB39C1744D1... _ Title: (Provider's Signature) President &CEO Date: 8/27/2018 (El Centro Hispano, Inc) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -9l E1- A9D77FC4C488 ELCENTR -04 SPIKE 'ACC]RU CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD /YYYY) 08/14/2018 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 NAME: PHONE FAX (A/c, No, Ext): (919) 337 -0000 (A/c, No):(866) 553 -5124 Hub International Carolinas E -MAIL ADDRESS: PHPK1802727 INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE INSURER A:Philadelphia Indemnity Insurance Company 18058 DAMAGE TO RENTED PREMISES Ea occurrence INSURED INSURER B : MED EXP (Any one person) INSURER C : El Centro Hispano, Inc. INSURER D: $ 1,000,000 600 East Main Street Durham, NC 27701 INSURER E $ 2,000,000 INSURER F: $ 2,000,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL IN SD SUBR WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_X] OCCUR PHPK1802727 04/06/2018 04/06/2019 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JERCOT F—] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ • X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE PHUB624430 04/06/2018 04/0612019 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DIED I X I RETENTION $ 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECU I IVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT • • Crime Professional Liabili PHPK1802727 PHPK1802727 04/06/2018 04/06/2018 04/06/2019 04/06/2019 Employee Dishonesty Each Incident 120,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Professional Liab Aggregate $3,000,000 Sexual or Physical Abuse or Molestation Vicarious Liability $1,000,000 per claim, $1,000,000 Aggregate CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count Government 9 Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron St PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: A899BE5E- BAEC- 40F3 -91 E1- A9D77FC4C488 '` � °r CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 07/31 /18 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 Aon Risk Services, Inc of Florida CONTACT Aon Risk Services, Inc of Florida NAME: PHONE FAX A/C, No, Ext : 800 - 743 -8130 A/C, No): 800- 522 -7514 1001 Brickell Bay Drive, Suite #1100 Miami, FL 33131 -4937 EMAIL ADDRESS: ADP.COI.Center@Aon.com INSURER(S) AFFORDING COVERAGE NAIC # (Rohde INSURER A: New Hampshire Ins Cc 23841 INSURED ADP TotalSource FL XVI, Inc. INSURER B: INSURER C : $ 10200 Sunset Drive Miami, FL 33173 PERSONAL & ADV INJURY $ L /C /F INSURER D: $ INSURER E: $ El Centro Hispano Inc. 201 W Main St suite 100 INSURER F Durham, NC 27701 COVERAGES CERTIFICATE NUMBER: 2105612 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. LIMITS SHOWN ARE AS REQUESTED. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MMIDD /YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑ OCCUR AUTHORIZED REPRESENTATIVE o a &6k 8wevLcC3,, 41.mt< o (Rohde EACH OCCURRENCE $ DAMAGE PREM SESOE. olccur ence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FI PROJECT FI LOC OTHER GENERAL AGGREGATE $ PRODUCTS - COMP /OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Ea acccideDtSINGLE LIMIT $ BODILY INJURY Per person $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DEC I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC 047022346 INC 07/01/18 07/01/19 X PER ISTA TUTE OTH- ER E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All worksite employees working for EL CENTRO HISPANO INC., paid under ADP TOTALSOURCE, INC's payroll, are covered under the above stated policy. CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 S Cameron St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE o a &6k 8wevLcC3,, 41.mt< o (Rohde © 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD