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2018-586-E Finance - Boomerang Youth outside agency agreement
(Boomerang Youth, Inc.) Orange County Outside Agency Performance Agreement Revised 7/2018 Page 1 of 9 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 Boomerang Youth, Inc., a not-for-profit corporation, located at 825A N. Estes Drive, Chapel Hill, NC 27514 (“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 Boomerang Youth, 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 $13,008. 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 $3,252. 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. DocuSign Envelope ID: D1A090F6-2A4E-4F0B-9FB7-92FFFC9E13D2 (Boomerang Youth, Inc.) Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7/18 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. f. 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. DocuSign Envelope ID: D1A090F6-2A4E-4F0B-9FB7-92FFFC9E13D2 (Boomerang Youth, Inc.) Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7/18 c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker’s Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE x Worker's Compensation Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee x Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate x Automobile Liability $500,000 Combined Single Limit x Professional Liability $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. DocuSign Envelope ID: D1A090F6-2A4E-4F0B-9FB7-92FFFC9E13D2 (Boomerang Youth, Inc.) Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7/18 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 Boomerang Youth, 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: DocuSign Envelope ID: D1A090F6-2A4E-4F0B-9FB7-92FFFC9E13D2 (Boomerang Youth, Inc.) Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 7/18 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on behalf of the Provider _____________________________ _______________________ , Date For and on behalf of Orange County Government _______________________________ ________________________ Bonnie Hammersley, County Manager Date County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Boomerang Youth, Inc. 825A N. Estes Drive Chapel Hill, NC 27514 DocuSign Envelope ID: D1A090F6-2A4E-4F0B-9FB7-92FFFC9E13D2 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Boomerang Youth Inc. Applicant Organization's Physical Address: 825A N. Estes Drive Chapel Hill NC 27514 Applicant Organization's Mailing Address: 825A N. Estes Drive, Chapel Hill, NC 27514 Applicant Organization's Web Address: hops:llbvomerangyouth.org Executive Director: Tami Pfeifer Telephone Number:-(919) 968-2146 E-Mail: tami.pfeifer&boomeran gyouth.or Tax ID Number: 47-4660452 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 Ch_ apel Orange Total - HS Hill -HS Count -HS Alternative to Suspension Program Program Manager salary and contracts for psycho- educational skill building groups (conflict resolution, 5,000 11,000 15,000 31,000 healthy relations, substance use, communication and self-expression, personal rowth Continuing Connections After School Program 0 1,000 1,000 2,000 Contracts& materials for after school activities Totals 5,000 12,000 16,000 330000 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. �-•, Signatu �.. a Pfeifer,'Ex u ive actor D to Signature: Isa el Geffner, and it erson Date AGENCY INFORMATION Page 8 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NONDISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO El ® a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ c) Current beneficiaries of the program for which funds are being requested? ❑ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination {policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be Minding 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. Si nature: g Ae utive Dir t Date Signatur. Y :� g Board Chaff pe on Date AGENCY INFORMATION Page 9 of 26 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (MonthlYear): August 24, 2015 b) Agency's Purpose/Mission (no more than a few sentences): Boomerang inspires youth to bounce back from challenges and move towards positive change. We provide youth with the support they need in times of crisis and beyond, to manage their challenges, cope with adversity and become resilient, independent young people. We strive to disrupt the school-to-prison pipeline by providing alternative-to- suspension and after school programming for middle and high school students in Chapel Hill-Carrboro City Schools and Orange County Schools. All services are provided at no cost to students/families. c] Types of Services the Agency Provides (bullet format): • Alternative to Suspension Program for middle and high school students • Continuing Connections After School (year-round) o What's Next? Middle School: skill-building workshops for middle school students © What's Next? High School: skill-building workshops for high school students including college and career readiness a What's Next? Surnmer: college and career readiness workshops o Homework Help & Tutoring o Support on Demand: brief counseling, intervention and support for students o Community Service & Service Learning projects (year-round) d) Agency's History with Providing These Services: Launched as a pilot alternative to suspension program of the Chapel Hill-Carrboro YMCA in January 2006, Boomerang expanded to include after school activities in 2008 and began summer programming in 2010. Boomerang Youth, Inc., began operations as a 501(c)3 on July 1, 2015. 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?) Boomerang completed its first year of operations as an independent non-profit. Boomerang has new partnerships with: • The Teen Center/Town of Chapel Hill where Boomerang delivers after school programming for high school students with the assistance of a part-time Parks & Rec employee during the school year. • Town of Chapel Hill Police Department where police officers participate in weekly restorative circles during Alternative to Suspension programming (conflict & communication skill-building). • Refugee Community Partnership where Boomerang provides after school services to refugee high school students, including summer programming. Agency Information Page 4 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION f) Schedule of Positions (For Entire Agency) • Full Time Equivalent(FTE)staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 2,080 # of FTE - Full-Time Paid Positions: 5 #of FTE - Paid Part-Time Positions: 1 #of Volunteers: 24 #of FTE -Volunteers: 0.5 *1,110 Volunteer hours, including UNC-MSW intern, 3 Bonner interns 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 P a g e 5 of 2 0 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget i. Is your agency currently receiving and/or requesting other (non-Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (YeslNo) Yes If yes, please list below: Include all programs that have funding requestslawardsltotals 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 17Y18-19 Source Award Request $28,131 $40,000 Juvenile Crime Prevention Council + Boomerang + $8,439 County Match $1,983 $2,500 Orange County Arts Commission Total $38,553 $42,500 `Add rows or attach additional page, if needed. ii. Submit your agency's budget. ATTACHED iii. Does your agency budget show a Surplus or Deficit? Deficit Is there a significant change?Yes/No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes. Deficit: A deficit of$18,896 is projected for FY 2018-19 as Boomerang will not be eligible to apply for fund from two foundations — Strowd Roses and Morgan Creek; they do not fund organizations for more than 2 consecutive years. Boomerang will re-apply to these foundations for 2019-2010. The deficit should be offset by surplus income from prior years. In addition, Boomerang is actively applying to other foundations. iv. What is your agency's fiscal year? July 1 2017—June 30 2018 (Example: July 1, 2016 through .June 30, 2017) DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name. Boomerang -Alternative to Suspension & Continuing Connections After School Program Primary Contact and Title: Sonia Frischemeier, Director of Operations Telephone Number: 9919) 968-2146 E-Mail: son ia.frischemeieraboomerangyouth.org 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 b3 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 Jobs/Jobs Training Food Transportation Other: Please specify c) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated/collaborative efforts. • School districts - Chapel Hill-Carrboro City Schools and Orange County schools — are core partners in coordinating services provided to suspended students and transitioning them back to school. • Department of Juvenile Justice is a core partner in coordinating services and follow- up with court-involved students. • UNC Outpatient Substance Abuse Clinic provides weekly workshops on substance use to supplement Boomerang's assessments and psycho-educational skill-building activities; an important service as substance use has been the most common reason for suspension over the last 2 years. • Orange County Rape Crisis Center provides weekly workshops on healthy relations and sexual health to supplement Boomerang's self-care and communication skill- building activities. PROGRAM INFORMATION Page 7 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 0 Partnerships: * Volunteers for Youth and the Adult Community Service to provide approved community service programming at Boomerang for juvenile and adult court-involved youth during after school hours. c The ARC of Orange County and Eyes Ears Nose and Paws (EENP) provide expanded opportunities for youth to engage in meaningful service to the community. * UNC School of Social Work provides a MSW intern each year. The intern functions as staff and provides additional support during alternative to suspension and afterschool programming. o Campus Y provides Bonner interns each year; each intern stays with Boomerang for 4 years. o UNC's APPLES Service Learning volunteers provide academic support to students, both during Alternative to Suspension and after school tutoring. o The Teen Center/Town of Chapel Hill where Boomerang delivers after school programming for high school students with the assistance of a part-time Parks & Rec employee during the school year. a Town of Chapel Hill Police Department where police officers participate in restorative circles during Alternative to Suspension programming. © Refugee Community Partnership where Boomerang provides after school services to refugee high school students, including summer programming. * Compass Center to provide financial workshops. o Durham Tech to provide career navigation workshops. o Pathways Education Consulting to provide college planning workshops pro bona. • Boomerang works with partner agencies to refer students and families for follow-up services, including: • Mental health (e.g. Carolina {Outreach, El Futuro) • Family support to provide critical assistance to parents raising school-age children with emotional/behavioral issues, mental illness, learning differences, substance abuse problems and other challenges (Freedom House, Youth Villages), and substance use (UNC-ASAP). Boomerang is a community impact partner of Orange County Family Success Alliance, contributing to the development of activities and services for youth on the cradle to college/career continuum. • Boomerang is a community partner in Orange County Misdemeanor Diversion Program: rather than face arrest and prosecution in adult criminal court, 16 and 17 year old first-time offenders with eligible misdemeanor offenses are placed on a 90-day diversion plan that focuses on addressing individual therapeutic needs or the completion of community service hours. • Boomerang is a member of the Third Sector Alliance, a community organization that seeks to address community needs and support collaborations to improve the quality of life of all who live and work in Orange County. • Boomerang is a member of the Youth Workforce Convening (Community Empowerment Fund and Chapel Hill-Carrboro Chamber of Commerce). PROGRAM INFORMATION Page 8 of 20 DocuSign Envelope ID: DlA090F6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT 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? Proposed Program Services At Boomerang, students participate in structured programming which emphasizes positive behavioral-change outcomes, and provides an opportunity to re-engage students in school and community. We do this through two program services: Positive Alternative to Suspension Boomerang's Alternative to Suspension program provides a structured and supervised environment for 6th to 12th grade students who have been short-term suspended from school. Students: • Engage in 1:1 sessions with licensed staff to discuss underlying issues that led to the suspension, identify their strengths and learn about alternative, positive behaviors/skills and coping strategies. • Receive academic support and tutoring to stay on task with schoolwork. • Build social skills and identify core values during structured group discussions. • Participate in psycho-education groups: conflict resolution; self-expression; healthy relationships; and substance use prevention & education. • Lead a wrap-up meeting with family and school representatives (and court counselor if applicable) to support their re-entry back to school. Boomerang is the only or anization that offers an alternative to short-term suspension for youth in Orange County. Our principal partners for student referrals are Chapel Hill- Carrboro City Schools, Orange County Schools and the Department of Juvenile Justice Continuing Connections After School During the critical hours after school and over the summer, Boomerang provides youth with additional learning opportunities and support, as well as recreational opportunities, to help them: • Build skills that support academic achievement. • Gain confidence and cultivate leadership skills through service learning, community service and other civic engagement opportunities. • Learn independent living and leadership skills. • Develop self-expression and communication skills through the arts. Specific services provided: - What's Next?: life skills workshops for high school students, including college and career readiness and self-expression - Tutoring (math/all levels, English, sciences) - Service learning & community service projects - Individual brief counseling Monthly: Reunions for youth to reconnect with Boomerang in a recreational setting. PROGRAM INFORMATION P a g e 9 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Summer: Weekly life skills workshops for youth, including those participating in summer employment programs and internships such as EmPowerment's Career Explorers, and for youth in Orange County Misdemeanor Diversion Program. e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services feeds Assessment, Orange County_BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. Healthy development and wellbeing are essential for youth readiness for college, work and life. Positive identity formation, parent and peer relations, and community connection are critical protective factors. However, bias, marginalization, violence and trauma can negatively affect a young person's physical, social-emotional and mental health and lead to disengagement and disconnection. In Orange County, 4.4% or 1,300 youth are neither in school or gainfully employed, and thus disconnected from educational and employment opportunities necessary to lead productive lives (Measure of America). This number does not capture the number of youth at high risk for disconnection: • Students suspended from school are up to ten times more likely to drop out of school or repeat a grade, • Youth in the juvenile justice system, • Young people with limited means and access to opportunities. The majority of students at Boomerang experience multiple forms of social and economic disadvantage: poverty, racialization, undocumented status, and/or underserved families (education, employment), and many (over 60%) have experienced trauma. These stressors can cause the disruptive, risky behaviors that interfere with a young person's daily functioning. They affect school performance, and can lead to dropping out of school, homelessness, substance use, other health-compromising behaviors, and/or involvement with the justice system. Our aim is to reduce their risk of disconnection by: • Building relationships of mutual trust (CONNECT) • Helping students acquire the knowledge, skills, and agency to successfully navigate critical transitions during their school years (BUILD) • Providing college and career readiness opportunities that supports them to move towards long-term success, developing leadership, and social and emotional skills to create positive change in self and community (INSPIRE) Boomerang seeks to empower vulnerable young people to have crisis-free lives, and build strong connections to family, school and positive peers in a supportive environment during out of school time. PROGRAM INFORMATION Page 10 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Our programming aligns with the following community goals: • Orange County BOCC Goals and Priorities Applies to all goals: • Social Justice Values: • Foster a community culture that rejects oppression and inequity. • Ensure economic self-sufficiency. • Create a safe community. • Enable full civic participation. Goal 1: Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents. Boomerang is a community member of Family Success Alliance (FSA); our work falls under the following goals of FSA's Strategic Plan 2016-2018: - Goal 2: Children and youth are healthy and succeed in school - Goal 3: Youth graduate from high school and college. Goal 6: Ensure a high quality of life and lifelong learning that champions diversity, education at all levels, libraries, parks, recreation, and animal welfare. Specifically, EDUCATION: AT-RISK CHILDREN Continue to close the achievement gaps and end the school to prison pipeline. CONNECT STUDENTS TO COMMUNITY COLLEGES • Chapel Hill Human Services Needs Assessment Education & Family Resources are identified as an important community need. According to one stakeholder, with the "tremendous spike in our number of homeless students, free and reduced lunch numbers and English language learners," many students still need help. Quality, equitable education for everyone One stakeholder explained, "The public school system is not adequately preparing [students] for successful independent living after high school." Within this category, Youth Support and Activities are highlighted with many participants agreeing "Chapel Hill lacks sufficient low-cost/free activities that positively engage children and youth, especially those from at-risk and low-income households". Among the responses to this Assessment, participants specifically cited the need to support [for] at-risk children and teens. • Town of Chapel Hill Council Goals, 2016-18 Community Prosperity: Develop a strategy for creating vocational classes and career development for youth with the school system, Durham Tech and other non-profit organizations. This builds on the 2016 Council Goal (2014-2016 Council Goals Status Report), under Nurture Our Community: Create a strategy to impact out of school time, ESL, and vocational classes for youth with non-profit organizations (2016 Goal) • Chapel Hill 2020 -Theme 1: A Place for Everyone states "Chapel Hill is a place for PROGRAM INFORMATION Page 11 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION youth, students, singles, families, retirees, and people at every life stave." Carrboro Board Priorities: E. Enhance and sustain quality of life/place issues for everyone 7. Help citizens develop a human environment that promotes trust, mutual respect, acceptance, happiness and well being. (Planning) f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Boomerang primarily serves youth ages 11-19 in Orange County. Please note, we continue to provide support to a small cohort of young people who are now beyond this a e_range, but who return to us after high school for support and mentorship. Youth are referred by the two school districts, juvenile justice system and other non-profits whose work supports at risk youth including Family Success Alliance and Orange County Misdemeanor Diversion Program. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Direct Support Staff Administration Executive Director (LCSW) Executive Director Program Manager (LCSW-A) Director of Operations Program Manager (LCAS) Office Manager ATS Student Coordinator MSW Intern Direct services are provided by licensed staff with graduate degrees in Social Work or Counseling, or equivalent experience working with vulnerable youth. A part-time student coordinator and a MSW intern (UNC-Chapel Hill School of Social Work) assist direct support staff for the Alternative to Suspension program. Licensed staff participates in Continuing Education throughout the year to keep licenses in good standing. In addition, Boomerang has three interns from the UNC-CH Bonner Leaders Program who help with student supervision, 1:1 tutoring, and program development and evaluation, among other duties. All staff members, including our MSW Intern, participate in an annual 2-day training retreat before the start of a new school year conducted by the Executive Director. All volunteers participate in a half-day orientation. All staff, interns and volunteers carefully review and sign Boomerang's Code of Conduct, Child Safety Policy and Confidentiality Agreement, and go through a comprehensive background check. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Activities will be carried out from July 1, 2018 to June 30, 2019. PROGRAM INFORMATION P a g e 12 of 2 0 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Alternative to Suspension Traditional school calendar for CHCCS and OCS; community service opportunities are provided on teacher workdays; Monday-Friday, 9am-2pm. Continuinq Connections After School During the school year: Monday to Wednesday, 4-6pm Summer schedule is posted in June ii) 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) Boomerang contributes to safer schools and community. As the only organization that offers an alternative to short-term suspension for youth in Orange County, youth are supervised in a safe, positive environment, get the support they need at a time of crisis, learn and build on skills that will help them be successful, and keep up or catch up with schoolwork. Our after school programming continues the important work of skill-building and support. It is critical to provide a safe space—for learning, support and recreation -to young people who often have limited access to after school activities. Investing in all our youth is vital for the social and economic wellbeing of our community. We believe that empowering underserved youth is key to achieving greater equity of opportunity and outcomes for all Orange County residents. Boomerang programs work with vulnerable youth to address some of the barriers they face so they can be successful in school and in life. We do this in concert with other local partners to build and maintain a network of services and activities that lift young people up. j) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If the requested funding is not awarded or is at a reduced level, Boomerang may need to reconsider services offered and the number of youth served. k) What percentage of your target population is low-moderate income? Boomerang does not require families to provide this information. According to self-reports when provided, approximately 60% of students served are low income. I) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc.?) Student surveys • Parent/guardian surveys Follow-up phone surveys with families • Focus groups on program services • Focus needs assessment groups m) Include any other pertinent information. PROGRAM INFORMATION P a g e 1 3 o f 2 0 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Boomerang will be undertaking a program evaluation in 2018, including reviewing program evaluation metrics. This will build capacity both in program development and delivery. Additional Program Information n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics-ALTERNATIVE TO SUSPENSION PROGRAM Actual Estimated Projected 2015-17 2017-18 2018-19 Gender Male 113 100 100 Female 58 50 50 Total 181 150 150 Ethnicity African-American 82 65 65 American Indian or Alaska Native 0 0 0 Asian 0 0 0 Caucasian 48 75 75 Other: specify Hispanic/Latino 37 ' Other: Not specified/Multi-Racial 14 10 10 Total 181 150 150 Of the above, how many Hispanic/Latino 37 45* 45 * Of the above, how many non-Hispanic/Latino 144 105 105 Total 181 150 150 Age Ages 10-13 46 30 30 Ages 14-16 91 100 100 Ages 17-19 44 20 20 Total 181 150 150 Geographic Location Orange County Breakdown Chapel Hill: zip codes 27514, 27516, 27517 87 85 85 Town of Carrboro: zip code 27510 17 15 15 Orange County 77 50 50 Total 181 150 150 Note: We do not have the means of determining whether students reside within Chapel Hill or Carrboro city limits, in public housing, or in unincorporated areas. PROGRAM INFORMATION Page 14 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT 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 9 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 elderlyldisabled 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 900 meals per day, Monday-Friday.) Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 905 meals per day.) Work Statement:Chart for Program Boomerang 1. Program Activity Name Alternative to Suspension Program Goal 85% of students will successfully complete the alternative to suspension com onent Performance Measures School referral, daily attendance, qualitative notes on student participation and behavior, student External Service Note to schools/courts, internal service notes Previous Year Program Results 97% - 176 out of 181 referrals Current Year Estimated Results 85% - 128 out of 150 Next Year Projected Results 85/0 - 128 out of 150 2. Program Activity Name Community Service Program Goal 50% (15130) of youth will self-report learning/improving skills and will actively participate in Community Service projects Performance Measures Community service referral forms, daily timesheets, reports to Volunteers for Youth and Adult Community Service, youth surveys Previous Year Program Results 72 individual students performed 381 instances of community service equaling 720 hours; students participated in 100% of scheduled community service days at Boomerang—goal has since been revised Current Year Estimated Results 50% (15 students) Next Year Projected Results 50% (15 students) 3. Program Activity Name What's !Next? Program Goal 75% of youth attending What's Next?life skills workshops will report having significantly improved knowledge of subject area Performance Measures Post-session surveys, focus groups Previous Year Program Results 67.5% of youth reported having increased knowledge. 6 workshops were held for high school students and 6 workshops were held for middle school students. • 6 What's Next?workshops were held on life skills development for high school students. PROGRAM INFORMATION P a g e 15 of 2 0 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION • What's Next? For Middle School: Six workshops were held at A.L. Stanback between April and June for eight 6th grade boys.The objective is to provide support for the"transition" years between elementary and high school. Boomerang is committed to providing these workshops in 2017-18 and hopes to secure funds to support this. • Floraffiti: 6 court-involved youth participated in a rehearsal workshop on April 6th, and performed their spoken word poetry during the 2"d Friday ArtWalk on April 14th in Chapel Hill and Carrboro. Current Year Estimated Results 75% Next Year Projected Results 75% 4. Program Activity name Intensive Follow Up Program Goal 50% of youth (6/12) identified for intensive follow up services will show an increase in social connectedness (positive peers, family, school, community) by the end of the school year Performance Measures Beadiness to Change scale, post-surveys, school/family feedback, decreased recidivism Previous Year Program Results 140% of the 12 students identified for intensive,follow-up services showed an increase in social connectedness. Staff visited students at school when feasible, followed up with families as needed and engaged students via social media.All either graduated or were promoted to the next grade. Each one of them moved upwards in the Readiness to Change Index' from 5 to 8 or 9. Current Year Estimated Results 50% Next Year Projected Results 50% p) Program Budget 1. Submit your program budget. ATTACHED 2. Program Budget Detail— Provide description of"other" budget items, not defined. The attached budget provides itemized detail for the majority of anticipated expenses. The budget line `other costs" is for miscellaneous expenses that we have not foreseen. Other Expenses 2016-17: Contracted Services $14,858.00 Communications & Postage (telephone/Internet) $1,949.00 Printing & Binding $503.00 Repairs & Maintenance $847.00 Dues &Subscriptions $864.00 Insurance & Bonding $8,136.00 Bank Fees $40.00 Website Development $2,950.00 Marketing $838.00 Translation Services $795.00 Conferences $50.00 Total Other Expenses $31,930.00 ' Pre-contemplation (0-3): students do not recognize the need to make any changes Contemplation (4-6): students are considering making a change and benefit from Boomerang's brief intervention made§and follow-up services Preparation (7-8): students are preparing to take action and need follow-up services to support them Action/Maintenance (9-10): students have made positive changes and need support to maintain the gains they have made PROGRAM INFORMATION Page 16 of 20 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 3. This program budget represents what percent of the agency budget? 100% 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total programs budget divided by the total number of program individuals in this application. ,Actual 2018-17 Estimated 2017-18 Projected 2018-19 Total Cost of Program 285,898 332,807 331,496 Total# of Individuals 1094 1250 1250 Cost Per Individual 243 286 265 We define "# of individuals" in terms of weighted Units of Service. UNIT OF SERVICE: reflects the services each student receives in terms of 1:1 time with the licensed clinical staff, 'dosage' of services they receive with guest speakers, group sessions and academic engagement (tutoring, communicating with teachers, follow-up support), as well as after school programming (community service, service learning, What's Next?, drop-in brief crisis counseling, schoolwork help). 2016-17 2-4 day ATS = 1 unit of service = 126 units 5-7 day ATS = 2 units of service = 27x2 = 54 units 8-10 day ATS = 3 units of service = 28x3 = 84 units Instances of students working on service projects = 1 unit of service = 381 units Students receiving intensive follow-up services = 3 units of service = 12x3 = 36 units Instances of students attending What's Next? = 1 unit of service = 231 units Instances of students receiving after school tutoring = 2 units of service = 8x2 = 16 units Student attending Open Doors (drop in, brief crisis counseling) = 1 unit of service = 156 units PROGRAM INFORMATION P a g e 1 7 o f 2 0 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME: Boomerang Youth Inc. Actual Estimated Projected Percent AGENCY REVENUE 2016-17 2017-18 2018-19 Change Private Donations $ 33,413 $ 45,000 $ 60,000 33% Agency Generated Revenue(fees) $ - $ - $ - 0 Local Government Grants; Human Services-Town of Carrboro $ 2,500 $ 3,500. $ 5,000 43°/0 Other-Town of Carrboro $ - 5 - $ - 0 Human Services-Town of Chapel Hill $ 3,500 $ 7,000 $ 12,000 71% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-orange County $ 8.750 $ 11,725 $ 16.000 36% Other-Orange County Arts Commission 1 $ - $ 1,983 1 $ 2,500 1 26% Other-Town of Hillsborough $ - $ - $ 0 Other Government Grants Triangle United Way/Family Success Alliance $ 6 371 $ 6,950 $ 6,950 0% Juvenile Crime Prevention Council $ 41,276 $ 36570 $ 55,000 50% School Districts $ 55,000 1 $ 55,000 $ 55,000 0% Private& Non-Profit Foundation Grants 1 $ 219,868 1 $ 170,500 $ 97,000 113% Other Revenue $ 3 150 $ 3 150 $ 3 150 0°I0 Total Agency Revenue 1 $ 373,828 $ 341,3781 $ 312,600 -8% AGENCY EXPENSES 0 Compensation S 199,650 $ 267,274 $ 273,486 2% Rent& Utilities $ 19,001 $ 21,400 $ 21,400 0% Supplies& Equipment $ 14,766 $ 15,029 $ 6,300 -58% Travel&Training $ 551 $ 1,100 $ 1,000 -9% Other Expenses: $ 31 930 $ 28,004 $ 29,310 5% Total Agency Expenses $ 265,8981 $ 332,807 1 $ 331,496 0% SURPLUS/(DEFICIT) FOR PERIOD: $ 107,930 $ 8,571 $ (18,896) -320% FY 2018-19 Agency Budget DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: BOOMERANG Y0LffC4PJ@RA§ '@W,§ A9Y9RttY PP LMATION ANNUAL INCOME 2018-19 Sunrise Rotary Club 1,000.00 GSK Foundation EasyMatch 1,000.00 United Way (Family Success Alliance) 6,950.00 Juvenile Crime Prevention Council 55,000.00 Orange County Schools 25,000.00 Chapel Hill-Carrboro City Schools 30,000.00 Outside Agency Funding - Orange County 16,000.00 Outside Agency Funding - Town of Chapel Hill 12,000.00 Outside Agency Funding - Town of Carrboro 5,000.00 Oak Foundation 75,000.00 Mead Family Foundation 15,000.00 Orange County Arts Commission 2,500.00 Mary Duke Biddle Foundation 5,000.00 Individual Contributions 50,000.00 Other Types of Income 3,150.00 TOTAL INCOMEJ 312,600.00 ANNUAL EXPENSES 2018-19 Salaries $ 239,460.00 Payroll Taxes $ 23,946.00 Benefits $ 10,080.00 Worker Camp Insurance $ 3,000.00 Payroll Service $ 1,500.00 Background Checks $ 300.00 Outside Contract Services $ 10,540.00 Accounting Fees ($40/hr) $ 1,920.00 Building Maintenance & Repair $ 1,000.00 Rent $ 17,400.00 Utilities $ 4,000.00 Office Expenses & equipment $ 1,000.00 Postage, Mailing $ 500.00 Printing, Copying $ 1,000.00 Program Expenses $ 2,000.00 Telephone $ 2,200.00 Bank Service Charges $ 100.00 Marketing $ 2,000.00 Insurance $ 3,500.00 Membership & Professional Cues $ 750.00 Program Food $ 3,000.00 Food-StaffNolunteers $ 154.00 Other Costs $ 500.00 Staff Development $ 1,000.00 Translationllnterpretation $ 550.00 Local Travel $ 100.00 TOTAL EXPENSES 331,496.00 Net Income - 18,896.001 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 XHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Schedule of Receipts and Expenditures For Agencies with Revenues Less than$500,OOD Purpose:This form Is—agencies�nith receipts less Ihan$6WAD that do not have a rmancial audit for a flriandal report),prepared by a certified public accountant(CFA]Am agency does not need to cOnplete this form if it has a prepared audltlrepod a.can si�7mit for the calendar year and ng December 31,2U76 orthe fiscal year ending June 30.2017.Agencies with receipts totaling$500,000,from any source,must submit a CPA- certified finandal audn. Directions:Tab through each field to enter information.The ReceiptrdAmounts columns will Calculate totals for each sectionlsubsecton row.You wilt oe unable to r[odl Pocked cells. �Aczencv en fnfo rmatlon Name: fnc. ailin Address 825A N.Estes Lk enc Fiscal Year End: mrrddc 6f3>712Ut7 2. Proparer.p��u 5wo n,�s Employee arrawAnnvsreucwcu xru THE ooraaFCreat: p Y CPAIAccountaart Name of Pre rer. Tike Barron Pre hers rrde. Bookkee -r Da 'me Phone Number. 919-417-6M t snail Address: tikx& c"izw 3. Recei ndin Source Pu DollarAmount Foundations Fu 8 Trust Cwts FundlR far prngrams 120.000 Non refit 6 aruzatlan Grants Fundin for rams 102 827 IndMdual Business Conalbutions Funding for .rams 33 413 Lace)Gavamment Contrails rams for rams School Grants Funding for 53 087 rams 53 000 United CFC Conhibuiians Fundin for programs 6 371 Rental income Funding for rams(Boomerang rents one pMrarn spa ce 3.15.0: during the sr3hW y ear to the Chapel Hill-Carrhoro YMCAfcr their after srdwd outreach Prograrn-ilarntaa students in ubllc hatch Total Receipts: 373,828 4. 5xpInditures Parson C o DollarAmourrt e9 1 Contracted Services 14,858 a Total PersonrrelfCnMraeted Services Costs: $ 214,507 Office Su Iles&Materials Servic 2 049 e fielated Su Vies 1 498 b Total Su IIas&material Costs: $ 3 547 Travel 47 Communications&Posta 9 Utilities 1.901 1 944 Printin &Binding Re i 603 t&MaIntenance e03 Meetin Confamnce Ex nse - Ein h e'rrdinin notravei 505 CiassiFred Advertisin In-State Board Moubno Exoenses c T aI Hon•Rxed[f rah ift nse: $ 5768, Office Rent Land Buildin s ate_ 17 1100 Furniture Rental - _ _Equip,ment Rental Phones Computers.etc. Vahicle Rental Dues&Subscrintons 864 insurance s Bonin S 136 BookslLibra Reference MaLerFa& Mort a e Princi i Interest and Bank Fees 40 Id Total Fixed Charges&Other Expenses: $ 26 940 Building a Improvements Leasehold I mprovqements Fumiturelhion-Oom ter Equip.,5500+per item _ Cam ker E ui entfPrinters$5W+ r item 9 Fumi€urelE i under$50D per item e atal P e &E ui ment O S 9=1 Purchase of Services Corrects Wth Serviee praMars Sb ndslScholarshi onusesGrents Total Serulemicontraets: S Website development wabste development and maintenance 2.950 Marketing Brodures event invitations 838 Otherexpense _ Transta6ah(S795);Conferences SW etechiciar S85 23p Food Ar S.onianizaton students receive tree meals,snacks 1.838 Total Otlfer f x nses 5 6.556 Total Expenditures ISlurn of subtotals a tlrrau h $ 265,898 unex eroded cash balance do NOT use with reimbursement rants E3e innin of me Year cash halan $ End of th;Q- S 107 833 Date1 d 7'AMI PFEIrER Pint Name DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 EXHIBIT "B" Scope of Services—FY 2018-19 Outside Agency Performance Agreement Agency Name: Boomerang Youth, Inc. Program Name: Early Intervention Services for Youth Funding Award: $13,008 Outline how the agency will spend Orange County's funding award. Expense Description Amount Program Manager Salaries 12,258.00 Contractors for psycho-educational skill building groups 750.00 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2019. • Alternative to Suspension: structured day program for short-term suspended middle and high school students attending Orange County Schools and Chapel Hill-Carrboro City Schools • Continuing Connections After School o Support and skill-building groups for middle and high school students, and summer interns a Individual brief counseling o Community service projects Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of personslunits 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 85% of students attending Boomerang's Alternative to Suspension program will successfully 128 out of complete it 150 50% of youth will self-report learning/improving skills and will actively participate in community 15 out of 30 service projects 75%of youth attending skill-building groups will report having significantly improved 30 out of 40 knowledge youth 50%of youth identified for intensive follow up services will show an increase in social 6 out of 12 connectedness by the end of the school year E OocuSignejrd�br jyr:��(< lt P!�'1 v' SB35A.F5,2C51431... Executive Director 8/16/2018 J Certified by: - r J_ Title: Executive Director Date: 7/24/2018 (Provider's Sig at ) DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 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. [I-mi UocuSigned by: P�� Executive Director 8/16/2018 Certified by: sas5ai Title: Date: (Provider's Signature) (Boomerang Youth,Inc.) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID: DlA09OF6-2A4E-4FOB-9FB7-92FFFC9El3D2 A� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ 07/25/22018 018 Y) 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 Diane Nadeau NAME: Business Insurers of Carolinas AICONNo Ext: (919)968-4611 FAX No): (919)968-8991 800 Eastowne Drive,Suite 208 E-MAIL dnadeau @business-insurers.com ADDRESS: PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INSURERA: Western World Insurance Company 13196 INSURED INSURER B: Amguard Insurance company Boomerang Youth Inc INSURER C: United States Liability Insurance Company 25895 825-A North Estes Dr INSURER D: INSURER E: Chapel Hill NC 27514 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 GL,WC 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 DAMAGE CLAIMS-MADE OCCUR ,REM SESOEa oiccErDence $ 100,000 MED EXP(Anv one person) $ 5,000 A NPP8393619 07/01/2018 07/01/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ LOC PRODUCTS-COMP/OPAGG $ INCL PRO- OTHER: Professional $ INCL AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED NPP8393619 07/01/2018 07/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION X1 PER STATUTE EORH AND EMPLOYERS'LIABILITY YIN 100 0�0 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED? N/A R2WC908075 06/30/2018 06/30/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Directors&Officers Each Occurence $1,000,000 C ND01570583B 07/01/2018 07/01/2019 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orange County Human Services ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough NC 27278 Qt6ja%! @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD