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2018-634-E Finance - Movement of Youth outside agency agreement
(Movement of 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 Movement of Youth Inc., a not-for-profit corporation, located at 406 Blackwell Street B030, Durham, NC 27701 (“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 Movement of 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 $30,529. 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 $7,632.25. 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: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 (Movement of 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: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 (Movement of 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: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 (Movement of 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 Movement of 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: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 (Movement of 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: Movement of Youth Inc. 406 Blackwell Street B030 Durham, NC 27701 DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 1. COVER PAGE a)Applicant Contact Information Applicant Organization’s Legal Name: Movement of Youth, Incorporated Applicant Organization’s Physical Address: 406 Blackwell Street, Suite B030, Durham, NC 27701 Applicant Organization’s Mailing Address: Same as above Applicant Organization’s Web Address: www.movementofyouth.org Executive Director: Atrayus Goode Telephone Number:(800) 956-3820E-Mail:agoode@movementofyouth.org Tax IDNumber: 26-2399990 b)Funding Request List all FY18-19Human Services(HS)Funding Being Requested – For All Programs)and the Proposed Use of Funds (2-3 lines or less) Program Carrboro -HS Chapel Hill-HS Orange County-HS Total MBK Spring Break College Tour.Travel and Lodging for 50 students from MBK-related agencies 26,250.00 26,250.00 MBK Saturday Leadership Academy & Team Mentoring.Cost for 50 students from MBK-related agencies to receive comprehensive Saturday Leadership Academy that focuses on mastery of 21st Century Skills and Team Mentoring that focuses on life skills and character development. 12,736.00 12,736.00 MBK Opportunity Summits.Cost for supplies, food, presenters, and materials for two (2) MBK Opportunity Summitsfor high school students, college students, K- 12 educators, and community and business leaders. Summits will focus on student achievement, career/personal/professional development, social justice and engagement, and mentorship. 10,000.00 10,000.00 Mentoring&YouthProgramDevelopment.Cost for technical assistance to support MBK-related agencies, including in-person staff training workshops, training facilitation (mentor/mentee/parents), and baseline data assessments to help these programs incorporate or enhance quality youthdevelopment practices that lead to long term sustainability. 40,000.00 40,000.00 EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Totals 88,986.00 88,986.00 c)To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: January 23, 2018 Executive DirectorDate Signature: January23,2018 Board ChairpersonDate EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 d)DISCLOSURE OF POTENTIAL CONFLICTS OF INTERESTAND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates… YESNO a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, orOrange County? b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, orOrange County? c) Current beneficiaries of the program for which funds arebeingrequested? 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 enforcedby 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 programineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: January23,2018 Executive DirectorDate EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Signature: January 23, 2018 Board ChairpersonDate EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pagesOR LESS): a)Years in Operation, Date of Incorporation (Month/Year):11years, incorporated in 2008 b)Agency’s Purpose/Mission (no more than a few sentences): Movement of Youth (MOY) prepares diverse youth to lead and succeed in the 21st Century through mentoring and targeted enrichment activities led by college students. MOY aspires to be the nation’s leading movement for young people to disrupt the status quo and build a safer, smarter, more socially conscious world. c)Types of Services the Agency Provides (bullet format): x Leadership Academy x Team Mentoring x College Tours x Summer Enrichment Academy x International travel via the J.U.S.T Global Fellowship x College scholarships through the Tyreic E.Hemphill Memorial Scholarship Fund d)Agency’s Historywith Providing These Services: Targeting only 11 students in 2006, MOY has grown to impact hundreds of middle and high school students annually and is in the process of scaling nationally.MOY was recognized in 2016 as the North Carolina Innovative Program of the Year by the Public School Forum of North Carolina, a well- respected think tank that for more than 30 years has provided trusted, nonpartisan, evidence-based research, policy analysis and innovative programs that empower an informed public to demand that education best practice becomes common practice throughout North Carolina. Student Population x 6th –12th grade students x 95% African American x 4% Latino Achievement x 100% of MOY students complete at least eight (8) hours of community service per year, amounting to 10,000+ hours since 2006 x 100% of MOY high school students are enrolled in at least one (1) honors or Advanced Placement Course x 100% of MOY students graduate from high school x 96.5% of MOY graduating seniors enroll in college x Through the J.U.S.T. Global Fellowship (est. 2014), 20 people of color (youth and adults) have had the opportunity to travel abroad x Through the Tyreic E. Hemphill Memorial Scholarship Fund (est. 2012), $20,000 in scholarships have been awarded to graduating seniors EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 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?) MOY has been commissioned by the National Mentoring Partnership (MENTOR) to launch MENTOR Carolinas, a local Affiliate that will provide the leadership and infrastructure necessary to support the expansion of quality mentoring relationships across North and South Carolina. MENTOR Carolinas will also serve a unique role as a clearinghouse for training, resources, public awareness and advocacy, providing the critical link between MENTOR’s national efforts and local organizations and programs that foster and support quality mentoring relationships. f)Schedule of Positions (For Entire Agency) x Full Time Equivalent (FTE)staff will be noted as 1.00; half time as .50; quarter time as .25, etc. x 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: 2 # of FTE -Paid Part-Time Positions:1 # of Volunteers:220 # of FTE -Volunteers:0 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?No If no, please explain. MOY is based in Durham County. EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 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?(Yes/No)No If yes, please list below: Include all programs that have funding requests/awards/totalsfrom Carrboro, Chapel Hill, and Orange County governments(other than Human Services).DO NOT include federal funding sources, such as CDBG and HOME. Program FY17-18 Award FY18-19 Request Source Ex: Affordable Rental Rehabilitation 0 $20,000 Carrboro -Affordable Housing Ex: Agency Administration $15,000 $15,000 Carrboro –Other Ex.Total $15,000 $35,000 Carrboro Total Funding *Add rows or attach additional page, if needed. ii.Submit your agency’s budget.You may complete the provided template(separate xlsfile)or you may submit your own budget file (as long as it contains the same information, and in a similar format, asrequested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: x Revenues o Private Donations o Program Generated Revenue o Local Government Grants Carrboro Human Services Carrboro Other Chapel Hill Human Services Chapel Hill Other (DO NOT include CDBG funding here) EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Orange County Human Services Orange County Other (DO NOT Include HOME funding here) o Other Government Grants Triangle United Way State Government Federal Government (CDBG/HOME/etc.) Private Foundation Grants o Other Revenue x Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel & Training o Other Expenses iii.Does your agency budget show a Surplus or Deficit? Small deficit in 2016-2017, surplus in 2017-2018 and 2018-2019 Is there a significant change? Yes/No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes. x 2016-2017 deficit is due to unreimbursed expenses associated with the relaunch of MENTOR Carolinas. x 2017-2018 surplus is due to anticipated funds from foundations to support capacity building for MENTOR Carolinas. Surplus will be invested in personnel and program related expenses. x 2018-2019 surplus is 6 month emergency reserve. Significant changes are noted due to anticipated funds associated with the launch of MENTOR Carolinas. MENTOR Carolinas will support the capacity building needs of MBK Orange County. iv.What is your agency’s fiscal year? January 1 through December 31 (Example: July 1, 2016 through June 30, 2017) EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Agency Budget Operating Budget for Entire Agency Actual 2016-17 Estimated 2017-18 Projected 2018-19 Percent Change 154,119$ 720,286$ 732,326$ 2% 69,045$ 56,414$ 330,982$ 487% -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ 24,213$ 88,986$ 268% -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ 1,000.00$ 339,183.00$ 33818% -$ -$ -$ 0 Private Foundation Grants-$ -$ -$ 0 -$ -$ -$ 0 223,164$ 801,913$ 1,491,477$86% 50,817$ 72,542$ 414,705$ 472% 8,640$ 10,939$ 10,568$ -3% 20,241$ 21,787$ 18,680$ -14% 21,775$ 6,149$ 11,140$ 81% 130,243$ 129,986$ 493,846$ 280% 231,716$ 241,403$ 948,938$ 293% (8,552)$ 560,510$ 542,539$ -3% Total Agency Revenue Agency Generated Revenue (fees) AGENCY NAME: Other Revenue SURPLUS/(DEFICIT) FOR PERIOD: Other Government Grants Triangle United Way State Government Federal Government (CDBG/HOME/etc.) Compensation Rent & Utilities Other Expenses: Total Agency Expenses Supplies & Equipment Travel & Training AGENCY EXPENSES AGENCY REVENUE Private Donations Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Movement of Youth Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill FY 2018-19 Agency Budget EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Program Budget Operating Budget for Program Actual 2016-17 Estimated 2017-18 Projected 2018-19 Percent Change -$ -$ -$ 0 -$ 22,640$ 22,640$ 0% -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ 24,213$ 88,986$ 268% -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ 1,000.00$ -$ (1.00)$ -$ -$ -$ 0 Private Foundation Grants-$ -$ -$ 0 -$ -$ -$ 0 -$ 47,853$ 111,626$ 133% -$ 5,550$ 5,550$ 0% -$ -$ -$ 0 -$ 7,327$ 8,876$ 21% -$ -$ -$ 0 -$ 45,347$ 99,821$ 120% -$ 58,224$ 114,246$ 96% -$ (10,371)$ (2,620)$ 75% PROGRAM REVENUE PROGRAM NAME My Brother's Keeper Orange County 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 Travel & Training Other Expenses: Federal Government (CDBG/HOME/etc.) Supplies & Equipment Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities SURPLUS/(DEFICIT) FOR PERIOD: Total Program Expenses FY 2018-19 Program Budget EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: My Brother’s Keeper (MBK) Orange County Program Primary Contact and Title: Atrayus Goode, President & CEO, Movement of Youth Telephone Number:(800) 956-3820E-Mail: agoode@movementofyouth.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 b)Indicate the type of program for which you are requesting funding (Check all that apply to this program) c)Provide a bulleted list ofother 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. x Beyond Expectations is dedicated tomentoring adolescents in grades 6 through 12 in Orange County, NC. On two Saturdays each month, youth participate in a variety of activities to support them academically, emotionally, and socially. Jeff and Charlene Campbell, Program Directors, have actively supported MBK Orange County activities for the past two years, through coordination of community summits. They will continue serving MBK Orange County through work on the inaugural Board of Advisors. x Fathers on the Move provides transitional services to males over the age of 16 who are involved in the criminal justice system and have children. The program is also open to all males needing support, guidance and mentorship. Victor Glover, leader of Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare Education X FamilyResources X Jobs/Jobs Training X Food Transportation Other: Please specify Capacity building for organizations providing the services listed in Priority Area #2 _________________X EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Fathers on the Move, has supported MBK Orange County as a member of the Board of Advisors. x North Carolina Scholars Latino Initiative (N.C. Sli)seeks to create pathways to educational, professional, and civic engagement opportunities for a new generation of Latinx leaders in North Carolina. In 2015, N.C. Sli was named a “Bright Spot in Hispanic Education” by the White House Initiative on Educational Excellence for Hispanics. In Orange County, N.C. Sli currently works with students from Carrboro High School and Chapel Hill High School. MOY President & CEO Atrayus Goode serves on their Board of Directors, and MOY and N.C. Sli work together through sharing of best practices and collaboration on funding proposals to expand the capacity of both organizations. Program Description (3 pagesOR LESS) Please provide thefollowing information about the proposed program: d)Summarize the program services proposed and how the program will address a Town/County priority/goal? Per Orange County BOCC priorities to foster a community that rejects oppression and inequity, ensure economic self-sufficiency, and close the achievement gap and end the school to prison pipeline, MBK Orange County will ensure that participating youth (1) meet the requirements to graduate from high school to enter careers or to pursue higher education; (2) have access to post-secondary educational options or work-based learning options that lead towards job placement; and (3) have access to jobs that provide a livable wage.The following strategies will be employed to accomplish this goal: 1.Identifying career clusters and specific job pathways to identify key knowledge and skills that students need to perform in defined career areas. 2.Expanding the capacity of organizations and programs that support the development of 21st Century Skills (also referred to as the New Basic Skills). 3.Developing a youth one-stop-shop to provide young people with information about how to access relevant services. 4.Increase local business and nonprofit participation to expand work-based learning programs (e.g. Institute of Civic Engagement for Emerging Leaders, AmeriCorps) to serve greater numbers of Orange County Youth. 5.Expand the capacity of organizations and programs that support college access and readiness. e)Describe thecommunityneedorproblem tobe addressed in relation tothe Chapel Hill Human Services Needs Assessment,Orange County BOCC Goals and Priorities,Town of Chapel Hill Council Goals,Carrboro Board Priorities,or other community priorities (i.e. Council/Board Goals). Referencelocal data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. The stakes are high for society as a whole, but especially for disadvantaged youth. If they do not graduate from high school, they are less likely to be prepared to raise a family, become civically engaged, or be able to compete in the workforce. Locally, outcomes within the Chapel Hill-Carrboro City Schools System can still be predicted by race, with white students’ outcomes in every area always above those of black and brown EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 students. For example, in 2013-2014, only 20-30% of African American children meet standard achievement requirements for their grade level. Recent data reveal that 85% of black male students in 8th grade were unable to pass the end-of-grade reading test. The Board of Orange County Commissioners in its 2016 annual retreat committed to social justice valuesas well as enhancing education for at-risk children; MBK Orange County represents a focused, coordinated initiative that is organized to identify and support opportunity youth—in particular boys and young men of color—who can be successful when given the opportunity to pursue the best lives possible. f)Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? MBK Orange County has beenwork with diverse youth—in particular boysand young men of color—that need access the knowledge, skills, and resources needed to be engaged, productive 21st century citizens. We will expand the work that we began last year, and participating youth come from Orange County community organizations, Chapel Hill Carrboro-City Schools, and Orange County Schools, all of which are represented on the MBK Advisory Board and currently work with Movement of Youth/MBK Orange County. g)Describe the credentials of the program manager and other key staff.(Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Seeing such a need to address the educational and social needs of underrepresented populations, Atrayus founded Movement of Youth (MOY) in 2006 as a junior at the University of North Carolina at Chapel Hill. Targeting only 11 students in 2006, MOY has grown to impact hundreds of middle and high school students annually and is in the process of scaling nationally. Atrayus has received numerous awards and accolades for his work, including the Triangle Business Journal's 40 Under 40 Leadership Award and the North Carolina Governor’s Medallion Award for Volunteer Service, the state’s highest award for volunteer service. He has also been featured on various media platforms, including TED. Atrayus will oversee overall strategic and operational responsibility for MBK Orange County staff, programs, expansion, and execution of its mission. Education x Duke University Divinity School, Master of Arts, Christian Practice (expected 2019) x American University -School of Public Affairs, Master of Science, Organization Development (2015), Cohort 69 Representative x Duke University, Certificate, Non-Profit Management (2013) x The University of North Carolina at Chapel Hill, Bachelor of Arts, Communication Studies (Interpersonal and Organizational Concentration), (2007), Order of the Golden Fleece Honor Society, 100 Black Men of America Merit Scholarship Recipient x Myers Briggs Type Indicator (MBTI®) Step I™ and Step II™ Certification, Myers & Briggs Foundation(2017) Associate Director, MBK Orange County –TBA August 2018 The Director of Programs will be tasked with convening various groups to ensure community support towards the MBK initiative. The Director will do the following: x Increase community engagement x Increase Service Provider/Non-Profit/Government Agencies Engagement EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 x Increase engagement of funding community x Research and develop comprehensive list of organizations that impact males of color x Plan and organize targeted outreach events to these organizations x Attend community events to provide information on MBK x Research best practices to increase website traffic, social media engagement, and other communication outlets x Develop and analyze custom data reports to illustrate the impact of MBK and recommend how to integrate results into sustainable efforts AmeriCorps VISTA Members –TBA August 2018 MBK Orange County VISTAs will advance the MBK agenda in Orange County in partnership with Movement of Youth (host agency) and various stakeholders.VISTAs will support execution of the MBK Orange County Community Challenge Action Plan, which calls for individuals to work on key initiatives to support boys and men of color in Orange County through activities such as: x Engaging key stakeholders in advancing the local MBK strategy; x Raising money and/or developing resources to implement communities’ local MBK strategy; x Developing and implementing a public service campaign to raise awareness of communities’ local MBK initiative; and x Evaluating the impact ofthe local MBK initiatives. h)Describe thespecific periodoverwhichtheactivities will be carried out andinclude an implementation timeline. Implementation Timeline (Jul 2018 –Jul 2019) x Establish shared measurement practices and begin baseline data assessment (Jul 2018 –Sept 2018) x MBK Agency Technical Assistance (Sept 2018 –ongoing) x Scan of current youth-serving and mentoring organizations completed (Dec 2018) x MBK Mentor recruitment, training, and screening (Jul 2018 –Sept 2018) x MBK Mentee recruitment, orientation, and screening (Jul 2018 –Sept 2018) x Saturday Leadership Academy and Team Mentoring (Sept 2018 –Apr 2019) x Step to the Future Spring Break College Tour (Apr 2019) x Host Opportunity Summits to engage public, private, and nonprofit leaders, provide technical assistance and training, and to track progress on goals (Nov 2018, Apr 2019) x End of program year data assessment (Jul 2019) i)Why is funding this program a good investmentfor the community?How does funding this program add value to the community? (250 words OR LESS) Investment is needed in these types of initiatives. Poor students and students of color are more likely to drop out of school than any other group of Americans and end up underemployed, reliant on government assistance, and facing a lifetime of health problems as a result. Funding MBK Orange County adds value to the community because it will augment or intensify the work in progress, as opposed to starting a new program, based on data and findings. Movement of Youth, the back bone organization, will continue to leverage stakeholders, manage workflow, and capture outcomes to ensure progress towards goals. j)Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Movementof Youth (MOY) has had success this past year serving as the backbone agency of MBK Orange County. Specifically, the work engaged 14 key community stakeholders that describedacommon MBK agenda,publicly discussed and advocatedfor common agenda goals, and hosted join programming. This collaborative work led to a grant from the NC MLK Commission to host A Dream Revitalized, an event to engage Orange County youth in identifying discrimination and its effects, identifying historic and modern-day community activism techniques and determining resources needed to participate in positive social change as a young person. If MBK Orange County is not fundedthis year, the momentum built last year will decline, as MOY would need the funds to continueits work. k)What percentage of your target population is low-moderate income?50% l)What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc.?). Post-session evaluations are conducted to solicit feedback aboutour performance. m)Include any other pertinent information. Key Orange County stakeholders engaged this past year included the United Way of the Greater Triangle, Beyond Expectations, Habitat for Humanity of Orange County, Fathers on the Move, Boomerang Youth, Inc., Chapel Hill Carrboro City Schools, Orange County Sherriff’s Office, Orange County Board of Commissioners, Town of Hillsborough, Town of Chapel Hill, Orange County Schools, 100 Black Men of Triangle East, Durham Technical Community College, and Movement of Youth. EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 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 PopulationDemographics Actual 2016-17 Estimated 2017-18 Projected 2018-19 Gender Male 72 87 104 Female 89 106 128 Total 161 193 232 Ethnicity African-American 153 183 220 American Indian or Alaska Native Asian Caucasian 2 3 3 Native Hawaiian or other Pacific Islander Latinx 6 7 9 Total 161 193 232 Of the above, how many Hispanic/Latino 6 7 9 Of the above, how many non-Hispanic/Latino 155 186 223 Total 161 193 232 Age 0-5 years 6-18 years 161 193 232 19-50 years 51+ years Total 161 193 232 Geographic Location AlamanceCounty Chatham County Durham County Wake County Orange CountyBreakdown Chapel Hill Public Housing 40 44 49 Town of Chapel Hill (Non-Public Housing)48 53 59 Town of Carrboro 56 62 68 Town of Hillsborough 17 18 19 City of Mebane(Orange County) Orange County (Outside Municipalities) Total 161 193 232 EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Work Statement o)Complete the Work Statement Chart to describe theworktobeperformed. This chartis 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 projectedinformation.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. x Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) x 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.) x Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number ofmeals delivered each day.) x Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chartfor Program My Brother’s Keeper (MBK) Orange County Program Activity Name MBK Leadership Summit Program Goal To build a program and policy agenda for MBK Orange County Performance Measures 1.# of partners that accurately describe common agenda 2.# of partners that publicly discuss/advocate for common agenda goals Previous Year Program Results n/a Current Year EstimatedResults 1.20 2.20 Next Year Projected Results n/a (goal will be completed) Program Activity Name MBK Opportunity Summit, Saturday Leadership Academy, and Team Mentoring Program Goal x To provide 2opportunity summits will focus on student achievement, career/personal/professional development, social justice and engagement, and mentorship. x To providestudentscomprehensive Saturday Leadership Academy that focuses on mastery of 21st Century Skills and Team Mentoring that focuses on life skills and character development. Performance Measures 1.# of mentors/mentees participating in MBK related activities 2.# of students that complete at least 8 hours of community service perschool year 3.% of students that report satisfactory mentoring relationships in monthly contact reports 4.# of stakeholders that attend MBK Opportunity Summit Previous Year Program Results n/a Current Year EstimatedResults 1.100 2.50 3.50 4.100 EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Next Year ProjectedResults 1.232 2.100 3.80 4.200 Program Activity Name MBK Spring Break College Tour Program Goal To provide studentswitha multi-state college tour that exposes students to various college options. Performance Measures 1.#ofstudentsthatparticipateinMBKCollegeTour 2.%ofstudentsthatreportcollegeasaviablefutureoption 3.%ofgraduatingseniorsthatenrollincollege Previous Year Program Results n/a Current Year EstimatedResults 1.10 2.n/a(newperformancemeasure) 3.n/a(newperformancemeasure) Next Year Projected Results 1.30 2.80 3.80 Program Activity Name MentoringandYouthProgramDevelopment Program Goal Toprovidetechnical assistance to support atleast10MBK-related agencies, including in-person staff training workshops, training facilitation (mentor/mentee/parents), and baseline data assessments to help these programs incorporate or enhance quality youth development practices that lead to long term sustainability. Performance Measures #ofMBK-relatedagenciesusingevidence-basedyouth developmentpractices Previous Year Program Results n/a Current Year EstimatedResults n/a(newperformancemeasure) Next Year Projected Results 10 EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 p)Program Budget 1.Submit your programbudget.You may completethe provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, in the same format, asrequested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: x Revenues o Private Donations o Program Generated Revenue o Local Government Grants Carrboro Human Services Carrboro Other Chapel Hill Human Services Chapel Hill Other(DO NOT include CDBG funding here) Orange County Human Services Orange County Other (DO NOTInclude HOME funding here) o Other Government Grants Triangle United Way State Government Federal Government (CDBG/HOME/etc.) Private Foundation Grants o Other Revenue x Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel & Training o Other Expenses 2.Program Budget Detail –Provide description of “other” budget items, not defined. Mentoring&YouthProgramDevelopment.Cost for technical assistance to support MBK-related agencies, including in-person staff training workshops, training facilitation (mentor/mentee/parents), and baseline data assessmentsto help these programs incorporate or enhance qualityyouthdevelopmentpractices that lead to long term sustainability. MBK Opportunity Summits. Cost for supplies, food, presenters, and materials for two (2) MBK Opportunity Summits for high school students, college students, K-12 educators, and community and business leaders. Summits will focus on student achievement, career/personal/professional development, social justice and engagement, and mentorship. 3.This program budget represents what percent of the agency budget? 6% 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. EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 PROGRAM INFORMATION1/23/2018 4:41:44 PM Page 19 of 20 Actual 2016-17 Estimated 2017-18 Projected 2018-19 Total Cost of Program N/A $58,224 $114,246 Total # of Individuals 161 193 232 Cost Per Individual N/A $301.67 $492.44 EXHIBIT A: Provider's Outside Agency Application DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 EXHIBIT “B” Scope of Services – FY 2018-19 Outside Agency Performance Agreement Agency Name: Movement of Youth Program Name: My Brother’s Keeper (MBK) Orange County Funding Award: $30,529 Outline how the agency will spend Orange County’s funding award. Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. •To build a program and policy agenda for MBK Orange County •To provide 2 opportunity summits will focus on student achievement, career/personal/professional development, social justice and engagement, and mentorship. •To provide students comprehensive Leadership Academy that focuses on mastery of 21st Century Skills and Team Mentoring that focuses on life skills and character development. •To provide students with a multi-state college tour that exposes students to various college options. •To provide technical assistance to support at least 10 MBK-related agencies, including in-person staff training workshops, training facilitation (mentor/mentee/parents), and baseline data assessments to help these programs incorporate or enhance quality youth development practices that lead to long term sustainability. 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 20 100 50 50% (25) # of stakeholders that attend MBK Opportunity Summit 100 30 80% (24) Expense Description Amount MBK Leadership Summit $1,526 MBK Opportunity Summit, Leadership Academy, and Team Mentoring $6,106 MBK Spring Break College Tour $15,264 Mentoring and Youth Program Development $7,633 DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 Certified by: _______________________ Title: President & CEO Date: 7/27/18 (Provider’s Signature) Performance Measures Anticipated Results # of MBK-related agencies using evidence-based youth development practices 10 ::: DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 (Movement of Youth Inc.) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7/18 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. Certified by: _______________________ Title: __________________________ Date: ___________ (Provider’s Signature) DocuSign Envelope ID: 7399BACD-0CBF-4EF4-9068-B429A8CA12F8 DocuSign Envelope ID:7399BACD-OCBF-4EF4-9068-B429A8CA12F8 MOVEM-1 ,a►CC7R[7 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODIYYYY) �— 09125/2018 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 poficy(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 919-471-2541 CONTACT Codruta E. Roberts NAME: The Insurance Center of Durham PHONE 919-471-2541 FAX 919-471-2132 1920 Front St.,Suite 710 (Arc,No,Ext): IA1C,No): P.O.Box 15369 E-MAIL codruta@insurancecenterofdurharn.com ADDRESS: Durham,NC 27704- Codruta E.Roberts INSURER{S)AFFORDING COVERAGE NAIC N INSURER A:Philadelphia Indemnity Ins Co INSURED Movement Of Youth Inc. INSURERS:L.Iberty Mutual Ins, Co. (AWC) 406 Blackwell St Ste B030 Durham,NC 27701 INSURER C INSURER 0: INSURER E: INSURER r: COVERAGES CERTIFICATE NUMBER: REVISI N 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 ADDL SUER POLICY EFF POLICY EXP TYPE OF INSURANCE INS12 WVQ POLICY NUMBER - LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK1884875 09121/2018 09121/2019 PREMISES, 100,000 PREMISES.(Eapccur[oncQ) 5 PHPK1884875 09/2112418 09121/2019.ME EXP(Any one person) 5 5,000 PERSONAL ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY X JELT LOC PRODl1C7S-COMF'!OP AG .5 Included OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,0{}0. (Ea accwerll) S ANY AUTO PHPK1884875 0912112018 09121/2019 BO D ILY I NJ U RY(Per person) ;& OWNED SCHEDULED AUTOS ONLY AUTOS- BODILY INJURY(Per accident)_S �1( HIRED X NON-OWNED PROPERTY DAMAGE S Fer accident .S AUTOS ONLY AUTD ONLY € ) UMBRELLA LIAB OCCUR - I,EACH OCCURRENCE_ .__S EXCESS LIAB CLAIMS-MADE; AGGREGATE DED RETENTION S B WORKERS COMPENSATION PER _- X OTH- AND EMPLOYERS'LIABILITY STATUTE ER YIN WC539S386381018 0210512018 02/0512019 1,000,000 ANY PROPRIETORlPARTN ERIC XECUTIVE E.L.EACH ACCIDENT 5 OF ff,CRIm EMBER EkCLUDEDa N WA A . . . (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE_-POLICY LIMIT S A .Professional Liab. 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