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2017-667-E Finance - Triangle Bikeworks outside agency agreement
(Triangle Bikeworks) Orange County Outside Agency Performance Agreement Revised 7/2017Page 1of 7 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2017,(“Effective Date”)by and between the County of Orange, a political subdivision of the State of North Carolina, 200South Cameron Street, Hillsborough, North Carolina, 27278, ("County")and Triangle Bikeworks,a not-for-profit corporation, located at 115 West Main Street , Suite C1,Carrboro,NC 27510(“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 Triangle Bikeworksagree as follows: 1.Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2017to June 30, 2018. 2.Scope of Services. a.Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments orrevision 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 Agreementas 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 ExhibitB, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of 2200 b.All funds appropriated shall be used for purposes described in ExhibitB. 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 equalinstallments in the amount of550. The first payment is contingent upon receipt of the agency’s performance agreement; the remaining payments arecontingent 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: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 (Triangle Bikeworks) Orange County Outside Agency Performance AgreementPage 2of 10 Rev. 7/17 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 Reportwhichever is later. f.The County is not obligatedto provide any other support to Providerin this or in succeeding fiscal years. 4.Agency Reporting. a.Provider will provide Orange County a Progress Report that includesa fiscal report and updates on performance measuresas outlined intheScope of Services.Progress Report datesare: July 1 –December 31;January1–March 31and April1-June 30.Reportsare due on January 12,April 13,and July13of 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 effectivedate 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 Agreementand Provider shall return all paymentsalready 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 obtainpayment 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 inthe 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: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 (Triangle Bikeworks) Orange County Outside Agency Performance AgreementPage 3of 10 Rev. 7/17 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 terminationand any unusedfunds shall be returned to the County within 10 days of termination. d.Any termination of this Agreement for defaultunder 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 arisingout 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 DESCRIPTIONMINIMUM 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 sectionis intended to affect or abrogate the County’s sovereign immunity defenses. DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 (Triangle Bikeworks) Orange County Outside Agency Performance AgreementPage 4of 10 Rev. 7/17 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 permittedunder 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 underthis 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 therights 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 $13.75per hour.To the extent possible, Orange County recommends that Triangle Bikeworksprovide 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: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 (Triangle Bikeworks) Orange County Outside Agency Performance AgreementPage 5of 10 Rev. 7/17 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 affectwhatsoever 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. 18.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. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of the Agreement and County may immediately terminate this Agreement without further obligation on part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. 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. 19.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 Providerhave 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 County: Finance &Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Triangle Bikeworks 115 West Main Street , Suite C1 Carrboro, NC 27510 DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 (Triangle Bikeworks) Orange County Outside Agency Performance AgreementPage 6of 10 Rev. 7/17 For and on behalf of Orange County Government _______________________________________________________ Bonnie Hammersley, County ManagerDate DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 FY2017-2018 Outside Agency Funding Application HUMANSERVICES x ORANGE COUNTY x TOWN OF CARRBORO x TOWN OF CHAPEL HILL Orange County (OC) 200 S. Cameron Street Hillsborough, NC 27278 Town of Carrboro (CA) 301 W. Main Street Carrboro, NC27510 Town of Chapel Hill (CH) 405 Martin Luther King, Jr. Blvd. Chapel Hill, NC 27514 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 DO NOT SUBMIT THIS PAGE 2/9/2017 4:13:51 PM Page 2 of 22 INFORMATION Each year, Orange County Government, the Town of Carrboro and the Town of Chapel Hill invite program funding requests from non-profit providers that support the delivery of vital community services. The application process is very competitive and not all applicants will be awarded funding. Recommendations for funding may be for an award amount less than that requested by the applicant. Agencies that are currently receiving funds from Orange County, the Town of Carrboro, or the Town of Chapel Hilllocal governments, and are also applying for new funds, must be in compliance with all terms of their current agreement(s)and must not have any outstanding audit findings, monitoring findings or concerns as determined by the municipality. Recipients are required to submit written progress reports on their SMART Measures that include: goals, description of activities/challenges, revisions of timelines/budgets, and other relevant information Funded projects will be monitored for progress and performance, financial and administrative management, and compliance with the terms of Performance/Development Agreement(s). Monitoring may involve site and/or office visit(s). Once applications are received, they are reviewed by staff for completeness and eligibility. The applications are presented to a specific application review group, depending on the funding source. The review group will make a recommendation, based on available funding and the priorities identified by the participating jurisdiction. The recommendation is presented to the appropriate Board/Council for consideration and approval. The Board/Council approves/adopts the final allocations. TIMELINE November 15 Funding Application Posted on Websites November29 Funding Application Workshop Held October 18-January23 Agency Prepares Application January10 January 31 Q&A Session Held Application Submissions are Due March - May Application Review & Agency Presentations June Agency Funding Approval by Board/Council July Contracts Executed & Programs Begin EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 DO NOT SUBMIT THIS PAGE 2/9/2017 4:13:51 PM Page 3 of 22 SUBMITTAL INFORMATION Welcome to the Outside Agency Common Funding application for local/general funds, which will be distributed through this competitive application process. All entities or organizations requesting funds must complete and submit this application prior to the deadline to be considered for FY 2017-2018 funding. The Application Submittal Deadline is:Tuesday, January 31, 2017 5:00 PM In the event of inclement weather, check the website for each Town/County you are applying to, for further instructions. Please note that late, handwritten, or incomplete applications will not be accepted. (Applications not signed by the Chair or President of the Board of Directors, are considered incomplete.) An application orientation workshop will tentatively be held on Tuesday, November 29, 2016 at 9 AM to Noon to review the application and submittal requirements. SUBMITTAL REQUIREMENTS FOR EACH MUNICIPALITY Human Services– Town Of Carrboro Applications are accepted once a year and reviewed by the Town’s Human Services Advisory Commission, which makes a recommendation for funding to the Board of Aldermen for final approval. For more information about the Town of Carrboro Human Services program, see here. Questions and submittals should be directed to: Annette Stone, 301 W. Main Street Carrboro, NC 27510 919-918-7319 astone@townofcarrboro.org Submission: We strongly encourage applications to be single-spaced, with 12-point arial font and normal margins. Application: One (1) original plus Two (2) paper copies of the application must be hand delivered or mailed to Annette Stone, 301 West Main Street, Carrboro, NC 27510;AND One Application and Attachments files must be submitted by email. Any .pdf files must be accompanied by the original file format of .doc, .xls, etc. EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 DO NOT SUBMIT THIS PAGE 2/9/2017 4:13:51 PM Page 4 of 22 Human Services – Town Of Chapel Hill In 1982, the Town established local funding to support local nonprofit organizations that carry out human service work throughout the community. Applications are accepted once a year and reviewed by the Town’s Human Services Advisory Board, which makes a recommendation for funding to the Town Council for final approval. For more information about the Town of Chapel Hill Human Services program, see here. Questions and submittals should be directed to: Jackie Thompson 405 Martin Luther King Jr. Blvd. Chapel Hill, NC 27514 919-969-5081 jthompson@townofchapelhill.org Submission: We strongly encourage applications to be single-spaced, with 12-point arial font and normal margins. Application: Two (2) paper copies of the application with ORIGINAL signatures must be hand delivered or mailed to Jackie Thompson, 405 Martin Luther King, Jr. Blvd., Chapel Hill, NC 27514; AND Attachments: The application submittal must be accompanied by a flash drive with the application and all attachment files in electronic format. Any .pdf files must be accompanied by the original file format of .doc, .xls, etc. Human Services– Orange County For more information about the Orange County Human Services program, see here. Questions and submittals should be directed to: Allen Coleman PO Box 8181 Hillsborough, NC 27278 (919) 245-2151 acoleman@orangecountync.gov Submission: Email application and ALL Attachments prior to the deadline.Any .pdf files must be accompanied by the original file format of .doc, .xls, etc. Please request a delivery receipt of email with application and attachments. EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 Application Submittal Checklist 2/9/2017 4:13:51 PM Page 5 of 22 Agency _____Triangle Bikeworks_________ Program(s) __Spoke’n Revolutions________ Section Subsection 1. Cover Page a.Applicant Contact Information b.Funding Requests c.Signed Application Cover Page d.Signed Disclosure of Conflicts of Interestand Clause 2.Agency Informationa.Agency’s Years in operation b.Agency’s Purpose/Mission c.Agency’s Types of Services Provided d.Agency’s Experiencewith Programs e.Other Pertinent Agency Information f.Schedule of Positions g.Living Wage h.Agency Budget 3.Program Information A separate Section 3 is required for eachprogram. a.Human Services Needs Priority b.Type of Program c.Agency Collaboration d.Summary of Program e.Description of Identified Need f.Description of Population to be Served g.Program Staffing, Capacity, & Expertise h.Program Implementation Timeline i.Value of Investment j. Impact of Reduced/No Allocation k.Other Pertinent Information l.Target Population/Beneficiary Chart m.Work Statement n.Program Budget, Detail, & Cost per Individual 4.Attachments a. Audit: Organizations receiving $300,000 or more in Federal financial assistance, and/or organizations with more than $500,000 of receipts and expenditures in a fiscal year, must secure an audit. b.IRS Federal Form 990 c. NC Solicitation License d.IRS Federal Tax-Exemption Letter e. Certificate of Insurance f.List of Board of Directors g.Solid Waste Program Fee (SWPF) Verification FOR OFFICE USE ONLY Received By ________ Date/Time ___________/_________ EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 Agency Information2/9/2017 4:13:51 PM Page 9 of 22 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): Triangle Bikeworkshas been in operation seven years providing youth programming activities since 2011. The organization was incorporated April 2014 b)Agency’s Purpose/Mission (no more than a few sentences):Theyouthparticipants of Triangle Bikeworks are enriched in mind, body and spirit through transformative community, cultural and cycling experiences. c)Types of Services the Agency Provides (bullet format): o Physical Development o Self Development o Programs against summer learning loss o Cultural Development d)Agency’s Historywith Providing These Services: Triangle Bikeworks provides a non-traditional means of physical activity and education. Through the Spoke’n Revolutions Youth Cycling program youth are engaged in a physically demanding means of travel. Using the bicycle, youth travel pre-designated routes where they learn the culture and history of the region they bike through. By exposing young people to new challenges, other cultures and diverse environments through a challenging hands-on experience, Triangle Bikeworks believes we can open young people's eyes to new ways of thinking and inspire them to create positive change in their own lives and communities for the future Our first tour was in 2011. It was the Underground Railroad tour where it was written that the program “is project-based learning at its best, combining travel to powerful places with authentic experience of history and geography, collaboration towards a common goal, and intense physical activity.” Now in our 7th year we approach these tours with confidence and caution. The approach is to learn from each tour to improve the experiences of the youth participants. Since inception, the camp has been free to all participants. For the selection process, the Spoke'nRevolutions summer camp has relied on invites from teachers and students to hold interest meetings within the A.V.I.D. (Advancement Via Individual Determination) classes. Working with the school social worker to find youth who participate in "Free and Reduced" lunch program is another method used. Peer recommendation has also been one way to find students interested in this type of development. Youth are encouraged to supplement the cost of the tour by assisting in fundraising. 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?) EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 Agency Information2/9/2017 4:13:51 PM Page 10 of 22 New initiatives for Triangle Bikeworks is to hire a part-time staff person to handle some of the workload of the part-time Executive Director. The goal is to use this person to increase community awareness and donations to lessen the dependencies on grants. 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: 0 # of FTE - Paid Part-Time Positions:0 # of Volunteers:6 # of FTE - Volunteers:1 g)Living Wage Does this agency pay permanent employees a minimum living wage?(Yes/ No)No If yes, is this agency an Orange County Living Wage Certified Employer? If no, please explain. EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 Agency Information2/9/2017 4:13:51 PM Page 11 of 22 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)Yes 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 FY16-17 Award FY17-18 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 Spoke’n Revolution tour of the Trail of Tears $2,000$5,000Town of Chapel Hill funding Spoke’n Revolution tour of the Trail of Tears $1,250$5000Town of Carrboro funding Spoke’nRevolution tour of the Trail of Tears $1,000$5,000Orange County 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 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 Agency Information2/9/2017 4:13:51 PM Page 12 of 22 Chapel Hill Human Services Chapel Hill Other (DO NOT include CDBGfunding here) 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? Surplus Is there a significant change? Yes/No Yes Please provide a brief explanationfor Surplus or Deficit, and significant changes. Board of Directors thought it important to carry a reserve to ensure organization is able to weather any future tough times. iv.What is your agency’s fiscal year? (Example: July 1, 2016 through June 30,2017) January 1, 2017 through December 31, 2017 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 13 of 22 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Spoke’n Revolutions Youth Cycling Program Primary Contact and Title: Kevin Hicks Telephone Number:919-452-2272 E-Mail: Kevin@TriangleBikeworks.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 applytothis program) 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. 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? Concerning Priority Area #2 Triangle Bikeworks helpsto make sure summer learning loss is reduced for low to middle income youthof color participating in the program. e)Describe thecommunityneedorproblem tobe addressed in relation to the Chapel Hill Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare EducationX Family Resources Jobs/Jobs Training Food TransportationX Other: Please specify _EDUCATION ENRICHMENT___ EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 14 of 22 Human Services Needs Assessment,Orange County BOCC Goals and Priorities,Town of Chapel Hill Council Goals,Carrboro goals,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 Chapel Hill/Carrboro City Schools district continues to struggle with addressing the Achievement Gap. Part of this struggle is in how youth relate to the topics in school and their relation to those topics. The goal of Triangle Bikeworks is to make one of the many topics enjoyable to the learner. We engageyouth in Project Based Learning and bringto life historical moments. With the bicycleplacing them in the locations where such history was made, what they learnbecomes tangible and relevant. By cyclingto these locations under their own power, self-esteem and self- empowerment aspects are elevated. Arriving with this elevation is self-discovery anda more engaged learner. f)Who is your target population of individuals to benefit from this program and how will they be identified and connected withthe program? Students reside in Orange County 35% Black 35% Karen 30% Latino/a The students are identified by word of mouth from students who have previously participated in the touring program, interest meetings held at schools and working with the counselors in schools. g)Describe the credentials of the program manager and other key staff.(Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Kevin Hicks is the Program Managerwhoinitiated the first tour in 2011and continues to oversee the program. To this date there is no other program in the nation providing this service to any youth of color. Kevin is a certified instructor under the League of American Cyclists, which qualifies him to teach bike road safety to youth and young adults. h)Describe the specific periodoverwhichtheactivities will be carried out andinclude an implementation timeline. The activities will be carried out in the summer of 2018. Timeline of activity is proposed for two weeks beginning June 22, 2018 or shortly after school is dismissed. 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) This is a great community investment because it directly affects the mental and physical well being of the youth. Human development is a lifelong process of physical, behavioral, cognitive, and EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 15 of 22 emotional growth and change. From the early stages of life through adolescence to adulthood, enormous changes take place. Throughout the process, each person develops beliefs, attitudes, and values that guide understanding, choices, and relationships. Most teens will: o Attain cognitive maturity—the ability to make decisions based on knowledge of options and their consequences o Build skills to become self-sufficient o Develop increasingly mature relationships with others o Seek increased power over their lives Learning history and its effects on their ancestral past and current standing, students are able to think comparatively. This brings them to deeper self- understanding. It is natural to imagine what you would do if you were a person of history, whether that history is uplifting or heart wrenching. Either way, knowing self brings you closer to knowing what is and IS NOT acceptable to you, as well as seeking to change that which you can and accept that which you cannot. The Spoke’n Revolutions program helps youth learn history and its impact on them, whothey are, what they want, and how to get it, moving them from knowledge to action. j)Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. There are two scenarios that would occur if no funding or funding is reduced. No Funding:Fewer youth are able to participate in the summer program of Spoke’nRevolutions. In 2016, five youth participated in the tour of the Underground Railroad. This number was down significantly from prior years of 9-12 youth and ¼ of the youth sought for future participation. Reduced Funding:The participating youth will have to work harder at raising the necessary funding so that all 20 youth can join the tour. k)Include any other pertinent information. I reiterate that this is the only program of its kind for youth of color. Due to complications with the IRS website I was unable to submit Triangle Bikeworks’ 990-Nfiling. I called it in and verification will be available in 8 weeks (April) Renewal of the NC Solicitor’s license has been processed. EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 16 of 22 Additional Program Information l)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 2015-16 Estimated 2016-17 Projected 2017-18 Gender Male41110 Female1910 Total 52020 Ethnicity African-American377 American Indian or Alaska Native Asian166 Caucasian Native Hawaiian or other Pacific Islander Other: specify ___Latino____177 Total 52020 Of the above, how many Hispanic/Latino177 Of the above, how many non-Hispanic/Latino41313 Total 52020 Age 0-5 years 6-18 years 19-50 years52020 51+ years Total 52020 Geographic Location AlamanceCounty Chatham County Durham County Wake County11 Orange CountyBreakdown EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 17 of 22 Chapel Hill Public Housing Town of Chapel Hill (Non-Public Housing)4 10 10 Town of Carrboro 6 7 Town of Hillsborough City of Mebane(Orange County) Orange County (Outside Municipalities)3 3 Total 52020 Work Statement m)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 projected information.Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time-bound. Click on SMART Goals to learn more. 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 of meals 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 _______Triangle Bikeworks__________ 1.Program Activity Name Spoke’n Revolutions Buffalo Soldiers/Lewis & Clark tour 2018 Program Goal To decrease summer learning loss for student participants Performance Measures We review journal entries to assess impact of tour and discuss Previous Year Program Results Youth were able to recountlearning moments on the Underground Railroad tour well into the school year (December 2016) Current Year EstimatedResults For youth already engaged in learning of The Trail of Tears education will be enhanced by experiences obtained on tour. For other youth this will be a tremendous enhancement to the topic they will be learning on the subject. Boosted elevations of self- esteem and confidence help to improve student classroom performance. Next Year Projected Results Youth will understand the value and contributions of the Buffalo Soldiers and the trek of Lewis and Clark’s EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 18 of 22 journey west. Contributions of the soldiers as the initial stewards of the National Parks and their personal efforts in making the partial journey themselves via bicycle. Boosted elevations of self-esteem and confidence help to improve student classroom performance. 2.Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year EstimatedResults Next Year Projected Results 3.Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year EstimatedResults Next Year Projected Results 4.Program Activity Name Program Goal Performance Measures Previous Year Program Results Current Year EstimatedResults Next Year Projected Results EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 Actual 2015-16 Estimated 2016-17 Projected 2017-18 Percent Change 9,759$16,462$14,462$-12% 2,670$2,670$3,000$12% -$1,250$5,000$300% -$-$-$0 -$2,000$5,000$150% -$ -$1,000$5,000$400% -$-$-$0 -$-$-$0 -$-$-$0 -$-$-$0 -$-$-$0 Private Foundation Grants16,474.50$7,500.00$20,000.00$1.67$ -$-$2,000$0 28,904$30,882$54,462$76% -$-$22,500$0 600$932$2,097$125% -$500$500$0% -$-$-$0 18,718$28,718$29,118$1% 19,318$30,150$54,215$80% 9,586$732$247$-66% Total Agency Revenue Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Total Agency Expenses Compensation SURPLUS/(DEFICIT) FOR PERIOD: AGENCY EXPENSES Rent & Utilities Other Expenses: Supplies & Equipment Travel & Training Agency Generated Revenue (fees) Private Donations Local Government Grants: AGENCY REVENUE Human Services - Orange County State Government Federal Government (CDBG/HOME/etc.) Triangle United Way Other - Town of Hillsborough Other Government Grants Other Revenue Other - Orange County TRIANGLE BIKEWORKS Agency Budget Operating Budget for Entire Agency AGENCY NAME: EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 PROGRAM INFORMATION2/9/2017 4:13:51 PM Page 19 of 22 n)Program Budget 1.Submit your programbudget.You may complete the 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. 3.This program budget represents what percent of the agency budget? 71% 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. Actual 2015-16 Estimated 2016-17 Projected 2017-18 Total Cost of Program7,127.00$15,899.50$16,281.50 Total # of Individuals52727 Cost Per Individual1018.90$588.87$603.02 EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 DO NOT SUBMIT THIS PAGE 2/9/2017 4:13:51 PM Page 20 of 22 4.ATTACHMENTS Description of Required Attachments a)Financial Audit A recent financial audit that should cover CY 2015, for calendar year agencies, and FY 2015-16, for fiscal year agencies. For agencies with prior year revenues totaling $500,000 or more a financial audit, prepared by a certified public accountant is required. Agencies with prior year revenues of less than $500,000 may submit a completed Schedule of Receipts and Expenditures form (see application materials), in lieu of an audit/report. Agencies with a certified audit/report should not complete the form. b)IRS Federal Form 990 A copy of the agency’s 2014 Form 990 is required. The specific form depends upon the agency’s financial activity. Review the IRS’ table guide, for more details. For Form 990-N (e- postcard) filers, include a copy of the postcard, with the agency’s application materials. c)NC Solicitation License A copy of the agency’s current solicitation license is required. Organizations that solicit contributions in North Carolina, directly or through a third party, must renew their licenses annually. For more details, refer to the NC Secretary of State’s licensing website and its Frequently Asked Questions Guide (PDF), about exemptions. If exempt per N.C.G.S. § 131F-3, include a copy of the exemption letter with the agency’s application materials. d)IRS Federal Tax-Exemption Letter A copy of the agency’s IRS tax-exempt letter that confirms its nonprofit status is required. An agency can request a copy of its letter from the IRS’ Customer Account Services. e)Certificate of Liability Insurance A copy of the agency’s current certificate, from the agency’s insurance carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker’s Compensation compliance, include a statement explaining why, with the agency’s application materials. *Note: If Approved for Funding:Approved agencies must provide an updated insurance certificate. The update should reflect the funding jurisdiction as an additional insured party and certificate holder and provide coverage for the duration of the funding period (July 1 – June 30). Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any stipulated insurance coverage. EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 DO NOT SUBMIT THIS PAGE 2/9/2017 4:13:51 PM Page 21 of 22 Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required INSURANCE TOWNOF CARRBORO TOWN OF CHAPEL HILL ORANGE COUNTY3 Worker's Compensation1 Limits for Coverage A- Statutory State NC, for each employee Limits for Coverage B- Employers Liability of: $1 million Each Occurrence $1,000,000 BID2 limit Limits for Coverage A - Statutory State NC, for each employee Limits for Coverage B - Employers Liability of: $100,000 Each Occurrence $100,000 BID for each employee $500,000 BID limit Limits for Coverage A - Statutory State NC, for each employee Limits for Coverage B - Employers Liability of: $500,000 each accident, $500,000 BID for each employee $500,000 for BID limit Commercial General Liability $100,000 Property Damage Liability $1,000,000 Bodily Injury and Property Damage Limit $1 million Each Occurrence $2 million Aggregate $1 million Each Occurrence $2 million Aggregate Automobile Liability Not Applicable$1 million Each Occurrence $500,000 Each Occurrence Professional LiabilityNot ApplicableNot Applicable $1 million Each Occurrence $2 million Aggregate 1. Visit the NC Industrial Commission’s website for more information regarding Coverage A. Also, note that if an agency uses subcontractors, it must require subcontractors to have workmen’s compensation insurance. 2. Bodily Injury by Disease (BID) 3. Please visit Orange County’s contracts webpage for more information about the County’s risk assessment procedures. f)List of Board of Directors Provide the following information about each board of director’s member:name, telephone number,address, occupation or affiliation of each member and the list must identify the principal officers of the governing body, and length of term. g)Solid Waste Program Fee (SWPF) Verification This fee finances Orange County's recycling and waste reduction program.Submit either a.) proof of payment of the agency’s FY 2016-17 Solid Waste Program Fee, OR b.) a statement on agency letter head indicating exemption and specify the person(s), business, etc. that is responsible for paying this fee. EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 Certified by: _______________________ Title: __________________________ Date: ____________ (Provider’s Signature) EXHIBIT “B” Scope of Services –FY 2016-17 Outside Agency Performance Agreement Agency Name:Triangle Bikeworks Funding Award:$1,000 Outline how the agency will spend Orange County’s funding award. Program Services For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes below, by June 30, 2016. x Provide youth engage in self powered vehicles x Provideyouth experience health outdoor activities x Provide youth with a historical view from a different prespective Anticipated Outcomes The Anticipated Results column must include quantifiable results in theform 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 Youth will create compleegin narratives about their tour experience via blogs, journal entries, and video diaries. 11 youth Engage in polling before and after tour to capture transformation11 youth Youth will share experience with other youth11 youth Expense Description Amount 2017 summer tour cycling of the Trail of Tears1,000 ExecutiveDirectorAug3,2017 DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 (Triangle Bikeworks) Orange County Outside Agency Performance AgreementPage 10of 10 Rev. 7/17 ATTACHMENT “A” Orange County Certifications –FY 2017-18 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 FinancialReview 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 andany money not used for those purposes will be promptly returned to Orange County. Certified by: _______________________ Title: __________________________ Date: ___________ (Provider’s Signature) DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3 The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE$ MED EXP (Any one person)$ PERSONAL & ADV INJURY$ GENERAL AGGREGATE$ PRODUCTS - COMP/OP AGG$ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE$ EACH OCCURRENCE$UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO OWNEDSCHEDULED HIREDNON-OWNEDAUTOS ONLYAUTOS AUTOS ONLYAUTOS ONLY COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7/21/2017 Marsh & McLennan Agency LLC 1400 Eastchester Drive, St 200 High Point NC 27265 Triangle Bikeworks PO Box 17202 Chapel Hill NC 27514 Alliance Member Services10023 Anita M. Chick, CIC, CISR, CIIP 336-899-2402212-607-6550 Anita.Chick@marshmma.com TRIAN03 667901568 A2017-378046/11/20176/11/2018 1,000,000 500,000 excluded 1,000,000 2,000,000 2,000,000 X X A X 2017-37804 6/11/20176/11/2018 1,000,000 Orange County (OC) 200 S. Cameron Street Hillsborough NC 27278 DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3