HomeMy WebLinkAbout2018-659-E Finance - Planned Parenthood outside agency agreement
(Planned Parenthood South Atlantic)
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 Planned Parenthood South Atlantic, a not-for-profit
corporation, located at 100 S Boylan Ave, Raleigh, NC 27603 (“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 Planned Parenthood South Atlantic 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 $20,000.
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 $5,000. 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: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
(Planned Parenthood South Atlantic)
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: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
(Planned Parenthood South Atlantic)
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
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
Commercial General $1,000,000 Each Occurrence
Liability $2,000,000 Aggregate
Automobile Liability $500,000 Combined Single Limit
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: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
(Planned Parenthood South Atlantic)
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 Planned Parenthood South
Atlantic 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: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
(Planned Parenthood South Atlantic)
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: Planned Parenthood South
Atlantic
100 S Boylan Ave
Raleigh, NC 27603
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
1. COVER PAGE
a) Applicant Contact Information
Applicant Organization’s Legal Name: Planned Parenthood South Atlantic
Applicant Organization’s Physical Address: 1765 Dobbins Drive, Chapel Hill, NC 27514
Applicant Organization’s Mailing Address: 1765 Dobbins Drive, Chapel Hill, NC 27514
Applicant Organization’s Web Address: www.ppsat.org
President & CEO: Jenny Black
Telephone Number: 919-833-7526 x6140 E-Mail: jenny.black@ppsat.org
Tax ID Number: 56-1282557
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
Ex. Youth Afterschool Program
Afterschool Program Coordinator salary and materials
for youth activities and projects
$10,000 $15,000 $5,000 $30,000
Sexual Health Education and Outreach $1,000 $2,500 $20,000 $23,500
Totals $1,000 $2,500 $20,000 $23,500
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: 1/12/18
President & CEO Date
Signature: 1/19/18
Board Chairperson Date
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON
DISCRIMINATION CLAUSE
Are any of the Board Members or employees of the agency which will be carrying out this
program or members of their immediate families, or their business associates…
YESNO
☐ ⛝ a) Employees of or closely related to employees of the Town of Carrboro, the Town of
Chapel Hill, or Orange County?
☐ ⛝ b) Members of or closely related to members of the governing bodies of the Town of
Carrboro, the Town of Chapel Hill, or Orange County?
☐ ⛝ c) Current beneficiaries of the program for which funds are being requested?
☐ ⛝ d) Paid providers of goods or services to the program or having other financial interest
in the program?
If you have answered YES to any question, please provide a full explanation below.
NON-DISCRIMINATION
Provider agrees as part of consideration of the granting of funds by funding agencies to the
parties hereto for themselves, their agents, officials, employees and servants agree not to
discriminate in any manner of these basis of race, color, gender, national origin, age, handicap,
religion, sexual orientation, gender identity/expression, familial status or veterans status with
reference to any activities carried out by the grantee, no matter how remote. The parties hereto
further agree in all respects to conform to the provision and intent of Orange County Civil Rights
Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is
enforced by action for specific performance, injunctive relief, or other remedy as by law
provided; this provision shall be binding on the grantees, the successors and assigns of the
parties hereto with reference to the above subject manner.
To the best of my knowledge and belief all of the above information is true and
current. I acknowledge and understand that the existence of a potential conflict of
interest does not necessarily make the program ineligible for funding, but the existence
of an undisclosed conflict may result in the termination of any grant awarded.
Signature: 1/12/18
President & CEO Date
Signature: 1/19/18
Board Chairperson Date
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
2. AGENCY INFORMATION (Be Very Brief and Concise)
Please provide the following information about your agency (2 pages OR LESS):
a) Years in Operation, Date of Incorporation (Month/Year):37 years, July 1980
b)Agency’s Purpose/Mission (no more than a few sentences):
Planned Parenthood South Atlantic proactively ensures comprehensive reproductive health
care by: providing services in settings that preserve and protect the individual’s right to
privacy and reproductive choice; by advocating public policies that advance these rights and
expand access to such services; by providing educational programming that fosters a
culture of healthy sexuality; by working with and meeting the needs of diverse communities
and the underserved; and by leading broad-based strategies that further these fundamental
rights.
c) Types of Services the Agency Provides (bullet format):
●Reproductive health care
●Contraceptives
●Cancer Screenings
●Testing and treatment for sexually transmitted infections
●HIV/AIDS testing
●Abortion care
●Evidence-based education programs for teens and their parents or caregivers
●Community-based sexuality education programs
d)Agency’s History with Providing These Services:
For 37 years, PPSAT has provided high-quality education that reflects the needs of young
people, their families, our patients and the communities we serve. Last year we provided
sex education to more than 11,000 young people in settings such as public schools, the
Boys & Girls Club, local health departments, and places of faith. We place an emphasis on
multi-session sex education programs that are evidence-based and proven to meet the
needs of the participants. We have offered education programs in Orange County for the
past 35 years.
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?)
This summer, we saw a number of bills aimed at “defunding” Planned Parenthood by
eliminating us from the Medicaid program. We engaged in a grassroots resistance effort,
and we remain determined to protect our patients’ access to health care and education. In
September, the Senate bill to “defund” Planned Parenthood failed by a vote of 51-49. We
will no doubt continue to see attacks on Planned Parenthood, but we are using this time to
prepare ourselves by investing in initiatives that strengthen our business and diversifying our
funding and services.
In the past year, we have made significant progress on all of our strategic plan goals. We
have completed renovations on many of our health centers, implemented online patient
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
scheduling, invested in our call center, significantly reduced our staff turnover, increased the
capacity of our advocacy work in all four states, and surpassed our fundraising goals in
every category. Our patient volume is growing due to a real focus on the patient experience.
f) Schedule of Positions (For Entire Agency)
●Full Time Equivalent (FTE) staff will be noted as 1.00; halftime as .50; quarter time as .25, etc.
● Calculate a Full Time Equivalent for all recorded volunteer hours using the following:
Total Volunteer Hours =Volunteer FTE
2,080
# of FTE - Full-Time Paid Positions: 80
# of FTE - Paid Part-Time Positions: 179
# of Volunteers: 600 # of FTE - Volunteers:2.25
g) Living Wage
Does this agency pay permanent employees a minimum living wage?(Yes / No)YES
If yes, is this agency an Orange County Living Wage Certified Employer?YES
If no, please explain.
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
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/totals from Carrboro, Chapel Hill, and
Orange County governments (other than Human Services). DO NOT include federal funding
sources, such as CDBG and HOME.
Program FY17-18
Award
FY18-19
Request
Source
Ex: Affordable Rental
Rehabilitation
0 $20,000 Carrboro -Affordable Housing
Ex: Agency Administration $15,000 $15,000 Carrboro –Other
Ex. Total $15,000 $35,000 Carrboro Total Funding
*Add rows or attach additional page, if needed.
ii. Submit your agency’s budget. You may complete the provided template (separate
xls file) or you may submit your own budget file (as long as it contains the same
information, and in a similar format, as requested in the provided template).
Agency Budgets are required to define budget amounts for the previous program
year, current program year, and next program year for the following categories:
● Revenues
o Private Donations
o Program Generated Revenue
o Local Government Grants
▪ Carrboro Human Services
▪ Carrboro Other
▪ Chapel Hill Human Services
▪ Chapel Hill Other (DO NOT include CDBG funding here)
▪ Orange County Human Services
▪ Orange County Other (DO NOT Include HOME funding here)
o Other Government Grants
▪ Triangle United Way
▪ State Government
▪ Federal Government (CDBG/HOME/etc.)
▪ Private Foundation Grants
o Other Revenue
● Expenditures
o Compensation
o Rent & Utilities
o Supplies & Equipment
o Travel & Training
o Other Expenses
iii. Does your agency budget show a Surplus or Deficit? Yes
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Is there a significant change? Yes/No No
Please provide a brief explanation for Surplus or Deficit, and significant changes.
In the past year, we surpassed our fundraising goals in every category and our patient
volume is growing. We plan to reinvest these funds in our organization through staff pay
increases, continued professional development and expansion of services.
iv. What is your agency’s fiscal year? July 1, 2017 through June 30, 2018
(Example: July 1, 2016 through June 30, 2017)
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Actual
2016-17
Estimated
2017-18
Projected
2018-19
Percent
Change
9,120,935$ 7,235,309$ 7,452,368$ 3%
9,370,477$ 11,555,742$ 11,902,414$ 3%
1,000$ 1,000$ 1,000$ 0%
-$ -$ -$ 0
2,500$ 2,500$ 2,500$ 0%
-$ -$ -$ 0
20,000$ 20,000$ 20,000$ 0%
-$ -$ -$ 0
-$ -$ -$ 0
-$ -$ -$ 0
-$ -$ -$ 0
2,965,828$ 3,029,993$ 3,029,993$ 0%
Private Foundation Grants2,376,454$ 1,492,757$ 1,537,540$ 3%
257,225$ 23,008$ 23,008$ 0%
24,114,419$ 23,360,309$ 23,968,823$ 3%
11,295,276$ 13,300,650$ 13,699,669$ 3%
848,908$ 884,137$ 884,137$ 0%
3,358,176$ 3,816,662$ 3,892,995$ 2%
744,796$ 900,270$ 918,276$ 2%
4,203,939$ 4,179,402$ 4,262,990$ 2%
Depreciation583,051$ 564,857$
Facilities Maintenance442,370$ 554,477$
Contract Services709,126$ 635,680$
Marketing 363,649$ 512,013$
20,451,095$ 23,081,121$ 23,658,067$ 2%
3,663,324$ 279,188$ 310,756$ 11%SURPLUS/(DEFICIT) FOR PERIOD:
State Government
Federal Government (CDBG/HOME/etc
Other Revenue
AGENCY EXPENSES
Rent & Utilities
Supplies & Equipment
Triangle United Way
Local Government Grants:
Other Expenses:
Total Agency Expenses
Other - Orange County
Human Services - Orange County
Other - Town of Hillsborough
Other Government Grants
Travel & Training
Compensation
Total Agency Revenue
Agency Budget
Operating Budget for Entire Agency
Agency Generated Revenue (fees)
Private Donations
AGENCY NAM
AGENCY REVENUE
Human Services - Town of Chapel Hill
Other - Town of Chapel Hill
Planned Parenthood South Atlantic
Human Services - Town of Carrboro
Other - Town of Carrboro
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
3. PROGRAM INFORMATION (Submit a separate Section 3 for each program)
Program Name: Sexuality Health Education and Outreach
Program Primary Contact and Title: Daniela Sostaita
Telephone Number: 919 869 4786 E-Mail: daniela.sostaita@ppsat.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)
Program Category Youth Adult Elderly Disabled Public Housing
Neighborhoods/Residents
Affordable Housing
Affordable Healthcare
Education X X
Family Resources X X
Jobs/Jobs Training
Food
Transportation
Other: Please specify
_________________
c)Provide a bulleted list of other agencies, if any, with which your agency
coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s)
to be funded. For each, briefly describe the coordinated/collaborative efforts.
● Chapel Hill Teen Center - hosting space and recruitment
● Compass Center – participant recruitment
● Orange County Library Systems – hosting workshops, sessions, and alumni meetings
● Chapel Hill, Carrboro, and Orange County Schools – participant recruitment
● El Centro Hispano – participant recruitment
●Orange County Rape Crisis Center’s Youth Against Rape Culture- participant recruitment
● Orange County Latino Health Coalition- participant recruitment
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Program Description (3 pages OR LESS)
Please provide the following information about the proposed program:
d)Summarize the program services proposed and how the program will address a
Town/County priority/goal?
In the coming year, our community health educator will provide Orange County teens and young
adults with medically accurate, intensive, and balanced sexuality education programs that promote
positive sexuality, healthy behavior, and responsible choices – with the goal of reducing the rates of
unintended pregnancy and sexually transmitted infections (STIs).
In doing so, we are addressing the following goals and priorities:
● Chapel Hill - Education and Family Resources: Youth support and activities.
● Carrboro - Enhance and sustain quality of life/place issues for everyone.
● Orange County - Ensure a community network of basic human services and infrastructure
that maintains, protects, and promotes the well-being of all county residents.
PPSAT aims to provide high-quality education that reflects the needs of young people, their
families, our patients, and the communities we serve. PPSAT will provide sexual education
programs for adolescents to increase many of the knowledge and skill-based protective factors
about contraception use and negotiation skills. The goal of these programs is to build self-esteem
and healthy decision-making, to delay initiation of sex, increase condom use of sexually active
teens, and reduce the number of sexual partners for those teens.
Key elements of our education program include:
●Multi-session education programs that use an evidence-based curriculum supplemented by
topics such as gender identity, sexual orientation, and consent. While the look and feel of
programming varies, all programs have been proven through rigorous evaluation to have a
positive impact on preventing teen pregnancies, STIs, or sexual risk behaviors.
●Family engagement programs that foster open, effective parent/child communication to help
families talk more comfortably about issues that can be difficult to discuss.
●Alumni programs: As they learn, develop, and hone their skills, alumni become the next
generation of Planned Parenthood leaders, making a meaningful difference in their
community through service projects, educational presentations, and advocacy.
●Science-based community presentations that are specifically designed for the age and
demographics of the audience. Lessons are drawn from the multi-session programs and
include contraceptive methods, STI prevention, and health decision-making for example.
e)Describe the community need or problem to be addressed in relation to the 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). Reference local data (using the provided links, i.e. Chapel Hill
Human Services Needs Assessment) to support the need for this program.
Adolescents in Orange County need both accurate, engaging education about sexual health and
access to medical services if they are to avoid STIs, pregnancy, and too-early parenthood. The
consequences of adolescent pregnancy and childbearing are serious and numerous. Teen mothers
are less likely to graduate from high school and more likely to live in poverty and to rely on welfare.
The children of teenage mothers are often born at low birth weight, experience health and
developmental problems, and are likely to be poor, abused, and/or neglected
In 2016, the most recent year for which data is available, North Carolina’s teen pregnancy rate fell
7% to 28.1 out of every 1,000 15-19 year old girls, which is a record low in the state’s history. In
comparison Orange County’s teen pregnancy rate rose 25.4% from 2015 - from 6.3 to 7.9. Orange
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
County has historically had one of the lowest rates in the state, so even small changes have a
dramatic effect on the rate. However, further reduction in the number of pregnant and parenting
teens should be a critical goal for our community.
In addition, rate disparities exist by race and ethnicity. Though minories make up just 30.7% of the
population in Orange County, 60% of the teen pregnancies occurred among women of color.
Furthermore, the repeat pregnancy rate among Orange County teens is higher than the state
average - 25% of all teen pregnancies in Orange County, compared to 22.1% statewide.
The CDC has set teen pregnancy prevention as one of its top six priorities. It considers it a
“winnable battle” in public health and of paramount importance to health and quality of life for our
youth. The CDC suggests that effective evidence-based teen pregnancy prevention programs that
address specific protective factors can provide teens with greater understanding of the significant
health risks of unprotected sexual activity as well as the personal skills to make responsible
decisions and to communicate those decisions.
By supporting Planned Parenthood in its effort to provide preventive educational programming to
Orange County’s at-risk youth, you are helping our community address important public health
issues of teen pregnancy, too-early parenthood, and the spread of STIs.
f)Who is your target population of individuals to benefit from this program and how will they be
identified and connected with the program?
This project will primarily serve middle and high school age teens living in Orange County, Chapel
Hill and Carrboro. Our community health educator works with social workers and counselors in the
schools and community partners to promote the program and receive direct referrals. The multi-
session programs are available to any teen that meets the age requirements for the curricula.
Interested teens complete an application and interview with the educator to demonstrate their
interest in the program. When there are more applicants than spaces available, the educator gives
priority to older teens that may age out of the program sooner and reserves a space the following
year for teens that she cannot accommodate.
g)Describe the credentials of the program manager and other key staff. (Ex. Identify Program
Manager and credentials, describe training provided to volunteers, etc.)
Our program is conducted by Daniela Sostaita, a full-time community educator serving Orange and
Durham Counties. Daniela has been with PPSAT since July 2017 and is trained to deliver Becoming
a Responsible Teen, Get Real, Reducing the Risk, and Smart Girls, evidence-based or promising
curricula. Prior to coming to Planned Parenthood, Daniela attended Elon University where she
graduated with a Bachelor of Arts in Sociology and Religious Studies. During her time at Elon,
Daniela completed a year-long, faculty-mentored research project focused on religion and sexuality
where she did fieldwork in a Latinx church in Raleigh, NC. Through this experience, Daniela not only
began learning about sexuality education but also connected with several community organizations,
particularly within Latinx communities, in the Triangle.
The program is overseen by Monika Thigpen, Sr. Director of Education. Ms. Thigpen has
more than 20 years of experience developing and implementing successful community
education programs.
h)Describe the specific period over which the activities will be carried out and include an
implementation timeline.
Sept-Nov 2018 Begin preparation for program
January 2019 Set up dates/time for spring health fair, workshops, other activities
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
February 2019 Begin recruitment process through guidance counselors, Teen Center, social
workers, and referrals for multi-session program.
March 2019 High School, multi-session program starts - 12 weeks, 12 sessions
April 2019 Middle School, multi-session program starts - 10weeks, 10 sessions
March-April 2019 Parent session in between the program dates for high school and middle
school programs (Other parents are allowed to attend)
May/June 2019 Graduation for multi-session programs
Throughout the year - workshops, health fairs, Teen Connections Alumni meets once a month
i)Why is funding this program a good investment for the community? How does funding this
program add value to the community? (250 words OR LESS)
Our programs help participants to increase self-esteem and delay sexual activity. This is especially
important because teens who begin having sex at an earlier age are less likely to use contraception
and more likely to become pregnant and to become a parent. Lifetime achievement for teen parents
is significantly less than for their peers who are able to pursue their education or career training.
They are more likely to live in poverty and require assistance from their communities. Investing in
our teens today provides a solid knowledge base that will assist them as they navigate their teen
years and will positively impact their future success.
j)Describe what would happen if requested funding is not awarded at all or if a reduced
allocation is recommended.
PPSAT is committed to maintaining these education programs in Orange County. In addition to
County and Town support, PPSAT receives funding for its educational programs from a number of
private foundations. All of these foundations have a long history of supporting our programs and we
anticipate their renewed support for FY19. If requested funding is not awarded, we will need to
identify alternative sources of funding raised for our operating expenses. That said, we deeply
value our partnership with Orange County and the towns of Chapel Hill and Carrboro.
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.?)
Educators solicit feedback from program participants by administering satisfaction surveys at the
conclusion of each multi-session and single-session program. In addition, at the conclusion of each
session, participants are asked to write either a question or comment on a piece of paper and put it
in a question box. Participants that do not have a question or comment are still be asked to submit a
blank piece of paper, thereby preserving anonymity. Multi-session participants also have access to
an Education Participant Complaint Form in case they have issues with the educator they wish to
report directly to the supervisor. During the intake process the coordinators provide participants with
their supervisor’s email and phone number, and participants are told they can report any concerns
they have directly to her.
m)Include any other pertinent information.
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Additional Program Information
n) Target Population
Program Target Population Demographics
Actual
2016-17
Estimated
2017-18
Projected
2018-19
Gender
Male 38 94 90
Female 89 269 273
Total 127 363 363
Ethnicity
African-American 21 82 75
American Indian or Alaska Native 4
Asian 18 50
Caucasian 84 123 238
Native Hawaiian or other Pacific Islander
Other: specify __________________158
Total 127 363 363
Of the above, how many Hispanic/Latino 8 90 90
Of the above, how many non-Hispanic/Latino 119 273 273
Total 127 363 363
Age
0-5 years
6-18 years 61 238 238
19-50 years 66 134 134
51+ years
Total 127 363 363
Geographic Location
Alamance County
Chatham County
Durham County
Wake County
Orange County Breakdown
Chapel Hill Public Housing
Town of Chapel Hill (Non-Public Housing)55 110 160
Town of Carrboro 18 106 100
Town of Hillsborough 50
City of Mebane (Orange County)
Orange County (Outside Municipalities)54 157 53
Total 127 363 363
* In FY17, each of our peer educators reached 20 teens (300 total), but we only collected demographic information
on 48 of them. This chart does not include 252 additional individuals for which no demographic information was
collected. We are working to improve this data collection in FY18.
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Work Statement
o)Complete the Work Statement Chart to describe the work to be performed.
This chart is used to document program activities, program goals, performance measures,
and actual results. (Add more rows as needed) If this is a new program, you will only
document the projected information. Every program is required to have AT LEAST 1 Program
Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time-
bound. Click on SMART Goals to learn more.
●Program Activities should outline major activities the agency implements to accomplish its
program goals. (i.e. Deliver meals to elderly/disabled residents.)
●Program Goal should explain what the program is trying to achieve/accomplish. Goals are
statements about what the program should accomplish. (i.e. Deliver 100 meals per day,
Monday-Friday.)
●Performance Measures describe how you will evaluate the degree in which you achieved
the stated goals. (i.e. Will track the number of meals delivered each day.)
●Actual Program Results use program results to indicate the actual measurable
achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of
105 meals per day.)
Work Statement Chart for Program Sexual Health Education and Outreach
1.Program Activity Name Multi-session programs
Program Goal Provide at least 15 high school and 10 middle school teens with
evidence-based, multi-session sexuality education programs.
Performance Measures PPSAT will measure the competency levels of participants through
pre-and post-program tests. The pre-test will be administered at
the beginning of the first session, and the post-test will be
administered immediately following the conclusion of the program.
Measurable outcomes include a change in knowledge, attitudes,
and behaviors.
Previous Year Program Results We graduated 15 high school students and 13 middle school
students. Through pre-and post-testing, high school participants
demonstrated a 10% increase in knowledge, middle school
students demonstrated a 12% increase in knowledge.
Current Year Estimated Results Through pre-and post-testing, participants will demonstrate at least
a 10% increase in knowledge about preventing pregnancy and
STIs.
Next Year Projected Results Through pre-and post-testing, participants will demonstrate at least
a 10% increase in knowledge about preventing pregnancy and
STIs.
2.Program Activity Name Peer to Peer education
Program Goal Each high school student will work within their schools and
communities to disseminate to others the information they have
learned to at least 20 peers each.
Performance Measures Peer-educators maintain contact logs so that the community
educator can review them for accuracy and completeness.
Previous Year Program Results Each peer educator made 20 contacts for a total of 300 contacts.
Current Year Estimated Results Each peer educator will make 20 contacts.
Next Year Projected Results Each peer educator will make 20 contacts.
3.Program Activity Name Parent Workshops
Program Goal Provide family engagement for at least 15 parents.
Performance Measures Participants will provide feedback on the quality of the program by
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
completing surveys.
Previous Year Program Results We reached 26 parents and 96% reported increased comfort in
talking with their kids about sexualityissues.
Current Year Estimated Results At least 75% of parents will report increased comfort in talking with
their kids about sexuality issues.
Next Year Projected Results At least 75% of parents will report increased comfort in talking with
their kids about sexuality issues.
4.Program Activity Name Single-session community presentations
Program Goal Provide single-session community presentations to at least 15(50,
Year 2) individuals.
Performance Measures Participants will provide feedback on the quality of the program by
completing surveys.
Previous Year Program Results We reached 17 individuals through single-sessions. We were not
able to complete evaluations surveys as the tool we currently use
was under review.
Current Year Estimated Results At least 75% of participants will rate presentations as excellent or
above average and would recommend them to a friend.
Next Year Projected Results At least 75% of participants will rate presentations as excellent or
above average and would recommend them to a friend.
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Program Budget
1.Submit your program budget. 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, as requested 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:
● 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 NOT Include HOME funding here)
o Other Government Grants
▪ Triangle United Way
▪ State Government
▪ Federal Government (CDBG/HOME/etc.)
▪ Private Foundation Grants
o Other Revenue
● Expenditures
o Compensation
o Rent & Utilities
o Supplies & Equipment
o Travel & Training
o Other Expenses
2.Program Budget Detail –Provide description of “other” budget items, not defined.
Personel Community health educator -$18/hr x 20 hr/wk x 52 wk = $18,720
Benefits (FICA, Health Ins, Life Ins, Workers Comp, Disability,
Retirement) x 50% = $4,885
Sr Director of Education -$66,547 annually + $13,234 Benefits x 5% =
$3,989
$27,594
Incentives –Gift Cards 15 participants x $300 + $2 fee ($4,530); 10 participants x $100 +
$2 fee($1,020); workshops x 4 x $50 ($200); parent multi-sessions -
$15 x5 sessions x10 parents ($750); t-shirts: 32 (25 participants + 7
alumni) x $7.50 ($240)
$6,740
Office Supplies $100 per quarter x 4 $400
Postage $150
Printing $100 per quarter x 4 $400
Mileage $95 miles per month x 12 $1,045
Lodging $210
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Seminars/Conferences 50%-$1,500 evidence-based training program
50%-$600 SHIFT Conference
$1,050
Refreshments $7 each x 15 participants x 12 sessions; $7 each x 10 participants x
10 sessions; Alumni –$50 x 12 sessions; Graduations -$350;
Workshops -$215
$3,125
Program Supplies Community outreach (condoms, lubricants, etc) -$2/item x 250
($500); education brochures -$2/item x 100 ($200); swag for
tabling events (buttons, cups, stickers) $0.50/item x 500 ($250)
$950
Peer Assistant $160
Telephone $50/month x 12 x 50%$300
Facilities Allocation $567/month x 12 x 50%$3,402
IT Allocation $127/month x 12 x 50%$760
3.This program budget represents what percent of the agency budget? 0.2%
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 2016-17 Estimated 2017-18 Projected 2018-19
Total Cost of Program 39,868 45,508 46,286
Total # of Individuals 379 363 363
Cost Per Individual $105.19 $125.37 $127.51
● The cost per individual is lower in FY17 because there was a period of time, after
programs were completed, when we did not have a community health educator.
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Actual
2016-17
Estimated
2017-18
Projected
2018-19
Percent
Change
1,368$ 2,008$ 2,786$ 39%
-$ -$ -$ 0
1,000$ 1,000$ 1,000$ 0%
-$ -$ -$ 0
2,500$ 2,500$ 2,500$ 0%
-$ -$ -$ 0
20,000$ 20,000$ 20,000$ 0%
-$ -$ -$ 0
-$ -$ -$ 0
-$ -$ -$ 0
-$ -$ -$ 0
-$ -$ -$ 0
Private Foundation Grants15,000.00$ 20,000.00$ 20,000.00$ -$
-$ -$ -$ 0
39,868$45,508$46,286$2%
18,585$ 26,816$ 27,594$ 3%
712$ 300$ 300$ 0%
1,013$ 1,350$ 1,350$ 0%
5,243$ 2,305$ 2,305$ 0%
14,315$ 14,737$ 14,737$ 0%
39,868$45,508$46,286$2%
(0)$ -$ -$ 0SURPLUS/(DEFICIT) FOR PERIOD:
Triangle United Way
Federal Government (CDBG/HOME/etc.)
Total Program Revenue
PROGRAM EXPENSES
Compensation
Supplies & Equipment
Rent & Utilities
Program Budget
Operating Budget for Program
Local Government Grants:
Travel & Training
Other Expenses:
Total Program Expenses
Other Revenue
Private Donations
Program Generated Revenue
Human Services - Town of Carrboro
PROGRAM NAME Sexual Health Education and Outreach
PROGRAM REVENUE
Other - Town of Carrboro
Other - Orange County
State Government
Other - Town of Hillsborough
Other Government Grants
Other - Town of Chapel Hill
Human Services - Orange County
Human Services - Town of Chapel Hill
Exhibit A: Provider's Outside Agency Application
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
Certified by: _______________________ Title: __________________________ Date: ____________
(Provider’s Signature)
EXHIBIT “B”
Scope of Services –FY 2018-19
Outside Agency Performance Agreement
Agency Name:Planned Parenthood South Atlantic
Program Name:Sexual Health Education and Outreach
Funding Award:$20,000
Outline how the agency will spend Orange County’sfunding award.
Expense Description Amount
Personnel -Salaries $20,000
Program Services
Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019.
Ɣ Using an evidence-based curriculum, provide a diverse group of adolescentswith trainingaround
issues of sexuality.
Ɣ Peer-educators will work within their schools and communities to disseminate to others the
information they have learned.
Ɣ Provide parent workshops
Ɣ Host workshops to help women of reproductive age assess their risk of pregnancy.
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
Recruit teens (ages 14-18) for evidence-based sexuality program.15
Recruit girls (10-14) for middle-school science-based sexuality program. 10
Participants of multi-session programs will demonstrate an increase in knowledge about
preventing pregnancy and STIs
300
Recruit parents of middle and high school students for parent workshops 15
Parents will report increased comfort in talking with their kids about sexuality. 80%
(approx.
12/15)
Recruit community members for single-session workshops about birth control, reproductive
health, and sexuality.
15
Participants will rate PPSAT programs as excellent or above average80%
(approx.
12/15)
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
(Planned Parenthood South Atlantic)
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: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
DocuSign Envelope ID: ED368FB6-6FB1-45A7-A8CA-9AB3EAEB624E
CERTIFICATE OF LIABILITY INSURANCE D0A8rI0eM0MlrsDrrYYY,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
Marsh USA,Inc, NAME: _
1166 Avenue of the Americas a�NE Fax
A!C No
New York,NY 10035 MAIL
ARn:healthcare.accountsess @marsh.00m Fax:212-948-1307 CDRESS:
INSURER(S)AFFORDING_COVERAGE NAIL p
CN101357758-NIP-CAS-18-i9 RAL,NC GLPL INSURER A:New Hampshire Insurance Com n 23841
INSURED - INSURER B:National Union Fire Ins.Co.of PlUsbu h PA 19445 PLANNED PARENTHOOD SOUTH ATLANTIC AN AFFILIATE OF PLANNED PARENTHOOD INSURER C
FEDERATION OF AMERICA,INC. INSURER D
100 S.BOYLAN AVE
RALEIGH,INC 27603 INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: NYC-009577927-13 REVISION NUMBER: 11
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,
EXCLUSION_S AN CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE Ar)nL SUER POLICY NUMBER _ MMJDD/YY F- (MNF DDIYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY 082695195 4110112018 0110112019 EACH OCCURRENCE $ UNION
AMAGE TO R 500,000
CLAIMS-MADE f j+� ±OCCUF2 _PREMISES{Ea occurrence $ _
X SIR:$100,000 MED EXP=Any one person) $ Included
-
PERSONAL&ADV INJURY S i'0001000
GEN'L AGGREGATE LIMIT APPLIES'PER: GENERAL AGGREGATE $ 2,000,000
POLICY�JECT I_:]LOC PRODUCTS-COMPIOP AGG $. 2,iI00,000
OTHER: E $
AUTOMOBILE LIABILITY COMBIN ft I) LE LIMIT $
a accideent)
ANY AUTO BODi''-Y INJURY(Per person) $
OWNED SCHEDULED BOOILY INJURY(Per ecddent) $.
AUTOS ONLY AUTOS
HIRED NON-CWNEO PROPERTY DAMAGE
AUTOS ONLY AUTOS ONLY _Par accident
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB _ CLAIMS-MADE AGGREGATE
DEL) I I RETENTION$ _ $
WORKERS COMPENSATION STATUTE ER
AND --
AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETORIPARTNER!EXECUTIVE ❑ NIA EL.EACH ACCIDENT $ _
OFFICERIMEMBER EXCLUDEI)Y
{Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
If yyees,dcritae under
DLYS6RIPesT_iON OF OPERATIONS below E.L.DISEASE.POLICY LIMIT $
B MEDICAL PROFESSIONAL 6793786 01/0112018 0IM1 019 EACH WRONGFUL ACT $1.000,000
CLAIMS-MADE COVERAGE Program Retro Date:1111176 AGGREGATE $3,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space Is,required)
EVIDENCE OF INSURANCE FOR ALL SITES FOR PLANNED PARENTHOOD SOUTH ATLANTIC FOR 2018,THE GENERAL LIABILITY POLICY DOES NOT CONTAIN A SPECIFIC SEXUAL MOLESTATION
EXCLUSION,
CERTIFICATE HOLDER CANCELLATION
ORANGE COUNTY GOVERNMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
ATTN:HUMAN SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
200 S CAMERON STREET ACCORDANCE WITH THE POLICY PROVISIONS.
PO BOX 8181
HILLSBOROUGH,NC 27276 AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Ricki Fitzsimmons
t7 1988.2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD