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Home My WebLink About2018-750-E Finance - New Destinations performance agreement(New Destinations) Orange County Cardinal Managed Care FundPerformance Agreement Revised 8/2018Page 1of 9 CARDINAL MANAGED CARE FUNDS 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, 200South Cameron Street, Hillsborough, North Carolina, 27278, ("County")and New Destinations,a not-for-profit corporation, located at 5720 Turner Store Lane,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 animportant 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 New Destinationsagree as follows: 1.Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2018to June 30, 2019. 2.Scope of Services. a.Provider will provide servicesto the residents of Orange County, as outlined in the attached Cardinal Managed Care Fundsand any amendments or revision thereto which is attached as Exhibit “A”,which are incorporated by reference. The Scope of Services and the Program Budget may be different 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. 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.Cardinal Managed Care Funding. i.Cardinal Managed Care Funding. The County agrees to appropriate funds for the provision of services described in Exhibit A, Work Statement and may be more particularly described in the Revised Program Budget in Exhibit B, the maximum sum of 35,100in Cardinal Managed Care Funds. ii.The Provider shall be paid Cardinal Managed Care Funds in twelve equal monthly installments in the amount of$8,775.The first payment is contingent upon receipt of the agency’s performance agreement;the remaining payments are contingent uponreceipt of the request for reimbursement and related supporting documentation. b.All funds appropriated shall be used for purposes described in ExhibitA. 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 DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 (New Destinations) Orange County Cardinal Managed CareFund Performance AgreementPage2of 9 Rev. 8/18 the Provider. If the funds are expended not in accordance with theWork Statement, at the discretion of the County the Provider may be required to repay the funds to the County. c.The County’s obligation to make the payments is contingent upon receipt of Progress Reportsand requests for reimbursements as provided in Section 4 below, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Work Statement. d.Once Provider has satisfied its obligations as provided inSections 3and/or4paymentwill be made within 21days after receipt of the Progress Report andRequest for Reimbursement. e.The County isnot obligatedto provide any other support to Providerin this or in succeeding fiscal years. 4.Agency Reporting. a.Cardinal Managed Funds Reporting. Provider will provide Orange County a Monthly Progress Report for Cardinal Managed Care funds that includes a fiscal report and updates onperformance measuresas outlined in the Work Statement. Progress Reportsare due by the 15th of the next month following the month being reported. 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 Agreementand Provider shall return all payments already made to it by the County for services which have not been provided or forwhich 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 tothe 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. DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 (New Destinations) Orange County Cardinal Managed CareFund Performance AgreementPage3of 9 Rev. 8/18 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 shall pay Provider that portion of the fees and expenses that it has earned to the date of termination, less any costs orexpenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider.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. 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 unused funds 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. e.Should this Agreement be terminated, the Provider shall deliver to the County within seven (7) days, at no additional cost, all deliverables including any electronic data or files relating to the Project. f.Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 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 coveringclaims 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 DESCRIPTIONMINIMUM REQUIRED COVERAGE DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 (New Destinations) Orange County Cardinal Managed CareFund Performance AgreementPage4of 9 Rev. 8/18 x Worker'sCompensation Limits for Coverage A -Statutory State NC & Coverage B -Employers Liability $500,000 each accident, disease policy limit and disease each employee x Commercial General $1,000,000 Each Occurrence Liability$2,000,000 Aggregate x Automobile Liability$500,000 Combined Single Limit x Professional Liability$1,000,000 Each Occurrence $2,000,000 Aggregate c.All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 d.Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. 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 respectivedepartments, 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 thisAgreement 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.Limitation and Assignment.The County and the Provider each bind themselves,their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement or the rights to payment to any other party without the written consent of theother. 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 theCounty 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. DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 (New Destinations) Orange County Cardinal Managed CareFund Performance AgreementPage5of 9 Rev. 8/18 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, employeesand 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.Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however, the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. 15.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 $14.25per hour.To the extent possible, Orange County recommends that New Destinationsprovide a living wage to its employees. 16.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: 17.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. 18.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 orin 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 County: Finance &Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: New Destinations 5720 Turner Store Lane Raleigh, NC 27603 DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 (New Destinations) Orange County Cardinal Managed CareFund Performance AgreementPage6of 9 Rev. 8/18 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.By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81. 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 ____________________________________________________ Larry Lackey,Executive DirectorDate For and on behalf of Orange County Government _______________________________________________________ Bonnie Hammersley, County ManagerDate DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 AGENCY INFORMATION 8/31/2018 11:35:08 AM Page 1 of 11 FY2018-19 MENTAL HEALTH SERVICES APPLICATION a)Applicant Contact Information Applicant Organization’s Legal Name: New Destinations, Inc. Applicant Organization’s Physical Address: 5720 Turner Store Lane –Raleigh, NC 27603 Applicant Organization’s Mailing Address: 5720 Turner Store Lane –Raleigh, NC 27603 Applicant Organization’s Web Address: www.newdestinationsinc.com Executive Director: Larry Lackey Telephone Number:(919) 414-2860E-Mail: larrylackey@newdestinationsinc.com Tax IDNumber: 26-4220482 b)Funding Request Program Total Ex. Youth AfterschoolProgram Afterschool Program Coordinator salary and materials for youth activities and projects $30,000 Orange Apartments-Residential Services for Adults with Severe Persistent Mental Illness $35,100 Totals $35,100 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: Executive DirectorDate Signature: Board ChairpersonDate Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 AGENCY INFORMATION 8/31/2018 11:35:08 AM Page 2 of 11 d)DISCLOSURE OF POTENTIAL CONFLICTS OF INTERESTAND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will becarrying out this program or members of their immediate families, or their business associates… YESNO a)Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, orOrange County? b)Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, orOrange County? c)Current beneficiaries of the program for which funds arebeingrequested? d)Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote.The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy.This provision is 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 programineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: Executive DirectorDate Signature: Board ChairpersonDate Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 Agency Information8/31/2018 11:35:08 AM Page 3 of 11 AGENCY INFORMATION Please provide the following information about your agency: a)Years in Operation, Date of Incorporation (Month/Year):10/2018 b)Agency’s Purpose/Mission (no more than a few sentences): New Destinations, Inc. was created to provide support for individuals and families impacted by mental disorders, substance abuse and/or developmental disabilities, while working in collaboration with the community, empowering clients to experience personal satisfaction and to live with dignity in their own Communities . . . c)Living Wage Does this agency pay permanent employees a minimum living wage?(Yes/ No)Yes If yes, is this agency an Orange County Living Wage Certified Employer?No If no, please explain.Current Funding only allows for an hourly wage of $13.00 per hour. Current level of funding is insufficient to provide Employer paidhealth insurance coverage. Apartment Unit including utilities is provided. # of FTE -Full-Time Paid Positions: 1 # of FTE -Paid Part-Time Positions:0 # of Volunteers:0 # of FTE -Volunteers:0 Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 PROGRAM INFORMATION8/31/2018 11:35:08 AM Page 4 of 11 PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: Orange County Apartments –(14) Resident Units –(1) Manager Unit Program Primary Contact and Title: Larry Lackey –Executive Director Telephone Number:(919) 414-2860E-Mail: larrylackey@newdestinationsinc.com Program Description (3 pagesOR LESS) "Supervised Living" is provided in individual apartments. This is the least restrictive residential service which includes room and periodic support care. These apartments are the individual's home, and they are not licensed facilities. In limited cases residents may receive an amount of rental assistance from the area program, but no mental health services are attached to the apartment. The individual may receive periodic mental health services such as outpatient treatment, structured day programming, etc., independent of the "supervised living" apartment, and may also be eligible for a subsidy from an additional funding source. Community based mental health services such as ACTT may be provided to the individual in the home, but the service is not programmatically linked to the home. Apartment Manager conducts periodic unit inspections, collects apartment rents, provides assistance/guidance with Resident’s issues, prepares Annual Recertifications to establish the Resident’s continued eligibility, assists with conflict resolutions and other day-to-day operational activities. Please provide thefollowing information about theproposed program: DDescribe the community needorproblem 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. Provide housing for low income individuals diagnosed with SPMI and at a high risk for homelessness. EDescribe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) New Destinations has Mental Health QP’s on staff that assist the Apartment ManagerLQ providLQJ the service inaccordance with State Requirements. FWhat efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc.?) Annual Surveys, periodic/unannounced site visits by New Destinations’ Client Rights Director, Locked Suggestion Box located in the Apartment’s common area. Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 PROGRAM INFORMATION8/31/2018 11:35:08 AM Page 5 of 11 Additional Program Information d)Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served,to the best of your ability, Program Target PopulationDemographics Actual 2016-17 Estimated 2017-18 Projected 2018-19 Gender Male 9 9 9 Female 4 4 4 Total 13 13 13 Ethnicity African-American 3 3 3 American Indian or Alaska Native Asian 1 1 1 Caucasian 9 9 9 Native Hawaiian or other Pacific Islander Other: specify __________________ Total 13 13 13 Of the above, how many Hispanic/Latino 0 0 0 Of the above, how many non-Hispanic/Latino 0 0 0 Total 0 0 0 Age 0-5 years 6-18 years 19-50 years 6 6 6 51+ years 7 7 7 Total 13 13 13 Geographic Location AlamanceCounty Chatham County Durham County Wake County Orange CountyBreakdown Chapel Hill Public Housing 13 13 13 Town of Chapel Hill (Non-Public Housing) Town of Carrboro Town of Hillsborough City of Mebane(Orange County) Orange County (Outside Municipalities) Total 13 13 13 Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 PROGRAM INFORMATION8/31/2018 11:35:08 AM Page 6 of 11 Work Statement e)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. 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 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 OrangeApartments (AKA: Overlook Apartments) 1.Program Activity Name Program Goal Maintain safe and pleasant living environment Performance Measures Well maintained grounds and buildings Previous Year Program Results Achieved. Current Year EstimatedResults Achieved Next Year Projected Results Achieved 2.Program Activity Name Program Goal Routine Apartment Inspections Performance Measures Units maintained in accordance with HUD Standards Previous Year Program Results Achieved Current Year EstimatedResults Achieved Next Year Projected Results Achieved 3.Program Activity Name Program Goal Facilitate Resident’s Involvement with the Community. Performance Measures Provide monthly activity; Dining-Out, Resident’s Gathering Previous Year Program Results Achieved Current Year EstimatedResults Achieved Next Year Projected Results Achieved 4.Program Activity Name Program Goal Maintain Facility Structures in accordance with HUD Standards Performance Measures Pass Annual Construction Inspections Previous Year Program Results Achieved Current Year EstimatedResults Achieved Next Year Projected Results Achieved Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 PROGRAM INFORMATION8/31/2018 11:35:08 AM Page 7 of 11 d)Agency Budget (See Excel Spreadsheet) i.Is your agency currently receiving and/or requesting otherlocalgovernment funding?(Yes/No)No If yes, please list below: 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 Chapel Hill -Other Ex.Total $15,000 $35,000 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 longas 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: 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.) Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 PROGRAM INFORMATION8/31/2018 11:35:08 AM Page 8 of 11 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? Deficit Is there a significant change? Yes/No No Please provide a brief explanationfor Surplus or Deficit, and significant changes. Typically, annual funding of $35,100 is depleted by the9th month of the fiscal year. New Destinations charges a 10% Management Fee based on expenses. This fee is depleted by the (2) to (3) months of ‘No Funding’near the fiscal year-end.New Destinations operates the Program at a loss. iv.What is your agency’s fiscal year? January1, 2018 Through December31, 2018 Exhibit A Provider's Cardinal Managed Care Application and Work Statement DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 Certified by: _______________________ Title: __________________________ Date: ____________ (Provider’s Signature) EXHIBIT “B” Scope of Services –FY 2018-19 Outside Agency Performance Agreement Agency Name: Program Name: Funding Award: Outline how the agency will spend Orange County’s funding award. Program Services Outline the critical services (activities)the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. Apartment Manager conducts periodic unit inspections, collects apartment rents, provides assistance/guidance with Resident’s issues, prepares Annual Recertifications to establish the Resident’s continued eligibility, assists with conflict resolutions and other day-to-day operational activities. 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 (14)Adults diagnosed with SPMI and at a heightened risk for homelessness will receive assistance in maintaining independent living and avoid psychiatric hospitalizations. Achieve Goals Expense Description Amount Payroll Employee Benefits -Calculated @ 20% of Payroll Commercial Property Insurance/Liability/Data/Umbrella Vehicle Insurance Van Fuel Van Repair/Maintenance Telephone Internet Program Supplies Postage Cellular Phone Staff Training -Relias Learning Replacement Furnishings -Resident Units Resident Recreation Trash Removal Subtotal Administrative Fee (10%) Total Expenses & Administrative Fee Due $22,680 $4,536 $2,136 $1,104 $576 $1,200 $2,676 $1,500 $60 $408 $600 $1,800 $1,680 $180 $41,136 $4,114 $45,250 ([HFXWLYH'LUHFWRU NewDestinations Mental Health $35,100(maxamounttobereimbursed) $35,100wastheamountapprovedforNewDestinations. TheCountywillonlyreimbursefeesupto$35,100 XXXXXXX XXXXXX XXXXX DocuSign Envelope ID: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 (New Destinations) Orange County Cardinal Managed CareFund Performance AgreementPage10of 9 Rev. 8/18 ATTACHMENT “A” Orange County Certifications –FY 2018-19 Cardinal Managed Care FundPerformance 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 Boardof 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: 45F8D9E2-21AC-4868-9A00-7CEFD1517F11 DocuSign Envelope ID:45F8D9E2-21AC-4868-9A00-7CEFD1517F11 NEWDE-1 OP ID: C1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)08/31/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 919-467-6339 CONTACT Ed Moore&Associates,Inc. NAME: Ed Moore&Associates,Inc. PHONE 919-467-6339 FAX 919-467-6434 103-B Kilmayne Drive (A/C,No,Ext): (A/C,No): Cary, NC 27511 E-MAIL SS:cmoore @edmooreinsurance.com Ed Moore&Associates,Inc. INSURERS AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED New Destinations Inc INSURER B:All Risks Ltd-Oak River Ins CO PO Box 1239 Fuquay Varina, NC 27526 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTIR MM/DD/YYYY DD YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR ETD 0388216 05/26/2018 05/26/2019 DAMAGE TO RENTED 1,000,00 Y PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 X POLICY� PECOT- F7 LOC PRODUCTS-COMP/OP AGG $ 3,00,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO ETD 0388216 05/26/2018 05/26/2019 BODILY INJURY Per person) $ OWNED SCHEDULED X AUTOS ONLY LXX AUTOS BODILY INJURY Per accident $ X AUTOS ONLY NON-OWNED ONEY PerOacciden DAMAGE $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE ETD 0388216 05/26/2018 05/26/2019 AGGREGATE $ 2,000,000 DIED RETENTION$ PER OTH B WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE E NEWC907081 05/26/2018 05/2612019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Professional Liab ETD0388216-INCL PRIOR ACT 05126/2018 05/26/2019 Incident 1,000,000 RETROACTIVE DATE 05/26/09 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County Government is an additional insured with respect to General Liability coverage when required by written contract. CERTIFICATE HOLDER CANCELLATION ORANGCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. 200 South Cameron Street P.O. Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 Ed Moore&Associates, Inc. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD