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HomeMy WebLinkAbout2019-116-E Health - Race for Equity equitable outcomes DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 [Departmental Use Only] TITLE RFE-Equit. Outcomes FY 2018-2019 NORTH CAROLINA SERVICES AGREEMENT UNDER$90,000.00 NO RFP/RFQ ORANGE COUNTY This Services Agreement (hereinafter "Agreement"), made and entered into this 20ffi day of February, 2019, ("Effective Date") by and between Orange County, North Carolina a political subdivision of the State of North Carolina (hereinafter, the "County") and Race for Equity, LLC, (hereinafter, the "Provider"). WITNESSETH: That the County and Provider, for the consideration herein named, do hereby agree as follows: 1. Services a. Scope of Work. i) This Agreement is for services to be rendered by Provider to County with respect to (insert type of project): Training and Facilitation: Achieving Equitable Outcomes with Results Based Accountability. ii) By executing this Agreement, the Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner. iii) Time is of the essence with respect to this Agreement. iv) The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof. Compensation to the Provider for Basic Services under this Agreement shall be as set forth herein. 2. Responsibilities of the Provider a. Services to be provided. The Provider shall provide the County with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b. Standard of Care. i) The Provider shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of Provider practice throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the performance of these services. Provider is solely responsible for the professional Revised 12/18 1 DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 quality, accuracy and timely completion and/or submission of all work related to the Basic Services. ii) Provider shall be responsible for all errors or omissions of its agents, contractors, employees, or assigns in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. iii) The Provider shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of the County. No permission for subcontracting shall create, between the County and the subcontractor, any contract or any other relationship. iv) Provider is an independent contractor of County. Any and all employees of the Provider engaged by the Provider in the performance of any work or services required of the Provider under this Agreement, shall be considered employees or agents of the Provider only and not of the County, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the Provider. v) If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials Provider represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. vi) In determining the basic services to be provided, should any documents be referenced in this Agreement, the terms of this Agreement shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. Should a request for proposals and a proposal be referenced the terms of the request for proposals shall have priority over the terms of any proposal. 3. Basic Services a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows (fully describe services to be provided): Train and facilitate Orange County Health Department staff, partners and select community members in Advancing Measurable Health Equity with Results Based Accountability as stated in the attached Exhibit A - Scope of Work. 4. Duration of Services a. Term. The term of this Agreement shall be from February 22, 2019 to May 31, 2019. b. Scheduling of Services. i) The Provider shall schedule and perform its activities in a timely manner. Revised 12/18 2 DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 ii) Should the County determine that the Provider is behind schedule, it may require the Provider to expedite and accelerate its efforts, including providing additional resources and working overtime, as necessary, to perform its services in accordance with the approved project schedule at no additional cost to the County. iii) The Commencement Date for the Provider's Basic Services shall be February 22, 2019. 5. Compensation a. Compensation for Basic Services. Compensation for Basic Services shall include all compensation due the Provider from the County for all services under this Agreement. The maximum amount payable for Basic Services shall not exceed Thirteen Thousand Five Hundred Dollars ($13,500). Payment for Basic Services shall become due and payable within thirty(30) days of Provider properly invoicing County. Payment shall be subject to provisions of Section 5(b). b. Disputes. In the event the amount stated on an invoice is disputed by the County, the County may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. Should Provider fail to perform its duties under the terms of this Agreement, County may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. c. Additional Services. County shall not be responsible for costs related to any services in addition to the Basic Services performed by Provider unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6. Responsibilities of the County a. Cooperation and Coordination. The County has designated (Beverly Scurry) to act as the County's representative with respect to the Project and shall have the authority to render decisions within guidelines established by the County Manager and/or the County Board of Commissioners and shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. Insurance a. General Requirements. Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by County's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing division/contracts.php). If County's Risk Manager determines additional insurance coverage is required such additional insurance shall consist of N/A (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in Revised 12/18 3 DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 effect and certification thereof has been received by the County's Risk Manager. 8. Indemnity a. Indemnity. The Provider agrees, without limitation, to defend, indemnify and hold harmless the County from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Project and arising from property damage or bodily injury including death to any person or persons caused in whole or in part by the negligence or 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 provision to require the Provider to indemnify the County to the fullest extent permitted under North Carolina law. 9. Amendments to the Agreement a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written Amendment to this Agreement executed by the County and the Provider. The Provider shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from the County. 10. Termination a. Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days' prior written notice to the Provider. b. Other Termination. The Provider may terminate this Agreement based upon the County's material breach of this Agreement; provided, the County has not taken all reasonable actions to remedy the breach. The Provider shall give the County seven (7) days' prior written notice of its intent to terminate this Agreement for cause. c. Compensation After Termination. i) In the event of termination, the Provider shall be paid that portion of the fees and expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. ii) 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. d. 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. Revised 12/18 4 DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 e. Suspension. County may suspend the Basic Services and this Agreement at any time for County's convenience and without penalty to County upon three (3) days' notice to Provider. Upon any suspension by County, Provider shall discontinue work on the Basic Services and shall not resume the Basic Services until notified to proceed by County. 11. Additional Provisions a. 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 without the written consent of the other. b. 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 identified, 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. c. Non-Discrimination. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal non-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy(each policy is incorporated herein by reference and may be viewed at http://www.oran eg countync. og v/departments/purchasing division/contracts.php.) Any violation of the Orange County Non-Discrimination Policy is a breach of this Agreement and County may immediately terminate this Agreement without further obligation on the part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. d. 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. e. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. Revised 12/18 5 DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 f. Severability. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. g. Ownership of Work Product. Should Provider's performance of this Agreement generate documents, items or things that are specific to this Project such documents, items or things shall become the property of the County and may be used on any other project without additional compensation to the Provider. The use of the documents, items or things by the County or by any person or entity for any purpose other than the Project as set forth in this Agreement shall be at the full risk of the County. h. Non-Appropriation. Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County's obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. It is expressly agreed that County shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. In the event of a change in the County's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects County's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to Provider of such limitation or change in County's legal authority. i. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the consent of the Parties to utilize electronic signatures and the intent of the Parties to comply with Article I IA and Article 40 of North Carolina General Statute Chapter 66. j. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Provider's Name Attention: Kimberlee Quatrone Race for Equity P.O. Box 8181 2237 Brisbane Woods Way Hillsborough,NC 27278 Cary,NC 27518 [SIGNATURE PAGE TO FOLLOW] Revised 12/18 6 DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PROVIDER: ocuSigned by: UocuSigned by: 1�6' Rmi&#Lrst t� �]t,iBy3799d6755E477.. By. aF1277C8CA304C0.. County Manager Deitre Epps, CEO and Founder Printed Name and Title Revised 12/18 7 DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 KAXExhibit A R.A.E.E. for EQUITY Scope of Work for Orange County Health Department Advancing Measurable Health Equity with Results Based Accountability Submitted by: Deitre Epps, CEO & Founder Race for Equity, LLC deitre@race4equity com (410)262-3470 Submitted to: Beverly Scurry Board of Health Strategic Plan Manager Orange Country Health Department RALE for EQUITY fl �.•• L k DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 PROJECT PURPOSE The purpose of this project is to provide health equity training and facilitation in support Orange County Health Department as it fulfills its Agreement Addendum to become familiar with, adopt, implement and assess itself against the National Culturally and Linguistically Appropriate Services (CLAS) standards in Heath and Health Care. PROJECT OVERVIEW Orange County Health Department (OCHD) has entered into an Agreement Addendum with the North Carolina Office of Minority Health and Health Disparities. The Agreement Addendum details the steps that OCHD will take to address the local health disparities by engaging in best practices included in the 15 National CLAS Standards. In the proposed project, Race for Equity will provide training, technical support and facilitation in support of achieving equitable health outcomes with Results Based Accountability. These services will be provided for OCHD staff, the health equity work- group, and for the community forum participants. COMPANY OVERVIEW The Lead Consultant for this project is Deitre Epps, CEO and Founder, Race for Equity. Since 2003, Deitre Epps has worked with government, non profit and philanthropic leaders in support of improved health outcomes for clients and communities. Through coaching, training, facilitation and technical assistance, she equips organizational staff and local resident leaders to work collaboratively in data-driven decision-making towards the achievement of measurable results that advance equity. Ms. Epps engages with clients both nationally and internationally and has provided consultation support the development of numerous results based community health plans, including plans for the City and County of San Francisco, Colorado Trust's Early Childhood Health Integration Councils, the Children's Trust of Miami-Dade, Florida Oral Health for Children receiving Medicaid, Health Foundation of South Florida, and the HigherLife Foundation in Harare, Zimbabwe. As a Results Based Facilitator, Ms. Epps has also provided consultation services in leadership development programs in both public and nonprofit sectors, including the National Institutes of Health Senior Leadership Program, the National Heart, Lung and Blood Institute Leadership Lab, the National Institute of Environmental Health Sciences Leadership Development Program, the Annie E. Casey Foundation's Leadership in Action Program, and for the Maryland-National Capital Parks and Planning Commission Transformational Leadership. She taught Results-Based Accountability and Collaborative Leadership as adjunct faculty at University of Maryland School of Public Policy for federal agencies and as faculty for CDC University at Centers for Disease Control and Prevention. She is the author of "Achieving Collective Impact with Results- Based Accountability," a white paper on the intersection of RBA and Collective Impact. DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 Ms. Epps holds a Bachelor's degree in Microbiology and a Master of Science degree in Human Services Administration. She is certified in Myers Briggs Type Indicator (MBTI), the Fundamental Interpersonal Relationship Orientation - Behavior (FIRO-B) and is a Certified Professional Diversity Coach. SCOPE of WORK: 1) OCHD Training: Achieving Equitable Outcomes with Results Based Accountability • Up to 100 OCHD staff will learn and apply effective, data-driven decision making for improving outcomes that advance equity • OCHD staff will understand the distinction between population accountability and performance accountability for systems, agencies and programs • OCHD staff will use both quantitative and qualitative data for understanding the barriers to health equity, including racism and social determinants of health. • OCHD staff will understand the importance of developing and providing culturally and linguistically appropriate services • OCHD staff will apply RBA's Turn the Curve questions to a health disparity indicator 1. How are we doing? (quantitative data on the headline measures) 2. What is the story behind the data? (what are the historical causes of the data) 3. Who are the partners that have role to play in improving the data? 4. What works to improve the data, including low/no cost actions? 5. What do we propose to do? (action plan for health equity) 2) Selecting Headline Performance Measures for Health Equity - • Work wth Executive Director and Team review and finalize existing measures • Determine health equity measures for strategic planning for equitable outcomes 3) Health Equity Council Meetings • Co-design support of Health Equity Council meetings • On-site support of two meetings (training and/or technical assistance and facilitation) • Co-design and strategic planning for community forum • Data selection for community forum on health equity 4) ) Community Forum on Health Equity: Co-design, Planning and Facilitation • Work with the Health Equity Council to design and plan for the Community Forum • Support planning for the presentation of CLAS-related and other local data using data visualization and presentation that is culturally and linguistically appropriate. • Prepare culturally and linguistically appropriate materials for the Community Forum • Facilitate the community forum, supporting staff and other presenters • Co-design Gallery Walk: How are Orange County Residents Doing? 5) Project Planning and Management (selected examples) • Planning, monitoring and executing project deliverables • Materials preparation and development (agenda, PowerPoints, etc.) • Forecasting and managing project risks • oversee progress and to determine corrective actions where necessary DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 Co-design Team: Project will be completed with co-design and planning with the Health Equity Council. Expected Outcomes: This training will enable committee members to understand the RBA framework in relationship to the health equity impact assessment. • Number of OCHD staff trained in using data and results based planning for advancing health equity (Achieving Equitable Health Outcomes with Results Based Accountability) • Number of community members engaged in the Heath Equity Council • Number and Percent of Health Equity Council members that attend all meetings • Number of Health Equity Council members who understand the how to achieve health equity with RBA • Number of participants who understand the importance of cultural and linguistic competence in strategy development and selection • Number of results based health equity strategies developed • Number of attendees at Community Forum • Number of meeting with Results Based Agendas • Summary of action steps Schedule: The proposed timeframe is February to May 2019 Budget DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 Participants Deliverables Cost Achieving OCHD Staff • Planning $ 2,500 Equitable Health • Co-design call Outcomes with • Materials Prep Results Based • Training Delivery Accountability (half day) Developing OCHD OCHD Director, • Headline $1,000 Headline Health Leadership Team Performance Equity Indicators and Racial Equity Measures and 4 Strategic Planning • Data Dev Agenda Performance Manager for Measures Disaggregated (4 hours) Data Health Equity Health Equity • Planning meeting $ 2,500 Council Meetings Council Members Virtual support • On-site support of 2 meetings • Agenda Prep Community Community • Co-design with $5,000 Forum on residents (and Health Equity Health Equity representatives of Council community based • Planning and Preparation of organizations) Project Gallery Walk: 44 Management How are Orange • Agenda County Residents Preparation Doing? • Training / Facilitation • Data and Posters for Gallery Walk Data Readiness Health Equity Selection of $2,500 Support- Council Headline Indicators Disaggregated and Performance Measures OCHD staff Measures AL ===9 TOTAL $13,500 Assumption is made that logistical support, meals for meeting & forums and printing of posters and materials will be provided by Orange County Health Department E(MM/DDIYYYY) DocuSi��velope ID:45EF61F8-8C51-4DEC-AE81-436OE25C8CF2 (ABILITY INSURANCE 79/7/2018 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 CONTACT NAME: AICNPHOE No Ext: (866)823-7504 AIC No): (866)828-2424 MCGRIFF INS SERVICES,INC.HANOVER CL CSC ADDRESS: Certificate@Hanover.com 414 GALLIMORE DAIRY RD#F INSURERS AFFORDING COVERAGE NAIC# GREENSBORO NC 27409 INSURERA: Hanover American Ins Cc 36064 INSURED INSURER B: INSURER C: RACE FOR EQUITY LLC INSURER D: 2237 BRISBANE WOOD WAY INSURER E: CARY NC 27518 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 EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DDIYYYY MM/DDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE F-/7 OCCUR PREMISES Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 A N N OZ6 D688371 00 09/06/2018 09/06/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- F,/7 L 0 C PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N NIA N WZ6 D688362 00 09/06/2018 09/06/2019 (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 $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ORANGE COUNTY HEALTH DEPARTMENT AUTHORIZED REPRESENTATIVE 200 S CAMERON STREET P O BOX 8181 1 HILLSBOROUGH NC 27278 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:45EF61F8-8C51-4DEC-AE81-4360E25C8CF2 Declarations rrO�� This is a description of your coverage GFMICO Tel: 1 S�0 841-3gOfl Please retain for your records_ geicv.cvm Number: 4�49-15-38-35 GOVERNMENT EMPLOYEES INSURANGI~ COMPANY one GEICO Boulevard (coverage period: Fredericksburg. VA 22412-0003 09.02-18 through 03_Q2-19 insured. 1201 a.rn. local time at the address of the named Date Issued: July 30, 2018 item 1: DEITRE LYNN EPPS 2237 BRISBANE WOODS WAY CARY NC 27518-9257 Email Address: deitre.epps@gmail.com Named insured Additional Driver Deitre L Epps Keith Allen — - Vehicle Location Finance Company/ Vehicle VIN Liene, 12018 Toyota Gamry 4T1B11HKIJU102348 Cary NC 27518 Navy Fcu -..—_ Vehicle 1 Vera es` -mi and/of D -r.n $ - A Liability Coverage Bodily Injury Liability $50.0001$100.000 $72.24 Each PersonlEach Occurrence .......... ................................. . .... - ------property damage Liability $25,000 $95•94 Each Occurrence .............. ........ ..... .. ... ......... .. B Medical Payments $3,000 $17,90 EachPerson ............... . ................................................................ ... ................. C. Combined Uninsured/Underinsu red Bodily Injury Liability Each PersonlEach occurrence $50,[]00!$140,OQD $12.00 Property Damage Each Occurrence $25,000 $1 ,00 D Damage To Your Auto Other Than Collision Loss Acv Minus $250 $35.00 Collision $250 Ded $197.00 Towing & Labor Costs Non-Ded $6.40 a ti a n T-C a Coverages Continued on Back DEC_PAGE(03 i4y [Page 1 of Z} Renewal Policy Page 7 of 14