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2019-772-E DSS - Interfaith Council performance agreement
DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2019,("Effective Date")by and between. the County of Grange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ("County") and Inter-Faith Council for Social Services, Inc., a not- for-profit corporation, located at 110 West Main Street,Carrboro,NC 27510("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Provider agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1,20I9 to dune 30,2020. 2. Scope of Services. a. Provider will provide services to the residents of Orange County, as outlined in the Outside Agency Funding Application and any amendments or revision thereto (Exhibit "A") and Emergency Assistance Scope of Work ("Exhibit B"), both of which are attached and hereby incorporated into this document as if set out herein. The Scope of Services in Exhibit A 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 C. 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 funds for the provision of services described in Exhibit A, Scope of Services, and more particularly described in the Program Budget or Revised Program Budget, the maximum sum of Fifty Seven Thousand, Six Hundred and Three Dollars ($57,603). The County also agrees to appropriate funds for the provision of services described in Exhibit B, the maximum sum of Eighty Five Thousand Dolloars ($85,000). The total amounted appropriated by the County to Provider for these services shall be One Hundred and Forty Two Thousand, Six Hundred and Three Dollars ($142,603). b. All funds appropriated shall be used for purposes described in Exhibit A and Exhibit B. 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 provided in Exhibits A and B, at the discretion of the County the Provider may be required to repay the funds to the County. c. Funds Appropriated for Outside Agency Funding(Exhibit A)Services. Inter-Faith Council far Social Services,Inc. Orange County Outside Agency Performance Agreement Revised7712018 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 i. For funds appropriated for Exhibit A services, the Provider shall be paid in four equal installments in the amount of$14,400.75 . 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. ii. 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. iii. Once Provider has satisfied its obligations as provided in c.l. above 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. d. Funds Appropriated for Emergency Assistance(Exhibit B) Services. i. For funds appropriated for Exhibit B services, the County will reimburse Provider for services described in Exhibit B up to the limits allocated by this Agreement. Provider shall only be reimbursed for actual expenditures for approved services. ii. For reimbursement, Provider must submit copies of bills, checks, receipts and/or other proof of expenditures to the person designated by the County. Reimbursement will be provided bimonthly. iii. For reimbursement of staff costs, Provider shall submit the payment records for staff cost. The County will reimburse the Provider monthly upon receipt of a complete and correctly fled report. e. 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: duly 1 —December 31; January 1 —March 31 and April 1 -June 30. Reports are due on January 17,April 17,and July 17 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 2 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 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. 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 3 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 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 insurances coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE 0 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. 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. ll.. 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 4 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 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. Nan-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. Laving 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$ 14.95 per hour. To the extent possible, Orange County recommends that Provider 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: County: Provider: Nancy Coston Executive Director Department of Social Services The Inter-Faith Council for Social Orange County Service,Inc. Post Office Box 8181 110 W.Main Street Hillsborough,North Carolina 27278 Carrboro,North Carolina 27510 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. 18. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. 5 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of the Agreement and County may immediately terminate this Agreement without further obligation on part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 19. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures axed hereto evidence the intent of the Parties to comply with Article 1 i A 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. EDocu tf 5igned by: � of the Provider a.&(, �" 10/17/2019 B317305AEFF04A9 Jackie Jenks, Executive Director Date r.__ __ _r —__ t_L_Fr—r.1—_ Doc u5igned by: nge County Government �bttiln df. Rm�tyYS 10/18/2019 OG3799d8755E477.. Bonrue haminersley, county Manager Date 6 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 Exhibit A Outside Agency Application and Scope of Services 8 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 - COVER PAGE Applicant Contact Information Applicant Organization's Legal Name: Inter-Faith Council for Social Service Applicant Organization's Physical Address: 110 West Main Street Carrboro NC 27510 Applicant Organization's Mailing Address: 110 West Main Street, Carrboro, NC 27510 Applicant Organization's Web Address:www.ifcweb.or Executive Director:Jackie Jenks Telephone Number:(919) 929-6380 x14 E-Mail: lienks(Wornailbox_om Tax ID Number:59-1224041 Funding Request Please list all Fiscal Year 2020 Human Services(HS)funding requested for all programs and the proposed use of funds(please list program mime only) Program Carrboro- Chapel Orange Total HS Hill-H5 County-HS Residential Services: $5,000 $2.5,000 $35,000 $65,000 HomeStart, shelter for women and families Communi House, shelter for men Food Security Programs: $10,000 $25,000 $35,000 $70,000 Food Pantry Communi Kitchen Totals $15,000 $50,000 $70,000 $135,000 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: V t� r 11 Executive Director Date Z Signature: (2ZI j 2 2 1 oar Chairperson Date Cover'Page P a g e S 0 F 2 5 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 - 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. YES NO x❑ ❑ a) Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, or Orange County? ❑ x❑ b7 Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill,or Orange County? x❑ ❑c)Current beneficiaries of the program for which funds are being requested? ❑ x❑ d7 Paid providers of goads 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. a) One of our part-time residential staff members at HomeStart is an employee of the Orange County Health Department. c) Embracing a commitment to diversity and representation of all stakeholder perspectives; IFC has seats on our Board of Directors for shelter residents and other members of our programs. A member of our Board of Directors is currently a resident at Community House. 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 [aw 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: Executive Director Date Signature: o a rJ Chairperson Date _......-....... - — — Cover Page Page 5 ❑ f 20 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 AGENCY INFORMATION Please provide the following information about your agency. 1. Date of Incorporation [Month/Year]: November 1970 IFC was founded in 1963 and has been operating for 56 years. It was incorporated in November 1970. 2. Agency's Purpose/Mission(no more than a few sentences): IFC confronts the causes and responds to the effects of poverty in our community. We believe in a community where everyone's basic needs are met, including dignified and affordable housing, an abundance of healthy food, and meaningful social connection. 3. Please provide a brief description of your organization's past achievements in carrying out similar projects and evidence of successful record of meeting proposed budgets and timetables (no more than 100 words). In 1963, seven women united to address the conditions of poverty in Chapel Hill and Carrboro through the efforts of volunteers. Since then, IFC has become the primary non- profit provider of basic needs services for people living or working in our community. IFC has built capacity over decades to respond quickly and competently to residents' diverse needs in partnership with the County's Department of Social Services, the Towns of Chapel Hill and Carrboro, the OC Partnership to End Homelessness, United Way of the Triangle, the Emergency Solutions Grant Program, the Department of Housing and Urban Development, and many private foundations. 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,we are proud to be If no, please briefly explain. Schedule of Positions: #of FTE—Full-Time Paid Postions: 28 #of FTE—Part-Time Paid Positions: 7 IFC is grateful to leverage the time and energy of 750+ volunteers, who provide almost 30,000 hours of pro Bono staff time each year. IFC could not operate without them. - - ........................................................... ....-- ---.... _..............._......... Pi-ogram information Page 4 o F 17 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Residential Services Program Primary Contact and Title: Ste hani Ki lipatrick. Residential Services Director Telephone Number: (919) 967-1086 x12 E-Mail:skilpatrick(o-)ifcmailhox.org 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of ChaPei Hill and Carrboro's Results Framework, and Orange County BOCC Goals and Priorities, and the target population to benefit from the program. [100 words or less] As Orange County's only provider of homeless shelter services, 1FC works with numerous community partners to ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents, including social safety net services such as safe shelter and meals, which are critical to well-being. IFC works with residents to identify their goals in increasing their livelihood security and access the most appropriate social safety net services, partly by participating in Orange County's Coordinated Entry system, which determines quickly, consistently and effectively which services or resources will best help people experiencing homelessness. 7.Target Population: Please complete the table below with numbers(not percentages) of individuals served and projected to be served. Program Target Population Demographics Projected Actual Estimated Projected 2017-18 2017-18 2018-19 2019-20 Gender Men 230 252 264 250 Women 145 122 96 100 Nonbinary/Genderqueer Self-Describe Total 375 374 360 350 Race and Ethnicity 61ack or African-American 230 194 178 180 American Indian or Alaska Native 2 0 12 6 Asian 1 2 2 2 White 130 167 162 153 Native Hawaiian or other Pacific Islander 0 1 2 2 Other:specify: Multi-racial 12 10 4 7 Total 375 374 360 350 Of the above,how many Hispanic/Latinx 2 2 2 2 _._.............................................. -- ......................... ..__..............__--•.—._........................_................................ .._ �. Program Information Page 5 o F 17 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 of the above,how many non-Hispanic/Latinx 373 372 358 348 Total 375 374 360 350 Age 0-5 years 42 25 18 22 6-1S years 33 37 28 30 19-50 years 180 189 198 178 51+years 120 123 116 120 Total 375 374 360 350 Geographic Location Town of Chapel Hill 130 25Q F 242 226 Town of Carrboro 25 6 4 6 Orange County{outside of Chapel Hill/carrboro) 33 18 20 19 outside of Orange County 187 100 94 99 Total 375 1 374 360 350 Income Low-income(80%of the Area Median Income and Below) Please see income table In the attachments 375 374 360 350 Total 375 374 360 350 8. 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 2017-18 Estimated 2018-19 Projected 2019-20 Total Cost of Program $887,572 $800,625 $832,650 Total#of individuals 374 360 350 Cost Per Individual $2,373 $2,224 $2,379 9. Performance Indicators NEW THIS YEARI For Chapel Hill and Carrboro applicants: Please complete the fallowing chart with information about the Strategic Objective, Intermediate Result, and the Agency Performance Indicator for each program for which you are applying for funding. Please see the Results Framework in the Attachments section as a reference. Program Name: Residential Services Strategic ❑ Children improve their educational outcomes Qbj ective (please choose onefrom X Residents Increase their livelihood security the Results Framework) ❑ Residents improve their health outcomes . ...... ..... .---...................... ............ Program information Page 6 of 17 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 NEW THIS YEAR! For Orange County Applicants: WORK STATEMENT i Performance Quantifiable FY 2017-18 ACtual FY 2018-19 FY 2019-20 Projected Measurement 13OCC Goals and Priorities ❑bjective Outcome Estimated Outcome ❑utcomeTPragram e ((Numerical] (Numerical) (Numerical) %and#of Ensure a community IFC 374 community 360 community 350 community unduplicated network of basic Residential members members will members will human services and Services community received receive receive infrastructure that provide basic members who emergency emergency emergency Residential receive maintains, protects, shelter and shelter services shelter services shelter services x and promotes the well- case Services emergency being of all county management (program (program (program shelter services residents to individuals participants and participants and participants and and families Inclement inclement inclement experiencing weather guests) weather guests) weather guests) homelessness %and#of Ensure a community IFC shelter 75(20%) 73(20%) 88(25%) program network of basic residents program program program participants who human services and move from participants who participants who participants who are homeless or infrastructure that shelter to are homeless or are homeless or experiencing maintains, protects, permanent were homeless experiencing experiencing experiencing Residential unstable housing and promotes the well- housing or unstable housing unstable housing 2 Services who obtain being of all county unstable will obtain will obtain housing residents housing housing upon housing upon exit obtained exit from shelter from shelter housing upon exit from shelter Prograru ofoon:,bon P a g.l . 8 of 17 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 PROGRAM INFORMATION *Please submit for each program if applying far funding for more than one program. S. Program Name:Food Security Programs Program Primary Contact and Title: Kristin Laver ne Community Services Director Telephone Number: (919) 929-6380 x41 E-Mail: kiaver ne ifcmailbox.or 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chapel Hill and Carrboro's Results Framework,and Orange County BOCC Goals and Priorities,and the target population to benefit from the program. (100 wards) As the largest provider of food security in our community, IFC ensures a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all County residents. IFC's Community Kitchen serves hot meals daily to anyone who is hungry, and the Food Pantry provides a full complement of groceries, personal care items and emergency financial assistance to prevent eviction and utility disruption. These programs advance the priorities of the Towns to increase residents' livelihood security and support residents in accessing the most appropriate social safety net services within and beyond IFC, 7.Target Population: Please complete the table below with numbers(not percentages)of individuals served and projected to be served. Program Target Population Demographics Projected Actual Estimated Projected 2017-18 2017-18 2018-19 2019-20 Gender Men 1501 1513 1500 1500 Women 2161 2049 2100 2100 Nonbinary/Genderqueer 0 0 0 0 Self-Describe 0 0 0 0 Total 3662 3562 1 3600 3600 Race and Ethnicity Black or African-American 2222 1871 2000 2000 American Indian or Alaska Native 14 68 50 50 Asian 11 66 50 50 White 1082 942 1050 1050 Native Hawaiian or other Pacific Islander 15 65 1 50 1 50 Other:specify—Multiracial,Hispanic/Latinx,unknown 318 550 400 400 ---._..__...--............................................................................................................. Program information P a g e 11 of 17 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 Total 3662 3562 3600 3600 Of the above,how many HispaniclLatinx 403 332 350 350 Of the above,how many non-HispaniclLatinx 3259 3230 3250 3250 Total 3662 3562 3600 3600 Age 0-5 years 0 0 0 0 6-18 years 36 21 30 30 19-SO years 2161 2126 2100 2100 51+yea rs 1465 1415 1470 1470 Total 3662 35621 3600 3600 Geographic Location Town of Chapel Hill 2454 2464 2450 2450 Town of Carrboro 916 1021 1000 1000 Orange County{Outside of Chapel H i I I/Ca rrboro) 73 40 50 50 Outside of Orange County 219 37 100 100 Total 36621 3562 3600 3600 Income Low-income(80%of the Area Median Income and Below) Please see income table in the attachments 3500 3460 3492 3492 Total 3662 3562 1 3600 3600 8. 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 2017-18 Estimated 2018-19 Projected 2019-20 Total Cast of Program $475,629 $592,158 $615,844 Total #of Individuals 3,562 3,600 3,600 Cost Per individual $134 $164 $171 9. Performance Indicators NEW THIS YEAR! For Chapel Hill and Carrboro applicants: Please complete the following chart with information about the Strategic Objective, Intermediate Result,and the Agency Performance Indicator for each program for which you are applying for funding. Please see the Results Framework in the Attachments section as a reference. Program Name: Food Security Programs Strategic © Children improve their educational outcomes Objective (please choose one from x Residents Increase their livelihood security ............................. ... Program information 1' a g e I r o f ;. 7 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 NEW THIS YEAR! For Orange County Applicants: WORK STATEMENT FY 2017-18 FY Z618-19 FY 2019-20 Projected Measurementement Program performance 90CC Goals and Priorities Quantifiable Ohlective Outcome si Estimated Outcome Outcome tcom (Numerical) (Numerical) (Numerical) Ensure a community network of basic Food Pantry will human services and collect and Food #of households infrastructure that purchase enough Security that receive food maintains, protects and food items to 1 Programs promotes the well- provide rotaries 3,562 3,600 3,600 (Food assistance p p g Pantry) being of all county -as often as once a residents. month to member households Ensure a community A hot,nutritious network of basic meal will be Food human services and served to any Security #meals provided) infrastructure that hungry person 2 Programs food assistance maintains, protects and who shows up at 61,599 65,000 65,000 (Community promotes the well- mealtimes at the Kitchen) being of all county Community residents. Kitchen NOTE:At the request of OSS,IFC has partnered with Orange County beginning FY19 to dlssemInate dSS emergency financial assistance funds and report on them through a separate agreement.The performance measurements above reflect our request to use 0ut5l4e Agency funds from Orange County solely to provide food securlty services. Program information P a g e 14 o f 17 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 Agency Budget Operating Budget for Program PROGRAM NAME: Inter-Faith Council for Social Service Actual Estimated 2018 Projected Percent PROGRAM REVENUE 2017-18 19 2019-20 Chan e Private Donations $ 980,969 $ 1,013,421 $ 1.059,092 5% Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ 13,450 $ 12,000 $ 15,000 25% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 25.000 $ 29,000 $ 50,000 72% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 50,000 $ 53,650 $ 70,000 30% Other-Orange County $ - I $ 86,500 $ 86,500 0% Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ 53,819 $ 27,408 $ 20,000 -27% State Government $ 92,394 $ 34,868 $ 30,000 -14% Federal Government(CDi3GIH0MEIetc.) $ 162,932 $ 176,613 $ 176,613 0% Private Foundation Grants $ 319,807 $ 351.874 $ 323,800 -8% Other Revenue* $ 453,732 $ 301,372 $ 334,365 11 Total Program Revenue $ 2,162,103 $ 2,086,706 $ 2,165,370 4% PROGRAM EXPENSES Compensation $ 1,377,080 $ 1,395,643 $ 1,451,469 4% Client assistance $ 253,670 $ 284,159 $ 291,184 2% Special events $ 10,812 $ 7,500 $ 7,500 0% Admin/Program expenses $ 305,514 $ 223,874 $ 232,829 4% Rent&Utilities $ 106,599 $ 107,260 $ 111,550 4% Supplies&Equipment $ - $ - $ - 0 Travel&Training $ 6,828 $ 4,080 $ 4,080 0% Other Expenses: $ 91,600 $ 64,190 $ 66,758 4% Total Program Expenses $ 2,152,103 $ 2,086,706 $ 2,165,370 4°I6 SLIRPLLISI(DEFICIT) FOR PERIOD: $ - $ - $ - 0 *Other Revenue includes transfers from iFC's endowment and designated reserve funds Please explain Other Grants IFC receives grant funding from the State ESG program for HomeStart and from HUD.for Permanent Supportive Housing Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. NIA DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 Applicant Contact Information Appiicant 0 rga nizatio n's Legal Name: Inter-Faith Council for Social Service Applicant Orga nizatio n's Physical Address:110 W Main St.,Carrboro NC 27510 Applicant Organizations Mailing Address:110 W.Main 5t. Carrhoro NC 27510 Applicant❑rganization's Web Address:www.ifr-web.or Executive Director:lackie Jenks Telephone Number:919-929-6380 x41 E-Mail:lienks ifcrnailbox_or Tax ID Number:59-1224041 Funding Request Please list all Fiscal Year 2020 Human Services(HS)funding requested for all programs and the proposed use of funds(please list program name only) Program Carrboro- chapel pranEE Total HS Hill-HS County-H5 Food for the Summer $1,500 $1,500 $1.SQ0 $4,500 Totals 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: C,)�&,,- Jam'~—' l Z 1 Executive Director Hate Signature: Z i I 2_ card 6hairperson Date C�zvera��e P a ❑ _- DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAU5E 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. YES NO ❑ ® 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? ❑ ® d7 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 anv grant awarded. Signature: J c' .L L- 1 ) l 2-Z L ! Executive Director Date p� Signature: 6 /4 k ( 2- Abare Chairperson Date Cover ?uge a g e 6 0 Y .0 S DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 a;yf e 1VGY:.INF:C7RIVIAT N:;;; Please provide the following information about your agency: 1. Date of Incorporation(MonthJYear): )November 1970 IFC was founded in 1953 and has been operating for 56 years. It was incorporated in November 1970. 2. Agency's Purpose/Mission (no more than a few sentences): IFC confronts the causes and responds to the effects of poverty in our community. We believe in a community where everyone's basic needs are met, including dignified and affordable housing, an abundance of healthy food, and meaningful social connection. 3. Please provide a brief description of your❑rganization's past achievements in carrying out similar projects and evidence of successful record of meeting proposed budgets and timetables(no more than 100 words). In 1953, seven women united to address the conditions of poverty in Chapel Hill and Carrbaro through the efforts of volunteers. Since then, IFC has become the primary non- profit provider of basic needs services for people living or working in our community_ IFC has built capacity over decades to respond quickly and competently to residents' diverse needs in partnership with the County's Department of Social Services, the Towns of Chapel Hill and Carrbaro, the dC Partnership to End Homelessness, United Way of the Triangle, the Emergency Solutions Grant Program, the Department of Housing and Urban Development, and many private foundations. 4. Living Wage: Does this agency pay permanent employees a minimum livin,wage?(Yes/No) Yes if yes, is this agency an Orange County Living Waee Certified Employe ?Yes If no, please briefly explain. Schedule of Positions: #of FTE—Fuil-Time Paid Positons: 28 #of FTE—Part-Time Paid Positions: 7 IFC is grateful to leverage the time and energy of 750 volunteers, who provide almost 30,000 hours of staff time pro bona each year. We could not operate without them. Program information P a g e 7 of 2 2 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 PROdMI: ,71VfiORNIATfON:. -r: *PJease.submrt for each prograrrr rf p]!jrrrfg; r fundirl0 for more than:one.:program. 5. Program Name: Food For the Summer Program Primary Contact and Title: Kristin Lavergne, Community Services Director. IFC Telephone Number: 919 929-6380, ext. 41 E-Mail:kIavergne65Jfcmai1box.ora 6. Please Briefly describe the proposed program, including an explanation of how it aligns with the Town of Chapel H i I I and Carrboro's Results Framework,and Orange County BOCC Goals and Priorities, and the target population to benefit from the program. (100 words or less) Food for the Summer is a "mini lunch camp" program which provides nutritious weekday lunches and offers creative and fun enrichment opportunities at local camps and walkable sites throughout the district to children and youth under 18 for the full summer break. Leveraging federal summer meal subsidies, meals are prepared by CHCCS cafeteria workers and distributed by a network of volunteers. The program aligns closely with the goals, priorities and results of Chapel Hill, Carrboro and Orange County, by helping to fill a gap in food and enrichment access for children during the summer months, thus strengthening the community network of basic human services and infrastructure that maintains, protects; and promotes the well-being of all county residents. 7.Target Population: Please Complete the table below with numbers(not percentages)of individuals served and projected to be served. PLEASE NOTE: Because the federal government prohibits FFTS and other programs from registering attendees at Open Sites, the following information: 1) Is based on observations from staff members in order to provide a general understanding of the diverse population served by our program. 2) Reflects the number of individual children in attendance on a particular day but not the number of individual children who participated during the course of the summer. The program serves children and youth under 18 years of age. Most of the children served are elementary school aged. We serve children from 211 three communities and are unable to break out totals by town/county. Program information Page a of 2 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 Program Target.Population-Demographics Projected Actual Estimated projected 2017-18 2017-18 2019-19 2019-20 Gender Men Women Non b i nary/Genderq ueer Self-Describe Total 0 0 0 0 Race and Ethnicity Black or African-American 142 American Indian or Alaska Native 21 Asian 79 White 80 Native Hawaiian or other Pacific Islander 11 Other:specify Hispanic 141 Total 0 0 474 0 Of the above,how many Hispanic/Latinx 141 Of the above,how many non-Hispanic/Latinx 333 Total 0 0 474 0 Age 0-5 years 6-18 years 19-50 years 51+years Total 0 0 0 0 Geographic Location Town of Chapel Hill Town of Carrboro Orange County{Outside of Chapel Hill/Ca rrbo ro) Outside of Orange County Total 0 0 0 0 Income Low-income(80%of the Area Median Income and Below) Please see 474 income table in the attachments Total 0 0 474 0 Program information p a g e S. o f 2 2 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 S. Cost Per Individual This cost per individual must reflect the total program budget divided by the total number of program individuals in this application. *'Because we are not allowed to roster children for the open sites (to encourage access), it is difficult to enter exact numbers here. However if one assumes 474 children receiving meals on any given day and that there were 54 days of service, the estimated costs are entered below.$1-02 Ac#ua tlmated 1?ro'ecte Total Cost of Program 25,400 24,272 Total #of Individuals 474 Soo Cost Per Individual $1.02 $0.95 (per meal served,which could be to an indi►tiduai,once or more than once over the course of the summer) 9. Performance Indicators NEW THIS YEAR? For Chapel Hill and Carrboro applicants: Please complete the following chart with information about the Strategic Objective, intermediate Result, and the Agency Performance Indicator for each program for which you are applying for funding. Please see the Results Framework in the Attachments section as a reference. Program!Name: Strategic Objective Residents Increase their livelihood security (please choose one from the,Rest da Framework) Intermediate Residents access the most appropriate social safety net services. Result (please choose one from Food For the Summer works to address two key issues for children and youth in our the Results Framework) community throughout the summer: 1. Help to address food insecurity by providing a healthy, hot meal every weekday. 2.Help to reduce the"Sum merSlide" by engaging children every day. An added benefit of providing daily lunch is that it helps address the financial challenge that low income families who rely on free-and-reduced lunch during the summer,face when children are home over the summer. RE5ULT5 AetLaf; Estiir�Wd. :: Protected c Performance Number of program partfcipants 24,512 meals 22.084 meals 22,000—25,000 Indicators that receive food assistance delivered by delivered by meals delivered by Program information Page 30 Of 71 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 (Please choose at least (duplicated#of people based an FFTS volunteers FFTS volunteers FFTS volunteers one performance #of mews served) indicator to report on fram the Results Framework and add Help reduce the summer sfide by 54 days of 54 days of 54 days of service additional performance providing daily opportunities for service service indicators tharyou outdoor recreation,interaction Fun Buckets—daily would like to report to and frequent enrichment Fun Buckets-- Fun Buckets— Free Book the Towns. Please insert activities. daily daily Wednesdays— additional rows as needed listing one per Free Book free Book weekly row). Wednesdays— Wednesdays— weekly weekly Enrichment activities:2—3 Enrichment Enrichment times per week a ctivities—4 to 5 a ctivities.2—3 times over times per week Special Visitors summer (police,fire...]at all Special Visitors sites Special Visitors (police,fire.._)at (police,fire...)at all sites all sites Proararn-information P a Se 11 o f ? NEW THIS YEAR! For Orange County Applicantsz WORK STATEMENT ............ ............. .......... . . ..... ... ...... ................... F -2019r.ry �y"2018- ZU-Frojected FY'201748,Actua .19 !able P f norrhes:��- U.UPM-e-- s imated Outcome ..-.;..--.-..Outcome, .. .............. E't- e Or BOCC--Goa s a-; d P 0 mier,61 ........... en rica. ............ ........... ... ..... . Ensure a community Food for the Number of network of basic human Summer breakfast,lunches services and infrastructure 22.084 meals Meal and/or snacks that maintains,protects, #Meals Served 24,512 meals delivered by FFTS 22,000—25,000 delivery delivered at meal and promotes the well- delivered by FFTS volunteers sites or to camps being of a I I co u nty volunteers residents Ensure a community network of basic human Food for the Provide food services and infrastructure 2 Summer Meal throughout the that maintains, protects, delivery entire summer break and promotes the well- being of all county oresidents Service Days 54 54 54 U I-- < Engage Ensure a community Free book Free book Free book C\j children/youth and network of basic human Wednesdays; Fun Wednesdays; Fun Wednesdays- Fun C:) Food t Fd for 0 offer opportunities services and infrastructure Buckets(daily); Buckets(daily); Buckets(daily); 3 Summer Meal o delivery for recreation and that maintains, protects, Planned activities Planned activities(2 Planned activities(2 00 enrichment and promotes the well- (2—3 times/week); —3 times/week); —3 times/week); CD being of all county Enrichment Community visitors Community visitors Community visitors LL residents Activities (2 times/weetimes/week) 12 times/week} (2 times/week) co U- co W a) 0- O a) LU Program information I., Age 1 2 of 21 .D U)=3 0 0 0 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 NEW THIS YEAR! Community Impact Mai` - p -•-acg.� lf.you.are�applying:far the Tow n.of Chapel Hili's Community I*t ct Award, please provWe ..--.. . ..,: . responses to the.questions below. All other.applicants, please skip these questions l'.�l�esponses. should;riot=;exdee4100 words per.question} 1. Please describe the impact the proposed programs will have on the target population? Please include specific quantitative and qualitative data in your response. According to No Kid hungry:" Summer can be the hungriest time of the year for many children from low-income families. When schools close students no longer get school meals and families struggle to put food on the table. This hunger can have a long-term impact on a child's health, ability to learn and general well-being", "43% of low income families say it is hard to make ends meet during the summer" when free and reduced lunch) is not available. 2- What methods/tools will your organization use to evaluate the proposed program's effectiveness? Please include specific examples,such as a logic model. The collaborative meets monthly all year round and members bring ideas and challenges to the table as they arise in order to brainstorm and seek input. Volunteers and graduate students have been invaluable being creative about how to track what is being done and evaluate from the perspective of children receiving meals, volunteers transporting and setting up food, leading enrichment activities and staff doing a summer end review with Town of Chapel Hill staff. 3. Please briefly describe how your proposed programs aligns with evidence based approaches to addressing human service need(s). The collaborative has chosen to provide open meals sites in order to remove barriers that exist when children have to be enrolled in order to eat. School social workers have been engaged both in terms of identifying sites that might draw more kids and getting the word out to families. Enrichment activities have been built up to offer there more often and to a whole range of ages. 4. Please describe one to three key partnerships/collaborations that add the most value to the success of the proposed programs. There are many partners involved in the collaborative to plan and implement Food for the Summer. However, the leadership and push by the Mayor of Chapel Hill and support by the Town in gathering the different players has been instrumental. Chapel Hill-Carrbom City Schools have prepared the meals in cafeterias at several school sites, as well as provided student volunteers. Staff and graduate students at No Kid Hungry have developed and implemented activities, provided troubleshooting, have Program information Page 13 o f 21 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 done research regarding other communities that are trying to feed kids during the summer and conducted evaluation of the program. Program information Pace 14 o f 2 ? DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 Exhibit B Emergency Assistance Scope of Services Federal Tax Id.or SSN 59-1224041 Contract 9 A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Inter-Faith Council for Social Service,Inc. 2, .1,f dierent from Contract Administrator Information in General Contract: Address Telephone Number: Fax Number: Email: 3. Name of Program(s):Emergency Assistance 4. Status: ( )Public (X)Private,Not for Profit t )Private,For Profit 5. Contractor's Financial Reporting Year July 1,2019 through June 30,2020 B. Explanation of Services to be provided and to whom: Through the Emergency Assistance Program,the Contractor will assist eligible individuals with rent and related costs as well as Orange-Water and Sewer Authority(OWASA)bills and related costs.The County will reimburse the Contractor up to $5,000/month, unless prior approval by County,for a total of$60,000 for the contract period for rent/related costs and/or Orange Water and Sewer Authority O� WASA)bills/related costs.To be eligible clients must: be residents of Orangety,have income at or below 200%of the Federal Poverty Level and have a household experiencing a financial crisis.Payments are limited to$200 within a 12-month period, The Counjy will also reimburse the Contractor for staff casts(including salary,FICA and fringe) for administering the Emergency Assistance Program up to $25,000 for the contract period.The Contractor will submit program paperwork provided by County at time and dates designated by Coun . C. Funding reimbursement limits by category: Rent/related costs and OWASA bills/related costs $60,000( 5 000 per month) Staff costs: salary, FICA,fringe $25,000 D.Number of units to be provided:NA E.Area to be served/Delivery site(s): Oran e Coun Ez" ocuSigned by: DocuSigned by: 13B317305AEFF04Ag « ,JUS 858828E0453- Nancy Caxton,Social Services Director (Signature of Contractor) 10/18/2019 10/17/2019 (Date Submitted) (Date Submitted) 9 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 EXHIBIT"C" Scope of Services---FY 2019-20 Outside Agency Performance Agreement Agency Name:Inter-Faith Council for Social Service Program Name: Residential Services Funding Award:$31,1 03 Outline how the agency will spend Orange County's funding award. Expense Descri tion Amount Prognim staff salary and benefits $3 I,103 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated outcomes below,by June 30,2020. ■ IFC Residential Services provide basic shelter and case management to individuals and families experiencing homelessness ■ IFC shelter residents move from shelter to permanent housing Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within OranEe 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. Anticipated Performance Measures Results Number of community members that will receive emergency shelter services(program 150 artici ants and inclement weatherguests) Certified by: &i:k� . Title C .ram mn 6 Date: (Provider's Signature) �V— V�C-R— Orange County Outside Agency Peormonce Agreement Revised 612018 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 EXHIBIT"C" Scope of Services—FY 2019-20 Outside Agency Performance Agreement Agency Name:Inter-Faith Council for Social Service Program Name:Food Security Programs Funding Award: $25,000 Outline how the agency will spend Orange County's funding award. F Expense Description Amount Program staff salary and benefits $25,000 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2020. • Collect or purchase enough food items to provide groceries as often as once per month to Pantry member households, • Serve a hot,nutritious meal to any hungry person who shows up at mealtimes at the:Community Kitchen. Anticipated Outcomes The Anticipated Results column,must include quantifiable results in the form of number of persons/units served within Orange County,one(ali 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 Resu Its Number of households that receive food assistance 3,600 Number of meals provided 65,000 y Y 4 Y V Certified by4--n Title: ��yv► +�r��i, Date: 6 (Provider's re) � s � 2 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 E�7BTd`"C" Scope of Services—FY 2019-20 Outside Agency Performance Agreement Agency Name: Inter-Faith Council for Social Service Program Name: Food for the Summer Funding Award- $1,500 Outline how the agency will spend Orange County's funding award. ),x ense Description Amount Staff sala $1 500 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2020. • Provide healthy meals/snacks and enrichment activities on weekdays to children and youth in the Chapel Hill Carrboro school System who qualify for free and reduced lunch throughout the entire summer break- Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of personslunits served within_ranee 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. Anticipated Performance Measures Results Number of days served 54 Number of total meals served 22,000- 25,000 Opportunities for recreation and enrichment 2 times per week Certified b Titie: t- C Bate: I � {Provider's Signature} ry%LA- 3 DocuSign Envelope ID:7E3AF63A-2F47-4028-951A-OOBA2A7COOB2 �1 INTE=COU-01 MUMMERS CERTIFICATE OF LIABILITY INSURANCE °A TE 711�r2f)17120f 19 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER-THIS CERTIFICATE DOES NOT AFFIRMATIVELY ❑R NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING fNSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiflcate holder is an ADDITIONAL INSURED,the Poll cy(Ias)must have AIDDiTIONAL INSURED provisions or be endorsed. If SUEROGATION 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 Ileu of such endorsement(s). PRODUCER C g,CT Megan Summers Summers Thompson Lawry,Inc. PHONE FAX 2113 Cameron Street (A1C,No,Extl:(919)539-5318 WC,No):(919)942-4221 Suite 219 AaoREs .Megan@STLlnsure.com ]Raleigh, NC 27605.1370 INSURER S YAFFORIDING COVERAGE NAIC0 INSURER A:Alliance rer Hon-Profits for Insurance RISK Retention Group 10023 INSURED INSURER B:Eastern Alliance.Insurance Co Inter-Falth Council for Social Service Inc. INsuRERC:Hartford Fire Insurance Company 19682 110 W.Main Street INSURER :The Hanover Ins Co 2 g2 Carrbora, NC 27510 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWTH STANDING ANY-REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMQNT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED. OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR{BED HEREIN IS SUBJECT TO ALL THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY,HAVE BEEN REDUCED BY PAID CLAIMS. IL_MN511 7ypE OF INSURANCE OL UBR POLICY EFF POLICY EfP INSD WVD POLICY NUMBER IMM D= IMMJ LIMITS A X COMMERCIAL GENERAL LIAaILITY koOCCURRENCE 1,OQ0,000 CLAIMS-MADE z OCCUR X 016-17938 7/1/2019 71112U20 DAMAISEs Ea M arwe � 500,000 X Professional 1iNr2M A PRgME DEXP(Any one pa ream $ 20,000 PERSONAL&AOV INJURY 8 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ LOC PRODUCTS-COMPIoP AGG $ 2,000,000 OTHER: SEXUAL ABUSE I A ALITOMO BILE LIA8ILITY COM IIi�EDSINGIElIM1T $ 1,000,000 X O AUTO 0.1fi-1783$ 711/2019 7/1/2020 BODILY tNJURY(Par person) $ OWNED SCHED ULED AHUppT��OppS ONLY {A�UpT�OOSy �p BODILY INURY Per aodderh At1T05 ONLY WJTOS ONLY P�2�ei RJYr MkGE A X UMBRELLA LI.CB X OCCUR EACH OCCURRENCE 1,000,000 EXCESS LIAR CLAIMS-Ma,DE x 017-17838-!_MIS 7/1/2019 7/1/2020 AGGREGATE $ .DED X RETFMION$ 11J,f]00 Aggregate S 1,00 ,000 B WORKERS COMPENSATION x pq� _ AND EMPLOYERS'LIABILITY D000583899 7/1/2019 71112020 ANY PRO p�IErORIpARTNERlFC1JL]1+E. YIN 1,000,000 OFFICERIkSi�mg�R)EXCLUDED? NIA E.L.EAGM ACC�fT $ 1,OOQ,OQO (Mandator, - '} E,L.DISEASE-FAEhkPLOYEE # If yes.daepi be undor DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT 1,000,000 C Grime/ERISA 28D5KR(6511 711120.19 711/2020 1,000,000 ID D&OIEmplayment Pract LH68785106 711/2019 711/2020 1,000,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Addition*Remarks Schedule,mry ha attached If more a pace Is ra 6d) It Is understood and agreed that the certificate holder Is Included as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hilfsbarough,NC27278 AUTHORIZED REPRESEWATIVF T W"tM14 F� 5wrtn^n�.$ ACORD 25(2016103) l Q 1988-2015 ACORD CORPORATION. All rights reserved. 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