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HomeMy WebLinkAbout2019-781-E DSS - The Exchange Club Family Center Alamance County DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2019,("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ("County") and The Exchange Club's Family Center in Alamance County,a not-far-profit corporation, located at 200 N.Main Street,Graham,NC 27253 ("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: I. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1,2019 to June 30,2020. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit "A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of$13,464.00. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services,at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of$3,366.00. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Revised 712018 Page I of 9 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31;January 1 —March 31 and April 1 -June 30. Reports are due on January 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 of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement;or H. 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 HL 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. The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain,during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury,including bodily injury,sickness,disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any,covering personal injury or death,and property damage; and iv. Professional Liability Insurance,covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents,consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM RE UIRED OVERAGE • 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 Sox 8181 Hillsborough,NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. The Exchange Club's Family Center in A lam ance County Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage,to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves,their agents,officials,employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 14.95 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: Department of Social Services Provider: The Exchange Club's Family The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Orange County Center in Alamance County Post Office Box 8181 200 N.Main Street Hillsborough,NC 27278 Graham,NC 27253 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. Severahility. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the Other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part,term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective patties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified,and has not utilized the services of any agent or subcontractor,on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement,effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. --UocuSyigned___by:Y-' -Tof the Provider 1SO4, 64& 10/21/2019 B39B7EA4B90B412 Sarah Black,Executive Director Date " oocu5igned by: 'zge County Government E66KA ll. A wtt#'S 10/22/2019 0637994B755E477.. Bonnie Hammersley, County Manager The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 7118 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Exhibit A Provider's Outside Agency Application The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 7118 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 .=..it.;�Y,��.'�.'--•'.'»9:.4•G c. '!•'s iC�IP�Y'1r:.='�5�?ws .�r- .. •a�.Y!'a.'a, 'Y. .a. Applicant Contact Information Applicant Organlzation's Legal Name:The Exchange Club's Family Center in Alamance Coun Applicant Organization's Physical Address:200 N_ Main Street Graham, NC 27253 Applicant Organization's Mailing Address:200 N. Main Street Graham, NC-27253 Applicant Organization's Web Address:www.facebook.comifamil CenterinAiamanceOran e Executive director;Sarah E.G. Black M.A., MFT Telephone Number:336-227-5601 E-Mail:sarahbi_ack(cr exchangefcp.org Tax ID Number:56-2227006 i Funding Request Please list ail 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 Or.aneg Total H5 Hill-HS Count t_HS Ex. Youth Afterschool Program _ $10,000 $15,000 $5,000 $30,000 Parent Aide Program: salary and benefits of $2,000 $23,327 $23,377 $48,654 program staff, mileage, supplies/client emer ency funds, rentlutilitieslo erations, Children's Parents Parenting Classes: salary $0 $1,000 51,000 $2,000 and benefits of facilitator, mileage, pro ramloffice supplies. Totals $2,0W $24,327 $24,327 $50,654 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: °7, q Executive Director Date _ I Signature: ' — Board 8iairperson Date Cover Page I DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 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 o members of their immediate families,or their business associates. YES NO ❑ ® a}Empioyees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill or Orange County? ❑ ® by Members of or closely related to members of the governing bodies of the Town of Carrboro,the Town of Chapel Hill,or Orange County? ❑ ®c)Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question,please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves,their agents,officials, employees and servants agree not to discriminate in any manner of these basis of race,color,gender,national origin,age,handicap,religion,sexual orientation, gender identity/expression,familial status or veterans status with referenceto 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. I To the hest of my knowledge and relief 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 inetigible for funding,but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: _ �Wtuk_� �"_ [ Executive Directo�rJ_� Date Signature: ""� � z �/9 "! -- - Board Chairperson Date Over?age ? u g E .. -- DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 t5'f i�''4::r1•.f : :j:•.xi: iw:" �..a+risti+':r•,q.{c .w,.• c t: -r r;!r`'f�t.1.. �°�.t`rKsSi••-. -',:5= -s+.•: _•a'�i.. c&.: ..,i--..�•.r�s-' .:x -. .o.p;:Y'::-�:'.. Please provide the following information about your agency: I. Date of Incorporation(Month/Year):05/2000 2. AgenWs Purpose/Mission(no more than o few sentences): The agency's mission is the prevention and treatment of child abuse and neglect. This mission is implemented by enhancing parent child relationships, increasing community awareness, and increasing community involvement in prevention efforts. The center currently offers 9 evidence-based or evidence-informed programs and a 24-hour crisis line in 7 counties in the triangieltriad area (Alamance, Orange, Chatham, Person, Caswell, Guilford, and Randoiph). 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). The family Center has 22 years of experience in administering grant funds, meeting proposed budgets and timetables, and providing successful abuse prevention services in the community. The agency has been offering Parent Aide services in Alamance County for 22 years, in Orange County for 12 years, and expanded into Caswell County in 2016. Parenting classes have been offered successfully to families for 22 years in Alamance, offered to Orange County families for 12 years, and this year housed in Chapel Hill and Hillsborough. The agency has decades of experience with in-home visitation and parenting education to address complex childhood trauma. 4. Living Wage: Does this agency pay permanerrt employees a minimum living wa e?(Yes/No) Yes If yes,is this agency an Orange County_Living Wage Certified Employer?No If no,please briefly explain. The agency is currently waiting on Board approval to begin the certification process after the Board completes the first annual salary review and adjustment of staff positions! Schedule of Positions: #of FTE—Full-`time Paid Positons: S #cf FTE—Part-Ti me Paid Positions: 3 i I ?rograrn fnscr rn;tion a r. 7 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 "+rw r,�v•� "-•-s-y.`r�'F�,.4•1-g?- ' .a-4(.t�K-"'i{.:�,i:•+.�''Y'r':;%-.i�ert?•,�R,y;;ti:�• - ..�s:WOW' 'i OROGRAV y a.j �v.:�:•�'d�:C.' ` - [3C CU �(7Ct' r F•'17JiE7f@ `rIlIR; ` 5. Program Larne: Parent Aide Services Program Primary Contact and Title: Sarah E.G. Blackr Executive Director Telephone Number: 336-227-5601 E-Mail:sarahblackC@,exchangefcp.org 6. Please briefly describe the proposed prograrn, including an explanation of how it aligns with the Town of Chapel Hill and Carrboro's Results Framework,and Cranige County 6OCC Goals and PriOrltle5 and the target population to benefrt front the program- (100 words or less) The evidence-based program will provide home visitation for a minimum of 6 months to 18 (I Carrboro, 9 Chapel Hill, 8 Grange County) families (all socio-economic and ethnic populations) at-risk for child abuse and neglect. Last year, 2017-18, 772 children were reported for child abuse in Orange County(Duncan et al., 2019). Parent education, coaching, concrete supports, life skills, and advocacy is provided. The program aligns with framework and goals by increasing livelihoods security, ensuring a high quality of life through the absence of violence, improving health outcomes by increasing new healthy lifestyle behaviors, promoting well-being, and increasing life skills. i 7.Target Population: Please complete the table below with numbers(not percent-ages)of individuals served and projected to be served. Program Target Papuiatian Demographics Projected Actual Estimated Projects 2017-18 2017-18 2019-19 20194 11 Families 11 Fam_ 13 Fam. 1s Fam Gender Men 21 22 24 37 I Women 25 25 26 39 Nonbinary/Genderqueer 0 f1 0 0 Self-Deseribe D 0 0 { 0 Total 46 47 50 76 Race and Ethnicity Black or African-American 16 16 21 31 American Indian or Alaska Native 0 0 0 0 Asian 0 0 0 0 White 23 24 25 33 Native Hawaiian or other Pacific islander D 0 0 o ` Other:specify_Mixed Ethnicity 7 1 7 4 12 f Total 46 47 s0 76 $ 77. Of the above,how many Hispanic/l_atinx 3 7 Pro ram nfar,^at:on C r 2 1 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 I Of the above,how many non-Hispanic/Latinx 43 40 42 65 Total 46 47 50 76 Age 0-5 years 16 16 12 27 6-18 years 13 14 21 20 19-50 years 17 17 17 28 51+years 0 0 0 1 Total 46 47 5o 76 Geographic Location Town of Chapel Hill 25 25 22 40 Town of Carrboro 3 3 0 4 Orange County i Outside of Chapel Hill/Carrboro) 18 19 28 32 Outside of Orange County 0 0 0 0 Total 46 47 50 ff 76 Income V Low-income(W%of the Area Median Income and Below) Please see 42 60 income table in the attachments 40 141 Total 46 47 50 76 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. 'Actpal:2U'17-1.8': �l�mated.201849 Projected 2019=20 Total Cost of Program $21,988 $26,854 $48,654 Total#of Individuals 47 50 76 Cast Per Individual $467.83 $537.08 $640.18 9. Performance Indicators I� NEW THIS YEAR! For Chapel Hill and Carrboro applicants: Please complete the following chart with information about the Strategic Objective, Intermediate Result,an 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:Parent Aide Services Strategic ❑ Children improve their educational outcomes Objective {please choose one from 0Residents Increase their livelihood security the Rend&Framework) © Residents improve their health outcomes DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 NEW THIS YEAR! For Orange County Applicants: WORK STATEMENT Performance guantlfiable FY'2017.18Actusl FY 241$719 FY.200-20 Projected Program BOCC G.dais and Pr.latltles Outtorhe 0stimated Outcome Outcome Measurement Objective (Numerlcal) :tNgmerl�all (Numerical) 1)Ensure a community 1}93%of 1}92%of network of basic 1}90%of families will families(11 out Protective human services and improve families(10 out of 12 families} 1)94%of Factors Survey, infrastructure that of 11 families} families(17 out of North Carolina maintains,protects, parenting improved will improve 18)will Improve Family and promotes the well- skills, parenting skills, Parenting skills,i mprove safety, parenting skills, improve Assessment being of all county improved safety, improve safety, Parent safety, increase 1 Scale,Adult residents.2}Ensure a increased increase problem- Aide increase problem-solving Adolescent high quality of life and problem-solving solving skills, increase Parenting lifelong learning that problem- skills,increased skills, increase support, Inventory, Safe champions diversity, solving skills, support,and support,and and improve Care education at all levels, increase improved improve health. health. Assessments. libraries, parks, support' & health. recreation,and animal improve health. welfare. 2 3 Nmr;rmD ir+i0f111.51ian P;1 g C 3 A O F 1 3 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44B02730E7D2 •.. r�,.. _ 'yi i ;a'•:.�:r.+Sr..e.[J 'Y,7.rev �ecrs a r ;arp ra dry w err r e f.9 i� 5. Program Name:Children's Parents Parenting Classes Program Primary Contact and Titie:Sarah F.G- 31ack, Executive Director Telephone Number: 336-227-5601 E-Mail:sarahblack(Wexchanciefco-oral 6. please briefly describe the proposed program,including an explanation of how it aligns with the Town of Cho el 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) Classes will be provided to 24 parents, 12 kids, at-risk for child abuse& neglect. 3 sessions are 12 weeks, 1-5 hours, using Triple P, Children's Parents, and Strengthening Families curricula. Homework and skill practice is expected on topics around parenting, trauma, child development, and communication. Last year, 2017-18, 772 children were reported for child abuse in the county(Duncan et al., 2019). The program aligns with framework and goals by increasing livelihoods security, ensuring a high quality of life through the absence of violence, improving health outcomes by increasing new healthy lifestyle behaviors, promoting well-being, and increasing life skills. 7.Target Population: Please complete the table below with numbers(not percentages)of individuals served and projected to be served. _.•= .;.y ;_ ,�� ;•���:.�,-. s:,P��r �"�..'' �obuiatiorr bernvgrap ids'.-.°:;.-,. . .`a•'.'' , Projected Actual. �1 Estimated Projects 2017-18 2017-18 2018-19 2019-2 11 Families 11 Fam. 13 Fam. 1$Fam Men 0 0 7 17 Women 0 0 9 1s Non bin ary/Genderqueer 0 0 0 0 Self-Describe 0 0 0 0 �yy, a'A yfk' { ' yyo�u J •:r k. Total_ 0 0 I's -36 O� w 1 Black or African-American 0 ❑ 5 II American Indian or Alaska Native 0 0 0 0 Asian 0 0 0 0 White 0 0 8 19 Native Hawaiian or other Pacific Islander 0 0 0 0 Other:specifyMixed Ethnicity 0 0 2 4 Total 0 0 16 35 3 5 of the above,how many Hispanic/Latinx 0 0 Program information Page 12 of 23 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Of the above,how many non-Hispanic/l-atinx 0 ` 0 13 30 Total 0 0 16 36 ._T1. �-.. T - . . II 0-5 years 0 0 0 6 6-18 years 0 0 0 5 19-50 years 0 0 16 24 51+years 4 0 ❑ 0 Total 0 0 15 1 113, Town of Chapel Hill 0 0 8 23 Town of Carrhora 0 0 1 1 11 Orange County(Outside of Chapel HIII/Carrboro) 0 0 6 12 Outside of Orange County 0 0 1 0 Total 0 0 16 136 REHM.}si: {i�et.�•:: 7� v Y'; .-Yea rY T Low-income(SG%of the Area Median Income and Below) Please see 13 28 income table in the attachments 0 ❑ Total 0 a 16 36 S. Cost Per Individual This cost per individual must reflectthe total program budget divided by the total number of program individuals in this application. Total Cost of Prograrn $0 $2,000 $6,640 Total#of Individuals 0 16 36 Cost Per Individual $0 $125 $184 9. Performance Indicators 3VEW 1S YEAR. For Chapel Hiil 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:Parent Aide Services Strategic 0 Children improve their educational outcomes Objective (please choose onefrom oResidents increase their livelihood security the Results Framework) ❑ Residents improve their health outcomes p., U Program Information Page 13 of 23 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 NEW THIS YEAR! For Orange County Applicants: WORK VATEMEKT Performance Cluantif{a61e FY 2017-18'Aetual' FY 26jflkU. FY 2019 zo projected Program BOCC.Goa Is and Priorities Outcome Estimated Outcome'. Outcome - Measurement O}iieetive (Numerical). - (Numerical) (NuRjerk3lf n 1)89%Parents/ Parents/ Guardians will 1)89%Parents/ Guardians Increase Guardians will 1)Ensure a community will increase parenting increase network of basic knowledge, parenting human services and parenting knowledge, skills,child - knowledge,skills, Adult/Adolescent skills,child Infrastructure that development child development Parenting development Children's maintains,protects, INA knowledge, knowledge, 1 Parents Inventory and and promotes the well knowledge, problem-solving problem-solving Parenting being of all county skills,coping skills,coping Client Satisfactlon problem- classes residents.2)Ensure a skills knowledge, skills knowledge, Surveys high quality of life and salving skills, and report and report feeling lifelong learning that coping skills feeling more more competent champions diversity, knowledge, competent in in their role. education at all levels, and report their role. feeling more libraries, parks, competent in recreation,and animal their role. welfare. 2 3 Pig rr.im iiifnrn�4iurti a e ].w c f 3 s DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Program Budget Operating Budget for Program PROGRAM NAME Parent Aide Services - _Estimated. .,Projeate-d Percent PROGRAM REVENUE Private Donations $ $ $ 0 Program Generated Revenue $ $ 0 Local Government Grants. Human Services-Town of Carrbaro $ 2,000 $ 2,000 $ 2,000 0% Other-Town of Carrboro - $ $ - 0 Human Services-Town of Chapel Hill 10,350 $ 12,390 $ 23,327 880/0 Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 9,638 $ 12,464 23,327 87% Other-Orange County $ - $ - - 01 Other-Town of Hillsborough $ - $ $ 0 Other Government Grants Triangle United Way S - $ $ 0 State Government $ - 1 $ $ 0 Federal Government(CDl5G/HOME/etc.) $ - $ $ 0 Private Foundation Grants $ - $ 01 Other Revenue $ $ 0 Total Program Revenue 21,988 $ 26,854 $ 48,664 81% PROGRAM EXPENSES Compensation 15,516 $ 20r125 $ 41,256 105% Rent&Utilities $ 2,326 $ 1,242 $ 1,270 2% Supplies&Equipment $ 257 $ 373 $ 534 43% Travel&Training $ 4,930 $ 4,182 $ 4,770 14% Other Expenses: $ - $ 931 $ 524 -11% Total Progr6m Expenses 1 $ ­23,az9.1 $ 26,854 1 $ 48,6541 81% SURPLUSI(DEFICIT) FOR PERIOD: 1 $ (1,041)1 $ -- $ 0 Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. The program for 2017-2018 showed a deficit of$1,041 due to increased mileage costs(travel to client homes)and unanticipated h eatth care benefits costs under the former parent company. FY 2018-19 Program Budget DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Program Budget Operating Budget for Program PROGRAM NAME Children's Parents Parenting Glasses .'ActuL PROGRAM REVENUE 2❑T7=��,w;T r ::=2018 19` ..'' ,''�1'���'': : :' hange.:. Private Donations $ - $ 1,000 $ 1,000 0% Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Servlces-Town of Chapel H111 $ - $ - $ 1,000 0 Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ - $ 1,000 $ 1,000 0% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBGIHOMEIetc.) $ - $ - $ 2,040.00 ❑ Private Foundation Grants $ - $ - $ 1,600.00 0 Other Revenue $ - $ - Is - 0 Total Program Revenue $ $ 2,000 1 $ 6,640 1 232°/° PROGRAM EXPENSES Compensation $ - $ 1,000 $ 4,306 331% Rent& Utilities $ - $ - $ - 0 Supplies &Equipment $ - $ 555 $ 1,480 167% Travel &Training $ - $ 445 $ 854 92% Other Expenses: $ - $ - 'lei. .,. '�' •. .. C' 2; 0 $ �• 6,640] ;Ttrtal Prnorarxr Epiirse `., - �: -. '' -.: .'- '� +P SURPLUS/(DEFICIT) FOR PERIOD: $ - $ - $ - Q Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Agency Budget Operating Budget for Program PROGRAM NAME The Exchange CIub's Family Center in Aiamance �C'c4i al::': =::;::EsE` -af ti` kPr9 -�.,.;Percent 'x2�17-18' i- M•" �=1j9.'-:. Chan 'e PROGRAM REVENUE Private Donations $ 200 $ 1,000 S 1,000 0% Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ 2,000 $ 2,000 $ 2,000 0% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 10,350 $ 12,390 $ 24,327 96% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 9,638 $ 13,464 $ 24,327 81% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Govemment S - $ - $ - 0 Federal Government(CDBGJHOMEIetc.) $ 456,619.00 $ 571,462.00 $ 573,502.00 $ 0.00 Private Foundation Grants $ 74,904.00 $ 2,500.00 $ 2,500.00 S - Other Revenue $ 3,579 $ 5,390 $ 5,390 $ - Total Program Revenue $ a 7,29Q $ 6178,206 $ Ii33,04fi 4°� PROGRAM EXPENSES Compensation $ 406,172 S 377,026 $ 411,427 9% Rent&Utilities $ 24,362 $ 26,306 S 26,3O6 0% Supplies&Equipment $ 28,163 $ 25,685 $ 26,765 4% Travel &Training $ 38,157 $ 38,751 $ 38,751 0% Other Expenses: $ 50,578 $ 71,764 $ 71,764 0% `I Total Pliglllr Earpes �;� 53 ;53 $ 575,013 7% SURPLUS!{DEFICIT} FOR PERIOD: $ 9,768 $ 68,674 $ 58,033 -15% Please explain Other Grants floes your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. For this year we plan to hire an office manager but that Is contingent on all funding sources coming in as projected_ The salary and benefits for that position would eliminate the projected surplus.The projected surplus for the 19-20 year is predicated on receiving estimated grant funds without increasing staff, if all grant funds are received then staffing will be increased to reflect needs of services. DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Exhibit B Provider's Revised Scope of Services and Program Budget The Exchange Cluh's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 8 of 9 Rev. 7/18 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 EXHIBIT"B" Scope of Services—FY 2019-2020 Outside Agency Performance Agreement Agency Name: The Exchange Club's Family Center in Alamance County Program Name:Parent Aide Program Funding Award: $12,464 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Salary&Benefits $11,129 Mileage $889 Rent&Utilities $446 Program Services Outline the critical services (activities)the agency will employ to attain the Anticipated Outcomes below, by June 30,2020. • Provide in-home visitation to seven families (7 with funding and 1 family with volunteer assistance) through the Parent Aide Program through professional level staff and Master's level interns. ■ Provide weekly home visits to at-risk families to increase safety, parenting, problem-solving, social support,and health of the family. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County,only(all Towns and municipalities).If you use percentages,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Number of{unduplicated}families enrolled in Parent Aide in-home visitation services and 8 receiving weekly visits to reduce the risk of child maltreatment. Average number of hours for weekly visits for families enrolled in Parent Aide program. 2 Average number of months families are enrolled in Parent Aide program. 10 Percent of families who will increase parenting skills and parent/child interaction. 94% Percent of families who will enhance home safety and parental supervision. 94% Percent of families who will increase problem-solving skills and family functioning. 94% Percent of families who will increase linkages to social/community support. 94% Percent of families who will improve their capacity to maintain their child's health. Docu5igned by: I W4 10/21/2019 Certifiedb Executive Director Date: y' H3967EA4H896412.. (Provider's Signature) DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 EDIT«$n Scope of Services—FY 2019-2020 Outside Agency Performance Agreement Agency Name:The Exchange Club's Family Center in Alamance County Program Name: Children's Parent Program Funding Award: $1,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Office,Transportation,&Program Supplies $1,000 Program Services Outline the critical services (activities)the agency will employ to attain the Anticipated Outcomes below, by June 30,2020. ■ Provide 2, 12-week long parenting classes, 1.5 hours in length, to increase parenting skills and provide parental support to 16 parents/guardians of children 0-24 at risk for child abuse and neglect. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange Counly,only tall Towns and municipalities).If you use percentages,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Number of parents/guardians completing parenting classes and graduating successfully after 12 out of 16 or 12 weeks 75% Number of parents/guardians increasing parenting knowledge,skills,and child development 13 out of 16 knowled a or 81 Number of parents/guardians increasing problem-solving skills,coping skills,knowledge,and 13 out of 16 reporting feeling more competent in their role or 81% UocuSigned¢¢bby: Certified b SA'� 19-4���� Title: Date:Executive Director 10/21/2019 y B3967Ea4689B412.. (Provider's Signature) DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 ATTACHMENT"A" Orange County Certifications—FY 2019-20 Outside Agency Performance Agreement Chief Contact,Administrators,Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact,administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name,title,residential address;phone and email address and if possible,fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name, physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County,and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. ESDocuSiigned by: W4 16& Executive Director 10/21/2019 Certified by. B3967EA4B89B412.. 11�IL: _ I7 itL: (Provider's Signature) The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID:94DODA4A-83C1-42A4-8FB2-44BO273OE7D2 Client#: 1877352 04EXCHACLUI DATE(MMIODfYYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 08/02/2019 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(les)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 any rights to the certificate holder In lieu of such endarsement(s). PRODUCER CONTACT NAME: McGriff Insurance Services PNONE 888 743_gg17 Imc No,: 888$279861 Arc No Ext 414 Gallimore Dairy Road E-MAIL ADDRESS: Suite F INSURER(S)AFFORDING COVERAGE NAIC 4 Greensboro,NC 27409 INSURER A r Philadelphia Indemnity Insurance Co. 18058 INSURED INSURER B:Stonewood Insurance Company 11828 The Exchange Club Family Center in INSURER C:Mount Vernon Fire Insurance Company 26522 Alamance County INSURER D 200 N Main Street INSURER E Graham,NC 27253 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMfOWNW MMIDDIYYYY A X COMMERCIAL GENERAL LIABILITY PHPK1989088 7106/2019 0710612020 EACH OCCURRENCE $1 000 000 CLAIMS-MADE �OCCUR PREMISES [aE+�rrenca $100 000 MED EXP(Any one person} s5,000 PERSONAL&ADV INJURY $1,000,000 r,CTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRC PRODUCTS-COMPIoP AGG $2000 000 POLICY JECT LOC $ A AUTOMOBILE LIABILITY PHPK1989088 - — 7/06/2019 07/061202 E°agclden SINGLE LIMIT 1,000,000 ANY AUTO I BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLYE AUTOS x HIRED NON-OWNED Peres RTYDAMAGE $ AUTOS ONLYAUTOS ONLY $ an UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAM CLAIMS-MADE AGGREGATE $ DIED I I RETENTIONS $ OTH B WORKERS COMPENSATION WC10000748812019A 7/01/2019 07/01/202 X PERTUTE ER AND EMPLOYERS'LIABILITY ANY PRROPRIETER EXCLUDRtEED?ECUTIVE� NIA E.L.EACH ACCIDENT $100 000 OFF(Mandatary in NH) .E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $500,000 C Cyber Covera CY2111371 0713012019 0713012020 $1,000,000 A Professional Liab PHPK1989088 7/0612019 071061202 $1,000,0001$2,000,000 A Abuse]Molestation PHPK1989088 7/0512019 0710612020 $1,000,0001$2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES{ACORD 101,Additional Remarks Schedule,may ha attached If more apace is required) 4**Workers Comp Information'* Other States Coverage CERTIFICATE HOLDER CANCELLATION Orange County Gov't SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County, NC ACCORDANCE WITH THE POLICY PROVISIONS. 200 South Cameron Street P.O.Box 8181 AUTHORIZED REPRESENTATIVE Hillsborough, NC 27278 klurha�q O 1988-2015 ACORD CORPORATION.All rights reserved. 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