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HomeMy WebLinkAbout2021-044-E Housing-EmPOWERment Inc outside agency agreement DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2020, ("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 EmPOWERment, Inc, a not-for-profit corporation, located at 109 N. Graham Street#200, Chapel Hill,NC 27516 ("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 EmPOWERment,Inc, agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2020 to June 30, 2021. 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$30,613. 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$7,653.25. 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. EmPOWERment,Inc Orange County Outside Agency Performance Agreement Revised 1121 Page I of 9 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E e. Once Provider has satisfied its obligations as provided in(d)payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services.Progress Report dates are: July 1 —December 31; January 1 —March 31 and April 1 -June 30. Reports are due on January 11,April 12, and July 12 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below(hereinafter referred to as"default"), the County may immediately terminate this Agreement,in whole or in part,and from time to time.Notice of termination must be in writing,state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings,be declared insolvent,or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above,the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider,the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten(10)business days from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E c. Notwithstanding the foregoing,either parry may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other parry at least 30 days prior to termination.In the event of such termination,any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof, iii. Comprehensive Automobile Liability Insurance,including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A- Statutory State NC &Coverage B -Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies(with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E 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 parry 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$15.40 per hour. To the extent possible, Orange County recommends that EmPOWERment, Inc 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: EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E County: Finance&Administrative Services Provider: EmPOWERment, Inc Orange County 109 N. Graham Street#200 Post Office Box 8181 Chapel Hill,NC 27516 Hillsborough,NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede,replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms,and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability.All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States,the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part,term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified,and has not utilized the services of any agent or subcontractor,on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on behalf of the Provider FDocuSigned by: �b�S 1/26/2021 Pew§cB7dPrt5Fj Executive Director Date For and on behalf of Orange County Government DocuSigned by: �bladMt, � I, 1/27/2021 �R&Pmiv+famnersley, County Manager Date EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name:EmPOWERment,Inc Party/Vendor Contact Person:Delores Bailey Contact Phone:919-967-8779 Party/Vendor Address: 109 N. Graham Street #200 City Chapel Hill State: NC Zip: 27516 Department: Finance & Administrative Services Amount: $50,000 Purpose: FY 2020-21 Outside Agency/Human Services Performance Agreement Budget Code(s): 10495050-710015 Vendor#800065 (N/A if new vendor)Vendor is a BOCC consultant? Yes❑No® Contract Type: (Check one)New®Renewal❑Amendment❑Effective Date 7/l/2020 Approved by Board Yes®No❑Agenda Date: 6/16/2020 This agreement is approved as to technical sforrr�and content: ocu ort 'a Department Director's SignatureEAD42BO75CF42M7 WA Sl bin. Date: 1/27/2021 ... Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards,specifications,and requirements: DocuSigned""by: ''ll� Office of the Risk Management OfficerPCs& rbvvu 6 Date:112712021 7FDCF9176800498... Financial Services This instrument has been pre-audited in th%maocu�egr�y quired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer e� Date: 1/27/2021 7NE5181ACC1409... Legal Services This agreement is approved as to legal form and sufficiency: ocuSigned by: Office of the County Attorne 04CMA Date: 1/27/2021 4035CB839... Clerk to the Board Received for record retention: All Docusign contracts must be copied to Sherri Ingersoll upon completion @ sin erg sollP_oran eg countync. oovv The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Exhibit A Provider's Outside Agency Application EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E COVER PAGE Applicant Contact Information Applicant Organization's Legal Name: EmPOWERment Inc. Applicant Organization's Physical Address: 109 N. Graham Street Suite 200 Chapel Hill, NC 27516 Applicant Organization's Mailing Address: 109 N. Graham Street Suite 200 Chapel Hill NC 27516 Applicant Organization's Web Address: www.empowermentinc-nc.org Executive Director: Delores Bailey Telephone Number: 919-967-8779 E-Mail: empowermentincnc(&amail com Tax ID Number: 56-1969772 Funding Request Please list all Fiscal Year 2021 Human Services (HS)funding requested for all programs and the proposed use of funds(please list program name only) Pro CarrboroCarrboro Chapel Qcangg Total HS Hill-HS County-HS Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 Operations or Personnel Operations Personnel Operations Affordable Rental Program $20,000 $40,000 $40,000 $100,000 Career Explorers $14,000 $14,000 Community Outreach $15,000 $15,000 Totals $34,000 $55,000 $40,000 $1 99,000 Briefly explain your proposed use of funds: EmPOWERment, Inc. will use these funds to support programs that address affordable housing, youth employment and community outreach specifically: $34,000 requested from TOC will be used to fund both El's Affordable Housing Rental Program and the Career Explorer program which is El's summer youth employment program. The $40,000 requested from TOCH will be used to fund El's Affordable Housing Rental Program and the $15,000 will be used to fund the quarterly community outreach. The $40,000 requested from OC be used to fund the Affordable Housing Rental Program which requires more subsidy as rental inventory increases. EmPOWERment will use Human Services Funding to support programs beneficial to Chapel Hill, Carrboro and Orange County. DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E 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. v a Signature: 3 -. .Executive Director Date Signature 0 Pvt 324 2 4 Board Chairperson Date DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E 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 YES a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill,or Orange County? NO 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? NO C) Current beneficiaries of the program for which funds are being requested? NO 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. Board Member Jabe Hunter is employed by the Chapel Hill Police Department but he does not receive any financial benefits from serving on EmPOWERment, Inc's Board of Directors. Mr. Hunter's job as Assistant Chief of Police does not pose a conflict of interest with El providing affordable rental units. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves,their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee,no matter how remote.The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy.This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: 13 Executive Director Date DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Signature: "` . 131 242.,d Board Chairperson Date DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): 03/1996 2. Agency's Purpose/Mission(no more than o fewsentences):The mission of EmPOWERment, Inc. is to empower people and communities to determine their own destinies through affordable housing, community organizing, and grass roots economic development. 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). EmPOWERment was created 24 years ago to address the needs of gentrifying low wealth African American neighborhoods of Orange County. A Cornerstone agency providing resources and services. Successful programs below demonstrate accurate timetables and budgets. • Procure/maintain rental inventory of 53 units at a annual procurement rate of 3 units per year. • Home Buyers/Rental Counseling, homeownership, foreclosure at 500+ hours annually • Community Outreach: Resident capacity building through advocacy, resource sharing (monthly meetings attended by approximately 25 persons) • Career Explorers Summer Youth Program: 10 interns annually for 15 years • Midway Business Center: reducing barriers for women and minority entrepreneurs 200+ businesses • Living Wage: Does this agency pay permanent employees a minimum living wage?YES If yes, is this agency an Orange County Living Wage Certified Employer?YES If no, please briefly explain. Schedule of Positions: #of FTE—Full-Time Paid Positons: 4 #of FTE—Part-Time Paid Positions: 1 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. S. Program Name:Affordable Rental Program Program Primary Contact and Title: LaTanya Davis, Operations Manager Telephone Number: 919-967-8779 E-Mail: empowermentincnc(c_gmail.com 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chapel Hill HYPERLINK "file://chfs/Documents/Departments/Housing%20and%20Community/COMMUNITY%2000NNECTIONS /Funding/Human%20Services/Human%20Services%20Program%20Process%201mprovement/Human% 20Services%2OResults%2OFramework%2010.8.18.docx" and Carrboro's HYPERLINK "file://chfs/Documents/Departments/Housing%20and%20Community/COMMUNITY%2000NNECTIONS /Funding/Human%20Services/Hu man%20Services%20Program%20Process%20lm prove ment/Human% 20Services%20Results%20Framework%2010.8.18.docx"Res uIts Framework, and Orange County BOCC Goals and Priorities, and the target population to benefit from the program. (100 words or less) EmPOWERment's rental program maintains and promotes the well-being of residents by providing affordable rental housing for the most vulnerable populations in Orange County. Typical residents are transitioning from homeless or poverty, veterans, seniors and single income families. Tenants earn between 30% - 80% of AMI. This program aligns with the Town by addressing low, low income residents. Only forty-eight percent of our units are subsidized with vouchers. Fifty-Two percent of our units are subsidized with EmPOWERment operating dollars. EmPOWERment assist displaced mobile home tenants and has added mobile units to our rental inventory. Rental counseling is key to this program. DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E 7.Target Population: Please complete the table below with numbers(not percentages) of individuals served and projected to be served. Projected Actual Projected Projected 2018-19 2018-19 2019-20 2020-21 Gender Mien 272 330 339 349 Women 411 650 670 690 Nonbinary/Genderqueer Self-Describe Total 683 980 1009 1039 Race and Ethnicity Black or African-American 530 805 829 854 American Indian or Alaska Native Asian 1 White 152 175 180 185 Native Hawaiian or other Pacific Islander Two or more races Some other race Total 683 980 1009 1039 Of the above, how many Hispanic/Latino 45 40 41 42 Of the above, how many non-Hispanic/Latino 638 940 968 997 Total 683 980 1009 1039 Age 0-5 years 126 167 172 177 6-18 years 166 229 235 242 19-50 years 264 419 431 444 51+years 127 165 171 176 Total 683 980 1009 1039 Geographic Location Town of Chapel Hill 373 550 567 585 Town of Carrboro 310 370 381 393 Orange County(Outside of Chapel Hill/Carrboro) Outside of Orange County 60 61 61 Total 683 980 1009 1039 Income Low-income(80%of the Area Median Income and Below) 683 980 1009 1039 Please see income table in the attachments Total 683 980 1 10091 1039 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E 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 2018-19 Projected 2019-20 Projected 2020-21 Total Cost of Program $425,122.00 $446,377.00 $468,696.00 Total # of Individuals 980 1009 1039 Cost Per Individual $433.00 $442.00 $451.00 9. Performance Indicators 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 • Children improve their educational outcomes Objective (please choose one X Residents Increase their livelihood security from the Results Framework) . Residents improve their health outcomes Intermediat Eix cDiv t,,,si en f increase their fivelihoods security e Result Intermediate Result 2.2:Residents increase Job skills appropriate for the local economy (please choose one from the Results Vacancy rate for rental units stays below 3%. Program participants Framework) lives are more stable due to safe affordable rentals and are able to stay in place. RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performanc % and # of program 97%,250 97%,285 97%,258 e Indicators participants who (Please choose at least one maintain or improve performance indicator to report their housing status on from the Results Framework,and add additional performance indicators that you would like to report to the Towns. Please insert additional rows as needed,listing one per row). DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E F. N ,W Outside Agencies/Human Services Please use the drop down menu below to select which function area best aligns with your agency and program(s) in which you are requesting funding. Please select only one from the drop down menu below. Housing If you selected other, please tell us what function area best aligns with your organization: Please indicate three program goals/performance measures below. A few notes: • If you use percentages, please put the actual number equivalence. • Please ensure your performance measures are outcome based and not outputs. Program Goal# 1 To avoid/lessen the number of evictions due to the nonpayment of rents. Tenants who are behind in rent are given the opportunity to go to counseling with a HUD certified Performance Measure housing counselor. These sessions include information (How willyou accomplish your goal?) on finance, budgeting, insurance and the eviction process. After classes are completed, payment arrangements are made. Actual Results g (Outcome) Ending FY18-19 Projected Results 10 (Outcome) Ending FY2020 Projected Results 12 (Outcome) Ending FY2021 Program Goal# 2 Increase the number of rental units by 3 Apply for HOME, TOCH, Carrboro, for profits, for Performance Measure acquisition dollars (How willyou accomplish your goal?) DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E Actual Results 3 (Outcome) Ending FY18-19 Projected Results 3 (Outcome) Ending FY2020 Projected Results 3 (Outcome) Ending FY2021 Program Goal#3 To provide housing for the most vulnerable population: i.e. homeless, disabled, and veteran populations through collaboration with other agencies. Performance Measure Collaboration with other agencies to reach these low (How willyon accomplish your goal?) income and disfranchised populations. Actual Results 7 (Outcome) Ending FY18-19 Projected Results 6 (Outcome) Ending FY2020 Projected Results 8 (Outcome) Ending FY2021 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. S. Program Name: Career Explorers Program Primary Contact and Title: Sarita Nwachukwu, Community Programs Director Telephone Number: 919-967-8779 E-Mail: empowermentincnc(a_)gmail.com 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 words or less) The Career Explorers program provides a full-time, 8 week work experience and personal development workshops for youth between the ages of 16 and 22. The program partners with local businesses and the University to provide jobs that are mutually beneficial to the youth, their family, the employer and the community. Since 2004 the program has successfully employed and helped to develop approximately 210 young people into well-rounded citizens ready for gainful employment in the workforce. 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 Projected Projected 2018-19 2018-19 2019-20 2020-21 Gender Men 5 6 3 5 Women 5 4 3 5 Nonbinary/Genderqueer Self-Describe Total 10 10 6 10 Race and Ethnicity Black or African-American 4 7 5 5 American Indian or Alaska Native Asian White 1 2 Native Hawaiian or other Pacific Islander Other:specify Hispanic/Latinx 6 3 4 3 Total 10 10 10 10 Of the above, how many Hispanic/Latinx 6 3 4 3 Of the above, how many non-Hispanic/Latinx Total 10 3 4 3 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Age 0-5 years 6-18 years 4 3 2 2 19-50 years 6 7 $ 8 51+years Total 10 10 10 10 Geographic Location Town of Chapel Hill 10 $ 4 7 Town of Carrboro 2 3 3 Orange County(Outside of Chapel Hill/Carrboro) Outside of Orange County 3 Total 10 10 10 10 Income Low-income(80%of the Area Median Income and Below) Please see 10 10 income table in the attachments 10 10 Total 10 10 10 10 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 2018-19 Projected 2019-20 Projected 2020-21 Total Cost of $22,350.00 Program $24,715.00 39,000.00 Total # of Individuals 6 6 10 4,119.00 (wages at $3,900 (wages at $3,725.00 $10.00 per hour x $10.00 per hour x (wages, 40 hours per week 40 hours per week Cost Per Individual materials and x 8 weeks, x 8 weeks, administrative supplies/materials supplies/materials fees) and and administrative administrative costs costs DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E 9. Performance Indicators 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: Career Explorers Strategic ❑ Children improve their educational outcomes Objective (please choose one from Residents Increase their livelihood security the Results Framework) ❑ Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result rategic Ubjective Z. kesidents increase their hveifificoods secc,", (please choose one from Intermediate Result 2.2: Residents increase job skills appropriate for the local the Results Framework) economy Career Explorers provides full-time summer employment for 8 weeks to low income youth between the ages of 16 and 22. RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Insert Performance Indicator Indicators here. (Please choose at least one Increase the number of low 6 6 10 performance indicator to income youth with full time report on from the Results summer employment that Framework,and add additional performance prepares them for the indicators that you would workforce. We would like to like to report to the Towns. Please insert additional increase the number of rows as needed,listing youth from Carrboro from 2 one per row). to 4. DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Community Outreach Program Primary Contact and Title: Sarita Nwachukwu, Director of Community Programs Telephone Number: (919) 967-8779 E-Mail: empowermentincnc(cDg mail.corn 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 Oranize County BOCC Goals and Priorities, and the target population to benefit from the program. (100 words or less) The Community Outreach program serves the historically disenfranchised neighborhoods of Chapel Hill, preserving their diverse history, especially among growing Latino and Asian populations. Community service includes: • Facilitating community meetings that inform residents of available resources and provide a bridge between community and the police department to eliminate the gap between crime and neighborhoods. • Providing opportunities for court ordered community service; • During the last 12 months El has identified a need for Organizing inside mobile home park communities; • Working with Town of Chapel Hill Housing Authority information sharing and programing for Housing tenants; • Assist with implementation of annual Neighborhood Night Out 7.Target Population: Please complete the table below with numbers (not percentages) of individuals served and projected to be served. Due to the open to the public nature of the meetings and programs associated with the program, it is very difficult to collect specific demographic information. However, we do provide a sign-in sheet at each event and so the numbers listed in Question 8 are reflective of the attendance logs. Program Target Population Demographics Projected Actual Projected Projected 2018-19 2018-19 2019-20 2020-21 Gender Men Women Nonbinary/Genderqueer Self-Describe Total 0 0 0 0 Race and Ethnicity Black or African-American DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E American Indian or Alaska Native Asian White Native Hawaiian or other Pacific Islander Two or more races Some other race Total 0 0 0 0 Of the above, how many Hispanic/Latino Of the above, how many non-Hispanic/Latino Total 0 0 0 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/Carrboro) Outside of Orange County Total 0 0 0 0 Income Low-income(80%of the Area Median Income and Below) Please see income table in the attachments Total 0 0 0 0 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 2018-19 Projected 2019-20 Projected 2020-21 Total Cost of Program $14,000.00 $27,000.00 $15,000.00 Total # of Individuals 650 780 975 Cost Per Individual $21.54 $34.62 $15.38 9. Performance Indicators DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E 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: Community Outreach Strategic ❑ Children improve their educational outcomes Objective X Residents Increase their livelihood security (please choose one from ❑ Residents improve their health outcomes the Results Framework) Intermediate Insert Intermediate Result here. Result (please choose one from intermediate result 2.1. Residents access the most appropriate social safety net the Results Framework) services EmPOWERment provides access to resources for community residents. We will partner with the Town of Chapel Hill Community Policing Advisory Committee to foster a positive relationship between community and police. Utility Fund to help residents pay delinquent utility bills; Provide opportunity for local residents to complete community service hours either court ordered, mandated by local area educational networks or housing authorities; Convene regular community outreach meetings to inform residents of the governmental policies, political action items, and local infrastructure programs and/or changes that may impact their families or neighborhood; In conjunction with the Town of Chapel Hill EmPOWERment provides a safe place for immigrant residents to understand their right and services available to them. RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Insert Performance Indicator Indicators here. (Please choose at least To increase the number of 650 780 975 one performance residents that participate in indicator to report on community outreach from the Results programs through Framework,and add expanding partnership with additional performance indicators that you the Community Policy would like to report to Advisory Committee, Family the Towns. Please Success Alliance and insert additional rows Housing Authority as needed,listing one per row). DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Community Impact Award If you are applying for the Town of Chapel Hill's Community Impact Award, please provide responses to the questions below. All other applicants, please skip these questions. (Responses should not exceed 100 words per question) • Please describe the impact the proposed programs will have on the target population? Please include specific quantitative and qualitative data in your response. Our target population is Chapel Hill residents looking for affordable rentals whose income falls below 80% AMI. Typical residents include homeless, families living at the poverty level (10%), vets, seniors (14%), disabled or Housing Choice Voucher (HVC) holders (76%). We continue to purchase units to create inventory addressing the critical needs for affordable rentals. Units are attractive because of the low rents. Low vacancy rates indicate family stability. In collaboration with Orange County we were able to provide mobile homes for two displaced families. • What methods/tools will your organization use to evaluate the proposed program's effectiveness? Please include specific examples, such as a logic model. The Rental Program sets numeric goals each year to reach for the following program activities: Increase of rental units; stable housing, healthy communities and information access for the most vulnerable population; and completed annual housing inspections. EmPOWERment uses a tracking log to keep account of the number of telephone calls, in office visits, and applications submitted for requested housing. We conduct annual tenant surveys to assess concerns and address them as needed. EmPOWERment makes available to tenants and the community the services of a Certified Housing Counselor. • Please briefly describe how your proposed programs aligns with evidence-based approaches to addressing human service need(s). These programs distinguish EmPOWERment from other commercial landlords because we offer tenant education, home ownership classes and community engagement. With a proven track record of implementing safe, clean and affordable places for low income and disenfranchised families to live. Our programs utilize the following: • Rental services and maintenance. • Inventory has increased annually to 53 owned by the organization and manage for private landlords. • In 2019 the programs fielded approximately 980 inquiries. • 90% of the program inquiries are for rental properties. • 80% of inquiries are from female heads of households that include young children. DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E • Please describe one to three key partnerships/collaborations that add the most value to the success of the proposed programs. EmPOWERment works with the following local partners to address the needs of our target population: • Family Success Alliance o Resource to tenants with school aged children o Bringing light to neighborhood issues that may require the town's attention • Town of Chapel Hill Community Policing Advisory Committee o Liaison to enhance community and police relations • DSS, Interfaith Council & Cardinal Innovations o Provides vouchers and resources for our tenants o Security deposit and utilities assistance • Community Empowerment Fund, local faith-based organizations o Transitioning homeless individuals into permanent housing o Providing temporary financial assistance to residents o Providing free furniture and appliances. DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Program Budget Operating Budget for Program PROGRAM NAME: Community Outreach Actual Estimated Projected Percent PROGRAM REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ - $ - $ - 0 Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 14,000 $ 27,000 $ 15,000 -44% Other-Town of Chapel Hill 0 Human Services-Orange County $ - $ - $ - 0 Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ - $ - $ - 0 Other Revenue $ - $ - $ - 0 Total Program Revenue $ 14,000 $ 27,000 $ 15,000 -44% PROGRAM EXPENSES Compensation $ 11,000 $ 22,000 $ 10,000 -55% Rent&Utilities $ - $ - $ - 0 Supplies& Equipment $ 1,000 $ 2,000 $ 2,000 0% Travel &Training $ - $ - $ - 0 Other Expenses: $ 2,000 $ 3,000 $ 3,000 0% Total Program Expenses $ 14,000 $ 27,000 $ 15,000 -44% SURPLUS/(DEFICIT) FOR PERIOD: $ - $ - $ - 0 Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. FY 2018-19 Program Budget DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Program Budget Operating Budget for Program PROGRAM NAME: Career Explorers Percent PROGRAM REVENUE Actual 2018-19 Estimated 2019-20 Projected 2020-21 Change Private Donations $ 10,000 $ 5,000 $ 15,000 200% Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ $ 8,000 $ 14,000 75% Other-Town of Carrboro $ - $ - 0 Human Services-Town of Chapel Hill 0 Other-Town of Chapel Hill 0 Human Services-Orange County $ $ - $ 0 Other-Orange County $ 7,350 $ 7,500 $ -100% Other-Town of Hillsborough $ - $ - $ 0 Other Government Grants Triangle United Way $ $ $ 0 State Government $ $ $ 0 Federal Government(CDBG/HOME/etc.) $ $ $ - 0 Private Foundation Grants $ 5,000.00 $ 5,000.00 $ 10,000.00 $ 1.00 Other Revenue $ - $ - $ - 0 Total Program Revenue $ 22,350 $ 25,500 $ 39,000 53% PROGRAM EXPENSES Compensation $ 19,200 $ 22,254 $ 36,000 62% Rent&Utilities $ - $ - $ - 0 Supplies&Equipment $ 1,150 $ 1,116 $ 1,500 34% Travel&Training $ - $ - $ - 0 Other Expenses: $ 2,000 $ 2,130 $ 1,500 -30% Total Program Expenses $ 22,350 $ 25,500 $ 39,000 53% SURPLUS/(DEFICIT) FOR PERIOD: $ - $ - $ - 0 Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. FY 2018-19 Program Budget DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Program Budget Operating Budget for Program PROGRAM NAME EmPOWERment's Affordable Rental Program Projected 2020- PROGRAM REVENUE Actual 2018-19 Estimated 2019-20 21 Percent Change Private Donations $ - $ - $ - 0 Program Generated Revenue $ 494,300 $ 509,129 $ 524,403 3% Local Government Grants: Human Services-Town of Carrboro $ 16,000 $ 16,000 $ 20,000 25% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 13,500 $ 28,500 $ 40,000 40% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 28,250 $ 30,613 $ 40,000 31% Other-Orange County $ - $ 46,500 -100% Other-Town of Hillsborough $ $ - $ - 0 Other Government Grants Triangle United Way $ $ $ 0 State Government $ $ $ 0 Federal Government(CDBG/HOME/etc.) $ $ $ 0 Private Foundation Grants $ $ $ 0 Other Revenue $ $ $ - 0 Total Program Revenue $ 552,050 $ 630,742 $ 624,403 -1% PROGRAM EXPENSES Compensation $ 113,533 $ 119,210 $ 125,171 50% Rent&Utilities $ 161,095 $ 169,150 $ 177,607 5% Supplies&Equipment $ 38,709 $ 40,644 $ 42,676 5% Travel&Training $ - $ - $ - 0 Other Expenses: $ 111,784 $ 117,373 $ 123,242 5% Total Program Expenses $ 425,121 $ 446,377 $ 468,696 5% SURPLUS/(DEFICIT)FOR PERIOD: $ 126,929 $ 184,365 $ 155,707 -16% Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. The rental program indicates we are operating at a surplus but the program budget does not include the mortgages and El operates on a calender year. FY 2018-19 Program Budget DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Agency Budget Operating Budget for Program PROGRAM NAMI EmPOWERment,INC Percent PROGRAM REVENUE Actual 2018-19 Estimated 2019-20 Projected 2020-21 Change Private Donations $ 30,447 $ 31,056 $ 31,677 2% Program Generated Revenue $ 17,779 $ 18,135 $ 18,498 2% Local Government Grants: Human Services-Town of Carrboro $ 16,000 $ 16,000 $ 20,000 25% Other-Town of Carrboro $ $ 8,000 $ 14,000 75% Human Services-Town of Chapel Hill $ 17,012 $ 28,500 $ 40,000 40% Other-Town of Chapel Hill $ $ 126,000 $ 15,000 -88% Human Services-Orange County $ 28,250 $ 30,613 $ 40,000 31% Other-Orange County $ 242,085 $ $ 0 Other-Town of Hillsborough $ $ $ 0 Other Government Grants Durham Community Land Trust $ 5,000 $ 5,000 $ -100% State Government $ 5,689 $ 15,000 $ 15,000 0% Federal Government(CDBG/HOME/etc.) $ 271,300 1$ 276,000 $ 110,000 -60% Private Foundation Grants $ -1$ - $ 0 Other Revenue $ 563,742 $ 575,017 $ 586,517 2% Total Program Revenue $ 1,197,304 $ 1,129,321 $ 890,692 -21% PROGRAM EXPENSES Compensation $ 468,245 $ 311,507 $ 317,737 2% Rent&Utilities $ 275,358 $ 289,126 $ 303,582 5% Supplies&Equipment $ 17,377 $ 18,246 $ 19,158 5% Travel&Training $ 10,838 $ 7,800 $ 8,190 5% Other Expenses: $ 204,002 $ 214,202 $ 224,912 5% Total Program Expenses $ 975,820 $ 840,881 $ 873,579 4% SURPLUS/(DEFICIT)FOR PERIOD: $ 221,484 $ 288,440 $ 17,113 -94% Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. `Rental inventory was increased by 3. Two units were gifted by CASA @$75,000. One unit was purchased for$196,300 with OC grant funds. The Agency income increased by$271,300 which shows on the balance sheet but not reflected as an expense item on this form. If this number were subtracted from Expenses,the deficit would be($49,816)of which the County paid$46,500 in the first quarter of 2019-2020. DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E Exhibit B Provider's Revised Scope of Services and Program Budget EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 8 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E EXHIBIT "B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: EmPOWERment El Program Name: Affordable Rental Housing Program Funding Award: $30,613.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Funds will be use to support the Affordable Rental Housing Program $30,613.00 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. Rental counseling Increase the number of affordable rental units Provide housing for the most vunerable popuiation:ie homeless, disabled, and veteran populations 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 Tenants who are behind in rent are given the opportunity to go to counseling with a HUD certified 10 housing counselor. These sessions include information on finance, budgeting, insurance and the eviction process. After classes are completed, payment arrangement are made 3 Apply for HOME, TOCH, Carrboro and for profits for acquisition dollars Collaboration with other agencies to reach these low income and 6 disfranchised populations Certified Title: �—y e—Cl,L'h V�— Date: (Provider's Electronic Signa "You will sign this document electronicall ith your performance agreement. DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C781B247516E ATTACHMENT "A" Orange County Certifications—FY 2020-21 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. DocuSigned by: t,IhMS f?#A Executive Director 1/26/2021 Certified by: Title: Date: i&evSignature) EmPOWERment,Inc Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 1121 DocuSign Envelope ID: FF8EA4C7-AC32-4CCF-ADC4-C78lB247516E ACo® CERTIFICATE OF LIABILITY INSURANCE Ff018/1 (MMIDDIYYYY) �� 3/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: Michael Riggsbee,Jr. Titan Risk Consultants, LLC PHONE 919 636 3252 FAX C „ 107 Conner Drive,Suite 225 E-MAIL l.riggsbee@titanriskconsultants.com INSURERS AFFORDING COVERAGE NAICA Chapel Hill NC 27514 INSURER A: Mesa Underwriters Specialty Insurance Company 36838 INSURED INSURER e: The Phoenix Insurance Company 25623 Empowerment, Inc. INSURERC: United States Liability Insurance Company 25895 109 N. Graham St.#200 INSURERD: INSURER E: Chapel Hill NC 27516 INSURERF: 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 SV8R POLICY EFF POLICY EXP LTR POLICY NUMBER fmmfDDffYYYIMM DDIYYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurtence $ 100,000 MED EXP(Anyone person) $ A A MP0032010000695 06/16/2020 06/16/2021 PERSONAL&ADV INJURY $ 5,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jE O- LOC PRODUCTS-COMPIOP AGG $ Included OTHER; $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ( ) HIRED NON-OWNED PROPERTY pAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION �/ $ WORKERS COMPENSATION /� STATUTE ERH AND EMPLOYERS'LIABILITY Y I N B OFFICERIMEMBER EXCLUDED?EANY PROPRIETORfPARTNERIEX CUTIVE ❑ NIA UB-8N099723-19-42-G 06/16/2020 06/16/2021 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500.000 it yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s 500,000 Professional Liability Each Claim $1,000,000 C PM1553951 07/29/2020 07/29/2021 Aggregate $1,000,000 Retention $2,500 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Certificate holder is added as Additional Insured as respects General Liability as required by written contract. 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