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HomeMy WebLinkAbout2021-096-E Social Svc - ARC of the Triangle Cardinal managed funds DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD OUTSIDE AGENCY AND CARDINAL MANAGED CARE FUNDS 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, Post Office Box 8181, Hillsborough, North Carolina, 27278, ("County") and The Are of the Triangle, Inc., a not-for-profit corporation,located at 1709 Legion Road, Suite 100,Chapel Hill,North Carolina 27517("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«Agencys_Name>> 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 to the residents of Orange County, as outlined in the attached Cardinal Managed Funds Work Statement and any amendments or revisions thereto which is attached as Exhibit A,which is incorporated by reference. The Scope of Services and the Program Budgets 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. 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. Outside Agency Funding. i. Outside Agency Funding. The County agrees to appropriate funds for the provision of services described in Exhibit B, Scope of Services and may be more particularly described in the Revised Program Budget in Exhibit B,the maximum sum of$6,653 in Outside Agency Funds. ii. The Provider shall be paid Outside Agency Funds in four equal installments in the amount of$$1,663.25. 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. b. Cardinal Managed Care Funding. i. Cardinal Managed Care Funding. The County agrees to appropriate funds for the provision of services described in Exhibit A, Work Statement and may be more particularly described in the Revised Program Budget in Exhibit C,the maximum (aAgencys Name») Orange County Outside Agency and Cardinal Managed Care Fund Performance Agreement Revised 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD sum of$33,320 in Cardinal Managed Care Funds. ii. The Provider shall be paid Cardinal Managed Care Funds in twelve equal monthly installments in the amount of$2,776.66.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. c. 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 and Work Statement, at the discretion of the County the Provider may be required to repay the funds to the County. d. The County's obligation to make the payments is contingent upon receipt of Progress Reports and/or request for reimbursement as provided in Section 4 below, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services and Work Statement. e. Once Provider has satisfied its obligations as provided in Sections 3 and/or 4 payment will be made 21 days after receipt of the Progress Report or Request for Reimbursement. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Outside Agency Funds Reporting. Provider will provide Orange County a Quarterly Progress Report for Outside Agency funds 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 10,April 10,and July 10 of the program fiscal year. b. Cardinal Managed Funds Reporting. Provider will provide Orange County a Monthly Progress Report for Cardinal Managed Care funds that includes a fiscal report and updates on performance measures as outlined in the Work Statement. Progress Reports are due by the 15'of the next month following the month being reported. c. 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 («Agencys Name») Orange County Outside Agency Performance Agreement Page 3 Rev. 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD 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 shall pay Provider that portion of the fees and expenses that it has earned to the date of termination, less any costs or expenses incurred or anticipated to be incurred by the County due to errors or omissions of the Provider. The County may(but shall not be required to)grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing,either parry 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. e. Should this Agreement be terminated,the Provider shall deliver to the County within seven (7) days, at no additional cost, all deliverables including any electronic data or files relating to the Project. f. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts; (t�Agencys Name��) Orange County Outside Agency Performance Agreement Page 4 Rev. 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD 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. 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. (Mgencys_Name))) Orange County Outside Agency Performance Agreement Page 5 Rev. 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD 10. Limitation and Assignment. The County and the Provider each bind themselves,their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the Provider shall assign or transfer its interest in this Agreement or the rights to payment to any other party without the written consent of the other. 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. Dispute Resolution.Any and all suits or actions to enforce,interpret or seek damages with respect to any provision of, or the performance or non-performance of,this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County, North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party,however,the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. 15. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 15 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. 16. Notice. The Parties hereto agree and understand that written notice,mailed or delivered,to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance&Administrative Services Provider: Jennifer Pfaltzgraff Orange County The Are of the Triangle,Inc. Post Office Box 8181 1709 Legion Road, Suite 100, Hillsborough,NC 27278 Chapel Hill,NC 27517 («Ager.ys_Name») Orange County Outside Agency Performance Agreement Page 6 Rev. 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD 17. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede,replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or 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. 18. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal 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. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81. 19. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the 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. a& iehalf of the Provider J .IA& PI WI�Oraff 1/27/2021 Jenne er a tzgraff,The Are of the Triangle,Inc. Date am6aa4ehatf of Orange County Government F�6.37994M in mt, (�Glwt►Mt,-sb-� 211112021 Bonnie Hammersley, County Manager Date (o(Agencys Namev) Orange County Outside Agency Performance Agreement Page 7 Rev. 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: The Arc of the Triangle,Inc. Party/Vendor Contact Person: Jennifer Pfaltzgraff Contact Phone: 919-942-5119 Party/Vendor Address: 1709 Legion Road, Suite 100 City Chapel Hill State: NC Zip: 27517 Department: Social Services Amount: $39,973 Purpose: outside agency funds +Behavioral Health MOE Budget Code(s): 10420020-710050/10495050-719023 Vendor#50706 (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 form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: pDooccuSiggneddby* Department Director's Signature N- -1 (,hs bt& Date:2/10/2021 Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: 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 sufficien foMiW1 :standards,specifications,and requirements: QuSa CbV'In,h{fb 1/26/2021 Office of the Risk Management Office �eaeoa� Date: Financial Services This instrument has been pre-audited' mnerasequired by the Local Government Budget and Fiscal Control Act: rqta +� � Office of the Chief Financial Officer Date: 2/11/2021 Legal Services This agreement is approved as t gl!4@ti -&%d sufficiency: Office of the County Attorney ` Date:2/11/2021 Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: (aAgencys Na me Orange County Outside Agency Performance Agreement Page 8 Rev. 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD ATTACHMENT "A" Orange County Certifications—FY 2021 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:: P���� r� � Executive Director 1/27/2021 Certified by: c Title: Date: (Provider's Signature) (aAgencys Name») Orange County Outside Agency Performance Agreement Page 12 Rev. 112021 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD .x�e4bif COVER PAGE Applicant Contact Information Applicant Organization's Legal Name:The Arc of the Triangle,, Inc. Applicant Organization's Physical Address: 1709 Legion Road, Suite 100, Chapel Hill, NC 27517 Applicant Organization's Mailing Address: 1709 Legion Road, Suite 100, Chapel Hill, NC 27517 Applicant Organization's Web Address:www.arctriangle.org Executive Director:Jennifer Pfaltzqraff Telephone Number:919-942-5119 x117 E-Mail:jpfaltzgraff(d.arctrlangle.orq Tax ID Number:56-1214133 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) Program Carrboro- Chapel Orange Total HS Hill-HS County-HS Ex.Youth Ajierschool Program $10,000 $15,000 $5,000 $30,000 OperahoPs orT4rsonnf2l Operations Personnel Operations Community Programs $7,500 $15,000 $7,500 $30,000 Operations Personnel Operations Totals $7,500 $15,000 $7,500 $30,000 Briefly explain your proposed use of funds: The proposed use of funds will go towards the expense of operating and running our Community Programs located in Orange County. To the best of my knowledge and belief all information and data in this application is true and current. The document h s been duly authorized by the governing board of the applicant. Signature: E ive Director Date Signature: 90�4 1/�_ 1oeo Board Chairperson Date Cover Page P a 0 0 6 0 1 :_f Y DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD 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 ❑ ® a) Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, or Orange County? ❑ ® b) Members of or closely related to members of the governing bodies of the Town of Carrboro,the Town of Chapel Hill,or Orange County? ❑ ®c)Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? if you have answered YES to any question,please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves,their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: I r; 3 �� he'tive,Direct r Date Signature: ��! / �� Board Chairperson Date Cover PFaf;e Page 7 of 21 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): 12/1979 2. Agency's Purpose/Mission (no more than a few sentences): The Arc of the Triangle supports children and adults with intellectual and developmental disabilities []/DDJ in the achievement of their personal goals and dreams in our community through partnership and advocacy. 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 Arc of the Triangle has managed a variety of grants for our community programs for over the past 14 years and is currently the recipient of the Section 5310 transportation grant with the city of Raleigh and Chapel Hill/Carrboro Human Services grant. The agency has ample experience with financial reporting and meeting deadlines required by state and federal grants which have all required monthly and/or quarterly invoicing, quarterly and annual reports. The Arc has always been good stewards of its grant money and plans to continue in that line. Funding is crucial to the program's success. 4. Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes/No) Yes and No If yes,Is this agency an Orange County Living Wage Certified Employer? If no,please briefly explain. Our full-time office employees are all paid a living wage by Orange County standards. Our part-time support professionals are paid less because it is part-time work, not meant to be a complete income. Schedule of Positions: #of FTE—Full-Time Paid Positons: 28 #of FTE—Part-Time Paid Positions:265 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Orange County Community Based Programs & Services Program Primary Contact and Title: Michelle Foy, Community Programs Director Telephone Number: 919-942-5119 x134 E-Mail mfoy(j�arctriangle.org 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chapel Hill and Carrboro's Results Framework, and Orange County BOCC Goals and Priorities and the target population to benefit from the program. (100 wards or less) Program iniomiation B t 2 .1 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD The Arc's Community Programs allow individuals with disabilities the opportunity to be active participants in their community through diverse and integrated settings. The program provides an outlet for individuals to develop meaningful and productive routines while becoming physically and socially active. Studies show that reducing social isolation in conjunction with increased physical activity has many health benefits contributing to a person's overall quality of life. The program will not only continue to aid in helping individuals choose healthy lifestyles but it will also help to increase the community's capacity to include people of all abilities in its infrastructure. 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 2018-19 201$-19 2019-20 2020-21 w r �F Men 376 231 220 253 Women 200 113 145 131 Non bin ary/Genderqueer 1 2 1 Self-Describe Total 1 559 345 417 385 Race and Ethnic►ty Black or African-American 99 70 88 76 American Indian or Alaska Native 9 1 7 Asian 19 12 13 18 White 287 184 196 204 Native Hawaiian or other Pacific Islander Two or more races(Latino, Indian,Mixed Race) 148 79 119 80 Some other race Total 559 345 417 385 Of the above,how many Hispanic/Latino 18 65 13 14 Of the above, how many non-Hispanic/Latino 541 280 404 373 Total 559 345 417 385 ;Age 0-5 years 8 2 5 4 6-18 years 120 63 75 63 19-50 years 371 237 286 270 51+years 60 43 5.1 48 Total I S59 345 417 385 Geographic Location. Town of Chapel Hill 170 94 110 102 Town of Carrboro 18 15 19 17 Orange County(Outside of Chapel Hill/Carrboro) 72 20 36 31 Pro,;ram information P a (; e 9 o f 2 z I i DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD Outside of Orange County 299 216 252 235 Total 559 345 417 385 Income Low-income(80%of the Area Median Income and Below) Please see 337 income table in the attachments Total N/A N/A 337 337 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 $81,905 $68,400 $68,330 Total #of Individuals 69 97 101 Cost Per Individual $1,187.02/year $705.15/year $676.53/year 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: Orange County Community Based Programs & Services Strategic ❑ Children improve their educational outcomes Objective (please choose onefrom ❑ Residents Increase their livelihood security the Results Framework) ❑x Residents improve their health outcomes Intermediate 3.2-Residents demonstrate new healthy lifestyle behaviors. Result (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance %and #ofprogram participants a) 20 a) 32 a) 32 who demonstrate new physical skills b) 20 75%will be able 85%will be able Indicators that support their independence c) N/A to prepare a meal to prepare a meal (Please choose at least one performance a) Cooking&Nutrition Class b) 30 b) N/A indicator to report on students will demonstrate 75%will be able from the Results their skills by preparing a to co-lead a Framework,and add Prog)an'I Infnrn at u)i P c f. f loot DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD additional performance simple nutritious meal of meeting c) 32 Indicators that you their choice for their c) N/A 50%will be able would like to report to classmates with limited to co-lead a the Towns. Please support after 12 classes. cooking class insert additional rows as needed,listing one per row). b) Triangle Self-Advocacy Network members will co- lead a meeting with self advocate advisor on a topic of interest a minimum of 1 time each year c) Cooking.&Nutrition Class students will help to co- lead a cooking class a minimum of 1 time each year Performance %and#ofprogram participants a) 29 a) 35 a) 37 who demonstrate new, improved, or b) 20 80%attendance 90%attendance Indicators restored social skills weekly weekly (Please choose at least one performance a) Petals with a Purpose b) 30 b) 32 Indicator to report on participants will attend and 75%attendance 75%attendance front the Results interact with group Framework,and add additional performance members while engaging a) 32 indicators that you in floral projects. 75%of members . would like to report to will participate in the Towns. Please b) Triangle Self-Advocacy TSAN insert additional rows Network members will fundraisers as needed,listing one participate in The Arc's per row). Friday Fun Day activities (various community activities and outings)a minimum of one time a month. c) Triangle Self-Advocacy Network members will coordinate one fundraising activity Performance %and#ofprogram participants a) 20 b) 32 who demonstrate a basic b) 20 80%of students Indicators understanding of money will demonstrate (Please choose at least management their new skills at one performance a local market indicator to report on a) Cooking&Nutrition Class shopping trip from the Results students will learn about Framework,and add additional performance the cost of ingredients and c) 30 indicators that you groceries used to prepare 50%of members would like to report to their meals and discuss this will participate in the Towns. Please as part of class curriculum. TSAN insert additional rows fundraisers as needed,listing one b) Triangle Self-Advocacy Per row). Network members will include money management skills in their curriculum and discuss both personal finances and fundraising activities. faro€.ram information f' a €: f, 1 _r. o f 2 1 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD x«' :I`I I C- tOIA NA 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. Recreational 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, Cooking and Nutrition Class J&H Program Goal#1 i) _Students will decide on culturally diverse menus, incoiTorating healthy choices. Performance Measure2) Students will bake dessert l xmonth for Meals on Wheels. (Ho,v,vtllyou accomplish your goal?) 3) Cooking Instructor will keep attendance and report monthly on menus and volunteerism of the group. 4) Use participant annual surveys to measure satisfaction. Actual Results 20 (Outcome) Ending FY18-19 Projected Results 32 (Outcome) Ending FY2020 Projected Results 32 (Outcome) Ending FY2021 Program Goal#2 Triangle Self Advocacy Network 1) Self-advocate advisor will report out monthly on curriculum and topics discussed Performance Measure 2) Advisor will take attendance. (How rvin yqu accomplish yourgoal?) 3) TSAN group will decide by vote what topics they wish to discuss/learn about, x;> Program hfoR oration P a g e 2 o l 21 l DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD C" Outside Agencies/Human Services 4) Use participant annual surveys to measure safisfaction, Actual Results 20 (Outcome) Ending FY18-19 Projected Results 30 (Outcome) Ending FY2020 Projected Results 32 IN (Outcome) 'A NO Ending FY2021 Program Goal#3 Petals with a Purpose 7�.iV- 1) Group will discuss quarterly who benefits from the flower arrangements(Meals on Wheels,Hospice, etc.) 2) Discuss quarterly how the environment benefits from the Performance Measure program, (How willyou accomplish your goal?) 3) Use participant and stakeholder annual surveys to measure satisfaction, 4) Petals organizer will take attendance and track donations to community partners, Actual Results 29 (Outcome) Ending F118-19 Projected Results 35 (Outcome) Ending FY2020 Projected Results 37 (Outcome) LndingFF2021 Program information P a g 0 1 v 0 f 2 1 DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD Agency Budget Operating Budget for Entire Agency AGENCY NAME: The Arc of the Triangle, Inc. Projected 2020- AGENCY REVENUE Actual 2018-19 Estimated 2019-20 21 Percent Change Private Donations $ 53,930 $ 81,000 $ 95,000 17% Agency Generated Revenue(fees) $ 40,312 $ 46,000 $ 50,000 9% Local Government Grants: Human Services-Town of Carrboro $ 6,000 $ 5,400 $ 7,500 39% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 6,000 $ 12,000 $ 15,000 25% Other-Town of Chapel Hill $ $ - $ - 0 Human Services-Orange County $ 6,608 $ 6,653 $ 7,500 13% Other-Orange County $ 33,320 $ 33,320 $ 33,320 0% Other-Town of Hillsborough $ - I $ - I $ 0 Other Government Grants Triangle United Way $ 864.00 $ - $ 0 State Government $ 3,240,000.00 $ 2,970,000.00 1 $ 3,200,000.00 $ 0.08 Federal Government(CDBG/HOME/etc.) $ - $ $ - 0 Private Foundation Grants $ 15,950.00 $ 4,000.00 1 $ 5,000.00 $ 0,25 Other Revenue $ 8,045 $ 7,700 $ 8,000 $ 0.04 Total Agency Revenue $ 3,411,029 $ 3,166,073 1 $ 3,421,320 8% AGENCY EXPENSES Compensation $ 2,793,043 $ 2,750,000 $ 2,960,000 80/. Rent&Utilities $ 110,449 $ 112,304 $ 121,000 8% Supplies&Equipment $ 76,905 $ 61,600 $ 66,500 8% Travel&Training $ 111,906 $ 113,700 $ 123,000 8% Other Expenses: $ 289.178 $ 313,000 $ 337,000 8% Total Agency Expenses $ 3,381,481 $ 3,350,604 1 $ 3,607,500 8% SURPLUS/(DEFICIT)FOR PERIOD: 29,548 (184,531) (186,180) -1% FY 2018-19 Agency Budget DocuSign Envelope ID:2B362E51-9A19-4059-AA75-CO8A33D65AFD Program Budget Operating Budget for Program PROGRAM NAME Orange County Community Based Programs &Services Actual Estimated Projected Percent PROGRAM REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 376 $ 750 $ 1,000 33% Program Generated Revenue $ 11,392 $ 3,000 $ 3,500 17% Local Government Grants: Human Services-Town of Carrboro $ 6,000 $ 6,400 $ 7,500 39% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 6,000 $ 12,000 $ 15,000 25% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 6,608 $ 6,653 $ 7,500 13% Other-Orange County $ 33,320 $ 33,320 $ 33,320 0% Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ - 1 $ - 1 $ - 0 Private Foundation Grants is - 1 $ _ $ _ 0 Other Revenue $ - $ - $ _ 0 Total Program Revenue $ 63,696 $ 61,123 $ 67,820 11% PROGRAM EXPENSES Compensation $ 63,455 $ 41,000 $ 47,730 16% Rent& Utilities $ 7,731 $ 5,400 $ 8,900 65% Supplies&Equipment $ 5,383 $ 8,000 $ 8,000 0% Travel&Training $ 767 $ 1,000 $ 1,200 20% Other Expenses: $ 14,569 $ 6,000 $ 2,500 -58% Total Program Expenses $ 81,905 $ 61,400 $ 68,330 11% SURPLUS/(DEFICIT) FOR PERIOD: (18,209) (277) (510) -847. FY 2018-19 Program Budget DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD EXIIIBIT`B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: The Arc of the Triangle(MOE Funds) Program Name: Community Programs Funding Award: $33,230.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Expenses:Salary Michelle Foy,Community Programs Director,Ellen Perry,TSAN Advisor;Staff Mileage(35¢a mile) $16,220 Office Expenses(coples,printing,phone,Internet,office supplies,Business Insurance,Workers Comp Insurance,PPE,Background checks $8,800 Rent, Utilities,and Maintenance $8,300 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. cooking and Nutdtlon class I&II-Weekly;students will decide on culturally diverse menus,Incorporating healthy choices.Cooking Instructor will • demonstrate preparation and students will also prepare the meal. • Triangle Self Advocacy Network-Monthly;Self advocates(adults with Intellectual and developmental disabilities)will decide on monthly topics(housing, managing money,Interacting with police,voting and more)Advisor will present topics for discussion. • Petals with a Purpose-Weekly;students will Interact with group members while engaging In floral projects made from recycled materials.Arrangements donated to local groups like Meals On Wheels and Hospice. - 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 32 Enrollment in Cooking & Nutrition Class Enrollment in Triangle Self Advocacy Network 32 Enrollment in Petals with a Purpose Program 37 Certified by: Title: Executive Director Date:8/21/2020 (Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD EXHIBIT"B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: The Arc of the Triangle Program Name: Community Based Programs & Services Funding Award: 6,653.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Expenses:Salary Michelle Foy,Community Programs Director,Ellen Perry,TSAN Advisor;Staff Mileage(350 a mile) $3,632 Office Expenses(copies,printing,phone,Internet,office supplies,Business Insurance,Workers Comp Insurance,PPE,Background checks $1,608 Rent, Utilities,and Maintenance $1,413 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. Cooking and Nutrition Class Ir£II-Weekly;Students will decide on culturally diverse menus,incorporating healthy cholces.Cooking Instructor will • demonstrate preparation and students will also prepare the meal. • Triangle Self Advocacy Network-Monthly;Self advocates(adults with intellectual and developmental disabilities)will decide on monthly topics(housing, managing money,Interacting with police,voting and more)Advisorwill present topics for discussion. • Petals with a Purpose-Weekly;students will interact with group members while engaging in floral projects made from recycled materials.Arrangements donated to local groups like Meals On Wheels and Hosplce. 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 Enrollment in Cooking & Nutrition Class 32 Enrollment in Triangle Self Advocacy Network 32 Enrollment in Petals with a Purpose Program 37 ExecutiveD .:e r,:, 8/21/2020 it cto Certified by: Title. -- Date: (Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID:2B362E51-9A19-4059-AA75-008A33D65AFD 1 ® DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 6/17/2020 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 endorsement(s). CNTAPRODUCER NAME: Christina Luckey,CLCS,CISR Marsh&McLennan Agency LLC PHONE FAx 5605 Carnegie Blvd. A/c No Ext:704-556-3329 A/C Ne:212-948-9366 Suite 300 ADDR1ESS: christina.luckey@marshmma.com Charlotte NC 28209 INSURERS AFFORDING COVERAGE NAIC# INSURERA;Selective Insurance Company of America 12572 INSURED ARCOF-4 INSURER B:Key Risk Insurance Company 10885 The Arc of the Triangle, Inc. INSURER C:United States Liability Insurance Co 25895 1709 Legion Rd,Suite 100 Chapel Hill NC 27514 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1097109420 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR D WVD POLICYNUMBER MM/DD MMIDD A X COMMERCIALGENERALLIABILITY S2258874 7/1/2020 7/1/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence) ccurrence $1,000,000 MED EXP Any one person) $20,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY❑PRO LOC PRODUCTS-COMP/OP AGG $3,000,000 JECT OTHER: $ A AUTOMOBILE LIABILITY S2258874 7/1/2020 7/1/2021 COMBINED SINGLE LIMIT $1,000,000 accident IANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR S2258874 7/1/2020 7/1/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION KEY0137206 7/4/2020 7/4/2021 AND EMPLOYERS'LIABILrrY STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE —] N/A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Directors&Officers Liability ND01070176D 7/1/2020 7/1/2021 Limit of Liability 1,000,000 A Professional Liability S2258874 7/1/2020 7/1/2021 Ded 1,000 Abuse/Molestation` Limit of Liability 'See Below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) *Professional Liability//Abuse/Molestation coverage: Incident Limit$1,000,000 Aggregate$3,000,000 PROOF OF INSURANCE ONLY. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Human Services P O Box 8181 AUTHORIZED REPRESENTATIVE 200 S Cameron St Hillsborough NC 27278 ©1988-2015 ACORD CORPORATION. All rights reserved. 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