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HomeMy WebLinkAbout2020-881-E Aging - A Helping Hand outside agency agreement DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 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 A Helping Hand, 1502 West NC Highway 54, Suite 450,Durham NC 27707, a not-for-profit corporation, located at ("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,A Helping Hand 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$6000. 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 $1500. 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. (aAgencys_Name») Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 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. (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 c. Notwithstanding the foregoing,either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain,during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof, iii. Comprehensive Automobile Liability Insurance,including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance,covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM 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. (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 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 $ 14.95 per hour. To the extent possible, Orange County recommends Charles House Association 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: (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 County: Finance&Administrative Services Provider: A Helping Hand Orange County 1502 West NC Highway 54, Post Office Box 8181 Suite 450 Hillsborough,NC 27278 Durham,NC 27707 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. L aaW ,behalf'ofthe Provider 11/5/2020 eaaeoo-�� Date For and on behalf of Orange County Government (aMgencys_Name») Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 FV DocuSigned by: owmt, I�GUAmws� 11/6/2020 Bonnie Hammersley, County Manager Date (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: A Helping Hand Party/Vendor Contact Person: Jennifer Ashley Contact Phone: 919-403-5555 Party/Vendor Address: 1502 West NC Highway 54,Suite 450 City Durham State:NC Zip:27707 Department:Finance & Administrative Services Amount:6000 Purpose: FY 2020-21 Outside Agency/Iluman Services Performance Agreeement Budget Code(s): 10495050-720085 Vendor#vendor) 32018 Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one)New Renewal x❑ Amendment ❑ Effective Date 7/l/2020 Approved by Board Yes®No❑ Agenda Date: This agreement is approved as to tec U an apd content: JaA&tV, - b r 11/5/2020 Department Director's Signature Date: B7E962DIBF454 ... 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 j&%ijAW�,standards,specifications,and requirements: (,OV7nt,{fb Office of the Risk Management OfficerF&A, Date:11/5/2020 7FDCF9176800498... Financial Services This instrument has been pre-audited in nwaaaarquired by the Local Government Budget and Fiscal Control Act: ,L� m,L 11/6/2020 Office of the Chief Financial Officer ('� Date: Legal Services This agreement is approved as t 46imard sufficiency: Office of the County Attorney -4444 Date: 11/6/2020 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Sherri Ingersoll upon completion @ singersoll&oran e�ync.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_Name») Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 Exhibit A Provider's Outside Agency Application (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 8 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 Exhibit B Provider's Revised Scope of Services and Program Budget (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 ATTACHMENT "A" Orange County Certifications—FY 2018-19 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. Certified by: Title: Date: (Provider's Signature) (aAgencys—Name») Orange County Outside Agency Performance Agreement Page 10 of 9 Rev. 7118 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 COVER PAGE Applicant Contact Information Applicant Organization's Legal Name:A Helping Hand Applicant Organization's Physical Address: 1502 West NC HWY 54, Suite 405 Durham, NC 27707 Applicant Organization's Mailing Address: 1502 West NC HWY 54,Suite 405 Durham, NC 27707 Applicant Organization's Web Address:www.ahelpinghandnc.org Executive Director:Jennifer Ashley Telephone Number: 919-403-5555 E-Mail:Jennifer.ashlev@ahelpinghandnc.org Tax ID Number: 56-1923835 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 Caregiving Collaborative $6,000 $6,000 $6,000 $18,000 Personnel Personnel Personnel Totals Briefly explain your proposed use of funds: The Caregiving Collaborative provides access to healthcare through evidence based interventions for seniors and adults living with disabilities, regardless of their ability to pay.This program provides consistent and reliable service through it's innovative Caregiving Collaborative, an internship and volunteer based program, utilizing the local universities to create a meaningful experience for pre- med students. To the best of my knowledge and belief all information and data in this application is true and current. The document s been duly authorized by the governing board of the applicant. Signature: 1/1/20 E ec tive Dir for Date Signature: ��� � r s��` ` � 1/1/20 Board Chairperson Date DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 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 anv Brant awarded. Signature: 1/1/20 JE cutive Director Date Signature: 1/1/20 Board Chairperson Date DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 AGENCY INFORMATION Please provide the following information about your agency: I. Date of Incorporation (Month/Year):June 1995 2. Agency's Purpose/Mission(no more than a few sentences): To promote self-sufficiency, quality of life and the highest level of independence for low income older adults and adults living with disabilities. 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). A Helping Hand has been working for the past 24 years to improve the quality of life, decrease health disparities and reduce barriers to human services. In addition,we are an active participant in county and statewide aging initiatives as well as a trusted community partner to organizations and companies working within the aging community. Our performance and responsiveness as a service provider has garnered us funding, awards and contractual agreements within the counties that we work and has recently enabled us to partner with Carol Woods on an exciting homecare initiative. 4. Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes/No) Yes If yes, is this agency an Orange County Living Wage Certified Employer? No If no, please briefly explain. A Helping Hand provides living wage salaries for Administrative staff and any paid caregivers working on Orange County cases. In addition, we have made strides this year to increase companion pay rates by 12%and a very competitive starting rate for CNA's of$12.46. In addition, all caregivers receive the IRS rate of.54 per mile for any client transportation. We continue to work diligently toward living wage for all employees as well as aiming to impact larger workforce issues in the homecare industry. Schedule of Positions: #of FTE—Full-Time Paid Positons: 5 #of FTE—Part-Time Paid Positions: 1.5 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. S. Program Name: Careeivine Collaborative Program Primary Contact and Title:Jennifer Ashley, Executive Director Telephone Number: 919-403-5555 E-Mail:Jennifer.ashlev@ahelpinghandnc.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 words or less) A Helping Hand has created an innovative approach to address the increased demand for vital services by low income seniors. By utilizing the naturally occurring resource of UNC, Duke and NCCU pre-health students,we have formed a Caregiving Collaborative that serves two vital purposes: 1. Provide access to healthcare through evidence based interventions for senior citizens and adults with disabilities, regardless of their ability to pay. Services include escorted medical transportation, shopping assistance and companionship. These services are provided by pre health interns who are assigned 10 hours per week of scheduled service to low income or older adults. 2. An internship program focused on preparing future practitioners for an increase in the national geriatric population. A primary goal of this program is to provide exposure and meaningful interaction that will result in these future practitioners experiencing older adults as people before they ever encounter them as patients. Additionally, students who participate in this program develop a more intimate connection to their community. DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 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 75 78 75 75 Women 250 244 250 250 Non binary/Genderqueer Self-Describe Total 325 322 325 325 Race and Ethnicity Black or African-American 90 89 90 90 American Indian or Alaska Native Asian White 235 233 235 235 Native Hawaiian or other Pacific Islander Two or more races Some other race Total 325 322 325 325 Of the above, how many Hispanic/Latino 20 22 20 20 Of the above, how many non-Hispanic/Latino 305 300 305 305 Total 325 322 325 325 Age 0-5 years 6-18 years 19-50 years 51+years 325 322 325 325 Total 325 322 325 325 Geographic Location Town of Chapel Hill 140 138 140 140 Town of Carrboro 40 42 40 40 Orange County(Outside of Chapel Hill/Carrboro) 10 9 10 10 Outside of Orange County 135 133 135 135 Total 325 322 325 325 Income Low-income(80%of the Area Median Income and Below) Please see income table in the attachments 325 322 325 325 Total 325 322 325 325 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 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 158,543 159,000 159,000 Total #of Individuals 322 325 325 Cost Per Individual $492 $489 $489 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 onefrom ❑ Residents Increase their livelihood security the Results Framework) X Residents improve their health outcomes Intermediate Intermediate Result 3.1: Residents access basic health care services (primary, Result behavioral, dental) (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance % and #of program 80%/172 80%/152 80%/152 Indicators participants who report they (Please choose at least have improved access to oneperformance health care services. indicator to report 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: FC789A20-4CA3-4AD8-9131-02C5424DF839 ORANGE COUNTY NI )It I I t ±8 YI IN � 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. Senior Services 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 Performance Measure #of medical appointment visits according to individual (How willyou accomplish your goal?) daily visit reports. Actual Results 172 clients indicated they had improved access to (Outcome) healthcare Ending FY18-19 Projected Results 152 clients will indicate that they have improved access to (Outcome) healthcare Ending FY2020 Projected Results 152 clients will be escorted to at least 2 medical (Outcome) appointments per month. Ending FY2021 Program Goal#2 Performance Measure # of trips provided to increase physical activity and (How will you accomplish your goal?) mental stimulation Actual Results 692 trips provided to increase physical activity and (Outcome) mental stimulation Ending FY18-19 Projected Results 700 trips provided to increase physical activity and (Outcome) mental stimulation Endin FY2020 Projected Results 700 trips provided to increase physical activity and (Outcome) mental stimulation Ending FY2021 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 ORANGE COUNTY Outside Agencies/Human Services Program Goal#3 Performance Measure #of trips provided to increase access to adequate (How will you accomplish your goal?) nutrition Actual Results 889 trips provided to increase access to adequate nutrition (Outcome) Ending FY18-19 Projected Results 890 trips provided to increase access to adequate (Outcome) nutrition Ending FY2020 Projected Results 890 trips provided to increase access to adequate (Outcome) nutrition Ending FY2021 DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 Program Budget Operating Budget for Program PROGRAM NAME A Helping Hand Actual Estimated Projected Percent PROGRAM REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 99,543 $ 100,000 $ 100,000 0% Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ 6,000 $ 6,000 $ 6,000 0% Other-Town of Carrboro 0 Human Services-Town of Chapel Hill $ 6,000 $ 6,000 $ 6,000 0% Other-Town of Chapel Hill $ - $ _ $ _ 0 Human Services-Orange County $ 6,500 $ 6,000 $ 6,000 0% Other-Orange County $ - $ - $ _ 0 Other-Town of Hillsborough $ - $ _ $ _ 0 Other Government Grants Triangle United Way 1 $ _ $ _ $ _ 0 State Government $ _ $ _ 0 Federal Government(CDBG/HOME/etc.) $ - 1 $ _ $ - 0 Private Foundation Grants $ 15,500.00 $ 16,000.00 $ 16,000.00 $ - Other Revenue $ 25,000 $ 25,000 $ 25,000 $ - Total Program Revenue $ 158,543 $ 159,000 $ 159,000 0% PROGRAM EXPENSES Compensation $ 82,223 $ 82,000 $ 82,000 0% Rent& Utilities $ 12,000 $ 12,000 $ 12,000 0% Supplies&Equipment $ 5,420 $ 5,500 $ 5,500 0% Travel S Training $ 500 $ 500 $ 500 0% Other Expenses: $ 58,400 $ 59,000 $ %000 0% Total Program Expenses $ 158,543 $ 159,000 $ 159,000 1 01%11. SURPLUS/(DEFICIT) FOR PERIOD: - Is - is - I 0 FY 2018-19 Program Budget DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 Agency Budget Operating Budget for Entire Agency AGENCY NAME: A Helping Hand Actual Estimated Projected Percent AGENCY REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 99,543 $ 100,000 $ 100,000 0% Agency Generated Revenue(fees) $ 468,972 $ 500,000 $ 500,000 0% Local Government Grants: Human Services-Town of Carrboro $ 6,000 $ 6,000 $ 6,000 0% Other-Town of Carrboro 0 Human Services-Town of Chapel Hill $ 6,000 $ 6,000 $ 6,000 0% Other-Town of Chapel Hill $ - $ _ $ _ 0 Human Services-Orange County $ 6,500 $ 6,000 $ 6,000 0% Other- Orange County $ - $ _ $ _ 0 Other-Town of Hillsborough $ - $ _ $ _ p Other Government Grants Triangle United Way $ _ $ _ $ _ 0 State Government $ _ $ _ 0 Federal Government(CDBG/HOME/etc.) $ - $ _ $ _ 0 Private Foundation Grants $ 15,500.00 $ 16,000.00 $ 16,000.00 $ - Other Revenue $ 25,000 $ 25,000 $ 25,000 $ - Total Agency Revenue $ 627,515 $ 659,000 $ 659,000 0% AGENCY EXPENSES Compensation $ 509,715 $ 533,000 $ 533,000 0% Rent& Utilities $ 29,300 $ 32,000 $ 32,000 0% Supplies & Equipment $ 11,000 $ 15,000 $ 152000 0% Travel &Training $ 5,500 $ 7,000 $ 7,000 0% Other Expenses: $ 72,000 $ 72,000 $ 72,000 0% Total Agency Expenses $ 627,515 $ 669,000 $ 659,000 1 0% SURPLUS/(DEFICIT) FOR PERIOD: - Is _ _ 1 0 FY 2018-19 Agency Budget DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 EXHIBIT `B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: A Helping Hand Program Name: Caregiving Collaborative Funding Award: $6,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Partial Salary of Volunteer Coordinator 6,000 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. Provide essential services to underserved Orange County seniors;including transportation to medical appointments,food shopping and • companionship • Provide consistent services through our pre health internship program Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oran e County,only(all Towns and municipalities). If you use yercentaees,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results participants who report they have improved access to health care services. 85% participants who report they have improved access to food 85% participants who report improved socialization 85% Certified by: Title: Date: (Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 I AHELP-1 OP ID: JB ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 07/21/2020 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 773-754-0849 CONTACT S.Wolf and Associates,Inc. NAME. 2338 W.Morse (A/CNNo,Ext):773-754-0849 (A/C,No): Chicago,IL 60645 E-MAIL Polly Kosyla ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Wesco Insurance Company INSURED INSURER B: A Helpin�g�Hand INC 1502 W NC HvnE 54-#405 INSURER C: Durham,INC 2T707 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUBR POLICY NUMBER POLICY EFF POLICY EXP yyy) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE ❑ OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY El PECOT- LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED L $ NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ A WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N WWC3476987 07/30/2020 07/30/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count Government THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g Y ACCORDANCE WITH THE POLICY PROVISIONS. 200 South Cameron Street PO Box 8181 Hillsborough, INC 27278 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: FC789A20-4CA3-4AD8-9131-02C5424DF839 AHELPIN-01 ZDIAMOND ,4coR0` CERTIFICATE OF LIABILITY INSURANCE DAT9/4/2 D/YYYY) /4/2020 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). PRODUCER CONTACT NAME: High&Rubish Insurance PHONE FAX 6015 Farrington Rd.,Ste 101 (A/C,No,Ext): (919)913-1144 (A/C,No):(919)913-1155 Chapel Hill,NC 27517 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Companies 10677 INSURED INSURER B:USLI 25895 A Helping Hand INSURER C: 1502 W Hwy 54 Ste 405 INSURER D: Durham,INC 27707 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM DD YYY MM DD YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR ETD 0424582 3/1/2019 3/1/2022 DAMAGE TO RENTED 100,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 20,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY El JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO X ETA0424582 3/1/2020 3/1/2021 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Prof Liability ND010541770 9/9/2020 9/9/2021 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count Government 200 S.Cameron St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. P.O.Box 8181 Hillsborough,INC 27278-8181 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD