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HomeMy WebLinkAbout2020-882-E Social Svc - Exchange Club Family Center in Alamance outside agency agreement DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 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 The Exchange Club's Family Center in Alamance County, a not-for-profit corporation, located at 200 N.Main Street,Graham,NC 27253 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Provider agree as follows: 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$13,464.00. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of$3,366.00. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Revised 712018 Page I of 9 --DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 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 22,April 16, and July 16 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 in. 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. change Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 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 MITIIMUM 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. r &change Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment,to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage,to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves,their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 14.95 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered,to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Department of Social Services Provider: The Exchange Club's Family Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 Orange County Center in Alamance County Post Office Box 8181 200 N. Main Street Hillsborough,NC 27278 Graham,NC 27253 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. 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 1 IA 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. eta L Wro&I,behalf of the Provider I/ 11/5/2020 Sarah Black,Executive Director Date 0Nbbehalf of Orange County Government b6Vk'lAA' hmKI trsb-� 11/6/2020 Bonnie Hammersley, County Manager Date Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 7118 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 ORANGE COUNTY—DEPARTMENT USE ONLY Department PartyNendor Name: Exchange Club's Family Center in Alamance County, dba Exchange Club's Family Center of the Central Piedmont Party/Vendor Contact Person: Sarah Black Contact Phone: 336-227-5601 Party/Vendor Address: 200 N. Main Street City Graham State: NC Zip: 27253 Department: Social Services Amount: $13,464 Purpose: Outside Agency Funding: Parent Aide Program & Children's Parent Program Budget Code(s): 10400120- 63000 Vendor#65197 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one) New ❑ Renewal ® Amendment ❑ Effective Date July 1, 2020 Approved by Board Yes® No❑ Agenda Date: June 10,2020 This agreement is approved as to to oaiufftrM Wnd content: Department Director's Signature N" (,hsf6a, Date:111512020 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 standards, specifications, and requirements: Q�tSa r,bVl�t,f.,{fb 11/5/2020 Office of the Risk Management Officer �e Date: Financial Services This instrument has been pre-audited ii rdTeDmaftW Pequired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer Date:11/6/2020 Legal Services This agreement is approved as t at 9�,Ahd sufficiency: Office of the County Attorney 4-q Date;11/6/2020 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Donna Lloyd upon completion @ Dolloyd@0Tan ecountync.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: The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 7118 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 Exhibit A Provider's Outside Agency Application i The Exchange Cluh's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 7118 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 - s s l s n{ „ s t s i t l ' ( i� � I , ',�� �,g t �86 .I:I r i� i1� 1 1, ,8i�I �111�11•',01� 1 1,Rl�l 111"Wi11-1 il�r-}�lill?!l hu[�}s�tiflti iibtil' Applicant�onta-t Inform':ation A0plicant Organization's Legal Larne:Exchange Club's Family Center in Alamance County DEX:Exchange Club's Family Center of the Central Piedmont Applicant Organization's Physical Address. 200 N. Main Street Graham NC 27253 /?ppiicant Organization's Mailing Address:200 N. Main Street Graham, NC 27253 Applicant Organization's Web Address:www.facebook.com/familycenterinAlamanceOrange Executive Director:Sarah E.G, Black, M.A, MFT Telephone'Num6er:336-227-5601 E-Mail:sarahblack(a)-exchangefcp.org Tax lO Number: 56-2227006 ..Funding Request please!ist all Fiscal Year 2021 Human Services(HS)funding requested for all programs and the proposed use of funds(please list program name only) I Prvgrarn Carrboro- Chapel Orange Total - HS Hill-HS County-HS ;�° ?I; e,';I t " t; °tli I tt 1 ! $10,000 $15,000 $5,000 $30,000 ss <,� p t7 erations Persanne! Operations Parent Aide Program $1,500 $22,336 $22,336 $46,172 O erations, Supplies, & Personnel Personnel All All 3 Children's Parents Parenting Classes $0 $1,844 $1,000 $2,844 Travel, Supplies, & Personnel Totals $1,500 $24,180 1 $23,336 $49,016 Briefiv explain yourproposed use of funds: The funds for the Parent Aide program will be used for salary and benefits of program; staff, mileage, supplies/ client emergency funds, rent/utilities/operations. The funds for the Children's Parents classes will be used for salary and benefits of facilitator, mileage, and program/office supplies. To the best of my knowledge and belief all information and data in this application is true and current. The ocumen has bee dul a thor' �ed by the governing board of the applicant. Signature: J 10 jZoZO Executive Director, Date Sign ature: Board Chairperson Date Cover Page P a g e 2 o f 10 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 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 ❑ Z' a}Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, or•,Orange County?, ❑ b) Tvlembers of or closely related to members of the governing bodies of the Town of Carrboro,the Town of Chapel Hill,or Orange County? 0 ®c) Current beneficiaries of the program for which funds are being requested? ❑.. Z.d) PaJd providers of goods or services to the program or having other financial interest in the „'grogram? If you:hwe answered.YES to any question, please provide a full explanation below. ....NON-DISCRIMI NATION 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;thee.best of my knowledge and belief all of the above information is true and current. I acknowledge'ar d undeestand that the existence of a potential conflict of interest does not necessarily hake#hb�ro&jm'ineligible:for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. •J i . Signature: ICJ 1, f 1�o aZn Executive Director Date ( j Signature: 0 1 zo z_0 Bo; rd C airperson Date aver'Page Page 3 o i 14 - s • •..ram.m..r.�.. ;.. .w.-....T ,... �..'., ..... .. .. ..,.,® ,..,.....Y . , DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 iI .! ! s ..I ! I !u lNfSt I I!I lull ,�'l}1Ii`` ! Ili i !�! I l�l. {i a ills, .,.} il,. �i !i.. lwi i l ►,, 6 I ! P �i !1, I` ,l!�'1.1� �',}t.}''s� ;1 } 1r r 1 r I� u- r hn r t r r» r ., lr I r u II I , S! if:},}l i11�r"'HIM ER ..;;!ti Please provide the followingtinforMation about your agency: 1. Date of Incorporation(Month/Year):015/2000" ,,,.:.;. .,r. 2. Agency's Purp®se/rviission(no more than a few sentences): The agenpy's mission is the prevention and treatment of child abuse and neglect. The Mission helps to create loving and safe communities where families and children are empowered,.to.thrive emotionally, relationally, and holistically. The center currently offers 9 evidence-based or evidence-informed programs and a 24-hour crisis line in 7 counties in the triangle/triad'area (Alamance, Orange, Chatham, Person, Caswell, Guilford, and Randolph). 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 foo wordsj.'The Family Center has 23 years of experience in administering grant funds, meeting proposed budgets and timetables, and providing successful abuse prevention services in the community. The agency has been offering Parent Aide services in Alamance County for 23 years, in Orange County for 13 years, and expanded into Caswell County in 2016. Parenting classes have been offered successfully to families for 23 years in Alamance, offered to Orange County families for 13 years, and 2 years directly in Orange County. The agency has decades of experience with in-home visitation and parenting education to address complex childhood trauma. 4. Living Wage: noes 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. The agency is currently waiting on Board approval to begin the certification process after the Board completes the first annual salary review and adjustment of staff positions. Schedule of Positions: #of FTE—Full-Time Paid Positons: 10 #of FTE—Part-Time Paid Positions: 5 Program information P a g e 4 o f 16 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 ITI'l i t 11"I'll I �i t,I{ !III 1 it 'I I 111 t 1 ,q_ t.:. 10„i' ti. - ,I l.1.:, •Ilt 1��[,�]— colas nl e: .n.. �+r!W:i:,.. da;Nhltl�Ir{1. 5: Program Name: Parent Aide Program Program Primary Contact and Title:Sarah E.G. Black, Executive Director Telephone Number:,, • 336-227•-5601 . E-mail: sarahblackCDexchangefco.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 fess) The evidence-based program provides home visitation from 6 to 18 months to 18 (1 Carrb(?ro. 8.Chapel. Hi11,.9.Orange County) families (all populations) at-risk for child abuse and neglect. In 2017-2018, the last reporting year, 772 children were reported abused or neglected•in Orange County and 112 remain in custody (Duncan et al., 9/2019). Education, coadhing, support, lffe skills, and advocacy is provided. The program aligns with framework gods.6y, in livelihoods security, ensuring a high quality of life through the absence of violence, improving health outcomes by increasing new healthy lifestyle behaviors, promoting well-being, and increasing life skills. 7.Target Population:' Please'cainplete the table below with numbers(not percentages)of individuals served and projected to be served. ! y',IU7;p";I h:,}•.� 1I�1,,i,.t.ii,t(,,•(te.„,a,1'.,l,,,l,I,,1t t+I:tI,Il hPl I,!t IIljIa l,l..�I,a'�.hr{I 1f,-Iap,yVt,.:1,.I!:f.1tIfI:.1lP-i lI i,.iIi tIt lIi 11, 1 111 iI Is N 1 ,liP�R, 9,11,01111.111. 101�u{i 1:1f .i..1 c.itlp,,i�iiai,ls.,,ta,i,l'i:.ui.9l�:.i.i;ll,.l���tr,.1a1l ilt I ii,[._'l.ss,.usia,7.�.pn.i1,.:.)I!'(I•:•i'1,!;i:+:)':'l, lrl ii`l iJi.t...,.i:r,a:%' :•,�=;i::,.a.l,la,f i�!. ;�.,,;:;::.:: Projected Actual Projected Projected 2018-19 2018-19 2019-20 2020-21 t�1 �IIr,Ui({�3f!` 18 Fam.13 Families 13 Fam_ 13 Pam.l1- ili'i I� IIai?i a 1'liL;a;llil:!b� " tlo , 11 ! Men 24 24 24 36 Womeh 26 25 25 38 Nonbinary%Genderqueer 0 1 1 Self-Describe 0 1 1 p�, p� Total 50 49 51 76 rE Raee ll I°>I� ,i...,i�;I<i�l � i Mal a l III 1111} 411t 31 11•'Black or African-American 21 14 ' 17 American Indian or Alaska Native 0 Asian 0 , r White 25 20 23 33 Native Hawaiian or other Pacific Islander 0 Two or more races 4 6 6 12 Some other race 9 5 Total 50 49 51 76 0fthe above,how many Hispanic/Latino 8 9 5 11 ................ - .......__......... ._.... ..._._:... program information Page 5 a P 16 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 Of the above,how many non-Hispanic/Latina 42 40 46 65 Total 50 49 51 76 i1,4I1 l ! I l 1 1a ffi 'Rill 1ti1i,,�iil ll�Il i�illI,►,�a1l 1�pi�aiil l�ltl�=�l 11 Is� �ll ��i 111 l�Ilkl;s ill 0-5 years 12 11 12 27 6-18 years 21 20 20 20 19-50 years 17 18 19 28 51+years 0 1 Total 50 L 49 1 51 1 76 `•R1I iy:ih fl>lt''[, ,t, Ir+II S ( l s' + ' Town of Chapel Hill 1 22 22 23 40 Town of Carrboro 0 3 3 4 Orange County(Outside of Chapel Hill/Carrboro) 28 24 25 32 Outside of Orange County 0 0 Total 50 49 51 76 I;,"; w�'.�v��'.lulaf��17llL4iaJl �1t-Wva1 a t i I a ,It I' , FI �i d L Lak-lncorne(80%of the Area Median Income and Below) Please see income table in the attachments 42 24 26 36 Total 42 24 26 36 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. ERA , I Total Cost of Program $26,854 $26,273 $48,672 Total##of individuals 49 51 76 Cost Per Individual $548.04 $515.16 $640.42 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. Prog"ram Name: �t rategic ❑ Children improve their educational outcomes Objecose Residents Increase their livelihood security (please choose one ,,,,,,u from.theResulls ; ❑ Residents improve their health outcomes 1k't11 1!"IW- II i III 1u11�1171 11111E I H1 ( I!1 I i I [ [IN0111011111 I ROME 1 ........_------- Froram information_.•__.._.__......____.__ _..__._�_�.._�._ _._�._ ___..___—_—�-___..•___•__.•...•....._.._._...._ . g Page 6 of 16 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 Insert Intermediate Result here. Result' Intermediate Result 2.1: 88ideh#g access the most appropriate social j {please Moose,one from the.Resu&5 I safety net services I Framework) i I t rlt 1� r liq t ,I ,it .,S INMI "tt °i 1 I,'I }�lt� III M i! 1-101117,;I im 11,llii,(;��fa+ ' 'r1�1,1�11�� Performance Insert Performance Indicator 1) 49 1) 51 1) 76 here• individuals individuals individuals Indicators 1) % and #of individuals (PIeasechooseatleast (13 farriilies (13 families (18 Families) oneperformance that receive abuse and total) total) are will receive indicator to report on neglect prevention and received expected to abuse/neglect from the Results response services. Framework,and add abuse/neglect receive prevention adds onalperformarce prevention abuse/neglect and response ' dscatorsthatyou and response prevention services. Would like to report to the Taw'ns. Please services. and response insert a4-Mifional rows services. as needed;lmng one Per row,+. 2) 93% of families will 2) Of the 6 2) 94% of 2) 94% of improve parenting skills, families,that families (13 families (17 parentichild interaction, discharged in families out of 18)will and increase problem- 2018_19 served) improve solving skills/family 100% (8 out discharged parenting functioning. of 6) are expected skills, improved to improve parent/child parenting parenting, interaction, skills, parent/child and family parent/child interaction, functioning, interactbn, and family and family functioning. functioning. 3) 93% of families will 3) Of the 6 3) 94% of 3) 94% of enhance home safety, familiesAhat families families (17 increase linkages to discharged in discharged out of 18)will social/eommunity 2018-19, are expected improve supports, and improve 100% (0 out to increase safety, their capacity to maintain , of 6) safety, supports, and their child's health. increased supports, and child health safety, child health outcomes. supports, and outcomes. child health outcomes. Pro ._Program - -.._.__.-_ _.._............_._..__.___.._.__._. g Page 7 of 16 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 r `'; Outside Agencies/Human Services Pleas tzsi-It•h't2u pA6wn menu below to:select yvhich, ,unction area best aligns 'with your agency �rl progrand(s) in which you are requesting funding. please select only one from the drop down 5elairior Health' . I#'vou selected others please tell us what functiori area best aligns with your organization: ;'.P.loase indicate three program.goals/performance measures below. ' i•A#ew.notes:- .' . - :' ,�...;1#yc6..use percentages,please.put the actual number equivalence. e Please ensure your performance measures are outcome based and not outputs. , U•�l''h•;:,i`i '+b i {j,. !I lt';1=! i!.,n „5 �.'. t „ �'° �1 I!li s,.,,s it• :i ,, a:: I,- ,•,;;: !;. 1 ; ;', y` t: i t' i'4N .fit ��� l.:��•� h ! F ,r 'I I{:. .�: ;• t'f ' ,:11`t{�14 !, i�..' r,i r ���' �t; '' '•i � '�l �� �rPr 'ail 1t�f f-ihk'')1!i�.J 11,Il �flf' �tr. 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It, tui, 1 a�la i 1HNtt ii a' •,.I r,'±t�'i^'2 �;I�'+4f y:,b'-t 2 i'''9 , s, i"�i' I`INSIiI IR11�, ', - , u' •� 'Itu n spu �. ,,u+ I ,.•i,... x,�a•u.�,,t: .l IIIIIII It a t 9 t l ! I d c l„I •i t 31LMW y� ,n �8 � ,uu fl �� , � rp I(G"Jj ..0 n, u _ .I LT' 'I til...,.,•:-"• I�" au u�•p-.,..1ju ' p_tli I r `•I f�' Iji w Z? 's ��' r ail?li`'II ,'. 'tn ,i�' ` ' ` t�Eu � ,� I # l t' tl�a ��� ti�l`:i' aL• !(�;itt.1 ,i. lt,ti-::. Program information P a g e 9 of ,1..6... -DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 i i Mali,' qJ ,! 'i' 1111 -,a 1 t I .I .!,al p.L, 1n 11 uilf tilll i;pci. si!s f1;;mb'i�N�t,tu, 5. Program Name:Children's Paren$s Parenting Classes Program Primary Contact and Title:Sarah E Q. Black, Executive Director Telephone Number: 336-227-5601' . E-mail:sarahblack(cDexchan_qefcp.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) Classes will be provided to 24 parents, 12 kids, at-risk for child abuse/neglect. Three sessions are 12 weeks, 1.5 hours, using evidence informed curricula for the family. Homework and skill practice occur on multiple topics around parenting and prevention. In 2017-18, the last reporting year, 772 children were reported abused or neglected in Orange County and 112 remain in custody(Duncan et al., 9/2019). The program aligns with framework goals by increasing livelihoods security, ensuring a high quality of life through the absence of violence, improving health outcomes by increasing new healthy lifestyle behaviors, promoting well-being, and increasing life skills. 7.Target Population: Please complete the table below with numbers(not percentages)of individuals served and projected to be served. :�, ( 't 1:-;-,1�i!k•,!h, �I` I ,,s�it I i I ,f„ p l;t: pg ;,( py�j ,.t1!IlIIL„�n!n ,�,il'!t.I.�IIF,dt,I;ql*,�{t A1ru�17.11!if:BY-t`id lib,n.(f ai .INIS,II.,.II�SitlliCtil{Ifl 1;.II.iH I, I S��!!�!'1:4!i(i:lp!:ItlS��fii:{;1�11'>'�i:c IS�� ,1 1.ijnt: Projected Actual Projected Projected 2018-19 2018-19 2019-20 2020-21 Men 7 10 13 17 Women 9 11 15 18 Nonbinary/Genderqueer 0 0 Self-Describe 0 1 1 Total 16 22 28 36 U►.,v' Black or African-American 6; 7' 11 15 American Indian or Alaska Native 0. Asian 0% White 8 10 12 16 Native Hawaiian or other Pacific Islander 0 Two or more races 2 1 1 1 Some other race1 4 4 4 Total 16 22 28 36 4 Of the above, how many Hispanic/Latino 3 4 4 --_,___-----__—_ ........ . ::Pro ram information Page 11 o f 16 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 ------------ . i Of the above,how many non-Hispanic/Latina I ;13 18 24 32 Total ; 16 28 36 }' N, � Icl,l� 111��+.i u!�� 0-5 years 0 2 2 2 6-18 years r_16 3 10 10 19-50 years 1651+years 1 1 Total 16 22 28 36 ,.ii� a';��e '3'J6� Q �ll+i}',Ll(l��LVii� �IIi�C�W1 u�l:i�l���� I,�il�liflllU�l I S�(I I11� L� ��Gt�, Town of Chapel.Hill 8 12 19 23 Town of carrboeo 1 0 Orange County-(Outside of Chapel Hill/Carrbero) 6 9 8 12 Outside of Orange County 1 1 1 1 Total 16 22 28 36 HIM, Low-inc6rhe'(8b%'ofthe Area Median Income and Below) Please see 8 12 income table in the attachments 13 6 Total F 13 1 6 1 12 1 12 S. Cost Per Individual This,cost per individual must reflect the total program budget divided by the total number of program individuals in this application. plll'1G ' ,r " 'il' t Total,Cost.ofProgram $2,000 $1,6,640 $7,572 Total#of Individuals 22 28 36 Cost Per Individual ( $90.90 $237.14 $210.33 9. Performance Indicators For Chapel dill 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 ®bje'ctiVe 1 (grease choose one from .Residents Increase their livelihood security 1 the Results Framework) ❑ Residents improve their health outcomes ,v,t 1 ''`s i t I i I „ 1 � 'i I��{}4 iC I � i}� •l I ia�fl 1 I ... �. ( f� ! .,, l � t, , � ,. Program information P a 4 e 12 of 16 -DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 I pei ioaetlite Insert Intermediate Result here. Intermediate result 2-1: Pv��sidentsiaccess the most appropriate social 'please choose one from the-Results Framework) safety net services . ��� � � �{'�li �' ,.,H' ` fI �!'.,. �i{, so' SIi1B ��+ '���5 a•h�, ff @��ttii{}i�I'� MINE" U : Performance Insert Performance Indicator here. 1} 17 1) 16 1)24 Indicators' 1) % and #of individuals parents and parents and parents and (Please choose at least that receive abuse and 5 children 12 children 12 children onepeiformance neglect prevention and received will receive will receive indicator to report on response services. abuse and abuse and abuse and from the Results framework,and add neglect neglect neglect additionatlperformance prevention prevention prevention indicatorsthalyou and and and would like to report to ff the Towns Please I response response response Insert additional rows as services, services, services. ,aceded,listing one per row). 2) 89% Parents/Guardians 2) Of the 17 2) Of the 16 2) 88% (21 will increase parenting knowledge, skills, chid parents parents of 24} of f g attending receiving parents/ development knowledge, classes services guardians problem-solving skills, 88%:(15 out 88% (14 out will increase 1 coping skills knowledge, and of 17.) of 16) will their skills & report feeling more Increased increase knowledge competent in their role. their;skills & their skills & and will knowledge knowledge report feeling and and will more reported report feeling competent in feeling more their role. more competent in competent their role. *only for 19/20 & 20/21 in their role. i goals 3) Of the 12 3) Of the 12 3 88% of children and children children parents will report an enrolled 91% enrolled 91% improvement in social skills (11 of 12) (11 of 12) and age appropriate will report an will report an behaviors and increase improvement improvement resiliency. in behavior, in behavior, skills, & skills, & resiliency. resiliency. Program information P age 13 o f 16 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 {outside Agencies/Human Services Please;use they drop down menu below e:,select vvKjcbt function area best aligns with your agency I a'nd programs)in which-you'are requesting funding. Please select only one from the drop down rmeriei`fieloav: ' .Behayigr'Health ' t 4f yois.si lkkbad'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. ..0 ' - , � ,t tt t I ",: ': , ?�i „ .T t r{L L... -.. 'xS tI f�`•I t� I'.: �` i`' ,i li �R �l�l S}riS€:j;i t{71 ;I ' (r�'l i '' ;. �,� j., I y� � , .,';1�•�w''� Lail�'`::r h I i! '{ ! 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'( I+J�"��! ��{d'�;i� � ."1'i r .t', t�14t �G' f�'; P".•�� � ��,t�I t ���� ' k r' _,� d y V4 E� c6mti`W y{, l � y�J��,1 I ';` i••, 1.17t�..y+l i en1,f'� ,! h f .{tl����i�'✓� ��'t.�� a e 3� i i(y ,fl`�+ � !( � '-�'�E� �mt E , ��� ,'ti' ` f�to tw� �`i � •t E ..�f<'t't! .�1 !. �I ;:•�,.�t�; 4;f� '¢ ..I. a o� o�o {; - �!o "q, a ram-.��,t` _1 a ,1 �I 1 3±�1 !� t•tlt� }� � '!,' , �7Y �t E,' sL1�� r"N ,'`Jhy '1•I�jl4 E� t ��I�,d , �'�lv' �m + ,� Is •,Lt;tt �n7tt.,,,�tShlE�i 1;Er<•f�t� ',1. ..1 R�°,A.7 MEM �1 } i � t �,� 4�-,€,�, i a !I� �i��'S t) ''ii1{1.�y..t: �i�'.s�`I t o`�t��!,"�1t't�t=`"•.!1'j�(��.�� 'IfLI, 1 p -+ •I , -� DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 Agency Budget Operating Budget for Entire Agency i Exchange.Club's Family Center in.Ala ance DBA Exchange Club's Family Center of AGENCY NAME: the Central-Piedmont •; ::,.;,F�w:µ�„. . .. . . .. � MR ,;, ,Ili . :,Ill,F, '1 ,� t!`4� I ,i}tis , i i': r° „ n iA,.Glr,I.r ,11`" !f";, t•I�{. lq,i�,171 ,Y.t,.. , $ 109,031 -$ 6,388 $ 5,750 -1Q% gern �;U�e0erated Revenue(feesp �, - $ - $ - 0 e_I Gi?i effnment Grants: t` Wuman'Services-Town of Carrboro $ . 12,000 $ $ 1,500 0 Other-Town of Carrboro $ $ - $ - 0 Human Services-Town of Chapel Hill $ 12,390 $ 13,000 $ 24,180 86% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 13,464 $ 13,464 $ 23,336 7.30/- Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ 565,7110.14 $ 635,618.00 $ 662,618.00 $ 0.04 Federal Government(CDBG/HOME/etc.) $ 9,1174.73 $ 11,040.00 1 $ 11,978.00 $ 0.08 Private Foundation Grants $ - $ 10,000.00 $ - $ (1.00) Other Revenue $ 21 $ 25 $ 10,000 $ 399.00 :::y:is.. ....._ ... •,.-I,.... ,u.`,.,,. .{_. , { ,{.,.,.,s}.I,...... ,, i .:.»1,.1..i^an !a;{ }.{ I G,,1.1.},,,II. ..., ,. ,..,. �I {. ,' ... {....::„ ., ...,.,:.. .:,!.... ,... .._I ..,,, `•s:,i,:`it:::!''a.,I?,iy+1:;,,�I{,; .:.,:.I�I I if .I., I,,,�, VV1,F�y.!+:f.F ,l � �,I .I I, t,':j•(' 11. yy, ,{�,y ,�.{� ',1tC�a }I;'i %,I!>{,I}L. •I�`;,.fit {�i.l {^�i,_uii ri };I,,....I y y.q'fIn �j O t�,•r/T a4'`�+:.� 1,.,.f F 1.,I:^,'' fl:.•ni f'ilt�'1 � I.•�Ji�rSil I�.I :� ��.iJ � I�>t � T ba,, .Ill.:,«.4 "..,-,:.:::.lia?I„i,:,{, },•:I,:II, ,+Ili,,,,,,I,+s.J}S(':I{,t,l,,+l}dl1:a:?i„ hl}::•::,,t ! ,.n ,},ICC.,, ACZ�N'CY EXPENSES Compensation $ 305,840 $ 499,611 $ 541,980 8% Rent&UtilEbies $ %029 $ 51,032 $ 51,032 0%j Supplies&Equipment $ 0,993 $ 25,308 $ 26,723 6% Travel&Training $ 41,146 $ 43,350 $ 45,674 5% .0t.,er.Expenses: $ 823 $ 70,234 $ 73,953 5% aR(}�psi,,,p i?tq%;i",1 Pa•;anm ! I F, 'tlll ,} '`}}+'ai), 'iF i}- •+.-�.-,:.. ;F:-,.•�:-.I. 1 Ili}11i]}11}Ill li, !, l+I I F _ t rr 1 ii ,,}:F=Ik i i }.11`.^.1•,I {14: gg.�jl i ;,} F' 1 �,,F}1, ;..��,}t`+ ,1116111�11' lu!�i,:li I' ...!.!1 ;I}i •H' ,iltl I'' L•. ..I(.I, I, { .,};+ifh.1, {,,,„•:{a,I�,;,,,y�:,s,.;SE:::_t..;i,:,.:.al:•le';!i;;i., `F._�>_.h'-,h! rl I :,.d. �,}i} :a{II l I! ,1•d �,1, i ; f��+}, l,. ;F} l.,n ;S i 3; + IUtI'I IIII}ilii-(� �' l! !} t� It IIi I iT �ll.ti!�I _ll,i .11� , ,�!.,. ,.I iIJ-.......:L•..I, q,l:•t i �,.;i�:.: :• .l as r'i'111yaF ,r,,r I S/ :. :.MgIlC�:01 I The Family Center anticipates onl*having a surplus in the overall agency budget in 2018-2019.The agency was in the first year of independent operations from the former parent company and we had several generous donors that are documented in the above Private Donations line that donated specifically to the agency to give a starting reserve fund. The s urplUs is now allocated by the Board for reserves that will al'ow the agency to operate for 3 months in a state of emergency if funding should suddenly disappear for programming and/or in a case of emergency.The Board will supplement this reserve with fundraising in the next couple of years to maintain it at 6 months of reserve and then focus on fundrWsing to supplement agency programming funding needs. I � I i I I FY 2011&19 Agency Budget DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 il, I Program Budget i Operating Budgiet for Program I PROGRAM NAME Parent Aide Program • I Ili � ;!, � ... : }! �.,:.,1'PROGRAM REVENUE Private Donations I 1al�i$!f l`„I,.ni!T-'•p -!I I$(I11�Ilft�<til}','s,1 lto�its,{I 2,500 ,500.II. �''•I$i!Ii{;11.:.'i:u•;�,,:.2II'�+�1,�}5�}3�0'}i4Fll01��t'ifY if 0% Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro S 12,000 $ $ 1,500 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 12,390 $ 11,309 $ 22,336 98% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 1'2,464 $ 12,464 $ 22,336 79% 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 r::;:r::mms:rnzn, ::oci,i=,.ha+;.a.n:',.,•-:,,,:niraN;=r. ��,r:• -Y, f'ili bi: AN:{l - - - - ,: •,-,:.. .,; �f;tt'•_;:{tr'I`ii {•'� r... I ,:;=ii::ed,l.,.`T.,.Ican::: III.. I rl,! { w!i I lI ,. I! -{:P'tiiiil?'? l,y � ..l i...,..1.. ..,..I.,.i,s.i .. .s,Ft,l !� .t..l., ,..1.1. ...AI f1 ...,,. c•4= ,.i 1,..t..i 1,... ...,.,:.in!iit3i!i�Y.�:i�,::::.::�!,:,:,::!!{::!•',i::::::..;.., f I!.!,• ,I!,., .,1...,,_1!,,.. ...,,..f,.,...., . ,., ,r,, .,: f,,.,:,..,...i. !,,...,, ul !,.I. .. ... ...........!t!-!:,t.I::................:..::.,:„ I i .,,,,,.n,lli ,.Is................r,L.<i .. I!R,;li,!:.1,.,,.....t,e.,:It..,.. .. .:L,{•,!:l�i!pl.g::,.,?,:,ti..t. ....9.,,,.11, ,!r;„�i,!it,.G,: , t,.!;::,:L,.,.,...r,..,!,•i,r:,�u„I:d;il< !i1- �Ii•,;�,.L{.;.I,i,•,t,., i, ,.t., ,. {. ,. ,r: ,. .;:.::.. ..:..... . .! ,'�,,.}III( J �;!!. ti I o!!s. . Ii ;! h (► (y.ate,Re�►en•ul�tu!!!::•..,.. II.{.t,i•.. ..I ,I, !!,.i ..,,.....:!.... g ..7.....,.•..... .... .l,. .o.:,i d.,;c i.t...,,.,..,4;•. I:I'. v�i;!'•.{Isi..l..,,.,.U.., :,,1!u ..�>�,., „1,!'' .,. ,..�.��. ..�.,,,.;=,L,.,._,,.;i.....:................,..I.,.,il.�..!.,.i..!Ll..�i. ,.:li.11?!i.l.l.,,I:;:{.!!!!:,!, ,,.,, ,..,.:{.. ....:., :,,_,... .,,•. ,.,,•:_,_;::y,,: PROGRAM EXPENSES Compensation $ 19,957 $ 20,000 $ 38,980 96% Rent&Utilities $ 1,386 $ 1,400 $ 2,411 72% Supplies&Equipment $ 116 $ 250 $ 1,181 372% Travel &Training $ 0,063 $ 6,063 $ 6,100 1% Other Expenses: $ 128 $ 120 $ - -100% !,LIt?j:;,-i,.�l:u'ine,O nn'tt4m,atu s�'?Ii 1u tL••,..i;, #a�' ,.1 I.t l}:�li:l i u?s.(r.I,n,,�,r,l,t ilI�ll'I�+Il}(.iii I lI{�4�I 1l I i,ti iI � ��I!I`l 1 lll(!IkiE,#liI<t33!fi((i'.�{ i,{I;f ,.,! (�I i i�i.I �I.l..�{,.I[i{Q��I f{ Il�}{l,IIt�,,l lI,l�i:� ,i,?s•,�.,.!._I�( rai- •Ii,lI,I!{,I?I,,.......!,. I ;il:l•i i;:i:i:i,,;'ir jiV;:,.,;i:�P,INTO ,i M N 'la, {, ••I: ,,. ...:: ,—:�irt>�:.,,,n._.,•�........................ — llj'{ilif(}il::�,ml,{, �!i;ls,:}!lip,y F - Q. . In 2018-19 the program costs exceeded funding allocated.We anticipate again the program to operate in a deficit due to lack of support from Town of Carrboro this contract year.We jorginally asked for funds to help serve the one family that typically gets referred from Carrboro each year. The Town of Chapel Hill funds and the;Orange County funds are covering the rest of the County and the donations help to pay for mileage since costs are high to do in-home work for mileage. FY 2018-19 Program Budget - DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 i I , Program Budget Operating Budget for Program i i PROGRAM N ME Children's Parents Parenting Classes i I till)i'i PROGRAM RNUE Private Donations $ 1,000 $ ,1�t,,9i,0.i 9,rI l.1 ns.,,7i;;t d5,I+0 �-�8I-.lI".r1'; f l:% Progra n, Generated Revenue $ $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ - $ 1,691 $ 1,844 9% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 1,000 $ 1,000 $ 1,000 0% , Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 Star Government $ - $ - $ - 0 Fed ral Government(CDBG/HOME/etc.) $ - $ 2,040.00 $ 2,978.00 $ OA6 Priv6te Foundation Grants $ - $ - $ - 0 Other Revenue $ - $ - $ - 0 ., ..,,....- . n :d�l,,:r,,....I r...:,:,.,•r::,:,,n !:,:.:;�,.,. ,g,::'hrr;,.f.i��''!•:,:r f!,,;,I,,.r,!,t f.!{.I•!.,.L..1. „ a t:....i...,�:,...t:..w,.,!.f:ill;ii!...... ,:..- ..';:.;,,:.. ,..:,,.,;;>..t:•,,i::,�.,I:E sf.1,1_.......:,I:=::-:,,a„n.e..1...ia.:,:.,n,a...:!.!!.::L.,.,,... r,!r.....:.....:... ]] :. :.:...,.;. ....:.: : .:... ..._......,,.,:.. ...r..i.,........,...,...,..,.., :. ..rr..r. _'.,. •ti�,SL. ,{,.I:,r,;,hnl'l,I:!.{1.,....w...;,i....,.;v.r, .....,::::�,:�:�''.:,.:..::,,.., .•....!,::,a:;,.•:r: .r.he I .�,.s� ::I:::.• :;...:.I.�:,.,. �-:'::,!,..s;r:!:�!,.!!1.S.i,.,. ..,..,<•;:;:<.,r;i:.4•r+,,,,Vi .,... ,I!. ,_ :...:.. .........i.u..;. %:..:,,:: ..,:,:..,_,.,,::!�r;l„�nr!;`....:::a.�i,...,�,,!,::,II,,,•.;,,s a.d',,,... .n .i.n�4.,t.14+::a:!'nii,,ll'}�i��.!a...:t,.a� ,-:"�Ptl�,:h!�,t,�r�� n�!r 7�,i� PROGRAM EX .ENSES Compensation $ 1,000 $ 4,306 $ 5,179 20% Rent&Utilities $ - $ - $ - 0 Suppliers&Equipment $ 400 $ 1,480 $ 1,540 4% Travel &Training $ 600 $ 854 $ 853 0% Other 4penses: $ - $ - $ - 0 i ii ,`-`S 4�rjjfp s( I h+ mm71111,,�l it +tl li li I Ii}i + 1 I' 11 , 'I 1;ii, 3 lira,;t i I 41• t ii i i, l:Ii I :l!ail ,111111:11`�.,I I }!:�; {;1!i;' '};t I:y t i f l!:I•,i,i r k1`. !{itl 1!:li 1 ht„,;!I i I,! I:••::l!:I:=!i,;;1 � 91���11!1� �� ...t1 }fit iii lu L'li .l.l!IILI i,li 1It,l ,. � Iltlr.., i!)l. a.,.!qd'!::n(Iil!I{!...a:...'!r.:-..!'fit n...,.:.a',?i!ur.,, .. ::.,., '•.,., .rwy,,...,.. A,,.,. ,. :: ... -y_.ri„�.,,,. .,.,, :+"-,ri{,",(,ui`li?i!i •Ilrozi{rt,.,_ ry il'i i o=:�. ,..;f.y yr;r.�.- .!.:. . J .:�I: �:t,. . � .. .. :..,:�r;i•�,.,�,�: .... i .. ..�L !' .ltil•�U. . ::Ri , � !...,.i:.!.... .r..�.�...., 1�17 ... ,.: ,. „ r, � .�•�pp. �� ............. i i ! i i ill I FY 2018-19 Program Budget DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 Exhibit B Provider's Revised Scope of Services and Program Budget T�K�change Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 8 of Rev. 7118 DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 EXHIBIT`B" Scope of Services—FY 2020-2021 Outside Agency Performance Agreement Agency Name: The Exchange Club's Family Center in Alamance County Program Name: Parent Aide Program Funding Award: $12,464 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Salary&Benefits $10,232 Mileage $168 Rent/Utilities/Operational Costs $1,741 Supplies $323 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30,2021. • Provide in-home visitation to seven families (7 with funding and 1 family with volunteer assistance) through the Parent Aide Program through professional level staff and Master's level interns. • Provide weekly home visits to at-risk families to increase safety, parenting, problem-solving, social support, and health of the family. • The agency will follow policies of the state for COVID-19 safety measures including: using video conferencing technology to visit face to face with families,using masks and gloves to meet with families in person via social distancing 6 feet away to help improve safety for both clients and staff. The agency will resume"normal"operations when the state permits a"full"opening of the agency to resume operations in a "normal"status. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County,only(all Towns and municipalities). If you use percentages,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Number of(unduplicated)families enrolled in Parent Aide in-home visitation services and 8 receiving weekly visits to reduce the risk of child maltreatment. Number of families with an open CPS case at time of referral. 7 Average length of time between referral received and initial point of contact. *When case load is 5 business full for staff then the family and referral source will be contacted with estimated time of service. days Average number of hours for weekly visits for families enrolled in Parent Aide program. 2 Average number of months families are enrolled in Parent Aide program. 10 Percent of families who will increase parenting skills and parent/child interaction. 94% Percent of families who will enhance home safety and parental supervision. 94% Percent of families who will increase problem-solving skills and family functioning. 94% Certified by: �ar Title: Executive Director Date: 11/5/2020 rovi er s ignature) --DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 EXIMIT"B" Scope of Services—FY 2020-2021 Outside Agency Performance Agreement Agency Name: The Exchange Club's Family Center in Alamance County Program Name: Children's Parent Program Funding Award: $1,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Facilitator Salary&Fringe $620 Mileage $221 Program Su lies $159 Program Services Outline the critical services (activities)the agency will employ to attain the Anticipated Outcomes below, by June 30,2021. • Provide 2, 12-week long parenting classes, 1.5 hours in length, to increase parenting skills and provide parental support to 16 parents/guardians of children 0-24 at risk for child abuse and neglect. • The agency will follow policies of the state for COVID-19 safety measures. Until given approval by the state regulations to resume "normal" in person classes the agency will attempt modifications for safety reason. In Phase II classes will be performed collectively on video conferencing with homework and tests via email.Phase III will include small size classes socially distanced apart using masks and gloves. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oranee County,only(all Towns and municipalities).If you use percentages,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Number of parents/guardians completing parenting classes and graduating successfully after 12 out of 16 or 12 weeks 75% Number of families with an open CPS case at time of referral. 12 out of 16 or 75% Number of parents/guardians increasing parenting knowledge,skills,and child development 13 out of 16 knowledge or 81% Number of parents/guardians increasing problem-solving skills, coping skills,knowledge, and 13 out of 16 reporting feeling more competent in their role or 81% DocuSigned by: �ar4, 6a�l 11/5/2020 Certified by: �E ���z Title: Executive Director Date: (Provider's Signature) DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 ATTACHMENT "A" Orange County Certifications—FY 2020-2021 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: Certified by:ISW4 66& Title: Executive Director Date: 11/5/2020 (Provider's Signature) NW change Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 — DocuSign Envelope ID:789E95FE-A609-46D6-AEOC-EDB3D189AD23 Client#: 1877352 04EXCHACLU1 DATE(MMIDDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 07127/2020 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: McGriff Insurance Services aco"r o Ext:888 743-2217 1 a,No): 8888279861 7701 Airport Center Dr E-MAIL ADDRESS: Suite 1800 INSURER(S)AFFORDING COVERAGE NAIC# Greensboro, NC 27409 INSURER A:Philadelphia Indemnity Insurance Co. 18058 INSURED INSURER B:Stonewood Insurance Company 11828 The Exchange Club's Family Center in INSURER C:United States Liability Insurance Co. 25895 Alamance County Mount Vernon Fire Insurance Company 26522 INSURER D: p y 200 N Main Street INSURER E Graham,NC 27253 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER ADDLISUBR MMIDIDNYYY MMIDD POL Y EXP LIMITS A X COMMERCIAL GENERAL LIABILITY PHPK2155837 7/06/2020 07/06/2021 EACH OCCURRENCE $1,000,000 CLAIMS-MADE [X OCCUR PREMISES Ea occu D nce $100 000 MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 � OTHER: OM $ A AUTOMOBILE LIABILITY PHPK2155837 7/06/2020 07/06/2021 Ea ao.IdentsiNGLE LIMIT 1,000,000 IANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ XAUTOS ONLY X AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC10000748812020A 7/01/2020 07/01/2021 X PER OTH- AND EMPLOYERS'LIABILITY STATUTE IER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $100 000 OFFICER/MEMBER EXCLUDED? a N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Professional Liab PHPK2155837 7/06/2020 07/06/2021 1,000,000/2,000,000 C Directors&Offic ND01573934C 0710612020 07/06/20211 $1,000,000 Aggregate D I C ber Covera I I CY2111371A 7/30/2019 07/30/202 1,000,000/2500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - PHPK2155837:Sexual Abusive Policy Aggregate:$2,000,000 Each Abusive Conduct Limit:$1,000,000 CERTIFICATE HOLDER CANCELLATION Orange County Gov't SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County, NC ACCORDANCE WITH THE POLICY PROVISIONS. 200 South Cameron Street P.O. 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