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HomeMy WebLinkAbout2021-202-E-Human Rights Relations-Refugee Community Partnership-Provide a centralized location of services for refugees DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of April 2021, ("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina,Post Office Box 8181, Hillsborough,North Carolina,27278, ("County")and Refugee Support Center, a not-for-profit corporation, located at 401 NC 54 Byp,E# 15,Carrboro,North Carolina 27510("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. j NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Refugee Support Center agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning April 1, 2021 to June 30,2021. i 2. Scope of Services. i 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. 1 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$5,000.00. 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$1,250.00. 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. Refugee Support Center Orange County Outside Agency Performance Agreement Revised 712018 Page I of 9 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 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. I 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 3 0. Reports are due on January 10,April 10, and July 10 of the program fiscal year. i 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. j 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. Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 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. j i 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; i ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness,disease or death of any j 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. I 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 j Liability $2,000,000 Aggregate j • 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. i i Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 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 j execution of this Agreement or are adopted at any time following execution of this agreement. I 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. I 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, j 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 j out by the grantee,no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 15.40 per hour. To the extent possible, Orange County recommends that 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: Finance&Administrative Services Provider: Refugee Support Center Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Orange County 401 NC 54 Byp, Post Office Box 8181 E#15 Hillsborough,NC 27278 Carrboro,NC 27510 I 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire j 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 j 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. i 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 lA and Article 40 of North Carolina General Statute Chapter 66. j 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 j below. I For and o g , ie Provider � WA, 4/23/2021 Flicka Bateman, xecutive Director Date For and o E,1687%4 ba1ta4SgfbQrange County Government WM(, t� MKAU-S� 4/23/2021 Bonnie Hammersley, County Manager Date Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: Refugee Support Center Party/Vendor Contact Person: Flicka Bateman Contact Phone: 919- 423-1478 Party/Vendor Address:401 NC 54 Byp,E#15 City:Carrboro State:NC Zip:27510 Department:Human Rights&Relations Amount: 5,000 Purpose: Provide a centralized location of services for refugees Budget Code(s): Vendor#62967 (N/A if new vendor) Vendor is a BOCC consultant? Yes❑No❑ Contract Type: (Check one)New ❑ Renewal❑ Amendment ❑ Effective Date Approved by Board Yes❑ No❑ Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: DocuSigned by: Eimti 4/22/2021 Department Director's Signature aossceasoacaaA9... Date: Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed'and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insur Awdeode;specifications, and requirements: aura. Chnu,TTb 4/25/2021 Office of the Risk Management Officer Date: Financial Services This instrument has been pre-audited in the manner r un$gf`h3�°`�f ILocal Government Budget and Fiscal Control Act: ('1� +� 4/26/2021 Office of the Chief Financial Officer 1Acc14o9 . Date: Legal Services This agreement is approved as to legal form and suf ciency igned by: alnk , ,V�U'll, 'No 4/26/2021 Office of the County Attorney o�saaoszecoFaFe... Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Exhibit A Provider's Outside Agency Application Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 COVER PAGE Applicant Contact Information Applicant Organization's Legal Name: Refugee Support Center Applicant Organization's Physical Address: 401 NC 54 Byp, E # 15, Carrboro, NC 27510 Applicant Organization's Mailing Address: PO Box 1025, Carrboro, NC 27510 Applicant Organization's Web Address www.refugeesupportcenter.org Executive Director: Flicka Bateman Telephone Number: 919-423-1478 E-Mail: fbatemanrsc(@gmail.com Tax ID Number: 46-3944698 Funding Request Please list all Fiscal Year 2021 Human Services (HS) funding requested for all ro rams and the proposed use of funds please list pro ram name only) Program Carrboro Chapel Orange Total - HS Hill - County-HS HS Centralized Location for Services $7,500.00 $7,500.00 Operational Totals $7,500.00 $7,500.00 Briefly explain your proposed use of funds: Funding will assist with rent for dedicated space to provide direct services to refugees,to store and distribute essential items and goods to refugees,to maximize opportunities for collaboration with other organizations and to serve as training site for volunteers. Craver Page Page 6 of � DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. .. Signature-, Executivip Diteclor Date Snurva, ad iw� ersrsr� Date I i i I i i i i II Cover Page P a g e 7 o f 2 2 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 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 ❑ X❑a) Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, or Orange County? ❑ X❑ 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? ❑ X❑ c)Current beneficiaries of the program for which funds are being requested? ❑ X❑ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color,gender, national origin, age, handicap, religion,sexual orientation, gender identity/expression,familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief,or other remedy as by law provided;this provision shall be binding on the grantees,the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding,but the existence of an undisclosed conflict may result in the termination of any grant awarded. sigtrsature: ,_ L 'Lp ._ ` Dirert-or Efate Signature-, Berl �I Cover Page P a g e 8 o f 2 2 i I I DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): September 2013 2. Agency's Purpose/Mission (no more than a few sentences): The Refugee Support Center is a volunteer-based organization established to facilitate the transition of local refuges to a new life in our community by providing them with services, assisting them with access to resources, and teaching them skills to promote self- sufficiency. 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). Past achievements include successfully providing refugees with assistance related to housing, employment, transportation, health care access, legal counsel through our pro bono law clinic, immigration legal assistance for green card, citizenship and family reunification applications, English/ citizenship instruction, after school tutoring, personal financial literacy, and food/clothing access. Services are typically offered individually and in small classes, but periodic community-wide workshops have been held on Health Education, Immigration, and Legal Information. Timetables and budget deadlines have been met when required by grants: Strowd Roses, UNC Center for Public Service, Orange County Social Justice, the Town of Chapel Hill Human Services and Orange County Human Services. 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? Yes If no, please briefly explain. Schedule of Positions: # of FTE — Full-Time Paid Positons: # of FTE — Part- Time Paid Positions: 3 PROGRAM INFORMATION *Please submit for each program if applying for funding for more Than one program. 5. Program Name: Centralized Location for Services Program Primary Contact and Title: Flicka Bateman Prograrn inforrnat:ion P a g e 9 o f 2 2 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Telephone Number:919-423-1478 E-Mail: fbatemanrsc(a).gmail.com 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chapel Hill and Carrboro's Results Framework, and Orange County BOCC Goals and Priorities, and the target population to benefit from the program. (100 words or less) RSC is part of the network of services and infrastructure that helps meet refugees' needs, ensures their well-being and increases their financial stability. The proposed program seeks funding for a centralized, accessible location for refugees to come for help with employment, housing, safety net applications, legal counsel, immigration applications, citizenship/ ESL classes, and essential items (food, clothing, diapers, school supplies). BOCC's Goals and Priorities include: ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the wellbeing of all county residents. Target population is all refugees who come to us. 7. Target Population: Please complete the table below with numbers (not percentages) of individuals served and projected to be served. Program Target Population Demographics Projecte Actual Project.. d 2018- Projected d 2018-19 19 2019-20 2020-21 Gender Men 336 401 346 384 Women 364 434 374 416 Nonbinary/Genderqueer 0 0 0 0 Self-Describe 0 0 0 0 Total 700 835 720 800 Race and Ethnicity Black or African-American 80 84 90 92 American Indian or Alaska Native 0 0 0 0 Asian 585 693 574 650 White 55 58 56 58 Native Hawaiian or other Pacific Islander 0 0 0 0 Two or more races 0 0 0 0 Some other race Total 700 835 720 1800 Of the above, how many Hispanic/Latino 0 0 0 0 Of the above, how many non-Hispanic/Latino 700 835 720 800 Total 700 835 720 800 Age 0-5 years 80 92 80 88 Program h-0orrnai:ion P a g e 1 0 o f y, 2 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 6-18 years 88 109 95 104 19-50 years 450 534 453 512 51+ years 82 100 92 96 Total 700 835 720 800 Geographic Location Town of Chapel Hill 350 417 352 394 Town of Carrboro 250 301 258 288 Orange County ( Outside of Chapel Hill/Carrboro) 55 67 65 70 Outside of Orange County 45 50 45 48 Total 700 835 720 800 Income Low-income (80% of the Area Median Income and Below) Please see income table in the attachments Total 700 835 720 800 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- Projected 2019- Projected 2020- 19 20 21 Total Cost of Program $13,087 $14,878.00 $15,000.00 Total # of Individuals 835 720 800 Cost Per Individual $15.67 $20.66 7$18.75 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 ❑ Residents Increase their livelihood security one from the Results ❑ Residents improve their health outcomes Framework AM Program ini`orrnation P a g e 1. .I o f 2 2 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Intermediate Insert Intermediate Result here. Result (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Insert Performance Indicator Indicators here. (Please choose at least one performance 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). Program inforrnaiJon P a g e 12 of 22 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 ORANGL CUUNTY 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. Human Rights and Community 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. 110 refugees sampled in FY 2020-21will indicate on Program Goal # 1 Client Satisfaction Survey receiving the help that they requested and that they will return. Performance Measure 110 refugees will indicate on survey receiving the (How will you accomplish help that they requested and will return. ourgoal?) Actual Results 95 refugees who were surveyed indicated (Outcome) receiving the help that they requested and that they Ending FY18-19 will return. Projected Results 100 refugees who were surveyed will indicate (Outcome) receiving the help that they requested and will Ending FY2020 return. Projected Results 110 refugees who were surveyed will indicate (Outcome) receiving the help that they requested and will Ending FY2021 return. Program Goal # 2 100 refugees will have immigration applications submitted to USCIS by RSC in FY 2020-21. Performance Measure 100 refugees will have applications submitted to (How will you accomplish USCIS. ourgoal?) Actual Results 90 refugees had applications submitted. (Outcome) Ending FY18-19 Projected Results 100 refugees will have applications submitted. Program information 11 a B e 1, o f 2 2 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Outside Agencies/Human Services (Outcome) Ending FY2020 Projected Results 100 refugees will have applications submitted. (Outcome) Ending FY2021 600 refugee clients will receive at least 1 donated Program Goal # 3 essential item (food, clothes, diapers, school supplies, householdproducts) in FY2020-21. Performance Measure 600 refugee clients will receive at least 1 donated (How will you accomplish essential item. ourgoal?) Actual Results 420 refugees received at least one donated essential item x (Outcome) Ending FY18-19 Projected Results N/A Not a program goal in FY2019-2020 (Outcome) Ending FY2020 Projected Results 600 refugees will receive at least 1 donated (Outcome) essential item. Ending FY2021 I Program information P a g e 14 o f 2 2 l i i DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Agency Budget Operating Budget for Entire Agency AGENCY NAME: Refugee Support Center Actual Estimated Projected Percent AGENCY REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 17,433 $ 28,000 $ 20,200 -28% Agency Generated Revenue (fees) $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 2,000 $ - $ - 0 Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 5,000 $ 5,000 $ 7,500 50% 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 $ 14,000.00 $ 13,000.00 $ 19,000.00 $ 0.46 Other Revenue $ 17,630 $ 10,000 $ 14,000 $ 0.40 Total Agency Revenue $ 56,063 $ 56,000 $ 60,700 8% AGENCY EXPENSES Compensation $ 28,293 $ 32,000 $ 37,500 17% Rent&Utilities $ 11,845 $ 14,878 $ 15,000 1% Supplies &Equipment $ 4,500 $ 5,000 $ 5,300 6% Travel &Training $ 600 0 Other Expenses: $ 10,025 $ 6,100 $ 3,100 49% Total Agency Expenses $ 55,263 $ 57,978 $ 60,900 5% SURPLUS/(DEFICIT) FOR PERIOD: $ 800 1 $ (1,978) $ (200) 900/. FY 2018-19 Agency Budget DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Program Budget Operating Budget for Program PROGRAM NAME: Centralized Location for Services Refugee Support Center Actual Estimated Projected Percent PROGRAM REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ - $ - $ - 0 Program Generated Revenue $ - $ - $ - 0 Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town ofCarrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 2,000 $ - $ - 0 Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 5,000 $ 5,000 $ 7,500 50% 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 $ 7,000 1 $ 10,000 $ 8,000 $ 0.20 Total Program Revenue $ 14,000 $ 15,000 $ 15,500 3% PROGRAM EXPENSES Compensation $ - $ - $ - 0 Rent&Utilities $ 13,087 $ 14,878 $ 15,325 3% Supplies &Equipment $ - $ - $ - 0 Travel &Training $ - $ - $ - 0 Other Expenses: $ - $ - $ - 0 Total Program Expenses $ 13,087 $ 14,878 $ 15,325 3% SURPLUS/(DEFICIT) FOR PERIOD: $ 913 $ 122 $ 175 43% FY 2018-19 Program Budget DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 Exhibit B Provider's Revised Scope of Services and Program Budget Orange County Outside Agency Performance Agreement Page 8 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 EXHIBIT `B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement I Agency Name: Refugee Support Center Program Name: Centralized Location for Services Funding Award: $5,000.00 i Outline how the agency will spend Orange County's funding award. Expense Description Amount i Funding will assist with rent for dedicated space to provide direct services,to store and distribute $5,000.00 essential items and goods,to maximize opportunities for collaboration with other organizations,to serve as site for after school program and training site for volunteerism and training site for volunteers Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. • Provide a centralized location to connect refugees to services and resources • Provide a centralized location for authorized immigration legal services • Provide a centralized location to distribute food, clothing, school supplies, diapers and household items Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oran Se 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 110 refugees sampled in FY 2020-21 will indicate on Client Satisfaction Survey(CSS)receiving 110 surveyed the help that they requested and that they will return refugees will give positive responses on CSS 100 refugees will have immigration applications submitted to USCIS by RSC in FY 2020-21 100 refugees will have applications received by USCIS 600 refugees will receive at least 1 donated essential item(food,clothing,diapers,school 600 refugees supplies,household items)in FY 2020-21 will receive at least 1 donated DocuSigned by: essential item Certified by: & Title: Director, Refugeefla�appor r t�rl (Provider's Signature) DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 ATTACHMENT "A" Orange County Certifications—FY 2019-20 Outside Agency Performance Agreement i 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. F�&A DocuSigned by: Certified by: � aA& Title: Director, Refugeel j ayppo+k2b tk:� (Provi er s ignature) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 1121 DocuSign Envelope ID:5AA6A454-5FE1-4D3D-BC86-92EE503AC9A3 REFUSUP-01 VDECAMP ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/5/2021 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 Victoria DeCamp NAME: Titan Risk Consultants LLC PHONE FAX 107 Conner Drive,Suite 225 (A/C,No,Et):(919)636-3252 2 (A/C,No): Chapel Hill,NC 27514 ADDD AIL v-decamp@titanriskconsultants.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Alliance for Non-Profits INSURED INSURER B: Refugee Support Center INSURERC: P.O.Box 1025 INSURER D: Carrboro,NC 27510 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 IN SD WVD MM DD MM DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR 2020-53837 1/16/2021 1/16/2022 DAMAGE TO RENTED 500,000 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 PRO-JECT ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED NON-OWNED Per PROPERTY $ AUTOS ONLY AUTOS ONLY 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? NIA (Mandatory in NH) E.L.DISEASE-Fes,EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A General Liability 2020-53837 1/16/2021 1/16/2022 SAM Claim 1,000,000 A General Liability 2020-53837 1/16/2021 1/16/2022 SAM Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certficate holder is added as Additional Insured as respects General Liability as required by written contract 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 9 Y ACCORDANCE WITH THE POLICY PROVISIONS. Attention: Risk Manager P.O. Box 818 Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE . ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD