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HomeMy WebLinkAbout2021-218-E-Human Rights Relations-El Centro Hispano-Budget DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July, ("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 El Centro Hispano,Inc., a not-for-profit corporation, located at 2000 Chapel Hill Road, Suite 26A,Durham,North Carolina 27707 ("Provider"). WITNESSETH: i 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 El Centro Hispano,Inc. agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2020 to June 30,2021. 2. Scope of Services. I a. Provider will provide services, as outlined in the attached Outside Agency Funding j 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$33,609. i 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$8,402.25. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. i («Agencys Name))) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 i DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 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. £ 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 10,April 10, and July 10 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"), I 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 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 i I 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:4CB52244-A26D-418A-B4AE-8C84440B4D81 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 j 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; i iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any,covering personal injury or death, and property damage; and iv. Professional Liability Insurance,covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents,consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A- Statutory State NC &Coverage B -Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 1121 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 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. S. 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 $ 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: El Centro Hispano,Inc. Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 1121 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 Orange County 2000 Chapel Hill Road Post Office Box 8181 Suite 26A Hillsborough,NC 27278 Durham,NC 27707 i 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. 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 I 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. oatW.a*:behatf of the Provider Acting President & CEO 5/3/2021 Pilar Rocha-Goldberg,Executive Director Date For and on b oqfige County Government f 61A,kit, A6lwt►Mt,-sb-� 5/3/2021 Bonnie Hammersley, County Manager Date Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 1121 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: El Centro Hispano,Inc. Party/Vendor Contact Person:Pilar Rocha-Goldberg Contact Phone:919- 687-4635 ext.125 Party/Vendor Address: 2000 Chapel Hill Road, Suite 26A City: Durham State: NC Zip: 27707 Department:Human Rights&Relations Amount:$33,609.00 Purpose: Budget Code(s): Vendor#801399 (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: July 1,2020 to June 30,2021 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: F 5/3/2021 Department Director's Signature Date: Agreements for emergency services or repair are not Su Ject V 0 t re 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 i (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 iris uran Jq�j bWecifications,and requirements: Q�tSa rbrvu,TTb 5/4/2021 Office of the Risk Management Officer Date: Financial Services This instrument has been pre-audited in the manner r byAlisyLocal Government Budget and Fiscal Control Act: 5/4/2021 Office of the Chief Financial Officer Date: Legal Services This agreement is approved as to legal form ands r Ms�ned by: Office of the County Attorney L Qkku ha,iL T�w Date: 5/4/2021 Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 1121 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 Exhibit A Provider's Outside Agency Application Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 1121 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 COVER PAGE Applicant Contact Information Applicant Organization's Legal Name: El Centro Hispano, Inc Applicant Organization's Physical Address: 2000 Chapel Hill Road,Suite 26A, Durham NC 27707 Applicant Organization's Mailing Address: 2000 Chapel Hill Road,Suite 26A, Durham NC 27707 Applicant Organization's Web Address:www.elcentronc.org Executive Director: Pilar Rocha-Goldberg Telephone Number: (919) 687-4635 Ext. 125 E-Mail: procha@elcentronc.org Tax ID Number:56-2011661 Funding Request Please list all Fiscal Year 2021 Human Services (HS)funding requested for all programs and the proposed use of funds(please list program name only) Program Carrboro- Chapel Orange Total HS Hill-HS County-HS Ex. YouthAfterschool Program $10,000 $15,000 $5,000 $30,000 Operations or Personnel Operations Personnel Operations Education(PreK-12&Adult)-personnel&operations $15,938 $18,304 $5,361 $39,603 CommSupport&Engagement-personnel&operations $6,000 12,156 $23,759 $41,915 Health&Wellness-personnel&operations $3,062 6,000 $11,211 $20,273 Totals $25,000 $36,460 $40,331 $101,791 Briefly explain your proposed use of funds: Funds will be used to expand services and reach in the Orange County,Carrboro-Chapel Hill area, and surrounding municipalities for ECH's Education,Workforce Development, and Health and Wellness Initiatives (community support, health screenings,outreach, etc. Funds are used to support staff time, rent, mileage, and other program related expenses. 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-P0 Signature f"`-/• WO I f Executive Director Date Signature: _ BowdiXalirperson Date Coven Page P a g e 6 o 1 2 3 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates. YES NO ❑ ® a) Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill,or Orange County? ❑ ® b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill,or Orange County? ❑ ® c) Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veteran's status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance,as amended and the Orange County Anti-Discrimination Policy. This provision is enforced by action for specific performance, injunctive relief,or other remedy as by law provided;this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding,but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: ] a1/ Executive Director Date Signature: t 2 Z Boa airp on Date Cover Page _ P a ge ) o f DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 AGENCY INFORMATION 1. Date of Incorporation (Month/Year):01 1998 2. Agency's Purpose/Mission (no more than a few sentences): El Centro Hispano strengthens the community, builds bridges, and serves as advocates for equity and inclusion of Hispanics/Latinos in the Triangle area of North Carolina. 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). El Centro Hispano has serve Orange-Chapel Hill-Carrboro are for approximately 10 years. A final look at 2019-2020 data shows 2,133 service contacts with 1,523 non- repeats surpassing ECH's goal. The tutoring program, summer camps, ESL classes, worker job placement and trainings, Faith ID, immigration services, and the Deferral Program continue to be on demand. This past fiscal year two community groups were formed; Padres Comprometidos which trains parents on the school system and how to get involved and Creando Comunidad, an all women community engagement and advocacy group who will work on voter registration, the Census, and issue forums. 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 Positions: 13 #of FTE—Part-Time Paid Positions: 1 1 Program inrorrnaiJon P a g e u i ° ,I DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 PROGRAM INFORMATION M *Please'Submit for each program if applying for funding for more than one progrc S. Program Name: Community Support & Engagement Program Primary Contact and Title: Kattia Blanco, Health & Wellness Manager Telephone Number: (919) 687-4635 E-Mail: kblanco@elcentronc.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) ECH's Community Support & Engagement Services is a component of our Health & Well-being Department which aligns with the BOCC Goals to "ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents" and Chapel Hill's overall goal for "residents to experience economic and social well-being & opportunities to thrive ". Staff, in collaboration with partner agencies, help residents access social safety net and health resources through information & referral services, case management, legal assistance, interpretation, health screenings, peer support, and educational forums. 7.Target Population: Please complete the table below with numbers (not percentages) of individuals served and projected to be served. Program Target Population Demographics Projected Actual Projected Projected 2018-19 2018-19 2019-20 2020-21 Gender Men 385 381 400 400 Women 825 771 850 850 Nonbinary/Genderqueer 228 250 250 Self-Describe/Unreported 371 Total 1438 1,523 1500 1500 Race and Ethnicity Black or African-American 7 8 10 10 American Indian or Alaska Native Asian 160 85 180 180 White 15 14 20 20 Native Hawaiian or other Pacific Islander Two or more races Some other race 1,256 1,416 1290 1290 Total 1,438 1 1,5231 1,500 1,500 Of the above, how many Hispanic/Latino 1,288 1,416 1290 1290 Of the above, how many non-Hispanic/Latino 176 107 210 210 Total 1,438 1,523 1,500 1,500 Prograrn irilorrnaiion 6' a g e Est o f DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 �e 0-5 years 6 6-18 years 15 36 20 20 19-50 years 1,393 706 1,450 1,450 51+years 30 98 30 30 unreported 677 Total 1,438 1,5231 1,5001 1,500 Geographic Location Town of Chapel Hill 250 238 250 250 Town of Carrboro 655 449 700 700 Orange County(Outside of Chapel Hill/Carrboro) 250 57 300 300 Outside of orange County 283 365 250 250 unreported 414 Total 1,438 1,523 1,500 1,500 Income' Low-income(80%of the Area Median Income and 1,350 1,350 Below) Please see income table in the attachments n/a** n/a Total 1 0 1 0 1,350 1,350 ** ECH did not require income data on those served. However, 90% of the population served is consider low-income. Data will be collected moving forward. 8. Cost Per Individual This cost per individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2018-19 Projected 2019-20 Projected 2020-21 Total Cost of Program $211,653 $313,360 $328,610 Total # of Individuals 1523 + 1256 + 1500 + 1200 + 200 1500 + 1200 + 200 = 200= 2979 = 2,900 2,900 Cost Per Individual $71 $108 $113 Program irifoi-mai.ion F, age . o r 2 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 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: Col'Y muniity Support & Engagement Strategic ❑ Children improve their educational outcomes Objective (please chooseonefrom X Residents Increase their livelihood security the Results Framework) ❑ Residents improve their health outcomes i Intermediate Insert Intermediate Result here. Result 2.1: Residents access the most appropriate social safety net services (please choose one from the Results Framework) Actual Projected Projected 2018-19 2019-20 2020-21 Performance Indicators (Please choose at least # people provided direct oneperformance support services to include indicator to report on referrals, case 1 ,523 1,500 1,500 from the Results Framework,and add management, immigration additionalperformance legal assistance, ndicatorsthatyou interpretation, health would like to report to the Towns. Please screenings, etc. insert additional rows as needed,listing one per row). Program irnUrrriarion a ge 1. 1 � � DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 PROGRAM INFORMATION *Please submit for each program if applying far funding for more than one program. 5. Program Name: Health Promotion & Access to Care Program Primary Contact and Title: Kattia Blanco, Health &Wellness Manager Telephone Number: (919) 687-4635 E-Mail: kblanco(a.elcentronc.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) ECH's Health Promotion is the other component of our Health & Well-being priority area which aligns with Chapel Hill's objective of"Residents improve health outcomes" and the BOCC goal to "ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county resident". ECH's Health Promotion interventions promote healthy lifestyles behaviors and access to care. Staff work with community organizations and Promotoras to visit neighborhoods, conduct free health screenings, refer to area health providers, and provide health education. 7.Target Population: Please complete the table below with numbers(not percentages)of individuals served and projected to be served. Program Target Population Demographics Projected Actual Projected Projected 2018-19 2018-19 2019-20 2020-21 Gender Men 400 23 400 400 Women 800 88 800 800 Nonbinary/Genderqueer Self-Describe/Unreported 1,147 Total 1,200 1,256 1,200 1,200 Race and Ethnicity Black or African-American 25 American Indian or Alaska Native Asian 150 White 25 Native Hawaiian or other Pacific Islander Two or more races Some other race 1,000 1,256 1,200 11200 Total 1,200 1,256 1,200 1,200 Of the above,how many Hispanic/Latino 1,000 1,256 1,200 1,200 Of the above,how many non-Hispanic/Latino 200 Total 1,200 1,256 1,200 1,200 Prof.rarn inforrnaiiion P a l 1 u i ,, DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 Age 0-5 years 30 30 30 6-18 years 40 40 40 19-50 years 1,100 1,256 1,100 1,100 51+years 30 unreported Total 1,200 1,256 1,200 1 200 Geographic Location Town of Chapel Hill 800 156 800 800 Town of Carrboro 50 210 50 50 Orange County(Outside of Chapel Hill/Carrboro) 350 890 350 350 Outside of Orange County unreported Total 1,200 1,256 1,200 1,200 Income' Low-income(80%of the Area Median Income and Below) Please see income table in the attachments n/a n/a Total 0 8. Cost Per Individual This cost per individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2018-19 Projected 2019-20 Projected 2020-21 Total Cost of Program $211,663 $313,360 $328,610 Total #of Individuals 1523 + 1256 + 1500 + 1200 + 200 1500 + 1200 + 200 = 200= 2979 = 2,900 2,900 Cost Per Individual $71 $108 $113 Program infoYf aiJori P it ! ! o I DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 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: Health Promotion & Access to Care Strategic ❑ Children improve their educational outcomes Objective (please choose onefrom ❑ Residents Increase their livelihood security the Results Framework) X Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result 2.1: Residents access the most appropriate social safety net services (please choose one from the Results Framework) 7 RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Indicators (Please choose at least oneperformance # people provided health indicator to report on screenings, health 1,256 1,500 1,500 from the Results Framework,and add education, and referrals to additional performance area health service indicators thatyou providers would like to report to the Towns. Please insert additional rows as needed,listing one per row). N ofjiarri iniorrna6or, P a g e 4 o f 2 3 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 *Please submit for each program if applying fir funding for more than one program. S. Program Name: ECH- Education Services & CEL Worker Development Program Primary Contact and Title:Antonio Alanis, Education Program Manager Telephone Number: (919) 687-4635 E-Mail: aalanis(d-)elcentronc.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) ECH's Education Initiatives align with BOCC goal to "Ensure a high quality of life and lifelong learning...and Chapel Hill's objective #1 "Children improve their education outcomes and Objective 2:2 Residents increase job skills appropriate for the local economy". ECH Interventions include Pre-K prep, K-12 tutoring, summer camps, parent education, ESL, HISET, worker training, etc. This year, ECH is growing its Padres Comprometidos program to help parents: • Understand the United States public school system. • Develop goals for their children to ensure they attend college. • Understand the academic requirements for college readiness. • Model behaviors at home that encourage and promote learning. 7.Target Population: Please complete the table below with numbers (not percentages)of individuals served and projected to be served. Program Target Population Demographics Projected Actual Projected Projected 2018-19 2018 19 2019-20 2020-21 Gender Men 80 65 80 80 Women 120 124 120 120 Non binary/Genderqueer Self-Describe/Unreported 32 Total 200 221 200 200 Race and Ethnicity Black or African-American American Indian or Alaska Native Asian 30 32 30 30 White 5 Native Hawaiian or other Pacific Islander Two or more races Some other race 170 184 170 170 Program in orroa ion P a P, e DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 Total 200 221 2001 200 of the above, how many Hispanic/Latino 170 184 170 170 Of the above, how many non-Hispanic/Latino 30 37 30 30 Total 200 221 200 200 Age 0-5 years 30 34 30 30 6-18 years 25 53 25 25 19-50 years 135 101 135 135 51+years 1 unreported 32 Total 200 221 200 200 Geographic Location Town of Chapel Hill 35 73 35 35 Town of Carrboro 25 98 25 25 Orange County(Outside of Chapel Hill/Carrboro) 140 39 140 140 Outside of Orange County 11 unreported Total 200 221 200 200 Income Low-income(80%of the Area Median Income and Below) 180 180 Please see income table in the attachments n/a** n/a Total 0 1 0 180 180 ** ECH did not require income data on those served. However, 90% of the population served is consider low-income. Data will be collected moving forward. 8. Cost Per Individual This cost per individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2018-19 Projected 2019-20 Projected 2020-21 Total Cost of Program $211,663 $313,360 $328,610 Total # of Individuals 1523 + 1256 + 1500 + 1200 + 200 1500 + 1200 + 200 = 200= 2979 = 2,900 2,900 Cost Per Individual $71 $108 $113 I'mr.rain iriiorrnai:ion P a g e 16 o f 2 3 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 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: ECH- Education Services (Children) Strategic X Children improve their educational outcomes Objective 1 (please choose one from ❑ Residents Increase their livelihood security the Results Framework) ❑ Residents improve their health outcomes Intermediate Result 1.2: Children demonstrate new grade-level-appropriate skills (please choose one from the Results Framework RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance # of children 0-5 Indicators participating in dual 34 30 30 (Please choose at least language preschool oneperformance program indicator to report on # of students K-8 from the Results Framework,and add participating in afterschool 53 50 50 additional performance tutoring & summer camp indicators that you would like to report to the Towns. please insert # of parents participating in additional rows as parent education and needed, listing one per support to support literacy 90 65 65 row). and learning in the home Prograrn inrorrnauon P a g e J1. f o r _.; DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 Program Name: ECH- Education Services (Adults) Strategic ❑ Children improve their educational outcomes Objective (please choose onefrom X Residents Increase their livelihood security the Results Framework) ❑ Residents improve their health outcomes Intermediate Result 2.2: Residents increase job skills appropriate for the local economy (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance # of people completing a Indicators workshop to build literacy 44 55 55 and job skills, i.e. ESL, OSHA, job skills Program information P a g e 1 8 o f 2 3 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 JJNTY 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. Program Goal# 1 Increase literacy and academic achievement in Latino children & youth in grades PreK-12 and literacy & work g v, skills for adults # of children, youth, and their parents participating in the dual language preschool, tutoring program, Performance Measure summer camps, and parent education & support group (How willyou accomplish your goal?) meetings r # of people completing a literacy and/or job skills training workshop i.e. HISET, ESL, OSHA, etc Actual Results � (Outcome) 221 Ending FY18-19 Projected Results (Outcome) 200 Ending FY2020 Projected Results (Outcome) 200 Ending FY2021 Program information P a g e 19 o f 2 3 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 kJ Outside Agencies/Human Services Program Goal#2 Increase the number of Latino residents who access community resources to address their needs/goals Performance Measure # people provided direct support services to include (How willyou accomplish your goal?) referrals, case management, immigration legal assistance, interpretation, health screenings, etc. Actual Results 1,523 (Outcome) Ending FY18-19 Projected Results (Outcome) 1,500 Endin FY2020 Projected Results (Outcome) 1,500 Ending FY2021 Program Goal#3 Increase the number of Latinos who access preventive health services to expand healthy lifestyle behaviors Performance Measure # of Latinos provide health screenings, health (How willyou accomplish your goal?) education, and/or who are referred to health care providers r a� Actual Results256 " (Outcome) " p �a & T FORM, Ending FY18-19 Projected Results (Outcome) _ 1,200 . Ending FY2020 Projected Results _ � ,t (Outcome) Ending FY2021 Prograrn information Page 20 of 23 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 Agency Budget Operating Budget for Entire Agency AGENCY NAME: El Centro Hispano, Inc Actual Estimated Projected Percent AGENCY REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 188,738 $ 180,000 $ 190,000 6% Agency Generated Revenue(fees) $ 84,603 $ 85,000 $ 85,000 0% Local Government Grants: Human Services-Town of Carrboro $ 19,000 $ 18,000 $ 21,938 22% Other-Town of Carrboro $ 42,970 $ 42,970 $ 42,970 0% Human Services-Town of Chapel Hill $ 25,000 $ 25,000 $ 36,460 46% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 32,834 $ 33,609 $ 56,120 67% Other-Orange & Durham County ABC $ 33,000 $ 33,000 $ 33,000 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 $ 361,048 $ 444,392 $ 241,948 $ (0.46) Other Revenue =1,245,234 1 $ 437,540 $ 592,075 $ 0.35 Total Agency Revenue $ 1,299,511 $ 1,299,511 0% AGENCY EXPENSES Compensation $ 458,522 $ 458,522 $ 458,522 0% Rent&Utilities $ 139,173 $ 139,173 $ 139,173 0% Supplies&Equipment $ 20,486 $ 20,485 $ 20,485 0% Travel &Training $ 31,765 $ 31,765 $ 31,765 0% Other Expenses: $ 435,888 $ 649,566 $ 649,566 0% Total Agency Expenses $ 1,085,834 $ 1,299,511 $ 1,299,511 0% SURPLUS/(DEFICIT) FOR PERIOD: $ 159,400 $ - $ - 0 FY 2018-19 Agency Budget DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 Program Budget Operating Budget for Program PROGRAM NAME ECH Community Education, Health, &Support Actual Estimated Projected Percent PROGRAM REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 14,141 $ 25,000 $ 35,000 40% Program Generated Revenue $ 6,599 $ 25,000 $ 25,000 0% Local Government Grants: Human Services-Town of Carrboro $ 19,000 $ 18,000 $ 25,000 39% Other-Town of Carrboro Comm Org& DACA $ 42,970 $ 52,970 $ 42,970 -19% Human Services-Town of Chapel Hill $ 25,000 $ 25,000 $ 36,460 46% Other-Town of Chapel Hill (DACA) $ - $ 3,000 $ - -100% Human Services-Orange County $ 32,834 $ 33,609 $ 40,331 20% Other-Orange County ABC 1 $ 13,000 $ 13,000 $ 13,000 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 $ 29,220 $ 56,591 $ 58,138 $ 0.03 Other Revenue $ 28,889 $ 61,190 $ 52,711 $ (0.14) Total Program Revenue 1 $ 211,653 $ 313,360 1 $ 328,610 5% PROGRAM EXPENSES Compensation $ 106,195 $ 206,639 $ 214,635 40/c Rent&Utilities $ 43,628 $ 49,860 $ 49,860 0% Supplies&Equipment $ 1,420 $ 1,800 $ 3,832 113% Travel &Training $ 2,743 $ 8,682 $ 8,682 0% Other Expenses: $ 57,667 $ 46,379 $ 51,601 1 11% Total Program Expenses $ 211,653 $ 313,360 $ 328,610 5% SURPLUS!(DEFICIT) FOR PERIOD: $ - $ - $ - 0 FY 2018-19 Program Budget DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 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:4CB52244-A26D-418A-B4AE-8C84440B4D81 EXEMIT"S" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: El Centro Hispano,Inc Program Name: Community Support&Engagement Funding Award: $33,609.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Program staff time,materials,rent,mileage,printing, supplies $33,609 I i Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. • Increase the number of Latino residents who access community resources to address their needs/goals • Increase the number of Latinos who access preventive health services to expand healthy lifestyle behaviors • Increase literacy and academic achievement in Latino children&youth in grades PreK-12 and literacy&work skills for adults 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 #people provided direct support services to include referrals,case management, 1,500 immigration legal assistance,interpretation,health screenings, etc #of Latinos provide health screenings,health education, and/or who are referred to 1,200 health care providers #of children,youth, and their parents participating in the dual language preschool, 145 tutoring program, summer camps, and parent education& support group meetings #of people completing a literacy and/or job skills training workshop(i.e.MSET,ESL, 55 OSHA, etc) DocuSigned by: Acting President & 5/3/2021 Certified by: Title: I �: (Provider's ignature DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C84440B4D81 i 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. I 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 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. i 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: � Title: Acting President scup 5/3/2021 (Prove eF-Os00ripacRtr'e) Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 1121 DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C8444OB4D81 ELCENTR-04 RPUTNAM ,4coR0` CERTIFICATE OF LIABILITY INSURANCE DATE,(MMIDD/YYYY) 4/22/2021 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 Ellie Leon NAME: Hub International Carolinas PHONE FAX 751 Corporate Center Drive (A/C,No,Ext): (A/C,No): Suite 120 ADDRESS:ellie.leon@hubinternational.com Raleigh,INC 27607 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: El Centro Hispano,Inc. INSURER C: 600 East Main Street INSURER D: Durham,INC 27701 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM DD YYY MM DD YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 5w] OCCUR PHPK2095310 4/6/2021 4/6/2022 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICYEl PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED L $ NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PHUB710889 4/6/2021 4/6/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Crime PHPK2095310 4/6/2021 4/6/2022 Employee Dishonesty 120,000 A Professional Liab. PHPK2095310 4/6/2021 4/6/2022 Each Incident 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Professional Liab Aggregate$2,000,000 Sexual or Physical Abuse or Molestation Vicarious Liability $1,000,000 per claim,$1,000,000 Aggregate 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. PO Box 8181 Hillsborough,INC 27278 AUTHORIZED yREPRESENTATIVE v 1• pq`. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID:4CB52244-A26D-418A-B4AE-8C8444OB4D81 ELCENTR-04 RPUTNAM ,4coR0` CERTIFICATE OF LIABILITY INSURANCE DATE,(MMIDD/YYYY) 4/22/2021 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 Ellie Leon NAME: Hub International Carolinas PHONE FAX 751 Corporate Center Drive (A/C,No,Ext): (A/C,No): Suite 120 ADDRESS:ellie.leon@hubinternational.com Raleigh,INC 27607 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: El Centro Hispano,Inc. INSURER C: 2000 Chapel Hill Road,Ste 26A INSURER D: Durham,INC 27707 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD MM DD YYY MM DD YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR PHPK2095310 4/6/2021 4/6/2022 DAMAGE TO RENTED 100,000 X PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY El PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO PHPK2095310 4/6/2021 4/6/2022 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident) ent $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE PHUB710889 4/6/2021 4/6/2022 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Crime PHPK2095310 4/6/2021 4/6/2022 Employee Dishonesty 120,000 A Professional Liab. PHPK2095310 4/6/2021 4/6/2022 Each Incident 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Professional Liab Aggregate$2,000,000 Sexual or Physical Abuse or Molestation Vicarious Liability $1,000,000 per claim,$1,000,000 Aggregate CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange Count Risk Manager THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 Y 9 ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 8181 Hillsborough,INC 27278 AUTHORIZED yREPRESENTATIVE v 1• pq`. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD