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HomeMy WebLinkAbout2021-247-E-Human Rights-The Marian Cheek Jackson Center outside agency agreement DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F 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 The Marian Cheek Jackson Center, a not-for-profit corporation, located at 512 W. Rosemary St, Chapel Hill,North Carolina 27516 ("Provider"). j WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and The Marian Cheek Jackson Center 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. i 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit "A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County I 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. i 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$21,319. 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$5,329.75. 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. («Agencys Name))) Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F 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. i 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. 5. Termination. 1 i 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 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 I i 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. I i 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. I I I I I Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 1121 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F 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. 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. i I 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 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. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MQNUVIUM 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 j $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 Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 1121 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F 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. i 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 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. 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. i 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. i 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: The Marian Cheek Jackson Center Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 1121 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F Orange County 512 W.Rosemary St Post Office Box 8181 Chapel Hill,NC 27516 Hillsborough,NC 27278 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 j 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 executing this Agreement Provider certifies that Provider has not been identified,and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and o k kiefike'P�ro�vider C-"r,t, 1jmrd 5/6/2021 George Barrett,Executive Director Date i For and on behal ;Q[Mge County Government la.ln G h*MtY1bj 5/6/2021 Bonnie Hammers e?, touri{y'Manager Date Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 1121 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: The Marian Cheek Jackson Center Party/Vendor Contact Person: George Barrett Contact Phone: 919-960-1670 Party/Vendor Address: 512 W. Rosemary St. City: Chapel Hill State: NC Zip: 27516 Department: Human Rights&Relations Amount: $21,319.00 Purpose: Outside Agency Performance Agreement Budget Code(s): Vendor# 62588 (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: iDepartment Director's Signature hvu` Date: 5/3/2021 Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insuranTE r p bp'ecci1ifications,and requirements: 'I rbvv�.c lib 5/4/2021 Office of the Risk Management Officer Date: Financial Services This instrument has been pre-audited in the manner r u"LbyLocal Government Budget and Fiscal Control Act: Office of the Chief Financial Officer Date: 5/4/2021 Legal Services This agreement is approved as to legal form and s effi6unoyned by Office of the County Attorney Alit liter �l aVlt. S(h Date: 5/5/2021 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: I Office of the Clerk to the Board Date: i I j Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 1121 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F Exhibit A Provider's Outside Agency Application Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 1121 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F COVER PAGE Applicant Contact Information Applicant Organization's Legal Name:The Marian Cheek Jackson Center for Saving and Making History Applicant Organization's Physical Address:512 W. Rosemary St, Chapel Hill, NC 27516 Applicant Organization's Mailing Address:Same as above. Applicant Organization's Web Address:www.)acksoncenter.info Executive Director: Hudson Vaughan Telephone Number: 919-960-1670 E-Mail: Hudson@Jacksoncenter.info Tax ID Number:46-1988511 Funding Request Please list all Fiscal Year 2021 Human Services(HS)funding requested for all programs and the proposed use of funds(please list program name only) Program Carrboro- Chapel Orange Total HS Hill-HS County-HS Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 O eralions or Personnel Operations Personnel Operations Learning Across Generations:Local Civil Rights&Oral $9,000 $9,000 $17,500 $35,500 History Education Personnel Personnel Personnel Keeping Your House a Home:Long-term neighbor (other (other $10,000 $10,000 retention and advocacy sources) sources) Personnel Totals $9,000 $9,000 $27,500 $45,500 Briefly explain your proposed use of funds: Funding will provide critical capacity for our teacher teams to reach over 3,000 k-12 students with critical civil rights history education, and for our Community Advocacy Specialist to connect over 125 low-income community elders with critical home repairs, retention tools, and land-loss prevention programs. To the best of my knowledge and belief all information and data in this application is true and current. The document Pas been duly authorized by the governing board of the applicant. r Signature: ,. Executive Dir t Date Signature: � � Boa46alrpersod Date Cover Page P a g e 6 o f 2 1 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families,or their business associates. YES NO ❑ ® a) Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, or Orange County? ❑ ® b) Members of or closely related to members of the governing bodies of the Town of Carrboro,the Town of Chapel Hill,or Orange County? ❑ ®c)Current beneficiaries of the program for which funds are being requested? ❑ ® d) Paid providers of goods or services to the program or having other financial interest in the program? if you have answered YES to any question, please provide a full explanation below. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race,color,gender,national origin,age, handicap, religion,sexual orientation, gender identity/expression,familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief,or other remedy as by law provided;this provision shall be binding on the grantees,the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding,but the existence of an undisclosed conflict may result in the termination of any grant awarded. 1 a' a Signature: /41 / Executive Director Date Signature: Boar ai person Date DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): March 2012 2. Agency's Purpose/Mission(no more than a few sentences):The Marian Cheek Jackson Center's mission is to honor, renew, and build community in the historic Northside, Pine Knolls, Tin Top, and Lloyd/Broad communities of Chapel Hill and Carrboro.We were established in 2008 to respond to rapid demographic changes in historically Black, low-wealth communities in Orange County, NC. As a place-based and oral history-driven organization, we preserve the future of neighborhoods in transition and pursue MLK's vision of beloved community through education & youth leadership, organization & advocacy, and community events. 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). We have a team of professional staff and trained community mentors who have successfully carried out this program for 6 years. Each year,we increased capacity while keeping to our budget. In the past year,we greatly exceeded our target numbers, more than doubling the number of workshops offered and almost doubling the number of students served. For this reason,we will employ more workshop leaders to meet demand.We maintain very high levels of teacher satisfaction and student engagement.Students of color and low-income families are overrepresented in our audiences; responses consistently show our workshops are empowering and impactful. 4. Living Wage: Does this agency pay permanent employees a minimum living wage?(Yes/No) Yes If yes, is this agency an Grange Count-v Living Wage Certified Employer?Yes If no, please briefly explain. Schedule of Positions: #of FTE—Full-Time Paid Positons: 5 #of FTE--Part-Time Paid Positions:5 PROGRAM INFORMATION *Please submit for each program if opplying for funding for more than one program. S. Program Name: Learning Across Generations(LAG):Local Civil Rights and Oral History Education Program Primary Contact and Title:Dr.Andrea Wuerth, Dir of Education and Communications Telephone Number: 919-960-1670 E-Mail:andrea@iacksoncenter.info 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chanel 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) Based on the transformative power of stories and storytelling, our LAG program shares the rich local history of Northside and other historically black neighborhoods in Chapel HIII with K-12 students, primarily in Chapel Hill, Carrboro, and Orange County. Our workshops bring oral histories into classrooms through multimedia presentations and experiential activities, often featuring interactions between students and our Community Mentor Team,veterans of the local civil rights movement. The LAG program aligns with TOCH Intermediate Result 1.2, in which children Program information P a g e 8 o f 2 1 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F demonstrate grade-level skills, and Orange County BOCC Goals related to lifelong learning that champions diversity and education at all levels. 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 938 1329 1462 1608 Women 1024 1391 1528 1681 Nonbinary/Genderqueer -- 71 78 86 Self-Describe -- -- 2 2 Total 1962 2791 3070 3377 Race and Ethnicity Black or African-American 472 613 674 741 American Indian or Alaska Native 7 8 8 9 Asian 147 236 260 286 White 1222 1774 1951 2146 623Native Hawaiian or other Pacific Islander 2 0 1 1 Two or more races Some other race 113 160 176 194 Total 1962 2791 3070 3377 Of the above,how many Hispanic/Latino 333 494 543 597 Of the above,how many non-Hispanic/Latino 1629 2297 2527 2780 Total 1962 2791 3070 3377 Age 0-5 years 0 65 20E217 6-18 years 1320 2225 2499 19-50 years 590 322 354 51+years 52 179 197 Total 1962 2791 3070 3377 Geographic Location Town of Chapel Hill 894 1295 1512 1663 Town of Carrboro 570 808 989 1088 Orange County(Outside of Chapel Hill/Carrboro) 283 178 339 373 Outside of Orange County 215 510 230 253 Total 1962 2791 3070 3377 Income Low-income(80%of the Area Median Income and Below) Please see 1000 1100 income table in the attachments -- 899 Total --- 899 1 1000 1100 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F 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 $56,997 $66,440 $79,150 Total#of Individuals 2791 3070 3377 Cost Per Individual 1 $20.42 $21.64 $23.44 "Our cost per individual is going up slightly because we are adding capacity to our team of professional staff and contractors to keep the quality of services high. But the overall cost per individual is still very low. 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: Learning Across Generations Strategic ❑ Children improve their educational outcomes Objective (please choose one from the Results Framework Intermediate Result IR 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 (1) %and#of students in Learning NOTE:Since (1) 80% or (1) 80%or Across Generations workshops who these were new 1883 2073 Indicators report increased confidence in performance (Please choose at leadership and pro-social abilities, indicators least one including the ability to affect implemented in performance positive change in their 2019-20 grant indicator to report communities application, on from the Results results will be Framework,and add additional (2) %and#of students in available only (2) 80% or (2) 80%or performance StoryStudio program(formerly, for 2019-20 60/75 64/80 indicators that you Telling Your Story program)who reporting would like to report report greater confidence in ability period. to the Towns. to be successful in school, Please insert especially in social studies and additional rows as language arts needed,listing one per Program information P a g e 10 o f 2 1 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F (3) %and 9 of'students in oral (3) 90%or (3) 90%or history workshops who report 2119 2333 gaining oral history interviewing proficiency as well as an understanding of importance of knowing local history. I 1 I I I I j i I I DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F N FY Outside Agencies/Human Services Please use the drop down menu below to select which function area best aligns with your agency and programs) in which you are requesting funding, Please select only one from the drop down 1 menu below. j Youth Services If you selected other, please tell us what function area best aligns with your organization: 1 I 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. Improve students' confidence in their leadership, Program Goal#1 including the ability to affect positive change in their communities Performance Measure More than 90% of teachers who report increased student (How will you accomplish your goal?) confidence in leadership on post-workshop surveys 100% (75/75) of teachers who reported that workshops Actual Results were effective or very effective in "communicating the (Outcome) idea that every child can be powerful and make a Ending FY18-19 difference." Projected Results 100% (80/80) of teachers (Outcome) Ending FY2020 Projected Results 100% (80/80)of teachers (Outcome) Endin FY2021 i Improve cross-generational learning by training and Program Goal#2 involving 20 community mentors/elders in at least 25 workshops and tours. Performance Measure #and % of workshops including participation or j (How willyou accomplish your goal?) facilitation by Northside Community Mentors Actual Resultsa 40/75,S3/o o (Outcome) Ending FYI 8-19 - I Program information P a g e 1 2 of 21 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F 4 N ' i Outside Agencies/Human Services Projected Results �� -•- 40180, 50% � (Outcome) Ending FY2020 Projected Results 40180,50% (Outcome) - ANNOW 1". _. Endi4k FY2011 Increase number of county K-12 students who acquire Program Goal#3 local history skills in oral and local history workshops by 10% Performance Measure # of students who acquire local history skills, as reported (How will you accomplish your goal?) 4W by post-workshop teacher surveys Actual Results 2791 (95%) 1 � (Outcome) § Ending FY18-19 Projected Results 3070 (10/o) 0 (Outcome) Ending FY2020 Projected Results (Outcome) 3377(10%) Ps. Endbig FY2021 Program information P a g e 1 3 o f 2 1 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F PROGRAM INFORMATION *Please submit for each program/f applying for funding for more than one program. S. Program Name:Keeping Your House a Home:Lone-term neighbor retention and advocacy Program Primary Contact and Title: Hudson@Jacksoncenter.info Telephone Number: 919-960-1670 E-Mail: Hudson@iacksoncenter.info 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chaoel Hill and Carrboro's Results Framework, and Orange County SOCC Goals and Priorities, and the target population to benefit from the program. (100 words or less) Two County priorities are "to ensure a community network of basic human services...that maintains, protects, and promotes the wellbeing...," and to "ensure a high quality of life and lifelong learning that champions diversity." Our program addresses these priorities in critical ways: we help retain low-income elders in their homes safely through home repair support and advocacy, improving the county's community network and providing a higher qualify of life for elders. We facilitate "preservation toolkit" workshops that connect residents with the resources that help preserve affordable housing and promote lifelong learning. Finally,we organize a network of attorneys to provide free estate planning to elders throughout the County that help prevent land loss, protecting the wellbeing and diversity of generations to come. 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 ]::��jected Projected 2018-19 2018-19 019-20 2020-21 Gender Men 40 31 38 43 Women 75 74 78 83 Nonbinary/Genderqueer Self-Describe Total 115 105 116 126 Race and Ethnicity Black or African-American 107 99 108 112 American Indian or Alaska Native Asian 4 4 5 8 White 3 2 3 5 Native Hawaiian or other Pacific Islander Two or more races 1 Some other race 1 Total 115 105 116 126 6 Of the above,how many Hispanic/Latino 4 2 4 Program information Pa g e 10 of 21 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F Of the above,how many non-Hispanic/Latino 111 103 112 120 Total 115 105 116 126 Age 0-5 years 6-18 years 4 3 3 4 19-50 years 10 10 11 12 51+years 101 92 102 110 Total 115 105 116 126 Geographic location Town of Chapel Hill 65 61 67 70 Town of Carrboro 35 31 33 35 Orange County(Outside of Chapel Hill/Carrboro) 15 13 16 21 Outside of Orange County 0 Total 115 105 116 126 Income Low-income(80%of the Area Median Income and Below) Please see 116 126 income table in the attachments 115 105 Total 115 105 116 126 S. Cost Per Individual This cost per individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2018-19 Projected 2019-20 Projected 2020-21 Total Cost of Program $74,979 $82,775 $89,400 Total# of Individuals 105 116 126 Cost Per Individual $714.09 $713.58 $709.52 9. Performance Indicators info nation 1 0 2 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F )P. t 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. Housing 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. Ensure that 75 elderly or low income residents have Program Goal# 1 home preservation plans that help retain them in their home. Performance Measure #of low-income who complete workshop, preservation (How will you accomplish your goal?) plan, and evaluation that shows increase in retention 60 Actual Results Y (Outcome) `P`' b 1 'a "S 3-S •5 Y..4- hty9- ., Rtns.Y .,,C. .: -` 'I Ending FYI 8-19 Projected Results 65 � z (Outcome) $ � Ending FY2020 . Projected Results 75 Tff � , # (Outcome) Y fr En&n.FY2021 Program Goal#2 Provide 20 elderly households with attested wills that help prevent land loss # low income Orange County residents who complete Performance Measure(How will}•ou accomplish your goal.?) wills and end of life documents through the Jackson Center network of )ro-bono attorneys ' 22 Actual Results _ (Outcome) gam. 3 c ' EndingFY1819 Projected Results 23 Program information P a g e 1 2 o f 2 1 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F z IL Outside Agencies/Human Services (Outcome) Ending FY2020 Projected Results .:;, , 25 (Outcome) Ending FY2021 Ensure at least 15 households receive coordinated, Program Goal#3r ,, comprehensive, quality home repairs that help retain them in their homes # of households that receive coordinated response Performance Measure through the Jackson Center,confirm all repairs are (How will you accomplish your goal?) complete, and report "high quality" on satisfaction surveys Actual Results - 12 - (Outcome) "S Ending FY18-19 41 _ Projected Results 13 (Outcome) Endin,FY2020 Projected Results 15 (Outcome) Ending FY2021 Program information P a g e 13 o f 2 1 DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F Agency Budget Operating Budget for Program AGENCY NAR The Marian Cheek Jackson Center for Saving and Making History Actual Estimated Projected Percent REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 41,991 $ 39,881 $ 42,250 6% Program Generated Revenue $ 151,190 $ 185,000 $ 190,000 3% Local Government Grants: Human Services-Town of Carrboro $ 7,000 $ 6,300 $ 9,000 43% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 4,500 $ 5,000 $ 9,000 80% Other-Town of Chapel Hill $ 40,000 $ - $ - 0 Human Services-Orange County $ 19,875 $ 21,319 $ 27,500 29% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants MM Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBG/HOME/etc.): NEH $ 34,074 $ 57,500 $ 25,000 -57% Private Foundation Grants $ 76,808 $ 150,000 $ 225,000 50% Other Revenue $ 25,532 $ 25,000 $ 27,500 10% Total Revenue $ 400,969 $ 490,000 $ 555,250 13% EXPENSES Compensation $ 275,362 $ 371,800 $ 425,950 15% Rent& Utilities $ 16,463 $ 17,000 $ 18,700 10% Supplies & Equipment $ 15,205 $ 17,500 $ 21,440 23% Travel &Training $ 3,156 $ 9,800 $ 11,500 17% Other Expenses: $ 31,183 1 $ 73,900 1 $ 77,660 1 5% Total Expenses $ 341,369 $ 490,000 $ 555,250 13% SURPLUS/(DEFICIT) FOR PERIOD: $ 59,600 $ - $ - 0 Please explain Other Grants: Promise of Home Reimbursement Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. Our budget from last year shows a surplus, which has allowed us to build safety reserves to become a healthier organization. DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F Program Budget Operating Budget for Program PROGRAM NAME: Keeping Your House a Home: Long-term neighbor retention and advocacy Actual Estimated Projected Percent PROGRAM REVENUE 2018-19 2019-20 2020-21 Change . Private Donations $ 2,941 $ 3,178 $ 3,400 7% Program Generated Revenue $ 24,000 $ 24,000 $ 24,000 0% Local Government Grants: Human Services-Town of Carrboro $ - $ - $ - 0 Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ - $ - $ - 0 Other-Town of Chapel Hill $ 10,000 $ 10,000 $ 12,000 20% Human Services-Orange County $ 7,375 $ 8,097 $ 10,000 24% 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 $ 10,000.00 $ 12,500.00 $ 15,000.00 $ 0.20 Other Revenue $ 20,663 $ 25,000 $ 25,000 $ - Total Program Revenue $ 74,979 $ 82,775 $ 89,400 8% PROGRAM EXPENSES Compensation $ 48,651 $ 51,500 $ 57,850 12% Rent&Utilities $ 2,803 $ 3,060 $ 3,100 1% Supplies&Equipment $ 2,389 $ 2,540 $ 2,700 6% Travel&Training $ 473 $ 675 $ 750 11% Other Expenses: $ 20,663 $ 25,000 $ 25,000 0% Total Program Expenses $ 74,979 $ 82,775 $ 89,400 8% SURPLUS/(DEFICIT) FOR PERIOD: $ - $ - $ - 0 Please explain Other Grants: Home repair reimbursement grants from partners. Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. FY 2018-19 Program Budget DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F Program Budget Operating Budget for Program PROGRAM NAB Learning Across Generations: Local Civil Rights and Oral History Education Actual Estimated Projected Percent PROGRAM REVENUE 2018-19 2019-20 2020-21 Change Private Donations $ 1,947 $ 6,418 $ 8,650 35% Program Generated Revenue $ 6,050 $ 8,000 $ 10,000 25% Local Government Grants: Human Services-Town of Carrboro $ 7,000 $ 6,300 $ 9,000 43% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 4,500 $ 5,000 $ 9,000 80% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 12,500 $ 13,222 $ 17,500 32% Other-Orange County 1 $ - I $ - I $ - 1 0 Other-Town of Hillsborough $ t $ - $ - 0 Other Government GrantsTriangle United Way $ $ - $ - 0 State Government $ $ - $ - 0 Federal Government(CDBG/HOME/etc $ $ - $ - 0 Private Foundation Grants $ 25,000 $ 27,500 $ 25,000 $ 0.09 Other Revenue $ - $ - $ - 0 Total Program Revenue $ 56,997 1 $ 66,440 $ 79,150 19% PROGRAM EXPENSES Compensation $ 50,474 $ 56,800 $ 67,500 19% Rent& Utilities $ 2,850 $ 3,200 $ 3,450 8% Supplies &Equipment $ 2,368 $ 2,990 $ 3,700 24% Travel &Training $ 993 $ 2,350 $ 2,900 23% Other Expenses: $ 312 $ 1,100 $ 1,600 45% Total Program Expenses $ 56,997 1 $ 66,440 $ 79,150 1 190/. SURPLUS/(DEFICIT) FOR PERIOD: $ - $ - $ - 0 Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. FY 2018-19 Program Budget DocuSign Envelope ID:70FA685C-230D-4616-AOFD-2C4EC50BBB3F 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:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F EXHIBIT "B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: Marian Cheek Jackson Center Program Name: Learning Across Generations and Keeping Your House a Home Funding Award: 21,319 Outline how the agency will spend Orange County's funding award. Expense Description Amount Operations $3,875 Personnel $17,444 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. • Develop and launch new education initiatives to serve students and teachers in a remote learning context,including piloting online workshops in local and oral history to 750 K-12 students,and deliver Family Activity Boxes to 300 elementary school students. • Organize and manage after school enrichment program for 25-35 K-8 students at the Boys and Girls Club,located in the Northside Neighborhood. • Conduct critical home repairs and advocacy,and connect residents to the resources that preserve affordable housing through estate planning workshops,and provide free estate planning for elders to prevent land loss. 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 Anticipated Results Measures 225/250 or 90% #/% of elementary school students report increased vocabulary for elementary school discussing historical events. students #/% of middle school students increase their knowledge in local 225/250 or 90% history. middle school students #/% of high school students gain a sense of themselves as agents 225/250 or 90% high of change, or"history makers." school students # Family Activity Boxes distributed 300 Family Activity Boxes distributed to students #/% of interviewed families report improved home learning 10/10 or 100% environment from Family Activity Box. families reporting improvements through qualitative interviews DocuSign Envelope ID:70FA685C-230D-4616-AOFD-2C4EC50BBB3F % of interviewed families served by the Jackson Center's partnership 10/10 or 100% with the Boys and Girls Club report learning the values and skills of families reporting living in a close and connected community. improvements through qualitative interviews # low-income and elderly residents retained in stable housing. 75 individuals # low-income and elderly Orange County residents receive free will and testaments. 25 individuals # households report home repairs as "high quality" 15 individuals DocuSigned by: Certified by: �jEEsaeeay'V't,ff Title: Executive Director Date: 4/26/2021 5/6/2021 (Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F ATTACHMENT "A" Orange County Certifications—FY 2019-20 Outside Agency Performance Agreement Chief Contact,Administrators,Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact,administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name,title,residential address;phone and email address and if possible, fax number. I ill 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 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 j 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 j 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. i DocuSigned by: (�,py �°jq, Ytff Executive Director 5/6/2021 Certified by: �' Title: Date: (Provider's Signature) i Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 1121 DocuSign�elope ID:70FA685C-23OD-4616-AOFD-2C4EC50BBB3F MARICHE OP ID: NJE A���o CERTIFICATE OF LIABILITY INSURANCEFDATE0111 IDDIYYYY) 01/12/2021 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 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 Natalie Engelhart The Sorg!Insurance Agency PHONE FAX 16 Consultant Place Suite 102 AIC No Ext:919-682-4814 AIc,No): 919-682-4906 Durham, NC 27707 —ADDRESS:James E.Sorgi,CIC natalie@SOrgiinSUranCe.COm INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Erie Insurance Exchange 26271 INSURED Marian Cheek Jackson Center INSURER B:Westchester Fire Insurance Co for Saving and Making History 512 West Rosemary St INSURER C: Chapel Hill,NC 27510 INSURERD: 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 EFF POLICY EXP LIMITS LTR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY Q970503239 08/15/2020 08/15/2021 DAMAGE TO RENTED 1,000,00 PREMISES Ea occurrence $ CLAIMS-MADE � OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 X POLICY JEC T PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,00 Ea accident $ A ANY AUTO Q970503239 08/15/2020 08/15/2021 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N Q921501020 08/15/2020 08/15/2021 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 B Professional Liab. EONNCF138950892004 11/05/2020 11/05/2021 Prof Liab 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION INFORM1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Insured's Information CO THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Copy ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD