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HomeMy WebLinkAbout2021-381-Health-Table-Outside agency funds («Agencys_Name») Orange County Outside Agency Performance Agreement Revised 1/21 Page 1 of 9 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2020, (“Effective Date”) by and between the County of Orange, a political subdivision of the State of North Carolina, Post Office Box 8181, Hillsborough, North Carolina, 27278, ("County") and TABLE, a not-for-profit corporation, located at 209 East Main Street, Carrboro, North Carolina 27510 (“Provider”). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and «Agencys_Name» agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2020 to June 30, 2021. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit “A” and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of $10,450. 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 $2,612.50. 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. DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 1/21 e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 – December 31; January 1 – March 31 and April 1 - June 30. Reports are due on January 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”), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten (10) business days from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County’s remedies in law or in equity. DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 1/21 c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker’s Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 d. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 1/21 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County’s living wage is $ 14.95 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance & Administrative Services Provider: TABLE DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 1/21 16. E n tire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on behalf of the Provider _____________________________ _______________________ , Date For and on behalf of Orange County Government _______________________________ ________________________ Bonnie Hammersley, County Manager Date Orange County Post Office Box 8181 Hillsborough, NC 27278 209 East Main Street Carrboro, NC 27510 DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 6/27/2021 Executive DirectorAshton C. Tippins 7/8/2021 Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 1/21 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Party/Vendor Name: TABLE Party/Vendor Contact Person: Ashton C. Tippins Contact Phone: 919-636-4860 Party/Vendor Address: 209 E. Main Street City Carrboro State: NC Zip: 27510 Department: Health Amount: $10,450 Purpose: Outside Agency Funding Budget Code(s): 10495050-720116 Vendor # 800791 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 7-1-20 Approved by Board Yes No Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: Department Director’s Signature ________________________________________ Date: ________ Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: Turnover in original department generating contract. 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 insurance standards, specifications, and requirements: Office of the Risk Management Officer___________________________________ Date: _________ Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ____________________________________ Date: _________ Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney __________________________________________Date: ________ Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board __________________________________________Date:_________ DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 6/28/2021 7/7/2021 7/8/2021 7/8/2021 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATIONDocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 TABLE, Inc. Agency Budget 2018-2021 Actuals Budget Forecast 2018-19 2019-20 2020-21 Ordinary Income/Expense Income Operating Income Grants 53,038 83,354 91,689 Gifts in Kind - Goods 196,453 250,061 275,067 Individual Donations 262,064 279,188 307,106 Matching Gifts 1,010 1,000 1,100 Rebate cash, gift cards 1,011 500 550 Local Bus, Clubs, Orgs, Events 35,718 56,683 62,351 Religious Organizations 17,009 30,006 33,007 UNC Groups and Events 880 1,250 1,375 Foundations and Trusts 64,500 83,354 91,689 Corporations / Corp Foundations 2,538 2,084 2,292 Special Events 24,767 35,120 38,632 Total Operating Income 658,987 822,599 904,859 Total Income 658,987 822,599 904,859 Expense Program Expenses Total Backpack Program 291,887 417,771 458,723 SnackChef 13,781 17,337 19,071 Alternative Sites 21,595 0 0 Other Prgms (Camp, Field Trips)1,956 2,500 2,750 Total Program Expenses 329,220 437,608 480,544 Payroll Expenses Salaries Executive Director 47,662 58,433 61,354 Associate Director 0 45,150 47,408 Program Director 44,219 0 0 Program Position (TBD)0 27,500 31,500 Program Associate 29,000 31,200 32,760 Community Relations Director 20,628 14,573 15,301 Marketing Director 13,700 17,280 18,144 Project Specialist 11,839 12,500 13,125 Volunteer Coordinator 5,395 0 0 Family Engagement Coord.6,780 9,360 9,828 Total Salaries 179,223 215,995 229,420 Payroll Taxes 14,661 17,852 18,962 Total Payroll Expenses 193,884 233,847 248,382 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 6,435 6,475 9,150 28,057 58,720 61,320 Development and Fundraising 12,305 11,570 17,000 15,529 15,415 17,262 7,112 9,756 9,756 40,191 41,590 41,590 1,023 0 0 14,808 7,617 11,095 Total Expense 648,563 822,598 896,099 Net Operating Income 10,424 0 8,760 -225 120 240 35,073 650,000 850,000 Net Income 45,272 650,120 859,000 Other Employee-Related Expenses (Disability Ins, Training, Reviews, Workers' Comp, Mileage) Other Income (Interest income on investments this year and budget, loss on sale of vehicle) Total Space Contributions Contract and Professional Svces (CPA, Accounting, Capital Campaign Consulting, HR and Personnel) Office Expenses (Office Supplies, Printing, Postage, Fees, Etc.) Information Technology (IT Resource, Software, Filesharing, Netowrking, Consultant and Projects) Facilities and Occupancy (Rent, Parking, Utilities, Building Maintenance) Vehicle Expenses (Fuel, Registration, Maintenance, Insurance) Operations (Insurance, Meetings, Depreciation, Inventory Adjustment) EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 TABLE, Inc. Program Budget 2018-2021 2018-19 2019-20 Ordinary Income/Expense Income Operating Income Grants 53,038 83,354 Gifts in Kind - Goods 196,453 250,061 Individual Donations 262,064 279,188 Matching Gifts 1,010 1,000 Rebate cash, gift cards 1,011 500 Local Bus, Clubs, Orgs, Events 35,718 56,683 Religious Organizations 17,009 30,006 UNC Groups and Events 880 1,250 Foundations and Trusts 64,500 83,354 Corporations / Corp Foundations 2,538 2,084 Special Events 24,767 35,120 Total Operating Income 658,987 822,599 Total Income 658,987 822,599 Expense Program Expenses Total Backpack Program 291,887 417,770.99 SnackChef 13,781 17,336.86 Alternative Sites 21,595 0.00 Other Prgms (Camp, Field Trips)1,956 2,500 Total Program Expenses 329,220 437,608 Payroll Expenses Salaries Executive Director 23,831 29,216 Associate Director 0 45,150 Program Director 44,219 0 Hunger Relief Program Associate 0 27,500 Nutrition Education Program Associate 29,000 31,200 PT Community Relations Director 10,314 7,286 PT Marketing Director 6,850 8,640 PT Senior Admin Specialist 2,960 3,125 Volunteer Coordinator 5,395 0 Family Engagement Coord.6,780 9,360 Total Salaries 129,349 161,478 Payroll Taxes 10,581 12,884 Total Payroll Expenses 139,930 174,362 1,609 1,619 Actuals Budget Other Employee-Related Expenses (Disability Ins, Training, Reviews, Workers' Comp, Mileage) EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 0 0 Development and Fundraising 0 0 6,212 6,166 4,267 5,854 36,172 37,431 1,023 0.00 8,885 4,570 Total Expense 527,317 667,609 Net Operating Income 131,670 154,989 -225 120 35,073 650,000 Net Income 166,518 805,109 Operations (Insurance, Meetings, Depreciation, Inventory Adjustment) Other Income (Interest income on investments this year and budget, loss Total Space Contributions Contract and Professional Svces (CPA, Accounting, Capital Campaign Consulting, HR and Personnel) Office Expenses (Office Supplies, Printing, Postage, Fees, Etc.) Information Technology (IT Resource, Software, Filesharing, Netowrking, Consultant and Projects) Facilities and Occupancy (Rent, Parking, Utilities, Building Maintenance) Vehicle Expenses (Fuel, Registration, Maintenance, Insurance) EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 EXHIBIT “B” Scope of Services – FY 2020-21 Outside Agency Performance Agreement Agency Name: TABLE Ministries, Inc. Program Name: Weekend Meal Backpack Program Funding Award: $10,450 Outline how the agency will spend Orange County’s funding award. Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2021. ●Delivery of nutritious food to kids in Orange County every week. ●Pilot of an online shopping experience for fully custom healthy food delivery directly to the homes of our kids and their families. ● 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. Expense Description Amount Nutritious fresh and non-perishable food 4,450 Staff 3,000 Space 3,000 Performance Measures Anticipated Results # kids served weekly 750 Children eat, taste, or are exposed to more fresh (65%)488 Rate of food insecurity decreases among TABLE participants and they can rely on steady food assistance. (13%) 98 Parents report healthier lifestyle behaviors such as improved nutrition. (60%) 450 Certified by: Title: Executive Director Date: 6/25/21 (Provider’s Signature) DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 6/27/2021 Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 1/21 ATTACHMENT “A” Orange County Certifications – FY 2020-21 Outside Agency Performance Agreement Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, residential address; phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization’s Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. Certified by: _______________________ Title: __________________________ Date: ___________ (Provider’s Signature) DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 6/27/2021Executive Director The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS PERSTATUTE OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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. INSD ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) OTHER: 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1/10/2020 AssuredPartners of NC,LLC -Raleigh 4505 Falls of Neuse Road,Suite 350 Raleigh NC 27609 Select Business Unit 844-206-9394 sbu.servicenc@assuredpartners.com Cincinnati Insurance Company 10677 TABLMIN-01 Table Ministries Inc 209 E Main St Carrboro NC 27510 932998092 A X 1,000,000 X 100,000 10,000 1,000,000 2,000,000 ETD 0496055 7/9/2019 7/9/2022 2,000,000 A Property Sexual Abuse &Molestation ETD 0496055 7/9/2019 7/9/2022 BPP Aggregate 25,000 2,000,000 Orange County PO Box 8181 Hillsborough NC 27278 DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH- STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD TABLE-1 OP ID: GL 08/20/2020 Mark O. McBee Brewer Group - Pittsboro 120 Lowes Dr., Suite 103 Pittsboro, NC 27312 Mark O. McBee 919-642-0475 919-642-0496 Amtrust North America TABLE MINISTRIES, INC 209 E Main St CARRBORO, NC 27510 A FWC1005079 12/04/2019 12/04/2020 100,000 100,000 500,000 ORANG-4 ORANGE COUNTY NORTH CAROLINA 200 S CAMERON ST PO BOX 8181 HILLSBOROUGH, NC 27278 919-642-0475 DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0 DocuSign Envelope ID: AF95FE12-E608-4F58-A58D-996D127743A0