HomeMy WebLinkAbout2020-796-E Finance-Boomerang Youth Inc. outside agency agreement DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
OUTSIDE AGENCY PERFORMANCE AGREEMENT
THIS AGREEMENT,made and entered into the first day of July 2020, ("Effective Date")by and between
the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street,
Hillsborough, North Carolina, 27278, ("County") and Boomerang Youth, Inc., a not-for-profit corporation
located at 825A N. Estes Drive, Chapel Hill,NC 27514("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 Boomerang Youth,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.
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 B,
Scope of Services,the maximum sum of$13,358.00.
b. All funds appropriated shall be used for purposes described in Exhibit B. Any funds not
used for the purposes stated shall be returned to the County. Any changes in the use of
funds must be authorized in writing by the County prior to any expenditure of the funds by
the Provider. If the funds are expended not in accordance with the Scope of Services, at the
discretion of the County the Provider may be required to repay the funds to the County.
c. The Provider shall be paid in four equal installments in the amount of$3,339.50. 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: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
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 11,April 12, and July 12 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: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
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: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
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 $ 14.25 per
hour. To the extent possible, Orange County recommends that Boomerang Youth, Inc. 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:
DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
County: Finance&Administrative Services Provider: Boomerang Youth,Inc.
Orange County 825A N. Estes Drive
Post Office Box 8181 Chapel Hill,NC 27514
Hillsborough,NC 27278
16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire
Agreement between the parties and shall supersede, replace or nullify any and all prior
Agreements of understandings; written or oral, relating to the matters set forth herein, and any
such prior Agreements or understandings shall have no force or affect whatsoever on this
Agreement. The County and Provider have read this Agreement and agree to be bound by all of
its terms, and further agree that this Agreement constitutes the complete and exclusive statement
of the Agreement between the County and Provider.
17. Severability. All clauses found herein shall act independently of each other. If a clause is found
to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It
is understood by the parties hereto that if any part, term or provision of this Agreement is by the
Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United
States, the validity of the remaining portions or provisions shall not be affected, and the rights
and obligations of the parties shall be construed and enforced as if the Agreement did not contain
the particular part,term or provision held to be invalid.
a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of
respective parties hereunder shall be governed by the laws of the State of North Carolina. By
executing this Agreement Provider affirms that Provider and any subcontractors of Provider are
and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General
Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and
has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer
pursuant to G.S. 147-86.58.
18. Signatures. This Agreement together with any amendments or modifications may be executed
electronically. All electronic signatures affixed hereto evidence the intent of the Parties to
comply with Article 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.
ErawlifA&lWhalf of the Provider
12/21/2020
Ta W P ei er,Executive Director Date
For and on b fcf 0rAwge County Government
661A Ak � � 12/30/2020
f1RZ7QQdR7.-;
Bonnie Hammersley, County Manager Date
r
DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
ORANGE COUNTY—DEPARTMENT USE ONLY
Department
Party/Vendor Name: Boomerang Youth, Inc. Party/Vendor Contact Person: Sonia Frischemeier Contact Phone:
919-968-2146 Party/Vendor Address: 825A N. Estes Drive City Chapel Hill State: NC Zip: 27514 Department:
Finance & Administrative Services Amount: $13,358 Purpose: FY 2020-21 Outside Agency/Human Services
Performance Agreeement Budget Code(s): 10495050-710015 Vendor# 800060 (N/A if new vendor) Vendor is a
BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date
7/l/2020 Approved by Board Yes®Nor-1 Agenda Date: 6/16/2020
This agreement is approved as to technical form g9WWeW!by.
r,AAlul& Ft,bUd,OOt,& 12/21/2020
Department Director's Signature Date:
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 insuran 0.6peccifications,and requirements:
QLISA C,Ovvu lf0 12/28/2020
Office of the Risk Management Officer e Date:
Financial Services
This instrument has been pre-audited in the mann "Ythe Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer Date: 12/30/2020
Legal Services
Doc igned by:
This agreement is approved as to legal form ndency:
rvj` 12/30/2020
Office of the County Attorney 4035CB8304CA4A9... Date:
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to Allen Coleman upon completion @ acoleman@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: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
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.
DocuSigned by:
Executive Director 12/21/2020
Certified by: Title: Date:
(Prove er s ignature)
r
DocuSign Envelope ID:BE69D0F4-65F9-4511-85C7-BCBB1 0605A1 1
COVER PAGE
Applicant Contact Information
Applicant Organization's Legal Name: Boomerang Youth, Inc.
Applicant Organization's Physical Address: 825A N. Estes Drive, Chapel Hill, NC 27514
Applicant Organization's Mailing Address: 825A N. Estes Drive, Chapel Hill, NC 27514
Applicant Organization's Web Address: https://boomerangyouth.org
Executive Director:Tami Pfeifer
Telephone Number: (919) 968-2146 E-Mail:tami.pfeifer@boomerangvouth.org
Tax ID Number: 47-4660452
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
STRIVE—alternative to suspension and school re- $8,000 $16,000 $24,000 $48,000
engagement Personnel Personnel Personnel
Totals $8,000 $16,000 $24,000 $48,000
Briefly explain your proposed use of funds:
Funds will be used to pay living wage salaries to qualified staff that provide direct services to middle
and high school students.
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.
j� P+ ---
Signature: 1-13-2020
Executive Director Date
Signature: 1-14-2020
Board Chairperson Date
Cover Page P a g e 3 o f 18
DocuSign Envelope ID:BE69D0F4-65F9-4511-85C7-BCBB1 0605A1 1
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.
Signature: 1-13-2020
Executive Director Date
Signature: 1-14-2020
Board Chairperson Date
Cover Page P a g e 4 o f 18
DocuSign Envelope ID:BE69D0F4-65F9-4511-85C7-BCBB1 0605A1 1
ORANGE COUNTY
".: )I" I II i , I., ,. ..;
Outside Agencies/Human Services
AGENCY INFORMATION
Please provide the following information about your agency:
1. Date of Incorporation (Month/Year): 08 2015
2. Agency's Purpose/Mission:
Boomerang inspires youth to bounce back from challenges and move towards positive
change. Our programs fulfill Boomerang's mission by keeping vulnerable students in
school and engaged in learning. Vulnerable youth are those who navigate adolescence
with additional challenges and fewer resources and supports to draw on ... young people
with trauma histories, students of color facing systemic disadvantages, students from
immigrant communities, and students from low-income families. Our model develops
students' strengths, builds essential life skills, and creates a network of support in school
and community.
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).
Boomerang successfully implemented the following programs —Alternative to
Suspension (now STRIVE), Continuing Connections (now CAP) and TRANSITIONS.
Since 2006, Boomerang has served over 3000 Orange County youth at risk of
disconnection, supporting them to stay in school and engage in their education.
We have a proven track record of meeting our proposed outcomes, budgets and
timelines with the Town of Carrboro, the Town of Chapel Hill, and Orange County over
the last 10 years.
4. Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes/No) Yes
If yes, is this agency an Orange County Living Wage Certified Employer?Yes
If no, please briefly explain.
Schedule of Positions: #of FTE—Full-Time Paid Positons: 5 #of FTE—Part-Time Paid Positions: 1
Cover Page P a g e 5 o f 18
DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
ORANGE COUNTY
Outside Agencies/Human Services
PROGRAM INFORMATION
*Please submit for each program if applying for funding for more than one program.
5. Program Name: STRIVE—alternative to suspension and school re-engagement
Program Primary Contact and Title: Sonia Frischemeier, Director of Operations
Telephone Number: (919) 968-2146 E-Mail: Sonia.frischemeier@boomerangyouth.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)
STRIVE is Boomerang's alternative to suspension program designed to keep middle and
high school students from further school disengagement by helping them understand the
issues behind their suspension, providing social-emotional learning and goal-setting for
successful school re-entry. Working closely with school and family, Boomerang bridges
students back to school and provides in-school follow-up to high school students on a
weekly basis during the school year.
The program is part of a community network of human services that protects and promotes
the well-being of youth, champions education at all levels (BOCC Goals and Priorities), and
helps children improve their education outcomes (Strategic Objective 1).
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 100 95 100 100
Women 50 48 50 50
Nonbinary/Genderqueer 0 0 0 0
Self-Describe 0 0 0 0
Total 150 143 150 150
Race and Ethnicity
Black or African-American 65 50 65 65
American Indian or Alaska Native 0 0 0 0
Asian 0 2 0 0
White 75 67 75 75
Cover Page P a g e 6 o ,
DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
ORANGE COUNTY
Outside Agencies/Human Services
Native Hawaiian or other Pacific Islander 0 4 0 0
Two or more races 10 14 10 10
Some other race 0 6 0 0
Total 150 143 150 150
Of the above, how many Hispanic/Latino 45 30 45 45
Of the above, how many non-Hispanic/Latino 105 113 105 105
Total 150 143 150 150
Age
0-5 years 0 0 0 0
6-18 years 150 143 150 150
19-50 years 0 0 0 0
51+years 0 0 0 0
Total 150 143 150 150
Geographic Location
Town of Chapel Hill 85 82 85 85
Town of Carrboro 15 29 15 15
Orange County(Outside of Chapel Hill/Carrboro) 50 25 50 50
Outside of Orange County 0 7 0 0
Total 150 143 150 150
Income
Low-income(80%of the Area Median Income and Below) na na na na
Total na na na na
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 232,918 226,380 240,165
Total # of Individuals * 373 355 355
Cost Per Individual 624.45 637.69 676.52
* We define V of individuals"in terms of weighted Units of Service. A Unit Of Service
reflects the services each student receives in terms of 1:1 time with program staff, `dosage'
of services they receive such as social-emotional skill building groups, academic
engagement (tutoring, communicating with teachers) and in-school follow-up support post-
suspension.
Cover Page P a g e 7 _ 8
DocuSign Envelope ID:BE69D0F4-65F9-4511-85C7-BCBB1 0605A1 1
ORANGE COUNTY
".: )I" I II i , I., ,. ..;
Outside Agencies/Human Services
2018-19 Actuals Weight # of Students Total Units
2-4 day suspension 1 110 110
5-7 day suspension 2 28 56
8-10 day suspension 3 5 15
In-school follow-up post-suspension 4 48 192
Total 373
9. Performance Indicators
Program Name: STRIVE
Strategic Q Children improve their educational outcomes
Objective ❑ Residents Increase their livelihood security
(please choose one from
the Results Framework) ❑ Residents improve their health outcomes
Intermediate
Result Intermediate Result 1.2: Children demonstrate new grade-level-
(please choose one from appropriate skills (grades K-12)
the Results Framework)
RESULTS Actual Projected Projected
2018-19 2019-20 2020-21
Performance 65% of program participants 70%
Indicators that express greater 100 out of 98 out of 150 98 out of 150
confidence in their ability to 143 students
be successful at school
75% of students achieve an 70% 113 out of 113 out of
academic and/or personal 100 out of 150 150
oal u on return to school 143 students
85% of students attending
for a minimum of 3 days 96°
�0 of 128 out of 128 out of
143
successfully complete the 143 out students 150 150
program
Cover Page P a g e 8 o f 18
DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
ORANGE COUNTY
NOIt 1 1 1 ( A Rol I N A
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.
Youth Services
If you selected other, please tell us what function area best aligns with your organization:
Please indicate three program goals/performance measures below.
Program Goal# 1 85% of students attending for a minimum of 3 days
successfully complete the program
Students demonstrate increased sense of connectedness to
Performance Measure school and self
(How will you accomplish your goal?) (indicators: active participation, schoolwork completion, goal
setting)
Actual Results 96%
(Outcome) 137 out of 143 students
Ending FY18-19
Projected Results 128 out of 150 students
(Outcome)
Ending FY2020
Projected Results 128 out of 150 students
(Outcome)
Ending FY2021
Program Goal#2 75% of students achieve an academic and/or personal goal
upon return to school
Performance Measure Students demonstrate new grade-level-appropriate skills
(How will you accomplish your goal?) (indicators: improved participation and schoolwork completion,
accessing school supports)
Actual Results 70%
(Outcome) 100 out of 143 students
Ending FY18-19
Projected Results 113 out of 150 students
(Outcome)
Ending FY2020
Projected Results 113 out of 150 students
Cover Page P a g e 9 o f 18
DocuSign Envelope ID:BE69D0F4-65F9-4511-85C7-BCBB1 0605A1 1
ORANGE COUNTY
Outside Agencies/Human Services
(Outcome)
Ending FY2021
Program Goal#3 65% of program participants that express greater confidence
in their ability to be successful at school
Performance Measure Students demonstrate increased engagement in learning
(How will you accomplish your goal?) (indicators: goal attainment, school feedback,
promotion/graduation)
Actual Results 70%
(Outcome)
100 out of 143 students
Ending FY18-19
Projected Results 113 out of 150 students
(Outcome)
Ending FY2020
Projected Results 113 out of 150 students
(Outcome)
Ending FY2021
Cover Page P a g e 10 o f 18
DocuSign Envelope ID:BE69D0F4-65F9-4511-85C7-BCBB1 0605A1 1
Agency Budget
Operating Budget for Entire Agency
AGENCY NAME: Boomerang Youth, Inc.
Actual Estimated Projected Percent
AGENCY REVENUE 2018-19 2019-20 2020-21 Change
Private Donations $ 35,669 $ 30,000 $ 35,000 17%
Agency Generated Revenue (fees) $ - $ - $ - 0
Local Government Grants:
Human Services-Town of Carrboro $ 3,500 $ 3,150 $ 8,000 154%
Other-Town of Carrboro $ - $ - $ - 0
Human Services-Town of Chapel Hill $ 7,000 $ 9,000 $ 16,000 78%
Other-Town of Chapel Hill $ - $ - $ - 0
Human Services-Orange County $ 13,008 $ 13,358 $ 24,000 80%
Other-Orange County-JCPC County Match $ 8,439 $ 8,439 $ 10,000 18%
Other-Town of Hillsborough $ - $ - $ - 0
Other Government Grants
Triangle United Way-Family Success Alliance $ 6,950.00 $ 8,137.00 $ 9,000.00 $ 0.11
Juvenile Crime Prevention Council $ 29,316.00 $ 41,035.00 $ 30,000.00 $ 0.27
Orange County Arts Commission $ 1,495.00 $ - $ - 0
School Districts $ 55,000.00 $ 60,000.00 $ 60,000.00 $ -
Private Foundation Grants $ 131,744.00 $ 139,000.00 $ 130,000.00 $ 0.06
Other Revenue $ 2,521 $ - $ - 0
Total Agency Revenue $ 294,642 $ 312,119 $ 322,000 3%
AGENCY EXPENSES
Compensation $ 272,831 $ 287,100 $ 299,073 4%
Rent&Utilities $ 20,893 $ 21,400 $ 24,520 15%
Supplies & Equipment $ 4,997 $ 8,900 $ 9,000 1%
Travel &Training $ 1,484 $ - $ 2,000 0
Other Expenses (insurance, depreciation, marke $ 10,352 $ 6,000 $ 8,500 42 0
Total Agency Expenses $ 310,557 $ 323,400 1 $ 343,093 1 6%
SURPLUS/(DEFICIT) FOR PERIOD: 1 $ (15,915) $ (11,281) $ (21,093) -87%
FY 2018-19 Agency Budget
DocuSign Envelope ID:BE69DOF4-65F9-4511-85C7-BCBB10605A11
Program Budget
Operating Budget for Program
PROGRAM NAME: STRIVE- Boomerang Youth, Inc.
Actual Estimated Projected Percent
PROGRAM REVENUE 2018-19 2019-20 2020-21 Change
Private Donations $ 24,968 $ 21,000 $ 24,500 17%
Program Generated Revenue $ - $ - $ - 0
Local Government Grants:
Human Services-Town of Carrboro $ 3,500 $ 3,150 $ 8,000 154%
Other-Town of Carrboro $ - $ - $ - 0
Human Services-Town of Chapel Hill $ 5,000 $ 7,000 $ 10,000 43%
Other-Town of Chapel Hill $ - $ - $ - 0
Human Services-Orange County $ 9,000 $ 10,000 $ 18,000 80%
Other-Orange County $ 8,439 $ 8,439 $ 10,000 18%
Other-Town of Hillsborough $ - $ - $ - 0
Other Government Grants
Triangle United Way-Family Success Alliance $ - $ - $ - 0
Juvenile Crime Prevention Council $ 29,316.00 $ 41,035.00 $ 30,000.00 $ 0.27
School Districts $ 55,000.00 $ 50,000.00 $ 50,000.00 $ -
Private Foundation Grants $ 92,220.80 $ 97,300.00 $ 91,000.00 $ 0.06
Other Revenue $ 2,521 $ - $ - 0
Total Program Revenue $ 229,965 $ 237,924 $ 241,500 20i
PROGRAM EXPENSES
Compensation $ 204,623 $ 200,970 $ 209,351 4%
Rent&Utilities $ 16,714 $ 14,980 $ 17,164 15%
Supplies &Equipment $ 3,498 $ 6,230 $ 6,300 1%
Travel &Training $ 1,484 $ - $ 1,400 0
Other Expenses: $ 6,599 $ 4,200 $ 5,950 42%
Total Program Expenses $ 232,918 $ 226,380 $ 240,165 6%
SURPLUS/(DEFICIT) FOR PERIOD: 1 $ (2,953)1 $ 11,544 1 $ 1,335 -88%
FY 2018-19 Program Budget
DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
EXHIBIT `B"
Scope of Services—FY 2020-21
Outside Agency Performance Agreement
Agency Name: Boomerang Youth Inc
Program Name: STRIVE
Funding Award: 13,358.00
Outline how the agency will spend Orange County's funding award.
Expense Description Amount
Wages& FICA costs for Program Manager 10,000
Wages&FICA costs for Student Coordinator 3,358
Program Services
Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021.
Middle and high school students referred to STRIVE will attend a minimum of 6 sessions,receiving individual social-emotional and academic support,as
• prescribed by their referring school,and receive follow-up services throughout the school year.
• Middle and high school students referred to STRIVE will attend at least 3 group mentoring sessions during their referral period.
•
`Due to COVID-19,services will be provided remotely for the foreseeable future.If school resumes in-person,we will revert to services as specified in our
application.
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
85%
Students will successfully complete the program
75%
Students will achieve an academic and/or personal goal as stipulated in
their STRIVE Action Plan
Program participants will express greater confidence in their ability to be 65%
successful at school
FDo Title:cuSigned by:
Certified by: AtMI ��LIFLV Executive Director Date: 12/21/2020
(Provi er's Electronic Signature)
"You will sign this document electronically with your performance agreement.
DocuSign Envelope ID: BE69DOF4-65F9-4511-85C7-BCBB1 0605A1 1
�• Tti� A4TL;MM.U[uYYYYF
Rv�_AL CERTIFICATE OF UMILITY INSURANCE
T HIIS CETITIF11CATE IS ISSUED AS A MA7'rIER INFOFMATION ONLY AND CONFERS NO RIGHTS UPON T14E CERTIFICATE HOLDER-THIS
CERTIFICATE DOES NOT AFFIRMATNELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW- THIS CERTF"TE OF INSURANCE DOES NOT CONSTITUTE ACONTRACT BETWEEN THE FSSIIIhlG IN$UP.El%5).AUTHORiZIED
R EPREuIENTAT1YE OR PRCOUCER,AND THE CERTIFICATE TrIOLDER-
IMPORTAN{ If the ceffil5Date holder is an ADDrfIOFJ:AL INSURED,Use pDlicy{ies)nm st have ADDITIONAL INSURED prpvrtipog or be C;jjdc eEd
If SUBROGAT'>i0N IS WANED.Sub oct to Ilso UVMS and conditions of trio policy,certain polidrs may require an endarsemenL A statement on
Viih rertificata does not confer rights 1n Use cerd icaW holder In lieu of such endorsement(s)-
PROMMER c❑NTAcT Diane H yv-au
NAME:
Buskm s InsLerers of CarolinaE (319)OG84611 FAX ( 19)466-8999
601 tA4'ICw)F} ¢fib,$U0k,250 lDOE RESS.' ea dnadearu@b less-kwxers-com
PO Box 2EW _ IHMPEFNSp AFFORDIWG COVERAGE NAIL a
Chapel Fii9 NC 27515 IN5URERA: USLI 25995
Ir;94REP INSURFR 6: Gujrd in5lirfflK0 0281
LirAmv-rang Youth Lnf_ INEW R c: United States Liabdrty Insurance Company 25995
925-ANath Esics Or IwkwFa a
114SU2ERE-
Chape-I Hill NO 77514 INSUREgF F;
COVERAGES CERTIFICATE NUMBER: CL20GOD2 93 REVISION NUMBER:
TJ JIS 1$TO CEFMIF4'TI LOT TI JE POLICIr5 Cr WMIRMC;F L I TD BELOW HAVE BEEN ISSUED TO THE.INSURED XAMEL)ABOVE rtr THL r'CxeI y Pmici6
MDICATED. NOT4trITHSTANDNG ANY RLOUIRLMENT,TrRM OR CONEH1PDN OF MY CON 1KAe1 OM 0I HER LIOCUMENr WIYH KLsptcf 10 wKGH 1His
C:ERf IFICATE MAY BE MSUED OR MAY PERTAIN,YHt INSURANCE AFFORDEDSY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTFIETERhc&
EXCLUStONSAm WNOITKW43 OF SUCH POLICIES.LWIITSSHOWN MAY HAVE BEEN KEOCED BY PALD CLAJMS.
INSR fuQR Pq4 FFF PRA 1E
I-Tit TTJ'r Of IrltCURAWK IN68 I W4O I POLICY NWADER LIMITS
G❑MMMCL4L GBIERALLWaIfrY C}CHOOCUfiRENCE f 1,U(X1,[F(}0
i;LAIM5 hI8Dr �S}C{:SJR PPEKL`YS Ca arc+sienor f 1�'S��
MFDFXPf0nrrubf-Aw,I $ CI{x}
A NPP15M9542 (1710 112 0 2 1) p7.41V2021 PERSONALavUV IN.IuRr I 1,p00,040
OFNI AC'C;RrfaArr:IUIr a.F+PI IC-9 F+rR• rFJNFRAL ACX9WCALTF ; OQ9.04U
POLICY LCIC PRODUUn-COPANOPAGG S 7,[ICkJ,Qf10
OTHER PL1m&Mokstatkm s 25,ODD
Aur010311LE LUMURY COI{GNCD MINGLE IJW S 1.0%.000
ANYAITO DDnILY MJUFUWf p�) i
A OrrMED SCHDIJULED DCUILY ra.WRY fP*p&UM a At S
AIJM�ONLY ALr1G6
FNH.M NOr OYMED EFL7Y LV5kL5UL
Au'IOs OrfY A"'fOC:CM,LY Tc �
S
UNOR6-LALUU! C} -R EhCN0=PRRENU $
FXEFSE LIAS CLAW&})AIC AcrvFf AW S
rwD I I Rr-T TION 5 $
W090-R5 GUMPE SAY1014 3'JR {YTFL
AWD ENFLDYE3?- LJABrLJrY STATUTE £R
Y 1 N 100.000
aNVF+R{;F�FtICTpr�iAt{T}aEp�f{ECUTrwE E.LEnc�,AcciccNr �
8OFEICEFUME11 RFR E-XCJ-UDED7 ti` WA
F��LIYf:172728 U71U1r'2J]2D {77�01f2a27
pVl.nd�er.ry fn lArl FI WISER-SF-Fn F'M'Er}►EF. L 100.00Q
Ir 4cs,Uoscrft unfW
DESCRIPTION CK OPLPAM0NS below C L DISSD%St-POLICY LIMIT 4
Ornci❑ra cJirwx rs Eao Occurerce 57,40UAU�
c N1]015M&t 3C1 0i illzow i17f01 mri A99 2Ie S3,o00,040
EESGR CN❑F❑PERAMON51 LOCATONS!VEFIICLES fAC❑RD 101.Atla 6"al Ro da SaN dulo.may bo aM it m r4 ipa L,rrr{u:acl4
CERTIFICATE EIOLDER CANCELLATION
SHOU LID At"OF 711E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE i:xriRAr103f DA1 E THEREOF,NOVICE 4YILL BE OL:LIYEFrEID w
Orange County Human Services Ar'CORDANCF.WrrHTHF POLICY PROVISMS.
PC Box R11
AUTYIgRQ[r}RFPRF4FNTATI4F
Fidl,hnrnugh NC 27275 +`
Cc, ACCORD CORPORATION- All i1ghL5 Feserved.
ACORD 25(201 Libl) The ACORD name and logo are registered marks or ACORD