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2020-797-E Finance-Pathways to Change outside agency agreement
DocuSign Envelope ID:29B34BCC-1A11-4063-9EE7-168E6261E415 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, P.O. Box 8181, Hillsborough, North Carolina, 27278, ("County") and Pathways to Change, Inc., a not-for-profit corporation located at 960 Corporate Drive, Suite 408,Hillsborough,NC 27278 ("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 Pathways to Change, 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$11,351.00. 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$2,837.75. 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. DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 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:29B34BCC-1A11-40B3-9EE7-168E6261E415 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:29B34BCC-1A11-40B3-9EE7-168E6261E415 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 Pathways to Change, 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:29B34BCC-1A11-4063-9EE7-168E6261E415 County: Finance&Administrative Services Provider: Pathways to Change, Inc. Orange County 960 Corporate Drive, Suite 408 Post Office Box 8181 Hillsborough,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 I IA and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and onrehi'Lotic 1 ,e'P1r1ovider b �, wiutMsm 12/22/2020 47A5BB033B994D9... John C. Williamson,Executive Director Date DocuSignedwaru�q For and o b�danty Government 12/23/2020 0637994B755E477... Bonnie Hammersley, County Manager Date r DocuSign Envelope ID:29B34BCC-1At1-4063-9EE7-168E6261E415 ORANGE COUNTY-DEPARTMENT USE ONLY Department Party/Vendor Name: Pathways to Change, Inc. Party/Vendor Contact Person: John C. Williamson Contact Phone: 919-245-3309 Party/Vendor Address: 960 Corporate Drive City Hillsborough, State: NC Zip: 27278 Department: Finance & Administrative Services Amount: $11,351 Purpose: FY 2020-21 Outside Agency/Human Services Performance Agreeement Budget Code(s): 10495050-710015 Vendor# 800060 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑No® Contract Type: (Check one)New® Renewal ❑ Amendment ❑ Effective Date 7/l/2020 Approved by Board Yes®Nor-1 Agenda Date: 6/16/2020 DocuSigned by: This agreement is approved as to technical fo fr=78HEFC51493 d_gontel}b:� 12/22/2020 Department Director's Signature .. Date: Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management DocuSigned by: This agreement is approved for sufficiency of ins u ar 6fkaf$"s ecifications,and requirfTJ2!s/2020 Office of the Risk Management Officer 7FDCF9176800498... Date: Financial Services DocuSigned by: This instrument has been pre-audited in the man ferp"e4&AbgAWa1 Government Budget Fiscal Control Act: ... /2 Office of the Chief Financial Officer 7D4E5181ACC1409 Date: Legal Services DocuSigned by: This agreement is approved as to legal form and suft4035CB8304CA4A9 cy 12/23/2020 ew_ Office of the County Attorney ... 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:29B34BCC-1A11-4063-9EE7-168E6261E415 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. DD/IocuSigned by:11 t6 V C,, Wl�dAmS6V, Executive Director 12/22/2020 Certified by: 47'5BB033B994D9... Title: Date: (Provider's Signature) r DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 COVER PAGE Applicant Contact Information Applicant Organization's Legal Name: Pathways to Change Applicant Organization's Physical Address: 960 Corporate Dr. Suite 408, Hillsborough, NC 27278 Applicant Organization's Mailing Address: 960 Corporate Dr. Suite 408, Hillsborough, NC 27278 Applicant Organization's web Address: www.pathwaystochangenc.org Executive Director: John Williamson Telephone Number: 919-245-3309 E-Mail: john(c�pathwaystochangenc.org Tax ID Number: 58-2063924 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 Hill- Orange Total HS HS County-HS Ex. Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 Operations or Personnel Operations Personnel Operations Partner Abuse Intervention $2137.00 $5734.00 $12,386.00 Personnel Personnel $2,300.00 $2215.00 Operations Operations Partner Abuse Intervention (Female Group) $2137.00 $4351.00 Personnel $2214.00 Operations Anger Management $845.00 $2538.00 $6067.00 Personnel Personnel 695.00 $1989.00 Operations Operations $12,Strong Fathers $3238.00 $1807.00 $9198.00 Personnel Personnel $2201.00 $1952.00 Operations Operations Totals $1540.00 $9876.00 $20,586.00 $32.002.00 Cover Page DocuSign Envelope ID:29B34BCC-1A1 1-40B3-9EE7-168E6261 E415 Briefly explain your proposed use of funds: Pathways to Change will use these funds to start and operate a new Partner Abuse Intervention program for females and to start and operate an additional Partner Abuse Intervention group to serve the residents that have been mandated to complete the twenty-six-week course. Pathways will also use the funds to start and operate a twelve-week Anger Management group in Orange County. These programs have a direct bearing on the safety and wellbeing of the residents of Chapel Hill, Carrboro, and Orange County. To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: /11 G�Z/3��e o xecutive Director Date Signature: i 1 �/ c� O / / ,� 02 v v Board Chairperson Date DocuSign Envelope ID:29B34BCC-1A11-40133-9EE7-168E6261E415 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 anv grant awarded. Signature: / "�`v 6 i /3z e Executive Direccto�r� Date Signatur Board Chairperson Date DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): 10/01/1993 2. Agency's Purpose/Mission (no more than a few sentences): Pathways to Change has served the communities of Orange, Chatham, and Durham counties in North Carolina for over 25 years. Pathways is a non-profit organization dedicated to improving social well-being by prioritizing victim safety and offender (batterer) accountability through social change programs. Pathways' primary focus is on group sessions that provide offenders the tools for change through three different programs: Partner Abuse Intervention, Strong Fathers, and Anger Management. 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). Pathways serves offenders using evidence and research-informed curriculum rooted in the theories of the Duluth (new behavior learning) and Emerge (dosage) models. Pathways has earned the approval of the NC Council for Women to offer certified Batterer Intervention programs in Orange, Durham, and Chatham Counties. Pathways is the only organization that serves the three-county area. Pathways has effectively operated all three programs in Durham County and has recently begun hiring additional staff to start and operate all three programs in Orange County 4. Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes/No) YES If yes, is this agency an Orange County Living Wage Certified Employer?YES If no, please briefly explain. Schedule of Positions: #of FTE—Full-Time Paid Positions: 1 #of FTE—Part-Time Paid Positions: 10 Program information P a g e 9 of 37 DocuSign Envelope ID:29133413CC-1A11-40B3-9EE7-168E6261E415 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Partner Abuse Intervention (Male) Program Primary Contact and Title: John Williamson, Executive Director Telephone Number:919-245-3309 E-Mail: John(a-pathwaystochangenc.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) Partner Abuse Intervention meets NC requirements for Batterer Intervention by providing 26 sessions of information and dialogue for participants who have used violence in intimate partner relationships. To complete the program, each participant must attend 26 group sessions and two individual meetings with staff. They must reflect upon past incidents in which they used violence and abuse tactics, and deepen their understanding of motivations, beliefs, and the effects of abuse. Participants must read to the group a "closure" letter which they composed, followed by a group evaluation of the quality of their work. 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 50 42 64 89 Women 2 0 0 Non-binary/Genderqueer Self-Describe Total 52 42 64 89 Race and Ethnicity Black or African-American 17 18 27 40 American Indian or Alaska Native 3 2 Asian 3 4 White 27 14 21 30 Native Hawaiian or other Pacific Islander Two or more races Some other race 8 10 10 13 Total 52 42 64 89 Program information P a g e 10 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 Of the above, how many Hispanic/Latino 8 6 10 13 Of the above, how many non-Hispanic/Latino 44 36 54 76 Total 52 42 64 89 Age 0-5 years 6-18 years 19-50 years 50 40 60 83 51+years 2 2 4 6 Total 52 42 64 89 Geographic Location Town of Chapel Hill 5 10 10 14 Town of Carrboro 5 2 2 3 Orange County(Outside of Chapel Hill/Carrboro) 25 5 10 14 Outside of Orange County 17 25 42 54 Total 52 42 64 89 Income* Low-income(80%of the Area Median Income and Below).Please see income table in the attachments 50 *See note below Total 50 0 0 0 *Pathways has not requested information related to income,so we have no verifiable data to support any claims of low-income participants.A request for this information will be added to our intake forms so we can report accurately in the future. 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 See note below $33,150 $79,034 Total # of Individuals 50 89 Cost Per Individual $546 $883 *Pathways is working with our accountants to establish our financial records according to GAAP (Generally Accepted Accounting Principles)for non-profit organizations. Income and expenses were not consistently entered against programs.We cannot with certainty state actual program income or expenses for accounting years prior to FY 2020. 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 information P a g e 11 o f 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 Program Name: Partner Abuse Intervention (Male) Strategic ❑ Children improve their educational outcomes Objective (please choose onefrom ❑ Residents Increase their livelihood security the Results Framework) X Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result Result 3.2: Residents demonstrate new healthy lifestyle behaviors (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Insert Performance Indicator here. Indicators All participants will attend 26 (Please choose at least 42 64 89 oneperformance sessions of 29 scheduled indicator to report on sessions and any participant from the Results who misses more than 3 Framework,and add scheduled sessions will be additional performance indicators that you terminated and required to would like to report to re-enroll as a new the Towns. Please insert additional rows as participant. needed,listing one per row). All participants will take an abusive behavior survey before and after the 26 42 64 89 sessions to determine their improvement in understanding healthy behavior and beliefs as they relate to equality in intimate partner relationships. All participants will demonstrate respectful, 42 64 89 healthy communication skills by writing and sharing with the group an empathy letter written to their victim(s). Program information P a g e 12 o f 3 7 DocuSign Envelope ID:29133413CC-1A11-40B3-9EE7-168E6261E415 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Partner Abuse Intervention (Female) Program Primary Contact and Title: John Williamson, Executive Director Telephone Number:919-245-3309 E-Mail: John(a-pathwaystochangenc.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) Partner Abuse Intervention for females is a new program proposed for Orange County. From July 2019 — December 2019 seven women have been referred by the courts to a Domestic Violence program for women. The only domestic violence program for women in our area is over 50 miles one direction. Just like the male program, participants will deepen their understanding of motivations, beliefs, and the effects of abuse. Participants must read to the group a "closure" letter which they composed, followed by a group evaluation of the quality of their work. 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 Women 8 Non-binary/Genderqueer Self-Describe Total 0 0 0 0 Race and Ethnicity Black or African-American 4 American Indian or Alaska Native Asian White 3 Native Hawaiian or other Pacific Islander Two or more races Some other race 1 Total 0 0 0 0 1 Of the above, how many Hispanic/Latino Program information P a g e 13 o f 3 7 DocuSign Envelope ID:29133413CC-1A11-40B3-9EE7-168E6261E415 Of the above, how many non-Hispanic/Latino 7 Total 0 0 0 8 Age 0-5 years 6-18 years 19-50 years 8 51+years Total 0 0 0 8 Geographic Location Town of Chapel Hill 2 Town of Carrboro Orange County(Outside of Chapel Hill/Carrboro) 3 Outside of Orange County 3 Total 0 0 0 8 Income Low-income(80%of the Area Median Income and Below).Please see income table in the attachments *See note below Total 0 0 0 0 *Pathways has not requested information related to income,so we have no verifiable data to support any claims of low-income participants.A request for this information will be added to our intake forms so we can report accurately in the future. 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 N/A N/A $18,469 Total # of Individuals N/A N/A 8 Cost Per Individual N/A N/A $2,308.63 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 information P a g e 14 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 Program Name: Partner Abuse Intervention (Female) Strategic ❑ Children improve their educational outcomes Objective (please choose onefrom ❑ Residents Increase their livelihood security the Results Framework) X Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result Result 3.2: Residents demonstrate new healthy lifestyle behaviors (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Insert Performance Indicator here. Indicators All participants will attend 26 (Please choose at least N/A N/A 8 oneperformance sessions of 29 scheduled indicator to report on sessions and any participant from the Results who misses more than 3 Framework,and add scheduled sessions will be additional performance indicators that you terminated and required to would like to report to re-enroll as a new the Towns. Please insert additional rows as participant. needed,listing one per row). All participants will take an abusive behavior survey before and after the 26 N/A N/A 8 sessions to determine their improvement in understanding healthy behavior and beliefs as they relate to equality in intimate partner relationships. All participants will demonstrate respectful, N/A N/A 8 healthy communication skills by writing and sharing with the group an empathy letter written to their victim(s). Program information P a g e 15 o f 3 7 DocuSign Envelope ID:29133413CC-1A11-40B3-9EE7-168E6261E415 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Strong Fathers Program Primary Contact and Title: John Williamson, Executive Director Telephone Number:919-245-3309 E-Mail: John(a)-pathwaystochangenc.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) The Strong Fathers Program is for fathers working to end the cycle of violence in their families. During the 20 weekly sessions, participants develop new tools and strategies for parenting and partnering in an environment of support, friendship, education, and growth. Through role playing, participants learn how to implement the following parenting skills: praise, active ignoring, and giving good directions with warning and consequences. Participants' beliefs about power and control are challenged, and they are equipped to make healthy behavioral choices. 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 30 47 40 56 Women Nonbinary/Genderqueer Self-Describe Total 30 47 40 56 Race and Ethnicity Black or African-American 13 21 18 26 American Indian or Alaska Native Asian 2 1 1 White 12 16 13 19 Native Hawaiian or other Pacific Islander Two or more races Some other race 5 8 8 10 Total 30 47 40 56 Program information P a g e 16 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 Of the above, how many Hispanic/Latino 5 2 8 10 Of the above, how many non-Hispanic/Latino 25 45 32 46 Total 30 47 40 56 Age 0-5 years 6-18 years 1 1 1 2 19-50 years 26 44 38 52 51+years 3 2 1 2 Total 30 47 40 56 Geographic Location Town of Chapel Hill 5 10 10 14 Town of Carrboro 5 2 2 3 Orange County(Outside of Chapel Hill/Carrboro) 15 5 10 14 Outside of Orange County 5 30 18 25 Total 30 47 40 56 Income Low-income(80%of the Area Median Income and Below) Please see income table in the attachments *See Note Below Total 0 0 0 0 *Pathways has not requested information related to income,so we have no verifiable data to support any claims of low-income participants.A request for this information will be added to our intake forms so we can report accurately in the future. 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 *See note $30,303 below Total # of Individuals 56 Cost Per Individual $541.00 *Pathways is working with our accountants to establish our financial records according to GAAP (Generally Accepted Accounting Principles)for non-profit organizations. Income and expenses were not consistently entered against programs.We cannot with certainty state actual program income or expenses for accounting years prior to FY 2020. 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. Page 17 of 37 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 Program Name: Strong Fathers Strategic ❑ Children improve their educational outcomes Objective (please choose onefrom ❑ Residents Increase their livelihood security the Results Framework) X Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result Result 3.2: Residents demonstrate new healthy lifestyle behaviors (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Insert Performance Indicator here. Indicators All participants will watch (Please choose at least the video of Michael's Story one performance 47 40 56 indicator to report on and accept responsibility for from the Results their own actions in the Framework,and add cycle of violence by additional performance indicators that you reporting to the group their would like to report to own cycle of violence story the Towns. Please insert additional rows as needed,listing one per row). All participants will improve in their ability to engage with their child(ren) in ways that are appropriate to the child's 47 40 56 developmental stages through education, implementation, and reporting back to the group for accountability and feedback. All participants through role playing and discussion will demonstrate they have learned the parenting skills 47 40 56 of praise, active ignoring, and giving good directions with warning and consequences. Program information P a g e 18 of 3 7 DocuSign Envelope ID:29133413CC-1A11-40B3-9EE7-168E6261E415 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: Anger Management Program Primary Contact and Title: John Williamson, Executive Director Telephone Number:919-245-3309 E-Mail: John(a)-pathwaystochangenc.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) The Anger Management program is a twelve-session behavior education program that provides participants with tools for discovering triggers for anger and aggressive action cues. Participants explore the origins of anger, how to monitor intensity of angry feelings, strategies for managing anger expression, and how distorted beliefs and thoughts can fuel anger. They practice respectful, controlled, and assertive communication and learn the dynamics of social and emotional competence. This program includes an exercise of writing an empathy letter to determine the participants effectiveness in understanding the effect of their past aggressive behavior. 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 20 33 47 68 Women 5 6 13 18 Nonbinary/Genderqueer 5 1 4 4 Self-Describe 0 0 0 0 Total 30 40 64 90 Race and Ethnicity Black or African-American 10 18 28 41 American Indian or Alaska Native 0 2 1 1 Asian 2 1 2 3 White 13 14 25 30 Native Hawaiian or other Pacific Islander Two or more races Some other race 5 5 8 15 Total 30 40 64 90 Program information P a g e 19 o f 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 Of the above, how many Hispanic/Latino 3 8 8 9 Of the above, how many non-Hispanic/Latino 27 32 56 81 Total 30 40 64 90 Age 0-5 years 0 0 0 0 6-18 years 5 8 5 6 19-50 years 15 30 49 76 51+years 10 2 10 8 Total 30 40 64 90 Geographic Location Town of Chapel Hill 10 5 10 14 Town of Carrboro 5 0 3 2 Orange County(Outside of Chapel Hill/Carrboro) 10 11 22 22 Outside of Orange County 5 24 29 52 Total 30 40 64 90 Income Low-income(80%of the Area Median Income and Below) Please see income table in the attachments *See note below Total 0 0 0 0 *Pathways has not requested information related to income,so we have no verifiable data to support any claims of low-income participants.A request for this information will be added to our intake forms so we can report accurately in the future. 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 *See note $25,039 below Total # of Individuals 90 Cost Per Individual $278.21 *Pathways is working with our accountants to establish our financial records according to GAAP (Generally Accepted Accounting Principles)for non-profit organizations. Income and expenses were not consistently entered against programs.We cannot with certainty state actual program income or expenses for accounting years prior to FY 2020. 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 information P a g e 20 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 Program Name: Anger Management Strategic ❑ Children improve their educational outcomes Objective (please choose onefrom ❑ Residents Increase their livelihood security the Results Framework) X Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result Result 3.2: Residents demonstrate new healthy lifestyle behaviors (please choose one from the Results Framework) RESULTS Actual Projected Projected 2018-19 2019-20 2020-21 Performance Insert Performance Indicator here. Indicators All participants will accept (Please choose at least 30 64 90 oneperformance responsibility and indicator to report on accountability for their own from the Results actions by recording their Framework,and add aggressive behavior incident additional performance indicators that you in the cognitive behavior would like to report to triangle the Towns. Please insert additional rows as needed,listing one per row). All participants will be equipped to respond to 30 64 90 unmet expectations by recognizing their own aggressive behavior cues and responding according to their written strategy for healthy behavioral choices. All participants will demonstrate personal 30 64 90 responsibility for their actions, as well as proficiency in assertive communication and conflict management skills through an empathy letter written to their victim(s). Program information P a g e 2 1 o f 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 GE N�1 'L., '0A: 1 1 1 1 '. �'1 ^i i Outside Agencies/Human Services (Partner Abuse Intervention Program - Male) 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. Juvenile and Adult Justice Services If you selected other, please tell us what function area best aligns with your organization: Please indicate three program goals/performance measures below. A few notes: • If you use percentages, please put the actual number equivalence. • Please ensure your performance measures are outcome based and not outputs. Program Goal# 1 All participants will attend 26 sessions of Partner Abuse Intervention within 29 scheduled sessions. Group facilitators will take weekly attendance and Performance Measure(How will you accomplish your goal?) recommend for termination from the program any participant who misses more than three sessions. Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) 64 Ending FY2020 Projected Results (Outcome) 89 Ending FY2021 Program information P a g e 22 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 GE N�1 t,, °,Ae 1 1 1 1 1. �'1 'e 1 - ill. Outside Agencies/Human Services All participants will demonstrate a new understanding Program Goal# 2 of healthy behavior and beliefs as they relate to equality in intimate partner relationships. Trained facilitators will provide evidence and research-informed instruction that is rooted in the Performance Measure theories of the Duluth (new behavior learning) and (How will you accomplish your goal?) Emerge (dosage) models. Actual Results N/A (Outcome) Ending FYI8-19 Projected Results (Outcome) 64 Ending FY2020 Projected Results (Outcome) 89 Ending FY2021 Program Goal# 3 All participants will learn to communicate with intimate partners in respectful, healthy ways Performance Measure All participants will demonstrate respectful and healthy (How will you accomplish your goal?) communication by writing an empathy letter to their victims and sharing it with the group. Actual Results N/A (Outcome) Ending FYI8-19 Projected Results (Outcome) 64 Ending FY2020 Projected Results (Outcome) 89 Ending FY2021 =4 Program information P a g e 23 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 GE N�1 'L., '0A: 1 1 1 1 '. �'1 ^i i Outside Agencies/Human Services (Partner Abuse Intervention Program - Female) 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. Juvenile and Adult Justice Services If you selected other, please tell us what function area best aligns with your organization: Please indicate three program goals/performance measures below. A few notes: • If you use percentages, please put the actual number equivalence. • Please ensure your performance measures are outcome based and not outputs. Program Goal# 1 All participants will attend 26 sessions of Partner Abuse Intervention within 29 scheduled sessions. Group facilitators will take weekly attendance and Performance Measure(How will you accomplish your goal?) recommend for termination from the program any participant who misses more than three sessions. Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) N/A Ending FY2020 Projected Results (Outcome) 8 Ending FY2021 Program information P a g e 24 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 GE N�1 t,, °,Ae 1 1 1 1 1. �'1 'e 1 - ill. Outside Agencies/Human Services All participants will demonstrate a new understanding Program Goal# 2 of healthy behavior and beliefs as they relate to equality in intimate partner relationships. Trained facilitators will provide evidence and research-informed instruction that is rooted in the Performance Measure theories of the Duluth (new behavior learning) and (How will you accomplish your goal?) Emerge (dosage) models. Actual Results N/A (Outcome) Ending FYI8-19 Projected Results (Outcome) N/A Ending FY2020 Projected Results (Outcome) 8 Ending FY2021 Program Goal# 3 All participants will learn to communicate with intimate partners in respectful, healthy ways Performance Measure All participants will demonstrate respectful and healthy (How will you accomplish your goal?) communication by writing an empathy letter to their victims and sharing it with the group. Actual Results N/A (Outcome) Ending FYI8-19 Projected Results (Outcome) N/A Ending FY2020 Projected Results (Outcome) 8 Ending FY2021 Program information P a g e 25 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 ORANGE COUNTY Outside Agencies/Human Services (Strong Fathers Program) 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. Juvenile and Adult Justice Services If you selected other, please tell us what function area best aligns with your organization: Please indicate three program goals/performance measures below. A few notes: • If you use percentages, please put the actual number equivalence. • Please ensure your performance measures are outcome based and not outputs. Program Goal# 1 All participants will accept responsibility for their own actions in the cycle of violence Performance Measure All participants will watch the video, Michael's Story (How will you accomplish your goal?) and report to the group their own cycle of violence story Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) 40 Ending FY2020 Projected Results (Outcome) 56 Ending FY2021 Program information P a g e 26 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 GE N�1 t,, °0Ae 1 1 1 1 1. �'1 'e 1 - ill. Outside Agencies/Human Services All participants will improve in their ability to engage Program Goal# 2 with their child(ren) in ways that are appropriate to the child's developmental stages. All participants will write a father-child engagement Performance Measure(How will you accomplish your goal?) plan and report back to the group for accountability and feedback. Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) 40 Ending FY2020 Projected Results (Outcome) 56 Ending FY2021 All participants will learn to implement praise, active Program Goal #3 ignoring, and giving good directions with warning and consequences. Performance Measure All participants will demonstrate proficiency through (How will you accomplish your goal?) discussion and role-playing exercises Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) 40 Ending FY2020 Projected Results (Outcome) 56 Ending FY2021 ;Am Program information P a g e 27 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 ORANGE COUNTY Outside Agencies/Human Services (ANGER MANAGEMENT PROGRAM) 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. Juvenile and Adult Justice Services If you selected other, please tell us what function area best aligns with your organization: Please indicate three program goals/performance measures below. A few notes: • If you use percentages, please put the actual number equivalence. • Please ensure your performance measures are outcome based and not outputs. Program Goal# 1 All participants will accept responsibility and accountability for their own actions Performance Measure All participants will record their incident in the cognitive (How will you accomplish your goal?) behavior triangle Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) 64 Ending FY2020 Projected Results (Outcome) 90 Ending FY2021 Program information P a g e 28 of 3 7 DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 GE N�1 t,, °1Ae 1 1 1 1 1. �'1 '1 1 - ill. Outside Agencies/Human Services Program Goal# 2 All participants will respond to unmet expectations with healthy behavioral choices. All Participants will recognize their own aggressive Performance Measure(How will you accomplish your goal?) behavior cues and create a written strategy for healthy behavioral responses. Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) 64 Ending FY2020 Projected Results (Outcome) 90 Ending FY2021 Program Goal #3 All participants will learn assertive communication and conflict resolution skills All participants will share with the group an empathy Performance Measure(How will you accomplish your goal?) letter written to their victim(s) which states what they will do to resolve future conflict. Actual Results N/A (Outcome) Ending FY18-19 Projected Results (Outcome) 64 Ending FY2020 Projected Results (Outcome) 90 Ending FY2021 MW Program information P a g e 29 of 3 7 N I r- 1 1 1 U') Co jn Co m N -0 I I C 7 U- ff} EA Ef3 GG Ef3 K? 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H s] a) a) LL m J Cl) I 0 - o 0 w (Dc�E c�E v C z a)CO) W - Q) a) a) c iu is a) Q .2 O ,U > m o LL LL co d a) � 0 � � Qa 4 co cn aL M UU m a) ~ Q C c E ° � cc U Eli cn � � W � � L) 0 � cN 0UU ISO N � � Fu cU o �� � Ali m �~ c � oO a) o L W O U 0 0 c k k O O U 3 aaa c c U- >o Y o i o Y cNa cm 00 o O �zzU W m H � Ua- UU o -Z � � 0 (D0 (D ca w 10_ I- Z cn 12 U) (o U) U O 0 q C / , C14 mmm _ _ \ Nt � � � a n \ / to mmm _ a (D 7 t-7 _ / mm6q _ _ 2 / / 7 2 q \ mmm _ a \ / \ V) Cl) » - COS 9 E o / 6q09-� _ _ / $ \ \ q lc� Ir n R / mmm _ _ / / qq LO $ Nn _ Cl) q q / , Q LO i _ «a _ _ \ 2 co � cn§ \§ § \ o L \ \ } \ [ 0 w \ ƒ \ / a. a. 9 .g \ 6 2 % � � \ cm / 2 # / 0 J 4 $ t 2 m w R R a / j DocuSign Envelope ID:29B34BCC-1Al1-4063-9EE7-168E6261E415 EXHIBIT `B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: Pathways to Change Program Name: Anger Management (New Program for Orange County) Funding Award: 11,351.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Wages and FICA for group facilitators 3175.00 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. 12 weekly group sessions for individuals who have used aggressive behavior on the road,with strangers,police officers,siblings,friends, co-workers,or other members of the community to whom they do not have an intimate relationship with Participants reduce aggressive behavior by learning their own triggers and cues. Participants increase their emotional intelligence through consistent evaluation of the factors that contribute to their anger 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 All participants will accept responsibility and accountability for their own actions 64 All participants will respond to unmet expectations with healthy behavioral 64 choices All participants will learn assertive communication and conflict resolution 64 skills IDocu Igoe y: 6LL C, (PlaY4S6in, Executive Director 12/22/2020 47A51313033B994D9... Certified b ,& C. Title: Executive Director Date: 8/21/2020 (Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID:29B34BCC-1 Al 1-40B3-9EE7-168E6261 E415 EXHIBIT `B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: Pathways to Change El Program Name: Partner Abuse Intervention - Male Group Funding Award: $11,351.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Wages and FICA costs for program facilitators $500.00 Outreach (Website and Internet Service) $500.00 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. • Male DV Offenders Program: 26 Week Virtual Group Sessions for DV offenders • Provide accurate information that informs participants of the myths and realities of domestic violence Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oran e County,only(all Towns and municipalities). If you use yercentaees,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results All participants will attend 26 sessions of Partner Abuse Intervention within 26 30 scheduled sessions All participants will demonstrate a new understanding of healthy behavior 26 and beliefs as they relate to equality in intimate partner relationships All participants will learn to communicate with intimate partners in 26 respectful, healthy ways. I Docu Igoe y: Executive Director 12/22/2020 61 It C, w10jMSbtn 47A5BB033B994D9... Certified by: �& C . Title: Executive Director Date: 8/21/2020 Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID:29B34BCC-1 Al 1-40B3-9EE7-168E6261 E415 EXHIBIT `B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: Pathways to Change Program Name: Partner Abuse Intervention - Female Funding Award: $11,351.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Wages and FICA costs for program facilitators $2,000 Outreach to DV Coordinated Response Team $500.00 Facilitator Training $1500.00 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. Female DV Offenders Program: 26 Week Virtual Group Sessions for DV offenders Provide accurate information that informs participants of the myths and realities of domestic violence Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oran e County,only(all Towns and municipalities). If you use yercentaees,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results All participants will attend 26 sessions of Partner Abuse Intervention within 8 30 scheduled sessions All participants will demonstrate a new understanding of healthy behavior 8 and beliefs as they relate to equality in intimate partner relationships All participants will learn to communicate with intimate partners in 8 respectful, healthy ways. D—Signed by. ,6Lt C, MA.1MSft, Executive Director 12/22/2020 47A5------------- Certified by. U)4&�&�)title: Executive Director Date: 8/21/2020 Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID:29B34BCC-1 Al 1-40B3-9EE7-168E6261 E415 EXHIBIT `B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: Pathways to Change Program Name: Strong Fathers Funding Award: 11,351.00 Outline how the agency will spend Orange County's funding award. Expense Description Amount Wages and FICA costs for program facilitators $3,176.00 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. The Strong Fathers program provides 20 group sessions of information and dialogue. Participants receive tools for parenting and partnering in an environment of support,friendship,education,and growth. • Participants maintain or increase the time they spend living with their children Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oran e County,only(all Towns and municipalities). If you use yercentaees,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results All participants will accept responsibility for their own actions in the cycle of 40 violence All participants will improve in their ability to engage with their child(ren) in 40 ways that are appropriate to the child's developmental stages. All participants will learn to implement praise, active ignoring, and giving 40 good directions with warning and consequences. ocu i , gne y'':11 6LL C, ( l ayAs6w Executive Director 12/22/2020 47A5BB033B994D9... Certified by: C. ��rLTitle: Executive Director Date: 8/21/2020 (Provider's Electronic Signature) "You will sign this document electronically with your performance agreement. DocuSign Envelope ID:29B34BCC-1A11-40B3-9EE7-168E6261E415 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 07/30/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Heather Salas NAME: Business Insurers of Carolinas aCC Ext: (919)968-4611 AIX No): (919)968-8991 501 Eastowne Drive,Suite 250 E-MAIL HSalas@business-insurers.com ADDRESS: PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515 INSURERA: Continental Casualty Company 20443 INSURED INSURER B: HISCOX Inc 10200 Pathways To Change INSURER C: 960 CORPORATE DRIVE,SUITE 408 INSURER D: Suite 408 INSURER E: HILLSBOROUGH NC 27278 INSURER F: COVERAGES CERTIFICATE NUMBER: 20-21 GL Only 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. 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