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2021-601-E-Aging-Meals on Wheels of Orange Count
DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2021, ("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina, Post Office Box 8181, Hillsborough, North Carolina, 27278, ("County") and Meals on Wheels of Orange County, a not-for-profit corporation, located at 632 Laurel Hill Road, Chapel Hill,North Carolina 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 Provider agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2021 to June 30,2022. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit "A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means,methods,techniques,sequence,safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of$54809. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of$13702.25. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. Orange County Outside Agency Performance Agreement Revised 1012021 Page I of 10 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 e. Once Provider has satisfied its obligations as provided in(d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31;January 1 —March 31 and April 1 -June 30. Reports are due on January 10,April 10,and July 10 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. Termination for Cause. 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. 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 Orange County Outside Agency Performance Agreement Page 2 of 10 Rev.10/21 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 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. e. Waiver. The payment of any sums by the County under this Agreement or the failure of the County to require compliance by the Provider with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 6. Responsibilities of the County. Cooperation and Coordination. The County has designated (Janice Tyler) to act as the County's representative with respect to the Project who shall have the authority to render decisions within guidelines established by the County Manager or the County Board of Commissioners and who shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. 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. v. Sexual Misconduct. Sexual Abuse/Molestation Insurance is required when Provider works directly one-on-one with children, elderly or other at-risk populations. 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 Orange County Outside Agency Performance Agreement Page 3 of 10 Rev.10/21 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 • 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 • Sexual Misconduct $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. For more information see the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements, (each document is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing division/contracts.php.) 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. 8. General Provisions. 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 identified, on the list created by the State Treasurer pursuant to G.S. 147-86.58. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor identified, on the list created by the State Treasurer pursuant to G.S. 147-86.81. b. 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, which is incorporated herein by reference and can be viewed at http://www.oran eg cogptync. og v/departments/purchasing_division/contracts.php. The County may enforce this provision by an 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. c. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of,or the performance or non-performance of,this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County,North Orange County Outside Agency Performance Agreement Page 4 of 10 Rev.10/21 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. Binding arbitration may not be initiated by either Party, however,the Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. d. 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 Orange County Living Wage Policy, which is incorporated herein by reference, can be viewed at: http://www.orang_ecoggtync. og v/departments/purchasing_division/contracts.php. The County's living wage is $15.40 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. e. 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. f. 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. g. 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. h. 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. i. 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. j. 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. k. 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. Orange County Outside Agency Performance Agreement Page 5 of 10 Rev.10/21 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 1. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the Provider and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. m. Notices.Any notice required by this Agreement shall be in writing and delivered by certified or registered mail,return receipt requested to the following: Orange County Provider's Name Meals on Wheels of Orange County Attention: Janice Tyler Attention: Rachel Sobel Bearman P.O. Box 8181 Address: 632 Laurel Hill Road Hillsborough,NC 27278 Chapel Hill,NC Email.jtyler@orangecountync.gov Email: execdirector@mowocnc.or n. 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 11 A 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. "batW @AOehalf of the Provider 10/22/2021 Race o el Barman,Executive Director Date FWbaudganbO.eha4f of Orange County Government 156V1alt, hkKmtrsb-� 10/24/2021 Bonnie Hammersley, County Manager Date Orange County Outside Agency Performance Agreement Page 6 of 10 Rev.10121 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 ORANGE COUNTY—DEPARTMENT USE ONLY Party/Vendor Name: Meals on Wheels of Orange County Party/Vendor Contact Person: Rachel Sobel Bearman Contact Phone: 919-942-2948 Party/Vendor Address: 632 Laurel Hill Road City Chapel Hill State: NC Zip: 27514 Department: Aging Amount: 54809 Purpose: Budget Code(s): 10495050-719053 Vendor# 800080 (N/A if new vendor) Vendor is a BOCC consultant? Yes ❑ No❑ Contract Type: (Check one) New ❑ Renewal Amendment ❑ Effective Date 7/1/2021 Approved by Board Yes❑No❑ Agenda Date: This agreement is approved as to technical form and content and I as Department Director affirmatively state work on this project has not been initiated prior to execution of the agreement: IL ned by: fi�� 10/22/2021 Department Director's Signature4FA Date: Agreements for emergency services or repair are not subject to the above affirmation. If services related to this agreement have already begun or been completed please briefly describe the nature of the emergency condition that was addressed: 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-f-inawgwaWandards,specifications,and requirements: Office of the Risk Management OfficerF&a rbVlnt,{fb Date:10/22/2021 Financial Services This instrument has been pre-audited in tocomquired by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer ('� Date: 10/22/2021 aa€s7 Legal Services This agreement is approved as to 1 d'�ganlisufficiency: ak L Awil, Tma 10/24/2021 Office of the County Attorney Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: Orange County Outside Agency Performance Agreement Page 7 of 10 Rev.10121 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 Exhibit A Provider's Outside Agency Application Orange County Outside Agency Performance Agreement Page 8 of 10 Rev.10/21 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 Exhibit B Provider's Revised Scope of Services and Program Budget Orange County Outside Agency Performance Agreement Page 9 of 10 Rev.10121 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 ATTACHMENT "A" Orange County Certifications—FY 20 - Outside Agency Performance Agreement Chief Contact,Administrators,Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name,title,residential address;phone and email address and if possible, fax number. 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: Certified b 1� � Title: Executive Director Date: 10/22/2021 za Y �D�Fa 59724sn (Provider's Signature) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev.10121 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 NCCHAP7 ACORD. CERTIFICATE OF LIABILITY INSURANCE F DATE TE(MMDD/ YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nayab Alam The CIMA Companies, Inc. PHONE 703-778-7304 FAX 703-778-7354 A/C,No,Ext: (A/C,No): 2750 Killarney Dr, Suite 202 E-MAIL ss: nalam@cimaworld.com Woodbridge,VA 22192-4124 CUSTOMER ID#: 703 739-9300 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Alliance of Nonprofits for Ins 10023 Chapel Hill-Carrboro Meals on Wheels INSURER B:Hartford Underwriters Insurance 30104 dba Meals on Wheels Orange County, NC INSURER C: `7 Carolina Casualty Insurance Com 10510 PO Box 2102 INSURER D: Chapel Hill, NC 27515 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR D POLICY NUMBER MM/DD MM/DD/YYYY LIMITS A GENERAL LIABILITY X 202136882 07/01/2021 07/01/2022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE F* OCCUR MED EXP(Any one person) $20,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ A AUTOMOBILE LIABILITY X 202136882 07/01/2021 07/01/2022 COMBINED jSINGLE LIMIT $1000000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION 6S60UBOG11045221 07/01/2021 07/01/202 X WCSTATU- Y/N OTH- AND EMPLOYERS'LIABILITY T RY LIMIT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? �N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Liquor Liab 202136882 07/01/2021 07/01/2022 $1,000,000 C D&O DCP1231894P9 �07/03/2021 07/03/2022 $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certtificate holder is an additional insured but only with respect to the operations and activities of the named insured. Certificate is subject to all policy conditions, exclusions, limits and terms. CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Attn: Human Services ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron St. PO Box 8181 Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S401041/M400750 N PA DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 COVER PAGE Applicant Contact Information Applicant Organization's Legal Name: Chapel Hill Carrboro Meals on Wheels, INC DBA Meals on Wheels Orange County, NC Applicant Organization's Physical Address: 632 Laurel Hill Road, Chapel Hill, NC 27514 Applicant Organization's Mailing Address: PO BOX 2102 Chapel Hill, NC 27515 Applicant Organization's Web Address: www.MOWOCNC.org Executive Director: Rachel Sobel Bearman Telephone Number: 919-942-2948 E-Mail: execdirector@mowocnc.org Tax ID Number: 59-1721954 Funding Request Please list all Fiscal Year 2022 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 Meal cost,delivery+check-In $16,500 $37,273 $54,809 $108,582 Operations Operations+ Operations +Personnel Personnel +Personnel Totals $16,500 $37,273 $54,809 $108,582 (=1,983 (=4,480 (=6,587 (13,050 meals meals meals meals delivered) delivered) delivered) delivered) Briefly explain your proposed use of funds: Funds would be used to cover both operational expenses (70%) and personnel (30%). 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: January 10, 2021 Executive Director Date Board Chairpe Signature: January 10, 2021 Cover Page P a g e 6 o f 2 2 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 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 ❑ x❑ a) Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, or Orange County? ❑ x❑ 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? ❑ x❑ c) Current beneficiaries of the program for which funds are being requested? ❑ x❑ 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: January 10, 2021 Executive Director Date —JliiiL� 2 — Board Chairpe Signature: January 10, 2021 Cover Page P a g e 7 o f 2 2 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year):09 1976 2. Agency's Purpose/Mission (no more than a few sentences): To enhance the well-being of older adults by alleviating hunger and reducing isolation. 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). For the past 44 years, Chapel Hill Carrboro Meals on Wheels (CHCMOW) has been faithfully serving older adults in Orange County. On June 29, 2020 Orange County Rural Alliance officially merged into CHCMOW, forming Meals on Wheels Orange County, NC. In response to the merger and COVID we increased meal distribution by 17,000 meals, a 39%increase over 2019, pivoted our operations to meet COVID safety requirements, expanded services to include emergency food and supply distributions, and widened our donor base to help fund our growth. We enter 2021 as a financially and structurally strong non-profit. 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: 4 PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 8. Program Name: Meal Delivery & Check-In Program Primary Contact and Title: Rachel Bearman, Executive Director Telephone Number: 919-942-2948 E-Mail: execdirector(@mowocnc.org 8. 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) MOWOCNC delivers balanced meals and check-ins to older adults, homebound adults,adults with disabilities and those convalescing, who do not have access to, or the ability to prepare healthy meals. MOWOCNC supports each recipient's efforts to age in place with dignity, providing sustenance and human connection Program information P a g e 8 of 2 2 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 while improving health, alleviating hunger and reducing isolation. MOWOCNC improves the livelihoods security as well as health outcomes of our recipients and we play a vital role in ensuring community network of basic human services and infrastructure that maintains, promotes and protects the well-being of county residents. 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 2019-2020 2019-20 2021-22 (OCRA#) (OCRA#) 2020-21 Gender Men 110(37) 119(30) 171 146 Women 210(88) 224(66) 239 270 Non binary/Genderqueer - - - Self-Describe - - Total 320(125) 343(96) 410 416 Race and Ethnicity Black or African-American 131(52) 145(36) 167 170 American Indian or Alaska Native - 2 2 Asian 5 5(0) 8 8 White 170(73) 189(60) 224 228 Native Hawaiian or other Pacific Islander - Two or more races Some other race 14(0) 4(0) 8 8 Total 320(125) 343 (96) 410 416 Of the above, how many Hispanic/Latino 14(1) 4(0) 10 8 Of the above, how many non-Hispanic/Latino 306(124) 339(96) 400 408 Total 320(125) 343 (96) 410 416 Age 0-5 years - - - 6-18 years - - - 19-50 years 10 8(0) 12 12 51+years 310(125) 335(96) 398 404 Total 320(125) 343(96) 410 416 Geographic Location Town of Chapel Hill 157 222 168 191 Town of Carrboro 91 75 97 85 Orange County(Outside of Chapel Hill/Carrboro) 72(125) 46(96) 145 140 Outside of Orange County - - Total 320(125) 343 (96) 410 416 Program information P a g e 9 of 2 2 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 Low-income(80%of the Area Median Income and Below) Please see 410 400 income table in the attachments 320(125) 343 (96) Total 320(125) 343(96) 410 416 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 2019-20 Projected 2020-21 Projected 2021-22 CHCMOW# MOWOCNC MOWOCNC Total Cost of Program $388,241 $497,713 $541,046 Total#of Individuals 343 410 416 Cost Per Individual $1,132 $1,213 $1,300 Cost Per Meal Delivered —$7.23 —$7.81 —$8.32 Actual 2019-20 OCRA# Total Cost of Program 73,355.77 Total#of Individuals 96 Cost Per Individual* $764 *Cost per individual is significantly less than CHCMOW(above#'s) because from July into mid-March OCRA was only paying for one meal per week. 9. Performance Indicators For Chapel Hill and Carrboro applicants: Please complete the following chart with information about the Strategic Objective, Intermediate Result, and the Agency Performance Indicator for each program for which you are applying for funding. Please see the Results Framework in the Attachments section as a reference. Program Name: Strategic ❑ Children improve their educational outcomes Objective (please choose one from X Residents Increase their livelihoods security the Results Framework) X Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result 2.1 Residents access the most appropriate social safety net services (please choose one from the Results Framework) 3.2 Residents demonstrate new healthy lifestyle behaviors RESULTS Actual Projected Projected 2019-20 2020-21 2021-22 Performance 2.1 %and#of program 343—100% 410 participants that receive food OCRA: 416 Indicators assistance Program information Pa g e 10 of 2 2 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 3.2%and#ofprogram Estimate 58%— Estimate 58%— 60%—250 participants who report new, 200 individuals 237 improved or restored,social Survey to be connections. completed in January 2021 tracking social isolation/loneliness OCRA: 3.2%and#of program 343—100% 410 416 participants that consume fresh OCRA: ood Program information P a g e 1 1 o f 2 2 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 ORANGE COUNTY NXW i 1 i c )LINA 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. Other If you selected other, please tell us what function area best aligns with your organization: Unsure which to choose: Food or senior services as we fall under both. Please indicate three program goals/performance measures below. A few notes: • If you use percentages, please put the actual number equivalence. • Please ensure your performance measures are outcome based and not outputs. Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents. Equitable access to Meals on Wheels service across Orange County [Increase meal delivery and check-ins in Program Goal# 1 rural north to match services in southern Orange County to reduce food insecurity and social isolation/loneliness.] Performance Measure # of northern rural recipients who have option to receive (How will you accomplish your goal?) at least 5 meals per week and regular check-ins. Meal Delivery: As of March 2020 all northern rural recipients have access to and receive 5 meals per week Actual Results (faster achievement due to COVID and change in (Outcome) catering operations.) 79 Ending FY19-20 Check-In: rural north recipients check-in lx/week. 79 Meal Delivery: All northern rural recipients have access to 5 meal/week. 65 Projected Results (Outcome) Check-in: All rural recipients have at least 3 check-ins Ending FY20-21 per week(virtual) or if/when receive hot meal delivery— in person check-ins. 60 if virtual 65 if inperson) Projected Results Meal Delivery: 96 N. Orange hL (Outcome) Check-In: 86 N. Orange (86 if virtual; 96 if in person) Ending FY21-22 Program information P a g e 12 o f 2 2 DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 ORANGE COUNTY NORTI I CN"Zt.lLINA Outside Agencies/Human Services Program Goal#2 Reduce Isolation/loneliness amongst older adults, # of recipients that self-report on recipient survey that Performance Measure(How will you accomplish your goal. MOWOCNC has helped reduce social isolation & ?) loneliness. Actual Results Survey to be completed in January 2021. Anecdotal evidence suggests approximately 58% of recipients (Outcome)Ending FY19-20 report reduced social isolation/loneliness. Projected Results 237 recipients (Outcome) Ending FY20-21 Projected Results 250 recipients (Outcome) Ending FY21-22 Community Outreach: Increase# of Volunteers to Program Goal#3 increase meal delivery service Performance Measure # of new volunteers (How will you accomplish your goal?) 370 volunteers (During COVID using significantly fewer Actual Results volunteers for once per week delivery of frozen meals and (Outcome) distribution of emergency food and supply boxes). Ending FY19-20 Volunteer lists have grown with offers, but limited options. Projected Results If return to daily weekday delivery will need to ramp up (Outcome) volunteer recruitment to at least 330 volunteers to meet Ending FY20-21 delivery demand. Projected Results 450 volunteers (Outcome) Ending FY21-22 Program information P a g e 13 of 22 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 Community Impact Award If you are applying for the Town of Chapel Hill's Community Impact Award, please provide responses to the questions below. All other applicants, please skip these questions. (Responses should not exceed 100 words per question) 1. Please describe the impact the proposed programs will have on the target population. Please include specific quantitative and qualitative data in your response. In 2020, MOWOCNC increased meal distribution by 39%, distributing over 17,000 more meals, with a significant increase in Chapel Hill residents served. The award will help sustain this level of service. Delivery of healthy meals accompanied by friendly check-ins, help improve health, alleviate hunger and reduce isolation. Studies show that MOW recipients (average after 30, 90 & 120 days) have reduced emergency room visits (20%), hospitalization rates (36%) and nursing home usage (30%). Moreover, they report healthier eating, improvement in mental health, and reductions in the rate of falls, feeings of isolation and loneliness, and anxiety about aging at home. 2. What methods/tools will your organization use to evaluate the proposed program's effectiveness? Please include specific examples, such as a logic model. Inputs: Staff, Volunteers, Supplies, Equipment, Partnerships, Funding Outputs: Meals delivered, human connections, referrals. Outcomes: Maintain increased service to recipients. Reduced food insecurity. Reduced isolation/social isolation. Sustained ability to age in place. Evaluation:January 2021 new recipient survey will be launched that includes both food insecurity and social isolation and loneliness scales. This data will be compared against recipient intake questions as well as national Meals on Wheels data to evaluate the effectiveness of our program. Moreover, qualitative data collected from recipient interactions and conversations with staff or volunteers are captured, tracked and will be analyzed in conjunction with survey data. 3. Please briefly describe how your proposed programs aligns with evidence-based approaches to addressing human service need(s). The core of our service is the delivery of consistent, nutritious meals and friendly check-ins. Access to good nutrition is critical as older adults are often at risk of malnutrition given the biological, social, economic and functional challenges that often accompany aging and limit a senior's ability to acquire, prepare and consume nutritious foods. Research suggests that receiving MOW services reduces food insecurity rates by up to 28%. Moreover, MOW recipients report feeling less isolated, less anxious about aging in place and more secure in Program information Pa g e 14 of 2 2 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 their homes reducing the negative health consequences of isolation and associated healthcare costs. 4. Please describe one to three key partnerships/collaborations that add the most value to the success of the proposed programs. • Meals on Wheels America: Resource for studies, research, data, program development, and implementation strategies. Collective knowledge and practice from MOW's across the US. • Chapel Hill, Carrboro and Orange County: provide consistent funding through human service grants, particularly vital partner as we move through pandemic as conveners and resource hubs. Specific to this award: funding will offer support in a transition year, enabling us to maintain our increased level of meal deliveries while we expand our development operations to match the level of services provided to ensure long-term sustainability. • St Thomas More: use of office space and facilities Program information Pa g e 15 of 2 2 DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 4. ATTACHMENTS Description of Required Attachments a) Financial Audit A recent financial audit that should cover CY2019, for calendar year agencies, and FY2019-20, for fiscal year agencies. For agencies with prior year revenues totaling $500,000 or more a financial audit, prepared by a certified public accountant is required. Agencies with prior year revenues of less than $500,000 may submit a completed Schedule of Receipts and Expenditures form (see application materials), in lieu of an audit/report. Agencies with a certified audit/report should not complete the form. Schedule of Receipts and Expenditures form is listed on the Town's and county website here. b) Agency Budget Please complete the provided template or submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template. Please explain other in your budget). Agency Budget Template is listed on the Town's and County website here. Please submit In PDF form only. c) Program Budget You may complete the provided template, or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template. Please explain other in your budget). Program Budget Template is listed on the Town's and County website here. Please submit in pdf only. d) IRS Federal Form 990 A copy of the agency's 2019 Form 990 is required. The specific form depends upon the agency's financial activity. Review the IRS'table guide,for more details. For Form 990-N (e-postcard)filers, include a copy of the postcard,with the agency's application materials. e) NC Solicitation License A copy of the agency's current solicitation license is required. Organizations that solicit contributions in North Carolina,directly or through a third party, must renew their licenses annually. For more details, refer to the NC Secretary of State's licensing website and its Frequently Asked Questions Guide (PDF), about exemptions. If exempt per N.C.G.S.§131F-3,include a copy of the exemption letter with the agency's application materials. f) IRS Federal Tax-Exemption Letter A copy of the agency's current IRS tax-exempt letter that confirms its nonprofit status is required. An agency can request a copy of its letter from the IRS' Customer Account Services. g) List of Board of Directors Provide the following information about each board of director's member: name, telephone number, address, occupation or affiliation of each member and the list must identify the principal officers of the governing body, and length of term. DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 h) Solid Waste Program Fee (SWPF)Verification This fee finances Orange County's recycling and waste reduction program. Submit either a.) proof of payment of the agency's FY 2019-20 Solid Waste Program Fee, OR b.) a statement on agency letter head indicating exemption and specify the person(s), business, etc. that is responsible for paying this fee. i) Certificate of Liability Insurance A copy of the agency's current certificate,from the agency's insurance carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker's Compensation compliance, include a statement explaining why,with the agency's application materials. NOTE: Proof of insurance is not required at the time of application submission. If your agency is approved for funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and certificate holder and provide coverage for the duration of the funding period (July 1 —June 30). Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any stipulated insurance coverage. NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the Town or County. Please contact the staff identified on the Submission Requirements on Page 2 if you have questions or would like to request a review of your insurance requirements. Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required INSURANCE TOWN OF CARRBORO TOWN OF CHAPEL HILL ORANGE COUNTY3 Worker's Limits for Coverage A- Compensation' Limits for Coverage A-Statutory State NC,for Limits for Coverage A-Statutory Statutory State NC,for each each employee State NC,for each employee employee Limits for Coverage B- Limits for Coverage B-Employers Limits for Coverage B- Employers Liability of: Liability of:$100,000 Each Employers Liability of: $1 million Each Occurrence$100,000 BID for each $500,000 each accident,Occurrence employee $500,000 BID for each $1,000,000 BID limit $500,000 BID limit employee $500,000 for BID limit Commercial General $100,000 Property Liability Damage Liability $1 Million Bodily Injury $1 million Each Occurrence $1 million Each Occurrence $2 million Aggregate $2 million Aggregate and Property Damage Limit Automobile Liability $1 million Each Occurrence Not Applicable *Only required for agencies doing $1 million Each Occurrence travel as part of the agreement with the Town. Professional Liability Not Applicable $1 million Each Occurrence $1 million Each Occurrence $2 million Aggregate $2 million Aggregate Sexual Abuse& Not Applicable $1 million Each Occurrence $1 million Each Occurrence Molestation $2 million Aggregate $2 million Aggregate DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 *Only required for agencies doing direct work with minors(under the age of 18). $1 million Each Occurrence Cyber Liability $2 million Aggregate Not Applicable *Only required for agencies $1 million Each Occurrence transmitting personal identifiable $2 million Aggregate information that is disseminated electronically. ■ Visit the NC Industrial Commission's website for more information regarding Coverage A.Also, note that if an agency uses subcontractors, it must require subcontractors to have workmen's compensation insurance. ■ Bodily Injury by Disease (BID). ■ Please visit Orange County's Risk Management page for more information about the County's Minimum Insurance Requirements. ■ For additional information regarding the Town of Chapel Hill's Minimum Insurance Requirements, please contact the Office of Risk Management or Business Management. Town of Chapel Hill At-your-Service. 2020 Income Limits US Department of Housing and Urban Development (HUD) Durham-Chapel Hill Metropolitan Statistical Area (Durham, Orange, and Chatham Counties) Income Level 1 2 3 4 5 6 7 8 person people people people people people people people 30%area median $19,100 $21,800 $24,550 $27,250 $30,680 $35,160 $39,640 $44,120 income 50%area median $31,850 $36,400 $40,950 $45,450 $49,100 $52,750 $56,400 $60,000 income 60%area median $38,200 $43,680 $49,140 $54,540 $58,920 $63,300 $67,680 $72,200 income 80%area median $50,900 $58,200 $65,450 $72,700 $78,550 $84,350 $90,150 $96,000 income Attachments Pa g e IS of 2 2 o ms)nUvel opeID:4mTc$21E4-9G8A Dm9D34Em» R m © @ a n a _ E 'S 2 & \ / ƒ J % % \ � k / V $ / u \ 7 § 0 2 � _ 0aj 0 \ E /� � ' ' 2E � GGE \ 3 � f u ., » � a 2Q) ¥ _ ° a 2 k (A � _ _ $ » Ca +10 E a � % r_ U � / - -0Q) \ LL u \ — � \ \ '� O r4 2 — 4-0 & CL5 CL E / X $ 3 ) > \ 4-1 § J= (A0 2 E2 CA r \ \ \ ) \ 2 � wpm = i 0u [ 0E [ § 22u / 0 A ° ~ � E� \ � ƒ ) i 0 \ % 3 2 m ® 0 E § % 2 Q) j 2 . ƒ 0 / % _ ma e m u u 0 . 5 a, \ 0 m = 2 • _ ) 41 \ / w w \ y � \ % � ? � 2 � 22 / a) f \ m < m E ƒ C 2 ° / / k � f0 Ew § § / � § a / \ f ¢ 2 'v \ / '0 O m � 0 3 % » § ° 0 3 R7 I ) " W 3 E 0 k / ° S = / / © / # EZ 0 d \ \ 22 \ \ \ / o �� K § 0 > s / t - E & _ / / f p O � \ J0 / ƒ - % \ $ � ƒ e e ± m E 0 s aj k / ; 0u CL I 0 u / � 2 = 0 � u \ � 0 u J 7 E \ § ,e 0 ® � ) \ \ ® 2 / - k \ \ \ E t LAu = $ = 3 = , a \ / 5 2f ) \ & \ W \ ¢ ± CL aj \ § ± g = o k \ DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 Strategic Objective 1: Children improve their education outcomes Intermediate Result 1.1: Children birth-to-K access early childhood development opportunities Agency Performance Indicators ■ %and#of children receiving scholarships who attend licensed, 4-5-star child care facilities ■ %and#of program participant children who are read age-appropriate books in their home once a week ■ %and#of children referred to socio-emotional health services that complete an age appropriate therapeutic or enrichment program Intermediate Result 1.2: Children demonstrate new grade-level-appropriate skills(grades K-12) Agency Performance Indicators ■ %and#of program participants that are promoted to the next grade ■ %and #of program participants that improve grades by end of program period ■ %and #of program participants that improve classroom behavior ■ %and#of program participants that express greater confidence in their ability to be successful at school % and #of program participants that express greater confidence in their leadership and pro- social abilities % and # of children referred to socio-emotional health services that complete an age appropriate therapeutic or enrichment program ■ % and #of program participants who plan on attending post-secondary education Strategic Objective 2: Residents increase their livelihoods security Intermediate Result 2.1: Residents access the most appropriate social safety net services Agency Performance Indicators ■ % and #of program participants with knowledge of appropriate social services ■ % and # of completed referrals ■ % and # Client satisfaction rates ■ % and #of program participants who meet at least 1 financial goal ■ % and #of program participants who maintain or improve their housing status ■ % and #of unduplicated community members who receive emergency shelter services ■ % and # of program participants who are homeless or experiencing unstable housing who obtain housing ■ % and # of individuals that receive abuse and neglect prevention and response services ■ % and #of program participants that receive food assistance ■ % and # of individuals who receive emergency financial assistance for essential needs ■ % and # of individuals who receive legal information, services or referral ■ % and # of participants who do not become court involved during the program Intermediate Result 2.2: Residents increase job skills appropriate for the local economy Agency Performance Indicators ■ % and #of participants who pass ESL tests ■ % and # of participants who self-report improved English language abilities ■ %and#of participants who earn GEDs ■ % and # of program participants who secure employment Attachments DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 ■ % and #of program participants who report improved wages and benefits ■ % and # of program participants who report that services enabled employment, education or training ■ % and #of participants who increase incomes (wages, disability, public benefits, or other income) ■ % and #of participants who maintain incomes (wages, disability, public benefits, or other income) Strategic Objective 3: Residents improve their health outcomes Intermediate Result 3.1: Residents access basic health care services(primary, behavioral,dental) Agency Performance Indicators ■ %and #of program participants that report they have access to primary care ■ %and #of program participants that report they have access to behavioral care ■ %and #of program participants that report they have access to dental care ■ %and# of program participants who report they have improved access to health care services ■ % and # of preventive screenings provided ■ % and#of individuals referred to health promotion and/or healthcare services ■ % and #of program participants that report they have access to substance abuse treatment Intermediate Result 3.2: Residents demonstrate new healthy lifestyle behaviors Agency Performance Indicators ■ #of people reporting healthier functionality and lifestyle behaviors (improved nutrition, conflict resolution skills, stress reduction practices, exercise at least 30min 3x a week, annual check-ups, etc.) ■ % and #of program participants who demonstrate new physical skills that support their independence ■ %and#of program participants who demonstrate new, improved, or restored social skills ■ %and#of program participants who demonstrate new, improved, or restored life skills ■ %and#of program participants who report new, improved, or restored social connections ■ %and#of program participants who meet one wellness goal ■ %and#of program participants who comply with treatment ■ %and#of hospitalization rates among program participants with substance abuse and/or psychiatric disorders ■ %and#of program participants that consume fresh food Other Measures ■ Total residents served ■ %and #of agencies that pay employees a living wage ■ %and #of agencies that offer health benefits to employees Key Terms ■ Goal:The longer-term, wider change to which the program contributes. ■ Strategic Objective (SO):The benefit expected to occur for beneficiary groups. SOs express the central purpose of the program in a realistic, specific, measurable way. ■ Intermediate Result (IR):The expected change in identifiable behaviors of a specific group or the expected change in systems, policies or institutions required to achieve the strategic objectives. Attachments DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 ■ Output:The goods, services, knowledge,skills, attitudes and enabling environment that are delivered by the project(as a result of the activities undertaken). ■ Indicators: Quantitative or qualitative factors or variables that provide a simple and reliable means to measure achievement,to reflect the changes connected to an intervention, or to help assess the performance of a development actor. Performance indicator statements should be SMART(specific, measurable, achievable, relevant,time bound). Measurement In a results framework, results statements are measured through performance indicators. Agency performance indicators will be measured and reported on annually by funded agencies. The Human Services Program will report on the overall results. During the first year of implementation of the results framework, staff will determine the appropriate frequency of measurement and reporting. We anticipate being able to disaggregate measures by gender, race, ethnicity, age, and disability status. Attachments DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 Agency Budget Operating Budget for entire Agency AGENCY NAME: Actual Estimated Projected Percent PROGRAM REVENUE 2019-20 2020-21 2021-22 Change Private Donations $ 412,031 $ 309,806 $ 236,000 -24% Program Generated Revenue $ 58,174 $ 43,002 $ 48,000 12% Local Government Grants: Human Services-Town of Carrboro $ 13,500 $ 15,000 $ 16,500 10% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 10,500 $ 28,000 $ 37,273 33% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 21,310 $ 44,823 $ 54,809 22% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ - $ - $ - 0 State Government $ - $ - $ - 0 Federal Government(CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ 154,182.00 $ 95,608.00 $ 48,000.00 $ (0.50) Other Revenue $ 68,300 $ 3,282 $ 12 $ (1.00) Total Program Revenue $ 737,996 $ 539,521 $ 440,594 -18% PROGRAM EXPENSES Compensation $ 104,532 $ 167,857 $ 178,826 7% Rent& Utilities $ 3,428 $ 5,961 $ 5,040 -15% Supplies & Equipment $ 236,477 $ 286,347 $ 312,962 9% Travel &Training $ 2,497 $ 4,675 $ 3,250 -30% Other Expenses: $ 41,308 $ 32,873 $ 40,968 25% Total Program Expenses $ 388,241 $ 497,713 $ 541,046 9% SURPLUS/(DEFICIT) FOR PERIOD: $ 349,755 $ 41,808 1 $ (100,452) -340OX011 Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. FY 2021-22 Agency Budget DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 MOWOCNC shows a significant surplus for 2019-2020. MOWOCNC formed at the end of June 2020 with the merger of Orange County Rural Alliance into Chapel Hill Carrboro Meals on Wheels. Exepnses for OCRA prior to June 2020 do not appear in this budget breakdown. When OCRA closed, $92,000 of funds were granted to MOWOCNC. The remaining surplus of$257,755 was from COVID emergency funding grants through Meals on Wheels America and other granting agencies as well as individual donations. The surplus has been used to increase our reserves to meet stated guidelines of 6 months of annual operation expenses (reserves that had been depleted by previous deficits)to bring us in compliance with our bylaws. The remiaining surplus of approximately $179,755 will fund projected budget deficits in 2021 and 2022 (based on our increased service levels (#of meals delivered), average number of years recipients receive service, and the expected loss of significant COVID relief funding). FY 2021-22 Agency Budget DocuSign Envelope ID:41`676C90-21 E4-4097-A8AC-0087D34EB013 s d 0 t m c d m m m m m m m m m m m m m m m c ' O c U y O U N C K V N H LL 7 C m C W ° 010 m £ U O m 2 w U ° z a O yOj Q W W m `y = V W u u 10 u L C m '£ F o o u LL N N O s UM o- W ° ° a, N W _ W O c O O O T U1 0 W W Q W W W W W O n O 3 t ¢ O w E £ m m m m x u a li z m u rc d s s s E c� c E C C 8 c E E r m E E c8 E E E ° m E m 8 N `� � E c°� U U E E `� o N N E °? E o a 'm d E m o ° E c m E m Y E E °m E E m C E O E O Y O m - m — O m L O O C m M O yco m m N 03 LCQQ� m (p C y 3 y U c a E E Q ° MOL Y C 0] N y ry o a m m m Oo N m i m m c t0 V 00 M M N ^ N N N OP N O �O m O w mw n w N N w N N Ol N L M V V N M M vt V O M N V 6 1p Hf ^ VI 01 N N V N 1� OP a N Vf Vf VI N ill ill I� ^ N N 1� N N N �l1 Vf ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ N N N N N N N N N N N N N N N N W R Vl u u u u u u u u u u u u u u u u Z Z Z Z Z Z IZ Z Z Z Z Z Z Z IZ Z « > ° ° = E E ° l7 E _ _ ° _ _ O O F. W. W. W.� n n O W.n W.n O _ > � I> m w _ u u u I u u 0 U 0 lu lu I u u '6 E o E o Y _ 'c t o Y t oOm cc mu Omao Q is oma iWo o >! o o ° o w o °° mN Em a u a s N u m LL 00 `o c t O m a W U o o m u 2 O w m m m m m m m u > u o >° a a a a a a a a W w W W R z � w E w w n m E - w E m « t E 000 K d V N H Q OO U ? N N W 3 M M E R z w 1 c w o �. E m +, ° o u u l7 m ie Z vLi s I DocuSign Envelope ID:4F676C90-21 E4-4097-A8AC-0087D34EB01 3 Delivering more than MEALS meals since 1976 lie on W H E E L S ORANGE COUNTY, NC Board of Directors: January 10, 2021 Patricia Bergey, Solid Waste Program Fee 2021 Chair AlexAuriti Meals on Wheels Oraneg County, NC Jordan Buck 632 Laurel Hill Road Sharon Bushnell Chapel Hill, NC 27514 Michelle Campbell Located at St Thomas More Catholic Church South Campus, MOWOCNC Carolyn Cattle utilizes space within St Thomas More. St Thomas More covers such fees on Gregg Flynn behalf of the organization. Haniya Mir Mary Passannante Brian Rowe Richard Schramm Kit Stanley Lee Strange Jennifer Thomason Norma White Rachel Bearman, Executive Director St Thomas More South Campus 632 Laurel Hill Road Chapel Hill NC 27514 PO Box 2102 Chapel Hill NC 27515•919-942-2948•www.chcmow.org MEALS ON WHEELS AM ERkCA 2020 MEMBER EXHIBIT "B" Scope of Services — FY 2021 -22 Outside Agency Performance Agreement Agency Name : Meals on Wheels Orange County, NC Program Name : Food delivery and Check- In Funding Award : $ 54, 809 Outline how the agency will spend Orange County ' s funding award . Ex ense Descri tion Amou nt O erat* ons + Personnel : Total Meal Cost elive + Check- In $ 54809 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 20220 • Mamtaaand expand meal delivery service • Outreach to community to attract recipients in need • Expand volunteer outreach and engagement to be able to maintain service delivery levels 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 muni cipalities). 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 17, f northern rural recipients who have option to recceive at least 5 meals per week 96 # of recipients that self-report that MOWOCNC has helped reduce social isolation and 250 loneliness Increase # of volunteers to increase meal delivery service (if return to daily hot meal 4.5 0 delivery l, Certified Title: (,Ut"V� , �I� CitAq Date : C . z Z (Prov ider' s Signature)