HomeMy WebLinkAbout2022-290-E-Aging-Meals on Wheels of Orange County-Outside AgencyOrange County Outside Agency Performance Agreement
Revised 10/2021 Page 1 of 10
OUTSIDE AGENCY PERFORMANCE AGREEMENT
THIS AGREEMENT, made and entered into the first day of July 2022, (“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,
2022 to June 30, 2023.
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 $60000.
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 $15000. 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: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Orange County Outside Agency Performance Agreement Page 2 of 10
Rev.10/21
e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days
after receipt of the Progress Report and Request for Reimbursement or 21 days after due date
of Progress Report whichever is later.
f. The County is not obligated to provide any other support to Provider in this or in succeeding
fiscal years.
4. Agency Reporting.
a. Provider will provide Orange County a Progress Report that includes a fiscal report and
updates on performance measures as outlined in the Scope of Services. Progress Report dates
are: July 1 – December 31; January 1 – March 31 and April 1 - June 30. Reports are due on
January 10, April 10, and July 10 of the program fiscal year.
b. Provider agrees to allow the County to inspect its financial books and records, which
document costs of those services, upon reasonable notice during normal working hours.
5. Termination.
a. 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
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Orange County Outside Agency Performance Agreement Page 3 of 10
Rev.10/21
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
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Orange County Outside Agency Performance Agreement Page 4 of 10
Rev.10/21
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.orangecountync.gov/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
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Orange County Outside Agency Performance Agreement Page 5 of 10
Rev.10/21
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.orangecountync.gov/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.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Orange County Outside Agency Performance Agreement Page 6 of 10
Rev.10/21
l. 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 11A and Article 40 of North Carolina General Statute Chapter
66.
IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on
the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures
below.
For and on behalf of the Provider
_____________________________ _______________________
Rachel Sobel Bearman, Executive Director Date
For and on behalf of Orange County Government
_______________________________ ________________________
Bonnie Hammersley, County Manager Date
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
7/12/2022
7/21/2022
Orange County Outside Agency Performance Agreement Page 7 of 10
Rev.10/21
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: $60000 Purpose: outside agency 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 7/1/2022 Approved by Board Yes No Agenda Date:
This agreement is approved as to technical form and content and I as Department Director affirmatively state work on
this project has not been initiated prior to execution of the agreement:
Department Director’s Signature ________________________________________ Date: ________
Agreements for emergency services or repair are not subject to the above affirmation. If services related to this
agreement have already begun or been completed please briefly describe the nature of the emergency condition that
was addressed:
Information Technologies
(Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is
approved as to information technology content and specifications:
Office of the Chief Information Officer___________________________________ Date: ________
Risk Management
This agreement is approved for sufficiency of insurance standards, specifications, and requirements:
Office of the Risk Management Officer___________________________________ Date: _________
Financial Services
This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act:
Office of the Chief Financial Officer ____________________________________ Date: _________
Legal Services
This agreement is approved as to legal form and sufficiency:
Office of the County Attorney __________________________________________Date: ________
Clerk to the Board
Received for record retention:
All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov
The following signature block is for hard copies only and is not required for Docusign contracts:
Office of the Clerk to the Board __________________________________________Date:_________
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
7/18/2022
7/18/2022
7/20/2022
7/21/2022
Orange County Outside Agency Performance Agreement Page 8 of 10
Rev.10/21
Exhibit A
Provider’s Outside Agency Application
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Orange County Outside Agency Performance Agreement Page 9 of 10
Rev.10/21
Exhibit B
Provider’s Revised Scope of Services and Program Budget
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Orange County Outside Agency Performance Agreement Page 10 of 10
Rev.10/21
ATTACHMENT “A”
Orange County Certifications – FY 2022-23
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 agenc y and the budget
adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate
sheet of paper.
Alignment with Organization’s Mission
I certify that the programs and services for which this funding is requested align with the mission of the
organization.
Intended Purpose
I certify that the funds provided to the agency under the terms of this Agreement will be used for a public
purpose and shall only be used for the purposes intended and any money not used for those purposes will be
promptly returned to Orange County.
Certified by: _______________________ Title: __________________________ Date: ___________
(Provider’s Signature)
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
7/12/2022Executive Director
Cover Page Page 6 of 25
COVER PAGE
Applicant Contact Information
Applicant Organization’s Legal Name: Chapel Hill Carrboro Meals on Wheels 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 2023 Human Services (HS) funding requested for all programs and the proposed
use of funds (please list program name only)
Program Carrboro - HS Chapel Hill
- HS
Orange
County-HS
Total
Meal Delivery: Food + Check-in $14,000
Operations +
Personnel
$45,000
Operations
+ Personnel
$60,000
Operations
+ Personnel
$119,000
Totals $14,000 (1,545
meals
delivered)
$45,000
(4,966
meals
delivered)
$56,000
(6,622
meals
delivered)
$119,000
13,133 meals
delivered (~
20% of meals in
22-23)
Briefly explain your proposed use of funds:
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: 11-29-21
Executive Director Date
To alleviate hunger and reduce social isolation and loneliness among older adults
living in Chapel Hill, Carrboro and rural Orange County through the delivery of
balanced meals and check-ins.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Cover Page Page 7 of 25
Signature: 11-29-21
Board Chairperson Date
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Cover Page Page 8 of 25
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: 11-29-21
Executive Director Date
Signature: 11-29-21
Board Chairperson Date
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Program information Page 9 of 25
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 social isolation and loneliness.
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 45 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, 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. In 2021, we maintained our heightened service capacity
serving approximately 61,000 meals.
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?
If no, please briefly explain.
Schedule of Positions: # of FTE – Full-Time Paid Positions: 1 # of FTE – Part-Time Paid Positions: 4
NEW THIS YEAR
Consistent with our commitment to equity and inclusion, the Towns of Chapel Hill and Carrboro and
Orange County Government are taking steps together to center racial equity in the Human Services
Funding Program. Over the course of the next year, the Towns and County will conduct a comprehensive
racial-equity analysis of the program and we are requesting basic information about your organization’s
racial equity work.
a. Please describe how you have involved the intended beneficiaries of the
proposed project in the planning and design process (in 100 words or
less). We do an in-depth intake interview for all potential clients that focusses
on food insecurity, health and wellness, social isolation and loneliness, and
offers all the options MOWOCNC currently has the capacity to offer which
enables the client to have choice/input into the services received.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Program information Page 10 of 25
b. How has your organization incorporated racial equity goals into your
organizational goals?
For the past three + years MOWOCNC has been working on expanding board
and staff diversity to be more representative of the Orange County community
and the recipients we serve. MOWOCNC has a low threshold to apply,
attempting to provide as close to no-barrier-to-entry as possible. You may be
referred to MOWOCNC in multiple ways, including by friends, neighbors and
self. All initial eligibility phone calls and the in-depth intakes follow the same
questions and procedures. We have developed and incorporated operational
policies and procedures that hopefully limit/account for potential bias that may
impact service decisions and are very aware of how and when bias may play a
role or impact service. Recognizing we do have barriers for those in the
Hispanic/Latinx and Asian communities potentially based on language and
food, MOWOCNC has engaged two UNC student teams to investigate current
barriers and propose solutions to expand our service within both groups.
c. Please fill in the below questions and provide any additional context on
the racial composition of the organization and board leadership:
i. % of staff that are Black, Indigenous, or People of Color (BIPOC) : 20%
ii. % of board that are BIPOC: 20%
iii. % of staff that have attended racial equity training: 20%
d. Please describe any additional activities your organization is doing to
address racial equity.
Please see B above. We are starting a strategic planning process in January
and this is one of the issues we will be addressing. Specifically, how to make
institutional/organizational changes for the long-term and assessment and
evaluation to be sure we are achieving our stated goals.
PROGRAM INFORMATION
*Please submit for each program if applying for funding for more than one program.
6. Program Name: Meal Delivery and Friendly Check-In
Program Primary Contact and Title: Rachel Bearman, Executive Director
Telephone Number: 919-942-2948 E-Mail: execdirector@mowocnc.org
7. 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. (250 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.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Program information Page 11 of 25
8. Target Population: Please complete the table below with numbers (not percentages) of individuals served
and projected to be served.
Program Target Population Demographics
Projected
2020-2021
Actual
2020-
2021
Projected
2021-2022
Projected
2022-2023
Gender
Men 171 131 [5] 146 140
Women 239 254 [18] 263 276
Nonbinary/Genderqueer -
Self-Describe -
Total 410 385 [23] 416 416
Race and Ethnicity
Black or African-American 167 154 [8] 170 170
American Indian or Alaska Native 2 2 0
Asian Indian
White 225 221 [15] 228 230
Native Hawaiian or other Pacific Islander
Chinese 2 2 2 4
Japanese
Vietnamese
Filipino
Korean
Some other race 14 8 14 12
Total 410 385 [23] 416 416
Of the above, how many Hispanic, Latino or Spanish origin 10 5 [0] 8 10
Of the above, how many non-Hispanic, Latino or Spanish origin 400 380 [23] 408 406
Total 410 385 [23] 416 416
Age
0-5 years 0
6-18 years 0
19-50 years 12 9 12 10
51+ years 398 376 [23] 404 406
Total 410 385 [23] 416 416
Geographic Location
Town of Chapel Hill 168 176 [17] 191 191
Town of Carrboro 97 57 [3] 85 70
Orange County ( Outside of Chapel Hill/Carrboro) 145 152 [3] 140 155
Outside of Orange County
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Program information Page 12 of 25
Total 410 385 [23] 416 416
Income
Low-income (80% of the Area Median Income and Below) Please see
income table in the attachments
410 374 [21] 400 410
Total 410 385 [23] 416 416
9. 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 2020-2021 Projected 2021-2022 Projected 2022-2023
Total Cost of Program $471,906.84 $529,255.52 $567,256.00
Total # of Individuals 385 416 416
Cost Per Individual $1,225.73 $1,272.25 $1,363.00
10. 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
Objective
(please choose one from
the Results Framework)
o Children improve their educational outcomes
X Residents Increase their livelihood security
X Residents improve their health outcomes
Intermediate
Result
(please choose one from
the Results Framework)
Insert Intermediate Result here.
2.1: Residents access the most appropriate social safety net services
3.2: Residents demonstrate new healthy lifestyle behaviors
RESULTS Actual
2020-2021
Projected
2021-2022
Projected
2022-2023
Performance
Indicators
(Please choose at least
one performance
indicator to report on
from the Results
Framework, and add
additional performance
Insert Performance Indicator
here.
2.1
§ % and # Client
satisfaction rates
New
measure
90% (374) of
recipients
are satisfied
or very
satisfied with
food taste,
93% (386) of
recipients
are satisfied
or very
satisfied with
food taste,
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Program information Page 13 of 25
indicators that you
would like to report to
the Towns. Please
insert additional rows
as needed, listing one
per row).
variety and
portion.
variety and
portion.
2.1
§ % and # of program
participants that
receive food
assistance
100% (385) 100% (416) 100% (416)
3.2
# 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.)
New
measure
93% (386)
agree or
strongly
agree that
receiving
MOWOCNC
enables me
to eat more
nutritious
food.
90% (374)
agree or
strongly
agree that
MOWOCNC
has
improved my
health.
94% (391)
agree or
strongly
agree that
receiving
MOWOCNC
enables me
to eat more
nutritious
food.
90% (374)
agree or
strongly
agree that
MOWOCNC
has
improved my
health.
3.2
% and # of program
participants who report
new, improved, or
restored social
connections
96% (369)
agree or
strongly
agree
he/she/they
have
formed a
connection
to
MOWOCNC
volunteers.
96% (399)
agree or
strongly
agree
he/she/they
have formed
a connection
to
MOWOCNC
volunteers.
97% (403)
3.2
% and # of program
participants that
consume fresh food
100% (385) 100% (416) 100% (416)
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Outside Agencies/Human Services
Program information Page 14 of 25
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.
Senior 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
Equitable access to Meals on Wheels service
across Orange County to reduce food
insecurity/improve nutrition amongst older adults.
Performance Measure
(How will you accomplish your goal?)
Maintain expanded access to 5 meal per week, shelf
stable food and emergency food and supply boxes.
Actual Results
(Outcome)
Ending FY2021
End FY 2021 served 86 recipients in northern Orange
County.
Output: 100% (86) with access to 5 meals per week.
[78% (67) receive 5 meals per week; 4% (3) receive 3
meals per week; 1% (1) receive shelf stable meals;
96% (82) receive 1 hot meal/week (Mondays); 4% (3)
just receive fruit]
Outcome: Overall 93% (79) of MOWOCNC recipients
report that “receiving meals on wheels enables me to
eat more nutritious foods” and 90% report that
“receiving services from MOWOCNC has improved my
health.”
Projected Results
(Outcome)
Ending FY2022
100% (90 with access to 5 meals per week.
95% (85) report reduced food insecurity/improved
nutrition.
Projected Results
(Outcome)
Ending FY2023
100% (93) with access to 5 meals per week.
96% (89) have access to 5 meals per week and friendly
check-ins
We fall under Senior Services and Food and Nutritional Services
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Outside Agencies/Human Services
Program information Page 15 of 25
Program Goal # 2
Equitable access to Meals on Wheels service
across Orange County to reduce social
isolation/loneliness amongst older adults.
Performance Measure
(How will you accomplish your goal?)
Increase delivery days in northern Orange County
and/or expand volunteer phone brigade to more
recipients.
Actual Results
(Outcome)
Ending FY2021
With once per week in-person check-ins and about
20% of northern recipients receiving phone calls,
overall, 96% (81) of MOW recipients report establishing
a connection with the MOWOCNC volunteer.
Projected Results
(Outcome)
Ending FY2022
Add additional delivery day to increase in-person
check-ins to at least two days per week. 100% of
northern Orange recipients (90)
Projected Results
(Outcome)
Ending FY2023
Add additional delivery day to increase in-person
check-ins to at least three days per week. 100% of
northern Orange recipients (93)
Program Goal # 3
Increase # of volunteers in northern Orange County
to increase hot meal delivery service and in-person
check-ins to multiple days.
Performance Measure
(How will you accomplish your goal?)
Expand community outreach activities and # of
volunteers recruited, trained and retained.
Actual Results
(Outcome)
Ending FY2021
Limited volunteer outreach due to COVID. Have re-
filled most volunteer slots in southern Orange County
from approximately 50+ during COVID to
approximately 200 with return to daily weekday hot
meal delivery. To date we have expanded our sub-
driver list in northern Orange County by at least 5
regular volunteers and are currently training an
additional 5.
Projected Results
(Outcome)
Ending FY2022
Full volunteer capacity with 300 volunteers (drivers,
set-up, bakers, food sorters, etc) with 5 day per week
delivery in southern Orange County and at least 2 day
per week delivery of hot meals (+ frozen meals) in
northern Orange County.
Projected Results
(Outcome)
Ending FY2023
400+ volunteers with 5 day per week delivery in
southern Orange County and at least 3 day per week
delivery of hot meals (+ frozen meals) in northern
Orange County.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Program information Page 16 of 25
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. That growth
was maintained throughout 2021. The Community Impact award will help sustain this
level of service into 2022-23. 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, feelings of isolation and loneliness, and anxiety about aging at home.
In our latest survey recipients strongly agree or agree that receiving MOWOCNC
services enables them to:
• “eat more nutritious food” (94%)
• “improve my health” (90%)
• “remain in my home” (99%)
• and “reduces my need for in-home care” (86%).
2. What methods/tools will your organization use to evaluate the proposed program’s
effectiveness? Please include specific examples, such as a logic model.
Evaluation: In late 2021 a new recipient survey was launched that focusses on general
satisfaction with MOWOCNC service, as well as food insecurity and social isolation
and loneliness scales. The data will be analyzed and integrated into our overall
program evaluation and will serve as the basis of our 2022 strategic planning process
from Jan-June. Qualitative data collected from recipient interactions and conversations
with staff or volunteers are also captured, tracked and will be analyzed in conjunction
with survey data.
Program effectiveness based on: satisfaction with food service, connectedness with
volunteers, impact of MOWOCNC service on nutrition, health and ability to age in place
as well as impact on reducing food insecurity (as well as associated stress and
financial pressures) and social isolation and loneliness as measured by new or
improved connections and improved mental health.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Program information Page 17 of 25
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 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.
• UNC student groups: in the past UNC groups have designed and tested our
recipient survey, investigated differing needs between suburban and rural older
adults, developed pilot program to test delivery of medically tailored meals and next
semester will be investigating and analyzing opportunities for MOWOCNC to
improve the mental health (specifically social isolation and loneliness) of MOW
recipients.
5. If you are not awarded a Community Impact Award, what would your agency’s funding
request be?
As much funding as possible to enable MOWOCNC to sustain increased meal delivery
service in Chapel Hill, not only in actual meals delivered but more than a meal services
combatting social isolation and loneliness, emergency food and supply needs, and
resource connector.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Attachments Page 18 of 25
4. ATTACHMENTS
Description of Required Attachments
a) Financial Audit
A recent financial audit that should cover CY2020, for calendar year agencies, and FY2020-2021, 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 2020 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: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Attachments Page 19 of 25
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 2020-2021 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
Compensation1
Limits for Coverage A -
Statutory State NC, for
each employee
Limits for Coverage B -
Employers Liability of:
$1 million Each
Occurrence
$1,000,000 BID2 limit
Limits for Coverage A - Statutory
State NC, for each employee
Limits for Coverage B - Employers
Liability of: $100,000 Each
Occurrence $100,000 BID for each
employee
$500,000 BID limit
Limits for Coverage A -
Statutory State NC, for each
employee
Limits for Coverage B -
Employers Liability of:
$500,000 each accident,
$500,000 BID for each
employee
$500,000 for BID limit
Commercial General
Liability
$1 million , Each
Occurrence;
$2 million aggregate
$1 million Each Occurrence
$2 million Aggregate
$1 million Each Occurrence
$2 million Aggregate
Automobile Liability $1 million Each
Occurrence
*Only required for
agencies doing travel as
part of the agreement
with the Town.
$1 million Each Occurrence
*Only required for agencies doing
travel as part of the agreement with
the Town.
$1 million Each Occurrence
Professional Liability $1 million Each
Occurrence
$2 million Aggregate
$1 million Each Occurrence
$2 million Aggregate
$1 million Each Occurrence
$2 million Aggregate
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Attachments Page 20 of 25
Sexual Abuse &
Molestation
$1 million Each
Occurrence
$2 million Aggregate
*Only required for
agencies doing direct work
with minors (under the
age of 18).
$1 million Each Occurrence
$2 million Aggregate
*Only required for agencies doing
direct work with minors (under the
age of 18).
$1 million Each Occurrence
$2 million Aggregate
Cyber Liability
$1 million Each
Occurrence
$2 million Aggregate
*Only required for
agencies transmitting
personal identifiable
information that is
disseminated
electronically
$1 million Each Occurrence
$2 million Aggregate
*Only required for agencies
transmitting personal identifiable
information that is disseminated
electronically.
$1 million Each Occurrence
$2 million Aggregate
§ 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.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Attachments Page 21 of 25
2021 Income Limits
US Department of Housing and Urban Development (HUD)
Durham-Chapel Hill Metropolitan Statistical Area
(Durham, Orange, and Chatham Counties)
Income Level 1
person
2
people
3
people
4
people
5
people
6
people
7
people
8
people
30% area
median
income
$18,150 $20,750 $23,350 $26,500 $31,040 $35,580 $40,120 $44,660
50% area
median
income
$30,250 $34,600 $38,900 $43,200 $46,700 $50,150 $53,600 $57,050
60% area
median
income
$36,300 $41,520 $46,680 $51,840 $56,040 $60,180 $64,320 $68,460
80% area
median
income
$48,400 $55,300 $62,200 $69,100 $74,650 $80,200 $85,700 $91,250
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Prepared by the Town of Chapel Hill Office for Housing and Community
Approved by the Chapel Hill Town Council June 20, 2018 and the Town of Carrboro Board of Alderman October 23, 2018
Attachments
Human Services Program Results Framework
The Town of Chapel Hill and the Town of Carrboro’s Human Services Program funds programs that improve education, livelihood security, and
health outcomes for all residents. The program’s overarching goal is to achieve economic and social wellbeing and opportunities to thrive for all
residents, particularly those who are low-income or otherwise disenfranchised.
Goal: All Chapel Hill and Carrboro residents experience
economic and social well-being & opportunities to thrive.
Strategic Objective 1:
Children improve their
education outcomes
Strategic Objective 2:
Residents increase their
livelihoods security
Strategic Objective 3:
Residents improve their health
outcomes
Intermediate Result 1.1:
Children birth-to-K access
early childhood
development
opportunities
Intermediate Result
1.2: Children
demonstrate new
grade-level-appropriate
skills
Intermediate Result
2.1: Residents access
the most appropriate
social safety net
services
Intermediate Result
2.2: Residents
increase job skills
appropriate for the
local economy
Intermediate Result
3.1: Residents access
basic health care
services (primary,
behavioral, dental)
Intermediate
Result 3.2:
Residents
demonstrate new
healthy lifestyle
behaviors
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Attachments
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
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Attachments
§ % 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.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Attachments
§ 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.
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
Certified by: _______________________ Title: __________________________ Date: ____________
(Provider’s Signature)
EXHIBIT “B”
Scope of Services – FY 2022-23
Outside Agency Performance Agreement
Agency Name: Meals on Wheels Orange County, NC
Program Name:
Funding Award: $60,000
Outline how the agency will spend Orange County’s funding award.
Program Services
Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2023.
Equitable access to Meals on Wheels service across Orange County to reduce food
insecurity/improve nutrition amongst older adults.
Equitable access to Meals on Wheels service across Orange County to reduce social
isolation/loneliness amongst older adults.
Increase # of volunteers in northern Orange County to increase hot meal delivery service and in -
person check-ins to multiple days.
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
100% (90 with access to 5 meals per week. 95% (85) report reduced food
insecurity/improved nutrition.
Add additional delivery day to increase in-person check-ins to at least two days per
week. 100% of northern Orange recipients (90)
Full volunteer capacity with 300 volunteers (drivers, set-up, bakers, food sorters, etc)
with 5 day per week delivery in southern Orange County and at least 2 day per week
delivery of hot meals (+ frozen meals) in northern Orange County.
Expense Description Amount
Cost of Meal Delivered
$60,000
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
7/12/2022Executive Director
Certified by: _______________________ Title: __________________________ Date: ____________
(Provider’s Signature)
Performance Measures Anticipated
Results
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C
7/12/2022Executive Director
INSR ADDL SUBR
LTR INSR WVD
DATE (MM/DD/YYYY)
PRODUCER CONTACT
NAME:
FAXPHONE
(A/C, No):(A/C, No, Ext):
E-MAIL
ADDRESS:
PRODUCER
CUSTOMER ID #:
INSURED INSURER A :
INSURER B :
INSURER C :
INSURER D :
INSURER E :
INSURER F :
POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY)
GENERAL LIABILITY
AUTOMOBILE LIABILITY
UMBRELLA LIAB
EXCESS LIAB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
AUTHORIZED REPRESENTATIVE
INSURER(S) AFFORDING COVERAGE NAIC #
Y / N
N/A
(Mandatory in NH)
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
EACH OCCURRENCE $
DAMAGE TO RENTEDCOMMERCIAL GENERAL LIABILITY $PREMISES (Ea occurrence)
CLAIMS-MADE OCCUR MED EXP (Any one person)$
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER:PRODUCTS - COMP/OP AGG $
$PRO-POLICY LOCJECT
COMBINED SINGLE LIMIT
(Ea accident)$
ANY AUTO BODILY INJURY (Per person)$
ALL OWNED AUTOS BODILY INJURY (Per accident)$
SCHEDULED AUTOS PROPERTY DAMAGE
(Per accident)$HIRED AUTOS
$NON-OWNED AUTOS
$
OCCUR EACH OCCURRENCE $
CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $$
WC STATU-OTH-
TORY LIMITS ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below
c
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
CERTIFICATE HOLDER CANCELLATION
1988-2009 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORDACORD 25 (2009/09)
O
CERTIFICATE OF LIABILITY INSURANCEACORDTM 6/27/2022
The CIMA Companies, Inc.
2750 Killarney Dr, Suite 202
Woodbridge, VA 22192-4124
703 739-9300
Nayab Alam
703-778-7304 703-778-7354
nalam@cimaworld.com
Chapel Hill-Carrboro Meals on Wheels
dba Meals on Wheels Orange County, NC
PO Box 2102
Chapel Hill, NC 27515
Alliance of Nonprofits for Ins
Hartford Underwriters Insurance
Carolina Casualty Insurance Com
The Travelers Indemnity Company
10023
30104
10510
25658
A
X
X
X
202236882 07/01/2022 07/01/2023
3,000,000
3,000,000
1,000,000
1,000,000
500,000
20,000
A
X
X
202236882 07/01/2022 07/01/2023 1,000,000
B
N
6S60UB0G11045221 07/01/2022 07/01/2023 X
500,000
500,000
500,000
C
D
D&O
Cyber
DCP1231894P10
107079935
07/03/2022
04/18/2022
07/03/2023
04/04/2023
$1,000,000
1,000,000
The certificate holder is hereby listed as an additional insured.
Orange County, NC
P.O. Box 8181
Hillsborough, NC 27278
1 of 1
#S411679/M411678
NCCHAP7Client#: 58358
NPA
1 of 1
#S411679/M411678
DocuSign Envelope ID: 3E214CCE-9F32-46C0-9591-DFA25EDE6B6C