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HomeMy WebLinkAbout2022-422-E-Social Svc-Orange Congregations in Mission-Outside agency funding and emergency assistance program Orange Congregations in Mission Orange County Outside Agency Performance Agreement Revised 6/2018 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, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ("County") and Orange Congregations in Mission, a not-for-profit corporation, located at 300 Millstone Drive, Hillsborough, NC 27278 (“Provider”). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and 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 to the residents of Orange County, as outlined in the Outside Agency Funding Application and any amendments or revision thereto (Exhibit “A”) and Emergency Assistance Scope of Work (“Exhibit B”), both of which are attached and hereby incorporated into this document as if set out herein. The Scope of Services in Exhibit A 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 C. 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 funds for the provision of services described in Exhibit A, Scope of Services, and more particularly described in the Program Budget or Revised Program Budget, the maximum sum of Ninety-Two Thousand, Four Hundred and Fifteen Dollars ($92,415). The County also agrees to appropriate funds for the provision of services described in Exhibit B, the maximum sum of Fifty One Thousand Dollars ($51,000). The total amounted appropriated by the County to Provider for these services shall be One Hundred Forty Three Thousand, Four Hundred and Fifty Dollars ($143,415). b. All funds appropriated shall be used for purposes described in Exhibit A and Exhibit B. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services provided in Exhibits A and B, at the discretion of the County the Provider may be required to repay the funds to the County. c. Funds Appropriated for Outside Agency Funding (Exhibit A) Services. DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 2 i. For funds appropriated for Exhibit A services, the Provider shall be paid in four equal installments in the amount of $23,103.75. The first payment is contingent upon receipt of the agency’s performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. ii. 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. iii. Once Provider has satisfied its obligations as provided in c.1. above 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. d. Funds Appropriated for Emergency Assistance (Exhibit B) Services. i. For funds appropriated for Exhibit B services, the County will reimburse Provider for services described in Exhibit B up to the limits allocated by this Agreement. The County will make an initial payment of $12,750 to Provider. The initial payment shall be used by Provider to pay for services as follows: $ 3,750 will be used to pay for staff costs and $9,000 will be used for reimbursement of client costs. Provider must provide documentation as provided in subsection ii below. Once Provider has provided documentation indicating that the initial payment has been expended then Provider shall submit documentation to County to be reimbursed for actual expenditures for all other approved services. ii. For reimbursement, Provider must submit copies of bills, checks, receipts and/or other proof of expenditures to the person designated by the County. Reimbursement will be provided bimonthly. iii. For reimbursement of staff costs, Provider shall submit the payment records for staff cost. The County will reimburse the Provider monthly upon receipt of a complete and correctly filed report. e. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 – December 31; January 1 – March 31 and April 1 - June 30. Reports are due on January 10, April 10, and July 10 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as “default”), the County may immediately terminate this Agreement, in whole or in part, and from time to DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 3 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 least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker’s Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 4 iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 d. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 5 including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County’s living wage is $ 14.95 per hour. To the extent possible, Orange County recommends that Provider provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Provider: Nancy Coston Executive Director Orange County Orange Congregations in Mission Department of Social Services 300 Millstone Drive Post Office Box 8181 Hillsborough, North Carolina 27278 Hillsborough, North Carolina 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 6 18. 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. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of the Agreement and County may immediately terminate this Agreement without further obligation on part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 19. 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 _____________________________ _______________________ Rev. Sharon S. Freeland, Executive Director Date For and on behalf of Orange County Government _______________________________ ________________________ Bonnie Hammersley, County Manager Date DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 8/30/2022 9/1/2022 7 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Department Party/Vendor Name: Orange Congregations in Mission, Inc. Party/Vendor Contact Person: Rev. Sharon S. Freeland Contact Phone: 919-732-6194 Party/Vendor Address: 300 Millstone Drive City Hillsborough State: NC Zip: 27278 Department: Social Services Amount: $143,415 Purpose: outside agency funding & emergency assistance program Budget Code(s): 10290050-710031/10403020-630000 Vendor # 800010 (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: 6/21/2022 This agreement is approved as to technical form and content: Department Director’s Signature ________________________________________ Date: ________ Information Technologies (Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Risk Management This agreement is approved for sufficiency of 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 Donna Lloyd upon completion @ Dolloyd@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: 71F97F5F-5151-4635-B81A-84B74866F622 8/30/2022 8/31/2022 9/1/2022 9/1/2022 Orange County Outside Agency Performance Agreement Page 8 of 10 Rev.06/22 Exhibit A Provider’s Outside Agency Application DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Program information  P a g e  9  of 28  AGENCY INFORMATION    Please provide the following information about your agency:    1. Date of Incorporation (Month/Year): 05/1981      2. Agency’s Purpose/Mission (no more than a few sentences):  To minister to the urgent needs of northern Orange County through the volunteer efforts of diverse  congregations and individuals inspired by faith in God, and to enhance self‐sufficiency and awareness  of community resources.    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).  OCIM has provided food and financial assistance to Orange County residents in need for 40 years. During  the pandemic, OCIM has maintained fast, compassionate help to those seeking our services. In‐kind  donations to the pantry remained high and private financial donations have continued to allow this  organization to assist those in the community who are facing financial hardship. Our community trusts  OCIM to facilitate their desire to help those in the community needing food and financial assistance.         Required reports are turned in on time.    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? No    If no, please briefly explain. The topic has not been brought before the OCIM Board of Directors at  this time.         Schedule of Positions:   # of FTE – Full‐Time Paid Positions:  _4_   # of FTE – Part‐Time Paid Positions: _2.5_  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).    Orange Congregations In Mission is not set up in a manner that would facilitate beneficiary  participation in program design. In the past, there have been members of OCIM’s Board of  Directors who have needed OCIM’s services and have been able to impact agency policy.      b. How has your organization incorporated racial equity goals into your organizational goals?   Since its inception, OCIM has had the very intentional goal of racial equity and treating each  individual who seeks help with fairness and compassion. OCIM’s member congregations are  racially and spiritually diverse and a very intentional effort is made to mirror that diversity in  the board of directors and the agency staff. OCIM’s Statement of Non‐Discrimination :  DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Program information  P a g e  10 of 28  Orange Congregations In Mission will not discriminate against recipients of client services,  applicants, employees, providers, and volunteers, including board members, or any other  person or class of persons on the basis of race, gender, color, religion, sexual orientation,  national origin, age, marital or veteran status, disability, or any other legally protected  status.     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) : 63%  ii. % of board that are BIPOC: 60%  iii. % of staff that have attended racial equity training: 0      d. Please describe any additional activities your organization is doing to address racial equity.      PROGRAM INFORMATION  *Please submit for each program if applying for funding for more than one program.     6.    Program Name: Samaritan Relief Ministry      Program Primary Contact and Title: Kay Stagner, Manager of Client Services      Telephone Number:  919‐732‐6194 ex. 12    E‐Mail: ocimsrm@embarqmail.com    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)    The  Samaritan  Relief  Ministry  provides  groceries  and  financial assistance  for  rent,  utilities,  and  prescription  medication  for  people  living  in  northern  Orange  County.  This  program  aligns  with  Orange County’s Goal 1: Ensure a community network of basic human services and infrastructure  that maintains, protects, and promotes the well‐being of all county residents. The Samaritan Relief  Ministry provides services to people living within the geographical boundaries of the Orange County  School District. This area is primarily rural, with Hillsborough being the largest municipality. The  Samaritan Relief Ministry is a referral‐based program. Various Orange County departments, school  social  workers,  pastors,  mental  health  programs,  and  local  non‐profits  make  referrals  for  their  clients who are in need of the services this program offers.                 DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Program information  P a g e  11 of 28  8. Target Population:  Please complete the table below with numbers (not percentages) of individuals served  and projected to be served.      Program Target Population Demographics Samaritan Relief Ministry Projected  2021    Actual  2021   Projected  2022  Projected 2023  Gender           Men   4417   2577        2800 2800 Women   5584   2901  3500  3500 Nonbinary/Genderqueer        Self‐Describe        Total 10,000  5478   6300 6300 Race and Ethnicity                                     HOUSEHOLDS           Black or African‐American   1282   817    966 966 American Indian or Alaska Native            Asian Indian            White   2182  1158    1308 1308 Native Hawaiian or other Pacific Islander            Chinese         Japanese         Vietnamese         Filipino         Korean                     Some other race            Total 3464  1975   2274 2274            Of the above, how many Hispanic, Latino or Spanish origin   400  239   289 289 Of the above, how many non‐Hispanic, Latino or Spanish origin   3064   1736    1985 1985 Total 3464  1975   2274 2274 Age           0‐5 years   1310   626    650 650 6‐17 years   2770   1463    1500 1500 18‐64 years   5520   3187    3900 3900 65+ years   400   202    250 250 Total 10,000  5478   6300 6300 Geographic Location           Town of Chapel Hill         Town of Carrboro            Orange County ( Outside of Chapel Hill/Carrboro)  10,000  5478   6300 6300 Outside of Orange County         Total 10,000  5478   6300 6300 Income                                                      HOUSEHOLDS          Low‐income (80% of the Area Median Income and Below)  Please see  income table in the attachments 3464  1975  2274  2274 DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Program information  P a g e  12 of 28  Total 3464  1975   2274 2274       9.  Cost Per Individual SRM    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  $612,040  $530,216  $530,216  Total # of Individuals  5478  6300  6300  Cost Per Individual  $111.73  $84.16  $84.16                                                                                      PROGRAM INFORMATION  *Please submit for each program if applying for funding for more than one program.       6.    Program Name: Meals on Wheels      Program Primary Contact and Title: Kay Stagner      Telephone Number:  919‐732‐6194 ex. 12    E‐Mail: ocimsrm@embarqmail.com    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)  The Meals on Wheels program provides a nourishing, home delivered lunch, five days a week to homebound residents of northern Orange County. This program addresses Orange County’s Goal 1: Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents. While delivering lunch, volunteers are able to make a quick assessment of each recipient’s physical and cognitive condition; if there appears to be a change in condition, it is reported to the program coordinator who follows through with the recipient’s emergency contact or appropriate Orange County department, including Emergency Services.        DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Program information  P a g e  13 of 28  8. Target Population:  Please complete the table below with numbers (not percentages) of individuals served  and projected to be served.      Program Target Population Demographics Meals on Wheels Projected   2021  Actual  2021   Projected   2022  Projected  2023  Gender           Men   30   24    26 26 Women   44   34   37  37 Nonbinary/Genderqueer        Self‐Describe        Total 74  58   63 63 Race and Ethnicity             Black or African‐American   27   15        17 17 American Indian or Alaska Native            Asian Indian            White   47   43    46 46 Native Hawaiian or other Pacific Islander            Chinese         Japanese         Vietnamese         Filipino         Korean                     Some other race            Total 74  58   63 63            Of the above, how many Hispanic, Latino or Spanish origin   0         Of the above, how many non‐Hispanic, Latino or Spanish origin   74   58    63 63 Total 74  58   63 63 Age           0‐5 years            6‐18 years            18‐64 years   7   6    7 7 65+ years   67   52    56 56 Total 74  58   63 63 Geographic Location  HOUSEHOLDS           Town of Chapel Hill         Town of Carrboro            Orange County ( Outside of Chapel Hill/Carrboro)  74  58   63 63 Outside of Orange County         Total 74  58   63 63 Income  HOUSEHOLDS          Low‐income (80% of the Area Median Income and Below)  Please see  income table in the attachments 74  58  63  63 DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Program information  P a g e  14 of 28  Total 74  58   63 63       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  $85,937  $63,525  $63,525  Total # of Individuals  58  63  63  Cost Per Individual  $1,481.67  $1,008  $1,008    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)    Children improve their educational outcomes   Residents Increase their livelihood security   Residents improve their health outcomes Intermediate Result   (please choose one from the Results Framework)  Insert Intermediate Result here.                 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 indicators that you would like to report to the Towns. Please Insert Performance Indicator here.     DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Program information  P a g e  15 of 28  insert additional rows as needed, listing one per row).    DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Outside Agencies/Human Services Program information  P a g e  16 of 28  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.   Food and Nutritional Services If you selected other, please tell us what function area best aligns with your organization:       Please indicate three program goals/performance measures below. SRM  A few notes:   If you use percentages, please put the actual number equivalence.     Please ensure your performance measures are outcome based and not outputs.   Program Goal # 1 All eligible northern Orange County residents facing hunger are able to access emergency food. Performance Measure (How will you accomplish your goal?) # qualified/referred individuals will receive a week of groceries Actual Results (Outcome) Ending FY2021 4375 individuals received a week of food Projected Results (Outcome) Ending FY2022 5175 individuals will receive a week of food Projected Results (Outcome) Ending FY2023 5175 individuals will receive a week of food   Program Goal # 2 Orange County residents avoid eviction and utility shut- off Performance Measure (How will you accomplish your goal?) # households will receive financial assistance Actual Results (Outcome) Ending FY2021 109 households received financial assistance Projected Results (Outcome) Ending FY2022 117 households will receive financial assistance DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Outside Agencies/Human Services Program information  P a g e  17 of 28  Projected Results (Outcome) Ending FY2023 117 households will receive financial assistance   Program Goal # 3 Food pantry maintains adequate food supplies Performance Measure (How will you accomplish your goal?) # pounds of donated food will be procured Actual Results (Outcome) Ending FY2021 164,329 pounds of donated food was procured Projected Results (Outcome) Ending FY2022 165,000 pounds of donated food will be received Projected Results (Outcome) Ending FY2023 165,000 pounds of donated food will be received   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.   Food and Nutritional Services If you selected other, please tell us what function area best aligns with your organization:       Please indicate three program goals/performance measures below. MOW  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 Homebound seniors and disabled adults will improve nutrition and reduce social isolation Performance Measure (How will you accomplish your goal?) #individuals will receive Meals on Wheels DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Outside Agencies/Human Services Program information  P a g e  18 of 28  Actual Results (Outcome) Ending FY2021 58 individuals received Meals on Wheels Projected Results (Outcome) Ending FY2022 63 individuals will receive Meals on Wheels Projected Results (Outcome) Ending FY2023 63 individuals will receive Meals on Wheels   Program Goal # 2 Homebound seniors and disabled adults will receive a home delivered meal Performance Measure (How will you accomplish your goal?) # meals delivered Actual Results (Outcome) Ending FY2021 8,203 meals were delivered Projected Results (Outcome) Ending FY2022 8,883 meals will be delivered Projected Results (Outcome) Ending FY2023 8,883 meals will be delivered   Program Goal # 3 Volunteers will deliver Meals on Wheels Performance Measure (How will you accomplish your goal?) # volunteers scheduled Actual Results (Outcome) Ending FY2021 65 volunteers were scheduled Projected Results (Outcome) Ending FY2022 65 volunteers will be scheduled Projected Results (Outcome) Ending FY2023 65 volunteers will be scheduled    DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 9 Exhibit B Emergency Assistance Scope of Services Federal Tax Id. or SSN ____58-1563438____________ Contract # ________________ A. CONTRACTOR INFORMATION 1. Contractor Agency Name: Orange Congregations in Mission 2. If different from Contract Administrator Information in General Contract: Address _______ ___ ______ Telephone Number: _ Fax Number: Email: 3. Name of Program (s): Emergency Assistance 4. Status: ( ) Public (X) Private, Not for Profit ( ) Private, For Profit 5. Contractor's Financial Reporting Year July 1, 2022 through June 30, 2023 B. Explanation of Services to be provided and to whom: Through the Emergency Assistance Program, the Contractor will assist eligible individuals with rent and related costs as well as Town of Hillsborough water bills and related costs. The County will reimburse the Contractor up to $3,000/month, unless prior approval by County, for a total of $36,000for the contract period for rent/related costs and/or Town of Hillsborough bills/related costs. To be eligible clients must: be residents of Orange County, have income at or below 200% of the Federal Poverty Level, and have a household experiencing a financial crisis. Payments are limited to $200 within a 12-month period. The County will also reimburse the Contractor for staff costs (including salary, FICA, and fringe) for administering the Emergency Assistance Program up to $15,000 for the contract period. The Contractor will submit program paperwork provided by County at time and dates designated by County. C. Funding reimbursement limits by category: Rent/related costs and Town of Hillsborough bills/related costs $36,000 ($3,000per month) Staff costs: salary, FICA, fringe $15,000 D. Number of units to be provided: NA E. Details of Billing process and Time Frames: One fourth of the contract amount ($9,000 for rent and related costs and $3,750 for staff costs) for Emergency Assistance services described in this contract will be paid upon receipt of a completed contract. The Contractor will subsequently provide payment records for actual costs for the initial payment. After payment records are provided for the entire initial payment, the County will reimburse the Contractor for services described in this contract up to the budgetary limits of the contract allotment. The County will reimburse the Contractor for actual expenditures for approved services provided. For reimbursement, the Contractor must submit copies of bills, checks, receipts and/or other proof of expenditures by the fifth of the month for the preceding month’s expenditures to the designated County Administrator. The Contractor must submit a payment records for staff cost reimbursement. The County will reimburse the Contractor monthly upon receipt of a complete and correctly filed report. DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 $47,932.50 DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 Orange County Outside Agency Performance Agreement Page 10 of 10 Rev.06/22 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 agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization’s Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. Certified by: _______________________ Title: __________________________ Date: ___________ (Provider’s Signature) DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 8/22/2022 High &Rubish Insurance PO Box 3040 Chapel Hill NC 27515-3040 919-913-1144 919-913-1155 License#:1000008811 Cincinnati Insurance Companies 10677 OCIMINC-01 Cincinnati Surplus Lines 13037OCIM,Inc. Orange Congregations in Mission 300 Millstone Dr. Hillsborough NC 27278 USLI 25895 Hartford Underwriters Ins.30104 2144087635 A X 2,000,000 X 2,000,000 10,000 2,000,000 4,000,000 X Y Y ECP 0349072 10/15/2021 10/15/2024 4,000,000 B 2,000,000 X X EBA 0349072 10/15/2021 10/15/2022 D X22WECBV63608/18/2022 8/18/2023 100,000 100,000 500,000 C D&O NDO1043382J 7/21/2022 7/21/2023 D&O 1,000,000 Orange County PO Box 8181 302 W.Tryon St Hillsborough NC 27278 USA DocuSign Envelope ID: 71F97F5F-5151-4635-B81A-84B74866F622