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2023-463-E-Aging-OC MEALS ON WHEE;S-OUTSIDE AGENCY
Orange County Outside Agency Performance Agreement Revised 06/23—County Manager Version Page 1 of 10 OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2023, (“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 OC MEALS ON WHEELS, 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, 2023 to June 30, 2024. 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 $75000. 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 $18750 d. . 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. e. 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: E701E49A-4289-4810-AE30-AED24F19182B Orange County Outside Agency Performance Agreement Page 2 of 10 Rev.06/23 f. 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. g. 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 8, April 8 and July 8 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: E701E49A-4289-4810-AE30-AED24F19182B Orange County Outside Agency Performance Agreement Page 3 of 10 Rev.06/23 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. Cyber Liability. For protection from claims resulting from data breach, virus, and cyberattack; iii. 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; iv. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and v. 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. vi. 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 ‐ DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Orange County Outside Agency Performance Agreement Page 4 of 10 Rev.06/23 Statutory State NC, for each employee Limits for Coverage B ‐ Employers Liability of: $1 million Each Occurrence $1,000,000 BID limit Cyber Liability $1,000,000 Each Occurrence; $2,000,000 Aggregate *Only required for agencies transmitting personal identifiable information that is disseminated electronically. Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate Automobile Liability $1,000,000 Each Occurrence *Only required for agencies doing travel as part of the agreement with the County. Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate Sexual Misconduct $1,000,000 Each Occurrence $2,000,000 Aggregate *Only required for agencies doing direct work with minors (under the age of 18). 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 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Orange County Outside Agency Performance Agreement Page 5 of 10 Rev.06/23 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 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 $15.85 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 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Orange County Outside Agency Performance Agreement Page 6 of 10 Rev.06/23 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. 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 ame nded 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 OC MEALS ON WHEELS Attention: JANICE TYLER Attention: Rachel Sobel Bearman P.O. Box 8181 Address: 632 Laurel Hill Road Hillsborough, NC 27278 CHAPEL HILL, NC 27514 Email: Email: execdirector@mowocnc.org 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 _____________________________ _______________________ , Date For and on behalf of Orange County Government _______________________________ ________________________ Bonnie Hammersley, County Manager Date DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B 8/24/2023 Rachel Bearman Executive Director 8/28/2023 Orange County Outside Agency Performance Agreement Page 7 of 10 Rev.06/23 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Party/Vendor Name: OC MEALS ON WHEE;S Party/Vendor Contact Person: Rachel Sobel Bearman Contact Phone: 919-942-2948 Party/Vendor Address: D632 Laurel Hill Road City CHAPEL HILL State: NC Zip: 27514 Department: AGING Amount: 75000 Purpose: OUTSIDE AGENCY Budget Code(s): 1029005-719053 Vendor # 800080 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date 7/1/23 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: E701E49A-4289-4810-AE30-AED24F19182B 8/24/2023 8/28/2023 8/28/2023 8/28/2023 Orange County Outside Agency Performance Agreement Page 8 of 10 Rev.06/23 Exhibit A Provider’s Outside Agency Application DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Orange County Outside Agency Performance Agreement Page 9 of 10 Rev.06/23 Exhibit B Provider’s Revised Scope of Services and Program Budget DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Orange County Outside Agency Performance Agreement Page 10 of 10 Rev.06/23 ATTACHMENT “A” Orange County Certifications – FY 20 - Outside Agency Performance Agreement Chief Contact, Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, residential address; phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be c overed 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 ou r 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: E701E49A-4289-4810-AE30-AED24F19182B Cover Page Page 7 of 28 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 2024 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 Cost of Meal Delivered $16,000 Operations + Personnel $50,000 Operations + Personnel $75,000 Operations + Personnel $141,000 Totals $16,000 (1,777 meals delivered) $50,000 (5,555 meals delivered) $75,000 (8,333 meals delivered) $141,000 15,665 meals delivered ~ 24% of meals in 23-24 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. To nourish and enrich the lives of older adults living in Chapel Hill, Carrboro, and rural Orange County through the delivery of balanced meals and personal connections via check-ins. DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Cover Page Page 8 of 28 Signature: 1-10-22 Executive Director Date Signature: 1-10-22 Board Chairperson Date Application Signatures: Please submit a wet signature or electronic signature, MS Word cursive fonts are not acceptable. DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Cover Page Page 9 of 28 DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON‐DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates. YES NO ☒ a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ☒ b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ☒ c) Current beneficiaries of the program for which funds are being requested? ☒ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. NON‐DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti‐discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: 1-10-23 Executive Director Date Signature: 1-10-23 Board Chairperson Date DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Cover Page Page 10 of 28 Application Signatures: Please submit a wet signature or electronic signature, MS Word cursive fonts are not acceptable. DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 11 of 28 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 nourish and enrich the lives of older adults through meal delivery and personal connection. 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 46 years MOWOCNC has faithfully served older adults, maintaining or increasing service levels through strong financial oversight, community outreach and engagement, innovation, and the dedication and commitment of our donors and volunteers. In 2022, through a year of heightened food costs and economic challenges, we increased meal distribution by 8.9%, despite a $1.60 per meal price increase in August of 2022. We served 67,292 meals along with friendly check-ins to over 400 older adults across Chapel Hill, Carrboro, and rural Orange. 4. Living Wage: Does this agency pay permanent employees a minimum living wage? (Yes / No) Yes If yes, is this agency an Orange County Living Wage Certified Employer? Yes If no, please briefly explain. Schedule of Positions: # of FTE – Full-Time Paid Positions: _1__ # of FTE – Part- Time Paid Positions: _5_ Race & Equity 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. We are requesting basic information about your organization’s racial equity work. 5. How has your organization incorporated racial equity goals into your organizational goals? For the past five 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 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 12 of 28 the same questions and procedures. We have developed and incorporated operation 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. Since we’ve recognized we do have barriers for those in the Hispanic/Latinx and Asian communities potentially based on language and food, MOWOCNC has translated brochures about our program into Spanish, Mandarin, Burmese, and Karen. One of the four goals of our current strategic plan focuses on ensuring our volunteers, staff, board, and recipients better reflect the diversity of the communities in which we serve. 6. 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. We also work collaboratively with partners to better understand the needs of current and potential recipients and the challenges some older adults may face in learning about or accessing services. 7. Please fill in your agency demographics in the table below: Agency Demographics Staff Board Gender Men 6 Women 6 12 Nonbinary/Genderqueer Self-Describe Total 6 18 Race and Ethnicity Black or African-American 1 American Indian or Alaska Native Asian Indian 1 2 White 4 14 Native Hawaiian or Other Pacific Islander Chinese 1 1 Japanese Vietnamese Filipino Korean Some other race Total 6 18 Of the above, how many Hispanic, Latino or Spanish origin 0 0 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 13 of 28 Of the above, how many non-Hispanic, Latino or Spanish origin 6 18 Total 6 18 8. Please describe any activities your organization is doing to address racial equity. a. % of staff that have attended racial equity training: 100% b. % of board that have attended racial equity training: 72% c. Any additional activities: Our organization is working to develop a recruitment plan to expand volunteer diversity and further our outreach to bilingual volunteers, board, and community members. PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 9. 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 10. 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 along with friendly check-ins to older adults, homebound adults, older 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. MOWOCNC helps ensure that residents access the most appropriate social safety net services and helps older adults improve their health outcomes. 11. Target Population: Please complete the table below with numbers (not percentages) of individuals served and projected to be served. Program Target Population Demographics Projected 2021‐2022 Actual 2021‐2022 Projected 2022‐2023 Projected 2023‐2024 Gender Men 150 156 165 172 Women 266 272 281 293 Nonbinary/Genderqueer Self‐Describe Total 416 428 446 465 Race and Ethnicity DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 14 of 28 Black or African‐American 170 144 159 167 American Indian or Alaska Native 2 2 2 2 Asian Indian 1 1 2 White 228 249 249 255 Native Hawaiian or Other Pacific Islander 1 1 1 Chinese 2 17 20 20 Japanese Vietnamese Filipino Korean Some other race 14 14 14 18 Total 416 428 446 465 Of the above, how many Hispanic, Latino or Spanish origin 8 7 10 15 Of the above, how many non‐Hispanic, Latino or Spanish origin 408 421 436 450 Total 416 428 446 465 Age 0‐5 years 0 6‐18 years 0 19‐50 years 12 11 12 12 51+ years 404 417 434 453 Total 416 428 446 465 Geographic Location Town of Chapel Hill 191 195 200 213 Town of Carrboro 85 67 72 74 Orange County (Outside of Chapel Hill/Carrboro) 140 166 174 178 Outside of Orange County Total 416 428 446 465 Income Low‐income (80% of the Area Median Income and Below) Please see income table in the attachments 400 420 436 455 Total 416 428 446 465 12. 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 2021- 2022 Projected 2022- 2023 Projected 2023- 2024 Total Cost of Program $565, 386.00 $669,481.00 $774,055.00 Total # of Individuals 428 446 465 Cost Per Individual $1,290.83 $1,501.08 $1,664.63 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 15 of 28 13. 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 select one strategic objective per program. If you would like to provide additional information on how your program aligns with additional strategic objectives, please include that information in Question 10 – Program Description. 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 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 2021‐2022 Projected 2022‐2023 Projected 2023‐2024 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 additional rows as needed, listing one per row). Insert Performance Indicator here. 2.1 % and # Client satisfaction rates Not a measure in 21-22 93% (414) of recipients are satisfied or very satisfied with food taste, variety and portion. 94% (437) of recipients are satisfied or very satisfied with food taste, variety and portion. 2.1 % and # of program participants that receive food assistance 100% (428) 100% (446) 100% (465) 3.2 # of people reporting healthier functionality and lifestyle Not a measure in 21-22 94% (419) agree or strongly agree that 94% (437) agree or strongly agree that DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 16 of 28 behaviors (improved nutrition, conflict resolution skills, stress reduction practices, exercise at least 30min 3x a week, annual check- ups, etc.) receiving MOWOCNC enables me to eat more nutritious food. 90% (374) agree or strongly agree that MOWOCNC has improved receiving MOWOCNC enables me to eat more nutritious food. 90% (374) agree or strongly agree that MOWOCNC has improved 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 volunteer 95% (423) 95% (441) 3.2 % and # of program participants that consume fresh food 100% (428) 100% (446) 100% (465) DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Outside Agencies/Human Services Program information P a g e 17 of 28 Please select which function area best aligns with your agency and program(s) in which you are requesting funding. Please select only one from the list below: ☐ Behavior Health ☐ Public Health & Health Education ☒ Food & Nutritional Service ☐ Recreational ☐ Housing ☒ Senior Services ☐ Human Rights & Community Services ☐ Youth Services ☐ Juvenile & Adult Justice Services ☐ Other 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 and reduce social isolation/loneliness amongst eligible older adults. Performance Measure (How will you accomplish your goal?) Increase delivery days in northern Orange to increase access to hot meals and more frequent check-ins. Actual Results (Outcome) Ending FY2022 100% (133) with access to 5 meals per week. 95% (85) report reduced food insecurity/improved nutrition. 94% (125) report social connection with volunteers Projected Results (Outcome) Ending FY2023 100% (158) with access to 5 meals per week. 95% (150) report reduced food insecurity/improved nutrition. 94% (148) report social connection with volunteers Projected Results (Outcome) Ending FY2024 100% (160) have access to 5 meals per week 95% (152) report reduced food insecurity/improved nutrition. 94% (150) report social connection with volunteers We fall under Senior Services and Food and Nutritional Services DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Outside Agencies/Human Services Program information P a g e 18 of 28 Program Goal # 2 Equitable access to Meals on Wheels service across Orange County, targeting unserved and underserved communities Performance Measure (How will you accomplish your goal?) Expand outreach through creation of partnerships, materials in multiple languages, and menu development Actual Results (Outcome) Ending FY2022 New Measure Projected Results (Outcome) Ending FY2023 1. Established partnerships with agencies working with targeted populations. 2. Increased referrals/intakes from targeted populations 3. Menu development plan focused on culturally tailored meals Projected Results (Outcome) Ending FY2024 Increased # of recipients from targeted populations/communities. Program Goal # 3 Increase # of volunteers to reduce food insecurity/improve nutrition and reduce social isolation/loneliness amongst eligible older adults. Performance Measure (How will you accomplish your goal?) Expand outreach to increase # of volunteers and attract more diverse volunteers. Actual Results (Outcome) Ending FY2022 300 + volunteers (drivers, set-up, bakers, food sorters, etc.) Projected Results (Outcome) Ending FY2023 320 + Volunteers with at least 15% from diverse communities (race, ethnicity, sexual orientation, location, etc.) Projected Results (Outcome) Ending FY2024 325 + volunteers with at least 20% from diverse communities ((race, ethnicity, sexual orientation, location, etc.) DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 19 of 28 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. The delivery of healthy meals accompanied by friendly check-ins, improves health, alleviates hunger, and reduces isolation. Nationally, MOW recipients have reduced emergency room visits (20%), hospitalization rates (36%) and nursing home usage (30%). They report healthier eating, improved mental health, and reductions in the rate of falls, feelings of loneliness, and anxiety. Locally, recipients agree/strongly agree that (93%) receiving meals on wheels helps me to eat more nutritious food. (90%) receiving meals on wheels has improved my health. (100%) receiving services helps me remain in my home. (87%) receiving services reduces my need for in-home care. 2. What methods/tools will your organization use to evaluate the proposed program’s effectiveness? Please include specific examples, such as a logic model. Program effectiveness is based on: satisfaction with 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 and social isolation and loneliness Quantitative and qualitative data from recipient (bi-annually), volunteer, board member and staff (annually) surveys along with donor, volunteer, and community focus groups (tri- annually) were analyzed and integrated into our new strategic plan. The data is continually utilized and updated along with the daily direct feedback from volunteers and recipients to consistently evaluate program effectiveness and impact. 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 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Program information P a g e 20 of 28 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 – research projects, evaluation, program development and recipient informational updates 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 meal delivery service in Chapel Hill. In August of 2022, meal prices increased by $1.60 per meal, adding an additional $100,000 to meal expense annually, just to maintain current delivery levels. We are projecting significant budget deficits in 2023 which suppress our ability to roll recipients off the waitlist or reach out to the unserved or underserved. DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Attachments Page 21 of 28 4. ATTACHMENTS Description of Required Attachments a) Financial Audit A recent financial audit that should cover CY2021, for calendar year agencies, and FY2021‐2022, 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: E701E49A-4289-4810-AE30-AED24F19182B Attachments Page 22 of 28 h) 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: $1,000,000 Each Occurrence $1,000,000 BID for each employee $1,000,000 BID policy limit The contractor shall provide and maintain, during the life of the contract, workers’ compensation insurance as required by law, as well as employer’s liability coverage as noted below. Employer’s Liability: Workers’ Compensation is required if the contractor/vendor has employees. Owner Waiver is acceptable for a Sole Proprietor. 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 Commercial General 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: E701E49A-4289-4810-AE30-AED24F19182B Attachments Page 23 of 28 Products/Completed Operations, Explosion, Collapse & Underground Automobile Liability $1 million Each Occurrence *Only required for agencies doing travel as part of the agreement with the Town. $1 million Each Occurrence *Owned/non‐owned, and hired motor vehicle $1 million Each Occurrence *Only required for agencies doing travel as part of the agreement with the County. Professional Liability $1 million Each Occurrence $2 million Aggregate $1 million Each Occurrence $2 million Aggregate $1 million Each Occurrence $2 million Aggregate 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 *May be required for contractors working directly one‐on‐ one with children and elderly or in overnight sheltering capacities. $1 million Each Occurrence $2 million Aggregate *Only required for agencies doing direct work with minors (under the age of 18). 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 *May be required for Contractors having access to personal identifying information, and/or computer networks. $1 million Each Occurrence $2 million Aggregate *Only required for agencies transmitting personal identifiable information that is disseminated electronically. Visit the NC Industrial Commission’s website for more information regarding Coverage A. Also, note that if an agency uses subcontractors, it must require subcontractors to have workmen’s compensation insurance. Bodily Injury by Disease (BID). Please visit Orange County’s Risk Management page for more information about the County’s Minimum Insurance Requirements. For additional information regarding the Town of Chapel Hill’s Minimum Insurance Requirements, please contact the Office of Risk Management or Business Management. Town of Chapel Hill At‐your‐Service. DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Attachments Page 24 of 28 2022 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 $20,100 $22,950 $25,800 $28,650 $32,470 $37,190 $41,910 $46,630 50% area median income $33,450 $38,200 $43,000 $47,750 $51,600 $55,400 $59,250 $63,050 60% area median income $40,150 $45,850 $51,600 $57,300 $61,900 $66,500 $71,100 $75,650 80% area median income $53,500 $61,150 $68,800 $76,400 $82,550 $88,650 $94,750 $100,850 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B 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: E701E49A-4289-4810-AE30-AED24F19182B 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 childcare 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 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Attachments % and # of program participants who secure employment % 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 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B Attachments 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. 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: E701E49A-4289-4810-AE30-AED24F19182B Certified by: _______________________ Title: __________________________ Date: ____________ (Provider’s Signature) EXHIBIT “B” Scope of Services – FY 2023-24 Outside Agency Performance Agreement Agency Name: Program Name: Funding Award: 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, 2024. 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 Expense Description Amount DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED 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) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached 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 RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED 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 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Alliance of Nonprofits for Ins RRG Hartford Underwriters Insurance Co. Carolina Casualty Insurance Company The Travelers Indemnity Company 8/07/2023 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 10023 30104 10510 25658 A X X X 202336882 07/01/2023 07/01/2024 1,000,000 500,000 20,000 1,000,000 3,000,000 3,000,000 A X X 202336882 07/01/2023 07/01/2024 1,000,000 B N 6S60UB0G11045223 07/01/2023 07/01/2024 X 500,000 500,000 500,000 C D D&O Cyber DCP1231894P11 107079935 07/03/2023 04/04/2023 07/03/2024 04/04/2024 $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 #S423572/M423570 NCCHAP7Client#: 58358 NPA 1 of 1 #S423572/M423570 DocuSign Envelope ID: E701E49A-4289-4810-AE30-AED24F19182B