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HomeMy WebLinkAbout2023-472-E-DEAPR-Bridge II Sports-Outside Agency FundingOrange 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 Bridge II Sports, a not-for-profit corporation, located at 3729 Murphy School Road, Durham, North Carolina 27705 (“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 $15,000. 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 $3750. The first payment is contingent upon receipt of the agency’s performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. d. The County’s obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 Orange County Outside Agency Performance Agreement Page 2 of 10 Rev.06/23 e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 – December 31; January 1 – March 31 and April 1 - June 30. Reports are due on January 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: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 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 (Ardra Webster) 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: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 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: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 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: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 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 amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. m.Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Attention: Ardra Webster P.O. Box 8181 Hillsborough, NC 27278 Provider’s Name Bridge II Sports Attention: Ashely Thomas Address: 3729 Murphy School Rd Durham, NC 27705 Email:awebster@orangecountync.gov Email: ashley@bridge2sports.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 _____________________________ _______________________ Ashley Thomas, Executive Director Date For and on behalf of Orange County Government _______________________________ ________________________ Bonnie Hammersley, County Manager Date DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 8/22/2023 8/29/2023 Orange County Outside Agency Performance Agreement Page 7 of 10 Rev.06/23 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Party/Vendor Name: Bridge II Sports Party/Vendor Contact Person: Ashley Thomas Contact Phone: 866-880-2742 Party/Vendor Address: 3729 Murphy School Rd. City Durham State: NC Zip: 27705 Department: DEAPR Amount: $15,000 Purpose: Outside Agency Funding Budget Code(s): 10290050 719056 Vendor # 62735 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date July 2023 Approved by Board Yes No Agenda Date: June 20, 2023 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: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 8/22/2023 8/28/2023 8/28/2023 8/29/2023 Cover Page P a g e 3 o f 21 COVER PAGE Applicant Contact Information Applicant Organization’s Legal Name: Bridge II Sports Applicant Organization’s Physical Address: 3729 Murphy School Rd, Durham, NC 27705 Applicant Organization’s Mailing Address: 3729 Murphy School Rd, Durham, NC 27705 Applicant Organization’s Web Address: www.bridge2sports.org Executive Director: Ashley Thomas Telephone Number: 866 880-2742 E-Mail: ashley@bridge2sports.org Tax ID Number: 20-8577055 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 Ex. Youth Afterschool Program Operations or Personnel Operations Operations Operations EveryBODYPlaysNC – in school adapted sports program 5,000 Operations 30,000 Operations 30,000 Operations 65,000 Totals 65,000 Briefly explain your proposed use of funds: To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: Executive Director Date Signature: Board Chairperson Date These funds will be used to deliver the EveryBODYPlaysNC program to 13 schools. This is a mobile interactive adapted sports program allowing student s with physical disabilities to learn and play alongside their able-bodied peers. Funds are spent on transportation, adapted sports equipment, equipment maintenance, curriculum and staffing expenses directly related to the delivery of programming. DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 8/22/2023 Cover Page P a g e 4 o f 21 Application Signatures: Please submit a wet signature or electronic signature, MS Word cursive fonts are not acceptable. DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 Cover Page P a g e 5 o f 21 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: Executive Director Date Signature: Board Chairperson Date Application Signatures: Please submit a wet signature or electronic signature, MS Word cursive fonts are not acceptable. DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 8/22/2023 Program information P a g e 6 o f 21 AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): February 2007 2. Agency’s Purpose/Mission (no more than a few sentences): Bridge II Sports educates, develops and implements opportunities for youth, adults and Veterans with physical disabilities to play individual, team and recreational sports finding the player within. By creating opportunities Bridge II Sports develops a culture of empowerment that fosters respect for all abilities and has a life changing impact on all humanity. 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). Bridge II Sports has collaborated with local school systems to bring EBPNC to over 26,000 students. We receive requests from pediatric OT’s, PT’s, RT’s as well as P.E. teachers, school staff and parents to bring this program to schools throughout NC. In addition to the success of EBPNC, we run year-round adapted sports camps, clinics, events and several competitions. Our budget has been developed and honed over the years and is comprehensive, including educational/curriculum supplies. 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: _7__ # 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? Bridge II Sports first Board represented diversity in gender, ethnicity, and disability as the population of people served by Bridge II Sport represent a variety of individuals from all walks of life. Additionally, the Founder and CEO is a woman who lived with disability every day of her life. I believe that is why Bridge II Sports has historically had staff, volunteers, represent all. Currently, the Bridge II Sports team including full time and PT people represent 14 people, 7 with disabilities, 7 without. Additionally, the team represents female/male to a 50/50 ratio and diversity of ethnicity and religious beliefs. This is something the Founder is very proud of. The history of inclusion continues from the beginning. In the seventeen years of history, Bridge II Sports had an athlete when through transgender medical procedure as a wheelchair user. Again, all have been welcomed and included. DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 Program information P a g e 7 o f 21 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). EBPNC serves grade school students with physical disabilities. As an experiential educational format, students with physical disabilities and able-bodied students actively participate. The planning, design and curriculum are informed and delivered by a diverse team that represents diversity across the race, gender and ability spectrums. BIIS is a disability led organization. EBPNC grew out of the experiences of children within the physical disability ecosystem and a need for inclusion in sports participation for youth. 7. Please fill in your agency demographics in the table below: Agency Demographics Staff Board Gender Men 7 5 Women 7 5 Nonbinary/Genderqueer Do not ask Do not ask Self-Describe 1 Total 14 10 Race and Ethnicity Black or African-American 6 1 American Indian or Alaska Native Asian Indian White 8 9 Native Hawaiian or Other Pacific Islander Chinese Japanese Vietnamese Filipino Korean Some other race 7 w/disability 4 w/ disability Total 14 10 Of the above, how many Hispanic, Latino or Spanish origin Of the above, how many non-Hispanic, Latino or Spanish origin Total 0 0 8. Please describe any activities your organization is doing to address racial equity. a. % of staff that have attended racial equity training: b. % of board that have attended racial equity training: DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 Program information P a g e 8 o f 21 c. Any additional activities: Bridge II Sports creates a diverse working environment. Staff training includes all. Each member of the team has the opportunity to lead and teach policies, processes. This includes the entire team. BIIS rich history of inclusion has always invited all. PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 9. Program Name: EveryBODYPlaysNC Program Primary Contact and Title: Ashley Thomas, CEO/Founder Telephone Number: 866-660-2742 E-Mail: ashley@bridge2sports.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). The BIIS program, EBPNC, introduces adapted sports and equipment to children with physical disabilities in an experiential setting creating access to recreational opportunities they may not otherwise have access to. Adapted equipment can be costly and awareness of adapted sports may be limited in many communities. Through the introduction of adapted sports at a grade level age, children with disabilities are able to establish new and lifelong healthy behaviors and a community is educated on the power of adapted sports and the inclusion of all abilities in recreational and sporting opportunities. 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 1064 600 700 Women 698 500 600 Nonbinary/Genderqueer Self-Describe Total 750 1762 1100 1300 Race and Ethnicity Black or African-American 133 American Indian or Alaska Native 1 DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 Program information P a g e 9 o f 21 Asian Indian White 401 Native Hawaiian or Other Pacific Islander 3 Chinese 46 Japanese 1 Vietnamese Filipino Korean Some other race 13 Total 750 * 598 1100 1100 Of the above, how many Hispanic, Latino or Spanish origin 21 Of the above, how many non-Hispanic, Latino or Spanish origin 21 Total 0 21 0 0 Age 0-5 years 0 6-18 years 1167 19-50 years 383 51+ years Total 0 1550* 1100 1300 Geographic Location Town of Chapel Hill Town of Carrboro Orange County (Outside of Chapel Hill/Carrboro) *800 Outside of Orange County *962 Total 750 *1762 0 0 Income Low-income (80% of the Area Median Income and Below) Please see income table in the attachments We do not track We do not track We do not track We do not track Total 750 50% 1100 1300 *Note: at Adapted Sporting Events, we do not collect all of this detail, thus this is why numbers do not add up 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 $891,449 963,980 1,200,000 Total # of Individuals 1762 1100 1300 Cost Per Individual $506 $876 $923 13. Performance Indicators DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 Program information P a g e 10 o f 21 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: EveryBODYPlaysNC Strategic Objective (please choose one from the Results Framework)  Children improve their educational outcomes  Residents Increase their livelihood security X Residents improve their health outcomes Intermediate Result (please choose one from the Results Framework) Insert Intermediate Result here. The intermediate result is, strategic objective 3, (residents) children with physical disabilities have access to basic healthy recreational options and services. The impacts have shown improvements in academic performance, decreased school bullying and increased physical activity among youth with physical disabilities. 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). ▪ % and # of program participants who demonstrate new physical skills that support their independence . 800 2600 3000 DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 Certified by: _______________________ Title: __________________________ Date: ____________ (Provider’s Signature) EXHIBIT “B” Scope of Services – FY 2023-24 Outside Agency Performance Agreement Agency Name: Bridge II Sports Program Name: EBPNC and Year-round Adapted Sports Programming Funding Award: $15,000 Outline how the agency will spend Orange County’s funding award. Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2024.  Provide Adapted Sports Programming for Orange County residents with physical disabilities  Provide EveryBODYPlaysNC Program for Orange County residents  Provide Disability Etiquette Training for Orange County residents 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 Improved understanding of disability 675 Increased understanding of the ability of people with physical disability 675 Increase knowledge for children with disabilities about BIIS Adapted Sports Programs 67 Expense Description Amount Staff Payroll/Benefits/Consultants 5000 Adapted Sports Equipment Rental 10000 DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 8/22/2023Founder and CEO Orange County Outside Agency Performance Agreement Page 10 of 10 Rev.06/23 ATTACHMENT “A” Orange County Certifications – FY 2023-2024 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: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 8/22/2023Founder and CEO 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) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY Willis Towers Watson Northeast, Inc. c/o 26 Century Blvd P.O. Box 305191 Nashville, TN 372305191 USA Move United 451 Hungerford Drive Suite 608 Rockville, MD 20850 This Voids and Replaces Previously Issued Certificate Dated 08/11/2023 WITH ID: W29829232. Coverage policies to use for all Chapter requests: Bridge II Sports Program Start Date: 07/31/2023 Program End Date: 11/30/2023 Name of Program/Event: EveryBODYPlaysNC Orange County 300 West Tryon Street PO Box 8181 Hillsborough, NC 27278 08/18/2023 1-877-945-7378 1-888-467-2378 certificates@willis.com Arch Insurance Company 11150 W29878787 A 1,000,000 1,000,000 Excluded 1,000,000 5,000,000 5,000,000 Y SBCGL0408105 12/01/2022 12/01/2023 A 1,000,000 SBFXS0054005 12/01/2022 12/01/2023 1,000,000 A Sexual Abuse & Molestation Each OccurrenceSBCGL040810512/01/2022 12/01/2023 Aggregate 309745924540739SR ID:BATCH: CLUB $1,000,000 $1,000,000 Willis Towers Watson Certificate Center Page 1 of 2DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Move United 451 Hungerford Drive Suite 608 Rockville, MD 20850 Type of Program/Event: Adapted Sports Program training clinics for NC schools Safety Equipment or Precaution: All adaptive equipment including wheelchairs, blackout goggles, etc., are checked and monitored by trained BIIS staff. Providing the educational training/disability awareness event at multiple schools within Orange County. Event Address: 3729 Murphey School Rd, Durham, NC 27705 Orange County, its officers, agents and employees are included as Additional Insured as respects to General Liability. Excess Abuse limits via Umbrella Coverage. 2 2 Willis Towers Watson Northeast, Inc. See Page 1 See Page 1 See Page 1 See Page 1 25 Certificate of Liability Insurance W29878787CERT:3097459BATCH:24540739SR ID: DocuSign Envelope ID: 5B0A0BDD-DA6D-48E7-A65E-A0859BD61F52