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2023-484-E-DEAPR-Triangle Bikeworks -Outside Agency Funding
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 Triangle Bikeworks, a not-for-profit corporation, located at 117 W. Main Street, Carrboro, North Carolina 27510 (“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 $5000. 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 $1250. 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: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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 Provider’s Name Triangle Bikeworks Attention: Ardra Webster Attention: Kevin Hicks P.O. Box 8181 Address: 117 W. Main Street Hillsborough, NC 27278 Carrboro, NC 27510 Email:awebster@orangecountync.gov Email: kevin@trianglebikework 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 _____________________________ _______________________ Kevin Hicks, Executive Director Date For and on behalf of Orange County Government _______________________________ ________________________ Bonnie Hammersley, County Manager Date DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 8/27/2023 9/8/2023 Orange County Outside Agency Performance Agreement Page 7 of 10 Rev.06/23 ORANGE COUNTY—DEPARTMENT USE ONLY ______________________________________________________________________________ Party/Vendor Name: Triangle Bikeworks Party/Vendor Contact Person: Kevin Hicks Contact Phone: 919-452-2272 Party/Vendor Address: 117 W. Main Street City Carrboro State: NC Zip: 27510 Department: DEAPR Amount: $5000 Purpose: Outside Agency Funding Budget Code(s): 10290050-720271 Vendor # 800879 (N/A if new vendor) Vendor is a BOCC consultant? Yes No Contract Type: (Check one) New Renewal Amendment Effective Date July 1, 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: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 8/27/2023 9/7/2023 9/8/2023 9/8/2023 COVER PAGE Cover Page Page 7 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F Cover Page Page 8 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F Cover Page Page 9 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F AGENCY INFORMATION Please provide the following information about your agency: 1.Date of Incorporation (Month/Year):April 4, 2014 2.Agency’s Purpose/Mission (no more than a few sentences): The mission of Triangle Bikeworks (TBW) is to strengthen the power of youth who are Black, Latine*, Asian, Indigenous, and People of Color to overcome challenges, achieve audacious goals, and discover their true selves. Our primary purpose is to provide experiential learning opportunities, social emotional support, and leadership development through year-round cycling and educational programs, and community events. *We use the term Latine (lah-teen-eh) as a gender-neutral form of the word Latino. For more information visit: https://callmelatine.com/faq/ 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). Since 2011, TBW has provided over 290 teens with unique out-of-school programming. Students participate in organized cycling, experiential out of state field trips, and community-wide rides. In 2019, TBW offered year-round programming, providing almost 50 hours a month of physical training and enrichment. Our team building components during the pandemic were crucial in helping youth find solid footing when the world was on shaky ground. In 2020, the TYMBR Wolves mountain biking program offered competitive cycling. TBW stays within our budget and timetables as evidenced by the consistent support of local organizations and foundations. We fulfill all necessary reporting. 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: 2 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 Program informationPage 10 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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? Equity and anti-racist work has had its home in TBW’s mission since the organization’s inception. By design, 100% of the youth we serve identify as BIPOC, and we remain committed to intentional DEI practices on an individual and systems level in every aspect of our work. All our youth programs center racial equity goals. Because research tells us that the lack of background knowledge about BIPOC history, people, and cultures contributes to the opportunity gap among young people, TBW’s overarching goal is to provide our youth with programs, support and historical frameworks not directly provided in school. As such, we build intentional programs highlighting and celebrating the history and cultures of BIPOC people. Our weekly out of school and excursions programs include history lessons that tell a more complete story of our individual and collective past, and an inclusive interpretation of history that includes BIPOC people. We also create safe spaces of connection, learning, belonging, and inclusion which both respects and reflects our youth. In all of our program planning, we leave intentional space for conversation and reflection among and between our youth and staff. 75% of our staff identifies as BIPOC, including our Executive Director and Co-Founder, bringing lived experiences to our collective work. Our curriculum designer is trained in DEI practices, and we include equity goals in all program design. Our Board of Directors leads with the same principles. In 2020, the organization approved an anti-racist statement reflecting the equity values long rooted in our work. 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). TBW encourages teen members to participate on the Board of Directors, giving them an opportunity to advise on the direction of the organization.We hold three seats open on the Board for youth leadership positions. While in the field, teens are also encouraged to rotate through lead roles during training rides and long tours. Our SEL lessons are predicated on youth input about what they desired to learn and discover. Program informationPage 11 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 7. fill in your agency demographics in the table below: Agency Demographics Staff Board Gender Men 1 4 Women 1 6 Nonbinary/Genderqueer Self-Describe Total 2 10 Race and Ethnicity Black or African-American 1 5 American Indian or Alaska Native Asian Indian 1 White 3 Native Hawaiian or Other Pacific Islander Chinese Japanese Vietnamese Filipino Korean Some other race 1 1 Total 2 10 Of the above, how many Hispanic, Latino or Spanish origin Of the above, how many non-Hispanic, Latino or Spanish origin 1 1 Total 1 1 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: c. Any additional activities: Program informationPage 12 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 9. Program Name: Triangle Bikeworks Program Primary Contact and Title: Kevin Hicks, Executive Director Telephone Number: 919-452-2272 E-Mail: kevin@trianglebikeworks.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) TBW’s youth programs provide physically challenging out-of-school activities that develop leadership and build social-emotional learning competencies through three learning pathways: Cycling, Untold History, and Environmental Education. We serve BIPOC youth ages 11-18. 85% of our youth are from low-income households. In 2023/2024, TBW will provide up to 340 hours of out-of-school programming that includes workshops, lectures, guest speakers, mindfulness practices, team-building activities, and above all, training rides and Fall and Spring bike tours. Youth ready to advance are invited to the 2-week immersive cross-country summer tour with stops at historical and educational sites. Our spring mountain biking program takes the youth across the state of North Carolina, making peer connections from the coast to the mountains. In all, TBW programs have the goal of increasing health outcomes for the youth, which through research leads to in-class effectiveness, increased social interactions, and growth in their resilience to challenges. TBW’s theory of change shows that after completing our program, youth will have an increased understanding of the world around them, increased social emotional awareness, and increased power to overcome challenges and achieve personal and collective goals. This increases the likelihood of improved academic outcomes and capacity to work with others to co-create a more healthy, just and equitable world. Our physical, education-based programs align well with the Towns’ Strategic Objective #3 (Residents improve their health outcomes), and the OC BOCC Goal to ensure a high quality of life and lifelong learning that champions diversity and education at all levels. Program informationPage 13 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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 021-2022 Projected 2022-2023 Projected 2023-2024 Gender Men 47 40 50 55 Women 7 21 20 25 Nonbinary/Genderqueer Self-Describe 1 1 1 2 Total 55 62 71 77 Race and Ethnicity Black or African-American 32 27 33 35 American Indian or Alaska Native 2 1 Asian Indian 3 1 2 2 White 1 4 2 3 ative Hawaiian or Other Pacific Islander Chinese Japanese Vietnamese Filipino Korean Some other race 17 29 34 37 Total 55 62 71 77 Program informationPage 14 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F Of the above, how many Hispanic, Latino or Spanish origin 5 12 15 15 Of the above, how many non-Hispanic, Latino or Spanish origin 50 60 56 62 Total 55 62 71 77 Age 0-5 years 6-18 years 50 42 50 55 19-50 years 5 20 21 22 51+ years Total 55 62 71 77 Geographic Location Town of Chapel Hill 15 17 15 25 Town of Carrboro 16 7 16 15 Orange County (Outside of Chapel Hill/Carrboro)5 5 5 5 Outside of Orange County 19 33 34 32 Total 55 62 60 77 Income w-income (80% of the Area Median Income and Below) Please see income table in the attachments 45 40 50 60 Total 55 62 60 77 Program informationPage 15 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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 $74,573 $79,387 $79,387 Total # of Individuals 60 71 77 Cost Per Individual $1,243 $1,118.13 $1,031.00 Program informationPage 16 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F 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) X 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. Residents demonstrate new healthy lifestyle behaviors RESULTS Actual 2021-2022 Projected 2022-2023 Projected 2023-2024 Performance Indicators % and # of program participants that express greater confidence in their leadership and prosocial activities. 100% (60 out of 60) 100% (71 out of 71) 100% (77 out of 77) RESULTS Actual 2021-2022 Projected 2022-2023 Projected 2023-2024 Performance Indicator % and # of youth that meet the wellness goal of cycling 21 miles within 2 hours. 100% (60 out of 60) 100% (71 out of 71) 100% (77 out of 77) Program informationPage 17 of 31 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F Executive Director 8/27/2023 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 8/22/2023 Marsh &McLennan Agency LLC 1400 Eastchester Drive,St 200 High Point NC 27265 Erin Whittington 336-899-2444 212-607-6552 Erin.Whittington@marshmma.com Alliance of Nonprofits forInsurance RRG 10023 TRIAN03 Triangle Bikeworks Kevin Hicks 117 W Main Street Carrboro NC 27510 620124139 A X 1,000,000 X 500,000 1,000,000 3,000,000 X 202337804 6/11/2023 6/11/2024 3,000,000 A 1,000,000 X X X 202337804 6/11/2023 6/11/2024 A Improper Sexual Conduct 202337804 6/11/2023 6/11/2024 Each Claim/Aggregate $1MM /$2MM Orange County,it's officers,agents and employees are to be designated as additional insured. Orange County 300 West Tryon St P BOX 8181 Hillsborough NC 27278 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 9/6/2023 Marsh &McLennan Agency LLC 1400 Eastchester Drive,St 200 High Point NC 27265 Erin Whittington 336-899-2444 212-607-6552 Erin.Whittington@marshmma.com Alliance of Nonprofits forInsurance RRG 10023 TRIAN03 SummitPoint Insurance Company 15136TriangleBikeworks Kevin Hicks 117 W Main Street Carrboro NC 27510 1423693642 A X 1,000,000 X 500,000 1,000,000 3,000,000 X 202337804 6/11/2023 6/11/2024 3,000,000 A 1,000,000 X X X 202337804 6/11/2023 6/11/2024 B X89740118/31/2023 8/31/2024 500,000 500,000 500,000 A Improper Sexual Conduct 202337804 6/11/2023 6/11/2024 Each Claim/Aggregate $1MM /$2MM Orange County,it's officers,agents and employees are to be designated as additional insured. Orange County 300 West Tryon St P BOX 8181 Hillsborough NC 27278 DocuSign Envelope ID: 6A73A95F-9EEF-4EFD-96FE-00C59AA0BD1F