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HomeMy WebLinkAbout2024-571-E-Aging Dept-CHARLES HOUSE-OUTSIDE AGENCYOrange 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 2024, (“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 CHARLES HOUSE, a not-for-profit corporation, located at 7511 Sunrise Rd, 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, 2024 to June 30, 2025. 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 $26000. 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 $6500. 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: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 2 of 12 Rev.06/24 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 7, April 7 and July 7 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: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 3 of 12 Rev.06/24 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: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 4 of 12 Rev.06/24 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: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 5 of 12 Rev.06/24 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 $17.65 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. There are no third party beneficiaries of this Agreement and nothing in this Agreement, express or implied, is intended to confer on any person other than the parties hereto (and their respective successors, heirs and permitted assigns), any rights, remedies, or obligations. 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. Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 6 of 12 Rev.06/24 h. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. i. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. j. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. k. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remai ning 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 CHARLES HOUSE Attention: JANICE TYLER Attention: DEAN FOX P.O. Box 8181 Address: 7511 Sunrise Rd Hillsborough, NC 27278 CHAPEL HILL NC 27514 Email: Email: dean@charleshouse.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 Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 9/25/2024 Orange County Outside Agency Performance Agreement Page 7 of 12 Rev.06/24 _______________________________ ________________________ , County Manager Date Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 10/9/2024 Orange County Outside Agency Performance Agreement Page 8 of 12 Rev.06/24 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: CHARLES HOUSE Vendor Contact Person: DEAN FOX Phone: Address: 7511 SUNRISE ROAD City CHAPEL HILL State: NC Zip: 27514 Department: AGING Amount: 26000 Purpose: OUTSIDE AGENCY Budget Code(s): 10290050-710029 Vendor # 800031 Vendor Status with NCSOS: Vendor is a BOCC consultant: Yes No Contract Details Contract Type: New Amendment (Original Contract: ) (Most Recent Amendment ) Effective Date JULY 1,2024 End Date JUNE30,2025 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: ); Made or Administered by Signature Authority - BOCC Express Delegation (Agenda Date: ) - Policy 9.4: Under $5,000; Service Under $90,000; Construction Under $250,000 - Budget Policy Section XV (Capital Improvement Project: ) Bidding Informal Bidding ($30k-$90k); Formal RFP ($90k+); Other (<$30k); Exception(# ) Department Affirmation 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. This agreement is approved as to technical form and content. Services related to this agreement have already begun or been completed. Description of the nature of the emergency condition that was addressed: Department Director’s Signature ________________________________________ Date: ________ Information Technologies This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer___________________________________ Date: ________ Inapplicable because no hardware/software purchases or related services 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 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: Received for record retention: Office of the Clerk to the Board __________________________________________Date:_________ Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 9/26/20249/26/2024 10/9/2024 10/9/2024 10/9/2024 Orange County Outside Agency Performance Agreement Page 9 of 12 Rev.06/24 Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 10 of 12 Rev.06/24 Exhibit A Insert Provider’s Outside Agency Application (located on the T:drive/Outside Agencies FY24-25 folder) Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 11 of 12 Rev.06/24 Exhibit B Insert Provider’s Revised Scope of Services and Program Budget Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 12 of 12 Rev.06/24 ATTACHMENT “A” Orange County Certifications – FY 2024-2025 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 exe cutive 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: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 13 of 12 Rev.06/24 FOR INFORMATION ONLY ATTACHMENT “B” As mentioned in Sections 3- Funding and Section 4- Agency Reporting of the performance agreement, the following two forms will be required before quarterly reimbursements can be made. They are included below for informational purposes. Forms are available online at https://www.orangecountync.gov/736/Contracts-Reporting Quarterly Expense Report Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B Orange County Outside Agency Performance Agreement Page 14 of 12 Rev.06/24 Quarterly Outcomes Form Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 1/13 Town of Chapel Hill, NC 2/7/2024 HSOA-24-26 Human Services/Outside Agencies Funding Application Fiscal Year 2025 Status: Active Submitted On: 1/12/2024 Applicant PAUL KLEVER 919-967-7570 info@charleshouse.org 7511 SUNRISE RD Chapel Hill, NC 27514 Agency Information Agency's Legal Name Charles House Association Agency's Mailing Address (Street, City, State & Zip Code) 7511 Sunrise Rd Agency's Physical Address (Street, City, State & Zip Code) 7511 Sunrise Rd Agency’s Web Address https://charleshouse.org/ Tax ID: – Date of Incorporation (Month/Year) 03/1984 Executive Director Name Paul Klever E-Mail Address info@charleshouse.org Telephone Number 919-967-7570 Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 2/13 Agency's Purpose/Mission Statement brief description of your organization’s past achievements Wages and Positions Does the agency pay permanent employees a living wage? Yes Is the agency an Orange County Living Wage Certified Employer? Yes Award Programs Check one or more of the following application types. Human Services Awards (Chapel Hill, Carrboro, and Orange County) Small Awards (Chapel Hill & Carrboro Applicants Only) Community Impact Awards (Chapel Hill Applicants Only) Enriching the lives of seniors1. Supporting families caring for aging family members2. Representing the community’s commitment to its elders3. Since 1990, Charles House has exemplified an innovative approach to serving and working with elders with frailty, challenges of aging, and their caregiving families. The Charles House Method has established a reputation for being vastly different than most settings for eldercare, a non-institutional approach that proves to be effectively therapeutic and supportive of families. Charles House has adapted its experience into creating the pioneering Neighborhood Eldercare Home. Thirty-three years later, Charles House continues to be a beacon for caregiving families and an exceptional learning experience for students and interns. Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 3/13 Agency Demographics Please ensure that each subsection listed below adds up to the total number of staff and board members listed here. Number of Part-Time Paid Positions 11 Number of Full-Time Paid Positions 18 Staff Members Total Number of Staff 29 Staff Members - Sex Number of Male Staff 7 Number of Female Staff 21 Number of Nonbinary Staff 1 Number of Staff who prefer not to answer – Staff Members - Race and Ethnicity Number of American Indian or Alaska Native Staff – Number of Asian Staff – Number of Black or African American Staff 14 Number of Native Hawaiian or Other Pacific Islander Staff – Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 4/13 Number of White Staff 15 Number of Staff of more than one race – Number of staff who prefer not to answer 0 Number of Staff who identify as a race/ethnicity not listed – Total Number of Staff who identify as Hispanic or Latino 2 Total Number of Staff who do not identify as Hispanic or Latino 26 Board Members Total Number of Board of Members 12 Board Members - Sex Number of Male Board Members 5 Number of Female Board Members 7 Number of Nonbinary Board Members – Number of Board Members who prefer not to answer – Board Members - Race and Ethnicity Number of American Indian or Alaska Native Board Members – Number of Asian Board Members – Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 5/13 Number of Black or African American Board Members 3 Number of Native Hawaiian or Other Pacific Islander Board Members – Number of White Board Members 9 Number of Board Members of more than one race – Number of Board Members who prefer not to answer – Number of Board Members who identify as a race/ethnicity not listed – Total Number of Board Members who identify as Hispanic or Latino – Total Number of Board Members who do not identify as Hispanic or Latino – 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. Describe how the agency incorporates racial equity into its goals. (150 word limit) Describe how the intended beneficiaries of the proposed project(s) were involved in the planning and design process. (150 word limit) The board of directors devoted a portion of each board meeting from June, 2020 to April, 2023 to exploring issues of racial and social injustice. Board members contributed individually to the development of the material explored and to the shared observations and reflections. Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 6/13 Percent (%) of Staff who attended racial equity trainings. 7 Percent (%) of Board Members who attended racial equity trainings. 100 Describe other racial equity related activities. Program Funding Request Please list all of the current Fiscal Year Human Services (HS) funding requested for all programs and the proposed use of funds. Program Name Daytime Eldercare Program Town of Carrboro 1000 Town of Chapel Hill 4000 Orange County 26000 Total Short description of proposed use of funds. The Daytime Eldercare Program includes presentation of topics inclusive of African- American history and leaders, as well as religious and ethnic diversity. 31000 Support personnel expenses for implementing the program. Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 7/13 Funding Totals Carrboro Chapel Hill Orange County Total Program Information Program Name Charles House-Daytime Eldercare Primay Contact's Name Paul Klever Primary Contact's Phone Number 9199677570 Primary Contact's Email Address paul@charleshouse.org Describe the proposed program and the target population to benefit from the program. Please also explain how the program aligns with the Town of Chapel Hill and Carrboro's Human Services Program Results Framework and/or Orange County's BOCC Goals and Priorities (250 words or less). 1000 4000 26000 31000 The Day Program enriches the lives of vulnerable elders and supports families caring for aging family members, primarily with dementia and other challenges of aging. The program promotes the well-being of these courageous families in our community. Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 8/13 Target Population The program target population demographics table is included as an attachement on the application cover page. Please download the excel spreadsheet and fill out the demographic data in the table and then upload it with your application. Provide one copy per program that you are requesting funding for. Program Cost This cost per individual must reflect the total program budget divided by the total number of program individuals in this application. Actual Cost 2022-2023 Total Program Cost (Actual 2022-2023) 690750 Total Number of Individuals (Actual 2022-2023) 114 Cost Per Individual (Actual 2022-2023) 6060 Projected Cost 2023-2024 Total Program Cost (2023-2024) 772000 Total Number of Individuals (Projected 2023- 2024) 110 Cost Per Individual (Projected 2023-2024) 7018 Projected Cost 2024-2025 Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 9/13 Total Program Cost (Projected 2024-2025) 844000 Total Number of Individuals (Projected 2024- 2025) 115 Cost Per Individual (Projected 2024-2025) 7340 Performance Indicators/Program Goals Strategic Objective* 3. Residents improve their health outcomes Intermediate Result* 3.2 Residents demonstrate new healthy lifestyles behaviors If applying to Orange County, please select the funding area that best aligns with your program. Senior Services Based on the strategic objective, intermediate result, and/or funding area selected above, what are the performance indicators/program goals related to this program? 1. 50% of enrolled families in the funding year will have the capacity to continue providing care in the home and not require, or delay, residential care placement for their participant/ enrolled family member. 2. Over 80% of families will report in the annual evaluation survey satisfaction with the Charles House program and will report positive effects of the program for their enrolled family members, such as improvement in their participant/enrollee’s behavior, emotional status, physical and/or cognitive functioning. 3. The Program will meet the qualifications for annual state certification Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 10/13 Actual Outcomes 2022-2023 Projected Outcomes 2023-2024 Projected Outcomes 2024-2025 Community Impact Award Please describe the impact the proposed programs will have on the target population. Please include specific quantitative and qualitative data in your response. 1. Of the 72 families who were enrolled in Charles House in July, 16 had made decisions to place their family member in residential care, 14 discontinue and 4 participants died.53% continued in-home caregiving at end of Q4. 2. A survey was conducted of families enrolled in Charles House; 92% reported any improvements in their participant family member. 3. NC DHHS recertified Charles House Daytime Program in July, 2022 1. Of the 71 families who were enrolled in Charles House in July, 55% are anticipated to continue caregiving at the end of F& 2023-2024 grant year. 2. A survey was conducted of families enrolled in Charles House in September; 95% (44 of 46) reported improvements in their participant family member. 3. NC DHHS recertified Charles House Daytime Program in July, 2023 1. 50% of enrolled families in the funding year will have the capacity to continue providing care in the home and not require, or delay, residential care placement for their participant/ enrolled family member. 2. Over 80% of families will report in the annual evaluation survey satisfaction with the Charles House program and will report positive effects of the program for their enrolled family members, such as improvement in their participant/enrollee’s behavior, emotional status, physical and/or cognitive functioning. 3. NC DHHS will recertify Charles House Daytime Program in July, 2024 Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 11/13 What methods/tools will your organization use to evaluate the proposed program’s effectiveness? Please include specific examples, such as a logic model. Please briefly describe how your proposed programs aligns with evidence-based approaches to addressing human service need(s). Please describe one to three key partnerships/collaborations that add the most value to the success of the proposed programs. If you are not awarded a Community Impact Award, what would your agency’s funding request be? Applicant Statement Disclosure of Conflicts of Interest Are any board members or agency employees, including their immediate relatives and business associates, current beneficiaries of the proposed program for which funds are being requested? No Are any board members or agency employees, including their immediate relatives and business associates, members of or related to members of the governing bodies of Chapel Hill, Carrboro, or Orange County? No Are any board members or agency employees, including their immediate relatives and business associates, paid providers of goods or services to or have other financial interest in the proposed program? No Are any board members or employees, including their immediate relatives and business associates, related to employees of that Town of Chapel Hill, Town of Carrboro, or Orange County? No Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 12/13 If the answer to any of the above is yes, please provide an explanation. Non-discrimination Clause 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. Applicant Statement 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. Name of Person Submitting the Application Paul Klever Agency Role of Person Submitting the Application Executive Director Agency Representative Signature Paul Klever Jan 4, 2024 Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 2/7/24, 3:04 PM HSOA-24-26 https://chapelhillnc.workflow.opengov.com/#/explore/records/63179/react-form-details/63179 13/13 By submitting this application, the agency representative noted above affirms they are either the Executive Director, or, if someone other than the Executive Director is submitting this application, they affirm the Executive Director has reviewed the application for accuracy and approved it for submittal. Approval Details Approved Amount – Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B Actual 2022-2023 Projected 2023-2024 Projected 2024-2025 Percent Change -$ -$ -$ 0 680,000$ 655,000$ 756,000$ 15% 500$ -$ 1,000$ 0 -$ -$ m 0 4,000$ 2,000$ 4,000$ 100% -$ -$ -$ 0 24,000$ 25,000$ 26,000$ 4% -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 -$ -$ -$ 0 Private Foundation Grants -$ -$ -$ 0 -$ -$ -$ 0 708,500$ 682,000$ 787,000$ 15% 532,500$ 562,000$ 680,000$ 21% 89,000$ 90,000$ 91,000$ 1% 40,500$ 44,000$ 44,000$ 0% 5,750$ 53,000$ 6,000$ -89% 23,000$ 23,000$ 23,000$ 0% 690,750$ 772,000$ 844,000$ 9% 17,750$ (90,000)$ (57,000)$ 37% Please explain Other Grants Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus or deficit. 2022-23 2023-24 2024-25 During this FY, the Day Program continued re-building from the pandemic closure. The deficit is primarily the result of commitments the Charles House board has made to increase employee compensation to comply with Orange County Living Wage guidelines. The projected deficit represents a continuing board commitment to increase employee compensation, surpassing Orange County Living Wage guidelines, providing employer-sponsored health insurance, etc. Operating Budget for Specific Program Program Budget PROGRAM REVENUE (FY 2024-2025 Application) PROGRAM NAME:CHARLES HOUSE - DAYTIME ELDERCARE PROGRAM Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Admin & Outreach Other Expenses: Depreciation Federal Government (CDBG/HOME/etc.) Supplies & Equipment Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities SURPLUS/(DEFICIT) FOR PERIOD: Total Program Expenses FY 2021-22 Program Budget Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B 5/30/2024 Titan Risk Consultants, LLC 107 Conner Drive, Suite 225 Chapel Hill, NC 27514 License #: 1000643509 Victoria DeCamp (919)636-3252 v.decamp@titanriskconsultants.com 00065712-0 4 Charles House Association Paul Klever 7511 Sunrise Road Chapel Hill, NC 27514 Philadelphia Indemnity Insurance Company 18058 A Y PHPK2394159 5/10/2024 5/10/2025X 1,000,000 100,000 5,000 1,000,000 3,000,000 3,000,000 Philadelphia Indemnity Insurance Company 18058 A PHPK2394159 5/10/2024 5/10/2025 X X 1,000,000 Philadelphia Indemnity Insurance Company 18058 A PHPK2394159 5/10/2024 5/10/2025XX 0.00 1,000,000 1,000,000 Carolina Mutual Insurance Company B WC23000-2020 6/25/2024 6/25/2025 1,000,000 1,000,000 1,000,000 Certificate holder is added as Additional Insured as respects General Liability as required by written contract. Orange County Government P.O. Box 8181 Hillsborough, NC 27278 (VCD) Printed by VCD on 05/30/2024 at 01:45PM ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: 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) 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 EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY 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 INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) 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 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) CERTIFICATE OF LIABILITY INSURANCE Docusign Envelope ID: 6903FE25-A33A-4AF8-8716-51B4372E243B