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2024-636-E-Cooperative Extension Dept-Table Ministries -Outside Agency Performance Agreement
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 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 Table Ministries, a not-for-profit corporation, located at 311 E. Main Street, Carroboro, 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, 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 $23,000. 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 $5750.00. 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: D43192F0-F492-433D-8CDD-C94458BC2F9A 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: D43192F0-F492-433D-8CDD-C94458BC2F9A 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 (Jonathon Smith) 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: D43192F0-F492-433D-8CDD-C94458BC2F9A 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: D43192F0-F492-433D-8CDD-C94458BC2F9A 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: D43192F0-F492-433D-8CDD-C94458BC2F9A 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 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 Table Ministries Attention: Jonathon Smith Attention: Ashton Tippins P.O. Box 8181 Address: 311 E. Main Street Hillsborough, NC 27278 Carrboro, NC 27510 Email:josmith@orangecountync.gov Email: info@tablenc.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 _____________________________ _______________________ Ashton Tippins, Executive Director Date For and on behalf of Orange County Government Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A Orange County Outside Agency Performance Agreement Page 7 of 12 Rev.06/24 _______________________________ ________________________ Travis Myren, County Manager Date Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A Orange County Outside Agency Performance Agreement Page 8 of 12 Rev.06/24 ORANGE COUNTY—INTERNAL USE ONLY ______________________________________________________________________________ Finance Information Vendor Name: Table Ministries Vendor Contact Person: Ashton Tippins Phone: 919-636-4860 Address: 311 E. Main Street City Carrboro State: NC Zip: 27510 Department: Cooperative Extension Amount: $23,000 Purpose: Outside Agency Performance Agreement Budget Code(s): 10290050-720116 Vendor # 800791 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 June 30, 2025 Notice Date (Notice Purpose ) Award Approved by Board (Agenda Date: June 18, 2024); 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: D43192F0-F492-433D-8CDD-C94458BC2F9A 10/15/2024 10/20/2024 10/21/2024 10/21/2024 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: D43192F0-F492-433D-8CDD-C94458BC2F9A Orange County Outside Agency Performance Agreement Page 14 of 12 Rev.06/24 Quarterly Outcomes Form Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 1/15 Town of Chapel Hill, NC 1/11/2024 HSOA-24-13 Human Services/Outside Agencies Funding Application Fiscal Year 2025 Status: Active Submitted On: 1/11/2024 Applicant Laura Dille 919-636-4860 ldille@tablenc.org 311 E. Main St. Carrboro, NC 27510 Agency Information Agency's Legal Name Table Ministries, Inc. Agency's Mailing Address (Street, City, State & Zip Code) 311 E. Main St. Carrboro, NC 27510 Agency's Physical Address (Street, City, State & Zip Code) Agency’s Web Address https://www.tablenc.org/ Tax ID: **-***1735 Date of Incorporation (Month/Year) 11/2007 Executive Director Name Ashton Tippins E-Mail Address info@tablenc.org Telephone Number 9196364860 Exhibit ADocusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 2/15 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) TABLE delivers healthy food and nutrition education to children in Orange County, North Carolina. We envision a community where all children have equitable access to nutritious food and knowledge in order to experience optimal health, well-being, and dignity. Since our founding in 2008, TABLE has grown from feeding 12 children at their elementary schools to now nearly 1,000 children weekly, county-wide and year-round. We incorporate fresh food, collaborate with local farms, teach family-based nutrition education, partner with our Parent Advisory Committee, and much more to ensure kids have the best health outcomes we can achieve through nutrition! Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 3/15 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 3 Number of Full-Time Paid Positions 7 Staff Members Total Number of Staff 10 Staff Members - Sex Number of Male Staff 0 Number of Female Staff 10 Number of Nonbinary Staff 0 Number of Staff who prefer not to answer 0 Staff Members - Race and Ethnicity Number of American Indian or Alaska Native Staff – Number of Asian Staff – Number of Black or African American Staff 1 Number of Native Hawaiian or Other Pacific Islander Staff – Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 4/15 Number of White Staff 6 Number of Staff of more than one race 2 Number of staff who prefer not to answer – Number of Staff who identify as a race/ethnicity not listed 1 Total Number of Staff who identify as Hispanic or Latino 1 Total Number of Staff who do not identify as Hispanic or Latino 9 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 1 Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 5/15 Number of Black or African American Board Members 1 Number of Native Hawaiian or Other Pacific Islander Board Members – Number of White Board Members 7 Number of Board Members of more than one race 1 Number of Board Members who prefer not to answer 1 Number of Board Members who identify as a race/ethnicity not listed – Total Number of Board Members who identify as Hispanic or Latino 1 Total Number of Board Members who do not identify as Hispanic or Latino 11 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. Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 6/15 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) Percent (%) of Staff who attended racial equity trainings. 90 Percent (%) of Board Members who attended racial equity trainings. 82 While 24% of local residents are BIPOC,,disproportionately 89% of our participants are children of color & 43% speak a language other than English at home. Therefore, we s eek to incorporate racial equity initiatives throughout TABLE: -Staff: Established hiring policies to promote a diverse, committed, and supportive workplace; staff participate in DEI-related professional development 1-2x/year -Food Access: Prioritize partnerships with local farmers of color; provide variety of culturally-preferred foods; introducing customization- families choose foods that are best for them -Nutrition Education: Provide cooking tips/recipes for foods that may be new to participants from different cultures -Family Engagement: Ensure a fluent Spanish-speaker is on staff (29% of our families are Spanish-speaking); take racial equity results from annual survey to our bilingual Parent Advisory Committee for feedback By incorporating racial equity initiatives in food access, nutrition education, and family engagement, we work toward equitable health outcomes for all kids. Prioritizing the needs and desires of our participants and ensuring they have a voice in the planning conversatio n is very important to TABLE. We have employed 2 full- time Family Engagement Coordinators; one is also fluent in Spanish to ensure full transparency and communication with the Spanish-speaking community. Through surveys, calls, texting, focus groups, and our bilingual Parent Advisory Committee (PAC), we hear and process feedback and make applicable programmatic changes. Some of our greatest partners are in our PAC. This was established in 2022 & is composed of parents/guardians of participating children. Most committee members are Latina (40% of our families are Latino/a). They’ve come up with eligibility criteria for a program, planned a Family Farm Day, & served as a focus group for nutrition education programs. As they partner with staff to inform programming, we are excited to see how this group may guide us! Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 7/15 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 TABLE@Home Town of Carrboro 10000 Town of Chapel Hill 35000 Orange County 23000 Total We can provide additional details on any of the above activities (such as recruitment procedures and culturally-varied foods). We are planning to begin a Spanish-speaking volunteer shift later this year to increase accessibility of volunteer opportunities. Several years ago we also had a volunteer campaign focused specifically on recruiting UNC minority groups (such as Black sororities, Hispanic clubs, etc.) and we intend to repeat something similar in the near future. Specific trainings staff have participated in include: "We Are" anti-racist training (Feb 2020 and again in Jan 2023); a series of trainings on respect, implicit bias, and microaggressions with Duke's Director of DEI; learning opportunities for staff specific to Burmese culture and Latinx migration issues; a racial equity cohort learning series; and a DEI/HR webinar series focusing particularly on inclusion (race, gender, ability, etc.). 68000 Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 8/15 Short description of proposed use of funds. Funding Totals Carrboro Chapel Hill Orange County Total Program Information Program Name TABLE@Home Primay Contact's Name Laura Dille Primary Contact's Phone Number 9196364860 Primary Contact's Email Address ldille@tablenc.org Funding from the Towns and County would allow TABLE to sustain and serve the 1,000 children on our roster - local children in need of continued, weekly, food deliveries to help them be healthy kids. Funding would go to food, operations, program staff, and supplies. 10000 35000 23000 68000 Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 9/15 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). 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. TABLE@Home, our main food access program, aligns directly with both Chapel Hill-Carrboro and Orange County's priorities: we seek to promote our youngest neighbors' well-being and improve health outcomes. TABLE delivers healthy nonperishables and fresh (often local & organic) produce to over 900 children's (ages 0-20) homes weekly. Our nutritionist-reviewed menu includes healthy, culturally-varied, kid-friendly foods. From 2008-2020, we delivered food to schools where it was sent home in kids' backpacks. In 2020, we pivoted to door- to-door, increasing the quantity of fresh food sent home, eliminating stigma, encouraging more participation among food-insecure teens, & increasing family engagement. One parent said, "I truly appreciate, look forward to, and enjoy the "TABLE Delivery" knocks!" Through TABLE@Home, participants have improved food security, healthy behaviors, and outcomes. -84.3% of parents report that their children are willing to try more fruits and vegetables than they did before participating in TABLE; -82% of parents are encouraged to purchase more nutritious food options when grocery shopping because of participation in TABLE; -69.4% of families report eating more meals together because of food from TABLE (family meals have been shown to improve children’s health - source); -51% of children experience improved overall health (physical, mental, and emotional). TABLE would benefit greatly from continued Human Services funding for our efforts to alleviate childhood hunger and help our kids experience better nutrition, less illness, improved academics, & success for life! With your support we can deliver to more homes so more families can "enjoy the "TABLE Delivery" knocks!" Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 10/15 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) 1359411 Total Number of Individuals (Actual 2022-2023) 860 Cost Per Individual (Actual 2022-2023) 1580.71 Projected Cost 2023-2024 Total Program Cost (2023-2024) 1949112 Total Number of Individuals (Projected 2023- 2024) – Cost Per Individual (Projected 2023-2024) 2164.68 Projected Cost 2024-2025 Total Program Cost (Projected 2024-2025) 2216900 Total Number of Individuals (Projected 2024- 2025) 1100 Cost Per Individual (Projected 2024-2025) 2014.36 Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 11/15 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. Food & Nutritional 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? Actual Outcomes 2022-2023 Projected Outcomes 2023-2024 Goal 1: Provide healthy nonperishable and fresh food to children throughout Orange County. Goal 2: Children consume more fruits and vegetables per week because of food from TABLE Goal 3: Parents report children are experiencing improved physical health due to food from TABLE. Goal 1: Fed up to 860 children weekly Goal 2: 67.5% (580) of children consume 3-4 more servings of fruits and vegetables per week because of food from TABLE. Goal 3: 65% (559) of children experience improved physical health due to food from TABLE Goal 1: Feed up to 900 children weekly (as reported previously: we will actually reach 1,000 children this year). Goal 2: 67.5% (607) of children consume 3-4 more servings of fruits and vegetables per week because of food from TABLE. Goal 3: 65% (585) of children experience improved physical health due to food from TABLE Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 12/15 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. What methods/tools will your organization use to evaluate the proposed program’s effectiveness? Please include specific examples, such as a logic model. Goal 1: Feed up to 1100 children weekly Goal 2: 67.5% (770) of children consume 3-4 more servings of fruits and vegetables per week because of food from TABLE. Goal 3: 65% (737) of children experience improved physical health due to food from TABLE TABLE's impact surpasses meals delivered and food security. Better nutrition means less illness, better development and success in school, and longer, healthier lives. 98% of participants - local kids - increased consumption of fruits & vegetables, resulting in 51% experiencing improved physical, emotional, and mental health because of TABLE's food. Our families experience more family meals and less stress - one mom shared, “Having to choose between healthy food for my kids and paying my bills is a choice that would break my heart to have to make. But with the help from TABLE I don't have that burden.” We recently met with a program evaluation consultant from Duke’s Social Science Research Institute to improve our logic model and determine our ultimate outcome goals, with short-term goals feeding directly into medium- and long-term goals to ensure we are strategic and intentional about achieving them. Goals are tracked on an internal platform and our annual survey measures how successful our outputs are at creating these positive health outcomes in participating children. While many of our goals relate to nutrition and health, we also compare data over time and across races/ethnicities to see how our programs are impacting children overall. Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 13/15 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 Childhood hunger and inadequate nutrition has proven, serious, long-term effects: poor language comprehension, developmental delays, and higher incidence of chronic illnesses, cancer, and mood/behavior disorders. TABLE alleviates many of these risks, helping kids thrive by providing sufficient, nutritious food. We have a Parent Advisory Committee and, when possible, we provide customization/personalization options - these incorporate agency and dignity in the process and beneficiaries improve our programs as well. Furthermore, home delivery has reduced stigma, increased food assistance participation among older children/teens, and enabled us to increase the quantity of food distributed: all further improving kids’ health. Our local farm partnerships add the most value to our programs: Orange County farms like Wildflower Lane, Sankofa, and Elysian Fields, plus other NC sources like Gabor Farm and Farmer Foodshare. In 22-23, we spent $120,000 with local Black- and woman-owned farms (23% of all purchased fresh food) and distributed an additional 118,000 pounds of donated produce from local farms and gardens. Local fresh food is better for kids, the economy, and environment! One parent said, “Thanks for all you are doing for children… mine in particular have really enjoyed having fresh foods to add to their menus.” We currently have a waitlist of over 200 children in need of food support, beyond our current 950 children. Any funding provided will gratefully help alleviate that. If we are not awarded a Community Impact Award, we respectfully request $22,000 from the Town of Chapel Hill. This amount of funding would provide nutritious food for 6 months for 30 children, support local farmers, and improve children's health outcomes both short- and long-term. Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 14/15 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 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. Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A 1/11/24, 11:14 AM HSOA-24-13 https://chapelhillnc.workflow.opengov.com/#/explore/records/62510/react-form-details/62510 15/15 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 Laura Dille Agency Role of Person Submitting the Application Director of Operations Agency Representative Signature Laura Allison Moore Dille Jan 11, 2024 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: D43192F0-F492-433D-8CDD-C94458BC2F9A Certified by: _______________________ Title: Director of Operations_______ Date: 9/27/24_____ (Provider’s Signature) EXHIBIT “B” Scope of Services – FY 2024-25 Outside Agency Performance Agreement Agency Name: Table Ministries, Inc. DBA "TABLE" Program Name: TABLE@Home Funding Award: $23,000 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, 2025. ● TABLE will continue to deliver healthy nonperishables and fresh food every week directly to kids' homes throughout Orange County. ● TABLE will continue to deliver nutrition education meal kits to our participating families every month to teach healthy eating habits and cooking skills. ● TABLE will continue local farm partnerships to provide high-quality, fresh & delicious fruits and vegetables to kids. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served withi n 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 Provide healthy nonperishable and fresh food to children throughout Orange County. Feed up to 1100 children weekly Expense Description Amount Healthy nonperishable & fresh food $10,000 Program staff $10,000 Operations and supply needs $3,000 Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A Certified by: _______________________ Title: Director of Operations_______ Date: 9/27/24_____ (Provider’s Signature) Performance Measures Anticipated Results Children consume more fruits and vegetables per week because of food from TABLE. 67.5% (770) of children consume 3- 4 more servings of fruits and vegetables per week because of food from TABLE. Parents report children are experiencing improved physical health due to food from TABLE. 65% (737) of children experience improved physical health due to food from TABLE Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A Orange County Outside Agency Performance Agreement Page 11 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 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: D43192F0-F492-433D-8CDD-C94458BC2F9A Executive Director 10/12/2024 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD 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 COMPENSATIONAND 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 AGGJECT 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 LIMITDESCRIPTION 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 1/4/2024 (919) 636-3252 2 18058 TABLE Ministries, Inc. 311 E. Main Street Carrboro, NC 27510 A 1,000,000 X PHPK2629439 12/4/2023 12/4/2024 100,000 5,000 1,000,000 2,000,000 2,000,000 EBL 1,000,000 1,000,000A X PHPK2629439 12/4/2023 12/4/2024 1,000,000A X PHUB891187 12/4/2023 12/4/2024 10,000 1,000,000 B WWC3612506 12/4/2023 12/4/2024 500,000 500,000 500,000 A General Liability PHPK2629439 12/4/2023 Abuse Occ/Agg 1,000,000 A General Liability PHPK2629439 12/4/2023 12/4/2024 E&O Agg 2,000,000 D&O $1,000,000 EPLI $1,000,000 Aggregate (all parts) $2,000,000 Per Claim $5,000 Certificate holder is added as Additional Insured as respects General Liability, Business Auto and Umbrella as required by written contract. SEE ATTACHED ACORD 101 Orange County Government P.O. Box 8181 Hillsborough, NC 27278 TABLMIN-01 VDECAMP Titan Risk Consultants LLC107 Conner Drive, Suite 225Chapel Hill, NC 27514 Victoria DeCamp v.decamp@titanriskconsultants.com Philadelphia Indemnity Insurance Company Wesco Insurance Company Aggregate 12/4/2024 X X X X X X Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. Titan Risk Consultants LLC TABLMIN-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance 1 SEE P 1 TABLE Ministries, Inc.311 E. Main StreetCarrboro, NC 27510 SEE PAGE 1 VDECAMP 1 Description of Operations/Locations/Vehicles: Cyber Liability ACE American Insurance Company 12/4/2023-2024 D98357944 $1,000,000 occ/$1,000,000 agg/ $2,500 ded Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD 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 COMPENSATIONAND 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 AGGJECT 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 LIMITDESCRIPTION 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 1/4/2024 (919) 636-3252 2 18058 TABLE Ministries, Inc. 311 E. Main Street Carrboro, NC 27510 A 1,000,000 X PHPK2629439 12/4/2023 12/4/2024 100,000 5,000 1,000,000 2,000,000 2,000,000 EBL 1,000,000 1,000,000A PHPK2629439 12/4/2023 12/4/2024 1,000,000A PHUB891187 12/4/2023 12/4/2024 10,000 1,000,000 B WWC3612506 12/4/2023 12/4/2024 500,000 500,000 500,000 A General Liability PHPK2629439 12/4/2023 Abuse Occ/Agg 1,000,000 A General Liability PHPK2629439 12/4/2023 12/4/2024 E&O Agg 2,000,000 D&O $1,000,000 EPLI $1,000,000 Aggregate (all parts) $2,000,000 Per Claim $5,000 Certificate holder is added as Additional Insured as respects General Liability as required by written contract. SEE ATTACHED ACORD 101 Town of Carrboro 301 W. Main Street Carrboro, NC 27510 TABLMIN-01 VDECAMP Titan Risk Consultants LLC107 Conner Drive, Suite 225Chapel Hill, NC 27514 Victoria DeCamp v.decamp@titanriskconsultants.com Philadelphia Indemnity Insurance Company Wesco Insurance Company Aggregate 12/4/2024 X X X X X X Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. Titan Risk Consultants LLC TABLMIN-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance 1 SEE P 1 TABLE Ministries, Inc.311 E. Main StreetCarrboro, NC 27510 SEE PAGE 1 VDECAMP 1 Description of Operations/Locations/Vehicles: Cyber Liability ACE American Insurance Company 12/4/2023-2024 D98357944 $1,000,000 occ/$1,000,000 agg/ $2,500 ded Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTR INSD WVD 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 COMPENSATIONAND 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 AGGJECT 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 LIMITDESCRIPTION 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 1/4/2024 (919) 636-3252 2 18058 TABLE Ministries, Inc. 311 E. Main Street Carrboro, NC 27510 A 1,000,000 X PHPK2629439 12/4/2023 12/4/2024 100,000 5,000 1,000,000 2,000,000 2,000,000 EBL 1,000,000 1,000,000A PHPK2629439 12/4/2023 12/4/2024 1,000,000A PHUB891187 12/4/2023 12/4/2024 10,000 1,000,000 B WWC3612506 12/4/2023 12/4/2024 500,000 500,000 500,000 A General Liability PHPK2629439 12/4/2023 Abuse Occ/Agg 1,000,000 A General Liability PHPK2629439 12/4/2023 12/4/2024 E&O Agg 2,000,000 D&O $1,000,000 EPLI $1,000,000 Aggregate (all parts) $2,000,000 Per Claim $5,000 Certificate holder is added as Additional Insured as respects General Liability as required by written contract. SEE ATTACHED ACORD 101 Town of Chapel Hill 405 Martin Luther King, Jr. Boulevard Chapel Hill, NC 27514 TABLMIN-01 VDECAMP Titan Risk Consultants LLC107 Conner Drive, Suite 225Chapel Hill, NC 27514 Victoria DeCamp v.decamp@titanriskconsultants.com Philadelphia Indemnity Insurance Company Wesco Insurance Company Aggregate 12/4/2024 X X X X X X Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A FORM NUMBER: EFFECTIVE DATE: The ACORD name and logo are registered marks of ACORD ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE FORM TITLE: Page of THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, ACORD 101 (2008/01) AGENCY CUSTOMER ID: LOC #: AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE © 2008 ACORD CORPORATION. All rights reserved. Titan Risk Consultants LLC TABLMIN-01 SEE PAGE 1 1 SEE PAGE 1 ACORD 25 Certificate of Liability Insurance 1 SEE P 1 TABLE Ministries, Inc.311 E. Main StreetCarrboro, NC 27510 SEE PAGE 1 VDECAMP 1 Description of Operations/Locations/Vehicles: Cyber Liability ACE American Insurance Company 12/4/2023-2024 D98357944 $1,000,000 occ/$1,000,000 agg/ $2,500 ded Docusign Envelope ID: D43192F0-F492-433D-8CDD-C94458BC2F9A