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050415a Agenda PackageK. Harnett County Public Library requests that an addition be made to the current Library hours of operation to include Friday from 9 am to 5 pm effective July 1, 2015. The addition would provide a benefit to the public in delivering more comprehensive coverage throughout the week and raise the total service hours from 48 to 56 as well as allow more effective work with the affiliate town libraries. 5. Period of up to 30 minutes for informal comments allowing 3 minutes for each presentation 6. Appointments 7. Presentation of N.C. Forest Service 2014 Summary of Accomplishments in Harnett County, Buren Fulmer, Harnett County Ranger 8. Sandhills Center Budget Request and Program Update, Victoria Whitt, Executive Director 9. County Manager's report — Joseph Jeffries, Interim County Manager - Sandhills Center Fiscal Report for the period ending March 31, 2015 10. New Business 11. Closed Session 12.2015/2016 Budget Discussion 13. Adjourn Page 2 Agenda Item y • BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015; Section 1. To amend the General Fund, Health Department, the appropriations are to be changed as follows: REVENUE CODE NUMBER DESCRIPTION OF CODE AMOUNT INCREASE AMOUNT DECREASE EXPLANATION: To move funds in the BT (State) Program for travel expenses in May and to better meet the needs of the program. Department Head (date) Finance Officer 7 Count fVlana Y r (lte) Section 2. Copies of this budget amendment shall be furnished to the Clerk of the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of ,2015 Margaret Regina Wheeler, Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioners EXPENDITURE AMOUNT AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE DECREASE 110 -7600- 441.11 -00 Salaries & Wages $ 757.00 110 -7600- 441.21 -00 Group Insurance $ 100.00 110 - 7600 - 441.22 -00 FICA $ 50.00 110 - 7600 - 441.23 -00 Retirement $ 50.00 110 - 7600 - 441.32 -26 Incentives $ 12.00 110 -7600- 441.33 -45 Contracted Services $ 650.00 110 - 7600 - 441.44 -21 Rent $ 307.00 110 - 7600 - 441.58 -01 Training $ 110.00 110- 7600 - 441.58 -14 Travel - Employee $ 283.00 110 - 7600- 441.60 -46 Medical Supplies 161.00 REVENUE CODE NUMBER DESCRIPTION OF CODE AMOUNT INCREASE AMOUNT DECREASE EXPLANATION: To move funds in the BT (State) Program for travel expenses in May and to better meet the needs of the program. Department Head (date) Finance Officer 7 Count fVlana Y r (lte) Section 2. Copies of this budget amendment shall be furnished to the Clerk of the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of ,2015 Margaret Regina Wheeler, Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioners BUDGET ORDINANCE AMENDMENT d BERl ORDAINED bv the Governing Board of the County ofHarne�,No�h Carolina, that the foUovvng rn aen rnentoemagetotheannua|bud8etordinanceforthe�sca|yearending]une3CLZOI5: ' Sect/onl. To amend the General Fund, Public Buildings Department, the appropriations are to be changed as fojlows: EXPENDITURE CODE NUMBER DESCRIPTION OF CODE 110-4700-410-74-74 Capital Outlay — Equipment I10-4700-410'43'24 Operating — Repair/Maint Boone Trial AMOUNT INCREASE 5,000.00 AMOUNT DECREASE 5,000.00 REVENUE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE EXPLANATION: Purchase cargo traiter for grounds crew. partment Hea AMOUNT DECREASE ountyMa ha8er(date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their directiori. Adopted this day of Margaret Regina Wheeler, Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioners BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: Section 1. To amend the Solid Waste Department, the appropriations are to be changed as follows: EXPENDITURE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE 580 - 6600 - 461.74 -74 Capital Outlay Equipment $60,000.00 580 - 6600 - 461.11 -05 Overtime 580- 6600 - 461.44 -21 Building & Equipment REVENUE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE AMOUNT DECREASE $35,000.00 $25,000.00 AMOUNT DECREASE EXPLANATION: To replace vehicles. Randy Smith's current vehicle, 2009 Ford Ranger 4x4 pick -up with 70,856 miles to be used for litter control. Currently, the vehicle used for litter control is a 2007 Ford F -150 with 172,500 miles. This truck was a meter reader truck transferred from public utilities. The truck is leaking oil. Andrew Holland's current vehicle, 2001 Dodge Laramie pick -up with 143,822 miles, to be used as a shop / tool truck at Anderson Creek landfill. APPROVALS: D . ment Head (date) Finance Officer (•,t County ., :ger (date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this Margaret Regina Wheeler Clerk to the Board day of Jim Burgin, Chairman Harnett County Board of Commissioners BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: Section 1. To amend the General Fund, Public Buildings Department, the appropriations are to be changed as follows: EXPENDITURE CODE NUMBER DESCRIPTION OF CODE 110-4700-410-74-74 110-4700-410-41-29 Capital Outlay Operating Utilites — Courthouse AMOUNT INCREASE 31,500.00 AMOUNT DECREASE REVENUE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE AMOUNT DECREASE EXPLANATION: Purchase truck for employee (Kenneth). VVe want to give Kenneth's truck /OS[hev with l2I,0S2mi/edtuJeremy. the Courthouse. As _1 , awn / �� mepa't ��` - "t � �I![78-> Head (date) County ana er (date) Section 2. Copies of this budget amendment shal be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of Margaret Regina Wheeler, Clerk to the Board ,2O15. Jim Burgin, Chairman Harnett County Board of Commissioners ,r23' \D, BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: follows: Section 1.To amend the Airport Capital Reserve et CP/1302 budget, g the appropriations are to be changed as EXPENDITURE CODE NUMBER DESCRIPTION OF CODE 301 - 8300 - 406.90 -03 - - _ Capital Project nano; mac; L& E. - AMOUNT INCREASE 26,667 REVENUE CODE NUMBER 301 - 0000 - 389.10 -00 DESCRIPTION OF CODE nS C'v - e — General Fund AMOUNT INCREASE 26,667 AMOUNT DECREASE AMOUNT DECREASE EXPLANATION: To budget funds allocated by the board for FY1415 for the Airport Capital Reserve. APPROVALS: Dep rtment Head (date) Finance Office rs =te) y M ager(date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of Margaret Regina Wheeler Clerk to the Board Jim Burgin, Chairman Harnett County Board of Commissioner 4?jb BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: Section 1. To amend the General Fund, Public Buildings Department, the appropriations are to be changed as foUows: EXPENDITURE CODE NUMBER DESCRIPTION OF CODE INCREASE AMOUNT 583'8300'461'45'20 Legal & Administrative 583-8300-461-45-80 Contingency 10,000.00 AMOUNT DECREASE 10,000.00 REVENUE CODE NUMBER AMOUNT DESCRIPTION OF CODE INCREASE AMOUNT DECREASE EXPLANATION: Move monies for Dunn/Erwin Landfill Project SW1301 to pay Poyner Spruill invoices. Poyner Spruill is our counsel for transfer floor dispute. ment Head (date) Fina ce Offic Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of Margaret Regina Wheeler, Clerk to the Board ,20I5. Jim Burgin, Chairman Harnett County Board of Commissioners 3(6 n Nr — BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: Section 1. To amend the Runway 5 Approach Clearance CP1405, the appropriations are to be changed as follows: EXPENDITURE CODE NUMBER AMOUNT DESCRIPTION OF CODE E-tle 1 n, :,� r, Runway 5 Approach Clearing Runway 5 Approach Construction 333 - 8300 - 406 -45 -30 333 - 8300 - 406 -45 -01 INCREASE $40,1 12 $204,888 AMOUNT DECREASE REVENUE CODE NUMBER AMOUNT 333 - 0000 - 334 -83 -10 DESCRIPTION OF CODE NCDOT 3624435.6.1 333 - 0000 -389 -71 -00 Capital Reserve INCREASE $220,500 AMOUNT DECREASE --$2276446- EXPLANATION: APPROVALS: To correct Harnett County Jetport Runway 5 Approach Clearing Project Ordinance Board Approved 2 -15 -2014. This ordinance was to budget grant funds from NCDOT Division of Aviation. The 10% local match will come from remainder of funds in Capital Reserve Account and the balance of the local match will come from the General Fund. Dep rtment Head (date) Finance Offic te) County Manager (date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted Margaret Regina Daniel, Clerk to the Board Jim Burgin , Chairman Harnett County Board of Comm "5$5o BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal yeor ending June 30, 2015: Section]. To amend the General Fund, the appropriations are to be changed as follows: EXPENDITURE CODE NUMBER 1 10 -8701 - 490 -90 -5L. DESCRIPTION OF CODE Airport Capital Reserve AMOUNT INCREASE $22,605 AMOUNT DECREASE REVENUE CODE NUMBER 1 10 -0000 - 399 -00 -00 DESCRIPTION OF CODE Fund Balance Appropriated AMOUNT INCREASE $22,605 AMOUNT DECREASE EXPLANATION: APPROVALS: Dep rtment Head (date) To budget local match required by the North Carolina Department of Transportation, Division of Avaition Grant 36244.35.6.1 for Runway 5 Approch Clearing Project. Fi •ce Officer *(22 (5 County Manager (date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted Margaret Regina Daniel, Jim Burgin , Chairman Clerk to the Board Harnett County Board of Comm BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: Section 1. To amend the Planning Services Departments, the appropriations are to be changed as follows: EXPENDITURE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE 110 - 7200 - 465 -74 -74 Capital Outlay-Equipment 47,500 110 - 7200 - 465 -11 -00 Salaries & Wages 110 - 7200 - 465 -12 -00 Salaries & Wages -Part Time 110 - 7200 - 465 -60 -31 Gas, Oil, Auto Supplies 110 - 7200 - 465 -22 -00 FICA 110 - 7200 - 465 -23 -00 Retirement 110 - 7200 - 465 -21 -00 Group Insurance REVENUE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE EXPLANATION: To move funds to cover the purchase of two vehicles for the 2014 -2015 fiscal year. APPROVALS: Department Head (date) Finance Off4 (date) 412_7 15 AMOUNT DECREASE 25,000 2,500 5,000 3,000 2,000 10,000 AMOUNT DECREASE C unt Man2 date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted this day of Margaret Regina Wheeler Clerk to the Board Harnett County Board of Commissioners Jim Burgin, Chairman BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: Section 1. To amend the , Sheriff's Execution fund, the appropriations are to be changed as follows: EXPENDITURE CODE NUMBER 252 -5100- 420.35 -98 252 -5100- 420.35 -97 DESCRIPTION OF CODE NC Dept of Revenue Execution Sale AMOUNT INCREASE $60,000 $43,765 REVENUE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE 252- 0000 - 336.24 -03 NC Dept of Revenue $60,000 252- 0000 - 336.35 -02 Execution Sale $43,765 EXPLANATION: To adjust budget to reflect activity for current fiscal year. APPROVALS: Department Head (date) Finance Of"4r (date)I 123 t5 AMOUNT DECREASE AMOUNT DECREASE County Manager (date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted Margaret Regina Wheeler, Jim Burgin, Chairman Clerk to the Board Harnett County Board of Comm '114b BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015: Section 1. To amend the Airport Capital Reserves CP1302, the appropriations are to be changed as follows: EXPENDITURE CODE NUMBER DESCRIPTION OF CODE 301- 8300 - 406 -90 -03 Capital Project AMOUNT INCREASE AMOUNT DECREASE 4 REVENUE CODE NUMBER 301- 0000 - 378 -00 -00 DESCRIPTION OF CODE Residual Equity AMOUNT INCREASE AMOUNT DECREASE 4 EXPLANATION: To reduce residual equity to actual APPROVALS: 141),1-)J.5 Projects /Cants Finance & Accounting Specialist Finance Offic .ate) I 2 5 County Man ger (date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted Margaret Regina &eififel, Clerk to the Board WW,kr Jim Burgin, Chairman Harnett County Board of Comm '2A9b BUDGET ORDINANCE AMENDMENT BE IT ORDAINED by the Governing Board of the County of Harnett, North Carolina, that the following amendment be made to the annual budget ordinance for the fiscal year ending June 30, 2015 Section 1. To amend the School Project (CP1501), the appropriations are to be changed as follows: EXPENDITURE CODE NUMBER 308 - 8300 - 480 -47 -06 308 - 8300 - 480 -47 -03 DESCRIPTION OF CODE Construction - Triton AMOUNT INCREASE Dunn Middle $10,000 $77,515 REVENUE AMOUNT CODE NUMBER DESCRIPTION OF CODE INCREASE 308 - 0000 - 389 -43 -25 Interfund Transfer Article 46 Sales Tax $85,751 308 - 0000 - 314.50 -00 Sales Tax Refunds - Projects $1,764 AMOUNT DECREASE AMOUNT DECREASE EXPLANATION: To budget the transfer of funds due to more pineline is needed in the mechanical room at Triton High school and to repair chillers at Dunn Middle School. APPROVALS: Department Head (Date) Finance Offic 15 County Manager (date) Section 2. Copies of this budget amendment shall be furnished to the Clerk to the Board, and to the Budget Officer and the Finance Officer for their direction. Adopted Margaret Regina Wheeler, Jim Burgin, Chairman Clerk to the Board Harnett County Board of Commissioner Board Report Date : 05/04/2015 Agenda Item 41 • C Approved By : TO : HARNETT COUNTY BOARD OF COMMISSIONERS RE: CONSIDERATION OF REFUND FOR TAXES, INTEREST AND PENALTIES FOR ALL MUNICIPALITIES Tax, Interest Total Re oast Stat and Penalties Refund q City 0.00 No Name of Tax Payer 1 GRIER, JERRY GLYNN JR GRIER, CALA MICHELLE S. KEITH FAULKNER Revenue Administrator CC: S. KEITH FAULKNER 0002110967- 2013- 2013- 000000 County 84.84 City Total County Total Total to be Refunded 84.84 Refund 0.00 84.84 84.84 Reason' Military exemption Agenda Item y D Board Meeting Agenda Item MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Award of in -car camera system through the N.C. Governor's Highway Traffic Safety Grant REQUESTED BY: Sheriff Rollins REQUEST: Sheriff Rollins request to accept the award of two Watch Guard in -car camera system. These units are awarded to Harnett County based upon the N.C. Governor's Highway Traffic Safety Grant point system. Each unit is valued at $5,000.00 with no match required. The Harnett County Sheriffs Office was approved by the Board of Commissioners to participate in the NC Governor's Highway Safety Program in 2009. At that time the Grant purchased two patrol vehiles and paid 100% of two Deputies salaries the 1st year, 75% the sencond year, 50% the thrid year and 25% the fourth and final year. The Sheriff via the Traffic squad also submitted a wish list of traffic enforcement equipment in conjunction with the NC Governor's Highway Safety Program. Even though the Grant no longer pays the Traffic Deputies salaries Harnett County still participates in the grant program by submitting traffic statistics and participating in joint check points. Once Harnett County accumalates enough points the N.C. Governor's Highway Traffic Safety Grant purchases the traffic safety equipment and sends it to the participating agencies. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: C:\ Users\ khoneycutt\AppData \Local\Microsoft\Windows \Temporary Internet Files \Content.Outlook\20SROKOA \agenda form 2015 Traffic Grant camera.doc Page 1 of 2 D I G I T A L I P3 C A R V I D E O WatchGuard Video 415 Century Parkway Allen TX 75013 Bill To: North Carolina DOT Attn: Deidra Joyner 215 East Lane Street Raleigh NC 27601 " Drop Ship items yet to be delivered Purchase Order No. 4300288213 Ordered 1 1 1 2 2 2 2 2 2 2 2 2 2 Shi. 1 Customer ID NORTHCAR0001 RIO Sales Pe on Margo M Item Number Serial # 0 NOTE NOTE 1 0 SFW -ELX- KIT -300 WGS00175 -R3 0 SFW- ELX -VWR W GS00175 -200 2 0 4RE- STD- GPS -RV2 WGA00480 -101 2 0 4RE -DIS -RCP WGA00370 -200 2 0 CAM - 4RE - ZSL -UWD WGA00496 2 0 CAM - BST - 102 -NEW Camera, Infrared Analog, WMv.1, 2 -Pin Connector W GP01760 -100 W G P01760 -100 2 0 CAB-ZSL-STR-15F Cable, 4RE, HDMI, ZSL, Straight, 15' Packing Slip Packing Sli, 4ELXORD0001520 Document Date Page Date/Tirrte Prin Ship To: HARNETT CO SHERIFF'S DEPT Attn: Sgt Tim Bradley 175 Bain St Lillington NC 27546 DVR2- 017138 DVR2 - 019027 DIS4- 008021 DIS4- 008223 CAM5- 010393 CAM5- 010394 Shi..in• Method UPS GROUND Pa en Te s Net 30 esrt•tion��,j Re Sill : Date 5/7/2015 Master No. 210,274 FBO: Harnett Co SO (NC) HARNETTC0001 NOTE Software Installation Disc, 4RE Evidence Library Express3, w/ Case and Documen W GS00175 -R3 ELX3 Viewer Software Installation Disc w/ Case and Document W GS00175 -200 4RE, HD DVR, Gen 2, 200GB HDD W GA00480 -101 4RE, Remote Display Control Panel, Gen 3 WGA00370 -200 Front Camera, 4RE, HD Zero Sightline (ZSL) WGA00496 2 0 CAB - 4RE- HDM -PRT Cable, 4RE, HDMI, Port 2, IR Camera, 2 -Pin Connect, Straight, 16'(5000mm) WGP01832 WGP01832 2 0 WGP02055 -KIT R/A Adapter KIT, HDMI Cables, Dual Mount Bracket, 4RE DVR W GP02055 -KIT W G P02055 -KIT 2 0 CAB-HDM-4RE-15F Cable, 4RE, HDMI/Mini, Display ONLY, Straight, 15' 2 0 BRK- 4RE - DIS -101 Bracket Kit, 4RE, Display, w/ Diamond 1" Ball Mounts & 2" RAM WGA00420 WGA00420 2 0 BRK- 4RE- DCM -DC1 Bracket, 4RE Display /HiFi Mic/Zoom Camera Mount, Visor Post, Charger, Kit WGP02225- 200 -KIT WGP02225- 200 -KIT ATTENTION: YOUR PRODUCT(S)HAVE BEEN CAREFULLY PACKED TO PROTECT THEM FROM SHIPPING DAMAGE. PLEASE DO NOT THROW PACKING MATERIAL OR BOXES AWAY UNTIL ALL ITEMS ARE ACCOUNTED FOR!! D I G I T A L I I`J WatchGuard Video 415 Century ParKway Allen TX 75013 Bill To: A R V I D E O North Carolina DOT Attn: Deidra Joyner 215 East Lane Street Raleigh NC 27601 Drop Ship items yet to be delivered Purchase Order No. Customer ID Packing Slip Packing Slip` Document::Date Page DatelTime Printed Ship To: 4ELXORD0001520 4/16/2015 2 4/20/2015 3:57:53 PM HARNETT CO SHERIFF'S DEPT Attn: Sgt Tim Bradley 175 Bain St Lillington NC 27546 4300288213 NORTHCAR0001 Sales Person Margo M Ordered 2 2 2 2 2 2 2 2 1 2 Shipped 8/0 0 BRK- 4RE- FPK -02I W G P01487 -KIT 0 GPS- ANT- MGN -16F WGP362 0 WGP02073 -300K WGP02073- 300 -KIT 0 MIC -WRL- KIT -1v2 W GA00475- KIT1 -V2 0 WGA00510 -005 WGA00510 -005 0 MIC -CBN- 100 -07F WGP412 0 MIC - CBN- EXT -12F WGP412-300 0 WGD00085 -KIT W G D00085 -KIT 0 WGD00089 -KIT WGD00089 -KIT 0 WAR - 4RE -CAR -1ST WGW00124 Serial # Shippinq Method UPS GROUND esarlption Payment Terms Net 30 Req Ship Date 5/7/2015 Master No. 210,274 Bracket Kit, 4RE, DVR, Console Faceplate, 2° W G P01487 -KIT GPS Antenna, Magnetic Mount WGP362 Cable Assembly, DV-1C/4RE, Power /Input, R/A 24' W G P02073- 300 -KIT Hi -Fi Microphone Kit 1v.2 (Transmitter, Cradle, Belt clip, Pivot clip, 10' ant W GA00475- KIT1 -V2 Cable Assembly, DVR to Hi -Fi MIC, 180" WGA00510 -005 Cabin Microphone - 7' WGP412 Cabin Microphone Extension Cable - 12' WGP412-300 Kit, 4RE DVR Installation Kit W GD00085 -KIT Kit, 4RE In -Car Video System User Guide W G D00089 -KIT Warranty, 4RE, In -Car, 1st Year (Months 1 -12) WGW00124 ATTENTION: ,�EM,aoM=��oo�.��saa�� o,..�.....�_.___ _ RACKED TO PROTECT i�IMI1V!I'�i'V9tl�'oW�!P��NN�'N' FROM SHIPPING DAMAGE. PLEASE DO NOT THROW PACKING MATERIAL OR BOXES AWAY UNTIL ALL ITEMS ARE ACCOUNTED FOR!! Board Meeting Agenda Item Agenda Item MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Waiver of Fingerprint fees REQUESTED BY: Sheriff Rollins REQUEST: Sheriff Rollins is requesting to waive the current fingerprint fees of $ 10.00 for in- county residents and $ 15.00 for out of County residents for current Harnett County employees who are being fingerprinted as a requirement of their employment duties and for volunteers of Harnett County Fire departments. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: F:\2014- 2015\Agenda Request \agenda form 2015.doc Page 1 of 1 RECEIVED BY LEGAL SERVICES DATE: L /1171S BY: ,/, (Vendor Legal Name: Type of Contract: COUNTY DOCUMENT REVIEW COVER SHEET .(. This Block ONLY to be completed by Department .j. Harnett County Sheriffs Office Descri.tion /Scope of Work: Funding Source: ❑ New ❑ Goods Ether: o Renewal ❑ Consulting o Amendment ❑ Construction ❑ Services ❑ Lease Department: Sheriff Project Code: ounty ❑ State Grant ❑ Federal Grant ❑ Local Grant .Other Expenditure /Revenue Code(s) (all 14 digits required) o To Be Financed Annual Contract Amount: Dept. Contact: -N rc Date Needed /Board Review: Department Head Signature: Departm ead has eview and is satisfied with material terms Budget Amendment MUST be attached if needed Contract Period (dates): tact Telephone: •,-- Date: - q ew d attached a INFORMATION TECHNOLOGY DIRECTOR (Applicable only for hardware /software purchased or related technology services) This contract has been reviewed and approved by the IT Director as to technical content and network compatibility. IT Director's Signature: Date: Comments: Signature: COUNTY STAFF ATTORNEY L- N O i. 7c, Ac (_ 2 t ev4 f. is U l rteo C Date: (-441 /13 RISK MANAGEMENT Risk Management has received a copy of the Certificate of Insurance. Yes No gnature: Date: Comments: Signature: Signature: FINANCE Date: 4 RC COUNTY MANAGER D`ate: Comments: Signature: CLERK TO THE BOARD OF COMMISSIONERS (Agenda Request form must be attached) Date: CONTRACT ADMINISTRATION Date Provided to Clerk for Board Packet: Final Contract Distribution Date: Contract Control Number: L515 —'ZD Scanned ❑ Original /Copy to Dept. ri Original to Clerk ❑ To Dept for vendor sig. Rev. 05 /2012 Ninatibs Board Meeting Agenda Item Agenda Itern F MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Fire Protection Services Agreement REQUESTED BY: Gary Pope, Emergency Services Director REQUEST: We would like to request approval for the revision of the Fire Protection Services Agreement. This agreement is between County of Harnett and the fire protection providers for Harnett County. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECO 1 NDATION: SAES - FINANCE\AGENDA FORM\agendaform2015.doc Page 1 of 1 STATE OF NORTH CAROLINA COUNTY OF HARNETT PROTECTION SERVICES AGREEMENT FOR FIRE THIS AGREEMENT is made and entered into this the day of 2014, b y and between COUNTY OF HARNETT (sometimes hereinafter referred to as "County ") and (sometimes hereinafter referred to as "Contractor "). RECITALS: THAT WHEREAS, The County Service District Act of 1973, pursuant to North Carolina General Statute § 153A -300, et. seq. provides that the board of commissioners of any county may finance, provide, or maintain fire protection services, facilities, and functions through designated service districts; WHEREAS, North Carolina General Statute §159 -13(a) provides, in part, that the board of commissioners of any county may adopt a "budget ordinance making appropriations and levying taxes for the budget year in such sums as the board may consider sufficient and proper," and "the budget ordinance may be in any form that the board considers most efficient in enabling it to make the fiscal policy decisions embodied therein." WHEREAS, County has established various Fire Protection Service Districts pursuant to The County Service District Act of 1973, levies and collects taxes, and is responsible for appropriating said funds for the use and benefit of the citizens in the designated district; and WHEREAS, Contractor has secured equipment, land, and buildings for the operation of a fire department capable of providing fire protection services within a designated district; and 1 WHEREAS, County desires to contract with Contractor to provide fire protection services, facilities, and functions for the benefit of the designated Fire Protection Service District; NOW THEREFORE, in consideration of the mutual promises contained herein and other good and valuable consideration, the parties hereto contract and agree as follows: 1. GENERAL: Contractor shall furnish fire protection services, facilities, and functions pursuant to the standards set forth by the North Carolina Department of Insurance, County of Harnett, and all other pertinent federal, state, and local laws and regulations within the boundaries of the Fire Protection Service District (hereinafter sometimes referred to as "Fire Protection Service District "). The Fire Protection Service District is defined in the map of the Fire Protection Service District on record with the Clerk to the Harnett County Board of Commissioners and in the GIS /Land Records Management of Harnett County. Contractor shall provide the necessary equipment, personnel, facilities, and all other things necessary for furnishing such protection in the Fire Protection District. The services shall be in accordance with the standards as set forth in this Agreement by the North Carolina Department of Insurance, County of Harnett, and all other federal, state, and local regulations regarding fire protection, and all future amendments adopted in accordance with paragraph 17 of this Agreement. The Contractor shall furnish fire protection services, facilities, and functions without charge to all persons and property located within the Fire Protection Service District in an efficient and workman -like manner. This provision shall not prohibit the Contractor from entering into contracts with Federal, State, or local governments, or utility companies for the provision of emergency 2 protection services for a fee, or from applying for and /or receiving any donations, grants, or contributions of any kind, whether governmental or private. 2. PAYMENT: For fiscal year July 1, 201 to June 30, 201, County shall cause to be assessed or levied property taxes for fire protection services, facilities, and functions for the Fire Protection Service District and paid to Contractor in an amount of $0. per one hundred dollars valuation on all real and personal property located in the Fire Protection Service District, pursuant to North Carolina General Statute §153A-307 and as adopted in the budget ordinance of County. For each fiscal year following the July 1, 2014 through June 30, 2015 fiscal year, the amount paid to Contractor will be determined by the parties and the amount paid to Contractor will be reflected in the budget ordinance adopted by County for the Fire Protection Service District. In determining the amount to be assessed or levied, the Harnett County Board of Commissioners will take into consideration the needs of citizens of the Fire Protection Service District as projected by Contractor in a budget estimate submitted by Contractor to the Harnett County Board of Commissioners through the Harnett County Fire Marshal. 3. TIME OF PAYMENT: County shall pay to Contractor the monthly collection of current and delinquent property taxes levied pursuant to The County Service District Act of 1973 for the Fire Protection Service District by the 15th day of the month following the month of collection by County. County may pay to Contractor the monthly collection of sales tax levied for the Fire Protection Service District by the 15th day of the month following collection by County. 3 4. USE OF FUNDS: Contractor shall use all funds paid to it by County under this Agreement solely and exclusively to provide for fire protection services, facilities, and functions for the benefit of the citizens of the Fire Protection Service District (and other areas of response as dispatched by County) and to meet the standards and requirements of County established by this Agreement. 5. PURCHASES OVER $20,000.00: If Contractor desires to make any single capital purchase in the amount of $20,000.00 or greater and said purchase has not been approved by the Harnett County Board of Commissioners in the current year capital outlay in the Contractor's estimated budget, Contractor shall submit a written request for purchase which must be approved by the Harnett County Board of Commissioners. The written request shall be submitted by Contractor to the Harnett County Fire Marshal who, in turn, shall forward the request to the Harnett County Board of Commissioners for its consideration. The Harnett County Board of Commissioners may accept or reject the request in its sole discretion. 6. INSPECTIONS /AUDITS /BUDGETING /BONDING: Contractor agrees that County has the right to inspect all books and accounts of Contractor at any time. Said inspection shall be conducted by the Harnett County Board of Commissioners through the Harnett County Fire Marshal, the Harnett County Finance Officer, or other designees of the Harnett County Board of Commissioners. It is further agreed that Contractor will present the Harnett County Board of Commissioners with an annual audit by a certified public accountant which shall be in conformity with Generally Accepted Accounting Principles (GAAP) or other comprehensive bases of accounting. Contractor agrees to comply with all County budgeting procedures and such other 4 federal, state, county, and local laws, rules, procedures, or policies as may be applicable. Contractor agrees to submit budget estimates by the date requested by the Harnett County Fire Marshal to the Harnett County Board of Commissioners on the standard forms used by County. Contractor agrees to use standard line items for accounting as requested or consented to by the Harnett County Finance Officer. Contractor shall secure and maintain a blanket bond which is acceptable to County on all persons who have access to or authority to receive or disburse funds belonging to the Contractor. Such blanket bond shall be through a company licensed to provide said blanket bonds and which is acceptable to County, and shall be in an amount of not less than $100,000.00. Proof of such bonding shall be provided prior to the disbursement of any funds by County to Contractor under this Agreement. 7. CORPORATE DOCUMENTS: Contractor shall provide the Harnett County Fire Marshal with a true copy of its Articles of Incorporation, existing Bylaws, and any subsequent amendments. Contractor agrees to adopt Bylaws which meet all minimum legal requirements and which have reasonable provisions enabling citizens of the community to participate in the affairs of the Contractor, including provisions for an annual meeting and vesting in a Board of Directors the authority to manage the affairs of the Fire Department without a vote of the membership, to the extent permitted by North Carolina General Statutes §55A, et. seq., The North Carolina Nonprofit Corporation Act. 8. ASSETS /INVENTORY /RETURN OF ASSETS ON TERMINATION: Contractor shall maintain an accurate accounting of the use of funds paid to it by County under this Agreement and shall maintain an accurate inventory of any property with a 5 purchase price of $1,000.00 or greater purchased in whole or in part with County Fire Protection Service District Funds for the purpose of providing and furnishing fire protection services to the Fire Protection Service District pursuant to the provisions of this Agreement. Should the Contractor no longer provide fire protection services, facilities, and functions to the Fire Protection Service District pursuant to this Agreement, all assets and property that have been acquired using County Fire Protection Service District funds at any time past, present, or future, and having a value of $1,000.00 or greater at time of termination shall become the property of County at the expiration of the Agreement. 9. WITHHOLDING OF FUNDS ON NON- COMPLIANCE: If any condition of this Agreement is not being fulfilled by Contractor to the satisfaction of County, in County's sole discretion, the Harnett County Finance Officer has the right to withhold any and all funds to be paid to Contractor under this Agreement until such time as the Contractor complies with the terms of this Agreement. If Contractor refuses or fails to provide fire protection services, facilities, or functions as contemplated under this Agreement to the satisfaction of County, the Harnett County Fire Marshal shall investigate the cause of said refusal or failure. During the investigation by the Harnett County Fire Marshal, County may withhold any and all funds due and payable to Contractor. If the investigation by the Harnett County Fire Marshal determines that Contractor has refused or failed to perform the duties and obligations of it as required herein, and certifies the results of the investigation to the County Manager, the County Manager may instruct the Finance Officer to withhold any and all funds to be paid to Contractor under this Agreement until a resolution regarding the refusal or failure to 6 perform is reached by the parties. If a resolution is unable to be reached by the parties, County, in its sole discretion, may withhold any and all funds to be paid to Contractor under this Agreement, terminate this Agreement for cause, or take any other such action as County deems necessary to protect the citizens of the Fire Protection Service District. Contractor's failure to file reports required of it to any Federal, State, or local authority shall be grounds for County to terminate this Agreement with Contractor for cause. If this Agreement is terminated by County for cause, Contractor shall be liable to County for any and all funds appropriated and paid to Contractor during the fiscal year in which the termination occurs. Additionally, Contractor shall not be relieved of its obligations to County under paragraph 8 of this Agreement. Nothing herein shall affect Contractor's ultimate rights to payments, or County's responsibility for payments, as outlined herein for services actually rendered by Contractor prior to the effective date of any termination. Nothing herein shall prevent County and Contractor, in the event of a termination of this contract for any reason, from entering into an agreement to provide services beyond the effective date of any such termination. 10. INSURANCE COVERAGE REQUIREMENTS: Contractor shall obtain and keep in force during the term of this Agreement the following minimum insurance coverage: a. Workers' Compensation: Coverage for all paid and volunteer workers meeting the statutory requirements of North Carolina General Statutes §97, et. seq., The North Carolina Workers Compensation Act; b. Comprehensive General Liability, Malpractice, and Errors and Omissions: Coverage with minimum limits of $1,000,000.00 per occurrence, 7 $1,000,000.00 aggregate combined single minimum for bodily injury liability and property damage liability; c. Business Auto Policy: Coverage with minimum limits of $1,000,000.00 per occurrence combined single limit for bodily injury liability and property damage liability. This shall include owned, hired, and non -owned vehicles, and employee non - ownership. d. Management or Directors and Officers Liability: Coverage with minimum limits of $1,000,000.00 per claim and $2,000,000.00 aggregate. e. Umbrella Liability: Coverage with a minimum limit of $1,000,000.00 with underlying coverage of auto liability, general liability, employer's liability, and $1,000,000.00 aggregate. f. County as an Additional Insured: County of Harnett shall be named as an additional insured on all policies of insurance required pursuant to this Agreement. Contractor shall furnish County all certificates of insurance annually. g. Indemnity Agreement: Contractor shall and hereby agrees to indemnify and hold harmless County from any and all liability and expenses, including attorney's fees, court costs, and other costs incurred by County caused by the negligent acts or omissions of Contractor, its volunteers, agents, and employees. 11. FIRE RATING REQUIREMENT: Contractor shall maintain a minimum of 9S/E rating or better with the Department of Insurance, Office of State Fire Marshal. Contractor shall maintain its present nonprofit corporation status pursuant to North Carolina General Statutes §55A. Contractor shall continuously comply with all 8 applicable federal, state, county, and local laws, rules, procedures, or policies regarding fire rating requirements. 12. WATER USE REQUIREMENTS: Contractor shall comply with all County directives associated with the use of water from any County owned or operated water system within the geographic area in which services under this Agreement are provided. It is further agreed that any water withdrawn from a County owned or operated water system will be reported on a monthly basis to the Harnett County Department of Public Utilities. 13. MAINTENANCE/UPGRADE OF INSURANCE RATING: Contractor shall annually submit to the Harnett County Fire Marshal a written plan outlining how it will maintain or upgrade its current insurance rating. 14. PERFORMANCE STANDARDS: The parties agree to the following minimum performance standards and agree that these performance standards are material terms to this Agreement: a. DISPATCHING PROTOCOLS: Contractor shall comply with the County Dispatching protocols as established by County. b. RESPONSE TIME: Contractor shall have an average response time, defined as the time period from dispatch until arrival on scene, of 11 minutes or less for fire calls within the North Carolina Rating System recognized fire insurance district. The average response time will be determined by the Harnett County Fire Marshal on a quarterly basis. 9 c. MANPOWER (ON SCENE): Contractor shall adopt a standard operating guideline that addresses the number of firefighters required on all types of fire calls. A current, valid copy of the Contractor's guideline shall be kept on file with the Harnett County Fire Marshal. Contractor shall place four (4) trained personnel on the scene to operate at least one (1) pumper when making the initial attack on all structure fire calls. d. TRAINING: Contractor shall have the minimum standard training requirements, as established by the State of North Carolina, for providing fire, rescue, and emergency management services. Contractor shall maintain training levels in accordance with National Incident Management System (NIMS) directives. e. PRE -FIRE INCIDENT SURVEYS: Contractor shall develop a pre -fire incident survey and update it annually for all commercial buildings within the Fire Protection Service District. Facilities that should be given priority are those buildings displaying NFPA 704 placards, as well as hazardous, institutional, and assembly occupancies. Contractor agrees to cooperate with local fire code enforcement officials to determine hazards and occupancies. Upon request, the Harnett County Fire Marshal or his designee shall assist Contractor in developing pre -fire incident surveys for buildings within the Harnett County Fire Marshal's fire code enforcement service area. f. FIRE INVESTIGATIONS: 10 Contractor's officer in charge at all fire scenes shall attempt to determine the origin and cause of every fire. When the officer in charge cannot determine the origin and cause of the fire, if the cause is suspected to be incendiary in nature, or if the incident involves a burn injury, the officer in charge shall request assistance from a representative of the Harnett County Fire Marshal's Office. Contractor shall provide any reasonable assistance requested by the Harnett County Fire Marshal's Office at the fire scene. g. SOFTWARE AND REPORTS: Contractor shall use reporting software supplied by County. No less than the following information is required to be reported in the reporting software to be used for compiling reports: 1. Incident; 2. Staff; 3. Hydrants; 4. Training. Fire Incident Reports shall be completed, utilizing the software provided by County, by the 10th day of the month showing completion of the reports for the previous month. Contractor shall keep all reports and records on site at Contractor's principal place of business for at least five years from the creation date. All mandatory State and County reports and rosters shall be submitted to the appropriate authority by the requested deadline. h. FIRE HYDRANTS: Contractor shall conduct fire hydrant testing and maintenance on not less than an annual basis. Testing shall ensure that every wet and dry fire hydrant in the Fire Protection Service District is flushed and checked for accessibility, functionality, visibility, and operation. Records of fire hydrant tests and 11 maintenance conducted by Contractor shall be completed and maintained in compliance with the North Carolina Rating System. i. MEDICAL FIRST RESPONDER: Contractor may choose to participate in County's Medical First Responder Program. Participation in this program is fully voluntary. If Contractor elects to participate in the program, Contractor's participation shall conform to the Harnett County EMS System Plan, as amended from time to time. j. EMERGENCY DISASTER RESPONSE: Contractor shall follow the Harnett County Emergency Operations Plan, as may be amended from time to time, when responding to an emergency disaster. k. STATE OF EMERGENCY: At the request of County, Contractor shall assist County in providing services during and following times of emergencies or disasters, including, but not limited to: i. Debris Removal; ii. Debris Clearance; iii. Traffic Control; iv. Search and Rescue; v. Evacuation; vi. Medical Services as identified by County; and vii. Other life- saving and property protection measures as necessary. 12 All operations shall be in accordance with the Harnett County Emergency Operations Plan and County Emergency Management Ordinance, as may be amended from time to time. 1. HARNETT COUNTY CHIEF'S ASSOCIATION: Contractor shall participate in the Harnett County Chief's Association to allow for an exchange of information between County and Contractor. Such participation shall include, but is not limited to, having a representative at Harnett County Chief's Association meetings. m. SOFTWARE USER GROUP: County will organize reporting software user group meetings periodically to enhance user training. Contractor shall send at least one (1) representative to these meetings. 15. EFFECTIVE DATE: This effective date of this agreement is July 1, 2014, subject always to the continued legal existence of the Fire Protection District and Contractor, and shall continue from fiscal year to fiscal year unless terminated by either party pursuant to the provisions contained herein, and is subject always to appropriation of funds by the Harnett County Board of Commissioners. 16. TRANSFER/ASSIGNMENT: This Agreement or any responsibilities for fire protection services required herein may not be transferred or assigned by Contractor without the written consent of County. 17. AMENDMENT OR TERiMINATION OF AGREEMENT: This Agreement may be terminated by either party upon advance written notice to the other party, served upon the other party by certified mail at least ninety (90) days prior to telniination. Failure 13 of County and Contractor to agree upon the amount of funding shall cause this Agreement to terminate upon written notice to the other party, served upon the other party by certified mail, at least thirty (30) days prior to teimination. This Contract may be amended only by mutual agreement of the parties in a written addendum hereto. Either party may propose an amendment to this Agreement by submitting the amendment in writing to the other party at least sixty (60) days in advance of the amendment's proposed effective date. 18. EXCLUSIVE AGREEMENT: This Agreement is not intended to serve for the benefit of any third party. The rights and obligations herein belong exclusively to the entities which are parties hereto and no third party shall rely upon anything contained herein as a benefit to that third party. 19. RELATIONSHIP OF THE PARTIES. The relationship of the parties established by this Agreement is solely that of independent contractors, and nothing contained in this contract shall be construed to (i) give any party the power to direct or control the day- to-day activities of the other; (ii) constitute such parties as partners, joint venturers, co- owners, or otherwise as participants in a joint or common undertaking; (iii) make either party an agent of the other for any purpose whatsoever; or (iv) give either party the authority to act for, bind, or otherwise create or assume any obligation on behalf of the other. Nothing herein shall be deemed to eliminate any fiduciary duty on the party of the Contractor to the County that may arise under the law or under the terms of this Agreement. 20. ENTIRE AGREEMENT: The terms and provisions contained herein constitute the entire agreement by and between County and Contractor and shall supersede all 14 previous communications, representations, or agreements, either oral or written, between the parties hereto with respect to the subject matter hereof; except that this paragraph shall not be construed to supersede any existing and applicable Mutual Aid and /or Automatic Aid Agreements. 21. CHOICE OF LAW: This Agreement shall be governed by the laws of the State of North Carolina. Any and all actions and proceedings arising under this Agreement shall be brought and heard in the Superior Court of Harnett County. 22. SAVINGS CLAUSE: In the event any provision of this Agreement is adjudged to be not enforceable or found invalid, such provision shall be stricken and the remaining provisions shall be valid and enforceable. 23. EQUAL OPPORTUNITY EMPLOYMENT: County is an equal employment opportunity employer. County is a federal contractor, and therefore the provisions and affirmative action obligations of 41 CFR 60- 1.4(a), 41 CFR 60- 741.5(a), and 41 CFR 60 -250.4 are incorporated herein by reference, where applicable. 24. E- VERIFY: Contractor certifies that it and any subcontractors will comply with the requirements of North Carolina General Statutes §64, et. seq. 25. NOTICES: All notices or other communications which shall be made pursuant hereto shall be in writing and shall be deemed to be given and received (a) when hand delivered to the address stated below; or (b) three (3) days after being mailed to the address stated below, postage prepaid by certified or registered mail of the United States, return receipt requested to the address set forth below: TO CONTRACTOR: 15 TO COUNTY: County of Harnett Post Office Box 370 (mail) 1005 Edwards Brothers Drive (physical) Lillington, North Carolina 27546 Attn: Harnett County Fire Marshal With copy to: County of Harnett Post Office Box 238 (mail) 102 East Front Street (physical) Lillington, North Carolina 27546 Attn: County Staff Attorney Either party to this Agreement may change its designated person or designated address at any time and from time to time by giving notice of such change to the other party in the manner set forth herein. IN TESTIMONY WHEREOF, on the date and year first above written, County has caused this instrument to be executed by the Chairman of the Board of Commissioners of County and attested by the Clerk to said Board, and Contractor has caused this instrument to be signed in its name by its President by authority duly given, attested by the Secretary, and its corporate seal hereto affixed, all by order of its Board duly given. (The remainder of this page left blank intentionally) 16 COUNTY OF HARNETT JIM BURGIN, CHAIRMAN ATTEST: MARGARET REGINA WHEELER, CLERK STATE OF NORTH CAROLINA COUNTY OF HARNETT I� , a Notary Public of the County and State aforesaid, certify that Jim Burgin personally came before me this day, who being by me duly sworn, deposes and says: that he is the Chairman of the Harnett County Board of Commissioners and Margaret Regina Wheeler is the Clerk of said Board, that the seal affixed to the foregoing instrument is the official seal of Harnett County, that said instrument was signed by him, attested by said Clerk and the County's seal affixed thereto, all by authority of the Board of Commissioners of said County, and the said Jim Burgin acknowledged said instrument to the act and deed of Harnett County. Witness my hand and official stamp, this the My Commission Expires: [SEAL] day of 20 , Notary Public 17 PRESIDENT ATTEST: SECRETARY STATE OF NORTH CAROLINA COUNTY OF I, , a Notary Public of the County and State aforesaid, do hereby certify that personally appeared before me this day and acknowledged that he /she is , and that by authority duly given and as an act of Contractor, the foregoing instrument was signed in its name by its , sealed with its corporate seal, and attested by the foregoing as its Secretary. Witness my hand and official stamp or seal, this day of 2013. My Commission Expires: [SEAL] Notary Public 18 Board Meeting Agenda Item Agenda Item if MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Agreement for Emergency Medical Services REQUESTED BY: Gary Pope, Emergency Services Director REQUEST: We would like to request approval for the revision of the Agreement for Emergency Medical Services. This agreement is between the County of Harnett and the EMS Providers for Harnett County. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: C: \Users \bstancil \AppData \Local \Temp \agendaform2015 EMS Agreement _4407837 \agendaform2015 EMS Agreement.doc Page 1 of 1 NORTH CAROLINA COUNTY OF HARNETT AGREEMENT FOR EMERGENCY MEDICAL SERVICES THIS AGREEMENT is made and entered into as of this the day of 2014, by and between the COUNTY OF HARNETT (sometimes hereinafter referred to as "County "), and (sometimes hereinafter referred to as "EMS Provider "). RECITALS: THAT WHEREAS, North Carolina General Statute §153A-250 provides that counties may provide for ambulance services and may contract for ambulance services in all or a portion of a county; and WHEREAS, North Carolina General Statute §159-13(a), provides, in part, that the board of commissioners of any county may adopt a "budget ordinance making appropriations and levying taxes for the budget year in such sums as the board may consider sufficient and proper;" and "the budget ordinance may be in any form that the board considers most efficient in enabling it to make the fiscal policy decisions embodied therein;" and WHEREAS, County has established various Emergency Medical Services Response Areas within Harnett County and appropriates funds for the purpose of providing emergency medical services within Harnett County; and WHEREAS, EMS Provider has secured equipment, land, and buildings for the operation of a non - profit corporation capable of providing emergency medical services within a designated Emergency Medical Services Response Area; and 1 WHEREAS, County desires to contract with EMS Provider to provide emergency medical services, facilities, and functions for the benefit of the citizens and residents of Harnett County; NOW, THEREFORE, in consideration of the mutual promises contained herein and other good and valuable consideration, the parties hereto contract and agree as follows: 1. GENERAL: EMS Provider shall furnish emergency medical services, facilities, and functions pursuant to the standards set forth by the North Carolina Medical Care Commission, County of Harnett, and all other pertinent federal, state, and local laws and regulations within the boundaries of the Emergency Medical Services Response Area (hereinafter sometimes referred to as "the Service Area') and other areas of response as may be dispatched. The Service Area is defined in the map of the Emergency Medical Services Response Areas on record with the Harnett County Emergency Services Department of County and in the GIS /Land Records Management of County. EMS Provider shall provide the necessary equipment, personnel, facilities, and all other things necessary for furnishing such services in the Service Area. The services shall be in accordance with the standards as set forth in this Agreement by the North Carolina Medical Care Commission, County of Harnett (including the Harnett County EMS System Plan), and all other federal, state, and local regulations regarding emergency medical services, and all future amendments adopted in accordance with paragraph 14 of this Agreement. The EMS Provider shall furnish services, facilities, and functions in an efficient and workman-like manner. 2. PAYMENT: For fiscal year July 1, 2015 to June 30, 2016, County shall pay EMS Provider the total sum of $ , which shall be divided and paid in twelve 2 (12) equal monthly payments by the 15th day of each month. For each fiscal year following the July 1, 2015 through June 30, 2016 fiscal year, the amount paid to EMS Provider will be determined by the parties and the amount paid to EMS Provider will be reflected in the budget ordinance adopted by County. In determining the amount to be paid to EMS Provider, the Harnett County Board of Commissioners will take into consideration the needs of citizens of the Emergency Medical Services Response Area as projected by EMS Provider in a budget estimate submitted by EMS Provider to the Harnett County Board of Commissioners through the Harnett County Emergency Services Director. For each fiscal year following the July 1, 2014 through June 30, 2015 fiscal year, the total amount paid by County to EMS Provider shall be divided and paid in twelve (12) equal monthly payments by the 15th day of each month. 3. USE OF FUNDS: EMS Provider shall use all funds paid to it by County under this Agreement solely and exclusively to provide for emergency medical services, facilities and functions for the benefit of the citizens of the Emergency Medical Services Response Area (and other areas of response as dispatched by County) and to meet the standards and requirements of County established by this Agreement. 4. PURCHASES OVER $20,000.00: If EMS Provider desires to make any single capital purchase in the amount of $20,000.00 or greater and said purchase has not been approved by the Harnett County Board of Commissioners in the current year capital outlay in the EMS Provider's estimated budget, EMS Provider shall submit a written request for purchase which must be approved by the Harnett County Board of Commissioners. The written request shall be submitted by EMS Provider to the Harnett County Emergency Services Director who, in turn, shall forward the request 3 to the Harnett County Board of Commissioners for its consideration. The Harnett County Board of Commissioners may accept or reject the request in its sole discretion. 5. INSPECTIONS /AUDITS /BUDGETING /BONDING: EMS Provider agrees that County has the right to inspect all books and accounts of EMS Provider at any time. Said inspection shall be conducted by the Harnett County Board of Commissioners through the Harnett County Emergency Services Director, the Harnett County Finance Officer, or other designees of the Harnett County Board of Commissioners. It is further agreed that EMS Provider will present the Harnett County Board of Commissioners with an annual audit by a certified public accountant which shall be in conformity with Generally Accepted Accounting Principles or other comprehensive bases of accounting. EMS Provider agrees to comply with all County budgeting procedures and such other federal, state, county, and local laws, rules, procedures, or policies as may be applicable. EMS Provider agrees to submit budget estimates by the date requested by the Harnett County Emergency Services Director to the Harnett County Board of Commissioners on the standard foul's used by County. EMS Provider agrees to use standard line items for accounting as requested or consented to by the Harnett County Finance Officer. EMS Provider shall secure and maintain a blanket bond which is acceptable to County on all persons who have access to or authority to receive or disburse funds belonging to the EMS Provider. Such blanket bond shall be through a company licensed to provide said blanket bonds and which is acceptable to County, and shall be in an amount of not less than $100,000.00. Proof 4 of such bonding shall be provided prior to the disbursement of any funds by County to EMS Provider under this Agreement. 6. CORPORATE DOCUMENTS: EMS Provider shall provide the Harnett County Emergency Services Director with a true copy of its Articles of Incorporation, existing Bylaws, and any subsequent amendments. EMS Provider agrees to adopt Bylaws which meet all minimum legal requirements and which have reasonable provisions enabling citizens of the community to participate in the affairs of the EMS Provider, including provisions for an annual meeting, vesting in a Board of Directors, and the authority to manage the affairs of the EMS Provider without a vote of the membership, to the extent permitted by North Carolina General Statutes § 55A et. seq., the North Carolina Nonprofit Corporation Act. 7. ASSETS /INVENTORY /RETURN OF ASSETS ON TERMINATION: EMS Provider shall maintain an accurate accounting of the use of funds paid to it by County under this Agreement and shall maintain an accurate inventory of any property with a purchase price of $1,000.00 or greater purchased in whole or in part with County funds for the purpose of providing and furnishing emergency medical services to the Emergency Medical Services Response Area pursuant to the provisions of this Agreement. Should the EMS Provider no longer provide emergency medical services, facilities, and functions to the Emergency Medical Services Response Area through this Agreement, all assets and property that have been acquired using County funds at any time past, present, or future, and having a value of $1,000.00 or greater at time of termination shall become the property of County at the expiration of this Agreement. 5 8. WITHHOLDING OF FUNDS ON NON - COMPLIANCE: If any condition of this Agreement is not being fulfilled by EMS Provider to the satisfaction of County, in County's sole discretion, the Harnett County Finance Officer has the right to withhold any and all funds to be paid to EMS Provider under this Agreement until such time as the EMS Provider complies with the terms of this Agreement. If EMS Provider refuses or fails to provide services, facilities, or functions as contemplated under this Agreement and to the satisfaction of County, the Harnett County Emergency Services Director shall investigate the cause of said refusal or failure. During the investigation by the Harnett County Emergency Services Director, County may withhold any and all funds due and payable to EMS Provider. If the investigation by the Harnett County Emergency Services Director determines that EMS Provider has refused or failed to perform the duties and obligations of it as required herein, and certifies the results of the investigation to the County Manager, the County Manager may instruct the Finance Officer to withhold any and all funds to be paid to EMS Provider under this Agreement until a resolution regarding the refusal or failure to perform is reached by the parties. If a resolution is unable to be reached by the parties, County, in its sole discretion, may withhold any and all funds to be paid to EMS Provider under this Agreement, terminate this Agreement for cause, or take any other such action as County deems necessary to protect the citizens of the County. EMS Provider's failure to file reports required of it to any Federal, State, or local authority shall be grounds for County to terinate this Agreement with EMS Provider for cause. If this Agreement is terminated by County for cause, EMS Provider shall be liable to County for any and all funds appropriated and paid to EMS Provider during the fiscal year in 6 which the termination occurs. Additionally, EMS Provider shall not be relieved of its obligations to County under paragraph 7 of this Agreement. Nothing herein shall affect EMS Provider's ultimate rights to payments, or County's responsibility for payments, as outlined herein for services actually rendered by EMS Provider prior to the effective date of any termination. Nothing herein shall prevent County and EMS Provider, in the event of a termination of this contract for any reason, from entering into an agreement to provide services beyond the effective date of any such termination. 9. INSURANCE COVERAGE REQUIREMENTS: EMS Provider shall obtain and keep in force during the term of this Agreement the following minimum insurance coverage: a. Workers' Compensation: Coverage for all paid and volunteer workers meeting the statutory requirements of North Carolina General Statutes § 97, et. seq., The North Carolina Workers' Compensation Act; b. Comprehensive General Liability, Malpractice, and Errors and Omissions: Coverage with minimum limits of $1,000,000.00 per occurrence, $1,000,000.00 aggregate combined single minimum for bodily injury liability and property damage liability; c. Business Auto Policy: Coverage with minimum limits of $1,000,000.00 per occurrence combined single limit for bodily injury liability and property damage liability. This shall include owned vehicles, hired, and non -owned vehicles and employee non - ownership. 7 d. Management or Directors and Officers Liability: Coverage with minimum limits of $1,000,000.00 per claim and $2,000,000.00 aggregate. e. Umbrella Liability: Coverage with a minimum limit of $1,000,000.00 with underlying coverage of auto liability, general liability, employer's liability, and $1,000,000.00 aggregate. f. County as an Additional Insured: County of Harnett shall be named as an additional insured on all policies of insurance required hereunder. EMS Provider shall furnish County all certificates of insurance annually. g. Indemnity Agreement: EMS Provider shall and hereby agrees to indemnify and hold harmless County, from any and all liability and expenses, including attorney's fees, court costs, and other costs incurred by County caused by the negligent acts or omissions of EMS Provider, its volunteers, agents, and employees. 10. LICENSING REQUIREMENT: EMS Provider shall be required to submit a current, valid copy of its license to operate as an emergency medical services provider from the North Carolina Medical Care Commission. EMS Provider shall maintain its present nonprofit corporation status pursuant to North Carolina General Statutes § 55A. EMS Provider shall continuously comply with all applicable federal, state, county, and local laws, rules, procedures, or policies under this Agreement. 11. PERFORMANCE STANDARDS: The parties agree to the following minimum performance standards and agree that these performance standards are material terms to this Agreement: a. DISPATCHING PROTOCOLS: 8 EMS Provider shall comply with County dispatching protocols as established by County. b. RESPONSE TIME: EMS Provider shall have an average response time, defined as the time period from dispatch until arrival on scene, of 10.0 minutes or less for emergency medical services calls within the Emergency Medical Services Response Area. The average response time will be determined by the Harnett County Emergency Medical Services System Medical Director. c. MANPOWER (ON SCENE): EMS Provider shall provide minimum staffing per North Carolina General Statute §131E -155. d. TRAINING: EMS Provider shall have the minimum standard training requirements, as established by the State of North Carolina, for providing emergency medical services. EMS Provider shall maintain training levels in accordance with National Incident Management System (NIMS) directive and the Harnett County Emergency Medical Services Plan, and shall report said training to the Harnett County Emergency Medical Services System Continuing Education Coordinator. e. SOFTWARE AND REPORTS: EMS Provider shall utilize electronic patient care reporting software supplied by County. EMS Incident Reports shall be completed, including quality control and billing export, utilizing the software provided by County, not later than forty -eight (48) hours subsequent to the reported incident. EMS Provider shall assign 9 someone to maintain information for its members and vehicles in the credentialing information system database, not less than one (1) time per month. EMS Provider shall keep all records and reports on site at EMS Provider's principal place of business for at least eleven (11) years from the creation date. All mandatory State and County reports and rosters shall be submitted to the appropriate authority by the requested deadline. f. EMERGENCY DISASTER RESPONSE: EMS Provider shall follow the Harnett County Emergency Operations Plan, as may be amended from time to time, when responding to an emergency disaster. g. STATE OF EMERGENCY: At the request of County, EMS Provider shall assist in providing services during and following times of emergencies or disasters, including, but not limited to: i. Debris Removal; ii. Debris Clearance; iii. Traffic Control; iv. Search and Rescue; v. Evacuation; vi. Medical Services as identified by the County; and vii. other life- saving and property protection measures as necessary. All operations shall be in accordance with the Harnett County Emergency Operations Plan and County Emergency Management Ordinance, as may be amended from time to time. h. HARNETT COUNTY CHIEF'S ASSOCIATION: 10 EMS Provider shall participate in the Harnett County Chiefs Association to allow for an exchange of information between County and EMS Provider. Such participation shall include, but is not limited to, having a representative at Harnett County Chiefs Association meetings. i. PEER REVIEW MEETINGS: EMS Provider shall have a representative present at all Peer Review Committee meetings. These meetings shall take place in accordance with the Harnett County Emergency Medical Services Plan. Nothing is this Agreement shall be construed to abridge, limit, or in any way compromise the integrity of any and all peer review privileges enjoyed by County pursuant to North Carolina General Statutes §131E, et. seq., or any other peer review statute applicable to County in its role as a health care provider. j. BILLING: County agrees to manage the billing for the EMS Provider at no charge and is entitled retain all funds collected pursuant to services provided under this Agreement. County shall not otherwise be a billing agency for the EMS Provider. EMS Provider shall instruct personnel to obtain all billing, insurance, and other necessary information, including the HIPAA Signature Billing Form that is required by County. k. EMS Provider will maintain a unit in ready response mode at all times within the Emergency Medical Service Response Area consistent with the Harnett County Emergency Medical Services System Plan. 11 12. EFFECTIVE DATE: This effective date of this agreement is July I , 2015, subject always to the continued legal existence of the EMS Provider, and shall continue from fiscal year to fiscal year unless terminated by either party pursuant to the provisions contained herein and is subject always to appropriation of funds by the Harnett County Board of Commissioners. 13. TRANSFER /ASSIGNMENT: This Agreement or any responsibilities for services required therein may not be transferred or assigned by EMS Provider without the written consent of County. 14. AMENDMENT OR TERMINATION OF AGREEMENT: This Agreement may be terminated by either party upon advance written notice to the other party, served upon the other party by certified mail at least ninety (90) days prior to termination. Failure of County and EMS Provider to agree upon the amount of funding shall cause this Agreement to terminate upon written notice to the other party, served upon the other party by certified mail, at least thirty (30) days prior to termination. This Agreement may be amended only by mutual agreement of the parties in a written addendum hereto. Either party may propose an amendment to this Agreement by submitting the amendment in writing to the other party at least sixty (60) days in advance of the amendment's proposed effective date. 15. EXCLUSIVE AGREEMENT: This Agreement is not intended to serve for the benefit of any third party. The rights and obligations herein belong exclusively to the entities which are parties hereto and no third party shall rely upon anything contained herein as a benefit to that third party. 12 16. RELATIONSHIP OF THE PARTIES. The relationship of the parties established by this Agreement is solely that of independent contractor EMS Providers, and nothing contained in this contract shall be construed to: (i) give any party the power to direct or control the day -to -day activities of the other; (ii) constitute such parties as partners, joint venturers, co- owners, or otherwise as participants in a joint or common undertaking; (iii) make either party an agent of the other for any purpose whatsoever; or (iv) give either party the authority to act for, bind, or otherwise create or assume any obligation on behalf of the other. Nothing herein shall be deemed to eliminate any fiduciary duty on the part of the EMS Provider to the County that may arise under the law or under the terms of this Agreement. 17. ENTIRE AGREEMENT: The terms and provisions herein contained constitute the entire agreement by and between County and EMS Provider and shall supersede all previous communications, representations, or agreements, either oral or written between the parties hereto with respect to the subject matter hereof; except that this paragraph shall not be construed to supersede any existing and applicable Mutual Aid and /or Automatic Aid Agreements. 18. CHOICE OF LAW: This Agreement shall be governed by the laws of the State of North Carolina. Any and all actions and proceedings arising under this Agreement shall be brought and heard in the Superior Court of Harnett County. 19. SAVINGS CLAUSE: In the event any provision of this Agreement is adjudged to be unenforceable or found invalid, such provision shall be stricken and the remaining provisions shall be valid and enforceable. 13 20. EQUAL OPPORTUNITY EMPLOYMENT: County is an equal opportunity employer. The County is a federal EMS Provider, and therefore the provisions and affirmative action obligations of 41 CFR 60- 1.4(a), 41 CFR 60- 741.5(a), and 41 CFR 60 -250.4 are incorporated herein by reference, where applicable. 21. E- VERIFY: EMS Provider certifies that it and any subcontractor with whom it contracts to provide EMS services complies with the requirements of North Carolina General Statutes §64, et. seq. 22. NOTICES: All notices or other communications which shall be made pursuant hereto shall be in writing and shall be deemed to be given and received (a) when hand delivered to the address stated below; or (b) three (3) days after being mailed to the address stated below, postage prepaid by certified or registered mail of the United States, return receipt requested to the address set forth below: TO EMS PROVIDER: TO COUNTY: County of Harnett Post Office Box 370 (mail) 1005 Edwards Brothers Drive (physical) Lillington, North Carolina 27546 Attn: Harnett County Emergency Services Director With copy to: County of Harnett Post Office Box 238 (mail) 102 East Front Street (physical) Lillington, North Carolina 27546 Attn: County Staff Attorney 14 Either party to this Contract may change its designated person or designated address at any time and from time to time by giving notice of such change to the other party in the manner set forth above. IN TESTIMONY WHEREOF, on the date and year first above written, County has caused this instrument to be executed by the Chaiiinan of the Board of Commissioners of County and attested by the Clerk to said Board and the EMS Provider has caused this instrument to be signed in its name by its President by authority duly given, attested by the Secretary, and its corporate seal hereto affixed, all by order of its Board duly given. (The remainder of this page left blank intentionally) 15 COUNTY OF HARNETT JIM BURGIN, CHAIRMAN ATTEST: MARGARET REGINA WHEELER, CLERK STATE OF NORTH CAROLINA COUNTY OF HARNETT I, , a Notary Public of the County and State aforesaid, certify that Jim Burgin personally came before me this day who being by me duly sworn, deposes and says: that he is the Chairman of the Harnett County Board of Commissioners and Margaret Regina Wheeler is the Clerk of said Board, that the seal affixed to the foregoing instrument is the official seal of Harnett County, that said instrument was signed by him, attested by said Clerk and the County's seal affixed thereto, all by authority of the Board of Commissioners of said County, and the said Jim Burgin acknowledged said instrument to the act and deed of Harnett County. Witness my hand and official stamp, this the My Commission Expires: [SEAL] day of 20 , Notary Public 16 EMS PROVIDER: PRESIDENT ATTEST: SECRETARY STATE OF NORTH CAROLINA COUNTY OF I, , a Notary Public of the County and State aforesaid, do hereby certify that , personally appeared before me this day and acknowledged that he /she is , and that by authority duly given and as an act of the Contractor, the foregoing instrument was signed in its name by its , sealed with its corporate seal, and attested by the foregoing as its Secretary. 2013. Witness my hand and official stamp or seal, this day of My Commission Expires: [SEAL] Notary Public 17 18 Board Meeting Agenda Item MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: North Carolina Department of Public Safety Program Agreements REQUESTED BY: Wendy Butcher 3CPC C h 0, REQUEST: Requesting petlttission to submit Program Agreements from the North Carolina Department of Public Safety JCPC for the following programs: Harnett County Restitutuion Program 10% local cash match required 4 -H Teen Court and At -Risk YOuth Development (No County Cash Match Required) ReEntry Psychological Services -pass thru ReEntry Healthy Choices -pass thru JCPC ADM (no match required) FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: C: \Users \wbutcher \AppData \Local \Microsoft\ Windows\Temporary Internet Files \Content.Outlook\ 1 86SNNI 1 \agendaform2015.doc Page 1 of 1 Harnett County NC DPS - Community Programs - County Funding Allocation Available Funds: $ S224,037 Local Match: $ $25,664 Rate: 10% A Program Agreement Form for each program listed below is included as an attachment to the Community Prevention and Intervention Plan. Program Provider DPS Funding LOCAL Fi.'iNDiNG Local Cash Local In- Match Kind OTHER State/ Federal OT ER Funds ReEntry, Inc. - Psychological Services $6,000 $600 Iota 2 ReEntry, Inc. - Healthy Choices $56,756 $200 $5,675 3 Harnett Co. 4 -H Teen Court $49,773 $7,692 4 Harnett Co. Restitution & Community Service $103,468 $ 11,497 5 JCPC Administration S8,040 $6,600 $62,631 $57,46 $114,965 58,040 10 11 12 13 14 15 16 18 TOTALS: $224,037 $11,697 $13,967 50 $0 The above plan was derived through a planning process by the Juvenile Crime Prevention Council and represents the County's Plan for use of these funds in FY 2015 -2016 . $0 50 $0 $0 50 50 50 $0 $0 $0 $0 50 $0 $249,701 Harnett County % Non -DPS' " ogram enues d %; #DIV /0! #DIV /0! #DIV /0! #DIVIO!', #DIV /0!' #DIV /0!' #DIV /0!' #DIVIO!; #DIV /0!'I #DIVIO! #DIVIO! #DIVIO! 10% Chairperson, Jdy %ni e Crime Prevention Council (' t ate) Chairperson, Board of County Commissioners (Date) or County Finance Officer North Carolina Department of Public Safety JCPC Program - Program Application SECTION IA SPONSORING AGENCY AND PROGRAM INFORMATIC FUNDING PERIOD: FY 15 -16 DPS /JCPC FUNDING # (cont o SPONSORING AGENCY MAILING ADDRESS: PO Box 1153 Smithfield NC 27577 TYPE: Non -Profit 1 ( FEDERAL ID # 56- 2106268 COUNTY: Harnett AREA: Central Area Multi- TOTAL COST OF EACH COMPONENT 11288 Healthy Choices County: No Multi- Components No Total cost of components: $ 62,432 NAME OF PROGRAM:JHealthy Choices N nly)1543 -XXXX SPONSORING AGENCY: Eleventh Judicial District ReEntry, Inc. ....wo. SPONSORING AGENCY PHYSICAL ADDRESS: 1329 N. Brightleaf Blvd. Suite A -2 Smithfield NC 27577 SPONSORING AGENCY MAILING ADDRESS: PO Box 1153 Smithfield NC 27577 TYPE: Non -Profit 1 ( FEDERAL ID # 56- 2106268 COMPONENT ID # NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF EACH COMPONENT 11288 Healthy Choices Interpersonal Skill Building $ 62,432 - Total cost of components: $ 62,432 Program Manager Name & Address Name: Danny Walton same person on signature page) • ax: `(919) 989 -8943 Zip: E- mail:' reentrycp@aol.com 27577 Contact Person (if different from program manager) Name: Danny Walton Title Pro ram D a ....wo. • ,,,9,0111 uucuuJ Mailing Address: PO Box 1153 City: Smithfield ax: `(919) 989 -8943 Zip: E- mail:' reentrycp@aol.com 27577 Contact Person (if different from program manager) Name: Danny Walton Title Pro ram D a ax: (919) 989 -8943 Zip: E-mail: f reentrycp @aol.com 27577 Program Fiscal Officer (cannot be program manager) Name: Dot Ehlers Title: Executive Director Mailing Address: PO Box 1153 Phone: (919) 989 -7278 Ext:11 1 City: Smithfield Fax:1(919) 989 -8943 1 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Zip: E- mail:1 reentrycp@aol.com 27577 VW ire IJI Mailing Address: PO Box 1153 City: Smithfield ax: (919) 989 -8943 Zip: E-mail: f reentrycp @aol.com 27577 Program Fiscal Officer (cannot be program manager) Name: Dot Ehlers Title: Executive Director Mailing Address: PO Box 1153 Phone: (919) 989 -7278 Ext:11 1 City: Smithfield Fax:1(919) 989 -8943 1 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Zip: E- mail:1 reentrycp@aol.com 27577 SECTION I B PROGRAM COMPONENT DESCRIPTION COMPONENT ID # COMPONENT INFORMATION 11288 NAME OF COMPONENT: Healthy Choices BRIEF DESCRIPTION: HC is a parenting and family skills program that teaches interpersonal skills to families and at -risk youth. HC will build family relationships by improving communication skills and strengthening family bonds. Utilizing Strengthening the Familiy, an evidence based curriculum we will improve family relations, increase parenting skills, improve youth's behavior, increase youths' social competencies and reduce substance abuse. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION II Multi- Components No COMPONENT STATISTICAL INFORMATION Component Service Statistics (PROGRAM COMPONENT INFORMATION - APPLICATION YEAR Component Name: Healthy Choices What is this component's maximum c lent capacity at any given time? Frequency of client contact per month: 11 Anticipated Average Length of Stay: Total Component Cost: $62,432 by Estimated Average Cost Per Youth: Component ID # 11288 30 120 Estimated # to be served during funding period: $2,081 Applies to continuation programs only. Actual number of youth admitted last fiscal year. 34 34 number of admissions Juvenile Court referred 0 number of admissions Law Enforcement referred Days 30 100% of total admissions Form JCPC/PA 004 JCPC Program Application Form structure last revised 01/09/2012 Department of Public Safety 0% of total admissions SECTION III COMPONENT SUMMARY NAME OF COMPONENT: Healthy Choices 1_ Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in the county. Harnett County JCPC identified the following concerns for our youth and their families. There is an elevated percentage of parents with marginal parenting skills who provide inadequate suppervision; there is an elevated percentage of parents /custodians and siblings with a criminal history; and there is an elevated youth reported family discord. HC will provide parenting, family skills building, and interpersonal skills. Many of the families of the at -risk youth we serve lack communciation skills, parent and child bonds, and the ability to settle family conflicts. Parents lack the knowledge and skills to manage thier youth's behavior, utilize effective discipline, manage stress and often abuse drugs. These parents do no recognize the effect of their behavior on their children. These deficits often lead to youth non - complaince, poor grades, the lack of attachtment to school, agressive behavior and depression. These youth also have poor communtication skills, a lack of coping skills for handing anger and substance abuse problems. Utilizing the Strenthening the Family model, we will build on the family protective factors that promote a positive family climate. The program promotes family bonding by opening each session with family meals. In a parent only sessions parental monitoring, supervision, discipline and child rearing are discussed. The youth only sessions will address managing anger, improving communciations skills, school success and substance abuse. Family communication of values and expectations will be addressed during the family portion of the program. 2. Target Population: Describe the target population, including age, and the steps taken to insure that the target population is served. Healthy Choices provides services to at -risk youth ages 12 to 17 and their families in an effort to build strong healthy families. We will serve youth with the following risk factors: skill deficits; low self - esteem; behavior problems; pro -drug attitudes; lack of academic motivation; psychological distubances; lack of peer refusal skills; and who reject pro - social values. These are considered the most at -risk youth. Youth and families will be identified by the Courts, schools, social services and parents. There will be continuous contact with the Courts, schools, family, and mental health programs to ensure the target population is served. 3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program. The goal is to nuture family relationships and increase adaptive functioning skills for family and youth. We will focus on building family bonds , increasing parenting skills, improving child behavior, and teaching youth skills for communicating, coping with anger and recognizing feelings.. Each family will be assessed with regard to strengths, protectative factors and deficits. lndividuallized plans for each family will be developed. We will support and build strong families which decreases the youth's likelihood to associate and be influenced by negative peers and participate in criminal behavior. 4. Measurable Objective(s): State in measurable terms ( %) the intended effect of the program on specific undisciplined and /or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior, disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives must include impact on participants. 70% Clients will successfully or satisfactorily complete services as intended by the program design /service plan. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION 111 COMPONENT SUMMARY NAME OF COMPONENT: Healthy Choices 70% Clients successfully /satisfactorily completing the program will have no new complaints in the 12 months following completion. 70% Clients will have no new adjudications for a complaint with an offense date after the admission date. 75% Clients will demonstrate improvement in targeted skills identified in the individual service plan. 70% Clients will have no new complaints with an offense date after the admission date. 70% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan. 70% Clients successfully /satisfactorily completing the program will have no new adjudications in the 12 months following completion. 5. Elevated Risks and Needs: Describe how you will address one or more of the Elevated Risk and Needs of adjudicated juveniles listed in the local JCPC Request for Proposal. Based on highlights of the FY 2014 -15 risk assessment data for Harnett County, we will address family domain risk factors. These factors are an elevated percentage of adjudicated youth parents who lack parenting and supervision skills, elevated percentage of parents /custodians and sublings with a criminal history and an elevated percentage of youth who report family discord. We will utilize the evidence based Strenthening the Family curriculm to improve family relations, increase parenting skills, improve youth's behavior, increase youth's social competencies and reduce or prevent drug abuse. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Healthy Choices 1. Location: List physical address(es) and describe where program services are delivered. ReEntry office located at 111 E. Ivey Street, Lillington, NC. 2. Operation: Describe the daily/weekly schedule of program operation. We are operating Healthy Choices familiy sessions on Monday nights 6 to 8:30pm. These are 14 week sessions lasting 2/12 hours and include youth and their families. Case managment with youth and parents will be conducted monthly and school visits completed. 3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and position(s) responsibilities relative to this component. Paid staff will include a full -time Case Manager, and 2 group facilitators; these staff will have a BA in Social Work or human service field, 2 years experience with youth, or a combination of education & experience, and a desire to implement a strength based model. Program oversight and clinical supervision will be provided as in -kind match by administrative staff - (Executive Director & Licensed Clinical Psychologist).The Director of Client Services is responsible for managing the day to day operations of the program and supervises the Case Manager, and facilitator positions. Case manager will be present in Juvenile Court to schedule intake appointment for each family. Case Manager will conduct intakes, advise family of program schedule, conduct case management sessions, and act as liasion between Office of Juvenile Justice, Juvenile Court, DSS, Mental Health, schools, and other referring agencies. Program oversight and clinical supervision will be provided as in -kind match by administrative staff (Executive Director & Licensed Clinical Psychologist). The CM reports directly to the Director of Client Services & staffs cases with the contractual psychologist & the DCS. The case manager and group facilitiators lead sessiions utilizing the Strengthening the Family curriculm. Group facilitators lead family groups, parent only groups and youth only groups. All program staff attend monthly treatment team meetings and receive guidance from the psychologist with regard to specific concems and stratergies. 4. Service Type SPEP: Describe implementation to include: Primary Service - Social Skills Training; Secondary Service - None 5. Admission Process: Describe the specific referral, screening, admission process (including timeline), the staff responsible for making decisions about admissions and reasons why a referral may not be accepted. At -risk youth are targeted through presentations to school social workers, mental health, DSS, Juvenile Court, and our collaboration with other community agencies. The Case Manager will conduct a staffing with the referring agency and a comprehensive psycho - social intake with the family and client in order to obtain a thorough family history. Based on the referral, assessments, and psycho - social history families will be assigned to groups. During the intitial group session, we review program outline, goals, and group rules. All releases will be signed during the intake process. Initial contact with families is made within 10 days of the referral. 6. Termination Process: Describe the termination process to include the staff responsible for making decisions and the criteria for a successful termination, satisfactory termination, unsuccessful completion and non - compliant Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Healthy Choices termination. Youth will be successfully terminated after completing 14 family sessions, case management an exit interview and graduation. A youth will be satisfactory terminated after completing at least 12 sessions and an exit interview. A youth will be unsuccessfully terminated for failure to attend or disruptive behavior. The case manager and Director of Client Services will review cases for status updates and termination results. How is the referring agency involved with the termination process? Monthly staffings are conducted with juvenile court counselors to monitor program compliance. Referring agency may participate in all family review meetings to address concerns. Juvenile court counselors may refer cases back to court for non - compliance. 7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and /or other referring agencies including how client progress will be communicated. The Case Manager is present in juvenile court each week to schedule an intake appt. for each family. A referral form is completed from the referring agency. The Case Manager will make initial contact with families, conduct intake & CM sessions, & schedule school visits as needed. The CM maintains ongoing contact with the Juvenile Court Counselor for each youth, with additional contacts as needed for critical cases. Each month, the CM and /or supervisor meet with Juvenile Court Counselors to staff cases regarding attendance, participation, successes, or concerns. Monthly progress reports are submitted to Juvenile Court or other referring agencies & client tracking is updated. 8. Intervention/Treatment: Describe specifically what the component will do to redirect inappropriate youth behavior or how the component will address the identified needs of the youth and family. What interventions will typically be utilized in this component and how will parents/guardians be involved? The family and youth will participate together is 14 group sessions. Each session begins with a family meal. These sessions will focus on building family bonds through family meetings, increased parent/youth time, and effective communcation skills. There will break out groups for parents and youth only and then the families come together to work as families. Parents will learn the need to provide supervision, effective discipline techniques while recognizing the the need for positive interactions. Youth will increase coping skills for anger, increase their ability to identify feelings, increase peer refusal skills and increase their knowledge of substance abuse. 9. Best Practice Model: Describe what model or evidence- supported/best practice the program is based upon. We will utilize the Strengthening Families Progam an evidence based model. This program addresses deliquent behavior by building on the family bonds, conducting family meetings, teaching parenting skills and increasing the youth's social competencies . Form JCPC/PA 004 JCPC Program Application Form structure Last revised 12/31/2012 Department of Public Safety SECTION V Terms of Agreement This section of the JCPC Program Application will ONLY be completed if approved for funding and will be included in the required JCPC Program Agreement document for completion. This Agreement is entered into by and between Department of Public Safety, (hereinafter referred to as the DPS), and County, (hereinafter referred to as the County), the County's Juvenile Crime Prevention Council (hereinafter referred to as the JCPC) and (hereinafter referred to as the Sponsoring Agency). The DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows: Term of Agreement This Agreement shall become effective and shall terminate Payment to Sponsoring Agency All parties agree that services will be delivered as described in the approved JCPC Program Agreement and that JCPC funds will be disbursed in an amount not to exceed the amount $ for the term of this agreement, unless amended by an approved JCPC Program Agreement Revision. Availability of Funds: All parties to this Agreement agree and understand that the payment of the sums specified in this JCPC Program Agreement budget is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to the DPS. Responsibilities of the Parties DPS shall: 1. Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the Juvenile Crime Prevention Council (JCPC) fund appropriation by the General Assembly; 2. Reserve the right to suspend payment to the County for any non - compliance by the Sponsoring Agency with any reporting requirements set forth in the JCPC Policy and Procedures; 3. Notify in writing the County and Sponsoring Agency immediately if payments are suspended and again once payments resume; 4. Pay only for work as described in the JCPC Program Agreement provided by the Sponsoring Agency and approved subcontractors; 5. Provide technical assistance, orientation and training to the Sponsoring Agency, the County and the JCPC; 6. Monitor Sponsoring Agency's JCPC funded program(s) in accordance with JCPC Policy 3. Operations: Program Oversight and Monitoring; and 7. Notify parties entering into this Agreement of all due dates in a timely manner in order for reports to be submitted by the established due date. Form structure last revised 12/20/2013 Depa, tnient of Public Safety The Sponsoring Agency shall: 1. Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the conduct of its business, including those of Federal, State, and local agencies having jurisdiction and /or authority; 2. Comply with all Federal and State laws relating to equal employment opportunity; 3. Keep as confidential and not divulge or make available to any individual or organization without the prior written approval of the DPS any information, data, instruments, documents, studies or reports given to or prepared or assembled by the Sponsoring Agency under this Agreement; 4. Acknowledge that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not further disclose the information except as otherwise provided in this Agreement; 5. Comply with the Juvenile Crime Prevention Policy and Procedures established by the DPS and the North Carolina Administrative Procedures; 6. Secure local match as required, pursuant to 14B NCAC 11E3.0105, for the approved JCPC funds; 7. Create and adopt individualized guidelines specific to the funded program, while also adhering to JCPC Policy and Procedures established by DPS for all JCPC funded programs and for the specific program type for which they receive funding; 8. Ensure that state funds received are spent in accordance with the approved JCPC Program Agreement and be accountable for the legal and appropriate expenditure of those state funds; 9. Maintain reports, records, and other information to properly document services rendered and outcomes; also maintain an ability to send and receive electronic communication; 10. Have the capacity to use DPS electronic, intemet -based system for tracking clients served; 11. Use generally accepted accounting procedures that guarantee the integrity of the expenditure of JCPC funds, maintain reports, records, and other information to properly account for the expenditure of all State funds provided to the Sponsoring Agency; 12. Receive from the North Carolina Division of Revenue a refund of all sales and use taxes paid by them in the performance of the JCPC Program Agreement, pursuant to N.C.G.S. §105- 164.14(c); and exclude all refundable sales and use taxes from all reportable expenditures before the expenses are entered in their reimbursement reports; 13. Submit JCPC Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed check ledgers to the JCPC. These reports must be in accordance with the submission process as outlined in the JCPC Policy and Procedures established by DPS and with the due dates established by DPS; 14. Make personnel, reports, records and other information available to DPS , the County, the JCPC, and /or the State Auditor for oversight, monitoring and evaluation purposes; 15. Submit any other information requested by the JCPC, County or DPS; 16. Be responsible for the performance of all subcontractors as described in the JCPC Program Agreement; 17. Indemnifies and holds harmless DPS, the State of North Carolina, the County and any of their officers, agents and employees, from any claims of third parties arising out of any act or omission of the Sponsoring Agency in connection with the performance of the JCPC Program Agreement; 18. Receive permission and budgetary approval from DPS prior to using the JCPC Program Agreement as a part of any news release or commercial advertising and acknowledge DPS funding in partnership with the County; 19. Comply with DPS trainings and requirements regarding the United States Department of Justice national standards to prevent, detect, and respond to prison rape under the Prison Rape Elimination Act (PREA); Reference: 148; Chapter 11; Subchapter B, and in compliance with JCPC Policy 2: Operations: Program Operational Requirements Sponsoring Agency Contractor(s) /Subcontractors Form structure last revised 12/20/2013 Department of Public Safety J Yes, subcontractors are included in the JCPC Program Agreement budget. No, subcontractors are not included in the JCPC Program Agreement budget. If yes, the following only applies when subcontractors are providing services as described in the JCPC Program Agreement (listed in Line Item 190 of the budget). 20. Receive prior approval from DPS in the form of an unsigned contract being submitted with the JCPC Program Agreement if any of the services described in the JCPC Program Agreement are provided by a subcontractor; NOTE: Contracts signed by all parties must be submitted once the JCPC Program Agreement receives signed approval from DPS. Sponsoring Agencies will be notified requesting this information. 21. Hold any contractor or subcontractor to which the Sponsoring Agency provides State funds accountable for the legal and appropriate expenditure of State funds, and to all applicable laws and Juvenile Crime Prevention Council Policies and Procedures; 22. Ensure that all subcontractors provide all information necessary to comply with the standards set forth in the JCPC Program Agreement; and 23. Be deemed an independent contractor in the performance of services described in the JCPC Program Agreement and as such shall be wholly responsible for the services to be performed and for the supervision of its employees. The Sponsoring Agency represents that it has, or shall secure at its own expense, all personnel required in performing the services as described in the JCPC Program Agreement. Such employees shall not be employees of or have any individual contractual relationship with, DPS; The JCPC shall: 1. Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in JCPC Program Agreement or JCPC Program Agreement Revision(s); 2. Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Code; N.C.G.S. §1438- 801(a);1438- 602;143B -851 3. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency and submit to the County in a timely manner; 4. Review and locally approve Third Quarter Accounting forms and submit to the County in order to meet the due date established by DPS; 5. Submit any other information requested by the County or DPS; and 6. Monitor the Sponsoring Agency's currently funded JCPC program(s) in accordance with JCPC Policy 3. Operations: Program Oversight and Monitoring Reference: 148 NCAC 118.0202 and JCPC Policy 1, 7, 8, 9, 10, and 11. The County shall: 1. Ensure the Sponsoring Agency is appropriately licensed, and either a public agency or a 501 (c) 3 private non- Form structure last revised 12/20/2013 Department of Public Safety profit organization; 2. Use JCPC funds only for the purposes DPS has approved in program agreements or program agreement revisions; 3. Disburse JCPC funds monthly and oversee JCPC funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108 4. Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Procedures; 5. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency for final approval from DPS; and 6. Review and locally approve Third Quarter and Final Accounting forms for the JCPC and all JCPC funded programs according to the procedures and due dates established by DPS. Reference: 148; Chapter 11; Subchapter 8; JCPC Policy 3, 7, 8, 9, 10, and 11 Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the agreement and should not be used to construe the meaning thereof. Choice of Law: The validity of this Program Agreement and any of its terms or provisions, as well as the rights and duties of the parties to this Program Agreement, are govemed by the laws of North Carolina. The parties, by signing this Program Agreement, agree and submit, solely for matters concerning this Program Agreement, to the exclusive jurisdiction of the courts of North Carolina and agree, solely for such purpose, that the exclusive venue for any legal proceedings shall be Wake County, North Carolina. The place of this Program Agreement and all transactions and agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all matters, whether sounding in Program Agreement or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Assignment: No assignment of the Sponsoring Agency's obligations or the Sponsoring Agency's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, DPS may: (a) Forward the Sponsoring Agency's payment check(s) directly to any person or entity designated by the Program Manager, or (b) Include any person or entity designated by Sponsoring Agency as a joint payee on the Sponsoring Agency's payment check(s). In no event shall such approval and action obligate DPS or County Government to anyone other than the Sponsoring Agency and the Sponsoring Agency shall remain responsible for fulfillment of all Program Agreement obligations. Form structure last revised 12/20/2013 Department of Public Safety Beneficiaries: Except as herein specifically provided otherwise, this Program Agreement shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this Program Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to DPS, the County Govemment, and the Sponsoring Agency. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any other third person. it is the express intention of DPS and County Govemment that any such person or entity, other than DPS or the County Government, or the Sponsoring Agency receiving services or benefits under this Program Agreement shall be deemed an incidental beneficiary only. Property Rights Intellectual Property - All deliverable items produced pursuant to this Program Agreement are the exclusive property of DPS. The Sponsoring Agency shall not assert a claim of copyright or other property interest in such deliverables. Physical Property - the Sponsoring Agency agrees that it shall be responsible for the proper custody and care of any property purchased for or furnished to it for use in connection with the performance of this Program Agreement and will reimburse DPS for loss of, or damage to, such property. At the termination of this Program Agreement, the Sponsoring Agency, County Government, and JCPC shall follow the guidelines for disposition of property set forth in Administrative Code and JCPC policy. Reference: 148 NCAC 118.0110; JCPC Policy 7. Fiscal Accounting and Budgeting: Audit Requirements Disbursements and Internal Controls Reversion of Unexpended Funds Any remaining unexpended JCPC funds DPS disbursed to the County for the Sponsoring Agency must be refunded/ reverted back to DPS at the close of fiscal year or upon termination of this Agreement. Accountability for Funds Audit Requirement - Local Government or Public Authority Requirements Local Government or Public Authorities in accordance with N.C.G.S. §159 -34 must have an audit performed in conformity with generally accepted auditing standards. The audit shall evaluate the performance of a unit of local government or public authority with regard to compliance with all applicable Federal and State agency regulations. This audit, combined with the audit of financial accounts, shall be deemed to be the single audit described by the Federal Single Audit Act of 1984 ". Audit Requirement — Non- Govemmental Entities: An audit, when required by law, or requested by the County or DPS shall be performed in conformity with generally accepted auditing standards and audits of non - governmental entities, both for - profit and not - for - profit, and must meet the requirements of OMB Circular A -133. At a minimum, the required report shall include the financial statements prepared in accordance with generally accepted accounting principles, all disclosures in the public interest required by law, and the auditor's opinion and comments relating to financial statements. The audit report must be submitted to the State Auditor's office as required by law, to the County and DPS, and to other recipients as appropriate within nine (9) months after the end of your program's fiscal year. Form structure last revised 12/20/2013 Department of Public Safety Oversight Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all Program Agreements entered into by State agencies or political subdivisions in accordance with N.C.G.S. §147 -64.7. Additionally, as the State funding authority, DPS shall have access to persons and records as a result of all Program Agreements entered into by State agencies or political subdivisions. Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of DPS. State basic records retention policy requires all records to be retained for a minimum of five years or until all audit exceptions have been resolved, whichever is longer. If the Program Agreement is subject to Federal policy and regulations, record retention may be longer than five years since records must be retained for a period of three years following submission of the final Federal Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Program Agreement has been started before expiration of the five -year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five -year period described above, whichever is later. No Overdue Tax Debt Not for profit organizations ONLY will comply with this section, Form rust be attached to the Program Agreement upon submission. The Sponsoring Agency shall be responsible for the payment of all State, local, and Federal taxes. Consistent with N. C.G.S. § 143C -6 -23 (c), not for profit organizations shall file with DPS and the County a written statement completed by that Sponsoring Agency 's board of directors or other governing body, stating that the Sponsoring Agency does not have any overdue tax debts, as defined by N.C.G.S. 105 - 243.1, at the Federal, State, or local level. This written statement, Certification of No Overdue Tax Debts, shall be completed by the Sponsoring Agency and attached to the Program Agreement upon submission. Conflict of Interest —Not for profit organize ions ONLY will comply with this section, Form must be attached to the Program Agreement upon submission. Consistent with the N.C.G.S. §143C -6 -23 (b), not for profit organizations shall file with DPS and the County a copy of that Sponsoring Agency's policy addressing conflicts of interest that may arise involving the Sponsoring Agency's management employees and the members of its board of directors or other governing body. The policy shall address situations in which any of these individuals may directly or indirectly benefit, except as the Sponsoring Agency's employees or members of its board or other governing body, from the Sponsoring Agency's disbursing of State funds and shall include actions to be taken by the Sponsoring Agency or the individual, or both to avoid conflicts of interest and the appearance of impropriety. The policy shall be filed before the County or DPS may disburse any funds. The Sponsoring Agency shall also complete the DPS Conflict of Interest Policy Statement (Form DPS 13 001) and attach the statement and the Sponsoring Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission. Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested by the Sponsoring Agency through submission of a JCPC Program Agreement Revision and executed by duly authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency. Form structure last revised 12/20/2013 Department of Public Safety Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this Program Agreement violates any applicable law, each such provision or requirement shall continue to be enforced to the extent it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this Program Agreement shall remain in full force and effect. Termination for Cause: If, through any cause, the Sponsoring Agency shall fail to fulfill its obligations under this Program Agreement in a timely and proper manner, DPS shall have the right to terminate this Program Agreement by giving written notice to the Sponsoring Agency and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Sponsoring Agency under this Program Agreement shall, at the option of DPS, become its property and the Sponsoring Agency shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Sponsoring Agency shall not be relieved of liability to DPS for damages sustained by DPS by virtue of the Sponsoring Agency's breach of this agreement, and DPS may withhold any payment due the Sponsoring Agency for the purpose of setoff until such time as the exact amount of damages due DPS from such breach can be determined. The filing of a petition for bankruptcy by the Sponsoring Agency shall be an act of default under this Program Agreement. Termination without Cause: DPS, the County Government, or the Sponsoring Agency may terminate this Agreement at any time and without cause by giving at least thirty (30) days advance written notice to the other. If this Program Agreement is terminated by DPS as provided herein, the Sponsoring Agency shall be reimbursed on a pro rata basis for services satisfactorily provided to DPS under this Program Agreement prior to Program Agreement termination. Waiver of Default: Waiver by DPS of any default or breach in compliance with the terms of this Program Agreement by the Sponsoring Agency shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms of this Program Agreement unless stated to be such in writing, signed by an authorized representative of DPS, County Government, the JCPC and the Sponsoring Agency and attached to the Program Agreement. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tomado, or other catastrophic natural event or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the Program Agreement expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation. END OF SECTION V — Terms of Agreement Form structure Last revised 12/20/2013 Depai talent of Public Safety Job Title Case manager oversees caseload Annual Expense Wages $36,720 Annual In Kind Wages Program oversight by Director of Client Services TOTAL $36,720 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety $2,062 $2,062 SECTION VI: BUDGET NARRATIVE Healthy Choices I Fiscal Year FY 15 -16 Item # Justification Expense In Kind Expense 120 Program oversight by Director Client Services, 58.1 hr. @ $20/ hr $2,062 $1,000 120 Full Time Case Manager $36,720 180 FICA expenses for Case Manager ($37,050 x 7.65 %) $2,809 190 2 Group Facilitiators $20/hr 105 hrs. each $4,200 190 Psychologist $50/hr 20hr year 190 $5624 to hire a masters level planner who will the Quality Assurance Manager who moniters program compliance of the curriculms, staff performance and training for SPEP.(23 hours/ month @ $20 /hour =$460 month x 12 months) $5,624 220 Meals before each group $50 for 42 sessions $2100 and $ 500 Graduation Expenses, supplies & materials for one (1) graduation event $2,600 260 Office Supplies & Materials - approx. $21 /month x 12 months $250 310 $163 /month in -kind staff travel (increase in In -Kind contribution in the amount of $451) @ federal mileage rate (staff travel to school meetings, juvenile court staffings, court, training, etc) $1,951 320 Phones - approx. $137 /month x 12 months $1,313 340 Printing /Binding of Program Materials $363 440 Copier - Maintenance contract $20mo x 12 months $240 510 Fax machine, desktop, scanner and printer $3,000 510 Equipment updating $300 TOTAL $57,056 $5,376 Job Title Case manager oversees caseload Annual Expense Wages $36,720 Annual In Kind Wages Program oversight by Director of Client Services TOTAL $36,720 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety $2,062 $2,062 SECTION VII Program: Healthy Choices Fiscal Year: FY 15 -16 Cash Number of Months: 12 In Kind Total I. Personnel Services $49,353 $3,062 120 Salaries & Wages 180 Fringe Benefits 190 Professional Services* *Contracts MUST be attached $36,720 $2,809 $9,824 $2,062 $1,000 II. Supplies & Materials $2,850 $52,415 210 Household & Cleaning 220 Food & Provisions 230 Education & Medical 240 Construction & Repair 250 Vehicle Supplies & Materials 260 Office Supplies and Materials 280 Heating & Utility Supplies 290 Other Supplies and Materials $2,600 $250 111, Current Obligations & Services $1,313 $2,314 $38,782 $2,809 $10,824 $2,850 $0 $2,600 so $0 so $250 so $0 310 Travel & Transportation 320 Communications 330 Utilities 340 Printing & Binding 350 Repairs & Maintenance 370 Advertising 380 Data Processing 390 Other Services $1,313 $1,951 $363 $3,627 $1,951 $1,313 $0 $363 $0 $0 $0 $0 IV. Fixed Charges & Other Expenses $240 410 Rental or Real Property 430 Equipment Rental 440 Service and Maint. Contracts 450 Insurance & Bonding 490 Other Fixed Charges $240 V. Capital Outlay $3,300 $240 $0 $0 $240 $0 $0 $3,300 [This Section Requires Cash Match] 510 Office Fumiture & Equipment 530 Educational Equipment 540 Motor Vehicle 550 Other Equipment 580 Buildings, Structure & lmprov. $3,300 $3,300 $0 $0 $0 $0 Total $57,056 $5,376 $62,432 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES) FY 15 -16 Harnett County Funding ID: 543 -XXXX Sponsoring Agency: Eleventh Judicial District ReEntry, Inc. Program: Healthy Choices $56,756 DPS /JCPC Funds 10% Local Match Rate $0 County Cash $300 Local Cash Local Cash $5,376 Local In -Kind ReEntry Other * This is the amount of your request on your application Is the Local Match Rate 10 %, 20% or 30 %? n/a ReEntry Other Other Other $62,432 TOTAL $5,676 (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) $5,676 Required Local Match Match Provided We, the undersigned, have reviewed this JCPC Program Application to be presented to the Juvenile Crime Prevention Council of this County in accordance with the procedures established by the local Juvenile Crime Prevention Council. Agencies seeking funding must be able to meet the applicable requirements of the North Carolina General Statutes, Administrative Code, and the Division of Adult Correction and Juvenile Justice. We understand and acknowledge that the approval process is first with the Juvenile Crime Prevention Council, second with the County Board of Commissioners, and the final authority with the Department of Public Safety, Division of Adult Correction and Juvenile Justice. All parties understand that the availability of funds is contingent upon the appropriation of those funds by the General Assembly of the State of North Carolina. Chair, County Board of Commissioners or County Finance Director Date Chair, Juvenile Cri Prevention Council Program Maria Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Date 4/17/15 Date North Carolina Department of Public Safety JCPC Program - Program Application SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION FUNDING PERIOD: FY 15 -16 COUNTY: Harnett DPS /JCPC FUNDING # (cont only)1543 -XXXX AREA: Central Area Multi- County: No Multi- Components No NAME OF PROGRAM: Psychological Services SPONSORING AGENCY: Eleventh Judicial District ReEntry, Inc. PROGRAM TYPE SPONSORING AGENCY PHYSICAL ADDRESS: 1329 N. Brightleaf Blvd. Smithfield NC Suite A -2 27577 SPONSORING AGENCY MAILING ADDRESS: PO Box 1153 Smithfield NC 27577 TYPE: Non- Profit FEDERAL ID # 56- 2106268 COMPONENT ID # NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF EACH COMPONENT 10786 Psychological Evaluations & Sexual Offender Evaluations Assessments $ 6,600 Zip: 27577 Total cost of components: $ 6,600 Program Manager Name & Address (same person on signature page) Name: Danny Walton Title: Mailing Address: PO Box 1153 City: Smithfield Zip: 27577 Phone: (919) 989 -7278 Fax: E -mail: reentrycp @ao .com Contact Person (if different from program manager, Name: Roy Haddock Title: Mailing Address: PO Box 1153 City: Smithfield Zip: 27577 Phone: (910) 624 -3094 Fax: E -mail: royhaddock @notmail.com Program Fiscal Officer (cannot be program manager, Name: Dot Ehlers Title: Mailing Address: PO Box 1153 City: Smithfield Zip: 27577 Phone: (919) 989 -7278 Fax: E -mail: reentrycp @aol.com Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION I B PROGRAM COMPONENT DESCRIPTION COMPONENT ID # COMPONENT INFORMATION :0786 NAME OF COMPONENT; Psychological Evaluations &Sexual Offender Evaluations BRIEF DESCRIPTION: Psychological testing to include personality assessment and cognitive functioning to assist in treatment /educational recommendations. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Form JCPC/PA 004 JCPC Program Application Form structure last revised 01/09/2012 Department of Public Safety SECTION !I COMPONENT STATISTICAL INFORMATION MJIt!- Components No Component Service Statistics PROGRAM COMPONENT INFORMATION - APP !CATION YEAR Component Name: Psyct:ologicai Evaluations & Sexual Offender Evaluat;cns Component ID # 10786 What is this component's maximum client capacity at any given time? 1 Frequency of client contact per month. 1 Anticipated Average Length of Stay: 1 Days Total Component Cost $6,600 - by Estimated # to be served during funding period: 15 Estimated Average Cost Per Youth: 5440 Applies to continuation programs only. Actual number of youth admitted last fiscal year 1 1 number of admissions Juvenile Court referred 100% of total admissions Q number of admissions Law Enforcement referred 0% of total admissions Form JCPC/PA 004 JCPC Program Application Form structure last revised 01/09/2012 Department of Public Safety Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION ill COMPONENT SUMMARY NAME OF COMPONENT: Psychological Evaluations & Sexual Offender Evaluations 1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in the county. In FY 12 -13, according Court Services data 63 juveniles intakes were placed on a diversion contract /plan Of 715 juvenile complaints that were received in Harnett County by class in FY 12 -13, 469 were class 1 -3 misdemeanors; 183 were class F Felonies -I and Al misdemeanors; 33 were Status Offenders; and 30 were class A -E Felonies. Of those 715 juvenile complaints, 76% were males and 24% were females. There continues to be a gap in the Service Continuum for the need for psychological services and /or Sex Offender Evaluatiohns for court involved youth. Often times, there is a waiting list for Psychological Evaluations which results in a gap in services. At this time those services are sought from the local mental health unit. Secondly, there is also a need for sex offender evaluations although there is not a large population of adjudicated youth according to the data in the county. However, it is a needed service in the event that the population increase or there is a need fo the service. 2. Target Population: Describe the target population, including age, and the steps taken to insure that the target population is served. Juveniles between the ages of six (6) and 17 years ofage that present some behavioral or emotional concerns, which warrant further diagnosis and clarification, juveniles between the ages of six (6) and 17, or otherwise under jurisdiction of and referred by juvenile court, including but not limited to, Interstate Compact juveniles. 3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program. The Psychological Evaluations and /or Sex Offender Evaluations contracted serves are to help court counselors and judges recommend the most appropriate consequences and treatment for court involved youth in a timely manner. To provide psychological evaluations to Court Counselors within 14 days of the referral and to provide Sex Offender Evaluations /a written report to the referring Court Counselor within 60 days, with detailed recommendations and risk level for re- offending. 4. Measurable Objective(s): State in measurable terms ( %) the intended effect of the program on specific undisciplined and /or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior, disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives must include impact on participants. 100% Assessments will include treatment recommendations. 100% Assessments will be completed within the timeframe permitted by JCPC policy. 100% Assessments will result from a diversion plan or condition of the court. 5. Elevated Risks and Needs: Describe how you will address one or more of the Elevated Risk and Needs of adjudicated juveniles listed in the local JCPC Request for Proposal. Based on highlights of the FY 11 -12 and 12 -13 Risk Assessment data for Harnett County, the elevated Risk Assessment are as follows: 77% of youth that entered DACJJ are overall Low Risk of reoffending in the juvenile justice system ; youth are age 12 or older when the 1st delinquent offense is alleged in a complaint; 62% of youth have serious school behavior problems, ; and 62.5% of youth that entered DACJJ lack pro - social peers and /or regularly and/ or sometimes associate with negative /delinquent peers. Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION HI COMPONENT SUMMARY NAME OF COMPONENT: Psychological Evaluations & Sexual Offender Evaluations Based on highlights of the FY 11 -12 and 12 -13 Needs Assessment data for Harnett County, the elevated Needs Assessments are as follows: 63% of youth have overall Low Needs Levels; 57.5% of youth sometimes and /or regularly associates with delinquent peers and /or rejected by positive peers; 54.5% of youth have serious behavior problems in school which is a result of poor school attendance and chronic suspensions from school: 60.5% of youth reported having mental health needs are currently being addressed and need further mental health assessing; youth reported domestic discord in their home and youth Family Supervision Skills are marginal. Psychological evaluations will help determine the type and nature of psychological services that the youth might need and help expedite referral for the proper services. Form JCPC/PA 004 JCPC Program Application Fonn structure last revised 12/31/2012 Department of Public Safety SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Psychological Evaluations & Sexual Offender Evaluations 1. Location: List physical address(es) and describe where program services are delivered. Services will be provided at 22 West Front Street .Lillington NC- DJJ Office upon scheduling and request. 2. Operation: Describe the daily /week /y schedule of program operation. The hours of operations are Monday- Friday as appointments are scheduled based on the referral from the Court Counselor's Office. 3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and position(s) responsibilities relative to this component. Psychological Evaulations and /or Sex Offender Evaluations services will be contracted with Roy Haddock. Mr. Haddock has a Masters degree in clinical psychology with over twenty five years of clinical experience. 4. Service Type SPEP: Describe implementation to include: Provides a service: Psychological Evaluations 5. Admission Process: Describe the specific referral, screening, admission process (including timeline), the staff responsible for making decisions about admissions and reasons why a referral may not be accepted. Initial contact with the referred juvenile will be made within 10 days of the referral. The Psychologist will respond to the referring agency regarding their admission decision within 15 days of the referral. The written referrrals may be delivered in person, mailed, or e- mailed to the psychologist. Court Counselors make referrals to the Psychologist which are screened and set for appointments after being court ordered .Court Counselors arrange for the youths to appear at the designated time. For Sex Offender Evaluation the Court Counselors will submit the referral form to include police reports, victim statements,and other applicable documents. 6. Termination Process: Describe the termination process to include the staff responsible for making decisions and the criteria for a successful termination, satisfactory termination, unsuccessful completion and non - compliant termination. If the youth that are reffered for a psychological evaluation complete all the testing requirements it will be deemed by the psychologist as a successful completion upon termination. The Psychologist will notify the parent(s) /legal guardian(s), Court Services, if applicable, if the assessment has been completed or not. A termination summary will be documented within 10 business days and will include, but not limited to: i) Dates of contact, results and recommendations; and ii) Parties to whom assessment or evaluation reports were provided including dates provided. iii) Clinical Evaluation /Assessment Outcome: 1. Successful Completion: Indicates a high level of juvenile participation in program activities and the evaluation /assessment is completed. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION W COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Psychological Evaluations & Sexual Offender Evaluations 2. Satisfactory Completon: Indicates an acceptable level of juvenile participation and the evaluation /assessment is completed. 3. Unsuccessful Completion: Failure to cooperate with the evaluation /assessment and the evaluation /assessment could net be completed. 4. Non - Compliance: Unexcused absences or refusing to participate. The contract provider will be responsible for entering client tracking admissions and termination data in NCALLIES within seven (7) days of the admissions and termination decision. How is the referring agency involved with the termination process? The referring agency will be contacted prior to termination of client from services via telephone and /or email. 7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and /or other referring agencies including how client progress will be communicated. Court Counselors will be consulted before testing and informed of the results of the testing. 8. Intervention /Treatment: Describe specifically what the component will do to redirect inappropriate youth behavior or how the component will address the identified needs of the youth and family. What interventions will typically be utilized in this component and how will parents /guardians be involved? The youth and family will be involved in a variety of testing and /or referral for counseling depending upon the identified needs. 9. Best Practice Model: Describe what model or evidence - supported /best practice the program is based upon. Psychological assessments are completed under the rules that govern the North Carolina Psychology Board. Form JCPC/PA 004 JCPC Program Application Form structure last revised ] 2/31/2012 Department of Public Safety SECTION Terms ofAgreement This Agreement is entered into by and between Department of Public Safety, (horeinaflerreferred to as the DPS, and County. (here/nafterreferred to as the County. the County's Juvenile Crime Prevention Council (hereinafterreferred to as the JCPC) and (hereinafter referred to as the Sponsoring Agency). The DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows: Term of Agreement This Agreement shall become effective and shall terminate Payment to Sponsoring Agency All parties agree that services will be delivered as described in the approved JCPC Program Agreement and that JCPC funds wifl be disbursed in an amount not to exceed the amount $ for the term of this agreement, unless amended by an approved JCPC Program Agreement Revision. Availability of Funds: AH parties to this Agreement agree and understand that the payment of the sums specified in this JCPC Program Agreement budget is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to the DPS. Responsibilities ofthe Parties DP8uhaU: 1. Disburse funds monthly to County Governments, for payment to the Sponsoring Agency from the Juvenile Crime Prevention Council (JCPC) fund appropriation by the General Assembly; 2. Reserve the right to suspend payment to the County for any non-compliance by the Sponsoring Agency with any reporting requirements set forth in the JCPC Policy and Procedures; 3. Notify in writing the County and Sponsoring Agency immediately if payments are suspended and again once payments resume; 4. Pay only for work as described in the JCPC Program Agreement provided by the Sponsoring Agency and approved subcontractors; 5. Provide technical assistance, orientation and training to the Sponsoring Agency, the County and the JCPC; 6. MonitorSponuohngAgoncy'oJCPCfundedpoognam(s)inaocondancewithJCPCPo|iuy3 Operations: Program mgram Oversight and Monitoring; and 7. Notify parties entering into this Agreement of all due dates in a timely manner in order for reports to be submitted by the estabHshed due date. Form structure last revise 12/20/208 Department ofPublic Safety The Sponsoring Agency shall: 1. Comply with all laws, ordinances. codes rules. regulations. and licensing requirements that are apolicable to the conduct of is business, including those cf Federal State, and local agencies having jurisdiction and /or authority; 2. Comply with all Federal and State laws relating to equal employment opportunity; 3. Keep as confidential and not divulge or make available to any individual or organization withcut the prior written approval of the DPS any information, data. instruments, documents, studies or reports given to or prepared or assembled by the Sponsoring Agency under this Agreement; 4. Acknowledge that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not further disclose the information except as otherwise provided in this Agreement: 5. Comply with the Juvenile Crime Prevention Policy and Procedures established by the DPS and the North Carolina Administrative Procedures; 6. Secure local match as required, pursuant to 14B NCAC 118.0105, for the approved JCPC funds; 7. Create and adopt individualized guidelines specific to the funded program, while also adhering to JCPC Policy and Procedures established by DPS for all JCPC funded programs and for the specific program type for which they receive funding; 8. Ensure that state funds received are spent in accordance with the approved JCPC Program Agreement and be accountable for the legal and appropriate expenditure of those state funds; 9. Maintain reports, records, and other information to properly document services rendered and outcomes; also maintain an ability to send and receive electronic communication; 10. Have the capacity to use DPS electronic, internet -based system for tracking clients served; 11. Use generally accepted accounting procedures that guarantee the integrity of the expenditure of JCPC funds, maintain reports, records, and other information to properly account for the expenditure of all State funds provided to the Sponsoring Agency; 12. Receive from the North Carolina Division of Revenue a refund of all sales and use taxes paid by them in the performance of the JCPC Program Agreement, pursuant to N.C.G.S. §105- 164.14(c); and exclude all refundable sales and use taxes from all reportable expenditures before the expenses are entered in their reimbursement reports; 13. Submit JCPC Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed check ledgers to the JCPC. These reports must be in accordance with the submission process as outlined in the JCPC Policy and Procedures established by DPS and with the due dates established by DPS; 14. Make personnel, reports, records and other information available to DPS , the County, the JCPC, and /or the State Auditor for oversight, monitoring and evaluation purposes; 15. Submit any other information requested by the JCPC, County or DPS; 16. Be responsible for the performance of all subcontractors as described in the JCPC Program Agreement; 17. Indemnifies and holds harmless DPS, the State of North Carolina, the County and any of their officers, agents and employees, from any claims of third parties arising out of any act or omission of the Sponsoring Agency in connection with the performance of the JCPC Program Agreement; 18. Receive permission and budgetary approval from DPS prior to using the JCPC Program Agreement as a part of any news release or commercial advertising and acknowledge DPS funding in partnership with the County; 19. Comply with DPS trainings and requirements regarding the United States Department of Justice national standards to prevent, detect, and respond to prison rape under the Prison Rape Elimination Act (PREA); - Reference: 14B; Chapter 11; Subchapter B, and in compliance with JCPC Policy 2: Operations: Program Operational Requirements Sponsoring Agency Contractor(s) /Subcontractors Fonn structure last revised 12/20/2013 Department of Public Safety Yes, subcontractors are included in the JCPC Program Agreement budget. No. subcontractors are not included in the JCPC Program Agreement budget. if yes, the following only applies when subcontractors are providing services as described in the JCPC Program Agreement (listed in Line Item 190 of the budget). 20. Receive prior approval from DPS in the form of an unsigned contract being submitted with the JCPC Program Agreement if any of the services described in the JCPC Program Agreement are provided by a subcontractor; NOTE: Contracts signed by all parties must be submitted once the JCPC Program Agreement receives signed approval from DPS. Sponsoring Agencies will be notified requesting this information. 21. Hold any contractor or subcontractor to which the Sponsoring Agency provides State funds accountable for the legal and appropriate expenditure of State funds, and to all applicable laws and Juvenile Crime Prevention Council Policies and Procedures; 22. Ensure that all subcontractors provide all information necessary to comply with the standards set forth in the JCPC Program Agreement; and 23. Be deemed an independent contractor in the performance of services described in the JCPC Program Agreement and as such shall be wholly responsible for the services to be performed and for the supervision of its employees. The Sponsoring Agency represents that it has, or shall secure at its own expense, all personnel required in performing the services as described in the JCPC Program Agreement. Such employees shall not be employees of, or have any individual contractual relationship with, DPS; The JCPC shall: Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in JCPC Program Agreement or JCPC Program Agreement Revision(s); . Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Code; N.C.G.S. §143B- 801(a);143B- 602;143B -851 Review and locally approve Program Agreement Revisions received from the Sponsoring Agency and submit to the County in a timely manner; Review and locally approve Third Quarter Accounting forms and submit to the County in order to meet the due date established by DPS; . Submit any other information requested by the County or DPS; and Monitor the Sponsoring Agency's currently funded JCPC program(s) in accordance with JCPC Policy 3. Operations: Program Oversight and Monitoring Reference: 14B NCAC 118.0202 and JCPC Policy 1, 7, 8, 9, 10, and 11. The County shall: . Ensure the Sponsoring Agency is appropriately licensed, and either a public agency or a 501 (c) 3 private non- Form structure last revised 12/20/2013 Department of Public Safety profit organization; Use JCPC funds only for the purposes DPS has approved in program agreements cr program agreement revisions; Disburse JCPC funds monthly and oversee JCPC funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108 Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Procedures; Review and locally approve Program Agreement Revisions received from the Sponsoring Agency for final approval from DPS; and Review and locally approve Third Quarter and Final Accounting forms for the JCPC and all JCPC funded programs according to the procedures and due dates established by DPS. Reference: 14B; Chapter 11; Subchapter B; JCPC Policy 3, 7, 8, 9, 10, and 11 Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the agreement and should not be used to construe the meaning thereof. Choice of Law: The validity of this Program Agreement and any of its terms or provisions, as well as the rights and duties of the parties to this Program Agreement, are governed by the laws of North Carolina. The parties, by signing this Program Agreement, agree and submit, solely for matters concerning this Program Agreement, to the exclusive jurisdiction of the courts of North Carolina and agree, solely for such purpose, that the exclusive venue for any legal proceedings shall be Wake County, North Carolina. The place of this Program Agreement and all transactions and agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all matters, whether sounding in Program Agreement or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Assignment: No assignment of the Sponsoring Agency's obligations or the Sponsoring Agency's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, DPS may: (a) Forward the Sponsoring Agency's payment check(s) directly to any person cr entity designated by the Program Manager, or (b) Include any person or entity designated by Sponsoring Agency as a joint payee on the Sponsoring Agency's payment check(s). In no event shall such approval and action obligate DPS or County Government to anyone other than the Sponsoring Agency and the Sponsoring Agency shall remain responsible for fulfillment of all Program Agreement obligations. Form structure last revised 12/20/2013 Department of Public Safety Beneficiaries: Excect as herein specifically provided otherwise, this Program, Agreement shall inure to the benelt of and be c r ding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions cf this Program Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to DPS, the County Government, and the Sponsoring Agency. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any other third person. It is the express intention of DPS and County Government that any such person or entity. other than DPS or the County Government, or the Sponsoring Agency receiving services or benefits under this Program Agreement shall be deemed an incidental beneficiary only. Property Rights Intellectual Property - All deliverable items produced pursuant to this Program Agreement are the exclusive property of DPS. The Sponsoring Agency shall not assert a claim of copyright or other property interest in such deliverables. Physical Property - the Sponsoring Agency agrees that it shall be responsible for the proper custody and care of any property purchased for or furnished to it for use in connection with the performance of this Program Agreement and will reimburse DPS for loss of, or damage to, such property. At the termination of this Program Agreement, the Sponsoring Agency, County Government, and JCPC shall follow the guidelines for disposition of property set forth in Administrative Code and JCPC policy. Reference: 14B NCAC 118.0110; JCPC Policy 7. Fiscal Accounting and Budgeting: Audit Requirements Disbursements and Internal Controls Reversion of Unexpended Funds Any remaining unexpended JCPC funds DPS disbursed to the County for the Sponsoring Agency must be refunded/ reverted back to DPS at the dose of fiscal year or upon termination of this Agreement. Accountability for Funds Audit Requirement - Local Government or Public Authority Requirements Local Government or Public Authorities in accordance with N.C.G.S. §159 -34 must have an audit performed in conformity with generally accepted auditing standards. The audit shall evaluate the performance of a unit of local government or public authority with regard to compliance with all applicable Federal and State agency regulations. This audit, combined with the audit of financial accounts, shall be deemed to be the single audit described by the °Federal Single Audit Act of 1984 ". Audit Requirement— Non- Governmental Entities: An audit, when required by law, or requested by the County or DPS shall be performed in conformity with generally accepted auditing standards and audits of non - governmental entities, both for - profit and not - for - profit, and must meet the requirements of OMB Circular A -133. At a minimum, the required report shall include the financial statements prepared in accordance with generally accepted accounting principles, all disclosures in the public interest required by law, and the auditor's opinion and comments relating to financial statements. The audit report must be submitted to the State Auditor's office as required by law, to the County and DPS, and to other recipients as appropriate within nine (9) months after the end of your program's fiscal year. Form structure last revised 12/20/2013 Department of Public Safety Oversight Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all Program Agreements entered into by State agencies cr political subdvisions in accordance with N.C.G.S. §147 -64.7. Additionally. as the State funding authority. DPS shall have access to persons and records as a result of all Program Agreements entered into by State agencies or political subdivisions. Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of DPS. State basic records retention policy requires all records to be retained for a minimum of five years or until all audit exceptions have been resolved, whichever is longer. If the Program Agreement is subject to Federal policy and regulations, record retention may be longer than five years since records must be retained for a period of three years following submission of the final Federal Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Program Agreement has been started before expiration of the five -year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five -year period described above, whichever is later. No Overdue Tax Debt -Not for profit organizations ONLY viii comply with this section. Form must he attached to the Progfam Agreement upon submission. The Sponsoring Agency shall be responsible for the payment of all State, local, and Federal taxes. Consistent with N. C.G.S. § 143C -6 -23 (c), not for profit organizations shall file with DPS and the County a written statement completed by that Sponsoring Agency 's board of directors or other governing body, stating that the Sponsoring Agency does not have any overdue tax debts, as defined by N.C.G.S. 105 - 243.1, at the Federal, State, or local level. This written statement, Certification of No Overdue Tax Debts, shall be completed by the Sponsoring Agency and attached to the Program Agreement upon submission. Conflict of Interest —Not for profit organizations ONLY will comply with this section. Form must be attached to the Program Agreement upon submission. Consistent with the N.C.G.S. §143C -6 -23 (b), not for profit organizations shall file with DPS and the County a copy of that Sponsoring Agency's policy addressing conflicts of interest that may arise involving the Sponsoring Agency's management employees and the members of its board of directors or other governing body. The policy shall address situations in which any of these individuals may directly or indirectly benefit, except as the Sponsoring Agency's employees or members of its board or other governing body, from the Sponsoring Agency's disbursing of State funds and shall include actions to be taken by the Sponsoring Agency or the individual, or both to avoid conflicts of interest and the appearance of impropriety. The policy shall be filed before the County or DPS may disburse any funds. The Sponsoring Agency shall also complete the DPS Conflict of Interest Policy Statement (Form DPS 13 001) and attach the statement and the Sponsoring Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission. Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested by the Sponsoring Agency through submission of a JCPC Program Agreement Revision and executed by duly authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency. Form structure last revised 12/20/2013 Department of Public Safety Severability: In the event that a court of competent t that p lunsc�c, ion holds �ha� a provision or requirement of this Program Agreement violates any applicable law each such provision or requirement shall continue to be enforced to the extent it is nct in violation of law or is not otherwise unenforceable and all other provisions and requirements of this Program Agreemert shall remain in full force and effect. Termination for Cause: If, through any cause, the Sponsoring Agency shall fail to fulfill its obligations under this Program Agreement in a timely and proper manner. DPS shall have the right to terminate this Program Agreement by giving written notice to the Sponsoring Agency and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Sponsoring Agency under this Program Agreement shall, at the option of DPS, become its property and the Sponsoring Agency shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Sponsoring Agency shall not be relieved of liability to DPS for damages sustained by DPS by virtue of the Sponsoring Agency's breach of this agreement, and DPS may withhold any payment due the Sponsoring Agency for the purpose of setoff until such time as the exact amount of damages due DPS from such breach can be determined. The filing of a petition for bankruptcy by the Sponsoring Agency shall be an act of default under this Program Agreement. Termination without Cause: DPS, the County Government, or the Sponsoring Agency may terminate this Agreement at any time and without cause by giving at least thirty (30) days advance written notice to the other. If this Program Agreement is terminated by DPS as provided herein, the Sponsoring Agency shall be reimbursed on a pro rata basis for services satisfactorily provided to DPS under this Program Agreement prior to Program Agreement termination. Waiver of Default: Waiver by DPS of any default or breach in compliance with the terms of this Program Agreement by the Sponsoring Agency shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms of this Program Agreement unless stated to be such in writing, signed by an authorized representative of DPS, County Government, the JCPC and the Sponsoring Agency and attached to the Program Agreement. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the Program Agreement expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation, END OF SECTION V — Terms of Agreement Form structure last revised 12/20/2013 Department of Public Safety SECTION VI: BUDGET NARRATIVE Item # Psychological Services Fiscal Year IFY 15 -16 Justification 190 Professional Contract w /Roy Haddock @ $400 x 15 for Sex 1Offender Evaluations and Psychological Assessments 410 1 Office space 15 days X $40 per day = $600- Harnett County Government Expense $6,000 In Kind Expense 5600 TOTAL $6,000 $600 Job Title Annual Expense Wages TOTAL Annual In Kind Wages Form JCPC/PA 004 JCPC Program Application Form structure last revised i 2/31/2012 Department of Public Safety SECTION VII Program: Psychological Services Fiscal Year: FY 15 -16 Cash Number of Months: 12 In Kind Total I. Personnel Services $6,000 120 Salaries & 'Wages 180 Fringe Benefits 190 Professional Services* *Contracts MUST be attached $6.000 $6,000 $0 50 $6,000 II. Supplies & Materials $0 210 Household & Cleaning 220 Food & Provisions 230 Education & Medical 240 Construction & Repair 250 Vehicle Supplies & Materials 260 Office Supplies and Materials 280 Heating & Utility Supplies 290 Other Supplies and Materials $0 50 $0 $0 $0 $0 $0 $0 III. Current Obligations & Services 310 Travel & Transportation 320 Communications 330 Utilities 340 Printing & Binding 350 Repairs & Maintenance 370 Advertising 380 Data Processing 390 Other Services $0 $0 $0 $0 $0 50 $0 $0 $0 IV. Fixed Charges & Other Expenses $600 410 Rental or Real Property 430 Equipment Rental 440 Service and Maint. Contracts 450 Insurance & Bonding 490 Other Fixed Charges $600 $600 $600 $0 $0 $0 $0 V. Capital Outlay $0 [This Section Requires Cash Match) 510 Office Furniture & Equipment 530 Educational Equipment 540 Motor Vehicle 550 Other Equipment 580 Buildings, Structure & Irnprov. $0 SO $0 $0 $0 Total $6,000 $600 $6,600 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES) FY 15 -16 Harnett County Funding ID: 543 -XXXX Sponsoring Agency: Eleventh Judicial District ReEntry, Inc. Program: Psychological Services S6.000 DPS /JCPC Funds 10% Local Match Rate County Cash Local Cash Local Cash $600 Local In -Kind Other Other Other Other $6,600 TOTAL This is the amount of your request on your application Is the Local Match Rate 10 %, 20% or 30 %? Harnet County Government $600 (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) $600 Required Local Match Match Provided We, the undersigned, have reviewed this JCPC Program Application to be presented to the Juvenile Crime Prevention Council of this County in accordance with the procedures established by the local Juvenile Crime Prevention Council. Agencies seeking funding must be able to meet the applicable requirements of the North Carolina General Statutes, Administrative Code, and the Division of Adult Correction and Juvenile Justice. We understand and acknowledge that the approval process is first with the Juvenile Crime Prevention Council, second with the County Board of Commissioners, and the final authority with the Department of Public Safety, Division of Adult Correction and Juvenile Justice. All parties understand that the availability of funds is contingent upon the appropriation of those funds by the General Assembly of the State of North Carolina. Chair, County Board of Commissioners or County Finance Director Chair, Juvenile Cri Danny Walton Program Manager Prevention Council Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Date Date 4/8/15 Date 13 *c;. North Carolina Department of Public Safety JCPC Program - Program Application SECTION I A SPONSORING AGENCY AND PROGRAM INFO FUNDING PERIOD: FY 15 -16 DPS /JCPC FUNDING # COUNTY: Harnett AREA: Centr Multi- County: No Multi- Components No NAME OF PROGRAM:JHarnett County Juvenile Restitiitinmmnmm.ffi, co., MATION (cont only) 543 -XXX0( SPONSORING AGENCY: H Harnett County Government SPONSORING AGENCY 2 22 West Front Street 2 I Area ice Program 7546 7546 ID # 56- 6000306 COMPONENT ID # NAME OF PROGRAM COMPONENT PROGRAM TYPE 11187 Harnett County Juvenile Restitution /Community Restitution /Community Service Service Program Total cost of corn Program Manager Name & Address sa ponents: TOTAL COST OF EACH COMPONENT $ 114,965 $ 114,965 Name: Barry Bievins Title: Program Manage Mailing POB 85 Address: City: Liilington Phone: (910) 893 -7536 1 Fax: I (910) 814 -8263 I E- mail:I bbl Contact Person if different from pro Zip: evins @harnett.org Name: Henry Evans Title: Program Coordinal Mailing POB 85 Address: City: Liilington Phone: (910) 814 -6155 Fax: (910) 814 -8263 E -mail: hlev Program Fiscal Officer Name: (cannot be program manager) or Zip: ans @harnett.org Henry Evans Mailing Address: POB 85 Phone: (910) 814 -6155 Fax: (910) 814 -8263 Title: Program Coordinator City: Liilington E -mail: Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety 27546 27546 Zip: hlevans @harnett.org 27546 Program Manager Name & Address sa ponents: TOTAL COST OF EACH COMPONENT $ 114,965 $ 114,965 Name: Barry Bievins Title: Program Manage Mailing POB 85 Address: City: Liilington Phone: (910) 893 -7536 1 Fax: I (910) 814 -8263 I E- mail:I bbl Contact Person if different from pro Zip: evins @harnett.org Name: Henry Evans Title: Program Coordinal Mailing POB 85 Address: City: Liilington Phone: (910) 814 -6155 Fax: (910) 814 -8263 E -mail: hlev Program Fiscal Officer Name: (cannot be program manager) or Zip: ans @harnett.org Henry Evans Mailing Address: POB 85 Phone: (910) 814 -6155 Fax: (910) 814 -8263 Title: Program Coordinator City: Liilington E -mail: Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety 27546 27546 Zip: hlevans @harnett.org 27546 Contact Person if different from pro Zip: evins @harnett.org Name: Henry Evans Title: Program Coordinal Mailing POB 85 Address: City: Liilington Phone: (910) 814 -6155 Fax: (910) 814 -8263 E -mail: hlev Program Fiscal Officer Name: (cannot be program manager) or Zip: ans @harnett.org Henry Evans Mailing Address: POB 85 Phone: (910) 814 -6155 Fax: (910) 814 -8263 Title: Program Coordinator City: Liilington E -mail: Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety 27546 27546 Zip: hlevans @harnett.org 27546 Program Fiscal Officer Name: (cannot be program manager) or Zip: ans @harnett.org Henry Evans Mailing Address: POB 85 Phone: (910) 814 -6155 Fax: (910) 814 -8263 Title: Program Coordinator City: Liilington E -mail: Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety 27546 27546 Zip: hlevans @harnett.org 27546 SECTION I B COMPONENT ID # PROGRAM COMPONENT DESCRIPTION' COMPONENT INFORMATION 11187 NAME OF COMPONENT: Harnett County Juvenile Restitution /Cornmunity Service Program BRIEF DESCRIPTION: Community -based program to hold at -risk and court involved juveniles accountable for their delinquent or undiscipline behavior. Juveniles are required to perform symbolic community service or work to make monetary restitution to their victims. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION II Multi- Components No COMPONENT STATISTICAL INFORMATION Component Service Statistics (PROGRAM COMPONENT INFORMATION - APPLICATION YEAR Component Name: Harnett County Juvenile Restitution /Community Service Program What is this component's maximum client capacity at any given time? Frequency of client contact per month: 8 Anticipated Average Length of Stay: Total Component Cost: $114,964 by Estimated Average Cost Per Youth: Component ID # 11187 50 60 Estimated # to be served during funding period: $575 Applies to continuation programs only. Actual number of youth admitted last fiscal year: 128 Days 200 105 number of admissions Juvenile Court referred 82.03% of total admissions 23 number of admissions Law Enforcement referred Form JCPC/PA 004 JCPC Program Application Form structure last revised 01/09/2012 Department of Public Safety 17.97% of total admissions SECTION III NAME OF COMPONENT: Harnett County Juvenile Restitution /Community Service Program 1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in the county. According to the North Carolina Department of Public Safety Division of Juvenile Justice 2011 Annual Report for the fifth consecutive year the juvenile delinquency rate (juvenile crime) in the State of North Carolina has decreased. Also according to this report, over that five -year period, the State has experienced a 28% decrease in juvenile delinquency. In addition, there are fewer youth being committed by the court to long -term stays in the Division of Juvenile Justice's youth development centers. Overall, over the last decade, juvenile commitments have dropped almost every year. With the juvenile delinquency rate being decreased from previous years, there is more emphasis focused on community based programming working with prevention and intervention. In FY 13/14, 97 juveniles intakes were placed on a diversion contracts /plans Of 567 juvenile complaints that were received in Harnett County by class in FY 13/14, 360 were class 1 -3 misdemeanors; 149 were class F Felonies -I and Al misdemeanors; 20 were Status Offenders; and 10 were class A -E Felonies. Of those 567 juvenile complaints, 70% were males and 30% were females. The intention and purpose of the Harnett County Juvenile Restitution /Community Service Program is to accept juveniles into the program that have been ordered to pay monetary restitution to a victim or perform symbolic community service. This program serves as a community -based sanction level 1 and 2 alternative to detention or youth development centers for court involved youth. This program also serves as an alternative to Juvenile Court through Intake Diversions. 2. Target Population: Describe the target population, including age, and the steps taken to insure that the target population is served. Harnett County Juvenile Restitution /Community Service Program will serve youth between the ages of 7 -17 referred by Juvenile Court Counselors Office and Juvenile Court. 3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program. To provide a community -based alternative to detention or youth development centers to hold youth accountable for their actions and restore them back into the community. These youth are at -risk or already involved with in the juvenile justice system. It is the goal of this program that the youth achieve maximum growth as well as learn accountability for their actions in the least restrictive setting. 4. Measurable Objective(s): State in measurable terms (%) the intended effect of the program on specific undisciplined and /or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior, disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives must include impact on participants. 85% Clients will successfully or satisfactorily complete services as intended by the program design /service plan. 90% Clients successfully /satisfactorily completing the program will have no new complaints in the 12 months following completion. 75% Clients will have no new adjudications for a complaint with an offense date after the admission date. 75% Clients will have no new complaints with an offense date after the admission date. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31 /2012 Department of Public Safety SECTION 111 PONENT SUMMARY NAME OF COMPONENT: Harnett County Juvenile Restitution /Community Service Program 75% Clients will complete restitution or community service within the timeframe permitted by JCPC policy. 85% Clients successfully /satisfactorily completing the program will have no new adjudications in the 12 months following completion. 75% Clients will demonstrate accountability by actively participating in restitution /community service activities. 5. Elevated Risks and Needs: Describe how you will address one or more of the Elevated Risk and Needs of adjudicated juveniles listed in the local JCPC Request for Proposal. Based on highlights of the FY 12 -13 and 13 -14 Risk Assessment data for Harnett County, the elevated Risk Assessment are as follows: 74% of youth that entered DJJDP are overall Low Risk of reoffending in the juvenile justice system ; 89% of youth are age 12 or older when the 1st delinquent offense is alleged in a complaint; 63% of youth have serious school behavior problems, ; and 63% of youth that entered DJJDP lack pro - social peers and /or regularly and /or sometimes associate with negative /delinquent peers. Based on highlights of the FY 12 -13 and 13 -14 Needs Assessment data for Harnett County, the elevated Needs Assessments are as follows: 61% of youth have overall Low Needs Levels; 58% of youth sometimes and /or regularly associates with delinquent peers and /or rejected by positive peers; 55% of youth have serious behavior problems in school which is a result of poor school attendance and chronic suspensions from school; 64% of youth reported having mental health needs are currently being addressed and need further mental health assessing; youth reported domestic discord in their home and youth Family Supervision Skills are marginal. Juveniles enrolled in this program for school related offenses will learn that their refusal to follow school guidelines indeed has consequences. Juveniles who successfully complete this program will gain personal as well as social recognition. This will lead to higher self esteem, which will decrease the need of juvenile to associate with persons or groups that are predisposed for criminal activity. Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV NAME OF COMPONENT: COMPONENT NARRATIVE (attach for each component) Harnett County Juvenile Restitution /Community Service Program 1. Location: List physical address(es) and describe where program services are delivered. Physical address is 200 Alexander Drive, Lillington, NC 27546. 2. Operation: Describe the daily /weekly schedule of program operation. Program office hours are 8am to 5pm. Program staff working with juveniles work flexible hours including Saturdays 3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and position(s) responsibilities relative to this component. Program coordinator must possess at least a Bachelors degree or higher with previous experience working with at -risk juveniles. The program coordinator is responsible for the daily scheduling of staff and juveniles; fiscal management of resources; recruitment of private and public sector worksites; completion of daily, monthly, quarterly and annual reports to state DPS- Juvenile Justice Division office; training of worksite supervisors; attends all juvenile court dates; processes all diversion contracts as it relates to community service /restitution through the intake counselors office; preparing program agreements; daily transportation and supervision of juveniles at community worksites; safety training to juveniles as it relates to proper use and safety of program equipment; monitoring purchases and expenditures. Program secretary must possess at least an Associates Degree or at least 2 years secretarial experience. Program secretary maintains records on each juvenile; preparing forms; answering phones; processing cash report forms; processing invoices; maintains balances on purchases and expenditures; prepares monthly and quarterly budget reports. Program assistant must possess at least an Associates degree or extensive experience working with at risk juveniles. The program assistant is responsible for daily transportation and supervision of juveniles at community worksites; safety training to juveniles as it relates to proper use and safety of program equipment; completion of daily program progress reports. Program volunteers should possess at least a GED, be employed at the worksite agency(completed and approved worksite agreement on file), submit a volunteer application, pass a criminal background check, be provided program training on how to work with kids and a willingness to work with at- risk juveniles. Program volunteer supervisors supervise juveniles at worksite. Juveniles may only be transported in sponsoring agency owned vehicles. 4. Service Type SPEP: Describe implementation to include: Primary Service - Restitution / Community Service; Secondary Service - None 5. Admission Process: Describe the specific referral, screening, admission process (including timeline), the staff responsible for making decisions about admissions and reasons why a referral may not be accepted. Juveniles may be referred by Juvenile Court or the local Office of Juvenile Justice(OJJ) Intake Counselor. Juveniles referred by Juvenile Court or by local OJJ Intake Counselor have been screened by the intake counselor. The admissions process comprises of the juvenile and the parent/guardian meeting with a program staff member to sign the necessary paprework for enrollment into program. This paperwork consist of medical, equipment and confidentiality waivers; social history; medical history; individual service plan and the community service /restitution agreement contract. Program staff meet with juvenile and parent/guardian at time of referral, either at local OJJ office or in Juvenile Court. 6. Termination Process: Describe the termination process to include the staff responsible for making decisions and Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Harnett County Juvenile Restitution /Community Service Program the criteria for a successful termination, satisfactory termination, unsuccessful completion and non - compliant termination. Program Coordinator is responsible for decisions concerning a juveniles successful, satifactory, unsuccessful or non- compliant termination from this program. Juveniles are terminated as successful upon their completion of community service and /or restitution owed. Juveniles are terminated as satisfactory if they complete required community service hours or restitution with minor behavior problems. Supervising court counselor reviews and signs off on termination documentation. Juveniles who fail to complete ordered community service and /or restitution are terminated as unsuccessful. Failure to cooperate with program staff, failure to show for work assignments and commission of a delinquent act while at a worksite would be grounds for a juvenile being terminated as unsuccessful. Non - compliant juveniles are referred back to their court counselor for appropriate measures. After consultation with court counselor, if juvenile continues to be non - compliant, juvenile will be terminated as unsuccessful. How is the referring agency involved with the termination process? When the termination involves a juvenile placed on probation, program staff confer with supervising court counselor upon juvenile's termination from program. Supervising court counselor is required to sign termination documentation before paperwork is included in legal file with the Harnett County Clerk of Court. When terminations are for juveniles placed on diversion contracts, the referring agency receives a copy of the juvenile's successful termination. If a juvenile fails to satisfy the requirements of the diversion contract, the intake counselor is notified by letter and /or email. 7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and /or other referring agencies including how client progress will be communicated. Juvenile court counselors are given monthly written reports on all juveniles served. Program staff contact court counselors as needed to address negative behavior of juveniles. 8. Intervention/Treatment: Describe specifically what the component will do to redirect inappropriate youth behavior or how the component will address the identified needs of the youth and family. What interventions will typically be utilized in this component and how will parents /guardians be involved? The intention of this program is to show program participants that their inapproppriate and illegal acts have victims and that the victims do suffer monetary and /or emotional loss by their actions. By requiring the juvenile to perform symbolic community service or work to pay actual monetary restitution to the victim(s), the juveniles see that their actions do indeed have consequences. Participation by the juvenile in this program is intended to deter future criminal activity. Parent/guardian is given daily and monthly updates on how their child is progressing in the program. Parent/ guardian is advised of any inappropriate behavior. Parent/guardian is asked to help program staff address those inappropriate behaviors. While the purpose of this program is to primarily address negative behavior of the juvenile referred, program staff, with the help of the referring agency, refer parent/guardian to programs that may strengthen areas that they feel they are difficient in. Areas such as job skills, parenting skill, anger management, etc... 9. Best Practice Model: Describe what model or evidence - supported /best practice the program is based upon. This program is based on philosophy of restorative justice. The model of justice that focuses on crime as an act against another individual or community. Juveniles that participate in program are held accountable for their delinquent or undisciplined acts through symbolic community service or work to recompensate the victims of their criminal acts. Completion of required community service and /or restitution satisfies their debt to the victim of their crime or the community as a whole. Per CTF Tracking Data for the fiscal year 2013/2014, 77% of juveniles served by Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV NAME OF COMPONENT: COMPONENT NARRATIVE (attach for each component) Harnett County Juvenile Restitution /Community Service Program this program had been successfully or satisfactorially terminated. Only 3.9% of juveniles have been terminated as unsuccessful due to nocompliance with program policies and rules. The remaining 18.76% of unsuccessful terminations were due to family relocations, out of county placement of juvenile, etc... Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION V Terms of Agreement This section of the JCPC Program Application will ONLY be completed if approved for funding and will be included in the required JCPC Program Agreement document for completion. This Agreement is entered into by and between Department of Public Safety, (hereinafter referred to as the DPS), and County, (hereinafter referred to as the County), the County's Juvenile Crime Prevention Council (hereinafter referred to as the JCPC) and (hereinafter referred to as the Sponsoring Agency). The DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows: Term of Agreement This Agreement shall become effective Payment to Sponsoring Agency and shall terminate All parties agree that services will be delivered as described in the approved JCPC Program Agreement and that JCPC funds will be disbursed in an amount not to exceed the amount $ for the term of this agreement, unless amended by an approved JCPC Program Agreement Revision. Availability of funds: All parties to this Agreement agree and understand that the payment of the sums specified in this JCPC Program Agreement budget is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to the DPS. Responsibilities of the Parties DPS shall: 1. Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the Juvenile Crime Prevention Council (JCPC) fund appropriation by the General Assembly; 2. Reserve the right to suspend payment to the County for any non - compliance by the Sponsoring Agency with any reporting requirements set forth in the JCPC Policy and Procedures; Notify in writing the County and Sponsoring Agency immediately if payments are suspended and again once payments resume; Pay only for work as described in the JCPC Program Agreement provided by the Sponsoring Agency and approved subcontractors; • Provide technical assistance, orientation and training to the Sponsoring Agency, the County and the JCPC; Monitor Sponsoring Agency's JCPC funded program(s) in accordance with JCPC Policy 3. Operations: Program Oversight and Monitoring; and Notify parties entering into this Agreement of all due dates in a timely manner in order for reports to be submitted by the established due date. Form structure last revised 12/20/2013 Department of Public Safety The Sponsoring Agency shall: 1. Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the conduct of its business, including those of Federal, State, and local agencies having jurisdiction and /or authority; 2. Comply with all Federal and State laws relating to equal employment opportunity; 3. Keep as confidential and not divulge or make available to any individual or organization without the prior written approval of the DPS any information, data, instruments, documents, studies or reports given to or prepared or assembled by the Sponsoring Agency under this Agreement; 4. Acknowledge that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not further disclose the information except as otherwise provided in this Agreement; 5. Comply with the Juvenile Crime Prevention Policy and Procedures established by the DPS and the North Carolina Administrative Procedures; 6. Secure local match as required, pursuant to 14B NCAC 116.0105, for the approved JCPC funds; 7. Create and adopt individualized guidelines specific to the funded program, while also adhering to JCPC Policy and Procedures established by DPS for all JCPC funded programs and for the specific program type for which they receive funding; 8. Ensure that state funds received are spent in accordance with the approved JCPC Program Agreement and be accountable for the legal and appropriate expenditure of those state funds; 9. Maintain reports, records, and other information to properly document services rendered and outcomes; also maintain an ability to send and receive electronic communication; 10. Have the capacity to use DPS electronic, internet -based system for tracking clients served; 11. Use generally accepted accounting procedures that guarantee the integrity of the expenditure of JCPC funds, maintain reports, records, and other information to properly account for the expenditure of all State funds provided to the Sponsoring Agency; 12. Receive from the North Carolina Division of Revenue a refund of all sales and use taxes paid by them in the performance of the JCPC Program Agreement, pursuant to N.C.G.S. §105- 164.14(c); and exclude all refundable sales and use taxes from all reportable expenditures before the expenses are entered in their reimbursement reports; 13. Submit JCPC Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed check ledgers to the JCPC. These reports must be in accordance with the submission process as outlined in the JCPC Policy and Procedures established by DPS and with the due dates established by DPS; 14. Make personnel, reports, records and other information available to DPS , the County, the JCPC, and /or the State Auditor for oversight, monitoring and evaluation purposes; 15. Submit any other information requested by the JCPC, County or DPS; 16. Be responsible for the performance of all subcontractors as described in the JCPC Program Agreement; 17. Indemnifies and holds harmless DPS, the State of North Carolina, the County and any of their officers, agents and employees, from any claims of third parties arising out of any act or omission of the Sponsoring Agency in connection with the performance of the JCPC Program Agreement; 18. Receive permission and budgetary approval from DPS prior to using the JCPC Program Agreement as a part of any news release or commercial advertising and acknowledge DPS funding in partnership with the County; 19. Comply with DPS trainings and requirements regarding the United States Department of Justice national standards to prevent, detect, and respond to prison rape under the Prison Rape Elimination Act (PREA); Reference: 14B; Chapter 11; Subchapter B, and in compliance with JCPC Policy 2: Operations: Program Operational Requirements Sponsoring Agency Contractor(s) /Subcontractors Form structure last revised 12/20/2013 Department of Public Safety Yes, subcontractors are included in the JCPC Program Agreement budget. No, subcontractors are not included in the JCPC Program Agreement budget. If yes, the following only applies when subcontractors are providing services as described in the JCPC Program Agreement (listed in Line Item 190 of the budget). 20. Receive prior approval from DPS in the form of an unsigned contract being submitted with the JCPC Program Agreement if any of the services described in the JCPC Program Agreement are provided by a subcontractor; NOTE: Contracts signed by all parties must be submitted once the JCPC Program Agreement receives signed approval from DPS. Sponsoring Agencies will be notified requesting this information. 21. Hold any contractor or subcontractor to which the Sponsoring Agency provides State funds accountable for the legal and appropriate expenditure of State funds, and to all applicable laws and Juvenile Crime Prevention Council Policies and Procedures; 22. Ensure that all subcontractors provide all information necessary to comply with the standards set forth in the JCPC Program Agreement; and 23. Be deemed an independent contractor in the performance of services described in the JCPC Program Agreement and as such shall be wholly responsible for the services to be performed and for the supervision of its employees. The Sponsoring Agency represents that it has, or shall secure at its own expense, all personnel required in performing the services as described in the JCPC Program Agreement. Such employees shall not be employees of, or have any individual contractual relationship with, DPS; The JCPC shall: 1. Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in JCPC Program Agreement or JCPC Program Agreement Revision(s); 2. Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Code; N.C.G.S. §1438- 801(a);143B- 602;143B -851 3. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency and submit to the County in a timely manner; 4. Review and locally approve Third Quarter Accounting forms and submit to the County in order to meet the due date established by DPS; 5. Submit any other information requested by the County or DPS; and 6. Monitor the Sponsoring Agency's currently funded JCPC program(s) in accordance with JCPC Policy 3. Operations: Program Oversight and Monitoring Reference: 148 NCAC 118.0202 and JCPC Policy 1, 7, 8, 9, 10, and 11. The County shall: 1. Ensure the Sponsoring Agency is appropriately licensed, and either a public agency or a 501 (c) 3 private non- Form structure last revised 12/20/2013 Department of Public Safety profit organization; 2. Use JCPC funds only for the purposes DPS has approved in program agreements or program agreement revisions; 3. Disburse JCPC funds monthly and oversee JCPC funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108 4. Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Procedures; 5. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency for final approval from DPS; and 6. Review and locally approve Third Quarter and Final Accounting forms for the JCPC and all JCPC funded programs according to the procedures and due dates established by DPS. Reference: 14B; Chapter 11; Subchapter B; JCPC Policy 3, 7, 8, 9, 10, and 11 Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the agreement and should not be used to construe the meaning thereof. Choice of Law: The validity of this Program Agreement and any of its terms or provisions, as well as the rights and duties of the parties to this Program Agreement, are governed by the laws of North Carolina. The parties, by signing this Program Agreement, agree and submit, solely for matters concerning this Program Agreement, to the exclusive jurisdiction of the courts of North Carolina and agree, solely for such purpose, that the exclusive venue for any legal proceedings shall be Wake County, North Carolina. The place of this Program Agreement and all transactions and agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all matters, whether sounding in Program Agreement or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Assignment: No assignment of the Sponsoring Agency's obligations or the Sponsoring Agency's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, DPS may: (a) Forward the Sponsoring Agency's payment check(s) directly to any person or entity designated by the Program Manager, or (b) Include any person or entity designated by Sponsoring Agency as a joint payee on the Sponsoring Agency's payment check(s). In no event shall such approval and action obligate DPS or County Government to anyone other than the Sponsoring Agency and the Sponsoring Agency shall remain responsible for fulfillment of all Program Agreement obligations. Form structure last revised 12/20/2013 Department of Public Safety Beneficiaries: Except as herein specifically provided otherwise, this Program Agreement shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this Program Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to DPS, the County Government, and the Sponsoring Agency. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any other third person. It is the express intention of DPS and County Government that any such person or entity, other than DPS or the County Government, or the Sponsoring Agency receiving services or benefits under this Program Agreement shall be deemed an incidental beneficiary only. Property Rights Intellectual Property - All deliverable items produced pursuant to this Program Agreement are the exclusive property of DPS. The Sponsoring Agency shall not assert a claim of copyright or other property interest in such deliverables. Physical Property - the Sponsoring Agency agrees that it shall be responsible for the proper custody and care of any property purchased for or furnished to it for use in connection with the performance of this Program Agreement and will reimburse DPS for loss of, or damage to, such property. At the termination of this Program Agreement, the Sponsoring Agency, County Government, and JCPC shall follow the guidelines for disposition of property set forth in Administrative Code and JCPC policy. Reference: 14B NCAC 118.0110; JCPC Policy 7. Fiscal Accounting and Budgeting: Audit Requirements Disbursements and Internal Controls Reversion of Unexpended Funds Any remaining unexpended JCPC funds DPS disbursed to the County for the Sponsoring Agency must be refunded/ reverted back to DPS at the close of fiscal year or upon termination of this Agreement. Accountability for Funds Audit Requirement - Local Government or Public Authority Requirements Local Government or Public Authorities in accordance with N.C.G.S. §159 -34 must have an audit performed in conformity with generally accepted auditing standards. The audit shall evaluate the performance of a unit of local government or public authority with regard to compliance with all applicable Federal and State agency regulations. This audit, combined with the audit of financial accounts, shall be deemed to be the single audit described by the "Federal Single Audit Act of 1984 ". Audit Requirement — Non- Governmental Entities: An audit, when required by law, or requested by the County or DPS shall be performed in conformity with generally accepted auditing standards and audits of non - governmental entities, both for - profit and not - for - profit, and must meet the requirements of OMB Circular A -133. At a minimum, the required report shall include the financial statements prepared in accordance with generally accepted accounting principles, all disclosures in the public interest required by law, and the auditor's opinion and comments relating to financial statements. The audit report must be submitted to the State Auditor's office as required by law, to the County and DPS, and to other recipients as appropriate within nine (9) months after the end of your program's fiscal year. Form structure last revised 12/20/2013 Department of Public Safety Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all Program Agreements entered into by State agencies or political subdivisions in accordance with N.C.G.S. §147 -64.7. Additionally, as the State funding authority, DPS shall have access to persons and records as a result of all Program Agreements entered into by State agencies or political subdivisions. Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of DPS. State basic records retention policy requires all records to be retained for a minimum of five years or until all audit exceptions have been resolved, whichever is longer. If the Program Agreement is subject to Federal policy and regulations, record retention may be longer than five years since records must be retained for a period of three years following submission of the final Federal Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Program Agreement has been started before expiration of the five -year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five -year period described above, whichever is later. No Overdue Tax Debt -Not for profit organizations ONLY will comply with this section. Form must be attached to the Program Agreement upon submission. The Sponsoring Agency shall be responsible for the payment of all State, local, and Federal taxes. Consistent with N. C.G.S. § 143C -6 -23 (c), not for profit organizations shall file with DPS and the County a written statement completed by that Sponsoring Agency 's board of directors or other governing body, stating that the Sponsoring Agency does not have any overdue tax debts, as defined by N.C.G.S. 105 - 243.1, at the Federal, State, or local level. This written statement, Certification of No Overdue Tax Debts, shall be completed by the Sponsoring Agency and attached to the Program Agreement upon submission. Conflict of Interest —Not for profit organizations ONLY will comply with this section. Form must be attached to the Program Agreement upon submission. Consistent with the N.C.G.S. §143C -6 -23 (b), not for profit organizations shall file with DPS and the County a copy of that Sponsoring Agency's policy addressing conflicts of interest that may arise involving the Sponsoring Agency's management employees and the members of its board of directors or other governing body. The policy shall address situations in which any of these individuals may directly or indirectly benefit, except as the Sponsoring Agency's employees or members of its board or other governing body, from the Sponsoring Agency's disbursing of State funds and shall include actions to be taken by the Sponsoring Agency or the individual, or both to avoid conflicts of interest and the appearance of impropriety. The policy shall be filed before the County or DPS may disburse any funds. The Sponsoring Agency shall also complete the DPS Conflict of Interest Policy Statement (Form DPS 13 001) and attach the statement and the Sponsoring Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission. Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested by the Sponsoring Agency through submission of a JCPC Program Agreement Revision and executed by duly authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency. Form structure last revised 12/20/2013 Department of Public Safety Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this Program Agreement violates any applicable law, each such provision or requirement shall continue to be enforced to the extent it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this Program Agreement shall remain in full force and effect. Termination for Cause: If, through any cause, the Sponsoring Agency shall fail to fulfill its obligations under this Program Agreement in a timely and proper manner, DPS shall have the right to terminate this Program Agreement by giving written notice to the Sponsoring Agency and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Sponsoring Agency under this Program Agreement shall, at the option of DPS, become its property and the Sponsoring Agency shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Sponsoring Agency shall not be relieved of liability to DPS for damages sustained by DPS by virtue of the Sponsoring Agency's breach of this agreement, and DPS may withhold any payment due the Sponsoring Agency for the purpose of setoff until such time as the exact amount of damages due DPS from such breach can be determined. The filing of a petition for bankruptcy by the Sponsoring Agency shall be an act of default under this Program Agreement. Termination without Cause: DPS, the County Government, or the Sponsoring Agency may terminate this Agreement at any time and without cause by giving at least thirty (30) days advance written notice to the other. If this Program Agreement is terminated by DPS as provided herein, the Sponsoring Agency shall be reimbursed on a pro rata basis for services satisfactorily provided to DPS under this Program Agreement prior to Program Agreement termination. Waiver of Default: Waiver by DPS of any default or breach in compliance with the terms of this Program Agreement by the Sponsoring Agency shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms of this Program Agreement unless stated to be such in writing, signed by an authorized representative of DPS, County Government, the JCPC and the Sponsoring Agency and attached to the Program Agreement. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the Program Agreement expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation. END OF SECTION V — Terms of Agreement Form structure Last revised 12/20/2013 Department of Public Safety SECTION VI: BUDGET NARRATIVE Harnett County Juvenile Restitution /Community Service Program f=iscal Year J FY 15 -16 Item # Justification Expense 120 Salaries for Full -time Coordinator /2 Part -time Program Assistants /18% Program Secretary's Salary, Longevity 1113 $77,675 180 FICA 5317; Workmans Comp 1499; Retirement 5493; Insurance 8316; Unemployment Insurance 547, Employee Clinic 354, Supplemental Retirement 191 $21,717 220 Food for juveniles while engaged in work activities $425 250 Tires and maintenance for three program vehicles 250 Gas for three program vehicles 260 Office supplies such as envelopes, pens, copier paper, etc $0 $5,500 $350 290 Restitution supplies (ex. gloves, trash bags, safety vest, goggles, etc...) $425 310 320 340 350 Travel reimburesment for staff(177 mls@ .565 pm) Cell phones, postage, faxes, etc.... @167 per month Program forms Repairs to program equipment such as lawnmowers, weedeaters, etc $100 $3,030 $400 $50 In Kind Expense 390 Copier contract 375; Restitution Bank 4000; Membership Dues 40; Uniforms 300; Training 300; Background Checks 100 $5,115 450 Insurance - Policy covering juveniles while participating in program activities $178 TOTAL $114,965 Job Title Annual Expense Wages Program Assistant $13,572 Annual In Kind Wages .1 Program Secretary (18% of Yearly Salary) $7,189 Program Coordinator $43,342 Program Assistant $13,572 TOTAL $77,675 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION VII Program: Harnett County Juvenile Restitution /Community Service Program Fiscal Year: FY 15 -16 Cash Number of Months: 12 In Kind L Personnel Services $99,392 120 Salaries & Wages 180 Fringe Benefits 190 Professional Services* Total *Contracts MUST be attached $77,675 $21,717 $99,392 $77,675 $21,717 II. Supplies & Materials $6,700 210 Household & Cleaning 220 Food & Provisions 230 Education & Medical 240 Construction & Repair 250 Vehicle Supplies & Materials 260 Office Supplies and Materials 280 Heating & Utility Supplies 290 Other Supplies and Materials $0 $6,700 $425 $5,500 $350 $425 III. Current Obligations & Services $8,695 $0 $425 $0 $0 $5,500 $350 $0 $425 310 Travel & Transportation 320 Communications 330 Utilities 340 Printing & Binding 350 Repairs & Maintenance 370 Advertising 380 Data Processing 390 Other Services $100 $3,030 $400 $50 $5,115 $8,695 $100 $3,030 $0 $400 $50 $0 $0 $5,115 IV. Fixed Charges & Other Expenses $178 410 Rental or Real Property 430 Equipment Rental 440 Service and Maint. Contracts 450 Insurance & Bonding 490 Other Fixed Charges $178 V. Capital Outlay $178 $0 $0 $0 $178 $0 $0 [This Section Requires Cash Match] 510 Office Furniture & Equipment 530 Educational Equipment 540 Motor Vehicle 550 Other Equipment 580 Buildings, Structure & Improv. $0 $0 $0 $0 $0 Total $114,965 $114,965 Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION VIII` SOURCES OF PROGRAM REVENUE (ALL SOURCES) FY 15 -16 Harnett County Funding ID: 543 -XXXX Sponsoring Agency: Harnett County Government Program: Harnett County Juvenile Restitution/ Community Service Program $103,468 DPS /JCPC Funds 10% $11,497 $114,965 Local Match Rate County Cash Local Cash Local Cash Local In -Kind Other Other Other Other TOTAL * This is the amount of your request on your application Is the Local Match Rate 10 %, 20% or 30 %? Harnett County Harnett County $10,347 (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) $11,497 Required Local Match Match Provided We, the undersigned, have reviewed this JCPC Program Application to be presented to the Juvenile Crime Prevention Council of this County in accordance with the procedures established by the local Juvenile Crime Prevention Council. Agencies seeking funding must be able to meet the applicable requirements of the North Carolina General Statutes, Administrative Code, and the Division of Adult Correction and Juvenile Justice. We understand and acknowledge that the approval process is first with the Juvenile Crime Prevention Council, second with the County Board of Commissioners, and the final authority with the Department of Public Safety, Division of Adult Correction and Juvenile Justice. All parties understand that the availability of funds is contingent upon the appropriation of those funds by the General Assembly of the State of North Carolina. Chair, County Board of Commissioners or County Finance Director Date Chair, Juvenile Crime Prevention Council Barry Blevins Program Manager Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Date 3/2/15 Date North Carolina Department of Public Safety JCPC Program - Program Application SECTION 1 A SPONSORING AGENCY AND PROGRAM INFORMATI( FUNDING PERIOD: FY 15 -16 DPS /JCPC FUNDING # (cont c COUNTY: Harnett AREA: Central Area Multi - County: No Multi- Components No NAME OF PROGRAM:I4 -H Teen Court and At -Risk Youth Develnnment N nly) 1 543 -XXXX SPONSORING AGENCY: Harnett County Government SPONSORING AGENCY PHYSICAL ADDRESS: 22 West Front Street Lillington NC 27546 SPONSORING AGENCY MAILING ADDRESS: POB 85 Lillington NC 27546 TYPE: Public FEDERAL ID # 56- 6000306 COMPONENT ID # NAME OF PROGRAM COMPONENT PROGRAM TYPE 10971 4 -H Teen Court and At -Risk Youth Development Teen Court TOTAL COST OF EACH COMPONENT $ 57,465 Total cost of components: Program Manager Name & Address Name: Mailing Address: Phone: same person on signature page) Jackie Helton 126 Alexander Drive Suite 300 (910) 814-6027 Fax: (910) 893 -7539 Title: City: County Extension 4 -H Agent Lillington E -mail Contact Person (if different from program manager) Zip: jhelton @harnett.org $ 57,465 27546 Name: Alia Langdon - Williford Title: Program Coordinator Mailing Address: 126 Alexander Drive Suite 300 City: Lillington Phone: (910) 814 -6022 Fax: (910) 893 -7539 E -mail: Program Fiscal Officer (cannot be program manager) Zip: alwilliford @harnett.org 27546 Name: Kimberly Honeycutt Title: County Finance Officer Mailing Address: PO Box 760 City: Lillington Phone: (910) 893-7557 Fax: (910) 893-3445 E -mail: Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Zip: 27546 khoneycutt @harnett.org SECTION I B PROGRAM COMPONENT DESCRIPTION COMPONENT ID # COMPONENT INFORMATION 10971 NAME OF COMPONENT: 4 -H Teen Court and At -Risk Youth Development BRIEF DESCRIPTION: The 4 -H Teen Court and At -Risk Youth Development Program will provide a sentencing alternative for juveniles ages 6 -17 years old, first time offenders whose referring behavior constitutes a violation of law or misdemeanor, are actively enrolled in an educational program and are deemed appropriate referrals for the program. Blending the research based techniques of both Teen Court and 4 -H the program will provide impact based on needs of youth resulting in accountability, and community cohesion. Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION II Multi- Components No COMPONENT STATISTICAL INFORMATION Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR Component Name: 4 -H Teen Court and At -Risk Youth Development What is this component's maximum c lent capacity at any given time? Frequency of client contact per month: 4 Anticipated Average Length of Stay: Total Component Cost: $57,465 Estimated Average Cost Per Youth: Component ID # 10971 20 120 Estimated # to be served during funding period: $1,197 Days 48 Applies to continuation programs only. Actual number of youth admitted last fiscal year: 34 number of admissions Juvenile Court referred 8.82% of total admissions 31 number of admissions Law Enforcement referred 91.18% of total admissions Form JCPC /PA 00-1 JCPC Program Application Form structure last revised 01/09/2012 Department of Public Safety SECTION III COMPONENT SUMMARY NAME OF COMPONENT: 4 -H Teen Court and At -Risk Youth Development 1. Statement of the Problem: In concise terminology. describe how the program will address continuum need(s) in the county. Based on current JCPC Risk and Needs Assessment data, 74% of Harnett County youth are at low risk of re- offending with a 21% are at medium risk of re- offending; however 63% are reported to lack pro - social peers resulting in association with negative or delinquent youth. County data is consistent with State data which reflects that the majority of youth for the two year period, average 89 %, are age 12 or older when their first delinquent offense was reported in an alleged complaint. In this same time span, an average of 67% of youth were first time offenders (current referral only) upon intake including both undisciplined and delinquent youth. To combat this problem, the 4 -H Teen Court and At -Risk Youth Development Program will provide youth with opportunities to not only be held accountable for their actions, but to continue association with pro - social peers while completing and also upon completion of mandated sanctions via year round 4 -H life skill development opportunities. 4 -H Teen Court provides an alternative sentencing method for first -time misdemeanor offenders and imposes sanctions that not only allow youth to be accountable for their actions, but also engages them in purposeful life skill building programming that will result in positive behavior change and increased interaction with pro - social peers within the traditional 4 -H program. This will potentially reduce the case load of the traditional court system and allow for more prompt reinforcement for the youth involved. All 4 -H program components are open to Teen Court youth during and after completion of required sanctions. Continued participation will be encouraged after sanctions have been completed. In addition to increasing opportunities for interaction with pro - social peers, program involvement allows youth to form trusting relationships with positive adults in the form of both paid and volunteer staff. 4 -H program involvement allows families to build a network of adults and positive teens to encourage and uplift youth. 2. Target Population: Describe the target population, including age, and the steps taken to insure that the target population is served. "The 4 -H Teen Court and At -Risk Youth Development Program will provide a sentencing alternative for juveniles ages 6 to 17 years old, who are first offenders whose referring behavior constitutes a violation of the law or misdemeanor, are actively enrolled in an educational program and are deemed appropriate referrals for a Teen Court program." 3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program. Goal 1: To provide an alternative sentencing method for first -time misdemeanor youth offenders ages 6 -17 in order to reduce the case load of the traditional juvenile justice system. Goal 2: To provide real world accountability for youth offenders using educational methods that result in positive behavior change reflected by increased civic /community engagement. Goal 3: To provide real world accountability for youth offenders using educational methods that result in positive behavior change reflected by an increased knowledge of career skills. Goal 4: To assist youth and families in developing a network of positive adults and teens to create increased opportunities for prosocial interactions. Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION III NAME OF COMPONENT: COMPONENT SUMMARY 4 -H Teen Court and At -Risk Youth Development 4. Measurable Objective(s): State in measurable terms ( %) the intended effect of the program on specific undisciplined and /or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior, disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives must include impact on participants. 95% Clients successfully /satisfactorily completing the program will have no new adjudications in the 12 months following completion. 85% Clients will have no new adjudications for a complaint with an offense date after the admission date. 90% Clients will successfully or satisfactorily complete services as intended by the program design /service plan. 90% Clients will demonstrate improvement in developing and /or maintaining social and interpersonal interactions during program participation. 75% Clients successfully /satisfactorily completing the program will have no new complaints in the 12 months following completion. 85% Clients will have no new complaints with an offense date after the admission date. 5. Elevated Risks and Needs: Describe how you will address one or more of the Elevated Risk and Needs of adjudicated juveniles listed in the local JCPC Request for Proposal. The 4 -H Teen Court and At -risk Youth Development Program will provide programming that will address the need for a Teen Court program as identified by the latest Juvenile Crime Prevention Council needs assessment. Assessment data reflects that Harnett County youth are at low risk of reoffending. Teen Court will target youth that commit first -time misdemeanor offenses ages 6 to 17. Life skill development sanctions will be mandated that hold the youth accountable for their actions and that promote increased knowledge and awareness of community enhancement and civic engagement. Youth will be empowered by involvement in real world projects to raise feelings of self -worth and competence. Sanctions will include but are not limited to: NC 4 -H Hungry to Help: NC is 2nd in childhood food insecurity only behind Louisiana. Youth will engage in gardening and food collection programs to assist in reducing childhood food insecurity. Projects will include 4 -H gardens, sweet potato gleaning, food drives, Stuff a Bus, and Community Dinners. Partners include NC 4 -H, the Central Food Bank of NC, the NC Cooperative Extension, Harnett County Schools and the Harnett County Food Pantry. Career Smarts: Career Smarts is a research based 4 -H curriculum that leads youth through a series of 10 lessons addressing employability skills. Topics addressed include professional dress, resume writing, public speaking, etiquette, interview skills and goal setting. 4 -H Life Skill Development Programming: 4 -H Teen Leadership /Presentation Program (Public Speaking Skills), 4 -H Livestock Judging (Critical Thinking, Organizational and Problem Solving Skills), 4 -H Shooting Sports Program (Safety, Self- Discipline and Value of Environmental and Natural Resources) Current assessment data also indicates that Harnett County youth are more likely to associate with undisciplined or delinquent youth. While participating in Teen Court sanctions, youth will interact with traditional 4 -H program youth Form JCPC?PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION III COMPONENT SUMMARY NAME OF COMPONENT: 4 -H Teen Court and At -Risk Youth Development creating opportunities for increased association with prosocial peers and adult volunteers and staff. Upon completion of sanctions, youth will be encouraged to continue 4 -H participation to maintain opportunities for prosocial interaction. Form JCPC /PA 00-1 JCPC Program Application Form structure Last revised 12/31/2012 Department of Public Safety SECTION IV NAME OF COMPONENT: COMPONENT NARRATIVE (attach for each component) 4 -H Teen Court and At -Risk Youth Development 1. Location: List physical address(es) and describe where program services are delivered. Program Staff Harnett County Agriculture Center 126 Alexander Drive, Suite 300 Lillington, NC 27546 Teen Court Proceedings Harnett County Courthouse 301 W. Cornelius Harnett Blvd. Lillington, NC 27546 The program will be housed within the NC Cooperative Extension. Harnett County Center office via the 4 -H Youth Development program. Program staff will be located in Suite 300 of the Agriculture Center. Conference room facilities will be available for parent/guardian meetings and the Training room will be utilized for Leadership Training and sanctions. Teen Court proceedings will take place at the Harnett County Court House. 2. Operation: Describe the daily /weekly schedule of program operation. Teen Court sessions will be held twice monthly on a regularly scheduled basis during the evening hours. Schedule will be subject to inclement weather closings and will be on schedule with Harnett County Schools. Example: 1st and 3rd Tuesday night of each month at 6:00 pm Referred youth will be accepted year round. Once accepted, the 4 -H Teen Court Coordinator will communicate with parents and youth once weekly until program termination to ensure understanding of Teen Court proceedings and sanction expectations. Communication may be via Teen Court sessions, involvement in sanctions, email with a response, phone calls or face to face meetings. Opportunities for sanction completion will be offered on a weekly basis. Sanctions will be conducted year round with schedules being set by the 4 -H Teen Court Coordinator. Sanctions with specific deadlines mandated by the NC 4 -H program will be planned accordingly with County level programming provided to support youth success such as presentation practice sessions. Outdoor /gardening activities will be conducted as weather is appropriate. Indoor oriented sanctions will be conducted year round. Youth will be enrolled for a maximum of 120 days. Extended involvement will be agreed upon as deemed necessary by the referring parties and parents. Involvement beyond 120 days will be outlined in a written agreement such as the 4 -H Enrollment Form or Teen Court Parent Agreement. The work schedule of the 4 -H Teen Court and At -risk Youth Development Program Coordinator will consist of 40 work hours each week. The primary work schedule will be 8:00 -5:00 with adjustments being made to allow for Teen Court sessions or sanctions that are required to occur after hours or on weekends in order not to exceed 40 hours per week. 3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and Form JCPC /PA 00-1 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: 4 -H Teen Court and At -Risk Youth Development position(s) responsibilities re ative to this component. 4 -H Teen Court and At -risk Youth Development Coordinator (4 -H Program Assistant) - Must possess a minimum of an Associates Degree in the area of Human Services or a related youth development field. A Bachelor's degree is preferred. Responsibilities will include case oversight and supervision of all Teen Court proceedings including court sessions and sanctions organized by 4 -H. The position is also responsible for evaluation of sanctions conducted by partnering agencies /organizations. In addition, the position will recruit, supervise and train all professional and community based program volunteers. The position will network with all partnering agencies needed to conduct Teen Court and to accept referrals. Partnerships will be fostered to ensure sustainability of program efforts. The position will be the main point of contact for the Teen Court program and maintain expected levels of partner and parent/youth communication. Responsibilities also include development of evaluation tools used to evaluate program success in addition to completing required funding and program impact reports. Teen Court Professional Volunteers: Adult Volunteers will be utilized to serve as career coaches for teens involved in Teen Court proceedings to include defense and prosecuting attorneys, clerk, bailiff and jury members. Professional volunteers will include Attorneys, Judges and District Attorneys. An Attorney will serve as the Teen Court Judge. Teen Court Community Volunteers: Adult community members will be utilized to ensure efficient proceeding of Teen Court cases. Community volunteers will assist with implementation of sanctions. Teen Volunteers: Youth ages 13 -17 will be recruited to serve as attorneys, jurors, the bailiff and clerk during all Teen Court proceedings. Teen volunteers will also be recruited to assist with sanction planning and implementation. All volunteers, both adult and youth will take part in a required Teen Court training addressing the needs of their assigned responsibility. All volunteers, both adult and youth, will receive written volunteer job descriptions. All adult volunteers will be required to complete the NC 4 -H Volunteer Screening application process that includes a background check. All adult and youth volunteers will also be required to sign a standards of behavior and confidentiality statement. Teen Court Program Director (In- Kind)- The Extension Agent, 4 -H Youth Development will serve as Teen Court Program Director. This position will provide direct supervision to the Teen Court Coordinator and will ensure that the program meets all required standards. The position will also oversee program evaluation to determine impact. The position will also ensure cooperation with Area Consultants for monitoring and required reporting. The position will also ensure that required program agreements and reporting are completed. Extension Secretary (In- Kind)- This position will provide clerical support 4. Service Type SPEP: Describe implementation to include: This program is a STRUCTURE ONLY. 5. Admission Process: Describe the .specific referral, screening, admission process (including timeline), the staff responsible for making decisions about admissions and reasons why a referral may not be accepted. 4 -H Teen Court referrals will be accepted from Schools, Juvenile Justice, and prevention specialists. Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety- SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: 4 -H Teen Court and At -Risk Youth Development Upon receiving a written referral, the Teen Court Coordinator will assess the suitability of referred youth. Questionable referrals will be reviewed by the Program Director and a determination will be made concerning acceptance. All other referrals will be approved by the Coordinator. Once a referral is received and accepted, the Teen Court Coordinator will contact the family to schedule an intake appointment followed by contact with the referring agency within 14 business days orally or in writing to confirm intake. A participation agreement will be signed by the referring agency, youth and parent/guardian during the intake appointment. Within 30 days of receiving the referral, the Coordinator will make contact with the victim to assess any monetary loss unless otherwise informed in writing by the referral source. Juveniles must be admitted into the program within 30 days of receiving the referral. The following referrals will not be accepted: Driving while impaired, Class Al misdemeanors, An assault in which a weapon was used, or A controlled substance offense under Article 5 of Chapter 90 of the NC General Statues, excluding simple possession of a schedule VI drug or alcohol offense and Sexual offenses. 6. Termination Process: Describe the termination process to include the staff responsible for making decisions and the criteria for a successful termination, satisfactory termination, unsuccessful completion and non - compliant termination. Termination forms will be completed upon termination of participation which will include sanctions (activities) completed, results, recommendations, last date of program contact and reason for termination. Terminations will be completed by the Teen Court Coordinator. Upon termination, copies of the termination form must be provided to the referring agency and the parent/guardian of the youth involved within 7 business days. Reasons for termination include: Successful Completion, Satisfactory Completion (Must obtain approval from Program Director and notify referring agency), Unsuccessful Completion (Must obtain approval from Program Director and notify referring agency), or Non - Compliance (Must obtain approval from Program Director and notify referring agency). Termination Criteria are as follows: Successful Completion - Juvenile has completed all required sanctions ordered by Teen Court and displays positive progress, Satisfactory Completion - Juvenile has attempted to complete all required sanctions however due to a documented hardship is unable to fully complete sanctions, Unsuccessful Completion - Juvenile has made limited attempts to fullfill sanctions and has made little progress, Non - Compliance - Juvenile refuses to complete sanctions or displays behavior that puts self, staff, volunteers or other youth in harms way. How is the referring agency involved with the termination process? Form JCPC/PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: 4 -H Teen Court and At -Risk Youth Development The referring agency will be notified in writing prior to termination in order to provide an opportunity to communicate with Teen Court program staff pertaining to expected youth progress. Feedback will be reflected on the termination form and filed for each juvenile. 7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and /or other referring agencies including how client progress will be communicated. The Teen Court Coordinator will communicate at least monthly with Court Counselors and other referring agencies in reference to client progress. Communication will take place via face to face meetings, phone or in writing. Client progress forms will be used to document monthly progress and filed. The Teen Court Coordinator will also attend the monthly meetings held by Juvenile Justice intended for partnering agency communication. The Teen Court Coordinator will also provide the program report at monthly JCPC meetings. 8. Intervention /Treatment: Describe .specifically what the component will do to redirect inappropriate youth behavior or how the component will address the identified needs of the youth and family. What interventions will typically be utilized in this component and how will parents /guardians be involved? The 4 -H Teen Court and At -risk Youth Development Program will engage youth in purposeful life skill enriching activities that will create opportunities for real world learning, youth empowerment and building of community capacity. As a result, youth will develop mastery of skills and gain an increased sense of self - worth. In addition, youth will increase time spent with pro - social peers and adults building a sense of acceptance. Research shows that if youth needs go unmet or are met in negative ways youth will: seek to belong through promiscuous behaviors, attempt to feel mastery by cheating or practicing other delinquent skills, try to establish independence by acting as a bully or by displaying defiant behavior, or feel unable to establish their own positive self identity. The 4 -H Teen Court and At -risk Youth Development Program will strive to involve youth in meaningful experiences that meet the needs of positive youth development in order to encourage youth who: experience belonging, and develop a trusting and friendly demeanor, seek productive opportunities to experience mastery of a skill and become problem solvers displaying self- motivation, and that when presented with opportunities to become independent, display self - confidence and self - discipline as youth leaders showing care and generosity to others. Parents /guardians will be involved in the Teen Court process by intake meetings, Teen Court proceedings, and weekly communication with program staff during Teen Court program involvement including sanctions. Parent surveys will be conducted during the termination process to gauge parental observations pertaining to youth progress and program impact. Parents will be encouraged to contact program staff with any concerns or celebrations regarding youth progress. 9. Best Practice Model: Describe what model or evidence - supported /best practice the program is based upon. Teen Court is based on North Carolina's comprehensive strategy for juvenile deliquency and resarch based best practice of graduated sanctions and is an alternative sentencing mothod for first -time misdemeanor youth offenders, Forni JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: 4 -H Teen Court and At -Risk Youth Development therefore minimizing the case load of traditional juvenile court. Teen Court utilizes a matrix to organize sanctions according to risk level and severity of the offense. Sanctions imposed take into consideration the characteristics of the client in addition to the intended outcome of the sanction being imposed. Dosage or amount of time engaged in the identified sanction is directly related to the characteristics of the juevenile client and the desired behavior change to be displayed. Supplementary or opportunities for follow up are also taken into consideration when imposing Teen Court sanctions. These are all identified as characteristics of effective programs and are identified in the Teen Court standard operating procedures. Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION V ' .`��*~ Terms of Ag This section of the JCPC Program Application will ONLY be completed if approved for funding and will be included in the required JCPC Program Agreement document for completion. This Agreement is entered into by and between Department of Public Safety, (hereinafter referred to as the DPS), and County, (hereinafter referred to as the County). the County's Juvenile Crime Prevention Council (hereinafter referred to as the JCPC) and (hereinafterreferred to as the Sponsoring Agency). The DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows: Term of Agreement This Agreement shall become effective and shaU terminate . Payment to Sponsoring Agency All parties agree that services will be delivered as described in the approved JCPC Program Agreement and that JCPC funds will be disbursed in an amount not to exceed the amount $ for the term of this agreement, unless amended by an approved JCPC Program Agreement Revision. Availability of Funds: All parties to this Agreement agree and understand that the payment of the sums specified in this JCPC Program Agreement budget is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to the DPS. Responsibilities uf the Parties DPS shall: 1. Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the Juvenile Crime Prevention Council (JCPC) fund appropriation by the General Assembly; 2. Reserve the right to suspend payment to the County for any non-compliance by the Sponsoring Agency with any reporting requirements set forth in the JCPC Policy and Procedures; 3. Notify in writing the County and Sponsoring Agency immediately if payments are suspended and again once payments resume; 4. Pay only for work as described in the JCPC Program Agreement provided by the Sponsoring Agency and approved subcontractors; 5. Provide technical assistance, orientation and training to the Sponsoring Agency, the County and the JCPC; U . Monitor Sponsoring Agency's JCPC funded program(s) in accordance with JCPC Policy 3. Operations: Program Oversight and Monitoring; and 7. Notify parties entering into this Agreement of all due dates in a timely manner in order for reports to be submitted by the established due date. Form structure last revised 12/20/2013 Department vf Public Safety The Sponsoring Agency shall: 1. Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the conduct of its business, including those of Federal, State, and local agencies having jurisdiction and /or authority; 2. Comply with all Federal and State laws relating to equal employment opportunity; 3. Keep as confidential and not divulge or make available to any individual or organization without the prior written approval of the DPS any information, data, instruments, documents, studies or reports given to or prepared or assembled by the Sponsoring Agency under this Agreement; 4. Acknowledge that in receiving, storing, processing or otherwise dealing with any confidential information it will safeguard and not further disclose the information except as otherwise provided in this Agreement; 5. Comply with the Juvenile Crime Prevention Policy and Procedures established by the DPS and the North Carolina Administrative Procedures; 6. Secure local match as required, pursuant to 14B NCAC 118.0105, for the approved JCPC funds; 7. Create and adopt individualized guidelines specific to the funded program, while also adhering to JCPC Policy and Procedures established by DPS for all JCPC funded programs and for the specific program type for which they receive funding; 8. Ensure that state funds received are spent in accordance with the approved JCPC Program Agreement and be accountable for the legal and appropriate expenditure of those state funds; 9. Maintain reports, records, and other information to properly document services rendered and outcomes; also maintain an ability to send and receive electronic communication; 10. Have the capacity to use DPS electronic, internet -based system for tracking clients served; 11. Use generally accepted accounting procedures that guarantee the integrity of the expenditure of JCPC funds, maintain reports, records, and other information to properly account for the expenditure of all State funds provided to the Sponsoring Agency; 12. Receive from the North Carolina Division of Revenue a refund of all sales and use taxes paid by them in the performance of the JCPC Program Agreement, pursuant to N.C.G.S. §105- 164.14(c); and exclude all refundable sales and use taxes from all reportable expenditures before the expenses are entered in their reimbursement reports; 13. Submit JCPC Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed check ledgers to the JCPC. These reports must be in accordance with the submission process as outlined in the JCPC Policy and Procedures established by DPS and with the due dates established by DPS; 14. Make personnel, reports, records and other information available to DPS , the County, the JCPC, and /or the State Auditor for oversight, monitoring and evaluation purposes; 15. Submit any other information requested by the JCPC, County or DPS; 16. Be responsible for the performance of all subcontractors as described in the JCPC Program Agreement; 17. Indemnifies and holds harmless DPS, the State of North Carolina, the County and any of their officers, agents and employees, from any claims of third parties arising out of any act or omission of the Sponsoring Agency in connection with the performance of the JCPC Program Agreement; 18. Receive permission and budgetary approval from DPS prior to using the JCPC Program Agreement as a part of any news release or commercial advertising and acknowledge DPS funding in partnership with the County; 19. Comply with DPS trainings and requirements regarding the United States Department of Justice national standards to prevent. detect, and respond to prison rape under the Prison Rape Elimination Act (PREA); Reference: 148; Chapter 11; Subchapter 8, and in compliance with JCPC Policy 2: Operations: Program Operational Requirements Sponsoring Agency Contractor(s) /Subcontractors Form structure last revised 12/20/2013 Department of Public Safety LJ Yes, subcontractors are included in the JCPC Program Agreement budget. No, subcontractors are not included in the JCPC Program Agreement budget. If yes, the following only applies when subcontractors are providing services as described in the JCPC Program Agreement (listed in Line Item 190 of the budget). 20. Receive prior approval from DPS in the form of an unsigned contract being submitted with the JCPC Program Agreement if any of the services described in the JCPC Program Agreement are provided by a subcontractor; NOTE: Contracts signed by all parties must be submitted once the JCPC Program Agreement receives signed approval from DPS. Sponsoring Agencies will be notified requesting this information. 21. Hold any contractor or subcontractor to which the Sponsoring Agency provides State funds accountable for the legal and appropriate expenditure of State funds, and to all applicable laws and Juvenile Crime Prevention Council Policies and Procedures; 22. Ensure that all subcontractors provide all information necessary to comply with the standards set forth in the JCPC Program Agreement; and 23. Be deemed an independent contractor in the performance of services described in the JCPC Program Agreement and as such shall be wholly responsible for the services to be performed and for the supervision of its employees. The Sponsoring Agency represents that it has, or shall secure at its own expense, all personnel required in performing the services as described in the JCPC Program Agreement. Such employees shall not be employees of, or have any individual contractual relationship with, DPS; The JCPC shall: 1. Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in JCPC Program Agreement or JCPC Program Agreement Revision(s); 2. Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Code; N.C.G.S. §1438- 801(a);143B- 602;143B -851. 3. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency and submit to the County in a timely manner; 4. Review and locally approve Third Quarter Accounting forms and submit to the County in order to meet the due date established by DPS; 5. Submit any other information requested by the County or DPS; and 6. Monitor the Sponsoring Agency's currently funded JCPC program(s) in accordance with JCPC Policy 3. Operations: Program Oversight and Monitoring Reference: 14B NCAC 11B.0202 and JCPC Policy 1, 7, 8, 9, 10, and 11. The County shall: 1. Ensure the Sponsoring Agency is appropriately licensed, and either a public agency or a 501 (c) 3 private non- Form structure last revised 12/20/2013 Department of Public Safety profit organization; 2. Use JCPC funds only for the purposes DPS has approved in program agreements or program agreement revisions; 3. Disburse JCPC funds monthly and oversee JCPC funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108 4. Comply with the Juvenile Crime Prevention Policy and Procedures established by DPS and the North Carolina Administrative Procedures; 5. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency for final approval from DPS; and 6. Review and locally approve Third Quarter and Final Accounting forms for the JCPC and all JCPC funded programs according to the procedures and due dates established by DPS. Reference: 14B; Chapter 11; Subchapter B; JCPC Policy 3, 7, 8, 9, 10, and 11 Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the agreement and should not be used to construe the meaning thereof. Choice of Law: The validity of this Program Agreement and any of its terms or provisions, as well as the rights and duties of the parties to this Program Agreement, are governed by the laws of North Carolina. The parties, by signing this Program Agreement, agree and submit, solely for matters concerning this Program Agreement, to the exclusive jurisdiction of the courts of North Carolina and agree, solely for such purpose, that the exclusive venue for any legal proceedings shall be Wake County, North Carolina. The place of this Program Agreement and all transactions and agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all matters, whether sounding in Program Agreement or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Assignment: No assignment of the Sponsoring Agency's obligations or the Sponsoring Agency's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, DPS may: (a) Forward the Sponsoring Agency's payment check(s) directly to any person or entity designated by the Program Manager, or (b) Include any person or entity designated by Sponsoring Agency as a joint payee on the Sponsoring Agency's payment check(s). In no event shall such approval and action obligate DPS or County Government to anyone other than the Sponsoring Agency and the Sponsoring Agency shall remain responsible for fulfillment of all Program Agreement obligations. Form structure last revised 12/20/2013 Department of Public Safety Beneficiaries: Except as herein specifically provided otherwise, this Program Agreement shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this Program Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to DPS, the County Government, and the Sponsoring Agency. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any other third person. It is the express intention of DPS and County Government that any such person or entity, other than DPS or the County Government, or the Sponsoring Agency receiving services or benefits under this Program Agreement shall be deemed an incidental beneficiary only. Property Rights Intellectual Property - All deliverable items produced pursuant to this Program Agreement are the exclusive property of DPS. The Sponsoring Agency shall not assert a claim of copyright or other property interest in such deliverables. Physical Property - the Sponsoring Agency agrees that it shall be responsible for the proper custody and care of any property purchased for or furnished to it for use in connection with the performance of this Program Agreement and will reimburse DPS for loss of, or damage to, such property. At the termination of this Program Agreement, the Sponsoring Agency, County Government, and JCPC shall follow the guidelines for disposition of property set forth in Administrative Code and JCPC policy. Reference: 14B NCAC 118.0110: JCPC Policy 7. Fiscal Accounting and Budgeting: Audit Requirements Disbursements and Internal Controls Reversion of Unexpended Funds Any remaining unexpended JCPC funds DPS disbursed to the County for the Sponsoring Agency must be refunded/ reverted back to DPS at the close of fiscal year or upon termination of this Agreement. Accountability for Funds Audit Requirement - Local Government or Public Authority Requirements Local Government or Public Authorities in accordance with N.C.G.S. §159 -34 must have an audit performed in conformity with generally accepted auditing standards. The audit shall evaluate the performance of a unit of local government or public authority with regard to compliance with all applicable Federal and State agency regulations. This audit, combined with the audit of financial accounts, shall be deemed to be the single audit described by the "Federal Single Audit Act of 1984 ". Audit Requirement — Non - Governmental Entities: An audit, when required by law, or requested by the County or DPS shall be performed in conformity with generally accepted auditing standards and audits of non - governmental entities, both for - profit and not - for - profit, and must meet the requirements of OMB Circular A -133. At a minimum, the required report shall include the financial statements prepared in accordance with generally accepted accounting principles, all disclosures in the public interest required by law, and the auditor's opinion and comments relating to financial statements. The audit report must be submitted to the State Auditor's office as required by law, to the County and DPS, and to other recipients as appropriate within nine (9) months after the end of your program's fiscal year. Form structure last revised 12/20/2013 Department of Public Safety Oversight Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all Program Agreements entered into by State agencies or political subdivisions in accordance with N.C.G.S. §147 -64.7. Additionally, as the State funding authority, DPS shall have access to persons and records as a result of all Program Agreements entered into by State agencies or political subdivisions. Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of DPS. State basic records retention policy requires all records to be retained for a minimum of five years or until all audit exceptions have been resolved, whichever is longer. If the Program Agreement is subject to Federal policy and regulations, record retention may be longer than five years since records must be retained for a period of three years following submission of the final Federal Financial Status Report, if applicable, or three years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Program Agreement has been started before expiration of the five -year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five -year period described above, whichever is later. No Overdue Tax Debt -Not for profit organizations ONLY will comply with this section. Form must be attached to the Program Agreement upon submission. The Sponsoring Agency shall be responsible for the payment of all State, local, and Federal taxes. Consistent with N. C.G.S. § 143C -6 -23 (c), not for profit organizations shall file with DPS and the County a written statement completed by that Sponsoring Agency's board of directors or other governing body, stating that the Sponsoring Agency does not have any overdue tax debts, as defined by N.C.G.S. 105- 243.1, at the Federal, State, or local level. This written statement, Certification of No Overdue Tax Debts, shall be completed by the Sponsoring Agency and attached to the Program Agreement upon submission. Conflict of Interest —Not for profit organizations ONLY will comply with this section. Form must be attached to the Program Agreement upon submission. Consistent with the N.C.G.S. §143C -6 -23 (b), not for profit organizations shall file with DPS and the County a copy of that Sponsoring Agency's policy addressing conflicts of interest that may arise involving the Sponsoring Agency's management employees and the members of its board of directors or other governing body. The policy shall address situations in which any of these individuals may directly or indirectly benefit, except as the Sponsoring Agency's employees or members of its board or other governing body, from the Sponsoring Agency's disbursing of State funds and shall include actions to be taken by the Sponsoring Agency or the individual, or both to avoid conflicts of interest and the appearance of impropriety. The policy shall be filed before the County or DPS may disburse any funds. The Sponsoring Agency shall also complete the DPS Conflict of Interest Policy Statement (Form DPS 13 001) and attach the statement and the Sponsoring Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission. Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested by the Sponsoring Agency through submission of a JCPC Program Agreement Revision and executed by duly authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency. Form structure last revised 12/20/2013 Department of Public Safety Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this Program Agreement violates any applicable law, each such provision or requirement shall continue to be enforced to the extent it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this Program Agreement shall remain in full force and effect. Termination for Cause: If, through any cause, the Sponsoring Agency shall fail to fulfill its obligations under this Program Agreement in a timely and proper manner, DPS shall have the right to terminate this Program Agreement by giving written notice to the Sponsoring Agency and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Sponsoring Agency under this Program Agreement shall, at the option of DPS, become its property and the Sponsoring Agency shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Sponsoring Agency shall not be relieved of liability to DPS for damages sustained by DPS by virtue of the Sponsoring Agency's breach of this agreement, and DPS may withhold any payment due the Sponsoring Agency for the purpose of setoff until such time as the exact amount of damages due DPS from such breach can be determined. The filing of a petition for bankruptcy by the Sponsoring Agency shall be an act of default under this Program Agreement. Termination without Cause: DPS, the County Government, or the Sponsoring Agency may terminate this Agreement at any time and without cause by giving at least thirty (30) days advance written notice to the other. If this Program Agreement is terminated by DPS as provided herein, the Sponsoring Agency shall be reimbursed on a pro rata basis for services satisfactorily provided to DPS under this Program Agreement prior to Program Agreement termination. Waiver of Default: Waiver by DPS of any default or breach in compliance with the terms of this Program Agreement by the Sponsoring Agency shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms of this Program Agreement unless stated to be such in writing, signed by an authorized representative of DPS, County Government, the JCPC and the Sponsoring Agency and attached to the Program Agreement. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the Program Agreement expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation. END OF SECTION V — Terms of Agreement Form structure last revised 12/20/2013 Department of Public Safety SECTION VI: BUDGET NARRATIVE 4 -H Teen Court and At -Risk Youth Development Fiscal Yea FY 15 -16 Item # Justification Expense 120 4 -H Agent supervision 2 hr /wk @ 17.00 /hr for 52 weeks and Extension Secretary for clerical support 1 hr /wk @ 12.00 /hr for 52 weeks 120 Full -Time Teen Court Program Manager $11.00 /hour @ 40hrs/ wk for 52weeks $22,880 180 County Package: FICA @ 7.65% (1,164), Work. Comp. (524), Regular Retirement @ 7.07% (1,618), Group Ins. @ 585.32/mo (7,024), HSA (0), Emp. Clinic @ 25 /mo (300), Unemployment Ins. (229), Incentives (0), Supplemental Retirement (300), Longevity (0) $11,159 220 Funds will be used to purchase /provide meals and /or snacks for youth during training and sanction implementation. Hungry to Help supplies, jury incentive meals, and volunteer /client family appreciation dinner. $2,500 In Kind Expense $2,392 250 Travel Cost for 15 passenger van (2,086 miles @ 0.575 /mile) $1,200 260 Supply Cost for program records and promotion (folders, printer cartridges, desk calendar, planner, and display board). $1,057 290 Supplies needed to support implementation of program sanctions and life skill programming (flip charts, markers, landscaping tools, and curriculum). $1,057 310 Travel Cost (3,652 miles @ .575 /mile) $2,100 320 Cell phone for program coordinator. 60 /mo = 720 /yr $720 340 5000 copies @ .10 each for communication and program promotion $500 390 Training opportunities for staff and youth (Association membership fees; registrations; lodging, food and etc) NC Congress; 4H Camps; NCJSA, Teen Court Association, DJJ Trainings. $7,000 410 Office Space (includes phone) $400 /mo 450 American Income Life Insurance - 4 -H Plan Supplemental Medical Coverage - $1.00 /youth for 100 youth and adult volunteers - covers entire year. $100 $4,800 TOTAL $49,773 $7,692 Job Title Annual Expense Wages 4 -H Teen Court and At -Risk Youth Development Program Manager (4 -H Program Assistant) - Responsibilities include implementation of teen court program, management/recruitment of teen court partners, volunteers and Annual In Kind Wages $22,880 Form JCPC /PA 004 JCPC Program Application Form structure Last revised 12/31/2012 Department of Public Safety communication with youth and families 4 -H Agent and Extension Secretary for direct supervision and clerical support $2,392 TOTAL $22,880 $2,392 Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety SECTION VII Program: 4 -H Teen Court and At -Risk Youth Development Fiscal Year: FY 15 -16 Number of Months: 12 Cash In Kind I. Personnel Services $34,039 $2,392 120 Salaries & Wages 180 Fringe Benefits 190 Professional Services* Total `Contracts MUST be attached $22,880 $2,392 $11,159 II. Supplies & Materials $5,814 $36,431 210 Household & Cleaning 220 Food & Provisions 230 Education & Medical 240 Construction & Repair 250 Vehicle Supplies & Materials 260 Office Supplies and Materials 280 Heating & Utility Supplies 290 Other Supplies and Materials $2,500 $1,200 $1,057 $1,057 III. Current Obligations & Services $9,820 $500 $25,272 $11,159 $0 $5,814 $0 $2,500 $0 $0 $1,200 51,057 $0 $1,057 310 Travel & Transportation 320 Communications 330 Utilities 340 Printing & Binding 350 Repairs & Maintenance 370 Advertising 380 Data Processing 390 Other Services $2,100 $720 $7,000 $500 IV. Fixed Charges & Other Expenses $100 $4,800 $10,320 $2,100 $720 $0 $500 $0 $0 $0 410 Rental or Real Property 430 Equipment Rental 440 Service and Maint. Contracts 450 Insurance & Bonding 490 Other Fixed Charges $100 $4,800 $7,000 $4,900 $4,800 $0 $0 $100 $0 V. Capital Outlay $0 [This Section Requires Cash Match] 510 Office Furniture & Equipment 530 Educational Equipment 540 Motor Vehicle 550 Other Equipment 580 Buildings, Structure & Improv. $0 $0 $0 $0 $0 Total $49,773 $7,692 $57,465 Form JCPC /PA 00-1 JCPC Program Application Forni structure last revised 12/31/2012 Department of Public Safety SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES) FY 15 -16 Harnett County Funding ID: 543 -XXXX Sponsoring Agency: Harnett County Government Program: 4 -H Teen Court and At -Risk Youth Development $49,773 10% $7,692 $57,465 DPS /JCPC Funds Local Match Rate County Cash Local Cash Local Cash Local In -Kind Other Other Other Other TOTAL This is the amount of your request on your application Is the Local Match Rate 10 %, 20% or 30 %? Harnett County Government $4,977 (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) (Specify Source) $7,692 Required Local Match Match Provided We" the undersigned, have reviewed this JCPC Program Application to be presented to the Juvenile Crime Prevention Council of this County in accordance with the procedures established by the local Juvenile Crime Prevention Council Agencies seeking funding must be able to meet the applicable requirements of the North Carolina General Statutes, Administrative Code, and the Division of Adult Correction and Juvenile Justice. We understand and acknowledge that the approval process is first with the Juvenile Crime Prevention Council. second with the County Board of Commissioners, and the final authority mith the Department of Public Safety, Division of Adult Correction and Juvenile Justice. All parties understand that the availability of funds is contingent upon the appropriation of those funds by the General Assembly of the State of North Carolina. Chair, County Board of Commissioners or County Finance Director Date Chair, Juverhle Crime Prevention Council Jackie Helton P Date 4/6/15 Program Manager Date Form JCPC /PA 004 JCPC Program Application Form structure last revised 12/31/2012 Department of Public Safety Agenda Item q Board Meeting Agenda Item MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Amendment to Backup 911 Center MOU with Johnston County REQUESTED BY: IT Department (GIS/E -911 Division) REQUEST: This request is to amend the MOU between Johnston County and Harnett County that was approved April 16, 2012. This amendment will allow Harnett County to install equipment on the communications tower at the 911 Backup Center in Clayton at no additional cost. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: S:\BOC \agendaform2015 -0504- Backup- Center- MOU- Amendment.doc Page 1 of 1 NORTH CAROLINA JOHNSTON COUNTY Amendment to Memorandum of Understanding THIS AMENDMENT is entered into by and between Johnston County, North Carolina ( "Johnston "), and Harnett County, North Carolina ( "Harnett "), as follows: WHEREAS, on or about May 7, 2012, Johnston and Harnett entered into a Memorandum of Understanding (the "MOU") regarding Harnett's utilization of Johnston's Backup 911 Center on Highway 42 East, Clayton, North Carolina (the "Backup 911 Center "), during such times and under such terms and circumstances as described in the MOU; and WHEREAS, the parties desire to amend the MOU in order to provide terms by which Harnett may add certain microwave equipment to the communications tower at the Backup 911 Center; and WHEREAS, the MOU may be amended in accordance with the terms of Section 6 of the MOU. NOW, THEREFORE, in consideration of the terms, conditions, and mutual premises contained herein, and other good and valuable consideration, the parties agree as follows: 1. During the term of the MOU, Harnett may, at its sole expense, install, maintain, and operate point -to -point microwave equipment (the "equipment") on and about Johnston's communications tower at the Backup 911 Center, as long as Harnett complies with the provisions of the MOU and this amendment thereto. 2. Before initiating any installation, Harnett must obtain at its sole expense a structural analysis signed and sealed by a properly licensed and qualified engineer indicating that the proposed installation and use is compatible with the structure and will not impair or compromise the structural integrity of the communications tower. The analysis, signed by the engineer, must be provided to the Johnston 911 Communications Director before any installation may begin. 3. Harnett may not conduct any activities or install any equipment which interferes with Johnston's use of the Backup 911 Center. 4. The terms and conditions of the MOU shall remain unchanged by this amendment and Harnett's responsibilities as expressed in the MOU shall apply also to Harnett's installation, maintenance, and operation of the equipment hereunder. IN WITNESS WHEREOF, this Amendment is adopted this the day of , 2015. JOHNSTON COUNTY Tony R. Braswell, Chairman of the Board ATTEST: Paula G. Woodard, Clerk IN WITNESS WHEREOF, this Amendment is adopted this the day of 2015. a ATTEST: Gina Wheeler From: Clint Williams Sent: Tuesday, April 21, 2015 2:36 PM To: Gina Wheeler Cc: Ira D. Hall; Paula Stewart; Shannon Eason Subject: May 4th - BOC Agenda Item Attachments: 2015 -0504- Backup -911- Center- MOU- Amendment.pdf Importance: High Gina, Please put the attached item on the May 4, 2015 BOC Consent Agenda. It has been through our Legal Dept and Johnston County Legal Dept and signed by Mr. Burgin. It has not been on a previous BOC Agenda. Johnston County is also putting this on their BOC Agenda to be signed. If you have any questions please let me know. Thanks, Clint Williams, ENP GIS /E -911 Operations Administrator Harnett County GIS /E -911 305 W. Cornelius Harnett Blvd, Suite 100 Lillington, NC 27546 Office: 910 - 893 -7523 Desk: 910 -814 -6371 Fax: 910 - 814 -8251 E -Mail: cwilliams@harnett.org Board Meeting Agenda Item Agenda Item 14 a MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: EMS Billing Writeoffs for 2015 REQUESTED BY: Kimberly Honeycutt, Finance Officer REQUEST: Enclosed are the delinquent accounts determined to be at write off status for the 2015 year. All of these accoaunts have been delinquent for more than seven years and total $1,308,672. The facilitation of these write offs is an important step in managing our collections and bad debt. The billing office has been utilizing the Local Government Debt Setoff Program to help collect delinquent patient accounts since December of 2007. To date, we have collected over $ 828,000.in delinquent accounts, through the Debt Setoff Program. Please place this request on the consent agenda at the next available meeting. FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: S :\Deanna\Emerg Medical Serv\FY 2015 \EMS Write off agendaform2015.doc Page 1 of 1 EMS Receivable Write Off OVER 2555 DAYS (7 + YRS) ANDERSON CREEK $ 130,931 BENHAVEN $ 153,113 BOONE TRAIL $ 73,012 BUIES CREEK $ 59,992 COATS $ 76,932 DUNN $ 222,459 ERWIN $ 107,736 HARNETr 911 $ 290,321 HARNETTTRANSPORTS $ 194,176 TOTAL $ 1,308,672 While the EMS Billing office has been using NC Debt Setoff for collections of past due patient bills, we have found over the past several years that once an account reaches a certain age, we are no longer receiving a significant amount of payments on those accounts. We believe that we are utilizing Debt Setoff fully, and would therefore like to write off the balance over seven years as uncollectable. No balances have been written off since 2009. The receivable balances will be reviewed for potential write offs every six months going forward. Agenda Item Board Meeting Agenda Item MEETING DATE: May 4, 2015 TO: HARNETT COUNTY BOARD OF COMMISSIONERS SUBJECT: Addition of Friday Service at Harnett County Public Library REQUESTED BY: Patrick Fitzgerald REQUEST: The Harnett County Public Library respectfully requests that an addition be made to the current Library hours of operation to include Fridays from 9atn to 5pm. The Harnett County Board of Trustees recently voted in favor of the change by a vote of 9 to 0. The addition would provide a benefit to the public in delivering more comprehensive coverage throughout the week and raise our total service hours from 48 to 56. Further, it would also allow us to work more effectively with our Affiliate Town libraries, all of which have Friday service. e4 ec4 -;ve I y 1 ao I5 FINANCE OFFICER'S RECOMMENDATION: COUNTY MANAGER'S RECOMMENDATION: C:'• Users' pfitzgerald y Documents +agendaform2015.doc Page 1 of 1 AGENDA ITEM 6 MAY 4, 2015 APPOINTMENTS NEEDED ADULT CARE HOME COMMUNITY ADVISORY COM 1T1'LE We need ten additional members appointed to serve on this committee. Members receive mileage reimbursement as claimed. This Committee was established to work to maintain the spirit of the Rest Home Sill of Rights and to promote community involvement and cooperation with rest homes, family care, and an integration of these homes into a system of care for the elderly. This group holds quarterly training and facility visits, Members receive mileage reimbursement as claimed. HARNETT COUNTY BOARD OF ADJUSTMENT We have a vacancy for District 1 on this board. HARNETT COUNTY PLANNING BOARD We have a vacancy for an at -large alternate member on this board. HARNETT COUNTY PUBLIC FACILITIES CORP. BOARD OF DIRECTORS We have a vacancy for an at -large member on this board. HARNETT NURSING HOME COMMUNITY ADVISORY COMMITTEE We need four additional members appointed to serve on this committee. This Committee was established to work to maintain the intent of the Nursing Home Resident Bill of Rights and to promote community involvement and cooperation with nursing homes.. This group holds quarterly training and facility visits. Members receive mileage reimbursement as claimed. HISTORIC PROPERTIES COMMISSION We currently have vacancies for regular members in Districts 2 and 5 as well as vacancies for alternate members on this commission. Page 1 - Appointments Agenda Item 7 North Carolina Forest Service 103 East ivy St Lillington, NC 27546 (910) 893 -4391 harnett.ncfs@a ncagr.gov 2014 Summary of Accomplishments in Harnett County 2014 NCFS Summary of Accomplishments in Harnett County County Resources Personnel POSITION NAME YEARS WITH NCFS County Ranger Assistant County Ranger Assistant County Ranger Forest Fire Equipment Operator Service Forester* Facilities Buren Fulmer Tom Steves Blake Johnson Jason O'Neal Brian Yeich Position 100% state funded 2 days per week in county. Headquarters - -- leased Harnett County office space Equipment Storage Building - -- Cameron Hill - -- 30+ years old Miscellaneous structures: 21 19 1 16 10 Cameron Fire Tower Mamers Fire Tower Used mobile home at Cameron Vehicles & Heavy Equipment YEAR MODEL 2008 Ford 350 - Type 6 Engine 2013 Ford 350 - Type 6 Engine 2014 Ford 350 - Type 6 Engine 2006 Ford 350 2008 Sterling Truck /Tractor & lowboy trailer 1998 TD 12 Crawler Tractor with fire plow 2 MILES 137,420 34,941 12,746 134,620 24,689 2,762 tach hrs 2014 NCFS Summary of Accomplishments in Harnett County FOREST RESOURCES & ECONOMIC STATISTICS Forest management and reforestation activities added over 2.4 million dollars to the Harnett County economy during 2013. These efforts also provided seasonal work for site preparation contractors, logging crews, planting crews and pre- commercial thinning crews. Continued management of reforested areas should result in estimated future economic benefits of over 3.1 million dollars. Forest Resources Commercial forest land (Protected by NCFS from wildfire, insects & disease) Privately owned forest land (Eligible for NCFS management assistance) Estimated forest volume Estimated timber value Economic Statistics Total Federal Cost Share (CRP) Rental Payments Total Federal Cost Share (CRP) Cost Share Payments Total Federal Cost Share (EQ1P) Total State (FDP) Cost Share Program monies received by landowners Estimated value of timber harvested on private lands TOTAL ADDED TO ECONOMY Future value added to County Econom Estimated value of new pine plantations in 35 years y 3 X83,400 acres 176,300 acres 788,206,716 cu. ft. $810,834,666 $73,783 $1540 $37,000 $36,081 $2,271,200 $2,419,604 2014 $3,113,432 2014 NCFS Summary of Accomplishments in Harnett County FOREST MANAGEMENT In 2014, 187 landowners were assisted by the N.C. Forest Service and 160 Forest Management Plans were prepared, placing an additional 7,584 acres under active forest management. Forest Management Plans include a field visit by a Service Forester and County Forest Service representative. During the field visit an examination of the land is made and written recommendations are made. Recommendations concerning timber harvesting, timber stand improvement and reforestation are given, taking into account both the goals of' the landowner and sound management practices that protect and enhance wildfire and water quality. Based on Forest Service recommendations, 1,049 acres were planted with trees. 1,360 acres of timber were harvested on NCFS projects. 2013 2014 Management Plans prepared: 102 160 Acres in plans: 4,640 7,584 Acres of site preparation: 654 597 Acres planted (trees): 1,053 1,049 Acres of natural regeneration: 0 0 Acres of timber harvested on NCFS projects: 1,344 1,360 Acres of Wildlife Habitat Improvement: 44 45 Acres of Best Management Practices: 442 3,596 Implemented Number of landowners assisted: 192 187 Water Quality Forest Practice Guidelines inspections: (in compliance) 54 42 Acres of Release (chemical) Acres of Pre - commercial Thinning (SPBPP) 4 173 236 83 245 2014 NCFS Summary of Accomplishments in Harnett County FOREST MANAri trMENT Harnett County Landowners Planting Trees JC Adams Jack Allen Dan Andrews Linda Andrews Ramon Atkins Freddie Brown John Buchanan Cameron Hill Church Lester Chalmers 'OIUlt CAROLINA Jeff Lucas Robert Morgan Henrietta Murray Ross Pittman Senter Family Smith Heirs Mollie Taylor Melanie Weaver Lois Wester Clint Williams 5 Rick Cotton Mike Dixon Paula Dunham Shirley Engle David Etheridge Carolyn Johnson Ruth Kinton Langston Family Trust Lloyd Enterprises 2014 NCFS Summary of Accomplishments in Harnett County FOREST STEWARDSHIP Allen Jones Bobby Wellons Bryan Raynor David Walker Elizabeth Grady Miranda Fleming George Isbell Graham Byrd Steve Hardee Buren Fulmer Tom Steves Brian Yeich Darrel Harrington Deanna Nobles Brian Parrish The Forest Stewardship Program is a cooperative effort involving several agencies and forestry professionals. It is designed to encourage landowners to manage their natural resources, to enhance timber, fish and wildlife, water, soils, and aesthetics. Below is a list of Harnett County Forest Stewardship Committee members and the agencies with which they are associated. N.C. Forest Service N.C. Forest Service N.C. Forest Service Natural Resources Conservation Service N.C. Wildlife Resources Commission Co -op Extension Chairman Approved Landowners Working Towards Certification King Roberts Ernest Alphin David Ward Johnny Steves Kenneth Byrd STM Farms Steve Hardee Jeff Swire Dustin Cashwell William Bell Frank Stump Dennis Shackelford Darin & Carrie Bibbens William J. Senter Parks Blake Headwaters LLC William Parrish Dirt Poor Farms, LLC Joe Harrill Mike Taylor Don Wellons Heinz & Mary Senign Graham Byrd Joey Strickland Derck Walker John E. Thornton Certified Stewardship Landowners - 2014 Roscoe Frizzelle Keith Chatellier Bill Carter John Ulam Ann Dougherty Terry Herndon Buren Fulmer Pat Spearman Robert Jones Thomas Blue Rick Rodgers John Bullard Summervilla Corp. Don Anderson Tom Irvin Mike Turner Wayne Fortenberry Paul Soublet Gareth Brookhart Sue Ross Larry Weathers David Averette J E Howard Richard Bogan Gary Pierce David Dummond Darin Burns Tony Hendricks Joe Byrd Dr. Richard Cotton David Whaley Bruce Fortenberry Mike Cardwell Tom Steves Timothy Holder Bill Carter Mark Bullard David Serina Clarence Marks 6 2014 NCFS Summary of Accomplishments in Harnett County WILDFIRE RESPONSE in 2014, the NCFS in Harnett County responded to 117 wildfires that burned 254 acres. Fifty eight (58) warning tickets were issued to burning offenders, along with 4 court cases. Fire Control 2013 2014 Number of forest fires controlled: 127 117 Number of' acres burned: 188 254 Threatened buildings / homes saved: 154 119 Value of buildings / homes saved: $9,740,000 8,747,000 Law Enforcement Number of' warning tickets issued: Number of court cases: Fire Prevention 2013 2014 64 58 1 4 2013 2014 Number of school programs: 4 5 Number of exhibits / displays: 5 5 Acres of hazard reduction and wildlife burning by NCFS 546 484 & landowners: 7 2014 NCFS Summary of Accomplishments in Harnett County INSECT & DISEASE CONTROL At this time there are no major forestry insect or disease problems in Harnett County. If informed of Southern pine beetle activity, County Forest Service personnel undertake the following activities: 1. The site is located and the affected landowner is informed; 2. Control measures are communicated to landowner; 3. NCDFR personnel assist landowner with marking infected trees and coordinating harvest of same. 0 2 - Aerial Surveys done in 2014 INFORMATION & EDUCATION Accomplishments in 2014 include: Smokey Bear Program Linden Oak School Holly Springs Family Fun Day Friend Raven Rock Fun Day Career Fair Triton High School Harnett Central High School Shawtown School Western Harnett High School Overhills High School 8 Parades Coats Christmas Parade Erwin Christmas Parade Angier Christmas Parade Coats Farmer's Day Public Events National Wild Turkey Federation jakes Day Carolina Lakes Firewise Day Harnett Environmental Field Day Kiwanis Meeting NC Tree Farm Annual Meeting Envirothon 2014 NCFS Summary of Accomplishments in Harnett County SPECIAL PROJECTS • NC Tree Farm Annual Meeting + Harnett County Forestry Association Assisted Harnett County Fire Marshall with searches Fire Wise Community USA at Carolina Lakes • Harnett County Environmental Field Day - YVille Elementary School Behaven Elementary School AG Science Day - 5th graders Angier Elementary School LaFayette School CURRENT NEEDS 5th graders Lillington Shawtown School Boone Trail School Service to the citizens of Harnett County will be enhanced by purchase of the following item: + ATV 9 2014 NCFS Summary of Accomplishments in Harnett County Machine Use (3) Miscellaneous (13) Harnett Fires 2014 FireCause (Number of Fires) Debris Burning (61) 10 SAND ITT ,LS C T ,�gendaItem A LOCAL MANAGEMENT ENTITY - MANAGED CARE ORGANIZATION MANAGING MENTAL HEALTH, INTELLECTUAL /DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES 910.673.9111 i3 (FAX) 910.673.6202 WWW.SANDHILLSCENTER.ORG n VICTORIA WHITT, CEO March 11, 2015 Mr. Joseph Jeffries Harnett County Interim Manager PO Box 759 Lillington, NC 27546 Dear Mr. Jeffries: During its March 10th meeting, the Sandhills Center Board of Directors discussed the issue of our County General Budget Request from our nine (9) constituent counties for FY 15 -16. Based on a review of the current fiscal situation that impacts our State and counties, it was decided that the Center would not request an increase in County General Funding from Harnett County. Therefore, Sandhills Center's FY 15 -16 County General Budget Request for Harnett County is as follows: Current County General Allocation: $ 199,679 Total FY 15 -16 County General Request: $ 199,679 Total Per Capita Allocation: $ 1.57 Note: See Attached County General Funding Chart. Total Harnett County Funding Request $ 199,679 In considering this request, please note the following: • Sandhills Center has not requested an increase in County General Funding during the past eleven years. • All County funding received is directed in support of local County Behavioral Health Urgent Access /Crisis Clinics, unless otherwise designated. • County General Funding is critical to sustaining the current level of crisis /psychiatric services for the consumers and families in Harnett County. Any reduction in that funding will result in a reduction in the services offered locally. If you have any questions concerning the Center's budget request for FY 15 -16, or any other issue associated with Sandhills Center, please feel free to contact me. Thank you for your continued support of Sandhills Center and the services we manage. The Center's Board of Directors and staff are committed to providing the citizens of Harnett County with quality, cost - effective services. I look forward to the opportunity to present the Center's budget request to your county commissioners in the near future P.O. Box 9, West End, NC 27376 Serving Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, & Richmond Counties Available 24 hours a day at 1- 800 -256 -2452 ACC RICDI7 P.D Victoria Whitt Chief Executive Officer Attachment cc: Ms. Barbara McKoy, Harnett County Commissioner Ms. Kimberly Honeycutt, Harnett County Finance Officer SANDHILLS CENTER COUNTY CONTRIBUTIONS FY 15 -16 COUNTY JULY 1, 2014 ESTIMATED POPULATION ACTUAL COUNTY GENERAL CONTRIBUTION FY 14 -15 PROPOSED COUNTY GENERAL CONTRIBUTION FY 15 -16 COUNTY GENERAL PER CAPITA CONTRIBUTION FY 14 -15 ANSON 26,638 $ 55,000 $ 55,000 $ 2.06 GUILFORD 516,089 $ 9,674,000 $ 9,674,000 $ 18.75 HARNETT 126,870 $ 199,679 $ 199,679 $ 1.57 HOKE 51,865 $ 58,000 $ 58,000 $ 1.12 LEE 60,628 $ 240,000 $ 240,000 $ 3.96 MONTGOMERY 28,216 $ 60,775 $ 60,775 $ 2.15 MOORE 92,992 $ 505,372 $ 505,372 $ 5.43 RANDOLPH 142,531 $ 844,000 $ 844,000 $ 5.92 RICHMOND 46,223 $ 147,000 $ 147,000 $ 3.18 TOTALS 1,092,052 __$ 11,783,826 $ 11,783,826 $ 10.79 SAND ITT 1T I5 C A LOCAL MANAGEMENT ENTITY - MANAGED CAR Agenda Item MANAGING MENTAL HEALTH, INTELLECTUAL /DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES 910.673.9111 (FAX) 910.673.6202 ti WWW.SANDHILLSCENTER.ORG El VICTORIA WHITT, CEO April 15, 2015 Ms. Kimberly Honeycutt Harnett County Finance Officer PO Box 759 Lillington, NC 27546 Dear Ms. Honeycutt: Attached you will find a copy of the Sandhills Center Quarterly Fiscal Report for the period March 31, 2015. This required State Division of Mental Health, Developmental Disabilities and Substance Abuse Services Report has been sent, on a quarterly basis, to each of the County Managers and County Commissioners in the Sandhills Area for a number of years. Please note that a revision to G.S. 122C- 117(c), enacted by the 2006 General Assembly, requires that this Report be sent directly to each County Finance Officer. More specifically, the revised Statute requires that: "The County Finance Officer shall provide the Quarterly Report to the Board of County Commissioners at the next regularly scheduled meeting of the Board." It should also be noted that the Statute requires that these Reports be submitted to the County Finance Officer within 30 days of the end of each quarter of the fiscal year. A review of the attached March 31, 2015, Quarterly Fiscal Report indicates the following: Actual Revenues = $ 255,816,786 Actual Expenditures = $ 211,338,334 Revenues in Excess of Expenditures = $ 44,478.452 Should you have any questions on this Quarterly Fiscal Report, please feel free to contact myself or Martha Rogers (Finance Director). Thank you for your assistance in addressing the requirements of our fiscal reporting requirements. S incerel /114-- Victoria Whitt Chief Executive Officer Attachment cc: Joseph Jeffries, Harnett County Manager Barbara McKoy, Harnett County Commissioner P.O. Box 9, West End, NC 27376 Serving Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, & Richmond Counties Available 24 hours a day at 1- 800 - 256 -2452 Revenues Medicaid Pass Thru Budgeted Fund Balance Other Local Total Local Funds Sandhills Center Quarterly Fiscal Monitoring Report For The Period Ending March 31, 2015 Item County Appropriations (by County Including ABC Funds) Anson Guilford Harnett Hoke Lee Montgomery Moore Randolph Richmond Total County Funds Local Management Entity Systems Admin Medicaid General Admin Medicaid Mental Health /Substance Abuse Treatment Planning Medicaid Intellectual /Developmental Disabilities Treatment Planning Division of Medical Assistance Risk Reserve Funding Division of Mental Health /Intellectual Developmental Disabilities /Substance Abuse Services Division of Medical Assistance Medicaid Capitation Funding All Other State /Federal Funding Total State and Federal Funds Total Revenues Medicaid Budget Actual Year 2014 -2015 To Date State Budget Actual Year 2014 -2015 To Date Tota 0 0 500,000 50,782 50,7E 292,795 223,406 223,4C 0 0 792,795 274,188 274.1F 0 0 55,000 9,674,000 199,679 41,250 7,255,502 0 17,624,453 3,883,354 5,431,264 5,431,264 239,192,881 271,563,216 13,701,915 3,019,066 4,222,470 4,226,286 192,568,626 217,738,363 58,000 240,000 60,775 492,122 844,000 147,000 11,770,576 3,505,766 32,594,417 5,387,162 41,487,345 149,759 31,356 180,000 45,581 492,122 633,100 112,423 8,941,093 2,629,323 24,087,268 2,146,551 28,863,142 Expenditures Local Management Entity Systems Admin Medicaid General Admin Medicaid Mental Health /Substance Abuse Treatment Planning Medicaid Intellectual /Developmental Disabilities Treatment Planning Medicaid Risk Reserve Medicaid Provider Payments State /Local Provider Payments All Other State /Federal Provider Payments IBNR (Incurred But Not Reported) Total Expenditures Ch ge In Cash balance 271,563,216 217;738,363 17,624,453 3,883,354 5,431,264 5,431,264 239,192,881 9,505,633 2,061,697 3,117,862 0 158,025,959 2,667,345 271,563,216 175,378,496 54,050,716 4,089,283 49,961,433 38,078,423 2,798,833 33,161,005 54,050,716 35,959,838 41,25 7,255,50 149,75 31,35 180,00 45,58 492,12 633,10 112,42 8,941,09 2,629,32 13,701,91 3,019,0E 4,222,47 4,226,28 24,087,26 192,568,62 2,146,55 246,601,50 255,816,78 2,798,83. 9,505,63: 2,061,69: 3,117,86: 158,025,955 33,161,00 LME -MCO Director Date LME -MCO cc: County Manager for each county within the catchment area.