071222 ws packet
WORK SESSION AGENDA
Date: Tuesday, July 12, 2022
Time: 9:00 a.m.
Location: Commissioners Meeting Room Harnett County Resource Center & Library 455 McKinney Parkway, Lillington
Harnett County Board of Commissioners
Page | 1
1. Call to order – Chairman Lewis Weatherspoon
2. Pledge of Allegiance and Invocation – Commissioner Brooks Matthews
3. Update on Farm-City Week; Tim Mathews; Harnett County Extension Director
4. Discuss a request from the Home Builders Association of Raleigh – Wake County to waive fees for the construction of a home at 64 Providence Creek for a wounded veteran; Home Builders Association of Raleigh - Wake County
5. Discuss JCPC request for permission to submit county plan program agreements for the NC Department of Public Safety, Juvenile Crime Prevention Council programs for FY2022-2023; Kimberly Whitted, Juvenile Crime Prevention Council
6. Discuss Dunn Fire Inspections and Plan Review 3 Year Agreement; Larry Smith, Emergency Services Director
7. Discuss Library Consolidation and budget; Angela McCauley, Library Director
8. Discuss Program Income Policy and Allowable Costs & Costs Principles Policy; Christopher Appel, Senior Staff Attorney
9. Discuss Riverside Flood Project Ordinance; Coley Price, Assistant County Manager
10. County Manager’s Report - Brent Trout, County Manager
• July 18, 2022 Regular Meeting Agenda Review
• Upcoming meetings and invitations
11. Closed Session
12. Adjourn
CONDUCT OF THE JULY 12, 2022 MEETING
Live audio of the meeting will be streamed on the Harnett County Government’s YouTube Channel
at https://www.youtube.com/channel/UCU7mTF6HTD65x_98EhAMeMg/featured.
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Board Meeting
Agenda Item
MEETING DATE: JULY 18, 2022
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: Request to waive permit fees and sewer/water fees for a home to be built at
lot 64 in Providence Creek for a wounded veteran.
REQUESTED BY: Home Builders Association of Raleigh- Wake County
REQUEST:
The Home Builders Association of Raleigh –Wake County is requesting a fee waiver to
support their Operation: Coming Home (OCH) initiative. The amount being requested is
$1000 for the permit fee and $4840 for the water/sewer fee for a home to be built at lot 64 in
Providence Creek for a wounded veteran.
This will be the 13th Operation: Coming Home OCH project, and the fourth in Harnett
County. The organization is planning to hold a groundbreaking event in July with a delivery
of the home in November. OCH, is a non-profit organization; therefore Mattamy Homes
donates the lot and oversees the build, while depending on our trade partners to donate labor
and materials. We will deliver this home to a deserving veteran free of charge. We are asking
for you to help donate to this cause by waving the $1000 permit fee and the $4840
water/sewer fee for this lot. We ask for the opportunity for this to be presented to the
Commissioner on our behalf. I have provided a link to the OCH homepage for additional
information about the program. https://www.hbawake.com/about-operation-coming-
home.html
FINANCE OFFICER’S RECOMMENDATION:
COUNTY MANAGER’S RECOMMENDATION:
Item 4
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Juvenile Crime Prevention Council County Plan
Harnett County
FY 2022-2023
Table of Contents
I.Executive Summary
II.Harnett County Funding Plan
III.Harnett County Juvenile Crime Prevention Council Organization
IV.Harnett County Risk and Needs Assessment Summary
V.Harnett County Juvenile Crime Prevention Council Request for
Proposals
VI.Funding Decisions Summary
VII.Funded Programs Descriptions
Attachments:
Funded Program Agreements
JCPC Program Monitoring Reports
JCPC Certification
Item 5
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I. Executive Summary
The Harnett County Juvenile Crime Prevention Council (JCPC), in fulfillment of the duties and
responsibilities as set forth in the General Statutes of the State of North Carolina, has reviewed
and updated the County Plan.
The JCPC has identified the issues and factors which have an influence and impact upon
delinquent youth, at-risk youth, and their families in Harnett County. Further, the JCPC has
identified the strategies and services most likely to reduce/prevent delinquent behavior.
JCPC Action Plan Progress:
We have consistent attendance at meetings and committed members. This fiscal year, the Harnett
County JCPC has continued to emphasize prioritizing youth that have been referred by the
Department of Juvenile Justice and to ensure the JCPC and funded programs met the
requirements given by the NC Department of Public Safety.
Priorities for Funding:
The risk and needs assessment and resource assessment has determined that the following
services are needed to reduce/prevent delinquency in Harnett County:
1. Parent/Family Skill Building
2. Mentoring Services
3. Vocational/Independent Living Skills
4. Clinical Assessments
5. Substance Abuse Treatment
6. Sex Offender Treatment
7. Tutoring/Academic Enhancement
8. Restitution/Community Service
9. Teen Court/Restorative Justice
10. Mediation/Conflict Resolution
11. Group Home Care
12. Runaway/Respite Shelter Care
13. Juvenile Structured Day Programs
14. Interpersonal Skill Building
15. Individual/Family Counseling
Monitoring and Evaluation:
Each program funded in the past year by the JCPC has been monitored. The monitoring results
and program outcomes evaluations were considered in making funding allocation decisions. The
JCPC continues to conduct implementation monitoring of its action plan and its funded programs
on a quarterly basis. (See attached monitoring reports.)
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Funding Recommendations:
Having published a Request for Proposals for these needed services for a minimum of thirty (30)
days, the JCPC has screened the submitted proposal and has determined which proposals best
meet the advertised needed services. The publication of the Request for Proposals was on
December 21, 2021 and the deadline date was March 1, 2022.
As required by statute, the JCPC recommends allocation of the North Carolina Department of
Juvenile Justice and Delinquency Prevention (NC DJJDP) funds to the following programs in the
amounts specified below for the upcoming fiscal year. (See JCPC funding description summary
and funded program descriptions.):
1. 4-H Teen Court - $35,000
2. Harnett County Juvenile Restitution - $88,000
3. Harnett County Sheriffs Department PAL Program - $64,00
4. Healthy Choices - $24,591
5. PAL Academic Career Readiness and School Kids In Power (SKIP) - $92,954
The JCPC further recommends that the amount of $15,500 be allocated from the NC DJJDP
funds for the administrative costs of the Council, which will include hiring a part time JCPC
Coordinator.
The funding planning sessions for the past two fiscal years have been challenging and the JCPC
has had to make difficult decisions to prioritize cost-effective dispositional alternatives and
intervention programs available for youth to (1) provide intervention when juveniles come to the
attention of the juvenile justice system; (2) prevent deeper engagement in the system; or (3)
prevent interfaces with juvenile justice as a solution to reducing delinquent behaviors. The
amount of funding available limited the JCPC’s ability to fund new initiatives or expand current
initiatives at all sponsoring agency’s requested capacity.
The JCPC makes the following additional recommendations to (or brings the following to the
attention of) the Harnett County Board of Commissioners:
1. Part of each county’s responsibilities when partnering with NCDPS is to plan for a
permanent funding stream for delinquency prevention programs to supplement the JCPC
allocation. Harnett County requires that program providers provide a 10% match of allocated
funds. In order for Harnett County to develop a strong array of JCPC services, the JCPC is
recommending the following in Harnett County’s next budget planning sessions in FY 2022-
23 for FY 2023-24:
a. That Harnett County increase its match to supplement the NCDPS/JCPC revenues.
b. That Harnett County make the investment annually to assist the JCPC in enhancing
the service array to prioritize needed programs that address risk and need factors
identified by the JCPC Risk and Needs Assessment Committee.
2. The JCPC supports local coalitions, collaborations, partnerships, and projects to bring models
of best practices to JCPC funded programs and other grass roots agencies. This serves to
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develop the professional capacity of those working with at-risk youth throughout the
community, which is part of the JCPC’s mission to create awareness and a more efficient
community response to juvenile crime and delinquency.
3. The local JCPC is committed to reducing racial and ethnic disparities to address the
disproportionate number of minority youth who have contact with the juvenile justice
system. The JCPC seeks to impact outcomes at decision points in the juvenile justice system
through research, community planning and the development of strategies to educate referral
agents on community intervention programs designed to address juvenile crime and
delinquency before juvenile justice system entry.
Respectfully Submitted,
Kimberly Whitted
Chairperson, Harnett County Juvenile Crime Prevention Council
Date: July 06, 2022
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II. Harnett County Funding Plan
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III. Harnett County Juvenile Crime Prevention Council Organization
Name Organization Title
Chairperson Kimberly Whitted Campbell University Director, Technology
Infrastructure &
Operations
Vice-Chairperson Roseanne Teniente Public Consulting
Group
Human Services
Consultant
Secretary Matthew Willis Harnett County
Register of Deeds
Register of Deeds
Number of Members: 18
List meeting dates during the current fiscal year and identify the number of JCPC members in
attendance for each.
Meeting Date Number of Members in
Attendance
Quorum Present? Yes/No
August 16, 2021 12 Yes
September 20, 2021 11 Yes
October 18, 2021 10 Yes
November 15, 2021 12 Yes
December 20, 2021 10 Yes
January 24, 2022 12 Yes
February 21, 2022 12 Yes
March 21, 2022 13 Yes
April 18, 2022 11 Yes
May 16, 2022 9 Yes
June 21, 2022 11 Yes
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FY2021-22 Harnett County JCPC Committees
Committee Description Member
Assignments
Risk and Needs
Assessment
Committee
Evaluates community risk and needs and develops a
continuum of services available to youth in Harnett
County; Makes a recommendation to the JCPC for local
programming needs to fill gaps of services; identifies
protective factors that will enhance the lives of youth and
families in the community; Develops Request for Proposals
and presents written report and RFP at November meeting;
Area Consultant will provide training and technical
support. The written report and RFP is required and
included in the JCPC Annual Plan and Certification.
Rose Teniente
Michael
Onufer
Millicent
Williams
Barbara
McKoy
Avis Watkins-
Smith
Monitoring
Committee
Evaluates the effectiveness of existing programs and makes
recommendations to the Council for changes, if needed;
including whether or not a program(s) should receive
continue funding for the current fiscal year. Program
Monitoring occurs during the December-January timeframe
with monitoring reports being provided at the February
meeting. Area Consultant will provide training and
technical support.
Matt Willis
Cindy
Delgado
Carl Davis
Dominic
Alvarado
Jermaine
White
Debbie
Chiovitti
Funding Committee After the RFP developed by the Risk and Needs Committee
is advertised for 30 days, the Funding and Review
Committee meets to review and score program
applications. The committee participates in applicant
interviews; deliberates funding amounts to applicants; and
makes funding recommendations to the full Council. The
Funding and Review Committee may meet at other times
Cindy
Delgado
Tracy Hair
Adrian
Standish
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of the year to make recommendations for funding that may
become available.
Mary Spell
Nominations/Bylaws
Committee
Identifies and recruits new members, as necessary; keeps
youth serving agencies; recommends/recruits a slate of
officers including securing each individual’s consent to
serve; developing and presenting Bylaw changes for
adoption, as directed by the Chair.
Matt Willis
Letitia
Maynor
Avis Watkins-
Smith
Kimberly
Whitted
Racial and Ethnic
Disparities Committee
Conducts relevant planning and define action steps to
address disproportionate minority representation among
juveniles in Harnett County; identify key partnership
potential to address unsupervised youth and employment,
mentorship or apprenticeship opportunities.
Rose Teniente
Michelle
Bennett
Kimberly
Whitted
Jermaine
White
Avis Watkins-
Smith
Public Awareness
Committee
Raises awareness of JCPC and community resources for at-
risk youth and encourage program participation by youth,
especially those involved in the court system; appropriates
governmental and community boards to make the general
public aware of existing services and the unmet needs in
the community.
Rose Teniente
Lynn Herring
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IV. Harnett County Risk and Needs Assessment Summary
I. Risk Assessment Summary
II. Needs Assessment Summary
III. Summary of the Existing Community Resources
IV. Summary of Gaps and Barriers in the Continuum of Services
V. Proposed Priority Services for Funding
Part I. Risk Assessment Summary
The Risk and Needs Assessment Committee reviewed data gleaned from the Juvenile Risk
Assessment instrument administered by Juvenile Court Counselors after juveniles are referred
with a complaint alleging that a delinquent act has occurred and prior to adjudication of the
juvenile. The Juvenile Risk Assessment is an instrument used to predict the likelihood of the
juvenile being involved in future delinquent behavior. For some youth, some of the individual
item ratings may be heavily dependent upon information reported by the juvenile or the
parent(s). For these items (represented by percentages which have a star next to them), there is a
likelihood of under-reporting the incidence of a particular behavior and the actual incidence may
be higher than suggested by these figures. In those cases, the figure should be interpreted as a
measure of the minimum level of occurrence.
County Risk Factor Observations: FY
Harnett County has seen an enormous decrease in the total number of youth dispositions in
FY21, dropping to 93 from 197 in the previous fiscal year. Despite the decrease in the number
of youth with dispositions, the total number of juvenile complaints in FY21 (476) is the highest
number in the past 4 fiscal years, with nearly all originating outside the school environment.
FY21 has seen upward trends in the number of youth assessed as being at the highest two risk
levels (RL4 and RL5), which means that they are at higher risk of future offending. Of the 93
youth assessed with NC Juvenile Risk Assessment, 68% were assessed at RL4-5, and of the 79
assessed via the YASI Screening, 20.3% were assessed as high risk, compared to the state level
of 16.7%.
Previous delinquency for Harnett County has been trending upward, with 20% of youth having
four or more prior referrals, up from 10% the previous year. Additionally, the percentage of
youth with prior class F-1 felonies or A-1 misdemeanors has seen an increase to 17% in FY21,
up from 12% the previous year. A larger percentage (19%) had been involved in prior assaults
(without a weapon) up from 13% in FY20.
The past two fiscal years have seen steady increases in substance use, with 36% of adjudicated
youth having used substances or received some treatment for substance use, up from 22% in
FY19.
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There was a noted increase in the percentage of youth that had ever run away from their home
or placement, at 26% up from 17% percent the three previous fiscal years.
Relationships with delinquent peers has been trending upward in Harnett County, with 29%
regularly associating with delinquent peers at 29% and 8% of youth either being a gang member
or associating with gang members (up from 14% and 2%, respectively, in FY19).
There was an increase in the percentage of parents or guardians of youth that were unable to
supervise their teens, despite their willingness to do so. Another risk factor for Harnett County is
a lack of adequate supervision skills. 62% of youth adjudicated in FY21 came from homes
assessed as having marginal supervision skills, up from 37% in FY19.
Part II. Needs Assessment Summary
The Risk and Needs Assessment Committee also reviewed data gleaned from the Juvenile Needs
Assessment instrument administered by Juvenile Court Counselors prior to court disposition of a
juvenile. The Juvenile Needs Assessment is an instrument used to examine a youth’s needs in
the various domains of his life: The Individual Domain, The School Domain, The Peer Domain,
and the Community Domain. This instrument was designed to detect service intervention needs
as an aid in service planning. As with the Juvenile Risk Assessment, some of the individual item
ratings may be heavily dependent upon information reported by the juvenile or the parent(s). For
these items (represented by percentages which have a star next to them), there is a likelihood of
under-reporting the incidence of a particular behavior and the actual incidence may be higher
than suggested by these figures. In those cases, the figure should be interpreted as a measure of
the minimum level of occurrence.
County Elevated Needs Observations: FY
There were 93 dispositions in Harnett County for the fiscal year 2020-2021. Of the 93 youth with
adjudications, 35% were considered medium needs, up from 26% in FY19-20.
Another need centers around positive peer relationships. There was a marked decrease in
positive peer relationships from the previous fiscal year, and there were significant increases in
youth association with delinquent peers and gangs.
Nearly half of the youth with dispositions exhibited serious school behavior problems (45%),
with 14% below their normal grade level.
The past two fiscal years have seen steady increases in substance use, with 36% of adjudicated
youth having used substances or received some treatment for substance use, up from 22% in
FY19.
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44% of youth needed more mental health assessment and treatment (up from 33% in the
previous year), markedly higher than the state’s rate of 31%.
Another need of Harnett County is enhanced development of parenting and supervision skills.
62% of youth adjudicated in FY21 came from homes assessed as having marginal supervision
skills, up from 37% in FY19. This is also connected to the high rate of youth coming from homes
with other household members having prior histories of criminal involvement and juvenile
delinquency.
Lastly 42% of the youth came from homes where household members had criminal histories,
up from 34% last year, and 6% of families were under active court supervision or had known
gang affiliation. Additionally, of the 79 youth assessed with the YASI assessment in FY21,
39.2% came from homes with prior criminal history, compared to the state rate of 26.2%.
Part III. Summary of the Existing Community Resources
The Harnett County JCPC funded the following programs in FY 2021-2022:
4-H Teen Court
Extended Learning
Harnett County Juvenile Restitution
Healthy Choices
PAL Academic Career Readiness and School Kids In Power (SKIP)
Community Resources
WIOA Next Gen-Employment and Training services for youth age 16+
Sandhills Center (Harnett’s LME-MCO) offers behavioral health services, support,
education, and events for parents and children, as well as free online screening and
referrals.
Harnett County Schools Programs:
o Mental Health Program
o Behavior Intervention Program
o School Counseling Team
o Section 504 (Disability) Services,
o School Social Work Attendance and Truancy Intervention Program
o SafeSchools Alert (alert system for students, parents, and staff to report concerns
of bullying or harm)
o Say Something Program (teaches middle and high school students to recognize
the warning signs of someone at-risk of hurting themselves or others and how to
say something to a trusted adult to get help. The Say Something program aligns
seamlessly with any school’s existing SEL curriculum, instruction, and
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programming. Students build essential SEL competencies, including how to
empathize with others and seek help when needed (relationship skills) and how to
identify problems and analyze situations, as well solve problems in an ethically-
responsible manner (responsible decision-making).
Think Smart: Think Smart Outreach Center, Inc. is a non-profit youth organization
serving youth grades K-12 in Harnett and surrounding counties.
Boys and Girls Club of Harnett County
Healthy Choices-Family Pride (Parent Skill-Building Program)
NC Extension: 4-H Programming
AMIKids: AMIKids is a nonprofit organization in North Carolina that provides an array
of services for youth including mentoring, career and technical education, residential
treatment, as well as day treatment including Juvenile Justice Day Treatment, Alternative
Education (Charter, Infinity), After School, Delinquency Prevention, Family Services,
and Pre-Apprenticeship. While the nearest office location is in Durham, AMIKids service
providers are able to travel to meet youth and families in Harnett County.
Community Resources available but difficult to access
Part IV. Summary of Gaps and Barriers in the Continuum of Services
Barriers to JCPC Programs
Gaps and Barriers of other Community Programs
In general, most programs are located in central Harnett County, leaving other areas of the
county without access to JCPC-funded services. A future goal for the JCPC is to identify other
services and programs that are located in the areas of the county that have been underserved.
Other gaps in services include parent/family skill-building programs, vocational rehabilitation
services, job training and mentoring programs for teens.
A service missing in Harnett County includes sex offender treatment programs for youth.
While the rate of court-involved youth that have sexually victimized others is low compared to
other offenses (approximately 4.5% in FY21), the absence of treatment programs for these youth
is a concern.
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Part V. Proposed Priority Services for Funding
The committee compared the services needed to address the elevated Juvenile Risk Factors and
Juvenile Needs with services currently available in the community. Services which are currently
available in the community and sufficient to meet the needs of court involved youth or those
youth most at risk for court involvement are not considered as a priority for JCPC funding.
The Committee proposes that the following services in ranked order be approved as the
funding priorities for FY 2022-2023:
1. Parent/Family skill-building programs
2. Mentoring programs
3. Job Training programs
4. Mental health assessment
5. Substance use treatment
6. Sex offender treatment
7. Restorative justice/restitution programs
8. Teen Court
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V. Harnett County Juvenile Crime Prevention Council Request for
Proposals
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VI. Funding Decisions Summary
VII. Funded Program Descriptions
See the attached program agreements.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
North Carolina Department of Public Safety
JCPC Program - Program Agreement
SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:FY 21-22 DPS/JCPC FUNDING # (cont only)243-XXXX
COUNTY:Harnett AREA:Central Area
Multi-County:No Multi-Components Yes
NAME OF PROGRAM:PAL Academic Career Readiness
SPONSORING AGENCY:Dunn Police Athletic & Activities League, inc.
SPONSORING AGENCY
PHYSICAL ADDRESS:
1501 S. Clinton Ave.
Dunn NC 28334
SPONSORING AGENCY
MAILING ADDRESS:
PO Box: 1238
Dunn NC 28335
TYPE:Non-Profit FEDERAL ID #46-4258788
COMPONENT ID #NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF
EACH COMPONENT
32111 PAL (SKIP) School Kids In Power Tutoring/Academic Enhancement $ 54,480
32112 PAL Academic Career Readiness Vocational Skills $ 54,479
Total cost of components:$ 108,959
Program Manager Name & Address (same person on signature page)
Name:Rodney Rowland Title:Executive Director
Mailing
Address:
PO Box: 1238
City:Dunn Zip:28335
Phone:(910) 892-1873 Fax: E-mail:director@dunnpal.org
Contact Person (if different from program manager)
Name:Rodney Rowland Title:Executive Director
Mailing
Address:
PO Box: 1238
City:Dunn Zip:28335
Phone:(910) 892-1873 Fax: E-mail:director@dunnpal.org
Program Fiscal Officer (cannot be program manager)
Name:Emmett Aldredge III Title:Board President
Mailing
Address:
PO Box: 1238
City:Dunn Zip:28335
Phone:(910) 892-1873 Fax: E-mail:emmett.aldredge3@arc3gases.com
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION I B PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #COMPONENT INFORMATION
32111 NAME OF COMPONENT: PAL (SKIP) School Kids In Power
BRIEF DESCRIPTION: Tutoring and Academic Enrichment for youth 10-17 years old to
increase grades in school in reading and math, increase school attendance, decrease school
suspensions and increase positive social interactions. The SKIP Program through Dunn PAL
provides services to help supplement Youths' school curriculum by providing hands on learning
to include College and Career Readiness Classes. The program also provides an opportunity
for field trips designed to be an educational enrichment experience.
COMPONENT ID #COMPONENT INFORMATION
32112 NAME OF COMPONENT: PAL Academic Career Readiness
BRIEF DESCRIPTION: The Career Readiness Program works with youth 13-19 years old in
training and skills development in a specific job trade. This program will expose youth to work
and college related experiences: teach youth proper etiquette in dress, manners, interview
skills, communications skills, money management and job skills. Youth partner with local
companies for work experience. We will work and partner with Central Carolina Community
College, Harnett County Schools, and Harnett NC Works.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components Yes
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:PAL (SKIP) School Kids In Power Component ID #
32111
What is this component's maximum client capacity at any given time?20
Frequency of client contact per month:12 Anticipated Average Length of
Stay:60 Days
Total Component Cost:$54,480 ÷ by Estimated # to be served during funding period:20
Estimated Average Cost Per Youth:$2,724
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:0
0 Number of admissions Juvenile Justice Referred 0% of total admissions
0 Number of admissions Law Enforcement Referred 0% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
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 2016 Annual Report for the
sixth consecutive year the juvenile delinquency rate (juvenile crime) in the State of North Carolina has decreased. Also
according to this report, over that six-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. In 2016 187 youth were committed to youth development centers which were the lowest
level ever recorded and represents a 48% decrease since 2010. 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.
According to the North Carolina Department of Public Safety Division of Juvenile Justice 2016 Annual Report, Juvenile
Gang Involvement/affiliation has been on the rise since 2014 increasing a half percent each year.
Due to Raise The Age, NC (Ages 16-17) we will add more youth into the Juvenile Services Division.
Low classroom grades and test scores of students in school, in-school and out-of-school suspensions as well as
excessive absences and trouble in school lead to juvenile problems both in school and in the community. Lack of
positive social interaction with both peers and adults lead to juvenile problems. Juvenile Gang Affiliation being on the
rise leads to Juvenile Crime and all the above stated. Lack safe places and supervised learning instruction for youth
after school.
2. Target Population: Describe the target population, including age, and the steps taken to insure that the target
population is served.
The target population will be ages 10-17 boys and girls in Elementary through High School in the Harnett County area
in keeping with PAL's Mission Statement. Those targeted are youth with minor court involvement, At-Risk of Court
Involvement and may be referred by any of the following sources (Parents, Court Counselors, Police Officers, School
Teachers, School Counselors and Administration staff, Community Leaders, Youth Themselves, Guardians, relatives,
etc.). There is application process to be completed prior to admission. We will target youth via multiple resources to
include (newspaper, social media outlets, schools, online outlets and personal contact).
3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program.
The program will assist in educating the youth it serves with their homework, tutoring youth on specific subjects of
weakness, and computer training with internet access to improve the youth grades in public school. We hope to lower
youth problems in school and in the community by working with area schools, parents and law enforcement. In working
with multiple resources in the government and private sector we hope to help provide sound education along with work
experience to get youth to work and thus lower juvenile crime and lower youth problems such as lack of respect for
authority, lack of socially acceptable values and improving positive self image.
1. Provide a safe environment
2. Provide safe and supervised programs
3. Keep constant communication with all stake holders (Community and School)
4. Enhance Police and Community Relations to give positive interaction with youth
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 22
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
5. Provide a learning environment on each youths level
6. Provide hands on learning for youth
7. Track progress for success, deficiencies and enhancements
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.
80% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
80% Clients will actively participate in tutorial and/or academic enhancement activities as intended by program design/
the service plan.
80% Clients will have no new complaints with an offense date after the admission date.
80% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
80% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
80% Clients will improve academic skills/performance.
80% Clients will have no new adjudications for a complaint 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.
SKIP component will work with youth ages 10-17 years old who are At-Risk of becoming 1st time delinquent juveniles
or have a first offense currently. We will also work with youth who are At-risk or involved with negative and/or
delinquent peers. We also work with youth and their families to fill in the gap of lack of parental supervision. We will
accomplish this as stated below.
Youth (ages 10-17) tutoring and homework assistance are priority risk factors in Harnett County. We will address lack
of respect for authority, absence of positive role models and lack of socially acceptable values in the SKIP component.
PAL will strive to prevent and reduce juvenile crime in Harnett County by focusing on identifying, tracking and
educating the youth on their academic weaknesses which will make them strong mentally and lower problems in the
classroom. PAL will coordinate with schools and teachers to ensure the student is getting help in the proper classes.
Individual and group sessions will be provided to ensure quality performance of each student. A comprehensive
mentoring program is in place to provide each student a mentor to help with homework and access with them in school.
This is a partnership with Dunn Area Chamber of Commerce, local churches and citizens in the community that
provide mentors and they are assigned to work with youth to help with grades and be positive role models.
Furthermore, helping educate the parents is a vital role for them successfully working with their children.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 23
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
1. Location: List physical address(es) and describe where program services are delivered.
Dunn PAL Main Office/Education Building
1501 S. Clinton Ave.
Dunn, NC 28334
Dunn PAL Main Office/Education Building is where students each have a hot meal each day in our cafeteria, attend
computer classes, do their homework and enrichment classes. The PAL Education Building is where our students
meet each day to finish homework and have some enrichment sessions to include STEAM (Science, Technology,
Engineering, Arts and Math).
2. Operation: Describe the daily/weekly schedule of program operation.
Snack/Lunch - Monday, Tuesday, Wednesday and Thursday = 3:00-3:30 pm
Tutoring/Homework help - Monday, Tuesday, Wednesday and Thursday = 3:30-4:30 pm
Enrichment Classes - Monday, Tuesday, Wednesday and Thursday = 4:30-5:30 pm
The schedule is basic and subject to change depending on activities for the day.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
After-school Instructors will work with youth in a group setting with their homework and specific course subjects.
Staff will also be able to assist parents with the proper way to help their children as it relates to helping them with their
homework. This will be two paid part-time positions working no more than 35 hours a week. Instructors will also
conduct hands on learning through Media Arts and STEM classes as well as educational field trips.
Must have prior experience in helping youth with homework. Must be willing to help youth. Teacher Certificate
preferred.
____________________________________________________________________________________________
Alternative Instructor I - Current Employee has been employed since April 2018. She has a Masters in Psychology,
EMT/CPR Certified & Effective teacher training certified.
Duties & Responsibilities- Youth intake, parent intake, assist with after school tutoring/homework help & enrichment.
Coordinate with school teachers & collect surveys, assessments & report cards.
_______________________________________
Alternative Instructor II-Recent hire. She has a degree in BS in Criminal Justice & AAS Certified Paralegal. 1 year
experience substitute teacher at Ramsey St Alternative School, 1 year community sport paraprofessional at Great
Expectations Mental Health Services, 2 years experience Residential Treatment Supervisor/Qualified Professional at
Children's Home Inc in Franklin, NC. 2 years experience as a Youth Program Assistant III at Meridiam Behavior Health
in Silva, NC.
Duties and Responsibilities- Attend Harnett County JCPC meetings
Attend monthly meetings
Attend juvenile court regularly and admit any referrals from juvenile court
Prepare notes, reports etc in juvenile court on deferred youth
Maintain NC Allies JCPC grant data bases
Provide intake, progress and termination documentation of deferred youth and regularly communicate with juvenile
court, law enforcement and any other referrals of youth
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 24
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
Assist with after school tutoring/homework help and enrichment. Coordinate with school teachers and collect surveys,
assessments and report cards
_______________________________________
Administrative Assistant- Employed since June 2015
Duties and Responsibilities- Answer phones, data entry, process payments, may assist Alternative Instructor II as
needed and attend JCPC meetings with Alternative Instructor II
_______________________________________
After School/Summer Program Coordinator-Employed since May 2019
Duties and Responsibilities- Oversees Alternative Instructor I, II and all after school/summer staff
Partner with schools for student education, may attend JCPC meetings
Reports to Executive Director and acts as liaison for schools & service agencies
Interacts with parents about any concerns
Processes any disciplinary actions of youth in after school/summer programs
4. Service Type SPEP: Describe implementation to include:
Primary Service: Remedial Academic Program; Secondary Service: Work experience
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.
Any youth or parent seeking to enroll in this program will have to meet with the After-school Coordinator, complete an
admission application, complete an education agreement, agree to all rules and must attend 12 hours a week. The
approval of the admission process takes 2-3 days. The referral process for Dunn PAL is implemented by a referral
form that their parent/guardian, court counselors, law enforcement, school staff or social services can complete and
send to Dunn PAL. Dunn PAL will then have the student and parent/guardian complete a full application and submit it
to Dunn PAL for membership. Since Dunn PAL is voluntary, it will be the responsibility of the parent/guardian to assure
completion. Each youth is tracked in our on-line database and must re-apply every year from the date the membership
is received. Anyone may also register on-line at Dunn PAL's website www.dunnpal.org. The After-school Coordinator
may place a student on a waiting list if the program is full. The Coordinator may reject an applicant if there is any sex
related crimes or the coordinator feels after consultation with authorities that the child could pose a severe security risk
to other students. After the initial admission process is complete the student will begin attending the next business day.
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.
A youth can be terminated at anytime for rule violations, moving out of county, quitting school or graduation from
school. Termination can also occur if the youth satisfactory completes all assignments and grades are increased above
a C for the entire semester. A student may also be terminated if they fail to complete the required 12 hours a week
attendance that was explained at admission. The After-school Coordinator checks all grades at school and checks to
see if youth in in compliance with all terms set out prior to admission. The After-school Coordinator makes all
determinations on criteria being followed. The After-school Coordinator or his/her designee will determine termination
procedures and contact parent/guardian and the referral agency of compliance either successful, satisfactory,
unsuccessful or non-compliant termination.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 25
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
A successful termination is student completing all assignments and complete the year, satisfactory is completing all
assignments, unsuccessful is not completing assignments and the year also moving out of area, non-compliant is not
attending and/or suspension of rules while attending.
How is the referring agency involved with the termination process?
The After-school Coordinator checks all grades at school and checks to see if youth are in compliance with all terms
set out prior to admission. The After-school Coordinator makes all determinations on criteria being followed. The After-
school Coordinator or his/her designee will determine termination procedures and contact parent/guardian and the
referral agency of compliance either successful, satisfactory, unsuccessful or non-compliant termination. The JCPC
Coordinator, After-school program Coordinator and the referring agency/juvenile court counselor will coordinate
ongoing concerns and courses of action to include termination.
7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring
agencies including how client progress will be communicated.
The SKIP component will communicate with Juvenile Court/services and referring agency through the After-school
Coordinator, Mentor Coordinator and Youth Advocate of the Dunn Police Athletic/Activities League (Dunn PAL). The
SKIP Component will also partner with various organizations to help youth to be well rounded.
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 component will work with the local school systems and youth through the After-school Coordinator to help better
educate the youth in the program, thus increasing grades and reducing drop out rates. Dunn PAL SKIP is partnering
with the Dunn Area Chamber of Commerce, local churches and citizens to add the mentoring program with the tutoring/
academic enhancement component. Each youth will be matched with an adult or peer and
have one-to-one assistance.
9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon.
Structuring out of school time to improve academic achievement, We use the US Department of Education 21st
Century Community Learning Centers model. Curriculum will be followed by the Harnett County School System.
School textbooks and online resources will be used. Professional Development will also be used online https://y4y.ed.
gov/ and Harnett County Schools. We also have a Professional Development facilitator on site.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 26
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components Yes
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:PAL Academic Career Readiness Component ID #
32112
What is this component's maximum client capacity at any given time?20
Frequency of client contact per month:12 Anticipated Average Length of
Stay:60 Days
Total Component Cost:$54,479 ÷ by Estimated # to be served during funding period:20
Estimated Average Cost Per Youth:$2,724
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:0
0 Number of admissions Juvenile Justice Referred 0% of total admissions
0 Number of admissions Law Enforcement Referred 0% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 27
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL Academic Career Readiness
1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in
the county.
Academic enrichment for youth ages 13-19 to increase grades in school reading and math, increase school
attendance, decrease school suspensions and increase positive social interactions. Through Dunn PAL we will
provide services to help supplement the youths' school curriculum by providing hands on learning to include College
and Career Readiness. The program also provides an opportunity for youth to engage in work-site learning experience.
2. Target Population: Describe the target population, including age, and the steps taken to insure that the target
population is served.
The target population will be youth in grades 9-12 in Harnett County. In keeping with the Dunn PAL's mission those
targeted are youth who are considered at-risk. These youth may be referred by any of the following sources; Juvenile
Court Counselors, parents, counselors, police officers, teachers, community leaders, youth themselves, guardians/
parents, relatives, etc. There is an instruction process to be completed prior to job placement. We will target youth by
connecting with schools, personal contact and the media.
3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program.
The program will assist youth in educating them on their workforce skill set and the best career for them. We hope to
lower youth problems in school and in the community by working with schools, law enforcement, parents and
employers. In working with multiple resources in the government and private sector, we hope to help provide excellent
career readiness training where youth will learn essential skills along with the ultimate goal to get youth employed
while lowering the juvenile crime rate and lower youth problems at school and home.
-Provide a safe environment
-Provide safe and supervised programs
-Keep constant communication with all stake holders (community and school)
-Enhance Police and Community Relations to give positive interaction with youth.
-Provide a learning environment on each youth's level.
-Provide hands on learning for youth.
-Track progress for success, deficiencies and enhancements.
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.
80% Clients will actively participate in vocational skill building activities as intended by the program design/service
plan.
80% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
80% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
80% Clients will have no new complaints with an offense date after the admission date.
80% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 28
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL Academic Career Readiness
completion.
80% Clients will increase overall knowledge of vocational skills or readiness to enter the workforce.
80% Clients will have no new adjudications for a complaint 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 Career Readiness Program will work with youth ages 13-19 who are identified through Raise The Age as being at-
risk of becoming first time delinquent juveniles or have a first offense currently, we also will be proactive in finding
resources and training for youth who may have reports of substance abuse issues, work with other providers on mental
health issues and work with youth that have low to serious behavior problems at school. We will also work with
youth who are at-risk or involved with negative and/or delinquent peers or have a lack of parental supervision. We will
accomplish this as stated below:
We will address lack of respect for authority, absence of positive role models and lack of socially acceptable values.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 29
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Academic Career Readiness
1. Location: List physical address(es) and describe where program services are delivered.
Dunn PAL Main Office/Education Building
1501 S. Clinton Ave.
Dunn, NC 28334
Location is now under one roof. The Career Readiness Instructor and STEM Instructor will work together and meet
with each other daily about the youth. They will also exchange youth weekly so both personnel work with all the youth
weekly.
The Career Readiness Instructor will visit in-person and email to the various employers in Harnett County and
development 30 day notes and evaluations on the youth progress assigned to each location. The Career Readiness
Instructor will also conduct training to the various employers on working with youth assigned as interns.
2. Operation: Describe the daily/weekly schedule of program operation.
Snack/Lunch - Monday, Tuesday, Wednesday, Thursday and Friday = 3:00-3:30 pm
Enrichment/STEM Classes - Monday, Tuesday, Wednesday, Thursday and Friday = 3:30-4:15 pm
College & Career Readiness - Monday, Tuesday, Wednesday, Thursday and Friday = 4:15-5:30 pm
Enrichment (Field Trips) College and Career Readiness classes and field trips - Fridays = 3:30-5:30 pm
The schedule is basic and subject to change depending on activities for the day.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
We will employ two individuals who will coordinate and operate this program:
1) Career Readiness Instructor
2) STEM Instructor
These instructors will provide instruction as it relates to :business etiquette, resume writing, literacy/financial literacy,
and help them with work-based learning.
Both Career Readiness Instructors will work with youth in a group setting on career classes to include work experience
placement with local companies Staff will also be able to assist parents with the proper way to help their children as it
relates to helping them with their homework. This will be two paid part-time positions working no more than 35 hours a
week. Instructors will also conduct hands on learning through Media Arts and STEAM classes as well as Harnett
County Workforce Development along with educational field trips.
Must have prior experience in helping youth with career related classes. Must be willing to help youth. Teacher
Certificate preferred.
____________________________________________________________________________________________
Career Readiness Instructor I - Qualifications: Degree in Business preferred, EMT/CPR Certified and Effective teacher
training certified preferred.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 30
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Academic Career Readiness
Duties and Responsibilities- Attend Harnett County JCPC meetings
Attend monthly meetings, Attend juvenile court regularly & admit any referrals from juvenile court
Prepare notes, reports etc in juvenile court on deferred youth, Maintain NC Allies JCPC grant data bases
Provide intake, progress and termination documentation of deferred youth and regularly communicate with juvenile
court, law enforcement and any other referrals of youth, work (coordinate) with Harnett County Schools CTE
Department, CCCC and Harnett County Workforce Development, Teach Career Classes and place youth with
prospective businesses and monitor progress. Recruit business to participate in the Job Experience portion of the
program. Coordinate with school teachers and collect surveys, assessments & report cards.
___________
STEM Instructor I--- Degree in Mass Communications and/or Education Preferred or equivalent experience in the field.
EMT/CPR Certified and Effective teacher training certified preferred.
Duties and Responsibilities- Attend monthly meetings, Prepare notes, reports, lesson plans, schedule, recruit youth for
the program, help recruit businesses to participate, recruit outside businesses to speak with youth and help with
planned activities, help Provide intake, progress and termination documentation of deferred youth and regularly
communicate with juvenile court, law enforcement and any other referrals of youth. Assist with the overall needs of the
Career Readiness Program. Coordinate with school teachers and collect surveys, assessments and report cards
__________
Administrative Assistant- Employed since June 2015
Duties and Responsibilities- Answer phones, data entry, process payments, may assist both instructors as needed &
attend JCPC meetings.
4. Service Type SPEP: Describe implementation to include:
Primary Service: Job Training; Secondary Service: Remedial Academic Program
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.
Any youth or parent seeking to enroll in this program will have to meet with PAL staff and our partner, Harnett
Workforce Development (Job Link) to complete an assessment, application, agree to all rules and must be committed
to daily involvement. The referral process for Dunn PAL is implemented by a referral form that their parent/guardian,
counselor, law enforcement, school staff or social services can complete. Each youth's progress will be tracked
through communication with our career readiness instructor, Job Link, employer partner and our online database.
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.
A youth can be terminated at anytime for rule violations, moving out of the county, quitting school or graduation from
school. Termination can also occur if the youth satisfactory completes all assessments, classroom training and work-
based learning, thus becoming full-time employed with a trade or industry.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 31
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Academic Career Readiness
A successful termination is student completing all assignments and complete the year, satisfactory is completing all
assignments, unsuccessful is not completing assignments and the year also moving out of area, non-compliant is not
attending and/or suspension of rules while attending.
How is the referring agency involved with the termination process?
The Career Readiness and the STEM Instructor will communicate with juvenile services via in-person, telephone,
email and 30 day progress notes. Communicate with Harnett County Workforce Development (Job Link) in-person,
telephone, email, in-person training and 30 day progress notes. Communicate with teachers in-person, telephone,
email and 30 day progress notes. Communicate with employer partners in-person, telephone, email and 30 day
progress notes.
7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring
agencies including how client progress will be communicated.
The Career Readiness and the STEM Instructor will communicate with juvenile services via in-person, telephone,
email and 30 day progress notes. Communicate with Harnett County Workforce Development (Job Link) in-person,
telephone, email, in-person training and 30 day progress notes. Communicate with teachers in-person, telephone,
email and 30 day progress notes. Communicate with employer partners in-person, telephone, email and 30 day
progress notes.
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 component will work with local school systems and youth through the Career Readiness and STEM instructors to
help better the youth in the program (s), thus reducing drop out rates and helping them learn a trade and become
employed. Dunn PAL Career Readiness is partnering with the Dunn Chamber of Commerce, local churches and
community to enhance this component. Each youth will be matched with a job
9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon.
The Dunn PAL's Career Readiness program is based on the Harnett County workforce development model and
Harnett County Schools CTE model. This is where we combine employment, training and supportive services and
programs into a market-based system that meets the needs of the workforce and industry.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 32
Form structure last revised 12/20/2013
Department of Public Safety
SECTION V Terms of Agreement
This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and
Harnett County, (hereinafter referred to as the County), the County’s Juvenile Crime Prevention Council (hereinafter
referred to as the JCPC) and Dunn Police Athletic & Activities League, inc. (hereinafter referred to as the
Sponsoring Agency).
DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows:
Term of Agreement
This Agreement shall become effective Jul 1, 2021 and shall terminate Jun 30, 2022.
Payment to Sponsoring Agency
All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be
disbursed in an amount not to exceed the amount $99054 for the term of this agreement, unless amended by an
approved Program Agreement Revision.
Availability of Funds:
All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement
budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the
appropriation, allocation, and availability of funds for this purpose to DPS.
Responsibilities of the Parties
DPS shall:
1.Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the 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 DPS 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 Program Agreement, or most recently approved Program Agreement
Revision, 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 funded program(s) in accordance with DPS 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.
The Sponsoring Agency shall:
1.Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
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Form structure last revised 12/20/2013
Department of Public Safety
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 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 DPS JCPC Policy and Procedures and the North Carolina Administrative Procedures;
6.Secure local match as required, if applicable, pursuant to 14B NCAC 11B.0105, for approved JCPC funds;
7.Create and adopt individualized guidelines specific to the funded program, while also adhering to DPS JCPC
Policy and Procedures for all 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 Program Agreement, or most recently
approved Program Agreement Revision, 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 funds, maintain
reports, records, and other information to properly account for the expenditure of all State funds provided to the
Sponsoring Agency;
12.When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by
the agency in the performance of the Program Agreement, or most recently approved Program Agreement
Revision, as allowed by NCGS §105-164.14(c), the agency shall exclude all refundable sales and use taxes from
reportable expenditures submitted to the County and DPS;
13.Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed
expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in
DPS JCPC Policy and Procedures 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, or most
recently approved Program Agreement Revision;
17. Indemnify and hold 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 Program Agreement or most recently approved Program Agreement
Revision;
18.Receive permission and budgetary approval from DPS prior to using the Program Agreement, or most recently
approved Program Agreement Revision, 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 NCAC 11B, and in compliance with DPS JCPC Policy 2: Operations: Program Operational
Requirements
20.Be deemed an independent contractor in the performance of services described in the Program Agreement, or
most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to
be performed and for the supervision of its employees;
21.Represent that it has, or shall secure at its own expense, all personnel required in performing the services as
described in the Program Agreement. Such personnel shall not be employees of, or have any individual
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 34
Form structure last revised 12/20/2013
Department of Public Safety
contractual relationship with, DPS;
Sponsoring Agency and Use of Contractor(s)/Subcontractors
The Sponsoring Agency may engage with independent contractors as needed to perform services or support services
described in the Program Agreement. When independent contractors (funds are included in line item 190 of the
budget) are providing services as described in the Program Agreement, the sponsoring agency must:
22.Upload a signed Contract for Professional Services into NCALLIES once the Program Agreement (or
Program Agreement Revision) is approved by DPS;
23.Be responsible for the performance of all contractors or subcontractors as described in the Program
Agreement, or most recently approved Program Agreement Revision;
24.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 DPS JCPC Policies and
Procedures; and
25.Ensure that all contractors or subcontractors provide all information necessary to comply with the standards
set forth in the Program Agreement or most recently approved Program Agreement Revision.
The JCPC shall:
1.Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in the JCPC Program
Agreement or most recently approved JCPC Program Agreement Revision;
2.Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Code; N.C.G.S. §143B-801
(a);143B-602;143B-851
3.Review and locally approve Program Agreement Revision(s) 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 (applicable only to JCPC funded agencies);
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 DPS JCPC Policy 3.
Operations: Program Oversight and Monitoring
Reference: 14B NCAC 11B.0202 and DPS JCPC Policy 1, 7, 8, 9, 10, and 11.
The County shall:
1.Ensure the Sponsoring Agency is appropriately licensed, and either local public agencies, 501(c) (3) non-profit
corporations or local housing authorities (applicable only to JCPC funded agencies);
2.Use funds only for the purposes DPS has approved in the Program Agreement or most recently approved
Program Agreement Revision;
3.Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108
4.Comply with DPS JCPC Policies and Procedures 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 jointly submit Final Accounting forms for the JCPC and all funded
programs according to the procedures and due dates established by DPS.
Reference: 14B NCAC 11B; DPS JCPC Policy 3, 7, 8, 9, 10, and 11
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 35
Form structure last revised 12/20/2013
Department of Public Safety
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.
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 11B.0110; DPS JCPC Policy 9. Fiscal Accounting and Budgeting: Final Accounting Process
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 36
Form structure last revised 12/20/2013
Department of Public Safety
Disbursements and Internal Controls
Reversion of Unexpended Funds
Any remaining unexpended 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 the program’s fiscal year.
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 must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 whether or not the Sponsoring Agency has 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
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 37
Form structure last revised 12/20/2013
Department of Public Safety
Overdue Tax Debts, shall be completed by the Sponsoring Agency to certify when there are no overdue taxes. If the
agency has overdue taxes, the Sponsoring Agency must notify DPS at the time of Program Agreement submission.
Conflict of Interest – Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 upload the statement and the Sponsoring
Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission.
Proof of 501(c) (3) – Not for profit organizations ONLY must comply with this section. This document must be
uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of
the Sponsoring Agency’s 501 (c) (3) status.
Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested in
writing by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly
authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency.
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
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 38
Form structure last revised 12/20/2013
Department of Public Safety
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.
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, pandemic, 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
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 39
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VI: BUDGET NARRATIVE
PAL Academic Career Readiness Fiscal Year FY 21-22
Item #Justification Expense In Kind Expense
120 Administrative Assistant - $12 x 16 hrs week x 50 weeks $9,600
120 Career Readiness STEM Instructor - PT $13.50 hr., 24 hours a
week, 44 weeks excluding holidays
$14,256
120 Career Readiness Coordinator $14 hours a week, 40hours a
week, 52 weeks, excluding holidays
$29,120
120 SKIP After-school Tutoring Coordinator -$14.00 hr, 40 hours a
week, 52 weeks, excluding holidays
$29,120
120 SKIP After-school Tutoring Instructor- PT $13.50 hr., 24 hours
a week 44 weeks excluding holidays
$14,256
180 FICA for Four Staff at 7.65% each ($86,752 x 7.65%)$6,637
180 Unemployment and workman's comp for four staff at 6% each
($86,652 x 6%)
$5,206
180 Administrative Assistant FICA at 7.65% ($9,600 X 7.65%)$764
TOTAL $108,959
Job Title
Annual Expense
Wages
Annual In Kind
Wages
Career Readiness STEM Instructor-(PT) working directly with youth clients on
STEM Enrichment, helping increase grades, working with CTE Program
$14,256
Administrative keeping up with paperwork for JCPC $9,600 $0
SKIP After-school Tutoring Instructor - (PT) Working with youth on homework,
tutoring, enrichment classes.
$14,256
SKIP After-school Tutoring coordinator and court counselor Liaison -monitors
program for success. develops programs to implement, supervises staff, recruit
volunteers, reports on program related to after-school tutoring and homework.
$29,120
Career Readiness Coordinator -working with juvenille court and counselors,
reporting on grant, working with youth on homework, tutoring, enrichment
classes to include college and career
$29,120
TOTAL $96,352 $0
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 40
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VII Program:PAL Academic Career Readiness
Fiscal Year:FY 21-22 Number of Months:12
Cash In Kind Total
I. Personnel Services $108,959 $108,959
120 Salaries & Wages $96,352 $96,352
180 Fringe Benefits $12,607 $12,607
190 Professional Services* $0
*Contracts MUST be attached
II. Supplies & Materials $0
210 Household & Cleaning $0
220 Food & Provisions $0
230 Education & Medical $0
240 Construction & Repair $0
250 Vehicle Supplies & Materials $0
260 Office Supplies and Materials $0
280 Heating & Utility Supplies $0
290 Other Supplies and Materials $0
III. Current Obligations & Services $0
310 Travel & Transportation $0
320 Communications $0
330 Utilities $0
340 Printing & Binding $0
350 Repairs & Maintenance $0
370 Advertising $0
380 Data Processing $0
390 Other Services $0
IV. Fixed Charges & Other Expenses $0
410 Rental or Real Property $0
430 Equipment Rental $0
440 Service and Maint. Contracts $0
450 Insurance & Bonding $0
490 Other Fixed Charges $0
V. Capital Outlay $0
[This Section Requires Cash Match]
510 Office Furniture & Equipment $0
530 Educational Equipment $0
540 Motor Vehicle $0
550 Other Equipment $0
580 Buildings, Structure & Improv. $0
Total $108,959 $108,959
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 41
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 21-22 Harnett County Funding ID: 243-XXXX
Sponsoring Agency: Dunn Police Athletic & Activities League, inc. Program: PAL Academic Career
Readiness
$99,054 DPS/JCPC Funds * This is the amount approved in your application
10%Local Match Rate Is the Local Match Rate 10%, 20% or 30%?
County Cash (Specify Source)
$9,905 Local Cash The Dunn Police Athletic League will match cash
on the grant
(Specify Source)
Local Cash (Specify Source)
Local In-Kind (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
$108,959 TOTAL $9,905 $9,905
Required Local Match Match Provided
/DPSSignature//DPSdt/
Authorizing Official, Department of Public Safety Date
The following signature certifies that this program agreement has been locally approved by the Board of County Commissioners.
/CountySignature//Countydt/
Chair, County Board of Commissioners or County Finance Director Date
The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention
Council.
/JCPCSignature//JCPCdt/
Chair, Juvenile Crime Prevention Council Date
/ProgramSignature//Programdt/
Program Manager Date
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
7/28/2021
7/28/2021
8/2/2021
8/3/2021
HCBOC 071222 ws Pg. 42
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Certificate Of Completion
Envelope Id: 7D5D741CEB2C4FE4B6EEE47D39085592 Status: Completed
Subject: DPS eSignature Request for Harnett 243-23366 PAL Academic Career Readiness
Source Envelope:
Document Pages: 32 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
3040 Hammond Business Pl
Raleigh, NC 27603
djjdp.applicationsupport@ncdps.gov
IP Address: 207.4.107.21
Record Tracking
Status: Original
7/28/2021 12:02:22 PM
Holder: DPS-DJJ Community Programs
djjdp.applicationsupport@ncdps.gov
Location: DocuSign
Signer Events Signature Timestamp
Captain Rodney Rowland
director@dunnpal.org
dunnpal.org
Security Level: Email, Account Authentication
(None)Signature Adoption: Drawn on Device
Using IP Address: 65.191.171.195
Sent: 7/28/2021 12:02:24 PM
Viewed: 7/28/2021 12:03:03 PM
Signed: 7/28/2021 12:03:37 PM
Electronic Record and Signature Disclosure:
Accepted: 7/31/2019 11:20:27 PM
ID: 5de52e88-bd6d-48ff-9edb-033865f625ba
Kimberly Whitted
kwhitted@campbell.edu
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 76.182.58.128
Sent: 7/28/2021 12:03:38 PM
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Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
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HCBOC 071222 ws Pg. 51
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Electronic Record and Signature Disclosure
HCBOC 071222 ws Pg. 52
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Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM
Parties agreed to: Captain Rodney Rowland, Kimberly Whitted, Kimberly Honeycutt
HCBOC 071222 ws Pg. 53
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HCBOC 071222 ws Pg. 54
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HCBOC 071222 ws Pg. 55
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
North Carolina Department of Public Safety
JCPC Program - Program Agreement
SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:FY 21-22 DPS/JCPC FUNDING # (cont only)243-XXXX
COUNTY:Harnett AREA:Central Area
Multi-County:No Multi-Components Yes
NAME OF PROGRAM:PAL Academic Career Readiness
SPONSORING AGENCY:Dunn Police Athletic & Activities League, inc.
SPONSORING AGENCY
PHYSICAL ADDRESS:
1501 S. Clinton Ave.
Dunn NC 28334
SPONSORING AGENCY
MAILING ADDRESS:
PO Box: 1238
Dunn NC 28335
TYPE:Non-Profit FEDERAL ID #46-4258788
COMPONENT ID #NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF
EACH COMPONENT
32111 PAL (SKIP) School Kids In Power Tutoring/Academic Enhancement $ 54,480
32112 PAL Academic Career Readiness Vocational Skills $ 54,479
Total cost of components:$ 108,959
Program Manager Name & Address (same person on signature page)
Name:Rodney Rowland Title:Executive Director
Mailing
Address:
PO Box: 1238
City:Dunn Zip:28335
Phone:(910) 892-1873 Fax: E-mail:director@dunnpal.org
Contact Person (if different from program manager)
Name:Rodney Rowland Title:Executive Director
Mailing
Address:
PO Box: 1238
City:Dunn Zip:28335
Phone:(910) 892-1873 Fax: E-mail:director@dunnpal.org
Program Fiscal Officer (cannot be program manager)
Name:Emmett Aldredge III Title:Board President
Mailing
Address:
PO Box: 1238
City:Dunn Zip:28335
Phone:(910) 892-1873 Fax: E-mail:emmett.aldredge3@arc3gases.com
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 56
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION I B PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #COMPONENT INFORMATION
32111 NAME OF COMPONENT: PAL (SKIP) School Kids In Power
BRIEF DESCRIPTION: Tutoring and Academic Enrichment for youth 10-17 years old to
increase grades in school in reading and math, increase school attendance, decrease school
suspensions and increase positive social interactions. The SKIP Program through Dunn PAL
provides services to help supplement Youths' school curriculum by providing hands on learning
to include College and Career Readiness Classes. The program also provides an opportunity
for field trips designed to be an educational enrichment experience.
COMPONENT ID #COMPONENT INFORMATION
32112 NAME OF COMPONENT: PAL Academic Career Readiness
BRIEF DESCRIPTION: The Career Readiness Program works with youth 13-19 years old in
training and skills development in a specific job trade. This program will expose youth to work
and college related experiences: teach youth proper etiquette in dress, manners, interview
skills, communications skills, money management and job skills. Youth partner with local
companies for work experience. We will work and partner with Central Carolina Community
College, Harnett County Schools, and Harnett NC Works.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 57
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components Yes
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:PAL (SKIP) School Kids In Power Component ID #
32111
What is this component's maximum client capacity at any given time?20
Frequency of client contact per month:12 Anticipated Average Length of
Stay:60 Days
Total Component Cost:$54,480 ÷ by Estimated # to be served during funding period:20
Estimated Average Cost Per Youth:$2,724
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:0
0 Number of admissions Juvenile Justice Referred 0% of total admissions
0 Number of admissions Law Enforcement Referred 0% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 58
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
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 2016 Annual Report for the
sixth consecutive year the juvenile delinquency rate (juvenile crime) in the State of North Carolina has decreased. Also
according to this report, over that six-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. In 2016 187 youth were committed to youth development centers which were the lowest
level ever recorded and represents a 48% decrease since 2010. 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.
According to the North Carolina Department of Public Safety Division of Juvenile Justice 2016 Annual Report, Juvenile
Gang Involvement/affiliation has been on the rise since 2014 increasing a half percent each year.
Due to Raise The Age, NC (Ages 16-17) we will add more youth into the Juvenile Services Division.
Low classroom grades and test scores of students in school, in-school and out-of-school suspensions as well as
excessive absences and trouble in school lead to juvenile problems both in school and in the community. Lack of
positive social interaction with both peers and adults lead to juvenile problems. Juvenile Gang Affiliation being on the
rise leads to Juvenile Crime and all the above stated. Lack safe places and supervised learning instruction for youth
after school.
2. Target Population: Describe the target population, including age, and the steps taken to insure that the target
population is served.
The target population will be ages 10-17 boys and girls in Elementary through High School in the Harnett County area
in keeping with PAL's Mission Statement. Those targeted are youth with minor court involvement, At-Risk of Court
Involvement and may be referred by any of the following sources (Parents, Court Counselors, Police Officers, School
Teachers, School Counselors and Administration staff, Community Leaders, Youth Themselves, Guardians, relatives,
etc.). There is application process to be completed prior to admission. We will target youth via multiple resources to
include (newspaper, social media outlets, schools, online outlets and personal contact).
3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program.
The program will assist in educating the youth it serves with their homework, tutoring youth on specific subjects of
weakness, and computer training with internet access to improve the youth grades in public school. We hope to lower
youth problems in school and in the community by working with area schools, parents and law enforcement. In working
with multiple resources in the government and private sector we hope to help provide sound education along with work
experience to get youth to work and thus lower juvenile crime and lower youth problems such as lack of respect for
authority, lack of socially acceptable values and improving positive self image.
1. Provide a safe environment
2. Provide safe and supervised programs
3. Keep constant communication with all stake holders (Community and School)
4. Enhance Police and Community Relations to give positive interaction with youth
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 59
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
5. Provide a learning environment on each youths level
6. Provide hands on learning for youth
7. Track progress for success, deficiencies and enhancements
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.
80% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
80% Clients will actively participate in tutorial and/or academic enhancement activities as intended by program design/
the service plan.
80% Clients will have no new complaints with an offense date after the admission date.
80% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
80% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
80% Clients will improve academic skills/performance.
80% Clients will have no new adjudications for a complaint 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.
SKIP component will work with youth ages 10-17 years old who are At-Risk of becoming 1st time delinquent juveniles
or have a first offense currently. We will also work with youth who are At-risk or involved with negative and/or
delinquent peers. We also work with youth and their families to fill in the gap of lack of parental supervision. We will
accomplish this as stated below.
Youth (ages 10-17) tutoring and homework assistance are priority risk factors in Harnett County. We will address lack
of respect for authority, absence of positive role models and lack of socially acceptable values in the SKIP component.
PAL will strive to prevent and reduce juvenile crime in Harnett County by focusing on identifying, tracking and
educating the youth on their academic weaknesses which will make them strong mentally and lower problems in the
classroom. PAL will coordinate with schools and teachers to ensure the student is getting help in the proper classes.
Individual and group sessions will be provided to ensure quality performance of each student. A comprehensive
mentoring program is in place to provide each student a mentor to help with homework and access with them in school.
This is a partnership with Dunn Area Chamber of Commerce, local churches and citizens in the community that
provide mentors and they are assigned to work with youth to help with grades and be positive role models.
Furthermore, helping educate the parents is a vital role for them successfully working with their children.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 60
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
1. Location: List physical address(es) and describe where program services are delivered.
Dunn PAL Main Office/Education Building
1501 S. Clinton Ave.
Dunn, NC 28334
Dunn PAL Main Office/Education Building is where students each have a hot meal each day in our cafeteria, attend
computer classes, do their homework and enrichment classes. The PAL Education Building is where our students
meet each day to finish homework and have some enrichment sessions to include STEAM (Science, Technology,
Engineering, Arts and Math).
2. Operation: Describe the daily/weekly schedule of program operation.
Snack/Lunch - Monday, Tuesday, Wednesday and Thursday = 3:00-3:30 pm
Tutoring/Homework help - Monday, Tuesday, Wednesday and Thursday = 3:30-4:30 pm
Enrichment Classes - Monday, Tuesday, Wednesday and Thursday = 4:30-5:30 pm
The schedule is basic and subject to change depending on activities for the day.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
After-school Instructors will work with youth in a group setting with their homework and specific course subjects.
Staff will also be able to assist parents with the proper way to help their children as it relates to helping them with their
homework. This will be two paid part-time positions working no more than 35 hours a week. Instructors will also
conduct hands on learning through Media Arts and STEM classes as well as educational field trips.
Must have prior experience in helping youth with homework. Must be willing to help youth. Teacher Certificate
preferred.
____________________________________________________________________________________________
Alternative Instructor I - Current Employee has been employed since April 2018. She has a Masters in Psychology,
EMT/CPR Certified & Effective teacher training certified.
Duties & Responsibilities- Youth intake, parent intake, assist with after school tutoring/homework help & enrichment.
Coordinate with school teachers & collect surveys, assessments & report cards.
_______________________________________
Alternative Instructor II-Recent hire. She has a degree in BS in Criminal Justice & AAS Certified Paralegal. 1 year
experience substitute teacher at Ramsey St Alternative School, 1 year community sport paraprofessional at Great
Expectations Mental Health Services, 2 years experience Residential Treatment Supervisor/Qualified Professional at
Children's Home Inc in Franklin, NC. 2 years experience as a Youth Program Assistant III at Meridiam Behavior Health
in Silva, NC.
Duties and Responsibilities- Attend Harnett County JCPC meetings
Attend monthly meetings
Attend juvenile court regularly and admit any referrals from juvenile court
Prepare notes, reports etc in juvenile court on deferred youth
Maintain NC Allies JCPC grant data bases
Provide intake, progress and termination documentation of deferred youth and regularly communicate with juvenile
court, law enforcement and any other referrals of youth
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 61
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
Assist with after school tutoring/homework help and enrichment. Coordinate with school teachers and collect surveys,
assessments and report cards
_______________________________________
Administrative Assistant- Employed since June 2015
Duties and Responsibilities- Answer phones, data entry, process payments, may assist Alternative Instructor II as
needed and attend JCPC meetings with Alternative Instructor II
_______________________________________
After School/Summer Program Coordinator-Employed since May 2019
Duties and Responsibilities- Oversees Alternative Instructor I, II and all after school/summer staff
Partner with schools for student education, may attend JCPC meetings
Reports to Executive Director and acts as liaison for schools & service agencies
Interacts with parents about any concerns
Processes any disciplinary actions of youth in after school/summer programs
4. Service Type SPEP: Describe implementation to include:
Primary Service: Remedial Academic Program; Secondary Service: Work experience
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.
Any youth or parent seeking to enroll in this program will have to meet with the After-school Coordinator, complete an
admission application, complete an education agreement, agree to all rules and must attend 12 hours a week. The
approval of the admission process takes 2-3 days. The referral process for Dunn PAL is implemented by a referral
form that their parent/guardian, court counselors, law enforcement, school staff or social services can complete and
send to Dunn PAL. Dunn PAL will then have the student and parent/guardian complete a full application and submit it
to Dunn PAL for membership. Since Dunn PAL is voluntary, it will be the responsibility of the parent/guardian to assure
completion. Each youth is tracked in our on-line database and must re-apply every year from the date the membership
is received. Anyone may also register on-line at Dunn PAL's website www.dunnpal.org. The After-school Coordinator
may place a student on a waiting list if the program is full. The Coordinator may reject an applicant if there is any sex
related crimes or the coordinator feels after consultation with authorities that the child could pose a severe security risk
to other students. After the initial admission process is complete the student will begin attending the next business day.
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.
A youth can be terminated at anytime for rule violations, moving out of county, quitting school or graduation from
school. Termination can also occur if the youth satisfactory completes all assignments and grades are increased above
a C for the entire semester. A student may also be terminated if they fail to complete the required 12 hours a week
attendance that was explained at admission. The After-school Coordinator checks all grades at school and checks to
see if youth in in compliance with all terms set out prior to admission. The After-school Coordinator makes all
determinations on criteria being followed. The After-school Coordinator or his/her designee will determine termination
procedures and contact parent/guardian and the referral agency of compliance either successful, satisfactory,
unsuccessful or non-compliant termination.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 62
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL (SKIP) School Kids In Power
A successful termination is student completing all assignments and complete the year, satisfactory is completing all
assignments, unsuccessful is not completing assignments and the year also moving out of area, non-compliant is not
attending and/or suspension of rules while attending.
How is the referring agency involved with the termination process?
The After-school Coordinator checks all grades at school and checks to see if youth are in compliance with all terms
set out prior to admission. The After-school Coordinator makes all determinations on criteria being followed. The After-
school Coordinator or his/her designee will determine termination procedures and contact parent/guardian and the
referral agency of compliance either successful, satisfactory, unsuccessful or non-compliant termination. The JCPC
Coordinator, After-school program Coordinator and the referring agency/juvenile court counselor will coordinate
ongoing concerns and courses of action to include termination.
7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring
agencies including how client progress will be communicated.
The SKIP component will communicate with Juvenile Court/services and referring agency through the After-school
Coordinator, Mentor Coordinator and Youth Advocate of the Dunn Police Athletic/Activities League (Dunn PAL). The
SKIP Component will also partner with various organizations to help youth to be well rounded.
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 component will work with the local school systems and youth through the After-school Coordinator to help better
educate the youth in the program, thus increasing grades and reducing drop out rates. Dunn PAL SKIP is partnering
with the Dunn Area Chamber of Commerce, local churches and citizens to add the mentoring program with the tutoring/
academic enhancement component. Each youth will be matched with an adult or peer and
have one-to-one assistance.
9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon.
Structuring out of school time to improve academic achievement, We use the US Department of Education 21st
Century Community Learning Centers model. Curriculum will be followed by the Harnett County School System.
School textbooks and online resources will be used. Professional Development will also be used online https://y4y.ed.
gov/ and Harnett County Schools. We also have a Professional Development facilitator on site.
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 63
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components Yes
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:PAL Academic Career Readiness Component ID #
32112
What is this component's maximum client capacity at any given time?20
Frequency of client contact per month:12 Anticipated Average Length of
Stay:60 Days
Total Component Cost:$54,479 ÷ by Estimated # to be served during funding period:20
Estimated Average Cost Per Youth:$2,724
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:0
0 Number of admissions Juvenile Justice Referred 0% of total admissions
0 Number of admissions Law Enforcement Referred 0% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 64
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL Academic Career Readiness
1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in
the county.
Academic enrichment for youth ages 13-19 to increase grades in school reading and math, increase school
attendance, decrease school suspensions and increase positive social interactions. Through Dunn PAL we will
provide services to help supplement the youths' school curriculum by providing hands on learning to include College
and Career Readiness. The program also provides an opportunity for youth to engage in work-site learning experience.
2. Target Population: Describe the target population, including age, and the steps taken to insure that the target
population is served.
The target population will be youth in grades 9-12 in Harnett County. In keeping with the Dunn PAL's mission those
targeted are youth who are considered at-risk. These youth may be referred by any of the following sources; Juvenile
Court Counselors, parents, counselors, police officers, teachers, community leaders, youth themselves, guardians/
parents, relatives, etc. There is an instruction process to be completed prior to job placement. We will target youth by
connecting with schools, personal contact and the media.
3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program.
The program will assist youth in educating them on their workforce skill set and the best career for them. We hope to
lower youth problems in school and in the community by working with schools, law enforcement, parents and
employers. In working with multiple resources in the government and private sector, we hope to help provide excellent
career readiness training where youth will learn essential skills along with the ultimate goal to get youth employed
while lowering the juvenile crime rate and lower youth problems at school and home.
-Provide a safe environment
-Provide safe and supervised programs
-Keep constant communication with all stake holders (community and school)
-Enhance Police and Community Relations to give positive interaction with youth.
-Provide a learning environment on each youth's level.
-Provide hands on learning for youth.
-Track progress for success, deficiencies and enhancements.
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.
80% Clients will actively participate in vocational skill building activities as intended by the program design/service
plan.
80% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
80% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
80% Clients will have no new complaints with an offense date after the admission date.
80% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL Academic Career Readiness
completion.
80% Clients will increase overall knowledge of vocational skills or readiness to enter the workforce.
80% Clients will have no new adjudications for a complaint 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 Career Readiness Program will work with youth ages 13-19 who are identified through Raise The Age as being at-
risk of becoming first time delinquent juveniles or have a first offense currently, we also will be proactive in finding
resources and training for youth who may have reports of substance abuse issues, work with other providers on mental
health issues and work with youth that have low to serious behavior problems at school. We will also work with
youth who are at-risk or involved with negative and/or delinquent peers or have a lack of parental supervision. We will
accomplish this as stated below:
We will address lack of respect for authority, absence of positive role models and lack of socially acceptable values.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Academic Career Readiness
1. Location: List physical address(es) and describe where program services are delivered.
Dunn PAL Main Office/Education Building
1501 S. Clinton Ave.
Dunn, NC 28334
Location is now under one roof. The Career Readiness Instructor and STEM Instructor will work together and meet
with each other daily about the youth. They will also exchange youth weekly so both personnel work with all the youth
weekly.
The Career Readiness Instructor will visit in-person and email to the various employers in Harnett County and
development 30 day notes and evaluations on the youth progress assigned to each location. The Career Readiness
Instructor will also conduct training to the various employers on working with youth assigned as interns.
2. Operation: Describe the daily/weekly schedule of program operation.
Snack/Lunch - Monday, Tuesday, Wednesday, Thursday and Friday = 3:00-3:30 pm
Enrichment/STEM Classes - Monday, Tuesday, Wednesday, Thursday and Friday = 3:30-4:15 pm
College & Career Readiness - Monday, Tuesday, Wednesday, Thursday and Friday = 4:15-5:30 pm
Enrichment (Field Trips) College and Career Readiness classes and field trips - Fridays = 3:30-5:30 pm
The schedule is basic and subject to change depending on activities for the day.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
We will employ two individuals who will coordinate and operate this program:
1) Career Readiness Instructor
2) STEM Instructor
These instructors will provide instruction as it relates to :business etiquette, resume writing, literacy/financial literacy,
and help them with work-based learning.
Both Career Readiness Instructors will work with youth in a group setting on career classes to include work experience
placement with local companies Staff will also be able to assist parents with the proper way to help their children as it
relates to helping them with their homework. This will be two paid part-time positions working no more than 35 hours a
week. Instructors will also conduct hands on learning through Media Arts and STEAM classes as well as Harnett
County Workforce Development along with educational field trips.
Must have prior experience in helping youth with career related classes. Must be willing to help youth. Teacher
Certificate preferred.
____________________________________________________________________________________________
Career Readiness Instructor I - Qualifications: Degree in Business preferred, EMT/CPR Certified and Effective teacher
training certified preferred.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Academic Career Readiness
Duties and Responsibilities- Attend Harnett County JCPC meetings
Attend monthly meetings, Attend juvenile court regularly & admit any referrals from juvenile court
Prepare notes, reports etc in juvenile court on deferred youth, Maintain NC Allies JCPC grant data bases
Provide intake, progress and termination documentation of deferred youth and regularly communicate with juvenile
court, law enforcement and any other referrals of youth, work (coordinate) with Harnett County Schools CTE
Department, CCCC and Harnett County Workforce Development, Teach Career Classes and place youth with
prospective businesses and monitor progress. Recruit business to participate in the Job Experience portion of the
program. Coordinate with school teachers and collect surveys, assessments & report cards.
___________
STEM Instructor I--- Degree in Mass Communications and/or Education Preferred or equivalent experience in the field.
EMT/CPR Certified and Effective teacher training certified preferred.
Duties and Responsibilities- Attend monthly meetings, Prepare notes, reports, lesson plans, schedule, recruit youth for
the program, help recruit businesses to participate, recruit outside businesses to speak with youth and help with
planned activities, help Provide intake, progress and termination documentation of deferred youth and regularly
communicate with juvenile court, law enforcement and any other referrals of youth. Assist with the overall needs of the
Career Readiness Program. Coordinate with school teachers and collect surveys, assessments and report cards
__________
Administrative Assistant- Employed since June 2015
Duties and Responsibilities- Answer phones, data entry, process payments, may assist both instructors as needed &
attend JCPC meetings.
4. Service Type SPEP: Describe implementation to include:
Primary Service: Job Training; Secondary Service: Remedial Academic Program
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.
Any youth or parent seeking to enroll in this program will have to meet with PAL staff and our partner, Harnett
Workforce Development (Job Link) to complete an assessment, application, agree to all rules and must be committed
to daily involvement. The referral process for Dunn PAL is implemented by a referral form that their parent/guardian,
counselor, law enforcement, school staff or social services can complete. Each youth's progress will be tracked
through communication with our career readiness instructor, Job Link, employer partner and our online database.
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.
A youth can be terminated at anytime for rule violations, moving out of the county, quitting school or graduation from
school. Termination can also occur if the youth satisfactory completes all assessments, classroom training and work-
based learning, thus becoming full-time employed with a trade or industry.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Academic Career Readiness
A successful termination is student completing all assignments and complete the year, satisfactory is completing all
assignments, unsuccessful is not completing assignments and the year also moving out of area, non-compliant is not
attending and/or suspension of rules while attending.
How is the referring agency involved with the termination process?
The Career Readiness and the STEM Instructor will communicate with juvenile services via in-person, telephone,
email and 30 day progress notes. Communicate with Harnett County Workforce Development (Job Link) in-person,
telephone, email, in-person training and 30 day progress notes. Communicate with teachers in-person, telephone,
email and 30 day progress notes. Communicate with employer partners in-person, telephone, email and 30 day
progress notes.
7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring
agencies including how client progress will be communicated.
The Career Readiness and the STEM Instructor will communicate with juvenile services via in-person, telephone,
email and 30 day progress notes. Communicate with Harnett County Workforce Development (Job Link) in-person,
telephone, email, in-person training and 30 day progress notes. Communicate with teachers in-person, telephone,
email and 30 day progress notes. Communicate with employer partners in-person, telephone, email and 30 day
progress notes.
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 component will work with local school systems and youth through the Career Readiness and STEM instructors to
help better the youth in the program (s), thus reducing drop out rates and helping them learn a trade and become
employed. Dunn PAL Career Readiness is partnering with the Dunn Chamber of Commerce, local churches and
community to enhance this component. Each youth will be matched with a job
9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon.
The Dunn PAL's Career Readiness program is based on the Harnett County workforce development model and
Harnett County Schools CTE model. This is where we combine employment, training and supportive services and
programs into a market-based system that meets the needs of the workforce and industry.
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Department of Public Safety
SECTION V Terms of Agreement
This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and
Harnett County, (hereinafter referred to as the County), the County’s Juvenile Crime Prevention Council (hereinafter
referred to as the JCPC) and Dunn Police Athletic & Activities League, inc. (hereinafter referred to as the
Sponsoring Agency).
DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows:
Term of Agreement
This Agreement shall become effective Jul 1, 2021 and shall terminate Jun 30, 2022.
Payment to Sponsoring Agency
All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be
disbursed in an amount not to exceed the amount $99054 for the term of this agreement, unless amended by an
approved Program Agreement Revision.
Availability of Funds:
All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement
budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the
appropriation, allocation, and availability of funds for this purpose to DPS.
Responsibilities of the Parties
DPS shall:
1.Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the 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 DPS 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 Program Agreement, or most recently approved Program Agreement
Revision, 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 funded program(s) in accordance with DPS 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.
The Sponsoring Agency shall:
1.Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the
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Department of Public Safety
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 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 DPS JCPC Policy and Procedures and the North Carolina Administrative Procedures;
6.Secure local match as required, if applicable, pursuant to 14B NCAC 11B.0105, for approved JCPC funds;
7.Create and adopt individualized guidelines specific to the funded program, while also adhering to DPS JCPC
Policy and Procedures for all 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 Program Agreement, or most recently
approved Program Agreement Revision, 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 funds, maintain
reports, records, and other information to properly account for the expenditure of all State funds provided to the
Sponsoring Agency;
12.When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by
the agency in the performance of the Program Agreement, or most recently approved Program Agreement
Revision, as allowed by NCGS §105-164.14(c), the agency shall exclude all refundable sales and use taxes from
reportable expenditures submitted to the County and DPS;
13.Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed
expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in
DPS JCPC Policy and Procedures 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, or most
recently approved Program Agreement Revision;
17. Indemnify and hold 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 Program Agreement or most recently approved Program Agreement
Revision;
18.Receive permission and budgetary approval from DPS prior to using the Program Agreement, or most recently
approved Program Agreement Revision, 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 NCAC 11B, and in compliance with DPS JCPC Policy 2: Operations: Program Operational
Requirements
20.Be deemed an independent contractor in the performance of services described in the Program Agreement, or
most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to
be performed and for the supervision of its employees;
21.Represent that it has, or shall secure at its own expense, all personnel required in performing the services as
described in the Program Agreement. Such personnel shall not be employees of, or have any individual
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Department of Public Safety
contractual relationship with, DPS;
Sponsoring Agency and Use of Contractor(s)/Subcontractors
The Sponsoring Agency may engage with independent contractors as needed to perform services or support services
described in the Program Agreement. When independent contractors (funds are included in line item 190 of the
budget) are providing services as described in the Program Agreement, the sponsoring agency must:
22.Upload a signed Contract for Professional Services into NCALLIES once the Program Agreement (or
Program Agreement Revision) is approved by DPS;
23.Be responsible for the performance of all contractors or subcontractors as described in the Program
Agreement, or most recently approved Program Agreement Revision;
24.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 DPS JCPC Policies and
Procedures; and
25.Ensure that all contractors or subcontractors provide all information necessary to comply with the standards
set forth in the Program Agreement or most recently approved Program Agreement Revision.
The JCPC shall:
1.Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in the JCPC Program
Agreement or most recently approved JCPC Program Agreement Revision;
2.Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Code; N.C.G.S. §143B-801
(a);143B-602;143B-851
3.Review and locally approve Program Agreement Revision(s) 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 (applicable only to JCPC funded agencies);
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 DPS JCPC Policy 3.
Operations: Program Oversight and Monitoring
Reference: 14B NCAC 11B.0202 and DPS JCPC Policy 1, 7, 8, 9, 10, and 11.
The County shall:
1.Ensure the Sponsoring Agency is appropriately licensed, and either local public agencies, 501(c) (3) non-profit
corporations or local housing authorities (applicable only to JCPC funded agencies);
2.Use funds only for the purposes DPS has approved in the Program Agreement or most recently approved
Program Agreement Revision;
3.Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108
4.Comply with DPS JCPC Policies and Procedures 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 jointly submit Final Accounting forms for the JCPC and all funded
programs according to the procedures and due dates established by DPS.
Reference: 14B NCAC 11B; DPS JCPC Policy 3, 7, 8, 9, 10, and 11
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Department of Public Safety
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.
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 11B.0110; DPS JCPC Policy 9. Fiscal Accounting and Budgeting: Final Accounting Process
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Disbursements and Internal Controls
Reversion of Unexpended Funds
Any remaining unexpended 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 the program’s fiscal year.
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 must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 whether or not the Sponsoring Agency has 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
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Overdue Tax Debts, shall be completed by the Sponsoring Agency to certify when there are no overdue taxes. If the
agency has overdue taxes, the Sponsoring Agency must notify DPS at the time of Program Agreement submission.
Conflict of Interest – Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 upload the statement and the Sponsoring
Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission.
Proof of 501(c) (3) – Not for profit organizations ONLY must comply with this section. This document must be
uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of
the Sponsoring Agency’s 501 (c) (3) status.
Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested in
writing by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly
authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency.
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
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 75
Form structure last revised 12/20/2013
Department of Public Safety
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.
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, pandemic, 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
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 76
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VI: BUDGET NARRATIVE
PAL Academic Career Readiness Fiscal Year FY 21-22
Item #Justification Expense In Kind Expense
120 Administrative Assistant - $12 x 16 hrs week x 50 weeks $9,600
120 Career Readiness STEM Instructor - PT $13.50 hr., 24 hours a
week, 44 weeks excluding holidays
$14,256
120 Career Readiness Coordinator $14 hours a week, 40hours a
week, 52 weeks, excluding holidays
$29,120
120 SKIP After-school Tutoring Coordinator -$14.00 hr, 40 hours a
week, 52 weeks, excluding holidays
$29,120
120 SKIP After-school Tutoring Instructor- PT $13.50 hr., 24 hours
a week 44 weeks excluding holidays
$14,256
180 FICA for Four Staff at 7.65% each ($86,752 x 7.65%)$6,637
180 Unemployment and workman's comp for four staff at 6% each
($86,652 x 6%)
$5,206
180 Administrative Assistant FICA at 7.65% ($9,600 X 7.65%)$764
TOTAL $108,959
Job Title
Annual Expense
Wages
Annual In Kind
Wages
Career Readiness STEM Instructor-(PT) working directly with youth clients on
STEM Enrichment, helping increase grades, working with CTE Program
$14,256
Administrative keeping up with paperwork for JCPC $9,600 $0
SKIP After-school Tutoring Instructor - (PT) Working with youth on homework,
tutoring, enrichment classes.
$14,256
SKIP After-school Tutoring coordinator and court counselor Liaison -monitors
program for success. develops programs to implement, supervises staff, recruit
volunteers, reports on program related to after-school tutoring and homework.
$29,120
Career Readiness Coordinator -working with juvenille court and counselors,
reporting on grant, working with youth on homework, tutoring, enrichment
classes to include college and career
$29,120
TOTAL $96,352 $0
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 77
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VII Program:PAL Academic Career Readiness
Fiscal Year:FY 21-22 Number of Months:12
Cash In Kind Total
I. Personnel Services $108,959 $108,959
120 Salaries & Wages $96,352 $96,352
180 Fringe Benefits $12,607 $12,607
190 Professional Services* $0
*Contracts MUST be attached
II. Supplies & Materials $0
210 Household & Cleaning $0
220 Food & Provisions $0
230 Education & Medical $0
240 Construction & Repair $0
250 Vehicle Supplies & Materials $0
260 Office Supplies and Materials $0
280 Heating & Utility Supplies $0
290 Other Supplies and Materials $0
III. Current Obligations & Services $0
310 Travel & Transportation $0
320 Communications $0
330 Utilities $0
340 Printing & Binding $0
350 Repairs & Maintenance $0
370 Advertising $0
380 Data Processing $0
390 Other Services $0
IV. Fixed Charges & Other Expenses $0
410 Rental or Real Property $0
430 Equipment Rental $0
440 Service and Maint. Contracts $0
450 Insurance & Bonding $0
490 Other Fixed Charges $0
V. Capital Outlay $0
[This Section Requires Cash Match]
510 Office Furniture & Equipment $0
530 Educational Equipment $0
540 Motor Vehicle $0
550 Other Equipment $0
580 Buildings, Structure & Improv. $0
Total $108,959 $108,959
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
HCBOC 071222 ws Pg. 78
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 21-22 Harnett County Funding ID: 243-XXXX
Sponsoring Agency: Dunn Police Athletic & Activities League, inc. Program: PAL Academic Career
Readiness
$99,054 DPS/JCPC Funds * This is the amount approved in your application
10%Local Match Rate Is the Local Match Rate 10%, 20% or 30%?
County Cash (Specify Source)
$9,905 Local Cash The Dunn Police Athletic League will match cash
on the grant
(Specify Source)
Local Cash (Specify Source)
Local In-Kind (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
$108,959 TOTAL $9,905 $9,905
Required Local Match Match Provided
/DPSSignature//DPSdt/
Authorizing Official, Department of Public Safety Date
The following signature certifies that this program agreement has been locally approved by the Board of County Commissioners.
/CountySignature//Countydt/
Chair, County Board of Commissioners or County Finance Director Date
The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention
Council.
/JCPCSignature//JCPCdt/
Chair, Juvenile Crime Prevention Council Date
/ProgramSignature//Programdt/
Program Manager Date
DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
7/28/2021
7/28/2021
8/2/2021
8/3/2021
HCBOC 071222 ws Pg. 79
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DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
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DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592
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DocuSign Envelope ID: 7D5D741C-EB2C-4FE4-B6EE-E47D39085592HCBOC 071222 ws Pg. 87
Certificate Of Completion
Envelope Id: 7D5D741CEB2C4FE4B6EEE47D39085592 Status: Completed
Subject: DPS eSignature Request for Harnett 243-23366 PAL Academic Career Readiness
Source Envelope:
Document Pages: 32 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
3040 Hammond Business Pl
Raleigh, NC 27603
djjdp.applicationsupport@ncdps.gov
IP Address: 207.4.107.21
Record Tracking
Status: Original
7/28/2021 12:02:22 PM
Holder: DPS-DJJ Community Programs
djjdp.applicationsupport@ncdps.gov
Location: DocuSign
Signer Events Signature Timestamp
Captain Rodney Rowland
director@dunnpal.org
dunnpal.org
Security Level: Email, Account Authentication
(None)Signature Adoption: Drawn on Device
Using IP Address: 65.191.171.195
Sent: 7/28/2021 12:02:24 PM
Viewed: 7/28/2021 12:03:03 PM
Signed: 7/28/2021 12:03:37 PM
Electronic Record and Signature Disclosure:
Accepted: 7/31/2019 11:20:27 PM
ID: 5de52e88-bd6d-48ff-9edb-033865f625ba
Kimberly Whitted
kwhitted@campbell.edu
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 76.182.58.128
Sent: 7/28/2021 12:03:38 PM
Viewed: 7/28/2021 12:15:03 PM
Signed: 7/28/2021 12:15:49 PM
Electronic Record and Signature Disclosure:
Accepted: 7/28/2021 12:15:03 PM
ID: a6857dd9-690b-428c-9e35-b5ca3f564adc
Kimberly Honeycutt
khoneycutt@harnett.org
Finance Officer
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 24.159.160.130
Sent: 7/28/2021 12:15:51 PM
Viewed: 8/2/2021 11:44:06 AM
Signed: 8/2/2021 3:08:28 PM
Electronic Record and Signature Disclosure:
Accepted: 8/2/2021 3:08:13 PM
ID: 38b2354f-7433-4797-87c8-5a2cd34e8500
Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 199.90.60.4
Sent: 8/2/2021 3:08:30 PM
Viewed: 8/3/2021 11:27:37 AM
Signed: 8/3/2021 11:27:42 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
HCBOC 071222 ws Pg. 88
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 7/28/2021 12:02:24 PM
Certified Delivered Security Checked 8/3/2021 11:27:37 AM
Signing Complete Security Checked 8/3/2021 11:27:42 AM
Completed Security Checked 8/3/2021 11:27:42 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
HCBOC 071222 ws Pg. 89
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Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM
Parties agreed to: Captain Rodney Rowland, Kimberly Whitted, Kimberly Honeycutt
HCBOC 071222 ws Pg. 90
electronically from us.
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HCBOC 071222 ws Pg. 91
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HCBOC 071222 ws Pg. 92
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
North Carolina Department of Public Safety
JCPC Program - Program Agreement
SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:FY 21-22 DPS/JCPC FUNDING # (cont only)543-XXXX
COUNTY:Harnett AREA:Central Area
Multi-County:No Multi-Components No
NAME OF PROGRAM:Healthy Choices
SPONSORING AGENCY:Eleventh Judicial District ReEntry, Inc.
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 FEDERAL ID #56-2106268
COMPONENT ID #NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF
EACH COMPONENT
32457 Healthy Choices Interpersonal Skill Building $ 45,800
Total cost of components:$ 45,800
Program Manager Name & Address (same person on signature page)
Name:Dot Ehlers Title:Executive Director
Mailing
Address:
PO Box 1153
City:Smithfield Zip:27577
Phone:(919) 989-7278 Ext:1 Fax:(919) 989-8943 E-mail:reentrycp@gmail.com
Contact Person (if different from program manager)
Name:Dot Ehlers Title:Executive Director
Mailing
Address:
PO Box 1153
City:Smithfield Zip:27577
Phone:(919) 989-7278 Ext:1 Fax:(919) 989-8943 E-mail:reentrycp@gmail.com
Program Fiscal Officer (cannot be program manager)
Name:Antoan Whidbee Title:Board Treasurer
Mailing
Address:
PO Box 810
City:Smithfield Zip:27577
Phone:(919) 934-3222 Ext:1 Fax:(919) 989-8943 E-mail:reentrycp@gmail.com
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 93
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION I B PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #COMPONENT INFORMATION
32457 NAME OF COMPONENT: Healthy Choices
BRIEF DESCRIPTION: Interpersonal skills group for youth. LifeSkills and TND are evidence
based curriculums that teach communication, managing stress & anxiety, decision making,
chemical dependency, peer pressure, thinking/feeling /acting process, anger management,
media influence, & conflict resolution. Virtual workshops are provided for parents including:
Substance Abuse Education/Prevention for Teens, Managing Emotions Birth thru Teens, and
Self Care for Parents. Workshops are 2 night series for 1.5 hrs.
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 94
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components No
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:Healthy Choices Component ID #
32457
What is this component's maximum client capacity at any given time?20
Frequency of client contact per month:8 Anticipated Average Length of
Stay:90 Days
Total Component Cost:$45,800 ÷ by Estimated # to be served during funding period:20
Estimated Average Cost Per Youth:$2,290
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:4
4 Number of admissions Juvenile Justice Referred 100% of total admissions
0 Number of admissions Law Enforcement Referred 0% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
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.
Youth often have difficulties during adolescence. For at-risk youth, these difficulties are compounded by poor
parenting skills, bad role models or possibly substance abuse and domestic violence. There may be inherent
difficulties such as learning disabilities, mental health issues, or anger management problems. These deficits manifest
in poor/disruptive school behavior, alcohol/substance abuse, unacceptable peers such as gangs, unruly behavior at
home & acting out against society. Disruptive youth are often expelled from services. Their behaviors worsens and the
criminal justice system is involved. We will intervene at all levels of dysfunction & provide youth with interpersonal skills
training, substance abuse education, anger management and problem solving skills.
Parents lack the education and skills to provide appropriate supervision, knowledge to identify substance abuse and
seek prevention skills, teach youth appropriate behavior, and provide safe non violent homes. Parents are provided 6
week workshops covering: Substance Abuse Education/Prevention for Teens, Managing Emotions-Birth through
Teens, and Self Care for Parents.
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 any at-risk youth ages 12 -18 and their parents iin 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 Juvenile
Justice, courts, schools, social services and parents. There will be continuous contact with referral and potential
referral agencies 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 increase adaptive functioning and skills for youth and parents. Youth will be accessed with regard to risk
and needs. Services will address the deficits therefore improving youths’ ability to manage their anger, improve
behavior in school and home, increase problem solving skills, choose appropriate peers, address mental health needs,
and impart substance abuse and prevention education.
Parents will increase their knowledge of substance abuse including: changes in school behavior, attendance and
grades; changes in behavior at home; physical changes in appearance; and changes in peer associations. Substance
abuse risk factors will be identified and parents will learn tools to prevent or address substance abuse. Parents will be
provided knowledge to assist youth in identifying and managing emotions in effort to understand and improve youths’
behavior. Parents will receive assistance in identifying and providing self care techniques to increase their coping
skills. Increasing parents’ self care increases their energy and motivation to “hang in there” and manage problem
behaviors.
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.
80% Clients will demonstrate improvement in targeted skills identified in the individual service plan.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:Healthy Choices
80% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
80% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
80% Clients will have no new complaints with an offense date after the admission date.
80% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
80% Clients will have no new adjudications for a complaint 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.
Based on highlights of the FY 2020/2021 risk assessment data for Harnett County, we will address family domain risk
factors. These factors are an elevated percentage of adjudicated youth whose parents’ lack parenting and supervision
skills, elevated percentage of parents/custodians and siblings with a criminal history and an elevated percentage of
youth who report family discord. Youth are also in need of substance abuse education.
Parents lack the knowledge, skills and ability to provide appropriate supervision, to manage high risk situations, to
identify substance abuse, to demonstrate appropriate behaviors, to provide an example of healthy nonviolent
relationships and the ability to advocate for their children.
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Form JCPC/PA 001 JCPC Program Agreement
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 has partnered with the Harnett County Commissioners for permanent office space at Shawtown. Our office is
located at the Shawtown Community Center 645 Shawtown Road Lillington NC. Currently, due to the COVID-19
services are provided virtually. Limited in person appointments are provided as needed at our Shawtown office.
2. Operation: Describe the daily/weekly schedule of program operation.
We are providing intakes and family case management at our ReEntry office located at the Shawtown Community
Center. Youth groups are Monday nights 5-6:30. Parental workshops are on Thursday 6:30-8. Due to COVID-19
these services are currently provided virtually and face to face are provided as needed. All services will return to the
Shawtown office based on the decline in COVID-19 restrictions.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
1 Program Director/Case Manager (3/4-time)
Qualifications: 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 best practice model.
Responsibilities: Case Manager oversee caseload and will conduct intakes, advise family of program schedule,
conduct case management sessions, and act as liasion between NCDPS-DACJJ, Juvenile Court, DSS, Mental Health,
schools, and other referring agencies. Case manager will be present in Juvenile Court to schedule intake appointment
for each family.
1 group facilitator
Qualifications: 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 best practice model.
Responsibilities: Lead sessions utilizing the Strengthening the Family and/or TND curriculum. Group facilitators lead
family groups, parent only groups and youth only groups.
1 Services Quality Assurance Manager (part-time)
Qualifications: 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.
Responsibilities: Program Development, Audit client records for compliance with NCDPS JCPC Policy Standards;
Monitoring Program compliance to the keep fidelity of the LifeSkills and TND curriculums.
NOTE: All program staff attend monthly treatment team meetings and receive guidance from the psychologist with
regard to clinical and implementation stratergies.
4. Service Type SPEP: Describe implementation to include:
Provides a service: Interpersonal skill building
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.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:Healthy Choices
Juvenile Court referrals are our top priority because it allows us to intervene and possibly disrupt the anti-social
patterns of court/court counselor involved youth. We attend truancy court to identify other families in crisis. The case
manager provides court coverage. At-risk youth are targeted in Court, are referred by DSS , and Juvenile Court
Counselors. We have also collaborated with the Faith Community. 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 youth the case manager will be assign
youth to group. During the intitial group session, we review program outline, complete pre-test, set 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
termination.
Youth will be successfully terminated after completing at least 12 weeks of group and all case management
appointments.
Youth will be satisfactorily terminated after completing 9 weeks of group and at least 1 case management appointment.
Youth will be terminated unsuccessfully for attending less than 9 groups and case management appointments.
Youth will be terminated for non-compliance for failure to attend or participate.
Youth may terminated successfully or satisfactory if changes in their plan are made beyond their control, such as
moving, out of home placement or case is closed by juvenile court.
Youth will not be penalized for parents lack of participation in the parenting workshops.
How is the referring agency involved with the termination process?
Monthly staffings are conducted and/or progress reports submitted to the juvenile court counselors or other referring
agency to monitor program compliance. The referring agency may participate in all family review meetings to address
concerns. Juvenile court counselors may refer cases back to court for non-compliance. Cases referred from Truancy
Court are reviewed as scheduled by the court.
7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring
agencies including how client progress will be communicated.
We are present in juvenile court and truancy court to target and screen appropriate cases and to schedule an intake
appointment with each family. A referral form is completed and submitted to ReEntry by the referring agency. The
Case Manager will make initial contact with families, conduct intake, family case management sessions, and schedule
school visits as needed. The CM maintains ongoing contact with the assigned 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 and 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
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:Healthy Choices
utilized in this component and how will parents/guardians be involved?
LifeSkills is an 8 week evidence based program which assist youth in identifying faulty thinking patterns, impact of
behavior and consequences. Youth are taught problem solving skills, anger management techniques, conflict
resolution, and social skills. Increased knowledge and skill utilization should decrease inappropriate behavior.
Project TND- Towards No Drug Abuse This program is a 6 weeks evidence based model and will supplement the
LifeSkills curriculum. It is facilitated in a group setting. Students will increase interpersonal skills, adaptive coping and
self-management skills, decision-making and critical thinking, and increased knowledge of the negative consequences
of drug use.
Six weeks of educational workshops will be provided to parents. Topics will include information on helping youth to
identify and manage their emotions and the effects on their behavior. Parents are provided information on identifying
substance abuse through behavioral changes, identifying risk factors and resources for substance abuse prevention/
education and treatment. Self care techniques are provided for parents to assist them with managing their behavior, to
energize themselves, to model appropriate behavior, adequate supervision and pro-social skills.
9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon.
We will utilize two different evidence-based curriculums. LifeSkills is an 8 week evidence based interpersonal skills
curriculum. Additionally we provide Project TND- Towards No Drug Abuse model a 6 week evidence based
curriculum. This will provide 14 weeks of interpersonal skills training. An educational 6 week track will be provided for
parents.
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Department of Public Safety
SECTION V Terms of Agreement
This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and
Harnett County, (hereinafter referred to as the County), the County’s Juvenile Crime Prevention Council (hereinafter
referred to as the JCPC) and Eleventh Judicial District ReEntry, Inc. (hereinafter referred to as the Sponsoring
Agency).
DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows:
Term of Agreement
This Agreement shall become effective Jul 1, 2021 and shall terminate Jun 30, 2022.
Payment to Sponsoring Agency
All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be
disbursed in an amount not to exceed the amount $35000 for the term of this agreement, unless amended by an
approved Program Agreement Revision.
Availability of Funds:
All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement
budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the
appropriation, allocation, and availability of funds for this purpose to DPS.
Responsibilities of the Parties
DPS shall:
1.Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the 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 DPS 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 Program Agreement, or most recently approved Program Agreement
Revision, 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 funded program(s) in accordance with DPS 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.
The Sponsoring Agency shall:
1.Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the
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Department of Public Safety
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 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 DPS JCPC Policy and Procedures and the North Carolina Administrative Procedures;
6.Secure local match as required, if applicable, pursuant to 14B NCAC 11B.0105, for approved JCPC funds;
7.Create and adopt individualized guidelines specific to the funded program, while also adhering to DPS JCPC
Policy and Procedures for all 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 Program Agreement, or most recently
approved Program Agreement Revision, 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 funds, maintain
reports, records, and other information to properly account for the expenditure of all State funds provided to the
Sponsoring Agency;
12.When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by
the agency in the performance of the Program Agreement, or most recently approved Program Agreement
Revision, as allowed by NCGS §105-164.14(c), the agency shall exclude all refundable sales and use taxes from
reportable expenditures submitted to the County and DPS;
13.Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed
expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in
DPS JCPC Policy and Procedures 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, or most
recently approved Program Agreement Revision;
17. Indemnify and hold 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 Program Agreement or most recently approved Program Agreement
Revision;
18.Receive permission and budgetary approval from DPS prior to using the Program Agreement, or most recently
approved Program Agreement Revision, 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 NCAC 11B, and in compliance with DPS JCPC Policy 2: Operations: Program Operational
Requirements
20.Be deemed an independent contractor in the performance of services described in the Program Agreement, or
most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to
be performed and for the supervision of its employees;
21.Represent that it has, or shall secure at its own expense, all personnel required in performing the services as
described in the Program Agreement. Such personnel shall not be employees of, or have any individual
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Department of Public Safety
contractual relationship with, DPS;
Sponsoring Agency and Use of Contractor(s)/Subcontractors
The Sponsoring Agency may engage with independent contractors as needed to perform services or support services
described in the Program Agreement. When independent contractors (funds are included in line item 190 of the
budget) are providing services as described in the Program Agreement, the sponsoring agency must:
22.Upload a signed Contract for Professional Services into NCALLIES once the Program Agreement (or
Program Agreement Revision) is approved by DPS;
23.Be responsible for the performance of all contractors or subcontractors as described in the Program
Agreement, or most recently approved Program Agreement Revision;
24.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 DPS JCPC Policies and
Procedures; and
25.Ensure that all contractors or subcontractors provide all information necessary to comply with the standards
set forth in the Program Agreement or most recently approved Program Agreement Revision.
The JCPC shall:
1.Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in the JCPC Program
Agreement or most recently approved JCPC Program Agreement Revision;
2.Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Code; N.C.G.S. §143B-801
(a);143B-602;143B-851
3.Review and locally approve Program Agreement Revision(s) 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 (applicable only to JCPC funded agencies);
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 DPS JCPC Policy 3.
Operations: Program Oversight and Monitoring
Reference: 14B NCAC 11B.0202 and DPS JCPC Policy 1, 7, 8, 9, 10, and 11.
The County shall:
1.Ensure the Sponsoring Agency is appropriately licensed, and either local public agencies, 501(c) (3) non-profit
corporations or local housing authorities (applicable only to JCPC funded agencies);
2.Use funds only for the purposes DPS has approved in the Program Agreement or most recently approved
Program Agreement Revision;
3.Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108
4.Comply with DPS JCPC Policies and Procedures 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 jointly submit Final Accounting forms for the JCPC and all funded
programs according to the procedures and due dates established by DPS.
Reference: 14B NCAC 11B; DPS JCPC Policy 3, 7, 8, 9, 10, and 11
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Department of Public Safety
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.
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 11B.0110; DPS JCPC Policy 9. Fiscal Accounting and Budgeting: Final Accounting Process
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Department of Public Safety
Disbursements and Internal Controls
Reversion of Unexpended Funds
Any remaining unexpended 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 the program’s fiscal year.
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 must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 whether or not the Sponsoring Agency has 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
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Department of Public Safety
Overdue Tax Debts, shall be completed by the Sponsoring Agency to certify when there are no overdue taxes. If the
agency has overdue taxes, the Sponsoring Agency must notify DPS at the time of Program Agreement submission.
Conflict of Interest – Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 upload the statement and the Sponsoring
Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission.
Proof of 501(c) (3) – Not for profit organizations ONLY must comply with this section. This document must be
uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of
the Sponsoring Agency’s 501 (c) (3) status.
Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested in
writing by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly
authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency.
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
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 106
Form structure last revised 12/20/2013
Department of Public Safety
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.
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, pandemic, 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
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 107
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VI: BUDGET NARRATIVE
Healthy Choices Fiscal Year FY 21-22
Item #Justification Expense In Kind Expense
120 1/2 Time Case Manager @ $25/hr x 960/hours a year $24,000 $24,000
120 1- Quality Assurance Manager @ $20/hr x 13 hrs month $3,200
120 1 Group Facilitator @ $20/hour x 55/hrs. each ($1,100)$1,100
220 Food for wkly group $100 month for 12 months $130
320 Phone services $150 mo x 12 $1,800
330 Electric 183 mo. X12 $2200 $2,200
410 Office Space $900 month x 12 months $10,800
430 copier maintenance $278
450 Professional Liability Insurance $2,292
TOTAL $35,000 $10,800
Job Title
Annual Expense
Wages
Annual In Kind
Wages
1- Case manager/program director completes intakes, providment, attends
client staffing, provides court coverage and facilitate groups 30 hours week at
$25/hr
$24,000
1- Quality Assurance Manager @ $20/hr x 13 hrs. mo. $3200 $3,200
1 group facilitator $20/hr. for 55 hr $1,100
TOTAL $28,300
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 108
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VII Program:Healthy Choices
Fiscal Year:FY 21-22 Number of Months:12
Cash In Kind Total
I. Personnel Services $28,300 $28,300
120 Salaries & Wages $28,300 $28,300
180 Fringe Benefits $0
190 Professional Services* $0
*Contracts MUST be attached
II. Supplies & Materials $130 $130
210 Household & Cleaning $0
220 Food & Provisions $130 $130
230 Education & Medical $0
240 Construction & Repair $0
250 Vehicle Supplies & Materials $0
260 Office Supplies and Materials $0
280 Heating & Utility Supplies $0
290 Other Supplies and Materials $0
III. Current Obligations & Services $4,000 $4,000
310 Travel & Transportation $0
320 Communications $1,800 $1,800
330 Utilities $2,200 $2,200
340 Printing & Binding $0
350 Repairs & Maintenance $0
370 Advertising $0
380 Data Processing $0
390 Other Services $0
IV. Fixed Charges & Other Expenses $2,570 $10,800 $13,370
410 Rental or Real Property $10,800 $10,800
430 Equipment Rental $278 $278
440 Service and Maint. Contracts $0
450 Insurance & Bonding $2,292 $2,292
490 Other Fixed Charges $0
V. Capital Outlay $0
[This Section Requires Cash Match]
510 Office Furniture & Equipment $0
530 Educational Equipment $0
540 Motor Vehicle $0
550 Other Equipment $0
580 Buildings, Structure & Improv. $0
Total $35,000 $10,800 $45,800
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 109
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 21-22 Harnett County Funding ID: 543-XXXX
Sponsoring Agency: Eleventh Judicial District ReEntry, Inc. Program: Healthy Choices
$35,000 DPS/JCPC Funds * This is the amount approved in your application
10%Local Match Rate Is the Local Match Rate 10%, 20% or 30%?
$0 County Cash n/a (Specify Source)
Local Cash (Specify Source)
Local Cash (Specify Source)
$10,800 Local In-Kind ReEntry (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
$45,800 TOTAL $3,500 $10,800
Required Local Match Match Provided
/DPSSignature//DPSdt/
Authorizing Official, Department of Public Safety Date
The following signature certifies that this program agreement has been locally approved by the Board of County Commissioners.
/CountySignature//Countydt/
Chair, County Board of Commissioners or County Finance Director Date
The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention
Council.
/JCPCSignature//JCPCdt/
Chair, Juvenile Crime Prevention Council Date
/ProgramSignature//Programdt/
Program Manager Date
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
7/28/2021
7/28/2021
8/2/2021
8/3/2021
HCBOC 071222 ws Pg. 110
DocuSignEnvelope |D.9467732A-CAB8-4F08-A1l 163C507C5A2
II]TERNAI, .?EVE}.TU' SEPJ/ICE
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Contar:t Person:
. D, A- Dcl{}qrt{c rDii -: ;505
Ccnbact TelePlo;r $':abarl
(877) 8;9-550n
.Iccou:l'.:.i, rr'1 Feri< ;3 !irr,1i rrg ;
June 3ii
I'oufioa:icn S:ac::: C:aisiilcacr.s:
s0, (a) i1j
Advance ltuiiag Perjoci Btgirls:
Cctcher 8, 7998
Aiivancf R'-rLirtg Pericd Etlds;
.]1If,e JU. ;iUJ
-Mrlex3r;m Appl^:c:
No
Dear APPIica:rt:
Rase,iorri::i:lrliallonyorlsuptrlie"dl.a'dassr]llli:igy.:urcpera:ions,,l.{-']i-'ea:+state. i.,r, yor'rr: ...pri-I';il"'"rot tLit'gt'it:io:r'of t,.*'tpi:'''t' xei ha"re deLe:'r';;eC ycu
afe exen,pL tro,n teOer-ai-irr."** lax i:irle:: sec:icn SUllai ot L,e Inler;:al icvenue
Code as an crgarl.:.zacion describeC in secrion 501 ici {j) '
- Becauge yc! airl:r newly created r;'YganizaL)'o!1' $e are llt: nou rrakirl' a
.:::rrri i.e1-a,]:Lrinalicr: of y':u: fnilndaLion sCstus undar sp:;t:l'lr 5OP {'1) oi :1.1 {:ode '
i{owever, ve lr.a1-i det-crnlrLed that you can.rqasor)ah1i. ex?cci \::.bI} a pr'rri'lli1-
^..nF^ire,.l ^'*ar.zaiiI;;;;;t;;;
'i:r st'ctions 5os iai (1) aad i?0{bl i1} (;r) 1'.J-i '
Aer:ordlngly- during al-r adTa::ce -t-.tii:lg lierro-l ycu +:11 'be Lreabed i'':j a
cubLir:l,y suppcrt:ed atr-n"'ci"'' a1:: 1oc is-a p:'iva:= Jo'inihLj-rr' f ir j= '1"'ac;c'
;;i;;-;"r;"'J l.';-i-." L:<i erids o;i she da'-e's showi:' abor;='
'rlillhan -c0 days ai:er L.ile eild of y:ut advance :;uli-lg peri'c'J' f..ou a"j1:i
gerrd u6 Lhe infc;:rraii""-"."i.a t0 det;rar,ne !,ihelher yo'-r have net lhe -'ja'r: j.re'
nears cli t:1:e a::l':caii" '"pi""' Le-st '3tLr::'! ''i-r: a''iv:lc'-. r''ililrg pelicti' "f lou
e$:abl":sb rhae toir h;";;;;;-; pJ:-i"fy.sup'CrLel ors:;:tz':'ti'ci, '*e x:li c:assi-
fy ycu as a Ee.cr,ao" iiti"iii:'o. sos(al {:; orgaoizaL;c; aN Long as you rDncirrJe
Eo nE€i: ihe rsqriiren*"Lt "l lhe appiicable euppo::t t-es:' }f 1'ou do na: rit3eE
t]ie public suppor." ,.!qrit"*o.,"" a'ui:.n' tbe arlva..ce rulirrg pericd, '*e 'vi-: l
classify you a6, pti'"t. foun'lat:on icr futurc perirCs- Alqo' if ee iia'seify
;;;";;-I ;.i"r,-= rttrrautio", .re \{i1i rieai you as a privare forurdalica {::crrr
your oeqiir.lnq car'e for purpr-ises of seciior 50?idi ari +940'
Graniofs e,tiri cont.r:i;uto]--r fliay rely oir cr:: riet'tlr,i:laLij:}l\ Lha: )'cu " nci "'
".ir.,,:" f 3rrn,f:rt:; r:r: tnril 90 d.ays iir:er ehe erC ci )lcur edvancc ruli':r; !' '-^od'
t: you sen<l ttg En: J:e.Ili:ej i:riormaL:or' uiEh':':' thc -'i iai's ' g::1rr:l7t :l;'-'
corl--:ibu'ig=" ro-t'=o^'Jirrue Lo -':e11- ott:he arl"'a:tce 'ieiel-ni:1aLra:r t:n'-:1 iig ''tki
a iirtal del:eLmi.r13tion cf you:: fortn<rai-iori Elet-u5 '
ll v/e pr:bl-islr a ECt:Ce in the 1riEerl]al lr>velrre Er-lll.e[j-r scaEingr [i',.?t se
l,etr€r i01-'; rDo/CG)
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 111
DocuSign Envelope lD.9467732A-CAB8-4F08-A1p 363C507C5A2
), LE-fi Ni',li J ull:c i.i.L L)r s TR I-r1 :{i:.\Ti 7
!jil1 no loQge;- i::eal ylu as a p..&"1.ic1.; suppcrlted ctgarrizatlol, 3rantolt; .':ri
.oui:ributors i*a-r-.irL rely,:ir r.:ir:* Ce-utlninaLicl] afLer "le-
di-r€ ir'e pub-i.i''ri'r L]re
ncLi.ce. .Ia adr,lirrc.n, .if yor,: lose ycur s.atxs as a pub!.icly Eupiarhed olcan-i-
UAiiOr. ard a gr;nto: .r1'coitr:ibnlat was resI:r:nsiJ:1e for, cr was aFaz^e:i, the
acl c.r'fai-l;r1.e tC aci:, Eha'; resulLed in your iosg of 'Eu'Jh $'iaElis, ahal ?'ll:soli
ma, iiota ::e1y oa i:jll€t deEelmirlaEi{:n fronr iiLe {iaer". oi tni act r:r fai.l ur1 iii ACE '
hfic, i.i a !rar.:cl o). contribu'.:cr lear.:reci:hat !{e had given ncci.e Lhat -'.'f-J
*o.r1,i be reiovei frOrr clacsi{ieaEiC:: as a prrirliCly SuppolLed' organizat-:r>ri, tii'n'
l)ral:;:er-rc:i rna-i ilot rely cn this dete:tnj.natlor as oi Eile riate ha or she
acquired eucli kni>trledge.
rlyouchs]l.jelloursouxcegofsr:pport.ycrr::p1ilp.ses/Charac{.el,.rneEicd
of cperalior, please let. us knoi so we cail consider file effeci cf the chriiqe ol
your: (:xeillp: 5Eai.'jS al1d foundabicB shal'.is . T.f yoa a*erld_your organizatj"r!-1
lccur.'.erl ir: i:y).:T :. piease seird rrs a c'ipY of -"be .a;cenCr'C dccume:i1 ot i:':''rt;:': '
A1*o, iel: lis Lrt;,, al-i chenges 'in y'cu:: Iialrl? or adi:ess
''' 1. :531 , '.,'.f i: ara l: able for sccial s"lcrr;f-y Lixes uI"!i'r-As uL udrrrc-; r
:Il ar'cu::!= cl S'00 or mf,te '/cL: -) ' ' t':the lrederai fr,slrr:aqQe Contribtrtionc Act (
*r"nrrfyoutemployeeeduringacalendarye-ar-Ycltalect):iiebLelorL';'et'axi*p""",i i:r,ler ii,: ie.ferai Untmp)optLerrl fax 'hc:- {fl-ri}:'i'
or-oariizail-,,]ns thaE are liot- privaie fcunelalior:s aI(' n(ll Bu,lject Lc r- i pr!-
,.rc* i.ri.arLicr: sxciue iaxes'urrcl-er ChrpLe:. 42 of the ir,[ernal iieventte ']c';t'
i{o'.Jeve:, '.'?11 a:c iJ: a'l:.':la'i:r'.i1'r:-rer'3fj:-rrr c''5t: I*ij:ra1 erJIje La("' -i
il".r
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*a-y qrn=,,irns ab.ruL er,ciie . trliitio)rrlr':iit'-, a:- ullier f eder-al iaxes ' l:lease.
let'- ,.:s kncs.
Dcnors rla7,led''tct crnt.ribn:il::13 io y<t! as pro';iCecl in secticn 1]0 r:'i lht.l
tnaerna] Beverru+ ilorle. ]l.quEsi5, 1e3acies, de'r-ts::;' llissfers' cr gifL:: l:c yotr
o: fo! your use a.re- dedlciil)i,e for fitieral est*aLe aril SifE cax p'.]Ipcsa:j ll' *'hey
"".t
.
i-fr,i' applical;le prr:visicrs of sections 2055 , 21tjb ' ,l;id 2s22 cf the '"t:t '
Doacrs rllay deducl cu!1.i.libuLioas L' ltcf, oniy ta bhl1 exl-^qi that bhi: j :
ccrrr_rj.5ui.ionr: ;.r::c ,lif ts, wtth i:6 call€i(iel.ailon receiv€..- IickeE pur:oa::l , ,:i:c
e:rniIar pa?-mejtljs r;1 conlr*Ctiq,-, ldiCh lundraisinq eYenls flay;ltt rlccessrr':.,.'r'
guillify 'as cieeuctjble ceni.riblltions, depenciing on iLe .:r.rcumElat'Lc3s. i{:'':L:lie
ir:ling".ai-?,16, p.,rbii_shed in Cumu.Iatj.vr: Eul1el-in t961-i, or1 page i04, gli,+:rr
guidelinen .ugrli:ng ilhen Laxpaye:rs ltay deducL pa:'Ire6is for a&rlesron L:'. oi
6ther patt.:,cipaEJ-cn in. fundraising ar:Li-vit'ies lcr :hc:1iy'
you aie not rcqui:.ed t.c f.i.ie fo:nr 9?0, Return oE c::gt'tllizaLion Exer:.i:r: I:,ottt
IncomB ?ax, lf yeur gross reas-:Fts eac-:r ye6r a::e rormaliy s25.0t)c cr iacrr. lf
yolr receiwe a Patm l-lO ;ackage i:r ti--e ,naiI, sintrIy atiil.lh ahe f dltre1 Pr-i-'!'.-r:a,
c}lt.:Ii :..:e ha>. r:. :.hl l.r Icl:.r:; : c i:ii:ar- e :'1a: 1'nlrE ':i' :rr I 'J:os3 l'ce:;rl i' ':'c
nr;z.mal.1y $?5, J,:)0 ,;l ies-q, atrd Si!t: ihe r-eiultl. Eecaus€ you *rll b€ Lr,rii:.13 as
a public cha:alt:, llcr re;uri: tiiing purFoses dLlring y;rr e::cir:'c a<ivaace :r;i i-::g
p"rloa, l.,ot shou:c fj.l_e Fo:m 990'tcr each year i:'r 1,r-':r sivance ruliag;r...r"ioil
i:hat i,ou ex(cei :he $25,6flJ lili:rg thre;;lio1C e'r=n j.f lcnr souices oI 6..!; (,ri
rio ::ot* sa:l$irw {:.s, F'tjb}}c suppor'fi Lesi sper-:i-f j.e'i in i:}l€ headi;g of thi3 ,. tilLcr.
I.ett-ct: l0{5 i;.1-\./CC)
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 112
DocuSignEnvelopelD:9467732A-CAB8-4F08-A1A 63C507C5A2
-:.-
Er.gv5ltli{ .iLD;c r.11, IJIST;{I{_'! nEE}n,p.y
If ;r r;tiirlr. rs reqfutred, j i B)r,i-cl. h€ filed bl7 tie lsti da:/ oI Lhe j .ir:hrnuith after the ::iri of ycur a.nual a.counling peirod" l penai:}- of g.i,l ., uayis cirarged sheu areELln iq fjled laie, rarleie tJrere.i$ ri:sonaile cr,ri,,. for'the Cejay, HolliriveI, l-,Ile I]ld(ittun pentlty chargee caar{ri cxceed SL0,oot ::
_. r.f-i. E,:.- .]z i-.: -,..r 4-r --,e /CJj., wlri:ic:.-: :. le .;:. -j-.:or:qar:lzaaions r"il:ie: r;:'css ::eceipt.r exceeci:,g $:l , 000, 0c1-.i ir;. atr)/ ytar.., Lirc -r,e[alr_yis s1c0 per dn? pe" return, l;riess Lhere is ressona,b}: c":use fol ihe dera;,The max.i-mum pena:i1' f;)r afl organlza:iori. .rith grass iecelEr6 exce€iiilg$:,cnc,000 shal-l ;rot exceed $50,000. tlis pe;ralty rEy aisc l:e crargid rI areturi is ncl cenpieie, ^9c, please be sure ycur ietu;ir is complete be_(crl,: vou:ile ir
Y'cu a)ie n.i l:equ:.yed to f j;.e iederal i-ncorns E,fx a+;,.rrns rrnlegg y{-,u diesubjecl: ic E]:e t:ax cii ur)re:l-ateal business j.;:co$e :rncr:r ;ect.icn 5 j._1 of a;i;r cocle.7i'.ttl:1Ie 6uh-i.t: Lo this tax, ycl: ru.st fj.ic .1;1 ir:aaf,1i u:;{ !eLuf-n oii i,_,:.:rr90-.'i. Iixernir:. t:'ltr,izaLion Eusines-s rncone 1'ax !eL,-1r:l- rn thi,s LetLe: rv,: arelot 6e|'e1:nj-ni:r:l rrJ:ather anlr of your preeeEt or proirori3d art-iriiaes dr. uiirc-lateg rrr:.de or Lcsixess as dcfined in secaiol 5r3 oi i:li* Cooe.
YDU are:-..t,liye-d Lc nake your a:utual fdt'J-i;t avaiia"b,ie fcr pr.&Iiclnspe:Licn for thte€ yeals aftcr lhe::erurn j.s due. Eol are alio requi.r:r:; lor.ake available.r cayy r:f your: exur,ptLon ai:-;l.Lcatio*, ary sr.:FpcrLilg cir:cr;r,rrnls,
a]1(i thig exE:{Jr-rrj,r J.ettsr. Fail"':re LC r.ake Lilei;e ric:jlaenEs'availahle fr::prrlrlj-= inspecL|-"r may s'.i):je r:r ycu !.., n'!i1l:.1t1, r:t lil) 1:ir day f ct e,rr:: : ;..,:ile:- .i x n la:. 1-. i.,) cc;r;)i' {-l; := a :,r.trin,rnr cf JtC, j,:i :r, uhe cdsE Jf iar.aua.]. r€:ur:l) .
- l-au lee: er-- enr;:aye: rCe:l.tl::ciLrJn r.un;rtr er-ln j i you l.:ve no er:..r ,...ees.rr an enplcyer id*nciSicai-ion.:rurni:e:: was rc: err.iered oi1 yor.lr app)lc:ltio:r 'rre
will asriigr-i ar n',::rber t.o r/cu ana ailwise you of iL:. pLease r:se l*:L t1u;nL=:: onall l:et:.jrns yci; :iie ana. ln. all correspond.erlce ?.ith Elle rrrlcrnal iieven.rirllerJi-ce.
If rt saj"d in :hp ire;:d:nq oi thj-c leLLe:. tllau an .;C.deed,.ir,,t aopires. :.j-..1dJ:eI)Cur.l eIc l:rs,t.j is .,r: :r:ucEr aJ pa:: cJ 3i.: s :eci.er,
Recause this leLter couiri heip us::escivs anlr +lssricns abo.lit rr'our-- ij.:en!islaf,us anC fcit:irJation staLus, you shoul.i keep it in yrriir Fe17narlent aaa"r,"l.,_ -
L€ t- Ler io45 i i 13,/cc)
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 113
D1OMTVENI OF PUAL C SAFEP
NOT F'OR PR*FIT
DPS CONFLTCT OF INTEREST POI,ICY STA"IEII,{EIiT
This document is only required frcrn not for profit organizations ONLY: ltt ctt'c'csrclsrtca tt'itft
tha j)i.('.{;.5. t43{'-6-33 {h), ct,ar}) (ir{tn/ac sh*l/.{ilc witlt tke Slolc ogent:y/{irrtnlar tt co|tt'o.f-lhe
{ir*yltc':; ilgefic1- 1tt/it't u.cltlre,s.sing t:an/lit'ts of inlerasl lhul mayori.sc involt'ing lha (irunlea's
ltLtpogcilrcnt eiltpler)ccs rtnd lhe ntcmher.r o./'its hoard o.f'tliratlors or olhar gavernin! bodr. 'l'hc
axLcpl 6s tlrc {irun!cc'.t ctuplol,ccs tsr mcnthars ol'its httttrtl or o{her grtrtrning hot/1',.front lha
{}rantee'.s rlisbursing o/'stute.fitntl.r ctnd shall inc:ltrdc tlttiotls lct be laliett ht: tlte (}t'*nfea rtr lhe
indivithru! , or futtlt to ut,t;iLl ttsnflids o.l'inlarcsl anrl the ilppa{trdlt}te tf itttproltrielr. Agcttt:1'
conflict 9J'inttrest trta!il61,shctll bc sttbntittct{ lo lhe f)eStat'inlcilf o./ hrhlit'Sr{b4' OPS}lo n'oid ctttl'
tlaIu.t' v iIh tht tji.vhur,scmcnt o/ I)I)S .l('l'('./itncls-
'l'hc Gruntaa shtll suhptit thi.s.fisrw (liol./i* I'rr;fit l)l'S *;n.t'lict of"lntcrtst llolic:1' Slulamcnl !;tsrnr
Dl'S' l3 00IS alongtt'ith the og:et?('),'s conflict o{inlerest polil:v'hcn ttppl.t:inglbr./irnding-
Accordingly, no member or board lnember of the private. notiprof'it entiry t'nay receive
directly or indirectly, an.v funds received fronr lhe State of Narlh Catolina, except for
duirv. authorized stall compensation and benefits, and reimbllrsen:lent tbr expenses
actgally incurred in connectiou r,vith the prir,ate, nonprofit entity's business and in
accorda:rce wilh linal approved grant agreetnents.
WHEREAS, {N*me af *titv}desires to
require its Board of Directors and'dranaging ernplo,vees to avoid conflicts of interest nr the
appearance of icrproprie[' in the disbr-rrseuent of State fr-ir-rds;
THEREFORE, no member of the Board of llir*ctors or statI members ol said private.
nonprofit entity shail participate in the solicitation. nesotiatiot"t. fonlatiotl, arvard.
arbitration. tloclification, or seltlemenl of any contract or grant lunded in rvholc or in pirrt
b;,* State lirnds or olany dispute:rrising under such coutt"act or gt'ant n{ren t}:e directot'or
staff members stands to benefit. eitlier directly or indirectly. trour such grant or contract;
PROYIDED. no merlber of the Board of Dilectors or statl'metnbers shall be deemed to
benefit directly or indirectly fi'om an-y contract or grant llnderl in whole or in par1b1' State
funds if heishe receives only the salarl- or stipend due to hitl,'her in the nonnal course of
employurent rvith, or service to. said pdvate, nonprofit entity.
F|RTHEIi.I\{ORE, said private. nonprofit entity has rvritten cont)ict ot- intere st prilicies
and reporting procedures applicable to boarcl menrbers, sterlf merrbet's anti volunteers rvho
have any interest or aoy autirority regarding the resources of the private, nonprofit entily.
Tliese policies lrave been comrnunicated to board tretnbers, staff mernbers and volunteers
ancl tull disclosure has becn provided lor any possible appearance of carlflict of interest
thal may exist.
Forrn DPS i 3 001 Not for Proiit DPS Conllicl ol Intercst Polict' Stalement
Form structr.ire lasi t'cvised .lrr11'?02{)
NC Depadn.rent of Pr.rblic Safety Pase 1 of3
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 114
NOT F'OR PROI]IT
DPS CONFLICT OF INI'EREST POLICY STATEMENT
The foltowifig senr€s to identify anrl datanrefit flny personal interest staff members,
offiierc, sndinen$ers af the Boord af Directors ru*y have Tltis doeunrcntis als* to be
ased to tlisclose finy traqsdctlans thot moy resalt in personal, ftnanclnl, pt'afessian*l
ttxtllorlwliticat gilin ut tlw Wtewe o!frPfl. The ststentent requires th$ atlpersolrn{
relatioishipt tn* ffi{ty inippropriatety infiuenee (bi*s) tetisns be dlsclosed.
Relttionsiips, be it person*i, linwcinl, prclessionsl awllor politicul arc_tequired to be
tlisclosetl i np$, ConJtia ,neflns a eonfiict or the fippeflrunce of rt contlict befi*een the
priattte intcrests anrt fficill rcsponsilsilities o{ a person in u positiotr oftrasl, Persons'in
a position of ffast itrclude staffnrcntbers ot the Board af Directots-
Pr.iv*te, nonprofit entities shall make full diselosure by notice in writing to the full
Gcvernirg Boarf,rConncil *II confficts of interest, if "yes- is tnswered to nny of the
fallowing, see pftge 3: (Check alt thnt apply)
YES NO
1, A Board member is relatecl to a stalf metnber.D
2. A ,strfrrr*"ber in a supervisory <;apacity is related to another staff
member whorrt he/she supewises.ii i<.--7
1,"\l
i. A staff member is related to anotlter staff rtrernber.D
A boald member or staff member has or firay have petsonal,
financial, professionalo an#or political gain at the expense cr
benefit of the private, nonprofit entity'
4.n l\,?lta\
Ihele is a business entity i1whish a staff, boartl, or'{an:ily nrenrtrcr
palticipates that may be vielved as having direct or indirest
inf'luenu,e over tlte priya!e,. nonprot!eqtilY's husinqls. *'----
5.I X
e a staff, board, or.larnily mcmber nray be viewed as having direct
or indilect linanciai gain fi'ont personal or Lrusitress
irrvesturents/interest i1real properly held by that statt, board, ot
talnily ntetlber,
il C7
i,/\
A stafl'or board rnetnber received honorarium or other
compeusation outside of the scope of enrpii-ryrnenUoperations rvith
lhe ,rr.rirra$4 nnrrgrjfi.t e.r*-i,ly tEot r..e"at s rr,'.+Vgsrs Jc. rT'*Je ltir.
u tr
8. A staff or board tnetnber securerl employment with a competitor or
other sirnilar private, nonprofit cntity.i-t R7tl!
Ongoing, paid consttlting u'ork orttsidc oJ'the staff trretlrher's
cnrrent etnployment ol board member's with youl privatc,
nonprollt entity exisls.
9.
L]lVt/*\
.[iornt IJPS 13 U0t Nor tol' Prafit t]PS ConfiLct of'l[tet'est Policy Statcment
Fornl structilre last revised Jrtty 2020
NC IJcpartnrcnt ot'Public Safbty Page 2 o{'3
1l
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 115
NOT FOR PROFIT
DPSCONT.LICToFINTERESTPOLICYSTATEMENT
1. If .Jres,, is checked to any of the aforementioned items, the JCPC Program
Manug"r and Board chair must ensure details for any transaction that exists are
described and attached to this foim'
2. If this statement fails to list a transaction that may exist that is non-financial in
natut€, please attzch details.
3. Details must include at least the name, and, address, or persons involved, and a
description of the relationship and the transaction'
Note: Failure to disclose any conflict of interest transaction that exists or is
potential within your private, nonprofit entity may result in the cessation
of any further DPS JCPC State funds'
County:
Agency's Name:
(Legal Applicant)
juilia,O b
f-lrL, nr4*
Federal rax ID #t fb S ! t") b?,b<
Private, NonProfit
EntrtY Name:
Executive Director's Print
Name: Sign
Board Chair's Print
Name: Sign
Sworn to and subscribed before me on the
Day of the date of said certification
0q /;l -a ( {a
Form DPS 13 001 Not for Pi'ofit DPS Conflict of Interest Policy Statement
Form structure last levised July 2020
NC Department of Public Safetv
(Date of Si
,"st*ffi
Page 3 of3
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 116
Eleventh Judiciol District ReEntry lnc
No Overdue Tax Debts'
Date of Certification 07 I 74 I 2071
To: State Agency Head and Chief Fiscal Officer
Certification:
We certify that the Eleventh Judicial District ReEntry forganization's NarneJ does not
have any overdue tax debts, as defined by N.C.G.S. 105'743.1, at the federal, State, or
locat levet. We further understand that any person who makes a fatse statement in
violar-ion of N.C-G-S . 143C-6-73(c) is guilt-y of. a crimJnal offense punishabl.e as provi.ded by
N.C.G.S. 143C-144.
Sworn Statement:
David McCrae [name of Boord Choir] dnd DorOthy Ehters [name of Second Authorizing
officiatl being duty sworn, say that we are the Board Chair and Executive Director [Titte
of the Second Authorizing Officiatl, respectivety,
of 11'h Judicial. District ReEntry lnc. forganizotion's Name] of Liltington and
Smithfietd tcityl in the State of NC [state]i and that the foregoing certification is
true, accurate and complete to the best of our knowtedge and was made and subscribed by
us. We also and understand that any misuse of State funds wiil be reported
for further action.
Board Chair
al.tsl ,l
Date I I
3l-4rr
Date I I
Sworn to and subscribed before of said certification.
My Commission Expires: '1-l -/ i i .-r "). ,1
(Notary and Seal)
lf there are any questions, ptease contact the Department of Pubtic Safety that funded the program
agreement. lf needed, you may contact the North Carotina Office of State Budget and Management,
NCGrants@osbm.nc.gov - (91 9) 807 -4795
MS&NCD Form 0008 Eff. Juty 1,2005 Revised Juty 18,7A06'7/07'9/08,7/10
Thjs form is avaitabte in electronic format (Microsoft Word document] at http://ncarts.org/qrants/grant-forms/
rizing Officiat Signature
ry,*;"irs
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 117
DocusignEnvelopelD 9467732A-CAB8-4F08-A'1A'63C507C5A2
eie:uqrthiudiglgl,glstyrc! feZnliytlnci': ,, - :,,' ,il,','r";;*u"s",il*i
P.t5t Of{ics Fsr 1i5I
ca|tFLrcrar:tr\ryr:RgiT poLt.,y :ruil;;1;|rt'Jff:
Eleyenrl 'udics Disrr.rrReEnrry, Irc. ills) ses,alol ro*
X?;#&;?ffiffi;E;qd 6 g1 1c6ral or prcciysd intetcsr by e staffr$embcr.sr jtuard h{crnber in rn acio:r S:r
.nr.iJ.-s ir:, or ha: dla aPp3i::trci of rsulrirg il, gesw.J, orymrzarianal oc prcftrsion*.i gair- A confli.cr of jnrer{sr ocrrrs
whcn an a:rplo;re e or Boerd Ma.nbcr hgr r dirccr'or. Sduciary inrer.es|in erorl'rel trlerionship, A confuct of inrrest could
ur cl; ia
. r Owntr'sUp ltith e xnernber of the Board c} Dirr*crs ot an u:tclc,;ee wherc one or rhc oiher l:s
supca,isory *urhoriry ove' the ochu or wjro a dient qho rcreivrs se:rices
t Erploy.ql*rl c_f o1 by " a:"SE: c{ rlre Eoard of Dii:crors or r:r e-.npioyea wirere oria or Ae olher tas
. superrfucry aurhoricy o,rer r!.e other cr virl a diq:t pho recdves seryiceJ
r . Contaelrl relrricnsiri wir]r a i,::eribu of rhe Eorxl ,:f'Dueln.r +. o *rplolee ,.tu.. gru or rire orl',cr
las.nipani:or7 ar.rCroriy over th.e oLlrer or rvidr a clierr who recuyes srrvices
. Crcditor or dcErpr.te a mcrnb* Cthe bcard of Direrrors c.r xn ernplolce r,here one or rle ortrcq bss
sapr<tlscsty authcriy ortr Ac ori:er or r+,ju( a<hear who icceiv.i senlces t
. Conr,rltarive sr cc?iJuncr rtiacionsirip wirn a me.nbcr of rheloard o.rDirccrnrs or an cmplo;rcc where ole
-or tLe o[ki Iu supcrv:-soy audorirl ofc dre orh* or wirh * cijarr wllo rec*ver scnrcas
Tlc dclloiuon uf conflict of interesr includ.s *n, biar or rhc alp.tarance ol birs rn a dec,iron rr:hing process rlar rvould
rcllt.t -a d,,z' roir lle]'cd b)' : me*b:: cIl\c crga.rrizr:ior, i:r grcup, ,{r axar:rir, ior'i.rrsc,uce. m:ghc Lvclve a pet:orlwiro
rs an enrpiuyci ard e Bori'd hle.nbcr, or r,pctsoo rho is re.trnployee l:d wiro ltes fara'ly m'-mbas i-r consiitanus
Enplol,ee Rcsp o nsibilro
Il ;s in .rl:e iL:iet*r of ihe cro-r-nr:adoo, i,-rdii{iual srafi an<i tsoard membls ri srrengt}ren rrusc a-nd :onflde,tca in earh
oile;, co expcCite resolurion c?problems, ro n::igace 6c efftc: l,r.d ro minimjze otgan-4tionaI alrl ra&riduai rcless clac
ca:r be catrseC by a conflicr ofurteres:
;.-t:riFr:I3- aru:. ii'iri r:y l;;iili;i of :',:isic.r, i,ver Lne a?De:rirlce oi'e coniiic; oiiatcrsa Tlris erg+.i,;1jsn scrvcr LIrc
coarmuniry as a ,a'1c.1e m.rher ihen only servi.rg * special iatercst grolp, TLe rppearance of r ronfiict of uit-resc (er cause
embar.essmenl'to rhe orgmiz:tion and jtoprrd,zc dre crcdibiliry of the orgoniznrion. Any confucc of I'rreresr, potcntirl
corfiicrofitlrerrtt,orthiapocrreacsofeco:rI.icc'oftrieressistoberrpori*dtoycursu?efliscrimmedietdy, Eraploycer
rc rc :niintern indq,r,rtdeocc and objecrivicv rrjth c[enrs, tht tcarn':air;r, rnd oryanrzacioa EropJoyees are csi]sd tc
nrriqtarr a seose.of fairness, c:viliq, crfuc.r, anl rersor:-ai laiegnf.egcl drougL hw, reguiaion, ot crrstorn dces::orrcquire
rjrern
.-Li -.rriJ'r!- w. v-' )
Employ:e$, membels oi earploycei immadrate iamill urd 4rerc5ers of &c Boatd are pra\ibired fror:: acceprirg giiir,
a. Persbrureceiving btnefitsfiou rhe.orguizarion
b, &rv pcrsch ot orgarri4doa pafor+ng qr seelmg ro perfoaa sesiccs u.nder conrr*ct ryir!
-Jre orgenizarioc
c lcrsors ivho are olirere/ise :n a posirion-t,.r benalrr (dnr tLe acrians of any unpicyee of'rhe
. 'c:ganiz-ation
.
Bmployees rnap rvid: the pricr writtae app:ovr-i of rheir.+l^oerruor, recrlvi honoraru (ol icctura: ;:rd ollcr s,ich lctiyirjes
tyhj.le on persc:nl da1s, cornpei:siroy rrte. annsal Jeavc; at7*t,e wilhoutXay, If tire enployee a acting in aay o$icial
.a!xaL?, honcraria received hy ur tlnplol'rc rn Onnecliou vith acririti.es relethg tu enrlolmenr wjrL the orgairizarion are
to I,e piiC ro the.orgrnizadon
DocuSign Envelope ID: B131A854-04E8-485E-BB90-68ED6E7C5AA6
HCBOC 071222 ws Pg. 118
Certificate Of Completion
Envelope Id: B131A85404E8485EBB9068ED6E7C5AA6 Status: Completed
Subject: DPS eSignature Request for Harnett 543-10619 Healthy Choices
Source Envelope:
Document Pages: 26 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
3040 Hammond Business Pl
Raleigh, NC 27603
djjdp.applicationsupport@ncdps.gov
IP Address: 207.4.107.21
Record Tracking
Status: Original
7/28/2021 12:11:45 PM
Holder: DPS-DJJ Community Programs
djjdp.applicationsupport@ncdps.gov
Location: DocuSign
Signer Events Signature Timestamp
Dot Ehlers
reentrycp@gmail.com
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 99.116.73.79
Signed using mobile
Sent: 7/28/2021 12:11:48 PM
Viewed: 7/28/2021 12:14:10 PM
Signed: 7/28/2021 12:14:43 PM
Electronic Record and Signature Disclosure:
Accepted: 7/28/2021 12:14:10 PM
ID: a8e4bd21-3770-43d4-97db-5883c17d028d
Kimberly Whitted
kwhitted@campbell.edu
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 76.182.58.128
Sent: 7/28/2021 12:14:45 PM
Viewed: 7/28/2021 12:16:21 PM
Signed: 7/28/2021 12:16:39 PM
Electronic Record and Signature Disclosure:
Accepted: 7/28/2021 12:16:21 PM
ID: b0df4d46-539a-4901-8ef8-260785d6b973
Kimberly Honeycutt
khoneycutt@harnett.org
Finance Officer
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 24.159.160.130
Sent: 7/28/2021 12:16:41 PM
Viewed: 8/2/2021 11:45:39 AM
Signed: 8/2/2021 3:07:09 PM
Electronic Record and Signature Disclosure:
Accepted: 8/2/2021 3:07:01 PM
ID: b696446f-3422-4b8e-bc14-d3272b5613e2
Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 199.90.60.4
Sent: 8/2/2021 3:07:11 PM
Viewed: 8/3/2021 11:27:50 AM
Signed: 8/3/2021 11:27:57 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
HCBOC 071222 ws Pg. 119
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 7/28/2021 12:11:48 PM
Certified Delivered Security Checked 8/3/2021 11:27:50 AM
Signing Complete Security Checked 8/3/2021 11:27:57 AM
Completed Security Checked 8/3/2021 11:27:57 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
HCBOC 071222 ws Pg. 120
CONSUMER DISCLOSURE
From time to time, NC Dept of Public Safety (we, us or Company) may be required by law to
provide to you certain written notices or disclosures. Described below are the terms and
conditions for providing to you such notices and disclosures electronically through the
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At any time, you may request from us a paper copy of any record provided or made available
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send you paper copies of any such documents from our office to you, you will be charged a
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procedure described below.
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If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
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disclosure in paper format and withdraw your consent to receive notices and disclosures
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Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign ‘Withdraw Consent’ form on the signing page
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your consent to receive required notices and disclosures electronically from us and you will no
longer be able to use the DocuSign system to receive required notices and consents electronically
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All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM
Parties agreed to: Dot Ehlers, Kimberly Whitted, Kimberly Honeycutt
HCBOC 071222 ws Pg. 121
electronically from us.
How to contact NC Dept of Public Safety:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: david.pozun@ncdps.gov
To advise NC Dept of Public Safety of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at david.pozun@ncdps.gov and in
the body of such request you must state: your previous e-mail address, your new e-mail address.
We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from NC Dept of Public Safety
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to david.pozun@ncdps.gov and in the
body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with NC Dept of Public Safety
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign session, and on the subsequent
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Acknowledging your access and consent to receive materials electronically
HCBOC 071222 ws Pg. 122
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you were
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by clicking the ‘I agree’ button below.
By checking the ‘I agree’ box, I confirm that:
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ELECTRONIC CONSUMER DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify NC Dept of Public Safety as described above, I consent to receive
from exclusively through electronic means all notices, disclosures, authorizations,
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available to me by NC Dept of Public Safety during the course of my relationship with
you.
HCBOC 071222 ws Pg. 123
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
North Carolina Department of Public Safety
JCPC Program - Program Agreement
SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:FY 21-22 DPS/JCPC FUNDING # (cont only)543-XXXX
COUNTY:Harnett AREA:Central Area
Multi-County:No Multi-Components No
NAME OF PROGRAM:4-H Teen Court and At-Risk Youth Development
SPONSORING AGENCY:Harnett County Government
SPONSORING AGENCY
PHYSICAL ADDRESS:
200 Alexander Drive
Lillington NC 27546
SPONSORING AGENCY
MAILING ADDRESS:
POB 940
Lillington NC 27546
TYPE:Public FEDERAL ID #56-6000306
COMPONENT ID #NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF
EACH COMPONENT
32104 4-H Teen Court and At-Risk Youth Development Teen Court $ 47,692
Total cost of components:$ 47,692
Program Manager Name & Address (same person on signature page)
Name:Jackie Helton Title:County Extension 4-H Agent
Mailing
Address:
126 Alexander Drive
City:Lillington Zip:27546Suite 300
Phone:(910) 814-6027 Fax:(910) 893-7539 E-mail:jhelton@harnett.org
Contact Person (if different from program manager)
Name:Alia Langdon Title:Program Coordinator
Mailing
Address:
126 Alexander Drive
City:Lillington Zip:27546Suite 300
Phone:(910) 814-6022 Fax:(910) 893-7539 E-mail:alangdon@harnett.org
Program Fiscal Officer (cannot be program manager)
Name:Kimberly Honeycutt Title:County Finance Officer
Mailing
Address:
PO Box 760
City:Lillington Zip:27546
Phone:(910) 893-7557 Fax:(910) 893-3445 E-mail:khoneycutt@harnett.org
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION I B PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #COMPONENT INFORMATION
32104 NAME OF COMPONENT: 4-H Teen Court and At-Risk Youth Development
BRIEF DESCRIPTION: Program provides as a community resource for the diversion of cases
in which juveniles ages 6-17 years old have allegedly committed certain offenses for hearing by
a jury of their peers The Teen Court Jury may assign the juvenile to counseling, restitution,
curfews, community service, or other rehabilitative measures.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components No
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:4-H Teen Court and At-Risk Youth Development Component ID #
32104
What is this component's maximum client capacity at any given time?20
Frequency of client contact per month:4 Anticipated Average Length of
Stay:120 Days
Total Component Cost:$47,692 ÷ by Estimated # to be served during funding period:30
Estimated Average Cost Per Youth:$1,590
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:22
1 Number of admissions Juvenile Justice Referred 4.55% of total admissions
21 Number of admissions Law Enforcement Referred 95.45% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
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Form JCPC/PA 001 JCPC Program Agreement
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
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, Harnett County youth are at the following levels for school
based offenses and complaints received. Non Court Involved/ Court Involved R1-23.5/ 1.7%, R2-35.3/ 6.7%, R3-36.3/
48.3%, R4-4.9/ 33.3%, R5-0/ 10%. County data is consistent with State data which reflects that the majority of youth
for the two year period, average 86.5%, are age 12 or older when their first delinquent offense was reported in an
alleged complaint.
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 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.
Youth, ages 6 to 17 years old whose referring behavior constitutes a violation of the law or misdemeanor 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 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.
4. Measurable Objective(s): State in measurable terms (%) the intended effect of the program on specific
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Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:4-H Teen Court and At-Risk Youth Development
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.
75% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
75% Clients will have no new complaints with an offense date after the admission date.
75% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
90% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
95% Clients will demonstrate improvement in developing and/or maintaining social and interpersonal interactions
during program participation.
75% Clients will have no new adjudications for a complaint 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 sweet potato
gleaning, and food drives. Partners include NC 4-H, the Central Food Bank of NC, the NC Cooperative Extension,
Harnett County Schools and the Harnett County Food Pantry.
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
creating opportunities for increased association with pro-social peers and adult volunteers and staff. Upon completion
of sanctions, youth will be encouraged to continue 4-H participation to maintain opportunities for pro-social interaction.
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Form JCPC/PA 001 JCPC Program Agreement
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
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 or at the Harnett County
Agriculture Center as needed due to extenuating circumstances.
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. Schedule is also
subject to change when Teen Court Staff is at a training.
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 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 bi-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, training or sanctions that are required to occur after hours or on weekends in order not to exceed 40 hours
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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
per week.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
1 F/T 4-H Teen Court Program Manager (4-H Program Assistant)
Qualifications: Must possess a minimum of an Bachelors degree in a Human Services or a related field or a four year
degree in any other field with at least 2 years experience as a direct service professional in a juvenile serving agency.
Responsibilities: 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 (Attorneys, Judges and District Attorneys)
Qualifications: Professional career in the specific volunteer role with Teen Court.
Responsibilities: 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.
Adult Volunteers
Qualifications: Must complete the NC 4-H Volunteer Screening application process that includes a background check.
Responsibilities: Ensure efficient proceeding of Teen Court cases. Community volunteers will assist with
implementation of sanctions.
Teen Volunteers
Qualifications: An interest in working with Teen Court and successfully completed the training for the role taken with
the program.
Responsibilities: Youth volunteers 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.
NOTE: All volunteers, both adult and youth, are required to attend Teen Court trainings that address the needs of their
assigned responsibility. All will receive written volunteer job descriptions and are required to sign a standard of
behavior and confidentiality statement.
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.
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Form JCPC/PA 001 JCPC Program Agreement
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
4-H Teen Court referrals will be accepted from Law Enforcement Officials and Juvenile Justice.
Referral Process: Email notification that there is a referral coming. Upon receiving a written referral by fax or in person,
the Teen Court Coordinator will assess the suitability of referred youth. Within 30 days of receiving the referral, the
Coordinator will make contact with the accepted referred youth's parent/guardian.
Screening Process: 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.
Admission Process: 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. Juveniles must be admitted into the program within 30 days of receiving the referral.
Client tracking data will be entered within 7 days of the admission decision.
Reasons why a referral may not be accepted: If a youth has reached their 18 birthday and/or is charged with any of the
following: Teen Court coordinator feels that the level of service needed is beyond the program's capacity. Driving while
impaired, Class A1 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.
The Teen Court Program Manager makes terminations decisions.
Termination Process: A written termination form will be completed which will include sanctions (activities) completed,
results, recommendations, last date of program contact and reason for termination. 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. Data will be entered into client tracking within 7 days of the termination decision.
Successful Completion: Indicates a high level of juvenile participation in program activities and achievement of
behavior improvement goals.
Satisfactory Completion: Indicates an acceptable level of juvenile participation and behavior improvement even though
the juvenile did not complete all program activities and did not meet all behavior goals.(Must obtain approval from
Program Director and notify referring agency)
Unsuccessful Completion: Failure to meet specific goals and requirements or make sufficient progress in the program.
(Must obtain approval from Program Director and notify referring agency),
Non-Compliance: Unexcused absences or refusing to participate in treatment activities. Must obtain approval from
Program Director and notify referring agency.
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Form JCPC/PA 001 JCPC Program Agreement
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
How is the referring agency involved with the termination process?
The referring agency will be notified through written, oral, or email correspondence 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, email or in writing.
Client progress forms will be used to document monthly progress and filed.
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.
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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
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,
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.
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Department of Public Safety
SECTION V Terms of Agreement
This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and
Harnett County, (hereinafter referred to as the County), the County’s Juvenile Crime Prevention Council (hereinafter
referred to as the JCPC) and Harnett County Government (hereinafter referred to as the Sponsoring Agency).
DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows:
Term of Agreement
This Agreement shall become effective Jul 1, 2021 and shall terminate Jun 30, 2022.
Payment to Sponsoring Agency
All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be
disbursed in an amount not to exceed the amount $40000 for the term of this agreement, unless amended by an
approved Program Agreement Revision.
Availability of Funds:
All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement
budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the
appropriation, allocation, and availability of funds for this purpose to DPS.
Responsibilities of the Parties
DPS shall:
1.Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the 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 DPS 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 Program Agreement, or most recently approved Program Agreement
Revision, 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 funded program(s) in accordance with DPS 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.
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;
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Department of Public Safety
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 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 DPS JCPC Policy and Procedures and the North Carolina Administrative Procedures;
6.Secure local match as required, if applicable, pursuant to 14B NCAC 11B.0105, for approved JCPC funds;
7.Create and adopt individualized guidelines specific to the funded program, while also adhering to DPS JCPC
Policy and Procedures for all 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 Program Agreement, or most recently
approved Program Agreement Revision, 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 funds, maintain
reports, records, and other information to properly account for the expenditure of all State funds provided to the
Sponsoring Agency;
12.When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by
the agency in the performance of the Program Agreement, or most recently approved Program Agreement
Revision, as allowed by NCGS §105-164.14(c), the agency shall exclude all refundable sales and use taxes from
reportable expenditures submitted to the County and DPS;
13.Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed
expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in
DPS JCPC Policy and Procedures 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, or most
recently approved Program Agreement Revision;
17. Indemnify and hold 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 Program Agreement or most recently approved Program Agreement
Revision;
18.Receive permission and budgetary approval from DPS prior to using the Program Agreement, or most recently
approved Program Agreement Revision, 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 NCAC 11B, and in compliance with DPS JCPC Policy 2: Operations: Program Operational
Requirements
20.Be deemed an independent contractor in the performance of services described in the Program Agreement, or
most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to
be performed and for the supervision of its employees;
21.Represent that it has, or shall secure at its own expense, all personnel required in performing the services as
described in the Program Agreement. Such personnel shall not be employees of, or have any individual
contractual relationship with, DPS;
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Department of Public Safety
Sponsoring Agency and Use of Contractor(s)/Subcontractors
The Sponsoring Agency may engage with independent contractors as needed to perform services or support services
described in the Program Agreement. When independent contractors (funds are included in line item 190 of the
budget) are providing services as described in the Program Agreement, the sponsoring agency must:
22.Upload a signed Contract for Professional Services into NCALLIES once the Program Agreement (or
Program Agreement Revision) is approved by DPS;
23.Be responsible for the performance of all contractors or subcontractors as described in the Program
Agreement, or most recently approved Program Agreement Revision;
24.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 DPS JCPC Policies and
Procedures; and
25.Ensure that all contractors or subcontractors provide all information necessary to comply with the standards
set forth in the Program Agreement or most recently approved Program Agreement Revision.
The JCPC shall:
1.Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in the JCPC Program
Agreement or most recently approved JCPC Program Agreement Revision;
2.Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Code; N.C.G.S. §143B-801
(a);143B-602;143B-851
3.Review and locally approve Program Agreement Revision(s) 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 (applicable only to JCPC funded agencies);
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 DPS JCPC Policy 3.
Operations: Program Oversight and Monitoring
Reference: 14B NCAC 11B.0202 and DPS JCPC Policy 1, 7, 8, 9, 10, and 11.
The County shall:
1.Ensure the Sponsoring Agency is appropriately licensed, and either local public agencies, 501(c) (3) non-profit
corporations or local housing authorities (applicable only to JCPC funded agencies);
2.Use funds only for the purposes DPS has approved in the Program Agreement or most recently approved
Program Agreement Revision;
3.Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108
4.Comply with DPS JCPC Policies and Procedures 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 jointly submit Final Accounting forms for the JCPC and all funded
programs according to the procedures and due dates established by DPS.
Reference: 14B NCAC 11B; DPS 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.
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Form structure last revised 12/20/2013
Department of Public Safety
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.
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 11B.0110; DPS JCPC Policy 9. Fiscal Accounting and Budgeting: Final Accounting Process
Disbursements and Internal Controls
Reversion of Unexpended Funds
DocuSign Envelope ID: 20FBF7CA-EFED-4B99-ACC2-9ED842FD6906
HCBOC 071222 ws Pg. 137
Form structure last revised 12/20/2013
Department of Public Safety
Any remaining unexpended 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 the program’s fiscal year.
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 must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 whether or not the Sponsoring Agency has 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 to certify when there are no overdue taxes. If the
agency has overdue taxes, the Sponsoring Agency must notify DPS at the time of Program Agreement submission.
DocuSign Envelope ID: 20FBF7CA-EFED-4B99-ACC2-9ED842FD6906
HCBOC 071222 ws Pg. 138
Form structure last revised 12/20/2013
Department of Public Safety
Conflict of Interest – Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 upload the statement and the Sponsoring
Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission.
Proof of 501(c) (3) – Not for profit organizations ONLY must comply with this section. This document must be
uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of
the Sponsoring Agency’s 501 (c) (3) status.
Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested in
writing by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly
authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency.
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.
DocuSign Envelope ID: 20FBF7CA-EFED-4B99-ACC2-9ED842FD6906
HCBOC 071222 ws Pg. 139
Form structure last revised 12/20/2013
Department of Public Safety
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, pandemic, 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
DocuSign Envelope ID: 20FBF7CA-EFED-4B99-ACC2-9ED842FD6906
HCBOC 071222 ws Pg. 140
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VI: BUDGET NARRATIVE
4-H Teen Court and At-Risk Youth Development Fiscal Year FY 21-22
Item #Justification Expense In Kind 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
$2,392
120 Full-Time Teen Court Program Manager $2206.75/mo x 12=
$26481.00
$26,481
180 County Package: FICA @ 7.65% (1588), Wrk Comp. (610),
Reg Retirement (1987), Group Ins. @ 652.740/mo (7829), HSA
(0), Emp. Clinic @ 15/mo (180), Unemployment Ins. (265),
Incentives (0), Supplemental Retirement (300), Longevity (400)
Dental (360)
$13,519
260 Office Supplies $0
320 Cell phone for program coordinator. 60/mo = 720/yr $0
340 5000 copies @ .10 each for communication and program
promotion
$500
390 NCTCA Dues, training opportunities for youth volunteers and
clientele.
$0
410 Office Space (includes phone) $400/mo $4,800
450 American Income Life Insurance - 4-H Plan Supplemental
Medical Coverage - $1.00/youth for 100 youth and adult
volunteers - covers entire year.
$0
TOTAL $40,000 $7,692
Job Title
Annual Expense
Wages
Annual In Kind
Wages
4-H Agent and Extension Secretary for direct supervision and clerical support $2,392
4-H Teen Court Program Manager (4-H Program Assistant) - Responsibilities
include implementation of teen court program, management/recruitment of teen
court partners, volunteers and communication with youth and families.
$26,481
TOTAL $26,481 $2,392
DocuSign Envelope ID: 20FBF7CA-EFED-4B99-ACC2-9ED842FD6906
HCBOC 071222 ws Pg. 141
Form JCPC/PA 001 JCPC Program Agreement
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 21-22 Number of Months:12
Cash In Kind Total
I. Personnel Services $40,000 $2,392 $42,392
120 Salaries & Wages $26,481 $2,392 $28,873
180 Fringe Benefits $13,519 $13,519
190 Professional Services* $0
*Contracts MUST be attached
II. Supplies & Materials $0 $0
210 Household & Cleaning $0
220 Food & Provisions $0
230 Education & Medical $0
240 Construction & Repair $0
250 Vehicle Supplies & Materials $0
260 Office Supplies and Materials $0 $0
280 Heating & Utility Supplies $0
290 Other Supplies and Materials $0
III. Current Obligations & Services $0 $500 $500
310 Travel & Transportation $0
320 Communications $0 $0
330 Utilities $0
340 Printing & Binding $500 $500
350 Repairs & Maintenance $0
370 Advertising $0
380 Data Processing $0
390 Other Services $0 $0
IV. Fixed Charges & Other Expenses $0 $4,800 $4,800
410 Rental or Real Property $4,800 $4,800
430 Equipment Rental $0
440 Service and Maint. Contracts $0
450 Insurance & Bonding $0 $0
490 Other Fixed Charges $0
V. Capital Outlay $0
[This Section Requires Cash Match]
510 Office Furniture & Equipment $0
530 Educational Equipment $0
540 Motor Vehicle $0
550 Other Equipment $0
580 Buildings, Structure & Improv. $0
Total $40,000 $7,692 $47,692
DocuSign Envelope ID: 20FBF7CA-EFED-4B99-ACC2-9ED842FD6906
HCBOC 071222 ws Pg. 142
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 21-22 Harnett County Funding ID: 543-XXXX
Sponsoring Agency: Harnett County Government Program: 4-H Teen Court and At-Risk Youth Development
$40,000 DPS/JCPC Funds * This is the amount approved in your application
10%Local Match Rate Is the Local Match Rate 10%, 20% or 30%?
County Cash (Specify Source)
Local Cash (Specify Source)
Local Cash (Specify Source)
$7,692 Local In-Kind Harnett County Government (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
$47,692 TOTAL $4,000 $7,692
Required Local Match Match Provided
/DPSSignature//DPSdt/
Authorizing Official, Department of Public Safety Date
The following signature certifies that this program agreement has been locally approved by the Board of County Commissioners.
/CountySignature//Countydt/
Chair, County Board of Commissioners or County Finance Director Date
The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention
Council.
/JCPCSignature//JCPCdt/
Chair, Juvenile Crime Prevention Council Date
/ProgramSignature//Programdt/
Program Manager Date
DocuSign Envelope ID: 20FBF7CA-EFED-4B99-ACC2-9ED842FD6906
7/29/2021
7/29/2021
8/2/2021
8/3/2021
HCBOC 071222 ws Pg. 143
Certificate Of Completion
Envelope Id: 20FBF7CAEFED4B99ACC29ED842FD6906 Status: Completed
Subject: DPS eSignature Request for Harnett 543-11764 4-H Teen Court and At-Risk Youth Development
Source Envelope:
Document Pages: 20 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
3040 Hammond Business Pl
Raleigh, NC 27603
djjdp.applicationsupport@ncdps.gov
IP Address: 207.4.107.21
Record Tracking
Status: Original
7/28/2021 12:21:11 PM
Holder: DPS-DJJ Community Programs
djjdp.applicationsupport@ncdps.gov
Location: DocuSign
Signer Events Signature Timestamp
Jackie Helton
jhelton@harnett.org
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 71.65.255.137
Signed using mobile
Sent: 7/28/2021 12:21:12 PM
Viewed: 7/29/2021 6:23:43 PM
Signed: 7/29/2021 6:24:54 PM
Electronic Record and Signature Disclosure:
Accepted: 7/29/2021 6:23:43 PM
ID: 5a660b91-407b-4390-94cd-5ba8e1e96149
Kimberly Whitted
kwhitted@campbell.edu
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 76.182.58.128
Sent: 7/29/2021 6:24:55 PM
Viewed: 7/29/2021 6:27:32 PM
Signed: 7/29/2021 6:27:46 PM
Electronic Record and Signature Disclosure:
Accepted: 7/29/2021 6:27:32 PM
ID: 00bc1773-552b-452f-a571-ad7b102a220c
Kimberly Honeycutt
khoneycutt@harnett.org
Finance Officer
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 24.159.160.130
Sent: 7/29/2021 6:27:47 PM
Viewed: 8/2/2021 11:57:52 AM
Signed: 8/2/2021 3:05:13 PM
Electronic Record and Signature Disclosure:
Accepted: 8/2/2021 11:57:52 AM
ID: d0df7e18-72e7-44db-88f5-8e05ed30852c
Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 199.90.60.4
Sent: 8/2/2021 3:05:14 PM
Viewed: 8/3/2021 11:28:05 AM
Signed: 8/3/2021 11:28:10 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
HCBOC 071222 ws Pg. 144
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 7/28/2021 12:21:12 PM
Certified Delivered Security Checked 8/3/2021 11:28:05 AM
Signing Complete Security Checked 8/3/2021 11:28:10 AM
Completed Security Checked 8/3/2021 11:28:10 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
HCBOC 071222 ws Pg. 145
CONSUMER DISCLOSURE
From time to time, NC Dept of Public Safety (we, us or Company) may be required by law to
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Unless you tell us otherwise in accordance with the procedures described herein, we will provide
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Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM
Parties agreed to: Jackie Helton, Kimberly Whitted, Kimberly Honeycutt
HCBOC 071222 ws Pg. 146
electronically from us.
How to contact NC Dept of Public Safety:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: david.pozun@ncdps.gov
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To let us know of a change in your e-mail address where we should send notices and disclosures
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in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from NC Dept of Public Safety
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to david.pozun@ncdps.gov and in the
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To withdraw your consent with NC Dept of Public Safety
To inform us that you no longer want to receive future notices and disclosures in electronic
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Acknowledging your access and consent to receive materials electronically
HCBOC 071222 ws Pg. 147
To confirm to us that you can access this information electronically, which will be similar to
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you.
HCBOC 071222 ws Pg. 148
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
North Carolina Department of Public Safety
JCPC Program - Program Agreement
SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:FY 21-22 DPS/JCPC FUNDING # (cont only)543-XXXX
COUNTY:Harnett AREA:Central Area
Multi-County:No Multi-Components No
NAME OF PROGRAM:Harnett County Juvenile Restitution/Community Service Program
SPONSORING AGENCY:Harnett County Government
SPONSORING AGENCY
PHYSICAL ADDRESS:
200 Alexander Drive
Lillington NC 27546
SPONSORING AGENCY
MAILING ADDRESS:
POB 940
Lillington NC 27546
TYPE:Public FEDERAL ID #56-6000306
COMPONENT ID #NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF
EACH COMPONENT
31969 Harnett County Juvenile Restitution/Community
Service Program
Restitution/Community Service $ 92,759
Total cost of components:$ 92,759
Program Manager Name & Address (same person on signature page)
Name:Barry Blevins Title:Program Manager
Mailing
Address:
POB 940
City:Lillington Zip:27546
Phone:(910) 893-7536 Fax:(910) 814-8263 E-mail:bblevins@harnett.org
Contact Person (if different from program manager)
Name:Henry Evans Title:Program Coordinator
Mailing
Address:
POB 940
City:Lillington Zip:27546
Phone:(910) 814-6155 Fax:(910) 814-8263 E-mail:hlevans@harnett.org
Program Fiscal Officer (cannot be program manager)
Name:Henry Evans Title:Program Coordinator
Mailing
Address:
POB 940
City:Lillington Zip:27546
Phone:(910) 814-6155 Fax:(910) 814-8263 E-mail:hlevans@harnett.org
DocuSign Envelope ID: 9E998559-F352-42C2-B1AB-70FF84D648B0
HCBOC 071222 ws Pg. 149
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION I B PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #COMPONENT INFORMATION
31969 NAME OF COMPONENT: Harnett County Juvenile Restitution/Community Service Program
BRIEF DESCRIPTION: Community-based program to hold at-risk and court involved juveniles
accountable for their delinquent or undisciplined behavior. Juveniles are required to perform
symbolic community service or work to make monetary restitution to their victims.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components No
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:Harnett County Juvenile Restitution/Community Service Program Component ID #
31969
What is this component's maximum client capacity at any given time?90
Frequency of client contact per month:4 Anticipated Average Length of
Stay:90 Days
Total Component Cost:$92,759 ÷ by Estimated # to be served during funding period:90
Estimated Average Cost Per Youth:$1,031
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:54
35 Number of admissions Juvenile Justice Referred 64.81% of total admissions
0 Number of admissions Law Enforcement Referred 0% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
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 Raising the Age Report
presented in the Spring of 2018, the overall juvenile crime rate in North Carolina has decreased from 41.87% in 1998
to 19.16% in 2016. Detention center admissions have decreased by 67% since 2006. Youth Development Centers
(YDC) admissions have decreased by 58% during the same time period. With the juvenile delinquency rate
continuing a steady decline, there is more emphasis focused on community based programming working with
prevention and intervention.
Per the 2019 County Databook released by the North Carolina Department of Public Safety, Division of Juvenile
Justice, the total number of delinquent complaints filed in Harnett County was 438. Of the 438, 280 were class 1-3
misdemeanors; 150 were class F thru I Felonies and A1 misdemeanors; 18 were Status Offenders; and there were 8
class A-E Felonies.
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 as well as Teen Court and Law Enforcement 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 6-18 referred by
Juvenile Court Counselors Office,Juvenile Court ,Teen Court and Law Enforcement.
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.
75% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
75% Clients will demonstrate accountability by actively participating in restitution/community service activities.
75% Clients will have no new complaints with an offense date after the admission date.
85% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
75% Clients will complete restitution or community service within the timeframe permitted by JCPC policy.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:Harnett County Juvenile Restitution/Community Service Program
75% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
75% Clients will have no new adjudications for a complaint 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.
Based on highlights of the FY 2019-2020 Risk Assessment data for Harnett County, the elevated Risk Assessment are
as follows: 83.76% of youth are age 12 or older when the 1st delinquent offense is alleged in a complaint; 56.35% of
youth have serious school behavior problems; and 63.45% of youth that entered Department of Public Safety, Juvenile
Services Division lack pro-social peers and/or regularly and/or sometimes associate with negative/delinquent peers.
Based on highlights of the FY 2019-2020 Needs Assessment data for Harnett County, the elevated Needs
Assessments are as follows: 64.08% of youth sometimes and/or regularly associates with delinquent peers and/or
rejected by positive peers; 57.65% of youth have serious behavior problems in school which is a result of poor school
attendance and chronic suspensions from school; 73.45% of youth reported having mental health needs are currently
being addressed and/or 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.
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Form JCPC/PA 001 JCPC Program Agreement
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
1. Location: List physical address(es) and describe where program services are delivered.
Physical address is 200 Alexander Drive, Lillington, NC 27546. Program activities take place at various private and
public worksites within Harnett County.
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.
1 F/T Program Coordinator
Qualifications: Must possess at least a Bachelors degree or higher with previous experience working with at-risk
juveniles.
Responsibilities: Oversight for the daily scheduling of staff and juveniles; fiscal management of resources; recruitment
of 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 or teen court; 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.
1 P/T Program Assistant
Qualifications: Must possess at least an Associates degree or extensive experience working with at risk juveniles.
Responsibilities: Provides 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.
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.
Referral Process: Referrals can only come from Juvenile Court, Juvenile Intake, Teen Court and Law Enforcement
Referral packets submitted by Juvenile Services(intake diversions, deferred prosecution or juvenile court) and Teen
Court must include a referral form, family data sheet and information disclosure form. Program coordinator will
complete the North Carolina Assessment of Risk (NCAR) form after meeting with juvenile and parent/guardian.
Referral packets submitted by Law Enforcement must include a referral form, family data sheet, an incident report and
information disclosure form. Program coordinator will complete the NCAR after meeting with the juvenile and parent/
guardian.
Screening Process: All referrals are reviewed by program coordinator to confirm that the youth is mentally and
physically appropriate for community service work groups/sites. Juvenile`s work assignments will be age and ability
appropriate. Referring agency (Juvenile Services/intake/Teen Court/Law Enforcement) have also taken into account
the juvenile`s age and abilities prior to making the referral.
Admission Process: Once the program coordinator receives a completed referral packet from the referring agency,
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Form JCPC/PA 001 JCPC Program Agreement
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
program coordinator will contact juvenile and parent/guardian within 7 business days to set up program intake. Intake
consist of completing several program waivers/forms such as the following: Individual Service Plan; Release of
Confidential Information Waiver; Equipment Waiver; Production Release Waiver; Community Service/Restitution
Contract; NCAR; Social History and Medical Treatment Waiver. Once all forms have been completed and signed, the
program coordinator will enter the juvenile into the NC ALLIES database within 10 days. Juvenile will also be entered
into program database within same time period.
Why a referral may not be accepted: Juvenile has reached their 18th birthday or juvenile is mentally or physically
unable to participate in program activities.
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.
Program Coordinator is responsible for decisions concerning a juveniles successful, satifactory, unsuccessful or non-
compliant termination from this program.
Termination Process: Upon termination, Program Coordinator completes a written termination form within 10 business
days for all juveniles terminated from the program and submits a copy to the parents/legal guardians. Information will
be entered into NCALLIES Client Tracking data base within 7 days of the terminations decision.
Successful Termination: Indicates a high level of juvenile participation in program activities and achievement of
behavior improvement goals.
Satisfactory Termination: Indicates an acceptable level of juvenile participation and behavior improvement even though
the juvenile did not complete all program activities and did not meet all behavior goals.
Unsuccessful Completion: Failure to meet specific goals and requirements or make sufficient progress in the program.
Non-Compliant Termination: Unexcused absences or refusing to participate in treatment activities.
How is the referring agency involved with the termination process?
Program staff confers with supervising court counselor or with referring agency 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 or
referrals from Teen Court or Law Enforcement, 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 or referring
agency 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 Services,Teen Court Coordinator and Law Enforcement Officers will be given monthly written reports on all
juveniles served. Program staff contact Juvenile Services,Teen Court Coordinator and referring Law Enforcement
Officer as needed to address negative behavior of juveniles.
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Form JCPC/PA 001 JCPC Program Agreement
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
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 inappropriate 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, may 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 compensate 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 FY 2019/2020, 98.53% of juveniles served by this
program had been successfully or satisfactorily terminated.
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Department of Public Safety
SECTION V Terms of Agreement
This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and
Harnett County, (hereinafter referred to as the County), the County’s Juvenile Crime Prevention Council (hereinafter
referred to as the JCPC) and Harnett County Government (hereinafter referred to as the Sponsoring Agency).
DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows:
Term of Agreement
This Agreement shall become effective Jul 1, 2021 and shall terminate Jun 30, 2022.
Payment to Sponsoring Agency
All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be
disbursed in an amount not to exceed the amount $81000 for the term of this agreement, unless amended by an
approved Program Agreement Revision.
Availability of Funds:
All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement
budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the
appropriation, allocation, and availability of funds for this purpose to DPS.
Responsibilities of the Parties
DPS shall:
1.Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the 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 DPS 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 Program Agreement, or most recently approved Program Agreement
Revision, 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 funded program(s) in accordance with DPS 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.
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;
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Department of Public Safety
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 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 DPS JCPC Policy and Procedures and the North Carolina Administrative Procedures;
6.Secure local match as required, if applicable, pursuant to 14B NCAC 11B.0105, for approved JCPC funds;
7.Create and adopt individualized guidelines specific to the funded program, while also adhering to DPS JCPC
Policy and Procedures for all 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 Program Agreement, or most recently
approved Program Agreement Revision, 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 funds, maintain
reports, records, and other information to properly account for the expenditure of all State funds provided to the
Sponsoring Agency;
12.When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by
the agency in the performance of the Program Agreement, or most recently approved Program Agreement
Revision, as allowed by NCGS §105-164.14(c), the agency shall exclude all refundable sales and use taxes from
reportable expenditures submitted to the County and DPS;
13.Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed
expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in
DPS JCPC Policy and Procedures 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, or most
recently approved Program Agreement Revision;
17. Indemnify and hold 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 Program Agreement or most recently approved Program Agreement
Revision;
18.Receive permission and budgetary approval from DPS prior to using the Program Agreement, or most recently
approved Program Agreement Revision, 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 NCAC 11B, and in compliance with DPS JCPC Policy 2: Operations: Program Operational
Requirements
20.Be deemed an independent contractor in the performance of services described in the Program Agreement, or
most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to
be performed and for the supervision of its employees;
21.Represent that it has, or shall secure at its own expense, all personnel required in performing the services as
described in the Program Agreement. Such personnel shall not be employees of, or have any individual
contractual relationship with, DPS;
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Department of Public Safety
Sponsoring Agency and Use of Contractor(s)/Subcontractors
The Sponsoring Agency may engage with independent contractors as needed to perform services or support services
described in the Program Agreement. When independent contractors (funds are included in line item 190 of the
budget) are providing services as described in the Program Agreement, the sponsoring agency must:
22.Upload a signed Contract for Professional Services into NCALLIES once the Program Agreement (or
Program Agreement Revision) is approved by DPS;
23.Be responsible for the performance of all contractors or subcontractors as described in the Program
Agreement, or most recently approved Program Agreement Revision;
24.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 DPS JCPC Policies and
Procedures; and
25.Ensure that all contractors or subcontractors provide all information necessary to comply with the standards
set forth in the Program Agreement or most recently approved Program Agreement Revision.
The JCPC shall:
1.Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in the JCPC Program
Agreement or most recently approved JCPC Program Agreement Revision;
2.Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Code; N.C.G.S. §143B-801
(a);143B-602;143B-851
3.Review and locally approve Program Agreement Revision(s) 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 (applicable only to JCPC funded agencies);
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 DPS JCPC Policy 3.
Operations: Program Oversight and Monitoring
Reference: 14B NCAC 11B.0202 and DPS JCPC Policy 1, 7, 8, 9, 10, and 11.
The County shall:
1.Ensure the Sponsoring Agency is appropriately licensed, and either local public agencies, 501(c) (3) non-profit
corporations or local housing authorities (applicable only to JCPC funded agencies);
2.Use funds only for the purposes DPS has approved in the Program Agreement or most recently approved
Program Agreement Revision;
3.Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108
4.Comply with DPS JCPC Policies and Procedures 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 jointly submit Final Accounting forms for the JCPC and all funded
programs according to the procedures and due dates established by DPS.
Reference: 14B NCAC 11B; DPS 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.
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Department of Public Safety
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.
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 11B.0110; DPS JCPC Policy 9. Fiscal Accounting and Budgeting: Final Accounting Process
Disbursements and Internal Controls
Reversion of Unexpended Funds
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Department of Public Safety
Any remaining unexpended 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 the program’s fiscal year.
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 must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 whether or not the Sponsoring Agency has 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 to certify when there are no overdue taxes. If the
agency has overdue taxes, the Sponsoring Agency must notify DPS at the time of Program Agreement submission.
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Department of Public Safety
Conflict of Interest – Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 upload the statement and the Sponsoring
Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission.
Proof of 501(c) (3) – Not for profit organizations ONLY must comply with this section. This document must be
uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of
the Sponsoring Agency’s 501 (c) (3) status.
Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested in
writing by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly
authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency.
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.
DocuSign Envelope ID: 9E998559-F352-42C2-B1AB-70FF84D648B0
HCBOC 071222 ws Pg. 162
Form structure last revised 12/20/2013
Department of Public Safety
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, pandemic, 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
DocuSign Envelope ID: 9E998559-F352-42C2-B1AB-70FF84D648B0
HCBOC 071222 ws Pg. 163
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VI: BUDGET NARRATIVE
Harnett County Juvenile Restitution/Community Service Program Fiscal Year FY 21-22
Item #Justification Expense In Kind Expense
120 Salaries for Full-time Coordinator-$22.1416 per hour@40 hours
a week@52 weeks /1 Part-time Program Assistants @ $9.621
an hour x 19.99 hours a week x 52 weeks
$58,274
180 401K - $935 FICA - $4457, State Retirement - $4929, Medical
Insurance - $10104, Dental Insurance - $384, Life Insurance -
$62, Unemployment - $284, Worker Compensation - $1674,
Employee Clinic - $180, Other Post Employment Expenses -
$120
$23,129
210 Uniforms-shirts/hoodies for program coordinator and program
assistant
$300
220 Food for juveniles while engaged in work activities $200
250 Gas and maintenance for two program vehicles $2,000
260 Office supplies such as envelopes, pens, copier paper, etc......$50
290 Restitution supplies (ex. gloves, trash bags, safety vest,
goggles, etc...)
$250
310 Hotel Fees and Meals for Conferences and Trainings $310
320 Cell phones $1140 (cell phones for program coordinator and
assistant at $95 x 12months), postage and faxes $200, internet
access for iPad $456 ($38 x 12 months)
$1,796
390 Restitution Earned and Paid to Victims -5000; Training-
Registration-100, Background Checks for volunteers-75
$5,175
430 Copier Contract $400, Lease of Computer $400, Lease of iPad
$192, Post Office Box Rental $20
$1,012
450 Insurance-Policy covering juveniles while participating in
program activities
$178
490 Dues and Subscriptions - Association Dues $85
TOTAL $92,759
Job Title
Annual Expense
Wages
Annual In Kind
Wages
Program Coordinator (52 weeks@40 hours per week@22.1461 per hour)$48,274
1 Program Assistant(52 weeks @ 19.99 hours per week @ 9.621 per hour)$10,000
TOTAL $58,274
DocuSign Envelope ID: 9E998559-F352-42C2-B1AB-70FF84D648B0
HCBOC 071222 ws Pg. 164
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VII Program:Harnett County Juvenile Restitution/Community Service Program
Fiscal Year:FY 21-22 Number of Months:12
Cash In Kind Total
I. Personnel Services $81,403 $81,403
120 Salaries & Wages $58,274 $58,274
180 Fringe Benefits $23,129 $23,129
190 Professional Services* $0
*Contracts MUST be attached
II. Supplies & Materials $2,800 $2,800
210 Household & Cleaning $300 $300
220 Food & Provisions $200 $200
230 Education & Medical $0
240 Construction & Repair $0
250 Vehicle Supplies & Materials $2,000 $2,000
260 Office Supplies and Materials $50 $50
280 Heating & Utility Supplies $0
290 Other Supplies and Materials $250 $250
III. Current Obligations & Services $7,281 $7,281
310 Travel & Transportation $310 $310
320 Communications $1,796 $1,796
330 Utilities $0
340 Printing & Binding $0
350 Repairs & Maintenance $0
370 Advertising $0
380 Data Processing $0
390 Other Services $5,175 $5,175
IV. Fixed Charges & Other Expenses $1,275 $1,275
410 Rental or Real Property $0
430 Equipment Rental $1,012 $1,012
440 Service and Maint. Contracts $0
450 Insurance & Bonding $178 $178
490 Other Fixed Charges $85 $85
V. Capital Outlay $0
[This Section Requires Cash Match]
510 Office Furniture & Equipment $0
530 Educational Equipment $0
540 Motor Vehicle $0
550 Other Equipment $0
580 Buildings, Structure & Improv. $0
Total $92,759 $92,759
DocuSign Envelope ID: 9E998559-F352-42C2-B1AB-70FF84D648B0
HCBOC 071222 ws Pg. 165
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 21-22 Harnett County Funding ID: 543-XXXX
Sponsoring Agency: Harnett County Government Program: Harnett County Juvenile Restitution/
Community Service Program
$81,000 DPS/JCPC Funds * This is the amount approved in your application
10%Local Match Rate Is the Local Match Rate 10%, 20% or 30%?
$8,759 County Cash Harnett County (Specify Source)
$3,000 Local Cash Harnett County (Specify Source)
Local Cash (Specify Source)
Local In-Kind (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
$92,759 TOTAL $8,100 $11,759
Required Local Match Match Provided
/DPSSignature//DPSdt/
Authorizing Official, Department of Public Safety Date
The following signature certifies that this program agreement has been locally approved by the Board of County Commissioners.
/CountySignature//Countydt/
Chair, County Board of Commissioners or County Finance Director Date
The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention
Council.
/JCPCSignature//JCPCdt/
Chair, Juvenile Crime Prevention Council Date
/ProgramSignature//Programdt/
Program Manager Date
DocuSign Envelope ID: 9E998559-F352-42C2-B1AB-70FF84D648B0
8/13/2021
8/13/2021
8/20/2021
8/23/2021
HCBOC 071222 ws Pg. 166
Certificate Of Completion
Envelope Id: 9E998559F35242C2B1AB70FF84D648B0 Status: Completed
Subject: DPS eSignature Request for Harnett 543-10591 Harnett County Juvenile Restitution/Community Service P
Source Envelope:
Document Pages: 18 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
3040 Hammond Business Pl
Raleigh, NC 27603
djjdp.applicationsupport@ncdps.gov
IP Address: 207.4.107.21
Record Tracking
Status: Original
8/13/2021 2:23:22 PM
Holder: DPS-DJJ Community Programs
djjdp.applicationsupport@ncdps.gov
Location: DocuSign
Signer Events Signature Timestamp
Barry Blevins
bblevins@harnett.org
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.86.10.234
Sent: 8/13/2021 2:23:23 PM
Viewed: 8/13/2021 3:27:55 PM
Signed: 8/13/2021 3:29:04 PM
Electronic Record and Signature Disclosure:
Accepted: 8/13/2021 3:27:55 PM
ID: bdfa65fa-7a80-4e3a-b756-0b552add3bd7
Kimberly Whitted
kwhitted@campbell.edu
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 76.182.58.128
Sent: 8/13/2021 3:29:05 PM
Viewed: 8/13/2021 3:36:16 PM
Signed: 8/13/2021 3:36:36 PM
Electronic Record and Signature Disclosure:
Accepted: 8/13/2021 3:36:16 PM
ID: bdbe6bfd-3820-4ce0-b11b-41588f783ab1
Kimberly Honeycutt
khoneycutt@harnett.org
Finance Officer
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 24.159.160.130
Sent: 8/13/2021 3:36:37 PM
Viewed: 8/20/2021 3:15:01 PM
Signed: 8/20/2021 3:18:45 PM
Electronic Record and Signature Disclosure:
Accepted: 8/20/2021 3:18:37 PM
ID: 33e5c170-dd59-43d3-bd2c-226cfa589256
Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 199.90.60.4
Sent: 8/20/2021 3:18:47 PM
Viewed: 8/23/2021 10:01:56 AM
Signed: 8/23/2021 10:02:06 AM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
HCBOC 071222 ws Pg. 167
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 8/13/2021 2:23:23 PM
Certified Delivered Security Checked 8/23/2021 10:01:56 AM
Signing Complete Security Checked 8/23/2021 10:02:06 AM
Completed Security Checked 8/23/2021 10:02:06 AM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
HCBOC 071222 ws Pg. 168
CONSUMER DISCLOSURE
From time to time, NC Dept of Public Safety (we, us or Company) may be required by law to
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Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM
Parties agreed to: Barry Blevins, Kimberly Whitted, Kimberly Honeycutt
HCBOC 071222 ws Pg. 169
electronically from us.
How to contact NC Dept of Public Safety:
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To contact us by email send messages to: david.pozun@ncdps.gov
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Acknowledging your access and consent to receive materials electronically
HCBOC 071222 ws Pg. 170
To confirm to us that you can access this information electronically, which will be similar to
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HCBOC 071222 ws Pg. 171
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
North Carolina Department of Public Safety
JCPC Program - Program Agreement
SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:FY 21-22 DPS/JCPC FUNDING # (cont only)1443XXXX
COUNTY:Harnett AREA:Central Area
Multi-County:No Multi-Components No
NAME OF PROGRAM:Harnett County Sheriffs Department PAL Program
SPONSORING AGENCY:Harnett County Government
SPONSORING AGENCY
PHYSICAL ADDRESS:
200 Alexander Drive
Lillington NC 27546
SPONSORING AGENCY
MAILING ADDRESS:
PO Box 940
Lillington NC 27546
TYPE:Public FEDERAL ID #56-6000306
COMPONENT ID #NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF
EACH COMPONENT
32168 PAL Tutoring Tutoring/Academic Enhancement $ 58,500
Total cost of components:$ 58,500
Program Manager Name & Address (same person on signature page)
Name:Samantha Blalock Title:Program Manager
Mailing
Address:
PO Box 399
City:lillington Zip:27546
Phone:(910) 893-9111 Ext:0138 Fax: E-mail:sblalock@harnett.org
Contact Person (if different from program manager)
Name:Mark Hornsby Title:
Mailing
Address:
2564 old us 421
City:lillington Zip:27546
Phone:(910) 890-5534 Fax: E-mail:dhornsby@harnett.org
Program Fiscal Officer (cannot be program manager)
Name:Cindy Blaylock Title:Board Treasurer
Mailing
Address:
345 Caulter Brown Rd
City:Lillington Zip:27546
Phone:(910) 237-4580 Fax: E-mail:blaylockcj@gmail.com
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
HCBOC 071222 ws Pg. 172
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION I B PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #COMPONENT INFORMATION
32168 NAME OF COMPONENT: PAL Tutoring
BRIEF DESCRIPTION: The Harnett County Sheriffs PAL program is an after school crime
prevention program that utilizes educational, athletic, and recreational activities to create trust
and understanding between the community, law enforcement officers and the youth. The PAL
Tutoring component will offer tutoring and homework assistance to middle and high school
students in underserved areas of Lillington and Western Harnett County.
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
HCBOC 071222 ws Pg. 173
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
SECTION II COMPONENT STATISTICAL INFORMATION
Multi-Components Yes
Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name:PAL Tutoring Component ID #
32168
What is this component's maximum client capacity at any given time?10
Frequency of client contact per month:6 Anticipated Average Length of
Stay:140 Days
Total Component Cost:$58,500 ÷ by Estimated # to be served during funding period:20
Estimated Average Cost Per Youth:$2,925
Applies to
continuation
programs only.
Actual number of youth admitted FY 19-20:0
0 Number of admissions Juvenile Justice Referred 0% of total admissions
0 Number of admissions Law Enforcement Referred 0% of total admissions
0 Number of admissions District Court Referred 0% of total admissions
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
HCBOC 071222 ws Pg. 174
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL Tutoring
1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in
the county.
According to Risk Assessment Data, the target population have: behavior problems at school; low grades in school;
associate with negative peers; mental health issues that are being addressed and/or need more assessments; and
parent/guardian/custodian supervision skills that are marginal.
PAL Tutoring Program will provide tutoring services to expose youth in the catchment area to opportunities that may
improve academic performance and reduce behavioral issues in their home, school and community.
2. Target Population: Describe the target population, including age, and the steps taken to insure that the target
population is served.
The program will target middle and high school students in Lillington and western Harnett County. Elementary
students have access to Boys and Girls Club tutoring activities on our campus. There is a need for middle and high
school students to have access to academic enrichment activities.
3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program.
To prevent the kids of Harnett County from entering/ re entering the justice system, prevent substance use disorders,
and help youth live more productive and successful lives.
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 have no new adjudications for a complaint with an offense date after the admission date.
70% Clients will actively participate in tutorial and/or academic enhancement activities as intended by program design/
the service plan.
70% Clients will improve academic skills/performance.
70% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
70% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
70% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
70% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
70% 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 PAL program will directly address the needs of adjudicated juveniles by providing them with a positive
environment, tutoring and mentorship. The program utilizes educational, athletic, and recreational activities to create
positive relationships between law enforcement and youth, and to give the youth a positive outlet. PAL Tutoring will
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
HCBOC 071222 ws Pg. 175
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION III COMPONENT SUMMARY
NAME OF COMPONENT:PAL Tutoring
strive to prevent and reduce the juvenile crime rate in Harnett County by focusing on identifying, tracking, and
educating youth served on their individual academic weaknesses and behavioral improvement so they will have the
opportunity to thrive in their home, school and community.
Program staff will coordinate with local schools and teachers to ensure the student is getting academic and behavior
management assistance according to their individual needs. If possible, youth will be paired with a mentor to assist in
addressing individualized needs and be a positive role model in the youth’s life.
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
HCBOC 071222 ws Pg. 176
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Tutoring
1. Location: List physical address(es) and describe where program services are delivered.
The tutoring component will be housed in a remodeled elementary school located at 645 Shawtown Road
Lillington NC, 27546. The program will have an individual room with a capacity of up to 10 youth per session.
The campus is shared with the Harnett County Boys and Girls Club and a representative from Workforce Development.
2. Operation: Describe the daily/weekly schedule of program operation.
The program will operate Tuesday through Thursday from 3:00pm to 7:00pm
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
Program Manager:
Must possess at least a Bachelor’s degree in a Human Service or related field, or a four (4) year degree in any other
field with at least two (2) years’ experience as a direct service professional in a juvenile serving agency. It is the
responsibility of the Program Manager to:
a. Ensure the program meets all appropriate standards and licensing requirements;
b. Ensure case oversight and supervision is provided to full-time staff, part- time staff, volunteers, interns, and
contractor(s);
c. Maintain sufficient information to allow for the determination of program effectiveness;
d. Cooperate with DPS Area Consultants and JCPC during monitoring and evaluation activities; and
e. Complete all reporting requirements as established by DPS.
Program Staff:
Must have at least an Associate’s Degree in a Human Services related field, or a high school diploma with at least one
(1) year of Human Service experience. Staff implementing curricula, or facilitating groups based on curricula, shall be
appropriately trained and qualified in both curricula content and facilitation techniques.
Volunteer Program Staff:
All volunteers providing direct services must have at least one (1) year of experience working with at-risk youth and
submit to background screening. PAL may use professional or community volunteers to assist or augment services
provided by paid staff.
We recruit volunteers to assist students in a variety of ways: small-group tutoring for academic skill practice,
apprenticeship or technical skill instruction, and enrichment projects. Other volunteers may work behind the scenes on
administrative tasks.
Current Roles:
Director - Deputy Mark Hornsby
Responsibilities: Plans day to day operations, fundraising, budgeting, and mentorship
Experience : 30 years in law enforcement
10 year volunteer with Dunn PAL program
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Tutoring
Program Manager/Tutoring Coordinator - Vacant Position Pending Funding
Responsibilities: program development and implementation; plan and deliver daily activities
Experience: Bachelors degree in human service field
4. Service Type SPEP: Describe implementation to include:
Primary Service: Remedial Academic Program; 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.
Referrals: The program will receive a written referral form for juveniles or family members to participate in the program.
The program shall:
1. Receive a written referral form to identify individual program and juvenile or family needs. The referral form shall
indicate the reason for referral and the concern(s) to be addressed and, provide other information as needed by the
program to facilitate screening and admission decisions.
2. Program Staff will schedule initial appointment with the juvenile and the parent(s)/legal guardian(s) within fifteen (15)
business days of the referral to schedule.
Admissions: Programs shall develop admission criteria covering age and gender appropriateness, the primary reasons
for which juveniles are considered for admission and any applicable admission restrictions. All JCPC funded
admissions will include:
Application;
Referral Form
Consent to Release of Information;
Participation Agreement Form signed by youth, parent/guardian, and staff;
Risk Assessment;
Individual Plan of Care/Service Plan signed by youth, parent/guardian, and staff;
Staff will enter client tracking admission data in NCALLIES within seven (7) days of admissions decision; and
respond to referring agency regarding their admission decision within fifteen (15) business days of receipt 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
termination.
Program Staff may terminate youth for the following reasons:
Successful termination:
At end of 20 week mark, student has successfully completed assignments and grades have increased by 1 or more
grade levels for the semester. (Verified with school); have no new adjudications for a complaint with an offense date
after the admission date; have no new complaints with an offense date after the admission date; and have reduced
specific problem behaviors presented at referral and targeted in the individual service plan.
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Tutoring
Satisfactory termination:
Moved out of county
Unsuccessful completion and/or non-compliant termination
Quit School or repeated violation Harnett PAL rules
Program Staff will request a parent/guardian conference to discuss issues. Afterwards, he/she will determine if it is
necessary to implement a corrective action plan or terminate services. He/she will contact parent/guardian and
referring agency (if applicable) in writing with the mentioned information.
Termination Process:
Complete a written Termination Form within ten (10) business days for all juveniles terminated from the program and
submit a copy to the parent(s)/legal guardian(s), Court Services, if applicable, placed in the juvenile’s file and other
referring entities as appropriate; enter client tracking termination data in NCALLIES within seven (7) days of
termination decision; and prior to a juvenile being terminated for any reason other than Successful or Satisfactory
Completion, the program will review the case status with the referring agency prior to a final termination decision. Prior
to the termination, Program Staff, the juvenile, parent(s)/legal guardian(s), juvenile’s Court Counselor, and/or other
referring entity must be involved in the development and implementation of an After Care Plan.
Program Staff will determine termination procedures and contact parent/guardian and the referral agency of
compliance and termination. Program Staff will mail the follow up letter to the parent/guardian of the youth on the
status of their termination and also contact the referring agency. The parent/guardian will be notified of any possible
violations within 5 days of the violation and initiate a corrective action plan. If the corrective action plan is not followed
within 20 days, the parent/guardian will be notified in writing and by telephone that the child has been terminated from
the PAL Tutoring Program.
How is the referring agency involved with the termination process?
N/A
7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring
agencies including how client progress will be communicated.
The PAL Tutoring Program will communicate with Juvenile Court Counselors as needed to meet the individual needs
of the youth served. We will collaborate with other organizations in order to improve support networks around youth
involved in the program. .
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?
Harnett PAL Tutoring Program Staff will never hit, slap, spank or use any form of corporal punishment, even with parent
/guardian permission or request. We do not ridicule, belittle, or humiliate yout in any way. Program Staff supports
positive redirection and self reflection for behavior management. Staff will develop and implement Individual Service
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION IV COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:PAL Tutoring
Plan/Behavior Modification Plans that use current best practice strategies for youth who consistently display negative
behaviors. We will align our behavioral expectations of students with the Harnett County School System.
We believe that positive interaction between adults and youth are essential to the development of a student’s social
and emotional health. Program Staff is responsible for teaching youth initiate self-control over their actions and to learn
to make good choices in their behaviors. Learning self-control is a normal part of growing up and our policy is never to
embarrass or ridicule a child when he or she misbehaves. Corporal or physical punishment is never allowed at Harnett
PAL Tutoring Program. Program Staff will practice preventive discipline by establishing a strong curriculum and
ensuring engagement with classroom materials, peers, and adults. Program Staff recognizes that youth come to the
Program bring their own experiences and traumas. Program Staff will reinforce more acceptable or alternative
behaviors and using redirection to more appropriate activities when youth displays undesired behaviors.
Youth will be taught to be responsible for their own actions; they make the choice to follow the rules and enjoy the
rewards or to ignore the rules and accept the consequences. Appropriate behavior will be encouraged by verbal
praise, rewards and positive communications with parents. Whenever possible, natural and logical consequences will
be provided for inappropriate behavior.
JRI follows the NC Discipline and Behavior Management Policy.
JRI also utilizes a reward/merit system to encourage positive behaviors and social interactions amongst its
participants. Behavioral goals are indicated in each participants Individual Service Plan.
9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon.
As a country, we are spending a tremendous amount of money toward incarceration and treatment for substance use
disorders. Early intervention programs not only prevent youth entering the justice system and SUD's, but it can give the
youth a productive and more successful life going forward. Harnett PAL Tutoring Program will strategize delivery of
tutoring services that meet NCDPS standards and give youth a positive outlet, mentorship, and educational
opportunities that can drastically change their life and perspective. As we grow, we are interested in incorporating
parent education so we can lean in to the youth's environment to support long-term change and growth.
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Department of Public Safety
SECTION V Terms of Agreement
This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and
Harnett County, (hereinafter referred to as the County), the County’s Juvenile Crime Prevention Council (hereinafter
referred to as the JCPC) and Harnett County Government (hereinafter referred to as the Sponsoring Agency).
DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows:
Term of Agreement
This Agreement shall become effective Jul 1, 2021 and shall terminate Jun 30, 2022.
Payment to Sponsoring Agency
All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be
disbursed in an amount not to exceed the amount $39500 for the term of this agreement, unless amended by an
approved Program Agreement Revision.
Availability of Funds:
All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement
budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the
appropriation, allocation, and availability of funds for this purpose to DPS.
Responsibilities of the Parties
DPS shall:
1.Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the 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 DPS 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 Program Agreement, or most recently approved Program Agreement
Revision, 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 funded program(s) in accordance with DPS 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.
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;
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Department of Public Safety
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 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 DPS JCPC Policy and Procedures and the North Carolina Administrative Procedures;
6.Secure local match as required, if applicable, pursuant to 14B NCAC 11B.0105, for approved JCPC funds;
7.Create and adopt individualized guidelines specific to the funded program, while also adhering to DPS JCPC
Policy and Procedures for all 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 Program Agreement, or most recently
approved Program Agreement Revision, 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 funds, maintain
reports, records, and other information to properly account for the expenditure of all State funds provided to the
Sponsoring Agency;
12.When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by
the agency in the performance of the Program Agreement, or most recently approved Program Agreement
Revision, as allowed by NCGS §105-164.14(c), the agency shall exclude all refundable sales and use taxes from
reportable expenditures submitted to the County and DPS;
13.Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed
expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in
DPS JCPC Policy and Procedures 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, or most
recently approved Program Agreement Revision;
17. Indemnify and hold 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 Program Agreement or most recently approved Program Agreement
Revision;
18.Receive permission and budgetary approval from DPS prior to using the Program Agreement, or most recently
approved Program Agreement Revision, 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 NCAC 11B, and in compliance with DPS JCPC Policy 2: Operations: Program Operational
Requirements
20.Be deemed an independent contractor in the performance of services described in the Program Agreement, or
most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to
be performed and for the supervision of its employees;
21.Represent that it has, or shall secure at its own expense, all personnel required in performing the services as
described in the Program Agreement. Such personnel shall not be employees of, or have any individual
contractual relationship with, DPS;
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Department of Public Safety
Sponsoring Agency and Use of Contractor(s)/Subcontractors
The Sponsoring Agency may engage with independent contractors as needed to perform services or support services
described in the Program Agreement. When independent contractors (funds are included in line item 190 of the
budget) are providing services as described in the Program Agreement, the sponsoring agency must:
22.Upload a signed Contract for Professional Services into NCALLIES once the Program Agreement (or
Program Agreement Revision) is approved by DPS;
23.Be responsible for the performance of all contractors or subcontractors as described in the Program
Agreement, or most recently approved Program Agreement Revision;
24.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 DPS JCPC Policies and
Procedures; and
25.Ensure that all contractors or subcontractors provide all information necessary to comply with the standards
set forth in the Program Agreement or most recently approved Program Agreement Revision.
The JCPC shall:
1.Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in the JCPC Program
Agreement or most recently approved JCPC Program Agreement Revision;
2.Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Code; N.C.G.S. §143B-801
(a);143B-602;143B-851
3.Review and locally approve Program Agreement Revision(s) 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 (applicable only to JCPC funded agencies);
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 DPS JCPC Policy 3.
Operations: Program Oversight and Monitoring
Reference: 14B NCAC 11B.0202 and DPS JCPC Policy 1, 7, 8, 9, 10, and 11.
The County shall:
1.Ensure the Sponsoring Agency is appropriately licensed, and either local public agencies, 501(c) (3) non-profit
corporations or local housing authorities (applicable only to JCPC funded agencies);
2.Use funds only for the purposes DPS has approved in the Program Agreement or most recently approved
Program Agreement Revision;
3.Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11B.0108
4.Comply with DPS JCPC Policies and Procedures 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 jointly submit Final Accounting forms for the JCPC and all funded
programs according to the procedures and due dates established by DPS.
Reference: 14B NCAC 11B; DPS 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.
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Department of Public Safety
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.
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 11B.0110; DPS JCPC Policy 9. Fiscal Accounting and Budgeting: Final Accounting Process
Disbursements and Internal Controls
Reversion of Unexpended Funds
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Department of Public Safety
Any remaining unexpended 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 the program’s fiscal year.
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 must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 whether or not the Sponsoring Agency has 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 to certify when there are no overdue taxes. If the
agency has overdue taxes, the Sponsoring Agency must notify DPS at the time of Program Agreement submission.
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Department of Public Safety
Conflict of Interest – Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. 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 upload the statement and the Sponsoring
Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission.
Proof of 501(c) (3) – Not for profit organizations ONLY must comply with this section. This document must be
uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of
the Sponsoring Agency’s 501 (c) (3) status.
Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested in
writing by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly
authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency.
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.
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Department of Public Safety
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, pandemic, 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
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Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VI: BUDGET NARRATIVE
Harnett County Sheriffs Department PAL Program Fiscal Year FY 21-22
Item #Justification Expense In Kind Expense
120 Director (30% of time committed to program) $50,000 x 30% =
$15,000
$15,000
120 Tutoring Coordinator 30 hrs x $20 = $600 x 40 weeks $24,000
180 FICA $24,000 x 7.65%$1,836
220 Food, snacks, drinks for 145 days at $17.25 per day/session =
$2,500
$2,500
230 Paper, pencils,and school supplies $500, Smartboard $2700,
Flat screen TV $850, Personal laptop for assistant $800,
Computer software $314, student computers 15 x $200 =
$8,164
$8,164
340 Brochures and posters $1,000
370 Advertising in local publications $500
410 Tutoring Space, 1 room x $500 per month x 8 months $4,000
450 Liability Insurance Annually $1,500
TOTAL $39,500 $19,000
Job Title
Annual Expense
Wages
Annual In Kind
Wages
Director (30% of time committed to program) $50,000 x 30% = $15,000 $15,000
utoring Coordinator 30 hrs x $20 = $600 x 40 weeks $24,000
TOTAL $24,000 $15,000
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
HCBOC 071222 ws Pg. 188
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VII Program:Harnett County Sheriffs Department PAL Program
Fiscal Year:FY 21-22 Number of Months:8
Cash In Kind Total
I. Personnel Services $25,836 $15,000 $40,836
120 Salaries & Wages $24,000 $15,000 $39,000
180 Fringe Benefits $1,836 $1,836
190 Professional Services* $0
*Contracts MUST be attached
II. Supplies & Materials $10,664 $10,664
210 Household & Cleaning $0
220 Food & Provisions $2,500 $2,500
230 Education & Medical $8,164 $8,164
240 Construction & Repair $0
250 Vehicle Supplies & Materials $0
260 Office Supplies and Materials $0
280 Heating & Utility Supplies $0
290 Other Supplies and Materials $0
III. Current Obligations & Services $1,500 $1,500
310 Travel & Transportation $0
320 Communications $0
330 Utilities $0
340 Printing & Binding $1,000 $1,000
350 Repairs & Maintenance $0
370 Advertising $500 $500
380 Data Processing $0
390 Other Services $0
IV. Fixed Charges & Other Expenses $1,500 $4,000 $5,500
410 Rental or Real Property $4,000 $4,000
430 Equipment Rental $0
440 Service and Maint. Contracts $0
450 Insurance & Bonding $1,500 $1,500
490 Other Fixed Charges $0
V. Capital Outlay $0
[This Section Requires Cash Match]
510 Office Furniture & Equipment $0
530 Educational Equipment $0
540 Motor Vehicle $0
550 Other Equipment $0
580 Buildings, Structure & Improv. $0
Total $39,500 $19,000 $58,500
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
HCBOC 071222 ws Pg. 189
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 21-22 Harnett County Funding ID: 1443XXXX
Sponsoring Agency: Harnett County Government Program: Harnett County Sheriffs Department PAL
Program
$39,500 DPS/JCPC Funds * This is the amount approved in your application
10%Local Match Rate Is the Local Match Rate 10%, 20% or 30%?
County Cash (Specify Source)
Local Cash (Specify Source)
Local Cash (Specify Source)
$19,000 Local In-Kind Harnett County Sheriffs Office (Director Salary);
Harnett PAL (Space for Program)
(Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
Other (Specify Source)
$58,500 TOTAL $3,950 $19,000
Required Local Match Match Provided
/DPSSignature//DPSdt/
Authorizing Official, Department of Public Safety Date
The following signature certifies that this program agreement has been locally approved by the Board of County Commissioners.
/CountySignature//Countydt/
Chair, County Board of Commissioners or County Finance Director Date
The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention
Council.
/JCPCSignature//JCPCdt/
Chair, Juvenile Crime Prevention Council Date
/ProgramSignature//Programdt/
Program Manager Date
DocuSign Envelope ID: 56683086-AEAA-4C6C-BB8C-7F7FFA76584F
11/16/2021
11/16/2021
11/16/2021
11/18/2021
HCBOC 071222 ws Pg. 190
Certificate Of Completion
Envelope Id: 56683086AEAA4C6CBB8C7F7FFA76584F Status: Completed
Subject: DPS eSignature Request for Harnett 1443-23559 Harnett County Sheriffs Department PAL Program
Source Envelope:
Document Pages: 19 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US & Canada)
3040 Hammond Business Pl
Raleigh, NC 27603
djjdp.applicationsupport@ncdps.gov
IP Address: 207.4.107.7
Record Tracking
Status: Original
11/16/2021 12:08:20 PM
Holder: DPS-DJJ Community Programs
djjdp.applicationsupport@ncdps.gov
Location: DocuSign
Signer Events Signature Timestamp
Samantha Jo Blalock
sblalock@harnett.org
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 198.86.10.234
Sent: 11/16/2021 12:08:21 PM
Viewed: 11/16/2021 12:10:03 PM
Signed: 11/16/2021 12:18:07 PM
Electronic Record and Signature Disclosure:
Accepted: 11/16/2021 12:10:03 PM
ID: 2246be7d-b360-4b1e-afd8-8370ecfcd219
Kimberly Whitted
kwhitted@campbell.edu
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 152.38.26.204
Sent: 11/16/2021 12:18:08 PM
Viewed: 11/16/2021 12:23:13 PM
Signed: 11/16/2021 12:23:45 PM
Electronic Record and Signature Disclosure:
Accepted: 11/16/2021 12:23:13 PM
ID: ae5a2039-4d5d-48f7-b0ad-c2d9fc155b29
Kimberly Honeycutt
khoneycutt@harnett.org
Finance Officer
Security Level: Email, Account Authentication
(None)Signature Adoption: Pre-selected Style
Using IP Address: 24.159.160.130
Sent: 11/16/2021 12:23:46 PM
Viewed: 11/16/2021 12:39:43 PM
Signed: 11/16/2021 3:55:05 PM
Electronic Record and Signature Disclosure:
Accepted: 11/16/2021 12:39:43 PM
ID: 7b28e26c-eb54-4ed5-aa6c-4fdb50168b99
Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 174.212.98.249
Signed using mobile
Sent: 11/16/2021 3:55:07 PM
Viewed: 11/18/2021 2:31:31 PM
Signed: 11/18/2021 2:31:42 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
HCBOC 071222 ws Pg. 191
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 11/16/2021 12:08:21 PM
Certified Delivered Security Checked 11/18/2021 2:31:31 PM
Signing Complete Security Checked 11/18/2021 2:31:42 PM
Completed Security Checked 11/18/2021 2:31:42 PM
Payment Events Status Timestamps
Electronic Record and Signature Disclosure
HCBOC 071222 ws Pg. 192
CONSUMER DISCLOSURE
From time to time, NC Dept of Public Safety (we, us or Company) may be required by law to
provide to you certain written notices or disclosures. Described below are the terms and
conditions for providing to you such notices and disclosures electronically through the
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satisfaction and agree to these terms and conditions, please confirm your agreement by clicking
the ‘I agree’ button at the bottom of this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
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to you through the DocuSign system during and immediately after signing session and, if you
elect to create a DocuSign signer account, you may access them for a limited period of time
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send you paper copies of any such documents from our office to you, you will be charged a
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procedure described below.
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If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
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Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign ‘Withdraw Consent’ form on the signing page
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your consent to receive required notices and disclosures electronically from us and you will no
longer be able to use the DocuSign system to receive required notices and consents electronically
from us or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM
Parties agreed to: Samantha Jo Blalock, Kimberly Whitted, Kimberly Honeycutt
HCBOC 071222 ws Pg. 193
electronically from us.
How to contact NC Dept of Public Safety:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: david.pozun@ncdps.gov
To advise NC Dept of Public Safety of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at david.pozun@ncdps.gov and in
the body of such request you must state: your previous e-mail address, your new e-mail address.
We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from NC Dept of Public Safety
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to david.pozun@ncdps.gov and in the
body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with NC Dept of Public Safety
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign session, and on the subsequent
page, select the check-box indicating you wish to withdraw your consent, or you may;
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state your e-mail, full name, US Postal Address, and telephone number. We do not need
any other information from you to withdraw consent.. The consequences of your
withdrawing consent for online documents will be that transactions may take a longer time
to process..
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** These minimum requirements are subject to change. If these requirements change, you will be
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browsers are not supported.
Acknowledging your access and consent to receive materials electronically
HCBOC 071222 ws Pg. 194
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you were
able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to e-mail
this disclosure and consent to an address where you will be able to print on paper or save it for
your future reference and access. Further, if you consent to receiving notices and disclosures
exclusively in electronic format on the terms and conditions described above, please let us know
by clicking the ‘I agree’ button below.
By checking the ‘I agree’ box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC CONSUMER DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify NC Dept of Public Safety as described above, I consent to receive
from exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by NC Dept of Public Safety during the course of my relationship with
you.
HCBOC 071222 ws Pg. 195
Program: 4-H Teen Court and At-Risk Youth Development
Teen Court is a community resource for the diversion of cases in which juveniles have allegedly
committed certain offenses for hearing by a jury of their peers. The juvenile may be assigned
counseling, restitution, curfews, community service or other rehabilitative measures.
Monitoring meeting: 2/9/22
Youth served per Program Agreement: 28
Youth actually served in 1st 6 months: 5 On track: No
Why not: Low referrals from Juvenile Justice and the school system. School resource officers have been
limited with their interactions with students and involvement with school discipline issues. The number
of referrals from Juvenile Justice has been reduced because youth/cases are not eligible for their service.
Covid has also had an impact on services.
Measurable Objectives: Objectives goals are set between 75-95%. All goals have been met with
100%. Intake forms and client documentation was provided for program assessment.
Per the Program Enhancement Plan (PEP), additional pandemic protocols were needed and the program
manual needed to be updated. This is currently being updated.
Financials: Statements were presented and were up-to-date with financial information. There was
a refund of 3,990.00 due in September. There were no staff vacancies. Funding is on track with
proposed program agreement.
Court Counselor review: Two court counselors reported making no referrals, although there is
regular communication between agencies and services are easily accessible. One stated that there were
no juveniles for this service and other stated no cases have been applicable, but has encouraged law
enforcement to make direct referrals and provided brochure.
Recommended for funding: Yes with conditions that referrals will increase this year as Covid
conditions improve.
HCBOC 071222 ws Pg. 196
Program: Dunn PAL Academic Career Readiness/SKIP
Program provides tutoring and vocational skills for children.
Youth served per Program Agreement: 40 total
Youth actually served in 1st 6 months: 56 ( SKIP: 35 Career Readiness: 21) On track: Yes
Monitoring date: 2/7/22
Measurable Objectives: Objectives have all been met and exceeded the program’s set goals.
Example: Clients will have no new adjudications for a complaint with an offense date after the
admission date. Goal: 80% Actual: 100%
Program provided grade reports, attendance data, and documentation for client’s progress.
Observations:
There were discrepancies in numbers on the monthly reports for clients served. They were advised to
update and correct this data on monthly reports so it is consistent.
Documentation was received with client names and other information visible. This information needs to
be blacked out for confidentiality reasons. In the Program Enhancement Form (PEP) it was
recommended for the agency to provide more staff training and to address staff turnover. Dunn PAL
stated stated that there has been staff trainings and they were asked to provide documentation to verify
trainings. We have not received this information as of 2/14/22
There were job vacancies, but they have since been filled.
Financials:
According to financial reports, the program appears to be on track with funding and not over or under
expended.
Some financial data was provided and it was requested to send additional information by submitting a
stand-alone expense report to include monies received and expenditures. We have not received this
information as of 2/14/22
Court Counselor review: Approximately counselors have not used Dunn PAL as a resource.
Those familiar with the program state that services are easily accessible and communication between
agencies is good.
Recommended for funding: Yes
HCBOC 071222 ws Pg. 197
Program: Healthy Choices Program
Healthy Choices is an interpersonal skills group for youth. Evidenced based curriculum is used to teach
communication, stress and anxiety management, decision making skills, anger management, and
conflict resolution. Workshops/meetings are provided for parents as well.
Monitoring meeting: 2/9/22
Youth served per Program Agreement: 20
Youth actually served in 1st 6 months: 1 client through 12/21 but currently serving 8 On track: No
Why not: Low referrals from Juvenile Justice and Truancy Court, and Covid related issues.
The program has begun working with STAR Academy and has received several referrals in just a few
weeks. This partnership should increase the number of youth served to line up more with the Program
Agreement. TND and Life Styles curriculums are currently used in groups.
Measurable Objectives: Objectives goals are set at 80%. All goals have been met and some have
exceeded expectation with 100%
Per the Program Enhancement Plan (PEP), additional training for staff was requested. Training is now
provided every other month for staff to learn about the curriculum programs and how to implement
them. Pre and post-test information, attendance, and grades are all used to assess the program. The
program is providing more mentoring to students this current year. The program has worked hard to
find new referral sources by contacting community resources and school personnel.
Financials: Statements were presented and were up-to-date with financial information.
Expenditures and revenues are consistent with the Program Agreement. There were no staff vacancies,
but contractual employees are used to assist with program delivery.
Court Counselor review: Referrals are not consistent between counselors. Some counselors
have made and others have not made referrals to this program. It was stated that no cases have been
applicable to refer, although the program has been used in the past. Another stated communication is
good and services are easily accessible. Juveniles reported that they enjoy the group sessions and the
virtual meetings make it easy to attend since transportation can be a problem for some.
Recommended for funding: Yes with conditions that referrals will continue to increase this year
as Covid conditions improve
HCBOC 071222 ws Pg. 198
Program: Harnett County Juvenile Restitution/Community Service
Program
Restitution works with juveniles who have been ordered to pay monetary restitution to a victim or
perform community service. The program serves as a community based sanction to hold youth
accountable for their actions in the least restrictive settings.
Monitoring meeting: 2/7/22
Youth served per Program Agreement: 90
Youth actually served in 1st 6 months: 26 ( ages 10-13: 8 ages 14-17: 18) On track: No
Why not: Low referrals, number of diversions from Juvenile Justice, and Covid related issues.
Measurable Objectives: Objectives have all been met and exceeded the program’s set goals.
Example: Clients will complete restitution or community service within the timeframe permitted by
JCPC policy. Goal: 75% Actual: 92.86%. Six and 12 month follow-up data included for documentation
purposes.
Financials: Statements were presented and up-to-date with expenditures. A program assistant has
not been hired due to lower than normal referrals
Court Counselor review: Accessibility, communication, and services are strong. Easy to work
with and quick to respond.
Recommended for funding: Yes without conditions
HCBOC 071222 ws Pg. 199
Juvenile Crime Prevention Council Certification
Form JCPC/OP 002 (a) Juvenile Crime Prevention Council Certification
Form structure last revised August 2020
NC Department of Public Safety Page 1 of 4
Fiscal Year: _____________
County: Harnett Date: 07/06/2022
CERTIFICATION STANDARDS
STANDARD #1 - Membership
A. Have the members of the Juvenile Crime Prevention Council been appointed by
county commissioners? Yes
B. Is the membership list attached? Yes
C. Are members appointed for two-year terms and are those terms staggered? Yes
D. Is membership reflective of social-economic and racial diversity of the community? Yes
E. Does the membership of the Juvenile Crime Prevention Council reflect the
required positions as provided by N.C.G.S. §143B-846? No
If not, which positions are vacant and why?
Person up to age 21, Person up to age 21/Youth Advocate, Representative United Way/other non-
profit
STANDARD #2 - Organization
A. Does the JCPC have written Bylaws? Yes
B. Bylaws are attached or on file (Select one.)
C. Bylaws contain Conflict of Interest section per JCPC policy and procedure. Yes
D. Does the JCPC have written policies and procedures for funding and review? Yes
E. These policies and procedures attached or on file. (Select one.)
F. Does the JCPC have officers and are they elected annually? Yes
JCPC has: Chair; Vice-Chair; Secretary; Treasurer.
STANDARD #3 - Meetings
A. JCPC meetings are considered open and public notice of meetings is provided. Yes
B. Is a quorum defined as the majority of membership and required to be present in
order to conduct business at JCPC meetings? Yes
C. Does the JCPC meet six (6) times a year at a minimum? Yes
D. Are minutes taken at all official meetings? Yes
E. Are minutes distributed prior to or during subsequent meetings? Yes
STANDARD #4 - Planning
A. Does the JCPC conduct a biennial planning process which includes a needs
assessment, monitoring of programs and funding allocation process? Yes
B. Is this Biennial Plan presented to the Board of County Commissioners and to
DPS? Yes
C. Is the Funding Plan approved by the full council and submitted to Commissioners
for their approval? Yes
HCBOC 071222 ws Pg. 200
Juvenile Crime Prevention Council Certification (cont'd)
Form JCPC/OP 002 (a) Juvenile Crime Prevention Council Certification
Form structure last revised August 2020
NC Department of Public Safety Page 2 of 4
STANDARD #5 - Public Awareness
A. Does the JCPC communicate the availability of funds to all public and private non-
profit agencies which serve children or their families and to other interested
community members? ( RFP, distribution list, and article attached) Yes
B. Does the JCPC complete a biennial needs assessment and make that information
available to agencies which serve children or their families, and to interested
community members? Yes
STANDARD #6 – No Overdue Tax Debt
A. As recipient of the county DPS JCPC allocation, does the County certify that it has
no overdue tax debts, as defined by N.C.G.S. §105-243.1, at the Federal, State, or
local level? Yes
Briefly outline the plan for correcting any areas of standards non-compliance.
Having complied with the Standards as documented herein, the Juvenile Crime Prevention Council may
use up to $15,500 of its annual Juvenile Crime Prevention fund allocation to cover administrative and
related costs of the council. Budget pages (sections VI and VII) printed from NCALLIES detailing the
expenditure's must be attached to this certification.
The JCPC Certification must be received by June 30, 2021.
JCPC Administrative Funds
SOURCES OF REVENUE
DPS JCPC
Only list requested funds for
JCPC Administrative Budget. $15,500
Local
Other
Total $15,500
JCPC Chairperson Date
Chairman, Board of County Commissioners Date
DPS Designated Official Date
Contact Harnett County Schools for person under 21 representatives, non-profit organizations, and
need to replace individuals that have cycled off the JCPC for various reasons.
HCBOC 071222 ws Pg. 201
Juvenile Crime Prevention Council Certification (cont'd)
Form JCPC/OP 002 (a) Juvenile Crime Prevention Council Certification
Form structure last revised August 2020
NC Department of Public Safety Page 3 of 4
Harnett County FY 2022-23
Instructions: N.C.G.S. § 143B-846 specifies suggested members be appointed by county commissioners to serve on local
Juvenile Crime Prevention Councils. In certain categories, a designee may be appointed to serve. Please indicate the
person appointed to serve in each category and his/her title. Indicate appointed members who are designees for named
positions. Indicate race and gender for all appointments.
Specified Members Name Title Designee Race Gender
1) School Superintendent or designee Jermaine White Asst.
Superintendent B M
2) Chief of Police or designee Tracy Hair Asst. to the
Chief of Police W F
3) Local Sheriff or designee Dominic
Alvarado
Deputy
M
4) District Attorney or designee Michael Onufer ADA W M
5) Chief Court Counselor or designee Chief Court
Counselor
Designee
6) Director, Local Management
Entity/Managed Care Organization
(LME/MCO), or designee
Mary Spell
Care
Coordinator
Specialist
B
F
7) Director DSS or designee
8) County Manager or designee
9) Substance Abuse Professional
10) Member of Faith Community Kimberly
Whitted
Director,
Technology
Infrastructure &
Operations
B F
11) County Commissioner Barbara McKoy B F
12) Two persons under the age of 21, or
one person under the age of 21 and
one member of the public
representing the interests of families
of at-risk juveniles
13) Juvenile Defense Attorney
14) Chief District Judge or designee
15) Member of Business Community
16) Local Health Director or designee Avis Watkins-
Smith
Social Worker B F
17) Rep. United Way/other non-profit
18) Representative/Parks and Rec. Carl Davis Director W M
19) County Commissioner appointee
20) County Commissioner appointee Rosanne
Teniente
Human Services
Consultant
F
HCBOC 071222 ws Pg. 202
Juvenile Crime Prevention Council Certification (cont'd)
Form JCPC/OP 002 (a) Juvenile Crime Prevention Council Certification
Form structure last revised August 2020
NC Department of Public Safety Page 4 of 4
21) County Commissioner appointee Cindy Delgado Success
Coach/Dropout
Prevention,
Harnett County
Schools
W F
22) County Commissioner appointee Matthew Willis Register of
Deeds, Harnett
County
23) County Commissioner appointee Debbie Chiovitti W F
24) County Commissioner appointee
25) County Commissioner appointee
HCBOC 071222 ws Pg. 203
S:\Clerk to the Board docs\AGENDAS\2022\071222ws\6.1 agendaform Dunn Inspections 3 year contract.docx Page
1 of 1
Board Meeting
Agenda Item
MEETING DATE: July 18, 2022
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: Dunn Fire Inspections and Plan Review 3 year agreement
REQUESTED BY: Larry Smith, Emergency Services
REQUEST:
Harnett County Emergency Services is seeking Board approval for a 3 year agreement with
the City of Dunn for Harnett County Fire Marshals Office to conduct the City's Fire
Inspections/Fire Plan Review. The City will compensate the county for this service. This
agreement is for a three year period and can be renewed.
FINANCE OFFICER’S RECOMMENDATION:
COUNTY MANAGER’S RECOMMENDATION:
Item 6
HCBOC 071222 ws Pg. 204
1
STATE OF NORTH CAROLINA
COUNTY OF HARNETT
FIRE PREVENTION CODE ENFORCEMENT
MUNICIPAL AGREEMENT
CITY OF DUNN
THIS AGREEMENT, made and entered into this first day of July, 2022, by and between the City of
Dunn, North Carolina, a municipal corporation organized and existing under the laws of the State of
North Carolina (hereinafter, " City '') and the County of Harnett, North Carolina, a body politic and
political subdivision of the State of North Carolina (hereinafter, "County").
Witnesseth
WHEREAS, City is required to provide fire prevention code enforcement services according to N.C.
General Statute § 160D-1105 and the North Carolina State Fire Prevention Code - Section 106; and
WHEREAS, County desires to provide to City the required fire prevention code inspections and
services; and
WHEREAS, City and County have reached an agreement for County to provide fire prevention code
inspections and services as described herein and the parties desire to set forth the terms and conditions in
this Agreement.
NOW, THEREFORE, in consideration of the public safety and welfare, the mutual benefits,
representations, and agreements contained herein and for good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties agree, each with the other, as follows:
1. County agrees to provide City the following fire prevention code enforcement services within
City's territorial jurisdiction:
A. Fire prevention code enforcement within day care centers, rest homes, foster homes, and
hospitals, when required by State or County agencies;
B. Non-residential and subdivision site plan approval for fire prevention code compliance,
upon request from City officials;
C. Response to complaints and requests for fire inspections of individual businesses;
D. Periodic Fire Prevention Code inspections in existing buildings, structures and premises
to which the current North Carolina State Building Code, Fire Prevention, is applicable;
E. New construction plan review of fire protection equipment and certification of
compliance inspections upon request from the appropriate building official(s) or
contractor; and
F. Other fire prevention code enforcement inspections and services as may be required by
State law.
2. City agrees that County, by and through the Harnett County Fire Marshal's office, shall have the
exclusive right to perform the above enumerated fire prevention code enforcement services for as
long as this Agreement remains in force and effect. City further agrees to fully cooperate with the
Harnett County Fire Marshal's office in providing these services.
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3. City agrees that County will have and may exercise the same inspection and enforcement powers
within City's regulatory and extraterritorial jurisdiction as are applicable within County's
jurisdiction.
4. This Agreement shall become effective July 1, 2022, subject to the mutual agreement of both
parties, and shall continue for a period of three years from July 1, 2022 through June 30, 2025,
unless terminated by either party in accordance with paragraph 8 of this Agreement.
5. Compensation for the services provided pursuant to this Agreement shall be $48,239.04 for fiscal
year 2023 and increase at a rate of three percent (3%) annually thereafter. County shall invoice
City each year month, in twelve equal installments per fiscal year, for said services and each
invoice is due and payable to County within thirty (30) days of the date of the invoice. City shall
pay an additional charge of one and one-half percent per month (18% annually), not to exceed the
maximum rate allowed by law for any payment not received by County more than thirty (30) days
from the date of invoice.
6. This Agreement, as written or as may be amended, shall be effective from the date first specified
above.
7. The City Attorney shall provide legal support and representation for City for all enforcement
actions taken by the Harnett County Fire Marshal's office on behalf of City on issues arising from
enforcement actions taken within and on behalf of City's jurisdiction by the Fire Marshal. To the
fullest extent allowable by North Carolina law, County shall have no liability regarding such
enforcement actions and City shall hold County harmless for any and all claims, liabilities, losses,
damages, costs, or expenses of whatever kind arising out of or relating to the provision of services
provided by County to City hereunder, except for those acts caused by the negligence of County.
To the fullest extent allowable by North Carolina law, County shall hold City harmless for any
and all claims, liabilities, losses, damages, costs, or expenses of whatever kind arising out of or
relating to the provision of services provided by County to City, except for those acts caused by
the negligent acts or omissions of City. City and County waive special, incidental, indirect, or
consequential damages, including lost profits, good will, revenues or savings, for claims, disputes
or other matters in question arising out of or relating to this Agreement. This limitation of
liability, covering matters contemplated by and occurring during the term of this Agreement, will
survive the expiration or termination of this Agreement.
8. This Agreement may be terminated for any reason by either party upon advanced written notice
to the other party, by certified mail at least ninety (90) days prior to the date of desired
termination. Termination shall not relieve City of financial obligations incurred prior to
termination.
9. Nothing contained in this Agreement shall create a contractual relationship with or cause of
action in favor of a third party against either Party.
10. 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.
11. This Agreement represents the entire agreement between County and City and supersedes all
prior negotiations, representations or agreements, either written or oral. This Agreement may only
be amended by written instrument signed by County and City.
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12. 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 City:
City of Dunn
401 E. Broad Street
Dunn, NC 28334
Attn: City Manager
To County:
Harnett County Fire Marshal
PO Box 370
Lillington, NC 27546
With a copy to: Harnett County Legal Services
PO Box 238
Lillington, NC 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 above.
13. This Agreement shall be governed by the laws of the State of North Carolina, The North Carolina
State Courts located in Harnett County, North Carolina shall have jurisdiction to hear any dispute
under this Agreement and legal or equitable proceedings by either party must be filed in Harnett
County, North Carolina.
14. The relationship of the parties established by this Agreement is solely that of independent
contractor, 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 ventures, 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.
[Remainder of This Page Intentionally Left Blank]
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IN WITNESS WHEREOF, the parties hereto, through their duly authorized representatives or officers
have executed this Agreement as to the date and year first above written.
CITY OF DUNN
By: ______________________________
___________________, City Manager
Attest:
_________________________________ (SEAL)
_______________________, Clerk
COUNTY OF HARNETT
By: ______________________________
Brent Trout, County Manager
Attest:
__________________________________ (SEAL)
Jaime Bell-Raig, Clerk
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Board Meeting
Agenda Item
MEETING DATE: July 18, 2022
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: Library Consolidation Update
REQUESTED BY: Angela McCauley
REQUEST:
The Hamett County Public Library respectfully requests consideration of the consolidation
budget. Based on current budget information and needs this budget is projected to be up to
$661,744 for year 1. These funds will be allocated to staffing and operating expenses for the
Angier Public Library, Coats Public Library, Erwin Public Library, Dunn Public Library,
as well as consolidation support staff at the Main Library. Actual funding needed could
potentially be less based on Municipal Commitment to joining the County Consolidation
or more based on any atypical needs that have not yet been identified.
FINANCE OFFICER'S RECOMMENDATION:
COUNTY MANAGER'S RECOMMENDATION:
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Item 7
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Board Meeting
Agenda Item
MEETING DATE: July 18, 2022
TO: HARNETT COUNTY BOARD OF COMMISSIONERS
SUBJECT: Adopt the Program Income Policy and Allowable Costs & Costs Principles
Policy
REQUESTED BY: Christopher Appel – Legal Department
REQUEST:
Adopt the Program Income Policy and Allowable Costs & Costs Principles Policies. These
two policies are to ensure compliance with the U.S. Department of Treasury's federal
regulations governing expenditures of ARP/CSLFRF funds. The Program Income Policy
provides guidance to account for program income earend from the expenditure of funds
pursuant to the ARP/CLSFRF award. The Allowable Costs & Costs Principles Policy
provides rules and procedures as to those items of cost that are allowable or unallowable
pursuant to Title 2 U.S. Code of Federal Regulations Part 200
FINANCE OFFICER’S RECOMMENDATION:
COUNTY MANAGER’S RECOMMENDATION:
Item 8
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County of Harnett
Program Income Policy
Effective July 18, 2022
PURPOSE AND SCOPE
The County of Harnett enacts the following procedures for its use of program income earned
from the expenditure of ARP/CSLFRF funds to ensure compliance with the Uniform Guidance,
including, but not limited to, 2 C.F.R. § 200.307, the ARP/CSLFRF award, and all applicable
Federal regulations governing the use of program income. The County agrees to administer
program income according to the requirements set forth in this policy and as required by the
Federal regulations and State law.
The responsibility for following this policy lies with the ARP/CSLFRF Management Team who
are charged with the administration and financial oversight of the ARP/CSLFRF award.
Questions on the use and/or reporting of program income should be directed to the Finance
Department.
DEFINITIONS
a. ARP/CLSFRF award means the Federal program governing the use of Coronavirus State
and Local Fiscal Recovery Funds as provided in the Assistance Listing and as
administered by the U.S. Department of Treasury pursuant to the American Rescue Plan
Act of 2021 (“ARPA”), Pub. L. No. 117-2 (Mar. 11, 2021).
b. ARP/CSLFRF funds means the portion of Federal financial assistance from the
Coronavirus State Fiscal Recovery Funds and Coronavirus Local Fiscal Recovery Funds
(collectively “CSLFRF”) awarded to the County pursuant ARPA.
c. Federal award means the Federal financial assistance that a recipient receives directly
from a Federal awarding agency or indirectly from a pass-through entity, as described in
§ 200.101. The Federal award is the instrument setting forth the terms and conditions of
the grant agreement, cooperative agreement, or other agreement for assistance.
d. Federal awarding agency means the Federal agency that provides a Federal award
directly to a non-Federal entity.
e. Federal financial assistance means the assistance that non-Federal entities receive or
administer in the form of grants, cooperative agreements, non-cash contributions, direct
appropriations, food commodities, or other financial assistance, including loans.
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f. Federal program means all Federal awards which are assigned a single Assistance
Listings Number.
g. Non-Federal entity means a State, local government, Indian tribe, Institution of Higher
Education (IHE), or nonprofit organization that carries out a Federal award as a recipient
or subrecipient.
h. Period of performance means the total estimated time interval between the start of an
initial Federal award and the planned end date, which may include one or more funded
portions, or budget periods. The period of performance for the ARP/CSLFRF award ends
December 31, 2026.
i. Program income means gross income earned by the non-Federal entity that is directly
generated by a supported activity or earned as a result of the Federal award during the
period of performance except as provided in § § 200.307(f).
PROGRAM INCOME OVERVIEW
For purposes of this policy, program income is the gross income earned by the County that is
directly generated by a supported activity or earned as a result of the ARP/CSLFRF award
during the period of performance, which closes December 31, 2026. 2 CFR 200.1.
Program income includes, but is not limited to, the following sources of income:
• The collection of fees for services performed.
• Payments for the use or rental of real or personal property.
• The sale of commodities or items fabricated under the Federal award.
• The payment of principal and interest on loans made under the Federal award.
Program income does not include fees or revenue from the following:
• The use of rebates, credits, discounts, and interest earned on any of them.
• Governmental revenues, such as taxes, special assessments, levies, or fines.
• Proceeds from the sale of real property, equipment, or supplies.1
USE OF PROGRAM INCOME
Program income earned pursuant to expenditures of ARP/CSLFRF funds is the property of US
Treasury and shall be accounted for in one of three ways pursuant to 2 C.F.R. § 200.307(e).
Deduction Method: Program income must be deducted from total allowable costs to
determine net allowable costs. Program income shall be used to reduce Treasury’s
obligation under the ARP/CSLFRF award rather than to increase the funds committed a
project. Program income shall be used for current costs. The County shall track and
account for program income during the period of performance and shall reimburse
Treasury, as required. 2 C.F.R. § 200.307(e)(1).
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Addition Method: With prior approval, program income may be added to the total
amount of the ARP/CSLFRF award, thereby increasing the total amount of the award.
Program income must be expended on an eligible project or program. 2 C.F.R. §
200.307(e)(2). Pursuant to the terms of the ARP/CSLFRF award, the repayment of
principal and interest on loans made with CSLFRF funds that will mature or be forgiven
on or before December 31, 2026, may be accounted for using the addition method (see
Section VI).
Matching or Cost Sharing Method: With prior approval, program income may be used
to meet the cost sharing or matching requirement of the Federal award. The amount of the
Federal award shall not change. 2 C.F.R. § 200.307(e)(3).
Unless the ARP/CSLFRF award otherwise stipulates, or the County has received prior approval,
the County shall apply the deduction method to account for the use of program income.
ALLOCATION OF PROGRAM INCOME
The County shall only expend program income on costs that are reasonable, allocable, and
allowable under the terms of the ARP/CSLFRF award. To adhere to these requirements, the
County shall comply with the cost principles included in 2 C.F.R. § 200, as outlined in the
County’s Allowable Costs and Costs Principles Policy. The County shall allocate program
income to the ARP/CSLFRF award in proportion to the pro rata share of the total funding (e.g., if
ARP/CSLFRF funds cover half of a project’s cost, with general revenue covering the other half,
the unit shall allocate 50% of any program income earned to the ARP/CSLFRF award and
account for its use pursuant to § 200.307).
REPAYMENT OF PRINCIPAL AND INTEREST ON LOANS MADE WITH
ARP/CSLFRF FUNDS
Treasury expects that a significant share of loans made with ARP/CSLFRF funds will be repaid.
Accordingly, it has issued guidance on how to appropriately account for the repayment of
principal and interest. The County agrees to appropriately account for the return of loan funds
according to the ARP/CSLFRF award terms, as follows:
• For Loans that mature or are forgiven on or before December 31, 2026: The County
may add the repayment of principal and interest (program income) to the ARP/CSLFRF award.
When the loan is made, the County shall report the principal of the loan as an expense.
The County shall expend the repayment of principal only on eligible uses and is subject
to restrictions on the timing of the use of ARP/CSLFRF funds pursuant to the
ARP/CSLFRF award. Interest payments received prior to the end of the period of
performance will be considered an addition to the total award and may be used for any purpose
that is an eligible use. The County is not subject to restrictions under 2 CFR 200.307(e)(1) (the
deduction method) in accounting for the use of program income.
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• For Loans with maturities longer than December 31, 2026: The County is not required
to separately account for the repayment of principal and interest on loans that will mature
after the ARP/CSLFRF award’s period of performance. The County may use
ARP/CSLFRF funds for only the projected cost of the loan. The County may estimate the subsidy
cost of the loan, which equals the expected cash flows associated with the loan discounted at the
County’s cost of funding. The cost of funding can be determined based on the interest rates of
securities with a similar maturity to the cash flow being discounted that were either (i) recently
issued by the County or (ii) recently issued by a unit of state, local, or Tribal government similar
to the County. If the County has adopted the Current Expected Credit Loss (CECL) standard, it
may also treat the cost of the loan as equal to the CECL-based expected credit losses over the life
of the loan. The County may measure projected losses either once, at the time the loan is
extended, or annually over the covered period. Under either approach, the County is not subject
to restrictions under 2 CFR 200.307(e)(1) (the deduction method) and need not separately track
repayment of principal or interest.
• Revolving Loan Funds: The County shall treat the contribution of ARP/CSLFRF funds to a
revolving loan fund according to approach described above for loans with maturities longer than
December 31, 2026. The County may contribute ARP/CSLFRF funds to a revolving loan
only if the loan is determined to be for eligible use and the ARP/CSLFRF funds
contributed represent the projected cost of loans made over the life of the revolving loan
fund.
ADDITIONAL PROGRAM INCOME REQUIREMENTS
(a) Identifying, Documenting, Reporting, and Tracking. To ensure compliance with the
requirements of program income as outlined by the Federal regulations, the terms and
conditions of the ASP/CSLFRF award, and the requirements set forth herein, each
department shall identify potential sources of program income and properly report the
program income for the period in which it was earned and dispersed.
Program income shall be accounted for separately. The County shall not comingle
program income earned from programs supported by ARP/CSLFRF funds with the
general award of ARP/CSLFRF funds the County received from Treasury. Any costs
associated with generating program income revenue shall be charged as expenditures to
the ARP/CSLFRF award.
(b) Program Income Earned After the Period of Performance. The County shall have no
obligation to report program income earned after the period of performance (December
31, 2026). However, the County shall report program income expended after the period
of performance if that program income was earned on or before December 31, 2026.
(c) Subawards. The County agrees to ensure that any subrecipient of ARP/CSLFRF funds
abides by the award of the terms and conditions of this policy and is aware that the
subrecipient is responsible for accounting for and reporting program income to the
County.
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(d) Compliance with State law. Program income shall not be expended for purposes
prohibited under State law.
(e) Subject to Audit. The County recognizes that its use of program income may be audited
and reviewed for compliance with Federal laws and regulations, State law, and the terms
of the ARP/CSLFRF award.
IMPLEMENTATION OF POLICY
The Finance Officer will adopt procedures to identify potential program income during the
project eligibility and allowable cost review, document actual program income, and follow the
requirements in this policy related to the treatment of program income.
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County of Harnett
Allowable Costs and Costs Principles Policy
Effective July 18, 2022
ALLOWABLE COSTS AND COSTS PRINCIPLES POLICY OVERVIEW
Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost
Principles, and Audit Requirements for Federal Awards, commonly called Uniform Guidance
(UG), specifically Subpart E, defines those items of cost that are allowable, and which are
unallowable. The tests of allowability under these principles are: (a) the costs must be
reasonable; (b) they must be allocable to eligible projects under the Coronavirus State and Local
Fiscal Recovery Funds of H.R. 1319 American Rescue Plan Act of 2021 (ARP/CSLFRF); (c)
they must be given consistent treatment through application of those generally accepted
accounting principles appropriate to the circumstances; and (d) they must conform to any
limitations or exclusions set forth in these principles or in the ARP/CSLFRF grant award as to
types or amounts of cost items. Unallowable items fall into two categories: expenses which are
by their nature unallowable (e.g., alcohol), and unallowable activities (e.g., fund raising).
Harnett County shall adhere to all applicable cost principles governing the use of federal grants.
This policy addresses the proper classification of both direct and indirect charges to
ARP/CSLFRF funded projects and enacts procedures to ensure that proposed and actual
expenditures are consistent with the ARP/CSLFRF grant award terms and all applicable federal
regulations in the UG.
Responsibility for following these guidelines lies with ARP/CLSFRF Management Team who
are charged with the administration and financial oversight of the ARP/CSLFRF. Further, all
County employees and officials who are involved in obligating, administering, expending, or
monitoring ARP/CSLFRF grant funded projects should be well versed with the categories of
costs that are generally allowable and unallowable. Questions on the allowability of costs should
be directed to the Finance Department. As questions on allowability of certain costs may require
interpretation and judgment, local government personnel are encouraged to ask for assistance in
making those determinations.
GENERAL COST ALLOWABILITY CRITERIA
All costs expended using ARP/CSLFRF funds must meet the following general criteria:
1. Be necessary and reasonable for the proper and efficient performance and
administration of the grant program.
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A cost must be necessary to achieve a project object. When determining whether a cost is
necessary, consideration may be given to:
○ Whether the cost is needed for the proper and efficient performance of the grant
project.
○ Whether the cost is identified in the approved project budget or application.
○ Whether the cost aligns with identified needs based on results and findings from a
needs assessment.
○ Whether the cost addresses project goals and objectives and is based on program
data.
A cost is reasonable if, in its nature and amount, it does not exceed that which would be
incurred by a prudent person under the circumstances prevailing at the time the decision
to incur the cost was made. For example, reasonable means that sound business practices
were followed, and purchases were comparable to market prices. When determining
reasonableness of a cost, consideration must be given to:
○ Whether the cost is a type generally recognized as ordinary and necessary for the
operation of Harnett County or the proper and efficient performance of the federal
award.
○ The restraints or requirements imposed by factors, such as: sound business
practices; arm’s-length bargaining; federal, state, and other laws and regulations;
and terms and conditions of the ARP/CSLFRF award.
○ Market prices for comparable goods or services for the geographic area.
○ Whether individuals concerned acted with prudence in the circumstances
considering their responsibilities to Harnett County, its employees, the public at
large, and the federal government.
○ Whether Harnett County significantly deviates from its established practices and
policies regarding the incurrence of costs, which may unjustifiably increase the
ARP/CSLFRF award’s cost.
2. Be allocable to the ARP/CSLFRF federal award. A cost is allocable to the
ARP/CSLFRF award if the goods or services involved are chargeable or assignable to the
ARP/CSLFRF award in accordance with the relative benefit received. This means that
the ARP/CSLFRF grant program derived a benefit in proportion to the funds charged to
the program. For example, if 50 percent of a local government program officer’s salary is
paid with grant funds, then the local government must document that the program officer
spent at least 50 percent of his/her time on the grant program.
If a cost benefits two or more projects or activities in proportions that can be determined
without undue effort or cost, the cost must be allocated to the projects based on the
proportional benefit. If a cost benefits two or more projects or activities in proportions
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that cannot be determined because of the interrelationship of the work involved, then the
costs may be allocated or transferred to benefitted projects on any reasonable documented
basis. Where the purchase of equipment or other capital asset is specifically authorized by
the ARP/CSLFRF, the costs are assignable to the Federal award regardless of the use that
may be made of the equipment or other capital asset involved when no longer needed for
the purpose for which it was originally required.
3. Be authorized and not prohibited under state or local laws or regulations.
4. Conform to any limitations or exclusions set forth in the principles, federal laws,
ARP/CSLFRF award terms, and other governing regulations as to types or amounts
of cost items.
5. Be consistent with policies, regulations, and procedures that apply uniformly to both
the ARP/CSLFRF federal award and other activities of Harnett County.
6. Be accorded consistent treatment. A cost MAY NOT be assigned to a federal award as
a direct cost and also be charged to a federal award as an indirect cost. And a cost must
be treated consistently for both federal award and non-federal award expenditures.
7. Be determined in accordance with generally accepted accounting principles
(GAAP), unless provided otherwise in the UGG.
8. Be net of all applicable credits. The term “applicable credits” refers to those receipts or
reduction of expenditures that operate to offset or reduce expense items allocable to the
federal award. Typical examples of such transactions are purchase discounts; rebates or
allowances; recoveries or indemnities on losses; and adjustments of overpayments or
erroneous charges. To the extent that such credits accruing to and received by the local
government related to the federal award, they shall be credited to the ARP/CSLFRF
award, either as a cost reduction or a cash refund, as appropriate and consistent with the
award terms.
9. Be adequately documented.
SELECTED ITEMS OF COST
The UGG examines the allowability of fifty-five (55) specific cost items (commonly referred to
as Selected Items of Cost) at 2 CFR § 200.420-.475.
ARP/CSLFRF Management Team members responsible for determining cost allowability must
be familiar with the Selected Items of Cost. Harnett County must follow the applicable
regulations when charging these specific expenditures to the ARP/CSLFRF grant. Finance
Department personnel will check costs against the selected items of cost requirements to ensure
the cost is allowable and that all process and documentation requirements are followed. In
addition, State laws, Harnett County regulations, and program-specific rules may deem a cost as
unallowable, and Finance Department personnel must follow those non-federal rules as well.
Exhibit A identifies and summarizes the Selected Items of Cost.
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DIRECT AND INDIRECT COSTS
Allowable and allocable costs must be appropriately classified as direct or indirect charges. It is
essential that each item of cost be treated consistently in like circumstances either as a direct or
an indirect cost.
Direct costs are expenses that are specifically associated with a particular ARP/CSLFRF-eligible
project and that can be directly assigned to such activities relatively easily with a high degree of
accuracy. Common examples of direct costs include salary and fringe benefits of personnel
directly involved in undertaking an eligible project, equipment and supplies for the project,
subcontracted service provider, or other materials consumed or expended in the performance of a
grant-eligible project.
Indirect costs are (1) costs incurred for a common or joint purpose benefitting more than one
ARP/CSLFRF-eligible project, and (2) not readily assignable to the project specifically
benefited, without effort disproportionate to the results achieved. They are expenses that benefit
more than one project or even more than one federal grant. Common examples of indirect costs
include utilities, local telephone charges, shared office supplies, administrative or secretarial
salaries.
For indirect costs, Harnett County may charge a 10 percent de minimis rate of modified total
direct costs (MTDC). According to UGG Section 200.68 MTDC means all direct salaries and
wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first
$25,000 of each subaward (regardless of the period of performance the subawards under the
award). MTDC EXCLUDES equipment, capital expenditures, charges for patient care, rental
costs, tuition remission, scholarships and fellowships, participant support costs and the portion of
each subaward in excess of $25,000.
SPECIAL PROVISIONS FOR STATE AND LOCAL GOVERNMENTS
There are some special provisions of the UG that apply only to states, local governments, and
Indian Tribes.
§ 200.444 General costs of government.
(a) For states, local governments, and Indian Tribes, the general costs of government are
unallowable (except as provided in § 200.475). Unallowable costs include:
(1) Salaries and expenses of the Office of the Governor of a state or the chief executive
of a local government or the chief executive of an Indian tribe;
(2) Salaries and other expenses of a state legislature, tribal council, or similar local
governmental body, such as a county supervisor, city council, school board, etc., whether
incurred for purposes of legislation or executive direction;
(3) Costs of the judicial branch of a government;
(4) Costs of prosecutorial activities unless treated as a direct cost to a specific program
if authorized by statute or regulation (however, this does not preclude the allowability
of other legal activities of the Attorney General as described in § 200.435); and
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(5) Costs of other general types of government services normally provided to the general
public, such as fire and police, unless provided for as a direct cost under a program
statute or regulation.
(b) For Indian tribes and Councils of Governments (COGs) (see definition for Local
government in § 200.1 of this part), up to 50% of salaries and expenses directly attributable
to managing and operating Federal programs by the chief executive and his or her staff
can be included in the indirect cost calculation without documentation.
§ 200.416 Cost allocation plans and indirect cost proposals.
(a) For states, local governments and Indian tribes, certain services, such as motor pools,
computer centers, purchasing, accounting, etc., are provided to operating agencies on a
centralized basis. Since Federal awards are performed within the individual operating
agencies, there needs to be a process whereby these central service costs can be identified
and assigned to benefitted activities on a reasonable and consistent basis. The central
service cost allocation plan provides that process.
(b) Individual operating agencies (governmental department or agency), normally charge
Federal awards for indirect costs through an indirect cost rate. A separate indirect cost
rate(s) proposal for each operating agency is usually necessary to claim indirect costs under
Federal awards. Indirect costs include:
(1) The indirect costs originating in each department or agency of the governmental unit
carrying out Federal awards and
(2) The costs of central governmental services distributed through the central service cost
allocation plan and not otherwise treated as direct costs.
(c) The requirements for development and submission of cost allocation plans (for central
service costs and public assistance programs) and indirect cost rate proposals are contained
in appendices V, VI and VII to this part.
§ 200.417 Interagency service.
The cost of services provided by one agency to another within the governmental unit may
include allowable direct costs of the service plus a pro-rated share of indirect costs. A
standard indirect cost allowance equal to ten percent of the direct salary and wage cost of
providing the service (excluding overtime, shift premiums, and fringe benefits) may be
used in lieu of determining the actual indirect costs of the service. These services do not
include centralized services included in central service cost allocation plans as described
in Appendix V to Part 200.
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COST ALLOWABILITY REVIEW PROCESS
Preapproval Cost Allowability Review
Before an ARP/CSLFRF-funded project is authorized, the Finance Department must review the
proposed cost items within an estimated project budget to determine whether they are allowable
and allocable and whether cost items will be charged as direct or indirect expenses. This review
will occur concurrently with the review of project eligibility and before obligating or expending
any ARP/CSLFRF funds.
• Harnett County personnel must submit proposed ARP/CSLFRF projects to the
ARP/CSLFRF Management Team for review. In addition to other required information,
all proposed project submissions must delineate estimated costs by cost item.
• Along with a general review of project eligibility and conformance with other governing
board management directives, the Finance Officer must review estimated costs for
specific allowable cost requirements, budget parameters, indirect rates, fringe benefit
rates, and those activities/costs that require pre-approval by the US Treasury.
• If a proposed project includes a request for an unallowable cost, the Finance Department
will return the proposal to the requesting party for review and, if practicable,
resubmission with corrected cost items.
• Once a proposed project budget is pre-approved by the Finance Department, County
personnel responsible for implementing the project must conform actual obligations and
expenditures to the pre-approved project budget.
Post-expenditure Cost Allowability Review
Once an expenditure is incurred related to an eligible project, and an invoice or other demand for
payment is submitted to the local government, the Finance Officer must perform a second review
to ensure that actual expenditures comprise allowable costs.
• All invoices or other demands for payment must include a breakdown by cost item. The
cost items should mirror those presented in the proposed budget for the project. If an
invoice or other demand for payment does not include a breakdown by cost item, the
Finance Department will return the invoice to the project manager and/or vendor,
contractor, or subrecipient for correction.
• The Finance Department must review the individual cost items listed on the invoice or
other demand for payment to determine their allowability and allocability.
• If all cost items are deemed allowable and properly allocable, the Finance Department
must proceed through the local government’s normal disbursement process.
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• If any cost item is deemed unallowable, the Finance Department will notify the project
management and/or vendor, contractor, or subrecipient that a portion of the invoice or
other demand for payment will not be paid with ARP/CSLFRF funds. The Finance
Department may in their discretion, and consistent with this policy, allow an invoice or
other demand for payment to be resubmitted with a revised cost allocation. If the local
government remains legally obligated by contract or otherwise to pay the disallowed cost
item, it must identify other local government funds to cover the disbursement. The
Harnett County Board of Commissioners must approve any allocation of other funds for
this purpose.
• The Finance Department must retain appropriate documentation of budgeted cost items
per project and actual obligations and expenditures of cost items per project.
COST TRANSFERS
Any costs charged to the ARP/CSLFRF federal award that do not meet the allowable cost criteria
must be removed from the award account and charged to an account that does not require
adherence to federal UGG or other applicable guidelines.
Failure to adequately follow this policy and related procedures could result in questioned costs,
audit findings, potential repayment of disallowed costs and discontinuance of funding.
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EXHIBIT A
Selected Items of Cost Uniform Guidance
General Reference
Allowability
Advertising and public relations costs 2 CFR § 200.421 Allowable with restrictions
Advisory councils 2 CFR § 200.422 Allowable with restrictions
Alcoholic beverages 2 CFR § 200.423 Unallowable
Alumni/ae activities 2 CFR § 200.424 Not specifically addressed
Audit services 2 CFR § 200.425 Allowable with restrictions
Bad debts 2 CFR § 200.426 Unallowable
Bonding costs 2 CFR § 200.427 Allowable with restrictions
Collection of improper payments 2 CFR § 200.428 Allowable
Commencement and convocation costs 2 CFR § 200.429 Not specifically addressed
Compensation – personal services 2 CFR § 200.430 Allowable with restrictions; Special conditions
apply (e.g., § 200.430(i)(5))
Compensation – fringe benefits 2 CFR § 200.431 Allowable with restrictions
Conferences 2 CFR § 200.432 Allowable with restrictions
Contingency provisions 2 CFR § 200.433 Unallowable with exceptions
Contributions and donations 2 CFR § 200.434 Unallowable (made by non-federal entity); not
reimbursable but value may be used as cost
sharing or matching (made to non-federal
entity)
Defense and prosecution of criminal and
civil proceedings, claims, appeals and patent
infringements
2 CFR § 200.435 Allowable with restrictions
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Depreciation 2 CFR § 200.436 Allowable with qualifications
Employee health and welfare costs 2 CFR § 200.437 Allowable with restrictions
Entertainment costs 2 CFR § 200.438 Unallowable with exceptions
Equipment and other capital expenditures 2 CFR § 200.439 Allowability based on specific requirement
Exchange rates 2 CFR § 200.440 Allowable with restrictions
Fines, penalties, damages and other
settlements
2 CFR § 200.441 Unallowable with exceptions
Fund raising and investment management
costs
2 CFR § 200.442 Unallowable with exceptions
Gains and losses on disposition of
depreciable assets 2 CFR § 200.443 Allowable with restrictions
General costs of government 2 CFR § 200.444 Unallowable with exceptions
Goods and services for personal use 2 CFR § 200.445 Unallowable (goods/services); allowable
(housing) with restrictions
Idle facilities and idle capacity 2 CFR § 200.446 Idle facilities - unallowable with exceptions;
Idle capacity - allowable with restrictions
Insurance and indemnification 2 CFR § 200.447 Allowable with restrictions
Intellectual property 2 CFR § 200.448 Allowable with restrictions
Interest 2 CFR § 200.449 Allowable with restrictions
Lobbying 2 CFR § 200.450 Unallowable
Losses on other awards or contracts 2 CFR § 200.451 Unallowable (however, they are required to be
included in the indirect cost rate base for
allocation of indirect costs)
Maintenance and repair costs 2 CFR § 200.452 Allowable with restrictions
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Materials and supplies costs, including costs
of computing devices 2 CFR § 200.453 Allowable with restrictions
Memberships, subscriptions, and
professional activity costs 2 CFR § 200.454 Allowable with restrictions; unallowable for
lobbying organizations
Organization costs 2 CFR § 200.455 Unallowable except federal prior approval
Participant support costs 2 CFR § 200.456 Allowable with prior approval of the federal
awarding agency
Plant and security costs 2 CFR § 200.457 Allowable; capital expenditures are subject to
§ 200.439
Pre-award costs 2 CFR § 200.458 Allowable if consistent with other
allowabilities and with prior approval of the
federal awarding agency
Professional services costs 2 CFR § 200.459 Allowable with restrictions
Proposal costs 2 CFR § 200.460 Allowable with restrictions
Publication and printing costs 2 CFR § 200.461 Allowable with restrictions
Rearrangement and reconversion costs 2 CFR § 200.462 Allowable (ordinary and normal)
Recruiting costs 2 CFR § 200.463 Allowable with restrictions
Relocation costs of employees 2 CFR § 200.464 Allowable with restrictions
Rental costs of real property and equipment 2 CFR § 200.465 Allowable with restrictions
Scholarships and student aid costs 2 CFR § 200.466 Not specifically addressed
Selling and marketing costs 2 CFR § 200.467 Unallowable with exceptions
Specialized service facilities 2 CFR § 200.468 Allowable with restrictions
Student activity costs 2 CFR § 200.469 Unallowable unless specifically provided for
in the federal award
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Taxes (including Value Added Tax) 2 CFR § 200.470 Allowable with restrictions
Termination costs 2 CFR § 200.471 Allowable with restrictions
Training and education costs 2 CFR § 200.472 Allowable for employee development
Transportation costs 2 CFR § 200.473 Allowable with restrictions
Travel costs 2 CFR § 200.474 Allowable with restrictions
Trustees 2 CFR § 200.475 Not specifically addressed
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HARNETT COUNTY RIVERSIDE DRAINAGE ASSESSMENT
PROJECT ORDINANCE
BE IT ORDAINED by the Board of Commissioners of Harnett County, North Carolina, sitting as the
governing board for Harnett County.
Section 1. The Riverside Community of Harnett County, located in the southeastern portion of the
County, has experienced long-term drainage issues. The citizens of the community have
requested assistance in identifying and remediating flooding and drainage in the low-
lying areas. The Soil & Water Conservation District staff have conducted site visits to
assess the drainage needs and organized community meetings to hear the concerns of the
citizens. The staff of the District, along with a third party, conducted a watershed
analysis to further assist in identifying drainage improvements in the Riverside
community. The Harnett County Board of Commissioners on July 18, 2022 voted to
approve the Harnett County Riverside Drainage Assessment Project Ordinance. This
project ordinance will allow the county to continue the implementation of the assessment
and remediation of the drainage issues.
Section 2. The officers of this unit are hereby directed to proceed with the capital project and the
budget contained herein.
Section 3. The following amounts are hereby appropriated for this project:
Professional $ 50,000
Construction 500,000
Contingency 200,000
Total $ 750,000
Section 4. The following revenues are anticipated to be available to complete this project:
Interfund Transfer – Displaced ARPA $ 750,000
Section 5. The Finance Officer is hereby directed to maintain within the Capital Project Fund
sufficient specific detailed accounting records to satisfy the requirements of the grantor
agency, the grant agreements, and federal regulations.
Section 6. Funds may be advanced from the General Fund for the purpose of making payments as
due.
Section 7. Copies of this capital project ordinance shall be furnished to the Clerk to the Governing
Board, and to the Budget Officer and the Finance Officer for direction in carrying out this
project.
Duly adopted this ___ day of _________, 2022. _________________________________
Lewis W. Weatherspoon, Chairman
Harnett County Board of Commissioners
ATTEST:________________________________
Melissa Capps, Clerk to the Board
Harnett County Board of Commissioners
Item 9
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