The URL can be used to link to this page

Home My WebLink AboutFY24 JCPC ADMIN PROGRAM AGREEMENTDocuSign Envelope ID: 48EC6CE0-AB30-4BDF-932E-73CE99FF30BA North Carolina Department of Public Safe Juvenile Justice and Delinquency Prevention JCPC Program Agreement Revision SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION FUNDING PERIOD: FY 22-23 DPS/JCPC FUNDING # (cont only) 965-11455 COUNTY: New Hanover AREA: Eastern Area NAME OF PROGRAM: JCPC Administration SPONSORING AGENCY: New Hanover County Name: Jay Corpening Title: Mailing Address: 138 N. 4th Street City: Wilmington Zip: 28401 Phone: (910) 772-6612 Fax: E-mail: julius.h.corpening@nccourts.org Program Manager Name & Address (same person on signature page) THE REASONS FOR THIS BUDGET REVISION ARE AS FOLLOWS: ❑ INCREASE IN DPS/JCPC REVENUES ❑ DECREASE IN DPS/JCPC REVENUES ❑ INCREASE IN OTHER REVENUES ❑ DECREASE IN OTHER REVENUES ❑ CAPITAL EXPENDITURE ADJUSTMENT ❑ CONTRACTED SERVICE ADJUSTMENT ❑ LAPSED SALARY ADJUSTMENT ❑Q LINE ITEM ADJUSTMENT ❑ CHANGE IN COMPONENT (attach revised Component Narrative) COMMENTS: Line item adjustment to purchase office supplies LINE ITEMS IN THE CURRENT DPS/JCPC APPROVED BUDGET ARE BEING ADJUSTED AS FOLLOWS: Item # Increase Decrease Explanation 220 $331 Adjustment to reflect actual cost of food for JCPC meetings 260 $398 Adjustment to purchase office supplies 370 $67 Adjustment to reflect actual cost to advertise RFP Total $398 $398 Difference $0 Form JCPC/PR 001 JCPC Program Agreement Revision Form structure last revised 12/12/2012 Department of Public Safety DocuSign Envelope ID: 48EC6CE0-AB30-4BDF-932E-73CE99FF30BA BUDGET NARRATIVE JCPC Administration Fiscal Year FY 22-23 Item # Justification Expense In Kind Expense 190 Clerical support for the JCPC ($20 per hour) $6,000 220 Food for JCPC meetings $2,869 260 General Office Supplies paper, note books, etc. $598 370 Advertising costs to advertise RFP $433 TOTAL $9,900 $0 Annual Expense Annual In Kind Job Title Wages Wages TOTAL Form JCPC/PR 001 JCPC Program Agreement Revision Form structure last revised 12/12/2012 Department of Public Safety DocuSign Envelope ID: 48EC6CE0-AB30-4BDF-932E-73CE99FF30BA Budget Information Page Program: JCPC Administration Fiscal Year: FY 22-23 Number of Months: 12 Cash In Kind Total I. Personnel Services $6,000 $6,000 120 Salaries & Wages $0 180 Fringe Benefits $0 190 Professional Services* $6,000 $6,000 *Contracts MUST be attached II. Supplies & Materials $3,467 $3,467 210 Household & Cleaning $0 220 Food & Provisions $2,869 $2,869 230 Education & Medical $0 240 Construction & Repair $0 250 Vehicle Supplies & Materials $0 260 Office Supplies and Materials $598 $598 280 Heating & Utility Supplies $0 290 Other Supplies and Materials $0 III. Current Obligations & Services $433 $433 310 Travel & Transportation $0 320 Communications $0 330 Utilities $0 340 Printing & Binding $0 350 Repairs & Maintenance $0 370 Advertising $433 $433 380 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 $9,900 $9,900 Form JCPC/PR 001 JCPC Program Agreement Revision Form structure last revised 12/12/2012 Department of Public Safety DocuSign Envelope ID: 48EC6CE0-AB30-4BDF-932E-73CE99FF30BA SOURCES OF PROGRAM REVENUE (ALL SOURCES) CURRENT BUDGET REVENUE NEW BUDGET REVENUE $9,900 DPS/JCPC Funds $9,900 DPS/JCPC Funds County Cash Local Cash 1 Local Cash 2 $0 Local In -Kind Local In -Kind 1 Local In -Kind 2 Local In -Kind 3 Local In -Kind 4 Local In -Kind 5 Other 1 Other 2 Other 3 Other 4 $9,900 TOTAL $0 Required Local Match Source of County Cash Source of Local Cash 1 Source of Local Cash 2 Source of Local In -Kind Source of Local In -Kind 1 Source of Local In -Kind 2 Source of Local In -Kind 3 Source of Local In -Kind 4 Source of Local In -Kind 5 Source of Other 1 Source of Other 2 Source of Other 3 Source of Other 4 DIFFERENCE $0 0% $0 Local Match Rate Local Match Provided County Cash Source of County Cash Local Cash 1 Source of Local Cash 1 Local Cash 2 Source of Local Cash 2 $0 Local In -Kind Source of Local In -Kind Local In -Kind 1 Source of Local In -Kind 1 Local In -Kind 2 Source of Local In -Kind 2 Local In -Kind 3 Source of Local In -Kind 3 Local In -Kind 4 Source of Local In -Kind 4 Local In -Kind 5 Source of Local In -Kind 5 Other 1 Source of Other 1 Other 2 Source of Other 2 Other 3 Source of Other 3 Other 4 Source of Other 4 $9,900 TOTAL $0 0% $0 Required Local Match Local Match Rate Local Match Provided Form JCPC/PR 001 JCPC Program Agreement Revision Form structure last revised 12/12/2012 Department of Public Safety DocuSign Envelope ID: 48EC6CE0-AB30-4BDF-932E-73CE99FF30BA —DocuSigned by: .f 6 ��onrG�eeanoGe�o [l�� 6/19/2023 Authorizing Official, Department of Public Safety Date —DocuSigneddby: �G (,& C6n88CFC5D1A485_.. 6/15/2023 Chair, County Board of Commissioners or County Finance Director Date DocuSigned by: nn8F1sn4A2540C 6/7/2023 Chair, Juvenile Crime Prevention Council Date DDoocuSignedd by: l` ��nnnF sndn,ITUU" 6/7/2023 Program Manager Date Form JCPC/PR 001 JCPC Program Agreement Revision Form structure last revised 12/12/2012 Department of Public Safety Certificate Of Completion Envelope Id: 48EC6CEOAB304BDF932E73CE99FF30BA Subject: DPS eSignature Request for New Hanover 965-11455 JCPC Administration Source Envelope: Document Pages: 5 Signatures: 4 Certificate Pages: 5 Initials: 0 AutoNav: Enabled Envelopeld Stamping: Enabled Time Zone: (UTC -05:00) Eastern Time (US & Canada) Record Tracking Status: Original 6/7/2023 7:58:01 AM Signer Events Jay Corpening julius.h.corpening@nccourts.org Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 6/7/2023 1:54:04 PM ID:923eb78f-b992-46b0-9f6a-4b7213ec58c4 J H Corpening II julius.h.corpening@nccourts.org Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 6/7/2023 5:25:53 PM ID:31101114-2f0a-4bd7-adf5-ef70faa56a9e Eric Credle ecredle@nhcgov.com Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 6/15/2023 1:11:54 PM ID:ebaa7321-6632-4cbf-abOc-be90667568c5 Cindy Porterfield cindy.porterfield@ncdps.gov Director of Juvenile Community Programs NC Dept of Public Safety Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Holder: DPS-DJJ Community Programs djjdp.applicationsupport@ncdps.gov Signature E,.0,USi,n,1 1ylI��11%% 8E15D4A2540C Signature Adoption: Pre -selected Style Using IP Address: 204.152.2.232 ED ... Sig -d by: N (muu," N 30D8E1504A2540C... Signature Adoption: Pre -selected Style Using IP Address: 204.152.2.231 EDOCUSigned y: 'b�I' � C6B88CFC5D1A4B5... Signature Adoption: Pre -selected Style Using IP Address: 152.31.193.130 by: ED—Sign1d 798FE7A4BD9F419.. Signature Adoption: Pre -selected Style Using IP Address: 70.40.80.201 DocuSign Status: Completed Envelope Originator: DPS-DJJ Community Programs 3040 Hammond Business PI Raleigh, NC 27603 djjdp.applicationsupport@ncdps.gov IP Address: 207.4.107.7 Location: DocuSign Timestamp Sent: 6/7/2023 7:58:03 AM Viewed: 6/7/2023 1:54:04 PM Signed: 6/7/2023 1:54:12 PM Sent: 6/7/2023 1:54:14 PM Viewed: 6/7/2023 5:25:53 PM Signed: 6/7/2023 5:25:59 PM Sent: 6/7/2023 5:26:01 PM Viewed: 6/15/2023 1:11:54 PM Signed: 6/15/2023 5:16:20 PM Sent: 6/15/2023 5:16:22 PM Viewed: 6/19/2023 12:31:18 PM Signed: 6/19/2023 12:31:22 PM 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 6/7/2023 7:58:03 AM Certified Delivered Security Checked 6/19/2023 12:31:18 PM Signing Complete Security Checked 6/19/2023 12:31:22 PM Completed Security Checked 6/19/2023 12:31:22 PM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM Parties agreed to: Jay Corpening, J H Corpening II, Eric Credle 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 DocuSign, Inc. (DocuSign) electronic signing system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the a€ -I agreed€TM 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 electronically to you by us. You will have the ability to download and print documents we send 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 (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per -page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent 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 only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. 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 K -Withdraw Consentd€TM form on the signing page of a DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn 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 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; ii. send us an e-mail to david.pozun@ncdps.gov and in the body of such request you must 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.. Required hardware and software Operating Systems: WindowsA@ 2000, Windows,&@ XP, Windows VistaA@; Mac OSA@ X Browsers: Final release versions of Internet ExplorerA@ 6.0 or above (Windows only); Mozilla Firefox 2.0 or above (Windows and Mac); Safaria„¢ 3.0 or above (Mac only) PDF Reader: Acrobat,&@ or similar software may be required to view and print PDF files Screen Resolution: 800 x 600 minimum Enabled Security Settings: Allow per session cookies ** These minimum requirements are subject to change. If these requirements change, you will be asked to re -accept the disclosure. Pre-release (e.g. beta) versions of operating systems and browsers are not supported. Acknowledging your access and consent to receive materials electronically 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 a€"I agreea€TM button below. By checking the a€"I agreea€TM 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.