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DocuSign Envelope ID:8BB7B367-E293-48C0-8E6E-6C2D2ACBDD69 <br /> E (6A 59 <br /> Scope of Services—FY 2015-16 <br /> Outside Agency Performance Agreement <br /> Agency Name: Orange Congregations In Mission <br /> Program Dame: Samaritan Relief Ministry <br /> Funding Award: $33,415 <br /> Outline how the agency will spend Orange County's funding award. <br /> Expense Description Amount <br /> Wages for program manager $5,000 <br /> Rent&Utility assistance for clients $8,500 <br /> Pantry food purchases 19,915 <br /> Program Services <br /> For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the <br /> contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes <br /> below,by June 30,2016. <br /> • Emergency financial assistance for households facing eviction and utility shut-off <br /> • A week of groceries, seven times a year for individuals and families facing hunger <br /> Anticipated Outcomes <br /> The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange <br /> County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants <br /> within that measure's description or for an earlier performance measure. <br /> Performance Measures Anticipated <br /> Results <br /> Qualified households receiving financial assistance for rent and utilities 130 <br /> Number of individuals receiving groceries 11,500 <br /> DocuSigned by: <br /> BE62EC6D675A483... <br /> Certified by Title: Date: <br /> (Prnvirlvr'c Ci(rnatim-) <br />