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A TRUE COPY Page I of I CERTIFICATION ON LAST PAGE J.R. SMITH, CLERK Indian River County Recreation Insurance. Indian River County Recreation further acknowledges that by participating in the following programs, participants shall not be considered USA Swimming members and shall not be covered by USA Swimming insurance. Program Promotion,Delivery&Scheduling The program will be a Indian River County Recreation program and will utilize the Indian River County Recreation learn-to-swim curriculum. In addition, Indian River County Recreation will provide training, risk management counseling, and ongoing supervision of the Indian River County Recreation aquatic staff. The program will be conducted as part of the Indian River County Recreation lesson program with the equivalent of no less than four(4)hours in-water Instruction for each participant; this equates to eight(8) half-hour swimming lessons. Disbursement and Use of Funds The USA Swimming Foundation has agreed to pay Indian River County Recreation$3000 to fund this program. Funds will be disbursed to Local Partner in one payment of$3000 upon receipt of this signed letter of agreement,a completedW-9/tax status form by USA Swimming, and verification of USA Swimming Foundation Make a Splash mark and link placement on the Indian River County Recreation website. The grant is unconditional. However, reporting requirements provide data that is critical to the success of the program. Reporting Requirements Indian River County Recreation agrees to provide enrollment reports to the USA Swimming Foundation. The report shall include a detailed accounting of all activities and expenditures. These reports shall follow the schedule below: I Ot Enrollment Report: Deadline: June 1, 2017 2nd Enrollment Report: Deadline: September 1, 2017 3rd Enrollment Report: Deadline: January 1, 2018 Each report should provide the following financial and program information for the most recent quarter: Financial Report A standard financial report outlining all expenditures related to the grant monies for the period. Learn-to-Swim Participant Data 1. Total number of participants enrolled in the lessons program for the quarter. 2. Number of participants served by the grant monies from the USA Swimming Foundation. 3. Number of participants served by grant monies from the Local Partner program or local funders. 4. Breakout of the ages of the participants according to the following age groups:Ages 6-8, Ages 9-11, Ages 12 &Older. 5. Breakout of the ethnicity of the participants according to the following options: African American,Asian,Caucasian,Hispanic,American Indian&Alaska Native,Native Hawaiian &Other Pacific Islander, and Other. 6. Breakout of the participants by gender. 7. A listing of the number of participants reaching each of five (generic 1-5) achievement https://app.hellosign.com/attachment/view?snapshot_guid=6co057ec94ae46d55d26f8666c3 I I f6a3a74b7e8&p... 5/3/2017