HomeMy WebLinkAbout2004-229U (�.
Indian River County Grant Contract () q - ZZ9tk
This Grant Contract (" Contract" ) entered into effective this 1st day of October 2004 y and between
Indian River County, a political subdivision of the State of Florida , 1840 25th Street, ero Beach FL ,
32960 (" County" ) and Substance Abuse Council of Indian River County (" Recipient') , o
Substance Abuse Council of Indian River County
2501 27 Avenue , Suite A- 107
Vero Beach , Florida 32960
Right Choice Program
Background Recitals
A. The County has determined that it is in the public interest to promote healthy children in a
healthy community .
B . The County adopted Ordinance 99- 1 on January 19 , 1999 (" Ordinance" ) and lestablished the
Children ' s Services Advisory Committee to promote healthy children in a healthy community
and to provide a unified system of planning and delivery within which childrenlIs needs can be
identified , targeted , evaluated and addressed .
C . The Children ' s Services Advisory Committee has issued a request for (proposals from
individuals and entities that will assist the Children 's Services Advisory Committee in fulfilling
its purpose.
D . The proposals submitted to the Children 's Services Advisory Com ittee and the
recommendation of the Children ' s Services Advisory Committee have beenieviewed by the
County .
E . The Recipient, by submitting a proposal to the Children ' s Services Advisory ommittee, has
applied for a grant of money (" Grant" ) for the Grant Period (as such ter is hereinafter
defined ) on the terms and conditions set forth herein .
F . The County has agreed to provide such Grant funds to the Recipient for the Grant Period (as
such term is hereinafter defined ) on the terms and conditions set forth herein .
NOW THEREFORE , in consideration of the mutual covenants and promises herein ) contained , and
other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged ,
the parties agree as follows :
1 . Background Recitals The background recitals are true and correct and form a material
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part of this Contract.
2 . Purpose of Grant The Grant shall be used only for the purposes set forth in the
complete proposal submitted by the Recipient attached hereto as Exhibit "A" and
incorporated herein by this reference (such purposes hereinafter referenced as " Grant
Purposes IT
3 . Term The Recipient acknowledges and agrees that the Grant is limited to the fiscal
year 2004/2005 ("Grant Period ") . The Grant Period commences on October 1 , 2004
and ends on September 30 , 2005 .
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4 . Grant Funds and Payment The approved Grant for the Grant Period is Sixty-Five
Thousand Dollars ($65 , 000) . The County agrees to reimburse the Recipient from
such Grant funds for actual documented costs incurred for Grant Purposes provided in
accordance with this' Contract. Reimbursement requests may be made no more
frequently than monthly . Each reimbursement request shall contain th information , at
a minimum , that is set forth in Exhibit " B" attached hereto and incorporated herein by
this reference . All reimbursement requests are subject to audit by the County . In
addition , the County may require additional documentation of expenditures , as it
deems appropriate .
5 . Additional Obligations of Recipient.
5 . 1 Records. The Recipient shall maintain adequate internal controls in order to
safeguard the Grant. In addition , the Recipient shall maintain adequate records fully
to document the use of the Grant funds for at least three ( 3) years after the expiration
of the Grant Period . The County shall have access to all books , records , and
documents as required in this Section for the purpose of inspection or audit during
normal business hours at the County' s expense, upon five (5) days prior written
notice .
5 . 2 Compliance with Laws . The Recipient shall comply at all times w th all applicable
federal , state , and local laws , rules , and regulations.
5 . 3 Quarterly Performance Reports. The Recipient shall submit QuartE rly Performance
Reports to the Human Services Department of the County within fifteen ( 15 ) business
days following : December 31 , March 31 , June 30 , and September 30 .
5 . 4 Audit Requirements . If Recipient receives $25 , 000 or more in the aggregate from
all Indian River County government funding sources , the Recipient is equired to have
an audit completed by an independent certified public accountant a the end of the
Recipient' s fiscal year. Within 120 days of the end of the Recipient' c i fiscal year, the
Recipient shall submit the audit to the Indian River County Office of N anagement and
Budget. The fiscal year will be as reported on the application for funding , and the
Recipient agrees to notify the County prior to any change in the fiscal period of
Recipient. The Recipient acknowledges that the County may deny funding to any
Recipient if an audit required by this Contract for a prior fiscal year is past due and has
not been submitted by May 1 .
5 . 4 . 1 The Recipient further acknowledges that, promptly upon eceipt of a
qualified opinion from its independent auditor, such qualified pinion shall
immediately be provided to the Indian River County Office of Management and
Budget. The qualified opinion shall thereupon be reported to t e Board of
Commissioners and funding under this Contract will cease immediately. The
foregoing termination right is in addition to any other right of the County to
terminate this Contract.
5 . 4 . 2 The Indian River County Office of Management and Budget reserves the
right at any time to send a letter to the Recipient requesting clarification if there
are any questions regarding a part of the financial statements , audit comments , or
notes .
5 . 5 Insurance Requirements . Recipient shall , no later than September 21 , 2004 ,
provide to the Indian River County Risk Management Division a certificate or
certificates issued by an insurer or insurers authorized to conduct business in Florida
that is rated not less than category A- : VII by A. M . Best, subject to a �proval by Indian
River County' s risk manager, of the following types and amounts of insurance :
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( i) Commercial General Liability Insurance in an amount not less than
$ 1 , 000 , 000 combined single limit for bodily injury and property damage,
including coverage for premises/operations, products/completed operations ,
contractual liability , and independent contractors ;
( ii ) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000
per occurrence combined single limit for bodily injury and property damage ,
including coverage for owned autos and other vehicles , hired autos and other
vehicles , non -owned autos and other vehicles ; and
( iii ) Workers' Compensation and Employer's Liability (current Florida statutory
limit)
5 . 6 Insurance Administration . The insurance certificates , evidenci g all required
insurance coverages shall be fully acceptable to County in both form and content,
and shall provide and specify that the related insurance coverag shall not be
cancelled without at least thirty ( 30) calendar days prior written notice having been
given to the County . In addition , the County may request such of er proofs and
assurances as it may reasonably require that the insurance is a d at all times
remains in full force and effect. Recipient agrees that it is theRecipient's sole
responsibility to coordinate activities among itself, the County , and the Recipient's
insurer(s) so that the insurance certificates are acceptable to and accepted by
County within the time limits set forth in this Contract. The County s all be listed as
an additional insured on all insurance coverage required by this Contract, except
Workers' Compensation insurance. The Recipient shall , upon ten ( 10) days' prior
written request from the County , deliver copies to the County , or make copies
available for the County's inspection at Recipient' s place of business of any and all
insurance policies that are required in this Contract. If the Recipient fails to deliver or
make copies of the policies available to the County ; fails to obtain replacement
insurance or have previous insurance policies reinstated or renewed upon
termination or cancellation of existing required coverages ; or fails in ally other regard
to obtain coverages sufficient to meet the terms and conditions of this Contract, then
the County may , at its sole option , terminate this Contract.
5 . 7 Indemnification . The Recipient shall indemnify and save harmless the County , its
agents , officials , and employees from and against any and all claims , liabilities ,
losses , damage , or causes of action which may arise from any misconduct, negligent
act, or omissions of the Recipient, its agents, officers, or employees in connection
with the performance of this Contract.
5 . 8 Public Records. The Recipient agrees to comply with the provisions of Chapter
119 , Florida Statutes ( Public Records Law) in connection with this Conract.
6 . Termination . This Contract may be terminated by either party, without cause , upon
thirty (30 ) days prior written notice to the other party . In addition , the County may
terminate this Contract for convenience upon ten ( 10) days prior writte notice to the
Recipient if the County determines that such termination is in the public interest.
7 . Availability of Funds . The obligations of the County under this Contact are subject
to the availability of funds lawfully appropriated for its purpose by :i the Board of
County Commissioners of Indian River County.
8 . Standard Terms . This Contract is subject to the standard terms alta hed hereto as
Exhibit C and incorporated herein in its entirety by this reference.
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IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date
first above written .
INDIAN RIVER COUNTY BOARD OF CO NTY COMMISSIONERS
By :
Arthur R . Net br-, a i an
BCC Approved :
`a
r
Attest.;. arton , Clerk
By .
Deputy Cie* 77V
r I
Approved : C1r'
Jos h A. Baird
County Administrator
Ap d as to orm and legal s iciency:
Marian E . Fell , Assistant (: ount rney
RECIPIENT:
By: / - 2 - G
Substance Abus Council of Indian River County
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EXHIBIT A
[Copy of complete proposal/application ]
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Right Choice Program Substance Abuse Council of Indian River County Children Services Adv sory Committee
PROGRAM COVER PAGE
Organization Name : Substance Abuse Council of Indian River County
Executive Director: Colette Heid E-mail : sacircabellsouth . net
Address : 250127 Avenue, Suite A- 7 Telephone : 772 - 770- 4811
Vero Beach, Florida 32960 Fax : 772 - 770- 4822
Program Director: Colette Heid E-mail :
Address : Telephone :
Fax :
Program Title : Right Choice Program
Priority Need Area Addressed: Mental Wellness Issues / Substance Abuse Coun elfin
LX-650. 800 (Accordike to the Taxonomy of Human Services Pro ram that provide individual group, or family therapv
or individuals who abuse substances of any kind and or for their families to help them better understand t/:e nature o
their Physical and or Psycholoeical dependency or impairment and to support their efforts to recover.
Brief Description of the Program : The Right Choice program is a comprehensive 26 week education
and counseling program that is targeted at reducing and preventing substance use/abusc among IRC yQUth .
This program is designed to chane adolescent and parental perceptions of risk vs . benefits of ATOD use
Parental use or varental attitudes towards use of ATOD also correlates with adolescent attitudes . B
impacting these factors a reduction in drug use/abuse promotes increased mental healtl of the individual .
SUMMARY REPORT — Enter Information In The Black Cells Only)
Amount Requested from Funder for 2004 / 05 : $ 70 , 000 . 00
Total Proposed Program Budget for 2004 / 05 : $ 70 , 000 . 00
Percent of Total Program Budget : 100 . 0 %
Current Program Funding ( 2003 / 04 ) : $ 60 , 000
Dollar increase / ( decrease ) in request : $ 105000
Percent increase / ( decrease ) in request * * : 16 . 7 %
Unduplicated Number of Children to be served Individually : -
Unduplicated Number of Adults to be served Individually :
Unduplicated Number to be served via Group settings : 200
Total Program Cost per Client : 350 . 00
* * If request increased 5 % or more, briefly explain why :
If these funds are being used to match another source, name the source and the $ amount :
The Organization 's Board of Directors has approved this application on (dat . 5/1 /04
r
Chief Huph Cox
Name of President/Chair of the Board Signa
Colette Heid, MS Ed. , CAPP '
Name of Executive Director/CEO Signature
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Right Choice Program Substance Abuse Council of Indian River County Children Services Advisory Committee
PROPOSAL NARRATIVE
A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one pq gre)
1 . Provide the mission statement and vision of your organization.
The Substance Abuse Council is committed to preventing the use of illicit drugs abuse of addictive,
mind altering substances.
It is the Council 's vision to increase community awareness concerning the levels qf drug use in Indian
River County; empower the community with the belief that the level of substance a ud drug use/abuse is
directly related to the level of community interaction with prevention activitie ; and to enlist the
community 's participation in prevention related activities Unless the community' s emphasis is
directed to substance and drug prevention educational programs, we can expect negative social and
economic impacts associated with substance and drug uselabuse to continue.
2. Provide a brief summary of your organization including areas of expertise, accomplishments,
and population served.
The Substance Abuse Council is dedicated to prevention education. It was founded in 1989 and was
incorporated as a not-for-profit agency in 1990 . Services are provided for I residents of IRC
regardless of age or race. The Council is the only agency focusing specifically on substance abuse
prevention education. The Council is licensed by the Department of Children and Families to provide
substance abuse information/referral, and universal, selective and indicated prevention services. The
Council has administered the Federal Bryne Block Grant for Indian River County since 1990 . The
Council has kept abreast of the County' s constantly changing and emerging drug use problem and
carries out its goals through a variety of programs.
The following are a list of programs provided by the Council.
• Community Education and Information and Referral
• Drug-Free Workplace Education
• PRIDE Survey Administration & Planning
• Lending Library of videos, books & materials
• Deep Impact- PREVENT Improv Troupe
• Teen STEP After-School Program
• Right Choice Program
• Life Skills Training Program
• Tobacco Violators Education Classes
• HIV TARGET Program
• TIP ' S Truancy Program
• Dasie Hope Center
• Adult Court Ordered Community Service Coordination
• Program AWARE
• Drug Screening for Youth and Adults
• Drug-Free Events, ie : Say Boo to Drugs, Red Ribbon, Brown Ribbon, Kick
Butts Day
• Administration of the Federal Byrne Anti-Drug Abuse Grant for Indian River
County
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Right Choice Program Substance Abuse Council of Indian River County Children Services A Ivisory Committee
B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one pyge
1 . a) What is the unacceptable condition requiring change? b) Who has the need9 c) Where do
they live? d) Provide local, state, or national trend data, with reference source, that
corroborates that this is an area of need.
Indian River County has a continuing need for a program that addresses drug and cohol offense
committed by it ' s youth. Some of these youth are charged with misdemeanor drig or alcohol related
charges. For others, their use is uncovered by a parent, without contact with law enforcement . This
program was designed to reduce drug and alcohol use by youth by increasing pr tective factors thus
reducing incidences of substance abuse and re-occurring juvenile offenses .
Juvenile delinquency cases received in Indian River County within the five year period from
FY96-97 to FY01 -02 decreased from 1 , 080 to 967 cases . But during the same time FY96-97
to
FY01 -02 the number of Indian River County youth charged with misdemeanor drug and alcohol
charges has increased by 55 % from 92 cases 142 cases. (These stats are based upon statistical data collected
and reported in the 2001 -02 Florida Profile of Delinquency Cases and Youths Referred Report by the Bureau of Data &
Research, DJJ).
The FYSA Survey provides scientifically sound information on the prevalence of ATOD use, risk and
protective factors. Risk and protective factors are characteristics of the community, school, family,
individual and peer characteristics that are known to predict alcohol and other drug use, delinquency,
and gang involvement. Besides measuring risk and protective factors, the FYS S also assesses the
current prevalence of these problem behaviors in the community. The FYSAS (20 )2), an indicates that
Indian River youth continue to exceeded the Florida State rate of youth reported alcohol use in their
lifetimes. A survey question relating to binge drinking, defined as consumption o five or more drinks
in one sitting within the past two weeks indicated that IRC, 22. 0% of surveyed stu nits reported binge
drinking, with corresponding rates of 11. 9% among middle school stridents 29. 3% among high
school students This represents higher rates of middle and high school binged I 'ng compared to the
state as a whole (8. 6%for middle school and 22. 3%for high school).
We can illustrate a similar story with data available for tobacco, marijuana, prescription and designer
drugs. The prevalence rates for all drug use in Indian RC have historically been elevated above the
state and national rates.
In addition the FYSA Survey (2002), IRC scored higher than the State and other lik a Counties in the
following risk factors areas_
• Poor Family Discipline • Early Initiation of Drug Use
• Youth Attitude Favorable to ATOD use • Parental Attitude Favorable to
Antisocial Behavior
• Family History of Antisocial Behavior • Current ATOD use aff ong youth
• Perceived Risks of Drug Use • Friends Use of Drugs
• Parental Attitude Favorable to ATOD use
2. a) Identify similar programs that are currently serving the needs of your targeted population
b) Explain how these existing programs are under-serving the targeted population of your
program.
New Horizons provides Student Support Specialist in the middle schools. DATA also provides services
to youth. Both these agencies work with a very small indicated population of students and can not serve
the entire indicated population of youth. These youth would receive no additional program services if
the Right Choice Program was not available. The Right Choice program provides no duplication of
services.
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Right Choice Program Substance Abuse Council of Indian River County Children Services A& risory Committee
C. PROGRAM DESCRIPTION (Entire Section C, 1 — b, not to exceed twopages)
List Priority Needs area addressed. Mental Wellness Issues
1 . Briefly describe program activities including location of services.
The Right Choice program is designed to engage and involve at-risk youth and their parents so they
may gain the needed skills to resist the negative temptations associated with drugs and alcohol. The
primary objectives are to help youth to abstain from negative peer pressures through prevention
information and build resiliency skills.
The overall goal is to decrease the impact and propensity for involvement in substance use and juvenile
crime. We propose to deter a multitude of high-risk behaviors by providing a sthictured and positive
environment, enhanced with information and positive alternative choices.
In an effort to identify the elements of a strength-based approach to healthy development, the Search
Institute developed the framework of developmental assets. This framework i lentifies 40 critical
factors for young people ' s growth and development. These risk and protective ft ctors offer a set of
benchmarks for positive child and adolescent development. The Right Choice prc gram is designed to
reduce the level of drug and alcohol use by youth and also address the issue con ming re-occurring
drug and alcohol offenses. This will be accomplished by :
1 . The juvenile will report to the Substance Abuse Council ' s office for program registration for the
Right Choice program. During this intake, all pertinent information will becollected; a psycho-
social assessment with a licensed mental health counselor will be scheduled, the youth will also be
informed of their responsibilities for completion of the educational component, where to register for
community service and the sanctions that will be imposed if any component o the program is not
completed.
2 . Registrants will be required to attend the 26-week educational component. The ucational program
utilizes the Adolescent Recovery Plan by Hanley-Hazelden and consist of a four ph ise plan :
• Accepting Responsibility • Getting the Stir
• Getting Honest • Out of My Min
• The Cost of Drugs • Successful Relationships
• The Disease of Addiction • The Miracle of Forgiveness
• Deciding to Make Change • Preventing Relapse
• Upward Pathways • Bridging the Gailf of Relapse
• Learning to Trust Again • My Plan against Relapse
• I' m Not Perfect, So What? • Getting Real About How I Feel
• Making Important Changes
3 . Parents will be asked to attend the 5-week Parent to Parent educational component of the program.
This will consist of:
• Getting Started : How to Prevent Drug Abuse in Your Family
• Setting Guidelines : Developing Healthy Beliefs and Clear Standards
• Avoiding Trouble: How to Say No to Drugs
• Managing Conflict : How to Control and Express Anger
Involving Everyone: How to Strengthen Family Bonds
On the FYSA Survey (2002), Indian River County scored higher than the State and other like Counties
in the following risk factors areas:
• Poor Family Discipline • Early Initiation of Drug Use
• Youth Attitude Favorable to ATOD use • Parental Attitude Favorable to Antisocial
Behavior
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Right Choice Program Substance Abuse Council of Indian River County Children Services A 'sory Committee
• Family History of Antisocial Behavior • Current ATOD use among youth
• Perceived Risks of Drug Use • Friends Use of Drugs
• Parental Attitude Favorable to ATOD use
2. Briefly describe how your program addresses the stated need/problem. Describe how your
program follows a recognized "best practice" (see definition on page 12 of i he Instructions)
and provide evidence that indicates proposed strategies are effective with t irget population.
According to Center for Substance Abuse prevention (CSAP), Selected Findings In Prevention, A
Decade of Results from the Center For Substance Abuse Prevention , 1997, the f ndings indicate that
the proposed strategies above are effective with target population. They demonstrated repeated
documentation that adolescent risk perceptions were favorably impacted by reducing favorable
parental, peer and community attitudes towards ATOD.
3. List staffing needed for your program, including required experience and estimated hours
per week in program for each staff member and/or volunteers (This sectiom should conform
with the information in the Position Listing on the Budget Narrative Workq heet).
The Right Choice program is currently staffed by two Council employees and one Licensed Mental
Health Counselor. The Prevention Program Coordinator assumes primary responsibility for the Right
Choice program. Fifty percent (50%) of this position is currently allocated to the program. Presently
the need exist to increase the position' s time allocation to approximately 75% to accommodate staff the
program. An Information Specialist is also assigned to this program and currently dedicates 33 % of
her time to the program. A Program Specialist additionally is needed with 15% of the positions time
allocated to Right Choice. The Prevention Program Coordinator has had six (6) y of experience in
the substance abuse prevention field with extensive background in administratio . The Information
Specialist has an extensive background in program coordination and evaluation. Tie Licensed Mental
Health Counselor holds a Masters Degree in Mental Health and is licensed by the State of Florida as a
Clinical Certified Forensics Counselor with a specialty in criminal offender counseling and youthful
offender counseling
4. How will the target population be made aware of the program?
The Right Choice program awareness was designed with the target population in mind . Many different
marketing campaigns are utilized to make the community at large aware the servic are available. The
program is open to all residents of Indian River County.
The Council promotes the use of the Right Choice program via it' s newsletters and brochures. Law
enforcement, school personnel, probation officers, student support specialist have all been briefed on
the Right Choice program. The Council also recommends the Right Choice program to parents. .
Juveniles can be referred to the Right Choice program. Each juvenile referred to the program must
complete the 10-week education program in order to achieve successful completion . Juveniles may be
referred to the program as follows :
1 ) Any Juvenile Justice Intake Counselor or Case Manager may include a recommendation to the State
Attorney' s Office for the Right Choice program as part of a disposition report on a juvenile arrested
for a first time misdemeanor offense of
• Misdemeanor non-marijuana drug • Possession of alcohol
• Marijuana misdemeanor • Other Alcohol Offenses
The jurisdiction of the court may sentence a juvenile to the Right Choice program, any law
enforcement agency, an school personnel or any parent.
5. How will the program be accessible to target population (i.e., location, transportation, hours
of operation)?
The Council attempts to be very accommodating in service offering times / hours fat the community.
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Right Choice Program Substance Abuse Council of Indian River County Children Services Advisory Committee
The Right Choice Program services occur Monday through Thursday . Group sessions begin either at
4 : 30 p . m. or 6 : 30 p. m. to accommodate work and travel schedules. The Council office is located in
Vero Beach and iso en from 8 a. m. to 5 p . m. Monday through Friday.
D. MEASURABLE OUTCOMES (Description of Intent)
Use the Measurable Outcomesform. This ' n Effe does not need to be included hr the prggesaL.
In order to show the impact that your program is having on the target population and the
community, the funders are requiring measurable outcomes. Please review the examples and
summaries below to insure your understanding of what is expected .
OUTCOMES : Describes what you want to achieve with the target population. Indicates the
results of the services you provide, not the services you provide. Outcomes utilize action words
such as maintain, increase, decrease, reduce, improve, raise and lower.
ACTIVITIES : Describes the tasks that will be accomplished in the program to achieve the
results stated in the outcomes. Activities utilize action words such as complete, establish, create,
provide, operate, and develop. The activities should reflect the services described in the
PROGRAM DESCRIPTION (C2).
Use the following elements to develop your outcomes All elements must be inclu d.
• Direction of change • Timeframe
• Area of change • As measured by
• Target population • Baseline: The number thayou will be
• Degree of chane measuring against
Example I (Outcome) .
To decrease (direction of change) number of unexcused absences (area of change) of enrolled
boys and girls (target population) by 75% (degree of change) in one year (time fr e) as
reported by the 2003 School Board attendance records (as measured by). Baseline : 2003 School
Board attendance records for enrolled boys and girls.
Example I (Activity).
To provide anger management classes to enrolled boys and girls 2 times a week fbi 12 weeks .
Example 2 (Outcome) :
75% (degree of change) of youth (target population) who have participated in the cademic
enrichment activities (as measured by) for 6 months or more (time frame), will improve
(direction of change) their scores in one or more subject area (area of change) . 25 % of
participants in academic enrichment activities will maintain the initial level of performance
assessed at entry. Baseline : Pre-test scores from the academic enrichment test.
Example 2 (Activity):
1 ) Provide pre and post-test exercises on the Advanced Learning System software; )
Participants will go through the one lesson per week and be graded for 10 weeks.
IWORTANT NOTE,
Keep in mind when developing your PROGRAM OUTCOMES, that if funded, this will be what
you are held accountable to accomplish. Also, the PROGRAM OUTCOMES should reflect the
information described in the PROGRAM NEED STATEMENT (B 1 ) .
All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes
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Right Choice Program Substance Abuse Council of Indian River County Children Services Advisory Committee
should be based on and measure program needs. Activities are the tasks you do that are going to
influence the outcome and impact the unacceptable condition in your Program Need Statement .
D. MEASURABLE OUTCOMES (Entire Section D not to exceed two page
OUTCOMES ACTIVIMS
Add all of the elements for the Measurable Outcomes) Add the tasks to accomplish the utcome(s)
1 . To decrease the number of positive drug la. To provide Right Choice psycho-education
screens among enrolled Right Choice group and individual sessions to outh.
participants by 75% over a 26 weeks as We will provide a total of twenty six (26)
reported by random drug screen. weekly 1 th hour ongoing educal ion sessions on
Baseline: Initial drug screening results prior to admission various substance abuse and resiliency skills
to Right Choice program. building topics. Session are based upon
Adolescent Recovery Plan Progre an by
Hazelton which focuses upon in easing
protective factors and decreasing risk factors.
b. Conduct weekly random sampling of
program participants following fur weeks in
program.
2. To increase audience knowledge of program 2. To provide factual, current and up-to-date
participants by 25% following educational information via on-going sessiow concerning
presentation forums concerning drugs and their drugs and their harmful effects.
harmful effects as reported by self-disclosure on pre/ post testing will be condt cted and rated
pre-testing. to indicate a change in knowledge.
(Baseline: Individual and group administered Pre-tests of
forum participants.)
3 . To reduce self-reported high-risk behaviors 3 . To provide factual, current andpAo-date
responses reported by audience participants by information via on-going session concerning
20% following educational presentation forums. high-risk behaviors and resulting iarniful
(Baseline: Individual and group administered KABP effects.
[Knowledge, attitude, belief and practice] of forum Pre/post evaluations of the YJd3Ps to
participants.) indicate a change in participation in high-
risk behaviors.
4 . To decrease the past 30 day use of 4 . To provide factual, current andup-to-date
marijuana of Right Choice program information concerning drugs and their harmful
participants by 50% as reported by self- effects.
reported ATOD use surveys. (Baseline: Pre/ testing and 30 day use s e will be
Individual and group administered Pre-tests of conducted and rated to indicat a change in
program participants.) ATOD use.
■ Provide factual, current and u -to-date
information concerning high-r i sk behaviors
and resulting harmful effects.
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Right Choice Program Substance Abuse Council of Indian River County Children Services A dvisory Committee
OUTCOMES ACTIVITIES
Add all of the glententsforyour Measurable Outcome(s) Add the tasks to accomplish the Outcome(s)
5 . Reduce the re-offend rate for program 5 . To create a system of substance abuse
completers to 10% for six (6) months screening , assessment and inte vention for
following the completion of the Right Choice youth involved in the Right Chc ice Program.
program. Baseline: Offender rate prior to Heighten the youth' s awarer ess to:
admittance into the Right Choice program ➢ The realities of drug use
➢ Victim awareness education
➢ Legal consequences of dug and
alcohol uselpossession
Build external & internal prot 've factors of.
➢ Empowerment
➢ Boundaries & Expectatic ns
➢ Positive values
➢ Social competency
➢ Positive Identity
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Right Choice Program Substance Abuse Council of Indian River County Children Services A "sory Committee
E. COLLABORATION (Entire Section E not to exceed one page)
1 . List your program ' s collaborative partners and the resources that they are providing to
the program beyond referrals and support. (See individual funder requirements for
inclusion of collaborative agreement letters.
Collaborative Agency Resources provi&d to the am
Juvenile Court Referrals to program
Department of Juvenile Justice Referrals to program
Case management of Client Progress
Venue for presentation
Indian River School District Referrals to program
Mental Health Association Case management of Client Progress
Children' s Home Society Referrals to program
Case management of Client Progress
Vero Beach School Resource Venue for Presentations, volunteers as guest
Officers speakers and instructors for program service
Sebastian Police Resource Officers delivery
IRC Clerk of Court Referral of clients
IRC Sheriff' s Office Program collaboration and support
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Right Choice Program Substance Abuse Council of Indian River County Children Services Advisory Committee
F. PROGRAM EVALUATION (Entire Section F not to exceed two pages)
1 . DEMOGRAPHICS : What information (data elements) will you need to co ect in order to
accurately describe your target population including demographics (age, ender, and ethnic
background) required by the funder in Section H? What are the pieces of nformation that
qualify them for your target population ? How do you document their neec for services or their
"unacceptable condition requiring change" from Section Bl ?
As a licensed substance abuse provider in the State of Florida, the Council is requited to utilize the State
of Florida, Department of Children and Families, MASA (Mental Health-Substance Abuse) Data
Warehouse Database. Complete, detailed, but confidential information is complied an all clients who
request services of the Council . The demographic information required includes bu is not limited to :
• Name • Living accommodations • Family composition
• Address • Type of services provided • Frequency of Use
• Type of services • Gender and ethnic • Length of Stay
needed background
• Age • Duration of services • SS #
• Drug of Abuse • Age of onset
In addition non-client specific data is also maintained. Time, duration, number of participants, location
of service delivery and date are maintained. Client and non-client specific data are maintained in a
confidential, password protected database.
Additionally the Council maintains statistics on the Right Choice Program. Clients may access
confidential Information and Referral services by the telephone, or in person. This dditional information
helps the Council to track new trends of use or abuse, types of drugs being used, types of services needed
and provides information on the type of educational development and continuing education needed for
both staff and community.
The Council is also a part of the State of Florida, Florida Youth Initiative Evaluation program. The
University of Miami conducts random, unannouncedd evaluation of both program process and content .
Establishing performance targets for strategy goals and objectives is a very important part of prevention
program implementation process. Ultimately they will also randomly sample our prelpost test and
conduct evaluations on their rate of change and validity.
2. MEASURES : What data elements will you need to collect to show that you have achieved (or
made progress toward) your Measurable Outcomes in Section D? What to Is or items are you
using as measures (grades, survey scores, attendance, absences, skill levels) for your program?
Are you getting baseline information from a source on your Collaboration List in Section E?
Are there results from your Activities in Section D that need to be docume ted ? How often do
you need to collect or follow-up on this data?
The collection of data elements will be collected as described in section F . 1 .
Client demographic information is requested of clients upon the client intake. Each client is provided a
client questionnaire.
The Right Choice Program utilizes several short term indicators to measure the impact on
achievement of this program' s goals . The evaluation tools used are as follows :
• Pre and Post testing - Pre test are performed to measure the audience' s basal knowledge prior
to the presentation. Following the presentation, post tests are conducted.
12
Right Choice Program Substance Abuse Council of Indian River County Children Services Advisory Committee
It is possible to measure the increase in knowledge directly related tote educational
presentation. Changes in attitudes, beliefs and practices take longer to manife t in the target
population. It is for this reason that a KABP was designed .
KABP - (Knowledge, Attitude, Beliefs and Practice) is administered prior to and again following
presentations. This tool may be administered several times to the target population . This evaluation tool
indicates if an impact has manifested itself into daily life, but no change in attitudes beliefs or practices
can be expected without the prevention education.
3. REPORTING: What will you do with this information to show that chang has occurred? How
will you use or present these results to the consumer, the funder, the program, and the
community? How will you use this information to improve your program?
Data is complied via computer database programs. Each staff member is responsible for the collection of
his or her confidential program data. Data and statistics are shared, as the law allows, with the
appropriate concerned parties
13
f
Right Choice Program Substance Abuse Council of Indian River County Children Services Advisory Committee
G. TIMETABLE (Section G not to exceed one page)
1 . List the major action steps, activities, or cycles of events that will occur within the
program year. New programs should include any start-up planning that may occur
outside the funding year. In completing the timetable, review information detailed in
prior sections.
Month/Period Activities
October 2004- June Coordinate the Right Choice Program Schedule
2005
Coordinate delivery and implementation of the program
Coordinate the collection of program statistical data for evaluation.
Post testing on cohorts following program completion.
Ongoing Instructor training and technical assistance.
December 2004 Compilation and evaluation of data for the 1 ' quarterly report
March 2005 Compilation and evaluation of data for the 2n" quarterly report
June 2005 Compilation and evaluation of data for the 3 `d quarterly r port
September 2005 Compilation and evaluation of data for the 4h quarterly and annual
report
October 2004- June Ongoing collaboration with all collaborating agency on program
2005 progress, obstacles and any other program responsibilities as they arise.
Address any additional program responsibilities
14
• 1 • - • • •J 1 I " . 1 1 1 1 I • 11 v � 11 • 1 1 y
Number ' 1 1 ' I • 1 by Location
1 r, 1 W, it 1 1, or, rmmmugit I 11 1 1 it 1 1.
• . 1 _ • -_ 11 11
u ' • 1 11 -. 11
wi "0 } 11 11
1 1 1 I 1 1 • —■
Pott Samt Lucie
St. Lucie
1
' OtherLocations e� �■�s
NumberI i 1 W, i Chents by Age_ __
Fjal� 1 .6..�
u r r c Y
Budget I ' ' I S '-",,.1.<-.•�5--y. ti --3 p r .� t (e
FIT ROA WIMIRM 17416
MI
Total Children
Total Adults
Edit ris Header. Type the organization i program name and the fimderfor • being completed. r ' page r - rrr • r
• page.
right
16 BUDGET FORMS 1 open t Budget 1 II please 1 1 1 o.i theicon below.
if
Budget
Substance Abuse Council Right Choice Children Serfices Advisory Committee
UNIFORM GRANT APPLICATION
BUDGET NARRATIVE WORKSHEET
IMPORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for
your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Progra m Budget and Funder
Specific Budget Forms.
AGENCY/PROGRAM NAME : Substance Abuse Council of IRC
FUNDER : Children Services Advisory Committee Right Choice Program
CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in lace. Gray areas should
;
! be used for calculations and to write information only.
CRAY ANE" FOR ,�
REVENUES AGENCY USE OWT Proposed Total Program Funder S ` Ic Totar Agency
(SHOW DETAL &
g
CALCUL TION4
Budget Budget Budget
L7 -- I
1 Children's Services CouncllSt. Lucie 0.00 0.00 0.00
2 Children's Services Council-Martin 0.00 0.00 0.00
3 Advisory Committee-Indian River 70.000.00 709000.00 211 ,500.00
4 United Way-St Lucie County 0.00 0.00 0.00
5 United Way-Martin County 0.00 0.00 0.00
6 United Way-indian River County 0.00 0.00 42 ,000.00
7 Department of Children & Families 0.00 0.00 75,000.00
8 County Funds 0.00 0.00 1 ,850.00
9 Contributions-Cash 0.00 O.OD 55,000.00
10 program Fees 0.00 0.00 40,000.00
11 Fund Raising Events-Net 0.00 0.00 400000.00
12 Sales to Public - Net 0.00 0.00 8,000.00
13 Membership Dues 0.00 0.00 6, 500.00
14 Inveshnent Income 0.00 0.00 800.00
15 Miscellaneous 0.00 0.00 0.00
16 Legacies & Bequests 0.00 0.00 0 .00
17 Funds from Other Sources 0.00 0.001 320,200.00
18 Reserve Funds Used for Operating 0.00 0.00 0.00
19 In-Kind Donations (Not included in total) 0.00 0.00 0.00
20 TOTAL REVENUES
(doesn't include line 19 $70,000.00 $70t000.00 800,850.00
A B G D
EXPENDITURESQMY WA8F Proposed Total.Program Funder Sped is Tata/ Agency
"NOMI -eau.M Budget Budget Bud et
21 Salaries - (must complete chart on next page) 39, 141 .00 3 )J41 .00 362,378.00
Salary
22 FICA - Total salaries x 0.0765 7.65%s 2,994.29 2 ,994.29 27,721 .92
23 Retirement - Annual pension for qualified staff 1 ,076.00 11076.00 5.773.20
24 Lite/Health - MedicadDentatlShort4errn Disab. 4,500.00 4, 500.00 36,000.00
25 Workers Compensation - # employees x rate 483.00 483.001 49674,68
Florida unemployment - # projected
26 employees x $7,000 x UCTS rate 0.00 0.00 0.00
A
POSITION N LISTING Gross Annual Portion of Salary on Proposed C % of Gross
Annual
Posftion Tile / Tota/ Hrs/wk (9�y) Program Funder Specific dget Salary Requested(GA)
snssnooa e-t
17
Substance Abuse Council Right choice Children Serfices Advisory Committee
Example: ExecutiveD1rector14Ohrs 70, 000.00 101000. 00 51000.00 7, 1400
Executive Director 40 hrs/ wk 55,000.00 0.00 0.00 0. 00%
Prevention Program Coordinator-40 hrs I wk 40,800.00 29,625.00 291625.00 72 .61 %
Community Health Educator -35 hrs /wk/$14.50 26,390.00 0.00 0.00 0.00%
PREVENT Program Coordinator-40 hrs / wk 287500.00 0.00 0.00 0.00,6
Peer Educator- 12 hrs /wk / $9 59616.00 0.00 0.0of 0.00%
Lifeskills Educator (1 ) - 33 hrs / wk/$13.75 23,595.00 0.00 0.00 0.00%
Lifeskills Educator (2) -25 hrs ! wk/$13.25 17,225.00 0.00 0.00 0.00%
Diversion Specialist -40 hrs / wk 28,000.00 0.00 0.00 0.00%
Diversion AssWant 26 hrs/wk /$12 15,600.00 0.00 0.00 0 .00°
HIV Program Coordinator-40 hrs / wk 287500.00 0.00 0.00 0.00%
HIV Program Assistant -40 hrs / wk 25,500.00 0.00 0.001 0.00%
Information Specialist- 30 hrs / wk/ $11 .50 17,940.00 6,240.00 69240.00 34.78%
HIV Peer Educator- 20hrs / wk/ $10 10,400.00 0.00 0.00 0.00%
Case Manager - 24 hrs / wk $14.00 17,472.00 0.00 0.00 0.00%
Program Specialiat 30 hrs / wk $14.00 21 ,840.00 3,276.00 31276.00 15.00%
0.00 0.00 #DIV/01
0.00 0.001 #DIV/0!
#DIV/0!
#DIV/0!
#DIV/01
Remaining positions throughout the agency
TotalSalwfetis $362 $ 78.00 $399141 .00 $39J41 .00 10.80%
FRINGE BENEFITS DETAIL A
(Funder Specific Budget Funder B D F G
Specific FICA 7.65% Pension Worker's Un loyme Total Fringes Funder
Column C only, from line 22 to 27 Health Ins.
lT Budget (A x 1.J Compens. nt pens. speclac
Posfiwn Tide / Tota{ H/s/wk
Example: Case Manager/40 hrs 5, 000.00 382.50 260.00 5wool 300. 00 200. 00 1,582. 50
Executive Director -40 hrs/ wk 0.00 0.00 0.00 0.00 0.00 0.00 0.
Prevention Program Coordinator-40 hrs / wk 29,625.00 2,266.31 888.75 21700.00 382. 16 OAO 6,237.2
Community Health Educator -35 hrs /wk/$ 14. 50 0.00 0.00 0.00 0.00 0.00 0.00 0.
PREVENT Program Coordinator-40 hrs / wk 0.00 0.00 0.00 0.00 0.00 0.00 0.
Peer Educator- 12 hrs /wk / $9 0.00 0.00 0.00 0.00 0.00 0.001 0.
Lifeskills Educator ( 1 ) - 33 hrs / wk/$ 13.75 0.00 0.00 0.00 0.001 0.00 0.00 0.
Lileskills Educator (2) -25 hrs / wk/$ 13.25 0.00 0.00 0.00 0.00 0.00 0.00 0.
Diversion Specialist -40 hrs / wk 0.00 0.00 0.00 0.00 0.00 0.00 0.
Diversion Assistant 25 hrslwk /$12 0.00 0.00 0.00 0.00 0.00 0.00 0.
HIV Program Coordinator-40 hrs / wk 0.00 0.00 0.00 0.00 0.00 0.00 0.
HIV Program Assistant -40 hrs / wk 0.00 0.00 0.00 0.00 0.00 1 0.00 0.
Information Specialist- 30 hrs / wk/ $ 11 .50 6.240.00 477.36 187.20 1 ,800.00 i06.50 0.00 2 , 545.
HIV Peer Educator- 20hrs / wk/ $ 10 0.00 0.00 0.00 0.00 0.00 0.00 0.
Case Manager - 24 hrs / wk $ 14.00 0.00 0.00 0.00 0.00 0.00 0.00 0.
Program Specialiat 30 hrs / wk $ 14.00 3,276.00 250.61 0.00 540.00 20.31 0.00 810. 9
0 0.00 0.00 0.00 0.00 0.00 0.001 0.
0 0.00 0.00 0.00 0.001 0.00 0.00 0.
0 0.00 0.00 0.00 0.001 0.00 0.00 0.
0 0.00 0.00 0.00 0.00 0.00 0.
0 0.001 0.001 0.00 0. 0.00 0.
TotelFundelRequest FdngeBwefiits $39, 141 .DOI $2,994.291 $1 ,075.95 $5,040.00 $482.971 $0.00 $9,593. 21
A B C D
EXPENDITURES OtAY MWAt OR Proposed Total Program Funder Spec' c Total Agency
AGEMY USE O LY TO
i�+owMAL Budget Budget Budget
27 Travel-Dally 750.00 750.00 249000.00
# of Staff x average # of miles/wk x 50 wks x $ x .29=$1 ,015
= Estimated Daily Travel/Mileage Reimb. SWAT 310 rales a month
5/25/2004 B4 ,V
Substance Abuse Council Right Chace Children Sei vices Advisory Committee
28 TraveUConferenceslTraining 500.00 5W001 28 , 000 . 00
• National Conference (cost per staff)• FADDA registration $250 Hotel
Training/Seminar (cost per staff) $150 per night x 3 nights = $450
• Other Trainings (cost of travel, lodging, $21 Per diem per day x 3 days = $63
registration, fes) 250 miles x .29 = $72.50
29 UffiFe Supplies 1 ,042.00 11042.00 24 , 000.00
Office supplies (monthly average x 12 months
r
= estimated cost of office supplies based on $50 x months for UW =
Other Program $500 a month x 12
pint history. months = $6000 0.00
30 Telephone 600.00 600.00 12 , 319.95
• # Phone fines x average cost per month x 12
months = local phone cost
12 months= $2688
Average long distance calls x 12 months = Pager $12 x 12moMhs x 3 employees
Estimated cost of long distance maims=114r ges $12o per month x
0.00
31 Postage/Shipping 250.00 250.001 5,000 .00
• Quarterly Mailing of Newsletter Bulk Mat $ 200 per month x 12
• Special events, etc. months= 2400
• Bulk mailings - appeals Bulk mal permit $300 0.00
32 Utilities 1 ,000.00 11000.00 6.000.00
• Electricity ($ x 12 months)
• Water/Sewer ($ x 12 months) Utilities $333
per tenth x 12 months+
• Garbage ($ x 12 months)
$4000 0.00
33 Occupancy (Building & Grounds) 23400.00 2,400.00 25,000.00
• Mortgage/Rent ($ x 12 months)
• Janitorial ($ x 12 months) Rent $1919 a month x 12 months
• Grounds MaiM_ ($ x 12 months) LST 300 x 12 RC 200 x12 $930 not
• Real Estate Taxes paid by grants 0.00
34 Printing & Publications 1 ,238.00 1238.00 47,500.00
• Quarterly Newsletter ($ x 4) Newsletters $300 x 4=1200
Letterheads, Envelopes, etc. Letterhead,etc $1200
Fundraising materials PRIDE Survey $9000
Other Other $30,000 0.00
35 SubscriptionlDues[Memberships
0.00 0.00 1 ,000.00
• Membership to National Organb*ion FADDA $250 CADCA
• Dues $250
• Subscriptions to Newspapers/magazines, etc. Subscriptions $500 0.00
36 nsurance 0.00 0.00 129000.00
• Directors/Officers Liab.
• Commercial/General Insurance Acro $7821
• Bond Ins. Commercial Liability $1750
• Auto Insurance Employee Bond $500
0.00
37 Equipment:11ental & Maintenance 750.00 750.001 8.000.00
• Copier lease x 12 months)
• Meter lease ($ x 12 months) Copier Main $150 x 12= 1800 DASIE
• Copier Maintenance ($ x 12 months) $50 x1200 Computer Main $
• Computer Maintenance ( $ x 12 months) 100 x 12 =1200 Other (Vehicle)
• Other $200 per month x 12 months--2400
0.00
38 Advertising 0.00 0.001 15, 317 .00
• Newspaper ads
Ads $250 x 10=2500
• Fundraising ads/promotions other $500
• Other (vacancies) Promotions $2000 Billboards $4000 0.00
39 Equipment PurchasessiCapital Fx'pWs'e 0.00 0.00 12 ,000.00
• Computer/monitor (# x )
• Laser Printer 2 computer systems wl monitors $1500 0.00
40 Professional Fees (Legal, Cons ng 0.00 0.00 3,000.00
• Legal advice ( estimated #his x $)
• Consultant fees
• Ott" Consulting Fees $2,000 0.00
41 ks/Educational Materials 0.00 0.00 51 .000 .00
5/25/2004 B-1 'q
1
Substance Abuse Council Right Choice Children Se rvices Advisory Committee
BooksMdeos Videos $200 each x 10
Materials ($ X staff) Eucational materials $ 42602 0.
4
42 Food & Nutrition 0.00 0.001 4. 195.00
Meals ( # meals x clients x 5days x 50 wks)
. Smacks Youth snacks $30 a week x 52 weeks 0.
43 Administrative Costs 0.00 0.001 0.00
Admin. Cost (% of total )44 0
Audit Expense 0.00 0.001 99000.00
•
Independent Audit Review 9j000.00
45 Specific Assistance to lndWuals 0 1 ,000.00
. Medi assistance
• Meals/Food
Rent Assistance
• Other 0.001
46 Other/Miscellaneous 0.00 0.00 11 .471 .00
• Background check/drug test � Screens 338 x Si: t90
• Other Dng Screen M $5 100 per month x 0.00
47 Other/Contract 13,276.00 139276.00 640500.00
• for program services session per week x 50 weeks--$4,500 0.00
48 TOTAL EXPENSES 703000.29 0,000.29 800,850.00
($0.29) 1 1
51250004 13-1 2LV
• TY ft Qrwv on wd Rw m Nertre
UNIFORM GRANT APPLICATION
TOTAL AGENCY BUDGET
AGENCYIPROGRAMNAME: i C h hick
FY 02/03 FY 03104 FY 04105 X INCREASE
FYELSept 30 FYE�Sept 30 FYE Sept 30 CURRENT VS,
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED czs. Byca a
REVENUES BUDGETED BUDGETED
1 Children's Services CouncdSt Lucie 0.00 0.00 0.00 #DIV/0!
2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/0!
3 Advisory Committee-Indian River 105 000.00 145 000.00 211 ,500.00 45.86%
4 United Way-St Lucie County 0.00 0.00 0.00 #DIV/0!
5 United Way-Martin County 0.00 0.00 0.00 #DIV/O!
s United Wa -indian River County 71 500.00 78 000.00 42 000.00 1 -46.15%
7 Department of Children & Families 75 000.00 75 000.00 75 000.00 0.00%
8 County Funds 1 r850.00 185000 1850.00 0.00%
9 Contributions-Cash 10 934.00 7500000 55 000.00 -26.67%
10 Program Fees 541461 .00 40 000.00 40 000.00 0.00%
11 Fund Raising Events-Net 55 02.00 259000.00 40 000.00 60.00%
12 Sales to PubficeNet 0.00 81000.00 89000.00 0.00%
13 Membership Dues 4,960,00 67500.00 6,500.00 1 0.00%
14 Investment Income 0.00 0.00 800.00 #DIV/0!
15 Miscellaneous 0.00 0.00 0.00 #DIV/01
t6 Legacies 8 Bequests 0.00 0.00 0.00 #DIV/O!
17 Funds from Other Sources 289 678.00 334 279.00 320 200.00 -4.21 %
is Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/0!
19 In-Kind Donations pio kwkK%d in rota► 0.00 0.00 0.00 #DIV/01
20 TOTAL 760 585.00 788 629.00 800 850.00 1 .55%
EXPENDITURES
21 Salaries 382 877.00 408,434.00 3627378.00 41 .28%
22 FICA 29y290,00 31 W245.00 27 721 .92 -11 .28%
23 Retirement 51526,00 TA68.00 5v773.20 -22.69%
24 LifeMealth 25 200.00 25 .00 3600000 42.867
25 Workers Compensation 49500.00 49860,00 49674.68 -3.81 %
2s Florida Unempluoyment 0.00 51000.001 0.00 400.00%
27 TraveWally 12,054.00 21 380.00 24 000.00 12.25%
29 TraveUConferences/Trainin 34039.00 24 566.00 28 000.00 13.98%
29 Office Suliplies 2 32.00 660000 24 000.00 263.64%
30 Telephone 13,345.00 13 500.00 12 319.95 -8.74%
31 Postage/Shipping Postage/Shipping39302,00 49220.00 59000.00 18.48%
32 Utilities 3,415.00 400000 6000.00 50.00%
33 Occupancy Build' & Grounds 23A66,00 23 028.00 25,000.00 8.56%
34 Printing S Publications 13 899.00 41 ,400.00 47 500.00 14.73%
35 Subscri tiorWues/Membershi s 170.00 1 ,000.00 11000.00 0.00%
36 Insurance 99583.00 10,071 .00 12 000.00 19.15%
37 EquipmentRental & Maintenance 0.00 61000.00 8r000.00 33.33%
38 Advertising 0.00 1 779.00 15 317.00 19.86%
39 Equipment Purchases:Ca ' I Expense 37461 .00 31000.00 12 000.00 300.00%
40 Professional Fees (Legal, Consulting) 79842.00 000.00 31000.00 50.00%
41 Books/Educational Materials 677099.00 50 968.00 511000.00'
0.06%
42 Food & Nutrition 0.00 1 r560.00 4195.00 168.91 %
43 Administrative Costs 0.00 0.00 0.00 #DIV10!
44 Audit Expense 0.00 79000.00 91000.00 28.57%
45 Specific Assistance to Individuals 97732.00 59000,00 19000.00 -80.00%
4s Other/Miscellaneous 11 320.00 6 350.00 11 471 .00 80.65%
47 Other/Contract 61 010.00 62,000.00 64 500.OD 4.03%
48 TOTAL 741 352.00 788 629.00 800 850.74 1 .55%
49 REVENUES OVE UNDER EXPENDITURES 18 233 .00 0.00 .0.74 #DIV/01
Type me Orem Am " Program Nana
UNIFORM GRANT APPLICATION
TOTAL PROGRAM BUDGET
AGENCYIPROGRAM NAME: waa«
FY 0=3 FY 03104 FY 04105 INCREASE
FYE Sept 30 FYE.Sept 30 FYE Sept 30 CURRENT VS.
N FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED L C-ca Bycel. B
REVENUES BUDGETED BUDGETED
t Children's Services Council-St Lucie 0.00 0.00 0.00 A#DIVIOI
2 Children's Services CouncilWartin 0.00 0.00 0.00 #DIVIO!
3 AdvisoryCommittee-Indian River 0.00 60 000.00 7000000
4 United Wa St Lucie County45 000.00 0.00 0.00 5 United Wa -Martin Cour 0.00 0.00 0.00 6
United Wa -Indian River Coun 0.00 0.00 0.00
7 Department of Children & Families 0.00 0.00 0.00 #DIV/0!
8 County Funds 0.00 0.00 0.00 #DIVIO!
9 ContributionsCash 0.00 0.00 0.00 #DIVIO!
to Program Fees 0.00 0.00 0.00 #DIVIO!
71 Fund Raising Events-Met 0.00 0.00 0.00 #DN/0 !
12 Sales to Public-Net 0.00 0.00 0.00 #DIVIO!
13 Membership Dues 0.00 0.00 0.00 #DIV/0!
14 Investment Income 0.00 0.00 0.00 #DIVIO!
15 Miscellaneous 0.00 0.00 0.00 #DIVIO!
1s Legacies & Bequests 0.00 0.00 0.00 #DIVIO!
17 Funds from Other Sources 0.00 0.00 0.00 #DIVIO!
18 Reserve Funds Used for Operating 0.00 0.00 0.00 #DN/01
191n-IQndDonations prarwitwedi. wto 0.00 0.00 0.00 #DIV/01
20 TOTAL 45 000.00 60 000.00 7000000 16.67%
EXPENDITURES
21 Salaries 24,095.00 249730.00 39141 .00 58.27%
22 FICA 118".00 1j"2,00 21994.29 58.26%
23 Retirement 637.00 742.00 1 076.00 45.01 %
24 Life/Health 21998,00 21988.00 41500.00 50.60%
25 Workers Compensation 287.00 294.00 483.00 64.29%
26 Florida Unemployment 0.00 0.00 0.00 #DIVIO!
27 Travel4:)aily 522.00 870.00 750.00 -13.79%
28 TravelfConferences/Traini 1 ,637,00 2634.00 500.00 -81 .02%
29 Office Supplies 600.00 600.00 1042.00 73.67%
30 TeklAukne 0.00 500.00 600.00 20.00%
31 PostagelShIpping Postage/Shipping300.00 500.00 250.00 50.00%
32 Utilities 0.00 0.00 17000.00 #DN/0!
33 Occupancy Builth & Grounds 0.00 0.00 2400.00 #DIVIO!
34 Printing & Publications 800.00 1 .00 19238 .00 -11 .57%
35 Subs ' tionlDues/Membershi 0.00 250.00 0.00 -100.00%
36Insurance 0.00 11000.00 0.00 400.00%
37 EquipmentRental & Maintenance 0.00 600.00 750.00 1 25.00%
38 Advertising 0.00 0.00 0.00F-26.240%
39 Equipment Purchases:Ca ' se 0.00 0.00 0.00
40 Professional Fees 1 Consulting) 0.00 0.00 0 .00
4/ Books/Educational Materials 500.00 17500.00 0.00 %
42 Food & Nutrition 0.00 0.00 0.00
43 Administrative Costs 0.00 0.00 0.00
44 Audit Expense 800.00 19500.00 0.00 %
45 S ific Assistance to Individuals 0.00 0.00 0.00
46 Other/Miscellaneous 0.00 0.00 0.00
47 Other/Contract 99990,00 18 000.00 13 276.00 %
48 TOTAL 45 000.00 60 000.00 70 000.29 16.67%
49 REVENUES OVER/(UNDER EXPENDITURES 0.00 -0 .29 IV/0!
Type " Orgarxzation am Program Name
UNIFORM GRANT APPLICATION
FUNDER SPECIFIC BUDGET
PROGRAM EXPENSES
AGENCY/PROGRAM NAME : Right Choice
FUNDER : A B C
FY 04105 FY 04105 % OF
TOTAL FUNDER TOTAL VS.
PROGRAM SPECIFIC FUNDER REQUEST
BUDGET BUDGET col. B/col. Aj
EXPENDITURES
21 Salaries 399141 .00 399141 .00 100 .00%
22 FICA 21994. 29 29994.29 100 . 00%
23 Retirement 1 ,076.00 19076.00 100 .00%
24 Life/Health 49500.00 49500a00 100 .00%
25 Workers Compensation 483 .00 483.00 100 .00%
26 Florida Unemployment 0 .00 0.00 #DIV/01
27 TraveWaily 750 .00 750.00 100 .00°/x,
28 Travel/Conferences/Training 500 .00 500.00 100.00%
29 Office Supplies 1 ,042.00 1104100 100.00%
3o Telephone 600.00 600 .00 100 .00%
31 Postage/Shipping 250.00 250.00 100.00%
32 Utilities 11000 .00 17000.00 100.00%
33 Occupancy (Building & Grounds 29400 .00 27400 ,00 100000%
34 Printing & Publications 17238 .00 19238.00 100.00%
35 Subscription/Dues/Memberships 0 .00 0.00 #DIV/01
36 Insurance 0.00 0 .00 #DIV/0 !
37 E ui ment:Rental & Maintenance 750.00 750 .00 100 .00%
3s Advertising 0 .00 0.00 #DN/0!
39 Equipment Purchases: Ca ital Expense 0 .00 0.00 #DIV/0 !
4o Professional Fees ( Legal, Consulting) 0 .00 0 .00 #DIV/0 !
41 Books/Educational Materials 0 .00 0 .00 #DIV/01
42 Food & Nutrition 0 .00 0 .00 #DIV/0 !
43 Administrative Costs 0.00 0 .00 #DIV/0 !
44 Audit Expense 0 .00 0.00 #DIV/0 !
45 Specific Assistance to Individuals 0.00 0 .00 #DIV/01
46 Other/Miscellaneous 0.00 0 .00 #DIV/0!
47 Other/Contract 139276 .00 13,276.00 100 .00%
48 TOTAL $ 709000 .29 $ 709000 .29 1 100 .00%
D1srjilCt D ERECTOR
r? S S . BOX Z4108Cr1 #+ TI , ON 40Z0t
Exaloyer Edent . ficatian Numoe :
Date : � I - 14806 ; .
_
OLIN :
17053042 '_ 75008
ST PETERS HUMM SUVICZ3 Contact Person :
INCORPORATE ? D . A _ DOWNING
C/ O REV ANDREW JEFFZRSON Contact Telephone Number :
4250 38TH AVE i ( 513 ) 241 - 5199
• GIFFORD , FL 32967
Accounting Period End inq
Auqus t 31
Form 790 Required :
Yes
Addendum Applies :
Yes
Dear Applicant .
Based an information supplied , and assuminq your operations wi 1 be as
stated in your application for recognition of exemption , re have de ermined
you are ex " pt from federal income tax under section 501 ( a ) of the nternal
Revenue Code as an organization described in section 50t ( c ) ( Z ) .
We have further determined that you are not a private foundation within
the meaninq of section 509 ( a ) of the Code , because you are an Organ zation
described in sections 509 ( a ) ( 1 ) and 1700 ) ( I ) ( A ) ( ii ) .
If your sources of support , or your purposes , charactar , or method of
operation change , please Let us know so we can consider the effect f the
change an your exempt status and foundation status . In the case of an amend -
ment to your organizational document or bylaws , please send us. A. cm ; ' Y of the
amended document or bylaws . Also , you should inform us of all clan es in your
name or address .
As of January 1 , 1984 , you are Liable far taxes under the Federal
Insurance Contributions Act ( social security taxes ) on - remuneration of st00
or more you pay to each of your employees durinq a calendar year. ou are
not liable for the tax imposed under the Federal Unemployment Tax Ad , ( FUTA ) .
Since you are not a private foundation , you are not subject to the excise
taxes under Chapter 42 of the Code . However , if you are involved in an excess
benefit transaction , that transaction might be subject to the excise taxes of
section 4918 . Additionally , you are not automatically exempt from Other
federal excise taxes . If you have any questions about excise , employment , or
other federal taxes , pLease contact your key district Office .
Grantors and contributors may rely an this deteraination unless the
Internal Revenue Service publishes notice to the contrary . Haw<ver it you
lose your section 509 ( a ) ( 1 ) status , a grantor a contributor m.ay no rely
On this determination if he or sine was in part responsible for , or was, aware
of , the act or failure to act , or, the substantial ar .itzrial clang an the
: -
part of the organ i sa tion that resulted in your Ions of such Status , he ar
or cmc that
she - acquired knowledge that the Internal Revenue Service had given ati
Letter 947 ( DO / C5 )
4
• cy ScRV �
. 'ST PEfERS HUMAN IC
YOU would no longer be classified as a section 509 ( a ) ( 1 ) organization - ^ • ;��
Donors may deduct contributions to you as provided in secticn 17 of the
Cade _ Bequests , legacies , devises , transfers , or gifts to you or for your use t
are deductible for federal estate and gift tax purposes if they meet the
Applicable provisions of Code sections 2055 , 2106 , and
Ccntriouticn deducticns are allowable to donors only to the exte t that
their contributions are gifts , with no consideration reCi! ived . Ticket pur -
chases and similar payments in Conjunction with fundraisinq events mar not
necessarily qualify as deductible contributions , depending on the cir ta - i
stan crs _ See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , I j
an page 104 , which sets forth guidelines regarding the deductibility , As Chari - �,
table contributions , of payments Made by taxpayers for admission to or other i
participation in fundraising activities for charity , ;
In the heading of this letter we have indicated whether you must file Fora
9901 Return of Organisation cxespt From Income Taz . If Yes is indicated , you
ire required to file Form 990 only if your gross receipts each year are
normally More than $25 , 000 . However , if you receive a Fora 990 packer a in the
Mail , please file the return even if you do not exceed the gross receipts test .
I " you are not required to file , simply attach the label provided , check the
box in the heading to indicate that your annual grass receipts are no sally
S2e , 000 or less , and sign the return .
If a return is required , it - oust be filed by the 15th day cf the fifth
month after the end of your annual accoun ting period . A penalty of s 0 a day
is charged when a return is filed late , unless there is reasonable ca se for
the delay . However , the Maximum penalty charged cannot exceed $ 10 , 00 or
5 percent of your gross receipts for the year , whichever is less . Foo
Organizations with gross receipts exceeding $ 1 , 000 , 000 in any year , tie penalty
is $ 100 per day per return , unless there is reasonable cause fcr the lelale
The maximum penalty for an organization with gross receipts exce-edinq
11 , 000 , 000 shall not exceed $ 50 , 000 . This penalty may also be charqel if a
- return is not complete , so be sure your return is Complete before you file it .
You are required to make your annual return available for public
inspection for three years after the return is due . You are also required
to make available a copy of your exemption application , any supporting
documents , and this exemption letter . Failure to make these document
available for public inspection & Ay subject you to a penalty of . $ 20 r day
for each day there is a failure to comply ( up to a maximum of $ 101000 in the
case of an annual return ) .
You are not required to file federal income tax returns unless you are
subject to the tax on unrelated business income under section 511 of the Cade .
If you are subject to this tax , you must file an income tax return on Form
990 - T , cxe. pt Organization Business Income Tax Return _ In this letter we are
not determining wnether any a -• your present or proposed activities arLa unre-
lated trade or business as defined in section 513 of the Code .
Le : ter 9 / ( DO / CG )
( 07 / OD ) Lb6 � a1 : a �
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• � a1jal s ? y1 ; o buTpray a42 ul ur. oys air jagsnu auogdala2
pur a ru 3soyR uoslad ay2 Zarl uoa asrald ' suozZsanb .Cur anry no .( 3I
- spicoaj juaursjad ' srno .( uT jT' daa-M pTnoys no .0 ' snlrjs uotjrpuno .; pur snZrjs
Zdsaza Jro . 0 jnogr suo ? jsanb .Cur anTosaa dTay pinc :) lajjal szgj asnraag
• 1aZ4al o jird Tr *Jbalui ur st snpuappr pasoTaua a44 ` saTTddr
• npua pr ur Zr4j aa1jal s ? qj ? o but pray a42 ut pajr:) tput anry am, ; I
( - qp � abrd ` Z - 9SbI ' fi ' 7 ` b0 � - 95
buiTnb an ag ) - aat_ njaS anuanaa Irulajul- aqj Xq Zsanbaj uodn pajrTZurjsgns
aq ura Trnptntpul c2 apr■ suctZngji4stp TTr pur .Cur jrg2 as ` = X o2 spunk
,� o slouop Jo saa15ns2 ' slaat � ro ` saa'gsas of ( .Cur 3 ? ) dtysuoTZrlai ` uai DaTas ; o
lauury ' spy mr so sasodlnd ` sassaAppr ` sasru bulmoys 46 " aq pinogs s4uatd : :) aj
aqj bu ? parbaa sa ? 1a4sty asra ` slrnpj ^ ipul al apru air suoTZngjw ; s '. p ; l
- juatd ? oaj aq„ .( q sasodlnd asogZ job pasn aq IT ? a A' ag2 4rg4 pur sasodlnd
pa 'jTnbai aqj cl paZra . pap u ? rsaa ITtpt spun4. ayj 1ry2 aauaptna aq pinogs
aiayj ' ( r ) ( ) IOS uo ? , pas japun Zdsaza jou sT ua : % rzTurblo ; uaidiaadj aqj aiayw
sass uI - ( ) ( o ) Ip ; uoT ; cas japun Zdsaza air ,CaU2 iayjayw ..oqs pinogs spiccaj
1noX ' suoTjr . Turblo iay10 of spunk ajngjijstp no .( 1I •• sasodlnd asog2 mot Xluo
pap " Cza a r SPUT4 ;r41 Moys a2 spicoai da " pTnogs no .( ' uotldsaza panutjuao
unox a nssr of OaDCD a41 10 uoi : oas UT palsTl sasodlnd auj c2
pa1r �. ? pa air spun } jno .0 jrtyl a :) uaptna uo pasrq st uo : lrvtiialap s ? y .L
• aoznlas anuanab
Truaalul a4a Q ; lPk oouapuodsaijco TTr u : pur aT . T noX suinlau IT ? uo -Jagsnu
jr4j asn asr Id - 1t to paslnpr aq Ili " noX pur no .( a1 paubissr aq Illm iagamu
r ' UaT1ro Toor JnoX uo paJalua lou 5 r lagsnu UO T1 r :) Iuapi � a �( oldsa ur � I
- soa / cissa
OU anry nog( ; l uat%a ,j. agwnu uoTjr :) i' " uapl -JaXolosa ur paau no ,t
S = ; TA2� 3S NvunH SE313d lS
EXHIBIT B
[ From policy adopted by Indian River County Board Of County Commissioners on February 19 ,
2002 ]
" D . Nonprofit Agency Responsibilities After Award of Funding
Indian River County provides funding to all nonprofit agencies on a reimbursement basis
only.
All reimbursable expenses must be documented by an invoice and/or a copy of the canceled
check. Any expense not documented properly to the satisfaction of the Office of Management &
Budget and/or the County Administrator may not be reimbursed .
If an agency repeatedly fails to provide adequate documentation , this may be reported to the
Board of Commissioners . In the event an agency provides inadequate docu entation on a
consistent basis , funding may be discontinued immediately. Additionally, this may adversely
affect future funding requests .
Expenditures may only be reimbursed from the fiscal year for which funding wa3 awarded . For
example , no expenditures prior to October 1st may be reimbursed with funds frorn the following
year. Additionally, if any funds are unexpended at the end of a fiscal year, thes B funds are not
carried over to the next year unless expressly authorized by the Board of Commissioners .
All requests for reimbursement at fiscal year end (September 30th) must be submitted on a timely
basis . Each year, the Office of Management & Budget will send a letter to all nonprofit agencies
advising of the deadline for reimbursement requests for the fiscal year. This deadline is typically early
to mid October, since the Finance Department does not process checks for the prior fiscal year
beyond that point.
Each reimbursement request must include a summary of expenses by type . These summaries
should be broken down into salaries , benefits , supplies , contractual services , etc . If Indian River
County is reimbursing an agency for only a portion of an expense (e. g . salary of anemployee) , then
the method for this portion should be disclosed on the summary. The Office of Management &
Budget has summary forms available .
Indian River County will not reimburse certain types of expenditures . These expenditure types are
listed below.
a . Travel expenses for travel outside the County including but not limited to ; mileage reimbursement,
hotel rooms , meals , meal allowances , per Diem , and tolls . Mileage reimbursement for local travel
(within Indian River County) is allowable .
b . Sick or Vacation payments for employees . Since agencies may have various sick and vacation
pay policies , these must be provided from other sources .
c. Any expenses not associated with the provision of the program for which the County has awarded
funding .
d . Any expense not outlined in the agency' s funding application .
The County reserves the right to decline reimbursement for any expense as deemed nE cessary. "
- 1 -
EXHIBIT C
STANDARD TERMS FOR GRANT CONTRACT
1 . Notices : Any notice , request, demand , consent, approval or other communication required or
permitted by this Contract shall be given or made in writing , by any of the following methods :
facsimile transmission ; hand delivery to the other party; delivery by commercial overnight courier
service; or mailed by registered or certified mail ( postage prepaid ) , return receipt requested at the
addresses of the parties shown below:
County: Joyce Johnston-Carlson , Director
Indian River County Human Services
1840 25th Street
Vero Beach , Florida 32960-3365
Recipient: Substance Abuse Council of Indian River County
2501 27 Avenue , Suite A- 107
Vero Beach , Florida 32960
Colette Heid , Executive Director
2 . Venue : Choice of Law: The validity , interpretation , construction , and effect of this Contract shall
be in accordance with and governed by the laws of the State of Florida , only . Tie location for
settlement of any and all claims, controversies, or disputes , arising out of or relatinc to any part of
this Contract, or any breach hereof, as well as any litigation between the parties , shall be Indian
River County , Florida for claims brought in state court, and the Southern District of Florida for
those claims justifiable in federal court.
3 . Entirety of Agreement: This Contract incorporates and includes all prior and con emporaneous
negotiations , correspondence , conversations, agreements , and understandings applicable to the
matters contained herein and the parties agree that there are no commitments , agreements , or
understandings concerning the subject matter of this Contract that are not con ained herein .
Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior
representations or agreements, whether oral or written . It is further agreed that no modification ,
amendment or alteration in the terms and conditions contained herein shall be effective unless
contained in a written document signed by both parties .
4 . Severability: In the event any provision of this Contract is determined to be unenforceable or
invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract,
and every other term and provision of this Contract shall be deemed valid and enforceable to the
extent permitted by law. To that extent, this Contract is deemed severable .
5 . Captions and Interpretations : Captions in this Contract are included for convenience only and are
not to be considered in any construction or interpretation of this Contract or any of is provisions.
Unless the context indicates otherwise , words importing the singular number include the plural
number, and vice versa . Words of any gender include the correlative words of the other genders ,
unless the sense indicates otherwise .
6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes
under this Contract. The Recipient is not an agent or employee of the County , and any and all
persons engaged in any of the services or activities funded in whole or in part performed pursuant
to this Contract shall at all times and in all places be subject to the Recipient' s sole direction ,
supervision , and control .
7 . Assignment. This Contract may not be assigned by the Recipient without the prior written consent
of the County.
- 1 -
Late : ll. / 1H / 04 Time : 10 : 18 .1M TO : 9 .18 - 1198 Page : 001 - 002
QR CERTIFICATE OF LIABILITY INSURANCE OATE (MWI)D,'Y (Y1)
11/08/2004
PRODUCEF. ( 772 ) 231 - 2828 - FAXY ( 772 ) 231 - 4413 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Felten & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
2911 Cardinal Drive ( 32963 ) HOLDER. THIS CERTIFICATE DOES N016 AMEND, EXTEND OR
P . O . Box 3488 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Vero Beach , FL 32964 - 3488 INSURERS AFFORDING COVERAGE NAIC #
INSURED Su stance Abuse Council of Indian River i"ounty INsuFE '� A Colony Insurance
2501 27th Ave Ste A- 7 NSLIFPI 51 Progressive Express -� 10193
Vero Beach , FL 32960 INSLr=E; c. Commerce & Industry Insurance
' INSLIF•E 'a 0:
INSUFEE:
BArjo
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TriE INSURED NAMED ABOVE FOR THE POLICY PERIOD N DICATED. NOTWITHSTANDIN
ANY REQUIREMENT, TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT VVJITH RESPECT TO WHICH THIS CEFri F CATEMAY BE ISSUED OR
MY PERTAIN , THE INSURANCE AFFORDED E: Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSION43 AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHO'AN MAY 1AVE BEEN REDUCED BY PAID CLAIMS .
INSR ADDI TYPE CFINSURANCE POLICY NUMBER POLICYEFFECTIV-c POUCYEXPIRATICN LIMITS
GENERAL LIABILITY MP714134 04/01/2004 04/01/2005 OcaJ v $ 1 000 00
)( (Y?VMERO)AL GENE:FAL LIABIL ; -Y DAMAGE TC HE
PRP �Alqcc 50 , 00
CL-AI W; NA_±E 04'CuF+ VED EXP Apiy a 4 ,er6. $ 5 , OO
A PERSr $ 1000 , 00
G= NEFbk- AGO ' ,; ATE $ 21000 , 00
GEN'LA.G3RHCA7E UvI' AFP-; =S PER: oc ,,., ,CIT ; EXCLUDE
POLICYED
CC
e
AUTOMOBLELIABILITY CA044377464 02/05/2004 02/05 /2005 a�� E; vlc. + wG LM ,
(_32_ :IdenC
ANY A .11 1 , 100C
ALL OY/v=DAU1 S
SODi _Y INd' 4GY
B X SCH -DOLED AU_0 'er p= s�n;
MREG AUTO:
BOC. _`i IN.. JRY
N[',N-p't/NEC; AUTOS (Per acr:idc' ;j
PR.�V�FgT. , nAVAi E
GARAGEUABiLITY I Al' i0ON; Y - =AA
3LKJYA
r� iNEr T AN
EA AOC , r
A::' TC, ON _Y: AG3 ti
EXCESSIUMBRELLALIABILITY-� EACH O; ,C;i. 1 RE11C . $
!JC!? iti a i:LAlh1 Mi�.[iF A W;EGATE -_- 1.4 - - - - -_•
VEDJCTOLE
REiENION $ $
WORKERS COMPENSATION AND WC3442796 01/10/2004 01/10/2005WCSTFTL - I IOTk. - �.
EMPLOYERS' UASILRY -C =M ` FP --
C RNVPRCPRET0F;/DARTN=rR1EYEC7,; TVVE E.L. EAC� AC . DEN $ 106 , 00
OTF'i'XF-MEMBER EXC L 5EGi E:L DiSEA E - EA IFL CYEc S 100 , 0O
iI Vn. ,�eacrieEV antler
SPFC`;A� FRWiSiON - beirw E.L. DISEASE - POL' Cy UV. 1 _ 1 6 i 5003 Iv
OTHER `
DESCRO ION OF OPEPATIONS / LOCATIONS I Vk 4ICL5S 1 EXCLUSIONS ADCED BY END04SEMENT I SPECIAL PROVISIONS
Indian River County is also an additional insured pEr business liability coverage .
ATE 6 .L2ER � r ELL ,
SHOULD ANY OF :*4E ABOVE DESCPI BED P000ES BE i ' NCELLED BEFORE THE
EXPIRATION DATE THL9EOF. THE ISSUING INSURER Wit L ENDEAVOR TO MAIL
The Board of County Commissioners 10 DAYS WFITTEN N. TILE TO THE: CERTIFICATE H LOER NAMED TO THE LEFT
Attn : Marion BUT FAILURE TO MAIL. SUCH N �YICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
1840 25th Street OF ANY KIND UPON THE INSURER , ITS AGENT SORREPRESENTATIVES.
Vero teach , FL 32960 AUTNORI?EC REPRESENTATIVE 7- . f —7
_ Kenneth 0 . Felten , LUTCF LB r
ACORD 25 (2001108) FAX : 97 ; - 1798 4)A ORD CORPORATION 1986