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Home My WebLink About2004-229V 10 1 00 R1G �- 0 Indian River County Grant Contract U4 nq This Grant Contract (" Contract" ) entered into effective this 1st day of October 2004 by and between Indian River County , a political subdivision of the State of Florida , 1840 25th Street, Vero Beach FL , 32960 ("County") and Substance Abuse Council of Indian River County (" Recipient" ) , of: Substance Abuse Council of Indian River County 2501 27 Avenue , Suite A- 107 Vero Beach , Florida 32960 Life Skills Training Program ( LST) Background Recitals A. The County has determined that it is in the public interest to promote healtrly children in a healthy community . B . The County adopted Ordinance 99- 1 on January 19 , 1999 (" Ordinance" ) and established 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 children 's 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 Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed 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 term 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 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" ) . 3 . Term The Recipient acknowledges and agrees that the Grant is limi ed to the fiscal year 2004/2005 ("Grant Period") . The Grant Period commences on October 1 , 2004 and ends on September 30 , 2005 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Sixty Thousand Dollars ($60 , 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 the 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 cont Is 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 aft3r 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 with all applicable federal , state, and local laws , rules , and regulations. 5 . 3 Quarterly Performance Reports . The Recipient shall submit Quarterly 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 fiscal year, the Recipient shall submit the audit to the Indian River County Office of IV anagement and Budget. The fiscal year will be as reported on the application for finding , 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 r ceipt of a qualified opinion from it' s independent auditor, such qualified o inion shall immediately be provided to the Indian River County Office of Management and Budget. The qualified opinion shall thereupon be reported to the Board of Commissioners and funding under this Contract will cease immed ately . 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 Septernber 21 , 2004 , provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct buc. iness in Florida that is rated not less than category A- : VII by A. M . Best, subject to approval by Indian River County' s risk manager, of the following types and amounts of ins rance: 2 - ( 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 , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage 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 other proofs and assurances as it may reasonably require that the insurance is arid 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 he 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 shall be listed as an additional insured on all insurance coverage required by this C ntract, 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 any 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 Con ract. 6 . Termination . This Contract may be terminated by either party , withou 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 written 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 Contract are subject to the availability of funds lawfully appropriated for its purpose by 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 . 3 — IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMM SSIONERS 7 4 By: 0,= Arthur F1 . 'Neub rger , tha ' a BCC Approved : : Ft _Y Atte rton , Clerk ' Deputy ' .. ibis Approved : Jos ph A. Baird County Administrator A o a o fora-and legal sufficiency : Mari n E . Fell , Assistant Cou ttorn y RECIPIENT : By: Substance Abuo Council of Indian River Cou ity 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - LifeSkills Training Program Substance Abuse Council of Indian River County Children Sery ces Advisory Committee PROGRAM COVER PAGE Organization Name : Substance Abuse Council of Indian River County Executive Director: Colette Heid , Ex . Dir. , CAPP E-mail : sacirc@.bel lsouth . net Address : 250127 Avenue, Suite A- 7 Telephone : 772 770- 811 Vero Beach, Florida 32960 Fax : 772 770-4822 Program Director : Colette Heid E-mail : Address : Telephone : Program Title : Life Skills Training Program (LST) Priority Need Area Addressed: Mental Wellness Issues Substance Abuse Education/Prevention LX- 825 (According to the Taxonomy of Human Services ) Programs that provide a variety of services including individual, group and /or family counseling; knowledge and skill enhancing activities; and structured groups which focus on family dynamics, problem-solving, self-esteem and other similar issues, for people of all ages who are at risk for substance abuse. Substance abuse education programs usually also offer presentations in schools and agencies and to family groups regarding the dangers of alcoholism , drug abuse and smoking. Brief Description of the Program: It is the LST program ' s intent to provide a compreh nsive, research based proven effective substance abuse prevention program . LST is targeted at reducing and preventing substance use/abuse among IRC middle school youth. There is a direct correlation between changing dolescent perceptions of the benefits vs . the risks of Alcohol, Tobacco and other Drugs (ATOD) to delaying the age of onset of initial use . By increasing protective factors and changing attitudes towards ATOD, the age of initial use an be delayed or put off completely . SUMMARY REPORT — (Enter Information In The Black Cells Onl Amount Requested from Funder for 2004 / 05 : $ E 09000 . 00 Total Proposed Program Budget for 2004 / 05 : $ E 0 , 000 . 00 Percent of Total Program Budget : 100 . 0 % Current Program Funding ( 2003 / 04 ) : $ 50 , 000 Dollar increase/ ( decrease ) in request : $ 30 , 000 Percent increase /( decrease ) in request * * : 60 . 0 % Unduplicated Number of Children to be served Individually : - Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be, served via Group settings : 3 , 900 Total Program Cost per Client : 20 . 51 * * If request increased 5 % or more, briefly explain why : Increase is due to the fact that one additional instructor is needed to implement the program , 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 (date). 511PI041 Chief Hugh Cox, Chairman Name of President/Chair of the Board Signatu Colette Heid, MS Ed. , CAPP Name of Executive Director/CEO Signature 3 l ifeSkills Training Program Substance Abuse Council of Indian River County Children So vices Advisory Committee PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Entire Section A not to exceed onepage) 1 . Provide the mission statement and vision of your organization. The Substance Abuse Council is committed to preventing the use of illicit drugs and abuse of addictive, mind4tering substances. It is the Council 's vision to increase community awareness concerning the levels of g use in Indian River County, empower the community with the belief that the level of suhstance drug use/abuse is directly related to the level of community interaction with prevention activities; and o enlist the community 's participation in prevention related activities Unless the community' s mphasis is directed to substance and drug prevention educational programs, we can expect negative social d 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 fo ded in 1989 and was incorporated as a not-for-profit agency in 1990. Services are provided for all resider is of IRC regardless of age or race. The Council is the only agency focusing specifically on substance abus4 h. 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 servi 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 goats through a variety of programs. The following are a list of programs provided by the Council. • Community Education and Information and Referral • Drag-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 A7 LifeSkills Training Program Substance Abuse Council of Indian River County Children Services Advisory Committee B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one e) 1 . a) What is the unacceptable condition requiring change? b) Who has then d? 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. According to the Florida Youth Substance Abuse (FYSA) and PRIDE Surveys, IRC youth exhibit above average risk factors and levels of drug usage. These survey reveals the extent of substance abuse occurring amongst our young in IRC. Even though there has been a downward pattern in dnig use trends over the past few years, IRC youth are still reporting drug use and delinquent behavior thal will negatively affect their lives and our society. IRC youth key Dru& Use Trends from the FYSA Survey 2000 to the 2002 refl the same observed pattern of reduced ATOD use as in the statewide survey . • The "past-304ay use of alcohol' by surveyed IRC students declined from 39. 3 % in 00 to 37 . 1 % in 02 . • Marijuana use also appears to reflect the statewide pattern. "Past-30,day use of marijuana by surveyed IRC students declined from 17. 2% in 2000 to 14. 3 % in 2002 . • Cigarette use among IRC students declined sharply in the past two years. In 20 0, 22 . 7% of surveyed students reported some use of cigarettes over the "past 30 days ". compared to IA. I % in 2002 . Attitudes toward Drug Ilse • Almost two thirds of surveyed IRC students (62. 9%) reported that daily use of cigarettes poses a "great risk" of harm. • Fear of marijuana use declines as students get older, while the fear of cigarette use actually appears to increase. While 67. 3% of surveyed middle school students believe regular marijuana use poses a "great risk" of harm, this number drops to 49. 3% among high school students. In contrast, perceptions of harm associated with daily use of cigarettes rise from 56. 8% among middle school students to 67. 4% among high school students. • Disapproval of substance use appears to decline as students get older. For instance, disapproval of alcohol use (76.2% in middle school and 52 . 2% in high school), disapproval of cigarette use (84 . 9% in middle school and 66. 5% in high school) and disapproval of marijuana use (9C . 0% in middle school and 69 . 3 % in high school) all decline between middle school and high school. Risk and Protective Factors • Surveyed students reported higher scores on the Personal Transitions and Mobil (63 ) and Favorable Attitudes toward Antisocial Behavior (57) risk factor scales, compared to the n itional average of 50 . This means that students in IRC are at greater risk for involvement in drug use and other antisocial behaviors due to a lack of long-term neighborhood connection, and due to dents' acceptance of antisocial behaviors. Parental use/parental attitude towards ATOD/use also torr Tates with adolescent attitudes towards/use of ATOD. These key findings illustrate the complexity of drug use and antisocial behavior among IRC ' s youth and the possible factors that may contribute to these activities. While some of the findings compare favorably to the national findings, Indian River County youth are still reporting drug use and d inquent behavior that will negatively affect their lives and our society. a) Identify similar programs that are currently serving the needs of your targete I population; b) Explain how these existing programs are under-serving the targeted population of your program. Local Law enforcement provides the DARE program to all 5'b grade students in IRC . No specific substance abuse prevention programs are directed at the middle school populations. Additionally, New Horizons and DATA provides Student Support Specialist and services in the public middle schools. Both these agencies work with a very small, indicated population of students and do not serve the entire population of youth. This remaining population of youth would receive no additionalprogram services if the LST program were not available. Collaboration is a part of the services provided t universal populations . The LST program provides no duplication of services. vie I ifeSkills Training Program Substance Abuse Council of Indian River County Children So vices Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, I - 6, not to exceed two es) 1 . List Priority Needs area addressed. Mental We llnes3 :r 5 5Ue 2. Briefly describe program activities including location of services. The LST program is a three year prevention program designed to be conduct in school classrooms. Based on Theoretical framework, the LST program was developed to impact g-related knowledge, attitudes and norms; teach skills for resisting social influences to use drugs and p mote the development of general personal self-management skills and social skills. Consistent with this, t ie LST program can be best conceptualized as consisting of management skills. The second compo ne t focuses on teaching general social skills. The third component includes information and skills that an specifically related to the problem drug abuse. The first two components are designed to enhance ov 1 personal competence and decrease both the motivations to use drugs and vulnerability to drug related cial influences. The problem specific component is designed to provide students with materials relatin directly to drug abuse (drug resistance skills, anti-drug attitudes, and anti-drug norms). Services will be provided in Indian River County Middle Schools. The LST program is a primary prevention program that targets individuals who have not yet developed drug abuse problems. The goal of the program is to prevent the use of gateway substance use among adolescents by making an impact on risk and protective factors associated with tobacco, alcohol, and marijuana use, particularly occasional and experimental use. Simultaneously a systematic community awareness campaign is conducted. It is designed to impact community norms and educate the community regarding the incidence of substanab abuse. 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 Supervision • Poor Family Discipline • Family History of Antisocial Behavior • Parental Attitude Favorable to ATOD use • Parental Attitude Favorable to Antisocial • Friends Use of Drugs Behavior • Peer Rewards for Antisocial Behavior • Youth Attitude Favo le to ATOD use • Youth Attitude Favorable to Antisocial • Perceived Risks of Drug Use Behavior • Early Initiation of Drug Use • Sensation Seeking According to Center for Substance Abuse prevention (C SAP), Selected Findings 11 1 Prevention, A Decade of Results from the Center For Substance Abuse Prevention, 1997, the findings indicate that the proposed strategies above are effective with this target population. They demonstrated rep ed documentation that adolescent risk perceptions were favorably impacted by reducing favorable parentic I, peer and community attitudes towards ATOD . We must take these facts and information and as with all knowledge, empower ow selves and educate our youth and community. The LST program is a research based, proven effective curr culum in the reduction of adolescent drug usage and has been endorsed by the Center for Disease Con sol (CDC) . The LST program was selected by the Center for the Study and Prevention of Violence I eCSPV), University of Colorado at Boulder as a Blueprint 2000 prograun and OJJDP selected the LST program for replication nation-wide and is 1 of only 11 programs that is considered "exemplary" by all program evaluators. WeSkills Training Program Substance Abuse Council of Indian River County Children Services Advisory Committee 3. Briefly describe how your program addresses the stated need/problem. Des ribe how your program follows a recognized "best practice" (see definition on page 12 of tt a Instructions) and provide evidence that indicates proposed strategies are effective with target population. The LST program is based on Theoretical framework. The LST program was develc ped to impact • drug-related knowledge • attitudes and norms • teach skills for resisting social influences to use drugs • promote the development of general personal self-management skills and soc al skills. Since all of these skills are directly related and positively impact to Drug Use Trend, Attitudes towards Drug Use and Risk and Protective Factors, the continuation of the LST program and is protective skill building framework should continue to contribute to the • Decline in Drug Use Trends • Increase in perceived risk or harm of substances • Decrease risk factors such as Favorable attitudes to ATOD use • Delay the age of onset for early initiation of drug use 4. List staffing needed for your program, including required experience and estimated hours per week in program for each staff member and/or volunteers (this section should conform with the information in the Position Listing on the Budget Narrative Worksheet). The LST program is currently staffed by three Council employees. The LST Coordi ator assumes primary responsibility for the LST program. One hundred percent (35 hours per week) of thi position is currently allocated to the program. One additional LST instructor (33 hours per week) is also signed to this program and currently dedicated 100'/6 of the position. The need now exists the n to increase staffing to add 15% of a Program Specialist time to the program to continue to implement th program to the incoming 6d', 7a` and 8* grades in the fall of 2004 . During year 3 , all 8a' graders will continue with LST booster instruction, while we ncurrently implement the 1s` and 2nd year classes to the 6a' & 7'h grades. Each year an estimated total of 3 ,900 students will receive • 17 sessions in the 6" grade With on going LST booster sessions, instruction will continue with • 10 sessions in the 7a` grade • 5 sessions in the 8a' grade The LST Coordinator has had 4 years of experience in the substance abuse prevention field holds BA and has a background in education. The other two LST instructors require a BA. All LST instructors are nationally certified to teach the LST curriculum. 5. How will the target population be made aware of the program? The LST program has been offered to all middle schools in Indian River County. In order to qualify as an OJJDP site all middle schools had to agree to allow the Substance Abuse Council to implement the LST program in a classroom period. The remaining private schools were also invited to receive services from the Substance Abuse Council . They were made aware of the program by letter with afollow-up face to face meeting. 6. How will the program be accessible to target population (i.e., location, transportation, hours of operation)? As previously stated, LST program is implemented during the school day in all Indian River County Middle Schools. Instructors render themselves to the individual school sites. Lifesk - Is Training Program Substance Abuse Council of Indian River County Children Services Advisory Committee D. MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomes orm. This dMZ&g6ffl gM does not need to he included in the o sax' 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 DE CRIPTION (C2). Use the following elements to develop your outcomes All elements must be inclu • Direction of change • Time frame • Area of change • As measured by • Target population • Baseline: The number t you will be measuring • Degree of chane 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 frame) as r ed by the 2003 School Board attendance records (as measured by). Baseline : 2003 School Board attendance records for enrolled boys and girls. Example 1 (Activity). To provide anger management classes to enrolled boys and girls 2 times a week for 1. 2 weeks. Example 2 (Outcome): 75% (degree of change) of youth (target population) who have participated in the academic 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; 2 Participants will go through the one lesson per week and be graded for 10 weeks. IMPORTANT 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 (B1 ). All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes 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. 3 � Lifeskills Training Program Substance Abuse Council of Indian River County Children Services Advisory Committee D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACT1VfHES Add all of the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To decrease by 5% the "first use" numbers of 1 . To provide 3,900 youth weeld r LST group sessions drug and alcohol use among middle school to youth according to the following schedule: 7"'2 a grade) students over a period of one year . 17 sessions in the 6`h grade as reported by the 2005 PRIDE survey. . 10 sessions in the 7`h (Baseline 2003 PRIDE Survey) . 5 sessions in the 8grades. 2 . To provide a total of seven-tee ( 17) weekly ongoing 2 . To reduce by 2% the incidences of sixth gradc education sessions to sixth grade dents on the various adolescents reporting the use of tobacco, alcohol substance abuse and resiliency skills building topics and marijuana following the first year of LST Program as reported by the 2005 PRIDE Survey (Baseline 2003 PRIDE Survey) 3 . To reduce by 2% the incidences of seventh 3 . We will provide a total of ten ( 1 ) weekly ongoing grade adolescents reporting the use of tobacco, booster education sessions to sevei ith grade students on alcohol, and marijuana following the second the various substance abuse and re iliency skills building year of LST program as reported by the 2005 topics PRIDE Survey (Baseline 2003 PRIDE Survey) 4. To reduce by I % the incidences of eight 4. We will provide a total of five ( ) weekly ongoing grade adolescents reporting the use of booster education sessions to seventh grade students on tobacco, alcohol, and marijuana following the various substance abuse and resiliency skills building the third year of LST program as reported topics by the 2005 PRIDE Survey (Baseline 2003 , PRIDE Survey) 5 . To increase audience knowledge by 25% 5 . Provide factual, current and u to-date information following educational presentation forums concerning drugs and their harmfu effects . concerning drugs and their harmful effects . pre/ post testing will be conducted and rated to as reported by self-disclosure on pre-testing. indicate a change in knowledge. (Baseline : Individual and group administered Pre-tests of forum participants. ) I i&Skills Training Program Substance Abuse Council of Indian River County Children Ser Aces Advisory Committee OUTCOMES ACTIVITIES Add all of the elements for your Measurable Outcome(s) Add the tasks to accomplish aOutcomes) 6 . To reduce by 20% self-reported high-risk 6. Provide factual, current and u -to-date information behaviors responses reported by audience concerning high-risk behaviors anresulting harmful participants following educational effects. presentation forums. (Baseline: Individual Prepost evaluations of the KABPs to indicate a change and group administered KABP [Knowledge, in participation in high-risk behaviors attitude, belief and practice] of forum participants. ) 39 UfeSkills Training Program Substance Abuse Council of Indian River County Children Ser ices Advisory Committee D. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program' s collaborative partners and the resources thata they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters. Collaborative Agency Resources provided to the pi logram Venue for program delivery, School Board of IRC Encourage teacher training Venue for on-going teacher training University of Miami Provide technical assistance for program evaluation Provide technical assistance in student progress evaluations Office of Juvenile Justice Provide Technical assistance for program implementation Delinquency Prevention Provide curriculum for student population receiving LST instruction Center for Violence Prevention, Provide Technical assistance for fidelity of program delivery University of Boulder Department of Children and Families Provide additional program funding 37 LifeSkills Training Program Substance Abuse Council of Indian River County Children S ices Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender, and ethnic background) required by the funder in Section H? What are the pieces of im formation that qualify them for your target population? How do you document their need 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 requir to utilize the State of Florida, Department of Children and Families, MA-SA (Mental Health-SubstanceAbuse) Data Warehouse Database. Complete, detailed, but confidential information is complied an all clients who request services of the Council . The demographic information required includes but is not limited to: • Name • Family composition aid status • Age • Living accommodation • Gender and ethnic background • Drug of Abuse • Address • Frequency of use • Social Security number • Age of onset • Type of services needed • Type of services provided • Duration of services • Length of stay In addition non-client specific data is also maintained. Time, duration, number of articipants, 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 LST program The Council is al a part of the State of Florida, Florida Youth Initiative Evaluation program. The University of Miami conducts random, unannounced 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 prepost test and conduct evaluations on their rate of change and validity. This additional 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 educati nal development and continuing education needed for both staff and community. The LST program utilizes several short term indicators to measure the impact onachievement 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 . • Pride Survey • Florida Youth Substance Abuse Survey (FYSA) 3 � LifeSkiffs Training Program Substance Abuse Council of Indian River County Children Servi = Advisory Committee 2. MEASURES: What data elements will you need to 'collect to show that you lis ve achieved (or made progress toward) your Measurable Outcomes in Section D? What tools or items are you using as measures (grades, survey scores, attendance, absences, skill levels) fo r your program? Are you getting baseline information from a source on your Collaboration Liq t in Section E? Are there results from your Activities in Section D that need to be documented? How often do you need to collect or follow-up on this data? Pre test are administered to the entire population of cohorts simultaneously, prior to instruction . Post testing is conducted following the completion of instruction. These pre and post test are evaluated by the University of Miami to establish achievement of measurable outcomes. Other program data elements such as program delivery and maintaining program fidelity are collected on a weekly basis and sent to the University of Colorado for evaluation. Required demographic data is complied and reported to the State of Florida monthly. PRIDE and FYSA Surveys are conducted alternating every other year. The 2003 PRIDE Survey results are due in the summer of 2003 and the FYSA Survey is due in 2004 3. REPORTING: What will you do with this . information to show that change hits 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? Establishing performance targets for strategy goals and objectives is a very impo part of prevention program implementation process. These performance measures indicate the success of the LST program by establishing the rate of change in perceived harm, level of drug use and the v idity of the program implantation. This additional 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 the community and its staff. All program data is complied via computer database programs. All program data and statistics are shared with the community, funders and concerned parties, as the law allows. LifeSkills Training Program Substance Abuse Council of Indian River County Children Sery ces Advisory Committee G. TEWETABLE (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 August 2004 Pre grant year request operations of coordination of school, lassroom and teacher LST schedules for instruction. September 2004 Implementation of all pre-testing on all cohorts simultaneously. October 2004- June Implementation of classroom instruction per coordinated schedules. 2005 December 2004 Compilation and evaluation of data for the Is` quarterly repo March 2005 Compilation and evaluation of data for the 2 d quarterly rep ort June 2005 Post testing on all cohorts simultaneously. Compilation and evaluation of data for the 3`d quarterly report July- August 2005 Ongoing Instructor training and technical assistance. September 2005 Compilation and evaluation of data for the a quarterly and annual report October 2004 Ongoing collaboration with all collaborating agency on program progress, September 2005 obstacles and any other program responsibilities as they anise 3�J 1 • I I L I v 1 ' I 1 / 1 1 1 I 1 i l i • 1 1 1 1 1 1 ' i1 1 • ' ` 'UF� F Mf "s"! �- . it I MIT1. 11 1 1 W w 1 i 1► ■ fTfY.�/ C � _.. . lig 1 1 1 rer 11 1 1 � 1 ; � 1 1 1 • / 1 • 11 .Port Saint Lucie • �� ■ 1 1r sem■ 111 : I r 11 � SII 1 • / / : • 11 Number of Unduplicated CHents by Age ._ f1 --• r c `a Z �✓' 3 � 1 1 • If � s F e € s r fia`� d' r 1 �.!kK `. Me FINIFIRM11=11 "M COWEArom c � � Coll In Vol I � 1 I 111 _O ' ll right Edit is Header. Type the organization and program is - and the funder forbeing completed. The p. ge # is al eady set at the bofton of every page. BUDGET 1 open Budget 1 I I please 1 1 1 1n ' the iconbelow. 9rr ifYY 5 Budget Substance Abuse Council Lifesirill Training Program Children Set vices 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 Progrc m Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Substance Abuse Council of IRC FUNDER: Children Services Advisory Committee LifeSkills Training 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. REVENUES AOBICY USE OKY rata/ Program Firflder S <' . c Total Agency CALCO` TIO % Bt dg#t Budget Bud%let 1 Children's Services Councti-SL Lucie 0.00 0.00 0.00 2 Children's Services Council-Martin 0.00 0.00 0.00 3 Advisory Committeedndlan River 80,000.00 .000.00 211 ,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 Waywi Mian River County 0.00 0.001 42.000.00 7 Department of Children & Families 0.00 0.001 759000.00 8 County Funds 0.00 0.00 1 ,850.00 9 Contributions-Cash 0.00 0.00 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 81000.00 13 Membership Dues 0.00 0.001 61500.00 14 investment Income 0.00 0.00 800.00 15 Miscellaneous 0.00 0.00 0.00 16 Legacies & Bequests 1 0.00 0.00 0.00 17 Funds from Other Sources 0.00 0.00 320,200.00 18 Reserve Funds Used for Operating 0.00 0.00 0.00 19 !n-Kind DonatlonS (Not included in total) 0.00 0.00 0.00 20 TOTAL REVENUES (doesn't include line 19 $809000.00 ,000.00 800,850.00 A IB I IC D EXPENDITURES QRAYAREASF4R Proposed Total Program Funder Spec ffc 7otaFAgency AQWY USE ONLY I ` (SIMW CALCULAYRMIS) - , . BudgetBYtdget _ . . Bu . , t. 21 Salaries - (must complete chart on next page) 53,261 .00 53,261 .00 362,378.00 Salary 22 FICA - Total salaries x 0.0765 7.65%e 4,074.47 4,074.47 27,721 .92 23 Retirement - Annual permon for qualified staff 0.00 0.00 59773.20 24 LifelHealth - Medical/DentallShoft-term Disab. 80790.00 81790. 00 36,000.00 25 Workers Compensation - # employees x rate 776.23 776.23 4,674.68 Florida Unemployment - # projected 26 employees x $7,000 x UCT-6 rate 0.00 0,00 0.00 A POS TIION LISTING Gross Annum B c Portion of Salary an Proposed % of Gross Annual Salary Program Funder Specific dget Salary,Requested(GA) Position Title / Total Hrs/wk (Agency) srzsn�a e-t 4o Substance Abuse Council Lifeskill Training Program Children Sery ces Advisory Committee Example. Executive Director / 40 hrs 70,000.00 10,000.00 ,000.00 7. 1401* Executive Director -40 hrs/ wk 55,000.00 0.00 0.00 0.00% Prevention Program Coordinator-40 hrs I wk 40,800.00 0.00 0.00 0.00% Community Health Educator -35 hrs /wk/$14.50 26,390.00 26,390.00 ,390.00 100.00% PREVENT Program Coordinator-40 hrs / wk 28,500.00 0.00 0.00 0.00% Peer Educator- 12 hrs /wk / $9 57616.00 0.00 0.001 0.00% Lifeskills Educator (1 ) - 33 hrs / wk/$13.75 23,595.00 230595.00 23t595.001 100.00° LifeskiNs 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 Assistant 25 hrs/wk /$12 15,600.00 0.00 0.00 0.00% HIV Program Coordinator-40 hrs / wk 28,500.00 0.00 0.00 0.00% HIV Program Assistant -40 hrs / wk 25,500.00 0.00 0.00 0.00% Information Specialist- 30 hrs / wk/ $11 .50 17.940.00 0.00 0.001 0.00% HIV Peer Educator- 20hrs / wk/ $10 100400.00 0.00 0.00 0.00° Case Manager - 24 hrs / wk $14.00 17,472.00 0.00 0.00 0.00% Program specialist 30 hrs twk $14.00 21 ,840.00 31276.00 8276. 15.00% 0.00 0.00 #DIV/0! 0.00 0.00 #DIV/0! #DIV/0! #DIV/0! #DIV/0! Remaining positions throughout the agency Total Salaries $362 ,378.00 $53,261 .00 $5 ,261 .00 14.70% FRINGE BENEFITS DETAIL A Specific MCA 7.65Yo Health Ins (Funder Specific Budget Funder a v Pension Walker's Un " oyme ToFringes Funder Column C only, from line 22 to 27 j Bu (AIX Y� Carnprr►s ret pens. specifrc Positibn riide / Total Hrs/wk ExanWfe Ca" AfsnaW.140 hrs 5r000 00 382.50 MAM 500.00 30800 200,00 1,582. 50 Executive Director -40 hrs/ wk 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Prevention Program Coordinator-40 hrs / wk 0.00 0.00 0.00 0.00 0. 0.00 0.00 Community Health Educator -35 hrs /wk/$ 14. 50 26,390.00 2 ,018.84 0.00 39300.00 340.43 0.00 51659.2 PREVENT Program Coordinator-40 hrs / wk 0.00 0.00 0.00 0.00 0. 0. 0.00 Peer Educator- 12 hrs /wk / $9 0.00 0.00 0.00 0.00 0.00 0. 0. Lifeskills Educator (1 ) - 33 hrs / wk/$ 13.75 230595 .00 1 ,805.02 0.00 30300.00 304.38 0. 5.409.3 Lifeskills Educator (2 -25 hrs / wk/$13 .25 0 .00 0.00 0.00 0.00 0.00 0.00 0. Diversion SpecWtst -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 0.00 0. Information Specialist- 30 hrs / wk/ $ 11 .50 0.00 0.00 0.00 0.00 0.00 0.00 0. HIV Peer Educator- 20hrs / wk/ $ 10 0.00 0.00 0.00 0.00 0. 0.00 0. Case Manager - 24 hrs / wk $ 14.00 0.00 0.00 0.00 0.00 0.00 0.00 0. Program specialist 30 hrs /Wk $ 14.00 39276.00 250.61 0.00 540.00 20.31 0.00 810.93 0 0.00 0.00 0.00 0.00 0.00 0.00 0. 0 0.00 0.00 0.00 0.001 0.001 0.00 0. 0 0.00 0.00 0.00 0.001 0. 0.00 0. 0 0.00 0.00 0.00 1 0.001 0.00 0. 0 0.001 0.001 0.00 1 0.001 0.001 0. Totd FundetReque3tF W Beneft 1 $53,261 .001 $4,074.47 $0.00 $7, 140.00 $665. 12 $0.00 $11 ,879. A B C EXPENDITURES oY pjwM FM Proposed Tota/ Program Funder SperA Ic Total Agency FG�k.'YUMOMYTO . - 'arorioErrrrL Budget Budget Budget 27 Travel-Daily 19470.00 1 $470.00 24,000.00 # of Staff x average # of miles/wk x 50 wks x $ x .29=$1 ,015 = Estimated Daily TraveUMileage Reimb. SWAT 310 miles a month �' 41 Substance Abuse Council Lifeskill Training Program Children Sery ces Advisory Committee 28 TmvellConferenceslTraining 250.00 250.00 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, food) 250 miles x .29 = $72.50 28ce Sup res 500.00 500.00 24,000.00 office supplies (monthly average x 12 months $50 x 12 months for UW = = estimated cost of office supplies based on Other Programs $500 a month x 12 present history. months = $6000 0.00 30 TelepMne 432.00 432.00 12, 319.95 • # Phone lines x average cost per month x 12 12 months= $2688 months = local phone cost Pager $12 x 12months x 3 employees - Average long distance calls x 12 months = Long distance charges $120 per month x Estimated cost of kug distance 12 months=1440 0.00 31 Postage/Shipping 0.00 0.00 59000 .00 • Quarterly Mailing of Newsletter Bulk Mail $ 200 per month x 12 • Special everts, etc. months= 2400 • Bulk mailings - appeals Bulk mail pemrit $300 0.00 32 Utilities 0.00 0.00 6,000.00 • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) Utilities $333 per month x 12 months+ • Garbage ($ x 12 months) $4000 0.00 33 Occupancy (Building & Grounds) 31000.00 1,000.001 25,000.00 • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) Rent $1919 a month x 12 months • Grounds Maint. ($ x 12 morths) LST 250 x 12 $930 not paid by • Real Estate Taxes grants 0.00 34 Printing & Publications 100.00 loo.001 47,500.00 • Quarterly Newsletter ($ x 4) Newsletters $300 x 4=1200 - Letterheads, Envelopes, etc. Letterhead,etc $1200 Fundraising materials PRIDE Survey $9000 • Other Other $307000 0.00 35 SubscriptionlDueslMemberships 0.00 0.00 1 ,000 .00 • Membership to National Organization FADDA $250 CADCA • Dues $250 • Subscriptions to Newspapers/magazines, etc. Subscriptions $500 0.00 36 Insurance 0.00 0.001 12.000.00 • Directors/Officers Liab. • Commercial/General Insurance Auto $7821 • Bond Ins. Commercial Liability $1750 • Auto Insurance Employee Bond $500 0.00 37 Equipment:11entai & Maintenance 438.00 438.00 8.000.00 • Copier lease J.$ x 12 months) • Meter lease ($ x 12 months) Copier - Copier Maintenance ($ x 12 months) Main $150 x Computer MainDAS $ Computer Maintenance $ x 12 months $50 x12 =12 Computer Main $ ' �pnt ( ) 100 x 12 =1200 Other (Vehicle) • Other $200 per month x 12 months--2400 0.001 0.00 38 Advertising 0.00 0.001 152317.00 • Newspaper ads Ads $250 x 10=2500 • Fundraising ads/promotions other $500 • Other (vacancies) Promotions $2000 Billboards $4000 0.00 38 Equipment Purchases:Capftal Expense 0.00 0.00 12 ,000.00 • Computer/monitor (# x ) • Laser Printer 2 computer systems w/ monitors $1500 0.00 40 Professional Fees (Legal, onsU ng 0,00 0.00 3,000.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other lConsuffing Fees $2,000 0.00 41Books/Educational Materials 6,908.301908.30 51 ,000.00 5/25/2004 B-' 412 Substance Abuse Council Lifeskill Training Program Children Ser &es Advisory Committee BooksMdeos Videos $200 each X 10 Materials ($ x staff) Euca6onal materials $ 42502 0.00 42 Food & Nutrition 0.00 0.00 41195 .00 Meals ( # meals x dients x 5days x 50 wks) Snacks Youth snacks $W a week x 52 Weeks 0.00 43 AAministrative Costs • 0.00 0.001 0.00 Admin. Cost (% of total budget) 0.00 44 Audit Expense 0.00 0.00 9.000.00 Review 9,400.00 45 Specific Assistance t0 hidiMuals 0.00 1 .000.00 Medical assistance Meals/Food = Rent Assistance Outer o. 46 Other isce aneous 0.00 0.00 11 .471 .00 Background check]&W test D L $38 x i90 Other [drug` sateen lots350ti per morflh x 0.00 47 Other/Contract 0.00 0.00 54.500.00 or program services sessionper week x 50 weeks ,%o 0.00 48 TOTAL EXPENSES $01000.00 800000.04800,850.74 $0.00 0.74 5252004 B-I V Type Cs Crgmnabon " PrWa Name UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCYIPROGRAM NAME: LIFE SKILL TRAMMG PROGRAM FY 02103 FY 03104 FY 04105 V6 INCREASE FYE Sept 30 FYE Sept 30 FYE Sept 3CL. CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED C-ca ByCoL a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 0.00 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/O! 3 Advisory Committeeandian River 105V000.00 145 000.00 211 500.00 45.86% 4 United Wa St Lucie County 0.00 0.00 0.00 #DIV/O! 5 United Way-Martin County 0.00 0.00 0.00 #DNIO! s United Way-Indian River County 71 500.00 78 000.00 42 000.00 46.15% 7 Department of Children & Families 75 000.00 75 000.00 75 000.00 0.00% s County Funds 11850.00 1 ,850,00 11850.00 0.00% 9 Contributions-Cash 102 934.00 759000.00 55 000.00 -26.67% to Program Fees 541"1 ,00 40 000.00 40 000.00 0.00% t1 Fund Raising Events-Met 559202,00 25 000.00 40 000.00 60.00% 12 Sales to Public-Net 0.00 89000.001 89000.001 0.00% t3 Membership Dues 47960.00 69500.00 6500.00 0.00% 14 Investment income 0.00 0.00 800.00 #DIV/0! 1s Miscellaneous 0.00 0.00 0.00 #DN/O! 1s Legacies 8 Bequests 0.00 0.00 0.00 #DN/0! 17 Funds from Other Sources 289t678.00 334,279.00 320 200.00 -4.21 % is Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 19 In4Cind Donations Ma kww wd in taM 0.00 0.00 0.00 #DN/O! 20 TOTAL 760,58S.00 M9629,00 800 850.00 1 .55% EXPENDITURES 21 Salaries 38218T7.00 4"A34" 362 378.00 1 41 .28% 22 FICA 29,290.00 31 ,2M.00 27 721 .92 41 .28% 23 Retirement 51526.00 7A68.00 51773.20 -22.69% 24 LifeMeagh 25 .00 25 200.00 36 000.00 42.86% 25 Workers Compensation 49500.00 49860,00 4674.68 -3.81 % 26 Florida Unemployment 0.00 59000.00 0.00 400.00% 27 Travel-11-My 1 054.0021 380.00 24 000.00 12.25% 29 TravellConferences/Tr ' " 32 039.0024 566.00 28 000.00 13.98% 29 Office Supplies 22 232.00 61600.00 24 000.00 263.64% 3o Telephone 13 345.0013 500.00 12 319.95 -8.74% 31 PoStagefShipping 3j30100 41220.00 57000.00 18.48% 32 Utilities 3t415.00 47000.00 61000.00 50.00% 33 Occupancy Build & Grounds 23A",00 239028.00 25 000.00 8.56% 34 Printing & Publications 13 899.00 41t400,00 47 500.00 14.73% 35 Sub s/Membershi s 170.00 19000,00 11000.00 0.00% 3s Insurance 99683,00 10 071 .00 12y000.00 19.15% 37 EquipmentRental & Maintenance 0.00 67000,001 8 000.00 33.33% 38 Advertising 0.00 129779.00 15 317.00 19.86% 39 Equipment Purchases:C se 3 1 .00 3 000,00 12 000.00 300.00% 4o Professional Fees 1 Consulting) 7984100 21000,00 31000.00 50.00% 41 Books/Educational Materials 67,099.00 50 968.00 51 w000.00 0.06% 42 Food & Nutrition 0.00 19560.00 4195.00 168.91 % 43 Administrative Costs 0.00 0.00 0.00 #DIV/01 44 Audit Expense 0.00 71000.00 91000.00 28.57% 45 Specific Assistance to Individuals 99732,00 S 000.00 17000.00 80.00% 46 Other/Miscellaneous 119320.008 6,350.00 11 471 .00 80.65% 47 Other/Contract 61 010.00 62y000.00 64 500.00 4.03% 48 TOTAL 741 352.00 788,629.00 800 850.74 1 .55% 49 REVENUES O UNDER EXPENDITURES 19 233.00 0.00 -0.74 #DIV10! vzsrzooa sx 4d Type °e Orgy ~ ad WW" Nem° UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: 1ffeS4dTrwVpw m FY 02/03 FY 03104 EPRED INCREASE FYE Sept 30 FYE Sept 30 FCURRENT VS. N FY BUDGET A B D ACTUAL TOTAL 1 esa eyea e REVENUES BUDGETED 1 Children's Services Council-St. Lucie 0.00 0.00 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/O! 3 AdvisoryCommittee-Indian River 40 000.00 50,000.00 80 000.00 60.00% 4 United Way-St Lucie County0.00 0.00 #DIV/01 5 United Wa aYlartin County0.00 0.00 0.00 #DIV/01 6 United Wa ian River County0.00 0.00 0.00 #DIV/0! 7 Department of Children & Families 75 000.00 75 000.00 0.00 -100.00% e County Funds 0.00 0.00 0.00 #DIV/O! 9 Contributions-Cash 0.00 0.00 #DMO! 10 Program Fees 0.00 0.00 0.00 #DN/O! 11 Fund Raising Events-Net 0.00 0.00 0.00 #DMO! 12 Saks to Publicwlet 0.00 0.00 0.00 #DIV/O! 13 Membership Dues 0.00 0.00 0.00 # DIV/O! 14 Investment Income 0.00 0.00 0.00 #DIV/01 15 Miscellaneous 0.00 0.00 0.00 #DIV/0! 1s Legacies & Bequests 0.00 0.00 0.00 #DIV/01 17 Funds from Other Sources 0.00 0.00 0.00 #DIV/O! 1e Reserve Funds Used for Op"ng 0.00 0.00 0.00 #DIV/O! 19 1n Kind Donations pianew.dmiaa! 0.00 0.00 0.00 #DIV/01 20 TOTAL 115 000.00 125 000.00 80 000.00 36.00% EXPENDITURES 21 Salaries T4X6,00 76 362.00 5326100 30.25% 22 FICA 67736.00 59842.00 4 074.47 30.26% 23 Retirement 0.00 901 .00 0.00 -100.00% 24 Lde/Fleallh 41200.00 11 0.00 89790.00 -22.89% 25 Workers Compensation 3,272.00 909.00 776.23 -14.61 % 26 Florida Unemployment 0.00 0.00 0.00 #DIV/01 27 TraveWally 990100 19015.00 1 A70.00 44.83% 28 TraveWonferences/Traini 5156.00 7p273.00 250.00 36.56% 29 Office Supplies 500.00 600.00 500.00 -16.67% 3o Telephone 1 000.00 111300 432.00 -61 .19% 31 Posta hi 500.00 608.00 0.00 400.00% 32 Utilities 250.00 264.00 0.00 400.00% 33 Occupancy & Grounds 11 160.00 11 160.00 3 o00.00 -73.12% 34 Printing & Publications 0.00 0.00 100.00 #DIV/01 35 SubscriptionMuesMemberships 250.00 250.00 0.00 400.00% 36 Insurance 1000.00 1001 .00 0.00 400.00% 37 Equipment.Rental & Maintenance 500.00 588.00 438.00 -25.51 % 3e Advertising2 500.00 21897.00 0.00 400.00% 39 E Purchases:C se 0.00 0.00 0.00 IV/0! 4o Professional Fees I Consu ' 0.00 0.00 0.00 IV/0! 41 Books/Educational Materials 1 500.00 19317.00 69908.30 424.55% 42 Food & Nutrition 0.00 0.00 0.00 IV/0! 43 Administrative Costs 0.00 0.00 0.00 IV/0! 44 Audit e 1 500.00 1 500.00 0.00 -100.00% 45 S Assistance to Individuals 0.00 0.00 0.00 IV/O! 4s Odw Miscellaneous 0.00 0.00 0.00 IV/01 47 OtherfContract 0.00 0.00 0.00 IV/o! 48 TOTAL 115 000.00 125 000.00 80 000.00 -36.00% 49 REVENUES OVERT UNDER EXPENDITURES 0.00 0.00 IV/0! W&M 45 Type vm Orgardra6on and Program Nerve UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCYIPROGRAM NAME : l.ge Sides Traing Program FUNDER : A B C FY 04105 FY 04105 % OF TOTAL FUNDER TOTAL VS, PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A EXPENDITURES 21 Salaries 539261 u00 53 261 .00 100.00% 22 FICA 49074.47 49074.47 100 .00% 23 Retirement 0 .00 0 .00 #DIV/0 ! 24 Life/Health 89790 .00 89790.00 100.00% 25 Workers Compensation 776.23 776 .23 100.00% 2s Florida Unemployment 0 .00 0 .00 #DIV/01 27 Travel4l)ai 11470.00 19470.00 100 .00% 28 Travel/Conferencesrrrainin 250 .00 250 .00 100.00% 29 Office Supplies 500 .00 500.00 100 .00% 3o Telephone 432.00 432 .00 100 .00% 31 Postage/Shipping 0.00 0.00 #DN/01 32 Utilities 0.00 0 .00 #DN/O! 33 Occupancy (Building & Grounds 39000w00 3,000.00 100.00% 34 Printing & Publications 100.00 100 .00 100 .00% 35 Subscription/Dues/Memberships 0 .00 0 .00 #DN/0 ! 361nsurance 0 .00 0 .00 #DN/01 37 E ui ment: Rental & Maintenance 438.00 438.00 100.00% 38 Advertising 0 .00 0 .00 #DIV/01 39 Equipment Purchases: Ca ital Expense 0.00 0 .00 #DN/O ! 40 Professional Fees (Legal, Consulting) 0 .00 0.00 #DN/01 41 Books/Educational Materials 6990830 6w90830 100.00% 42 Food & Nutrition 0 .00 0 .00 #DIV/01 43 Administrative Costs 0 .00 0 .00 #DIV/01 44 Audit Expense 0200 0.00 #DNIO ! 45 Specific Assistance to Individuals 0 .00 0 .00 #DIV/0 ! 46 Other/Miscellaneous 0.00 0200 #DIV/01 47 Other/Contract 0 .00 0.00 #DIV/O! 48 TOTAL $ 80 ,000 .00 $807000.00 100 .00% � Lim 7RLCT DERECTaR • _ , . Q _ EWX 2108 jr�CL ? + wTI , GH 41 ' 01 EmolOyer Edent : fication Nurce Date : 31 - 14506ZZ _ DLN : 17053042275005 ST PETERS HUMAN SERVICE ? Contact Person : INCORPORATE ] D . a _ DOyN1A.�G C/ 0 REV ANDREU JEFFERSON Contact Telephone Number : 4250 38TH AVE ( 513 ) 241 - 5199 • GiFFGRD , FL 32967 Accounting Period Ending : August 31 Farm 990 Required : Yes Addendum Applies : Yes Dear Applicant .• Based an information supplied , and assuming your operations wi 1 be as stated in your application for recognition of exemption , we have de ermined you are exempt from federal income tax under section 501 ( a ) of the onternal, Revenue Cade as an organization described in section 501 ( c ) ( 3 ) - We have further determined that you are not a private foundation within the meaning of section :09 ( a ) of the Code , because you are an organization described in sectians 509 ( a ) ( 1 ) and 170 ( b ) ( 1 ) ( A ) ( ii ) . Lf your sour' c2s of support , or your purposes , character , 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 - eent to your organizational document or bylaws , please send us. a. ca y of the amended document or bylaws . Also , you should inform us of all clan es in your name or address . As of 74nuary 1 , 1984 , you are Liable for taxes under the Federal Insurance Contributions Act ( social security taxes ) an . remuneration of s100 or mare you pay to eacl of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax A4 :: *, ( FUTA ) . Since you are not a private foundation , you are not subiect 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 exc '; 54e taxes of section 4918 . Additionally , you are not autamatiully exempt from other federal excise taxes . If you have any questions about excise , employment , or other federal taxes , please contact your key district affice . Grantors and contributors may rely an this determination unless the Internal Revenue Service publishes notice to the contrary . Ho "A" er , it you Lose your section 509 ( a ) ( 1 ) status , a grantor or contributor may not rely an this determination if he or sne was in part responsible for , or das aware of , the act or failure to act , or the substantial or material clang an part of the organi : Ation that resulted in your Loss of such status , or U he or she - acquired knowledge that the Internal Revenue Service had given lotLCb that Letter 947 ( 0 (3 / C' ) �r • . Y r 0*7 � `'5T PETERHUMAN S S . YOU would no longer be classified as a section 509 ( a ) ( 1 ) organization yam, ; Donors may deduct contributions to you as provided in section l7 of the Code . Bequests , legacies , devises , transfers , or gifts to you or for your use are deductible for federal estate and gift tax purposes if tney meet he applicable provisions of Code sections 2055 , 2106 , and 2527 . Cantriouticn deductions are allowable to donors only to the exte t that their contributions are gifts , with no consideration received . Tick2 _ Pur - cruses and Similar paymentS in conjunction with fundraisinq events ma not necessarily qualify as deductible contributions , depending on the cin uA - i stances . See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , i on page 104 , which sets forth guidelines regarding the deductibility , as chari - table contributions , of payments made by taxpayers for adaiss ion to 0 w other participation in fundraising activities for charity . ; In the heading of this letter re have indicated whether you must file Fora 990 , Return of Organization Exempt From Income Tax . If Yes is indica Ied , you are required to file Fora 990 only if your gross receipts each year Are normaLly *are than $25 , 000 _ However , if you receive a Fora 990 packs a in the t sail , please file the return even iT 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 gross receipts are no aally S= 1000 or less , and sign the return . If a return is required , it - oust be filed by the 15th day of the fifth monthafter the end of your annual accounting period . A penalty of S 0 a day is charged when a return is filed late , unless there is reasonable Cause for the delay . However , the maximum penalty charged cannot exceed SL0 , 000 or 5 percent of your gross receipts for the year , whichever is less . For organizations with gross receipts exceeding $ 1 , 000 , 000 in any Year , the penalty is 5100 per day per return , unless there is reasonable cause fc. r the delay . The maximum penalty for an organization with gross receipts exceeding ; 110001000 shall not exceed 550 , 000 . This penalty say also be charqed if a return is not complete , so be sure your return is complete before you file it . You are required to sake your annual return available for public inspection for three years after the return is due . You are also required to sake available a copy of your exeoptien application , any supporting documents , and this exemotion letter . Failure to make these document available for public inspection may subject you to a penalty of _ S20 r day for each day there is a failure to comply ( up to a maximum of 5101000 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 Fora 990 - T , Exempt Organization Business Inco ■ e Tax Return _ In this Tette we are not determining wnetner any of your present or proposed activities are unre^ lated trade or business as defined in section 51Z of tae Code . LeOft tem 947 S; PE7ZRS HUMAN SERVICZE You need an employer identification number even i ` you hive no e + clCyees . If an employer identification number was not entered on your aooiication , a number will be assigned to you and you will be advised of it . Please use that number on all returns you file and in Ali Correspondence with the Internal Revenue Service . This determination is based on evidence that your funds are dedicated to the purposes listed in section 50L ( c ) ( 3 ) of the Code . To assure your Continued exemption , you should keep records to show that funds are expended only for those purposes . If you distribute funds to other organizations , your retards should show whether they are exempt under section 50L ( c ) ( 3 ) . In cases where the recipient organisation is not exempt under section 50L ( c ) ( 3 ) , there should be evidence that the funds will remain dedicated to the req Fred purposes and that they will be used for those purposes by the reci ient . If distributions are aide to individuals , case histories reqs ding the recipients should be kept showinq names , addresses , purposes of awards , manner of selection , relationship ( if any ) to members , officers , trustees or donors of funds to you , so that any and all distributions made to individuals can be substantiated upon request by the Internal Revenue Service . ( Revenue Rulinq 56 -304 , C . S . 1456 - 2 , page 306 _ ) If we have indicated in the heading of this letter that an Addendum applies , the enclosed addendum is an integral part of this letter . Because this Letter could help resolve any questions about your exempt status and foundation status , you should keep .i t in your . permanent records . If you have any questions , please contact the person whosr- name and telephone number are shown in the heading of this letter . Sincerely yours , !� District Director Enclosure ( s ) : Addendum Letter 947 ( DQ / CG ) EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on Fet ruary 19 , 2002 ] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbLirsement 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 documentation 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 was awarded . For example, no expenditures prior to October 1st may be reimbursed with funds fro Rn the following year. Additionally , if any funds are unexpended at the end of a fiscal year, these funds are not carried over to the next year unless expressly authorized by the Board of Commis ioners . All requests for reimbursement at fiscal year end ( September 30th) must be submi ed 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 - r a EXHIBIT C STANDARD TERMS FOR GRANT CONTRACT 1 . Notices : Any notice , request, demand , consent, approval or other communicat on 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 184025 1h 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. The location for settlement of any and all claims, controversies , or disputes, arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties, E hall 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 contemporaneous 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 its 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 - Date : 11 / 18 / J4 Time : ! U : 18 AM To . 5078 - 1798 Page : 001 - 002 CERTIFICATE OF LIABILITY INSURANCE 11/0M; DQ' 11/08/200044 PRODUCEF ( 772 ) 231 -2828 . FAX(7 ' 2 ) 231 - 4413 THIS CERTIFICATE IS ISSUED AS A MA ER OF INFORMATION Felten & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 2911 Cardinal Drive ( 32963 ) HOLDER. THIS CERTIFICATE' DOES NO AMEND , EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P . O . Box 3488 Vero Beach , FL 32964 - 3488 INSURERS AFFORDING COVERAGE NAIC # INSURED Su Stance Abuse Counci o In Ian River county INSU=Ea A: Colony Insurance 2501 27th Ave Ste A- 7 NsuFE16 Progressive Express 10193 Vero Beach , FL 32960 !NSU =ESC. Commerce & Industi '}r Insurance INSLI=EI C% INSUFE ; E: Ypres THE POLICIES OF INSUR4N;WE LISTED BELOW HAVE BEEN ISSUED TO TriE INSURED NAMED ABOVE FOR THE POLICY PERIOD N ICATED. NOTWITHSTANDIN ANY REQUIREMENT, TERM OR CONDITION OP ANN' CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF i' E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED E: Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIDNZ AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHORN MAY 1AVE BEEN REDUCED BY PAID CLAIMS . ! NSR etDD'U TYPECFINSIASANCE y POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY MP714134 04/01/2004 04/01/2005 SACH occIaF :N E -� S 110002000 X COVVERC)AL GENEF+7'tL LIABILI -Y DAMAGfccO R 7 9:1 $ 509000 CL.4I �S Nt^;E 00::up IVIED EXP (Ani' ct 9 .e?•. F 5 , OO A PE9SCNALB .AD , ; 1. x a 1 000 00 G_NEFIA,:. AGG' ,L TE s 2 , 000 , 00 GE.N'LA.33REGAiE UVI' AFP_ . ES PER: PRODUCT. - pM 'UP A ua s EXCLUDE 17 FCLICY i..CC AOTOMOBLE LIABILITY CA044377464 02/05/2004 02/05 /2005 O-)MbNEL) INGLE LAI , - ANYA_ i-C (-s a_fltlent) F 1 , 1000 .ALL OWN ED AU T CG 60Di _Y INJ CRY B X SCH =DLI LCD A!r0: (Pet p Ssyn' . hIRED AUTC r 80DI _Y IN, JRY N (^-O'.YNE''; AtJTOg (F'or acride rj PROPERT" DA'NAC E _ (F'er acurnt) GARAGE LIABILITY I Al:Tn ON ' Y - 2A A TENT 1: nTHF'i- , IAN AUYO OIv :.Y: A33 F EXCESSAJMBRELLA LIABILITY EACH 0:'ca.IRRE7CE ICG, Ii a CLA:M1+ MA':IF A(iGkEGATE C DED ;CTIBLE -- a REiENTUJN S F WORKERS hIC' 3442796 01/10/2004 01/10/2005 j4'CSTf.TL � O'� - EMPLOYERS' LIABILITY c VY kNv PRCrFEi0R/Da5• iv _i ,�) c 'UiVe E.L. EACJAr�: �- 1061061 O"FiCLF/MEMBEA E. 0 RUDER` E.L. DiSEE - EAE FL ^YE. C _ 100 , +OO If yEF. �rvlbe �rltler AS --- SPFCA.LFRDVISiONSbelar E.L. DISEASE - POL' LIh%I - 16 500: lti � OTHER DESCRiP71ON OF OPERATIONS / LOCATIONS 7t HOLES : EXCLUSIONS ADCED BY ENDO -+SEMENT / SPECIAL PROVISIONS Indian River County is also an additional insured per business liability coverage . CERTIFICATE LDER CA ELL IQN SHOULD ANY OF :'HE ABOVE DESCP.IBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THL'SEOF. THE ISSUING INSURER WILL =NDEAVOR TO MAIL. The Board of County Cc"mi ss i oners 10 DAYSYYRITTEN N, TILE 1'0 THE CERTIFICATE H LDER NAMED TO THE LEFT Attn : Marlon BUT FAILURE TO MAIL SUCH I% OTICE SHALL IMPOSE NC OBLIGATION OR LIABILITY 1840 25th Street OF ANY KIND UPON THE INSURER. ITS AGENTS OR REPRESENTATIVES. Vero Beach , FL 32960 AL'THORIZEOREPRESENTATIVE Kenneth D . Felten , LUTCF LB ACORD 25 (2001 /08) FAX : 97 : - 1798 rc)AC ORD CORPORATION 1986