HomeMy WebLinkAbout2004-229W pR l
Indian River County Grant Contract Oil Z ?.9vv
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
PREVENT ! 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 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 Committee , 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 limited 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 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 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 required to have
an audit completed by an independent certified public accountant at the end of the
Recipient' s fiscal year. Within 120 days of the end of the Recipient's fiscal year, the
Recipient shall submit the audit to the Indian River County Office of Management 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 receipt of a
qualified opinion from it's independent auditor, such qualified opinion 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 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 approval by Indian
River County's risk manager, of the following types and amounts of insurance:
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 and at all times
remains in full force and effect. Recipient agrees that it is the Recipient'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 shall 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 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 Contract.
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 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 attached 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 CO NTY COMMISSIONERS
By :
Arthur R . Neuberger , Ch rman
BCC Approved : o, 4Le
Attes . . K. Ba on , Clerk
G
By: t
Deputy Clerk
yy� i Iti
Approved :
Jos ph A. Baird
County Administrator
Ap e o o and legal sufficienc
II , Assis ant Cou rney
RECIPIENT:
By :
Substance Abu Council of IndianIver County
4 -
EXHIBIT A
[Copy of complete proposal/application]
- 1 -
1 F :- li t • •
F / ( � ^� . . . y . yy ' . . . + a • n. -. - lU l . . - r y ! y . . . . r
�s� l
•
=71 . # .:y :. 0 : 1 1 ' i Y ♦ '�(►� ► f • !
• f : 1 , B ► � � w� l.11 , fl f i : l1 1 ! 1 ' Al 1fill 9 "
1 . L 1 N :.til» rl ! ' 1 tl ' � i� • 1 # 1 . • ' � � 1 4 i-♦ '
• f
r r f •
I • I • f • +
Tj
I • ! � f It 1 • t 1
1 y
bl r
z
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
PROPOSAL NARRATIVE
A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page)
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,
mind-altering substances
It is the Council ' s vision to increase community awareness concerning the levels of drug use in Indian
River County; empower the community with the belief that the level of substance and drug uselabuse is
directly related to the level of community interaction with prevention activities; 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
use/abuse 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 all 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
fl
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one e)
1 . a) What is the unacceptable condition requiring change? b) Who has the need ? 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.
Alcohol and drug abuse continues to be the number one problem facing the youth of America. The use
of mind altering chemicals has proven to be especially harmful to the adolescent growth
and
development process. Psychoactive drugs interfere with physical, social and emotional growth during
the critical years of adolescent development.
An adolescent who uses intoxicants is not only at high risk of becoming drug dependent but is also at
an increased . risk of dropping out of school, getting involved in crime, attempting suicide, or becoming
involved in an assortment of dangerous behaviors.
The prevention of adolescent drug and alcohol abuse is most likely to occur when parents, teachers, and
other individuals in the community who are part of the youth' s circle:
➢ are well informed of the harmful effects of drugs
➢ recognize behavioral changes that accompany drug use
➢ understand how drug use is encouraged and accepted in the social world of a youth.
According to the 2003 PRIDE Survey of Indian River County students, IRC students continue to have
incidences of substance abuse that are above national averages. Over the 14 years of data gathered, we
have seen significant changes in youth usage, but our youth continue to report a high level
of
availability for alcohol, marijuana and other illegal drugs. Of 6a' through 10th graders, 33 . 86% also
reported a perceived harm for usage of alcohol as very harmful, but continue to use alcohol at a rate of
42 . 78% . (PRIDE 2003 ).
When comparing the PRIDE Survey to the Florida Substance Abuse Survey (FSAS), we see
comparable rates within Indian River County. Reporting levels indicate that Indian River County youth
are at the highest category for Binge Drinking, Alcohol use in the past 30 days and Marijuana use in the
past 30 days. (FSAS 2002)
All of this combined have made it increasingly more important for efforts to focus on behavior
strategies and intervention for youth by promoting behavioral change including healthy lifestyles. (i. e. ,
not using drugs, alcohol, tobacco; practicing abstinence; participating in school; anger control with
focus on alternatives to violence) With substance uselabuse intertwined with so many other high risk
behaviors, early intervention must be available to specifically target the prevention education needs.
a) Identify similar programs that are currently serving the needs of your targeted populations b)
Explain how these existing programs are under-serving the targeted population of your program.
The Substance Abuse Council ' s program is the only program that provides comprehensive community
based prevention education within Indian River County, The Mental health Association does provide
the CLIP program where crisis intervention services are available but are not specifically substance
abuse related. 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
rogram services if the PREVENT ! Program was not available. The PREVENT ! program provides no
duplication of services.
5 �
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
CO PROGRAM DESCRIPTION (Entire Section C. I — 6, not to exceed two es)
1 . List Priority Needs area addressed. Mental Wellness Issues
2. Briefly describe program activities including location of services.
PREVENT ! combines outreach and group support to reach economically disadvantaged youth. These
youth are ages 13 - 18 ;
✓ who have repeated failure in school and/or little commitment to school
✓ do not have a supportive environment and
- ✓ whose lack of decision making skills may lead them to abuse tobacco, alcohol and other
drugs.
The Substance Abuse Council, a not-for-profit substance abuse prevention agency, proposes to continue
this project through a comprehensive range of substance abuse and educational activities for males
and females with substance abuse issues. Daily program services are provided by a full time
program coordinator and a licensed mental health counselor.
Two different components will constitute the PREVENT! program. The components are as follows :
• Crisis Intervention and Counseling
• Deep Impact-TARGET Troupe participation
The first component of the PREVENT program will be comprised of Crisis Intervention/ Counseling.
✓ A total of 75 individuals will receive Crisis Intervention or counseling services. The program will
be cyclical in nature, servicing approximately 15 individuals per cycle. Each treatment and
education cycle will last for ten ( 10) weeks.
✓ A total of 25 families will be provided with comprehensive assessments. Evaluation of
adolescents identified via psycho-socials comprehensive evaluations will be conducted
Adolescents selected from this population will also be assigned to the Crisis Intervention and
Counseling component.
✓ On-going, frequent drug screening will be conducted to provide IRC juveniles and families with
objective and accurate drug testing. An accurate testing program is the most objective and
efficient way to establish a framework for accountability and to gauge each participant's progress.
Modern technology offers highly reliable testing to determine if an individual has recently used
specific drugs
Substance abuse counseling and education will consist of a group therapy session a week, and one
aftercare session weekly focused on relapse prevention. There will also be family workshops
conducted at SAC for family members during the treatment cycle. Once the ten week cycle is completed,
Aftercare will be conducted weekly. The Aftercare component is structured to focus on relapse prevention
and life skills development. .
Behavioral Therapy for adolescents incorporates the principle that unwanted behavior can be changed by
clear demonstration of the desired behavior and consistent reward of incremental steps towards achieving
it. Therapeutic activities include fulfilling specific assignments, rehearsing desired behaviors, and
recording and reviewing progress, with praise and privileges given for meeting assigned goals. Urine
samples are collected regularly to monitor drug use. The program aims to equip the individual to gain
three types of control:
✓ Stimulus Control- helps individual avoid situations associated with drug use and learn to
spend more time in activities incompatible with drug use
✓ Urge Control- helps individual recognize and change thoughts, feelings, and plans that lead to
drug use.
✓ Social Control- involves family members and other people important in helping individuals
avoid drugs. A parent or significant other attends program sessions when possible and assists
with assignments and reinforcing desired behavior.
According to research studies, these type of services help adolescents become drug free and increase their
ability to remain drug free after the program ends. Adolescents also show improvement in several other
Substance Abuse Council of Indian River County PREVENT! Cbildren Service's Advisory Committee
areas—employment/school attendance, family relationships, depression, institutionalization, and alcohol
use. Such favorable results are attributed largely to including family members in services and rewarding
drug abstinence as verified by urinalysis.
The second component will be Deep Impact-TARGET troupe. The Deep Impact-TARGET troupe actively
develops innovative and high energy skits related to life issues they and their peers are facing. The troupe
has created a collections of 35 different skits for performances. The troupe continues to develop skits
dealing with issues on substance abuseluse, dieting (anorexia and bulimia), HIV/AIDS , pregnancy and
violence and will reach approximately 6,000 individuals. The Deep Impact-TARGET troupe members
are mentors to other youth, as well as friends, family and neighbors within the community. Participants in
the Deep Impact-TARGET troupe need not have any previous acting experience, just a desire to
participate. In many cases, we find that high risk youth become the best performers. Their presentations
via improvisation is not acting, but is real and from the heart. 80% of the youth participating in the
troupe have never had any formal Maming in acting-
3.
ctin .3. 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 the Instructions) and
provide evidence that indicates proposed strategies are effective with target 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 findings 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. The National Institute in Drug Abuse (NIDA) indicates that three decades of
scientific research and clinical practice have yielded a variety of approaches to prevent drug addiction.
The PREVENT ! Program ncorporates those approaches into its program design.
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 PREVENT program will be staffed by one Council employee and one Licensed Mental Health
Counselor. The Program Coordinator assumes primary responsibility for the PREVENT ! program. An
Program Specialist is also assigned to this program and will dedicates 15% of the position' s time to the.
program. The Prevention Program Coordinator has had two (2) years of experience in the substance abuse
prevention field with extensive background in administration. The Program Specialist has an extensive
background in program coordination and evaluation. The 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
5. How will the target population be made aware of the program ?
The PREVENT! program awareness was designed with the target population in mind. Many different
marketing campaigns are utilized to make the community at large aware the services are available. The
program is open to all residents of Indian River County.
The Council promotes the use of the PREVENT! program via it's newsletters and brochures. Law
enforcement, school personnel, probation officers, student support specialist have all been briefed on the
PREVENT.1 program. The Council also recommends the PREVENT1 program to parents. Youth and
families can be referred to the PREVENT! program
, 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 for the
community. The PREVENT ! Program services occur Monday through Friday. Group sessions begin
either at 4 :30 p. m. or 6 : 30 p. m. to accommodate work and travel schedules. Individual appointments
accommodate the individual schedules. The Council office is located in Vero Beach and is open from
8 am. to 5 p. m.
�'3
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
D. MEASURABLE OUTCOMES (Description of Intent)
11
Use the Measurable Outcomes orm. This &EEnLyfion EW does not need to he included in the proposal
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 included:
• Direction of change • Time frame
• Area of change • As measured by
• Target population • Baseline: The number that you will be
• Degree of change measuring against
Example 1 (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 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 for 12 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.
E IPORTANT 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.
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
D. MEASURABLE OUTCOMES (Entire Section D not to exceed two pages)
OUTCOMES ACTIVITIES
Add all of the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s)
1 a. To provide PREVENT ! Individual and group
1 . To decrease the number of positive drug sessions to individual and families
screens among enrolled PREVENT ! participants We will provide a total of weekly 1 hour
by 80% over a 10 weeks as reported by random individual and group sessions on various substance
drug screen. abuse and resiliency skills building topics. Session
Baseline: Initial chug screening results prior to admission are based upon Behavioral Therapy for Adolescent
to Right Choice program. Program which focuses upon increasing protective
factors, decreasing risk factors, Stimulus Control, Urg
Control and Social Control
b. Conduct weekly random sampling of program
participants following four weeks in program.
lb. To create a system of substance abuse screening,
assessment and intervention for youth involved in
the PREVENT ! Program.
■ Heighten the youth' s awareness to :
➢ The realities of drug use
➢ Victim awareness education
➢ Legal consequences of drug and alcohol
uselpossession
Build external & internal protective factors of:
➢ Empowerment
➢ Boundaries & Expectations
➢ Positive values
➢ Social competency
➢ Positive Identity
2 . To increase audience knowledge of program 2. To provide factual, current and up-to-date
participants by 25% following Deep Impact- information via Deep Impact- TARGET sessions
TARGET educational presentation concerning concerning drugs and their harmful effects,
drugs and their harmful effects as reported by . pre/ post testing will be conducted and rated to
self-disclosure on pretesting. indicate a change in knowledge.
(Baseline: Individual and group administered Pre-tests of
forum participants.)
3 . To reduce self-reported high-risk behaviors 3T provide factual, current and up-to-date
responses reported by audience participants by information via Deep Impact- TARGET educational
20% following Deep Impact- TARGET sessions concerning high-risk behaviors and resulting
educational presentation forums. (Baseline: harmful effects.
Individual and group administered KABP (Knowledge, ■ Pre/post evaluations of the KABPs to indicate a
attitude, belief and practice] of forum participants.) change in participation in high-risk behaviors.
C
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory 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 4genc
y Resources provided to the program
Indian River School District Referrals to program
Mental Health Association
Children' s Home Society Referrals to program
Case management of Client Progress
Vero Beach School Resource Referrals to program
Officers
Sebastian Police Resource Officers
Indian River County Sheriff' s
Office
� 5la
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
F. PROGRAM EVALUATION (Entire Section F not to exceed two es
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 information 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 required to utilize the
State of Florida, Department of Children and Families, MA-SA (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 but 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 PREVENT ! Program. Clients may access
confidential Information and Referral services by the telephone, or in person. 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 staff and community.
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 tools 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 documented ?
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 PREVENT ! 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.
It is possible to measure the increase in knowledge directly related to the educational
presentation. Changes in attitudes, beliefs and practices take longer to manifest 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.
X1-1- 5q
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
3. REPORTING: What will you do with this information to show that change 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
58
Substance Abuse Council of Indian River County PREVENT! Children Service's Advisory Committee
G. TIlVIETABLE (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 mpleting the timetable, review information detailed in prior sections.
Month/Period Activities
October 2004- June Coordinate the PREVENT ! Program Schedule
2005
Coordinate delivery and implementation of the program
Coordinate the collection of program statistical data for evaluation.
Post testing following program completion.
December 2004 Compilation and evaluation of data for the I ' quarterly report
March 2005 Compilation and evaluation of data for the 2 d quarterly report
June 2005 Compilation and evaluation of data for the 3`d quarterly report
September 2005 Compilation and evaluation of data for the 4" quarterly and annual report
Ongoing collaboration with all collaborating agency on program progress,
October 2004- June obstacles and any other program responsibilities as they arise.
2005
Address any additional program responsibilities
-�- 5y
I 1 I 1 ❑ 1 I I . t I 1 1 • I11 fit' 1
Number of Undupficated • ' Location
� � 4 �, _ � � 4cf ,fie Ee '_�- � � 1 � iw :� •,�, � � �> � r .� � p- �
1 1 I c • 1 ( s6t � � 11A€ t ' � F d
;,..16 ��.-7. �_,ga..._.,,,o-� +� .. :�.._.X.T; � �.•1�"�?.'.2a.�_.�:�._�^�.�r.�.�w.-mss`3'"�Y�n.r-_-c:
11I I W, 1 i ►. I t 1 1 W, : 1 I : 1 ►. 1 1 1 1 : 1
11 1 1 • 1 1 , ■ • I/
:✓t : ■
u _ . _ . 1 I _ I 1 � 1 ■ ■■■
. i s
1 U,
Numberof Unduplicated Clients by Age
ry
� � � � • � } r t �� o' < YJ r
Budget 2003/04
07 RAMI Man 170 ,71
IT1.0 owl 11 R1114, 11FIRM
Substance Abuse Council of Indian River County PREVENT! Children Services Advisory Committee
BUDGET FORMS To open I Budget t II please l l 6 on the Won below.
yr�i ,
"Core Budget Forms"
Substance Abuse Council Community Education Program
United Way of IRC
UNIFORM GRANT APPLICATION
BUDGET NARRATIVE WORKSHEET
IMPORTANT: The Budget Nan-afive 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 Program Budget and Funder
Specific Budget Forms,
AGENCY/PROGRAM NAME : Substance Abuse Council of IRC
FUNDER: Children Services Advisory Committee PREVENT! Program
; CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should
� be used for calculations and to write information only. 1
QRAY AREAS FOR f-.. a • = ..
lr/ �( /
REVENUES AQeICYtR:E01LY �ejBHrc; 7d�fatlgcy
(SIIOFIOEYALi x
cucunYwRsy
ut1tvtge#
1 Children's Services CoundlSt. Lucie 0.00 0.001 0.00
2 Children's Services Council-Martin 0.00 0.00 0.00
3A"soryCommittee-indtanRiver 619500.00 611500.00 211500.00
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 Wayandian River County 0.00 0.00 42,000.00
7 Department of Children & Families 0.00 0.00 75,000.00
a County Funds 0.00 0.001 1 ,850.00
9 ContributionsoCash 0.00 0-001 55,000.00
10 Program Fees 0.00 0.001 40,000.00
11 Fund Raising Events-Net 0.00 0.00 40,000.00
12 Sales to Public - Net 0.00 0.001 8,000.00
13 Membership Dues 0.00 0.001 61500.00
14 Investment Income 0.00 0.001 800.00
15 Miscellaneous 0.00 0.00 0.00
16 Legacies & Bequests
0.00 0.00 0.00
17 Funds from Other Sources 0.00 0.00 3209200.00
18 Reserve Funds Used for Operating 0.00 0.00 0.00
19 ln4QW Donations (Not included in total) 0.00 0.00 0.00
20 TOTAL REVENUES
doesnl include line 19 $61 , 500.00 $61 ,500.00 800,850.00
d
EXPENDITURES MAY AREAE FOR Prrop+oseoi Total Program Funder cifrc Tvt41 Aggency
. AGBKYIIS£ OILY .I��- yp -
(SHOWCA.CUA ifI eii
21 Salaries - (must complete chart on next page) 31 .776.00 31 ,776.00 362 ,378.00
Salary
22 FICA - Total salaries x 0.0765 7.65% 2,430.86 2,430.86 27,721 .92
23 Retirement - Annual pension for qualified staff 3% 641 .00 641 .00 5.773.20
24 LifdHealth - MedicallDentaUShort-tern Disab. 41140.00 4, 140.00 36,000.00
25 Workers Compensation - # employees x rate 388.00 388.00 4,674.68
Florida Unemployment - # pr
26 employees x $7,000 x UCT-6 rate
0.00 0.00 0.00
SALARIES A
Gross Annual B D
POSITION LISTING Sala Poon of Salary on Proposed C % of Gross Annual
Salary Funder Specific Budget
Position Tide / Total HmAvk (Agency) Program Salary Pequested(VA)
snsrzooa
62
T
Substance Abuse Council Community Education Program United Way of IRC
Example: ExecutWeDirector/ 40hrs 702000.00 10,000.00 5,000.000
7. 14/0
Executive Director 40 hrs/ wk 557000.00 0.00 0.00 0.00%
Prevention Program Coordinator40 hrs I wk 40,800.00 0.00 0.00 0. 00%
Community Health Educator -35 hrs /wk/$14.50 26,390.00 0.00 0.00 0.00%
PREVENT Program Coordinator4o hrs / wk 287500.00 283500.00 283500.00 100,00%
Peer Educator- 12 hrs /wk / $9 5,616.00 0.00 0.00 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 177225.00 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 Coordinator40 hM4.00
28,500. 0.00 0.00 0.00%
HIV Program Assistant -40 hrs25,500.00 0.00 0.00 0.00°,6
Information Specialist- 30 hrs / 17,940.00 0.00 0.00 0.00%
HIV Peer Educator- 20hrs / wkf10,400.00 0.00 0.00 0.00%
Case Manager - 24 hrs / wk $117,472.00 0.00 0.00 0.00%
Program Speciafiat 30 hrs / w21 ,840.00 39276.00 31276.00 15.00°,6
0.00 0.00 #DIV/0!
0.00 0.00 #DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Remaining positiom ftoughout the agency
Total Salaries $3629378.00 $31 ,776.00 $31 ,776.00 8.77%
FRINGE BENEFITS DETAIL a
(Funder Specific Budget Funder s c n E F G
Column C only, from line 22 to 27) specffrc FICA 7;6594 ' 1 ° Worker's Uir�mployme Total fringes Funder
flealelr Ins.
Posidon ride / Total HrsAvk Budget ( ) Compens i t otripens SPec/frc
Eirmwk. Case illanager/40 /rs 5, 000-00 38350 2U0-00 50000 300.00 20000 f,58350
Executive Director -40 hrs/ wk 0.00 0.00 0.00 0.00 OAO 0.00 0.
Prevention Program Coordinator-40 hrs / wk 0.00 0.00 0.00 0.00 0.00 0.00 0.
Community Health Educator -35 hrs twM14.50 0.00 0.00 0.00 0.00 0.00 0.00 0.
PREVENT Program Coordinator-40 hrs / wk 281500.00 27180.25 641 .00 31600.00 367-65 0.00 6,788.
Peer Educator- 12 hrs /wk / $9 0.00 0.00 0.00 0.00 0.001 0.00 0.
Lifeskills Educator ( 1 ) - 33 hrs / wk/$ 13.75 0.00 0.00 0.00 0.00 0.001 0.00 0.
Lifeskills 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 hrs/wk /$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 V.0020.31
0.00 0.
Information Specialist- 30 hrs / wk/ $ 11 .50 0.00 0.00 0.00 0.00 0.
HIVPeer Educator- 20hrs / wk/ $ 10 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.
Program Specialiat 30 hrs / wk $ 14.00 3,276.00 250.61 0.00 54 0.00 810.9
0 0.00 0.00 0.00 0.00 0.00 0.00 0.
0 0.00 0.00 0.00 0.00 0.001 0.00 0.00
0 0.00 0.00 0.00 0.00 0.001 0.00 0.
0 0.00 0.00 0.00 0.001 0.001 0.
0 0.001 0.001 0.00 0.001 0.001 0.
Total wnderRequest Fringe Benefits $31 .776.00 $2,430.86 $641 .00 $4, 140.00 $387.96 $0.001 $77599.8
A B C D
EXPENDITURES GMYMMASFOR Proposed Total Program
AGHICY USEON.Y M Funder Speck Total Agency
MMDVrAL Budget Budget Budget,
27 Travel-Dally
11000.00 10000.00 24.000 .00
6 of Staff x average 6 of miles/wk x 50 wks x $ x .29=$1 ,015
= Estimated Daily Travel/Mileage Reimb. SWAT 310 utiles a month
5f25/2004 84
63
f
Substance Abuse Council Community Education Program
United Way of IRC
2E TravellConferenceslTraining 0.00 0.00
28 .000.00
• National Conference (cost per staff) FAQDA registration $250 Hotel
• Training/Seminar (cost per staff)
• Other Trainings (cost of travel, lodging, $150 per nigh x 3 nights =
$21 Per diem per day x 3 daysys == $63
mgt. fes) 250 miles x .29 = $72.50
29 Office Supplies 1 ,042.00 1 ,042.00 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 Telephone
600.00 600.00 129319.95
• # Phone lines x average cost per month x 12
12 months= $2688
months = local phone cost Pager $12 x 12months x 3 employees
• Average kxtg distance calls x 12 months Long distance charges $120 per month x
Estimated cost of " distance 12 months=1440 0.00
31 PostagelShipping 250.00 250.00 5,000.00
• Quarterly Mailing of Newsletter Bulk Mail $ 200 per month x 12
• Special events, etc. months 2400
Bulk mailings - appeals Bulk mail permit $300 0.00
32 Utilities 1 .000.00 10000.00 6,000.00
• Electricity ($ x 12 months)
• Water/Sewer ($ x 12 months) Utilities $333 per month x 12 months+
• Garbage ($ x 12 months) $4000
0.00
33 Occupancy (Building & Grounds) 61480.00 63480.00 25,000.00
• Mortgage/Rent ($ x 12 months)
• Janitorial ($ x 12 months) Rent $1919 a month x 12 months
• Grounds Maint. ($ x 12 months) LST 300 x 12 RC 200 x12 $930 rot
• Real Estate Taxes paid by grants 0.00
34 Printing & Publications 19000.00 1 ,000.00 47,500.00
• Quarterly Newsletter ($ 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 Organization FADDA $250 CADCA
• Dues $250
• Subscriptions to Newspapers/magazines, etc. Subscriptions $500 0.00
36 surance 0.00 0.00 12,000.00
• Directors/Officers Liab.
• Commercial/General Insurance Auto $7821
• Bond Ins.
- Auto Insurance Commercial Liability $1750
Employee Bond $500 0.00
37 Equipment:Rental & Maintenance 750.00 750.00 81000.00
opier x
• Meter lease ($ x 12 months)
• Copier Maintenance ($ x 12 months) Copier Main $150 x 12= 1800 DASIE
Computer Maintenance ( $ x 12 months) $50 x1200 Computer Main $100 x 12 =1200 Other (vehicle)
• Other $200 per month x 12 monttis=2400 0.00
38 Advertising 20000.00 2,000.00 15, 317.00
• Newspaper ads Ads $250 x 10=2500
• Fundraising ads/promotions other $500
• Other (vacancies) Promotions $2000 Billboards $4000 0.00
39 qu pmentrc ases:Capital Expense 0.00 0.00 1 2.000.00
• Computerfmonitor (# x )
• Laser Printer 2 computer systems w/ monitors $15o0 0.00
40 Professional Fees (Legal, Consulting) 0.00 0.00 3,000.00
• Legal advice ( estimated #hrs x $)
• Consultant fees
Other Consulting Fees $2,000 0.00
41 Books/Educational Materials 11503.00 1 ,503.00 51 .000. 00
M25=0a a-r
r
Substance Abuse Council Community Education Program
United Way of IRC
• BooksMdeos Videos $200 each x 10
• Materials ($ x staff) Eucationat materials S 42602 0.00
42 Food & NutritionIA 0.00 0.00 49195.00
Meals ( # meals x clients x 5days x 50 wks)
Snacks Yoatti sriar~ls0'a vrreeel� z,52 yreeks 0.00
43 Administrative Costs 0.00 0.00 0.00
•
Admin. Cost (% of total budget)
0.00
44 Audit Expense 0.00 0.00 9,000.00
Independent Audit Review y
45 Specific Assistance to Individuals
0.00 1 .000.00
. Medical assistance
Meals/Food
• Rent Assistance
• Other 0.
00
46 Other1Miscel9iWFms 0.00 0.00 11 ,471 .00
Background check/drug test
Other Drix} Sc ii t2its per Moral 0.00
47 OtherlContract
6,500.00 67500.00 64,500.00
for prim services
sr±s§iori perinFeek k0"w +4, 00 0.00
48 TOTAL EXPENSES 61 ,500.861 611500.86 8009850.74
($0.86)
5/25!2004 B-1
65
r
TWO ft Orgs aftn °nil Pr°g°m game
UNIFORM GRANT APPLICATION
TOTAL AGENCY BUDGET
AGENCYIPROGRAM NAME: Substance Abuse Council of Indian River county
FY 02103 FY 03/04 FY 04105 X INCREASE
FYE Sept 30 FYE Sept 30 FYE Sept 30 CURRENT VS.
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED (eat C-ca Byoa e
REVENUES B(D,�p BUDGETED
1 Children's Services Council-St =Lu7cie0.00 0.00 0.00 #DIV/0 !
2 Children's Services Council-Ma0.00 0.00 0.00 #DIV/0!
3 Advi Committeedndian Rive00.00 145,000.00 211 500.00 NNANN"45.86%4 United Wa St Lucie Coun0.00 0.00 0.00 #DIV/0
!
5 United Wa -Martin Coun0.00 0.00 0.00 #DIV/0!NNNNNNNNNNN
6 United Wa 4ndian River Coun , 0.00 78,000.00 42 000.00 -46.15%
7 Department of Children & Families 75,000.00 757000.00 75,000.00 0.00%
WEEN
8 County Funds 11850.00 1850.00 1850.00 0.00%
8 Contributions-CashNONE102,934.00 759000.00 WON 55 000.00 -26.67%
to Program Fees 54,461 .00 409000.00 40 000.00 0.00%
ENNENEW
11 Fund Raisi Events-Net 55 202.00 25 000.00 40 000.00 60.00%
12 Sales to Pubfio-Net 0.00 81000.00 800000 0.00%
mommINES
13 Membership Dues 49960.00 6,500.00 6500.00 0.00%
14 Investment Income 0.00 0.00 800.00 #DIV/0!
MEN
15 Miscellaneous MEN 0.00 0.00 0.00 #DIV/0!
MINEENEMN16 Legacies & Bequests MEN 0.00 0.000MINNEW .00 #DIV/O!
NNOMENNEEN
17 Funds from Other Sources 289 678.00 MIN 334 279.00 320 200.00 -4.21 %
18 Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/O! NNNNNN
19 In-Kind Donations (naciaeiva°dinta°0 0.00 0.00 0.00 #DN/0!
TOTAL 760958S,00 788t629.00 800w850.00 1 .55%
EXPENDITURES
21 Salaries 382.877.00 408 .00 362,378.00 -11 .28%
MENNEN
22 FICA 29,290.00 31 ,,7A5.00 27 721 .92 -11 .28%
WENN
23 Retirement 51526.00 71"8,00 5,773.20 -22.69%
24 IateA-feallh 25,200.00 25y200.00 36y000.00 42.86%
25 Workers Compensation 4.500NONE .00 : 4,860.00 4,674.68 3 .81
2s Florida Unemployment 0.00 59000,00 0.00 -100.00%
2r TravelZaily 1 054.00 21 ,380.00 24 000.00 12.257
28 TraveUConferences/Tr ' 32 039.00 249566.00 l � m28 000.00 13.98%
-NEENNEENWNw
29 Office Supplies 22,232.00 69600.00 24 000.00 263.64%
MEN WON
30 Telephone 13,345.00 139500.001 ME 12 319.95 -8.74%
31 Postage/Shipping Postage/Shipping31302WOMEN .00 4,220.00 5 000.00 18.48%
32 Utilities 3,415.00 4,000.006 000.00 50.00%
33 Occupancy Builth & Grounds 23,466.00 23,028.00 259000.00 8.56%
34 Printf 8 Publications 139899.00 41 ,400.00 47 500.00 14.73%
35 Subsc . s/Membersh' s MENEM 170.00 NNNNNNNNNNNNNNNNN% 19000.00 1 000.00 0.00%
ee Insurance 9V583.00 10 071 .00 12w000.00 19.15%
37 E ui ent:Rental & Maintenance 0.00 6000 8 000.00 33.33%
38 Advertising 0.00 12,779.00 1531700 19.86%
N NONE39 Equipment Purchases:Capitaf Expense 3,451 .00 3,000.00 12,000.00 300.00%
40 Professional Fees Consulting) 7,842.00 4000.00 30000.00 50.00%
MEN
41 Books/Educational Materials 67 099.00 500968.00'
51 000.00 0.06% .
42 Food 8 Nutrition 0.00 ON 1 ,560.001 NEENNOW 4195.00 168.91 %
43 Administrative Costs OAO 0.00 0.00 #DIV/0!
44 Audit Expense 0.00 79000.00 9 000.00 28.577
MEN45 Specific Assistance to Individuals 9v732.00 59000.00 1 °000.00 -80.00%
WIN
46 Other/Miscellaneous 11 ,320.00 61350,010 11 ,471 .0-0 80.65%
47 Other/Contract 61 ,010.00 62 000.00ENNIN
64 500.00 4.03%
48 TOTAL 741 ,352.00 788 629.00 800,850.74 1 .55%
MINEENNEWN
49 REVENUES OVER/ UNDER EXPENDITURES MEMNON19,233 .00 0.00 -0.74 #DIV/O!
SOW"
/ ez
(D
TYPe ft Orye mffi n wo Propan Nene
UNIFORM GRANT APPLICATION
TOTAL PROGRAM BUDGET
AGENCY/PROGRAM NAME: Prevent!
FY 02103 FY 03104 FY 04105 % INCREASE
FYE Sept 30 FYELSept 30 FYE Sept 30 CURRENT VS.
NEXT FY BUDGET
A B C D
ACTUAL TOTAL PROPOSED (cat C.ca BSL e
REVENUES BUDGETED BUDGETED
1 Children's Services Council-St Lucie 0.00 0.00 #DIV/0!
2 Children's Services Council-Martin 0.00 0.00 #DIV/01
3 Advisory Committee-Indian River 0.00 61 500.00 #DIV/O!
4 United Way-St Lucie County 0.00 0.00 #DMO!
5 United Wa Martin County 0 .00 0.00 #DIV/0!
6 United Way-Indian River County 0.00 0.00 #DIV/O!
7 Department of Children & Families 0.00 0.00 #DIV/0!
s County Funds 0.00 0.00 #DMO!
9 Contribudonscash 0.00 0.00 #DMO!
io Program Fees 0.00 0.00 #DIV/0!
11 Fund Raising Events-Net 0.00 0.00 #DIV/O!
12 Sales to Pubic-Net 0.00 0.00 #DMO!
13 Membership Dues 0.00 0.00 #DIV/0!
14 Investment Income 0.00 0.00 #DMO!
is Miscellaneous 0.00 0.00 #DIV/0!
16 Legacies & Beciuests 0.00 0.00 #DMO!
17 Funds from Other Sources 72 350.00 0.00 -100.00%
i9 Reserve Funds Used for Operating0.00 0.00 #DIV/O!
19 in-Kind Donations pwtr.N:r,d°dntou# 0.00 0.00 #DIV/0!
20 TOTAL 72 350.00 61 500.00 -15.00%
EXPENDITURES
21 Salaries 289460.00 31 776.00 11 .65%
22 FICA 2,177.00 21430.86 11 .66%
23 Retirement 0.00 641 .00 #DIV/O!
24 t.IfeMeallh 3,600.004140.00 15.00%
25 Workers Compensation 339.00 388.00 14.45%
Florida Unemployment 0.00 0.00 #DIV/O!
27 Travel 19500.00 17000.00 33.33%
2s TravellConferences/Tr ' . 0.00 0.00 #DIV/0!
29 Office Supplies 2AOO,O0 1 042.00 -56.58°
Telephone 39500.00 600.00 -82.86%
31 Postage/Shipping Postage/Shipping600.00 250.00 58.33%
32 Utilities 1 500.00 100000 -33.33%
33 Occupancy Bu & Grounds 6A80,00 6A80.00 0.00%
34 Printing & Publications 4500.00 100000 60.00%
35 Subsc ' slMendwsh s Z500.00 0.00 -100.00%
36 Insurance 000.00 0.00 -100.00%
37 EquipmentRental & Maintenance 1 500.00 750.00 50.00%
3s Advertising 1 620.002 000.00 23.46%
39 Equipment Purchases: Expense 2,600.00 0.00 400.00%
40 Professional Fees , Consulting) 0:00 0.00 #DIV/O!
41 Books/Educational Materials 2A74.001 1 503.00 -39.25%
42 Food & Nutrition 0.00 0.001 #DIV/0!
43 Administrative Costs 0.00 0.00 #DIV/O!
44 Audit Expense 0.00 0.00 #DIV/O!
45 Specific Assistance to Individuals 0.00 0.00 #DIV/O!
46 Other/Miscellaneous 0.00 0.00 #DIV/O!
47 Other/Contract 6 600.00 67500.010 -1 .52%
49 TOTAL 72,350.00 6150086 -15.00%
49 REVENUES OVER/(UNDER EXPENDITURES 0.00 0.86 #DIV/0!
s#zvzo 4 r1 9
t0
Type the Organization end Progam Name
UNIFORM GRANT APPLICATION
FUNDER SPECIFIC BUDGET
PROGRAM EXPENSES
AGENCYIPROGRAM NAME : Substance Abuse Council of Indian River County
FUNDER: CSAC A B c
FY 04/05 FY 04105 % OF
w TOTAL FUNDER TOTAL VS,
PROGRAM SPECIFIC FUNDER REQUEST
BUDGET BUDGET (col, B/col. A
EXPENDITURES
21 Salaries 31 ,776.00 319776 .00 100.00%
22 FICA 21430 .86 29430 .86 100.00%
23 Retirement 641 .00 641 .00 100.00%
24 Life/Health 41140.00 49140.00 100.00%
25 Workers Compensation 388 .00 388.00 100.00%
26 Florida Unemployment 0.00 0.00 #DIV/01
27 TraveWaily 11000.00 19000.00 100.00%
2a Travel/Conferences/Training 0.00 0.00 #DIV/0!
29 Office Supplies 19042.00 11042.00 100.00%
3o Telephone 600.00 600 .00 100.00%
31 Postage/Shipping 250.00 250.00 100 .00%
32 Utilities 19000.00 17000.00 100.00%
33 Occupancy( (Building & Grounds 69480.00 69480.00 100.00%
34 Printing & Publications 17000.00 19000.00 100 .00%
35 Subscription/Dues/Memberships 0.00 0.00 #DIV/0 !
36 Insurance 0 .00 0.00 #DIV/0 !
37 E ui ment: Rental & Maintenance 750 .00 750.00 100.00%
38 Advertising 29000 .00 29000 .00 100.00%
39 Equipment Purchases:Ca ital Expense 0.00 0 .00 #DN/01
40 Professional Fees (Legal, Consulting) 0200 0.00 #DIV/0 !
41 Books/Educational Materials 19503.00 1 ,503 .00 100 .00%
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 69500.00 61500.00 100.00%
48 TOTAL $61 ,500 .86 $61 ,500.86 100 .00%
5250M 84
•
_ �
S pi " tea_ - � -w.-'� �-,` ^_ . k „F'"".;• as- Y'�t 4'i. r a" 3^,3' € t "'€ d` 6 i
r.`u+ t r --'S• 3" -- _ i ._.
77
x:
. . . lf t
y
. .: t
L-7i - . i i
� t
i
- + e t
.. . t t
. . : e
. � t
UNIFORM •
EXPLANATION • OF OR • •
FUNDER SPECIRC BUDGET
AGENCYIPROGRAM
s..Y-._ .....�_ .....�..�.�T�.b„�r�„-4.t j .t x . .xs�k�, a'xrF...=�t»"'K-s>._.'�.:; 'u�`�,. ..,.....s.:S..k�...a.�a����.<...a..�:�_,.�..� � � .f� - 6
5 I * � � �lr -ff,tim ` i q ' r � � ���.. s� � � 6�--•+
AML
_' ■ �1 \ 1 �� � ►jam
• , ' !1 ,
t1I
' \ 1Y1 \Pubrwafmms 1 ' 1
JAMR11 ' o wr
a \ � \ ' 1
w mw
lY \ l , i1 �
. V � l� � ► \
. \ml Ilk
lodmic2sui■ �_
Das �tICT DIRECTOR
'= w: g _ aox noe
. ; EaLayer [ dent : fication Nu ■ aer :
Date :
: OLN :
1705304227008
ST PE7ERS HUMAN SERVIC _ S Contact Person :
INCORPORATES D . A _ DOWNING
C/ C REV ANBREU JEFFERSON Contact Telephone Number :
4250 ZBTH AVE ( 513 ) 241 - 5199
GiFraRD , FL 32967
Acccun ting Period Ending :
Auqus t 31
Farm 990 Required :
Yes
Addendum Applies :
Yes
Dear Applicant .
Based an information supplied , and assuminq your operations will be as
stated in your appLication for recognition of exemption , we have determined
You are exempt frog federal income tax under section 501 ( a ) of the Internal
Revenue Cade as an organization described in section 501 ( c ) ( Z ) .
We have further determined that you are not a private foundation within
the meaning of section 509 ( a ) of the Cade , because you are an organization
described in sections '09 ( x ) ( 1 ) and 1700 ) ( 1 ) ( A ) ( ii ) .
It your sources of support , or your purposes , character , or method of
Operation change , please let us know so we can consider the effect of the
change an your exempt status and foundation status . In the case of an amend .
rent to your organizational document or bylaws , please send us. a• COPY of the
amended document or bylaws . Also , you should inform us of all changes in your
name or address .
As of January 1 , 1984 , you are liable for taxes under the Federal
Insurance Contributions Act ( social security taxes ) on . remuneration of s100
or more you pay to each of your emplayees durinq a calendar year . You are
not Liable for the tax imposed under the Federal Unemployment Tax Act ( 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 4938 . 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 con tributory say rely an this determination un Less the
Internal Revenue Service publishes notice to the contrary . HCWever , if you
lose your section 509 ( a ) ( I ) status , a grantor or contributor .ay not rely
on this determination if he aro s .ne was in part responsible for , ar was aware
of , the act or failure to act. , or the substantial or material caange- an tn<
part of the argani : ation that resulted in your Iass of such status , or i.f he ar
she acquired knowledge that the Internal Revenue Service had given notice that
Letter 947 ( 00 / CS )
I
• Y r �b 7
. c -�- ScRV : Ccs
'ST PETERS HUMAN .
you would no longer be classi ` ied as a section 509 ( a ) ( L ) organ i : Ation
.
Donors may deduct contributions to you as provided in section L70 of the
Cade _ Bequests , legacies , devises , transfers , or gifts to you or for your use f
are deductible for federal estate and gift tax purposes if they meet the
Applicable provisions of Code sections 2055 , 2106 , and 252' . E
t
CCntriouticn deduCtions are allowable to donors only to the extent that
their contributions are gifts , with no consideration received . Ticket pur -
chases and similar payments in conjunction with fundraising events may not i
necessarily qualify as deductible contributions , depending on tie circ..*- i
stances . See Revenue Ruling 67 - 246 , published in Cumulative Bulletin 1967 - 2 , 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
participation in fundraising activities for charity . i
In the heading of this letter we have indicated whether you must file Fors
990 , Return of Organization �. xeept From Income Tax . If Yes is indicated , you
are required to file Fora 990 only if your gross receipts each year are
normally more than $ 25 , 000 . However , if you receive a Fora 990 package in the
mail , please file the return even if you do not exceed the gross receipts test .
If 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 normally
5249 , 000 or less , and sign the return .
If a return is required , it - oust be filed by the 15th day c -44thefifth
month after the end of your annual accounting period . A penalty of S20 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 SLO , 000 or
5 percent of your gross receipts for the year , whichever is less . For
organizations with gross receipts exceeding 51 , 000 , 000 in any rfaar , the penalty
is 5100 per day per return , unless there is reasonable cause for the delay .
The maximum penalty for an organization with gross receipts exceeding
; 1 , 000 , 000 shall not exceed 150 , 000 . This penalty may also be charged 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 exeoption application , any supporting
documents , and this exemotion letter . Failure to make these documents
available for public inspection may subject you to a penalty of . S20 per day
for eacn day there is a failure to comply ( up to a maximus of 5101000 in the
case of an annual return ) .
You are not required tc 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 - Texempt Organisation Business Income Tax Return . In this letter we are
,
not deteraininq wnetner any of your present or proposed activities are unrt-
lated trade or business as defined in section SLS of tae Code .
Le : ter 941 ( DO / Cori )
- 3 -
5; PETERS HUMAN SERVICcS
You need an emoloyer identification number even i ` you have no evclCyees .
If an ea6loyer identification number eras not entered on your a0plication , 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 ala 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 ) ( � ) of the Cade . 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
reczrds should shorn whether they are exempt under section 50L ( c ) ( 3 ) . In cases
where the recipient organization is not exempt under section 50L ( c ) ( .'+ ) , there
should be evidence that the funds will remain dedicated to the requLred
purposes and that they will be used for those purposes by the recipient .
If dist . ibutions are made to individuals , case histories regarding the
recipients should be kept showing names , addresses , purposes all 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 Ruling
U, 304 , C . B . I ? U6 2 , page 30b . )
If me 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 .it in your . permanent records .
If you have any questions , please contact the person whose name and
telephone number are shown in the heading of this letter .
SincarLsIy yours ,
District Director
Enclosure ( s ) :
Addendum '
Letter 94 ; ( DO / CG )
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 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 from 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 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 an employee) , 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 necessary . "
- 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 . 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 , 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 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 contained 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 / 04 Time : 10 : 18 AM To : 978 - 1798
Page : 001 - 002
C• ERTIFICAT OF LIABILITY INSURANCE' 11/1MM'DD.YYYY)
PRODUCER (�7z ) 2 -2$ a qX "(7 ;J2 , 2�"'33 Y/OS/2004
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 NOT AMEND, EXTEND OR
P . O . Box 3488 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
IL—Vero Beach , FL 32964 - 3488 INSURERS AFFORDING COVERAGE NAIL #
INsuRED Su stance A use Council o Inc i an River t`ounty iNS1 =Ea A: Colony Insurance
2501 27th Ave Ste A- 7 F Progressive Express 10193
Vero Beach , FL 32960 NAL >-e , a Commerce & Industtly Insurance
I N sit F-E E ,
VERAQFS
THE POiICIES CF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TriE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATED, NOTWITHSTANDIN
ANY REQUIREMENT, TERM OR CONDITION Or ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF CAT"E iMAY BE ISSUED OR
MAY PERTAIN , THE INSURANCE AFFORDED EY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIC
POLICIES AGGREGATE LIMITS SHO'AN MAY 1AVE BEEN REDUCED BY PAID CLAIMS . e;JS AND CONDITIONS OF SUCH
lNSR ADD TYPECFINSURANCE POLICY NUMBER POLICYEFFECTfVE POLICY EXPIRATION
LIMITS
LEIW�UILITY MP714134 04/01/2004 04/0112005 .;C I IaF
,IAL- �E� .TGfi - 1 , QQQ , QQ
� ArtA ,t H 50 , 00� :� r A_� E
A ti+E� 5 00
pFy4cNAL & 41' f N, _ -+ r 11000100
u DdFFfi+i. AGC , s1-I _ " 2 , 000 , 00
G .N . A33F r„-ELiv I AF" _ . -5 PERn: =� r:r EXCLUDE
ONF `OFA-z, �,
ILS kTo I _ ..
AUTOMOBILE LIABILITY CA0443 77464 02105/2004
ANY A., 1 02105 /2005 1VE%iN .�. I
EC NG;. E L. Lh7 ..
� _� acri �7e� t` ! �'
1 , 000 , 00
ALL �AWNrC' A11T 1S
61-CY -YIN , ;RY
B X �:_J-hDiiLEC� Aii - _ '
hItiEL� AUhB
FOL i IN, . ' RY
N (!N -CIJ'1NL . ' Al '� TOS
F5 a� .diYe rltl
GARAGELIASLITY I +--
A . iOON ' Y - -AACC CENT
�iT a r T IAN EA 4�
A._ U Of. : Y'.
EXCESSUMBRELLA LIABILItt --' --
EA::H
A��r,FE-GA?� 5
GED QCT 10L E . . . ._-
NETENTION S $
R
WORKERS COMPENSATION AND K3442796 01/10/2004 01/10/2005 `•ti'c �TA- L
EMPLOYERS' LIABILITY — c
�I� � Fn� � EI ,�N, ,� � � I,ExE�� � �E I
E. '�_, EAC'a Al - IE!•1? $ IOC , OG
rl Fi "FF MF �MF3Ea Fh �!I ?EC . _ �-�
des, 1 XPO? JrICI& E ' Di ^.EA 'c` EA EVIF, "rE,- S 1002410
OErPE`✓iSION _, belmn
OTHER
E .L. r ,ISEASE POU,' CVi ' v . ._. , y SQQ.,. tU -
DESCRIPTION OF OPERATIONS / LOCATIONS J V!: wXCLES ; EXCLUSIONS ARCED BY ENDG -t5EME.NT / SPECIAL PROVISIONS
Indian River County is also an additional insured pEr business liability coverage .
CA
W=iffirw TE DERCA FIL I Ar,
--
SHOULD ANY OF fHE ABOVE DESCRIBED POUCIE^a BE CANCELLED BEFORE THE
EXPIRATION DATE THL'9EOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL.
10 DAYS WRITTEN N. T! CE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT
The Board of County Commissioners
Attn : Marion BUT FAILURE TO MAIL SUCH tt OTICE SHALL IMPOSE NO OBLIGAT,
ION 1$ 40 25th street OF; LIABILITY
OFANYKINDUPON THE INSURER, ITS AGENT SORREPRESENTATIVES.
Vero &.ach , FL 3296.0 AUTHORIZED REPRESENTATIVE
Kenneth D . Felten , LUTCF LB
ACORD 25 (2001 ;08) FAX : 97 ; - 1798 cACORD CORPORATION 1986