HomeMy WebLinkAbout2015-130OIndian River County Grant Contract
This Grant Contract ("Contract") entered into effective this 1st day of October
2015 by and between Indian River County, a political subdivision of the State of
Florida; 1800 27th Street, Vero Beach FL, 32960 ("County") and
Giving Kidz A Chance, Inc 333 17th St Suite 0, Vero Beach, FL 32960 ("Recipient")
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 or proposals to the Children's Services Advisory
Committee, has applied for a grant or grants of money ("Grant" or "Grants") 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 or Grants 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 thei 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 or Grants The Recipient has been awarded a Grant for:
"Healthy Families and T L C Newborn";
The Grant or Grants shall be used only for the purposes set forth in the complete
proposal or proposals 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 or Grants is limited to
the fiscal year 2015-16 ("Grant Period"). The Grant Period commences on October 1,
2015 and ends on September 30, 2016.
- 1 -
4. Grant Funds and Payment The total approved funds for the Grant or Grants for the
Grant Period is $32,000.00. The approved funds for
Healthy Families - $20,000
and TLC Newborn - $12,000
The County agrees to reimburse the Recipient for each separate Grant from such
separate Grant funds for actual documented costs incurred for the separate Grant
Purposes provided in accordance with this Contract. Reimbursement requests may
be made no more frequently than monthly Each reimbursement request shall indicate
the applicable Grant and 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 or the Grants. In addition, the Recipient shall maintain adequate
records fully to document the use of the Grant of Grants 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. All records for each Grant shall be maintained
separately.
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, cumulative,
Performance Reports for each Grant 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 $100,000 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 its 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 October 1, 2015, 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
(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
- 3 -
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.
IN WITNESS WHEREOF, County and Recipient have entered into this Contract on the date
first above written.
INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS
B
Wesley S. Day , Chairman
Attest: Jeffrey R S Clerk of Courts
Bv:
Co r
Approved:
Deputy C
C3(4 „
Jos ph A. Baird
County Administrator
Approved as to form and legal sufficiency.
Ian Reingold, County Attorney
RECIPIENT.
By: dt °__
tm ; e. 2-ed.mcn
G iv►03 Kidz A CHANCE
AGENCY NAME;
- 4 -
PROGRAM COVER PAGE
Organization Name: Giving Kidz A CHANCE, Inc.
Executive Director: Beth Dingee
Address: 333 17`h Street Suite 0
Vero Beach, Florida 32960
Program Director: Beth Dingee
Address: 333 17th Street Suite 0
Vero Beach, Florida 32960
Program Title: Healthy Families of Indian River County
Priority Need Area Addressed: Builds parents capacity for expectant mothers and fathers
experiencing high levels of stress and risk factors..
Brief Description of the Program: PH6100.3300 Home Based Parenting Education: Healthy Families
is a voluntary home visitation program that targets families with past or current emotional trau_ma_o r
-domestic violence. -The -program is rover to pre -Vent child abuse and neglect by promoting P P g positive
parent-child relationships. The staff are highly trained to provide intensive, comprehensive, long-term,
and culturally appropriate services to reduce children's exposure to toxic stress.
SUMMARY REPORT — (Enter Information In The Black Cells Only)
Giving Kidz A Chance, Inc.
Healthy Families of Indian River County
Children's Services Advisory Committee
E-mail:l kacacomcast.net
Telephone: 772-925-9234
Fax: 772-778-1340
E-mail: bdingee@hfirc.org
Telephone: 772-778-1323
Fax: 772-778-1340
Amount Requested from Funder for 2015/16:
Total Proposed Program Budget for 2015/16:
Percent of Total Program Budget:
Any Current Program Funding from THIS Funder (2014/15):
Dollar increase/(decrease) in request:
Percent increase/(decrease) in request **:
Unduplicated Number of Children to be served Individually:
Unduplicated Number of Adults to be served Individually:
Unduplicated Number to be served via Group settings:
Total Program Cost per Client:
$35,000.00
$372,920.00
9.4%
$ 10,000
$ _
0.0%
106
3518.11
**If request increased 5% or more, briefly explain why: This state agency requires a match 25%
$80,500 of total funds.
If these funds are being used to match another source, name the source and the $ amount: Ounce of
Prevention is ourprimary source for funds. .
The Organization's Board of Directors has approved this: application on (date). April -2015
F.milie_Redmon
Name of President/Chair, of the Board
Elizabeth Diane
Name of Executive Director/CPO
2
PROGRAM COVER PAGE
Organization Name: Giving Kidz a Chance, Inc
Executive Director: Elizabeth Dingee
Address: 333 17th Street Suite 0
Vero Beach, Florida 32960
Program Director: Cheryl Whitney
Address: 333 17`h Street Suite R
Vero Beach, Florida 32960
Giving Kidz A CHANCE, Inc.
TLC Newborn
Children's Services Advisory Committee
E-mail:gkac(a,comcast.net
Telephones: 772-925-9234
Fax: 772-778-1340
E-mail: chewhi2007(a,gmail.com
Telephone: 772-925-9182
Fax: 772-778-1340
Program Title: TLC (Touch, Love, Communicate) Newborn Focus Area: New Parent Assistance
for infant nutrition and early infant brain development.
Brief Description of the Program: The TLC Newborn program promotes and encourages bonding
activities ofparents with their newborn babies including successful principles of breast feeding,
reading early to infant and monthly newsletters of development milestones. TLC Newborn provides
-parents with infant safe sleeping practices to avoid accidental infant deaths and injuries.
SUMMARY REPORT —
Amount Requested from Funder for 2015/16:
Total Proposed Program Budget for 2015/16:
Percent of Total .Program Budget:
Any Current Program Funding from THIS Funder (2014/15):
$
$12,000.00
$92,562.00
13.0%
10,000
Dollar increase/(decrease) in request:
$
-
Percent increase/(decrease) in request **:
0.0%_
Unduplicated Number of Children to be served Individually:
960
Unduplicated Number of Adults to be served Individually:
Unduplicated Number to be served via Group settings:
-
Total Program Cost per Client:
96.42
**If request increased 5% or more, briefly explain why: N/A
If these funds are being used to match another source, name the source and the $ amount: N/A
The Organization's Board of Directors has approved this application on (date). April 15. 2015
Emilie Redmon
Name of President/Chair of the Board
Elizabeth Dineee
Signature
Cif.,
Name of Executive Director/CPO S'ig'natufe
2
I
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 15t 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 for each separate Grant 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. If applicable, separate reimbursement requests
must be made for each separate Grant.
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 "
- EXHIBIT B -
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:
Recipient:
Brad E. Bernauer, Director
Indian River County Human Services
1800 27TH Street
Vero Beach, Florida 32960-3365
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.
- EXHIBIT C -
•
o
00
0=
0=
o=
ao
008083
i'Wjy,‘ FLORIDA 11ORKEIVO PENSATrN
JOWT LPIDERNRFTNG ASSOCIAI ON, INC.
INSURER: FLORIDA W.C. JUA
1.
INSURED:
GIVING KIDZ A CHANCE INC
333 17TH STREET STE 0
VERO BEACH FL 32960
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6FR13UB-7D75634-1 -15 )
RENEWAL OF (6FR13UB-7D75634-1-14)
NCCI CO CODE: 80179
PRODUCER:
VERO INSURANCE INC DBA
3339 CARDINAL DR
VERO BEACH FL 32963
Insured Is a A CORPORATION
Other work places and Identification numbers are shown in the schedule(s) attached.
2. The policy period is from 06-27-15 to 06-27-16 12:01 A.M. at the insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) Ilsted here:
FL
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work In each state Ilsted In
item 3.A. The limits of our liability under Part Two are:
Bodily Injury by Accident: $
Bodily Injury by Disease: $
Bodily Injury by Disease: $
500000 Each Accident
500000 Policy Limit
500000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here:
SEE ENDORSEMENT FWCJUA 03 01
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating
Plans. All required information is subject to verification and change by audit. ANNUALLY.
DATE OF ISSUE: 06-29-15 WC ST ASSIGN: FL
OFFICE: FLORIDA WC JUA 821
PRODUCER: VERO INSURANCE INC DBA 2374L Page 1 of 1
A� D' CERTIFICATE OF LIABILITY INSURANCE
°";,,, 14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
HOLDER. THIS
BY THE POLICIES
AUTHORIZED
IMPORTANT: (1 the Certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. H SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require en endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER Phone: (772)492-8187 Fax (772)482-8192
TRUSTED INSURANCE PROFESSIONALS, LLC
87 ROYAL PALM -POINTE
VERO BEACH FL 32960
INSURED
GCtfrAcT Trusted Insurance Professionals, LLC
(PI
NC b.F,41: 1492-8187 tt too: (772) 492-8192
AADD�RES&
INSURERS) AFFORDING COVERAGE
NAIC I
INSURERA Underwriters at Lloyd's of London
uAeam'
COMMERCIAL GENERAL
INDIAN RIVER HEALTHY START COALITION, INC.
33317TH STREET SUITE 2R
VERO BEACH FL 32960
novenAnre nrnr,ra.. a rr ann.nr..-
INSURER 8
INSURER C .
ME0150540114
J•
---
INSURER D:
11/04/15
INSURER E :
INSURER F
-
W AAGE tokens.)
ens.)
_ .__.___ ncVplUP1 WW1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD
NDICATED. NOTWRHSTANDNO ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSONS AND CONDITIONS OF SUCH POLICI: LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
DSR
LIR
TYPE OF INSURANCE
ADMatBR
DOR
MVD
POUCY NUMBER
POLICY EFF
POLICY ECP
LIMITS$
A
GENERAL
X
uAeam'
COMMERCIAL GENERAL
X
NUBILITY
OCCUR
ME0150540114
J•
---
11/04/14
11/04/15
EACH occuFiRENco
1,000,000
W AAGE tokens.)
ens.)
$
en
50 ,E
CLANS -MADE
PREMISES (Ea oocua+ca)
MED. EXP (Arty ene person)
S
5,000
PERSONAL 8 ADV INJURY
S
S
1,000,ODi)
3,000,0Q0
.
GENERAL AGGREGATE
GENT_ AGGREGATE LJMIT APPLIES PER:
-I�ncr.n�WC
PRODUCTS - COMP/DP AGG
S
1,000000
.-
$
.
_AUT
—
_
LE
ANY AUTO ANY
ALL OWNED —
AUTOS—
SCHEDULED
AUTOS
NED
AUTOS
CDIr@OBINDLEED BLE LMer
accident)
$
BODLY INJURY (Per Person)
:
BODLY INJURY (Per. =Went)
S
HIRED AUTOS—
Meier/ OANAGE
(ow =Mang$
$
_
UMBRELLA tuB
EXCESS usa .
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
1
_
AGGREGATE
S
DED RETENTIONS
$
WOSIOSS CAMPEIBATIN
AND EMPL018tff LIABLIY
AN PROPRMTTTORTPARIER/EXEcUTNE
OFMCER8 M IEA EXCLUDED?
(Mandatory b NO
e Yea, durnba under
DESCRIPTION OF OPERATX:rB Woo
Y! N
M/A
WCSTATU- OTH
TORY LOATS ER
•$
B.L. EACH ACCL ENT-
S
El. DISEASE -EA EMPLOYEE
S
E.L DISEASE -POLICY LIMIT
S
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach ACORD 101, Addltlonei Renmrts Schedrde, If mere spans Is required)
POLICY INCLUDES: HIRED NON OWNED AUTO LIABILITY $1,000,000, PROFESSIONAL LIABILITY $3,000,000, SEXUAL ABUSE/MISCONDUCT
$3,000,000
CIFGTIFICATF IXII nro .....__.. ._. _..
INDIAN RIVER HEALTH START COALITION, INC.
333 17TH STREET SUITE 2R
VERO BEACH, FL 32980
Attentlon:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AVniCRQED. REPRESENTATIVE
'ACORD 25 (2010/05)
Jacqueline K.•Savelt
1988-2010 A RD CO PORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CO
t
HISCOX
Effective With UNDERWRITERS AT LLOYD'S, LONDON
Administered by Hiscox Inc.
520 Madison Avenue 32i° Floor, New York, NY 10022
(648) 462-2353
Insurance for Allied Healthcare Professionals
DECLARATIONS
THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS ONES LAW. PERSONS INSURED BY SURPLUS LINES
CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA INSURANCE GUARANTY ACT TO THE EXTENT OF ANY
RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNUCENSED INSURER.
SURPLUS LINES INSURERS' POLICY RATES AND FORMS ARE NOT
APPROVED BY ANY FLORIDA REGULATORY AGENCY.
Broker No.: US 0000114 American Professional Liability Underwriters
Inc (Gabor Insurance)
Certificate No.: ME01505401.14 7270 NW 12th St Ste 700 ROM^a ITEM GABOR
7770 tm 12STREET
Renewal of: NEW Miami, FL 33126-1929 'WitRD IA33s
m�HAanamAaun
SWUM IDCS AGENT • A00IM7
PROCIUMG ABM
1. Named Insured:
Address:
2. Policy Period:
3. General terms and
conditions wording:
Indian River Healthy Start Coalition Inc & Healthy Families of Indian River
33317th St Ste 2R
Vero Beach, FL 32960-7100
JACKIE SAVELL
ST ROYAL PALM PONTE
VENO BEACH, FL 32960
Inception Date: 11/04/2014 Expiration Date: 11/04/2015
Inception date shown shall be at 12:01 A.M. (Standard Time) to Expiration date shown above at
12:01 A.M. (Standard Time) at the address of the Named Insured.
WCL P0001 CW (05/13)
The General terms and conditions apply to this policy in conjunction with the specific wording
detailed in each section below.
4. Endorsements: E6002.1 - Florida Amendatory Endorsement, E6015.2 - Lloyd's Syndicate, E6016.1 - Service of
Suit, E6017.2 - Nuclear Incident Exclusion Clause -Liability -Direct (Broad) Endorsement. E6018.2
-Applicable Law Endorsement, and E6020.2 - War and Civil War Exclusion Endorsement
6. Optional Extension 12/24/36 months at 75/150/225 percent of the annual premium.
Period:
6. Notification of
claims to:
Hiscox Claims
520 Madison Avenue, 32nd floor
New York, NY 10022
Fax: 212-922-9652
Email: HiscoxClaims@Hiscox.com
POLICY FEE:
5% STATE TAX:
FSLSO FEE:
FHCF:
7. Policy Premium: $4.094 Administration Fee: N/A State Surcharge: N/A
quo
$2128.413
Allied Healthcare Professional Liability Claims -Made and Reported Coverage Part: WCLAHC P0001
CW (01/13)
Covered Professional Services: Solely in the performance of providing community health advocacy/education services.
THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES
LAW. PERSONS INSURED BY suRPL{$ LINES CARRIERS OO HOT HAVE THE
PROTECTION OF THE FLORIDA M$LFUJCE GWRANTY ACT TO THE EXTENT
OF ANY RIGHT OF RECOVERY FOR THE OeUGATIOH OF AIN INSOLVENT
UNLICENSED INSURER.
Requazi, S. 4a.bow-
Page 1 or 3
463
HISCOX
Effective with UNDERWRITERS AT LLOYD'S, LONDON
Administered by Hiscox Inc.
520 Madison Avenue 32nd Floor, New York, NY 10022
(646) 452-2353
Insurance for Allied Healthcare Professionals
DECLARATIONS
THIS INSURANCE IS ISSUED PURSUANT TO THE FLORIDA SURPLUS LINES LAW. PERSONS INSURED BY SURPLUS LINES
CARRIERS DO NOT HAVE THE PROTECTION OF THE FLORIDA INSURANCE GUARANTY ACT TO THE EXTENT OF ANY
RIGHT OF RECOVERY FOR THE OBLIGATION OF AN INSOLVENT UNLICENSED INSURER.
SURPLUS LINES INSURERS' POLICY RATES AND FORMS ARE NOT
APPROVED BY ANY FLORIDA REGULATORY AGENCY.
Broker No.: US 0000114 American Professional Liability Underwriters
inc'(Gabor Insurance) -
Certificate No.: MEO1505401.14 7270 NW 12th St Ste 700 a01""emu GABQ+
Renewal of: NEWMOM Nn�T
Miami, FL 33126-1929 USed AGOG' A1291847
PRODGGGI6 AGENT:
1. Named Insured: Indian River Healthy Start Coalition Inc & Healthy Families of Indian River JACKE SAVELL
87 Address: 333 17th St Ste 2R V O BEACyAL H. FLPOINTE
VERO BEACH, FL 32980
Vero Beach, FL 32960-7100
2. Policy Period: Inception Date: 11/04/2014 Expiration Date: 11/04/2015
Inception date shown shall be at 12:01 A.M. (Standard Time) to Expiration date shown above at
12:01 A:M. (Standard Tune) at the address of the Named Insured.
3. General terms and
conditions wording:
WCL P0001 CW (05/13)
The General terms and conditionsapply to this policy in conjunction with the specific wording
detailed in each section below.
4. Endorsements: E6002.1 - Florida Amendatory Endorsement, E6015.2 - Lloyd's Syndicate, E6016.1 - Service of
Suit, E6017.2 - Nuclear Incident Exdusion Clause -Liability -Direct (Broad) Endorsement, E6018.2
- Applicable Law Endorsement, and E6020.2 - War and Civil War Exclusion Endorsement
5. Optional Extension 12/24/36 months at 75/150/225 percent of the annual preinium.
Period:
6. Notification of
claims to:
Hiscox Claims
520 Madison Avenue, 32nd floor
New York, NY 10022
Fax: 212-922-9652
Email: HiscoxCiaims@Hiscox.com
POLICY FEE
5% STATE TAX:
FSLSO FEE.
FHCF:
7. Policy Premium: $4,094 Administration Fee: N/A State Surcharge: N/A
MUG
am
Allied Healthcare Professional Liability Claims -Made and Reported Coverage Part: WCLAHC P0001
CW (01/13)
Covered Professional Services: Solely in the performance of providing community health advocacy/education services.
THS INSURANCE IS ISSUED PURSUANT To THE A.ORIOA StRPL.U9 LINES
LAW. PERSONS IIID BY SURPLUS UNES CARRIERS 00 NOT HAVE THE
PROTECTION OF THE FLORIDA INSURANCE GUARANTY ACT TO THE EXTENT
OF ANY RIGHT OF RECOVERY FOR THE OBLIGATION OF ANY INSOLVENT
UNLICENSED INSURER.
Ro+1a.4.4 S. Gabor
PLige 1 of 3
o=
Oi=
N-
o=
Oa
e---
0080B3
i=
008083
A FLORIDA WORKERS'COMPENSATION
JOINT UNDERWRITING ASSOCIATION, INC.
INSURER: FLORIDA W.C. JUA
1.
INSURED:
GIVING KIDZ A CHANCE INC
333 17TH STREET STE 0
VERO BEACH FL 32960
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6FR13UB-7075634-1 -15 )
RENEWAL OF (6FR13UB-7D75634-1-14)
NCCI CO CODE: 80179
PRODUCER:
VERO INSURANCE INC DBA
3339 CARDINAL DR
VERO BEACH FL 32963
Insured Is a A CORPORATION
Other work places and identification numbers are shown in the schedule(s) attached.
2. The policy period is from 06-27-15 to 06-27-16 12:01 A.M. at the insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
FL
B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work In each state listed in
item 3.A. The limits of our liability under Part Two are:
Bodily Injury by Accident: $ 500000 Each Accident
Bodily Injury by Disease: $ 500000 Policy Limit
Bodily Injury by Disease: $ 500000 Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here:
SEE ENDORSEMENT FWCJUA 03 01
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE
4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating
Plans. All required Information is subject to verification and change by audit.. ANNUALLY.
DATE OF ISSUE: 06-29-15 WC ST ASSIGN: FL
OFFICE: FLORIDA WC JUA 821
PRODUCER: VERO INSURANCE INC DBA 2374L Page 1 of 1