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HomeMy WebLinkAbout2016-096B Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2016 by and between Indian River County, a political subdivision of the State of Florida, 1800 27th Street, Vero Beach FL, 32960 ("County") and the Indian River County Healthy Start Coalition, 333 17"' St. Suite 2R, Vero Beach, FL 32960. For"Parents as Teachers", "Belly Beautiful", "TLC", "Healthy Families" 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 2016/17 ("Grant Period"). The Grant Period commences on October 1, 2016 and ends on September 30, 2017. 4. Grant Funds and Payment The approved Grant for the Grant Period is (Total Dollar Amount of $68,000.00), "Belly Beautiful $6,000", "Parents as Teachers $30,000", "TLC $ 12,000", "Healthy Families $20,000". The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for Grant - 1 - 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, cumulative, 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. These reports should include but not limited to the number of unduplicated children served during the quarter, and the progress the agency has made toward meeting their goals and objectives as they stated in their RFP response. 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 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 County 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, 2016, 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) (iv) In the event that children are supervised, Sexual Molestation Liability Insurance in an amount not less than $1,000,000 each occurrence/claim. 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 1191 Florida Statutes (Public Records Law).. The Recipient shall comply with Florida's Public Records Law. Specifically, the Recipient shall: (1) Keep and maintain public records that ordinarily and necessarily would be required by the County in order to perform the service. (2) Provide the public with access to public records on the same terms and conditions that the County would provide the records and at a cost that does not exceed the cost provided in chapter 119 or as otherwise provided by law. 3 - public records that are exempt or confidential and exempt from public records disclosure requirements. All records stored electronically must be provided to the County in a format that is compatible with the information technology systems of the County. Failure of the Recipient to comply with these requirements shall be a material breach of this Agreement. 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. 9. Sovereign Immunity. Nothing herein shall constitute a waiver of the County's sovereign immunity. IN WITNESS WHEREOF, County and Recipient have entered into this Contract on the date first above written. INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONER%�M S*""'j�Rs.... 4L .. Dated: June 21, 2016 By: Commissioner Bob Solari, Chair n Attest: Jeffrey R Smit Clerk of Co Comptroller ••�����A N R IVEa��J� . D, y er Approved: J son rown Coun y A inistrator Approved as to form and legal sufficiency: Dylan Reingold, County Attorney RECIPIENT: / By: Andrea Berry, Executive Director AGENCY NAME: Indian River County Healthy Start Coalition - 4 - Indian Riva County Healthy Start Coalition,Inc. BELLY BEAUTIFUL Children's Service Advisory Committee PROGRAM COVER PAGE Organization Name: Indian River Counly Healthy Start Coalition Inc Executive Director: Kathleen Cain E-mail: Kathie a,irchealthystart.org Address: 333-170' Street, Suite 2R Telephone: 772-563-9118 Vero Beach, FL 32960 Fax: 772-563-9125 Program Director:_ Linda Roberts(PIWH at IRMC) E-mail: verodoula(a),vero.com Address: 1050-37h Place, Suite 101 & 102 Telephone: 772-770-6116 Vero Beach, FL 32960 Fax: 772-564-6120 Program Title: BELLY BEAUTIFUL Priority Need Area Addressed:_ Building parent capacity and improvinghealth prenatally for families to experience positive birth outcomes Brief Description of the Program: Taxonomy: PN8100.6500: Parent/Family Support Groups PH6100.1800-900: Teen Expectant/New Parent Assistance The Belly Beautiful program educates first-time; second time, teen mothers and fathers on topics related to healthy preggancy, peaceful childbirth and infant care. The group classes increase social support and health literacy among young families. The program is offered at IRMC and Gifford Youth Achievement Center. SUMMARY REPORT—(Enter Information In The Black Cells Only) Amount Requested from Funder for 2016/17: $ 6,000.00 Total Proposed Program Budget for 2016/17: $ 41,740.00 Percent of Total Program Budget: 14.4% Current Program Funding (2016/17): $ 6,000 Dollar increase/(decrease) in request: $ _ Percent increase/(decrease) in request ** 0.0% Unduplicated Number of Children to be served Individually: _ Unduplicated Number of Adults to be served Individually: _ Unduplicated Number to be served via Group settings: 335 Total Program Cost per Client: 124.60 **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 18,201 t5 P.Glenn Tremml,M.D. AD 0 Name of President/Chair of the Board Signature Kathleen Cain ` Name of Executive Director/CPO Signature 2 Indian River County Healthy Start Coalition PARENTS AS TEACHERS Children's Services Advisory Committee PROGRAM COVER PAGE Organization Name: _Indian River County Healthy Start Coalition Executive Director: Kathleen Cain E-mail:kathie(i,irchealthystart.org Address: 333 17th St. Suite 2R Telephone: 772-563-9118 Vero Beach, FL 32960 Fax: 772-563-9125 Program Director: Kristen Crocker E-mail: Kristen.crockerairmc.cc Address: 1000 361 Street Telephone: 772-567-4311 Vero Beach, FL 32960 Fax: 772-564-2415 Program Title: Parents As Teachers Priority Need Area Addressed: Building Parent Capacity for nurturing child development from birth to three years of age specifically, targeting families living in poverty in Vero Highlands and Gifford. Brief Description of the Program: Taxonomy_PH6100.3300: Home Based Parenting Education. The goal of the evidenced–based Parents As Teachers (PAT) Program is to provide low-income parents with skills to maximize their child's cognitive social, and emotional development during the most critical period of brain growth birth to three Years. Staff will screen children regularly for developmental delays and health issues. The program long—term goal is to increase children's readiness for kindergarten. SUMMARY REPORT—(Enter Information In The Black Cells Only) Amount Requested from Funder for 2016/17: $ 30,000.00 Total Proposed Program Budget for 2016/17: $ 161,962.88 Percent of Total Program Budget: 18.5% Current Program Funding (2015/16): $ 30,000 Dollar increase/(decrease) in request: $ - Percent increase/(decrease) in request ** 0.0% Unduplicated Number of Children to be served Individually: 53 Unduplicated Number of Adults to be served Individually: Unduplicated Number to be served via Group settings: Total Program Cost per Client: 3055.90 **If request increased 5%or more, briefly explain why: If these funds are being used to match another source, name the source and the $ amount: The Organization's Board of Directors has approved this application on(date). April 18,2016 P. Glenn Tremml, M.D. / r77� Name of President/Chair of the Board Signature Kathleen Cam C� Name of Executive Director/CPO Signature 2 J F q*1vih$ idz a CHA CE Brad Bernauer, Director Indian River County Human Services Department 4675 28th Ct. Vero Beach, FL Mr. Bernauer, Thank you for your partnership with our organization. We are confident in the progress the of Healthy Start Coalition and their collaboration with Indian River Medical Center and Tykes & Teens to manage Healthy Families Indian River County and TLC Newborn. As such, we would like to request that our grant contract submitted for the 2016-2017 year be assigned to Indian River County Healthy Start Coalition. Thank you, l� Emilie Redmon Chair, GKAC The mission of Giving Kidz a CHANCE is to strengthen efforts in a community-based approach to ensure all Indian River County infants and young children have access to health core and necessaryfamily support services for them to have a CHANCE in normal development and growth. 333 171h St. Suite 0 o Vero Beach, FL 32960 o 772-925-9324 Giving Kidz A CHANCE,Inc. TLC NEWBORN Children's Services Advisory Committee PROGRAM COVER PAGE Organization Name: Giving Kidz a CHANCE, Inc Executive Director: Brieanna Fernandez, Admin Coordinator E-mail:gkacAcomcast.net Address: 333 170i Street Suite 2S Telephones: 772-925-9234 Vero Beach, Florida 32960 Fax: 772-778-1340 Program Director: Cheryl Whitney E-mail: chewhi2007Agmail.com Address: 333 17th Street Suite R Telephone: 772-925-9182 Vero Beach, Florida 32960 Fax: 772-778-1340 Program Title: TLC (Touch, Love, Communicate)Newborn Focus Area: Early Childhood Development:New Parent Assistance for infant nutrition and earlinfant brain development. Brief Description of the Program: (Taxonomy: LJ-5000.1000: Breastfeeding Support Program) The TLC Newborn program promotes and encourages bonding activities of parents 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— Enter Information In The Black Cells Only) Amount Requested from Funder for 2016/17: $12,000.00 Total Proposed Program Budget for 2016/17: $109,597.00 Percent of Total Program Budget: 10.9% Any Current Program Funding from THIS Funder (2015/16): $ 12,000 Dollar increase/(decrease) in request: $ - Percent increase/(decrease) in request **: 0.0% Unduplicated Number of Children to be served Individually: 990 Unduplicated Number of Adults to be served Individually: Unduplicated Number to be served via Group settings: - Total Program Cost per Client: 110.70 **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 19.2016 Emilie Redmon 4 Name of President/Chair of the Board Signature Brieanna Femandez 'fiA A- di A Alk(I Name of Executive Director/CPO Signature 2 GiAng Kidz A CHANCE,Inc. HEALTHY FAMILIES Children's Services Advisory Committee PROGRAM COVER PAGE Organization Name: Giving Kidz A CHANCE Inc Executive Director: Brieanna Fernandez, Admin Coordinator E-mail: gkac64comcast.net Address: 333 17th Street Suite 2S Telephone: 772-925-9234 Vero Beach, Florida 32960 Fax: 772-778-1340 Program Director: Brieanna Fernandez E-mail: bfernandezna,hfirc.org Address: 333 17th Street Suite 2S Telephone: 772-778-1323 Vero Beach, Florida 32960 Fax: 772-778-1340 Program Title: Healthy Families of Indian River County Priority Need Area Addressed: Builds parents' capacity beginning with expectant mothers and fathers experiencing high levels of stress and risk factors and continuing through until the child is five years of age. 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 trauma or domestic violence. The program is proven to prevent child abuse and neglect by promoting 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) [Any mount Requested from Funder for 2016/17: $20,000.00 otal Proposed Program Budget for 2016/17: $353,880.00 ercent of Total Program Budget: 5.7% Current Program Funding from THIS Funder (2015/16): $ 20,000 Dollar increase/(decrease) in request: 0 Percent increase/ decrease in request ** 0.0% Unduplicated Number of Children to be served Individually: 102 Unduplicated Number of Adults to be served Individually: Und licated Number to be served via group settings: I - Total Program Cost per Client: 3469.41 **If request increased 5%or more,briefly explain why: If these funds are being used to match another source, name the source and the$ amount: Ounce of Prevention, Florida Department of Children and Families The Organization's Board of Directors has approved this application on(date). April 19,2016 Emilie Redmon CcA dllrvl � Name of President/Chair of the Board Si nature Brieanna Fernandez i Name of Executive Director/CPO S gnature 2 l 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 1s' 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 301h) 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." - 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: Brad E. Bernauer, Director Indian River County Human Services 1800 27TH Street Vero Beach, Florida 32960-3365 Recipient.- 2. ecipient: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 - ACC)R" CERTIFICATE OF LIABILITY INSURANCE 3/22/2016 DATE `. �D",rrr' 0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an 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)492-8192 CONTACTTrusted Insurance Professionals,LLC TRUSTED INSURANCE PROFESSIONALS,LLC NP1K 87 ROYAL PALM POINTE AP Exi: (772)492-8187 AF C (772)492-8192 E MAIL VERO BEACH FL 32960 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC t INSURER A : Underwriters at Lloyd's of London INSURED INDIAN RIVER HEALTHY START COALITION,INC. INSURER B 333 17TH STREET SUITE 2R INSURER C VERO BEACH FL 32960 INSURER D. INSURER E -. INSURER F COVERAGES CERTIFICATE NUMBER: 4013 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADm 1 SLOB POLICY NUMBER POLICY EFF POLICY Exp LIMITS I R Ww A GENERAL LIABILITY ME0150540115 11/04/15 11/04/16 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S 50,000 _ PREMISES(Ea o wence) i CLAIMS-MADE X OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL 3 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LMR APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,000 POLICY 1 JEa LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea WCOOM) $ ANY AUTO BODILY INJURY(Per person) $ ALL OW NED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) E HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (per accident) $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS I" CLAMS-MADE AGGREGATE $ : H -1 DED i RETENTIONS WC $ WORKERS COMPENSATION TORY LILL TORY LIER $ AND EMPLOYERS' LUB<n'Y ANY PROPRTORIPARTNER(EXECUTNE YIN M'eE.L.EACH ACCIDENT $ OFFICERMEMBER EXCLUDED? MIA E.L.DISEASE-EA EMPLOYEE $ (W��in H yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS bebw I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space Is required) POLICY INCLUDES:HIRED NON OWNED AUTO LIABILITY$1,000,000,PROFESSIONAL LIABILITY$3,000,000,SEXUAL ABUSEIMISCONDUCT 53,000,000 CERTIFICATE HOLDER CANCELLATION INDIAN RIVER HEALTHY START COALITION,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 333 17TH STREET SUITE 2R THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VERO BEACH,FL 32960 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEMATiVE Attention: Jacqueline K. Savell ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 00 (Policy Provisions: WC 00 00 00 B) 77 GD INFORMATION PAGE WEC WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY ONE HARTFORD PLAZA, HARTFORD, CONNECTICUT 06155 NCCI Company Number: 10456 THE it Company Code: 6 HARTFORD N lD Ol ko O Suffix LARS RENEWAL C) POLICY NUMBER: 21 WEC GD7700 14 o Previous Policy Number: 21 WEC GD7700 HOUSING CODE: DV Q 1. Named Insured and Mailing Address: INDIAN RIVER COUNTY HEALTHY (No., Street, Town, State, Zip Code) (SEE ENDT) N -1 0 333 17TH ST STE 2R Ln FEIN Number: 650363222 VERO BEACH, FL 32960 State Identification Number(s): UIN: The Named Insured is: CORPORATION Business of Named Insured: CIVIC ORGANIZATION Other workplaces not shown above: 333 17TH ST STE 2R VERO BEACH FL 32960 2. Policy Period: From 05/03/16 To 05/03/17 12:01 a.m., Standard time at the insured's mailing address. Producer's Name: USI INSURANCE SERVICES LLC/PHS PO BOX 29611 CHARLOTTE, NC 28229 Producer's Code: 227667 Issuing Office: THE HARTFORD 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 (866) 467-8730 Total Estimated Annual Premium: $593 Deposit Premium: N/A Policy Minimum Premium: $221 FL Audit Period: ANNUAL Installment Term: The policy is not binding unless countersigned by our authorized representative. Countersigned by 03/05/16 Authorized Representative Date Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page) Process Date: 03/05/16 Policy Expiration Date: 05/03/17 ORIGINAL i INFORMATION PAGE (Continued) Policy Number: 21 WEC GD7700 3. A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the states 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 $100, 000 each accident Bodily injury by Disease $500, 000 policy limit Bodily injury by Disease $100, 000 each employee C. Other States Insurance: Part Three of the policy applies to the states. if any , listed here: ALL STATES EXCEPT ND, OH, WA, WY, US TERRITORIES, AND STATES DESIGNATED IN ITEM 3 .A. OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedule: WC 09 04 03B WC 09 04 07 WC 99 03 65 WC 00 04 14 WC 00 04 19 WC 09 03 03 WC 09 06 06 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Classifications Total Estimated Rates Per Estimated Code Number and Annual $100 of Annual Description Remuneration Remuneration Premium 8810 157, 200 .23 362 CLERICAL OFFICE EMPLOYEES NOC TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 362 EXPENSE CONSTANT (0900) 200 TERRORISM (9740) 157, 200 . 020 31 TOTAL ESTIMATED ANNUAL PREMIUM 593 Total Estimated Annual Premium: $593 Deposit Premium: N/A Policy Minimum Premium: $221 FL Interstate/Intrastate Identification Number: NAICS: 813319 Labor Contractors Policy Number: SIC: 8641 UIN: NO. OF EMP: 2 Form WC 00 00 01 A (1) Printed in U.S.A. Page 2 Process Date: 03/05/16 Policy Expiration Date: 05/03/17