HomeMy WebLinkAbout2017-068 A TRUE COPY p e t of 1
CERTIFICATION ON LAST PAGE
Page
SMITH, CLERK
5VI le a
CA
ttM ►>r�i► E SAVING !I BUILDING
_01041 t LIVESCHAMPIONS
Indian River County Recreation
ATTN: Dave Smith
9450 CR 512
Sebastian, Florida 32958
March 22, 2017
2017 USA Swimming Foundation Make a Splash Grant
Letter of Agreement
'Dear Dave,
This letter outlines the terms and conditions governing a joint project between the Indian River
County Recreation and the USA Swimming Foundation (collectively, the Parties).
Program Definition
With funding provided by the USA Swimming Foundation, Indian River County Recreation will
provide a quality, multi-level learn-to-swim program. The lessons will expand opportunities for
at-risk students to learn to swim and to use the sport of swimming to expand fitness and
recreational opportunities.
Program Objectives
1. Prepare young children to be safer around bodies of water by teaching water safety skills
that could ultimately save lives.
2. Positively impact young people in the Indian River County Recreation community by
developing lifelong skills that combat childhood obesity by increasing health, recreational
and fitness opportunities.
3. Utilize a multi-level, progressive swimming program to teach children the process of
achieving—encourage them to dream, set worthy goals, work towards those goals, be a
good teammate and achieve measurable results.
4. Enhance the positive impact of the Indian River County Recreation aquatic program by
offering team-to-swim opportunities to young people who otherwise would not be in swim
lessons.
Program Description
Indian River County Recreation will provide 125 with free or reduced-cost swim lessons with the
assistance of USA Swimming Foundation grant funding.
Indian River County Recreation agrees that the programs will be conducted within the scope of
the Indian River Countv Recreation oroorams and that all oarticioants will be covered under
https://app.hellosign.com/attachment/view?snapshot_guid=6cc057ec94ae46d55d26f8666c3 l l f6a3a74b7e8&p... 5/3/2017
A TRUE COPY Page I of I
CERTIFICATION ON LAST PAGE
J.R. SMITH, CLERK
Indian River County Recreation Insurance. Indian River County Recreation further
acknowledges that by participating in the following programs, participants shall not be
considered USA Swimming members and shall not be covered by USA Swimming insurance.
Program Promotion,Delivery&Scheduling
The program will be a Indian River County Recreation program and will utilize the Indian River
County Recreation learn-to-swim curriculum. In addition, Indian River County Recreation will
provide training, risk management counseling, and ongoing supervision of the Indian River
County Recreation aquatic staff.
The program will be conducted as part of the Indian River County Recreation lesson program
with the equivalent of no less than four(4)hours in-water Instruction for each participant; this
equates to eight(8) half-hour swimming lessons.
Disbursement and Use of Funds
The USA Swimming Foundation has agreed to pay Indian River County Recreation$3000 to
fund this program. Funds will be disbursed to Local Partner in one payment of$3000 upon
receipt of this signed letter of agreement,a completedW-9/tax status form by USA Swimming,
and verification of USA Swimming Foundation Make a Splash mark and link placement on the
Indian River County Recreation website. The grant is unconditional. However, reporting
requirements provide data that is critical to the success of the program.
Reporting Requirements
Indian River County Recreation agrees to provide enrollment reports to the USA Swimming
Foundation. The report shall include a detailed accounting of all activities and expenditures.
These reports shall follow the schedule below:
I Ot Enrollment Report: Deadline: June 1, 2017
2nd Enrollment Report: Deadline: September 1, 2017
3rd Enrollment Report: Deadline: January 1, 2018
Each report should provide the following financial and program information for the most recent
quarter:
Financial Report
A standard financial report outlining all expenditures related to the grant monies for the period.
Learn-to-Swim Participant Data
1. Total number of participants enrolled in the lessons program for the quarter.
2. Number of participants served by the grant monies from the USA Swimming Foundation.
3. Number of participants served by grant monies from the Local Partner program or local
funders.
4. Breakout of the ages of the participants according to the following age groups:Ages 6-8,
Ages 9-11, Ages 12 &Older.
5. Breakout of the ethnicity of the participants according to the following options: African
American,Asian,Caucasian,Hispanic,American Indian&Alaska Native,Native Hawaiian
&Other Pacific Islander, and Other.
6. Breakout of the participants by gender.
7. A listing of the number of participants reaching each of five (generic 1-5) achievement
https://app.hellosign.com/attachment/view?snapshot_guid=6co057ec94ae46d55d26f8666c3 I I f6a3a74b7e8&p... 5/3/2017
P
A TRUE COPY age 1 of 1
CERTIFICATION ON LAST PAGE
J.R. SMITH, CLERIC
Please submit your enrollment reports using the new online submission format.
If you have other questions, please contact Shweta Shreyarthi:
Telephone number: 719-866-3546
Mailing address: USA Swimming Foundation
Attn: Shweta Shreyarthi
Make a Splash Program Coordinator
1 Olympic Plaza
Colorado Springs, CO 80909
Upon request, Indian River County Recreation agrees to provide additional reports and
information to the USA Swimming Foundation in connection with the operation of the above-
listed programs.
Use of USA Swimming Foundation Marks
USA Swimming authorizes and requests Indian River County Recreation to use, during the term
of this Agreement, the USA Swimming Foundation Make a Splash mark in connection with the
promotion and activities of this program. Use of this mark should follow the Logo Standards as
provided on the USA Swimming Foundation's Make a Splash Resource Library. Indian River
County Recreation agrees to place the www.usaswimmingfoundation.org/makeasplash link and
USA Swimming Foundation Make a Splash logo on their website.
Indemnification
To the fullest extent permitted by law, Indian River County Recreation shall indemnify, defend
and hold harmless the USA Swimming Foundation and USA Swimming and the directors,
officers, employees, agents and volunteers on both organizations from any and all claims,
damages (including but not limited to injury to persons or property), liabilities, fines and
expenses, including but not limited to court costs and attorney's fees,that arise out of or are
related to: (a)the actions or omissions, negligence or intentional misconduct of Indian River
County Recreation, its affiliates,agents,volunteers or employees; and (b) use by the Indian
River County Recreation of any equipment or swimwear provided by the USA Swimming
Foundation; and (c)breach of this Agreement by Indian River County Recreation.
Indian River County Recreation shall,at its option, maintain in force either(a)policy or policies
of insurance, (b)self-insurance program, (c)governmental risk sharing pool, or(d)combination
of insurance policy and self-insurance policy, with limits as specified below, insuring against
liability which may be imposed arising out of the above:
Commercial general liability including personal injury insurance with the following limits:
Each occurrence: $1,000,000
Personal and advertising injury: $1,000,000
Participant Liability: $2,000,000
General aggregate: $2,000,000
The coverages referred to above shall include the USA Swimming Foundation and USA
Swimming as an additional insured.
https://app.hellosign.com/attachment/view?snapshot_gold=6ccO57ec94ae46d55d26f8666c311 f6a3a74b7e8&p... 5/3/2017
A TRUE C 0 Py Page-1 of 1
CERTIFICATION ON LAST PAGE
J.R. SMITH, CLERK
ACCEPTED &AGREED:
Indian River County Recreation USA Swimming Foundation
By: By:
Name: IXIe11,4�J-1. C4, -4-7-1TD Name: Debbie Hesse
Title: ski eDuAlry zw, ,Vl-i7% i0Z-Title: Executive Director
Date: �,4Y �D/�° Date:
BOARD OF COUNTY COMMISSIONERS
OF INDIAN RIVER COUNTY, FLORIDA
B4ep
,��;�Y coh;,yss.,
JoE. lescher, brairman
Approved by BCC rLv 9. 2017 *'
Y O
.;9iy�,gCOUNr;�Q•
Attest:
Jeffrey R. Smith, Clerk of Circuit Court and
Comptroller
By: G' 6�j
(JDtytrle
Jason E. ro , County Administrator
Approved as to Form and Legal Sufficiency
Dylan Reingold, County Attorney
hrips:Happ.hellosign.com/attachment/view?snapshotJguid=6ccO57ec94ae46d55d26f8666c3 l l f6a3 a74b7e&&p... 5/3/2017
' I
A TRUE COPY
CERTIFICATION ON LAST PAGE
Consumer's Certificate of Exem #pori MITH, CLERK D 4/11
p R.oa/11
oEPARTMENr Issued Pursuant to Chapter 212,Florida Statutes
OF REVENUE
85-80126220340-3 06/30/2015 06/30/2020 COUNTY GOVERNMENT
Certificate Number Effective Date Expiration Date Exemption Category
This certifies that
INDIAN RIVER COUNTY BOCC
180127TH ST BLDG A
VERO BEACH FL 329603388
is exempt from the payment of Florida sales and use tax on real property rented,transient rental property rented,tangible
personal property purchased or rented,or services purchased.
Important Information for Exempt Organizations R.04/11
WN WUE
1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases.
See Rule 12A-1.038,Florida Administrative Code(F.A.C.).
2. Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's
customary nonprofit activities.
3. Purchases made by an individual on behalf of the organization are taxable,even if the individual will be
reimbursed by the organization.
4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible
personal property,sleeping accommodations,or other real property is taxable. Your organization must register,
and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this
requirement except when they are the lessor of real property(Rule 12A-1.070. FAC.).
5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no
circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for
payment of the sales tax plus a penalty of 200%of the tax,and may be subject to conviction of a third-degree
felony. Any violation will require the revocation of this certificate.
6. If you have questions regarding your exemption certificate,please contact the Exemption Unit of Account
Management at 800-352-3671. From the available options,select"Registration of Taxes,"then"Registration
Information,"and finally"Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480,
Tallahassee,FL 32314-6480.
W-9 FORM
REQUEST FOR TAYPAYER_IDENTIFICATION NUMBER AND CERTIFICATION
In order to satisfy Internal Revenue Service(IRSj regulations,we are required to obtain your Taxpayer Identification Number(TIN)
when maldng reportable payments to you or your company. If this information is not provided to us by you,we are required by law
to withhold thirty-one percent(31%)of all payments due to you and remit those funds to the IRS as income tax withholding. Also,If
you do not provide this information,you may be subject-to penalties imposed by the IRS.
THIS COMPLETED FORM IS REQUIRED TO BE FILED WITH USA SWIMMING BEFORE ANY
PAYMENTS CAN BE PROCESSED
PART I -Name,Address and Tax Status
Legal Name Indian River County Board of County Commissioners
(As reported for Federal income tax purposes and matdhes the number listed below)
Business or Trade Name Indian River County Recreation Department
Address 18091 27th street
City Vero Beach State Fi Zip 32960
Please indicate (X) ownership status and provide TIN
❑ Individual/Sole Proprietor Corporation (For Profit)
❑ Partnership LLC (Partner;- VE IMA
)
Governmental (U.S./State/Local) ❑ Other THIS IS TO CERTIFY THAT THIS IS
A TRUE AND CORRECT COPY OF
THE ORIGINAL ON FILE IN THIS
Non-Profit Organization (dredc type below) OFFICE
1 y � J Y R SMITH,CLERK
501(c) J BY / / D.0
® DATE
Designate 501(c)
SOCIAL SEWRIfY NUMBER EMPLOYER TAX ID NUMBER
85-8012622034C-3
PART II-Exemption
If you are exempt from Backup Withholding,you should still complete this form to avoid possible erroneous backup
withholding. Enter your correct name and TIN in Part I and write pEXEMPT"on the line provided here ' ;
sign,date and return to requester. (Individuals,Sole Proprietors are not exempt)
PART III -Certlflcation
Under penalties of perjury, I certify that: (1)the number shown on this form is my correct taxpayer identification
number(or I am waiting for a number to be issued to me), and (2) I am not subject to backup withholding because
(a)I am exempt from backup withholding, or(b) I have not been notified by the IRS that I am subject to backup
withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no
longer subject to backup withholding, and (3) I am a U.S. person (including a U.S. resident alien)
SIGNATURE TITLE DATE
Updated 11/3/2015