Loading...
HomeMy WebLinkAbout2003-253C CHILDREN'S SERVICES ADVISORY COMMITTEE C/O Human Services 1840 25'" Street Vero Beach , Florida 32960-3394 Phone: 561 -567-8000 (Ext. 467 or 524) Fax: 978- 1798 E-Mail : Jcarlsonabcc. co . indian-river.fl . us Mmasterson (cDbec. co . indian-river.fl . us To : Beth Jordan From : Joyce Johnston- Carlson Date : October 10 , 2003 Re : Grant Contracts 2003 - 04 The attached is a Children ' s Service Advisory Committee Grant Contract for : Boys & Girls Club of Indian River County Please review the insurance certificate and verify that it is adequate by signing on the line below. Contact me if you have any questions . Thank you . lLaf ,e, Beth Jordan Date ip vi0 o,3 E OCT 2 4 2003 CLERK TC Tj -! F CCAR, D _ 003 10 : 41 5612993840 3015 +a : RLS CLUB RC PA(JE 02 Cui� j rR I L u r ud rirl wn , UHYI I NU, FAX N0, 772 546 5772 P , GI " krw� 0 7CERTIFICATE OF LIABILITY INSURANCE ' _—_-- lertazaoa ;FFotwow% s CtiIRTIFI iS (9BUED A MATTER R tNfpRMAT Dey'Aganty, Mc, ONLY AND CONFERS NO RIQWS UPON THE CERTIFICATE MOLDER• THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 11310 S! Federal Hwy. --ALTZR ME COVIRRA06 A ORDlq A T E POL CIEB BELOW, H91:6 Bound FL 33455 ' 712L5464717 INSURERS AFFORDING COVERAGE NA�� Bcys & Gles Club of Iridian Riva' County, W. tN, rkal IPSUMM04 Co ' ?0 BOX 3066 I IN"IKR D,. _ - - Vero beech FL $2944 r rttnc: uaER r. - - I INSUM R C• r. �, rsR ,SCSF3 —. + ' CE LIV10 BELOW HAVE PEEN 18C1J[D ?O THE IN9UREG NAMGO ABO1f FOR T7V3 PDLIGY PERIO: INDICATED• NOTVIITI S � D' NG ^'U'� A •� ' . t ':rtM OR COND+TION OF ANY CDNTr+AC- 0R OTHER 000UMENT WITH R4$PECT TO WHICI' : "'43 CLItT F!CATi MAY Bt; ISS'JE7 Cil T tL• 1%$URANCE AFFORCEO BY 'THE FOLIOIES 0C8CR02D 40EN 19 StJY..ECT TO ALL THE T'EP.M64 EXCLU�!IOVS AN ' ) CONDI?+ONS O" '7U04 *%0jC -' A AGGAroC'.ATE LIMITS RPIOWN MAY ! IAVE BEEN REDUC40 0Y PAID CLAIMI, +N DfY —�• ~ poucyy Me j ICY LT P Y WWIT purrs f:RALLiA411,nY i� wl+,Qy I�;R4CNCE cep )A* Y"''fW- W � rtTv 9'�02CY7,241283 09M3103 0411�fOd .,r� denca�„ 100�Ob0 CLAMS INAOE X OC^.LiR � ! ;:X? (61 Im oY1,,or 5,000 NFRSQ1 Aj,�OV INIURV _} A MId, ~JI ! :,�NEKALAcaTLFcATE 5,000,000 EKL Af1G 7L LIMIT APPLirA Pitt; t' RODUACT! ; Cr, PmF A t 000,000 XI PITTfx i, 1y �!oe+omLE .IADi1TY (^-G�Mec]en+j INxE LIMIT $ 1 ,000,000 101YAJTO 8502CY2101243 09!13103 09fi3it14 (�. j - X A:LDWN50AUTO6 I � OCOILYImfly s SCHEU w AUTOS I Ips' person) X H RFO pm os I 900a•Y INrURy i X NOH-OYINF.D AUTOS 1Ih [tp7PRea C f S I iGARA3ELtABILtRY AU700Nt_Y - !J, Afk' I�, - ' ! I— ek AGr S ANY AUTO l ��►{ H,4N ' AU'CO ONLY AOC Z EX_CESMUMARtL IAOIISTY EAC � fOCCURR�NCE } — ^ CCv1 CIAMOMAOE I +j A6ORF.(� 1T? 'I s �4 s WCefA'I V �• WORKEft,S W W"NATIOR AND 1 I!YPLOVIRS' UAMLRY r L. EACH ACC, iANY f'ROPRIRTCRMAUDVCfLEXECUTNE 'r,El. OLR6ASC - EA FMPLaYE f OPFICCMNLhO6R CX^Lf, 4 itafm 4�ITQ v 11x CL . Dt&LASE - POLICY L 9 W .l' R GT!1aR DESCRIPTION Ot• OPERATIONS 1 LOCAT'ARS 1 V1!MK L= 1 EX(CI.LIGMNS APOSD eY eW4*!@MRNT ! SPECIAL PROVISIONS cerf9cateholder Is additional insured for G3enoral Liability & auto r, oc :°ce VpHes cicept fornen.pRymmt of premium i CERTIFICATE IJOLDER C giLLATION aMouaP ACY Of TNR AeOVE PF,6P.RI8ED PO4fCI$S 9E : AN Cn.l eo r•fFORC THE QXPIRATIDu Imitn RIVer County OATe TtlREAP, T7la lee{ANe wSURCp. MILLf:HDCAVdI '0 MAIL DAYS WRI Board of County Commoners NOTICE TO THE CIATIPICA" MOLOl1{ NAMGO rO TMU L "AFT, OUT FAILURE YO 0090 SHALL I w 25th St IMPOSE %C OBLIGA71ON OR LIAEIIJT4V OP ANY x,MO UF04 THE INWRUR, FTs AGENTS OR Vero Beech, FL 32160.1389 effIwe , AUTNOPUZ90 a>a ANCHTA,TIYE �O' ORD CORPOR N 1988 1 �1 ; _ J = ed3 10 : L4l = 61BUYS ialFLO :LJE IRC FADE 0 : I . - ' J .3 rni : utud IT will J9Y , iNG . FAX We 772 548 P � 2 P , 02 4 IMPORTANT I If the certificate holder is an ADDITIONAL INSURED , She policy(les) moat be endure statement an this Certificate does not confer rE9his to the certifkvte holder in lieu of such ar. dorsement(s). t if SUBROGATION tS WAIVE=D, subject to the terms and conditions of the pollcy, Certain policies may uiro an endorsement, A statement on this Certifteato does rot confer rights to the certificate re4 � holder in lieu of Such erdorrvernent(3l. DISCLAIMER The Cortiflcate of Insurance on the reverse side of this form does not cons titute a contra between the issuing insurer(a) , authorized representative or producer , and the certiflcate holder, nor does it affirmatively or negatively amend . extend or after the coverage afforded by the po' luies listed thereons i i I ACORa 25 (2 UNIJ Florida Retail Federales .0 BOAM Of 7r02k4tw% ♦ W, "l3rlt " Kurrdral. Jr. , l'hmrman. inn Ory l 'tR1rr Admiaislrmd ►4 SrMM4 silks 1979 Gourp Samdukr. Vru¢ Chairm+n. P.+laka ehind P.0 . Box 488 • Lakeluid, 17. 3 3802m0988 • mitw.scuumaho(di, � s torn v _ Ki.r.l . trkeland } !�� 'Cla.arur 5. l'ui�v� tY. l�krlanu! �f Tcleph4me iX63 ) t6i - 00) rlr 1 .800-282 - 643 • F3x ( 863 ) 66& 1958 ChAirlra X. Wrniz. .W. Avnniltr Certificate of Insurance RE : 0520 - 25864 ISSUED TO : Indian River County Board of County Commissioners 1840 25th St Vero Beach , FL 32960 - 3365 This is to certify that Boys & Girls Club of Indian River County , Inc P . O . Box 3068 Vero Beach . FL 32964 , being subject to the provisions of the Florida Workers ' Compensation Law , has secured the payment of any workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : 0520 - 25864 Statutory Limits - - State of Florida Employers Liability EFFECTIVE DATE : September 13 , 2003 $ 500 , 000 ( Each Accident) $ 500 , 000 ( Disease - - Each Employee ) EXPIRATION DATE : September 13, 2004 $ 500 , 000 ( Disease - - Policy Limit) This certificate is not a policy and of itself does not afford any insurance . Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or affording insurance to any insured not named above . The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement, term or condition of any contract or other document to which this certificate may pertain , the insurance made available by the described policy in this certificate is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits . If the policy described above is cancelled before the expiration date indicated , the issuing company will attempt to mail 30 days ' written notice to the certificate holder named above . However, the issuing company , its agents or representatives accept no obligation or liability of any kind for failure to mail such notice . Date 09/ 24/ 2003 summit consulting , : nc . , Administrator 71orida Retail Federation Self Insurers Fund �01�33 , 12�57 61 4tzrS� co N � ` Indian River County Grant Contract This Grant Contract ("Contract" ) entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County' ) and Boys & Girls Club of IRC , Inc . (" Recipient" ) ; of: (Address ) Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Youth Volunteer Corps 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Forty Thousand Dollars ($ 40 ,000 . .00) . 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 23 , 20031 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 - 2 - 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 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 . 3 - 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 RIVE OUNTY BOARD OF COUNTY COMMISSI ERS By: Kenneth R . ch , Cliairhiign Attest: J . K . Barton "` ����af��� By. Deputy M R4 i `Mw lYfi om 00 ! p Approved : <001de , J es ChandI4;%County Administrator AR ved as to form and legal sufficie S e I , Assistant Count orney RECIPIENT : Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 By: ame Title 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - 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 251h Street Vero Beach , Florida 32960-3365 Recipient : Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Attention : Leisa Smith - Fulton 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 - 1 - 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 . 2 - SEP -24- 2003 WED 02 ; 52 PM WM , DAY , INC , FAX N0 , 772 546 5772 P , 02 Florift uft"ratim r y Ulf ftSumrs u 1Rmrv1 rd 7wti�skr . W, `D' U " EPndtal, Jr. , (ltmmun , $lift i •il5. <'fnrer rtdJnigitJalrort i�' SNl�laiil SJnCR' �A7rJ (ix;ggt Sa�dck t , tirce C,'Ir�.rhxur, P.ticrr<rt 1� 0, R4xc (>♦t • 1 .;1k�1R+��1, 1I, 33t?01 "04)88 ■ sr n :,srrn�n�ri )n�f+ht�� r Jorn � t NAA,v , torlrtand fclgyh��to IRiS3) S �ErOf►0 or P It ic-?82 •7f4k • ]Tax ( 841) bf,l} 1 S) �R � �"rtyu" �'ckti, lY. ls�� rlrnur ..""»• —� _-.�•.,,. ..._ _ ._�_ ttlr . 1< trl'ar^r� r, rlfr• Certificate of insurance RE : 0520 - 25864 ISSUED TO : Indian River county Board of County Commissioners 1840 25th St vero Beach , FL 32960 -3365 This is to certify that Bpy zirj ..CI1flLaf,,.Indian foyer County, _ p �� 3p �/erQ Beaoht � X964, being subject to the provisions of the Florida Workers' Compensation Law, has secured the payment of any +A' O -kT �s ' compensation benefits due by Insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : Q520 23A54 Statutory Limits— State of Florida Employers Liability EFFECTIVE DATE ; .Septem�Li3, 2003. $ 500, 000 ( Each Accident) EXPIRATION DATE : Se . . a $ 500, 000 ( Disease - - Each Employee ) pk tuber 13 , 2004 $ 5001000 ( Disease- - Policy Limit ) This certificate Is not a policy and of itself does not afford any insurance. Nothing contained In this certificate shall be construed as extending coverage not afforded by the policy shown above or affording Insurance to any Insured not named above . The policy of insurance listed above has been issued to the named Insured for the policy period indicated . Notwithstanding any requirement, term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits . If the policy described above Is cancelled before the expiration date indicated , the Issuing company will attempt to mail 30 days ' written notice to the certificate holder named above . However, the Issuing company, its agents or representatives accept no obligation or liability of any kind for failure to mail such notice , Date 09/24/2003 u ^,nit consulting , Inc . , Admini .9trator riorida Retail Federation self Insurera Fund IM DAY FAX N0. 5615465772 P , 02 ACORDM CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Day Agency, Inc. HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 11320 SE Federal Hwy. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Hobe Sound FL 33455 772-546-5767 INSURERS AFFORDING COVERAGE NAIC A� INSURED Boys dI Girls Club of Indian River County, Inc. MsuRERA: MaOtf Insurance Co PO Box 3068 MIRER B: Vero Beach FL 32964 INSURER C: INSURER O: INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO ThIC INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMCNr, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RCSPECT 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCFD BY PAID CLAIMS. INTR ' DD' TYPE OF INV IRANCE POLICY NUMBER POUC'( EFFECTIVE POLICYE%PIRA710H LIMITS GENE4AL LIARILITY EACH oCCURRII+CE s 1 , 000,000 — n DAMAGE TO RENThD IA I X COMMERCIAL GENERAL L" ILITY 8502CY2201282 09113102 09113103 -PREWSE.S.Z-ft FCC s 100,000 1 CWMSMAOE OCCUR MED EXP Annnc efson S 000 PERSONAL 4 ADV INJURY S1 ,000,000 GENE RAI. ACCR£GATE s 3.000.000 GEN'L AGGREGATE UMITAIPLIESPER: PRODUC' COWtOP AGG S 1 ,000 _ 0 X POLICY - I `'ftO LOC I AUTOMOBILE LIABILITY COhIeINED SINGLE LIMIT S 1 ,000,000 A X ANY AUTO 8502CY2201282 09113102 09113103 (Ca °ctae''I ) X ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Pcr p=n) X HIRED AUTOS BODILY INJURY S X NON•OWNED AUTOS (Pei acaaml) 1 Pfi.Of%ER7Y DAMAGE S (Per aCCI::ern) GARAGE LIABILITY AUTO OWY -F.AACCIDENT S ANY AUTO OTHER THAN , FA ACC S AUTO ONLY: ACG S - _ !'_v�RELLALIABILITY EACH OCCURRENCE is OCCVft CLAIMS MADE AGC,RF.GATE S S 1 DEDUCTIBLE S RETENTION S 1 WCSTATU. OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIFTOR/PARTNER/EXECUI NE E.L. FACN ACCIDENT 1 • OFFICEWL4EMBER EXCLU0007 E1. DISEASE - Ell EMPLOYE . i N wyn dc-= bu undar . P AI PROVISKIN9 WowF.L. DI`rEASC - P'OLICY LIMIT S I OTHER I .�E£;CIPT10N OF OPERATIONS I LOCATIONS ( VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS C_ r:; `: css„ oider Is additional Insured for General Liability 6 auto 30 Days notice applies except for non-payment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY Of THE ABOVE DESCRIBED POLICIES 8E CANCELLED BEOR>: THE EXPIRATION Indian River County 10 DAYS WRITTEN Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TD MNL I NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHA 1840 25th St IMPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURER ITS AGENTS On Vero Beach, FL 329603365 REPRESENTATNE.4. i AUTHORIZED REPRESENTATNEAJD> " ACORD 25 (2001108 ) CORD CORPO ON 1988 lltil - GL- cuuo Irnu 1L@ io rll wn utit PMA ' Ixo. 30iO4uJ11C. UJ IMPORTANT If the certificate holder Is an ADDITIONAL INSURED , the policy(ies) must be endorsed . A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ). If SUBROGATION IS WANED , 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) . DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between I the issuing insurer(s), authorized representative or producer, and the certificate holder. nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon . { i ACORD 25 (2001108) ` —%�-2003 THU 12 : 15 PH WH DAY FAX We 5615465772 P . 04 Self rsrund l. wttr *4 h t-414o \V. "ITiU" liqudra4lr., l'ha�rnttn, l4rrt Cdr ( 'tRA•t 'V4 00. (l .orge 4: bjefer, Vi.. Chairmrn. P441afle {� A4x ialafar"I iy SLmini Nsinc* 1979 Nn Xuc,oa , JAelond 1'.U. likn 983 P l .a,kehutid, l t. 33.`" 12 -0`181'i • Ntl x• TUNuullitvltri.lRt. eorn ( DRi. lL 9Jrnki, Itl dmf v* rcicoviu! fr6i ► tSfii �i0!►{) or t K(m-2�?-T6�% • 1 =ax {R43) b6Cr195S certiricate of Insurance RE ; 0520 - 25864 Commissioners ISSUED T0 ; Indian River County Board of County 1840 25th St Vero Beach , FL 32960-3365 , Itis P ' 0 . box 3068 VerS���X2964, This is to certify that Boys & Girls Club of Iodirnn River Counfyhas secured the payment of any being subject to the provisions of the Florida Workers' Compensation Law , workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . = ^uC`! NUMBER : 952.0-25864 Statutory Limits --State of Florida Employers Liability 500 , 000 ( Each Accident ) EFFECTIVE DATE : Septerribef .2002 $ 500, 000 ( Disease - - Each Employee ) EXPIRATION DATE : September 13 , 201 $ 500 , 000 ( Disease-- Policy Limit) This certificate is not a policy and of itself does not afford any Insurance , Nothing this certificate shall be construed as extending coverage not afforded by the policy above or affording insurance to any insured not named above. The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement , term or condition of any contract or other document to which this certificate may pertain, the insurance made available by the described policy In this certificate Is subject to only the terms , exclusions and conditions of such policy , Paid claims may have reduced the shown limits . If the policy described above Is cancelled before the expiration date Indicated , the issuing company will attempt to mail 30 days ' written notice to the certificate holder named ind for faiovea lure However, theil h Hint company , its agents or representatives accept no obligation or liability of any Date 05/ 22/ 2003 G - air cor.�uicirp , :nc , . Admintetrator Florida Retail Federation. se1C Insuzers Fund I I 0 LI IJ 10 t � � • r 1 ( 1 . I I fi �' I1 ' t ' '�c� I : {h , l� t l nm I •.I k Fit w r7 It • q I 1 [I , y4 `r 11 it I 0 t1 M It 1] m (] 1 ' 11 .1 I ' G n Gl tJ' o N n (. 1•• x 'n n Y 11 tY P' � t r) • Id tJl ,� r v n r( n Ia I] J, P. a r. I • (t 11 P ((]] (I u p� i2 � In 11 %0 p � 1-' M U M r1• 611 1 11 11 A tl 11 t ►� • IA ' �.I (� �1'• n to 1, p P . 1 � {1 4 ti n u (l. It 1 u t� W ro 1 -4 }7 y x u u n n 'nK n ir ft r 1 } a r1 try II n . o n c� (t M ' rr 11 n ' I 1 • 7 , p (� , � p tt � a n It , 1 li J • 1 ` iv tr o 1t. o o t (a in F p DI It u A r: I1 a s to p. kt f� trI ►i I � p /tr c� c a n a1Arlrnn � rta io o (A ppm ut ( It It (n� p! m • 0 t '[1 ,I � A '❑ � fi Il tt K1 a p . r� 1 fi , (� :' p �i I t ry W cj I N +' Pn� � C} Rl n It ° n rt a t1 I li 1 ! �G ' tt . f to ( p i rt to Id o� i1 rJ v, u n n o41 I p n a a p, n n p 11 p4 r• 1 to o �] 11 111 p 11 � 11 61 it I ' r 11 it O C III It r� (p ( � y � Q1 '"� � 17 r'U I n tl (1 rn 1 V . ' 1 In of t7' It i It OH 4 o 1 I 1 , . .1� t Q L 6 W r l( , r ,. J , t I ri all 1 p l didu tI p tr (. p 1 � m n t o p Ir 11 ti rr so }I iia u L41 n lid 1 n pe o t , U• w . y 1 p• t �t rt W 5 .1 . t . o (1 . p n 1� ti ►R+ it cq A ( � Il r : •ti ° �' 1 11 a (= It a 1 cl r, , t , , i 1-, In I r �' II g . I n 10 1 1 � ii d j w r 1 li I ' 10 rr 1t, 1 { n a f -' I J- ( ,. 11 n II t1 r .r ,.4 n++. f r1 t �. 1G n t to i '. r II T 1. 1. tft r1 f • ti' ;� u1 1� , 1 ' I i *t 1f1v1 n n in }*t I� o � Ir I ! �1 (t I t. n li r' •I � 1 II 1 l; i . , 1 } It 1 � 11i .. I� ( i. p� {pI frit Ik M ({p(��11 i� jt 1 1 . r { rl ► � W `p ! ` ro I ti. r. (. r ti 1 { I III ". , fi � I f1 iJ ih < } �. 1 C in n ' P• T1 li �I C. n � ) 11 o Q n n r1 n c+ p+ t •'C ( t • �i . ►� t p• ro a l9 II 1, , r-• 1� a ( 1 ro to rt r1 rt y It tt o nl m 1 { ' tl ut 11 rr p • l ) In 0 r1 ill } ' • u ) I� rj 1 � {� 1 ', nt n - 1 n ' d a 11 n t , 1 I • • u 1 ' • a 0 � •n { 'd N 0 kJ p n1 . j r• 'n a• N II n U l ,. r tl 7 11 1 t H 1a J U h (1 1 �� �)• li . b S 1A tp N 1'-1 0 U to r-t Ir n4 n no 11 hl 1 1 � I� It . pa tr {► 1 • A. Il . p d !� 1 — rt t1 1 r• I M al 11 . } , . u rt m to r 1 ( W 16 rt f � •C p` r ,, 1� 1 n 1n Y) 1 1 , . . �i. i I pt 11 I ^1 Ip p n 11 O C It (Or ro •t _ ^C - a ' � r-• t h ` tl �-• rr t i iiiro n t1 U n 1� ► , . It fl (t 1 r h C .. {� n 1 1 ' I.t 1A . , Q p1 w } O 17 toot tt p�] JI 1 • • Il� 1 >' {'•' h1 F-' (1 ' o t) l � I' • n F' R F-J I � O U ( 1 . h ( J . I 1 (•. p . I� [1 V-• Ih O �-• tl `� ,( . N �^ a n ' I ! 4) KI q p Ih ll to 1 •- n 11 u 1 rA d n R ;I q A t• r 10 11 p. (1 n t'1 G e� (• r < • t1 • 1n o 1� • • It t n 4 It i� Il • o it to 1 < P• r by in , rlh :f (� ' I u G < 1 P n � M PI 'a } � ( 1 iL ( t t] �1 M i o p o tt I►� ��77 n , 1 t] p 'M 1-4 J II �� aaot A p t� p U A U hl �i n lfi l 1 n t W rr 1 , rT r n 1n n rn n It 0 0 11 N • n A I t1 to rt Old tr n 1 .1 w of p It p 14 r. p 11 u 0 (I 16 ' < 11 0 to F1 0 1 ' a u n to li 1 a 1 ' • 1n II :� n ►r r n 0 In ' a p . 0 tt .1t11 Al YI El . u1 1 , A , 1 tt , , I n r, n It a I1 [r k .. 0 I - 1 n 11 p . It }1 r1 I ! rl (I , 1 • • Qp1 1: It Ir! 41 t1 , of 1 It It O I • N It, 11U A ( ' f�tt tS W N It 0. O �l P1 I ' . ry I - -< n O 1 b' QG N N t1 . . • 1 ' w • 1 0 I • . E h •< >; O 11 . -) n •- 611 O p 11 11 IA It• „ It : I 0 IA nt t p • �. h • 1 t rn N tt 11 lu tt 1� • n 1 -� Ipit I Ir 11 , 11 ' W : } 14 • ' I P" }t ro 11 D� I t T4 . le p1 P1 nrV11- , I • L1tJ :1 i 11 n t} a • 1 II ► sn n I Ii1 k_• ••{ f1 1 It . rr 1n j n It . n 1 • � , r •. a n it t It I D• n 1 C Il II n q It ( 1, �J V ' � I• I I 1 u a d u I IV � • . 1 n it N 41 a U ` t2 11 1 • .,' h /) (t , . r rt 1p (,1 U lj U Ol II R, � !i 1 le 1 II 11 u a I ; u . d 't )� ►�� If/t to U tE U) •- I m ► � , i „ 0 N ;-. tl U I •• U / 1 ' U t U c , N d td ,JI D 0) 11 o,. If [ C tl T• u t7 U ❑. u vt 11 r I U w U ro V •- 1 rl c'1 U 1J .t , 0 •- 1 d [rot. J1 U lJ ►1 U 1 n ! 1 U rl > JI u 1 ) U ' I lI Q N O N U rl n 11 ❑ D U w 'r , 0 U rl N v u • rl ? r 1 It ,• w 11 I u L N r, 1) u V N u .q a � t J rl J1 V a 11 d r , + „ t 1I � d N n � u o '11 U IU .tl . t2 o b+ to 11 � [ li a n ur b U tll id ,� p i� ii m tl .� tli la „ U 14 40 1J U u [ .I h t� n 11 q t2 11 14 . I , t U In C 0 [>. u " r-1 r, N Jl J , . r1 0 L I CU2 u r1 UI U Jj 1 11 p hl 11 a lJ I : • ' • rl 1 N le .11 11 f1 U U ' Et• <1 ;� ll t1 v vl ( 1 . • I it Il �d • I II Ii U 1) 11 U 14 1 14 t1 1 u fl 11 / 'U r tlr U 11 a a tl U N 11 1,. . . I , d 1 3 n a '+ ' - , I Ill U Id U (tfl I� � , N it rt py1 ' rUI ISI 11 U U � I tl f1 C 1 q ri t7 ij l ' , ni I o . IJ y 1 U tl .r. 1 tJ tl • ' � pC �C l i I too U u pt u cr r J bl . i . , U h tJ ►1 c� o t t 1 o ti , ` `� tttlll U U 1� f , q I v I u r tl G I , 1- [ t tJ It i u t 1 �1 l i ii ^i J ' d � , tl tl at U 111 {tt'' ! , r}I I l , r ItU I V /- 1 1� f l) •. I ( 1, • r tV -I ! �1 ' , I I ' I 11 LOpl tUt !r I{ Y 1� 1 ) {yet ( 1 +� ' U I 1 fff t11 of t l H J 0 1 �i I~ rl I1 .II • rl N � • tj p 1 e] t turf ❑ p U blRj { k /1 't, i :; i; u ' a r♦ rd , , 1 I , r1 If ti to ,1 11 t! Ill .r � 1 11 ul tt 'tl t U 11 o •- I u If In d N � JJ 'U to tj [pi i� al C1 tt I ,y Ii ' � vJ t , al 1J .,j r+ t1 1� J� f� n ; ) J uu1 0.) n u ' U is N al r U d a w t U I [. l t t.l ff u t tl ) U H If -, o 'H .� U ( 1 LL/ U U U 1 '� 1{ I rl q O rl [� I � Y o N to '•, U 0 1J Ie ,1J U U ;d N U Iq jj i) a O tl MMM rl 11 Il ? 1 10 U It � . t d • r♦ to U •. I o u d 1 v It > , ll�-v� ll a q u u tv r , u y t • of to n rJ fl � . 1� /u Lit 1 U u It t' D N It to LIP 111 1 .L) to 11 1 N IV 11 F • rl %1 O O, ' 1 11 - 11 1 1 ,J Cpp : r "� S• J1 to 5 I/ 111 `-4 U u I tL 1 ' tl � 1 I � • 1 'I tt /11 �� (} -+ A U 0 O it U V d r'' u -u n d rd . � ❑ >, r1 I1 1 d t m ro , Lit 13 ,, b' , I 11 f1 v to (J dj1{{ � � [1 N ❑ 9 F' U t•1 0 , d -0 p D b t1 (J 11 U U m v, u , • i] to o ll iJ EI. tj V 1-1 'U O `tJ rtt U 9 d I 1! UUU ti 1 r{ v-1 N 1 AJ � , p "' ! 1 • s' d t O N V V 1S 4� N. '� IV d t•.t (� V rl N 1'1 Y, a, . 1 tl b t1 1 t' Il ' r1 0 U T n 1 W+. J 'll N F1 31 , •r, 1° �1 1 ,d L.1 Q U . -t S V 1 [j >. t ' 1 ) '� °1 D • r / N N 17 �` �' 01 U I) 1 q ) F + L p , I Or u 'r U y .r n i n l ) '� 17 ► U t2 F Q U t rl ❑ tl m ul t.• i ) O1 t F u 1i ti d p. IU u u 1 a u ;r1 `� tl Y ,) P,t : u i, •, , � J •u tl •J 1► r I ' „ 15 � I .� u U 1 � y J ' q .t1 aI ' 1 . ❑ 1, � t n 11 Q u ,V -1 r V �. tY 1 J2 , I Q u Jl •rl ,� ft , N , t t A �-I a s U u v •d w a 'rI rD rl to U +1.4 1$ N T. Fl [J Iq r 1.1 If >•• H tl U • rl Id lJ C. II C l II • ❑ t/ :1 •U 0 d to ° C a r O t p, tu .-1 •. , 1 O 't-J . 1 3 D —1 u r1 U v v ' . / 4, NN ❑, A Q -, 1 [,1 U u u '. � PI O ' ° .v r, • r ! -, U � p r� }Jx ;1 17 w1 , V u O •, I :s >, of r- I a 1 r1 0 O ,Fil '1 " ' E U I 1 •, I J . Il U 0 uJ M PI fl �N U 1 d [' U l N l • r1 I ) r b d •.l Ij IJ r . �' ' U U .`a Id O bl u1 01 f1 I U •-t fy ' CI 1 IC]I J• ) er }d kl u IpJ1 1 ' Ill n , �} If h13 f�; D I 1 1 IS7 '[ I] p p , , OJ l) b D [J 11 ll O Q !� 7 N rll �! 'i J' ' 'J U IJt z7 (1' -�i � , 1 t) • rt � 1 11 , 1 t JI ► 1 . `' tl id fJ �i .1-7' tl U (�' tl 111 11 [: Y t, U •rl ,tj u -rl Fi 0 ~ YJ u � •-I� 4a 11 iJ u n Is L4 u ► s .1 t� . � o , n • [1 �d � � u d n b u , t W • ., o [d1 u u �I 2f v d U� [ .a u I 11 u ` 'r ti d q o u n. rti n u 1 1 M V v .4 11 0 U u n u rl 1� J{ td O N 11 it u 1 (` 1 At 1 t2 ; C , I 12 1 tl 11 11 ll I I .0 if C' f� , • I U 1 lQ [ N •u t� U I RJ U ro U U g n tl u u �, y, lu +- 1 f j , Y 1 N rl 1 pl I '� l U Il tl tf d ] It 1 , I t71 } m ; , 1 u • { .y }1 q •rl 1 I y j (J �q 1pr11' t:It{ •�t� �1pa77 ' ,ry � �[Q�) 1 '�yt21 [I 11 'l� UI f '- [ 1 J 11 t1 ', � E I a.J (� y ► � 1 ' II ( 1 '1 U rl � JU { � "p1 ' 1t W � `� 'U � �� � IIUt I 'rl '� .` j ;� j (� � � II ► tl b • J . ,[d] n, t! c to r U It 1? a, o It a tU >, ' 1 U q [1 U t ,. • rl q tJ a 11 t w rr b [ '[1 - ht n d tl .1 ; '1 V 0. ut to ! I q N t ' U U A Y i i tr I� Il rl t l] y 1 G v► U W 11 rt 1 r1 >( j , ii ►� a 11 1, ►2 [l i ?� u' Eai tl �1 y o U t1 1 � r� 'j , � p �' i ; ' It 1>) I ' li U 6 ' V a N u off p vl t{ Il d p O N F� r I) le II U Ll p • rl , U 1 , 1 '[� t q ' N M. 'r7� 11 1 O Y� N l Il tD �) IY . I , J p C� p 1 q1 tl 1 of N of + U r1 tl t1 ?, U J.1 O 11 Y , i x t'' ll 0 6 U t'� nl I �y 1 h ' . I tr 1 f t) 1 i CI 1p t7 ) t° r' ' 1 1 ' el , ; v ` �' kava u •. , iItj51 vl { ' U � lo �S ., d vl J • 1 J 1-1 C ' of 11 t+ IJ ❑ n, 11 I , U re N U y O '•-+ Id U Jr D 11 �-. Pr O U „ • I • 1 ti i U D U [7 • n rf ppI t _ �r N „ q ', I It w n •- 1 > ' U a -I • -t tit r ( Ill - rl I ) - f U '1 U 1, {2 0 1 • I p TA U C 11 p tr 11 rt , f � 2 •U 11 E if .1! oil 1 + rl p U U I1 >. l0 1 II EI' '� 'l Il t0 U 11. J tl JJ Ill • - 1 T, U U u I Q 1 h O N u I� .1 p J ; J 'if pp rQJ 1 ; Id l' i1 u U Il C F' 1 ' r1 rj U � It � f n. II off I � ? U I : N rd f_ . 0 k u re U S. 'tl . t] ,Q d 7d j j O F U A • 1 y '] U Ii U 1 ' U D/ n : � 1 I ll r1 V, ►• 7( 1 -1 ii / ') I1 11 'U 1. II 11 n ' �I 1 - • a� • o t I to 1 it I1 1. � r t ' • O in {1 1 ' ' h n n I H • Iq ppr n n N r Ill o aI 0 + t1 ►r, P . to n 1 - 1 ►'! rr• N o ('r o �' n - ft In tu n n 1+ r , 1 I ( el I t. r t� t 1 Ali; � ,. u II a / n ro n • t a n In is I ' • r1 n U I •- t 91 f�. �. {� . p I ) G ro F o F' I P. � • U D law 1 . At n n 1' 1 ; 1 � it 1 ' - �� . . r� t4 r r, n K n In n It a � < t F n 1� o o f ro t II n tt h • a h ro ro : 1 '[rJ� � 0 n rt ( t D II d ti i1 1 p! a 1 11 ti , L' M (: 1� I 11 it 1tl �]. Q• a ¢ It O 7 }+ G 1 '. O ♦J al ,7 {� d !•h p (-1 � w t M ►•. ,� �i • oao I a 9Itn too � •orr •< � rrt, p t1 P• r � n r1 Iq r a 8 n 1 ,q9 Fry1 rr ro nt P1 Q, n o P. o rF l � . m I1 4 [1 o to rY I < l+ a, I1 tl N 1't to y H '� 9 It 0 o n • tl 1t � 11 • � II�J I . b n ri •< It w Lt .a 0 n 11 ! '• ro p • b 19 ro o U1 pp rt, C n to n L1 N A tL rr 0 I,t n tl rl 1 0 1' • n n 7 1U p ll ,Y, n Il 11 tl It p a rl Irl �1 t1 It rip �' (t 1 dl n 'C D �t ; r '•C AA A13, r it p . (a•• :1 tr rt N 'r lid to to 0 '-1. n l- 114 � o 11 ,1 to . In n fl a �' C 1•- Q . h u 1F � 11 11 � 1- 1 � " A 1 rr � m (l. r • r /, C1• q It it I m O a I • r. 11 II p1 1-• T1 {� N n !1' rt rt p 1 '• A 1 '• rr D (� n „ I I -1 I- t,1 ;J Ei tl X rr p rl n L' 1 I '- n I ' r•• 14 • I -' i (j I I-r, �'; n t , r . 1 Ir 11• n i H a '-4 11 1 It 1 P• 11 v nn art n 11 n '8 ana 1 (7g ' n t1 t �' nQ nn tot • I>E ti n 11I ; r 11• W rt ► '• IS rl. `f w tL n N a N r1 rn It O rr C) li In rt P1 n p n it, a � ► + t 1-1 n a m p It G• n ct o n 0 [A tfi N , a n V ti u 1 •• `� 14 W I •• �y 1 rt DI t � t N X n t h 01 r �j r to n 11 :r n. tl � I I n { � . C 9 I w I1 I ' • �r � ro n et to ;) 14 . • Cj 1 + I - m •� i + I { 1 _I tC 1t h' n W p 1' 11 {1 to W 11 ( 1 n n n p P1 is . rt tr {e n {� n rt m p n n ton p t r� ,1 r . F� 1: U rt Q, ti D I '• 1 • • ro fr 11 t1• l' •< t-• rr o n. r1 ?+ c+ , n r_ 11 b• o n• o ri H 1 n . In rl Q1 0 - o n tl p. I -• 1n 01 w p rr F{!��,1 1 . 1 - F� A r• . 0 tl (q.' v n O C1 M+ r1 ur rt t~ ,• . J. rn h } r>, r, Pit ry In I -• h : 1 I11 k7 YI 0 r1 U• It role to x n r • to In Irl .1 I4 - •q 1 •• K PI N n • ;1 r1 p1 ' O O 1.- • 44 L 1 ' R I '. 1-• o I' wb n 1 _A E1 o p H a fr ) '• p F a 1t tt t h 1 ' a `G I n U ao h 11 q 11 H 1 ' �* n tit n N rr rh I p G n P. (� • • G n f: (0 m •t tr ry III a N• It1 to p • p ( t p �J I- • tf 11 n. tt' 1 + • t , n A .t n 1 t] 1 h to O la o n rl r4e tl u 'h n rr N S n n h I ' - t1 t� ► ) 10 } • �i' , • . 11 d I . n o it n 0 o I I w It 14 ! 1 t1 n u N ry 1 ro ( 1 w t— n rl n Z( h 161 W 11 Of n n (� Lr " O I01 ry t I O p O f1 r •1 yt n It t7 •n /� c 11 . C7' 11 � iT rn� 11 n n r1 to tr I . r ' 1+ tl p H 11 n n n 0 t1 n rt r-• ro 11 rt tl p r • ti :1 1'• 9 . • • n m n n m 11 It 1 ,h H ro Ir 1 f tl tr to Q of r. .-• o a l • n n. 1 t1 Wp nt 0 l n o o tr, n 11, . n ten, rq C R n n I# • p tp ' r, n ro n Ir 11 IJ I, t j f. , 11 ' ; p i F- � Ic1 sr „• u I n n. t• it tl ( N 1 n 11 n . P. 1L r 1 . . I ' - It a ,• . , • . , < h r ♦ ro O , r u r u ro rr t> r I • n t•• :1 I ' Ir �. EA o r I � It t-- ft 't� w 1' M 1 0 n l I-' G`• rt p n . r :1 r1 D I- 1 I-A n J tf r iI PI n to N lI • FL , u 11 n t1 •� N • C '< to o , 1 N 11, p a n n < n rl .N tt h u ttt n r11 p u p • d o r• I - . , o li u o , 1Q ro N • Ia a p. ". o I • , 1I r - U It G ell p11to pp 1 u I1 rn a tl r bl ry a - to -n n r r1 r rl tT f• it rt I�-- p Il 11 1 � ri ti 1- 1 •tJ 1al p to 11 1- 4 a n u S P . tr III rr t1. a 1 • to A O N or PI • • `{ It 1 p l. 1 ,i ro rt a tJ G rl• I S' 1 1 - • ,. 11 n n 1 04 Pf N a �-• (6 r �t c 1 {{�.. t I1 •� 11 0 y n ro 1 �. . 1 t ro P' tl' .4 ,� 10 ` , . . n fl ! r 1. 11 . O IT ti' f, . 1 n 1 I� n ft . p � t 0 r. o n n =t It � o E1 n P. .r r + n ' 11 Ir ► • 0 11 I rA � � 1 rl P 11 � � ! t f: iN ry h o !1 1 1, rt x 1 0 1 k to rt r n It \ n n o Q l 1 • Ir G U 91 n 1• 61 r1 1-• All It n a -, tl n w 11 t � ro n n It I p I F to P . 0 li n I1 R rt P , 1• it rr n. u � jj tn1 tA I A. PAd to . t� n ' •< 7 ' "C I 'll r ll ftl I N t n 1 I� t1 u P 1/ Y In r; 1 (► n It 114 � 1 lit00 (11so1 ' �1i � (pt Is Uti (1T {�� � Sr0w' m �i � p1O (�1 i�� a�. I( 4 � . Id U 11 t 1 � 1 t lie (1 ' 11 G It II la 1 m 1 1 Na ' 1 A0 p :1 11 r 1 + rr r1 `J' t] n l a a t1 I � I • . n G � a fkt re n p h All •t! I I ' 1 1 t �, ll I `• nl P li • •l U I� In p ' t1 ►1 •` 0 I f� tit 1 I I t � • f1 r n 1 1 (1 ( r I , L• I It n �' f1 It 'A D p I1 fr 1�)< � I 1 II It n Yl If 1- U tD t I I C 1 :l to n tJ a1 it 11 � . ri l� .' I •• h n n rr. In m A. t1 �47 ro t n o I1 a 11 Ir h P la+ hI p ' I + • a N I { 111 W n 11111111 rt IA F r 10 / 1 II n M • 11 ro ••t o n G rr H , 11111 ID I - I r Io IJ ro U C u ro In 1 a o w .n n 1r :1 rl 11 11 n' n r11 t, a a I i n o u 11 n t r ri o a nl I - m In u ft f : t1' O •� a 11 in IO ' rt 134 F H, p ro It O tit 0 C h IonP + p . t1 n I - ` a con 01 N ` 00 ! " p ri EiK ; � n ' g rr '1 o � nnro �J � n In •tm n1 * " rt r. � I0 n m 10 Q1 It tr o A ro • It : O a . tl11 r; is n it o It PI it n tt rl 1 1 ' t1 to n o a I- • ` t ) n F r ! ~ 1 : J 1 -=a.& az �S l it Tv .n ,6 Z! t �210l. ATZ��7�i� p•� e a aflaur. lcssad o;� = as�.-a � ssaTd • s�asaa= �rz �.t 37 MAI-S fi'_'I = 3D M= o;7u :D 19 !;XD=. Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee ORGANIZATION. Boys & Girls Clubs of Indian River County, Inc. PROGRAM. Youth Volunteer Corps TABLE OF CONTENTS Please "X" the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Proposal Page # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 B . PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . - . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . 0 . . . . . . . . . . . . . . . . . . . . . . . 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . 12 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X G. TIlVIETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . : . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . 14 1 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 3 . Total Program Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 X 4. Funder Specific Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 X 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS (Copied once in White for all three programs submitted to CSAC for funding . ) J- 1 X 1 . List of current officers and directors 2 . Latest Financial Audit Report & Management Letter that conforms with the J-2 X AICIP Audit GUIDE X 3 . Most recent IRS Form 990, including all schedules J- 12 4 . Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating J-30 X Budget X 5 . Staff Organizational Chart J-31 X 6 . Most Recent Annual Report (if available) J- 52 X 7 . 501 (C) (3 ) IRS Exemption Letter J-53 X 8 . Articles of Incorporation J- 57 X 9 . Agency ' s Bylaws J-64 X 10 . Agency ' s written policy regarding Affirmative Action J-79 X 11 . Proof of Goals and Outcomes Workshop Attendance J-80 K. APPENDIX (Copied once in White for all three programs submitted to CSAC for funding . ) X 1 . NOT FOR PROFIT AGENCY CERTIFICATION K- 1 X 2 . Indian River County Authorization for Release of Information K-2 X 3 . Sworn Statement K-3 X 4 . Proof of Liability Insurance K-6 2 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee PROGRAM COVER PAGE Organization Name : Boys & Girls Clubs of Indian River County, Inc. Executive Director: Leisa Smith-Fulton Email : LeisaSmith@iuno . com Address: P . O . Box 3068 Telephone: (772) 299-7449 Vero Beach, FL 32964 Fax: (772) 299-3840 Program Director: Patti Nugent Email : pnugient bgc@lLotmaii . com Address : P . O . Box 3068 Telephone: (722) 299-7449 Vero Beach, FL 32964 Fax: _ 772) 299-3840 Program Title : Youth Volunteer Corps Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program : Juvenile Delinquency Prevention — FN 150 . 360 YVC Programs that offer a variety of activities for youth who are at risk for behavior which is likely to involve them in the juvenile justice system with the objective of assisting them to improve self- esteem, to become aware of alternative ways of dealing with feelings and leisure time, and to take renonsibility for the consequences of their actions Included may be counseling, rap and discussionr>roogps tutoring companionship programs alternative peer group experiences and supervised recreational activities . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . Amount Requested from Funder for 2003 /04 : $ 401000 Total Proposed Program Budget for 2003 / 04 : $ 115 , 865 Percent of Total Program Budget : 34 . 5 % Current Funding (2002 /03 ) : $ 40 , 000 Dollar increase/( decrease) in request : $ Percent increase/( decrease) in request : 0 . 0 % Unduplicated Number of Children to be served Individually : 1 , 100 Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 105 . 33 Will these funds be used to match another source ? no If yes , name the source : Amount : $ - The Organization 's Board of Directors has approved this application o at 544-2003 Jav Mc Namara Name of President>Chair of the BoardFa Leisa Smith-Fulton - Name of Executive Director/CEO 3 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services 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. Mission Statement: To inspire and enable all young people, especially those for disadvantaged circumstance to realize their full potential, as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in Indian River County with quality programs and staff. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments and population served. The Boys & Girls Club of Indian River County offers a diverse, affordable program to kids in a positive atmosphere . Our daily after-school and summer programs offered through our "Club" house locations and our outreach services provided through our Youth Volunteer Corps program allows us to serve over 2, 000 children annually . These program activities attract and maintain young people 6 through 18 years of age who pay a nominal membership fee of $ 5 . 00 for the school term and $30 . 00 for the summer (which includes a free Boys & Girls Club t- shirt) . Nowhere in the Indian River County area can kids or parents find such a bargain ! While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remain much the same . The overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. Again, these specialized services allow our Club facilities, outreach programs and staff to attract and maintain the interest of youth members ages 6 - 18yrs . The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . . . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general. • Character and Leadership Development . . . empowers youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others ' cultural identities. • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well -being, set personal goals and live successfully as self- sufficient adults. • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts, crafts, performing arts and creative writing . • Sports. Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills . 4 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) L . 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. a. ) Limited access to affordable after school and week-end programs for children 11 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change . b . & c . ) We define those who have a need as children between the ages of 11 to 18 years of age, with a special interest in working with disadvantaged youth. We define disadvantaged youth as children from low economic status, one-parent families and latch key kids . The Youth Volunteer Corp is a community wide outreach program that provides daily opportunities for kids to participate in community service projects through out Indian River County. d . ) Area of need : • Based on the 2000 Census, 19 . 2% of the total population or 21 , 685 youth are under 18 in Indian River County. • Bases on the 2001 Kids Count Data Book, funded by the Annie E . Casey Foundation, 30% or 6, 505 of those youth are living in a single parent home 82% of a student ' s time is spent outside of school • All Indian River students are dismissed on Wednesday afternoons which had added on additional time onto student' s out of school hours • Based on the 1998 report from Carnegie Council on Adolescent Development, that youth ages 12- 17 are unsupervised for 12 or more hours a week. 65% of youth involved in criminal activities, sexual activity and substance abuse and alcohol use participated during the hours of 3 : 00 pin to 6 : 00 prn during the weekdays . 2. a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program. No other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club , for children 6- 18 years of age with year round drop in services Monday —Friday . For every child the Boys & Girls Clubs serves, our youth development activities are designed to build the following traits : • Positive self- identity. A healthy self-concept, a strong belief in one ' s self-worth, and a sense of hope about one ' s future . • Educational, employment, social , emotional and cultural competencies. The knowledge, skills, strategies and attitudes necessary to have a positive foundation for success . • Community and civic involvement . A sense of belonging to community, family and/or group ; willingness to take civic responsibility . • Health and well-being. Living a healthy lifestyle, taking part in regular fitness activities, able to access health care resources and engage in positive behaviors . • Moral compass . Youth have values enabling them to develop positive relationships with others . Our target population is underserved by other programs for the following reasons : affordability, accessibility and scope of services . 5 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee Co PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) I. List Priority Needs area addressed. Mental Wellness Issues & Childcare Access 2. Briefly describe program activities including location of services. The Youth Volunteer Corps services focus on education, skill building, and leadership development while providing ongoing positive activities for youth outside of school hours everyday after school and during the week- ends . The following in a list of programs offered to youth through out Indian River County in the YVC program: • VIP PROGRAMS (Volunteers in Partnership) Weekend Service Projects throughout Indian River County. • YVC Summer Program : Service projects are provided daily throughout the summer for teams of Youth Volunteers which are led by YVC Staff Team Leaders . • PALS ("Pupils Assisting Learning in Schools ') After School Tutoring Program : Youth Volunteers work in teams under the leadership of an YVC Staff Team Leader in a structured tutoring program in elementary after school programs . • Exploring Your Community Through the Scientific Method : The Youth Volunteer Corps, provides service activities to replace required Science Fair projects in FLC ' s Biology classes . • YVC Clubs : The Philanthropy Club which is designed to assist young people in the grant writing process and to present opportunities to participate in the fundraising process and the YVC Computer Club is designed to assist the B &GC with their technology and to maintain the agency Web Page, YVC School Clubs which design school wide service projects and work as a recruitment source within the school . • Youth Volunteer Corps Advisory Council : Youth Volunteers who have shown consistency in participation, exemplary behavior, and leadership skills, are chosen to represent the members of the YVC in a monthly youth driven council . 3. Briefly describe how your program intends to address the stated need/problem . Include reference to any studies or evidence that indicate proposed strategies are effective with target population. Most youth programs reinforce the disconnection that young people feel in our society by treating them as clients rather than contributors. The youth volunteer is the primary focus of the YVC program, but youth in this program are given the responsibility as the contributors of service . The Youth Volunteer Corps places these young people into an environment of meeting the needs others . Studies have linked adverse youth behavior with low self esteem . Treating youth as resources and putting them in responsible, serving roles builds self esteem. Search Institute ' s study of 46, 000 young people, described in The Troubled Journey, found that youth who serve others are less likely to be involved in negative behaviors . The study showed that participating in "helping behavior" lowered adolescent ' s involvement in substance abuse, dropping out of school, teen pregnancy, and other negative behaviors . 6 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee 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). 1 full time Director of Operations — with a Bachelors in Human Services with a minimum of three years working in the non profit sector, dedicating 50% of his/her time in program support, evaluation & staff training . 1 full time Program Director — with a Bachelors in Human Services with a minimum of three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and implementing the daily Youth Volunteer Corps program in the community. Staff Team Leaders — with a demonstrated capability in working positively with youth . 3 Full time for 2 months, 4 full time for 10 months and 20 Full Time Summer dedicating 100% of his/her time in implementing the YVC program. Team Leaders provide onsite supervision of YVC members at community service projects . Parent & Adult Volunteers — with a demonstrated capability in working positively with youth . Numerous Adult lead and assist with projects, office support, data input data, filing and mailings . Volunteers . 5 . How will the target population be made aware of the program ? • School : Service Learning projects and clubs, bulletin board, announcements, distribution of calendars and flyers • Newsletter: YVC Volunteer Newsletter/Calendars, mailings, Junior League Wavelengths monthly newsletter • Court Ordered: Individuals ordered by probation to do community service • Newspaper: Press Journal and Vero Beach Forum Volunteer Watch column or articles • Family/Friend: Word of mouth • Service Projects : Recruitment source during weekend and after school projects • Other : Phone Book • Presentations : are given to schools and service organizations • TV : Channel 21 , 13 — "Notebook" Show, TV10 — "Marsha Littlejohn" and the Freddie Woolfork Show 6 . How will the program be accessible to target population (i. e. location, transportation , hours of operation) ? The key factor in reaching the clients of the Youth Volunteer Corps is through the efforts of the staff and the team leaders . Each team leader is assigned to a number of schools and specific projects . They are responsible for recruiting, marketing, and "reaching out" to the community to insure participation and interest . Each team leader has a regional area to saturate with flyers, calendars, sign up sheets, and announcements . They are also responsible for arranging transportation, if needed, organizing car pools, recruiting adult volunteers for transport and supervisory purposes, and for calling and following up on those who didn ' t make it to a project . There is a complex and intricate system of molding many forms of communication together to bring a project to a successful level . This system of " outreach" is significantly dependant on the dedication and efficiency of the YVC staff and the Team Leaders promoting the projects . 7 Boys & Girls Club of Indian Riva County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee D . D- l . FY03-04 MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) FY0344 OUTCOMES ACTIVITIES Add all the elements for the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To maintain register YVC members 100% • Provide weekend projects every weekend ( 1 , 100) as reported by the 2003 -2004 year and afterschool and during every school end YVC register member totals . Baseline: vacation_ 2002-2003 register member totals. . Provide full time summer program with al day service sites for youth to participate in as contributors of serviceunder the guided leadership of YVC staff and community partners. • Provide programs to YVC members which are ongoing which teach about special needs children and adults on weekends nights (Respite an Recreation) and on weekend days ( Sun Up) • Provide weekend and ongoing senior companionship programs (White Dove, Tandem Healthcare, Royal Palm) • Provide after-school mentoring/tutoring programs to YVC members for after school service opportunities . • Provide 5`h graders an introduction to YVC programs and service through PATHWAYS in elementary schools . • Providing service activities to every 9t' grade student at the Freshman Learning Center a extra credit in clas or as a required grade for Biology class . • Provide YVC Clubs focusing on areas of interest. (Philanthropy Club , Computer Club) • Provide Performance in service opportunities through the YVC Band, Hip Hop Performance Troupe, Step Performance troupe, and the Drama Team 2 _ To decrease juvenile crime rates of enrolled . Create an assessment during intake process 10 - 17 year old YVC Members to less than to target YVC members with high risk 3 % compared to non-club members which is factors_ 7% as reported by the 2000-2001 juvenile • Assign youth targeted with high risk arrests . Baseline : 2000-2001 Indian River factors by the Department of Juvenile County statistics from the FL Department of Justice to YVC staff Team Leader to case Juvenile Justice Bureau Data. (7% of all 10- manage with follow up, tracking and 8 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Giant Application to the Children Services Advisory Committee 17 year olds) referred to the juvenile justice specific reporting on participation. system. • Implement policies and procedures to create an inclusion of all youth to participate all YVC programs . • Create service project opportunities, which are available to all youth outside of school hours, which are promoted by YVC staff representatives at schools and throughout the community. • Provide appealing, creative service activities for diversity of participation such as computers clubs, performance troupes, philanthropy, environmental programs, tutoring programs, arts programs, assisting the elderly or disabled . • Participate in Boys and Girls Clubs programs : Smart Moves, Torch Club, Keystone Club , Junior Staff programs . 3 . To decrease out of school suspension rates • Maintain behavioral and conduct rules, amongst our 11 - 17 year old YVC Members which are strictly enforced, and holds YVC by 50% (YVC members reporting less than members accountable through defined 5 % suspensions in the school system, as process so high standards and expectations compared to 10% reported by school district are maintained. wide last year) Baseline: 2001 Indian River . Creating retention activities for older youth School District Database. to remain engaged and committed to the YVC program through peer mentoring programs like PALS , Career and College planning projects, Leadership Programs, and YVC internships . • Create incentive and rewards for involvement in programs in high risk factor schools (Charter Schools, Piper School, Alternative Education Schools, Drop Out Prevention Programs, to increase participation) such as parties, certificates, and field trips . • Create mentoring programs with older Youth Volunteers with established positive disciplinary record with youth with high risk factors to partner during service projects . • Maintain programs, which are appealing to youth on all levels such as the YVC Band, YVC Arts in Service programs and Environmental YVC programs . 9 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. [NOTE: Collaborative agreement letters are not required by United Way of Indian River County.] Collaborative Agency Resources provided to the program Promotion of YVC programs in middle and high Indian River School District schools, implementing YVC Clubs at schools, partnering with school service clubs to implement joint service projects, assisting teachers in service learning activities, PALS After school tutoring program, Exploring Your Community Program at FLC Reciprocal recruitment source, implement joint service The Substance Abuse Council projects, work together in Tobacco Program, Right Choice Program, and Teen Plus Program Youth in our diversion program work with court Juvenile Justice Department counselors and probation officers and the YVC program director and Team Leaders to strengthen our goal to divert youth from the system by placing him into Youth Volunteer Corps projects Promotion of the Youth Volunteer Corp within the Youth Guidance Youth Guidance program. Supply service opportunities for the Youth Volunteer Corp . Children ' s Home Society Promotion of the Youth Volunteer Corp amongst the group home residents. 10 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Each YVC participant will be required to fill out an application which will be kept on file that contains demographic, gender and ethnic background information. All applications are manually entered into an electronic database . Are target population is tracked by age . We are able to track our special interest in serving disadvantaged youth by asking and collecting the following : • Does your child receive free or reduced lunch? (Asked to determine low economics) . • Who does your child live with? (Asked to determine single parent family status) . • We submit our membership list to the Sheriff s Department to determine Juvenile arrest. 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? Structured Reflective Process : the team leader documents collected thoughts and /or collects written documentation from each Youth Volunteer. This information is retained for evaluation and tracking purposes . YVC Staff Evaluation : After each project each Team Leader present completes an evaluation . This document measures the impact and effectiveness of the youth volunteers and evaluates positive and negative elements of the project . After each PALS site, the YVC Team Leader completes a weekly evaluation of the existing program listing the level of participation, journal documentation, problems and success . The Tutees and Tutors journals are held by each YVC Team Leader for long-range tracking and analysis . After each week of the Summer Program, the Team Leader completes weekly evaluations from their sites . The Youth Volunteers reflection paperwork is held by each Team Leader for long-range tracking and analysis . Pre/ Post- Survey : After selected projects, a pre- and post survey is given to youth volunteers to measure personal growth and learning experience . Parent Evaluations : After the summer program, a program evaluation is sent home to receive feedback from the parents of the youth volunteers to gain insight in ways to improve or change the program in the future . Agency Evaluations : After the Youth Volunteer Corps has done a project at any agency, an evaluation is sent to receive feedback from the staff and supervisors of that agency . This is to _ 11 Boys & Girls Club of Indian River County, Inc. - Youth Volunteer Corps Grant Application to the Children Services Advisory Committee measure effectiveness of the YVC ' s presence at their site and honestly evaluate the program. YVC Staff/ Team Leader Weekly Activity Sheets : This form is required by the program director to evaluate the productivity and effectiveness of each YVC Staff Team Leader. Journals : In the PALS program, the tutor and the- tutee is required to place a daily entry into their journals. This is used to track the impact on both parties from the experience and to measure personal and academic growth. Even if the Tutee is not able to write, single drawings or words learned can serve as an effective tool of measurement. In the PATHWAYS program, each student is required to write directly from reflective activities and share feelings about personal growth and observations from the program. The student is directed to report activities so a measurement of effectiveness can be identified . Advisory Councils : • YVC Youth Advisory Council : This group is made up of 12 involved Youth Volunteers who represent the spectrum of ages and socioeconomic backgrounds that are representative in the Indian River County Area. They meet monthly to discuss past and future projects . Much time is spent in both the evaluation process and the project planning process . • Youth Volunteer Corps Advisory Council : This group is made up of 12 adult members of the community who represent the spectrum of socioeconomic backgrounds that are representative in the Indian River County area. Two or three youth volunteers are present at each meeting to represent the youth. Much time is spent in both the evaluation process and the project planning process . 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 elements will be collected : • Team Leaders will track daily attendance and number of volunteer hours completed at community service projects . • The Program Assistant will compile daily data collected by team leaders and track Americorp hours completed by team leaders . • The Program Director will track weekly by the • The Director of Operations monthly by the • The Executive Director will receive quarterly and annual reports. 12 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee G. TEMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Action Steps Time Frame Develop Program Budget for February January 2003 Approval Write and Prepare grants for next fiscal year March 2003 Implement PATHWAYS program April 2003 Close PALS program May 2003 Register Summer Program Participants May 2003 Hire Summer Team Leaders/Interns May 2003 i Close YVC School Year Activities June 2003 YCLP Graduation June 2003 YVC Awards Ceremony June 2003 Train YVC Summer Staff June 2003 Train Summer YVC Program Participants June 2003 Summer Program Celebration August 2003 End of Ameri Corps Staff Terms 2002/2003 August 2003 Training of AmeriCorps Staff 2003 /2004 September 2003 School Presentations September 2003 — December 2003 Train YVC participants and PALS members September, November 2003 i PALS Program begins September 2003 i Evaluation of YVC Programs November, February, May, August i 13 0 b N00 ON 00 ♦�1�1 O P..1 r-1 PROON ik . Ly M. . . .V11 , 1!•;:i: 1 I 00 Nj �• >, b # o . NOW 0 0 0 . :::: (> bow O A o .d v Op y �j .0 .� N .w; . � N 5 o F e� y In In O f- • V r 6 r� i � pa �o �v � � ; > AMA � v A � V ►� � V S W O O y 1• ''?�L� + • � M M � I I 1 1 1 1 I 1 I I 1 � {�??"t� t'+.`•f: • 1 I I 1 I 1 1 iiiii po In In o Ua f '�. r.l . . . 4M:: •::::. I 1 N v 1 1 F •° V c �' c 0 0 W a a Cd 0 oa1U l o a oorn ° tj a a a P� ' o - ,-4 In c O o o `n O 0 0 0 0 0 + F p� ZviSUrx � F-, a wa oaF oma, � P � �oLi Boys Girls Club of Indian River County, Inc. — Youth Volunteer Corps Program Grant Application to the Children Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT. The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Fonns. AGENCYIPROGRAM NAME : Boys & Girls Clubs of Indian River County/Youth Volunteer Corps Proc FUNDER: Children Services Advisory Committee I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I Abe used for calculations and to write information only, w ea eatiY ProposealTatalPrograrrx arnder5�recrfrc RL�ifF.IVtIES !&iowoErws c:<; : ;;:: : otal cy zu euurlort Budgef Bridget T . . . : Bu get 1 Children's Services Council-St. Lucie 2 Children's Services Council-Martin 3 Children's Services Council-Okeechobee 4 Advisory Committee-Indian River 40,000.00 407000.00 130,000.00 5 United Way-St Lucie County 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 54,000.00 1741000.00 9 Department of Children & Families 10 County Funds $'15. � L1t1[T Glvic :x �ouridetions � > Cnrpol-ations 11 Contributions-Cash $?E5;O.OQ: z:. 3,000.00 223,000.00 12 Program Fees Nis UAW ?' $f>30Ua w ::::->X $24;110© Steak :: 5talce $3aoa©, Outside. . . Fundraisers 13 Fund Raising Events-Ne! 80,700 .00 :. . . . . . :. . . . . . . . . . . . . . . . . :. . . Vending 14 Sales to Public - Net MacEienes 400 .00 Memtershlp ($S schoor Year : t $30 SUmmer) . 15 Membership Dues shirts::- $5 ea 61200.00 16,550 .00 16 Investment Income Ekcl tinge Club: .:: Rent =.$30Q 17 Miscellaneous month 31600 .00 18 Legacies & Bequests $.400©, alcs $25,.000, Jr 19Funds from Other Sources League $650Q> 14, 834.00 75 ,500. 00 5/272003 - 15 10 O l0 ' : O Lf)N 0 O 0 N O d K : O O0 O M N " N V7 7 : Q Iti - In O O O CIO i.i: M aJ N r D) N M O In N N M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 y h+�� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 0 O ft # VA9c ik is 4c *k it *k 4 w p h �o 0 0 0 0Q 0 M h; T rn M a b ug 8 ss s g s s sCID gsss s o f N C N O f0 N R M � .; fVM �- :� _ N N M N Q : co> � �, � . ., m;. c X. IU onk a p� t h V U b.m h: . X. C � p *' e e � : 0 0 0 0 0 8 0a : us ogn : x; 0000 0 0 �.j. 5411 O O In 1,,.o 1\ lat. u.: O lOf)_ (D 04 N uN) W 1itY" : q N vs Il y.: Cp OD o ., . . r X. t m N (U N C _ .. O O al O N N C _ v .� is (] xN X. E of Ol v € N C C U ! C oo&oo CL O O p 40 CL y C w y ° L° or. N N $ N 5tn y D1 t� ° t ,C O y, ] �G c E a tPy a) ° F- W >: ° � E ° affix WjpObL ' p ~ EL 0EL m � C: 41 Y ~ W 3 o E Sar$ ❑ f E chum 12 Q E T N N N N N N N N N pasNo g o g o o g o S $ m $ $ o o g $ o $ C C C G O O C O O C a G C O O O C C N p p m tn O C0 0 O O Nm 0 In O pp O cy; C4 q '. 8 N . C Q1 g $ a ; $ ' 00: M.' j r E 01 Qp:: Q p p p p v m O p 0 p p g N opoO f V E N to w L!i o S p Q Fbt > 47db � p,Q pQ pp fad ; P.O.::; N "': 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 a X. co M O O O O O O O O O O O o 0 o o 0 0 0 U C7 N co A d - N W m 0 ©© O O O pp pp pp O O O O O pC 0 0 0 0 0 0 0 O 0 0 0 0 0 0 0 8 0 0 0 0 0' O O o 0 0 o o O D �" 8 fl o a 0 0 0 0 C O O O O O O C O O O O O C O . Q : IARL �g■y `�( i MI �7 V) X rB CC O SNC 0 O X y M r° m K $ E o p y L� L Of W O p) N N ^ r N C tLl m m n C N y w v E S '` a T ° m N �i a w e ., C7 ° E g © s v $ — v ° r E yN c C -' Q v� > t win c �° �' rn z m o f oi � cr- ° •° J a� c �- ° o o > c J c0 c o 0 o. E N o c X o X �o L O T C N N E t C C m rN- X (V N W 61 "- a TL o 2S ti CL x c 10 a E c w C m U m rn ° w t e v n w m 'm v C o f > U) w CD > ° '� L N °� E c c c° t m E « m a°i co E m ``° ° c fn Mw m :r v x U .r n ° m o w m m w o a d c > :. H ° a — m m m ° o c E v c � ZF- O rnp d a oQ N ° dcAm �• W DC7 � � -miC7 � Z oa . 0000000000000000 I- xt r v 0 n CL E w a M co N M M N M M S g g g g g S S g g g o In 8 S g o '- N N f7 01 cr O r W ED m CID O : f ': V E a gg S g C9 8 g g g g g $ g o r. N O O O O 00 O tD U co y� p . . i N NCD tO c Z c N k. 66 1.16 a61 i . t c t U U 8 .. . . . . CL gn Q t m O JAE, R. .9. .9, •U r y y d y N c ApC �•. z y C to O a ° E � K t E d �o ° N e `x T v N m %ke E w O K to w U W x v ap`O1 °a L° c YZ c R UIlk r � X -o o N (D z y 'M C C K ... O V W qu 7 c N W W (UE IL �' c id zi 7 c otl N E r. E U o Q H 2 rn W 5 OOJJ c 1&0 fl QOO •" Ilk CL JE ac c m y c , cL °LLx �O- Tw :N a � � tri cmm � � a .m � Svc o •5c ' SSE t3 ED (u y �+ $ �i 0c ~ � m c to _w H tv �° d v m v N Z ,, U a v A m o y y 7 o C E z *3 a ... 7 d N l0 W f0 " N VI K c V LL N O O C o m y to y E y w E c o a a v 'a E ami ; c ° E 0) d m N w a Y :c 06� v m o 'c .c w a w. N Q .21 U N Ilk 7 � M to 7 7 0 0 '� o w o o > d d J LL O ❑ U) W ❑ U m C L 7 7 ° N O N O w O p 6 p tU C E •p 'O '� d N N N «�•, W U r N .D in N Q W U � UUO aZti0 WUJ aJUO 0 ° 2cn ma ° c rL wtn0 LL eQ� lQ� - �n O O M M th M et' sr �! 7 W co 0I Boys Gels CW° of lMm Rn Cowry. ss:. - YOUR Vusnl°rr rs PIogn n Cro P°Wceow ro rm C Ww Se°o°s AcMwrm Combe UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: FY OUO2 FY 02103 FY 03/04 '% INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (coL CcoL BVCoL B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.001 #DN/0! 2 Children's Services Council-Martin 0.00 #DN/01 3 Children's Services Council-Okeechobee 0.00 #DIV/01 4 Advisory Committee4ndian River 48,458.00 1007000.001 130 000.00 30.00% 5 United Wa St Lucie County0.00 #DIV/01 6 United Way-Martin County0.00 #DNIO! 7 United Way-Okeechobee County0.00 #DIV/0! B United Wa -Indian River County 80,000.00 136 000.00 1747000.00 27.94% 9 Department of Children & Families 0.00 #DIV/0! to County Funds 0.00 #DNIO! ttContributions-Cash 132,222.00 264900.00 2231000.00 -15.82% 12 Program Fees 940.00 0.00 0.00 #DIV/0 ! 13 Fund Raisin Events-Net 56,799.00 69 494.00 80,700.00 16.13% 14 Sales to Public-Net 710.00 300.00 400.00 33.33% 15 MembershipDues 91995.00 6850.00 16550.00 141 ,61 % 16 Investment Income 2,934.00 0.00 0.00 #DIV/01 17 Miscellaneous 11800.00 31600.00 39600.00 0.000 18 Legacies & Bequests 0.00 0.00 #DN/01 is Funds from Other Sources 96,924.00 127,977.0075,500.00 -41 .01 % 20a Reserve Funds Used for O eratin 0.00 0.00 #DIV/01 lob In-Kind Donations (rbe :,°e,ded in tow( 1408.00 ° 47,464.00 108,850.00 129.33 /° 21 TOTAL 430,782.00 709121 .00 7039750.00 -0 .76% _ . EXPENDITURES 22 Salaries 183,135.00 394 936.00 3939527.00 -0.36% 23 FICA 27,773 .00 267130.00 -5.92% za Retirement 6,992.00 19,025.00 22,750.00 19.58% 25 Life/Health 14318,00 28126.00 31 ,619.00 12.42% 26 Workers Compensation 2,524.009,730.00 9,154.00 5.92% 27 Florida Unemployment 2,788.002 379.00 2,404.00 1 .050% 28 Travel-Daily 897.00 748.00 17900.00 154.01 % 29 Travel/Conferences/Training 71169.00 229752.00 119500.00 X9.45% 30 Office Supplies 129863.00 34 655,00 14 267.00 58.45% 31 Telephone 4,932.00 8 105.00 9 580.00 18.20% 32 PostagetShipping 1 ,441 .00 11983.00 61960.00 250.98% 33 Utilities 59132.00 11 ,948.00 129444.00 4.15% 34 Occupancy (Building & Grounds 43,100.00 64,564.00 68,838.00 6 .62% 35 Printing & Publications 18,863.0010,215.00 169500.00 61 .53% 36 Subscription/Dues/Memberships 49626.00 3673.0 0 10,115.00 183.10% 37 insurance 89235.00 11015.00 14,763 .00 34.03% 38 E ui ment:Rental & Maintenance 115.00 0.00 7,200.00 #DIV/01 39 'Advertising546.00 1 ,200.00 11200 .00 0.00% 40 Equipment Purchases:Ca ital Expense 9,048.00 0.00 0.00 #DIV/0 ! 41 Professional Fees (Legal, Consultin 0.00 16 670.00 0.00 -100 .00% 42 Books/Educational Materials 29883.00 29000.00 1 ,000 .00 50.00% 43 Food & Nutrition 497.00 600.00 600.00 0.00% 44 Administrative Costs 0.00 #DIV/0! 45 Audit Expense 4,190.00 61000.00 97100.00 51 .67% 46 Specific Assistance to Individuals 0.00 0.00 0.00 #DIV/O! 47 Other/Miscellaneous 21 ,962.00 147327.00 10,389.00 -27,49% 48 Other/Contract 1 0.000.00 0.00 #DIV/0 ! as TOTAL 356.556.00 692,324.00 681 ,940.00 -1 .50% 5o REVENUES OVER/ UNDER EXPENDITURES 74,226.00 16,797.00 21 ,810.00 29 84% smnoo3 19 Bays G M CW of IndkM Ri%W Carty, I= - vaN Vol~ Ca Prowwn Grwt AP0000n ro ere Clatran Sn Aa"" Camra. UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: FY 01102 FY 02/03 FY 03104 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (cal. CKoL SycaL 9 REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 #DIV/O! 3 Children's Services Council-Okeechobee 0.00 #DIV/O! 4 Advisory Committee-Indian River g 50,000.00 40,000.00 407000.00 0.00% 5 United Way-St Lucie County 0.00 #DIV/0! 6 United Way-Martin County 0.00 #DIV/O! 7 United Way-Okeechobee County 0.00 #DIV/O! s United Way-Indian River County 51 000.00 467000.00 54,000.00 17.39% 9 Department of Children & Families 0.00 #DIV/O! 10 County Funds 0.00 #DN/0! 11 Contributions-Cash 107939.00 47900.00 31000.00 38.78% 12 Program Fees 19360.00 0.00 #DIV/01 13 Fund Raisina Events-Net 77779.00 0.00 #DIV/O! 14 Sales to Public-Net 0.00 #DIV/O! 15 Membership Dues 6,200.00 #DIV/01 1s Investment Income 0.00 #DIV/0! 17 Miscellaneous 0.00 #DIV/O! 19 Legacies & Bequests 0.00 #DIV/0! 19 Funds from Other Sources 67,484.00 27,833.00 147834.00 -46.70% 20a Reserve Funds Used for Operating 0.00 #DIV/01 20b In-Kind Donations (WA iwW ad in WOO 649100.00 35A".00 639580.00 79.280 21 TOTAL 188,552.00 118v733.00 118,034.00 -0.59% EXPENDITURES 22 Salaries 235 041 .00 101 ,356.00 81 ,292.00 -19.80% 23 FICA 9,071 .00 57569.00 41093.00 -26.50% 24 Retirement 0.00 19250.00 2,675.00 114.000/0 25 Life/Health 0.00 0.00 3,504.00 #DIV/O! 26 Workers Compensation 0.00 17951 .00 17434.00 -26.50% 27 Florida Unem to ent 0.00 363.00 378.00 4.13% 28MTelephone 41224.00 0.00 500.00 #DIV/0! 29 Travel/Conferences/Training 3 905.00 8 837.00 3,750.00 -57.56% 30 Supplies 31405.00 13,100.00 27994.00 -77.15% 31 8,692.00 0.00 0.00 #DIV/0! 32 in 2,436.001 ,200.00 450.00 -62.50% 33 0.00 4,400.00 0.00 -100.00% 34 Occupancy Buildin & Grounds 700.00 100.00 -85.71 % 35 Printing & Publications 29411 .00 67300.00 61000.00 - 4.76% 36 Subscription/Dues/Memberships 1 ,491 .00 11100.00 19100.00 0.00% 37 Insurance 1738.00 940.00 2,230.00 137.23% 38 Equipment: Rental & Maintenance81905.00 0.00 0.00 #DIV/O! 39 Advertising 256.00 500.00 500.00 0.00% 40 Equipment Purchases :Ca ital Expense 0.00 0.00 #DIV/O! 41 Professional Fees (Legal, Consulting ) 0 .00 0.00 #DIV/0! 42 Books/Educational Materials 0.00 100.00 #DIV/01 43 Food & Nutrition 0 .00 0 .00 #DIV/0! 44 Administrative Costs 0.00 0.00 #DIV/O! 45 Audit Expense 875.00 2,000.00 2.000.00 0.00% 46 Specific Assistance to individuals 0.00 0.00 #DIV/O! 47 Other/Miscellaneous 12,819.00 9,095.00 2,765.00 -69.60% 48 Other/Contract 0.00 #DIV/0! 49 TOTAL 295,269.00 1589661 .00 115,865.00 -26 .97% 5o REVENUES OVER/ UNDER EXPENDITURES -1061717.00 399928.00 27169.00 -105.43% smn0m ,0 Boys Girls Club of Indian River Coady, Inc. - Youth Volunteer Corps Program Grant Application to the Children Services Advisory Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER: A B c FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS, PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 22 Salaries 813292.00 379150 .00 45.70% 23 FICA 4,093 .00 27841 .98 69 .44% 24 Retirement 21675.00 0 .00 0 .00% 25 Life/Health 3 ,504.00 10.00 0.29% 26 Workers Compensation 19434.00 0.00 0 .00% 27 Florida Unemployment 378 .00 0 .00 0 .00% 28 Travel-Dail 500 .00 0 .00 0 .00% 29 Travel/Conferences/Training 39750 .00 0 .00 0 .00% 30 Office Supplies 29994.00 0 .00 0 .00% 37 Telephone 0 .00 0 .00 #DN/0 ! 32 Posta e/S hipping 450 .00 0 .00 0 .00% 33 Utilities 0.00 0.00 #DN/0 ! 34 Occupancy (Building & Grounds 100.00 0 .00 0.00% 35 Printing & Publications 61000.00 0.00 0 .00% 36 Subscription/Dues/memberships 11100.00 0 .00 0 . 00% 37 Insurance 21230.00 0 .00 0 .00% 38 Equipment: Rental & Maintenance 0. 00 0 .00 #DIV/0 ! 39 Advertising500 .00 0.00 0 . 00% 40 Equipment Purchases : Capital Expense 0 .00 0.00 0.00% 41 Professional Fees ( Legal, Consulting ) 0.00 0.00 0.00% 42 Books/Educational Materials 100 .00 0 . 00 0 .00% 43 Food & Nutrition 0 . 00 0 .00 #DIV/0 ! 44 Administrative Costs 0 .00 0 . 00 0 .00% 45 Audit Expense 27000 .00 0 . 00 0 . 00% 46 Specific Assistance to Individuals 0 .00 0 .00 0 .00% 47 Other/Miscellaneous 29765.00 0 . 00 0 .00% 48 Other/Contract 0 .00 0.00 0 . 00% 49 TOTAL $ 115 , 865.00 $409001 . 98 $0 .35 5272003 21 Boys GIM CNE of h olon River Courcy, he. — You1h Wheless Corps program Gard AppOcadon to IN Chlkhn Serest Advisory cormstse UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Gins Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee : :>::::::::::::>::> : :: : .. ... ::: :: zf11t6 E'Rd. . . . . . . . . . . . #DIV/O! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! We are requesting an increase in funding this year due to a variety of factors ranging from: shifting in funding focus from other funders, to a mis-conception of an economies of scale when joining with the B&GC. Money awarded to the YVC program mean direct United Wa -Indian River Countv services youth. #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Due to a NCCC Americorp grant, in-kind service through 20 college kids will be provided during the summer, plus an increase in 1 - In-Kind Donations Not included in total Americorp staff Position year round. This will allow us to serve 200 kids a day during the summer. Retirement #DIV/0! #DIV/0! #DIV/0! Insurance In transfering the YVC program to the B&GC insurance the policy was transferred to Markel which requires a different coverage. #DIV/0! #DIV/0! #DIV/0! #DIVl0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! VM2000 22 Bon Ghlt Chlb of h0an pMr County, Ac. — Youb Vahnaaw Cmpa pmp m Gram App0ealbn to the CMarm SwW=s A&.ftwy CmaNlaa UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee Salaries FICA #DIV/0! #DIV/0! #DIV/0! #DIV/0! 527/!003 23 Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street Vero Beach FL , 32960 ("County") and Boys & Girls Club of IRC , Inc. (" Recipient") ; of: (Address ) Boys & Girls Club of IRC , Inc. P . O . Box 3068 Vero Beach , Florida 32964 Attention : South County Branch 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Thousand Dollars ($ 30,000 . .00) . 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 Quarterlv 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 23 , 2003 , 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 - 2 - 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 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. - 3 - 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit • incorporated herein in its entirety by this reference . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first ab - . • • written . INDIAN RIVE UNTY BOAR COUNTY • a , r yl � t x 1 14 t q Kenneth R . acftz , Vt Attest : JX Barton , ! T B � a Deputy 34 Approved . I' Chandler,ames • Administrator Ap ed as to form and legal su iciency: un y Attorney Boys • Girls Club of IRC , Inc . P . O . i • , 6j Ver • Florida • ' ame t Title EXHIBIT A [Copy of complete proposal/application] - 1 - 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 184025 th Street Vero Beach , Florida 32960- 3365 Recipient: Boys & Girls Club of IRC , Inc. P . O . Box 3068 Vero Beach , Florida 32964 Attention : Leisa Smith - Fulton 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 - 1 - 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 . - 2 - SEP-24 -2003 WED 022152 PM WM, DAY , INC , FAX NO, , 772 546 5772 P , 02 1 � Florida Retail P% dwatim >�,• V �� Insurers <` tRdmiNixlarad {r .�llN!!ai{J W, `L3rU " Rut14ra1, Jc. C'hMrmtntr ( ' n ('rnh r '{y S�nCR ��ry Cite+tgt Said kr , tirccClWirhnn, P«aJfr�<, � 1?0, Iifxx Gltg • l .;itcalanrt, 17. 3380309�a • �y� y, :,sruuna+UlK)l�Ilrl$•rrom 665,6W or i - 90 -_8 764K • !� i* tiiea.r . JJ4rlred''�'••— '� ' I ) 7 � • �ax (�63} GF,C} trJ:�K '� rtlurl. PckvlY. 11drfrrnr! in ,alovR. Wj 1tIY , 1<ukm,aullr Certiricate of Insurance RE : 0520 -25864 ISSUED TO : Indian River county Board of county commissioners 1840 25th St Vero Beach , FL 32960 -3365 This is to certify that BQYs & Girls _gub ofJndian Riyer Count�C, Inc p� being Subject to the provisions of the Florida Workers ' Compensation Law,has sec the paycment Of arty , compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : 020 - 25864 Statutory Limlts--State of Florida EFFECTIVE bgTE ; epk�m�Lif Employers Liability $ 500, 000 ( Each Accident) EXPIRATION DATE : Sep er bAr 13 . 2Q04 $ 500, 000 ( Disease - - Each Employee ) $ 500 , 000 ( Disease- - policy Limit) This certificate is not a policy and of itself does not afford any insurance . Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or affording insurance to any Insured not named above . The policy of Insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirements term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the t �rmsr exclusions arid conditions of such policy . Paid claims may have reduced the shown limits . If the policy described above Is cancelled before the expiration date Indicated , the issuing company will attempt to mail 30 days ' written notice to the certificate holder named above . However, the Issuing company, its agents or representatives accept no obligation or liability of any kind for failure to mail such notice , Date 09/24/2003 sVst•Iit consulting , Inc . , ,ldrniniatrator Florida Retail Federation Self insurere Fund IM DAY FAX N0. 5615465772 P , 02 ACORDN CERTIFICATE OF LIABILITY INSURANCEDA'E ('°AIDD"'"'y) 112jowaz PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Da Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Day HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 11320 SE Federal Hwy. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Helie Sound FL 33455 772.546-5767 INSURERS AFFORDING COVERAGE NAIC 17 INSURED Boys & Girls Club of Indian River County, Inc. INSURERA: Market Insurance Co PO Box 3068 MJPZR B: Vero Beach FL 32964 INSURER Q INSURER O: _— ctSIIRFR E V =7:Z A .S I THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMCNr, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITtt RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DCSCRIBED HEREIN IS SUBJCCT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH _ POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCFD BY PAID CLAIMS. INSR D POLICY EFFECTIVE POLICY EXPIRATION IR POLICY NUMBER UTAITS _NERAL LIAAILITYEACH OCCUrUA04CE s 1000,000 I A I X COMMERCIAL GENERAL LIABILITY 8502CY2201282 09113102 09113/03 DAMAGE TO M NThuPRFIntFc Ira �.. s 140,000 ' CLAIMSMAOEOCCUR MED. EXP (Any c son S W00 PERSONAL Q ADV rUUKY S 1 ,000,000 CEfIERALAGCR1=GATE s 3=000 GEN'L AGGREGATE LIMIT APPLIES PER: PROOUCT5 - COWtOP AGG s 1000 _ 0 X POLICY yi PRO- LOC • AUTOMOBILE LIABILITY C0rle1NED SINGLE LIMIT s 1 ,0001000 A X ANYAUTO 8502CY2201282 09113/02 09113103 (C3acade-10 X ALL OWNCO AUTOS BODILY INJURY s SCHEDULED AUTOS (Pa per=n) X HIRED AUTOS BODILY INJURY I X NON•OWNCOAUTOS (Per acdoent) I PROrERTY DAMAGE (Per am.''.enlj GARAGE LIABILITY AUTO OW Y F.A A!:CIOENT S ANY AUTO OTHER THAI) FA ACC S r AUTO ONLY! AGS S ?S.'YSRELLA LIABILITY EACH OCCURRENCE is i OCCUR FICLAIMS MADE AGGRP.GATE s ' S 1 DEDUCTIBLE S RETENTION I S WORKERS CONPEN9AT10N AND WC SIAM OTH- i O&PLOYERS' LIABILITY E.L. FA(]1 ACCIDENT S AWPROPRIFTORIPARTNICRIEXECUI NE OFFICEKWEMBER EXCLU0007 E1. DISEASE - EA EMPLOYFF. s Nyye� At PR NASIO EL. DISEASE - POLICY LIMIT s . P ' . Al PROVISIONS DN OTHER `tsewqfwrION OP OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL. PROVISIONS C _ r: .`t'c:. t.r1& oider Is additional insured for General Liability & auto 30 Days notice applies except for non-payment of premium CERTIFICATE HOLDER CANCELLATION j Indian River County SHOUIDANYOFTHEAROVFDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATION Board of County Commissioners DATE THEREOF, THE ISSUINC INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRTITEN + 1840 25th St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO :0 SHA` Vero Beach, FL 329603365 IMPOSE NO OBLIGATION OR LABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS On I REPRESENTATIVES, AUTHOR2ED REPRESENTATIVE </UD> ACORD 25 (2001108 ) CWCORD CORPORMIoN 1988 IIHI -GG - cuuo Inn 1C lO rli Wfl UHT FttA : IYU. 00 '1U4UJi is r , U�) i IMPORTANT If the certificate holder is an ' ADDITIONAL INSURED , the policy(ies ) must be endorsed . A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ). If SUBROGATION IS WANED , 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 endomement(s ) . DISCLAIMER The Certificate of insurance on the reverse side of this form does not constitutea contract between the issuing insurer(s ), authorized representative or producer, and the certificate holder. nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon . I i ACORD 25 (2001108 ) 04 - %�-2003 THU 12 ' 15 PH WH DAY FAX N0. 5615465772 P , Florift Retafl er. Self curers n.Mir � rorfe � Al lY. "l3rti� lieu<Irar. lc, l'h urnttn, ,�Irrr [ '11r < 'fgf.•r Ad�nialalrrrYl iy layi r, ii since 1979 (l .;,r�t 4:utlefir, �'ic: ch.1h min. Pwlaf4a Nn Nrzsrii . JAeland r 1'.U. li � R >B� • [ .alcrltu�d, 1 [. z3.`�J ? -018 � sr<r x• sr+ nuuah4Gl;,rRt. iour Thorn" S_ Y. k,011. 1 <rd .l� $ Icigilu�rlc (AM )i 663 m600 nr l -8Mw242*7644 � RiX (941) 66C1• 195� (� .alrs 1L PJui ��, .►w Ilarmt+1(r �. �- - certificate of Insurance RE : 0520 - 25864 ISSUED TO , Indian River County Board of County Commissioners 1840 25th St Vero Beach , FL 32960-3365 This is to certify that Boys & Girls Club ofIndian River Counky, Jns P .O . Box 3068Verb a FL X2964, being subject to the provisions of the Florida Workers' Compensation Law , has secured the payment of any workers' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . =CL Cv NUMBER : 9_520-25864 Statutory Limits - -State of Florida Employers Liability EFFECTIVE DATE : SepterpbeL 1 2002 $ 500 , 000 ( Each Accident ) $ 500 , 000 ( Disease - - Each Employee ) EXPIRATION DATE : aggLembqrX3 , 2QQ2 $ 500 , 000 ( Disease- - Policy Limit) This certificate is not a policy and of itself does not afford any Insurance . Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or affording insurance to any insured not named above. The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement, term or condition of any contract or other document to which this certificate may pertain , the insurance made available by the described policy In this certificate Is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits , If the policy described above Is cancelled before the expiration date Indicated , the issding company will attempt to mail 30 days' written notice to the certificate holder named above. However, the issuing company, Its agents or representatives accept no obligation or liability of any kind for failure to mail such notice . Date 05/ 22/ 2003 ..... , tt corroulefrp , :nc . . Adrnintatzatar Florida Retail Federattor, sair Insurers Fund r + I 1 � I In • I ' '� n , ) f ( I `til rl 'r n rl •. t r� I, I , � ,, h LI Its tit I t ' iIi �a i. t M u 1� to `� li• ii I , .i ' . � Y/ 1 n � � r: rt Gl U' o N • I. l0 1•• x: , rl r)• 7• 1 � � J � ( 1 • t<I V n r ! A Ill U• ,Y ItsIq ( , . O It r ' I •• tl � M 11 t4 a I ti M u n, � (t U 11 n Y i] t• r, h � ' /t A ro 1 -4 �t1 tt • C (1 �r (1 I , 1 a „ O f) p n U. 1 ^ l H r i1 11 n . l7 n `(� to lot I. n ' 1 1 ) • ry n I, A . 1 n .i. �` 1 { a a• I •. .a P. YJ p, rrl tY ro ry j �' b �; .•�' ' n to c ' in `• to(r Pie ;G • t ' t{ wto �' r �' ti a a �. { �S � ,' p As �� rn I , t ro t, n rn ti 1 { Jim It• $1 , 11 . , t ' ht rL 1r io +d a C] b In to U n tl b k! r Il p '' u p p 6 P1 pp i P . n n p II p , r. 11 p n F t7 rn i It• � I 1 f• t o r. n to( + • r, I � ± ; ' � (� A lin . 00%, A 11 Ill I lot I • � 1 ro n •. n p 11 IS . I � a , fit u r1 1 , • It ;y ! ,tI r C (r p I� tL ( l p { [� [� ((�� l 11 b i nlet n �L nu 1 o pltt�jl i ,1 1iJ : (11j `° r { N d n I . i a u r, � . ( ;. II It r' � � ►; I� i n a �� �' f� �< � 1, "a � � b , u �,. I +• 2 1• , 1 II ) I ,, P. 1 Ii tr1 11 Ia % ( 11 • , : �It . �t t.^ fit tL tt 1 1 It „ , r , , 1 {,� I � . .. �� r n' I •� LE ur Its 1 ►J ea p• Pp Yl 1 1 11 I1 Irip U C 1 O P' Ili � n r n to ) ' (no 1"a rt j Irl y I t v Al ft1 II t1 1 . if c, to �' + 11 1� it r in p ' ro w p1 tit I� • u EJ E Iri, 1 1 , a, r• t1 Id ti ii i p H 1 ra i U O , V tI t„ r} ;d N n p AI . � r .0 i r n , .. I t1 1q1 n 1 ' p 1 r t ' , .n n r r 1 . u n n. to ti II 11 1 , , p Ir It I • • A , � ' Il . p �1 l7 o (�n1 .. �� r p (1 n t F hl la 4I 1 . f1 ' PS. 1141 tj } , ' to C P. + . � '! 1 (1 0 ' � Y•c]t It ( • • 1 ,- r-r to 1 � n, u ' m O G b q _ I f1� h' I7 t1 IY 1 II 'U � ,y I • • El 11 • ' �� d p P N a {j %, I ' h t `7 1 1. 1 r() , rQ Dr w I� t] p 1 7 w 1 11 1 (• P M 11 F-' In O f (� {1 r IC �- At n It I ' rt h' 1 O U I . • ly f i 1 ' 1 I ' • a 1 •• R 11 � !� G „ M �• 11 til hl C U E1 t• b � < ' tt 1 ,. , q O � . • ii i y �1 n t. r m u p• �u 4 < I P PI ,q n h re t7 �1 I ,. II n (' t1 1 yy }}�I r n C, n � p a pF� hM ( n• I � Rp Hn � 1 tuu! ( oton rnn11 nnti 1 ) • n >r 1q Inn ( T 11 n n 11 u , n U 1 • ' < tr t1 + n n 1 , . c, v u r ;� tit u1 to p n 14 11 J• F tt tq a P , U rt u �D tt y , 11 r0 1 ill 11 U !. , I p 'n 11 p I (r A .. n rl n � � , u) Iw . . x , � rt fi . , . . . . t 11 t l u 1 p I ^ p, PI A l ytoll I 1 � ' 1 ' w • 1 0 1 • . E '< E O n ' ) n •- k� O p li I ,it to • • rr (1 C n n ; 1 n i . . p, r It , . 11 1 L. N , •U to rl I r, I -� II 1 . II t " F• 1 ' (r 1� ! I 1 • • ; 1 j t DI I { CIA 7 I Lr t , 11. i . 1 , l w !L I �• 'w 1 I1 . 1t 11 . n 1 ' • IT 1 _ It n r rr Wtj it t n 1 p fl n e n c� n r. 11 rl 1 < �' to 07 II 1• , 1 U t1 0 ll , n _ u ' ' r, r1 41 .14 o u 1 � I v 1 a o a' Il x r JJ u u Ij lJ O! n I•i N bl a1 ,r1 �. .J" ti U I• i .� 4 ` , U U 11 - LI 'd O y Ut 0- 1 m I , „ ❑, -1 dj U , j td I 11 If 11 11 U ( l N y N ' `N U 1, > , I , II c 14 J }• U W u O, U 11 lel 11 r-1 V W U It, FI U 11 ' l1 ' • t (1 ( 1 O U1 n 0 1, .1 , d to Ji li b h 'U l n l + U • 11 > Jl U II •U ro u L N H 0 if u 11 N u . q O U i ? J U tt 0 ! b U u IIIQjj dl (° • 1 L 1 11 1• w el i t U �� U U 11 u N n ri u O 41 'U U Ag 1D Ut p L ll I tl N r � uI b1 U Ol ii Jr j ;J I1 t' {. 1 JI III 1J „ �• 'D tF Cu' u �/ •... . _ �-i •til �' " 1u1 O t1 Ic n. , I „ u u � ; G Ce• n ,J ;-I 1 11 U v d o d ii ,j 11 u _ t1 1 , fl• , 1 u U w v ,i I' t FI a 1l U I 'J U U W I U U • • t ll U i• ( ( I, 11 v p I : U nt it . . 1 t . I t ) j Mla a tl I ' p� � I u U ,I. r jd IU 111 � t 4 q TI 1 ) 1 1 � U I]tFt J� U U a . + q 'u C' P-4 11 1) 01 I1 tt U b 1 ' �.I q .- 1 u qq � d JJ I11 tI 1 e 1 11 71 M1r U V It • �I r y I I G ' 1 � 'U , i � . rI b c7 u n I v 1 , } If tl 1 11 I b u t s f)� r { I U L ~ VJ 1 1 r e t .1 � I 1 : 1 U JI , t1 w U IJ u , t n 1 ylrrl � I G � � f1 ul, � _ H r ) 1 (� •. I N rl 0 1+ � ,u (1 y t -1 � II rl ( I �I F7 U 8 II U uJ ) 7 n �. .FI �, n{ tl . ,A e1 11 •� t14 1n ! 1 11 V III bl t7' , 1 q o7 •if 11 ►1 lr1 (V 11 j la r �N ' rl Id . T F r IJ I N 1 Ib 0 r t1 t) rt+{ I r , ul r V I u M / o { 11 qq1 lu r',1 u to v �1 p, . � c1 11 I w �j .. 1 ur u J� L + + I7 I 1 i f� n ; i J U N lJ 1 V 'H .f , U FJI 11 aL�F °� V 1 rC c u I � t � t f u r . I J) U ► J Id ,II u ti CJ. U 'd N 'tJ l� {] 171 i� J O > (l 0 rl rl Il } 11 tp U {I 'd ' 1 `I 0 . ( 10 • r♦ 11 v r v 'll a tl u U U d Jf tj a N 11 0 11 St v U L 1J U U +� rl u N o; N I , r1 } . 11 V bt :� r• u ad (' ❑ 1J r :1 l • r1 til 0 1 � rla '1If 0 1 • . 1 •1 fit 1i I : .d U . ! t o q �'lit 10 p� 1t,1 �l U n 51 ij Ili }l. 1q+ I u t {i tl n, IJ u vUi i d '�d . t] '❑' >, n til u ovl p d v a o b ii bt i� u el u .f . � 1 Fr o J a 1V U tti F' IS 1 tJ an iJ I � •.. . I ' J N It tl 1d O ai U �' u• 1{ �+ 1a , a7 . • 1 U D U 'd N 'il L{ n{ .11 • { It � . UUU • 7 �' ) rV 41 4 +J • '� �• v ( I7 >, l 1 J J , FJ • rl O U • I 1 • iJ V u If I F E t 4) , 1 lF 01 1 U > of % 1 . 11 h a 1 : J t yl U .') ., . 1 F (� 'r7 [ 7 1, • 1 1 11 p P. Ill • . e of If U I r 0 u 1i 1 1e 1 p• u u u U ! E a U qit ❑ .� m " u , (J , 1 li Il U x 1C ;- � r � it L 9a1 J iJ Fl v lJ JJ • 1e C, V u �I u U IF1 rJ 'F ., . . 1 IJ ,d � r iJ I� eY) ) • E u f j J U 11 U i w a l J •-+ N JJ K1 1 'tj W 0 11 10 u N 1) F�ALL 11 •- I ' rr1 10 rl k' .O j� If n 0 V ; � •rl 1 � fl• 11 j •cj a u U •� U u V O C '.7 1d O 11 � ' H JI �•• N u (1 U • rl le 1, �y , ? of i 0 t1 rj u Jl •H n sl t1 a ❑ r: .1l ,.-1 n, + U r1! • 1• ' ', I O aJ • 1 ❑ �1 U • rl u V [� • I ; I ,It ✓✓ Lot •11 h U N U 4 F) O • rt •l) + 1 U b rlt I O d .tJ 11 4l 0 " U O 'tl y }, h rl P. 11 • r, �fl O 1 , >J . •1 } I U 1 7 v l J , 1.1 I t 1 aJ 7 C � 1 ; 4U1 11 r u v y 0 I t' U It Ill .1 TI • rt FF u 1 - 1 a1 tr o ro d u q fa I� kl `J u . . . to v vi bl tJ ' I v U �hI n y '! p1 'd ► l N R 11 , •r X11 vl �t ,fl rI . I U ,-I q , 1 1 11 1I V I I U U1 1 0 11 a O o n 1J ( rl q C r 'F7 rl rlt rl Jt 11 t U J `+ 1 [ o I 1 I Ffff1 t n H pt t , Il . H + u N >4 u a 11 tl la U Q dl lC� - , 1 , 7 F�}, ?I�IJ Ik�! L{ (Yti 1� J L 11 I1 + ' „ 1 .11 1' til J: u d r6 q q W O 14 1W r-f 1e t1 0 . v Iq u •rl n Y .'U7 •• I In tl 11 [1 ? �i r0 ' f Dd -I k� o � i, n � ;A4 l v �+ 0 i� Of 0* V Id 11U11 d U b f ► I 11 - 'r (� 'd d o u n1 M n u d , -+ 1 � h M J V v .1; II 0 u u Ir u 11 I F 11 EI d d H F1 l i . U r� l l 11 [1 v : 1 1 _, tt U U 11 N U U 't 11 11 , l 't1 I, t' t1 a - r 1 Fa II M , M rl r • 1+l U •+ • R G n 1 , N 11 V ,, N 1 N J � • al U ll � I U 'u c . U u1 , 1 I 1 0 o u to { 1 u ._F ' ' d q J a 1 q 1rI' 4 •rIJ re r r•. {[]I 1, • 1 Il 0, h 'r1 11rt'1 , F III , f> ` o, a Fl to I I r I () 1 � I) . ►� II ►� � � ' ' 41 � I Jf It u 111r t ► 1 ' 111 rl 11 1 I I u 11 If r - . 'd n1 FI 1 y � • �l 1, t u �1 Fi u t1, u u > l t O (�] it 'll I m r + •rl l IF '�. d t I ;• • ,'1 t 11 7 u ,d td O 11 > y t . JJ .Y t1 U U U #1 1 lU �1 tl L1 ] [f Fl 11. • . I O If 1 a , I 1. 1 U to .q �Wd 1. 1 le [ to •01 N tI 'tl - U1 ¢• 1 , v� 1:4U q 1 . G If u td a 1I td Ix� r1 . 1 `1 P tll U U' p w ' d rI rl Ut o' I1 J O a U/ EI 7 u �� U rl 1 �i p7 �j I ' ; : j I ' U I Ill O �� 'l1 ry 11 ,I II 1 u 1 t� r 11 Id N 11 b � U J 5t 11 u u 1 1 L5 tl 7 ri 1J , + rJ II t1 } a U ,t 1., 0 11 > 1 :1 N Id at Ill 11 + LF I7 11 : I tl II U q r., r 1 al J SI { 1 u U a p U 6 U r N 1� I1 V ' ( • �1 W O .q N v •' 1 .n t). l i ' J � / { 11 ' . �6 tJ u J ly i v I , ` . ;l 1 I-, C • . 1 Il to t e ' tl 1.1 'u I 7• ' ' e rI1 11 O U t ' U r < N u 11 q � l t! to a •1� 1 0 .y FF , P. ❑ U 1r I . I f ' ' V rt P1 ' I , a , a 111 N u Ll r u wl n .- I > 1 U al F v Irl rl 0 U u I1 jq 1u -t tJ tl �, 0 t ; 0 II, U U Vi N rl a1 li '11 11 E 11 .Y, 14 ll (l n a l( u 1-, , ; �' t11 l r[ w u n• 1J u u ii r 'F '�I u u a If n. to ut 1 . z u 1 : a ad F� . t r u 1d U I 11 IA ! ' 11 V O m , N U f1 1. r U / 7 rl' 1•: I/ t 0 i i U• 11 [ : •d 11. t K It I ' (n [ I - 1 i ( , -) II 1 1 it • q I - • :] + 0 Ii l� Iq 11 l � r 1 ' • O In 1 1 '' ' 1 Q. III 4 fn1 n r• i Ie ` , y1 J p n t 1 it rn O I ' . 3 >i n In N n ►+ b 0 rr U t1 CJI I o n o t' I n 1 In t) n y I r! I r] ' 01 n 1 I I in n o to (' . . ( n ri It 1 n tl � •• r DI f%• ( . t� I � . r] •S n I " o Ea I P• r o 1 � � it Ingn � l , n � ' < �i - oan ,i �� 0 ' 01 + • r� �_ r n L: tit to 0 In • n n n to : 1 ' n in a n ( r 1 1 ' w p ' fl EJ C a a G • �1 rl + It It 1 � u. Q. a r It a pN1 N rt � � 14. o r� of ;J t� 1rl r* a F cI p a t N 1 tl s I `u a o rr r�P t t P' A, ' h fNf o v' t1 c, o rt ro rr t( p it Q• O � n : I IQ r ,t 6 rt 1 q r1 I ' P, IV rT 11 +d I ] u p 0 ro 't 1 0 0 tl 11 r + N 1 . ro n to •< n 1a tI td o n N '• ro p • •d a n d m n, ' < I+ A' IL pIt ft pIIIa � t UN • (1 r n71upIf 14 n11 1 "k tot 1 1 (, tt I'• n r< tT N flp7 t rr I ►) tt tt h( pj tt G) n y trE •e A n up, r .t �t n (`I., Ir 4n 00 ' U n ►- a � Eo E0 l ( t[] . n I t1 a : v C H Q , N a . l t r A rT r v I- n � it l� R t In It. rp• • f4 •1 (1 ^ It Q• ir •'S tT G O n 14 • C r Ill F T1 N n tr rt ret O �j p, ( (r rt , Ipp ' N Gl ::I- 1 �I t ) N Yf 4 n r1 OI t r � n rr D n U rt ' G +� 11 F' q " r r t l I ( 1 + 0 ,i H 0 '�, I j I I I 11 �1. 11 fl t) i r rl t] 1 W n 1 rt n In • rt 'q •� tl rt PI h p n I % q tt F +• , ( ri � r A Il• n `� tl tt M Ir H O [r.; 0 11 F (n a n n d u 1 + . . ` , � pt I +, ft 'F I rr o, It H (� n n n o1 ,(Ir h r, r tn Ir n 11 :r p. � IJ t F � r � / 1 , a prp • I � n n It • 13 a + . n1 n �� p Is . n I cr rJ r R h p n h R (n i I: 0 n Q. :I G the I • • n r lt. Ix f1 t 7� Q . m rl p> p tt' O n to t C1 p n t� !. I— , q 01 N p n ii , 1 - I� n n F+ , a tl ra a n o n to ,. ,, t , r, j„ P r1 In t n t H. Ifi r� n y[ �t E n ' K P� I -+ n . 1 i1 '� 1 h t it 7 n r . 'o In IrJ :] 1 • . D a 1 • n 1 •. . P. , I-. Cl ►+ 1-+ '11 n 1 � I1 Imo• n � + f +. [[ o II t H , .. 0 ;� '< 1� n :1 (o n It p it I I '• t= n rl, n N tt rh I'• p a • � ((p➢ `C t7 rn lu O Y• 01 111 � . p u 't7 fi rr U n. ti' I ' • tl n n rh n I �' n n It `1 U Q Ir 4 n I ) H H < + n n 4 Ii ` I ) d A { Il (ip .1 a ( Ij a q U ' � n o N n 0 0 1 . 1 q n to n i I + • q p o ii r r� p p ii li y 11 li P • a' rt, T h 11 fi n o n Ir�i 1 . r 1-• O •d ' p n n n o n n n I-• a rt tt rt , h o p N • ri i1 1 + r • • P n f 0. 11 r. r.• 0 • • ttrl It Q. •11 n ( a nano � � q prvnn 4; n t1 4 ti tt rl `1 n O . n n. it U l N '^ fl 1 ( il . l • ' tl rf i � I � i� ► t n , , • _ I�j A ' ;. I • . t7 ' G nn �t n 1 � � rD 0 + t n u I < v n 1t a r • I + n (.•. :y I - It r a . n a it {_ 1 � n r 1 ! r • 1,• w I D n �1 G I C7 rr Q 11 . r :I it D Id t� n J ll r f1 PI n N If . Fl l u 1f !t rn �t ' •� IA . 0 `•C to U It N 11, N N U (n n M n o n tf n G n r, .v, w a � w d I_ t 0 1-• I � . , O '1 • 0 0 , I n r • q (r P. w o , " I I , , • • 11 It r h d 'U p1 If n 1 � n 1 ( n of tl fl (: � 1 ri In - (0 'rt n r f, , 1 (1 1 ' �- 1 I , t 1 rl tl H • 11 ).r tt N 11 1- 4 it h c , r r rr p � I 11 M 1 ' ( 1 A Q / rr PI • ' `{ 11 1 I* III 1 P . ( . ft t ^ < ( I n r 1 -0 P N I) �-• 1 r ( I n r 11 •� „ (l a . 1 . t n it rf 1f � t I 1 r• o If j . (I 'I n ri ri o r 1 C It '. 'O n• �] 14 . n r { � � I 0 IX 0 n 1f n =r If E ' Q {Lp±', ) , 1 r I � 1 I t1, tn! P n tt• �1. n n Ir II 0 1 ' . Q 1. n I; 1 ' p r1 •• ' Q (i• • a u 0 ' (1 r , I F,, 1-• AQ t n n ti (1 n „ II r p, n in 11 t � t rr n• It I _A r; H tr m p . 0 fi S n n m n P, ro. (► 11 n n A. no ; , 0 'S •� ] ' < h ' p (g rtr (1 ( j t✓ (- r prI r1 It-i t I -• 11 U A. li �° )+ rn v tQ • A N • ii I ItI t . f� J X ( t 1 n o m III D 'O fr n n A � d p I '• i' (i O n T1 I I I { 1 u r 1n+• ( Cyt rt �(►1 (1 (�� Oe � . ,0 Ir 11 t1 " N �0 �I i ' (t , I , • � 1 11 I ' II I1 ll ' O int, t ' fldl p N t a 11 f� `1 I1 n s toll p ; ; ' �f. u i� In p t1 n Il 1 , r 1n4 no i F p, I f I jl ( r n r I l II it to I� r + � •( �� �r � �r fv l � f f I � i ..r l� � � n r� � �, n � �. 'o I� 0 >1 rl 1 ^ 11 m I ' 1' t] 1 t ly, ( rj n n rr, In m ,1 �, { ro rr11 t t u ti o it ii 1 �r - (t A " a 14 If tit 0 n 1111 Il u rr • u II n rip I n I o n 1 +. rr n Hr a n C r* n n - 1 ( r 1 N I - { r to f n r. m ; t tr 1 ' u n n + It o a it s n o 13 1 Q o w .n n 1r n U 11 ij r : tr U ' D 7 tl N t ' 01 W' F ' +• d lot N (] It O r,, a G �t . a „ lu n It tp• • U . h n 1 o c ryryo n w o I r o o ) • , o t m r t r r I O F- rl n 7 ti It I n m t] H a NI t- , 18 N 0 r• n I r o p m to n 01 q (P n r ti O no 1 416 rt r1 U I, n Ia n It 0 It rD r t0 p Dt l tv 11 fi 1 i7 . " r 4 n : 1 rI ! t . ` 1 t 1 ZS7 j i7�t '*� � bQ1 ; o �C a� -G-AP u- -=M=. s �r L;•", atr��- a3 sr - aooun *Jes �ad o7 _asp assa� d • ssa san nuz =XnPz{ 37 } laf= IZL.pl = 3D aC� a7LfTD S.ZC° Boys & Girls Club of Indian Ricer County. Inc. — South County Branch Grant Application to the Children' s Services Advisory Committee ORGANIZATION : _ Bovs & Girls Clubs of Indian River County. Inc PROGRAM . South County Branch TABLE OF CONTENTS Please ' X" the parts of the grant application to indicate thev are included. ,also, please put the page number where the information can be located. X Section of the Proposal Pa e # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A . ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 Be PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . _ . . . . . . . 0 . . . . . . A . . . . . . . . . . . . . . . . . . 5 Co PROGRAM DESCRIPTION (two pages maximum) X 1 . Funding priority . . . . w . . . . . . 0 . . . . . . . . . . . . . . . . , . . . . . . 0 . . . . . . A . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . 0 . . . . . . . 0 . . . . . . A . . . . . . . . . . . . . . . . . A . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . A . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . w . . . . A . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . 0 . . . . . . . . . . . . w . . . . . . . . . . . . . 0 0 . . . . . . . . . . . 0 . . . . . . . . 7 X D . MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . 0 . . . . . . . . . 4 . 8 X E . COLLABORATION (one page mczrimum) . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X 1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 X 3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . w . . . . . . . . . . . . . . . . . . . . . . . . . w . . . . . . . . . . . . . . . . 12 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . 0 . . . . . . . . . 0 . . . . . . . 4 . . . . . . . . . . . - . . . . . . . . . . . . . . 14 1 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . 19 X 3 . Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . . . . . . . . . . . . 20 X 4 . Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 X 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS (Copied once in White for all three programs submitted to CSAC for funding . ) J- 1 X 1 . List of current officers and directors 2 . Latest Financial Audit Report & Management Letter that conforms with the J- 2 X AICIP Audit GUIDE X 3 . Most recent IRS Form 990 , including all schedules J- 12 4 . Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating J- 30 X Budget X 5 . Staff Organizational Chart J- 31 X 6 . Cost Recent Annual Report (if available) J- 52 X 7 . 501 (C) (3 ) IRS Exemption Letter J- 53 X 8 . Articles of Incorporation J- 57 X 9 . Agency ' s Bylaws J-64 X 10 . Agency ' s written policy regarding Affirmative Action J- 79 X 11 . Proof of Goals and Outcomes Workshop Attendance J- 80 _ K. APPENDIX (Copied once in White for all three programs submitted to CSAC for funding . ) X 1 . NOT FOR PROFIT AGENCY CERTIFICATION K- 1 X 2 . Indian River County Authorization for Release of Information K-2 X 3 . Sworn Statement K- 3 X 4 . Proof of Liability Insurance K- 6 2 Boys & Girls Club of Indian River County, Inc. — South Countv Branch Grant Application to the Children ' s Services Advisory Committee PROGRAM COVER PAGE Organization Name : Boys & Girls Clubs of Indian River County, Inc . Executive Director : Leisa Smith-Fulton Email : LeisaSmith@,,juno . com Address : P . O . Box 3058 Telephone : (772) 299-7449 Vero Beach, FL 32964 Fax : (772 ) 299- 3840 Program Director: Tony Ross Email : mrross001@hotmaii . com Address : P . O . Box 3068 Telephone : (722 ) 299- 7494 Vero Beach, FL 32964 Fax : (772 ) 794- 3903 Program Title : South County Branch Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program : Taxonomy Definition for Boys/Girls Clubs - PS - 980 . 1 Proerarns that provide a wide tame of supervised regional activities and ddinquency prevention services for children and youth ofall a= and backwp In s _bit particularly for disadvarlta d vouch through membership in boys and/or wris clubs. Club members are wed to use regional facilities and may have access to cot ulseling tutorial services employment assistance, ming progams, drag abuse and alcoholism preverrtion and other acm'j ies and services that direct than enemies toward positive social goals and facilitate healthy petro '—V development Amount Requested from Funder for 2003 /04 : S 30 , 000 Total Proposed Program Budget for 2003 / 04 : S 152 , 405 Percent of Total Program Budget : 19 . 7 % Current Funding (2002 /03 ) : $ 30 , 000 Dollar increase/( decrease) in request : S _ Percent increase/ ( decrease ) in request : 0 . 0 % Unduplicated Number of Children to be served Individually : 375 Unduplicated Number of Adults to be served Individually : 100 Unduplicated Number to be served via Group settings : 420 Total Program Cost per Client : 170 . 28 Will these funds be used to match another source ? No If yes , name the source : Amount : S - The Organization 's Board of Directors has approved this application o te) . 5 - 14-2003 Jav McNamara - } Z L Name of President/Chair of the Board Signature Leisa Smith-Fulton Name of Executive Director/CEO Signature Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services 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. Mission Statement: To inspire and enable all young people, especially those from disadvantaged circumstance to realize their full potential , as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in Indian River County with quality programs and staff. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments and population served . The Boys & Girls Club of Indian River County offers a diverse, affordable program to k7ina positive atmosphere . Our daily after- school and summer programs offered through our " Club " house locations and our outreach services provided through our Youth Volunteer Corps program allows us to serve over 2 , 000 children annually . These program activities attract and maintain young people 6 through 18 years of age who pay a nominal membership fee of $ 5 . 00 for the school term and $ 30 . 00 for the summer (which includes a free Boys & Girls Club t- shirt) . Nowhere in the Indian River County area can kids or parents find such a bargain ! While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remains much the same . The overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. Again, these specialized services allow our Club facilities, outreach programs and staff to attract and maintain the interest ofvouth members ages 6 - 18yrs . The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . . . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general . • Character and Leadership Development . . . empowers youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well- being, set personal goals and live successfully as self- sufficient adults . • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts, crafts, performing arts and creative writing . • Sports, Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills . 4 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children's Services Achisorc- Con;mittee B . PROGRA11Ni NEED STATEMENT (Entire Section B not to exceed one page) 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. a) Limited access to affordable after school programs for school age children 6 — 18 years of age. low economics, juvenile crime and below average academic achievement is the condition requiring change . b) We define those in need as children between the ages of 6 years old that have completed kindergarten through 18 years of age, with a special interest in working with disadvantaged youth . We define disadvantaged youth as children from low economic status, one-parent families and latch key kids . c) Through our South County Branch, located at 683 27 h Avenue S . W . , we mainly serve children who live within close proximity or who attend Thompson Elementary, Highlands Elementary, Oslo Middle and Vero Beach High School . d) According to the Indian River County School District 63 % of the children that attend Thompson Elementary School qualify to receive free and reduced lunch . -- Additionally, Thompson Elementary, Oslo Middle and Vero Beach High School are considered " C" rated schools according to the Florida Comprehensive :-assessment Test (FCAT ) standards . -- Indian River County statistics from the FL Department of Juvenile Justice Bureau of Data and research conclude that 7% of all 10- 17 vear olds have been referred to the juvenile justice system during 1999 & 2000 . 2 . a) Identify similar programs that are currently serving the needs of your targeted population; b) Explain how these existing programs are under- serving the targeted population of your program . i a) No other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club , for children 6 - 18 years of age with year round drop in services Monday — Friday . For every child the Boys & Girls Clubs serves_ our youth development activities are designed to build the following traits : • Positive self- identity . A healthy self- concept, a strong belief in one ' s self-worth_ and j a sense of hope about one ' s future . j • Educational, employment, social , emotional and cultural competencies . The knowledge, skills, strategies and attitudes necessary to have a positive foundation for I success . • Community and civic involvement . A sense of belonging to community, family and/or group ; willingness to take civic responsibility. • Health and well - being . Living a healthy lifestyle, taking part in regular fitness activities, able to access health care resources and engage in positive behaviors . • Moral compass . Youth have values enabling them to develop positive relationships with others . b ) Our target population is underserved by other programs for the following reasons : affordability, accessibility and scope of services . 5 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children 's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) I . List Priority Needs area addressed. Mental Wellness Issues & Childcare Access 2 . Briefly describe program activities including location of services. Boys & Girls Club programs are designed to meet members ' needs and provide them with a diverse range of activities that spark their interests, offering attractive alternatives to getting into trouble. They increase educational achievement, develop tolerance and build character. They are carefully researched, designed and field-tested . They are continually assessed and evaluated so we know they are working . Daily drop in hours are provided through our South County Branch located at 683 27th Avenue, Monday — Friday after school till 8 p . m . and during winter, spring and summer breaks from 8 a. m . — 6 p . m . Specific scheduled programs are offered in each five core area as follows : • CHARACTER AND LEADERSHIP DEVELOPMENT : Youth of the Year, TEENSupreme® Keystone Clubs and Torch Clubs • EDUCATION AND CAREER DEVELOPMENT : Project Learn : The Educational Enhancement Program, Goals for Graduation, POWER HOUR, The Ultimate Journey, JOB READY ! , Goals for Growth, Junior Staff Career Development, CareerLaunch, Skill Tech : A Club Tech Basic Skills Program • HEALTH AND LIFE SKILLS : SMART Moves (Skills Mastery and Resistance Training) , SMART Leaders, Family Advocacy Network (FAN Club, SMART Girls, Passport to Manhood, Act SMART and Child Safety and Protection • THE ARTS : Fine Arts Exhibit Program, ImageMakers : National Photography Program • SPORTS , FITNESS AND RECREATION : FITNESS AUTHORITY® • SPECIALIZED PROGRAM INITIATIVES : The Diversity Initiative & Family Support program . 3 . Briefly describe how your program intends to address the stated need/problem . Include reference to any studies or evidence that indicate proposed strategies are effective with target population. After- school programs keep kids safe. help working families and improve students ' academic achievement by providing critical opportunities for youth to learn and grow . • Students in quality after- school programs have better academic performance, behavior and school attendance and greater expectations for the future (US Departments of Education and Justice, 2000) . • Students who spend 1 - 4 hours per week in extracurricular activities are 51 percent less likely to have used drugs (Department of Health and Human Services . Adolescent Time Use, Risky Behavior and Outcomes : An Analysis of National Data. Washington D . C . , 1995 ) . • After- school programs in high crime areas can cut by as much as 3 /4 the high school student ' s risk of becoming involved in crime . And being supervised after school cuts in half the risk that middle school kids will smoke, drink, or abuse drugs, and reduces teen pregnancy as well . (National Center for Juvenile Justice, OJJDP , Wash . , D . C . 1997 . ) • The effectiveness of Boys & Girls Clubs has been proven repeatedly . A Louis Harris survey of Club alumni concluded that Clubs help young people grow into productive citizens . The survey revealed the firm conviction on the part of alumni that Club membership had a 6 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee positive effect on their lives, provided the skills necessary for leadership , improved their j relationships with others and influenced success in later life . The Carnegie Corporation' s report, A Matter of Time : Risk and Opportunity in the Non-School Hours, underscores the importance of community environment and institutions in contributing to the development of young people. The report emphasizes that the opportunity to make a positive I arises largely outside the structural academic environment . The report concludes that community-based youth development organizations such as Boys & Girls Clubs represent a valuable national resource with considerable untapped potential . 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) , I full time Director of Operations — with a Bachelors in Human Services with a minimum of three years working in the non profit sector, dedicating 25 % of his/her time in program support, evaluation & staff training . 1 full time Branch Director — with a Bachelors in Human Services with a minimum of three j years experience working with youth, dedicating 100% of his/her time in planning, coordinating and directing the daily program at the Club . 1 full time Program Director — with an Associates Degree or equivalent with a minimum of i three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and implementing the daily program at the Club . 1 part time Program Specialist & 2 Americorps Team Leaders — with a High School Diploma, working towards college degree with demonstrated capability in working positively with youth, dedicating 100% of his/her time in providing onsite supervision of YVC and teen members conducting community service projects within the Club . Volunteers - Demonstrated capability in working positively with youth . As many as we can get, dedicating specialized program opportunities for Club members _ 5 . How will the target population be made aware of the program ? All staff associated with the South County Branch will distribute flyers throughout Thompson Elementary, Oslo Middle School and Vero Beach High School to promote involvement in the Club program . Word of mouth from members seems to be our biggest method in informing our target audience about our program . 6 . How will the program be accessible to target population (i. e. location, transportation , hours of operation ) ? Boys & Girls Club programs provide access to its members by locating Club House facilities within walking or bike riding distance from our members . Currently, the School District of Indian River County offers transportation from Thompson Elementary and Oslo Middle School everyday after school . Our school year hours are Monday — Friday from 2 : 30 Plat to 8 : 00 PM . During the summer and non- school days, we are open from 8 AM to 6 PM . 7 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee D. FY0344 MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) FY03-04 OUTCOMES ACTIVITIES Add all the elements for the Measurable Outcome(s) Add the tasks to accomplish the Outcomes) 1 . To maintain an average daily attendance of Distribute Membership Recruitment Flyers enrolled boys & girls Club members 100% in the schools to announce after school (75 ) as reported by the 2003 -2004 year end program in the beginning of the school year average daily attendance totals . Baseline : and summer programs at end of the school 2002 -2003 average daily attendance totals . year. • Offer membership fees at $ 5 . 00 a school year and $30 a summer. • Provide transportation after school through Indian River County School District to the Boys & Girls Club . • Offer Youth Service Activities once a week that guide and foster a greater understanding and appreciation for diversity among Club members ages 6 - 18 . 2 . To decrease juvenile crime rates of enrolled Provide daily diversion activities at the 10 - 17 year old Club Members to less than Club to channel youth energies into a 3 % compared to non-club members which is positive direction . Games room 7% as reported by the 2000 -2001 juvenile tournaments and out door playground arrests . Baseline : 2000-2001 Indian River activities will be offer to initially spark County statistics from the FL Department of members interest . Once a rapport is built Juvenile Justice Bureau Data. (7% of all 10- with our members, staff will encourage 17 year olds) referred to the juvenile justice participation within our five core program system . service area. • Nominate eligible, deserving 14 year olds as Youth of the Month . Nominees will be requested to complete a nomination form to j bejudged to determine the organizations Youth of the Year. I • Implement a Keystone Club for members j 14 — 18 years that will meet a minimum of once a month . • Implement a Torch Club for 11 - 13 year olds that will meet a minimum of once a I month . • Create a Passport to Manhood program for 11 year old boys & up that will meet once a week for 8 weeks . i • Implement the SMART Moves program for all age groups that will be offered on a weekly basis . • Implement a SMART Girls program the will be offered weekly, for girls ages 10 - 8 Bovs & Girls Club of Indian River County. Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee 15 . The program is designed to encourage healthy attitudes that will enable early adolescent girls to develop to their full potential . • Implement a Child Safety & Protection Program that will meet once a week for 8 weeks . • Implement a violence prevention program that meets once a week for 12 weeks in collaboration with Safe Space . • Implement an anger management and conflict resolution program that meets once a week for 8 weeks in collaboration with Safe Space . 3 . Increase/improve grade and skill levels of n • Provide daily Homework Help , Reading & less than 20% of Club members Math skills enhancement activities, One- participating in its South County - Power On- One and Group Tutoring, POWER Hour program by grants end June 30 , 2004 . Pages and POWER Point activities during Baseline : I ' quarter school grades the school year. compared to 4th quarter grades . Establish good grades parties quarterly to celebrate improvements in school performance . • Meet with school officials to identify those members who are failing and provide additional homework and tutoring support . • Implement a peer leader homework and tutoring program 5 days a week during the school year. • Establish a Goals for Graduation program that meets one a week for 12 weeks . • Establish a Goals for Growth program that meets once a week for 8 weeks . • Create a Job Ready program that will be offered during the summer . • Create a Career Launch program that will be offered year round to teenagers accessing the web at the Boys & Girls Club . • Provide daily access to computers to improve technology competency levels . • Provide daily access to the Advance Learning Systems software in order to IMDove FCAT competencies . 9 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children 's Services Advisory Committee E . COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters.) Collaborative Agency Resources provided to the progrram Indian River County School District Transportation after school from Thompson Elementary_ and Oslo Middle School to the Boys & Girls Club _ After school snacks and summer lunch program . Art instruction, supplies , place to host exhibits and Center for the Arts museum in the basket series . Co-ordinate mentoring opportunities, encourage Youth Youth Guidance Guidance participants to become members of the Boys & Girls Club and promote Mentor and Mentees to meet at the Boys & Girls Club . Coordinate and administer the Value Visits program . Jr . League & Exchange Club Provide an on site councilor and arrange for sheriffs CASTLE deputy or officer to be on premises during non-custodial visitations . Provide instructors to conduct conflict resolution, Safe Space domestic violence and anger management sessions . Indian River County Sheriff s Will match members with juvenile arrest to help us Department determine % of members participating in juvenile crime. Volunteers to conduct troops at the B & G Club once a Girl Scouts week . 10 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Each participant will be required to fill out a membership application that is manually entered into a computer software program called " Child Tracking" , which allows us to electronically maintain a database on each member that includes demographic, age, gender, race, family economics, daily attendance, and activities participated in . Are target population is tracked by age. We are able to track our special interest in serving disadvantaged youth by asking and collecting the following : • Does your child receive free or reduced lunch ? (Asked to determine low economics) . • Who does your child live with ? (Asked to determine single parent family status) . • We collect report grades on a quarterly basis . • We submit our membership list to the Sheriff' s Department to determine Juvenile arrest . c) Limited access to affordable after school programs for school age children 6 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change . 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 ? • Membership Applications are collected upon registering for the program . Membership renewal applications are updated continuously throughout the year, with the bulk registering the beginning of the summer and the beginning of the school year. • Daily average attendance is collected by counting the number of members that attend daily divided by the numbers of days of service . Results are maintained and available on a monthly basis . • Club Activities are collected daily to track members participation in the various activities that are offered throughout the day . • Pre and Post Surveys are distributed prior to all drug, alcohol and teen pregnancy prevention programs to measure the knowledge gained through participation in our SMART Moves programs . • Juvenile Crime Rates will be collected by providingthe Indian River County Sheriff' s 11 Boys & Girls Club of Indian River County, Inc. — South Countv Branch Grant Application to the Children' s Services Advisory Committee Department with the names of all children enrolled in the program . The Sheriff' s Department will then notify us regarding the number of members arrested . Comparisons can be ran on an as need basis . • School Achievement will be measured by collecting report card data and providing a comparison of grades from quarter to quarter. A baseline will be established the 1 " quarter of each year and compared to results at the end of the year. • Parent & Member Surveys will be distributed to each parent & member in April to evaluate services being delivered . • B & GCA Outcome Measurements Tool every member is encouraged to enter a baseline survey upon registering for the program . Ongoing surveys are administered each year . 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 funde7theprogram, and the community ? How will you use this information to improve y program ? All data collected will be compiled and presented to all funders and contributors in order to present our agencies positive impact on the community . 12 Bovs & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start- up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Action Steps Time Frame Develop Program Budget for February January 2003 Approval Write and Prepare United Way Grant March 2003 Distribute Parent & Members Surveys April 2003 Start Registering Summer Members May 12 , 2003 Develop Summer Program Schedule that May 2003 incorporates all the National Programs mentioned in section C3 . Write, Prepare and Submit Children ' s Services May 2003 Advisory Committee Grant Summer Staff training & Building June 2 — 61 2003 Maintenance 1 '` Day of Summer Program for the South June 9 , 2003 County Branch offer hours Monday — Friday 8 a . m . — 6 p . m. Start registering Members for School Year August 2003 before summer program Program . concludes . Develop School Year 2003 -2004 Program August 2003 I Schedule that incorporates all the National Programs mentioned in section C3 . School Year Staff training and Building August 2003 Maintenance Evaluated Boys & Girls Club Program November, February, May , _august . Utilizing Commitment to Quality 4 times a year . 13 v, v, q rn rn o 0 ji ...Q WW: wA; �D oo r 1 OId t -- :::>: 44. 'G v, k-, Ly vi 00 00 i i 00 e 0 i i O , O q �,, b o a •° � o U LO C/1 pxIm 0 u PC go I •/.♦ Rj ►+I fry •�,,, vJ Wy ^� kn �n v) O kn �, ' > b q GA \1000 N o E r d bV N w `'' : :::::y :.t� ♦ y' : AMA Alt < . .. Ing CL PC :3 FRO O U U Ei F°, �'' �'' A ° � ' -1 . sr a a V V a Cd es Olt 00 GN '� 'b •� o b � H 0 0 0 0 0 + O Z vi V '� ti a w a O a O tn rn o C) �f � � �D Boys Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMP .wRTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County/South County Branch FUNDER : Children Services Advisory Committee I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I Abe used for calculations and to write information only. ;dwtvnax�asroa . REI/ENlES ���wusEa Y Proposed Total Program Foncier Specific Total Agency (sn0W.DEraiL::a : cu cuunor+si Budget Budget Budget 1 Children 's Services CouncilSt, Lucie 2 Children 's Services Council-Martin j 3 Children's Services Council-Okeechobee j 4 Advisory Committee-Indian River 30, 000. 00 30 , 000.001 130 , 000.00 5 United WaySt, Lucie County j 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 60,000.00 j 174, 000 . 00 9 Department of Children & Families 10 County Funds Individuals - $155000, Civic Groups - $13;000 , i ,.Foundations :., I $10;000, Corporations - 11 Contributions-Cash $451000 I 223 , 000 .00 12 Program Fees News Letter i $72300; Golf l Tournament'- $20,000, Steak & :Stake . $30;000,, Outside: I Fundraisers $22;000, Maif j Apeals 13 Fund Raising Events-Net $35000 50, 700 . 00 Vending 14 Sales to Public - Net Machienes 300.00 400. 00 Membership ($5 schoolYear, I $30 Summer) , t 15 Membership Dues shirts - $5 ea. 41900 . 00 16 , 550 .00 16 Investment Income Exchange Club Rent - $300 per 17 Miscellaneous month 31600.00 31600. 00 18 Legacies & Bequests FLDOE - $44,000, JICSL j $25;000, Jr. j 19 Funds from Other Sources League - $6,500 30 ,333 .00 j 75 , 500.00 5/27/2003 15 Boys Girls Club of Indian River County, Inc. - South County Branch Grant Application to the Children Services Advisory Committee 20a Reserve Funds Used for Operating Total Match from Amerieorp Ya pay Tears C�aders:- $98,850 phis Rer>t for Aimirs ' Office � 1?iper - 20b In-Kind Donations (trot included in til) $127000:::116, 635.00 108 , 850.00 21 TOTAL REVENUES (doesn't . . !.i include line 20b) $ 129, 133.00 $309000. 00 $703, 750. 00 Al . & C D, 66 :EXPENDITURES NArANEAs Fo,+ ;Proposed Tota! Program Funder Specific Ta#a/ A enc ACE}lCY USE:ONLY p ./ 9 Y ,LSXOW CALCUCAMONSl Bo et Buafge#. 22 Salaries - (must complete chart on next page) 81 , 118.00 28,500. 00 393, 527. 00 Salary 23 FICA - Total Salaries x 0.0765 7:55°le 51281 .00 21180. 25 26 , 130.00 24 Retirement - Annual pension for qualified staff 1u% 4,750.00 0.00 22 ,750.00 Provided :hy t t 25 Life/Health - Medical/Dental/Shorerrn Disab . BGGWA 9,466.00 0 .00 31 , 619.00 26 Workers Compensation - # employees x rate 12x2:68% 1 ,850.0010.001 9, 154. 00 Florida unemployment - # projected 12 x :$7 000:X 27 employees x $7, 000 x UCT-6 rate 2.7% 635 .00 0.00 21404.00 SALARIES A . a o Gross Annual portion of Sala o C Funder ° POSITION LISTING ry rs Proposed % 'o€ Gross Annual Salary. Specific Budget Position .7it/e l Tota/ Hts/wk (Agency) . Program Salary Requester+I `IAJ Example: Executive 0irectorf40hrs 70, 000. 00 f0000.0a 5, 000: 00 i . �4% Director of Operations/40 hrs 501000.00 12,500.00 0 .00% Branch Director/40 hrs 28 , 500.00 28, 500.00 28, 500.00 100.00% Program Director/40 hrs 25 ,500.00 25 ,500.00 0 .00% Summer Program Specialist/40 hrs 2,534.00 21534.00 0.00% Amedcorp Team Leader/32 hrs 6,042.00 61042.00 0. 00% Amedcorp Team Leader/32 hrs 67042.00 6,042 .00 0 . 00% #DIV/0 ! #DIV/0! #DIV/0 ! #DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0! #DIV/0! # DIV/0 ! #DIV/0 ! # DIV/0 ! #DIV/0 ! #DIV/0! #DIV/0 ! Remaining positions throughout the agency 274 , 909 .00 Total Salaries 1 $393 , 527.001 $81 , 118 . 00 $28 , 500. 00 7. 24 % FRINGE BENEFITS DETAIL A (Funder Specific Budget Funder e D E F G Specific FICA -7i65% Pension ',Health Ins. Workers Unemployme Total.Fringes Fu„ _ .r . Column C only, from line 22 to 27) (Ax %J Compens. ntCompens. Specific Position Fide / Total Hrs/wk Budget 5/27/2003 16 - � - a aee ra : r ea ee rr rr ev rr ae er r ' Americorp Team Leader/32 hrs ::: :.: . _ . . _ . . _ . . . . . . s�; 3:� : : :::: : ?: ::;�i;ic't::: ;�; D EXPENDITURES Proposed Total Program . - • - cific Total Agency Buderet Budget . i • • � � M to Madings to M of • . . ' Mailed - Office . _ • I • • i Z Boys Girls Club of Indian River County, Inc - South County Branch Grant Application to the Children Services Advisory Committee • Quarterly Newsletter ($ x 4) organizations • Letterheads, Envelopes, etc. pnnting is • Fundraising materials divided oJef all • Other agency. programs. <'F/4 - 36 Subscription/Dues/Memberships A ues 200 00 117, 115.00 • Membership to National Organization �� FL.: Rrea • Dues Aiiance.Dues $1 ,500, Rofary, • Subscriptions to Newspapers/magazines, etc. Kiv+anis 37 Insurance 2 ,685.00 14,763.00 • Directors/Officers Liab. General Liability • Commercial/General Insurance 6304 \Fefiicies = • Bond Ins. $11}20 Members • Auto Insurance Acctdent 38 Equipment: Rental & Maintenance 19000 .00 7,200.00 • Copier lease ($ x 12 months) Computer • Meter lease ($ x 12 months) Maintenance - • Copier Maintenance ($ x 12 months) Raiser's Edge • Computer Maintenance ( $ x 12 months) $3, 100 + Copier • Maartenance Other $31000 39 Advertising 250.00 1 ,200.00 • Newspaper ads • Fundraising ads/promotions Recruitment. for vacancies • Other (vacancies) $250 40 Equipment Purchases : Capital Expense 0 .00 p _Op Computer/monitor (# x $) Laser Printer 41 Professional Fees (Legal, Consulting) 0.00 0.00 Legal advice ( estimated #hrs x $) • Consultant fees • Other 42 Books/Educational Materials 100.00 1. 70 • Books/videos • Materials ($ x staff) 1 o ks/tlideos 43 Food & Nutrition 300. 00 600.00 • Meals ( # meals x clients x Sdays x 50 wks) Snacks from Treasure Coast • Snacks Food Bank 44 Administrative Costs • Admin . Cost (% of total budget) 0.00 45 Audit Expense 21000.00 9. 100.00 Independent Audit Review 46 Specific Assistance to Individuals 0.00 0.00 • Medical assistance • Meals/Food • Rent Assistance • Other 47 Other/Miscellaneous 11140. 00 4, 0 . 389.00 • Background check/drug test• Back ground'' ' Other check(Drug test 48 OtheriContract 0 . 00 Sub-contract for program services 49 TOTAL EXPENSES $ 152 , 405 .00 $30 . 680.25 $681 . 940 .00 5/27/20113 is BOYS Cans Cn Of Mw RIW CO:rt. irc - _v01 C_.rr. =rancn Gr" r'1K w w M ChM's S Ocn � C.:.'an°ea UNIFORM GRANT APPl.1CATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: FY 01 /02 FY 02103 FY 03/04 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED ICOL CGed. eyed a REVENUES BUDGETED BUDGETED I Children's Services Council-St Lucie 0.00 #DN/0! 2 Children's Services Council-Martin 0.00 #DN/0! 3 Children's Services Council-Okeechobee 0.00 #DN/0! 4 Advisory Committee4ndian River 48.458.00 100,000.00 130,000.00 30.00% 5 United Wa St Lucie County 0.00 #DN/0! 6 United Way-Martin County0.00 #DN/0! 7 United Way-Okeechobee County 0.00 #DN/0! 8 United Way-Indian River County 80.000.00 1369000.00 174,000.00 27.94% 9 Department of Children 8f Families 0.00 #DN/0 ! 10 CountyFunds 0.00 #DIV/01 11 Contributions-Cash 132.222.00 2647900.00 2237000.00 -15.82% 12 Program Fees 940.00 0 .00 0.00 #DIV/O! 13 Fund Raising Events -Net 56.799.00 699494.00 807700.00 16.137. 14 Sales to Public-Net 710.00 300.00 400.00 33.33% is Membership Dues 9.995.00 61850.00 16,550.00 141 .61 % 16 Investment Income 2.934.00 0.00 0.00 #DN/01 17 Miscellaneous 1 .800.00 3,600.00 37600.00 0.00% 1s Legacies & Bequests 0.00 0.00 #DN/0! is Funds from Other Sources 96.924.00 1277977.00 75,500.00 -41 .01 % 20a Reserve Funds Used for Operating 0.00 0 .00 #DIV/01 20t In-Kind Donations (Not included ;ntotal) 1 .408.00 47,464.00 1087850.00 129.33% 21 TOTAL 430.782.00 709,121 .00 703,750.00 -0.76% EXPENDITURES 23 Salaries 23 183.135.00 3947936.00 3937527.00 -0.36% FICA 27,773.00 26, 130.00 5.92% 2a Retirement 6.992.00 19,025.00 22,750.00 19.58% 25 Life/Health 14.318.00 28126.00 317619.00 12.42% 26 Workers Compensation 2.524.00 91730.00 9,154.00 5.92% a Florida Unemployment __ M 2.788,00 2,379.0021404.00 1 .05% 28 Travel-Daily 897.00 748.00 11900.00 154.01 % 29 Travel/Conferences/Training7.169.00 22,752.00 11 ,500.00 X9.45°/, 30 Office Supplies 12.863.00 34,655.00 147267.00 58.83 % 31 Telephone 4.932.00 81105.00 91580.00 18.20% 32 Postage/Shipping 1 .441 .00 11983 .00 61960.00 250.98% 33 Utilities 5.432.00 117948.00 121444.00 4.15% 34 Occupancy (Building & Grounds 43.100.00 64,564.00 687838.00 j 6.62% 35 Printing & Publications 18.863 .00 10,215.00 16,500.001 61 .53% 36 Subscription/Dues/Memberships 4.626.00 31573 .00 10JI5.001 183.10% 37 Insurance 8.235.00 11 ,015.00 141763.00 34.03% 38 Equipment: Rental & Maintenance 115.001 0 .00 77200.00 #DN/0 ! 39 Advertising U6.001 1 ,200.00 1 ,200.00 0.070% 4a Equipment Purchases :Ca ital Expense 9.048.00 0 .00 0 .00 #DN/0! 41 Professional Fees (Legal, Consulting) 0.00 16,670.00 0.00 -100.00% 42 Books/Educational Materials 2.883.00 29000.00 11000 .00 50 .00 % 43 Food & Nutrition 497.00 600.00 600.00 0 .00% 44 Administrative Costs 0.00 #DN/O ! 45 Audit Expense 4.190.0001 6,000.00 9, 100 .00 51 .67% 46 Specific Assistance to Individuals 0.001 0.00 0.00 #DN/0 ! 47 Other/Miscellaneous 21 .962.00 14,327.00 10,389.00 -27.49% 48 Other/Contract 0.00 0.00 0.00 #DIV/0 ! 4s TOTAL 356.556A0 692,324.00 681 ,940.00 -1 .50% 501 REVENUES OVER/ UNDER EXPENDITURES 74.226.00 16 ,797.001 21 ,810 .00 24.84% =.zrza°a 9 Boys GM1 Chia at Inpan River County. Inc. - Sou County Branco Grant A°aAat°M to Ike 01&m Soma" AaNsnry Comma" UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME : FY 01102 FY 02/03 FY 03/04 '/a INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (COL GeoL B)/COL B REVENUES BUDGETED BUDGETED 1 Children's Services CouncilSt Lucie 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Children's Services Council-Okeechobee 0.00 #DIV/O! 4 Advisory Committee-Indian River 25,467.00 307000.00 30,000.00 0.00% 5 United Wa St Lucie County0.00 #DIV/0! 6 United Way-Martin County0.00 #DIV/01 7 United Way-Okeechobee Coun 0.00 #DN/0! 8 United Way-Indian River County 60,000.0 01 54,000.00 60,000.00 11 .11 % 9 Department of Children & Families 0.00 #DIV/0! 10 County Funds 0 .00 #DIV/0! it Contributions-Cash 61252.00 0.00 0.00 #DIV/0! 12 Program Fees 495.00 0.00 0.00 #DIV/0! 13 Fund Raising Events-Net 0.00 #DIV/0! 14 Sales to Public-Net 692.00300.00 300.00 0.00% 15 Membership Dues 67134.00 4,350.00 4 900.00 12.64% is Investment Income 0.00 #DIV/0! 17 Miscellaneous 300.0031600.00 37600.00 0.00% is Legacies & Bequests 0.00 #DN/0! is Funds from Other Sources 31436.00 69,810.00 30,333.0056.55% 20a Reserve Funds Used for O eratin9 0.00 #DIV/0 ! 20b In-Kind Donations (Nut included in total) 0.001 0.00 167635.00 #DIV/01 21 TOTAL 1027776.00 162,060.00 1297133.00 -20.32% EXPENDITURES 22 Salaries 58,503.00 997500.00 81 , 118.00 -18.47% 23 FICA 5,178.00 7,612.00 5,281 .00 30.62% -- 2a Retirement 2,500.00 47525.00 4,750.00 4.97% zs 1 Life/Health 61938 .00 12,970.00 9 ,466.00 -27.02% 26 Workers Compensation 536.00 2,667.00 11850.00 30 .63% 27 Florida Unemployment 0 .00 819.00 635.00 -22.47% 26 Travel-Daily117.00 200.00 700.001 250.00% 29 Travel/Conferences/Trainin 1 ,264.00 4,231 .00 27750.00 35.00% 30 Office Supplies 4,886.001 11 ,395.00 31576.00 -68.62% 31 Telephone 21932.00 2,676.00 2,520.00 5.83% 32 Posta e/S hipping 215.00 140.00 140 .00 0,00% 33 Utilities 41547.00 4,608.00 57244.00 13 .80% 34 Occupancy (Building 8s Grounds 26, 121 .00 25, 108.00 25,200.00 0.377 35lEguipment Subs & Publications 2,456.00 17305.00 11500.00 14.94% 36Subscri tion/Dues/Membershi s 792.00 200.00 200 .00 0 .00% 37 Insurance 39113 .00 4,053 .00 2,685.00 33.75% 38E ui ment:Rental & Maintenance 0.00 0.00 0.00 0.00% 39Advertising182.00 250.00 250.00 0.00% 40 Purchases :Ca ital Expense 0.00 0.00 0.00 #DIV/0! 41 Professional Fees (Legal, Consulting ) 0.00 0.00 0.00 #DIV/0! 42 Books/Educational Materials 1 ,817.00 11000.00 100.00 -90.00% 43 Food 8. Nutrition 354.00 300.001 300.00 0.00% 44 Administrative Costs 0 .00 0 .0010.00 #DIV/0 ! 45 Audit Ex ense . 0.00 2,000.00 2,000 .00 0.00% 46 Sp ecific Assistance to Individuals 0.00 0.001 0.00 #DIV/0 ! 47 Other/Miscellaneous 1 .708.00 1 ,802.0011 1 , 140.00 36.74% 48 Other/Contract 0.00 #DIV/0! 49 TOTAL 124, 159 .001 187,361 .00 1519405.00 -19.19% 50 REVENUES OVER/ UNDER EXPENDITURES 21 ,383 .00 -25,301 .00 -22,272.00 -11 .87°/, 27/7003 Boys Girls Cob of Indian Rivw County, Inc. - South County Branch Grant Appication to the Children Services Advisory Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER : A B C FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS, PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 22 Salaries 81 , 118 .00 289500 .00 35 , 13% 23 FICA 59281 .00 2 , 180 .25 41 .28% 24 Retirement 4,750 . 00 0 . 00 0 . 00% 25 Life/Health 91466 . 00 0 . 00 0 .00% 26 Workers Compensation 19850.00 0 .00 0 . 00% 27 Florida Unemployment 635. 00 0 . 00 0 . 00% 28 Travel-Dail 700 .00 0 . 00 0 . 00% 29 Travel/Conferences/Training2, 750 . 00 0 .00 0 .00% 30 Office supplies 31576 .00 0.00 0 .00% 31 Telephone 29520 .00 0 .00 0 .00% 32 Postage/Shipping 140 .00 0 . 00 0 . 00°/a 33 Utilities 59244, 00 0 .00 0 . 00% 34 Occupancy ( Building & Grounds ) 25200. 00 0 . 00 0 .00% 35 Printing & Publications 19500.00 0 . 00 0 .00% 36 Subscri tion/Dues/Membershi s 200 . 00 0 .00 0 .00% 37 Insurance 29685.00 0 .00 0 . 00% 38 Equipment : Rental & Maintenance 17000 .00 0. 00 0 .00% 39 Advertising250 .00 0. 00 0 . 00% 40 Equipment Purchases : Ca ital Expense 0 .00 0 . 00 0 .00% 41 Professional Fees Legal , Consulting ) 0.00 0 . 00 0 .00% 42 Books/Educational Materials 100 . 00 0 . 00 0 . 00% 43 Food & Nutrition 300 . 00 0 .00 0 .00% 44 Administrative Costs 0 . 00 00001 0 .00°/a 45 Audit Expense 29000.00 0 .00 0 . 00% 46 Specific Assistance to Individuals 0 .00 0 .00 0 . 00 % 47 Other/Miscellaneous 1 ,140 . 00 0 . 00 0 . 00 % 48 Other/Contract 0.00 0 . 00 0 .00°/a 4s TOTAL $ 1521405. 00 1 $ 30 , 680 .25 $ 0 .20 5272003 21 Begs Glds CIUE of Indian Rhw County, Inc. — Sa1h Canty Branch Gram ApPUCANI n to the Children SeMCes Aduisny CommiBn UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee #DIV/0! #DN/O! #DIV/O! #DMO! #DIV/0! #DN/0! #DN/0! #DN/0! #DIV/O! #DN/0! #DN/0! #DIV/0! #DIV/0! #DN/O! Travel-E)LIM Travel reimbursement for staff members was not suffiently budgeted in previous years. #DN/0! #DN/0! #DN/0! #DN/O! #DN/0! saRnow 22 Boys GMs Chad Of mtllen River County. Inc. — South Caunly Branch Gram AppllcaBon to the ChXdren SeMaaa Advisory Committee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee saianes FICA i I I I I I I I I i I I i I i I - i sa7aooa 23 Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street, Vero Beach FL , 32960 ("County") and Boys & Girls Club of IRC , Inc . ("Recipient") ; of: (Address) Boys & Girls Club of IRC , Inc. P . O . Box 3068 Vero Beach , Florida 32964 Attention : Sebastian Club 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Thousand Dollars ($30, 000 . 00) . 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 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 September 23 , 20031 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 2 - 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 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. 3 - 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 CO NTY BOARD OF O NT COMMISSIO By. neth R . Macht, Chairman Attest : J . K. Barton , Clerk By: A69 Deputy Clerk Approved . ames Chandler, County Administrator e as to form and legal su ' kncy: ell , Assistant un y Attorney RECIPIENT: Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 i By ame Title 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - 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 25t' Street Vero Beach , Florida 32960-3365 Recipient : Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Attention : Leisa Smith-Fulton 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 - 1 - 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. - 2 - Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee ORGANIZATION : Boys & Girls Clubs of Indian River County. Inc PROGRAM: Sebastian Branch TABLE OF CONTENTS Please ' :Y " die para of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Proposal Pa e # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X L Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 Be PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4. Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 X E . COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . 4 . . . . . . . 4 . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . iNfeasures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee I. BUDGET FORMS X 1 . Budget Narrative Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 3 . Total Program Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . no X 4 . Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 X 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS (Copied once in White for all three programs submitted to CSAC for funding . ) J- 1 X 1 . List of current officers and directors 2 . Latest Financial Audit Report & Management Letter that conforms with the J- 2 X AICIP Audit GUIDE X 3 . Most recent IRS Form 990, including all schedules J- 12 4 . Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating J-30 X Budget X 5 . Staff Organizational Chart J- 31 X 6 . Cost Recent Annual Report (if available) J_ 52 X 7 . 501 (C ) (3 ) IRS Exemption Letter J- 53 X 8 . Articles of Incorporation J- 57 X 9 . Agency ' s Bylaws J- 64 X 10 . Agency ' s written policy regarding Affirmative Action J- 79 X 11 . Proof of Goals and Outcomes Workshop Attendance J- 80 K APPENDIX (Copied once in White for all three programs submitted to CSAC for funding . ) X 1 . NOT FOR PROFIT AGENCY CERTIFICATION K- 1 X 2 . Indian River County Authorization for Release of Information K-2 X 3 . Sworn Statement K- 3 X 4 . Proof of Liability Insurance K-6 Bovs & Girls Club of Indian River County, Inc. - Sebastian Branch Grant _application to the Children ' s Services Advisory Committee PROGRAM COVER PAGE Organization Name : Boys & Girls Clubs of Indian River County, Inc . Executive Director : Leisa Smith-Fulton Email : LeisaSmith@,iuno . com Address : P . O . Box 3068 Telephone : (772 ) 299- 7449 Vero Beach, FL 32964 Fax : _ (772 ) 299-3840 Program Director : Alex Soares Email : n/a Address : P . O . Box 3068 Telephone : (722 ) 388 -4944 Vero Beach, FL 32964 Fax : (772 ) 388 - 0904 Program Title : Sebastian Branch Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program : Taxonomy Definition for Boys/Girls Clubs - PS - 980 . 1 Promms that urovide a wide range of supervised recx-eational activities and dd Uenctiprevention services for children and youth of all asses and bacicQrounds but partio alarly for disadva=ged Mgh tluoughh membership in bons and/or wrls clubs. Club members are entitled to use reca eational facilities and may have access to cainseging tutorial services emplovmerrt assistance garb r]Mgmis &us abuse and alcoholism prevention and other activities and services that direct their enerPles toward positive social goals and facilitate healthy personality developmerrt Amount Requested from Funder for 2003 /04 : $ 60 , 000 Total Proposed Program Budget for 2003 / 04 : $ 206 . 680 Percent of Total Program Budget : 29 . 0 % Current Funding (2002 /03 ) : $ 30 , 000 Dollar increase/( decrease) in request : $ 301000 Percent increase/( decrease ) in request : 100 . 0 % Unduplicated Number of Children to be served Individually : 625 Unduplicated Number of Adults to be served Individually : 125 Unduplicated Number to be served via Group settings : 660 Total Program Cost per Client : 146 . 58 Will these funds be used to match another source ? No If yes , name the source : Amount : $ - The Organization 's Board ojDirectors has approved this applicat ' on (date). 5 - 14-2003 Jay McNamara Z Name of President/Chair of the Board ature Leisa Smith-Fulton ". Name of Executive Director/CEO Signature Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services .advisory Committee PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Enure Section A not to exceed one page) I . Provide the mission statement and vision of your organization . Mission Statement : To inspire and enable all young people, especially those from disadvantaged circumstance to realize their full potential, as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in Indian River County with quality programs and staff 2 . Provide a brief summary of your organization including areas of expertise, accomplishments and population served . The Boys & Girls Club of Indian River County offers a diverse, affordable program to kids in a positive atmosphere . Our daily after- school and summer programs offered through our " Club " house locations and our outreach services provided through our Youth Volunteer Corps program allows us to serve over 2 , 000 children annually . These program activities attract and maintain _young people 6 through 18 years of age who pay a nominal membership fee of $ 5 . 00 for the school term and $30 . 00 for the summer (which includes a free Boys & Girls Club t- shirt) . Nowhere in the Indian River County area can kids or parents find such a bargain ! While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remains much the same . The overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. Again, these specialized services allow our Club facilities, outreach programs and staff to attract and maintain the interest of youth members ages 6 - 18yrs . The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . . . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to I achieve success in a career and life in general . • Character and Leadership Development . . . empowers youth to support and influence their Club and community, sustain meaningful relationships with others , develop a positive self- image, participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well - being, set personal goals and live successfully as self- sufficient adults . • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts. crafts. performing arts and creative writing . • Sports. Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress i management, appreciation for the environment and social skills . 4 Bovs & Girls Club of Indian River Count},. Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisor- Committee B. PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 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. a) Limited access to affordable after school programs for school age children 6 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change . b) We define those in need as children between the ages of 6 years old that have completed kindergarten through 18 years of age, with a special interest in working with disadvantaged youth . We define disadvantaged youth as children from low economic status, one-parent families and latch key kids . c) Through our Sebastian Branch, located at 250 Sebastian Blvd . we mainly serve children who live within close proximity or who attend Sebastian Elementary, Pelican Island Elementary, Sebastian River Middle, Sebastian Charter Junior High and Sebastian River High School . d) According to the Indian River County School District 46% of the children that attend Sebastian Elementary, Pelican Island Elementary and Sebastian River Middle School qualify to receive free and reduced lunch . -- Additionally, Sebastian Elementary and Sebastian River Middle School are considered `B " rated schools according to the Florida Comprehensive Assessment Test (FCAT) standards . -- Indian River County statistics from the FL Department of Juvenile Justice Bureau of Data and research conclude that 7% of all 10- 17 year olds have been referred to the juvenile justice system during 1999 & 2000 . 7a) tify similar programs that are currently serving the needs of your targeted tion , b) Explain how these existing programs are under-serving the targeted tion of your program . other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club , for children 6- 18 years of age with year round drop in services Monday — Friday. For every child the Boys & Girls Clubs serves, our youth development activities are designed to build the following traits : • Positive self- identity . A healthy self- concept, a strong belief in one ' s self-worth, and a sense of hope about one ' s future . • Educational, employment, social , emotional and cultural competencies . The knowledge, skills, strategies and attitudes necessary to have a positive foundation for success . • Community and civic involvement . A sense of belonging to community, family and/or group , willingness to take civic responsibility. • Health and well - being . Living a healthy lifestyle, taking part in regular fitness activities, able to access health care - resources and engage in positive behaviors . • Moral compass . Youth have values enabling them to develop positive relationships with others . b ) Our target population is underserved by other programs for the following reasons : affordability, accessibility and scope of services . 5 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children 's Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Wellness Issues & Childcare Access 2 . Briefly describe program activities including location of services. Boys & Girls Club programs are designed to meet members ' needs and provide them with a diverse range of activities that spark their interests, offering attractive alternatives to getting into trouble . They increase educational achievement, develop tolerance and build character. They are carefully researched, designed and field-tested . They are continually assessed and evaluated so we know they are working . Daily drop in hours are provided through our Sebastian Branch located at 250 Sebastian Blvd . , Monday — Friday after school till 8 p . m . and during winter, spring and summer breaks from 8 a. m . — 6 p . m . Specific scheduled programs are offered in each five core area as follows : CHARACTER AND LEADERSHIP DEVELOPMENT : Youth of the Year, TEENSupreme® Keystone Clubs and Torch Clubs • EDUCATION AND CAREER DEVELOPMENT : Project Learn : The Educational Enhancement Program, Goals for Graduation, POWER HOUR, The Ultimate Journev, JOB READY ! , Goals for Growth, Junior Staff Career Development, CareerLaunch, Skill Tech : A Club Tech Basic Skills Program HEALTH AND LIFE SKILLS : SMART Moves ( Skills Mastery and Resistance Training) , SMART Leaders, Family Advocacy Network (FAN Club, SMART Girls, Passport to Manhood, Act SMART and Child Safety and Protection 0 THE ARTS : Fine Arts Exhibit Program, ImageMakers : National Photography Program • SPORTS , FITNESS AND RECREATION : FITNESS AUTHORITY® • SPECIALIZED PROGRAM INITIATIVES : The Diversity Initiative & Family Support program. F describe how your program intends to address the stated need/problem . reference to any studies or evidence that indicate proposed strategies are e with target population. l programs keep kids safe, help working families and improve students ' academic achievement by providing critical opportunities for youth to learn and grow . • Students in quality after- school programs have better academic performance, behavior and school attendance and greater expectations for the future (US Departments of Education and Justice, 2000) . • Students who spend 1 - 4 hours per week in extracurricular activities are )51 percent less likely to have used drugs (Department of Health and Human Services . Adolescent Time Use, Risky Behavior and Outcomes : An Analvsis of National Data. Washington D . C . , 1995 ) . • After- school programs in high crime areas can cut by as much as 3 /4 the high school student ' s risk of becoming involved in crime . And being supervised after school cuts in half the risk that middle school kids will smoke, drink, or abuse drugs, and reduces teen pregnancy as well . (National Center for Juvenile Justice, OJJDP , Wash . , D . C . 1997 . ) • The effectiveness of Boys & Girls Clubs has been proven repeatedly . A Louis Harris survey of Club alumni concluded that Clubs help young people grow into productive citizens . The survey revealed the firm conviction on the part of alumni that Club membership had a 6 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children 's Services Advisory Committee positive effect on their lives, provided the skills necessary for leadership, improved their relationships with others and influenced success in later life. The Carnegie Corporation ' s report, A Matter of Time : Risk and Opportunity in the Xon-School Hours, underscores the importance of community environment and institutions in contributing to the development of young people . The report emphasizes that the opportunity to make a positive contribution arises largely outside the structural academic environment . The report concludes that community-based youth development organizations such as Boys & Girls Clubs represent a valuable national resource with considerable untapped potential . 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). 1 full time Director of Operations — with a Bachelors in Human Services with a minimum of three years working in the non profit sector, dedicating 25 % of his/her time in program support. evaluation & staff training. 1 full time Branch Director — with a Bachelors in Human Services with a minimum of three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and directing the daily program at the Club . 1 full time Program Director — with an Associates Degree or equivalent with a minimum of three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and implementing the daily program at the Club . 1 full time Technology Director — with a Associates/Bachelors in a Computer Technology with a experience training computer workshops, dedication 100% of his/her time in planning, coordinating and implementing the daily technology program at the Club . 1 part time Program Specialist & 2 Americorps Team Leaders — with a High School Diploma, working towards college degree with demonstrated capability in working positively with youth, dedicating 100% of his/her time in providing onsite supervision of YVC and teen members conducting community service projects within the Club . Volunteers - Demonstrated capability in working positively with youth _ As many_ as we can get, dedicating specialized program opportunities for Club members . F How will the target population be made aware of the program ?l staff associated with the Sebastian Branch will distribute flyers throughout Sebastian ementary, Pelican Island Elementary, Sebastian River Middle School and Sebastian River High School to promote involvement in the Club program . Word of mouth from members seems to be our biggest method in informing our target audience about our program . 6. How will the program be accessible to target population (i. e. location , transportation , hours of operation ) ? Boys & Girls Club programs provide access to its members by locating Club House facilities within walking or bike riding distance from our members . Currently, the School District of Indian River County offers transportation from Sebastian area schools everyday after school . Our school year hours are Mon . — Fri . from 2 : 30 PM to 8 : 00 PM. During the summer and non- school days, we are open from 8 AM to 6 PM. 7 Bovs & Girls Club of Indian River County. Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee D . D- l . FY03-04 MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) FY03-04 OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcome(s) Add the tasks to accomplish the Outcome(s) 1 . To increase average daily attendance of . Distribute Membership Recruitment Flyers enrolled boys & girls Club members by 65 % in the schools to announce after school (from 75 to 125 ) as reported by the 2003 - program in the beginning of the school year 2004 year end average daily attendance and summer programs at end of the school totals . Baseline : 2002 - 2003 average daily year . attendance totals (75 ) . Offer membership fees at $ 5 . 00 a school year and $ 30 a summer . • Provide transportation after school through Indian River County School District to the Boys & Girls Club . • Offer Youth Service Activities once a week that guide and foster a greater understanding and appreciation for diversity among Club members ages 6 - 18 . 2 . To decrease juvenile crime rates of enrolled . Provide daily diversion activities at the 10 - 17 year old Club Members to less than Club to channel youth energies into a 3 % compared to non-club members which is positive direction . Games room 7% as reported by the 2000-2001 juvenile tournaments and out door playground arrests . Baseline : 2000-2001 Indian River activities will be offer to initially spark County statistics from the FL Department of members interest . Once a rapport is built Juvenile Justice Bureau Data. (7% of all 10- with our members, staff will encourage 17 year olds) referred to the juvenile justice participation within our five core program System. service area. • Nominate eligible, deserving 14 year olds as Youth of the Month . Nominees will be requested to complete a nomination form to be judged to determine the organizations Youth of the Year . • Implement a Keystone Club for members 1 =4 — 18 years that will meet a minimum of once a month . • Implement a Torch Club for 11 - 13 year olds that will meet a minimum of once a month . • Create a Passport to Manhood program for 11 year old boys & up that will meet once a week for 8 weeks . • Implement the SMART Moves program for all age groups that will be offered on a weekly basis . • Implement a SMART Girls program the will be offered weekly , for girls ages 10- 8 Boys & Girls Club of Indian River Counn., Inc. - Sebastian Branch Grant Application to the Children 's Sen-ices Advisory Committee 15 . The program is designed to encourage healthy attitudes that will enable early adolescent girls to develop to their full potential . • Implement a Child Safety & Protection Program that will meet once a week for 8 weeks . • Implement a violence prevention program that meets once a week for 12 weeks in collaboration with Safe Space . • Implement an anger management and conflict resolution program that meets once a week for 8 weeks in collaboration with Safe Space. 3 . Increase/improve grade and skill levels of n . Provide daily Homework Help, Reading & less than 20% of Club members Math skills enhancement activities, One- participating in its South County - Power On- One and Group Tutoring, POWER Hour program by grants end June 30 , 2004 . Pages and POWER Point activities during Baseline : ls` quarter school grades the school year . compared to 4u' quarter grades . . Establish good grades parties quarterly to celebrate improvements in school performance . • Meet with school officials to identify those members who are failing and provide additional homework and tutoring support . • Implement a peer leader homework and tutoring program 5 days a week during the school year. • Establish a Goals for Graduation program that meets one a week for 12 weeks . • Establish a Goals for Growth program that meets once a week for 8 weeks . I • Create a Job Ready program that will be offered during the summer. 4 . Establish Technology skills base line that . Create a Career Launch program that will measures member proficiency levels on the be offered year round to teenagers Computer at the beginning of the grant year. accessing the web at the Boys & Girls Outcome will be developed to show an Club . increase in skill level by end of grant term . Provide daily access to computers to June 30 , 2004 . Actual percentage of improve technology competency levels . increase will be determined after one . Provide daily access to the Advance funding cycle . Learning Systems software in order to im rove FCAT competencies . 9 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) I . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. [NOTE : Collaborative agreement letters are not required by United Way of Indian River County.] Collaborative Agency Resources provided to the program Indian River County School District Transportation after school from Sebastian Elementary. Pelican Island Elementary, Sebastian River Middle_ Sebastian Charter School and Sebastian River High School to the Boys & Girls Club . After school snacks and summer lunch program . Art instruction, supplies, place to host exhibits and Center for the Arts museum in the basket series . Co -ordinate mentoring opportunities, encourage Youth Youth Guidance Guidance participants to become members of the Boys & Girls Club and promote Mentor and Mentees to mee: at the Boys & Girls Club . Provide instructors to conduct conflict resolution, Safe Space domestic violence and anger management sessions . Indian River County Sheriff' s Will match members with juvenile arrest to help us Department determine % of members participating in juvenile crime_ Healthy Start Coalition Instructors to deliver a fatherhood preparation class_ I Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children 's Services Ad-visory Connnittee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) I . 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 B19 Each participant will be required to fill out a membership application that is manually entered into a computer software program called "Child Tracking" , which allows us to electronically maintain a database on each member that includes demographic, age, gender, race, family economics, daily attendance, and activities participated in . i Are target population is tracked by age . We are able to track our special interest in serving disadvantaged youth by asking and collecting the following: • Does your child receive free or reduced lunch ? (Asked to determine low economics) . • Who does your child live with ? (Asked to determine single parent family status) . • We collect report grades on a quarterly basis . • We submit our membership list to the Sheriff s Department to determine Juvenile arrest . i c) Limited access to affordable after school programs for school age children 6 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change . i 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 , j 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 ? • i Membership Applications are collected upon registering for the program . Membership renewal applications are updated continuously throughout the year, with the bulk registering jthe beginning of the summer and the beginning of the school year. • Daily average attendance is collected by counting the number of members that attend daily divided by the numbers of days of service _ Results are maintained and available on a I monthly basis . • Club Activities are collected daily to track members participation in the various activities I that are offered throughout the day . • Pre and Post Surveys are distributed prior to all drug, alcohol and teen pregnancy prevention programs to measure the knowledge gained through participation in our SMART LMoves programs . e Juvenile Crime Rates will be collected by providing the Indian River County Sheriff s 11 Boys & Girls Club of Indian River County. Inc. - Sebastian Branch Grant Application to the Children ' s Services ,advisory Committee Department with the names of all children enrolled in the program . The Sheriff s Department will then notify us regarding the number of members arrested . Comparisons can be ran on an as need basis . • School Achievement will be measured by collecting report card data and providing a comparison of grades from quarter to quarter. A baseline will be established the lst quarter of each year and compared to results at the end of the year. • Parent & Member Surveys will be distributed to each parent & member in April to evaluate services being delivered . • B &GCA Outcome Measurements Tool every member is encouraged to enter a baseline survey upon registering for the program . Ongoing surveys are administered each year . 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 ? All data collected will be compiled and presented to all funders and contributors in order to present our agencies positive impact on the community. 12 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee G. TEVIETABLE (Section G not to exceed one page) 1 . List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start- up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Action Steps Time Frame Develop Program Budget for February January 2003 Approval Write and Prepare United Way Grant March 2003 Distribute Parent & Members Surveys April 2003 Start Registering Summer Members May 12 , 2003 Develop Summer Program Schedule that May 2003 incorporates all the National Programs mentioned in section C3 . Write, prepare and submit Children ' s Services May 2003 Advisory Committee Grant . Summer Staff training & Building June 2 — 61 2003 Maintenance 1s` Day of Summer Program for the Sebastian June 9 , 2003 Branch offer hours Monday — Friday 8 a. m . — 6 p . m. Start registering Members for School Year August 2003 before summer program Program . concludes . Develop School Year 2003 -2004 Program August 2003 Schedule that incorporates all the National Programs mentioned in section 0 . School Year Staff training and Building August 2003 Maintenance Upon securing funding, hire and train October 2003 Technology Center Director Evaluated Boys & Girls Club Program November, February, May, August . Utilizing Commitment to Quality 4 times a year. 0 Boys & Girls Club of Indian River County. Inc. - Sebastian Branch Grant Application to the Children Services Committee H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location >�' 1 <' �a � > > CurrentFiscal Year . . . . . . .Nel:.: ' �< >_ >:= Locati n .. .. . :. . ...... ...::... > o Budget 2002/03 :4 - -< :. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g I. . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 326 595 11410 S . Indian River County - - - Indian River Co. Total 326 595 11410 Greater Stuart - - - Hobe Sound - - - Indiantovm - - - Jensen Beach - - - Palm City - - - Martin County Total - - - Fort Pierce Port Saint Lucie - - St. Lucie Co . Total - - Okeechobee County - - - Palm Beach County - - - TOTAL SERVED 326 5.95 11410 Number of Unduplicated Clients by Age : ct + » Fiscal >„ > > < > ' :. . : 'Current Y . Location :. : . . :.. . .: :. . . . :;. . . . . / 0� . . . . . . Bud et 2002/03 iroects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ijvl<iivals >':': :>teiQu ': Individuals Grou Itieltlua : : > :i 't3u PP .::.::.; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 to 4 - (Pre-school) - - - - - 5 to 10 - (Elementary) 162 - 100 - 390 - 11 to 14 - (Middle) 77 - 125 - 185 - 15 to 18 - (High School) 20 - 25 - 50 - 19 to 59 - (Adults ) 67 - 65 280 125 660 60 + ( Seniors ) - - - - - - TOTAL SERVED 326 - 315 1 280 750 1 660 14 Boys Girls Club of Indian River County .nc. — Sebasoan Branch Grant Application to the Children Seraces Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrafive 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 A Specific Budget Forms. gency Budget, Total Program Budget and Funder AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County/Sebastian Branch FUNDER : Children Services Advisory Committee AbI CA UT/ON : Do not enter any Figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I e used for calculations and to write information only, , GRAY AREA6FOR. REVENUES AGrttcr useGli} Proposed Total Program Funder Specit<e Total Is„owoErAL a. gency cucucuttorrst Budget Budget Budget 1 Children 's Services Council St. Lucie 2 Children 's Services Council-Martin 3 Children 's Services Council-Okeechobee 4 Advisory Committee-Indian River 5 United Way-St, Lucie County 60,000. 00 60,000. 00 4. 30, 000.00 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 9 Department of Children & Families 60,000. 00 174, 000.00 10 County Funds Individuals - $155,000, Civic'' Groups -- I $13,000 ; 1 . Fourtdations $10,000; 11 Contributions-Cash Corporations - $45 ,000. 12 Program Fees I :231000. 00 News Letter $7;300, Golf' Tournament. $20;000, Steak ' & Stake - $30 000; Outside Fundraisers f $22;000, Mail Apgafs 13 Fund Raising Events-Net $35,000 1 , 400. 00 Vending 30, 700. 00 14 Sales to Public - Net Machienes 100 .00 400.00 Membership - ($5 school Year, 15 Membership Dues $30 Summer); t shirts - $5 ea. 16 Investment Income 5 , 450. 00 76 , 550. 00 Exchange Club 17 Miscellaneous Rent $300 per 18 Legacies & Bequests month 3, 600.00 FLDOE - $44,000, JICSL $2519 Funds from Other Sources League e - $6 0, $6 Leagu ,500; 30, 333. 00 - 5/27/2003 75, 500.00 Boys Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children Services Advisory Committee 20a Reserve Funds Used for Operating Total Match from Amencorp :' to pay beam tiers . $88 ;85a plus. Rent for AdrnIns. +Office P(per 205 In-Kind Donations (Not included in total) 21TOTAL REVENUES (doesn't 16,635. 00 108,850.00 include line 20b) $ 157,283 .00 $60, 000.00 $703,750.00 AJ C D EXPENDITURES` cwcr tns�s ide Pro used Total Prar/ram Funder Specific Tata/ A enc AGENCI^IISE Of�Y �. •7 Isxowcw;euunonsl Budget Budget BtJd et 22 Salaries - (must complete chart on next page) 107, 618. 00 552000. 00 393 ,527. 00 Salary 23 FICA - Total salaries x 0.0765 Z.65% 7,308 .00 41207. 50 26, 130 .00 24 Retirement - Annual pension for qualified staff 6, 150.00 Provided by 0.00 22 ,750.00 25 Life/Health - Medical/Dental/Short-term Disa rBGCWA 10,525 .00 800. 00 31 , 619.00 26 Workers Compensation - # employees x rate 12x2.68% on a nemp oymen - P 1ec a t2 x,$7,000 Xro 2 ,560. 00 0.00 9. 154 . 00 ' 27 employees x $ 7, 000 x UCT-6 rate w 2:7% 824.00 0.00 2 , 404 . 00 SALARIES A Gross Antrual : .. p POSIT". �$ T/NG Portion ofSafargonProposed C Funder . Posid on Title / TOta1 HmAVk Salar�r Specific Budget o€ Gross Annual (Agency) Program SalaryRegyestr 1J 11 Example: . Execrltiire DlreetorfdOhrs 7D 00 '00. Director of Operations/40 hrs101000;00 5, 000: 00 714%: 501000.00 12 , 500.00 Branch Director/40 hrs 30,000.00 0.00°h 30,000. 00 30 ,000.00 100. 00° Program Director/40 hrs 25,500. 00 25 ,500.00 0.00% Technology Director/40 hrs 25,000.00 25,000.00 25,000. 00 100.00°5 Summer Program Specialist/40 hrs 21534.00 2 ,534.00 Americorp Team Leader/32 hrs 6,042.00 0. 00°,6 Americorp Team Leader/32 hrs6 ,042.00 0. 00% 6,042.00 61042 . 000. °00 � #DIV/0! # DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! # DIV/0! #DIV/0! # DIV/0 ! # DIV/0 ! #DIV/0! Remaining positions throughout the agency 248 ,409.00 #DIV/0! Total Salaries $3932527.00 $ 107, 618.00 $55t000.001 13. 98% FRINGE BENEFITS DETAIL (Funder Specific Budget Funder r . a Cre F Column G on/�/, frorn /ihe 22 to 27) Se FICA 7. (ib% Pension Health ins. W°+kers Unemployme Total Fringes Funder Position- Title / Totamrs/wk Budget ('4 x %)' Compens. ntCompens: Sp. 11 ec!>Sc 5/27/2003 16 rrr rr r ► r re ae em ee rr rr rr 1 11 1 / 1 - • - • / 1 / 1111 • 111 111 111 • 111 11 ® • 1 / 1 / - Ma as iiijillillill1illilliillillilli 121, 1111111111111,11 • e - • - 111 • • - - - • - - MINI 1 1 / 1 11 1 / 1 1 11 all off 1 11 all 1 11 • offMf 111 111 / 11 / 111 111 1 11 / / / / 11 / 11 / 1 . • e - C - . . . . . . . . . mom . . of 1 11 .X s • • e • y e under _ e • e erycy Budget oStafff - _ _ • • - wnwc;t/ 1 1 1 1 -- • / / / 1 - • - • - • • _ 111 11 1 / / 1 OF - • ' • • - • : 111 • - • • • �Long • - • _ Distance DSL Parents - . / 11 Wiled to • — Office 11 11 / 1 $19 • . 1 . 11 1 / 11 11 Boys Girls Club of Indian River County, Inc. - Seoasban Brancn Grant Application to the Children Services Aayscry Committee • Quarterly Newsletter ($ X 4) organizations • Letterheads , Envelopes, etc. printing is • Fundraising materials divided over all • Other agency; programs 'f/4 36 Subscription/Dues/Memberships C 'Dues • Membership to National Organization 32fi FLArea> . 200"00 10, 115.00 • Dues Alliance flues - • Subscriptions to News a ers/ma $1 ,500; ; Rotary, P P gaanes, etc. Kiwanls, 37 Insurance • 00 733. Directors/Officers Liab, Generaf!Liability 2 , 14.763. 00 • Commercial/General Insurance 6304 Vehicles -: • Bond Ins . • Auto Insurance Members Accident - 38 Equipment: Rental & Maintenance • Copier lease ($ x 12 months) Computer 7, 200.00 • Meter lease ($ x 12 months) Maintenance - • Copier Maintenance ($ x 12 months) Raisees. Edge. • Computer Maintenance ( $ x 12 months) $31700 } Copier • Other Ma'Intenance $3,000. 39 Advertising • Newspaper ads 250.0011 ,200.00 • Fundraising ads/promotions Recruitment. for • Other (vacancies) Vacancies .- $250 40 Equipment Purchases :Capitaf Expense • Computer/monitor (# x $) 0. 00 0.00 • Laser Printer 41 Professional Fees (Legal, Consutting ) • Legal advice ( estimated #hrs x $ ) 0. 00 0.00 • Consultant fees • Other 42 BookslEducatfonal Materials • Books/videos 100.00 1 . UVU. 00 • Materials ($ x staff) Books/Videos 43 Food & Nutrition 1. • Meals ( # meals x clients x 5da s x 50 wks) Snacks from 300.00 600. 00 • Snacks y Treasure Coast Food Bank. 44 Administrative Costs • Admin . Cost (% of total budget) 0.00 0.00 45 Audit Expense • Independent Audit Review 2 , 000-00 9. 100. 00 46 Specific Assistance to Individuals Medical assistance 0. 001 0. 00 Meals/Food Rent Assistance Other 47 Other/Miscellaneous • Background checWdrug test 1 , 170. 00 10. 389. 00 • Other Back ground' 48 Other/Contract check/Drug. test Sub-contract for program services 49 TOTAL EXPENSES $206 , 680 . 00 $60, 007 . 50 $681 . 940.00 5/27/2003 18 ews Gins CY of 'Ww Ri Co d irc. - SaE°sna +�cn Cr APC*C w ro lM Chk Swwc" Prt.+sory C,m UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: FY 01/02 FY 021113 FY 03/04 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (Col. C. oi. apeol, a REVENUES 3UDC+ T. BUDGETED I Children's Services CouncilSt. Lucie 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Children's Services Council-Okeechobee 0.00 #DIV/Ot 4 Advisory Committee-Indian River 0.00 #DIV/0! 48,458.00 100.000.00 130,000.00 30.00% S 5 United Wa t Lucie County 6 United Way-Martin County 0.Wo #DIV/0! 7 United Way-Okeechobee County0.00 #DIV/0! s United Way-Indian River County0.00 #DIV/0 ! 80,000.00 136.000-001 174,000.00 27.94% 9 Department of Children & Families 10 CountyFunds 0.00 #DIV/0! tt Contributions -Cash 0.00 #DIV/0! 132,222.00 264.900.00 223,000.0012 Program Fees 15.82% 940.00 p_pp 13 Fund Raisin Events -Net569799.001 0.00 #DIV/0! 56,799.00 69-494.00 80,700.00 16.13% 14 Sales to Public-Net 710.001 300.00 400.00 33.33% 15 MembershipDues 9,995.00 650.00 16v55-0.001141 .61 % 16 Investment Income 2,934.00 0.001 0.001 #DIV/0 ! 17 Miscellaneous 1 ,800.00 3.600.00 3,600.00 0.00% 16 Legacies & Bequests 1s Funds from Other Sources 0.00 0 .00 #DIV/0! 96,924.00 127.977.00 75,500.00 -41 .01 % 20a Reserve Funds Used for O eratin 0 00 20b In-Kind Donations (Not included In total) 0.00 #DIV/0 ! 1 .408.00 47.464.00 108,850.00 zt TOTAL 129.33%430,782.00 709.121 .001 703,750.00 -0.76% EXPENDITURES 22 Salaries 183,135.001 394.936.00 393.527.00 -0,36% 23 FICA 27.773.00 26, 130.00 -5,92% za Retirement 6,992.00 19.025.00 22,750.00 19.58% z5 Life/Health 147318.00 28.126.00 31 ,619.00 12.42% 26 Workers Compensation 2,524.00 9.730.0091154.00 5 92% 27 Florida Unemployment 2,788.00 2 37900 2.404.00 za Travel-Dail .897,00 748.00 11900.00 154.01 % 29 Travel/Conferences/Training 7, 169.00 2275200 30 Office Supplies 11 ,500.00 .49.45% 12.863.00 34.655.00 14,267.00 58.83% 31 Telephone 54.9312.0000 8,105.00 9,580.00 18,20%32 Posta e1Shi in 1 00 33 Utilities .4 . 1 .983.00 6,960 .00 250.98% ,432. 11 .948.00 34 Occupancy Buildin & Grounds . . .15% , ,00 64.564.00 68,838.00 6.62% 35 Printing & Publications 18,863.00 10.215.001 16,500 .00 61 .530%/o 36 Subscription/Dues/Memberships 4.626.00 3.573.00 10, 115.00 183.10% 37 Insurance 8,235.00 11 .015.00 14J63 .00134.03 % 38 Equipment: Rental & Maintenance 115.000.00 7.200.00 #DIV/0! 39 Advertisin 0546.00 ao Equipment Purc1200.00 1 ,200.001 Expense 0,0 % , . 0.00 0.00 #DIV/0 ! 41 Professional Fees (Legal, Consulting ) o .001 16.670.001 0.00 100.00% 42 Books/Educational Materials 2.883 .00 2000.00 1 .000 .00 50.00% 43 Food & Nutrition 497.00F 600.00 600.00 0.00%4a Administrative Costs 45 Audit Expense 0.001 #DIV/0! 4.190.00 6.000.00 9 ?100.001 51 .67% 46 specific Assistance to Individuals 0 .00 0.00 0.00 #DIV/0 ! a7 Other/Miscellaneous 21 ,962.00 14.327.00 10,389.00 27.49% as Other/Contract 0 .00 0 .00 0 .00 #DIV/0! as TOTAL 356.556.00 652324.00 681 . 940 .00 1 .50% 5o REVENUES OVER/ UNDER EXPENDITURES 74.226.00 16.797.00 21 ,810.00 29.84% 3oys ii.rs CLE or ros Pover Canty. irc _ 3wessen 8rerion was -b Mc re CN'° S"n FI3 say Com aee UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: FY 01/02 FY 02/03 FY 03104 Ye INCREASE FYE June 30 FYEL June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D PROPOSED REVENUES ACTUAL TOTAL (°°L C<°L ev= BUDGETED BUDGETED 1 Children's Services CouncilSt. Lucie 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Children's Services Council-Okeechobee 0.00 #DIV/0! 4 dvisory Committee-Indian River0.00 #DIV/0! Way-St St Lucie County- 12,685.00 30 000.00 607000.00 100.00% 5 United s United Way-Martin county 0.00 #DIV/0 ! 7 United Way-Okeechobee Coun 0.00 #DIV/0! 8 United Way-Indian River Coun 0.00 #D!V/0! s ent of Children & Families 20,000.00 36,000.00 60,000.00 66.67% De artm 1C Coun Funds 0.00 #DIV/0! 11 Contributions-Cash 0.00 #DIV/0! 3,214.00 12 Program Fees 0.00 #DIV/0!90.00 13 Fund Raisin Events-Net 0.00 #DIV/0! 14 Sales to Public-Net 1 ,400.00 #DIV/0! 15 Membership Dues 31813.00 100.00 #DIV/0! 1s Investment Income 2,500.00 5,450.00 118.00% 17 Miscellaneous 0.00 #DIV/0! 1s Legacies & Bequests 0.00 #DIWO! 1s Funds from Other Sources 0.00 #DIV/O! 27,849.00 30,333 .00 30 ,333.00 0.00% 20a Reserve Funds Used for O eratin 20bIn-Kind Dona tions (N°t6,ckWedint.tM) 0 0.00 #DIV/0! 21 TOTAL .00 0.00 16,635.00 #DIV/0! 67,651 .00 987833.00 157,283.001 59.14% EXPENDITURES 22 Salaries 23 FICA 30,111 .00 74,750.00 107,618.00 43.97% 2,303.00 24 Retirement 5,718.00 7,308.00 27.81 % 29500.00 41450.00 61150.00 25 Life/Health 1 ,912.00 38.20% 7,032.00 10,525.00 49.67% zs Workers Compensation 535.00 27 Florida Unemployment 27003.00 27560.00 27,810 28 TraveI4:)aiIv 630.00 824.00 30.79% 29 Travel/Conferen656.00 648.00 700.00 27.74% ces/Trainin 4,138.00 30 Office Supplies 3,852.00 3,000.00 22.12% 31 Telephone 41409.00 6,288.00 4,897.00 22.12°/a 32 Postage/Shipping 11,969 .00 2,676.00 3,640.00 36.02 % 33 Utilities 125.00 o.65T 370.00 #DIV/0! 988.00 2,940.00 7.200.001 144.90% 34 Occupancy ( Building & Grounds 13 ,686.00 38,756.00 43 ,535.00 35 Printing & Publications 12.33% 31821 .00 11305.00 1 ,600.00 22.61 % 36 Subscri tion/Dues/Membershi s 592.00 200.00 200.00 0 .00% 37 Insurance 11959 .00 2,500.00 2,733.00 9.32% 38 E ui ment:Rental 8aaintenance 117.00 39 Advertisin 0 .00 0.00 0.00% 364.00 250.00 250.00 0.00% 40 E ui ment Purchases :Ca ital Ex ense 0.00 41 Professional Fees 11 e al. Consultin 0.00 0.00 #DIV/0! 0.00 0.00 #DIV/0 ! 42 Books/Educational Materials 617.00 43 Food & Nutrition 1 ,000.000 .00 100.00 -90.00% 143.00 300.00 30000 0.00% 44 Administrative Costs . 0 .00 45 Audit Expense 0 .00 0.001 #DIV/0 ! 0 .00 1 ,700.00 2,000 .00 S ecific Assista17.65% as Assistance to Individuals 0.00 47 Other/Miscellaneous 0 .001 #DIV/0 ! 947.00 1 , 170.00 #DIV/01 4e Other/Contract 49 TOTAL 0 .00 #DIV/0! 71 ,892.00 156,898.00 206,680.00 31 .73% 50 REVENUES OVER/ UNDER EXPENDITURES -41241 .00 58,065.00 X9 ,397.00 14.93% 21,2003 BOYS Girls Club of Indian River Conry• Inc. . Sebastian Branch Grant APPlication to the Children Sarmces Advisory Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME . FUNDER : A B C FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS , PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 22 Salaries 1077618 .00 55,000 . 00 51 . 11 % 23 FICA 241 Retirement 79308 . 00 4,207. 50 57.57% 6 , 150 .00 0 . 00 p pp% 25 Life/Health 107525. 00 800 . 00 7. 60% 26 Workers Compensation 2,560 .00 0 . 00 0 . 00% 27 Florida Unemployment 824. 00 0 . 00 0. 00% 28 Travel-Dail 700 . 00 0 . 00 0 .00% 29 Travel/Conferences/Training 31000 . 00 0 . 00 0 . 00% 30 Office Supplies 41897. 00 0 . 00 0 .00°/a 31 Telephone 37640. 00 0 . 00 0 . 00% 32 Posta e/Shi in 370 .00 0 . 00 0.00% 33 Utilities 7,200 . 00 0 . 00 0 . 00% 34 Occupancy (Building & Grounds E437535000 0 .00 0 . 00% 35 Printing & Publications 1 , 600 . 00 0 . 00 0 . 00% 36 Subscri tion/Dues/Membershi s 200 .00 0 . 00 0 . 00% 37 Insurance 21733 . 00 0 . 00 0 . 00% 38 Equipment : Rental & Maintenance 0 .00 0 . 00 #DIW0 ! 39 Advertising 250 . 00 0 . 00 0 . 00% 4o Equi ment Purchases : Ca ital Expense 0 . 00 0 . 00 0 .00% 41 Professional Fees Le al, Consultin 0. 00 0. 00 0 . 00% 42 Books/Educational Materials 100. 00 0. 00 0 . 00% 43 Food & Nutrition 300 . 00 0 . 00 0 . 00 % 44 Administrative Costs 06001 0 . 00 0 . 00 % 45 Audit Expense IIIIIIIIIIIIIIIIm 2, 000 . 00 0 . 00 0 . 00% as S ecific Assistance to Individuals 0.00 0 .00 0 . 00% 47 Other/Miscellaneous 48 Other/Contract 1 , 170 . 00 0 .00 0 . 00% 0 . 00 0 . 00 0 . 00% 49 TOTAL $206 , 680 . 00 $ 60 , 007. 50 $ 0 ,Z9 5272003 21 Boys Gns Club of Indian Rear County. m. — Sabastlan arena Gram Application to the Cheutran Sem , MMsory Cunndtea UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee #DIV/0! . . . . . . . . . . . .:::::.�::.: ::::;::.;:o:.:•:.;:;.:;;: ;:;: ;::;::: . . . . . . . DIV/O! #DIV/0! Adviso Committee Indian River Are west in fundingwill be made to CSAC to ex and the ram from 75 kids doll to 125 with hirin a Te #DIV/0! chnolo Director. #DIV/O! #DIV/0! An increase United Wa -Indian River Coun members. infunding is being request to help us expand the program from 75 kids daily to 125 with hiring two Amencorps staff #DIV/0! #DIV/0! DIV/O! #DIV/0! #DIV/0! #DIV/0! Membershi Dues Due to the #DIV/0! tanned increase in doll service to ouch we will raise more money in collected membershi dues. 375 to 625 #DIV/0! #DIV/0! #DIV/0! #DIV/0! Salaries Additional staff will be re wired toserve more outh. FICA Additional staff expenses will be incured in order to serve more youth on a daily basis. Retirement Additional staff ex enses will be incured in order to serve more youth on a dailybasis. Life/Health Ad Workers Com ensation ditional staff ex arises will be incured in order to serve more youth on a dailybasis. Additional staff enses will be incured in order to serve more oath on a dailybasis. Florida Unem to ment Additional staff expenses will be incured in order to serve more youth on a daily basis. Travel-Dail Additional staff expenses will be incured in order to serve more youth on a daily basis. Tele hone #DIV/0! Utilities Printin & Publications #DIV/0! #DIV/0! #DIV/0! Audit Ex ense Increase in audit ex enses due to ex ansion in ro ram. #DIV/0! #DIV/0! #DIV/O! 5/272003 22 Boys Gift Cup arindtan Phw Courtly, mc. - Scanlan t3atett Grant Application to the CWtren Sory sAOusari Conwlaa UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCYIPROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee Salaries 714NE9 : =:'' : i `:`.»: »`> :> :<?»>: ::»'> >:f:: :z::.»>s:x-:<:;=:<:<>: FICA #DIV/0! 5127/2003 23 Board Members Roster 2002 - 2003 MYs & cams CWM OF INDIAN RIVER COUNTY Name Role on Board Business Jay McNamara President National Brand Licensing - Chairman Ken Felten Immediate Past Arden & Felten Insurance - Owner President Ross Cotherman Vice -President, Harris , Cotherman & Assoc . - CPA Financial Development Wil Murphy Vice -President, Moss , Henderson, Blanton, Lanier, Kretschmen & Murphy, P . A . - Attomev Beverly O ' Neill Vice -President, Retired - Nurse Support Services Andrea Thum Treasurer Morgan, Jacoby, Thum, Boyle & Associates , P . A . - CPA By Fauver I Secretary Retired Fritz Blaicher Board Member CDC - Owner Kay Brown Board Member Realtor Brian Fowler Board Member Indian River National Bank Lisa Giessert Board Member New Pi er Aircraft Tom Hurley , Board Member Becker Holding Company Dr . Bob Kelm Board Member Retired Educator France Kenyon Board Member Publisher ' s Alliance Corporation Joni Kinsley Board Member Comcast Wanda Lincoln Board Member Retired - Educator Gerald P . Lynch Board Member Retired Managing Director of Morgan Stanley ! Y Edwin Mellett Board Member Retired President of Coca- Cola Daniel R . Richey Board Member Riverfront Groves Lenora Ritchie ; Board Member Wahlstrom Foundation Bob Showfety i Board Member Retired - Banker - t f BOYS &- GIRLS CLUB OF D� DIA\ RIVER COUNTY. INC. Financial Statements and Supplemental Inior= tion with Independent Auditors ' Report June ) I002 Table of Contents Page Indepen= dent Auditors ' Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Financiai SCatements : '• t<-me:, t of Financial Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ` catemeat of Activities and Changes in Net Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � Eatemrznc of Functional Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . rate:nenc of Casa Flows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . `;ores to =financial Stements . . . . . . . . . . . . . . . . . . . . . 9 - 3 A� O 'Haire, Kme #z, Nuttall, Field - = _ - - - . _ = - _ - �i & Co . Chartered _ - -= - ^ - -_- - �Q�I ,PAS �®= kJ JIM Tax, Business and FFnancial Consultants -Mal A VEv ` ' RSJ1 ,M jamin = ES:: M = :::TA. . CPt Independent -auditors ' Report To the Board of Directors Boys 3. Girls Club of Indian River County, Inc . Vero Beach, Florida We have audited the accompanying statement of finan=; position of the Boys ,z,� Girls Crab of in River County. Inc . ( a nonprofit organization ) as of June = ) , 1002 . and the related statements of activities and c :;anges in net assets . functional expenses . and cash aow's to the vear then e- ded . These inanetai st�ztements are the responsibilin• of the Clubs =nagerne:a . Our responsibiliry a -o express an opinion or, these financial statements based on our audit . W e conducted our audit in accordance with audi .,ng standards generally accepted : n the United States of �rnerca. Those standards require that we pian, and pe-form the audit to obtair. -easonabie assurance about .whether the financial statements are free of mate:: ai ttusstatement . :fin nuc : : includes examini11 ng, on a test basis . evidence supporting the amounts and disclosures in the financial statements . .art audit also : rc : udes assessing the accounting principles used and sign aicant estimates made bv manage hent. as well as evaivating the overall financial statement presentation . We believe that our audi : provides reasonable basis :or our opinion . In our opinion . the financial statements referred to above present fairly . in ail -iaterial -espects . the thane : al position of the Boys &P Girls Club of :,- dian R : %-eCounty . Inc . as of ' _tie : 0 . = 'J02 . and ,he c ranges in its net assets and its cash flows for th: e vear teen ended in conforTntr}' '.: : r11 Jener ilv accepted accounting principles to the United States of _-gym :Ica . O ' Ila : re . Kmetz . Nurtall . Field Co . . chartered Ce -nt: ed Public .-accountants October _ . 2002 aR � INAL DRIVE = c n - _ • _ _ - - - - _ _ Boys & Girls Club of Indian River County. inc. Statement of Financial Position June 30 , 2002 Assets Current assets Cash Grants receivable S 182 , 863 Contributions receivable 29 , 175 Loan receivable - , 959 Prepaid expenses 600 : 6 . 98 i Total Current Assets _ ui Property and equipment, net ' 9s , s /21 Other Assets utility deposit x , 066 Security deposit 9 , 020 Liabilities and Net Assets Current Liabilities Accounts payable 8 '' Payroll taxes payable Loan payable 1 . 561 Total Liabilities ., 6 ; ; Net Assets Unrestricted Temporarily restricted -, 75 . 693 Total Net Assets 99 . 330 Ste ac . omcam� no notes [o rinar, c: ai s [a ,e-en [s . � 8 = J Bovs & Girls Club of Indian Rimer % ounnr, Inc. Statement of Activities nes and Chain Ne. Asset; Year ended June 30 , 2002 Temporarily �nrestr : ;ed Restricted Totai Revenues and other support Membership dues 9 . oa � Contributions I S 0 . 00 ; Grants 105 . 9 ° � 16 ; 11 = . 6 : 0 20 . . 8S3 19 . 500 - Fundraising events/projects - - - = ' = Interest income 90 . . 31 - 90 . 131 Other Net assets released from restrit__ions tluotl= satisfaction of requirements42 - , ; (42 _ i4 Total revenues and other support 464 . i 79 ( 15 . 606 ) Esnenses Program services : Youth Programs - South Counrr Facility 1 S4 . _ _ Youth Prom-ams - :vo:-.\4o, County Facilin ° - " ' - 103 . 011 ; 08 . 011 Youth Volunteer Corp Pro . , - - - 07 Total program services 305 . 3 7 0 - 30 : . 3 - 0 Supporting services : Management and General S _ Fundraisinc ` = - 00 - nIz z00 Total supporting services Total expenses = 6 _ _ 0 � Increase (decrease ~ in net assets 93 . 9 i 13 . 606 ) 30 . = oS Net assets , beginning ofyear Net assets . end of year See accorroamzng rotes to tiranrai stategenu JlD Iln } s & Girls ( ' lulr of ludian Itivcr ( ' aunt }' , lac . Slalcntcnl of F nnclMilal lixl > cnses Year cn ( Icd .lune ill 2002 -- - - __ - Program Services Suhporling Services `I"ota I Yotoll Soulll North Volunteer C ' ounl }' County Cor Pro grants I Management 6 Programs 1 rogratu and General Fundraising Salaries and %vagcs 101 ) 781 ----- Paymll late -; ; 111 ( 1 hCllclil .s $ 51 ) 526 $ 3 995 $ 6 , 677 $ 2 715 $ 1 ( Professional services ? 1 , 266 12 , 406 962 1 , 608694 Printing and advcrlising r) - 654 39 , 89 (1 4 , 190 4 , 405 8 , 595 Supplies anal I ) ( ) slagc , h01 3 , 379 1 , 697 2 , 238 10 , 463 Licenses anal dues 8 , 954 10 , 3 15 817 6 , 150 20 , 578 2 314 1 , 388 - 3 , 807 30 , 043 Item 20 286 c 925 - 4 , 627 Repairs and iu ; tinlen , tncc 9 , 120 - 4 , 234 3 , 456 Tclupliunc ; uul ulililics 3 , 521 6 , 050 _ 37, 096 Insurance 5 , 182 3 1 10 5 9 , 5 ? 6 4 , 117 2 - " , 07 : 1 I ' r4tl �. fant arllvtltr1 , , 1171 _ - 10 , 365 1 , 1 . � 7 t116 1647 8 , 235 (vlisccllanc " tts 1 • ) , � .t • It{ I lcltrcci : tl iun - 5 , 821 -! , 8 . 1 1 8 , 327 2 , 165 t > 25 =1 7 , 075 Stall training anti nteclings 2 , 276 - 200 - 10 , 992 - - - - - -- - 4 , 845 9 ; 2 , 386 _ 9 , 600 Total cxl � cnscs `►; 18 �I 152 - -- $ 108 , 011 $ 13 , ? 07 $ 33 , 835 -- See accompanying notes 11 ) financial Staten cols - - $ 25 , 500 $ 365 , 21) 5 l - 5 - Boys & Girls Club of Indian River County, inc. Statement of Cash Flows Year ended June ; 01 2002 1 Cash flows from operating activities : Increase in net assets S 30. 368 Adjustments to reconcile increase in net assert to net cash provided by operating activities : Depreciation Noncash contributions of fixed assets 10 , 992 Changes in assets and liabiliti ( 19 , 046 ) es : Accounts receivable Contributions receivable (20 . n) 77) Prepaid expenses (2 . 959 ) Loan receivable ( 6, 482 ) Deposits (600 ) Accounts payable ( 8 . 090 ) Payroll taxes payable 1 ' > 4" 1 . 608 Net cash provided by operating activities 4s . s4 —, Cash flows from investing activities : Purchase of property and equipment " (39 . 98 ) Net cash used for investing activities ( 39 . 958 ) Net increase in cash Cash_ be _innino of vear 8 . 389 17 -) ; 4 Cash. end or- year S i82 . 863 See aecompaming noes zo rinanciai szacernms . i _ n _ Boys & Girls Club of Indian River Counri •, 111c,Notes to Financial Statements Vote 1. — Summary of Significant Accounting Policies Organization Iite Boys & Girls Club of Indian River County Inc . (the Club) was formed on February 4. 2000 . to help youth OI all backo; euntis ;m tnaian .Diver County, with special concern for those �rom disadvantaged circumstances, develop he qualities n leaders . The Clubs supeeded to become responsible citizens and ort comeport primarily fromindividual donors ' contributions and various agency grants . The Club has two locations ;South County and North County) from whic :. the, operate their �.rr� , . P pro _ aiiLs ur Juir _ 00 = . the Club ol7rcially added the Youth Volunteer Or program that pro « aes vourhs an oI . Or-.inity to improve the locai community throutzh suoe�,zsea volunteering . Basis of Accounting The financial statements of the Club have been prepared on the accrual basis of accounrir g and accordingly reflect all signi-ricanr receivables , payables . and other liabilities . Basis of Presentation Financial statement presentation. foilo «-s the recommendarions of the Financial Standards 3oa rd in its S -zatement of Fina ieml AccOunrin ,_ Standards ( SFAS ) No . 117 , Financial Statemenrs � * _Vor- for-Profir Orgrani ations. linden SFAS i 17 , the Club is required to report infor:aation regarding its financial position and activities according to three classes of net assets : unrestricted net assets , temporarily restricted net assets , ana uermanentiy restricted net assets . Property and Equipment The Club follows the practice of capital`ng, at cost, all expenditures for fixed assets in excess or S500 . Donations of property• and egtupment are recorded as contributions at their es:mated fair value . Such lora ors are reported as NmresthcLea contributions unless the donor has reszicted the donated asset to a specific purpose . Depreciation is provided using the straight- line =hod over estu aced use :al iives ranging mom to _ 9 years . Revenue Recognition Contributions are recognized .vher. the donor .;lakes a promise to give to the Club that : s . r, substance , unconditionai . Conn•iounors that are resmcred by the donor are reported as ins_eases in unrestricted net assets if the reser mens expire in the Fiscal year in which the con [riounoas a.re recognized. All other donor-resumed contributions are reported as increases in temp_ oraniv or Permanently restricted net asses deuenaing on the nature of the restrictions . When a re .=.. crion expires . temporariiy restricted ner assets are reciassined to urresmcred net assess . Income Taxes The Club is a nonprorit orsani anon. as described in Sec . - 0l ( c) i = of the Intemai Revcnc = oce and is exempt from federai and state inc �) rne tapes . Functional _-kllocarion of Expenses The .: ost of providing the various programs and other aczn-iresads been summarize ,. Dr c funcnonai basis in the starerne- t of fu-cnonai expenses . _3ccordingh , certain costs hay : bc `rt aiIocated among tie programs nd suppc ,.;rig se-vices beneirted . bov, s & Girls Club of Indian River County, Inc _votes to Financial Statements (continued) ti Note 1 — Summary of Significant Accounting Policies r ntinued) Donated Services Zlle Club received donated services from unpaid volunteers for certain actitiZnes . No amounts have been recognized m the acco=an` gn2 financial statements as the criteria for recognition under Financial Accounting Standards Board Statement No . 116. `;accounting for Contriounons Received and Contributions Made " have not been satisfied. Use of Estimates The preparation of =mancial stateme=s in conformity; lTrfth orenerally accented accctl:.ang principles requires manage ment to m e estir = tes and assumptions that a. ect .he retorted atriounts of assets and liabilities and G'E'closure of contingent assets and `;% b ' 1neS at the date OI the financial statements aria the reported amount; of revenues and expenses during the reporinz period. Acnlal results could dij'.Fer from :hose estimates . Note 2 — Property and Equipment, net Property and .grtipment consists of the :pilo « inc at June 0 : Vehicles Leasehold improvements -10 . -0` Office equipment and furnishings '1 ' � 3 ' Club equipment and furnishings 36 , 641 ., i 10 . 794 Less accumulated depreciation S 98 . S_ 1 Note 3 — Loan Pavable In June 200 _. a board -ne:nber a -uric develop -Hent software pac :cage aria training or, behalf of the Club for X23 , 31 = . The C : is ooii ated to repay the board membe hen rands are avaiiahle . ?� o interest on the loan balanc : is beirQ charged . The entire S2 :. ' 12 loan. baiance :was forgiven in September _ 002 . Note 4 — TemporariIy Restricted -Net _-assets Temporarily restrictea net asset; consi _ : or .he :ollowinJ : ? outh Voiunteer Corn program . o . . 00 .Sebastian building :. coital smpaig?; _ Photogranhv orog: m - - = 1 � . _ _ I i Boys & Girls Club of Indian Diver County. Inc. Notes to Financial Statements (canunuea) Note 5 — Contributed Rent The Club receives donated rental space for its administrative oi�ices from a private corporation on a month to month basis ; bemnning in June 2002. The Club has estimated the fair value of this space to be S1 , 000 for the year ended June 30 , 2002 . This amount has been recognized in the accompanying financial statements as an in-land contribution and as rental expense . Vote 6 — Employee Benefit Plan The Club o_ anticipates in the Pension Trust of Boys & Girls Clubs of America. Each employee is eligible to participate when they reach 1 years of age and have completed one year of service to the Club . under the plan, the Club contributes 1011% of each eiigible employee ' s salary on a calendar year basis . Plan expenses incurred by the Club for the year ended June 30, 2002 were 56 .993 . Note i — Lease Agreements The Club . eases its South County and North County building facilities . The South County lease is from April 1 . 2001 through March 31 . 2003 with monthly rent .n the amount of S 1 .960 . The Club has the option to renew the lease for three additional t n , as of one year each. The North Counr, lease is from Nlay 1 , 2002 through April 30 , 2005 with monthly rent ranging from S3 , 060 to S3 , 949 over the life of the Iease . The future -ninirnum rental payments are as follows : June 30. 2003 S 54 . 808 June 30. 2004 40 , 37 June 30 . 2005 39 . 187 S 135 . 032 Note 8 — Conditional Promise to Give ine Club r°reived a 550 . 000 conditional promise to give fromthe John ' s Island Foundation . The donor is voiding the money in escrow ands surncient r'unds are raised to construct a 3' . 000 square :oot :ability in northern Indian River Counry . Because of the conditional nature of this contribuno .. the Club has not recognized ;his amount as revenue in the rinanc : ai statements . � - 1 'AE Ila. Rer 'urn or Oman izaLion �. e:ncz := ram n = me -.ax ` 00 04 Jnaer secion E54 ( c:, =Z7. a1` =947(24 ; 1 of the ! m.2trmi Revenue CJae Iexceat bias; : tuna -aecanmen! or :.ne -reasury benefit ::-ust or prr:ate rounazzcnl ❑te.Rtai Revenue Sennc? C) DentD:Aupiic ate cr �gn r. :ar rave !o use a copy or = =^„ !e =�: : e - =R:na reou:re ^ =nom_ 175t7eC1on or the 2001 cienaar near. or -ax near neatnni ' / 07 -` 0 — . _rpenainc � r = Qi 02 3 _^hecti if ag dchote: =lease l v C ,Norte o! argantmmn.*+ XI Address change !'Se IRs HOYS ac C-'RISS UB OF + Z =matoyer iD numaer tf - lanes on -'s = Name I a - 3623298 a mange print an ��F,'t'� C.oumN ►"-r .• eleoncine number !ntiial return type. i Numoer and sweat (or P. O_ :m! if mad is ng! ae!iverm to sweet anr-�cr I , caorrvsulie 772 - 290 - 7d_ aa _ =�� re�rn S�= o . BOX 3068 SoerSfia r At coundng method: r Amenaea re!tl!tr Insa'uc-i C::y or town. sty or country, and ZiF - a — _ =asp Acoli�agn , . 6I „C= la Other tsneay OOOLa= ending -ions , � Seciort 501tc;(31 orcar!is�ons ana ae47(ai( t1 nonexemat c•.rrtadie ;i -a-= t a:e not agol=n:e to sewn _27 oroan=cns. trusts must attact a emaietecl Scneduie A !Form 990 e- -za0�=e . H(at :s z;= a crauc ren.•m rc amilates7 — G 'Net) site: )► Yes No (b ) f �'e_t ' iter no. _. a=&—aZzes )00x NIA Organization type _ — . . . _ '( G Are all aTilares nauaen? _� WA Yes No cnecx onry one ! ► x1 '01 ( c : t < :r zr pall — ' n�71 - 5Z7 - — — K _ , al ( 11 or ' t -' :o. ' =r. a +ist : � :nr. : .,ecx nere )Po f ' e orcanlzzaon •s grossz^�ts a-e normally not more ^.an r :2`- . 0100 . ­­1-le crcantzzc ec i , aI s . a senor a en :. =leg ov an X ,V /A _ on ne not =ie a t':lm .vl h L* a iR � : =ut if the c >r-art ¢a� — -.�=r!.�nen chver�+ ^: a crgua ruling? -ece!vea a Form 990 Pac:cage In the maii, :i sr,ou� file a realm without =nancal cz_. - =. ,.•r y-.Matt GcV i► Some states require a camaiete rertm_ 'd C::ecv ► r the oroan¢aaon is not reaulre7 L Gress recemrs: Aad lines 6b _ 8b- 9b_ and ? Ob re lute 4, 2 I AAc z -+ , t — r a`unr_tt Scrt . ? ii[ rrtl 990 . 290-r_ or 990 PFl Fart I - Revenue . E: nenses , and Coanaes in Net Assets or =and Saianc.� rS �o Soecinc nsruc-ions ono at= ' 6 . ;' �Jnrnbucons . gifts, grant . arta simtiar a,T.aunts rew!Vl?d: ! _ - a tire= cuoiic su000rt o a _ = 3nI 7 noire : ; uclic Su000rt • , ! overrment ccnmbuucns ; cant : _ a 7orai ( 2Ca lines Is throucin ' c : ( r---sr, _ d - 4 + c 4 ``_ , 4 c _ 00, _� - _ Y •1 a t 0' =,O par„r se vlcz revenue incrdina covemment fees and cont a= ; front =;,: vif . .ine •VtemoErsnio cues ana assement ; nrerest on savings ana tempnrry Asn . . . . . . OoO n . � ivleencs ana interes: -nom .=.=c.,•rrdes 6a Gross rent b Less : rental expenses - -- . . . . . . . . . . . . . . . . . . . . . . . . _ Net rental incme or ( loss of ( suptrac :ine db it cm line dot 6c - ; ther roves.. , ent income (des .be I _ 3a Grass amount tam sales of assets amen Al Ser`=z :han lnventcrz -• i a _ ess : c;s: or arher aasls anc sates excenses ;b ' aln or ' loss ; ( attc' Gl sc: ecu:e ! ' c a Ne : cam or : loss ) ( camoine sne 8c_ =urns ; �. 1 ora ! E ) ) - ” JCeC:al event 'ana aCyVliles . ntTcC^, e =-. r`..`.Jlel gross revenue mot ; nc= ainc00- �ntnecaons recortea cn fine ' al - ar. `_ nc .c :S :' C Ve ! :nczme Cr ' loss ; !rcm sze^_ni eve..^. 'S SUC^. 'cC :: riE �4b RCnI me :an ) _ Oa doss _ales Ct ;nvenic v . ess re W':, rs araC alC.vanc. s `si Cr CCCcs _so :C a gess c ;crit cr floss ; from sales ar mven .-^, r au. = m. . : ! suoc-a.: : ; ne ' Ob - - ^ = y - - Coo -_venue from P_ „ `/ I . . .ine ' CZ1 doral revenue • acC lines c _ _ - C ] C • � c Inc 52 .^:ices Jrom ane — = 0 c " 0 J 'W. anaccmen. : ana cener✓i ( f- m fine -` _ ncr ;nc 'cm line mn_ _ _ 8 _6 � c- _vme.^. s :o a .;slates = 00 ; 2icG. S :recuie ! ' 6 otal expenses f20 lines - _ anc •: a All _ _ � 6 =_. ceSS zr Icenc::: l 'or mire vec- rc — ' — � -' C UDLraG -^re ' . �c :r! :;ne ' 2 ! _ ' 8 30 , 36 N <_ 'ale'. assets cr :Jnc balances at be'_'lnnlnc of •:ear fttC^l line r- ;Umn Ir : ' e , . a � ^ n , s6 _� _ _ LO Outer ^ances in net assets cr fun❑ ba:an Cr's : 2ttaCi eXplanacCnl i — c ; I 2Q . y Ne! assets cr vne balances at enc of ve`r lc= olne fines 4, 8 . ' C enc 2 o Cr O2w perom Recuction AQ Notica. see the sec-mate IRsi. tl C.iaRS. _ a r� r � -=m1 04 � fL'JQiI = rm 0 / 0011 �CYS ez G. =.L .�. ;.JUT= Cr Par.:; l , Statement of - -'-�� 1II oraanrzauons rust cdmc,etC cc:umn , ; C;, aria ( D ) are reawrea fcr s_a-_con 50 t (c: _ , ar„^, t 41 crzarZZUons 74,1n =icnai = =:lenses ;na sec•on a94:. allt 1 nonexemo: c:arm=e cults = _ - ,:cnai tar � T- ,s See sae_... : , trt _^..ens cn tate . o nor ! nCluoe arnounrs reaorred on fine = . i V 30 . 3b . 0b . ; Ob . or ' 6 or = = rr ! iElla.as,nc �ervrces ne�, - ana ce .2 Grants grid ailot.auarts tact SQIeepLiel ).: : port- . . . . . . . . . . . . . . . . . . . . . . I - - -- can c i - -- - _ _ M Soecmc assistance to inchno ats ; 23 i - — 34 9enents said to or for metnaers 24 25 :zmoensancn of om' cers. duecMrs, etc - . . . . . . . . . . 25 � 26 Other satanes aria wages p Z6 : fi= . 6 941 a 6 , _? 02 i a" a / 71 2 —= =7 Pension Dian wnvtnunons _7 I E C G2! E - _ 282 ! �8 Other eztatoyee bene*)ts ; 28 i J. i , 44 a1 16 , 4601 7031 _ Pavrotl maces - - 286 29 = 701 6231 2c - 3il P•ciessionsi fttndrrtsing fees - - 31 .c=unnng fees j r 31 — 901 I 4 - 901 - _ ^ar fees 32 i3 Suco,ies 30 04 = ! 20 0861E ' = 01 807 ' a . e:eonone =4 — '0 _ 6 = i 8 2921 2 0731 - Posmce aria snicoing 35 I i 36 Oc^aaancv ! 36 ! 3 -' , 096i 29 , 406i a , 23 A. 1 q = II 37 c-zwoment renmi ana maintenance _ 9 37 I n 5761 , 57I1 5i 1. 8 ?^nuns ana cubiicanons 3g 20 , �= 7 81 7 8771 2 2 3 81 _ 0 d E 2 ° gave! . . . . 39 I 40 Conferences . wnvennons . ana meeuna<_ is =2 �eerecazon . ] eoiencn . er_ : art Sc,. , -2 10 . 7921 2001 Wither expenses not =verea acove fitemtzel: a ,3a b SEE S '='�^'� *^ _ E 7 _ � b 7 2G g � 01 6 , 4601 '_ 0 _ Jzc i 'pie : d funcdonat expenses ( aad fines 4 - v) Crganmadans i comaterino CDWmnn Mlnl. nY these totals to tlnes 3-t 5 14 ? 6 = ? f,] C : 3 05 8 7 01e _ 0 0 joint C.ests. Cheat ► i ' if you are fallowing SCP 98, — Are any joint c::= iom a c=Dinea eaureaanat camca,gn ana funartsma sciact.-ttcn reaortea in tEl Purr, zerwces7 f "'es. " anter tQ the aggre=:Mw amaum of these latm cashj . ; Ill Me annum a,lo�-tea to program serv,ces 'iii) the amaum atta=ea to Manaaemem ana genera, 5 2422 ()vl mP a.-,aum a,lac,atea to Funar,s,na - Part?1I1- Statement of Program Service Acccmoiishmer) ts Ses 3o =r:nc Insirelc ions on o2ae Nhat Is ale arganizanon -s onmary exemot ourocse 7 _ -roarm Servtcam f SrE SMAr- M=I 2 = _menses All orcanizaricns must cescrae their exemot ourDOSE aGrl2vemenls ;n a Lear aria G^ 7Cse ma .heL ( fie=- �r =Oj1 (c :{3i Z,m State the numaer _ : c2s. . c4 ,-ra - t f caents setvec . =uoiir�nens ;ssuea . etc. Distils achievements that are not measumnte- ; Sew=n S01 ( c :(S ) ana (4 ) . rcani—vans ana - 947(a im nenexernot charmole trusts mus also enter me ameurt of crht ane ailo=nons to others . , BOYS AND G1=sLS CLIIB 3A.< A MEMRERSa ? C _ - -� _TCV� ER _ D00 . - - 60 . 2NC. _ =BDCG7:: A S . i=s anc a;;c-eonsP J . ; a"S c toms _ G 2--s ana aiz =z;cns Grans ana aio =nons c e Other orecram servTr=s ; atLMQI scnecuiei ; Grams ana aLI=mons 5 'otai or P -oaram Service ;= - senses Isnouta eauai line -,umn : — 1 ? - - — ' a — = 2c8 � srr iv 8alanc2 Sneem : mea Scec :flc ; nSzruc;icns or ^ c Vote: :7 ere re *wren . ac :ey _ c-ieauie_ ana amaunts :: r, ithi A i � ! :umn mould be for en ❑Of-ve=_ r �maunt< aniv45 . Casn-noninterest-heanng = e^:nntn ❑ ^ _ a = vear . . . . 7a1 8�ntents2 8s avings and temocrary casn inve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i$ =7a amounts recetvaole dip a Ass: allowance for aountfui accounts ib 9 078117c 2n 48a z'eages rece:vaale 4a 2 , 9 91 =-ss: aiiowance for dcuctfui accounts s8b . . . . . . . . . . . . . ^ uinnrs r -'�C 2 Q C e:ewaole _ a -O Rece:vaaies from omcers. direcars. 7ustees• ana key emoioyew I Zia � v. er nates ana loans eec.eivaoie lanacn �d s seeau!e : SEE WORK ; Sta - . 6001 _tss : adcwance for acucdul accounts Etb 72 nvencones for sale or use = 1 c 5 0 0 s F:mecaid exoenses and defer -ed ctaraes _2 ss investments-secunues - _ _ . . . . 9071 a _ 6 98 > ._a ' nvesiments"'ana. nuiidincs . and — ` d utamenr basis i =a - - _=ss: accumuiarea aearecadon iatzcc-t i ? 6 nvestments-motner (anac s =. eau !e ! - 57a = aa. butidings. ana ecutomenr casts 5,12 '_ . 0 . 7941 , . _ ss: ac` o mutatea aen'cadon ( a=ct . . _ . . . . . . . . s�. eoute : ' c er assets (descibe e ^1Iym 1 9091 57C ? 8 E21 - ' 7 31 assets (add lines 15 throuan X3 ) (must eaum tine 741 , ot1 A — ,unts aayeale ana a=uea exoenses - 7 641 = 42 4 S e 3 arils oayaale 1 302 ! 3<: � e±errea revenue . . . . . . . . � 1 _ . . . - . . . . 32 o _.;arts iram officers . aire`:ors . trustees. and key emmovees ta .-.cn sc-. eauie ! 1 3�a ax -exemot bona liaciiities ( a „act scteauie ) '.lcrrcaaes ana other notes oayaoie iartacn s �. eauie : �- a a 35 � C:er liaciiities ( desc-ibe i1 St,u cTIVI*r 1 6-tb liaciiities rand lines 60 :hroucn 1 . 02 ! . o - - On.anuz:aztons that follow SFAS "17 , c-tecx here ) _� ana o!e:e. : :nes - - - _ Z. nc : . nes . . . _ _ � a =-^• • � orniv res ClC:ea a I ' = - -^anentfv res ncea � 2 121 — OrSani«tiens that do not follow SFAS - . 7 - _necx Here ) Zinc 91 -- --- - ,i — ole;= lines 70 throucn , cnnccai . res icC n cr -- opal SurD ! Us . cr 'anc . Zti ! icinc , anc ecu : cment ::rc i - = c _ !nec eaminas . dncc-Nment. ac.' • muiareo : ncc me . c - = - ctai net assets or tuna balances + acc :Ines 67 "cl.'cr. 6 = { ncc _ - :;.: umn iA ) must eaua! line ' O : column iEl must ecuai line '1 — 2 . 9 . 162 ! ' GG Q cTM liaciiities ana net assets i tuna baiancas . aaa lines 66 anc ' - - 22 = . 7641 = � 2 - crm = :.,rm X90 ( 2001 Iti.LN ParriV-a - Reccnciiiavan of Revenueer Audited P Part: il/ teccnc: iialion or .; aenses ger '� uaited - ' nano:zi tzIen7en= with') Revenue per ' nanc:ni ata mmenTm with. ns - ncac Rerurn i ` �n � aecw= -ns ^ ^ : neaer . oeoe Relurn -oral revenue. ;mns. =na cater ;er auaiteo nnattrd s lit lterns a ( - excenses =nc .as___ e. 4 ^ 4 � . 1 auaiiea rlrianam s�rnents r - ( j lints inaunea an line a aux not crx _-= : _ - - c 3 1 Vim. ^ � Y�- _ h Amounts incuaea on line a out not - I.;Jj *C --41z Form on line 17, =arm �.p: (11 Net unrealizm coins al P - 71 - _— - - - - - ( 1 ) Danotea services ana use - nve_canents S Y - I ` - - ar ac:dbes $ . . (2) Donatea service ana use (2) Prior year aaiustmerrs - - 7r faaiities S - - zconea on line _0 . - (3) Recoveries of crtar rarm ccs S - iear amts S -�- (3) Losses reaanea an fine 20, rm (4) ether is ae=4yi ,cd amounts on iires 1 ) t.rcuan ( e1 )► mad amounts on iinez t i l mi-CUc- 141 a1 c i J ine a minus cine b 4 5 5731 c dc . nea ,:.muscine b ,mounts incuaer an lite �arrn _ - - _ .•. _. . , - d rtto euaea on line ; 7. as 0 but not on ire ( -- _ but not on line a. 1 ) Invesanent excenses - �--- + ( 1 ) ; nvestment excesses f - _�. T got incucea on ilne l.z -- - -iot incuaea on gine db . =arm ��0 - - 21trier =arm X93 s - - I+ 121 ther scec-VFl : nda amounts an fines i1 ) arta (2) )► a + )00i . 1 oral revenue ce< line : 2. =amt °S0 Aad amounts on sines 11 ) ana ( 2) ; I e 7Drat exrenses aer line • 7 . =arm ga0 line c crus line dl ] e , d d % ZI line c =:us cine a ) Pat' L; si O7 I.fF' CarS . UIrLS�:. ) i fU5229 s . and Key Employees iLzi ea C: one even .r not =.mcerrso [eo: =-C nSTrU Wens an cane 25. i A ) Name ana ar.'es (8 ) 7fUe ana average (C ::ml:uncenseman 1 of n� = w ease nouns oerwea.K If na> '-mofovee certeri - - Mato said. errtert aas�an : ants 3 a=enro ac=_r 4a ec e - '' S === VERO . . . . . IP- . . . . . . . . . . . .. 10 ROSS � I � ( COTB23�7 V_ CF �RE � v V�'RO BES -r: . . . 5 BEVERLftlp VE'RO BF.AC= . - - ANDREA ���tcN mREi�. C 'Jr�' - - VERO �B�[F�A�1 CB 01 .^.• 1lJ V ^ r _ W7FRC SEC=T i'�=c`_' is znv cn ,._ r . -_ e= = r` ' - • `,a ' _• • _ igvee rec.=:ve aggregate camoensaucn or 7-nC7e !pian . i cc . = 0c -Cm :CUr =rcantzauon anc aii .= - - - �tec „r� ancs _ • •.vrc • more � S 0 . 000 w- _ _ _- • — an 1 as croviaeg Cv _ . _ Pa s re:aw � 2 . a cc se.. e= a-see Soe= rs• c=cr. s on '7 � arc, c - �cr czoe _ . =DRTT 990 (2001 ) OF M Ea.N = �� as � an ''>/f Other lnrormatian iSea � t� ecinc lns �l c:ians :, n orae =' . ; - _ - � 'an Vo b DIG :rte crcant2=tion engage !n onV ,=.C.IVIP.' !lot I7rEVIOt1sIV re00REa to i;,e ! R .C. i " " ' -g ' - ^ =ate:. a^✓rtv 77 Nere anv canaes ranzae :n me eraantzna or governing aocments our not rece: ` to the ! FEE 6 _S i —, ' If ^. es. a=c:n a ccrnormea c=v of the esanges. -= 8a Did the ergani�tian nave unrp•- + business grass irtc. or 5 1 . 000 or more gurina t e year Frere^ by this reZlm ? b if ^fes." has ii ted a tax return an Form an{�-� for this yeat? . . . . . . . . . . . . . . . . . . 7E -o _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 'Nes there 'a Ilanloaricn, dissOilIDOn . :8rmination. or suastanuai contra Can ounno ^e year? " '-' - • - - - . . . . . . " . . . . . . - . . . . , 8b v a statement • . . e— ,tzGct a . - - - _ " • "30a the Orcan zzatin re:atea iote< laroy association with a Statewide or nationwlae orczinr�ons tilrouan common l Memaersnto. cavemtno bogies 7tts-,ees. racers. _tc.. LO any other exemor or ncnexemot o.=ntaon 7 —� - " b If "fes• ' _rater ase name or thehaan¢atiart ) 80a BOYS a GI-�S CLUE OF pt�R a-� __. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ =ria _ . . . . . . . . . . . . . _ . . . . . . . . . . . . . __ - _ Xl mot GR nonexempt 31a Enter alre� Or :ndire= aclit ai exoe'iditures. See line 23 , In57. _ — - _- . . . . . . . . . . . . . . . . . . .--fir b Did the ar>_cniza-don n-le Foran ' 120 -POL �zr this year? - re b I 32a Did s'he OrConlz-- dcn receive ecr.area serac`s or fhe use Of matenals . .-culament Cr .=Gilles 2 [ :91C Or at suostantlzJv less than fair .'ental value ? d . f "'' es ' ycu may Incipte elle va -ue of thr=e Items Here . Jo not Inauae trail amour.; as rever.;:e n Fart I Or as an exaense :n Par­L II . ;see :nsaucaons In Part 33a Did "the or ni�tion pmI . with � the oublie :nspecaon requirements for returns aria exemodcn aaciicadanss ? b Did the cr><n2rion cOmory with the aismOsure reouiremens relating to auid ora cuo pnmbuz-bns7 83a i 34a Did Ghe craan�don salict any pnthbuticns or gifts that were not tax ceauccibie ? 83b i i b if "'e5 . * ana rhe cd.a rOan M2dcn Inc:uee with every Solicitation an exoress statement Cat suer, =ncuticns - -1 Or yTS 'Here not =)t ceauc_bie7 ----- - 3S =J1 ( c :(G ) , . = . . . . . . . y � l. Eab Cr ' 6 i eraani7ancns . u 'Neve suostandaliv all cues ngnceaucOble cv -emoens b -' id ' e ore=n¢=agn .maze anry :-=louse !ccbyina exoenaitures or 5Is 2. 000 or less ' vas answerea to either °-5a Or 85n. ao not commete 85c :hrouan 85h beicw unless 7- E o.gan =- aon - a reca,Veq a waiver tor Croxv ,rax CArea for -T-se oner .year. C Dues. =Ssessments. aria 51mliar amounts 'Om memoers + h" ` 86c I a Seccn ' SZfel ;oobyinq ana OCL- -. CI exoe^oitures 85dd " - { _ a ac'erate nonceaucbie amount of se pcn o033 ( e1( 1 )(A) cues nouces a `E f t axacie ameurlt of ionbvina aria aoiitipl exaenditures (line 85d less 85e ! � _ '�- p j 9 Does he arc.anrzauon ele= to cav the se=On 6033(e ) tax an the amount in 85f7 N / 85a i in : f sz^on z5U33fe1( , ) (A) sues nC1Ces were sent noes the OraarilZaDOn agree to . . . . . . . . . . . . . - - - - aco the ame . , In 65f to is ,'e2son Hele e5a.Tiate of .'lues allot—Hole to ncricecumbte (oobvina anti ocutic3l excenaitures S. ale -rotlowvc :ax _rear? N i6 _011c : (7) Cres. =titer � Initiation fees ana tpOttai contributions Inauaea on Zine I = 3_ h ! a6a _- b �ress re CES on line ' Z. :�r culotte use of cuo faciities Ebb ; ! 7 '_ 01 (c1 ( 12 ' cres. =.nten 3 l: :-Oss :rte:mT" -n memaers or sharenalders 37a e - `-- - i _ - b gess Inccme ^am carer sour. ( Do not net amounts cue or oald to other -_ `-t = I : .cure`s acalns; amounts cue c: z�:veq =, 'cm [hem. ) 87b 8 ,? l_ ! -. t anv rime curne the year. Citi -." e crganction own a 5u90 or greater merest in a Mxzole c - c- - ' =ar'lersT'JC . Jr ori 2.^. LTJ c :sreca cec as S2-^. araate TDM me craarimaa OCn Unaer Rec-;:;aacns sr'; ns ana Z01 - 7701 - = 7 ! f 'es . _arnnle:e pan IX se =n - 912 > anO 7 :' i ( C : ( ) OrCs . t*he CfC c < er. _ J - _ aacn enaaa_ In ariV On a , c eYC'= ss cene - = unnC sale veer Cr oic it bei...:me aware OT ail excess oenerit ansa C'en rrom a crc7 near? s ;a ,=_rne.^. t e = ^mac. xc :alnlrc e .. C. tr ,-. sacon 39b .S _ -C .�fTIC :JnI C' tax :r Tlocsec cin :ne Oraa' _. uon managers Or mscuaunec ger c's Cunno e ve2r •incer j 1 ^ 'O. .' MC unsI Cr :ZX cn une ?. Gc_ = o0.te . : e'm Oursea ov Che Crcanr7z uCn Oa _ s : 'e s ;a ; 9s .V ; CI '.VnICn a C., ,T tu' :s rE_.T, Is ieu )10 *TCNE : u .^ Cern- .. : Ovees emolave: : n u, e oav = eneo hat incuees t.tac^. 1 -he COOKS are :n care of )10 - • RIS SMI '=H - =ULTCNOb at �rsC � - e! eanone no . rl - 7 C D - - _ + c �=C EM; �r - - ► = � a6 � '' Se`'cn = :( a l( ; ) ncnexemot antagie usm piing f=arm .90 In lieu cr c=orm 10.: 1 - .: 5ect - ..e ► -,- _,1 anc enter .:, e arount of tax-exemor !mere rece:veq or accnleq aunnc the au yea,' -� ► E2 =arra � � � IZCOT I ` - � CL- _ .J ( <UuI I .V _ cis �, _•Z� .., _ ' ori VII. Ansivsis Of lnczme-? roduc ; na AcaViiies ( Z .- .- . DerCric : nsu ctcns CIl Oarce 'Jam: Enter crass amounts unless o[herwise :Z,mEa bum eC _ 5Al a) , e; 01 = amea cr -- =^JC7am service revenue: "" '= =%e i -mount =,:;;s;c-1 -•-gun: _xemot funs==, ?ROGRSZRVRETJF�7IIE -cane a P� _ C^ = U I I O I , a i " I -1egiC2rerMeattrta oayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 rms ana contracs ;rem covemment agencies ?4 :lemoersnio dues ana assessments i ?_ ' Merest on savincs ana temoorary caasn invesU-nents 35 Zivldenas ana interest :.om securities Z a- d Net reninane or (less ) from real esmte: V a cert- inancea oroeenv nct gear-lnaricaac OrCae'•iV . . . . . _ ' Jer rental inc=me or ,' Icss I frcm oersonal orooenv =° 2trier rnvescnent ;nccme . . . . . . . . . . . . . . . . . . . . . . . . i 00 Sain or ( lass ) from sales of asses other than inventory : 01 Vet income or (loss ) from soeciai events r : 02 Zross orotit or (loss ) from sales of inventary I 0? Cuter revenue: a a 04 . uotctal ( aao columns i8 ), ( D ) , ana ( Ei ) i 01 a . 0= -ami ( acid line 11r=. =vwens ( 8 ) . 10 ) . ana ( E; JI . 84 ) _ . . . . . . . . . . . . . . . . . cite: _tte 105 ows tine ' d . �=an I , snowd equal the amount on line far' SII. . Ret21lOnsi71 ❑ Of AC'.IVIL1e5 zo the AC::, rilpllsnteent OT = empt PurMOSeS ; $ e° ` oeM-c ; sM ; Ctrs cin case • IExclain now esc; acdvmr for wni= income is reacnea in c=ualn ( El or Part VII =mnbutea imnartanuy .m Itte _=malisnment of the ctaanr,�.tion 's exerrtot ourooses ( other than ov crrnrtdirc Winos Tor sum ouroosesl_ I I Information Reaardina Tazabie Subsidiaries ana Disregarded Entities ;gee fcec c : n_�r, cgns cin s eae lame- address. anc) :N ci c croorawn . ( 8 ) t 01 =armersnio _ or nisreaenea entity �`ra=nmae ar Vature cr ac vides -ca; ;r. Vme =, a-_i-yesr :wner5nic Interest : <szr✓ Ja J lr r ar Information Reaaraing Transfers Assac: atea with Personal Benefit CJntra =s z _ a1 _<a the or>an(✓on. _,ulna the Year. .-ecelve Tarr Tunas. :P2GV er jnc:re=j. _ _ _v aremttrc- cina cersc,^a: cense- - r.—t _ al � i❑ tt a cas .�an � uc:, . aunng Erle near . oay arernlums . ]Ire^: Of ;i. ^'.?�/ . Zn a srOnai oe. " - p 'i �cC. . ' ?5 X •i0 JOTe : . ( '/ es ' c ( bl . .iie =crm 8870 and Form - 720 ( see : nsu-u=cnsl . — Jncer Cer..��,jj��_ .. ce^. as trio have esamtnea - s o.-. .. �'' / _.—.:nC eccatr=ar6:ana C' __ -.es u.^ s:a:2c. e. ._ '_^.e Ces c . -J Krc.v�ec^ 2 iC – en:• C ` < le . .-orreC. artO c7m I e. 2ec:z even Cr C:eC,"er ' — _ '-an omcer - -sea en cJ n!c.^e.;on o v me or _-Rt name atilt" = e. Wearers ' ate -=zrers ZiN TIN ( See v2n. . nsc 3TC _Ic.^aw a J Z ; err- — • �cr ` r, s _ l =mc«rv�^ > _ WOG QQ C ` C i - rm's name Icr yours � t �_RE . r_ Z r ail mmAT • - _: TAT C] I�� � � � � - - ^ , Q 1sa ' , ty 11 1sefi-.�notove_c ). 3111 "UM .1 DR . — — aao.Tess. ana —? VEi20 BEACH , :wL _ " a63 � h �r EDuL= . � raanizaiian Exemoz !: neer Soec:ion 501 ( c ( :; ) Form 990 or 290 -_? I Exceot Prnrate rounaation ) arc Sectian �J1 ( ei , 50i ( n . - :!e No. ' 545-G047 !0 Ifni , or Secian »947(a ) ( , , 'lanexemm C�aritanie Trust nn � eoanment or :.;e -rzasury Uppiemenmry Inrarmation - ':zee SerJara'ae in5ir UC:IOn5 . 1 ' ntemar Revenue ennce s► 'AUS be camaietea by the aaove orcanizauons and attacnea to thea roan 990 or gap __. Name or the orgarrn 30S'S & I 7 ^TPioyer identifiction Hamner GiIRLS CLUB OF =MZ:i 1^ 1 RIVER COMgTy , 72gC59 �_ 3623298 l Pard. " Compensation of the rive Highest Paid Emplayee_ss Other i han Officers. Direr rs . and Trustees Ses nage 1 or the inszucrons . List each one . If the are none enter " None. "' ai Wane aha aadress or ears : emoiayee nerd more : bi rtfe ane z+erage hours ; id) :anmduoons to (et =zcerse Tran SZ0,000 :er weex aevc a to aosndon (c) ."..'.moer=Mon zmmovee aen. pians b i acr7t7'ir as carer i 'jererreo cmaensation , *r_' . . . . . . . . . . . . . . . . . . . . . . . . . Z1FRO 3EC = . . . . . i r0 _ q ? 01 3001 0 Ctal nurroer of other entpiovees pain over 250. 000 )► Q — ° ar=il . Compensation or the Five Highest Paid independent Contmacors for Professicnai Services ' See gage 2 of the ; ns-Lr. pis: =is: e� r c � one rwne ,he. : ncrv) duais or ,irms ; . . f ;here ere none . shier " None . " ! ( a ) .Name ana aadress or eam trneoenaent cntracr t]ae mcrethan S !o.c.a ' bl --v pe ar sernce ( c; ,,... : .ce. =a:an i NONE - .'. tai numner c . ciners reCetvinc over 250 . 000 � . , roreszicnai serncas ` 'Dr Jcaerwerx Reauct : on Ac. .Vouca . . ee :re : nstruc:ions * or = crr . d90 . arm 99C � � IV Cneouie A IrrJ(nl �"U C. <t1u I Part911 : Statements About .Actvlties . SeeDaae II,f -i7E ; nst;ac tins . : - - — — — - - - _ - 'es; Dunna the year. .:as ;:e org-rt¢ancn a cmo:ea : Inriuenca naoarim. Z=M. l- :o�,t ; eaisiation. :ric icing env auemot to imiuencs cucliC :atnlgn on a :aamaave matrer ar ferere^Cum % ' f '^'Pw.' _ri:ar -,'te t^ta1 exoerl a Caia - or Incarrea in conne=cn with rite :000vtng awes )3 - Nust eaua amount on line 38. `(t VI-n. or tine i of Part �rganizatioms their mase an �ecian urtaer se^-^on =01 (h ) by trtng Form �r 68 mtL., 0=13,ete Fart VI-M. Otho: organ¢atians ate^cing ^'es ' wnuvL wtraiete part /I-8 AND atfaCt a statement m ma a de abed desrnotion of - :he )aahying activities_ _ I Ounng the year. :tas the argantZation . meter airec'v or indirer^y, enaagea in arty o; the foiiowma acts with env SUDSiantialrtuiCittDF_ 2tis�rees. Cire^.,�5` s. ...mc�, esters. fey emoioyees . ,� .'rt meoers of th e:r rnmliies. Cr .vith any taxanle crcant«uon with wnie: any suet oerson is amliamo as an omcer. =ire SOC. 7i15.ee, ma10r1IV owner, or prtncaai berte*icary? (If the a.swer to env question is ^.fes, " ataal a cem= ea statement exotaininc the I r a Sale. excanae, cr !easno of orocerty% _— b -enaina or money cr a ,:, er exmns;cn of mit? c =umisnina of 000c<_. se-vtces. oraciides: ? d Payment of cmoensation (or zavrnerit or -eunotImemern of exc. I more ren Stood )? - . . . =d ransfer of anv part of ix ;n=me cr as_<_. m ? I Does the arganizacon n aKe ^:ants tr =clarsnlcs . ;eaOWsniCS . saxent :oans . z=7 i52e Note ce!ow . ; : o you nave sermon - -72 ( bi annuiry o :ori ;ter your emotoyees .'4ote: Attacn a statement to e_Cciain now ole 2'"Ca =]3cn eeter mines mar inaivicuals cr CfCrltZnDCnS Z".elVin0 grana - Cons Tom it In furtherance of It_s ctarrrenie =scams '9vatife to receive cavntents. - - Part 'N Reason for Non ->7rivare Foundation Status (See Daces 3 throuan 6 of `he ins:ruC:ions . i her' •^an =1011 Is not a onva'te founaaacn oe�use it Is: ( Please cec.< only ONE a:olieu to oox. . 1 A cnurcl. =rrventicn of cure;es. or association of cnurces. Se=on 170(b )( 1 )(A )(i). sclooi. SeWon 170(b ) ( 1 )(Al(ii). 'Also =meiere Parr V. ) A hosaitai or a voce alive noscllm service cri anlzaaon . Semon t70(b ) ( 1 )(A )(777 ). ertaprlmgoer�i. ; te, or ot covere^t or verrtmenrai unit S2�"Dn ' ( '70 (bi ) (A)(v ). A meaiCCai researc organization ace ateo in .^niuntmon wtih a nosatai. S>~ont70(b )( i ) (A )(ul ). Enter ':he hosaitars name. city , _ and state lop• 4 _ r:fl OrCanC�ticn aoeratec for the ceDebi cr a cilege or unrvers;rr ownea cr oDe r-2iea by a CCVEmmental unit. 2 man i 70 ( b )( t ) (A ) QV 1 . ( Also ccmoie*_ me Suoport Scneauie in Part OV,% i 1a ,n orcaniz`ticn mat normally rer.=^les a Sue entiai Dart Of its sucocrt Tam c' ccvemmenta; unit or Tam nim oene.ai ouclic. S2 mon Adso c:rrtc •er= dte Suaport Schedule In Part ; V-=_ . ^ h _ COmrnuni[V L*:.'St ze=on ) 7Olb l( ' : (A ) ( VI ) , , lyse camolece the SUODOrt Scneeuie In ren IV-, — � : - - ' 1 mere than __ . _ . , , . "eCe:cLS 7Cm at._Jr :es r etanec 16 =-aarrmc: e . 2i:c. . vn C'C'rs-Suoie= :.o c=r=;n eXt cncns . anc ( Z ) no mare then ZZ ilf Oo/ cr is Suc Dori TCm crc_s investment in.—me anc unre!aiea bus; ness taxaole !r ,^_.rne ! less se^_cn ° i 1 :ax ) .Tom cusnesses acctarec JV the arcanlZtfan c-gar .. Lne . 0 . a . z2? < ecnan a7a( a 7 ( L ) . . Also =Mc:E*r Tie Sucoarr .c. cnecuie In -art : V- =. - An creanizaDcn lot a ncL .^nTC71eG w env iscuaunea cersons ; otner :.'tan ,^„uncatlon managers ) anc succcrLs crcanizeDons ' escnhec In : ; 11 lines S m. roue;: _ ci - = - ave : cf . �) se on ci t ( c : ( � 1 , c_ . . . . .. e•i mee' ^, e :es ; sa = on __ , ` isl ( <" ; . . 52? - e � ::cwrnC _' "7`C- "aDG"1 cCCUt :rte SLJCC ^e V' � n - al vameisl or sucoc.,ec c can `;:c - ; s ; DI -. - - " ' - cr - - - cove . d An organradcr, art anize✓ anc coe- c -ea iC lose for 7uollc Merv . SeCon C :!a !(�l. ( See caaee O of `e ! n_s u =-ins -M Scneduie A ( Form 990 or 990 =) Z001 ^, ec :e r=cm 9c0 or 990='. =701 _ Cvc77 7 .. uDOOrz qkl� cC -7eduie fCzmoiete cnty lr •:ou c =__.':eo a cox on line ' 0. - ' " `. : Use ccsn methoa or acctsunting. 7otec 'Cu . .:aV USE the `NOfKSReet :n the !nsv uc Ens 1Cr cce InC =, ,M *'le a - ! C ai IO the Cann r'=T 1CC O.. CCOurTIIt7C . _titercarveartar ^st-t yearoeatnnmaini ;• at 2: 00 b ) • cca o ; aa3 a ) 997 et -otal = .:;L_ ;.r-onL�, ane cantnbutians e=a'veo. : Oo not incuae unusual .:arms. See line 28. 1 I 342 ., 332 ! ^ 42 Z 16 Aemn�snio gees received 2 , 2 C 2 f - 17 _,mss r,e;2tum „nm mi aasstons. merctarraise I I 2 , 2E2 said cz services oerfannea. or fumtsnina of i M=ites in arty aczviiv th.^t is rea-tea to -e or=rr=on*s rsta+•tfaale. ez. Juroase irtL, 3rMdertas, amounts = t7 In -cervea from oymt on Securities i .:ens tsecron ci2fat(5)), rettts :wattles. 3 :nre!�=Sn. :axanle Inc. ('less ; l -e = taxed from businesses amulrea v the =man¢;non after ,une 30. ' �7� C] e I , 4 - - = a 'Jet :Home Tom unre!atea Custness - - == AZIRS not ;ncuaeo in line ' 8 20 ax rem ;evrea for the argan=aon•s Jen. s atCter Ca!d to it or ex0enaed an its gena f = 1 'ne vette or serv. or fait, vmishea to the :-7. _+ a governmental unit without aiarge_ -o no, c. :he value or serv_ or mc. :,en- di ally ^^rrsr.ea to the oualic without cnarca Zyter = =me_ At=cn a sc-.eawe. :]o net cure catn cr ! loss ! ar Ga. _ssem _ne ^ lines • � throucn d minus fine 17 : d 6 ^ p = d =,ter wo ai cine 4 ^ f ` 4 6 — n r -5 DraZnZZ--*ions destribea on lines 10 or 1 : a Enter 2'j or amount in Cctumn (e ), :fine _ . J* < Sa J - - e a iisi ;or `tour reC.^,ras t0 Snow z e name or anc amount Cnmbuteo by e=cn person l outer :Ian a- ;Eve-rnrrenMl unit or pudiciv suaporma organization ) wnose total a_.Ss rr 1 °O7 rougn 2000 ezt -eaea the -nous stricravri in line 26a. Do not 51e this list with your realm. Enter the total of all these e.-gess amounts � 26b c au1 :-noon `nr secan 609(x )( 1 ) tesc _.ter line 24 . =umn tet . . . . . 1 26c ? d6 - O ^ d .�rrtounLs „ m column let for ;fines 8 1 3 �.� . . . . . .c -cb -'-011c zuoccrt ( line 25c minus fine 26d =mil : 26e _ dal - fid 0 = 'ublic suoeort oercan=ce iline 26e 1 numerator) divides by line 26c idenominatortl lop _ mss ( as 361 � �; -7 Drnar.�ations describec on line 12: a Far amounts lncuaea in lines6 . =nit 1 i u ,a; • ._ . .vere rem ve .. =am a ' bisauatinec = e'scn . " Jrecare a list for your re C.-:IIS :0 snow the name Of, an ❑ =i zm ounLS ,eC.9!Ye0 in c= .- Year .Torn . _sal ' ;Isoua!met] CerSOn . ' 0o not ;file this fist vvith your retum . = ter 7te sum cf suc: amounts � r eac :e=r. I T � . OG7 c�gl o ic48 ) a , 1 _ _ 71 _ . . ;;.v __ . . 2mm� e Or. 3na amount reCca!vec ',.-.' == G, ve r . _ ci ':rs ^ C.'Q :^ e � aroer bi ( i I • _ = - - . . . .- ai. cunt On Ilne � � i0.' ale '/ear ( 2 ) :..^., . 'JOO . -• •_- - ! n " a : fist crcant auans aesC-:Ce^ ; n lines L; M;: cn _ s -.ve!i as ; namcUa!s . . Do rc ; pile this list with your retum . .-� 'er -- mcuunc c}rano.= cetwe-en fine amount recerveo anc ate lacer .=„—,cunt ceScncec :n 11 ) or ! Zl , a. . .>. sum or hest c rferences lG e esc =_s for eacn /ear. - - 00 : V acc ) • acS ) cc71 r. ._ � . . , . . . _ r. es : acral i> �7C _ L' C 3U CCOrt nine . ' C 'CE2 ; n1 !nU5 . .nE . - C :0 [a{ 1 - - - o C:al `.'oacrt 'cr se ^on 60cfal ( Z ) tesz: _.ter amount cn iine . = . .-c:umn le ! - 7f •folic suooart percanmge Cline 27e i numeratorl eivlaee by fine 271 ( denommatorl ) n nve-znent income cercentaoe cline - 8, column tel mumertort aividea by ; ine 27f ( aencmmatnn ) - 7o Z7h . 8 Unus..ni Grants : For an orcanizatien cescbea in line ' 0 . ' 1 . crZ that rel=!vec anv unusca ca s curing Pc i :hreuan 2000 . : rECzr=_ a lis! for your re=ras to snaw. �r eacn vear. :; e name or y e cntributcr. :he date arc amount or the c.ant, ana a Jner = es=:-=cn of the nature of the arznc Do not file this lis with vour retum . 2'o - ot incuae ^ ese cr- =nts In fine Scneaule A ( Farm 940 or 990 -=. � caecuie , r*jrrn Zc0 C- P a rrV :Parry = rivate � �^ ooi Guestiortnaire ( Sem Cc @ - ar `. . : ns^wcns . ir - o ce c= mmete� ONLY : v sL:toais t;, at cne= ea the :_x on line 5 in Par; JV ! cla crn on rave a rz=iv r.,,Icns•— mInHIOrV oc:ic. tarrra s v -=•rcenc in _ c^.aver. =flaws . Y i e corer aavemma Insa=;;enL cr In a resc:uuc.^. of i*s aoveminc coav7 ---e—r ° . . . . . . . . . . . - . . . . . . . . . . . . . . . 3 � Does �Us e anqzinizzlzon tn=ce a .aiemenc c� its raaaiiv non=a;nunausv oaric• cc�a sn:denls in all its - _- 1 aures. =mtoaue= arto ather •avriif>~i caanurttmtions ,++nils the eubiic ceamie we stuaent actlsssans. � ;:rogt-.rris. ano scotarssios7 . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . ; -p u .a .as :ne cram i� an cuniir:�� its cadv ncndismrninatory ^asicv throucn newst� or aroac= media aunne_ ! i ; • _ f he oenoa or saiiC aIIQ[t icr saiQe ts, c: aunTA the registratict oenoa if it .`as no soon orccm. n a wav ',`tat mixes �" A e petieor imourrs to Pit Harts of L`:e genera cmmrTauitty it serve:? f '•/es " Please cescr:te: :,I 'Vo ." =cease exs min . ' If you ne°_ mare saac _,:act a _=ZrEte s�.menm. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - ' '_ , • =� = Ces me or_.aniza_Cn rnain .din cze ac- - ` a .Re=res incuGUna THE: = ; corn=osidan e7 ,e saicient aoc':. tmuty , a,Rc aan•Jnis= e .Siafr, X2 - 2 i ze'.,;.res oc =menanc =tat su.otu5nlc5 anc aver ',nanazi asss,ance z c =wane:- —, a ,,acalN ^.ORCSCrfC:natCr': . . . oasis 7 . . . . . . . . . . . . . . . _ _ . . . - - - - - - . . . . .2b I c CJoles OT all (mmlocues. Orcaiures. annourcements. and c=ar written (...:nmunic==Is to the ^iic ,^.831inQ . . ' with sasdem aamissom. zmarms. ana s,=.ctarsniasl . . . . . . . . . . . . . . . . . . . . . . .2c d Ccoies or all mamr7ai Ireo �.v r17e croanzzarcc or on its bena:: tO solic t =nmbucers -:2d I f Ycu a-nswerec "`Jo" = anv of the aocve . ;::ea-se exoiain . iif %-ou neea m= a scz -- . C:. a sac-raze s:areMent. . roes me or'c-nic-Pen ds..:.:ninam ov -aca.. :rs anv way with m!aec to: I z ShtoenL ' nc_ . tts crcrtvsieces :' - - - nissans zotice_t ? "2b ! j c E-'77o1ovme:7r or- a=jty C acnint.y rive szm ' c .S.c' O:arsnics or cmer =:anal � d ! I ncaonai co:icas ' 3�e Jse ai tciities ' .3f ' 7 =. 'mlecc Croc.ams � a R 'her extrac:mc .::ar acvlr. es ' ` •: Cu cnswere_ - ' es • Z criC Cf * e PCC•: e . :. :-2 se 9xaiam . '-OU .^. don - - � e- _ -'_ — rn c " r - -• en• : '} : :.. . . . . _ ..aw _� � . a SEC = :c .._. -'. . . a = : . . = - a - ._GJ - C . SSS Cc i^ Ce a = 7, r= - - _ - 25 E OrCan :� = CTS - . .0 sL; = aic ever = ee .n. 'eVOKEC C. = uSC enaeC _ Ib * .' cu ainswerec - . - ; e= E .. . . O :aIR USiC _ Sn a= CnE--' Lao a ,atcr^ E- c - _ ice J: e arcanr=_cn . : :;tat ._ - as .=crrcaec ';nth the ac :: :: =cie j . =,rennc .—z =ai nonc :sc;Imin2 . ::n , ' f "V o . ' - -C aR c _ :znanon - q Se-ieeuie ;, ( Farm 990 or 90042:) 200 ' ..'., cnecule A ,Fou: 890 cr X90 _401 ::�7L _AI`7 Part - VILA Lanbying c: aenditures by E: eng Public CharrJes Ede psae ° OT `he InsiTuc-ions . ; -c be comoieTeb ONLY by en =: ioibie cm2niz_�icai i eT :;lea =pram 60" ) V / .iec � ' ',.`e araanry--Aon oetoncs to an an'Tuatec -duo. ;;;cam ;i 7 . t you cnecvea " a " ana "imae. ccntrcl _rovls(cnr -==: v- Limits an Lnbbyina E:cenaitures ial bl `Iiatea c_. cua cc a -o oe c_� �r ALI . �a (The term "exaenditures' means amomm said or incrrreo. ) ra � & oral labbving exnenaitures to influence public opinion (grassroots loobvingt i. . . . . . . . . . . . . . . . . 37 Taml lobbvino exaenditures to innuence a legislative bcav !direc lobbying) 37 38 oral loabving exoenaitrrres ;add lines 36 ana 37) -8 39 Other exempt oumose exaenaitures , . . . . - - - - • - - - - - • - - - - - - • . . . . . . . . . . . . . . . . . . . . . . . . . . . L ! 40 -alai exemor oumose excenaitures (add lines :;8 ana 39) ' . . . . . . . . . . . . . . . . . . . 41 Loobving nontaxanie amount. Enter the amount from the mowing moie- If the amount on line 40 is- The lobbying nomaxabie amount is- Not over 5500.000 20 % or the amount an line 40 Over 5500. 000 bur not over S 1 . 000. 000 5100 .000 C = 15 a of the excess =•er 55170 .000 - � ver 61 . 400 . 000 but not over 51 . 5170 .000 S4, 75.000 or " 0 a of the excess c:er51 . 000 . 000 41 giver S1 . 530. 000 but not over 517 . 000 . 000 522:.1700 oIL 5 ?'o of Ute excess c.zr 5 ; ._00 .000 giver 517 . 000. 000 51 . 000 . 000 I ! - - - ; - .0 _ rassrocis ncnmxanie amount ( enter 25% of line 411 - 42 Y3 Subtrac line 42 from line 36. Enter -0- if fine 42 is more the line 36 j A I . . . . . . . . . . . . . . . . . . . . . . . 44 Subt ac: line 41 tram line 38. Enter -0- if line 41 is more that line 38 I A4 . . . Caution _ !f there is an amount on either iine 43 or :ine44 . mu mus, file -arm &'771 f 4-Year Averaging Period Under Section ;% 01 ( h ) Scme organtzavons that mace a se t c011h i e! e-'cn cc rz- nave to cmolete ail at the rive cciumns ce!ow . wee the Insaucmons Tcr : ines thrcuan zu on cace ; e :nsavc`ons . : _abbvinc '_;penditures During a-.Year Averaging Penoa "Mend aryear ( or jbi Ic; ( d) e! riscl vearbeninnina inl i► 0.7001 2000 4eec • 008 _ L 45 '_oobvino nomaxaate amount 46 Loobvina ceiiino amcunt ( 150 % aT _ : ine - i ( 47 -aral loco Tina excericitures i I i 18 G assroers ncnmxacie smount �9 3rassrocts calling amount ( 150 % or ine u8 (e ! ) — ; . _ 1 0 � rassroCMS !eoovinc exoenoitures Par. Vl&.L2 Lnobying Activity by Noneiec:ina Puollc : hariiyes C^ - -= nr r"inc ^oniv C \/ rCcf l= 1S " lc? : C T1CIcrc ; � / I , C = c _ unna :he year . =1C die craanl=aon - aernot :o influence n2l =.-i . state cr ' G yl : e'_':S ;c_,^.n . . nauc :ne_ anv tternoc to influence ouc;ic 7olnicn an a legisiauve matter 0r -e=rencum . :^ muc_ n -" e _ze c^ ves .Vo amcun: a /Olunteers -' 31O siren Or ..-tanacement ( in CuOe = m" ensaoOn :n exc �'ses recartec cn : :nes : _ . mucn n . Mecia aaverasem. ents 'Aa ! IInCs :c .. . . , zero eq :z ;z :crs . Jr 'ne cumic ' -2micaacns . - r c cusnea cr rroaacas: s atemens 1-anis :o other c-zan !z aucns ;cr 'coovina purposes 0 : ire era e^ ! sa ^ . :7 -_ - - - - t-• 'mm - Lo , e!r smt , _ cvemrnen: n iailies . Zemansucaons . seminars . convenrlons , soeecn � . . e _'res . r v Oral IOoovina excen. aitures ( ucd lines c :hrcugn n . , es ' 40 anV OT u, e aoove . also attach a statement civ:- _ = cel lie _^ -. = s ^ , .-^., Cc ' _ ` e !cccv! ne ac•`Jitles - r .� Scneaule A iForim ace ar 990-- '. :001 . = aa, ^ eCille A e Form 990 ar �a0-_ ? <iiU i =L., . `_._,.:. .. 6j = . - — _ 1.YL �1Y ' — Ld 4'. .� G __e5 Part -Vii ) niOrination Regarding 7rans ,'ers i a ana !raansactcns anc = eiariansmus 'Nith Ncnc :; aritaiie � ern r3t 0raaniZntiOnsSCe e 'Jcce of -tc nsiiUC = ,ls . . 1 "id the reacruna oroarimmion eirec::v or noire_i encase anv c- ;he failowlnc with anv �_.r c- n = it c:as :c in s= 501tc; at the CZCe Bother tan se^cn croanizaucsi cr -n ser an :sung a -rnsiers from the renarurig orcmniZ-tion to a nornxtattraeie exerr= crMncr=�ucn cf Caen Yes , n) Other assets - - - - - - - . . . . . . . . . - - - - - - - - - - - - =12a) I v �a aitil P $ ❑ then transactions: � (P Sales or excrianges of asses with a noncan—.ante eze•nor craMmarion (ii) Purchases of asses from a none rmntaoie exemnr arr_rn . . . . . ytlt T� otic) X iii) Rental of faciities. _=auioment or osier as � tiiil i X tivj e:moursement arrangements btivi I X v ) loans or loan guarantees Divi � X (vi) Perms-mance of services or memo rsnio or -, unar-.isinc saii ==ons 7tvi) c Shauna or faciities. acuiament- mailing iLszs. other assess aatc emuiovees o t the answer to anv of the above Is T/es. ' .-mc:em the mic inc =ecuie. C : :.-,n ( b l silc- a,Wvs 5- �.v ^ _ :moi, 'aTXC vciCF C � � X ;coos . =ner assert. or services given CV fie recattina CPCanCz2t i . a me arc--- -tion reL``-'.-:� iess u;--. :gtr 7-;afT(E! vatl; = :n c.T: nsacccn or snanne artancernent Shaw m cc:umn ( c ) the •.aiue =i '..'ie occas . =- er asse= se!-vitas svfec : al (b) ne no. I :amour: invarvea Ntane ar nancnaniame exef= orZ=E=an _=e—.. n c _�iuzs. d= a� sr—_ ia a -- aemeas N /a i I i i i I , i i _ ! i I I I s . e orean ¢ation airecv or :ncire y auairotea wrath . or re!=: tc. one or more =x>xernot =-Dons 7esCngea In seffian 501 ( C ; of the l.Jae ( Cn': eru .an Beton z--J1 ( c ; S ) ) cr ran serve" AZT% _ 1 Y85 aS NO ` " 'es . ' ;cmoiete the icilowma sc: ecwe: al bi c : Name of c=snczuon -•.ro cr c..=nr`ron - icr-•c I era - -❑cr�.-ro M Scneoule A ==m : 90 or J90-E=: :001 =arm : tf7Er )Votas and Loans >isoaivaoie a90 /aa0 _ OC LO0 � ^f =encar vear 2001 . zr '?Y vee Ce !!nrlinc n ' Jame =.nocover eenuticuon r. umoer = Cv2 RIVER C ,7IIN'_^" A1C - ORM_ 990 PART _TT L %ATE _a - ? DD ,';'TCIATA , =C MICAT"ON I Name of borrt-rver - eaatxnsnro to eisoualinea person 11 ^ AM SAi,7, Y SLwMZ R Zl , t � ) ra ) cj 7 ) 8 ) 9 ) 101 Original amount I 1Aaurnty i -- interest � horrowea I of loan care :RecavmenT toms 11 200 o ; 5 / 02 2 / = � / 03 S100 s. '_dC FOR 12 MONTHS- � 1 4 ) Sj pj i 71 i . a1 01 _ , 110 ) SeaInty crovrcea Cv corrower =hoose of loan OF9 8 % c.EP S ., ,,, - - — .A.L ; OF OCNA—� VEH _ L .T . . , rr, 7%AAT 2 ) a ) of s ) 0 ) stance cue carica cue a [ - - air -rarxe . � ,.,. .. Jnsfoe .auOn �:1TISGeo e .^. Cer tec!nnrno or azr etc or vest X00 . l � I � j 7 ) a ) 10 ) -orals 600 til rpt 17l ( 7 jli � 'i � I UI ' n b1 O t*1 ( U 1d tIn uUt. JtnO pC) c) In1iIn (n ul ccCr � ii ll inOin � ] � 1rJt hILI Ilii 'i1 n� � 3 C ) rJ n) ' w rn to + , (� LD O � LIiI ( � w rt) � il� Ul [�I N 1� 13 � U !� Mt7 'IJ [n '* CIgII C7 CA Oil N (n � lD 1-r ' I' 1 tjU �ndq C,7 Ur ll 1 ' 1 [ n t� UII ( ) CII N I Itn d 0 m l] I c, C) =1D ( ) (n C ' CJ 1-9 -n L-II I m d t1i ( , III to ' ll to I I t ' t ; ti � � (D -u ( O - r ul Q� [ , G C'7 c) , 13 d ro O Q 11 ! r- I pl O _I � ' N (4 �l. rrry1 fHl- 1 . u1 ll , 1 . 1 1 ) , 1 1 (t) • 1 • to K ) I II CD ILI r 1 I C-) I . l (n 1 cl 124, , rh ro � Cn -u fij I , Q n I I�) 11J Ql I ' I ( n In f , l • 11n ( I U , i [ n h7 n i t77 1u ll , -. 1 CU f " , UI (Q D k I nuCDr ) I ' cu m t ? ( n p u , f17 H � ( tl N � ry to 111 I *- r ) ( Il m d • c. 1 !91 CI I - J . . , o O CD In ( n I ' ( C, o3 ( , O N C) CJ m I- I (D 1 �, 13 (n onPTM + d: to t rLj 0 �. l m in ro CI H1 A IA :3 -1 d � C tQ W •^� 7 � n ( N 11 , �n m m �D Ut 1'� 1. ) (D m to IkD (L) CO M- rn s to C w ? m (n Int n (D -, o N (moo 1 ) I , In m Ol Ol � t „ i Indirec: ? ui3iic Zuanorz Casa UancaSil ConiriouiorConmuton Conmoution JN a0 , X00 ^+ oma - - ` ' `_ = 80 , 300 l I� ( 1 '> ; ti ( ; III 5 r ; I i Ilj ( li - HAI ) IAH �� 0 - 3s2 :32J ( i Book Asset Detail 7 / 01101 - 6130 / 02 .1 .1 / 12 /2002 ( i : ( 1 / I � IvI FYE : 8 /30 / 20 ( ) 2 I ' el � lc I /lsst l I huluuly I ) ur . , lSI IO) ( 041lcInO . B ) uk So ( ; Btu , c Sal 131m) t;l( I ' tl , r Bo1 ( ) u : lCsl 170 Exp 3 , n , Ur , ul, ) Ier, fle ) redall0n Nr. ) redallon BOolc Value Melllutl I ' talutl - - - - . . . _ _ - - - - - - li , nnl ! : _ (; 1 27 Fill 11Nci I /\ III I : S 11 / 21 /01 28 AISSo lolwnul : / !) ') '' ' nn7,. 0 . 71 ► 1 ) 01) 1 11 . 7101 5 , 600 97 1► Il (1c 90 2O 60 . 26 733 . 23 0 29 AI . SSI ) I � " I \Unit l : 11 / 27/01 r 0110 0 . 00 1 , 119 (124 1 , 1190 . 24 •1 , 516 . 73 S / I . 3 (1 ( ' 1111 11 ' 1 RAI ' K 11 It i til ) I ' I \VAltli I /IIU/(01 5 , (1 (16 . 98 0 . II (lc 0 OA 0 00 90 25 1 , 090 . 25 3 11 1 , 150110 0Me 1 ' (I 4 , 515 . 73 571 , 311 31 ANIIs1( It : r\ 1J lil ll It ' A ' 11 ( 1N 5111 '" I 2 / 61 /02 560 00 n no non 191 67 191 h7 958 . 33 S/ I . 12 nnlliltl ( ' AI , 1A ) 11 ( ' A 11011 SOI 1 2 /07/02 0 . O0c (100 1100 69 . 44 69 . :14 ) 1 ) 33 IO( 1513A1I Atli ) IllINIpli1tl ' ( u , I / , 1 /(I2 , nll (Irl 0 (10c 1111(1 130 . 56 S/ I . 3I ) 1 , _ 85 (IO (1 (►Ilc (► Il (1 (i9 ' 1 .1 69 . •1 .1 4311 . 56 S/ 1 . 11 2 1 ' 1 ( ' 1 ( 1 ( ' • 1 :\ III IAN 1111110 ) 1100 0 (1 (1 10 00 30 611 3 n 35 SIII : I . VINc l 1011 ' 1 5 714 00 0 00t; 6 . 011 0 011 I 'I 110 1 , 254 . 40 S /I . 7 11 36 Cx11 LIZ s /nl /o2 199 . 76 0 one ono i / on 697 . 0(1 S/1 . i 1 ► 6/ 1 1 /02 1 , 795 f10 Q QOc 0 . 00 11 90 11 . 96 487 . 86 S/I , ) 0 37 (' OPIIsIt 611 3102 2 , 195 . (1(1 Q . 00 U)n 19 92 29 . 92 1 , 765 . 68 S/ I . 38 PI Ill I ll ' Il llt l : 6 / 11 /02 1 r O . Ooc () On 0 00 41 92 5 11 39 I ROId1 OI SI: 999 82 6 . nnc n Ofl 6 nl► •19 . 92 2 , 945 . 68 S / 1 . 5 n 6/ 311/(12 689 . 95 O . 00c 0 86 I6 66 I6 . 6G 983 . 1 C 511 . 5 1 ► 4 (► 51 OkAtil ? ( : :1UII IL 1 5 6120/02 B79 . 92 (► l►Il 0 (11) O nn 689 . 95 S / I . 4 I POOL TA r) ! 1 : 626/02 0 . 08CDOC 6 . 00 n N n nl► 6 00 7 n •12 PIM; 11O11 ( i ' r :� l11I 1 , 195 . 16 nnr► c 6 . 011 0 . 011 879 . 92 s /r . i0 6 / 26 /112 868 . 12 0 . 000 Il n0 6 (1(1 (1 . 00 1 , 195 . 00 S/ r . i 0 43 I . l ) ( : KISItS (i/ tri /(I2 1 , 823 . 34 (1 . 11(1 (100 (1 . (111 •14 C 1 lfl l ( ' A I S 0 . 60c 0 . 00 0 (10 0 11 (1 868 . 12 S/ 1 , 5 Il 6/ 27/02 I , I 13 23 0 OOc n nn O . nn 1 , 623 . 34 S/ I . 7 n 45 1) 1 ( 11 "fAl (' nh. 11 : lt ,\ ut , lln rl : l , 6 / 311/02 11 . 60 0 00 0 00 46 1 ' 001 . " fA fit li I ) ( - ) I I .,\ [; I ) 1 , 406 00 O . IIQc 0 On 11 . 011 I , 113 . 23 S/ I . 7 Il 47 ( :ON ( hil It Ill * A I IOII vs fl : nl 111111 �llz 2 , 1100 00 0 . 60C 1 . 00 n 33 0 . 00 1 , 406 . 67 S/ I . s 11 5 , 616 00 (LOOc 0 . 00 2 .13 33 233 . 33 1 , 766 . 57 S/ I . IR l0 ( '( lnll ' I I fl lt ; , t WHR ( '0 , It IIs 5120/(12 10 , 000 1111 (1 06 (1 00 :170 50 470 . 50 5 0 n 011c 0L0n 0 . 00 5 , 175 . 50 S/ I . 5 11 - - " - - 166 67 166 67 9 , 813 . 33 S/ I . ( ' 1 . 1111 1[ ( 11III ' nI1!: _ . 5 0 N " l 18 , 067 . 95 - ' - - - - . _ .. _ (1IlOc ' - - O On 3 , 66 . 1 20 .3 , 61 -1 . 20 163 . 75 _ �_ � y , . 1 .1 , •163 . 75 ( ; rr� � � I ! ? . I . ILASL: II ( II . 1l InlIFII ( WFAIENIS : : , . . . . .. sltn ., , au . _. AJ4e 8-Y .4AF 111 111111 1111111 111 : 11 ( 1 \� :\ 111111 :; Irl2 /111 1 , !) 111 15 I I (' Altl11 I ) ( INr\ fl 0 1 / 19/111 0 O1 ) 0 , 01 ) 11 . 211 - •t8 80 1 , 780 6n r1 66 0.111 90 n(l 21 . 00 1 , 811 . 15 5 / I . f9 0 - , 1 ` 5 . 1 (100 1130 n0 .3 , ISO 7n S / I , 7 Il IC :\ SI< Ilt 11 . 11 Inll ' Itlli' ILn14: N ' 1 "S S , G83 . 15 (1 61c _ . . . . . - 11011 - - -- -__ 102 . 20 588 . 80 691 . 06 4 , 992 . 15 l : Anll ! ll `1 11 / 1 1 /00 . 109 gra 2 ( ' Onll ' l 11 ' I It , 1 ' 0110 ( 111111 111111 06 61 111111111 1111 1 /110 8 .19 99 II M 0 00 166 A7 313 . 32 S /I . u 1 3 n11 ) lill l : l : :\ IIIIIL ri .' ' 8 /Ill r r 113 31 17 ( 166 283 . 33 11 •1 ( '( 1n1 (' l 111 . III ' / u ! t , 560 i7 0 00 O OO 0 06 566 55 S/ I . 5 0 1 1 / 1 3 /00 7 .19 J9 (1 Oh 0 (II► 81 " � '- 81 . 42 468 . 55 S/ I . 7 11 5 PON . I , A III I . 1 _) ; (, 5 /00 ) , 289 00 I rn1 00 ISO 110 250 . 1)6 .199 99 S / I . 6 I . AI ' ' 1 ol , I I ) KI pt I I I : It 1 : 1 , Itc ) P, I 9 / I POO 0 (►O 0110 190 . 75 327 00 517 . 75 5 0 7 6111 :1 50 :, 11 t x 11 ' ll : lt I , ss l ( In n 110 0 00 1 , 771 . 25 S /I . 7 0 6 /01 /01 2 , 995 (H ► (1110 (10 (1 258 Sn 310 20 568 . 70 982 . 30 S / I . ' S 11 9 ( "'flAll ' I I " (' lilt , nIi1111 I t Ilt , 111 ( 111 I ' 2 ( 15 /111 1 , 200 00 19 . 92 5991111 618 . 92 2 , 3 .16 68 S/ I . 19 2 1 Y 101111 I ' I I It ! ; , 0 (1(1 0 60 WON 2 :1 (1 00 3 •In On 5 A 27 st ) N \' I Af f01 ' \ \� / I \' It \V :\ R ! t I ) I ) iii i ; 5iri fir n nnr, 6 nr► 4136 40 S / 1 . 5 n 21 nl ; t II I I ( I : I ' Itr ) 12 . .! N /( 11 11110c 11 . 11(1 11 (111 159 611 159 . 51) 1 , •136 4 (1 S/ t , S 11 S 11 ) 9 !) Il Il (Ic 111111 173 56 173 . 50 1 , 561 . •16 S/ I , 5 11 22 2 C'Onll ' 1 ffl : lt 1 ; 1' 51 I nl :i 2 / 117102 , ( 111(1 91 67 91 67 IS8 . 32 S / I . 1 11 u 21 I A V ( rll , I , 5 1h (111 0 OOC 0 110 0 00 24 U01 OR 1 :\ SI : I < I ' u u I I I : It . 1it ' r (12 1 . 6 19 98 n nnn 0 M 133 00 133 06 1 , 4 (1 .3 nn S/ I . 5 0 (/ 1 , 15 /02 210 -19 83 0 00 at 00 81 00 1 , 538 98 S / I . 25 01 IP T, II ( , OI ; rltr ) (i ) 6 /62 r 11 (I lr nnn (1 011 In _> -19 162 . 49 1 , 9 =17 . 34 S/ I , 5 If 5 , 19 95 0 00 11 (111 5 ( 1 11110 6 11n 5 " I :) 95 S / I . 3 0 y, 12 : 19 PM 05/22/03 Boys & Girls Club of Indian River County Accrual Basis Profit & Loss Budget vs . Actual July 1 , 2002 through May 22, 2003 TOTAL Jul 02 Aug 02 Sop 02 Oct 02 Nov 02 Dec 02 Jan 03 Fob 03 Jul 1 , '02 - Ordlnary Income/Expense Mar 03 Apr 03 Me 1 - 22, 03 Bud et May 22603 Budget Income Unrestricted Donations 71850 .00 11660.00 27 ,722.39 68487 .89 100100 .00 40, 171 .57 18,031 .61 19,836.00 1 ,000.00 346980.46 42,620.36 4 ,258.07 210,240. 17 260, 158.0 / United Way Grant 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 11 ,333.34 0.00 124,666.74 136,000.00 CSAC Grants 0.00 5,366.28 5,366.28 21848.41 0.00 12,186.48 8,339.89 9 ,225.66 0.00 189451 .29 9 , 147.34 0.00 70,931 .63 1008000.00 Florida Dept of Education Grant 0.00 0.00 0.00 0 .00 0.00 16,747.84 3,887.36 3,606.52 0.00 Office of Justice Prog . Grant 0.00 0 .00 0.00 0.00 0.00 71242.20 0.00 31 ,383.92 440000.00 0.00 0.00 7 ,850.00 21150.00 0 .00 0.00 0.00 0.00 100000.00 10,000.00 Dept. of Juvenile Justice Grant 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1 ,306.33 0.00 26181 .01 0.00 3 ,487.34 39,477 .00 Other Restricted Grants 0.00 0.00 1 ,625.00 51 . 15 2,500.00 0.00 25 ,000.00 41 .85 500.00 0.00 0.00 0.00 29 ,718.00 69,964 .00 Memberships 1 , 188.49 802.45 165.00 515.60 322.55 376.25 106.25 161 .60 265.00 49.25 1 ,882.00 0.00 5 ,823 .24 4 ,850.00 Program Service Fees 517.03 770.58 300.00 623.55 59. 11 188.34 386. 18 300.00 760.02 1 ,662.90 168.70 17.74 5,736.41 31867.74 Contributions In-Kind/Prog. 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fund Raising Events/Projects 0.00 1 ,507.00 5,500.00 40.00 15,516.53 500310.67 7,278.79 1 ,350.00 25,699.06 47,060.75 31059.70 0.00 157,522.40 69,494 .00 Investment Income 175.84 0.00 232.02 0.00 140.96 51 .99 47.81 42.23 44 .37 0.00 0 .00 Uncategorized Income 0.00 0.00 0.00 0.00 0.00 312.06 0.00 0.00 0.00 0.00 0.00 735.22 ExpenTotal se 21 ,064 .70 21 ,329.65 62,244 .03 23,899.84 39,972.49 131 ,677.44 80,261 . 13 47,936. 10 41 , 108 . 12 113,537. 99 77,534 .64 4 ,275.81 650,566. 13 746,810.8 Expense Salary Benefits & Payroll Taxes 35,231 .54 30,866 .94 28,943. 10 35,638.69 29,594 . 19 32,491 .29 37,702.05 39 ,339.91 28,965.81 38,268 .61 18,319 .97 6,026.98 355,362. 10 5250311 .33 Operating Expenses 19, 147 .87 16,595.63 14 ,709.29 19,282. 18 17,481 .36 25,956.29 13 ,977.28 16,432.41 18,445.20 22,755.68 12,722.66 11 ,383.85 197,504 .75 184 ,638.97 Fundralsing Expenses 1 ,426.30 14000.00 1 ,470.44 11221 .23 9 ,066.80 13,803.86 1 ,072. 76 1 ,379 .49 9,028.94 6,678.39 561 .90 0.00 000 .00 46.600. 11 15 Total Expense 55 ,805.71 481462.57 45, 122.83 56,142. 10 56, 132.35 72,250.44 52,752.09 670151 .81 561439.95 67,602.68 31 ,604.43 16,410.83 599,466 .96 724 ,950.30 Not Ordinary Income •34 ,741 .01 -27 , 132 .02 7, 121 . 20 -32.242. 28 - 18, 169 .88 59,427 .00 27 ,600 .04 -9 ,216.71 - 16,331 . 03 46,936.31 46,930.21 - 12, 136.02 61 .000 . 17 21 ,060. 51 Not Income -34,741 .01 -27,132.82 7,121 .20 -320242.26 -180159.86 59,427.00 27,509.04 -9,215.71 46,331 .83 45,935.31 46,930.21 -120136.02 510099. 17 21 ,860.51 I /J - y `ago 1 of 1 MJAI 130Y ;3 um L3 I ; I 111.1 OI - 111HIAI J - -- : ' O 3c " " ;`� 13 Book Asset Del; °: 7 / 01 / 01 - G / 30 /02 I .I / i2 %�� � 1 � : ut ) I ' Ivi � . I Y1= : 6 / 3 ( / 1O1 ) 1 P . U �, le In Book ssel I ' co poll 11o5 , , 11 , lion Book Sec Book Sal book Prior Book Gurrenl Boole Encl book Nel - - - - - Solvic: o C; nsl 170 Ex ► r. Value - - - - - . . I - Bool; Uoul; dal !� lll ! e _�l !' rICIT 01111) AII_. N ' I ' cnnUnuc , l - - - - -1-- - - - De , lec Delreclalion I ) execlallon BoolcVahle Melho , l I ' Liliod 26 l ' 1MICA I S 6121102 1 , 2 .39 22 . . _ . .- - •19 III . Ar : KI ) A111p ;; , pl I \U :11t1 ! 6 / 35 /02 1lllllc 11 . ( 111 11 . 1111 111111 15 . 01111 OD 0 . 60c 0110 0 . 00 11110 1 , 239 . 22 S / I . / U I1 "T ICE L. 111111 ' Al l!. IV I 36 , 6 ;1087 ---� -- - — 0 0 (1 0 . (10 151060 . 00 S / l . 3 . 11 ___ - - — _ - _ 6 00° 0 . 00 879 . 17 2318 . 88 3 , 598 . 05 33 , 042 . 82 VIA11CI . Fs --- 8 I ) 11111i1 '. RAM 111111 VAN 6 / SII/Ill 211 ,1112 . 1111 _ _ (1 . 110 111111 0 . 00 4 11811 .111 - -- — - X' I� Illr ' 1 . 1:: 5 - -X0 , :103 . 00 -- - -- -- - •—_ _-- - - 1118 (1 . 10 I ( , 321 _( (I o . 00� o . 06 0 . 00 4 , nen 'lo — _� — - - - 4 , 080 . 40 16 --. . ---- -- � - - . _ : 32160 - -- - -------- ---- ( ; ruud ' I • olal 110 , 793 . 97 -------- _ -- -- . ---- 0 . 00 981 . 37 1092 . 28 110973 . 65 -- - 98 , 820 . 32 I fp '164 U:.;g::::. .J (fj } r, ? b h. . W .N L. at +cC G7 O o q N cL o o CN M m : # : S � K O o Ep V . ov } n + Uub Annual Report Page 1 of 21 B &GCA 2002 Club Annual Report t ' Organization Information Name Boys & Girls Club of Indian River EGlobal ID 14438 City/ State Vero Beach , Florida ership12/ 7/ 2000 County Indian River Type Traditional Organization Phone 772 . 299 7449 561 . 299 . 3840 Fax 772 . 299 . 3840 - Pending Web Site Approval Address A . Chief Professional Officer / Executive Director Name Leisa Smith - Fulton CPO Demographics Title Chief Professional Officer Gender Male Female Personal Phone 561 . 299 . 7449 — Age Group r 18 - 29 772 . 299 . 7449 - Pending Approval t' 30 - 45 .......... ... x' 46 - 55 56 + Personal Fax 561 . 299 . 3840 Ethnicity ' r Affriri can 772 . 299 . 3840 - Pending Approval American r Asian Caucasian Hispanic {' Multi - racial Native E- mail Address leisasmith American @juno . com Years / Months Years : 2 In Position Months : 6 Primary Mailing P . O . Box 3068 Address Years / Months Years : 15 Vero Beach , FL 32964 In Movement Months : 10 USA Primary Shipping 683 27th Avenue S . W . Mow Address Vero Beach , FL 32968 ( May Not Be A P . O . USA Box ) B . Chief Volunteer Officer Name Jay McNamara htti) :Hars . beca. net/OrganizationWizard/A.nnualReport/FullReport . asp ?ASID=43105 &RptY . . . 214/2003 Title Phone 772 . 299 . 7449 Fax 561 . 299 . 3840 772 . 299 . 3840 - Pending Approval E- mail Address ken@afins . com lay07l728@aol . com - Pending Approval Business Affiliation Primary Mailing Address P . O . Box 3068 Vero Beach , FL 32964 USA Primary Shipping Address ( May Not Be A P . O . Box ) C. Area Council Liaison Name Jay McNamara Dr . Bob Keim - Pending Approval Title Phone 772 . 299 . 7449 772 . 569 . 6359 - Pending Approval Fax 561 . 299 . 3840 772 . 794 . 5345 - Pending Approval mmo E- mail Address ken@afins . com Set data to nothing - Pending Approval Primary Mailing Address P . O . Box 3068 Vero Beach , FL 32964 USA Pending Approval 810 Fox Trail SW Vero Beach , FL 32962 USA MINE Primary Shipping Pending Approval Address 810 Fox Trail SW ( May Not Be A P . O . Box) Vero Beach , FL 32962 USA D . Organization Contact Person for any Questions about Submitted 2002 Annual Report Name Leisa Smith - Fulton Title Executive Director Phone 772 . 299 . 7449 E- mail Address LeisaSmith@juno . com VE 3 - 3 s: Club Name : Boys & Girls Club of Indian River County Club ID : 24103 http ://ars . beca. net/Org3nizationWizard/AnnualReport: FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 3 ott 21 CLUB INFORMATION A . CLUB INFORMATION Chartered Club Boys & Girls Club of Indian Name River County Global ID 24103 City/ State Vero Beach , Florida Membership 12/ 31/ 2001 Date County Indian River Type Unit Phone 772 . 299 . 7494 Fax 561 . 299 . 3840 772 . 299 . 3840 - Pending Approval Primary Mailing P . O . Box 3068 Address Vero Beach , FL 32968 USA Shipping Address Pending Approval ( May Not Be A P .O . Box) 683 27th Avenue SW Vero Beach , FL 32968 USA 1 . CLUB - DEMOGRAPHICS Please check all categories below that describe this Club . .._...... .... College/University Campus l— Detention Center I✓ Shopping Mall NEW F School r Church Salvation Army r Parks and Recreation I— SynagogueT Teen Center WEEN ,(r Native American F Temple l� Public Housing . Urban CommunityI✓ _. . Suburban Community r Rural Community 2 . CLUB - TRANSPORTATION IN CALENDAR YEAR 2002 a . Does this club provide transportation to youth either to School Year Summer or from the Club ? � Yes Yes No No b . If YES , is the transportation used by this Club owned or - - leased ? Owned r' Leased r None 3 . CLUB - TECHNOLOGY USE IN CALENDAR YEAR 2002 ( c . ) # ( a . ) # ( b , ) #. computers computers computers in ( a ) or ( b ) TOTAL # Used by Used by that are COMPUTERS CLUB STAFF YOUTH SHARED by at this CLUB CLUB STAFF & YOUTH a . How many computers are available for use at this Club for Club Staff? b . How many for Youth ? 2 9 0 11 c . How many of these computers are SHARED by Club Staff and Youth ? eemee d . Does this Club provide Internet Access to Club Staff? Yes t -- , No e . Does this Club provide Internet Access to Youth ? 4::E u http ://ars . beca. net/OrganizationWizard/AnnualReport/FullReport. asp ?ASID=43105 &RptY . . . 2/ 14 003 Yes No 4 . CLUB - BOYS & GIRLS CLUB NATIONAL PROGRAMS CONDUCTED IN CALENDAR YEAR 2002 PROGRAM NAME Check here if # OF YOUTH Please check the B&GCA National Programs your Club conducted in 2002. conducted PARTICIPATING Program in 2002 IN 2002 A. CHARACTER & LEADERSHIP DEVELOPMENT ( UnduplicatedONE Count) 1 . TEENSupreme Keystone Club — I✓ 75 2 , Torch Club t✓ . 35 3 . Youth of the YearFVO 1 Be EDUCATION AND CAREER DEVELOPMENT 1 . CareerLaunch �- 2 . Club Service F 211 3 . Goals for Graduation I✓ 41 4 . Goals for Growth FVO 18 5 . JOB READY ! (V, 24 6 . Jr . Staff Career Development 64 7 , Power Hour 1✓ 216 8 . Project Learn r- 236 9 . The Ultimate Journey F 72 Co HEALTH & LIFE SKILLS E] 1 . Act SMART r - 2 . Cavity - Free Zone 52 3 . Child Safety and Protection r 64 4 . SMART Girls 10 5 . SMART Moves 74 6 . Street SMART l - D . THE ARTS 1 . Fine Arts Exhibit Program 25 2 . ImageMakers National Photograhy ContestENNOWNEW r E . SPORTS, FITNESS AND RECREATION 1 . Fitness Authority 102 2 . Reviving Baseball in Inner Cities �- EE_ F . SPECIALIZED PROGRAM INITIATIVES 1 . Targeted Outreach Approaches for Reaching Out to At- Risk Youth (- 2 . The Diversity Initiative r- 3 . Family Support T` 4 . Passport to Manhood 34 http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport. asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report rage D of 21 G . TECHNOLOGY I . Club Tech ( Core Tech , Skill Tech , Web Tech ) �- 2 . How many Youth used your Technology Center at some time during 2002? 109 (e. g . used computers, internet access , etc. ) (Unduplicated count) 204 { 5 . CLUB - REGISTERED MEMBERS FOR CALENDAR YEAR 2002 Number Number TOTAL Number Number TOTAL Age Of Of REGISTERED Age Of Of REGISTERED Males Females MEMBERS Males Females MEMBERS 5 year- olds & under 0 0 0 13 year- olds 78 60 138 6 year- olds 5 5 10 14 year- olds 125 108 233 7 year- olds 16 9 25 15 year- olds 76 74 150 8 year- olds 20 14 34 16 year- olds 29 29 58 9 year- olds 23 22 45 17 year- olds 9 11 20 10 year- olds 25 18 43 18 year- olds 8 11 11 year- olds 73 64 19 137 19 year- olds 0 0 0 12 year- olds I73 66 139 20 year- olds 0 0 0 TOTAL 560 491 1051 6 . ETHNICITY - REGISTERED MEMBERS % African - American 21 % % Asian 1 % Hispanic 8 % ( � ) % Multi - Racial 2 % _ % Native American 1 % % Caucasian 670%,Io TOTAL ( Must TOTAL 100 100 % ) 7 . AVERAGE DUES PER CLUB MEMBER IN CALENDAR YEAR 2002 : $ 35 8 . REGISTERED MEMBER AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 EOnverage , how many Registered Members are served by this School Yearliiiiiii Summer( club house and off- site ) on a daily basis ? 171 190 9 . REGISTERED MEMBER FAMILY & HOUSEHOLD DEMOGRAPHICS A . What % of Registered Members are from single parent households ? 55 % B . What % of Other Youth Served are economically disadvantaged , based on the standards in your locality ? 80 % f] 10 . REGISTERED MEMBERS - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 During the School Year: a . On average, what % of Registered Members does this Club Serve . . . j 3 or more times a week ? 27 % Of Registered Members http ://ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 2 times a week ? 249/b Of Registered Members 1 time a week ? 24 % Of Registered Members 1 time a Month ? 11 % Of Registered Members 5 or fewer times a year? 141/o Of Registered Members Registered Members Served Seasonally - during the Summer School Holidays, Sports b . On average , what % of Registered Members does this Club serve seasonally ? ( i . e . during the summer, school 35 % Of Registered Members holidays , sports leagues ) 11 . CLUB - OTHER YOUTH SERVED FOR CALENDAR YEAR 2002 Number TOTAL TOTAL Age =Numbe Of umber OTHER g Number Number YOUTH Age Of OTHER Females Of Males YOUTH SERVED Females SERVED 5 year- olds & 0 under 0 0 13 year- olds 1 2 3 6 year-olds 4 3 7 14 year- olds 2 0 2 7 year-olds 4 4 8 15 year- olds 1 0 8 year- olds 1 1 2 1 16 year- olds 0 0 0 9 year- olds 3 2� 1111111, 5 17 year- olds0 0 10 year- olds 2 p 0 2 18 year- olds 0 0 0 11 year- olds 0 0 0 19 year- olds 0 0 12 year-olds 0 0 0 0 20 year-olds 0 0 0 TOTAL 18 12 30 12 . ETHNICITY - OTHER YOUTH SERVED % African - American 14 % % Asian 0 % % Hispanic 11 % % Multi - Racial 4% % Native American 0 % % Caucasian 71 % TOTAL ( Must TOTAL 100 100 % ) 13 . OTHER YOUTH SERVED AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 On average , how many Other Youth ( non - Members ) are served by School Year Summer this Club ( club house and off- site ) on a daily basis ? 0 0 14 . OTHER YOUTH SERVED FAMILY & HOUSEHOLD DEMOGRAPHICS FWhat % of Other Youth are from single parent households ? 64 % of Other Youth Served are economically disadvantaged , basedndards in your locality? 73 % http : //ars . beca. net/OrcranizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 7 of 21 15 . OTHER YOUTH SERVED - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 During the School Year: a . On average, what % of Other Youth does this Club Serve . . . 1 3 or more times a week? 0 % Of Other Youth Served 2 times a week? 1 time a week ? 55 % Of Other Youth Served 1 time a Month ? 45 % Of Other Youth Served 5 or fewer times a year? 0 % Of Other Youth Served 0 % Of Other Youth Served Other Youth Served Seasonally - during the Summer, School Holidays, Sports Leagues : b . On average , what % of Other Youth ( non - Members ) does this Club serve seasonally ? ( i . e , during the 0 % Of Other Youth Served summer, school holidays , sports leagues ) Club Name : Sebastian Unit Club ID : 24463 CLUB INFORMATION A . CLUB INFORMATION Chartered Club Name Sebastian Unit Global ID 1 11 211 411 4111 611 3 City/State Vero Beach , Membership Florida Date 12/ 5/ 2001 County Indian River Type Unit Phone 772 . 388 . 4944 Fax 561 . 299 . 3840 772 . 299 . 3840 - Pending Approval Primary Mailing P . O . Box 3068 Address Vero Beach , FL 32968 USA r( MayNot ddress Pending Approval P .O . Box) 250 Sebastian Blvd . Sebastian , FL 32958 USA 1 . CLUB - DEMOGRAPHICS Please check all categories below that describe this Club . College/ University Campus F Detention Center Shopping Mall )— School � Church Salvation Army Parks and Recreation Synagogue r Teen Center Native American r Temple r Public Housing Urban Comunity Ir Suburban Community m1` Rural Community 2 . CLUB - TRANSPORTATION IN CALENDAR YEAR 2002 http ://ars . beca. net/Or, anizationWizard/AnnualRe ort/Fu11Re ort . as 'S _^ 3 0 p p p . ASID=43105 &RptY . . . 2/ 14/2003 kb Does this club provide transportation to youth either to Schoot Year rom the Club ? Summer Yes Yes C NO No f YES , is the transportation used by this Club owned or ed ? Owned - _ . Leased ;None 3 . CLUB - TECHNOLOGY USE IN CALENDAR YEAR 2002 7( a ) or ( a . ) # ( b , ) # computers computers 7TOTALUsed by Used by CLUB STAFF YOUTH SHARED by sUB CLUB STAFF a . Howmany coffers are available & YOUTH for use at this Club for Club Staff? b . How many for A.Youth ? 3 c . How many of these computers are 11 0 14 SHARED by Club Staff and Youth ? d . Does this Club provide Internet Access to Club Staff? Yes C No e . Does this Club provide Internet Access to Youth ? Yes rNo 4 . CLUB - BOYS & GIRLS CLUB NATIONAL PROGRAMS CONDUCTED IN CALENDAR YEAR 2002 PROGRAM NAME sss ere if # OF YOUTHPlease check the B&GCA National Programs your Club conducted in 2002. cted PARTICIPATING::h n 2002 IN 2002 A. CHARACTER & LEADERSHIP DEVELOPMENT ( unduplicated Count) 1 . TEENSupreme Keystone Club 2 . Torch Club 45 3 . Youth of the Year 20 y B . EDUCATION AND CAREER DEVELOPMENT 1 I . CareerLaunch 2 . Club Service 3 . Goals for Graduation 245 4 . Goals for Growth 50 r 5 . JOB READY ! 14 6 . Jr . Staff Career Development 7 . Power Hour 38 8 . Project Learn 308 340 9 . The Ultimate Joumey C . HEALTH & LIFE SKILLS 55 1 , Act SMART 2 . Cavity - Free Zone V0 34 http ://ars . beca. net/OrLanizationWizard/AnnualRe ort/FullRe ort . as P p p . ASID=43105 &RptY . . . 2/ 14/2003 Uub Annual Keport Page 9 of 11 3 . Child Safety and Protection 4 . SMART Girls 68 12 5 . SMART Moves 78 �. 6 . Street SMART r . D . THE ARTS 1 . Fine Arts Exhibit Program � 62 2 . ImageMakers National Photograhy Contest E. SPORTS, FITNESS AND RECREATION I . Fitness Authority - 2 . Reviving Baseball in Inner Cities v 148 F . SPECIALIZED PROGRAM INITIATIVES 1 . Targeted Outreach Approaches for Reaching Out to At- 2 , Youth �-- 2 . The Diversity Initiative . 3 . Family Support r 4 . Passport to Manhood 20 G . TECHNOLOGY � 1 . Club Tech ( Core Tech , Skill Tech , Web Tech ) 2 . How many Youth used your Technology Center at some time during 2002 ? 127 (e . g . used computers, internet access, etc. ) (unduplicated count) 280 S . CLUB - REGISTERED MEMBERS FOR CALENDAR YEAR 2002 ( � Number Number TOTAL Number Number TOTAL Age Of Of REGISTERED Age Of Of REGISTERED Males Females MEMBERS 5 year- olds & Males Females MEMBERS under 0 0 0 13 year- olds 5 7 12 6 year- olds 7 7 14 14 year- olds 6 7 year- olds 14 14 4 10 28 15 year- olds 2 4 6 8 year- olds 21 22 43 16 year- olds 5 9 year- olds 22 18 3 40 6 17 year- olds 3 3 6 10 year- olds 16 21 37 18 year- olds 0 0 0 11 year- olds 12 19 31 19 year- olds 0 0 0 12 year- olds 14 10 24 20 year- olds 0 0 0 TOTAL 127 132 259 6 . ETHNICITY - REGISTERED MEMBERS % African - American 6 % % Asian 0 % % Hispanic 3 % % Multi - Racial 26 % % Native American 0 % % Caucasian 65 % http ://ars . beca. net/OrganizationWizard/AnnualRe ort/FullRe ort . as P p p . ASID=43105 &RptY . . . 2/ 14/2003 TOTALI ( Must TOTAL 100 100 % ) i 7 . AVERAGE DUES PER CLUB MEMBER IN CALENDAR YEAR 2002 : $ 35 8 . REGISTERED MEMBER AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 FOn average , how many Registered Members are served by this School Year Summer Club ( club house and off- site ) on a daily basis ? 75 65 9 . REGISTERED MEMBER FAMILY & HOUSEHOLD DEMOGRAPHICS A . What % of Registered Members are from single parent households ? 6 . What % of Other Youth Served are economically disadvantaged , based 40 % on the standards in your locality ? 60 % 10 . REGISTERED MEMBERS - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 During the School Year: a . On average, what % of Registered Members does this Club Serve . . . 3 or more times a week ? 25 % Of Registered MemberNo s 2 times a week ? 21 % Of Registered Members 1 time a week ? 19 % Of Registered Members 1 time a Month ? 14% Of Registered Members 5 or fewer times a year? 21 % Of Registered Members Registered Members Served Seasonally - during the Summer, School Holidays, Sports Leagues : b . On average , what % of Registered Members does this Club serve seasonally ? ( i . e . during the summer, school 40 % Of Registered Members holidays , sports leagues ) 11 . CLUB - OTHER YOUTH SERVED FOR CALENDAR YEAR 2002 Number TOTAL TOTAL Age Number Of OTHER Age Number Number OTHER Of Males Females YOUTH g Of Males Of YOUTH SERVED Females 5 year- olds & SERVED under 0 0 0 13 year-olds 0 0 0 6 year- olds 0 0MEN - 0 14 year- olds 0 0 0 7 year- olds 0 0 0 15 year- olds 0 0 0 8 year- olds 0 0 0 16 year- olds 0 0 0 9 year- olds 0 0 0 17 year- olds 0 0 0 10 year- olds 0 4 4 18 year- olds 0 0 0 it year- olds 0 6 6 19 year- olds 0 0 0 12 year- olds 0 8 8 20 year- olds 0 0 0 TOTAL 0 18 18 12 . ETHNICITY - OTHER YOUTH SERVED http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 J Ulub Annual Report Page 11 of 11 % African - American 0 % % Asian 5% % Hispanic 0 % % Multi - Racial 00/0 mmm % Native American 0 % % Caucasian 95 % TOTAL ( Must TOTAL i 100 % ) 13 . OTHER YOUTH SERVED AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 On average , how many Other Youth ( non - Members ) are served by School Year Summer this Club ( club house and off-site ) on a daily basis ? 0 0 14. OTHER YOUTH SERVED FAMILY & HOUSEHOLD DEMOGRAPHICS A . What % of Other Youth are from single parent households ? 0 % S . What % of Other Youth Served are economically disadvantaged , based on the standards in your locality ? 0 % 15 . OTHER YOUTH SERVED - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 _During the School Year: a . On average, what a/o of Other Youth does this Club Serve . . . 3 or more times a week ? 0 % Of Other Youth Served 2 times a week ? 0 % Of Other Youth Served , 1 time a week ? 100 % Of Other Youth Served 1 time a Month ? 0 % Of Other Youth Served 5 or fewer times a year? 0 % Of Other Youth Served Other Youth Served Seasonally - during the Summer, School Holidays, Sports Leagues : b . On average , what % of Other Youth ( =the does this Club serve seasonally ? ( Le , duosummer, school holidays , sports leagues0 /o Of Other Youth Served ORGANIZATION - CHARTERED CLUBS COUNTS FOR CALENDAR YEAR 2002 NUMBER OF CLUBS ( Units and 1 . Number of B &GCA units and extensions CHARTERED betweenMOmmmmm Extensions ) 1 / 1 / 2002 and 12 / 31 / 2002 2 2 . Number of B &GCA chartered units and extensions CLOSED between 1 / 1 / 2002 and 12 / 31 / 2002 0 3 . Number of B &GCA chartered units or extensions MERGED between 0 http ://ars . beca. net/OrganizationWizard/AnnualReport/FullReport. asp ?ASID=43105 &RptY . I . 2/ 14/2003 � � 1 / 1 / 2002 and 12 / 31 / 2002 4 . Number of B &GCA chartered units and extensions OPERATING on 12 / 31 / 2002 2 ORGANIZATION - STAFF TURNOVER AND RETENTION Please supply the number of employees in the indicated classifications for calendar year 2002 . Chief Full -time Full-time Part-time Professional Admin/Mgmt Youth Development/ Admin/ Mgmt Officer Professionals and Staff Program Staff (37. 5 Professionals and ( 37 . 5 hrs/wk or more ) hrs/wk or more) Youth Development/ Program Staff (less A . Number of than 37 . 5 hrs/wk) Employees on Payroll on 1 0 4 1 1 / 1 / 2002 Be Number of Employees on Payroll on 1 3 6 3 12 / 31 / 2002 C . Number of Terminations 1 / 1 / 2002 to 12 / 31 / 2002 ( both voluntary 0 2 3 14 and involuntary 1/ 01/2002 to 12/31/2002 ) D . How many of these Terminations were : Temporary Employees , Seasonal/Summer 0 1 Employees , or 0 12 Terminations due to lack of funding , death or retirement? Eligible Terminations ( C minus D ) 0 1 3 L7 2 ORGANIZATION - ADULT STAFF FOR CALENDAR YEAR 2002 African - Multi - Native A . ADULT STAFF American Asian Hispanic Caucasian Racial American Total M F M F M F M F M F M F Administrative/ Management Staff Paid Full -Time 0 0 0 0 0 0 0 0 0 0 1 4 5 http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport. a.sp ?ASID=43105 &RptY . . . 2/ 14/2003 _ y 3 klub Annual Report Page 13 of 21 Paid Part-Tim 0 0 0 0 0 0 0 0 0 Voluntee 0 0 0 0 0 p 0 0 0 0 LProgframstaff 0 0 0 0 0 0 0 id Full -Time 1 0 0 0 1 0 0 Paid Part-Tim 3 1 0 0 0 0 0 0 1 6 9 0 000028 Voluntee 0 0 0 14 0 0mmumme Other Staff (eager office 0 0 0 0 0 1 2 3 managers, secretarial staff, maintenance, etc. ) Paid Full-Time 0 0 0 0 0 0 00 Paid Part-Tim 0 0 0 0 0 0 1 1 0 0 0 Elij 0 0 0 0 0 Voluntee 0 0 0 0 0 0Mean 0 0 0 0 0 ORGANIZATION - YOUTH AND TECHNOLOGY STAFF FOR CALENDAR YEAR 2002 BeMOMMUMMEME YOUTH STAFF African - Multi - Native American Asian Hispanic Caucasian ( 17 and under) Racial American Total M F M F M F M F M F M F Program Staff Paid Part-Time 1 0 0 0 1 1 0 0 0 0 2 0 5 Volunteersi 0 0 0 0 0 0 0 0 0 0 0 C . TECHNOLOGY ADULT STAFF AT CLUBS Technology Staff are included in the Adult Staff numbers . Please proved the following detail : Paid Full-time Paid Part-time Volunteers ~J reClubs) pport Staff: How many are dedicated to supporting the Clubs ? (e . g . T of staff 2 0 rdware , software, networks, 3 ubs) Technology Program Staff How many Seen staff personsare dedicated to Technology 0 Programs at the Clubs ? 0 0 TOTAL 2 O 3 ORGANIZATION - ADULT GROUPS FOR CALENDAR YEAR 2002 ADULT GROUPS African - Multi- 1111 ,American Asian Hispanic Caucasian Type Of Group M F M Racial American otal F M F M F M F M F Board Members 0 0 0 0 0 0 Unit Advisory Board 0 0 0 0 13 8 21 Members 0 0 0 0 0 0 0 0 0 0 0 0 0 Auxiliary Group Members 0 0 0 0 0 0 0 0 0 0 0 0 0 Alumni Association Members 0 0 0 0 0 0 0 0 0 0 0 0 0 Parent Group Members 0 0 0 0 0 0 0 0 0 0 0 0 0 http ://ars . beca. net/OrganizationWizard/A-nnualReport/FullReport. asp ?ASID=43105 &RptY . . . 2/ 14/2003 _� ORGANIZATION FINANCIALS FOR CALENDAR YEAR 2002 - ASSETS AND LIABILITIES ASSETS M$ 29775 I . Cash & Cash Equivalents 2 . Market Value Of Investments 3 . Pledges Receivable 4 . Other Receivables S . Prepaid Expenses 6 . Market Value of Land , Building , & Equipment 7 . Other Assets TOTAL ASSETS ( 1 through 7 ) $ 342 , 485 . 00 LIABILITIES 2002 VALUE 1 . Accounts Payable 2 . Notes Payable / Loans $ 14782 3 . Other Liabilities $ 23312 TOTAL LIABILITIES ( 1 through 3 $4561 ) $4 $456100 2002 TOTAL NET ASSETS (Total Assets Minus Total Liabilities ) $ 299 . 830 . 00 2002 NET ASSETS 2002 VALUE Unrestricted $ 275693 Temporarily Restricted $ 24137 Permanently Restricted 41 ORGANIZATION FINANCIALS FOR CALENDAR YEAR 2002 - GOVERNMENT INCOMEIVALUES OF PROGRAMS 1 . U . S . Department of Agriculture Child & Adult Care Food Program Community Facilities Grant $ 0 Summer Food Service Program $ 0 Other $ 0 WIN OWN IIIII IBM IN NINE WIN 11 liiiii TO11 TAIII L UIII.III SIII.ME DEPARTMENT OF AGRICULTURE $ 0 .$ 000 2 . U . S . Department of Education Safe and Drug Free Schools and Communities Act 21st Century Community Learning Centers $ 0 Other $ 0 $ 0 TOTAL U . S . DEPARTMENT OF EDUCATION $ 0 . 00 3 . U . S . Department of Defense http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport. asp ?ASID=43105 &RptY . . . 2/ 14/2003 £OOZ/171 /Z • • • AldW7SIgOI £t7=� SVVZdsr -uodaWlin j/Tioda�•enuuV/p uzimuoREzrupBlp/Tau Co Qsig//: flu "1 tieuopa.jos ! d leuo !leN - uo !Iuana.Jd A3uanbu ! a ( Q pue aopsnC al ( uann [ jo aoW 0 $ ( 46nay1 ssed b'� I yoea�pnp Palabje1 gBnoa uo !4uanaad bueg - uo !Iuana.id � uanbu ( a y� 0 $ ( Q pue ao!}sn � al ! uann � � o ao !� p ( ( anal a� e�s � e paja4s! u ! wpy) we� 6o� d 4uea0 u011epunod aua �(g 0 $ paaS -Q Paa M - aoue4s ! ssy ao !gsn [ jo neaang 0 $ ao!40 s4ueag uawoM 4su1e6y aaualo !n - aouels ! ssy aopsn [ jo neaang 0005 £ $ yDEPQg woa gbno.I ssed We - aoue1s ! ssy ao !isn [ jo neaang aal;snr jo Wawwedaa assn of. 0040 $ 11MM31NI d0 1N3W121Hd3a Assn 111101 0 $ 0 $ aa440 0 $ 4ue-i0 uo!:pnj4suoJ sa!4 ! 11oed s.I ! eUy ueipul jo neaang ao1.i84ul Jo luawpedaa assn ' 9 00 ' 0 $ 1N3WdOl3A3a Nt can aNV shisnOH dO 1N3WJLII ld3a 'S ' (1 11/101 0 $ 0 $ _ aa440 0 $ ( d • a ' SmVwH ' d ' N ) 6u ! snoH ueo! rawy an!4eN 0 $ we.I u011eulwllg bna4 bu ! snoq �! lgnd pajosuods - QMH ) weJ6ol d In 9dOH 0 $ o ! lgnd paaosuods ( we-iboid bu ! snoy l µ cjnH ) wej6o.id aoue1s! ssy 4u9u3ano.I an! suayajdwo0 0 $ ( weabad 6u ! snoy o ! lgnd pa� osuods - aflf i ) we� 6o� d 4uelg an! suaya� dwoJ 0 $ AIleoo� para�s! u ! wpy - ( 99o0) s4ueJ0 �oolg 4u9wdol9n9a A4! unwwo0 ; uawdoianaa uegan pue 6ulsnoH JO luawpedaa fl. s S 0000 $ S33IAB3S NvwnH aNV H1lb►3H d01N3WJLHVd3 (3 oson 111101 0 $ 0 $ aa4� 0 0 $ S4Ue. E) x(0019 ;DDI /UaS lenoS - XX 914!1 0 $ ( spund )1-joM - O.I11 111 9M ) • d ' N ' y •1 ( pa6u911ey0 AIleO!sAqd eg4 .joj) swea6o� d uo!le4! i ! geya�l 0 $ ( DVO.L & S ' b' • d ) s4ue.� g il0olg asngy a0ue s n 0 $ q S Jo 4u9wje9j1 -g u014uanaad 0 $ 4ueJg an!} e !alul pooyIogy6laN 0 $ :weqS Pe9H 0 $ squej0 >pOl9 sa0lnlaS Aq! unwwo0 0 $ 9.1 PI ! 40 0 $ 4uaw4eaal asngy a0uu4sgnS .IuaD uo!4uanaad asngy a0ue4sgnS joj JE)4ua0 0 $ sa! i ! wed -g J144nDA ` ua,J PLi 4J uo uo !4el4s! u ! wpy s801J►.ias uewnH pue 441eON 10 4uaw:pedaQ . san At 0080 $ 3SN3ct3a d01N3W121Hd3a Assn 11/101 0 $ 99440 0 $ ( P.I 4seo0 pue 'anuasa�l ( way ' p� en0 leuo !leN ` sau !aeW ' a0aod a ! y 'AneN 'Away : 6u ! pnpul ) asuaJad Jo 4uaw:pedaa • S • n T7 To CT 05ET iiodaN TEnuu-v gnT7 Program Office of Juvenile Justice and Delinquency Prevention - State Juvenile Justice $ 0 Advisory Group Formula Grants $ 0 Other $ 747 TOTAL U . S . DEPARTMENT OF JUSTICE $ 35, 747 . 00 Be U .S. Department of Labor Career Prep Pass Through From B &GCA Summer Youth Employment Program (S . Y. E . P . ) $ 0 Workforce Investment Act ( Including Youth Opportunities Grants ) $ 0 Job Corps Program $ 0 Other $ 0 $ 0 TOTAL U . S . DEPARTMENT OF LABOR $ 0 . 00 E] 9 . All Other Federal Grants ACTION Corporation for National Service (AmeriCorps , National Civilian Community $ 0 Corp , VISTA) $ 0 National Endowment for the Humanities National Endowment for the Arts $ 0 Other $ 0 $ 0 TOTAL ALL OTHER FEDERAL GRANTS $ 0 . 00 TOTAL FEDERAL INCOME $ 35 , 747 . 00 10 . State Government Grants [ Specify source of money - e . g . Department of Family Services ] State Alliance FL Area Alliance State Bonding Funds ( Capital funding through Legislature or Governor) $ 1400 Other $ 0 $ 34677 TOTAL STATE GOVERNMENT GRANTS $ 36 , 077 .-00 11 . Local Government Grants Other $48458 TOTAL LOCAL GOVERNMENT GRANTS $48 , 458 . 00 TOTAL GOVERNMENT INCOME $ 120 , 282 . 00 ORGANIZATION FINANCIALS FOR CALENDAR YEAR 2002 - INCOME INCOME 2002 VALUE 1 . Contributions from Individuals 2 . Contributions from Corporations $ 57339 3 . Contributions from Foundations $ 19787 4 . Bequests Income $ 11750 $ 0 47 http ://ars . beca.net/OrganizationWizard/AnnualReport/FullReport. asp ?ASID=43105 &RptY . . . 2/ 14/ 2003 £OOZ/t' i /Z • • • A1d2I2gS0T £ t7=C[ISVZdsu • liodaMinJ/: Zoda�pEnuuV/pmzTA� uoi�Eztue� zp�auCIP a6 - z • ON .� sa' J se 6uiuoi4� unj spunj , ao juawmopua ue aney uoneziue6.ao jno�( saod • e M MOGN3 ' T ZOOZ Hv3A NVGN3lt/0 - S3RIOJ3JLVO 3WOON1 NIVIN30 30 SOIIV13a 669T $ ( ' s�soa uo.4eaiunwwoa pue ssa» e lawawl '� oddns � eoiuyaa4 '1uawdinba ; o asey�and sapnjoui ) swe� 6oad �( 6olouyaal qnlD aoj asuadx3 �( 6olouyaal q S •bS9Z $ poiAed pue s4uauaq 'same es e s ( • saxel I 1 ' i sapnpui ) jjejS aoj asuadxg �( 6ojouyoal • e 3nivA ZOOZ ( ' lie;ap 6ulmO1101 ay; apino.id aseald ) S3UOD311y� 3SN3dX3 A9OIONH �31 ' Z IRS p3nivA ' 06S ' SOZ $ ( o y6noay;IIIII e)11111 S 11 1 111 SIII N 111 3 111 d 11 X3 13NNOSS3d ZH101 800tT $ bLtpZZ $ saxel 11oa �( ed o 0T69T $ s4gaua8 • q saiaeJes • e ZOOZ a44 apInoid aseald •sasuadx3 6unejado ui papn ��u � aye sasuadx( apejap 6u�mo� �oj 3 fauuosalad ) SM10J31Ho 3SN3dX3 Z3NNOS?I3d ' T ZOOZ MV3A NVUN31VO - 23IN0031VO 3SN3dX3 NIVIN33 30 Sllvl30 00 ' SOZ ' S9E $ ( £ all+liiiiii Z IIIIIII+ T 11 11111) S 11 1 111 S 11 N 111 3 111 dX3 JNIJLVS3dO IVJLOl ( _ OOSSZ $ sasuadxg 6uisieapung • E SE8EE $ s9suadx3 saoinaaS jeaauag pue Tuawa6eueW • Z OL8SOE $ 3f1lHA ZOOZ saoinuas we.160ad aoJ sasuadxg • T S3SN3dX3 JNIlV3d0 - ZOOZ ad3A NVON31VO 2103 S "IlVNl3 NOIIHZINb�J2i0 ffOO ' 68S ' ': :"$ ( ST gBnoay; T ) 3WO � NI 7b101 OOS9Z $ awo� uj aay4p le4ol 69T tpSLtiZ $ 0TL $ saoinaaS pa4ngp4uoD jo amen ' ST ( sasuadxa laije lau ) suoissaouoD • {, T 0 $ OOST $ saag WeJ Aea • ET awoouI 121 • ZT ESOZ $ saa,d /Q !AI:PV weai6oa Z8ZOZT d ' TT (06 g6noj4; e6 ) awoaui 4uawu. @AOE) le 4ol ' OT LtiLSE $ awoouI } ueJg Iuawu.ianoE) iejapag 'SOT LL09E $ awoouI queaE) 4uawuJ9noE) agejS • qOT 8S•b8•b $ awoouI 4ue- g 4u9wuJanoE) ieoo-1 • e0T 00008$ AeM p94iun woJJ awoouI • 6 O $ saag dw � T888 $ sjagwaW woij sand • L 66L9L $ ( sasuadxa .I 491-1 ) s41.19n tiE6Z $ 3 lei:) ads • g awoouI quaLIanui • S T 7 TO L T aDECT uoda�j Tnnuuv gn17 Lan endowment? ' b . If YES , what was the current estimated value on 12/31 / 2002 ? $ 0 4. FOUNDATION a . Does your organization have a separate Foundation ? C Yes No b . What was the current estimated value of the Foundation 's Assets on $ 0 12/31/ 2002? c . Are the Assets of the Foundation reported under Section A (Value of r All Assets ) in this report? Yes r No d . Does your Board of Directors control this Foundation ? r Yes No MINIMUM AND ESSENTIAL BENEFITS A. RETIREMENT PROGRAM 1 . What type of retirement plan does your Defined Contribution Plan - B &GCA Plan organization provide ? -- Check only one plan . t' Defined Contribution Plan - Not B &GCA Plan Defined Benefit Plan Other (403b , IRA ) 2a . What is the % of salary contribution ? 10 % 2b . Of this % , what % does your Organization contribute ? 100 % 3 . What is the name of the Plan ? Plan Name : B&GCA Pension Plan Be BASIC HEALTH & SURGICAL COVERAGE - EMPLOYEE COVERAGE 1 . What type of Major Medical Insurance does your r HMO organization provide ? Check all that apply . _ PPO fi Indemnity 2 . What % of the Major Medical insurance premium is paid by your Organization for employee 100 % coverage ? 3 . What % of the Major Medical insurance premium is paid by your Organization for dependent 0 % coverage ? 4 . What is the name of the Insurance Carrier( s ) ? r Boys & Girls Clubs Workers ' Association ( B &GCWA ) ( Provider names that fail under B&GCWA include : Beech Street, Concentra , CTI , Health Payors Organization , Multiplan , Preferred Health Network ( PHN ) , Preferred Plan , QualCare, WPPN . ) - Aetna r Blue Cross &/or Blue Shield I— Chesterfield Resources r Kaiser � Other : ( specify ) C . GROUP LIFE INSURANCE 1 . What % of the Group Life insurance premium is paid by your Organization ? 100 % of Group Life insurance premium http ://ars . baca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &- RptY . . . 2/ 14/2003 �4 Club Annual Report Page 19 of 21 2 . What level of life insurance coverage does your r 1 time employee salary Organization provide ? -- �' 2 times employee salary C 3 times employee salary 1 G Other : (specify) 10000 � } 3 . What is the name of your Group Life insurance carrier? Carrier Name : B&GCWA D . SALARY CONTINUANCE / DISABILITY COVERAGE Lona Term Disability (LTD ) 1 . What is the % of premium paid by your 100 % of LTD premium paid by Organization for employee Long Term Disability Organization ( LTD ) ? 2 . What is the name of the insurance carrier for LTD ? Carrier Name : B &GCWA Short Term Disability ( STD ) 3 . What is the % of premium paid by your 100 % of STD premium paid by Organization for employee Short Term Disability Organization (STD ) ? 4 . What is the name of the insurance carrier for STD ? Carrier Name : B &GCWA ORGANIZATION ROLL -UP : REGISTERED MEMBERS , OTHER YOUTH SERVED AND TOTAL YOUTH SERVED IN CALENDAR YEAR 2002 2002 Annual Report Data 2001 Annual Report Data TOTAL TOTAL TOTAL TOTAL TOTAL TOTAL Age Registered Other Youth YOUTH Age Registered Other Youth YOUTH Members Served SERVED Members Served SERVED 5 year-olds & 0 under 0 0 5 year- olds & under 0 0 0 6 year-olds 24 7 31 6 year-olds 13 0 13 7 year- olds 53 8 61 7 year-olds 30 0 30 8 year-olds 77 2 79 8 year-olds 35 0 35 9 year-olds 85 5 90 9 year-olds 42 0 42 10 year-olds 80 6 86 10 year-olds 44 0 44 11 year-olds 168 6 174 11 year-olds 49 0 49 12 year-olds 163 8 171 12 year-olds 72 0 72 13 year-olds 150 3 153 13 year-olds 41 0 41 14 year-olds 243 2 245 14 year-olds 25 10 35 15 year-olds 156 1 157 15 year-olds 10 10 20 16 year-olds 66 0 66 16 year- olds 6 10 16 17 year-olds 26 0 26 17 year-olds 4 0 4 18 year-olds 19 0 19 18 year- olds 3 0 3 19 year- olds 0 0 0 19 year-olds 0 0 0 20 year-olds 0 0 0 20 year- oldsE374]E3 0 TOTAL 1310 48 1358 TOTAL 404 You Organization ' s 2002 Registered Member number is + / - 100/o of your 2001 http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . I . 2/ 14/2003 % JI LV L111tLLL[LL 1\lr�/Vll 1 aYV. V LV VL .:. 1 number. What is the primary reason for the Registered Member Increase / Descrease from 2001 to 2002 ? On July 1 , 2002 we adopted the Youth Volunteer Cors YVC ) program 11 - 18 year olds in 2001 . We have been able to recruit 698 of those kids tobe members of ich served the B &G Club in the 2002 program year. The YVC program is an outreach service program for 11 - 18 year olds . The focus of the YVC program is to learn the importance of volunteering and how to give back to the community . You Organization ' s 2002 Other Youth Served number is + / - 10 % of your 2001 number. What is the primary reason for the Other Youth Served Increase / Descrease from 2001 to 2002 ? We have increased other youth served for two reasons : 1 ) We have increased other youth served by collaborating with a program title Value Visit, which is a program that provides mandated courted ordered supervised visitation to take place at our South County Branch . 2 ) We allow a Girl Scout troop to utilize our Sebastian Branch , MEMBERSHIP DUES A. 2003 DUES Total 2002 B &GCA dues owed $ 3 , 326 . 02 FISCAL YEAR Indicate your Organization 's fiscal year dates : July 1 to June 30 A - 133 AUDIT REQUIREMENT 1 . Did your organization expend federal funds totaling $ 3001000 or more in its most recently completed fiscal year? C YES C NO - If " NO " , please proceed to the next section . If YES to guestionli please answer questions 2 4 2 . Has your organization completed the necessary audit mandated by the federal government through the OMD Circular A- 133 ? YES NO - If " NO " , A- 133 Audit will be completed by 3 . Did any of the $ 300, 000 or more expended by your organization consist of pass - through funding from Boys & Girls Clubs of America ? YES NO 4 . Has your organization submitted a copy of the A - 133 audit report to the appropriate grant manager ( s) at Boys & Girls Clubs of America ? http ://ars . beca. net/OrganizationWizard/AnnualRe oi-/FullR ort . as -, p ep p . ASID=43105 &RptY . . . 2/ 14/_ 00033 Club Annual Report Page 21 of 21 r YES f` NO SIGNATURES OF CHIEF VOLUNTEER OFFICER AND CHIEF PROFESSIONAL OFFICER I, have examined the information entered on this re and, to the best of my knowledge it is true, correct, and complete . Signature Title Date if have examined the information entered on this re and , to the best of my knowledge it is true, correct, and complete . Signature Title Date t` � L S http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 In It tfJ Ir if .•r,'� ► if 1� �� u`I ri (' I'� &I LI u, b!I� 11 � �'' 1� `'� /C� 1 • in_ , r, t,, � � , (0� t ( � • t , ; J it ntrM to •y ro 1 11 ` tl ��I [I •C �� 1 ! n 1 ~) ,9 f~ LI n rr n 1h �' r, , . o r '�4 n Y' ► 1 a a 11 P• to 1 11 • <I 1 .. � G N 11 t4 p F fl t p n 11 W r t r nnrnp w nat° r' !1 '� Cfi a • fln upas ,q � Il (' �' u W rr 1 u �itiro 1r n D � u , l4 h r tat Ir 1 . : ►) , 01 , Q : q tt q t � L� H r F p " ,III I jJ to o vr, a o n n1 1 HiriE�! C P I t q i >ti U n to ff t p }, a I q I d 1 p p, f n a 'n ,1 ` n '1 t'e t w rc c� Fi c C Ir �41 �' a � �' i � a +j i , p � 1 p CIl 1 0 .. ,11 , f], w 11 n '► n n b ( � 11 p C 11. s) ! f n A O N fo 'd q ; 'lot Rl pI , U ► 1 p n (r u q ° pp. rtnp Ir q. F" Nom. n Iro {Iq pnLIl a � �' it .gl a' q (�• � 1 �1 °; � Q n At t. hn �� jlvor� n t "1 t ► I1 C• n 1 4 p tY U • 4t ; u ( ' • D n ii ��. o �� , • ►� ;, �1 it r �1 ft , ( SA ° p I ' I nr� g Ids i61 n Nb � �a1 W �' ' ' A ,. .fir ,•, . r• p (1, N {L ��11 tAt (;. �; „ n rl q ' i !1 PI I• (1. ( p. 17 q ° N 1• �l I p' rl (i• r Ft11- it 111 1u( ' , n, y 'n ((v {p r {p p �' r f ( I 1 11 r: in �1 . t�' (� , r1 �' N 'h U CI 11 ° li. G cr p • •1 1'l , n In " t1 ir. 1 , c, �; � I ,� Ill I) �l p �1 P 11 ! n F u1 �,. Nt a p n n e n u M r �1 -- 11 -► a �d p It r) fi u n ti 11 n to r* 11 tt f1 f . U N m .. .r n p n n t rt , + • , ftttt�t tl , • a n 11 , h . 1 � (f w .1 n h1 1 1 P. ,1, r H p to tl d p 1� tJ q� n! .a .1 N (l k1 b f l . � `,. U •- 1 W r� 1 q. u IIl ti q I �• h I n ro (o r tl , ,� / ' ` p n to N hi ,p U to li to ^` r , „ . 11 0 4 11 to • � FI ,��, " Y tl rOn � � 1 ;. 1-1 rn 11 ro ,i , N i� IU �, It Q 1� , i f► r 11 i 1 ' (► 1 ► ' tJ ► r f 1 In Q b 11 d P N U p' `� 1� �J Or F 1 01 (1 lr .. H • t • l.! ,Cl n ,Q D, w �� cs 1 m I ,, n N n N1 O (Ul , . p p . 7 `t . n 11 EI n r a p '� re k, KI p 1 d ,�. y4 O 1� • • rt N fa m Ii p• d �;, t P. p j `� ` n h n l () In Il rn h n [r "1 r' Ir p iJ It ry t• A' � 61 � ' tr r. t D n p 1 n q • , U tort r • k n n �� ,f nuA 'oatltaaq 1s • 0 ci bnro {tv� to o, p n ii ri r1 (1 1 . . LL a q 'r► IV P . n A . tq It 14 1 it It D , . . N A �t rl n �► �„ - , to � . , .. , t • ,n rlow ° , E q •� t o n • 1 n it N tl hl ,u r, I�if H • n I •t rr 'r N• ',ts �f• r. �11 1 s� It , 1It it ro 1 + pl IJ l n I ' n p, r� ('r � ji, , ., rl Ii , 1 tl m N :1 1 p. a �. �, (1 �, w :y IA cAI ` 1 n , , . rt iii , � ; ,� n { n I n 1 114 n q n C W ` I to ° o 1 a :1 o '� , , � ' n G o r, u r � ' ct n H tt c a; c .- m r. ) , ((,- ' ' ,r N 0 p tP ro Q 0 PI 1 pl :r F L ri, at �' k Y .1 w a :, n >: . , u! •�[ n p• H. .. i •• rt 11 In h c rt •it n to u n 'y IQ �' n N o q Im. 1- 0 to n ,4 1 1-• It1 rn tl ';. tt G IM . G , , O � • ry aa M "C rt n n g N ry K c L7 m y p >h ry 11 rt �. n ; 1 iu o U IC. r 11 n ore �S p! IT O h o r4 H q . • i] O a n ! ! A < M1 I . . alr 1 of n n a • 1 ' Ij I 11. r1l , �j n , 1 11to o n P a , • • p A n ,n . 1 a '� n o it 1 I rn r ro tr 1 .. n b. a rl r r• r. Ottk N t1 t1 1 to {a I , H 1 , Q �y1 , ' { 11 o n n l� ,� . Ir re , n re p M ' , r h In h' it it,, .. n n it .b P• /r 6 r J ; c ,a U! 1 nj, n �' '� 14. 0 14 G r pr 'if 1 '4. n ' ' n - QQ I, ' r ' ` " " '1 Id 'q4 p. ] pG, rh• m t7 Iter C I ► ' � 1 t1 r1 C :1 Ib Iq {C � ' �y q ro i �l 'r: o �t 0' ` { rt A I , f+ rt /1 'i,' � � I ! 1 i4 rt � � ,1 l7 n n 6 � � If �t , W n d � 144 ;. n Irl ' h I ,. �r x < of tu 1 _4 rr tT C 11 O n b fxit re t` �, Q �1 i � G p ,,� , ,, 11 tl Iq IQ Iy hl 4 G t0 p U Ih F � Irl I • ' 1 • Iq 1 � 11 n Ile a tf i � a ti 1111 i 14. �f1 n' .'n°I {i n of �r c� '-' r ro `c n H II in ii R p a ii c nItW 'vnai pA. i �. °i U. I1. ! `1 � AMu r]• q. 1 � r. q' ' I E1H It H ' tl 11 1 1 H n to I r) 11 �: p to in ti h n tpnapC' p pl (] . a ]• hf I- fl „ @ .tte � U fT tl , rar y ;o; p f' t1 p b U pl n �n to t nH s, a n (� ti hl ! (= rA. H t J 1 , 1 1 - ' rt (( ,r� p s tt , u N u . ` i ' it rY (' r M q � 1t r �' n " F ' o a n d1 't w 1 H 4 Il . i1 ,y N 1 ppit . tY 1 '• tr I � • qqO f-• n ,• �. ��y1 .• '' '. . Ifl n �l. 11 r ;e 1 k] rt O O O n n r� ��ss f H • li H- of �1 h p ru. W n N n A 'Q H A N n n fn ' �' f ry g q p q L; `' o t .. ► . , , . d I � t0 '� G I '• p rt F �{ 1 p n ,7 rl ` r I '• pl r► a r� :u �. .ri `t :; y n n n tl e u i� n „ W rt �� p ,d �r�• w n n p C o of n n n Iq ii• p � `T la CC ' . a 19 n r- a H ►i U A. tr r1 .. rt MI r,. n ee 1 O , ,y to U H' CC t n n I uG r 1 t r n O , ,. et r t m ,� 1 r] n a h h Q H K n of Ei• Joe n F n u p n n P �" °1 fro] s W ell n t h n O o p i' a r - p » a . �' 1 ' r f aha ,inargl'• q rr Fit to cu pr1 �i ' 't h 'il nrYr rl t, /� ({ '.r �y tl Y r -. n I] a , > �j . n n of n 11 In , . � Im (J Ii n t) H r , (t rte, n tr tt , n at : r n n „ it. to o � n• r Idol to ii •< hit io .s 'I 'n7 d , 1 tr 1 �i (' (({�,,! rinj 1 Ih�• pPp. {1 rt "• r 1 I,- ap fj n ,-' p p . . r] '9 A !t 11 b o) iii o n. � i,° � �u � @ � ! � g N � � � ?�rIV n ^' an wP. � , po " ' i�f F• n ' 1 ( � a A !a tj '! I ,q to p n I a m N 1 t1 �j a p o ro/, l 1 n .. 'rI r It In •tl I — I , . �7 -h i� Il - , i1 ;] ►-• IIIin 1, � p ► 1 '. , � h h j7 •-t�ti pU '-{ U 1U--•' � P. •U � �)- Pl , w r: 1 � ` U' t� is � ' n '!11 K rt S. ,V K f? C 1 01 to Q N O y 1 � . tt n r P Ir n ,1 n A o , I ti t] n n r1 p 10 '1 a ,] p1 r a I ) p N n r , n, n p O r r 11 ' i ! 1 O Li P. a n G h n h or • tt1, r a 4 at tCn1 � 14 hC ( � r} ul h n nl, o 41 He 11 rs 4 r 11 I � I �]' J . qt+l I', tt r Il H f. (1,. n I n 13 r 17 1n r ! � p ' r� On tt IN n � 1 h �� o `° „ i o ,' fit a r-• rt H ' I n �� �1 I � o w 1.1 , n �j f rn H ' rn 1 ►I �n , r, �w f� n1 n Y] m , r1 r of I IL Ij. ' �. a ji. �r ' t] rf rot Inn • tt �r Q 1 tt P' [i m . 1, �• it p� u, �1 . 4 • • ; 1' `.� 1, , f rn I p' r' ' 10 , rL to h fr 'Ct , •; • �, 0111 gnaw ► � ! '; Ir , II► rl ; '� 1 rl 11 I� I � �' u p ' m II �' 1 '; h 1 • t' 11 1 -, N t> a � �• R h • Lt ti �, � 11 Y ro' n11r; t1nl " �' r r �-, 1. tGfl �r n rIt tr 11 1 . 1 , o , 1 11 a ' • 10 i , w p� o i�• n Ia tl 111 �j• 111 1� �)• �� o fb r• Il • If r o n n , t (11 Rl Ir W rr tryy Iltt o ri r1 t q a ti 1 ; Iu n In l n G ! Q O l ! j 4 '' r 11t 1 w ry n N 'lp7 n ' ' h a n (I lot r ► ry 1 i It �i n io , ° t.. n m ,t ' n t, 1 �� h ;d I If rp 11 n A '`r; n ' '�, u f I p '1 rl r r 1 , . ., 1 1 t4 n is n n a n o H • rr it N HI 1p �-� . 0i 1• tf ri rr d Iq 1-4 w pl tnt�t o iI i% . ro , 11 nrI r to `' a' , IH t • t G r1, '< K I I�p n C rryl 'q .'] p n 'N . ;� p N m n 1 % o IKj n p 0 0 N fD � t a w U It �r rt Il q tU a rr �° tel G tr rt C ti a m n n n I-1ry r '- n n O o ! 1 L. n h a u n rr t1 '� r'. n 0 ro I n CI , , . I -' O to O. . M fC0 {�+ It '1 U. I , rr n, tr Q. jr : r a pp ' p' a 'r 't 0 Ir 'O o 0 X11► w N t ) , 44 n n1 O 11 , n -� It m W �t o U It M• 11[u� Fr (> n Il. li 1 , 1: p, n' 1 Q ,[ F V, ' n of tl rr , � t/ :7 x C rl' t4 C] Gp(r rl G W td p j 1 1 !' A I h N yl u n 0`r ror n fIr I' n D h n'jell U C.. v n �• A 1 -• H• la i! ' � 11 1 '(7 'q yi h D '�I 1 ' ."] is to If l % r tt litIf I 1 -' p P, ( rO1 A r'1 fl ►1, �Q� p1 O l0 M P. to N � ' O In 1 1 ' � tl. 11 c: i• t1 IJ p !1 +if) 1� DI dj t tl �1 R o 9. p rl , n ICH tl Ji „ ❑ `i a r � h ro M • o ! 1 11 Ip p n It I j N 14 A• ., d ro I t ' • �•' n rr'i r• C pp� o 0404 W „ a n , II ;I ;R G. t° f tl- t1 0 tI St a tl o " n p r 11 t° b 0 r a H n A o ,d OI ,] + U t7 „„ � h h rtIt aro n o, a '< fl , rt 'C '(I It t1 CI ro N H @ a O P+ o 11 d D p. It N I. k :a u iiN � f' t1>, rr � p � � �� npp, ro oN • °' '�° ow ►� to �n p rr !� r, tt, It n no lot' 1 rt tt ►y m a p* r sf n rt p , 6 A , ' " " r • �* � �' � • � >r � n. hlri , " in 111 nMa oro W , rt r • 1 p I � pp r�• C i1 in a a w � r, It} n tWWrn 0 1 � A rr C A a rr ' 1 A rg AMNprti r4 (? (eftll + Il '� , IINr h wrow t `rr of p n n w �1 a (�, itp] ff M �i j1 n tl Q ' nugr R nn '1 ,q 1Hn ; 1 p. n 1j C, ° a duI •• k 7j; rtNpA IA � u "' I�. m � H d , to 11 4 A. (( 11 t '�C ,� + • `' tr r + u �' " P. H h n 0011 (r � Ifi . t-+ in l ri 111 t. . `� r (-io Pr 11 - I-• n '° d ti iJ. 1.. ❑r ��jj t► p (t (+ ►1 m p n n 14 0 vi' /1 'q q. p r+ N�� Iqp ' ' � „ j'' r� A p. [P 1 'N r' p K" A /i �q F� h K' 1. ti „ A n 0 t! b u ro ' o m rn1 PI O - o (1 to A f� J. n ~ rtlr, nage r� ,� rl � . n 0 U~ ,o (i rt Xnr. ',u,' OF p H o N ►-• •n rt I" t1 D ii• t• j h u q • n `c Fr n - .i ro n N C 11 H A. u n rn „ rn► �1 m aC (� w a P. In m � , a 11 « a (t 1� ( q d tr o q it P . I H ' ry n n tl H • i # .c 1~ n 10 w � � H oa p u t . n o u @' n a q t , !-• a /q '^ •1 0 1 Z 1 '• p • p d to dry►• �1 tt ;1 'l7 N fn I n }� !'t • W N N0 m n 4 D u u M tl f . bj p '❑ Ii rY 14 tr I.i• ;r 11 �i n n n in x Q (0 M � r$ yar, pn � �� ryAY + � np� mlrAmuil � pPnrn0 .111 rt 7 O t fnne. t• 11 A N ruh i7 to 11. I .. IN " ji 1� rd 14n 0 (- ' R IS, S N 1F]� s n rvj „ 1 w I-A N .r 1] n ►) {04• (l1 O n ! r tf r • if. tj fP i 'd'- t ( a N • I •- [7 ' ' < {�1 fp rel la Ile Q 11 N y H n Ih •f W ~ I< Ot tr U A (] . r d tl 0 ,-r 1041 n k to t1 � to la 51 P. 0 J. 1k It H. I° A d N J1 N I-k p D n n `C n q p' A 1-' LI• 1 ' • I -' �' I.- c H a Uu fir, 0 p, r' 'O1 1 r " 0 h X q , q M -�► !1 ►1 u w A rn rl EI ,i N r, it n �• ' Gl it t !1 O rn aj F1 D IN q ~ Iq U �1• 1'• Q f [7 ► r 1(�� � ' v 1d p 7° ro �n ro 0404 I I n fl 1' " •i 11 , rt p l.r 1{ n 1 1 • ❑ n o G p, a` It w a �' �r / , " U vl ' � ]. I Ii 'r n ,' • it •► h P. (1 r A ► 1, 1j 1 ! N ► 1 F p li i ' P. r '• 0 u r t a 1 • . tr�tt, �n{I f ro h ftit. °' n 1° iJ IA N w •U n rD 1 • {� A d of I \ I] n o , Q SS. `� (1 (0 W �5 li (1r p a to a Q t n• Q tJ n n Q ! ' , � m H q (h rh (1 r) It N !� n fnA1 It � ' `� i• 11 n n >0 in G 1 tl G , Yw N. � 1-4 1 1. rJ , ( i n W n t: 104• it tt � rr►t1 no in 111t0p� I1 1 � ( � pp, j Ito (n0 aro ( o ry a f li rr " np' li DI ( f • N' (1 H t1 (1 0 W m to fd n a " � 0 lIw , t 1.. a F n 1� "G n+ IO � N ' 1 ' . � fl � • �r n .1 t I ( n' p rvI r w 1 In p q p +. 14 1] p� F '�, 1•f � ' 1 II n n „ p �.t p �j ryQ I 1' {r 1 < I f A 1 ' �(��' �� p n ' �j . t (1 �1 tl u� p IV; �1 f . i , • 1 ;' I] n n re In t4 p 1 H[ f�j' .p�G, t �1 J l° a p 61 11 it 1 0 ,� A ❑ ro •. a N tl to M n 1�1 7 a '[1 t� o u u I all• h n 0 r h' 0 n a m n n rar 11 ; ! tr 1111. ID (- (r o �i to a ~ • • ,r( [[PPP" n •q o n 1�, ' n u It i� ° G a t 14 it o Is 11 „ `a u ri. `q na- lo- lao aroup � °04In r I�0o Q • it at ci , noI 1h•y , r w oa9 10 n 1-h Lt b a "I tD 1-] ro n n '4� N 11% rtO'h O 11 0 O n . il 'h . . ti a 13 H fl kfl vis - 1 rl a T I tatsa�; "' �2 �3 �T Stria 3D ar aII �� _TZ7 M- r=Rw3 �r =e"1.5 Vrbm BTSCy�L"�-2] � :.•? .T eEiOLTM ?1C52ad oy� _C__�.� � 3Saja ' S=C== swm A= i 381iZb fvflcmz 3D FLORIDA DEPARTMENT OF STATE Katherine Harris February 4, 2000 Secretary of State CAPITAL CONNECTION , INC . 417 E. VIRGINIA STREET, STEA TALLAHASSEE , FL 32302 The Articles of Incorporation for BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY , INC . were filed on February 4 , 2000 and assigned document number N00000000764 . Please refer to this number whenever corresponding with this office regarding the above corporation . The certification you requested is enclosed . PLEASE NOTE: COMPLIANCE WITH THE FOLLOWING PROCEDURES IS ESSENTIAL TO MAINTAINING YOUR CORPORATE STATUS . FAILURE TO DO SO MAY RESULT IN DISSOLUTION OF YOUR CORPORATION , A CORPORATION ANNUAL REPORT/UNIFORM BUSINESS REPORT MUST BE FILED WITH THIS OFFICE BETWEEN JANUARY 1 AND MAY 1 OF EACH YEAR BEGINNING WITH THE CALENDAR YEAR FOLLOWING THE YEAR OF THE FILING DATE NOTED ABOVE AND EACH YEAR THEREAFTER . FAILURE TO FILE THE ANNUAL REPORT/UNIFORM BUSINESS REPORT ON TIME MAY RESULT IN ADMINISTRATIVE DISSOLUTION OF YOUR CORPORATION . A FEDERAL EMPLOYER IDENTIFICATION ( FEI ) NUMBER MUST BE SHOWN ON THE ANNUAL REPORT/UNIFORM BUSINESS REPORT FORM PRIOR TO ITS FILING WITH THIS OFFICE . CONTACT THE INTERNAL REVENUE SERVICE TO RECEIVE THE FEI NUMBER IN TIME TO FILE THE ANNUAL REPORT/UNIFORM BUSINESS REPORT AT 1 -800-829-3676 AND REQUEST FORM SS4 . SHOULD YOUR CORPORATE MAILING ADDRESS CHANGE , YOU MUST NOTIFY THIS OFFICE IN WRITING , TO INSURE IMPORTANT MAILINGS SUCH AS THE ANNUAL REPORT/UNIFORM BUSINESS REPORT NOTICES REACH YOU . Should you have any questions regarding corporations , please contact this office at the address given below. Carolvn Batten , Document Specialist New Filings Section Letter Number. 900A00005849 Division of Corporations - P . O . BOX 6327 - Tallahassee , Florida 32314 _ S� • y_1l� NJ • M • N !•� N �1R��/ N M mil ! Iva/ • N11 ! •w ere • N \ N N N •• N N • N M M N M N M • M •• M • •• • •• . •• - 1 Rel(! 1 ! Rtiln • til ! ! 1c�1 ! ! • s� ! Sd ! Rte/ _! tom/[/ ! t-i1 v ILI ! Tc a • L '010 a 00 y = L • • �r • S L a • L • • y L 1 � L �r�q;� "f - � • • , Y ..� � _ �e• �j-� y L y SQL _ L+j • • - , • • ' s L s L a � • 4D y�= i •• • 3 = L • S _ 3 ? C :/ • s = ue a L ? S SS • - L 4W)- - a L s ; t SL 4w ? S • �•t y L S • L :/ - S s L - Mc L • - do • S s L ? • S 6 4- • S ? C L Al ! L - j L 4D 40 L 40 - 40 ? a L ? r • - N L 4 - y L " is • — s 40 a L S = L • - � - s S40 • — L 7 • S 4 • � - • • — 40 Ilk Vii.,..:?:� � • • y L • • • • S S • - S • N M M - M N N MM N M N •RNW-ORMON • N M 'G •� M M N M M am, M • N • N - N N - • ! ! i �Ye'~ zo /1 * P v Z ARTICLES OF 1NCORPORATiGiN F460 .% 1, OF i � 4 BOYS & GIRLS CLUB OF INDIAN RIVER COUNT 0 � �j c . .G I , the Incorporator , being a natural person of the age of twenty-one years or more and a citizen of the United States , for the purpose of forming a corporation under the provisions of Chapter 617 of the Florida Statutes , do hereby adopt the following Articles of Incorporation : ARTICLE I The name of this corporation shall be Boys & Girls Club of Indian River County n and it shall be referred to as the " Corporation . " ARTICLE 11 Purposes and Limitations 1 . The Corporation is organized exclusively for charitable , religious , literary , scientific and educational purposes as set forth in Section 501 ( c ) ( 3 ) of the Internal Revenue Code . 2 . No part of the net earnings of the Corporation shall inure to the benefit of , or be distributable to its directors , officers , or other private persons , except that the corporation shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes set forth in these Articles of Incorporation . 3 . No part of the activities of the Corporation shall be the carrying on of propaganda , or otherwise attempting to influence legislation , and the Corporation shall not participate in , or intervene in ( including the publishing or distribution of statements ) any political campaign on behalf of any candidate for public office . 4 . Notwithstanding any other provision of these Articles , the Corporation shall not carry on any other activities not permitted to be carried on ( a ) by a Corporation exempt from federal income tax under Section 501 ( c ) ( 3 ) of the Internal Revenue Code , ( b ) by a Corporation , contributions to which are deductible under Section 1 70 ( ci ( 2 ) of the Internal Revenue Code , or ( c ) by a nonprofit Corporation organized under the laws of the State of Florida , pursuant to the provisions of Chapter 617 of The Florida Statutes . S - � ARTICLE III Dissolution of the Corporation Upon the termination , dissolution or winding up of the Corporation , the Board of Directors shall , after paying or making provision for the payment of all liabilities of the Corporation ( as described in Chapter 617 . 1406 ( 3 ) ( a ) of the Florida Statues ) , distribute all assets of the Corporation ( including assets held by the Corporation under conditions requiring return , as described in Chapter 617 . 1406 ( 3 ) ( b ) of the Florida Statutes ) to such organization or organizations organized and operated exclusively for charitable , educational or scientific purposes as shall at the time qualify as an exempt organization or organizations under Section 501 ( c ) ( 3 ) of the Internal Revenue Code ( as described in Chapter 617 . 1406 ( 3 ) ( c ) of the Florida Statutes ) . In furtherance of the foregoing , any such plan of distribution shall be in accordance with the terms of Chapter 617 . 1406 of the Florida Statutes . Any such assets not so disposed of shall be disposed of by the Circuit Court to have jurisdiction over the matter occurring in the County in which the principal office of the Corporation is then located , exclusively for distribution to one or more domestic or foreign corporations , trusts , societies , or organizations engaged in activities substantially similar to those of the Corporation . ARTICLE IV Membership ; Directors and Election of Directors I `\ The Corporation shall be organized on a non - stock basis and shall have no members . The authority for all affairs of the Corporation shall be in a Board of Directors who shall have and may exercise all the powers of the Corporation as permitted by federal law , state law , these Articles of Incorporation , and the Bylaws of the Corporation as from time to time in effect . The Board of Directors will be elected under a method to be stated in the Bylaws of the Corporation . ARTICLE V Registered Agent The name and address of the initial registered agent and registered office are : Boys & Girls Club of Indian River County , Inc . C / o Lewis W . Murphy , Jr . , Esquire 817 Beachland Boulevard Vero Beach , norida 32963 u ARTICLE VI Initial Principal Office The name and address of the initial principal office of the Corporation ( which is the same as the street address ) are : Boys & Girls Club of Indian River County, Inc . C /O Lewis W . Murphy , Jr . , Esquire 817 Beachland Boulevard Vero Beach , Florida 32963 ARTICLE VII Indemnification The Corporation shall have the power to indemnify its officers , directors , employees and agents to the fullest extent permitted by any applicable law , including , but not limited to the provisions of Chapter 617 . 0831 of the Florida Statues . ARTICLE VIII Amendment Any amendments to these Articles of Incorporation shall be made in accordance with the provisions of the laws of the State of Florida . ARTICLE IX Incorporation of Definition of Terms All general or specific references herein made to the Internal Revenue Code shall be deemed to refer to the Internal Revenue Code of 1986 as now in force or later amended , or the corresponding provision of any future United States Internal Revenue law . Similarly , any general or specific references to the laws of the State of Florida shall be deemed to refer to the laws of the State of Florida as now in force or hereafter amended . I , the Incorporator , declare that I have examined the foregoing Articles of Incorporation and that the statements contained therein are , to the best of my knowledge and belief , true , correct and complete . � ^ el i Executed this day of February 2000 . — !}} i Lewis W . ur y , Jr . , p, Ire ` Incorporator 817 Beachland Boulevard Vero Beach , Florida 32963 ( 561 ) 231 - 1900 i STATE OF FLORIDA COUNTY OF INDIAN RIVER i The foregoing instrument was acknowledged before me this cQ day of February 2000 , by Lewis W . Murphy , Jr . , who is personally known to me or who has produced as identification and who did not take an oath . Notary ' s Stamp Name : I Notary Public , State of Florida t; ^. Commission No . REBEccAo. HARRIS Commission Expires : _•: MY COMMISSION t CC 833161 i EXPIRES: August 2o, 2o00 per„d 8*'dW Thru No" Pub ie ur4&-mit m I I I I i I1 i i I I I i i CERTIFICATE OF DESIGNATION OF REGISTERED AGENTIREGISTERED OFFICE PURSUANTTO THE PROVISIONS OF SECTION 617 . 0501 , FLORIDA STATUES , THE UNDERSIGNED CORPORATION , ORGANIZED UNDER THE LAWS OF THE STATE OF FLORIDA , SUBMITS THE FOLLOWING STATEMENT IN DESIGNATING THE REGISTERED OFFICE/REGISTERED AGENT, IN THE STATE OF FLORIDA . 1 . The name of the Corporation is : BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY . , Inc . 2 . The name and address of the registered agent and office are : Boys & Girls Club of Indian River County , Inc , C / o Lewis W . Murphy , Jr . , Esquire 817 Beachland Boulevard Vero Beach , Florida 32963 Having been named as registered agent and to accept service of process for the above stated Corporation at the place designated in this certificate , I hereby accept the appointment as registered agent and agree to act in this capacity . I further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties , and I am familiar with and accept the obligations of my position as registered agent . Date : Lewis W . ur hy , r 0 Registered A � ent f_ i I i i i BOYS & GMLS CLUB OF INDIAN RIVER COUNTY INC. CONSTITUTION We, the undersigned, being natural persons of the age of nineteen ( 19) years or more and citizens ofthe United States; for the purpose offorming anon-profit Corporation, under and pursuant to the laws of the State of Florida, do hereby adopt the following Articles of Incorporation. ARTICLE I - NAME The name of the corporation shall be Boys & Girls Club of Indian River County, Inc . ARTICLE II - PURPOSE Section 1 -- The purposes for which the corporation is organized are exclusively charitable within the meaning of Section 501 (c) (3 ) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States law. Section 2 -- Notwithstanding any other provision of these articles, this organization shall not carry on any activities not permitted to be carried on by an organization exempt from Federal income r _ 1 tax under Section 501 (c) (3 ) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States Internal Revenue law. Section 3 -- In accordance with Section 1 and Section 2 , the mission of the corporation shall be to help youth of all backgrounds, with special concern for those from disadvantaged circumstances, develop the qualities needed to become responsible citizens and leaders irrespective of race, color, creed or national origin; to receive. invest and disburse funds ; and to hold property for the purpose of the corporation . Section 4 -- No part of the income or assets of this corporation shall inure to the benefit of any private individual or member . Section 5 -- This corporation shall have no capital stock, its object and purpose being solely of a benevolent character, and not for individual pecuniary gain or profit to its members . � ' ( Sq BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 2 ARTICLE III - MEMBERSHIP Section 1 -- Any adult resident of the United States may become a member of the corporation. Section 2 -- In the beginning, the membership of the corporation shall consist of those persons who have associated together to form the corporation. Section 3 -- At the first meeting of the corporation and at any annual meeting thereafter, the members may elect additional members by a two thirds vote of the members present and voting. Section 4 -- Membership shall be for a three year term or until a member is automatically dropped for nonattendance at meetings or removed for other cause . Section 5 -- Any member who is absent from three consecutive annual meetings of the corporation shall be p dropped from membership unless reelected . At least thirty (3 0) days before the date of the next annual meeting, the secretary shall famish to the nominating committee the names of persons who were dropped from membership subsequent to the last annual meeting. Section 6 -- Any member may be removed from membership on recommendation of the board of directors by a two thirds vote of the members present and voting at any special or annual meeting . ARTICLE IV - MEETINGS Section 1 -- The first meeting of the members of the corporation shall be held at a time and place to be fixed by those who have associated themselves together to form the corporation. Section 2 -- The annual meeting of the members of the corporation shall be held in January of each year, at a time and place to be fixed by the board of directors, for the purpose of receiving � ' L BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. _ CONSTITUTION and BYLAWS (� Page 3 reports of officers, committees and the executive director; to elect members of the board of directors and members of the corporation; and to act on any other matters that may properly come before the annual meeting. Notices of such meeting shall be mailed by the secretary to the members of the corporation at least thirty (30) days before the date of the meeting . Section 4 -- 51 percent of the members of the corporation present in person shall constitute a quorum at any meeting of the corporation, but, in the absence of a quorum, a majority of those present at the time and place set for a meeting may take an adjournment from time to time until a quorum shall be present . ARTICLE V - NOMINATING CONBUTTEE Section 1 -- At each annual meeting of the members of the corporation, they shall elect, or �) authorize the appointment by the president of, a nominating committee of at least three (3 ) members and not more than five (5 ) members, whose duty shall be to present at the next annual meeting of the members of the corporation nominations for membership in the corporation and nominations for members of the board of directors . If the appointment of a nominating committee by the president is authorized , the appointment shall be made at least ninety (90) days before the date of the next annual meeting . The nominating committee shall exercise its responsibilities under the auspices of the board development committee and adhering to the board development process approved by the corporate board of directors . Section 2 -- .Any member of the corporation may, at any annual meeting, nominate candidates for members of the corporation and members of the board of directors . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 4 ARTICLE VI - BOARD OF DIRECTORS Section 1 -- The business, property and affairs ofthe corporation shall be managed by a board of directors, which shall have the power to : initiate and approve plans and programs for the welfare of Boys & Girls Club members ; have custody and management of the land, buildings, equipment, securities and all other properties of the corporation; adopt the annual budget of the corporation; borrow money; raise and disburse funds ; invest and reinvest funds of the corporation; sell, buy and exchange properties and securities of the corporation, make contracts ; appoint the executive director and appoint, or delegate the power to appoint, other employees of the corporation; perform all other duties and have such other powers as may be necessary to carry out the purpose of the corporation. Section 2 -- The number of members of the board of directors, who shall be members of the corporation, shall be fixed by the members of the corporation at their first meeting, and this number may be changed at any annual meeting, provided, however, there shall not be less than (5 ) members of the board of directors, exclusive of any officers of the corporation who may be ex- officio members of the board of directors . Section .3 -- At the first meeting of the members of the corporation, one third of the members of the board of directors shall be elected for one year. one third for two years and one third for three years, from among the members of the corporation. At each annual meeting thereafter, one third the number of directors shall be elected for three year terms . If the number of members of the board of directors is increased at any annual meeting, the additional members shall be elected in equal number for one, two and three year terms, and if the number of members is reduced at any annual meeting, the terms of the remaining members shall be adjusted, as may be necessary to provide an equal - kA� 7 BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS ( J Page 5 number serving one, two and three year terms . Section 4 -- All officers of the corporation shall be ex- officio members of the board of directors during their respective terms of office . Section 5 -- The board of directors shall have the power to fill vacancies in its own membership . Such new members shall have the power to fill vacancies in its own membership . Such new members shall hold office until the next annual meeting of the members of the corporation. Section 6 -- A majority of the members of the board of directors shall constitute a quorum at any regular or special meeting of the board of directors . Section 7 - - At least thirty (30) days before the date of the annual meeting, the secretary shall furnish the nominating committee with the names of the members of the board of directors whose terms will expire at such annual meeting. ARTICLE VII - OFFICERS Section 1 -- The officers of the corporation shall be a president, president- elect who will serve as one of the vice-presidents , three vice presidents, a treasurer and a secretary, who shall be elected annually by the board of directors . All officers shall serve for one year or until their successors are elected . Section 2 -- The board of directors shall have the power to fill vacancies among the officers at any time and officers so elected to fill such vacancies shall serve until the next annual meeting of the board of directors or until their successors are elected . S LC L BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 6 ARTICLE VIII - EXECUTIVE DIRECTOR The board of directors shall appoint an executive director of the corporation, fix his/her compensation, prescribe his/her duties and the terms of his/her employment, and supervise and evaluate his/her job duties . ARTICLE IX - BYLAWS The board of directors shall have the power to adopt bylaws regulating the affairs and prescribing the duties of the officers and executive director of the corporation, which bylaws shall not be inconsistent with this constitution . ARTICLE X - SEAL The seal of the corporation shall be a circular impression of the word and figures : Incorporation -- (date of incorporation), surrounded by the name of the Boys and Girls Club -- (name of city and state) . ARTICLE XI - USE OF ASSETS ON DISSOLUTION AND USE OF INCOME Section 1 - - In the event of dissolution, the residual assets of the organization will be turned over to one or more organizations which themselves are exempt as organizations described in Sections 501 (c) (3 ) and 170 (c) (2) of the Internal Revenue Code, or to the Federal, State, or local government for exclusive public purpose . Section 2 - - The corporation is one which does not contemplate pecuniary gain or profit to the members thereof and is organized for nonprofit purposes, and no part of any of the net earnings thereof shall inure to the benefit of any member or other individual . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY , INC . CONSTITUTION and BYLAWS Page 7 ARTICLE XII - AMENDMENTS The constitution may be amended upon a two thirds vote of the members present and voting at any meeting of the corporation, provided that a copy of the proposed amendment shall have been mailed to each member of the corporation at least thirty (30) days before the date of the meeting at which the proposed amendment is to be acted upon. ARTICLE XIII - EFFECTIVE DATE This constitution shall become effective immediately upon adoption by a two thirds vote of the members of the corporation present and voting . In witness whereof, the undersigned Incorporator has subscribed his name to the Articles of Incorporation on this Xd/ay of February, 2000 . j J� Signature : l— Lewis W. Mu pivy, Jr. State of Florida County of Indian River Sworn to and subscribed before me this the 40 day of February, 2000 , by Lewis W. Murphy, Jr. , who is personally known to me . "- REBECCA D. HARRIS iaAwvlrlxcl�I : r MY COMMISSION A CC 833161 a EXPIRES: August 20, 2000 (7)0 &21L':� Smiled Thru Notary Pudic Undenr "rs Notary Public My commission expires BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY._ INC. CONSTITUTION and BYLAWS Page 8 BYLAWS ARTICLE I - BOARD OF DIRECTORS Section 1 -- Regular meetings of the board of directors shall be held monthly at such places and times as the board of directors shall designate . Section 2 -- Special meetings may be held at the call of the president or of one third of the members of the board of directors providing notice of the time and purpose of the meeting is given to each member. ARTICLE II - COMMITTEES Section -- There shall be an executive committee, board of development committee, financial development committee, human resources committee, program committee, property management committee, marketing committee, legal and insurance committee, planning committee, and planned giving committee . Section 2 -- The executive committee shall consist of the officers of the corporation, the chairperson of various standing committees and other such members as may be deemed advisable . The committee meets on call between regular meetings of the board of directors and assumes such duties and powers as are delegated to it by the board of directors . Section 3 -- The board development committee shall consist of at least three ( 3 ) members, exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the board development committee to report and make recommendations to the board of directors concerning all matters of board separation. The board development committee shall appoint a nominating committee which shall BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS . Page 9 recommend to the board of directors a slate of candidates to fill vacancies on the board and a slate of officers for election_ The board development and nominating committees shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 4 -- The financial development committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors and shall include the treasurer. The chairperson shall be a member of the board of directors . It shall be the duty of the financial development committee to report and make recommendations to the board of directors concerning all the financial affairs of the corporation, including charging subcommittees to plan, direct, and lead in the areas of resource development and budget & finance . The financial development committee shall appoint a secretary from among its members who shall keep an �V accurate record of its meetings . Section 5 -- The human resource committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the human resource committee to report and make recommendations to the board of directors concerning all matters of human resources . The human resources committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 6 -- The program committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the program committee to report and make recommendations to the board of directors concerning the programs of the corporation, their relative J - � Z BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 10 healthfulness, safety and adequacy of supervision. The program committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 7 -- The property management committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the property management committee to report and make recommendations to the board of directors concerning the maintenance of the building and other properties ofthe corporation including the retention of adequate limits of property and casualty insurance and the provision of safety and loss prevention programs for the guidance of staff. The property management committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 8 -- The marketing committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the marketing committee to report and make recommendations to the board of directors concerning all matters of the development and execution of an annual marketing plan . The marketing committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 9 -- The legal and insurance committee, including the services of a competent insurance broker, reviews the insurance portfolio of the Boys & Girls Club annually to determine that adequate limits of coverage are kept in force . It develops and ,or board leadership to a loss-prevention program to assure the safe and healthful operation of the Boys & Girls Club . The legal and insurance committee shall appoint a secretary from among its members who shall keep an BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY INC_ CONSTITUTION and BYLAWS Page 11 accurate record of its meetings . Section 10 - - The planning committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors. The chairperson shall be a member of the board of directors . It shall be the duty of the planning committee to report and make recommendations to the board of directors concerning all matters of planning, including the implementation of a strategic planning process . The planning committee shall appoint a secretary from among its members who shall keep an accurate record or its meetings . Section 11 -- The planned giving committee shall consist of at least three (3 ) members , exclusive of ex-officio members, of the corporation and board of directors . The committee shall include the services of competent legal and financial counsel. The chairperson shall be a member of the board of directors . It shall be the duty of the planned giving committee to report and make recommendations to the board of directors concerning all matters of the development and execution of a comprehensive planned giving program. The planned giving committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . ARTICLE III - PRESIDENT The president shall : preside at all meetings of the members of the corporation and of the board of directors ; appoint the members of all committees and be an ex- officio member of all such committees ; sign such papers as may be required by his/her office or as may be directed by the board of directors ; make such reports and recommendations to the board of directors and to the members of the corporation at any regular or special meetings concerning the work and affairs of the i� corporation, as his/her judgment may be necessary for their information and guidance ; request from 5 - ' 74- BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 12 the treasurer, secretary and executive director such reports as in his/her judgment are necessary; and perform such other duties as may be incidental to the office. ARTICLE III - PRESIDENT The president shall : preside at all meetings of the members of the corporation and of the board of directors ; appoint the members of all committees and be an ex-officio member of all such committees; sign such papers as may be required by his/her office or as may be directed by the board of directors ; make such reports and recommendations to the board of directors and to the members of the corporation at any regular or special meetings concerning the work and affairs of the corporation, as his/her judgment may be necessary for their information and guidance; request from If the treasurer, secretary and executive director such reports as in his/her judgment are necessary; and perform such other duties as may be incidental to the office . ARTICLE IV - VICE-PRESIDENTS The vice-presidents, in the order named by the board of directors, shall perform the duties of the president in case of his/her absence, resignation or inability to act. There shall be three (3 ) vice presidents, each responsible for one of the followinggeneral areas : operations, financial and support services . Each general area will be assigned committees and subcommittees related to the work of that area. The vice president of operations will oversee and facilitate the functions of the human resource, program, and property management committees . The vice-president of support services «Mll oversee and facilitate the board development, marketing, planning, and the legal and insurance committees . The vice president of financial development will oversee and facilitate the budget and finance, resource development, and planned giving sub- committees . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS ) Page 13 ARTICLE V - SECRETARY The secretary shall : issue in writing all notices of meetings of members of the corporation and board of directors ; notify individuals elected to office or to membership of the corporation or to the board of directors ; keep complete records of the meetings of the members of the corporation and of the board of directors ; keep complete records of the meetings of the members of the corporation and of the board of directors ; including an accurate record of attendance of members ; notify the nominating committee of persons dropped from membership in the corporation for nonattendance or other cause; furnish the nominating committee with a list of officers and members of the board of directors whose terms shall expire at the next annual meeting; mail such other notices as may be directed by the board of directors ; be custodian of all records of the corporation, except such records and papers as shall be kept by the treasurer as herein provided; sign such papers as may be required by his/her office or as directed by the board of directors ; and perform such other duties as may be incidental to the office . ARTICLE VI - TREASURER The treasurer shall : receive all monies of the corporation and have custody thereof, deposit the funds of the corporation in one or more banks selected by the board of directors , to be disbursed in accordance with the directions of, and upon the signatures of, persons designated by the board of directors ; keep a full account of all monies received and paid out and make such reports thereof to the president and board of directors as they may require ; receive and have custody of all deeds, securities, notes, contracts and other financial papers of the corporation and place them for safekeeping in the safe deposit vaults of a bank designated by the board of directors and under such �f BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 14 rules of access as such board of directors shall determine; keep full account of all deeds, securities, notes and financial papers of the corporation and make such reports thereof to the president and board of directors as they may require, cause the books of account of the corporation to be audited at least once annually by a public accountant approved by the board of directors , cause to be prepared and present at each annual meeting of the members of the corporation a comprehensive financial statement including the report of the accountant ; sign such papers as may be required by his/her office or as may be directed by the board of directors ; and perform such other duties as may be incidental to the office . He/She may be required by the board of directors to give such bonds as they she determine for the faithful performance of his/her duties . The treasurer will serve as member of the financial development committee . ARTICLE VII - EXECUTIVE DIRECTOR Section 1 -- The executive director shall : manage the affairs and direct the work and employees of the corporation, subject to, and in accordance with, the directions of the board of directors; prepare budgets of expense for the approval of the financial development committee; and be authorized to incur expenses in accordance with the approved budget, or as directed by the board of directors . Section Z -- The executive director shall attend all meetings of the board of directors unless otherwise directed by the board of directors and shall be an ex-officio member of all committees . Section 3 -- The executive director shall from time to time make reports of the work and affairs of the organization to the president; board of directors and members ofthe corporation at their annual, monthly and special meetings . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, !NC . CONSTITUTION and BYLAWS ) Page 15 ARTICLE VIII - FISCAL YEAR The fiscal year of the corporation shall be the calendar year. ARTICLE IX - AMENDMENTS These bylaws may be amended by a majority vote of the members of the entire board of directors at any regular or special meeting called for that purpose, provided notice of the proposed change is given in the notice of the meeting at least ten ( 10) days prior to the meeting. ARTICLE X - SPECIAL AGENT The registered agent shall be and the registered office of said corporation shall be Lewis W. Murphy, Jr. , 817 Beachland Boulevard, Vero Beach, Florida 32964 . ARTICLE IX - INCORPORATOR Name Address Lewis W. Murphy, Jr. 817 B eachland Boulevard Vero Beach, FL 32964 IN WITNESS WHEREOF, the undersigned Incorporator has subscribed his name to the Articles of Incorporation on this the Ig day of February, 200 . Signatures : Lewis W. urpbI, Jr. STATE OF FLORIDA COUNTY OF INDIAN RIVER Sworn to and subscribed before me this the day of February, 2000 , by Lewis W. Murphy, Jr. , who is personally known to me . My commission Expires : Notary Public _ __ . > REBECCA 0. HARRIS MY COMMISSION If CC 833161 EXPIRES: August 20, 2000 Smsded TTru Notary Pubic WdewiWs q Ernniovee Reinrions the Club believer thar the work conditions, wages. and benedrs it overs to its a=iovees are conl-netitive with those orrered by other ®iovem in this area and in the non-prom youth serving industry. If emplovees have concerns about work conditions or co=enation, they are stronLriv encouraged to voice these concerns openiv and airectiv to their supervisors. Our experience has shown than when employees deal oneniv and directly with supervisors, the work environment can be exceilenL communications can be clear, and attitudes can be positive. We believe that the Club ampiv demonstrates its commitment to e=iovees by responding errecaveiv to empiovee concerns . Equal Employment Opportunity/Affirmative Action Poiicv i'ne Ciub is an e-n ,ai opporrlimry eIrMiover. The Cluo is committed to the spirit and letter of 2 re Sderai. crate and !ocai laws and reMamnons pertaining to equal opportunity. To this end. the Club does noraisc:.minare against anv individual with regard to race. color, religion, sex. age, nanonal origin. c sabiiiry, veteran status or other prorected status. This policy extends to all terms. conainons and privileges of emniovment . as wed as the use of ail Club facilities. In order to provide euuai employment and advancement opportunities to ail individuals, e=iovment decisions at he C'.un will be based on merit. qualifications, and aouines to aere zine die most suitable annUC::nt itie C:ub will foilow American Disabilities Act ( ADA ) guidelines for emnioymear and for enmiovee practices . This policy governs ail a=eces of empiovmear, inciuding selection. job assignment compeasanon. discipline. terminanon. and accLass to benefits and training. In addition to a commirment to provide equal employment opportunities to ail qualified individuais, the Club has established an a»rmative action program to promote opportunitiesfor inaivjduais in certain proreceed classes throughour the organization. No form of uniawr d discrizr nation, inciuding uniawful harassmear. will be condoned. Harassment It is the policy of the Club to provide. at .ail times. an environment free of harassing conduc* better enacting ns to focus on and fuifiil the mission of the Club. The Club will not toie.ate any form of harassing .: onduce that is based upon an individnai's race, color. religion. sex, age, national origm disabuiry, marital status. ver=n-s status or other protecma srarus; For these purposes. the term "harssing conduce" includes. but is nor timired to . slurs. voices . or oche: veroa.L laic, or physical conduct relating to an maividuai's race, color. religion. sex. ase. aationai orig"iti. disaDuiry or maritai status . The term harassing conduct aiso includes sexual advances. requests :or se xuai favors and other conduce of a sexual nature . Anv e:nn_ loyee viaiarina *his Doiicvr will be subject to corrective action. an to and mcmaing discharge. 5o char -,rou know . . . Harassme= on he basis of race, color. religion. sex. age. aanonai orim=n. c saouirv, maniai s=rus. veteran s status . Sexuai orientation. or other protected status is defined as conduce which has the purpose or =ecr of unreasonabiv inrerre=. g with an individual's work perrormanca or =wring an mrimigating, hostile. or offensive wore environment. == ies of ire= , which could be construed as har., ssmear mciude, but are not united to : • degrading anv groun or crass or. peopie _ • assignment of 'Less desiraoie :vork or woridng conditions to rnemc ..s of suc ororec:.d zroups based soieiv on their group membership ; treatment of prorecrea inaiviauais in a demeaning fashion. Dratted °/ ' 7/01 Emolovee Handbook i Juno e- mail for LeisaSmith@,juno . com printed on Thursday, May 22, 2003 , 11 : 08 AM From : "Marion Masterson " < mmasterson aaircgov com > To : " Boys & Girls Clubs " < Leis_ a �juno com> , "Camp Manatee " < Michelle anirmh com > , " CCCR" < cccrvero aol com> , " Children 's Home Society " < Kathy . rossini(cDchsfl oroora > , "children 's home society < marvellen . Ma -quire (� chsfl org> , "Children 's Home Society 2 " < Kathrvn . uibe k chsfl or > " Cultural Council" . . r ta") < mikellvcultural-council ory> , " Dasie Hope " < VwriQCa� ht561aoi com> , " Exchange Club Castle" < dborrieanexchangecastle ora> , " Four H of IRC" < Jawakefield(a� fas ufl edu > , "GROW Inc" < growinc2 Wbellsouth net> , " GYAC " < bad(a�gyac cc> , "GYAC Bobbie" < bohoda (& aol com> , " Healthy Start Coalition " < irchsc aol com> , "Help Me Behave Center" < Boohpy(& aol com > " Hibiscus Children 's Center" < Sshipe( , hccrkids ong > , " Homeless Assistance Center HAC " < SLRHome aaaol com> "HOPE " < Brotherpreach aol com> , " Kings Kids " < raveilee aabellsouth net> , " Kings Kids 2 " < mayamarion anyahoo com > , "Mental Health Association " < Krismhaaearthlink net> " Planned Parenthood " <triste . brooks(aMpppbtc ora> " Red Cross " < hsvcs (a bellsouth net> , " Samaritan Center" < SamaritanCenter1 ayahoo com> , "Special Equestrians of the TC " < Heather. Bulkanwachovia com> , "Substance Abuse Council" < sacircobellsouth net> , " Suncoast Mental Health Center" < scmh980bellsouth net> Date : Tue , 13 May 2003 10 : 04 : 01 -0400 Subject: GOALS WORKSHOP May 19 1 -4 MANDATORY .I. .. .. . . . . . . . .. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . Dear Grant Applicant C L �k So, " ;m % L. AtA -FNN One of the requirements for application for RFP is attendance at a goals workshop . A goals workshop is scheduled for May 19th at IPM at the Treasure Coast Homeless Center, 2525 St. Lucie Avenue, Vero Beach, Florida Please send a reply as soon as possible, stating I HAVE ATTENDED A GOALS WORKSHOP ON GIVEN BY (agency) OR I HAVE NOT ATTENDED A GOALS WORKSHOP AND WILL BE ATTENDING. THERE WILL BE 19TH PEOPLE ATTENDING FOR (agency) ON MAY : ) Thanks Marion 1 - 0 loft NOT FOR PROFIT AGENCY CERTIFICATION The County of Indian River requires, as a matter of policy, that any Consultant or firm receiving a contract or award resulting from the Request for Qualifications issued by the County of Indian River, Florida , shall make certification as below. Receipt of such certification, under oath , shall be a prerequisite to the award of contract and payment thereof. I (we) hereby certify that if the contract is awarded to me , our firm , partnership, or corporation , that no members of the elected governing body of Indian River County, nor any professional management, administrative official or employee of the County, nor members of his or her immediate family, including spouse , parents , or children , nor any person representing or purporting to represent any member or members of the elected governing body or other official , has solicited , has received or has been promised , directly or indirectly, any financial benefit, including but not limited to a fee , commission , finder's fee , political contribution , goods or services in return for favorable review of any Proposal submitted in response to the Request for Qualifications or in return for execution of a contract for performance or provision of services for which Proposals are herein sought. The undersigned certifies that he/she is a principal or officer of the firm applying for consideration and is authorized to make the above acknowledgments and certifications for and on behalf of the applicant. The undersigned certifies that the Applicant has not been convicted of a public entity crime within the past 36 months , as set forth in Section 287 . 133 , Florida Statutes . Failure to sign this form will result in disyualification Handwritten Si ature of Authorized Principal(s) : DATE: - �\7 — 2, 10 0S NAME : - yam TITLE : QC (— NAME OF FIRM/PARTNERSHIP/CORPORATION : Sworn to and subscribed to FOR AND ON BEHALF OF THE APP ( CANT: me , a otary Pub ' , this o� ay of 2003 . BY: ELLEN ML MOHR /4 'rit ' ` +�si6cf FW� �mAoi %P ate Pry f t Irl .-t �. # DIDApnl 18. (TYPE NAME & TITLE) 171` X t`1 — Indian River Board of County Commissioners 1840 25th Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and ; -r15 C1m1As 0 S14 - l :ah (Agency/Individual are in the process of negotiation of a contract for �ox � �• .� SOL*lV , �av� v��. � 3cuv� (S� �c�o4re&.v" Indian River County is authorized to make an investigation of the Agency/ Individual regarding its experience and qualifications . The Agency/Individual authorized the release of all relevant information concerning prior services furnished , contracts and background information of the Agency/Individual . The Agency/Individual authorizes any individual or organization that is in possession of relevant factual contract and background information , to release such data to Indian River County in response of the County' s request . When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee's criminal record , if any, and such other information that may be relevant to employee ' s good character and work experience. Authorization is given here by the Agency/ Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/ Individual T-) oWS L � � 1C \< MIL\,0 Print name Name Employee Providing uthorization L-9 SC( Print me Signature (in blue ink) Date Indian River Board of County Commissioners 1840 25h Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and �t Vol tol� ) • r (Agency/Individual are in the process of negotiation of a contract for , a}-, • Indian �rrr� ( u ►ti- River County is authorized to make an investigation of the Agency/Individual regarding its experience and qualifications . The Agency/Individual authorized the release of all relevant information concerning prior services furnished, contracts and background information of the Agency/ Individual . The Agency/ Individual authorizes any individual or organization that is in possession of relevant factual contract and background information , to release such data to Indian River County in response of the County' s request. When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee ' s criminal record , if any, and such other information that may be relevant to employee' s good character and work experience. Authorization is given here by the Agency/Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/Individual _ `$© u S � I� ; t1S \v�� ` z4 - e C141r Pent name Name Employee Providing authorization Nyw 44-L% Fk40h a Signature ( in blue ink) `az, Pent ne�.�,_ Date '; - a�7 - �po3 Indian River Board of County Commissioners ` 1840 251h Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and �o� s � � ; s1S Cl �1os JET ) ,a,, � „tr (Agency/Individual are in the process of negotiation of a contract for �a� '^ �• Indian River County is authorized to make an investigation of the Agency/ Individual regarding its experience and qualifications . The Agency/Individual authorized the release of all relevant information concerning prior services furnished , contracts and background information of the Agency/Individual . The Agency/Individual authorizes any individual or organization that is in possession of relevant factual contract and background information , to release such data to Indian River County in response of the County' s request . When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee' s criminal record , if any , and such other information that may be relevant to employee' s good character and experience. work Authorization is given here by the Agency/ Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/ Individual Print name Name Employee Providing authorization _ Print na !L - Signature ( in blue ink ) _ Date X1 SWORN STATEMENT UNDER SECTION 105. 08 , INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 . This sworn statement is submitted with RFP No . 4046 for 2 . This sworn statement is submitted by: IN CAr7y,� ( Name of entity submitting Statement) whose business address is : `� o�c X019 \) w4o i e& A. , 1�4' and ( if applicable) its Federal Employer Identification Number ( FEIN ) is ( If the entity has no FEIN , include the Social Security Number of the individual signing this sworn statement 3 . My name is ( Please print name of individual signing ) and my relationship to the entity named above is y-I CC 4 . 1 understand that an " affiliate" as defined in Section 105 . 08 , Indian River County Code , means : The term " affiliate" includes those officers , directors , executives , partners , shareholders , employees, members , and agents who are active in the management of the entity. XII 5 . I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt, first cousin , nephew, niece , husband , wife, father-in-law, mother- in-law, daughter- in -law, son -in-law, brother-in -law, sister-in- law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent , or grandchild . 6 . Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement . [ Please indicate which statement applies . ] ..s,,,z/Neither the entity submitting this sworn statement nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity , have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement , or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate _Name of County Commissioner Relationship or entity or employee XIII . � 4 (signature) ( date) STATE OF �tv �eid� COUNTY OF e The foregoing instrument was acknowledged before me this day of 2003 by , who is pers_IIy known to me or who has produced as identification . NOTARY PUB I IC SIGN : G" PRINT: State of Florida at Larg ' M• MOHR State of Florida My Commission Expire W comm. April 189 2006 Corrnn. DD 088983 ( Seal ) XIV �1 - S SWORN STATEMENT UNDER SECTION 105 . 08 , INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 _ This sworn statement is submitted with RFP No. 4046 for 2 . This sworn statement is submitted by: ( Name of entity submitting Statement ) whose business address is : ��© • ?, 04 � � Ue�c�, � L 3jgt04 and ( if applicable) { its Federal Employer Identification Number ( FEIN ) is ( If the entity has no FEIN , include the Social Security Number of the individual signing this sworn statement 3 . My name is ELL l �a L. ( Please print name of individuai signing ) and my relationship to thentity named above is � C.u�ivIL b ' -r r 4 . 1 understand that an " affiliate" as defined in Ser ion 105 . 08 , Indian River County Code , means : The term ` affiliate " includes those officers , directors . executives , partners , shareholders . employees , members . and agents wno are active in the management of the entity . i` ) . YII k - � 5 . 1 understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt, first cousin , nephew, niece, husband , wife , father-in -law, mother-in -law, daughter- in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent , or grandchild . 6 . Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement . [Please indicate which statement applies. ] N Neither the entity submitting this sworn statement, directors , executives , partners , shareholders , mployees , ymembers , or agents who are active in management of the entity, have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement , or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate _Name of County Commissioner Relationship or enti or employee XIII (signature) ( date) STATE OF COUNTY OF The foregoing instrument was acknowledged before me this �27 day of _ �—/ ; 20 03 by Lusa S�w , , Lc/4" who is pgxz ally kno_ wn to me or who has produced identification . as NOTARY PUBLI SIGN : PRINT: State of Florida at Large j a NOW State of Florida My Commission Expires : : I X AMI Own DD 9&20M ( Seal ) �1 - S SWORN STATEMENT UNDER SECTION 105. 08 , INDIAN RIVER COUNTY CODE; ON DISCLOSURE. OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 . This sworn statement is submitted with RFP No . 4046 for D p � vt�-� 2 . This sworn statement is submitted by: ( Name of entity submitting Statement ) whose business address is : � � � • � o�c 3 S � �ro`� c� (--'L and ( if applicable ) its Federal Employer Identification Number ( FEIN ) is Ski - ., '>� I q ( If the entity has no FEIN , include the Social Security Number of the individual signing this sworn statement 3 . My name is � A11� w ( Please print name of individual signing ) and my relationship to the entity named above is 4 . 1 understand that an " affiliate' as defined in Section 105 . 08 . Indian River County Code , means : The term " affiliate' includes those officers . directors , executives , partners . shareholders , employees . members . and agents who are active in the management of the entity. �I u - � 4 � 5 . I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt , first cousin , nephew, niece , husband , wife , father-in-law, mother-in -law, daughter- in-law, son -in -law, brother-in-law, sister-in-law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent , or grandchild . 6 . Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [ Please indicate which statement applies . ] Neither the entity submitting this sworn statement, nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity, have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee. The entity submitting this sworn statement, or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following _ .� relationships with a County Commissioner or County employee: Name of Affiliate Name of County Commissioner or entity Relationship or employee XIII oL (signature) ( date) STATE OF /oi2�p /f COUNTY OF — . .y401*40 � v,EX000 Te foregoing instrument was acknowledged before me this � 57'Iay of zl20 03 , by L �fs� Soni / kn _owri to me or who has produced who is Personally identification . as NOTARY PUBL SIGN : PRINT. State of Fiorida at Large ELLEN M. MOHR My Commission Expires : �� My State of Florida Comm. #ADAM 18 32008 ( Seal ) / r � ti MAY-22-2003 THU 12 ; 15 PM WM DAY FAX N0, 5615465772 P, 02 AC:ORDu CERTIFICATE OF LIABILITY INSURANCEDATE (1ae orr(yy) PRODUCER 12103102 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Day Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 11320 SE Federal Hwy, HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ff' Robe Sound FL33g55 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, t J _ 772.6465767 INSURERS AFFORDING COVERAGE !NSURED goys 81 GMs Club of Indian River Coun , MAIC ty Inc. INsuR� A; MarkellnsuranceCo PO Box 3068 INSURER B. Vero Beach FL 32964 INSURER C; INSURER D: INSURER E v ::Z:,GES r THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EEN 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 PErtTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D ' T POLICYNUMBER PEW MOT POLICYEl(PIRATION ' GENERAL LIABILITY LIMITS EACH OCCURRIS CE S 1 000 000 I A I X COMMFRCIAL GENERAL LIA8tLITY 8502CY2201282 09/13/02 09113103 DAMAGE TO RENTtO CLAIMS MADE X� OCCUR i 100 000 MED EXP An n2 son S OOO p�LSONAL a ADV INJURY S 1000,000 - GENERAL AGGRSGATE S 3 000.000 GEWL AGGREGATE LIMIT APPLIES PER PRODUCTS - CQ IP/OP AGG S 1000 0 X POLICY PRO- LOC AUTOMOBILE LIABILITY A X ANY AUTO 8502CY2201262 09/13102 09113103 (���1SINGLE LIMIT 3 1 ,000,000 X ALL OWNED AUTOS "— SCHEDULED AUTOS BODILY INJURY S X HIRED AUTOS (Pa permn) X NON•OWNEDAUTOS BODILY INJURY i (Per accident) PROPERTY DAMAGE S (Peracddwt) GARAGE LIABILITY AUTO OW Y - FA ACCIDENT i ANY AUTO OTHER THAN FA ACC S AV'TO ONLY! AcG S UV'5RELLA LIASILnT EACH OCCURRENCE i OCCUR CLAIMS MADE AGGREGATE S i DEDUCTIBLE S RETENTION i S WORKERS COMPENSATION AND WC STATU- orry- S EMPLOYERS' LIABILITY ANY PROPRIFTORIPARTNER/EXECU'1 NE E.L. FACH ACCKXNT S • OFFICEH/MEMBER EXCLUOEO7 II s 40=111: under E1. DISEASE - 6l EMPLOY ' F i SI ' I PROVISIO s bt4ow OTHER F.L. DISEASE . POLICY LIMIT S 1 '. pegCWTICN OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECUU, Is S1pNS c2ri? c oider Is addltlonal Insured for General Liability & auto 30 Days notice applies except for non-payment of premium CERTIFICATE HOLDER CANCELLATION 1 Indian River County SHOULD ANY OF THE AROV9DESCRIBED POLICIES eECANCEL.LEOWOK THE Xp(RATION Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 1840 25th St NOME TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 90 BHA(! Vero Beach, FL 329603365 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURIM ITS AGENTS wr% REPRESENTATIVES. AUTHORIZED REPRESENTATIVE <AJD> ACORD 25 (2001108) CORD CORPO ON 1488 I� - LG• 11111 LL LV VJ 111V 1L ' 1J 111 rill Vll1 1 11[ 1 11V1 VV 1 v7vv 1 1 L � Vv IMPORTANT If the certificate holder Is an ' ADDITIONAL INSURED, the poliey(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ). If SUBROGATION IS WANED , 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 endoreement(s). DISCLAIMER I The Certificate of Insurance on the reverse side - of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon. i i I AC 25 (2001108) Y -%�-2003 THU 12 ; 15 PM WM DAY FAX K 5615465772 P , 04 1.19010 ftdiwatbn u rum lt,w ►�► of 7hn.1ry NA k; A�misirer"I iy Sualn+iJ since 1979 IV. ~tT, p" Gaudrar. lr., Chmmin,Mer 011 ( IrM.•r Ockwge 4:rphkr, ViccMAmin: Poiarkee 1'.O, 0C 9$3 a 1 litlitud, 17. 33.X02=0188 � snr x• sr�nt ughvtrl;, t t or r N r, xo¢+s', . 1„aelan,t „gyp,_ 'Tclmluane f .11 bfiimiso 0 or I -880-2 &2.7154 ► 1 'ae (863) 66Cr1c)58 i'Ir< n+ ,� s_ Pria, fY, I<id �lsn.� <'h .wl" X. Mab, AnA.rrnraiile certiricate of Insurance RE : 0520 -25864 ISSUED T0 ; Indian River County Board of County Commissioners 1840 25th St Vero Beach , FL 32960-3365 This is to certify that Boys & G ' lub f Indian River CounP ty,�nr . O . Sox 3068 Ycl a FLZ964, being subject to the provisions of the Florida Workers' Compensation Law, has secured the payment of any workers' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . ?CLIA NUMBER ; oszo_25864 Statutory Limits—State of Florida 5e ternber 13r 2002 Employers Liability EFFECTIVE DATE : p $500 , 000 (Each Accident) EXPIRATION DATE : 59P tember 13 , 2QDJ $ 500, 000 (Disease-- Each Employee ) $ 500, 000 ( Disease-- Policy Limit) This certificate is not a policy and of itself does not afford any Insurance. Nothing contained in this certificate $hal{ be construed as extending coverage not afforded by the policy shown above or affording insurance to any insured not named above. The policy of insurance listed above has been issued to the named insured for the policy ) Notwithstanding any requirement, term or condition of any contract or other document to which his riod indicated certificate may pertaln, the insurance made available by the described policy In this certificate Is subject to only the - - terms, exclusions and conditions of such polity, Paid claims may have reduced the shown limits , If the polity described above Is cancelled before the expiration date Indicated , the issuing company will attempt to mail 30 days' written notice to the certificate holder named above. However, the issuing company, Its agents or representatives accept no- obligation or liability of any kind for failure to mail such notice . Date 05/22/2003 ^ :: :--;rtL corauiring , Inc,. Adrninietrator Florida Retail Federation SeIE Ynsusers Fund C2 CHILDREN'S SERVICES ADVISORY COMMITTEE © � � �3 � C/O Human Services 1840 25'" Street Vero Beach , Florida 32960-3394 Phone: 561 -567-8000 (Ext. 467 or 524) Fax: 978- 1798 E-Mail : Jcarlsonabcc. co . indian-river.fl . us MmastersonPbcc. co . indian-river.fl . us To : Beth Jordan From : Joyce Johnston-Carlson Date : October 10 , 2003 Re : Grant Contracts 2003 - 04 The attached is a Children ' s Service Advisory Committee Grant Contract for : Boys & Girls Club of Indian River County Please review the insurance certificate and verify that it is adequate by signing on the line below. Contact me if you have any questions . Thank you . IL*O — Beth Jordan Date /b " Id o3 . A OCT 2 4 2003 CLERK TD 711: CCAgD ' 003 10 : 41 5612993840 30tiS GIRLS CLUB RG PAGE 0 '2 r n 1 ) u ' ud t l7l Will UK , 1 NU , FAX N0, 772 546 5772 P , GI " ' RO CERTIFICATE OF LIABILITY INSURANCE ,or+olzaa°°""w' :PcOuCCATRO CGRTIFI I$ ISSUED A& A MATTFR R tNf MMATIOW psy 'AQenry, Mc, ONLY AND CONFERS NO RIONYS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AMEND, FXTIEND OR 11310 8E Fedorat Hwy. ALTER niff COVIRAOrl AFFORD120 BY THE POLICIES BELOW HOtii Sound FL 33455 ' "721.448.3717 INSURERS AFFORDING COVERAGE NAIC S x ' 4;3i'' = = Boys S Girls Club of Indian Rlvar County, Inc. IN, rkol It►suroltlN Co ?0 Box 3048 INS J",R l:-- Vero Beach FL 329411 rw: UMMC: �g—uREa rx ("sufsR C' r�� rsR �1.QF$ . N :URANCE L18tft BELOW HAVI PEFN ISSUED TO 1HE INSURED NAPACO ABOVE FGR T? 12 PLIUCY PERIO: INDICATED. NOTVIITI ', d:AkD' NG T '„RM OR CONDITION OF ANY CONTRAC' :R OTHER DOCUMENT WITH RQ$PECT TO WHICI' : '43 GLILTF7CATC MAY IK I$S'JED Cz KTAfI�o , T; r 04URANCE AFFORCED BY 'THE POLICIES DCOCA02D LGREN IS SUC..BCT TO ALL THE TEP•MSo EXCLUSIOVS ANI CON01 ONS O' - 'i. UOVA AGMII!oC,ATE LIMITS RPIOWN MAY ! IAVB BEEN REDUC 0 BY PAX) CLAILt9. +N Ob T� —••.•• --••• PO NMB j ICY BP Pggy Ex 1 TSN L 611TS Typo IF IWIJRANCL� ILWI!RAL I- M ITV ^ .� AOE TO ,'�CNlkp rat X _�r,4McrttIAL Oral MITY 9502CY7241263 09113103 0!!13104 CLAIMS OANEA I X =OUR I � u _ .)W (6 erv: rye.±�n Sim I�f� ` PFRACI6A,ADV INJURY _} � . Q W8, J . -._ , � ;.ENf!ItAL A�GrL�cATE S,00b,000 ' EtYI AGG TG WIT APPLI[l �; �'ROOI�CTl,_ CC P1QP AGO 1000,000 . X , Ol l -WOMOBILE AABLITV CGMBiF1ED 61N ]LE LVM{T 10000,000 101Y AUTO 6502CY2101253 08113103 091i3iO4 6:a sec ye^'' ,--X-11 A;L DWN'_ "JAUTOB 1 j DCDILY I):ATIV Ij SCHECJI GD AUTOS j ( POO "m kRFDI�1105 ROOLYINv1JRy _ f (P� occ aMl t X NON•OVJKF.D AUTOS ! i GARAGE 1.1104I11LRY AUTO ON Y • !J. AC/' t0 , ' — I ANY AUTO O��''11{{nn THAN E4 RrX: S i AUTO ONLY AOC ! K_5EEBUM0R1L 1Afl1L1Tv i EAC � LOCCLRRsNCE ! .t } r— ! ^ CCv'I CtA1N>t pJ•OL! � � ha6ilF i ! Is vp WORKjFM WWONDAYON AND I wC t i A'1Tl I V' a• ' C�GJ.Y6L5.1... eYK4Y1R$' L)AOILrrY 1AC0, aCC',GENT � ANY rROPRIRTORMAIq%ArJLE%:CUTr 0117110CRIMLWGR CX^LLUOP, 4P i F.L. DISEASE - EA I LOPE ! Yos, oasrwtz urlaff f e.L . QkW-A$E -�POLICY LIMIT I CTMEf( DESCRIPTION ON OPERATIONS I LOCATIONS I VEM1CLM I EXrAUSIONS APP4D aY ENROeIGMENY 1 BPECLAL PROVISIONS cerH!Icatehoider Is additional Insured for General Liability 6 auto A : x1. no :`cc VVIles except fornen.pAy+nent of premium i a CERTIFICATE ETIFICATE IJOLDER CANCELLATION sHcmP AI.Y OF THE ABOVE P=RIBEG POLICtn BE : AN c[LL 10 AeFORG THE FXPIRATIO% Indies RIYer County 1a onrs WRITTEN BDBrd of County Commissioners GATE TNEeeAP, r4s IS/WNn IN9URER WILL "DEAVOR TO MAIL l25thNOTICE TO THE C@NIPICATa HOLDER NAAARD TO TOOLAFT, BUT FAILURE TO DO SO SMALL 1 st IMPOSE NC OOLIGATION OR LIABILITY OF ARY KIND UrON 'HE INSUFGR, ITS AGENTS OR Vero beech, FL 12560.3389 0"Rvs AUTNOTUWA RmPnESSNTATIYE <AJWo ORD CORPORATION 1988 GG 't 7.5 (2001 /06) io '. _ r3 - U3 10 : 41 : 61 � 9336L: 0 EOYS uIRLS CLJE IRC FADE 0 . rni : usuu tai? wils J9Y , IN(; , FAY NOr 772 F48 577 ), F , 02 IMPORTANT + ' if the certificate kidder is an ADDITIONAL INSURED , the policy(les) must be endorsed. A statement on this Certificate does not oonfor rights to the certificate holder in {leu M such er. doreement(s)• ilii If SUBROGATION IS WAIVED, subject to the terms and conditicrs of the policy , car<.ain policies may regLlre an endorsement, A statement on this eertificaty does rot confer rights to the certificate I , holder in lieu of such erdorsement(sll DISCLAIMER e ntraebetween ThInsurance e Cortificate of Insunce on the reverse side of this form does not constitJte o0 the issuing Insurer(s) , authorizes representative or producer , and the certificate holder, nor does it efflnnatively or nsgativelY amend . extend or after the coverage afforoed by the po'taias listed thereon . t i i i I ACQRD 25 ( flO6) Florida Retail Federation 11 Pu &% of v Cesirr W. -USC " RujKlral . Jr. . ChmnSnu n+n. ( 'pry <'crtlar 4i Admiir+istemd ks Summit since 1979 (iairp Sardekr, Ywc Chaumrn. Palatka Vit Numes . Weieful P. 0 . 11ox 498 • Lakeland, 17. 33801 =088 • xtivw.summitho(dings. runt Tlrrninr S. Ptel"M. Likelvi l Apoi5> f Tclephine [8631 t65A00) or I .800-282 .7(54,8 • Fax ( 863 ) 66(} PAN char(:. R. winiz. A„ kirmkille Certificate of Insurance RE : 0520 - 25864 ISSUED TO : Indian River County Board of County Commissioners 1840 25th St Vero Beach , FL 32960 - 3365 This is to certify that Boys & Girls Club of Indian River County, Inc P . O . Box 3068 Vero Beach , FL 32964 , being subject to the provisions of the Florida Workers ' Compensation Law , has secured the payment of any workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : 0520 - 25864 Statutory Limits - - State of Florida Employers Liability EFFECTIVE DATE : September 13 , 2003 $ 500 , 000 ( Each Accident) $ 500 , 000 ( Disease - - Each Employee ) EXPIRATION DATE : September 13 , 2004 $ 500 , 000 ( Disease - - Policy Limit) This certificate is not a policy and of itself does not afford any insurance . Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or affording insurance to any insured not named above . The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement, term or condition of any contract or other document to which this certificate may pertain , the insurance made available by the described policy in this certificate is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits . If the policy described above is cancelled before the expiration date indicated , the issuing company will attempt to mail 30 days' written notice to the certificate holder named above . However, the issuing company, its agents or representatives accept no obligation or liability of any kind for failure to mail such notice . Date 09/ 24/ 2003 summit consulting , inc . , Administrator Florida Retail Federation Self Insurers Fund �02�,303 , 123 AW 57 GoN N S,y ��,�• ' � Cfl Indian River County Grant Contract This Grant Contract ("Contract" ) entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County" ) and Boys & Girls Club of IRC , Inc . (" Recipient") ; of: (Address ) Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Youth Volunteer Corps 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 2003/2004 ("Grant Period" ) . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Forty Thousand Dollars ($40 , 000 . . 00) . 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 23 , 2003 , 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 - 2 - 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 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. 3 - 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 RIVE OUNTY BOARD OF COUNTY COMMISSI ERS By. y Kenneth R . ch , Chair n Attest : J . K . Barton , Clerk By: V.- Deputy Clerk 0 Approved : - � 1 J es Chandler, County Administrator A� ved as to form and legal sufficie e I , Assistant Count orney RECIPIENT : Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 By: ame `-s tel Q C."\ ► P nQ cry Title 4 - EXHIBIT A [Copy of complete proposal/application) - 1 - b 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 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Attention : Leisa Smith - Fulton 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 - 1 - 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 . - 2 - SEP - 24 -2003 WED 02 ; 52 PM WM , DAY , INC , FAX N0 , 772 546 5772 P , 02 Motif, Utao it ftratim + Self rs rumd 11uhtrl r f 7r. slip. W", `B To Kw+rdral, Jr. , {'ltxrrn un , &It [ 4h- (left rer t�llllMip���4J�ffw' .�NJlJlxlll SlrCR' 1979 Limitgt Sarrdcki , titer Clu.rhaYrr, rtic{r{r, } Ia.U. li xc (lltg • I .;lic�lal�r�, l7, 3381J4 -U{)88 ■ n :,srui�tt�ulrtrf,li,iR.rTor�l Nix hieA%�a , 1,04riand ( n63) fiat,(ow or 1 ,goo.0m .764% v nix fi36g) Gf,C} 1 <) �K x �rn,ur �;. �. awn. Llirrrrrul Certificate ofofnsurance RE : 0520- 25864 ISSUED TO : Indian River County Board of county Commissioners 1840 25th St Vero Beach, FL 32960 -3365 This is to certify that BQYs & Girls .�l o.( Indian (liver County,4�_. p�� rq 6each , EU2g 41 being subject to the provisions of the Florida Workers ' compensation Law, has secured the payment of any o k3 *s ' compensation benefits due by Insuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : Q520_n2 a6-4, Statutory Limits— State of Florida Employers Liability EFFECTIVE DATE : sepkembOL134F20.3. $ 500, 000 ( Each Accident) EXPIRATION DATE : Sepa bet �12 �04 $ 500, 000 ( Disease - - Each Employee ) $ 500, 000 ( Disease- - policy limit ) This certificate is not a policy and of itself does not afford any insurance . Nothing contained In this certificate shall be construed as extending coverage not afforded by the policy shown above or affording insurance to any insured not named above . The policy of insurance listed above has been issued to the named Insured for the policy period indicated . Notwithstanding any requirement, term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits . If the policy described above Is cancelled before the expiration date Indicated , the Issuing company will attempt to mail 30 days' written notice to the certificate holder named above . However, the Issuing company, its agents or representatives accept no obilgation or liability of any kind for failure to mail such notice , Date 09/24/2003 a ^n;lit Consulting , Inc „ Administrator Florida Retail FederaLion ,Sell; lnsuxers Fund IM DAY FAX N0. 5615465772 P , 02 ACORDN CERTIFICATE OF LIABILITY INSURANCE 121°DAT " (MMMD"^ YI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION UPON THE Day Agency, Inc. HOLLDDER, THIS CERTIFICATE DOFFND CONFERS NOS NOT AMEND, CERTIFICATE EXTEND OR 11320 SE Federal Hwy. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Nobe Sound FL 33455 772.546-5767 INSURERS AFFORDING COVERAGE MAIC # !NSURED Boys Q Girls Club of Indian River County, Inc. INSURER A. Markef Insurance Co PO Box 3068 M)RER B: Vero Beach FL 32964 INSURER C: INSURER 0: WVAER E:- THE THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMCNr, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RCSPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY P=ERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH _ POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCFD BY PAID CLAIMS. . NSR , OPOLICYNUM9ER POLJCYEFFEGTNE POUCYEXPIRATION DATE wminnAm U111T5 SEVERAL LIAnILRY FACH OCCUr410*CE S 1 , 000, 000 —' DAMAGE TO RENTtU I A I X COMMERCIAL GENERAL LIABILITY 8502CY2201282 09113102 09113103 s 100,000 CLAIMS MAGE 0 OCCUR MED EXP Anme son S 000 PERSONAL 3 ADV NJUKY S 1 ,000.000 GENERAL AGGREGATE S 3,000 000 C•f-WLAGGREGATELIMITAPPLIESPER: PRODUC - C01.ppOPAGG S X POLICY I PRO- LOC AUTOMOBILE LIABILITY COWINED SINGLE LIMB A i X ANY AUTO 8502CY2201282 09113102 09113103 (C3 acca" ) s 1 ,000,000 X ALL OWNCD AUTOS BODILY INJURY SCHEDULED AUTOS (Pa pc,� ) s X HIRED AUTOS BODILY INJURY s X NON•OWNCD AUTOS (Pei ecaaeal) I PROPERTY DAMAGE S (Peracr :eMj GARAGE LIABILITY AUTO OMY =R.AA_^-CIDENT $ ANY AUTO OTHER THAN FA ACC S 1 AUTO ONLY: AGG s t :v5RELLALIABILITY EACH OCCURRENCE is I '�� OCCUR EICLAIMS MADE A(3GRFGATE S S I OCDUCTIBLE S RETENTION $ l} s WC STAT . OTH- WORKERS COMPENSATION ANDnOLUM i CMPLOYERS' LIA8IUTY E.L. FA01 ACCIDENT S A 4 PROPRIETORRARTNCRIEXECLn NE • OFFICEWMEMBER EXCLUOCD? E1. DISEASE - Er EMPLOYF.F. s N yynn dcaa� unaar . P . At PR< IONrbeICw EL. DISEASE - POLICY LIMIT $ I OTHER I nECQIPTION OP OPERATIONS I LOCATIONS r VEHCL ES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS c_ r:; `: cz. n ,% oider Is additional insured for General Liability & auto 30 Days notice applies except for non-payment of premium CERTIFICATE HOLDER CANCELLATION Indian River County SHOULD ANY OF THE ABOVE O ESCRIBED POLICIES BE CANCELLEO BrFORF THE EXPIRATION Indian of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MNL 10 DAYS WRITTEN I NOT)CE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 90 SHA 1840 25th St Vero Beach, FL 329603365 IMPOSE NO OBLIGATION OR LIABILITY Rn CITY OF ANY KIND UPON THE INSURER AGENTS O 1 REPRESENTATNES. I AUTHORIZED REPRESENTATIVE <AJD> ACORD 25 (2001108 ) QWc6RD CORPOFZMON 1988 iim - cc- cuuJ inu 1L@ 10 rli WI7 UHr Ctln ' lYu, 001040Ji i C. uJ 1 IMPORTANT If the certificate holder Is an' ADDITIONAL INSURED , the policy(ies ) must be endorsed . A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ). If 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 liOU of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between I the issuing insurer(s ), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon . i i i I AGORD 25 (2001108) 1L . � ". X2-2003 THU 12 15 PH WM DAY FAX N04 5615465772 P . 04 Florida Riot era�n ` 1V. "ITiC" lidudra4lr., ('ha�cman• ,SIfR ['i1r ( '(#4,rti Nv�omia � 4aadrfet, V iot C'hai, min. Haldr `tr � Ad,�niairfc►"t +y 'tAimmi l si ice 1779 N n N iaata . lAelaru( 1'.U. li �n9Bs � 1 .,tcrlt�id. IT. ? `'�JZ -4`188asr�� srrpuugh4t<li,�gt. i'o �n ci x piMk�iAn l�nm. r i o No 'rclgtluxl� fA611665060Qcrr I -K(10-28?•764 lax (84i) 66& I958 0 certificate of Insurance RE : 0520 - 25864 Commissioners ISSUED T0 : Indian River County Board of County 1840 25th St Vero Beach , FL 32960- 3365 JL 5296A, This is to certify that Boys & Girls Club of IodiarLRiver County, los P 0 has secured0tLh�e�payml t of any being subject a the provisions of the y insuring n uamgotheir,r risk with the Floridaon Law , Retail Federation Self Insurers Fund . workers' compensation benefits due by NUMBER , 9 .70-2586a Statutory Limits- - State of Florida Employers Liability 500 000 ( Each Accident ) EFFECTIVE DATE : 5epterrlbe209� $ 500 , 000 ( Disease - - Each Employee ) EXPIRATION DATE : September 13 , 209I $ 500 , 000 ( Disease - - Policy Limit) This certificate is not a policy and of itself does not afforded d any In the policy show above or affording certificate shall be construed as extending coverage not insurance to any insured not named above. The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement , term or condition of any contract or other document to which this certificate may pertain , the insurance made available by the described policy In this certificate Is subject to only the terms , exclusions and conditions of such policy , Paid claims may have reduced the shown limits . If the policy described above Is cancelled before the expiration date Indicated , the issuing company will attempt to mail 30 days ' written notice to the certificate holder named ind for e. Hfailuoe a r, he issuh Hint company , Its agents or representatives accept no obligation or liability of any Date 05/ 22/2003 tL coniulcina , :nc , . adrninlatzator Florida Retail Federation, self Insurers Fund 1 I ' 1 i I t I a all 1 I n I 1!1 Ct 11 I]f4 to 1 N ll , It �t � I � • r n Gl IT a N II � la 1•• x tr1 n Y 11 n Ir P � t 1) . ld 1 ) V' t► tl A I1, Il' ,t V. O L4 Y• (1 14• tt1 it I A 11 11 y qy to � t' 1 (: V1 11 .q a � w N to hu (r t R I] ; 1 t•- lA �tl G1 �r h n ) t. d N• ( � to M h' 111 upon h1 so< 11 r (rr r% i a „ I] . rt p ItGt+ II n . a n r rr (i n ' I l 1 7 , tt 1 n � • 1 � In : r n o `+• n to it F p It p { q 11 1. a ,o P. b tr 1 ro j i (. p t , �� c in t� � aPnt1l lF (Aitrq n (1 pt otA I�� N K1 Ike t t� w i pl h 0 ' tt l 00 p iJ Pt 7 CJl i , . !� ' tl N r nt n n ;t 11 rn t � 11 p � �• tl ' G II • ' trlp ti is 'd (i j ; � u n n n 41 r n t>• ' u o Cpm �� p 11 n ► ► I l t Y n h O �p� i- 11 r 1nn' t�ryp' I 11 . Jt (; i1 rnn 1 � • 6 1M W 1 ' I It A q 0 { ,• 1 � ( Lj Q �, y � . . h r n 11 IfL it soll �- �1 �1. �l If a ' }}qq a i� • o n t 11 • rr I a lr v V 1 1 ' m n n p III 000000 I to. kill ii -K ll u m LVt Ari a 11 tLo o r G; n tl r`a _ a p p�l as p n �. p laL r' it rC: A n I lit 11�J tl!_{,�. �1 ti a {= ' p o ( �• �.� t rl ` �j ' (1 :1 rt t ) 1 � { r 14t1 . F. bloo. r 'tl ' W t.4� q. R tC y A i7 0 u (1. 1 �• j� I0 11 I r Ir i +. 1. 1(W/y rtt �• u Il �11 Fit r . Ir � f lo' y( t— ! • ) (o f1. G 1 1 l ( - I in 1� • O C r' r O ( ( n`♦ Qn p. t1 a ( 11 1 1 0 q A n A n uth 0-4 In ti I li � � t ' �•� ' ' tl 111 f E r �'• p' ro a pt � ryt f [, n u u la in rt tl t f I 1 p 0 II to 8 tl ut (1 u I t} 1 . ), w !t - I /l pi td a rt D 1 E of t ' • cl t I � • q n u ;n l ;.) a o f01 � 1. 1 . , �• •q ,1. N U n U rl. .. . 1Iff7] rt (t 1 Illt �7 n q ra t(i �(�1 U I-) tt ( a• 1• p U ' �q (n W 1• t A a ( n r. . ; r n. A (I . n 'tt t t + r O . �i r t • • A. U' I ) ' ' n N p r 11 W i . t� "' S l� r• 1 (� a7 1 . ((( 1 1 Ij , p` 1 t ' p n , n 1' Yd) I � �• v l ,- 1-t (n I ru i r la n 1nt�1 o C n ry �i c ^C 'i a ' r {l F. 1 p t) rt 1 > ut tlpp o epi n t� �U U tti 1 • • 1� r, • ' a ► , (l a A ; ! H• , n 1 ' `n " 'q n F' (� o U ; d Oil -- At 0 ,� It . w Kt p U . • ) � ' 7 . m n tqi r? 5 r {n fi � n , .t to II p. ry i hl #0a1 < I P p n n M I� . a n o0 I � t tr t % , t I n to n lost n tt A n 11 it n (► . I a In R tr' n A rl m m p 1p (� b p 11 to r1 Q n ( ' ' < p t1 U] 3 o I � U u O { n 1 Itt I ] ] n ►, r 0 q IIt rt P . o rr UU .a t ) u ) p ul le P C. n It p I � rr A 0 rl A rt la N l '� ' I I ) it I . It q . I • . • ppt 1; O 1 `-) ' C 11 P. ofi I 1 11 0 1 � • (J 14 p, 11 A 1 ' t1 � W �. N' •— 11 Q n �I P, R � I 0 1 U' n N O N D 1 1t� t • 1 ' W 1 0 1 ' E 0.4 C n n • l n ld O PI H 11 to I f• H 11 kl) r: n n ' i n ) � n. tr p . n ) t tl : I n 1: ' :I 0 r 1 . . . 1 � N 1y ': PI ., ( 1 n N 191 Iu 0 1 h 1 -4 I r� I . tt t t , ' , 1 ti I • . �• to h it t • ' t t ppII I � f+ - 1y I t • n p . a 11• �� �r 01 n n 1 .6 lu F � n u c m ) n l n h . n t • • tr 14II I q a !1 11 . tY to ft I I' ' I 11Soo �� ). G II • p tl 11 n r.V4 n > j . � ) n It I < w e 1 I U ' •: I (61 0 al0 It) "• 1 •' l • I n C3 O rt rte . . , • Goo (1) _ �, t i tl A H J ro O 0 If •1 of ' r D O r ,, r. , r q{ a, r � : I n E : , If •U 1 ) 0 9 n rr N • j a 11 n A ► O U 1 ` lIl c I ' n u h (✓ C rt •I] n ro t, fI G 1 = U GG n h l 1 • • rt It In I 3 ► 1 f cn < rt n K c n t1 n i( Ir a 11 n• t1 1 I 111 n I A R o ' ' 0 ( ' r- • I ro n . 0 r • u1 M I , . , G x C It • I ,� tl I• 1 ! 0 rr H h Pr A rn O h O t Q :1 U p Il f 11 - • tI n o 'cl •� II D 1r n t/ � I F 1 n It p . n }o . 7n r r l i n ivv' /" 0 r • . • : a l NI G I ' ' !1 0 Pt ' n n fi tl . 11 fp I A h ( 1 Is . P rl r R O q In r !i H tl 11 I 11 p P , Ir�� ► I n , • ' < It O r, 1 n ' ( Lt 11 N r h 1 C A . G) it In n' Ql tt 1 '• N IS On `) 't 1 , f }; 'y1 DI , �t (l � , t4 Q 'C) 1 ' • Q h rl 11 v1 It I ' 1-t 1) n 10 rD }1 „ , .. " n It Ou A . 9 h . It} d ,7 tt i ` i ' c 1 rl o F t: t1 to w ! -' q • p H tt It + • I n m n U 1-• F E7 1 ,. t, � ' h (t . ; n `Z d Al III t] rr t�a . r U I� p b upl - A. 1 a e•• m 1 1 11 tr n n , 1 ! If Fi W o ( ] OI ' � r1 n I 'l tGj tl Ir +� fpff ( ..� '!t i n t , ` l p •� Il 4 . j �f C `I 'r0.1 m P` n . H H �' ' � n O • I e ( 1 r I } � ' r} ' r �1 ` � '�' I r41 i ti lit 11 ` L41tn0. 1111, I'll �, 6 , ate, . £ � �• qI� �dL' I �� r � C1p11I( ir It, II to In 11 , q { . lot tt.. G p. { • . (( r ' m 1i Fv ` ' In 1-• n I { �� 11 Il 0 p W 1 ' • r; I ' • 1 In Iq •• 11 N ( Ih (1 • 7 n . ro 41 it n of ( 1' p fl 71 I - • 'i1 N 'C r► ['1 ( 1 �1 fl (1 r7 f1 r1' 1y ( 1 ry ( • ; , ' d tf f I . it > :, tl Ir 11 it n • t ) n M P p t0 it r , ] fj A ' i 11 II 11 li 11 - n n n n 0 It 1' n n G a l� p• 1 . q • 1 (. Iq to A• • 1 • S 1 1 r i; n /l W 'U n d to Q. ) �1 . (t S !1 p �} l� Il (� In 1 A li r� f -' rl n (t a 1 •• � 0 �) U 7 tt n . a of A. r1, `t i D P . n fa , 1� ( i . .{ Ills U It p I , .. A i t,• 0 1 1 t CN A o to tfr h 1-tt h e ; f ttI� ' 1 it 1 r , Vii' n :�1 Y rany F` n p G 4 (i G ` 1 . jt Alto rp E ' U d n it p rl 'G r , I , q N U 1 li , I �l• I '� C tf tl t • ' F. (a to I t �I � ri � 1 0CIL C t � no0o� lap I . , n n i r? Ir I '• lr li o t4 t I t , . . Ir . 1 rI n ro I � �. 'a �i rnt u n IAn (;' to ' p G O n is f n r1 w R , — , . n r 1 • I H r a 't ;u ` ti I � to 'Q is I I• O rl 0 ' 1� N rt (, i p . r t ,. , fl. I O !e � ', n n rr IroA Ii. Ir tl � n 1- O E 1 ' rti O t •. ' •. ,� n • rU C ] >G 0 n N U / ' • n . n `tl y i n - rt n G r. n 1 o r t, n o rr n t too a i1 . (. t to n U o m `C It GI ri rt III N • r, r N• IrIt o Ii - [� � m n + t- �i n •� . o n v r n uI t - , ff �1 f1 r„1 t1 N Q, III f� '11 n ri tr iJ 0 N rq , I . rid � (�� rt Ir ry� � ff f� 3 oil �j o1 t C ra p t f n I - p . F 1� n n i ! ► n m t1 •C] 1 ►, 11{ O nIC tt n ". III 0 , I n t1 ` in �' Inlcmi j?. o • o t t ,. r .Ej 1 " � ' E` K) 6n n o kI 1 '1 t l to lot f 1 - rn N r , . . . r P 1 •< :I 1f t1 F • rt b ,-t, /- i ` }. 1 ,� ((•,! , Iv It A n :4. i - • ? a . ` a // q n , �1 ' t » h >I n nN m p p r i s n l • 0 1 a ;11% }!r! 11 f. Ro to I WW 1 • 1. n �, � al nn (Irito' � a ri `� aPI i� i i �' rr, an, I -In i , 'rr.�. (r rtuir� Ri f ( 11 In ►� p to r a m 1 t t ( i O h T Iw U `G O U P) A • U I •- :u n � � 11 II 1-• 111 U �) f r1 1 O t1 R M r t It 11 1: , L _ It (� •h II t� rr. 'U 0 If) 1 , ••� r, S . rU O N i�. �j , 0��II1 tr '� �^ r r• n o �i w ' q !1 �f I ' t1 1 � h 11 �0 11 n 11 91n n r/ n , 11 U !i ro ry n N a p. r 1 w tl � (r n . U 1 ., Il N • P , �j ` c( 1144,f } i� Pit PS I 'm t1 . ' I ' . lih l �If o !u n � tlli ° � lit ° Iri ° n It ft t�7 fn f* r * « lu n , n t1 ro 11 1 � 1 n 13 �i I � O w � ' �r ft t1% F I �j ro r ► I fl. t1 Ir O �, � I n' (i• at II, b • ►t tr u' n 1 n. s In �i it 1 H rl 1 ' 1 I � , •. , P, N , ( ro It f N ` q m f! tL 10 n r Id ICI to G r7 Ms n 1 • • ' y I a tr 1 ( In O I � 1y1 I O ( J n (L fro }I O+ N • rt { •. I1 • tl I Ir r q II , • (1 . iV 'i N n' fly i1 I ' • 1 � 1" r) . I r { ] p55 1 1 n1 r Itn{l1 ft N n 11 f m r ' I� p (1 IY „ I1 11 { N r- IIc� n II D�1 n 0 �l N W I 1• 1 ' + o ii Ir I ' It �1 • - IL f0 tl 1 J , ( p / nn ► I 1 �{ t ] tri fry a ii 0 . p ( a H n 1, p 8 n 111 ti ' o n Io 1 ' n u ' t �i q �C n q t,_ P� r� f n 11 u� n • Ii to a till ' pp 11 fl p n , 1 . w n If lu o II n 'il iI III Il p IJ v) ( H ` n n tl Iv I • 71 11 r • 11 1 ' n V1 tl N •l� It ro U I tl rt A 0 P . rr Ir 11 t • . I-' rr 1 •I n • C n c1 p t dl If , r 1 • • 11 H I u It a 111 `j. 1 - _ N G " r1 11 U' It II rr Ir II ry p n , i ro I 11 nrt r m Iq a ' 1 : r ro A too ii p n U n G tf N (D to W U' it (zI t1 Il tf q A In � I ! n n ti (( (1 Q o a U ro n 11 N O U YI re '� j , . n o A• �` 1t r+ n tool H r p / a if I • it ' ) r ,. I , n ro U n !t t1 r U �I' pptt Iy It < I 11 It U 1IN 11 . n, tt air r a 11 a a �" tI •t U to r1• I � tr ru n 1 • I - • n w Cl. M a 1-4 II p t � n 0 A a to ( it (1 " 1 0 13 (4 n rr �i W • 1 p I n . ; ) 1 if I1 At I m 1 - In h r. w la 1' �r `< Ei trop It ° I ( I r/ , , n n rr p • tr n " (, ) n , :1 I ►. to F d 10, N. F� O n �n' ror ( t p �, I n t) f a; 1 � 11 1 • N C 1 -1 :! 1 -1 II 1 1 't7 {, . i rt fI oil r • n 10 11 U to It , 0 . I . . O In ft it, i r j, 1 a p. rp � s I X J, r,, U rl 0 o rn C i n r to N .1' „ � ( 1 (t(� Ail 1 t b n - IO ,nom n P 1 k 1: i it 1 , A 1`� 1 I +• rll 91 ! I +• ��y;• !1 jS . {(�] ii •0 ct u r ' o jf /11 p� , I� . G. 0 V(1 In Q m � . , , n n r• 1 ; It !, n In p n Ir 1• � � < 11 • - F 111 .-4 , • `� O ft+ o I � • •T r r-1 n \ r ' f; r1 1 • t h • O n A IO ; 1 �rJ (1 kn 0 n It ( r p it yt 0 tl P P It w 0 P C p G r7 Ei r� , 11 it It] (7. P a G If O p1 ?+ G 1 •- or11 p W C ►1 ►•. ' ' Y ' ! ! a W 0 C 1 FI tNl H n t4 0 •O rl III •{ !!dd rt t, �l r i P• G (1 A II Iq I- P b n 1 c� � rr 19 PI As R. R O P• o � ! j . P . ro CT A :d 01 I] U a 0 to tr 1< G it 11 p N H tG gg H '1 IT 0 O 11 t ( ►' • :t 1 a 111 n rt •S n w lr al O n 11 ! '• In p •d 01 ro o m p n, t: 10 m n Lt U I rI < Ir Q li rt rnt p It h tr ry pP1 o N n n T t1 n ll n t , r � n [I, . � 0t' 0 , n pu !7 rt ' Irl + Itr � l1 riq j � 616 � b � tr nP • rat istI I wv It do Wo n ►- a >� o BaA at: c r P . tl , 1 trSnrT ntI • nn to p. r • r ► P C tf P• it "al Iy Ino n !� r, ItJ n W 1 n rr �j aro tr rr lotr1nn, 1 w tt � E+ itXrt Pr�+1rr r n �r n n is p i � � M �'' rp a p� It r , • n i H0 ' y 11 n Ifn �7 0nn (� 1pn U tin fy� rtn totq� A .� q It ; C Ir• w rt Ir• !i �' �r I �L n N a F rT M It U rr a H an 01 ui16 � r< ai � td� "1t1� rn� a In(I lit (t (t�t !� n 0n0mFr ' rt, l� �' t ! I- , i 11 1 P t� W e i Ir � i - 9 ■ p rl a Waf 'pp ' I n n n I 1 o F { ' n Cj � A na, 61 I'll n r p, ft � '1 mp pn (1 � cni n r: n a n. o f ,� r. r 7c r1 M p 1,, P . •< m r1 pi I P. O n to of n I - . A Pi P, p �► H!� it . 1 - f� A n 1rp�� 4 t� rq: I r! ,n rT q L. ,. I r f� P' P t1 n I � ;1 . f IIJ E7 YI q " ' n t] `� fi rpi n y� n r. ro In Iq F I' - tJ I �• '1 ! /N ~ r� li o a �• n ` rf [�E tl O O w< � 1 I •- • P. , ,. t • c, rr ► , ro n 1 � E1 Imo . n I � F n n, n s, q if, 1•- p a ` t 1 n I ` p '< 0 1- n - U to n r r It 1 •• �* qF n m < [r to lu o ►'• In tit r N 11 p 1- • 1l n n. tr' I • N It It .J11 n 1 U li {i w a P la o n PI ra tl � ' u •tl r6 , r N Q t/ n a 1 ' • P. tl 1 ra h rr 1 1 to a It 1n p • ll r 11 1' I r 1 t i R u 1 . n o 11 n ❑ 0 1 , p n n F' 10 11 1 { n p 1 ro r- h It W 1- r�• n rl rr }� If W a n m 1 9 (� R I • If r„ It ` n u p y 'n 1-4 C► . P • ❑• 11 : Ir h PI n n III n c• a II n i Ir • ti o h r g tl 1 N TY n n n p p n n I n ct rt rt tial '❑' � O uCI pa � 7at1 � . . � na n Inn � nof `� ASF m ro , n �j n K Q 0. n n. c i , tt t� P `, n , t !! • i�. t , IJ ` � ( 0 !c tr ` r f „ 1 . - {. ' IOj `tk 1 14. • �• < (� {[7 n ra rn O , t t1 ❑ f { J rl U n i . t ) r' • 1 • n 1-•• :T `•- a r, a . n o !1 • F-• t � tt r• t� u H ri I n N I tr 10 rr P n , r p 11 O 1. 1 1-• n J tl r 1 - G `< to U II N I1 0 n n < n rl -h ry h u Ifl b rr a u � w d I--' tf ❑ r 1 � . , O ry X ° O o '� , q n r1 ill a w o 1 • 1 rr 1 • - If N G p , tJ? R7 p , 1 / tl 1 � O t� 1n a rl Il F �I 'fl to - m 'n to c; rl , t1 Il" f, rt it h FF-- p It I1 I ri ! 1- r oil )a p N 11 1- 6 11 rl u 4 r tY f W EI n W 1 • 11 n ❑ N rr W 11 1 p 1. , r ; - II n rt 1 d 0 N U { P I cin 1 I , '%4 11 c n m II • . ! tP Ir t) t�0 n r a vt �i 1 c 11 ' w P. ►1 n �� n 1 [ r � ti t I � 1 r . (p P. � r tit ti r 1 ! - W {, ` ► o n p n Yi " Is 1t o j n p. i ' . ' nn fp1 • f. i+ t� r o �l L' u P1 le t ra 1-, , ' • A ' c It ^i 1 n O < 1 11• 1' • rt rr P . u • I� �� . f" Jnr m 1' u x p i ri ii p " m ii r ' P , ro. n n it r n I ' ' R• 1 A ' t •< H ~C h n �y rIt r0 11 N 1 n n 4 1 I� •ti u ri {p It 3+ to r+ v 0 n , l 11 0 1 ' CA . 1� N • 9 1 � w r • (i (} � p1 It li tt to n � 1• N n r0 rr II � r1I h i 11 G G I ' I t (1 O A '[ryf 1f ' I { I U 11 k 1 '• 110 t O W mb In (1 b a I m b II 11 A ' ' . " . IA I ` l�, b1 , 1 (nt , 1 , , T {� Ia �n1 •� n t1 �I' � h � 1' 11 t1 t1 l , ' 1 r ► N ' ( 1• ro J t + r 11 rr rl ! ' r1 nIr t � 1 n G n r , n p ! ' � ' 1 ' 1 f Gr ' n � �? n, p 1 t� ► �r w 1� i a ' , �1 ro �j n to E � ' III I I 10 II n 11 I'• U ro II' C7 tt It J ,n n tl In It r � . p .' 1 •• q n n r � In m .f kf ro CC11 G It a Il a I � rr , 0 lit o , I . • l , . a N 11 t, 1 to n 11 r a f(fr , o rt n r+, c n d o Art H A m A C r* (r n - I t1 I ID �- p, tr Io 11 N :1 Ir ry o ria F• p1 n n 1 + lI o a II n 0 u 7 . n u N 1 : b- o O rt a rd • q p' F H• to rY to o M m C h to n It 1• • rr ,] O I rt n 0 n j .n ft O 0 I ' - [i �i m S ,. It b p it n I a `rr1:± FW{ it n a N, t- j I� to C 1' N Ir O 11 in n Il PI ii Ir n 1 `t j n rt• 11 lotD j :1 A N n ,1 O , ! . ro ro 0 OY rI r 11 tl 1 •{ n if � I ' ` 1 Y;� I v 17 rr , ed r. to11 1 E a , E 0 i t U ' 61 t �v p r v IJ u W v It yfj � I . 'p 1 � � J 1 N >Owl . L4'' tlin 11 be 111 vl U O t ' N N tit iii al 1 � a • d ' H e L � N J i 11 h � �. •a i ' •1 i I Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee ORGANIZATION . Boys & Girls Clubs of Indian River County, Inc PROGRAM. Youth Volunteer Corns TABLE OF CONTENTS Please 'T" the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Proposal Pa e # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 B. PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 • X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . 4 . 4 . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . 4 . . . . . . . . . 7 X D. MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 • 1 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee I. BUDGET FORMS X 1 . Budget Narrative Worksheet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 3 . Total Program Budget. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 X 4 . Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 X 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS (Copied once in White for all three programs submitted to CSAC for funding . ) J- 1 X 1 . List of current officers and directors 2 . Latest Financial Audit Report & Management Letter that conforms with the J-2 X AICIP Audit GUIDE X 3 . Most recent IRS Form 990, including all schedules J- 12 4. Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating J-30 X Budget X 5 . Staff Organizational Chart J-31 X 6 . Most Recent Annual Report (if available) J- 52 X 7 . 501 (C) (3 ) IRS Exemption Letter J- 53 X 8 . Articles of Incorporation J- 57 X 9 . Agency ' s Bylaws J-64 X 10 . Agency ' s written policy regarding Affirmative Action J- 79 X 11 . Proof of Goals and Outcomes Workshop Attendance J- 80 K. APPENDIX (Copied once in White for all three programs submitted to CSAC for funding . ) X 1 . NOT FOR PROFIT AGENCY CERTIFICATION K- 1 X 2 . Indian River County Authorization for Release of Information K-2 X 3 . Sworn Statement K-3 X 4 _ Proof of Liability Insurance K-6 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee PROGRAM COVER PAGE Organization Name : Boys & Girls Clubs of Indian River County, Inc. Executive Director: Leisa Smith-Fulton Email : LeisaSmith@juno . com Address : P . O . Box 3068 Telephone: (772) 299- 7449 Vero Beach, FL 32964 Fax: (772) 299-3840 Program Director: Patti Nugent Email : pnugent bec@Hotmail . com Address : P . O . Box 3068 Telephone : (722) 299-7449 Vero Beach, FL 32964 Fax: (772 ) 299-3840 Program Title : Youth Volunteer Corps Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program : Juvenile Delinquency Prevention — IN 150 . 360 YVC Programs that offer a variety of activities for youth who are at risk for behavior which is likely to involve them in the juvenile justice system with the objective of assisting them to improve self- esteem, to become aware of alternative ways of dealing with feelings and leisure time, and to take responsibility for the consequences of their actions . Included may be counseling, rap and discussion groups, tutoring, companionship programs, alternative peer group experiences and supervised recreational activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Amount Requested from Funder for 2003 /04 : $ 401000 Total Proposed Program Budget for 2003 /04 : $ 115 , 865 Percent of Total Program Budget : 34 . 5 % Current Funding (2002 /03 ) : $ 40 , 000 Dollar increase/( decrease) in request : $ - Percent increase/ ( decrease) in request : 0 . 0 % Unduplicated Number of Children to be served Individually : 1 , 100 Unduplicated Number of Adults to be served Individually : - Unduplicated Number to be served via Group settings : - Total Program Cost per Client : 105 . 33 Will these funds be used to match another source ? no If yes , name the source : Amount : $ - The Organization 's Board of Directors has approved this application o _R 5-14-2003 Jay Mc Namara Name of President/Chair of the Board Sign e ` Leisa Smith-Fulton - Name of Executive Director/CEO ature 3 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services 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 . Mission Statement : To inspire and enable all young people, especially those for disadvantaged circumstance to realize their full potential, as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in Indian River County with quality programs and staff. 2. Provide a brief summary of your organization including areas of expertise, accomplishments and population served . The Boys & Girls Club of Indian River County offers a diverse, affordable program to kids in a positive atmosphere . Our daily after-school and summer programs offered through our "Club" house locations and our outreach services provided through our Youth Volunteer Corps program allows us to serve over 2 , 000 children annually . These program activities attract and maintain young people 6 through 18 years of age who pay a nominal membership fee of $ 5 . 00 for the school term and $30 . 00 for the summer (which includes a free Boys & Girls Club t- shirt) . . Nowhere in the Indian River County area can kids or parents find such a bargain ! While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remain much the same . The overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. Again, these specialized services allow our Club facilities, outreach programs and staff to attract and maintain the interest of youth members ages 6 - 18yrs . The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . . . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general. • Character and Leadership Development . . . empowers youth to support and influence their Club and community, sustain meaningful relationships with others, develop a positive self- image, participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well -being, set personal goals and live successfully as self- sufficient adults . • The Arts . . _ enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts, crafts, performing arts and creative writing . • Sports, Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills . 4 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee Be PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 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. a. ) Limited access to affordable after school and week-end programs for children 11 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change . b . & c. ) We define those who have a need as children between the ages of 11 to 18 years of age, with a special interest in working with disadvantaged youth . We define disadvantaged youth as children from low economic status, one-parent families and latch key kids . The Youth Volunteer Corp is a community wide outreach program that provides daily opportunities for kids to participate in community service projects through out Indian River County. d . ) Area of need : • Based on the 2000 Census, 19 . 2% of the total population or 21 , 685 youth are under 18 in Indian River County. • Bases on the 2001 Kids Count Data Book, funded by the Annie E . Casey Foundation, 30% or 6 , 505 of those youth are living in a single parent home 82% of a student ' s time is spent outside of school • All Indian River students are dismissed on Wednesday afternoons which had added on additional time onto student ' s out of school hours • Based on the 1998 report from Carnegie Council on Adolescent Development, that youth ages 12- 17 are unsupervised for 12 or more hours a week. 65% of youth involved in criminal activities, sexual activity and substance abuse and alcohol use participated during the hours of 3 : 00 pm to 6 : 00 prn during the weekdays . 2. a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program. No other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club, for children 6- 18 years of age with year round drop in services Monday —Friday . For every child the Boys & Girls Clubs serves, our youth development activities are designed to build the following traits : • Positive self- identity. A healthy self-concept, a strong belief in one ' s self-worth, and a sense of hope about one ' s future . • Educational, employment, social , emotional and cultural competencies. The knowledge, Skills, strategies and attitudes necessary to have a positive foundation for success . • Community and civic involvement . A sense of belonging to community, family and/or group ; willingness to take civic responsibility . • Health and well-being. Living a healthy lifestyle, taking part in regular fitness activities, able to access health care resources and engage in positive behaviors . • Moral compass . Youth have values enabling them to develop positive relationships with others . Our target population is underserved by other programs for the following reasons : affordability, accessibility and scope of services . 5 Boys & Girls Club of Indian River County, Inc. - Youth Volunteer Corps Grant Application to the Children Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1. List Priority Needs area addressed. Mental Wellness Issues & Childcare Access 2. Briefly describe program activities including location of services. The Youth Volunteer Corps services focus on education, skill building, and leadership development while providing ongoing positive activities for youth outside of school hours everyday after school and during the week-ends . The following in a list of programs offered to youth through out Indian River County in the YVC program : • VIP PROGRAMS (Volunteers in Partnership) Weekend Service Projects throughout Indian River County. • YVC Summer Program : Service projects are provided daily throughout the summer for teams of Youth Volunteers which are led by YVC Staff Team Leaders . • PALS ("Pupils Assisting Learning in Schools ') After School Tutoring Program : Youth Volunteers work in teams under the leadership of an YVC Staff Team Leader in a structured tutoring program in elementary after school programs. • Exploring Your Community Through the Scientific Method : The Youth Volunteer Corps, provides service activities to replace required Science Fair projects in FLC ' s Biology classes . • YVC Clubs : The Philanthropy Club which is designed to assist young people in the grant writing process and to present opportunities to participate in the fundraising process and the YVC Computer Club is designed to assist the B&GC with their technology and to maintain the agency Web Page, YVC School Clubs which design school wide service projects and work as a recruitment source within the school . • Youth Volunteer Corps Advisory Council : Youth Volunteers who have shown consistency in participation, exemplary behavior, and leadership skills, are chosen to represent the members of the YVC in a monthly youth driven council . 3. Briefly describe how your program intends to address the stated need/problem . Include reference to any studies or evidence that indicate proposed strategies are effective with target population. Most youth programs reinforce the disconnection that young people feel in our society by treating them as clients rather than contributors . The youth volunteer is the primary focus of the YVC program, but youth in this program are given the responsibility as the contributors of service . The Youth Volunteer Corps places these young people into an environment of meeting the needs others . Studies have linked adverse youth behavior with low self esteem . Treating youth as resources and putting them in responsible, serving roles builds self esteem . Search Institute ' s study of 46 , 000 young people, described in The Troubled Journey, found that youth who serve others are less likely to be involved in negative behaviors . The study showed that participating in "helping behavior" lowered adolescent ' s involvement in substance abuse, dropping out of school, teen pregnancy, and other negative behaviors . 6 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee 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). 1 full time Director of Operations — with a Bachelors in Human Services with a minimum of three years working in the non profit sector, dedicating 50% of his/her time in program support, evaluation & staff training. 1 full time Program Director — with a Bachelors in Human Services with a minimum of three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and implementing the daily Youth Volunteer Corps program in the community. Staff Team Leaders — with a demonstrated capability in working positively with youth . 3 Full time for 2 months, 4 full time for 10 months and 20 Full Time Summer dedicating 100% of his/her time in implementing the YVC program. Team Leaders provide onsite supervision of YVC members at community service projects . Parent & Adult Volunteers — with a demonstrated capability in working positively with youth. Numerous Adult lead and assist with projects, office support, data input data, filing and mailings . Volunteers . 5 . How will the target population be made aware of the program ? • School : Service Learning projects and clubs, bulletin board, announcements, distribution of calendars and flyers • Newsletter: YVC Volunteer Newsletter/Calendars, mailings, Junior League Wavelengths monthly newsletter • Court Ordered : Individuals ordered by probation to do community service • Newspaper: Press Journal and Vero Beach Forum Volunteer Watch column or articles • Family/Friend : Word of mouth • Service Projects : Recruitment source during weekend and after school projects • Other : Phone Book • Presentations : are given to schools and service organizations • TV : Channel 21 , 13 — "Notebook" Show, TV 10 — "Marsha Littlejohn" and the Freddie Woolfork Show 6 . How will the program be accessible to target population (i. e. location, transportation , hours of operation) ? The key factor in reaching the clients of the Youth Volunteer Corps is through the efforts of the staff and the team leaders . Each team leader is assigned to a number of schools and specific projects . They are responsible for recruiting, marketing, and "reaching out" to the community to insure participation and interest . Each team leader has a regional area to saturate with flyers, calendars, sign up sheets, and announcements . They are also responsible for arranging transportation, if needed, organizing car pools, recruiting adult volunteers for transport and supervisory purposes, and for calling and following up on those who didn ' t make it to a project . There is a complex and intricate system of molding many forms of communication together to bring a project to a successful level . This system of " outreach" is significantly dependant on the dedication and efficiency of the YVC staff and the Team Leaders promoting the projects . 7 Boys & Girls Club of Indian Ricer County, Inc_ — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee D . D- 1 . FY03-04 MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) FY03-04 OUTCOMES ACTIVITIES Add all the elements for the Measurable Outcome(s) Add the tasks to accomplish the Outcome (s) 1 _ To maintain register YVC members 100% • Provide weekend projects every weekend ( 1 , 100) as reported by the 2003 -2004 year and afterschool and during every school end YVC register member totals. Baseline: vacation. 2002-2003 register member totals. • Provide full time summer program with al day service sites for youth to participate in as contributors of serviceunder the guided leadership of YVC staff and community partners_ • Provide programs to YVC members which are ongoing which teach about special needs children and adults on weekends nights (Respite an Recreation) and on weekend days ( Sun Up) • Provide weekend and ongoing senior companionship programs (White Dove, Tandem Healthcare, Royal Palm) • Provide after-school mentoring/tutoring programs to YVC members for after school service opportunities . • Provide 5h graders an introduction to YVC programs and service through PATHWAYS in elementary schools . • Providing service activities to every 9th grade student at the Freshman Learning Center a extra credit in clas or as a required grade for Biology class . • Provide YVC Clubs focusing on areas of interest_ (Philanthropy Club , Computer Club) • Provide Performance in service opportunities through the YVC Band, Hip Hop Performance Troupe, Step Performance troupe, and the Drama Team 2 _ To decrease juvenile crime rates of enrolled . Create an assessment during intake process 10 - 17 year old YVC Members to less than to target YVC members with high risk 3 % compared to non-club members which is factors . 7% as reported by the 2000-2001 juvenile • assign youth targeted with high risk arrests . Baseline : 2000-2001 Indian River factors by the Department of Juvenile County statistics from the FL Department of Justice to YVC staff Team Leader to case Juvenile Justice Bureau Data. (7% of all 10- manage with follow up , tracking and 8 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee 17 year olds) referred to the juvenile justice spec reporting on participation. system. • Implement policies and procedures to create an inclusion of all youth to participate all YVC programs . • Create service project opportunities, which are available to all youth outside of school hours, which are promoted by YVC staff representatives at schools and throughout the community. • Provide appealing, creative service activities for diversity of participation such as computers clubs, performance troupes, philanthropy, environmental programs, tutoring programs, arts programs, assisting the elderly or disabled . • Participate in Boys and Girls Clubs programs : Smart Moves, Torch Club, Keystone Club, Junior Staff programs . 3 . To decrease out of school suspension rates • Maintain behavioral and conduct rules, amongst our 11 - 17 year old YVC Members which are strictly enforced, and holds YVC by 50% (YVC members reporting less than members accountable through defined 5 % suspensions in the school system, as process so high standards and expectations compared to 10% reported by school district are maintained. wide last year) Baseline: 2001 Indian River . Creating retention activities for older youth School District Database. to remain engaged and committed to the YVC program through peer mentoring programs like PALS , Career and College planning projects, Leadership Programs, and YVC internships . • Create incentive and rewards for involvement in programs in high risk factor schools (Charter Schools, Piper School, Alternative Education Schools, Drop Out Prevention Programs, to increase participation) such as parties, certificates, and field trips . • Create mentoring programs with older Youth Volunteers with established positive disciplinary record with youth with high risk factors to partner during service projects . • Maintain programs, which are appealing to youth on all levels such as the YVC Band, YVC Arts in Service programs and Environmental YVC programs . 9 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. [NOTE: Collaborative agreement letters are not required by United Way of Indian River County.] Collaborative Agenc y Resources provided to the program Promotion of YVC programs in middle and high Indian River School District schools, implementing YVC Clubs at schools, partnering with school service clubs to implement joint service projects, assisting teachers in service learning activities, PALS After school tutoring program, Exploring Your Community Program at FLC Reciprocal recruitment source, implement joint service The Substance Abuse Council projects, work together in Tobacco Program, Right Choice Program, and Teen Plus Program Youth in our diversion program work with court Juvenile Justice Department counselors and probation officers and the YVC program director and Team Leaders to strengthen our goal to divert youth from the system by placing him into Youth Volunteer Corps projects Promotion of the Youth Volunteer Corp within the Youth Guidance Youth Guidance program. Supply service opportunities for the Youth Volunteer Corp . Children ' s Home Society Promotion of the Youth Volunteer Corp amongst the group home residents . 10 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Each YVC participant will be required to fill out an application which will be kept on file that contains demographic, gender and ethnic background information. All applications are manually entered into an electronic database . Are target population is tracked by age . We are able to track our special interest in serving disadvantaged youth by asking and collecting the following : • Does your child receive free or reduced lunch? (Asked to determine low economics) . • Who does your child live with? (Asked to determine single parent family status) . • We submit our membership list to the Sheriff' s Department to determine Juvenile arrest . 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? Structured Reflective Process : the team leader documents collected thoughts and /or collects written documentation from each Youth Volunteer. This information is retained for evaluation and tracking purposes . YVC Staff Evaluation : After each project each Team Leader present completes an evaluation. This document measures the impact and effectiveness of the youth volunteers and evaluates positive and negative elements of the project . After each PALS site, the YVC Team Leader completes a weekly evaluation of the existing program listing the level of participation, journal documentation, problems and success . The Tutees and Tutors journals are held by each YVC Team Leader for long-range tracking and analysis . After each week of the Summer Program, the Team Leader completes weekly evaluations from their sites . The Youth Volunteers reflection paperwork is held by each Team Leader for long-range tracking and analysis . Pre/ Post- Survey : After selected projects, a pre- and post survey is given to youth volunteers to measure personal growth and learning experience . Parent Evaluations : After the summer program, a program evaluation is sent home to receive feedback from the parents of the youth volunteers to gain insight in ways to improve or change the program in the future . Agency Evaluations : After the Youth Volunteer Corps has done a project at any agency, an evaluation is sent to receive feedback from the staff and supervisors of that agency . This is to - 11 Boys & Girls Club of Indian River County, Inc. - Youth Volunteer Corps Grant Application to the Children Services Advisory Committee measure effectiveness of the YVC ' s presence at their site and honestly evaluate the program . YVC Staff/ Team Leader Weekly Activity Sheets : This form is required by the program director to evaluate the productivity and effectiveness of each YVC Staff Team Leader. Journals : In the PALS program, the tutor and the tutee is required to place a daily entry into their journals . This is used to track the impact on both parties from the experience and to measure personal and academic growth . Even if the Tutee is not able to write, single drawings or words learned can serve as an effective tool of measurement. In the PATHWAYS program, each student is required to write directly from reflective activities and share feelings about personal growth and observations from the program. The student is directed to report activities so a measurement of effectiveness can be identified . Advisory Councils : • YVC Youth Advisory Council : This group is made up of 12 involved Youth Volunteers who represent the spectrum of ages and socioeconomic backgrounds that are representative in the Indian River County Area. They meet monthly to discuss past and future projects . Much time is spent in both the evaluation process and the project planning process . • Youth Volunteer Corps Advisory Council : This group is made up of 12 adult members of the community who represent the spectrum of socioeconomic backgrounds that are representative in the Indian River County area. Two or three youth volunteers are present at each meeting to represent the youth . Much time is spent in both the evaluation process and the project planning process . 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 elements will be collected : • Team Leaders will track daily attendance and number of volunteer hours completed at community service projects . • The Program Assistant will compile daily data collected by team leaders and track Americorp hours completed by team leaders . • The Program Director will track weekly by the • The Director of Operations monthly by the • The Executive Director will receive quarterly and annual reports . 12 Boys & Girls Club of Indian River County, Inc. — Youth Volunteer Corps Grant Application to the Children Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) L List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start- up planning that may occur- outside the funding year. In completing the timetable, review information detailed in prior sections. Action Steps Time Frame Develop Program Budget for February January 2003 Approval Write and Prepare grants for next fiscal year March 2003 Implement PATHWAYS program April 2003 Close PALS program May 2003 Register Summer Program Participants May 2003 Hire Summer Team Leaders/Intems May 2003 j Close YVC School Year Activities June 2003 I YCLP Graduation June 2003 YVC Awards Ceremony June 2003 Train YVC Summer Staff June 2003 Train Summer YVC Program Participants June 2003 Summer Program Celebration August 2003 End of Ameri Corps Staff Terms 2002/2003 August 2003 Training of AmeriCorps Staff 2003 /2004 September 2003 i School Presentations September 2003 — December 2003 Train YVC participants and PALS members September, November 2003 PALS Program begins September 2003 i Evaluation of YVC Programs November, February, May, August i 13 ` d 0 N DD IN 1*1 O O N � NOV X. NO x NO pd NO do NOIN NO NO ON NO P4 ON NO NO :rNy:.�.. ee O ° Wb . ., N bo w pa do Now ~ NO., V Wo . <u«>c' . .00 0 NO ;:: CL t"NON 2 NO NO do O " Noo pro" : ;;:.>: >NO : ON 0 NO NO m NOD NO ON MO. Net NO z N c O Eo w A (u ~A 'b ob `" �. H o ~ H 0 0 0 0 0 + C� Zvi � xStia ww Ow � okn � � � �o Boys Girls Club of Indian River County, Inc. — Youth Volunteer Corps Program Grant Application to the Children Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMORTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County/Youth Volunteer Corps Proc FUNDER : Children Services Advisory Committee I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should 1 Abe used for calculations and to write information only. `:rrurax�sran R111f1ES a>yeriraedrer Propaised Total Program FnderSper : Total Agency iserowoeriuc a aucuurn►+ # Budget Budget 1 . Budget 1 Children's Services Council-St. Lucie 2 Children's Services Council-Martin 3 Children's Services Council-Okeechobee 4 Advisory Committee-Indian River 40,000.00 409000.00 130,000.00 5 United WaySt, Lucie County 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 54,000.00 174,000.00 9 Department of Children & Families 10 County Funds lnlrvldrtals $ 156000t .Givfc< Grtaups ri Nundstlons $143,DOi) CcporefJons 11 Contributions-Cash $45,000 3 ,000.00 223,000.00 12 Program Fees Nevys_ Getter::- $7;300 Go1P Td. mann ent- $2©,DOtl, Steak': & :stake - $3©,0(10, QuEside Fundraisers . $22 000. N1a� Apeals 13 Fund Raising Events-Net $35,000 80, 700. 00 Vending 14 Sales to Public - Net Maehienes 400.00 Membership ,= ($5 school Year > $30Spmmerj t 15 Membership Dues shirts $5 ea 69200.00 16, 550.00 16 Investment Income Exchange Club Rent - $300 per : 17 Miscellaneous month 31600.00 18 Legacies & Bequests FL{)t9E $44;:000, JIC8L ; $25000, Jr. 19 Funds from Other Sources League - $6,300 149834.00 75 ,500.00 5/27003 15 Boys Girls Club of Indian River County, Inc. — Youth Volunteer Corps Program Grant Application to the Children Services Advisory Committee 20a Reserve Funds Used for Operating Total Match from A rtenco,r tc pay . earn teadeis R¢trt foc Acimtn,. l7fPice (� P1per 20b in-Kind Donations (Not included In total) $12,OOtY 63580.00 108,850,00 21 TOTAL REVENUES (doesn't11 include line 20b _ _ . '>. _ $118,034.00 $40,000.00 $703,750.00 EXI'EN©J] URES oz on ' Proposed Tnta[ !'ragratrl funder Sc Tcta!Agency Acertcrvseort! r tsrra�rutcur �nonst Suc/gefBuat�ef Bil et 22 Salaries - (must complete chart on next page) 81 282.00 37, 150.00 393,527.00 Salary 23 FICA - Total salaries x 0.0765 41093.00 21841 .98 26, 130.00 24 Retirement - Annual pension for qualified staff A. 2,675.00 0.00 22,750.00 Provided 6y 25 Life/Health - Medlcal/DentaUShort-term Disab. MA 31504.00 10.00 31 ,619.00 26 Workers Compensation - # employees x rate42x2 48° 1 ,434.00 0.00 9, 154.00 t- londa Unemployment - projected 1TI600 X 42 27 employees x $7,000 x UCT-6 rate Z7% 378.00 0.00 21404. 00 SALARIES .4; Gross annual c D Pf� /.o � #SANG s8/ary Pordoa ot5alary on Proposed Funder � of6ross Ann#ral Pvsiffon v6IT`ota€ffts/t t Pragrarrr Specific: Budget fAgenoYl Salary Request 4} F�rarp/e F,•a: •,+�••Direstorf 6hrs 71 00006 ff flODOB Director of Operations/40 hrs 50,000.001 25,000.00 170500.00 35.00% Program Director/40 hrs 28,500.00 28,500.00 19,650.00 68.95% 3-Americorp Team Leader/32 hrs for 3 months 31625.00 39625.00 0.00% 4 - Americorp Team Leaderl32 hrs for 10 month 24, 167.00 249167,00 0.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/O! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/O! #DIV/0! Remaining positions throughout the agency 287,235.00 #DIV/0! Total Sa/arias $393,527.00 $81 ,292.00 $37, 150.00 9.44% FRINGE BENEFffS DETAIL A gig (Funder Speck Budget Funder B; © F c Column C only from Bite 22 to 27) P 99 Pension Warkees Unemp/oyme Tota! Fringes Funder S eClt/C FICA T, 65% Health lns 6 6166 i Position Title f Tota! Nts/wk Budget (ACompens. ntCompens. Specific 5!27/2003 t5 CA) AL m � m` o 0 m m -"_c � o 00 ou N Do � m � m 0 cc CD O iz o � 0000000000000000 � p 3 - C C Q »t (D 7c N ^b 3 N �. fD N tA. N ' S Nfu < N < y O d 7 (O N .ni A d S S 'O A ^� ? @ co N � o m �. m n� � M@ ? ' o O m o 3 0 N pMj ' (O 7 n H N 1 co N j C '". N fD Cl) '! 1 7 C 3 d S� _ m c u S ^' c c g -i co m C7 °: O m �. 3 ° A N N x N N �; y 0a — �i 2 co 3' m a N 9 0� v N _ . N to in a x N v m m M N' o m �' —I x o x o 3 v 0 o 'c < 3 0 n 0 ro m N o o�Di Z 0 m m �+ M 3 y NN S3 N— a � to g 3 3 �D w ° �' g m S � C v =r C CL n k � N C N Nv � ►�{ O 7 v f1D N — N f�D IA 3 3 ffk $ k y SN co Q W N S G 3 r II j 7 N 3 O N x fl c x � 7 7 7 7 7 7t7j 0OO 00 0 09 0 CT o OOO OpNp5OOO O O O C p p m o U 77. IQ � O (ll WW. h o 0 0 0 0 0 0 0 0 0 0 0 ooO O O O p Op O ppO W w D 00 O O O O O O O O O O O O O O O O W En :. , { LL LL 0 o o o cn a : cn 49 n 3 777777 77 S S S S I I I $ $ L. 3 ; Fn C ►M o N id I a _ I ILI �a J rn J {q OOD p A N N (11 _. .... a~. . co En (In 03 Q OOO OpoO O oO co O O O O O O O O O O O_ o 1.. T pO OO Op p O O C pO O O O OO W 60 ',Ai W Boys Girls Club of Indian River County, Inc. — Youth Volunteer Corps Program Grant Application to the Children Services Advisory Committee Quarterly Newsletter ($ x 4) orgarnzanoas Letterheads, Envelopes, etc. pnrrhttg is • Fundraising materials divided over atE • Other ate ' progCanlS 11+4 36 Subscription/Dues/Memberships ues 1 , 100.00 10, 115.00 • Membership to National Organization �i326 TE�AM4 • Dues Affiance.Dues • Subscriptions to Newspapers/magazines, etc: 37 Insurance 21230.00 14763 DD • Directors/Officers Liab. General LialsPity • Commercial/Geneml Insurance � d • Bond Ins. $1020"' Mernbecs • Auto Insurance A�ident 38 Equipment:Rental & Maintenance 0.00 7,200.00 • Copier lease ($ x 12 months) Computer • Meter lease ($ x 12 months) Maartenance - • Copier Maintenance ($ x 12 months) fiaisefs.Edge • Computer Maintenance ( $ x 12 months) ' • Other Iftwenance 39 Advertising 500,00 1 ,200 00 • Newspaper ads _ _ • Fundraisingads/promotions Reaut#rrer>ffior • Other (vacancies) vacanct 40 Equipment Purchases:Capital Expense 6 0.00 0.00 • Computer/monitor (# x $) • Laser Printer 41 Professional Fees (Legal, Consutting) 6 0.00 0.00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 42 Books/Educational Materials 100.00 • Books/videos _ . • Materials ($ x staff) 43 Food & Nutrition Srtzorrr 000 600.00 • racl� Meats ( # meals x clients x Sdays x 50 wks) 7reasure:Coast • Snacks Foci Bank 44 Administrative Costs 0,00 0.00 Admin. Cost (% of total budget) 45 Audit Expense 2,000.00 91100.00 Independent Audit Review 46 Specific Assistance to Individuals 0.00 0.00 • Medical assistance • Meals/Food • Rent Assistance • Other 47 Other/Miscellaneous 2,765.00 10 ,389.00 • Background check/drug test Back ground • Other checktDrug test 48 Other/Contract • Sub-contract for program services 49 TOTAL EXPENSES $ 115,865.00 $40,001 . 98 $681 ,940.00 _ 5/27/2003 18 80Y GM Ck0 of IWW Rn cowry, M - YouM Voknw C� prog" Gant Pppkc w to °n C7Yk $scats on sp Cmrness UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: FY 01/02 FY 02103 FY 03/04 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (COL GcoL BycoL B REVENUES MESON BUDGETED BUDGETED SEE 1 Children's Services CouncilSt. Lucie 0.00 #DIV/NSEEN, 01 2 Children's Services Council-MartinSIM 0.00 #DIV/0! 3 Children's Services Council-Okeechobee 00100 _ SSSSS 0.00 #DIV/0! a AdvisoryCommittee4ndian River 48 8.00 100,000.00 130 000.00 30.00%SON Way- St United Lucie County0.00 #DIV/01SSSSSS 6 United Way-Martin County000000,0, 0.00 #DIV/0! SOON 7 United Way-Okeechobee County 0.00 #DIV/01 8 United Way-Indian River County 809000.00 136 000.00 174,000.00 27.94% s Department of Children & Families 0.00 #DIV/0! 10 County Funds 0.00 #DIV/0! 11 Contributions-Cash 132,222.00 264 900.00 2237000.00 -15.82% 12 Program Fees 940.00 0.00 0.00 #DIV/01 13 Fund Raisin Events-let 569799.00 Im 69 494.00 80 700.00 16.13%ME 14 Sales to Public-Net 710.00 300.00 400.00 33.33% 15 Membership Dues 91995.001 M 6850.00 167550.00 141 .61 % 16 Investment Income 2,934.00 0.00 0.00 #DIV/0! 17 Miscellaneous 11800.00 31600.00 37600.00 0.00% 18 Le acies & Bequests EMN0.00 0.00 #DIV/01 is Funds from Other Sources 96,924.00 - 127,977.00 75,500.00 -41 .01 % 20a Reserve Funds Used for O eratin 0.00 0.00 #DIV/0! lob In-Kind Donations Inae :wn,e.a cetyl 1 ,408.00 47 464.00 108,850.00 129.33% 27 TOTAL ISMS430,782.00 709121 .00 7;261130.00 0.00 -0.76% : »:EXPENDITURES 22 Salaries 183,135.00 394936.0037.00 -0.36% z3 FICA27773.00 5.92% za Retirement 6,992.00 1902600 229750.00 19.58% 25 Life/Health 14,318.00 28126.00 31 ,619.00 12A2% 26 Workers Com )ensation 2SOONER MOSES, ,524.00 1 SEES97730.0 91154,00 5,92% 27 Florida Unemployment 2,788.00 NOSSZ 379.00 2,404.00 1 .05% ze Travet-0ai 897.00 748.00 11900.00 154.01 % 29 Travel/Conferences/Trainin 7,169.00 22 752.00 11 ,500.00 .49,45% 30 Office Supplies 1 863.00 U9655.00 1426700 58.83% SEE 31 Telephone 47932.00 87105.00 97580.00 18.20% 32 Postage/Shipping 1 ,441 .00 17983.00 6,960.00 250.98% 33 Utilities 59432.00 117948.00 127444.00 4.15% 34 Occupancy (Building & Grounds 43,100.00 1 Man, 64 564.00 68 838.00 6.62% 35 Printing & Publications 18,863.00 10,215.00 16,500.00 61 .53% 36 Subscription/Dues/Memberships 47626.00 37573.00 10,115.00 183.10% 37 Insurance 89235.001 molow, 11015.00 149763.00 34.03% 38 E ui mentRental & Maintenance 115.00 0.00 7,200.00 #DIV/01 001, 39 Advertising 546.001 19200.00 17200.00 0.00% 40 Equipment Purchases:Ca ital Expense 9,048.000.00 0.00 #DIV/0! SO at Professional Fees al Consul tin 0.00 16 670moffin, .00 0.00 -100 .00% 42 Books/Educational Materials 2,883.00 21000.00 1 ,000.00 50.00% a3 Food & Nutrition 497.00 600.00 600.00 0.00% 44 Administrative Costs w 0.00 #DIV/0! as Audit Expense 4,190.00 6,000.00 91100 .00 51 .670 46 Specific Assistance to Individuals 0.00 0.00 0 .00 #DIV/0! 47 Other/Miscellaneous 21 ,962.00 14,327.00 10,389.00 27.49% 48 Other/Contract 0.00 0.00 0.00 #DIV/0! as TOTAL WME,356.556.00 692,324.00 6817940.00 1 .50% 50 REVENUES OVER/ UNDER EXPENDITURES 74.226.00 16,797.00 21 ,810.00 29.84% • SSSSS vvrz003 9 90 GiN Ckb o1 IMm Rn°r Couto. Inc. - /am vor w ca pWmI Cx nnwcmw w °n Crum Sm ae. Ca UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: FY 01102 FY 02103 FY 03/04 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (°d, c-°°L eY°°L a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DN/01 2 Children's Services Council-Martin 0.00 #DN/0! 3 Children's Services Council-Okeechobee 0.00 #DN/01 4 Advisory Committee4ndian River 50,000.00 40,000.00 407000.00 0,00% s United Way-St. Lucie County0.00 #DIV/01 6 United Way-Martin County0.00 #DIV/O! 7 United Way-Okeechobee County0.00 #DNIO! e United Way-Indian River County 51 ,000.00 46,000.00 54,000.00 17.39% 9 Department of Children & Families 0.00 #DN/0! 10 CountyFunds 0.00 #DN/0! 11 Contributions-Cash 10,939.00 4r900.00 3,000.00 38,78°/, 12 Program Fees 11350.00 0.00 #DN/01 13 Fund Raising Events-Net 71779.00 0.00 #DN/0! 14 Sales to Public-Net 0.00 #DN/0! 15 Membership Dues 67200.00 #DNIO! 16 Investment Income 0.00 #DN/01 17 Miscellaneous 0.00 #DN/0! 18 Legacies & Bequests 0.00 #DN/O! 19 Funds from Other Sources 67,484.00 =27,833,00834.00 -46.70% 20a Reserve Funds Used for O erati0.00 #DIV/O! lob In-Kind Donations (►!ae incA,e°a :, coaq64100.00580.00 79.28% 21 TOTAL 188,552.00 , . ,034.00 -0.59% EXPENDITURES 22 Salaries 235T041 .00 1017356.00 817292.00 -19.80% 23 FICA 91071 .00 5,569.00 41093.00 -26.50% 24 Retirement 0.00 19250.00 29675.00 114.00% 25 LifelHealth 0.00 0.00 37504.00 #DIV/0! 26 Workers Compensation 0.00 11951 .00 1 ,434.00 -26.50% 27 Florida Unemployment 0.00 363.00 378.00 4,13°/, 28 'Travel-Daily 49224.00 0.00 500.00 #DN/01 29 Travel/Conferences/Training37905.00 8,837.00 31750.00 57.56% 30 Office Supplies 31405.0013,100.00 2,994.00 -77.15% 31 Telephone 8,692.00 0.00 0.00 #DN/0! 32 PostagelShipping 21436.00 19200.00 450.00 -02.50% 33 Utilities 0.00 4,400.00 1 0.00 -100.00% 34 Occupancy Buildin & Grounds 700.00 100.00 -85.71 % 35 Printing 8 Publications 2,411 .00 67300.00 6,000 .00 -4.76% 36 Subscription/Dues/Memberships 1 ,491 .00 17100.00 11100.00 0.00% 37 Insurance 19738.00 940.00 29230.00 137.23% 38 E ui ment:Rental 8, Maintenance 81905.00 0.00 0.00 #DIV/01 39 Advertising 256.00 500.00 500.00 0.00% 40 Equipment Purchases :Ca ital Expense 0.00 0.00 #DIV/01 41 Professional Fees (Legal, Consults 0.00 0.00 #DIV/0! 42 Books/Educational Materials 0.00 100.00 #DIV/0! 43 Food & Nutrition 0.00 0.00 #DIV/0! 44 Administrative Costs 0.00 0.00U#DIV/O ! as Audit Expense 875.00 21000.00 2.000.00 46 Specific Assistance to Individuals 0.00 0.00 47 Other/Miscellaneous 12,819.00 9,095.00 21765.00 48 Other/Contract 0.00as TOTAL 295,269.00 158,661 .00 115,865.00so REVENUES OVER/ UNDER EXPENDITURES 406,717.00 39,928.00 2,169.00 vnrt0w 20 Boys Girls Club of Indan River County, Inc. - Youth Volunteer Corps Program Grant "cation to the CHWen Services A(Msory Comnttee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER : A B C FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS, PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 22 Salaries 819292.00 371150.00 45.70% 23 FICA 4109300 27841 .98 69.44% 24 Retirement 29675.00 0 .00 0 .00% 25 Life/Health 37504.00 10 .00 0 .29% 26 Workers Compensation 19434.00 0.00 0.00% 27 Florida Unemployment 378 .00 0 .00 0 . 00% 28 Travel-Daily500.00 0 .00 0 .00% 29 Travel/Conferences/Traming 39750.00 0 .00 0.00% 30 Office Supplies 29994.00 0 .00 0.00% • 31 Telephone 0.00 0.00 #DIV/0 ! 32 Postage/Shipping 450. 00 0.00 0.00% 33 Utilities 0 .00 0 .00 #DN/0 ! 34 Occupancy ( Building & Grounds 100 .00 0 .00 0 .00% 35 Printing & Publications 69000 .00 0 .00 0 .00% 36 Subscription/Dues/Memberships 11100.00 0 .00 0.00% 37 Insurance 29230 .00 0 .00 0.00% 3E Eq ui ment: Rental & Maintenance 0.00 0 .00 #DIV/01 39 Advertising 500.00 0 .00 0 .00% 4o E ui ment Purchases : Capital Expense 0.00 0 .00 0.00% 41 Professional Fees ( Legal, Consulting ) 0 . 00 0.00 0 .00% 42 Books/Educational Materials 100 .00 0 . 00 0 .00% 43 Food & Nutrition 0 .00 0.00 #DIV/01 44 Administrative Costs 0 .00 0 . 00 0 . 00% 45 Audit Expense 29000 .00 0 . 00 0 . 00% 46 Specific Assistance to Individuals 0 . 00 0 .00 0 .00% 47 Other/Miscellaneous 29765.00 0 . 00 0 .00% 48 Other/Contract 0 .00 0. 00 0 , 00% • 49 TOTAL $ 1159865 .00 1 $407001 . 98 1 $ 0. 35 527/1003 21 Bays GMs Club N Indian River Coutiy, Inc — Youth Vohaaeer Corps Proyrnn Grant Application to the CMdren SrtNcaa Advisory Com"I lee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee #DIV/0! 777 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! We are requesting an increase in funding this year dim to a variety of factors ranging from : shifting in funding focus from other funders, to a mis-conception of an economies of scale when joining with the B&GC. Money awarded to the YVC program mean direct United Way-Indian River Countv services youth. #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Due to a NCC C Americorp grant, in-kind service through 20 college kids will be provided during the summer, plus an increase in 1 - In-Kind Donations Not included in total Americo staff osdion year round. This will allow us to serve 200 kids a day during the summer. Retirement #DIV/0! #DIV/0! #DIV/O! Insurance In transferin2 the YVC program to the B&GC insurance the policy was transferred to Markel which requires a different coverage. #DIV/0! #DIV/0! #DIVIO! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! SnR200a 22 Says GMs Club of Inman RMr County, Aw. — roan Vonowe« Corps Program Groh Apptica"an to Ino CN&M SWV"s AMhory CmaMee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee AMM Salaries ::. ::. . ::•::::::::::. ::::::::.: :: : :a;: :; ;:. FICA #DIV/O! #DIV/0! #DIV/O! #DIVIO! • 7/2000 23 Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street, Vero Beach FL , 32960 ("County") and Boys & Girls Club of IRC , Inc. (" Recipient") ; of: (Address) Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Attention : South County Branch 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Thousand Dollars ($ 30 ,000 . . 00) . 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 Reguirements 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 23 , 2003 , 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 2 - 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 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. 3 - 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 BOAR COUNTY COMMISSI RS B • Kenneth R . acht, Chairman Attest : J . K . Barton , Clerk By: yffAu, �4' ;, P Deputy Clerk Approved . .......... ..... --� ames Chandler, County Administrator Apl ed as to form and legal su iciency: i 1 a ' Fell , Assistant un y Attorney RECIPIENT : Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 R By. V -Name cgr ei.--o Title 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - 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 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Boys & Girls Club of IRC , Inc. P . O . Box 3068 Vero Beach , Florida 32964 Attention : Leisa Smith - Fulton 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 - 1 - 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. - 2 - SEP -24 -2003 WED 02 ' 52 PM WM, DAY , INC . FAX N0, 772 546 5772 P , 02 Florin Reftn Peftratim � ,. f OF �?• _ 1a Q, lil)C IM • N119r :S�ltllr►llj)h)1/1J1J�.1' J'0l11 (iY tg< Saradc. k i , Vrl!'�CiYC`�I1'�ir4ah,irf,'nl, sP4u�Jfurrn('AdmaxJami Fr NurA s:ers 2979 W, `I) 10 " 4lr , Oiavrnun1r0 ( h ( rol.'udr OKs01 ,MC1 1 JAI, 3�$ J� .Q $a IcIT1141ic V63) fico—W or 1 *00 -282 .7648 I' g < Ii7K,nlur ti. Nk- il. W rinrul • 8 !t (t ljj } 6fiC} 1 MK ( '1 ,111,• 4 R. Plnrlr , Ja baladlr certiircate of" Insurance RE : 0520 -25864 ISSUED TO : Indian River county Board of County Commissioners 1840 25th St Vero Beach , FL 32960 - 3365 This is to certify that Boys & Girls�l'o� Indian aiy 9unty, Inc p�t� 3o6s ver4 Ghr �_.29 4, being subject to the provisions of the Florida Workers ' Compensation Law, has secured the payment of any A = ? s ' compensation benefits due by Ensuring their risk with the Florida Retail Federation Self Insurers Fund . POLICY NUMBER : .020 - 2586�4 Statutory Limits--State of Florida EFFECTIVE DATE . Employers Liabilityepk�m4�L13, 2003. $ 500, 000 ( Each Accident) EXPIRATION DATE : SPptembr 13 . 2t?04 $ 500, 000 ( Disease - - Each Employee ) $ 500, 000 ( Disease- - Policy Limit ) This certificate Is not a policy and of itself does not afford any insurance . Nothing contained In this certificate shall be construed as extending coverage not afforded by the policy shown above or affording Insurance to any Insured not named above . The policy of insurance listed above has been issued to the named Insured for the policy period indicated . Notwithstanding ally requirement, term or condition of any contract or other document to which this certificate may pertain , the Insurance made available by the described policy in this certificate is subject to only the : Wt msr exclusions and conditions of such policy . Paid claims may have reduced the shown limits . If the policy described above is cancelled before the expiration date indicated , the Issuing company will attempt to mail 30 days ' written notice to the certificate holder named above . However, the issuing company, its agents or representatives accept no obllgation or liability of any kind for failure to mail such notice , Date 09/24/2003 c Lvlit consulting , inc „ muniniatrator rlorida Retail PederaLion self Insurers Fund IM DAY F'AX N0. 5615465772 P , 02 ACORDu CERTIFICATE OF LIABILITY INSURANCE DIITEpAWODlYYYY) 12103102 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Da Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Day 9 ' HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 11320 SE Federal Hwy, ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW, Helie Sound FL 73455 772.546-5767 INSURERS AFFORDING COVERAGE NAIC # INSURED Boys & Girls Club of Indian River County, Inc. rNsuRm A. Markel Insurance Cc PO Box 3068 IrtlRan a: Vero Beach FL 32964 INSURER C: INSURER D: INSURER E THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMCNr, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RCSPECT TO WHICH THIS CGRTIFICATE 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCFO BY PAID CLAIMS. SR D POI ICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS SEVERAL LIABILITY FACH OCCURRI9rCE s 11000.000 DAMAGE TO RENTtU A X , COMMERCIAL GENERAL LIABILITY 8502CY2201282 09/13102 09113103 s 100,000 1 1 CLAIMS MADE Q OCCUR MED. EXP (Any m p&sonj $ 5,000 PERSONAL a AOV WURY S 1 ,000,000 CENERAI. AGGREGAM s 3,000. 000 GEML AGGREGATE LIMIT APPLIES PER PRoOUC r . COkp/oP ASG I I,000 _00 X POLICY F1 P Oj LOC • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11 ,000,000 A X ANYAUTO 8502CY2201282 09113102 09113103 Icaamae1() X ALL OWNCO AUTOS BODILY INJURY I SCHEDULED AUTOS (Pa per^m) X HIRED AUTOS BOCILY INJURY I � X NON-OWNED AUTOS (Pet acclamt) I ( PROPERTY DAMAGE S (Per accGem) GARAGE LIABILITY AUTO om Y 2F.A A :CADENT S ANY AUTO OTHER THAN ' FA ACC S r AUTO ONLY: ACG f _V5RELLA LIABILrrY EACH OCCURRENCE is OCCUR CLAIMS MADE AGGREGATE• S 1 S DCDUCTIBLE S RETENTION I S WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS LIABILITY E.L. FA(,lt ACCIDENT S ANY PROPRFrORIPARTNCR/E.XECLn IVE • OFFICEHWAtMSER EXCLUDCD? EL DISEASE - EA EMPLOYEE. i KP 4axw � ON S below AI PRO&A, EL. DI_SEA.SE - POUCY UMIT S I OTHER t =_EC¢IaTION Of OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS c _r:; Scztnihoider Is additional Insured for General Uablllty & auto 30 Days notice applies except for non-payment of premium CERTIFICATE HOLDER CANCELLATION j Indian River County SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION d of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Boar { Boar 25th $t NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO Do 90 SHA ( 1840 Beach, FL 329603365 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, RS AGENTS On Vert REPRESENTATIVES. ALMIORRED REPRESENTATIVE <AJD> ACORD 25 (2001108 ) CORD CORPO ON 1988 11H1 -CC -CUUJ Itlu 1G • 1W fiI W17 urtI -fHA ' IYU. 00LOL WU is f , UJ IMPORTANT If the certificate holder Is an • ADDITIONAL INSURED , the policy(ies ) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ). If SUBROGATION IS WANED , 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 ). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitutea contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon . , t I ACORD 25 (2001108) -L-2003 THU 12 ' 15 PM WH DAY FAX N0. 5615465772 P . 04 �'larit Rett nderaion Self UrerS rund no.►d �[ 7r.r.1.r, ti4 �, %V, "Blj" l; dxdrar, Jr., Chairmi�, Mir t 'r!r ( '4rder {` r(diryiRia(flCrl +y !fLurrrli( Si�CR Iq79 (l .vrge 4:rulc4r, �i.: Chsi� mrn P.+(atka \ c. Xinot . lAe4and i ._ YA, Ilrn 983 al .akchiud, Fl, Tia>n+" S. PeWrl, 1.ade1cat IAS 'rclqune f8631 M36mOW or I -80-2114644 tFax (863) 66(x1958 ( hgks IL Pitmir, 4. 14(midte Certificate of Insurance RE ; 0520 - 25864 ISSUED TO , Indian River County Board of County Commissioners 1840 25th St Vero Beach , FL 32960- 3365 This is to certify that Boys & Girls Club of Indican River CounkyJnc P . O , Box _0_68Vcfg_DaFL � 2964r being subject to the provisions of the Florida Workers' Compensation Law , has secured the payment of any workers ' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . = 1 trC`! NUMBER : Q 0=2586a Statutory Llmits -State of Florida Employers Liability EFFECTIVE DATE : Septe. Mb.e 13, 2002 $ 500 , 000 ( Each Accident ) $ 500 , 000 ( Disease - - Each Employee ) EXPIRATION DATE : gtember13 , 2.O 1 $ 500 , 000 ( Disease - - Policy Limit) This certificate is not a policy and of itself does not afford any Insurance . Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or affording insurance to any insured not named above. The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement , term or condition of any contract or other document to which this certificate may pertaln , the insurance made available by the described policy In this certificate Is subject to only the terms , exclusions and conditions of such policy . Paid claims may have reduced the shown limits . If the policy described above Is cancelled before the expiration date Indicated , the issding company will attempt to mall 30 days' written notice to the certificate holder named above . However, the issuing company , Its agents or representatives accept no obligation or liability of any kind for failure to mail such notice . Date 05/22/2003 iL corrultirq , 3nc , . ,�drniniatrator Florida Retail Federatton Sell Insurers Fund I I n • � ' •; (, , 'I, (, 9 1 { 1f 1� � , r . , v IS LI all tit G ► ' { ( . � � �� � 11 I i ; • � r : r F � 1 ' f n 1 j� ii • r n n tr a" w `� m .i � t rl II.. l0 1 pp x ' q n ?� 11 tr w � 1 P . tJ r� 1 d If, U' n 1 ' • 0 U t'• 1 • ((77 rl Inn pp pp� 133 < r+ ! r . h rNt 1 -h 'Q P' \ H at U M pr 'rl \' 11 11 ; ' n � 1] 11 i t• • lA ' G �j al l Hy Y . u p n n pi . p h r I „ . Pool I r , I u r {� ro I •. p n c� r n (' A. , ( . , o . p tt u. I t , t l In , r' h o +• ��'{rrr111777, n + L, /�! H 11 (• � � rIt :1 { �,' 11 P M •• t0 II�j� ro o t -n o 0 1 In tgntn . na �1a P ' aprc r ri I1 i a1 U p • t r� ' n p In P1 �i Y k' CJ1 ''� to " I W ❑I nl to u A `' n n o tf tf rl 'j a u 'p ' hf N n ro 'd o llet .t � d to to p It � It ► t tt 1 Y n it a P . h p �{ ! I p , I { to o 1. ,i rOn L t1• v r �' F ' ► I o q o (➢ I , • 1 I � li ''1 p 40 'r1 �� I ' H �1 CP�t' , u]] 11tell r t .. a iY See f, , l+ ' i. tll 0 CL tr ~ 11 • o s,al . I p n o 1 � (� 11 —1 {'t 1 (� urs fit ' ° . .• � • a . 1 0 ! , ,- t T, a . � A 1 / 1 t ❑ � ilact n Ila 11ruaitlLn n { t � E� ` { n ; fltl p �� < to 1 (? n r0 n p n 1 ii n rt rfj IL r 16a l7 't • f► 1 o ' n, , it If q J I ��,', I, r t h ft � t n I co 1111 n b 6-4 n, II 1< W li 11• n 1 37 o u 1. ' ° �; � � �r � i. I1. t(t r , i U " jt ' �`� on v ^ n rC7 [a' 17. r l rr ILn ( n N Sp1 1 1 . w M ((� ' �` +r Let h 11 l �� f'l I ' • , N ( I. Q A rl A n' q �ill it1 1 ` ( F' Lf „ I! . 84 ' �) QQQU t1• PSI 1 1 ` 11 � ) 1 ❑ 14 ' 1 t I r. in n , �i . t1 u t P• to a p1 1i1 ►-• n n h ' n to rwt 11 41 n I th •< t { 1 1 . 11 v r II 1 I � ul 11 rr p ' 11 In 0 W Ill ( I . (, n - 1 n ..pprlI ' d a rl IA1 n It \ c P . ri 1 I ' • u n t i! a ( � r} p 1 " ((�� 11t1 nt { 1 ( J N II f ' 0 1 It L� { 1 ) q ((� �(�1 p r pl ,J W 0 y p " I so [+ .q J. _ , r n . A r1 . n hl 1 It 1�. 17 • W Rr 11 A. ` n U ' [l . p I U �i U � ' ! t � ' p ttrrq to a Ill ro a to ,•, t 11 n N 11 r It , , 'CI r ( f� 1I Ir 11 1 r• I !] It ^ti r1 p n 11 0 S 11 1j � ' ra •C P•� 1 n 6 3 [ ) 1 ' I •. •� I •• k- ' to 11 ru tit fo I1 •a Q 1r I � . 1 � rr n ► p r n , d ►-' 11 t1 �- rr it ut 't] 0 b 7 u n {C 1� 11 to O t. b I • • uI 11 ' V ' d M / ' a (j 1� I n H . • t r '• t . 1 •q w 10 P• w 1 � O p. 1 ry w rt ( ( I ( PPP 1 �i P A a n , n H n IJ I O U { p I , bI < 10 t ! t 0 ! r . f n R II at kl ❑ { ' ' r• 1 rq ❑ Il • rf It tt n r. r rD rI p, � ;; Q p• " a n ' rl h u' 1-' i �• I n fi � Ill 0 it �' " • �i � " lei trrt "• I ' 4 n lit Dr' �r ; t : l , 0 r+ � � i P � (l �i r • { l ' 0 1n 11 rn h 1 , . 1 rt rt b n 11 U 1 n ( 1 Il � � ;1 �I Q Q li . n •C.r' Q u n 1r• tY 1 .1 10 DI p n 1 Ali 11 f . ❑ 0 1 (1 Q P . 0 rt U .D I • i Yi I7 n I ' • Ifl It !y 1 ; 1 . 1 (y I R f. •0 1T d 1 fY A . o rl n ft t) , 11) ie Gx i 11 ( I rt I . n 11 . 1 • • p1 1: 11 1I q6al 1 II H 7 { ' t l I , It u I 1+ 1 ^ p, II n f ( �t W N 1: It Q p t . R 0 1 U• . ... n N a N n 1 ' t t. u ' A w .i1 o n •< E tt n . 1 n k1 o p N t , is rr !, 1 : I n t n. r p , p h , , r 1 .. •n ro ti •u 14 ' n 1'J • n C. 1 -4 i , -= tTI . `. 1_ ': ft R �� P• i1 N i + m ' h n I `' t n � �r ( t rr � n n , I � , GI r I � 1 [r1! 1 fl k7 .7 I ' I � F � n n t m 1 r a I I i a rw Ir II • � � 1 n f . 14 01 11 l� .7 p jj I I1 . ry 19 n r. I • U� = rl I U ,) . u r1 c: a o U I �77 I to I a o a' •It J; r 1, U u , 1 n 1,) N F I 91 , t' v t n , of b o b, ._ 1 to of m � , , 1 re F 1 , 11 • u a r ; ' u t, l •4 u ❑ > . 1J y d 3 1 T• u 0 u o, u vI N >• it U t .. u F , • u . r a c , ld L, ,I C a to J ; JF ro t) ,u 'O el .-I U w u o a • 1 , r 1 ', (]t , I u p V G .t , 0 •- 1 ' d t>. , t u Q U p N U •. I 1 ' li 0 > o u q , , U • I It L N •'•1 �p� ll u At N u 'cl ❑ U � 1 �, U t rl J , 11 Y , U r: • t , L , 1 ) :• t7 el E I U ❑ El 1f ' I I r1 n U J ) tl N [1 I1 U v 41 V U f : . t ; D bt N �, 1 , IL li nl f1 ut btu d u Jr '1 11 a ll . ij I Il „ U 0 11 U It . . l I W) lr it 0 it ) ( It. , t , r a In , r-I 1 11 a J , • t , o u t. U V ) F ) 1, U 1. 1 � , 01 Il I : . . • rl �t N ie I 01 1 P d , 1 U U 11 d 1 I1 I1 I ' U f)' tl 1 41 U 1 ll L1 v , 1 1 . - t l 1) • t O . n al 41 tl IJI u ld U , � 1 � r 11 , . I rt I ( I , U U o tl U u I It II F? • � E1 M t ) U U I l t1 U rI q U O . tJ Ir I•1 u 11 ,r. �C Y 1 ' I O, J1 1 q p I 1 O , / I ei I � d 0 V /1 I l l p ••, , I f(J� ' I]y;, �) (1IY,, u UU 11 U F7 u c� rt nl . , . r ` u v Il l 0uj r } U l ; � ! r 1 kl 1 1! ' I '� f� . i O p ,Ij1 I1 !, ll �' �1 r• ' � J u , . t It ,� it ! U u , 1 'N ' 11,E � 1 , ' ! • ' ( JI . 11 t : rJ U H }• I1 tl at GI o fl t � �1 � U 1 t1 Il �. vl 411 :71 . . i ;, r , p Il 41 tl a ,i �, q1 aF I U uJ It n }. .I ; I ,`j n 'j 1 4 / m [ 1 bt ,, `� N �J0,� -ItJJ (C)1 .r ,n N 1 �� El t I 1 UI rd f 'V t V M jl O rl I1 d N In tl •� [� 'tl �t i1 u v II ._l ' 1-I V , •il j, I) . J l 1 , I , 1 , E ` ►UI 1i , uu .tI J GIu Al t E u d to � � � u , t ` 1'� � I jr1 � 1 ', � J vii , e to v >• U EI ul �d N �J M {i la .r { N > t� ° h iJ ? i� a 'f U to I d 'tl a ti u u '- I o V �1 0 II > r , 1 J 0 U el Iv „ t! N o, , J, U 4 l' t 4 ,. p to f, p w V e 11 ' yy1�� �, n, U 11 t ) �- . 1 N 0 p, ru u u 1 : • t N D � 1 f1 I �� rV ,.1 el I li (1 -1 rV u :-J q O tl ii 10 .1 �l V 7 1 , Ill ->/. ) I la U n, ', r a � l ,. L, 1 , r Li M . I 1n f1+ • d ,d . tj ❑ �. 1, QQ 1 ! , Ei to a , l,J I . t u 1 1 II u •1 U 1 J , ' f) ti , 1, 0 E 1t u kV , U •i Lit { II U ,, , rJ n d J rt. y V I- I , IJ ° 4 , rd U r( .. p d tl Q D 11 tl 11 u U rti tl ., ' iJ V to '� ['' . , 0 ' ' o r v F ° d U '`J (�p] U Of �1 ry►J' PH I of 01) •fi 'il "! ` • I' 11 G etj ll N [1 el IJ G d L r a u . i > . °) C' U • I1a( v l u >, c J u u U °, f.: F: i u U f7• F-t J, Pp , [ I > of > . . , .0 u r u a •. , n �, , � ti n u u v ' ' � . � 1) E'' J a u q{I o , ❑ 1! ❑tul t o . It a It u u 15 i ) u , tl u 3 1, 1 . t 1 1, Il V ti -W • r ) V' , U A- u [1 r u 1. a (J [1 .l1 . , ' I I1`1 Y, �]t ,/ 1, ,■ �, ttl tl 11 a rt U t, ' t A ._1 'Cl . ❑ e! .- 1 n Il b u �' I�U.B., I� � [Y • tI; V t'I 1J t . "3 E U N J-1 • 1 tl q p td [1 1� <Sr 1♦ 11 N IF7J rl m IT , u , ` • I, 1 � h • �, POP D J I � .L 't U � u [1 t) D e J r 4 Pj o -1 in u v u ' I ❑ > o r, ° 1 a n ' t d r i i t i; w `J 1 l p •t I ti U u v t• . .` ; (� '' : EI , q >, : •1 } U 14 7 v I J , I !of p U U ' 1 u ,d ►lt U 1 t ' id ) { >. ti rl P. . i • .1 I o Aj Ill Cljl pt t :7 C [: u 14 IO .� , 1 • rl 11 la M tl • rod d d u .E� 41 ,i u . 4! Id o h nU bt o�3 :) } I 11 . lu Q tJ P. Id 41 .� o u o 0 o n u I I u tI �1 " u t I t � / 7 t (� 1 . I J r F 1t V IS 1 v U , I ) s+• >+ u k � t�' J rl t Ut 1 .I� ti rt D I ' , 1 1 / •I t) tit, �. U r I u O a : i :3 a ;I � � � � G' Ll •ta V • a 11 { I It I / � u PeA 44 to J u n PI y, u 1 , p n r oui ' V d ' ' • D a l a [U) s u I . t lr �a t7 n td U t • 1 rt . O Il 11 U V t7 U •� • . U I ,v } u lJ .a y r ti 'tl a o u n , 11 " d y J U ll U M n i, 11 ( f If tt I , •C)t E) ' I . tl (1 . - 1) 71 ►1 4 rd Il k ) . • U 1 11 j u U •4 • If a 1) V II (l IJ 1 . [ t I , D . t . A it , I 1 ' a U qUq G I) 1 , u II [1 41 > , p) ,d �� 1_ i �1 11 l0 I1 ll d ' V t r UMI , M II •• � t, t ti d J 4I u 'q H e t J . I U r I 'V .1 rlf1 Oi 1 . I II L , :161 J� l JJ �� C'I ;'1 3p C ,p , � &1 9 1i '�1 II :( tt7 )i � � J `� t� OP v f 11 • tl w O it > r td Or tl r f� 1 ! t) 11 It U [lr f U O ;• , ; ) 11 U .d rd N , J , a , >• .Y it u u U r1 t, r :J N >t , t 0 :1 ud a I ,. • , , O „ f v ���r orddd n� y� ~ d1 U U1 D u y 111 Vt { ' 1� y O U J] ' � I } • jf , gid dJ �' � „ U E 1 u U 'l1 a 11 l/ U � i t1 u y . ' � i! I t 'J 11 1 ( 1 V tl 7 r1 u r r1 1 , l H 0 'u ' w ' � U I� ' t 1 1 } .� Il E1 O �t N l 1t Ir t 14 Il 1 0 N. U t1 It! 11 ! tl 1 ) r • > J ws �, W 0 .q U � i ii ' [I f ���� U f1 R. ro t1 •f to Lr Fl �. tl ! , uJ { I }( J to l u • f , 11' to t, II } ' (� "t I 1 I , u I : tr C I it N o 01 11 1 1 il ,e u A r� J ' 1 4, 3 t U 0 b Il • ' p rl U , v v u O •rJ td u }) N u [bj Ut r1 rl •rl -rl I ) .- f u •1 �' 1, Ef 0 ! ♦ 1 , r 1 , tP • 1 > V Of I • 1 W > ); >4 � , r 1 q u u ) , >. w u 6' y t! t1 fU tJ [l i� ) 11 J til a i� : i . : ' .rto v u E u .V . 1 D O 11 U 1 .-1 p r ' p , } i U I ; U rd t1 , J t ! p J : Id It II . 11 ti t q �t • r1 J' U a { i n. ( t F. • C i u to U }. 't ) . � , 1 J . i y 0 O m ft N U U rl 111 y ) Lj v Ir rt 1 . It PIP I I (✓ ll � ' y c ; u _ • 1, � . LA tE . I1 11 N (1 ra t1 ) I , 1 , to V I• IN LI 1 ' U O c• d 0 0 l a 0 U 41 'YI N }t V dl �] r II U U I b O JI Y J J d1 L U p, 1 orl p o o 04 Ni 41- p U p 11 n e •� q , J 1I T •�� U P u tl q 1194 11 u a 1.4 In 11 n . �. ij � jo Ei m vyoiV R �Vi, Cot l oiUtiJ Vtv t . ni f . I _ u � N JJ r1 U a L. u n u U 41 II at , at tt, llI u m L1 ! 1 cP: u e, dCI I 0 IW 0 U q 1t�1 'j 14 a IA ° Ql 07 ( t E) �• a 3 11 r W U ) r.1 u IN1 �1 :. 1 I . rI .. I V F 1 D1 LNI t 1 f t• q .l It IN C. u 11 1 , 4 4 U ) 11 n � 14I.t t u I 11 ll 0 V :1 U ( t I, JJ 11 g l l I • l • '••I � U V.1 � U � ' � tI v fKl w m % o ` y � 11 ' 0 li In .°j " o � It11 ff ':2 :1 `{ c�i J !1 .0 JJ p' 11 al ' rt y u tri u , 1 I C U E IIn , t 51 • r{ q ,_I • t4 . cl > S u r1 CL rl r1 u u vl rr tl 'I , p. ' UU J . . U I pQ � ' u U u a 1 u oI U + K n ' � In 1 1 rl + It •U 11 CI y • t •tl I •� O U II 1 11 ',s I , y J� 11 p, q U l/ , U u �a]• [). .-q1 d (� a •-1 AE N ► I ( ) ' is Gr U l r ,N � 1 () t, U ° EI ., ) tUj 9 ; 11 .d U ( d 11 h iI U U F'11 v ►, v I t u • . 1 ( u a ' a ► � fy� , ' t ) v FI 1 J 'd '� jaII oqa . 1I p .rtI (� ° J � t1{t( � 11 1111 ' 1 ' (► 7 + 7 U Il . -1 tl N '1 n t•1 rl q 1 , {{ )� c4d It 1 ) II M 1 , D U U. a a 11 I ' :J lI if n t n • vi �i p 1i v ei i� q • � . � N [) 1 ' .r .rI a ;� u U •r+ "d q b1 r-1 a I c• O O + ►1 O � + I .-J I� 7 + „ . 1 . . , oldW v b) U N ll Vf l+ Y >. U t1 U N U d 47 N 17 n to >. 7 rE r0• [�Y, 0 V l U `I ( - 4 ' 11 r•I U Id IS J ' 11 1I (.� U rl E ' I O t� I' J • ( 1 d JJ q ILI r-I '1 • U 0 t ' at .1 •�1 (1' •-1 ll Not r J O U + Iq J 1: •rt U • I • .1 { ) + t f 0 Y ► , u I q - . I • ot ,a 11 • I r , t , U 1 ' l1 li U �I .1 Ii if y V v 11 tai .v al ] 1 • i ' u �J ap U ' �I el s � E b Ir� n u N �I b t) u ' 0 . v va �i t1 s u A J] f1 1111 U N U F I I I n v U to I� •ral u q a O •-• r-1 t I V N IJ u u r-I JJ U V o u u u C; 11 wl p . ' r 1 t? LI • , q p 0 1 I ' I r N u U u 14 1 ; N11 .t] • u q 3 U, v p l ) ti 1 � a o v r I u I n t •3 U a m ^] 4 u lJ tt �, q . I I] u a u q 1 ' I o O u N o u . I O U r! It - rl 11 r It b1 h d CI � i Q °' P, N 7 Z1 rt N U Y N 11 a tl . n q f l rl d p1 Ip •rt p nl a d Z t " . t u ( r v u u It t .1) u ( I 6 I t� U II J+ + 1 q .fl I) l l P 11 u d C; • u �1 t4 >. C o ,U N p I, 11 u 0 3 ty 'S u U • 1 q 0 I rl t3 rl 11 p• r1 +f O •-I •rl •[I tf -r > 0 .. O » Id I ✓. lu r.l l' I U ) a • J U 11 1J w � U I] N I l� [. ' V CJ p' d .a r 11 V t1 ,CE V JJ j 'J O i' • 1 N 11 q 7 to qbql bt Vj 1 1 RI C n ,t ' U 0 •.i u V u int otl t �' 1 u �] uuq } w� uuu1u u03 .0 r�No- . 1Notyto ° q U G: • •• E •i 4 t0 U 71 KI Ip/ J • r ( 1 '• I 11 trl / ''� t1• • 1 � a� rl IT• { Q J II � •V t11 � I I � 1 N ;11 k" ;1 J . a' pu u 0 J al u 7 +� i) U vI ' J tJ I }. •. 1 n U ul o In y N 011 N 11 .1-1 u U Url l \ 1 L 0rI u L] u QQN [� A N t� U 11 ^I t r �1 . 1 }! INA oil • I • 0 tJl U L ' tl U .,-1 1 ! Cl 11 . 0 1.� }t 01 17 U p r U ll V EJ bj U U 4 N ' I ll I ► I III,I 0 •-1 iiilll (' U •rl 11 I� 'r 7r 1 � 1 U .rI W I C� V rl rl r••t •rl a I u u U ) , fi (101 '!~jr Ia ,�, '! ' U V n N r1 ' u u 11 d u L V yCN, t] 1 rl 0 U L U it ;I{]� ' d r E 3 0 L4 vi 1 1�{1I r� `� V �j tJ ' .� 11 t�o ` a t u L .Git % ,7� �1 '1 v 14 U ' u q 14 " i �1d1) tJ ;1I u �; d Vq til ,•' >, � u V U vt I u 1 ) m 0 U m pp 4 v d I i ►1 U 0 a. l� vl 1I t ' I Il Y, • r1 I v O O ► �t' a N N 11 1 Is > + U al 0 13 n v CI ttcc , I p; P L ' U 'd • rl Q] 5 O d 0 U H 'd ' d IQ 6! 1J �' . U [ , Id r� 1J >1 !J U 04 � o % U N N 11 I � 0 19 r7 C u l(; [' -1 0 ) Ir I It [ 0 11 7 D 'O 't1 p C7 u U 'd ro dJ id I jr-E in(Jt o `� 'r``t l i v I 1 1, u 0 m U (1 � i i E I 1 11�i 11 y of le P Sol 0 w 1 [N .d 11 ' . t o o F�+ • 1 }. U py tl t > r m U1 ► 1 U Cpl b ) {� 1 !US II j u u tl E m a rl VI u r ' tl Sol 1 E I t1 1 II %A ► I u Ito � ) ti U 11 . V " t I I 1 . q . I '• 7! i1 ?+ 1 C U tx v1 it t - I q o U u I , O Q u r' N y t � a •tI 7 � , at 0 I+ (i It I) [�� • I rpI qu > xd I tor1I� U) 0 I � ) 11 4 , n 1 + o + C . - , 11 • { 1 n IA 'tJ tt I]. t - I (. 1 i i �l vUi tl n BOYS GIRLS = UZ OF = 1;I u S2tIr�= � ~ yU : kap �y pe= soa ahcae ^ ? ^❑ and ChCWZL in he==.i= of Chis iecce = _ '- ' u5tt� 2 � Gi :ar 8 : = C . cc -. z : Bovs & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee ORGANIZATION , Bovs & Girls Clubs of Indian River County. Inc PROGRAM: South County Branch TABLE OF CONTENTS Please ' X " the parts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Proposal Page # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A . ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 . Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 Be PROGRAM NEED STATEMENT (one page maximum) X 1 . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) • X 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Staffing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D . MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . 8 X E. COLLABORATION (one page maximum) . . . . . . . . . . . . . . . F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . Measures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X 3 . Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 X G. TIMETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 H. UNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1 Boys & Girls Club of Indian River County, Inc. - South Countv Branch Grant Application to the Children ' s Services Advisory Committee I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 3 . Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 X 4 . Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . 22 X 6 . Explanation for Variances — Funder Specific Budget , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS (Copied once in White for all three programs submitted to CSAC for funding . ) J- 1 X 1 . List of current officers and directors 2 . Latest Financial Audit Report & Management Letter that conforms with the J- 2 X AICIP Audit GUIDE X 3 . Most recent IRS Form 990, including all schedules J- 12 4 . Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating J-30 X Budget X 5 . Staff Organizational Chart J- 31 X 6 . Cost Recent Annual Report (if available) J- 52 X 7 . 501 (C) (3 ) IRS Exemption Letter J- 53 X 8 . Articles of Incorporation J- 57 X 9 . Agency ' s Bylaws J-64 X 10 . Agency ' s written policy regarding Affirmative Action J- 79 X 11 . Proof of Goals and Outcomes Workshop Attendance J- 80 K. APPENDIX (Copied once in White for all three programs submitted to CSAC for funding . ) X 1 . NOT FOR PROFIT AGENCY CERTIFICATION K- 1 X 2 . Indian River County Authorization for Release of Information K- 2 X 3 . Sworn Statement K- 3 X 4 . Proof of Liability Insurance K- 6 2 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee PROGRAM COVER PAGE Organization Name : Boys & Girls Clubs of Indian River County, Inc . Executive Director : Leisa Smith-Fulton Email : LeisaSmith@juno . com Address : P . O . Box 3068 Telephone : (772 ) 299- 7449 Vero Beach, FL 32964 Fax : (772) 299-3840 Program Director : Tony Ross Email : mrross001@hotmail . com Address : P . O . Box 3068 Telephone : ( 722 ) 299- 7494 Vero Beach, FL 32964 Fax : (772 ) 794- 3903 Program Title : South County Branch Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program : Taxonomy Definition for Boys/Girls Clubs - PS - 980 . 1 Prowarns that provide a wide tan= of su=vised regional activities and ddmgg ngy prevention services for children and youth of all ages and backoutmds but particA.iladv for disadvantaged youth throtrgll membership in boys and/or girls clubs. Club members are entitled to use re=ational facilities and may have access to Cmunselim tutorial services, employment assistance, wing pro tams, drug abuse and alcoholism prevention and other activities and services that dnW their enemies toward positive social goals and facilitate healthy pecsonality development • Amount Requested from Funder for 2003 /04 : 30 , 000 Total Proposed Program Budget for 2003 / 04 : S 1521405 Percent of Total Program Budget : 19 . 7 % Current Funding (2002 / 03 ) : $ 301000 Dollar increase/( decrease) in request : S _ Percent increase/ ( decrease ) in request : 0 . 0 % Unduplicated Number of Children to be served Individuallv : 375 Unduplicated Number of Adults to be served Individually : 100 Unduplicated Number to be served via Group settings : 470 Total Program Cost per Client : 170 . 28 Will these funds be used to match another source ? No If yes . name the source : Amount : The Organization 's Board of Directors has approved this application o te). 5 - 14-2003 y Ja McNamara 7 Z - ' Z Name of President/Chair of the Board < Signature Leisa Smith-Fulton Name of Executive Director/CEO Signature Boys & Girls Club of Indian River County. Inc. - South County Branch Grant Application to the Childr:n s Services 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 . Mission Statement: To inspire and enable all young people, especially those from disadvantaged circumstance to realize their full potential , as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach servicesin Indian River County with quality programs and staff. F Provide a brief summary of your organization including areas of expertise, accomplishments and population served . e Boys & Girls Club of Indian River County offers a diverse, affordable program to kids in a positive atmosphere . Our daily after- school and summer programs offered through our " Club" house locations and our outreach services provided through our Youth Volunteer Corps program allows us to serve over 2, 000 children annually . These program activities attract and rnairtain Young people 6 through 18 years of age who pay a nominal membership fee of $ 5 . 00 for the school term and $ 30 . 00 for the summer (which includes a free Boys & Girls Club t- shirt) . Nowhere in the Indian River County area can kids or parents find such a bargain ( While our method of program delivery may change with seasonal activities, or school related endeavors, � . the core of what and how we conduct daily activities remains much the same . The overall Boys & Girls Club program structure can be divided into "Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. Again, these specialized services allow our Club facilities, outreach programs and staff to attract and maintain the interest of youth members ages 6 - 18yrs . The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to I achieve success in a career and life in general . • Character and Leadership Development . . . empowers youth to support and influence their Club and community, sustain meaningful relationships with others , develop a positive self- image, participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well - being, set personal goals and live successfully as self- sufficient i adults . j • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts, crafts. performing arts and creative writing . • Sports . Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress management, appreciation for the environment and social skills . -I Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Adtiisorc- Committee B . PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 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. a) Limited access to affordable after school programs for school age children 6 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change . b ) We define those in need as children between the ages of 6 years old that have completed kindergarten through 18 years of age, with a special interest in working with disadvantaged youth . We define disadvantaged youth as children from low economic status, one- parent families and latch key kids . c) Through our South County Branch, located at 683 27h Avenue S . W . , we mainly serve children who live within close proximity or who attend Thompson Elementary, Highlands Elementary, Oslo Middle and Vero Beach High School . d) According to the Indian River County School District 63 % of the children that attend Thompson Elementary School qualify to receive free and reduced lunch . -- Additionally, Thompson Elementary, Oslo Middle and Vero Beach High School are considered " C" rated schools according to the Florida Comprehensive _-assessment Test (FCAT) I standards . -- Indian River County statistics from the FL Department of Juvenile Justice Bureau of Data and research conclude that 7% of all 10- 17 year olds have been referred to the juvenile justice system during 1999 & 2000 . 2 . a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under- serving the targeted population of your program . a) No other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club , for children 6 - 18 years of age with year round drop in services Monday — Friday. For every child the Boys & Girls Clubs serves_ our _youth development activities are designed to build the following traits : • Positive self- identity . A healthy self-concept, a strong belief in one ' s self-worth. and a sense of hope about one ' s future . • Educational, employment, social , emotional and cultural competencies . The knowledge, skills, strategies and attitudes necessary_ to have a positive foundation for success . • Community and civic involvement . A sense of belonging to community, family and/or group ; willingness to take civic responsibility . • HeaIth and well- being . Living a healthy lifestyle, taking part in regular fitness j activities, able to access health care resources and engase in positive behaviors . 0 Moral compass . Youth have values enabling them to develop positive relationships with others . b ) Our target population is underserved by other programs for the following reasons : j affordability, accessibility and scope of services . 5 Boys & Girls Club of Indian River County. Inc. - South Countv Branch Grant Application to the Children ' s Services Advisory Committee C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed . Mental Wellness Issues & Childcare Access 2 . Briefly describe program activities including location of services . Boys & Girls Club programs are designed to meet members ' needs and provide them with a diverse range of activities that spark their interests, offering attractive alternatives to getting into trouble . They increase educational achievement, develop tolerance and build character. They are carefully researched, designed and field-tested . They are continually assessed and evaluated so we know they are working . Daily drop in hours are provided through our South County Branch located at 683 27th Avenue, Monday — Friday after school till 8 p . m . and during winter, spring and summer breaks from 8 a. m . — 6 p . m . Specific scheduled programs are offered in each five core area as follows : • CHARACTER AND LEADERSHIP DEVELOPMENT : Youth of the Year, TEENSupreme® Keystone Clubs and Torch Clubs • EDUCATION AND CAREER DEVELOPMENT : Project Learn : The Educational Enhancement Program, Goals for Graduation, POWER HOUR The Ultimate Journey, JOB READY ! , Goals for Growth, Junior Staff Career Development. CareerLaunch, Skill Tech : A Club Tech Basic Skills Program • HEALTH AND LIFE SKILLS : SMART Moves ( Skills Mastery and Resistance Training) , SMART Leaders, Family Advocacy Network (FAN Club, SMART Girls, Passport to Manhood, Act SMART and Child Safety and Protection • THE ARTS : Fine Arts Exhibit Program, ImageMakers : National Photography Program • SPORTS , FITNESS AND RECREATION : FITNESS AUTHORITY® • SPECIALIZED PROGRAM INITIATIVES : The Diversity Initiative & Family Support program . 3 . Briefly describe how your program intends to address the stated need/problem . Include reference to any studies or evidence that indicate proposed strategies are effective with target population. After- school programs keep kids safe, help working families and improve students ' academic achievement by providing critical opportunities for youth to learn and grow . • Students in quality after- school programs have better academic performance, behavior and school attendance and greater expectations for the future (US Departments of Education and Justice, 2000) . • Students who spend 1 - 4 hours per week in extracurricular activities are 51 percent less likely to have used drugs (Department of Health and Human Services . Adolescent Time Use, Risky Behavior and Outcomes : An Analysis of National Data . Washington D . C . , 1995 ) . • After- school programs in high crime areas can cut by as much as 3 /4 the high school student ' s risk of becoming involved in crime . And being supervised after school cuts in half the risk that middle school kids will smoke, drink, or abuse drugs, and reduces teen pregnancy as well . (National Center for Juvenile Justice, OJJDP , Wash . , D . C . 1997 . ) • The effectiveness of Boys & Girls Clubs has been proven repeatedly . A Louis Harris survey of Club alumni concluded that Clubs help young people grow into productive citizens . The survey revealed the firm conviction on the part of alumni that Club membership had a 6 Boys & Girls Club of Indian River County, Inc. - South County Branch Grant Application to the Children 's Services advisory Committee Fpositive effect on their lives , provided the skills necessary for leadership , improved their relationships with others and influenced success in later life . e Carnegie Corporation ' s report, A Matter of Time : Risk and Opportunity in the Non-School Hours, underscores the importance of community environment and institutions in contributing to the development of young people. The report emphasizes that the opportunity to make a positive I arises largely outside the structural academic environment . The report concludes that community- based youth development organizations such as Boys & Girls Clubs represent a valuable national resource with considerable untapped potential . 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) . 1_ full time Director of Operations — with a Bachelors in Human Services with a minimum of three years working in the non profit sector, dedicating 25 % of his/her time in program support, evaluation & staff training . 1 full time Branch Director — with a Bachelors in Human Services with a minimum of three I years experience working with youth, dedicating 100% of his/her time in planning, coordinating and directing the daily program at the Club . 1 full time Program Director — with an Associates Degree or equivalent with a minimum of three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and implementing the daily program at the Club . 1 part time Program Specialist & 2 Americorps Team Leaders — with a High School Diploma, working towards college degree with demonstrated capability in working positively with youth, dedicating 100 % of his/her time in providing onsite supervision of YVC and teen members conducting community service projects within the Club . i Volunteers - Demonstrated capability in working positively with youth . As many as we can j get, dedicating specialized program opportunities for Club members . 5. How will the target population be made aware of the ro ram9 p g All staff associated with the South County Branch will distribute flyers throughout Thompson i Elementary, Oslo Middle School and Vero Beach High School to promote involvement in the Club program . Word of mouth from members seems to be our biggest method in informing our target audience about our program . 6 . How will the program be accessible to target population (i. e. location , transportation , hours of operation ) ? Boys & Girls Club programs provide access to its members by locating Club House facilities within walking or bike riding distance from our members . Currently , the School District of Indian River County offers transportation from Thompson Elementary and Oslo Middle School everyday after school . Our school year hours are Monday — Friday from 2 : 30 PM to 8 : 00 PM . During the summer and non- school days, we are open from 8 AM to 6 PM 7 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee D. FY03-04 MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) FY03-04 OUTCOMES ACTNITIES Add all the elements for the Measurable Outcome(s) ,-add the tasks to accomplish the Outcome (s) I . To maintain an average daily attendance of . Distribute Membership Recruitment Flyers enrolled boys & girls Club members 100% in the schools to announce after school (75 ) as reported by the 2003 -2004 year end program in the beginning of the school year average daily attendance totals . Baseline : and summer programs at end of the school 2002 -2003 average daily attendance totals . year. • Offer membership fees at $ 5 . 00 a school year and $ 30 a summer. 0 Provide transportation after school through Indian River County School District to the Boys & Girls Club . 0 Offer Youth Service Activities once a week that guide and foster a greater i understanding and appreciation for j diversity among Club members ages 6 - 18 . 2 . To decrease juvenile crime rates of enrolled e Provide daily diversion activities at the j 10 - 17 year old Club Members to less than Club to channel youth energies into a 3) % compared to non-club members which is positive direction . Games room 7% as reported by the 2000 - 2001 juvenile tournaments and out door playground arrests . Baseline : 2000-2001 Indian River activities will be offer to initially spark County statistics from the FL Department of members interest . Once a rapport is built Juvenile Justice Bureau Data. (7% of all 10- with our members , staff will encourage 17 year olds) referred to the juvenile justice participation within our five core program system . service area . • Nominate eligible, deserving 14 year olds as Youth of the Month . Nominees will be requested to complete a nomination form to be judged to determine the organizations Youth of the Year. I • Implement a Keystone Club for members 14 — 18 years that will meet a minimum of once a month . • Implement a Torch Club for 11 - 13 year olds that will meet a minimum of once a month . • Create a Passport to Manhood program for 11 year old boys & up that will meet once a week for 8 weeks . • Implement the SMART Moves program for all age groups that will be offered on a weekly basis . • Implement a SMART Girls program the I will be offered weekly , for girls ages 10 - s Boys & Girls Club of Indian River County. Inc. — South Countv Branch Grant Application to the Children ' s Services Advisory Committee T 5 . The program is designed to encourage ealthy attitudes that will enable early dolescent girls to develop to their full otential . • Implement a Child Safety & Protection Program that will meet once a week for 8 weeks . • Implement a violence prevention program that meets once a week for 12 weeks in collaboration with Safe Space . • Implement an anger management and conflict resolution program that meets once a week for 8 weeks in collaboration with Safe Space . 3 . Increase/improve grade and skill levels of n . Provide daily Homework Help, Reading & less than 20% of Club members Math skills enhancement activities, One- participating in its South County - Power On-One and Group Tutoring, POWER Hour program by grants end June 30 , 2004 . Pages and POWER Point activities during Baseline : I ' quarter school grades the school year. compared to 4th quarter grades . . Establish good grades parties quarterly to celebrate improvements in school performance . • Meet with school officials to identify those members who are failing and provide additional homework and tutoring support . • Implement a peer leader homework and tutoring program 5 days a week during the school year. • Establish a Goals for Graduation program that meets one a week for 12 weeks . • Establish a Goals for Growth program that meets once a week for 8 weeks . • Create a Job Ready program that will be offered during the summer . • Create a Career Launch program that will be offered year round to teenagers accessing the web at the Boys & Girls Club . • Provide daily access to computers to improve technology competency levels . • Provide daily access to the Advance Learning Systems software in order to im rove FCAT com etencies . 9 Boys & Girls Club of Indian River Countv, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters . ) Collaborative Agency Resources provided to the program Indian River County School District Transportation after school from Thompson Elementary_ and Oslo Middle School to the Boys & Girls Club . Ager school snacks and summer lunch program . Art instruction, supplies, place to host exhibits and Center for the Arts museum in the basket series . Co -ordinate mentoring opportunities, encourage Youth Youth Guidance Guidance participants to become members of the Boys & Girls Club and promote Mentor and Mentees to meet at the Boys & Girls Club . Coordinate and administer the Value Visits program . Jr . League & Exchange Club Provide an on site councilor and arrange for sheriffs CASTLE deputy or officer to be on premises during non-custodial visitations . Provide instructors to conduct conflict resolution, Safe Space domestic violence and anger management sessions _ Indian River County Sheriff' s Will match members with juvenile arrest to help us I Department determine % of members participating in juvenile crime . Volunteers to conduct troops at the B & G Club once a Girl Scouts week . 10 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children ' s Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements ) will you need to collect in order to accurately describe your target population including demographics (age, gender and ethnic background) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their " unacceptable condition requiring change " from Section B19 Each participant will be required to fill out a membership application that is manually entered into a computer software program called "Child Tracking" , which allows us to electronically maintain a database on each member that includes demographic, age, gender, race, family economics, daily attendance, and activities participated in . Are target population is tracked by age . We are able to track our special interest in serving disadvantaged youth by asking and collecting the following : • Does your child receive free or reduced lunch ? (Asked to determine low economics) . • Who does your child live with ? (Asked to determine single parent family status) . • We collect report grades on a quarterly basis . • We submit our membership list to the Sheriff' s Department to determine Juvenile arrest . c) Limited access to affordable after school programs for school age children 6 — 18 years of age, low economics , juvenile crime and below average academic achievement is the condition requiring change . 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 ? • Membership Applications are collected upon registering for the program . Membership renewal applications are updated continuously throughout the year, with the bulk registering the beginning of the summer and the beginning of the school year. • Daily average attendance is collected by counting the number of members that attend daily divided by the numbers of dav_ s of service . Results are maintained and available on a monthly basis . • Club Activities are collected daily to track members participation in the various activities that are offered throughout the day . • Pre and Post Surveys are distributed prior to all drug, alcohol and teen pregnancy prevention programs to measure the knowledge gained through participation in our SMART Moves programs . • Juvenile Crime Rates will be collected by providingthe Indian River County Sheriff' s 11 Boys & Girls Club of Indian River Countv, Inc. — South Countv Branch Grant Application to the Children ' s Services Advisory Committee Department with the names of all children enrolled in the program . The Sheriff s Department will then notify us regarding the number of members arrested . Comparisons can be ran on an as need basis . School Achievement will be measured by collecting report card data and providing a comparison of grades from quarter to quarter. A baseline will be established the 1St quarter of each year and compared to results at the end of the year. • Parent & Member Surveys will be distributed to each parent & member in April to evaluate services being delivered . • B & GCA Outcome Measurements Tool every member is encouraged to enter a baseline survey upon registering for the program . Ongoing surveys are administered each year . 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 ? All data collected will be compiled and presented to all funders and contributors in order to present our agencies positive impact on the community. 12 Boys & Girls Club of Indian River County, Inc. — South County Branch Grant Application to the Children' s Services Advisory Committee G. TIMETABLE (Section G not to exceed one page) 1 . List the major action steps , activities or cycles of events that will occur within the program year. New programs should include any start- up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Action Steps Time Frame Develop Program Budget for February January 2003 Approval Write and Prepare United Way Grant March 2003 Distribute Parent & Members Surveys April 2003 Start Registering Summer Members May 12 , 2003 Develop Summer Program Schedule that May 2003 incorporates all the National Programs mentioned in section C3 . Write, Prepare and Submit Children ' s Services May 2003 • Advisory Committee Grant Summer Staff training & Building June 2 — 61 2003 Maintenance Vt Day of Summer Program for the South June 9 , 2003 County Branch offer hours Monday — Friday 8 a . m . — 6 p . m. Start registering Members for School Year August 2003 before summer program Program . concludes . Develop School Year 2003 - 2004 Program August 2003 Schedule that incorporates all the National Programs mentioned in section C3 . School Year Staff training and Building August 2003 Maintenance i Evaluated Boys & Girls Club Program November, February, May . August . Utilizing Commitment to Quality 4 times a year . • 13 v) v) 00 00 1 ON 00 71' a V F .r �•�1 y+ D 00 f 1 o t v Via:><::::. . . `n `nCN UN kr) b�1D O O t •�V N N W • y 00 00 Cd 00CQ A � ads V A � o C7 .G 0 un cu v PC° a N ItTN Alt w o �.• a4mo -a INA " _ _ w V > > p b Co o as -- . � o a �••7 �r 00 rn cu Q �Y b b a U aCd a ° -• In cncd C F ' Z (n 1 . 11 c� 0 4 ti w 0 W O .n o 0 Boys Gids Club of Indian River County, Inc. — South County Branch Grant Application to the Children Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET 1ASTANT: The Budget Narrative should provide details to justify the amount requested in each line item of the budget for your program. From this worksheet, your figures will be linked to the Total Agency Budget, Total Program Budget and Funder Specific Budget Forms. AGENCY/PROGRAM NAME . Boys & Girls Clubs of Indian River County/South County Branch FUNDER : Children Services Advisory Committee I CAUTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I Abe used forcalculations and to write information only. GRAY ARM FOR REVENUES AGENcruSE ONLY Proposed Total Program Funder Specific Tota/ Agency (SHOW DETAIL t Bud et DALOtnATloRsj 9 Budget Budget. 1 Children 's Services Council-St. Lucie 2 Children 's Services Council-Martin 3 Children's Services Council-Okeechobee 4 Advisory Committee-Indian River 30 , 000. 00 30 ,000.001 130, 000.00 5 United Way-St. Lucie County 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County 60 ,000.00 174, 000.00 9 Department of Children & Families 10 County Funds I Individuals< - $155,000, Civic Groups ,- $13,000, i i Foundations .-, $10,000, Corporations - 11 Contributions-Cash $451000 i 223 ,000. 00 12 Program Fees News Letter - I $713001 Golf I Tournament' $20,000, Steak &:Stake' $30,000 Outside Fundraisers $22 ,000, Mail ' Apeals - ! 13 Fund Raising Events-Net $35;000 80 , 700 . 00 Vending 14 Sales to Public - Net Machienes 300.00 400.00 Membership ,- ($5 school Year; $30 Summer)', t 15 Membership Dues shirts - $5 ea. 41900. 00 16 , 550.00 16 Investment Income Exchange Club Rent - $300 per 17 Miscellaneous month 3 ,600 .00 31600.00 18 Legacies & Bequests FLDOE - $44,000; JICSL $25,000, Jr, 19 Funds from Other Sources League - $6;500 30 ,333 .001 ; 75 , 500.00 5T7/2003 45 i 1 • . 1 • • � . . .0 / / 1 / 1 / : 1 11 i • I ' 11 '. 1 1 / 1 / 1 '. 1 / 11 s EXPENDITURES PtOPose&TotalO 6 • • - • • • - s s s -Salaries - (must . . - n a •complete _ on - page) : 11 11 11 11 Total - 0.0765 1 / : 1 1 / • Life/Health - Medical/Dental/Short-term Disab . • • • - • - tile, • _ _ _ • 111 111 t / • • - 111 • _ - 11 1 11 • 1 • / / SALARIES _ I POSITIONLISUNG • Pardon• ♦ . _ ry onPropased % of Gross Annual Specific :Budget Program Position I I hrs AND= I e1r / 1 eoa r / Director of Operations/40 hrs1111111111 , Branch Director/40 : 1111 ; Program Di - • • / hrsSummer 1111 1111 111 ' , Program S • - _ • 1 hrs11 1 / 111 ' , Amencorp Team Leader/32 hrs FARM M11 I sell Americorp Team Leader/32 hrs . r 1 emaining positions throughout the agency Total Salaries o • . - ntCompens. . - 11 / / 11 Director of Operations/40 hrs Branch Director/40 hrs Immer Program Specialist/40 hrs Americorp Team Leader/32 hrs Americorp Team Leader/32 hrs Sonora 11 1 11 / 1 / i:;:::a=::2::::::i:? ::;ii; :: ; =::i::: :: :::i= 1111 '• / / / . / / / / / 1 111 EXPENDITURESD Proposed • • • rarn Funder speciric otal Agency Budget 11 / / • / 1 11 • MENEM • • 1 Estimated Daily Travel/Mileage Reimb. oil, ravel/Conferences/Training . . • . "" !�atiOnal d�onference (cost per staff) Training/Seminar (cost • - to invest 5% of,ian . Other • (costof • • . 1 Uffice Suppilles Office su • e • - • • - - • • • / / 1 - • 1 / / 11 11 - 11 1 / Boys Girls Club of Indian River County, Inc - South County Branch Grant Application to the Children Services Advisory Committee • Quarterly Newsletter ($ x 4) organizations • Letterheads, Envelopes, etc. printing is • Fundraising materials divided over all • Other agency programs. 114 36 Subscription/Dues/Memberships BGCA :Dues - 200 .00 • Membership to National Organization $3,326, FL Area 10. 115.00 • Dues Alliance !lues - $15W Notary, • Subscriptions to Newspapers/magazines, etc. Kiwani§ 37 Insurance 21685.00 14.763.p0 • Directors/Officers Liab. 6304 General Liability • Commercial/General Insurance . Vehicles • Bond Ins. Members • Auto Insurance Accident - 38 Equipment: Rental Bi Maintenance 1 .000. 00 200.00 • Copier lease ($ x 12 months) Computer • Meter lease ($ x 12 months) Maintenance • Copier Maintenance ($ x 12 months) RaisWs Edge • Computer Maintenance ( $ x 12 months) $3,700 "+ Copier Mai • Other ntenance $3,000:; 39 Advertising 250.00 1 .200.00 • Newspaper ads • Fundraising ads/promotions Recruitment for vacan1.cies - • Other (vacancies) $250 40 Equipment Purchases :Capital Expense 0.00 o . 00 • Computer/monitor (# x $ ) • Laser Printer 41 Professional Fees ( Legal, Consulting ) 0.00 0 . 00 • Legal advice ( estimated #hrs x $) • Consultant fees • Other 42 Books/Educational Materials 100.00 1 p • Books/videos • Materials ($ x staff) Booksltlideos 43 Food & Nutrition meals 300.00 soo_o0 • Meals ( # x clients x 5days x 50 wks) TreasureCoast Snacks from - • Snacks Food 'Bank 44 Administrative Costs 0 001 • Admin . Cost (% of total budget) 45 Audit Expense 2,000.00 9 . 104. 00 Independent Audit Review 46 Specific Assistance to Individuals 0.00 0,00 • Medical assistance • Meals/Food • Rent Assistance • Other 47 Other/Miscellaneous 1 , 140.00 0 . 389 . 00 • Background check/drug test Back ground' • Other checkt0rug test 48 Other/Contract 0 .00 • Sub-contract for program services 49 TOTAL EXPENSES $ 152 ,405. 00 $30. 680.25 $681 . 940 .00 smi2oas Boys Grs C[ of joo°w p1w Cy, if.0 - _VILf 1. n. �iBllGll ", &TAsoosim ro " CNWe S cesNMsory UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME: FY 01102FY 02/03 FY 03104 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (coL C-col. BycaL B REVENUES BUDGETED BUDGETED 1 Children's Services Council-4t Lucie 0.00 #aN/0! 2 Children's Services Council-Martin 0.00 #ON/0! 3 Children's Services Council-Okeechobee 0.00 #DN/0! 4 Advisory Committee-Indian River 48.458.00 1007000.00 1307000.00 30.00% 5 United Way-St Lucie County0.00 #DN/0! 6 United Way-Martin County0.00 #DN/0! 7 United Way-Okeechobee Countv0.00 #DN/0! a United Wa -Indian River County 80.000.00 136,000.00 1747000.00 27.94% 9 Department of Children & Families 0.00 #DN/0! 10 CountyFunds 0.00 #DN/0! 11 Contributions -Cash 132.222.00 1 264,900.00 223,000.00 -15.82% 12 Program Fees 940.00 0.00 0.00 #DIV/0! 13 Fund Raising Events-Net 56.799.00 699494.00 80,700.00 16. 13% 14 Sales to Public-Net 710.00 300.00 400.00 33.33% 15 Membership Dues 9.995.00 6,850.00 169550.00 141 .61 % 16 Investment Income 2.934.00 0.00 0.00 #DN/0! 17 Miscellaneous 1 .80o.00l 31600.00 31600.00 0.00% 1s Legacies & Bequests 0.00 0.00 #DIV/0! 1s Funds from Other Sources 96.924.00 127,977.00 75,500.00 -41 .01 % EEF - m -20a Reserve Funds Used for Operating 0.00 0.00 #DIV/0! lob in-Kind Donations (Not included i, focal) 1 .408.00 47,464.00 1087850.00 129.330/. 21 TOTAL 430.782.00 709, 121 .00 7037750.00 -0.76% EXPENDITURES 22 Salaries 183.135.00 3947936.00 3937527.001 -0.36% 23 FICA 27,773.00 26, 130.00 5.92% 24 Retirement 6.992.00 19,025.00 22,750.00 19.58% 25 Life/Health 14.318.00 28,126.00 31 ,619 .00 12.42% 26 Workers Compensation 2.524.00 9,730.00 9, 154.00 5.92% 27 Florida Unemployment 2.788.00 2,379.00 29404.00 1 .05% 28 Travel-Dail 897.00 748.00 1 ,900.00 154.01 % 29 Travel/Conferenc esfrrainina 7.169.00 22,752.00 11 ,500.00 X9.45% 30 Office Supplies 12.863.00 347655.0014,267.00 58.83% 31 Telephone 4.932.00 8,105.00 91580.00 18.20°/, 32 Postage/Shipping1 .441 .00 1 ,983.00 6q960.001 250.98% 33 Utilities 5.432.00 11 ,948.00 12,444.00 4.15% 34 iOccupancy ( Building8 Grounds ) 43.100.00 64,564.00 687838.00 6.62% 35 Printing & Publications 18.863.00 10,215.00 167500.00161 .53% 36 Subscription/Dues/Memberships 4.626.00 3,573.00 10, 115.00 183.10% sl Insurance 8.235.001 11 .015.001 14,763.00 34.03% 38 Equipment: Rental & Maintenance 115.001 0.00 7,200.00 #DN/0! Advertisin 546.00l 11200.00 1 ,200.001 0.00% 40 Equipment Purchases : Capital Expense 9.048.00 0.00 0.001 #DIV/0 ! Al Professional Fees Le al, Consulting ) 0.00 16,670.00 0.001 -100.00% 42 Books/Educational Materials 2.883 .00 2.000.00 19000.00 50.00% 43 Food & Nutrition 497.00 600.00 600.00 0.00% 44 Administrative Costs 0.00 #DIV/0 ! 45 Audit Expense 4. 190.001 67000.00 91100 .00 51 .67% 46 5 ecific Assistance to Individuals 0.001 0.00 F 0.001 #DIV/0 ! 47 Other/Miscellaneous 21 .962.001 14.327.00 10,389.00 -27.49% 48 Other/Contract 0.00 0.00 0.00 #DIV/0 ! a9 TOTAL 356.556.00 692,324.00 681 .940.00 -1 .50% 50REVENUES OVER/ UNDER EXPENDITURES 74.226.00 16,797 .00 21 ,810.00 29.84% • % 2;12003 s SOY5 G $ CW of 1"an River I.oV 4m- - SoI Cov Brancn Gran Awocanm to Te ChWen S c°s Pd Comm"" UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCYIPROGRAM NAME: FY 01 /02 FY 02/03 FY 03104 °/, INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B =BUDGETED D ACTUAL TOTAL 1COL CKW. B!/cal. a REVENUES BUDGETED 1 Children's Services CouncilSt Lucie 0.001 #DIV/O! 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Children's Services Council-Okeechobee 0.00 #13IV/0! a Advisory Committee-Indian River 25,467.00 30,000.00 30 ,000.00 0.00% s United Way-St Lucie Coun 0.00 #DIV/0! 6 United Way-Martin County 0.001 #DIV/O ! 7 United Way-Okeechobee County 0.001 #DIV/O! a United Way4ndian River Countv60,000.001 54,000.001 60,000 .001 11 . 11 % 9 Department of Children & Families 0.00 #DIV/0! IC Coun Funds 0.00 #DIV/0! 11 Contributions-Dash 61252.00 0.00 0.00 #DIV/0 ! 12 Program Fees 495.00 0.00 0.00 #DIV/O ! 13 Fund Raisin Events-Net 0.00 #DIV/01 14 Sales to Public-Net 692.00 300.00 300.00 0.00% 15 MembershipDues 69134.00 4,350.00 49900.00112.64°I° 1s Investment Income 17 Miscellaneous 0.001 #DIV10 ! 300.001 31600 .00 3,600 .00 0 .00% 19 Legacies 8, Bequests 0.00 #DIV/0! 19 Funds from Other Sources =102,776.00 69,810 .00 307333 .00 56.55% 20a Reserve Funds Used for Operating 0 .00 #DIV/0! 20b In-Kind Donations (Nwn°x,d°dnt«aq 0 .00 16,635.00 #DIV/0! 21 TOTAL 1621060.00 129,133.00 -20.32% EXPENDITURES 22 Salaries 589503.00 99,500.001 81 , 118.00 -18.47% 23 FICA 5178.00 7,612.00 5,281 .00 30.62% 24 Retirement 21500.001 __ 4v525.001 49750.00 4.97% 25 Life/Health 67938.00 12,970.001 9,466.00 -27.02% 26 Workers Compensation - 536.00 21667.00 1 ,850.00 30.63% 27 Florida Unemployment 0 .00 819.001 635.00 -22.47% 28 Travel -Daily 117.00 200.001 700.00 250.00% 29 Travel/Conferences/Training 11264.00 4y231 .001 2,750.00 35.00% 30 Office Supplies 47886.00 117395.00 3,576.00 -68.62% 31 Telephone 2,932.00 21676.00 2,520.00 5.83% 32 Posta e/Shi in 215.00 140.00 140.00 0 .00% 33 Utilities 4,547.00 4,608.00 1 59244.00 13.80% 34 Occupancy (Building & Grounds 26,121 .00 25, 108.00 25,200.00 0.37% 35 Printing8 Publications 21456.00 1 ,305.00W2,685.00 14.94% 36 Subscri tion/Dues/Membershi s 792.00 200.00 0.00% 371nsurance 3 ,113.00 4,053.0033 .75% 3a E ui ment Rental & Maintenance 0.00 0.00 0.00% 39 Advertisin 182.00 250.00 0 .00% 40 E ui ment Purchases :Ca ital Ex ense 0.00 0.00 #DIV/0 ! 41 Professional Fees Le al, Consultin 0.00 0.00 #DIV/0 ! az Books/Educational Materials 17817.00 19000.0-01- ,000.00 100.00 -90 .00% 43 Food 8 Nutrition 354.00 300.001 300.001 0.00% 44 Administrative Costs 0.001 0 .00 0.001 #DIV/0 ! 45 Audit Expense 0.001 21000.00 2,000.0010.00% 46 Specific Assistance to Individuals 0.00 0.00 0 .00 #DIV/0 ! 47 Other/Miscellaneous 1 ,708.00 10802.0011 , 140.00 36 . 74% 48 Other/Contract 49 TOTAL 0. 00 #DIV/0 ! 124, 159.00 1871361 .00 151 ,405.00 -19. 19% 50 REVENUES OVER/ UNDER EXPENDITURES .217383 .00 -25,301 .00 .22,272.00 -11 .97% 7rzom Boys Girls Ckb of Indian Rrver County, Inc. - South County Branch Grant Application to the ChWen Services A"sary Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET i PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER • A B c FY 03/04 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 22 Salaries 81 , 118 , 00 285500 . 00 35 , 13 % 23 FICA 5,281 , 00 2, 180 .25 41 .28 % 24 Retirement 41750.00 0. 00 0 , 00% 25 Life/Health 97466 . 00 0 . 00 0 , 00% 26 Workers Compensation 19850 .00 0 . 00 0 , 00% 27 Florida Unemployment 635. 00 0 . 00 0 ,00% 28 Travel-Daily700 .00 0 . 00 0 ,00% 29 Travel/Conferences/Training29750 ,00 0 . 00 0 ,00% 30 Office Supplies 31576 ,00 0 .00 0 , 00% 31 Telephone 29520 .00 0.00 0 .00% 32 Postage/Shipping Postage/Shipping140 ,00 0 .00 0 ,00% 33 Utilities 57244, 00 0 .00 0 , 00% 34 Occupancy (Building & Grounds 25,200. 00 0 .00 0 , 00% 35 Printing & Publications 11500 . 00 0 .00 0 ,00% 36 Subscription/Dues/Memberships 200 ,00 0000 0 .00% 37 Insurance 2 , 685.00 0. 00 0 ,00% 38 Equipment : Rental & Maintenance 11000000 0 . 00 0 , 00% 39 Advertising250 .00 0 . 00 0 , 00% 40 Equipment Purchases : Ca ital Expense 0900 0 , 00 0 , 00% 41 Professional Fees Legal , Consulting ) 0 , 00 0 . 00 0 . 00% 42 Books/Educational Materials 100 . 00 0 . 00 0 . 00% 43 Food & Nutrition 300000 0 , 00 0 , 00% 44 Administrative Costs 0 . 00 0 . 00 0 ,00% 45 Audit Expense 21000 . 00 0 , 00 0 ,00% 46 Specific Assistance to Individuals 0 . 00 0 . 00 0 . 00% 47 Other/Miscellaneous 11140 , 00 0 . 00 0 , 00% 48 Other/Contract 0 . 00 0 . 00 0 , 00% 4s TOTAL $ 152 ,405, 00 $ 30 , 680 ,25 $ 0 ,20 5272003 21 Boys GMs Cbub of IncYan RKw County. Inc. — South County Branch Gnats Appxcallon to Iho ChNben Sn 03 A@Asmy Conamaaa UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee #Deno! #DN/o! #DN/0! #DN/O! #DN/o! #DN/0! #DIV/0! #DN/0! #ON/0! #DN/0! #DN/o! #DN/0! #DIV/0! #DIV/O! #DIV/0! Travel-Dail Travel reimbursement for staff members was not suffient budgeted in revious years. #DIV/0! #DN/0! i#DN/O! #DIV/0! #DN/0! 5/27110x3 22 Boys Gins Clue of Indian River County, Inc. — SCIA11 County Bremen Grant Application to the C110dren Services Advisory Commmee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Boys & Gins Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee L7 777 Salaries I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FICA I I I I I I i i I I I I i I I • 5272003 23 Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this 1st day of October 2003 by and between Indian River County, a political subdivision of the State of Florida , 1840 25th Street , Vero Beach FL , 32960 ("County") and Boys & Girls Club of IRC , Inc . (" Recipient") ; of: (Address ) Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Attention : Sebastian Club 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 2003/2004 ("Grant Period") . The Grant Period commences on October 1 , 2003 and ends on September 30 , 2004 . - 1 - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Thousand Dollars ($ 30 , 000. 00) . 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 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 Reouirements Recipient shall , no later than September 23 , 2003 , 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 2 - 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 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. 3 - 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 CO NTY BOARD OF O NT COMMISSIO w By: neth R . Macht, Chairman Attest : J . K . Barton , Clerk By: Deputy Clerk Approved . ames Chandler, C unty Administrator ? ed as to form and legal su ncy : ell , Assistant le6unFy Attorney ` l RECIPIENT: Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 By: ame \ (� Title 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - 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 184025 th Street Vero Beach , Florida 32960-3365 Recipient : Boys & Girls Club of IRC , Inc . P . O . Box 3068 Vero Beach , Florida 32964 Attention : Leisa Smith - Fulton 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 . Entiretv 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 . Severabilitv: 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 - 1 - 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. 2 - Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee • ORGANIZATION . Boys & Girls Clubs of Indian River County. Inc. PROGRAM: Sebastian Branch TABLE OF CONTENTS Please ' .Y " dte pmts of the grant application to indicate they are included. Also, please put the page number where the information can be located. X Section of the Proposal Page # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Nfission and Vision of organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 X 2 _ Summary of expertise, accomplishments, and population served . . . . . . . . . . . . . . . . 4 B . PROGRAM NEED STATEMENT (one page maximum) X 1 _ Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C. PROGRAM DESCRIPTION (two pages maximum) X1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . . . . . . . V . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X4 . Stang . . . . w . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . 4 . . . 7 X 5 . Awareness of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 X D . NtEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 X E . COLLABORATION (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X1 . Demographics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X2 . %feasures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P . . . . M . . . . . . . . . . . . . . . . . . . . . . . 1 1 X3 . Reporting . . . w . . . . . . . w . . . . . m . . . . . m m . m m . . . . . . . . . . . . . w w . . . . . . . w w . . . . . . . . . . m . . . . . w . . . . . . m . . . 12 G. T04ETABLE (one page maximum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 H. tiNDUPLICATED CLIENT COUNT X 1 . Projections by Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 X 2 . Projections by Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 • 1 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant .application to the Children ' s Services ,advisory Committee I. BUDGET FORMS X 1 . Budget Narrative Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 X 2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 3 . Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 X 4 . Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 X 6 . Explanation for Variances — Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . w 4 . . . . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS (Copied once in White for all three programs submitted to CSAC for funding . ) J- 1 X 1 . List of current officers and directors 2 . Latest Financial Audit Report & Management Letter that conforms with the J- 2 X AICIP Audit GUIDE X 3 . Most recent IRS Form 990 , including all schedules J- 12 4 . Most recent Internal Financial Statement (i . e . : Balance Sheet and Operating J= 30 X Budget X 5 . Staff Organizational Chart J- 31 X 6 . Cost Recent Annual Report ( if available ) J- 52 X 7 . 501 (C ) (3 ) IRS Exemption Letter J- X 8 . Articles of Incorporation J- 57 X 9 . Agency ' s Bylaws J-64 X 10 . Agency ' s written policy regarding Affirmative Action J- 79 X 11 . Proof of Goals and Outcomes Workshop Attendance J- 80 K. APPENDIX (Copied once in White for all three programs submitted to CSAC for funding . ) X 1 . NOT FOR PROFIT AGENCY CERTIFICATION K- 1 X 2 . Indian River County Authorization for Release of Information K- 2 X 3 . Sworn Statement K- 3 X 4 . Proof of Liability Insurance K- 6 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant .application to the Children ' s Services Advisory Committee PROGRAM COVER PAGE Organization Name : Boys & Girls Clubs of Indian River County, Inc . Executive Director : Leisa Smith-Fulton Email : LeisaSmith@.juno . com Address : P . O . Box 3068 Telephone : (772 ) 299- 7449 Vero Beach, FL 32964 Fax : ( 772 ) 299-3840 Program Director : Alex Soares Email : n/a Address : P . O . Box 3068 Telephone : (722 ) 388 -4944 Vero Beach. FL 32964 Fax : ( 772 ) 388 - 0904 Program Title : Sebastian Branch Priority Need Area Addressed: Mental Wellness Issues & Childcare Access Brief Description of the Program : Taxonomy Definition for Boys/Girls Clubs - PS - 980 . 1 Promms that provide a wide range of wised recaieational activities and .de services for childterl and youth of all ages and bacicsrotlrtds. but particularly for disad�d youth thru igh membership in bM and/or girls clubs. Club members are erltifled to use recreadonal facilities and M have access to counseling tutorial services employment assistance gang pnWranu dnx abuse and alcoholism prevention and other activities and services that direct their enemies toward positive social goals and facilitate healthyxso development Amount Requested from Funder for 2003 /04 : $ 60 , 000 Total Proposed Program Budget for 2003 / 04 : $ 206 . 680 Percent of Total Program Budget : 29 . 0 % Current Funding (2002 / 03 ) : $ 30 , 000 Dollar increase/( decrease) in request : $ 30 , 000 Percent increase/ ( decrease ) in request : 100 . 00//o 11 Unduplicated Number of Children to be served Individually : 625 Unduplicated Number of Adults to be served Individually : 125 Unduplicated Number to be served via Group settings : 660 Total Program Cost per Client : 146 . 58 Will these funds be used to match another source '? No If ves , name the source : Amount : $ _ The Organization 's Board of Directors has approved this applica on (date) . 5 - 14-2003 Jav McNamara 2�2 Name of President/Chair of the Board ature Leisa Smith-Fulton Name of Executive Director/CEO Signature Bovs & Girls Club of Indian RiN y County. Inc. - Sebastian Branch Grant Application to the ChildrN s Services Advisory Committee PROPOSAL NARRATIVE A. ORGANIZATION CAPABILITY (Enure Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization . _Mission Statement : To inspire and enable all young people, especially those from disadvantaged circumstance to realize their full potential _ as productive, responsible and caring citizens . Vision : To accomplish our mission by establishing neighborhood clubs and outreach services in Indian River County with quality programs and staff. 2 . Provide a brief summary of your organization including areas of expertise, accomplishments and population served . j i The Boys & Girls Club of Indian River County offers a diverse, affordable program to kids in a positive atmosphere . Our daily after- school and summer programs offered through our " Club " house locations and our outreach services provided through our Youth Volunteer Corps program allows us to serve over 2, 000 children annually . These program activities attract and maintain young people 6 through 18 years of age who pay a nominal membership fee of $ 5 . 00 for the school term and $ 30 . 00 for the summer (which includes a free Boys & Girls Club t- shirt) . Nowhere in the Indian River County area can kids or parents find such a bargain ! While our method of program delivery may change with seasonal activities, or school related endeavors, the core of what and how we conduct daily activities remains much the same . The overall Boys & Girls Club program structure can be divided into `Five Core Service Areas" . Together, these core service areas provide a diverse base of activities designed to meet the needs and interests of every member. Again, these specialized services allow our Club facilities, outreach programs and staff to attract and maintain the interest of youth members ages 6 - 18yrs . The following Five Core program areas represent the Club ' s service offerings to its membership : • Education and Career Development . . . enables youth to become proficient in basic educational disciplines, apply learning to everyday situations and embrace technology to achieve success in a career and life in general . j • Character and Leadership Development . . . empowers youth to support and influence their I Club and community, sustain meaningful relationships with others, develop a positive self- image , participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . develops young people ' s capacity to engage in positive behaviors that nurture their own well - being, set personal goals and live successfully as self- sufficient adults . j • The Arts . . . enables youth to develop their creativity and cultural awareness through knowledge and appreciation of the visual arts. crafts. performing arts and creative writing . • Sports, Fitness and Recreation . . . develops fitness, positive use of leisure time, skills for stress j management, appreciation for the environment and social skills . 4 Boys & Girls Club of Indian River County. Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee B . PROGRAM NEED STATEMENT (Entire Section B not to exceed one page) 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. a) Limited access to affordable after school programs for school age children 6 — 18 years of age, low economics, juvenile crime and below average academic achievement is the condition requiring change . b ) We define those in need as children between the ages of 6 years old that have completed kindergarten through 18 years of age, with a special interest in working with disadvantaged youth . We define disadvantaged youth as children from low economic status, one-parent families and latch key kids . c) Through our Sebastian Branch, located at 250 Sebastian Blvd . we mainly serve children who live within close proximity or who attend Sebastian Elementary, Pelican Island Elementary, Sebastian River Middle, Sebastian Charter Junior High and Sebastian River High School . d) According to the Indian River County School District 46 % of the children that attend Sebastian Elementary, Pelican Island Elementary and Sebastian River Middle School qualify to receive free and reduced lunch . -- Additionally, Sebastian Elementary and Sebastian River Middle School are considered ` B " rated schools according to the Florida Comprehensive Assessment Test (FCAT) standards . -- Indian River County statistics from the FL Department of Juvenile Justice Bureau of Data and research conclude that 7% of all 10- 17 year olds have been referred to the juvenile justice system during 1999 & 2000 . 2. a) Identify similar programs that are currently serving the needs of your targeted population ; b) Explain how these existing programs are under-serving the targeted population of your program . a) No other program in Indian River County offers a dedicated youth facility, like the Boys & Girls Club , for children 6 - 18 years of age with year round drop in services Monday — Friday . For every child the Boys & Girls Clubs serves, our youth development activities are designed to build the following traits : • Positive self- identity . A healthy self-concept, a strong belief in one ' s self-worth, and a sense of hope about one ' s future . • Educational , employment, social , emotional and cultural competencies . The knowledge, skills, strategies and attitudes necessary to have a positive foundation for success . • Community and civic involvement . A sense of belonging to community, family and/or group ; willingness to take civic responsibility . • Health and well - being . Living a healthy lifestyle, taking part in regular fitness activities, able to access health care - resources and engage in positive behaviors . • Moral compass . Youth have values enabling them to develop positive relationships with others . b ) Our target population is underserved by other programs for the following reasons : affordability, accessibility and scope of services . 5 Boys & Girls Cub of Indian River Countv, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee C. PROGRAM DESCRIPTION ("Entire Section C, I — 6, not to exceed two pages) 1 . List Priority Needs area addressed. Mental Wellness Issues & Childcare Access 2 . Briefly describe program activities including location of services . Boys & Girls Club programs are designed to meet members ' needs and provide them with a diverse range of activities that spark their interests, offering attractive alternatives to getting into trouble . They increase educational achievement, develop tolerance and build character. They are carefully researched, designed and field-tested . They are continually assessed and evaluated so we know they are working . Daily drop in hours are provided through our Sebastian Branch located at 250 Sebastian Blvd . , Monday — Friday after school till 8 p . m . and during winter, spring and summer breaks from 8 a- m . — 6 p . m . Specific scheduled programs are offered in each five core area as follows : • CHARACTER AND LEADERSHIP DEVELOPMENT : Youth of the Year, TEENSupremeO Keystone Clubs and Torch Clubs • EDUCATION AND CAREER DEVELOPMENT : Project Learn : The Educational Enhancement Program, Goals for Graduation, POWER HOUR, The Ultimate Joumev, JOB READY ! , Goals for Growth, Junior Staff Career Development, CareerLaunch, Skill Tech : A Club Tech Basic Skills Program • HEALTH AND LIFE SKILLS : SMART Moves ( Skills Mastery and Resistance Training) , SMART Leaders, Family Advocacy Network (FAN Club , SMART Girls, Passport to Manhood, Act SMART and Child Safetv and Protection • THE ARTS : Fine Arts Exhibit Program- ImageMakers : National Photography Program • SPORTS , FITNESS AND RECREATION : FITNESS AUTHORITY® • SPECIALIZED PROGRAM INITIATIVES : The Diversity Initiative & Family Support program . 3 . Briefly describe how your program intends to address the stated need/problem . Include reference to any studies or evidence that indicate proposed strategies are effective with target population. After- school programs keep kids safe, help working families and improve students ' academic achievement by providing critical opportunities for youth to learn and grow . • Students in quality after- school programs have better academic performance, behavior and school attendance and greater expectations for the future (US Departments of Education and Justice, 2000) . • Students who spend 1 - 4 hours per week in extracurricular activities are 51 percent less likely to have used drugs (Department of Health and Human Services . Adolescent Time Use, Risky Behavior and Outcomes : An Analysis of National Data . Washington D . C . - 1995 ) . • After- school programs in high crime areas can cut by as much as 3 /4 the high school student ' s risk of becoming involved in crime . And being supervised after school cuts in half the risk that middle school kids will smoke, drink, or abuse drugs, and reduces teen pregnancy as well . (National Center for Juvenile Justice, OJJDP , Wash . , D . C . 1997 . ) • The effectiveness of Boys & Girls Clubs has been proven repeatedly . A Louis Harris survey of Club alumni concluded that Clubs help young people grow into productive citizens . The survey revealed the firm conviction on the part of alumni that Club membership had a 6 Bovs & Girls Club of Indian River County, Inc. - Sebastian Branch Grant application to the Children ' s Services Advisory Committee positive effect on their lives , provided the skills necessary for leadership, improved their relationships with others and influenced success in later life . The Carnegie Corporation ' s report, A Matter of Time : Risk and Opportunity in the Non-School Hours, underscores the importance of community environment and institutions in contributing to the development of young people . The report emphasizes that the opportunity to make a positive contribution arises largely outside the structural academic environment . The report concludes that community-based youth development organizations such as Boys & Girls Clubs represent a valuable national resource with considerable untapped potential . 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). 1 full time Director of Operations — with a Bachelors in Human Services with a minimum of three years working in the non profit sector, dedicating 25 % of his/her time in program support evaluation & staff training . 1 full time Branch Director — with a Bachelors in Human Services with a minimum of three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and directing the daily program at the Club . 1 full time Program Director — with an Associates Degree or equivalent with a minimum of three years experience working with youth, dedicating 100% of his/her time in planning, coordinating and implementing the daily program at the Club . 1 full time Technology Director — with a Associates/Bachelors in a Computer Technology with a experience training computer workshops, dedication 100% of his/her time in planning, coordinating and implementing the daily technology program at the Club . 1 part time Program Specialist & 2 Americorps Team Leaders — with a High School Diploma, working towards college degree with demonstrated capability in working positively with youth, dedicating 100% of his/her time in providing onsite supervision of YVC and teen members conducting community service projects within the Club . Volunteers - Demonstrated capability in working positively with youth . As many_ as we can get, dedicating specialized program opportunities for Club members . 5 . How will the target population be made aware of the program ? All staff associated with the Sebastian Branch will distribute flyers throughout Sebastian Elementary, Pelican Island Elementary, Sebastian River Middle School and Sebastian River High School to promote involvement in the Club program . Word of mouth from members seems to be our biggest method in informing our target audience about our program . 6 . How will the program be accessible to target population (i. e. location, transportation , hours of operation ) ? Boys & Girls Club programs provide access to its members by locating Club House facilities within walking or bike riding distance from our members . Currently, the School District of Indian River County offers transportation from Sebastian area schools everyday after school . Our school year hours are Mon. — Fri . from 2 : 30 PM to 8 : 00 PM. During the summer and non - school days, we are open from 8 AM to 6 PM. 7 Bovs & Girls Club of Indian River County. inc. - Sebastian Branch Grant Application to the Children ' s Servicrs Advisory Committee D . D- l . FY03- 04 MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) FY03-04 OUTCOMES ACTIVITIES Add all the elements for the Measurable Outcome (s) Add the tasks to accomplish the Outcome (sl 1 . To increase average daily attendance of . Distribute Membership Recruitment Flyers enrolled boys & girls Club members by 65 % in the schools to announce after school (from 75 to 125 ) as reported by the 2003 - program in the beginning of the school year 2004 year end average daily attendance and summer programs at end of the school totals . Baseline : 2002 -2003 average daily year . attendance totals (75 ) . • Offer membership fees at $ 5 . 00 a school year and $ 30 a summer . • Provide transportation after school through Indian River County School District to the Boys & Girls Club . • Offer Youth Service Activities once a week that guide and foster a greater understanding and appreciation for diversity among Club members ages 6 - 18 . 2 . To decrease juvenile crime rates of enrolled • Provide daily diversion activities at the 10 - 17 year old Club Members to less than Club to channel youth energies into a 3 % compared to non- club members which is positive direction . Games room 7% as reported by the 2000-2001 juvenile tournaments and out door playground arrests . Baseline : 2000- 2001 Indian River activities will be offer to initially spark County statistics from the FL Department of members interest . Once a rapport is built Juvenile Justice Bureau Data. (7% of all 10- with our members, staff will encourage 17 year olds) referred to the juvenile justice participation within our five core program system. service area. • Nominate eligible, deserving 14 year olds as Youth of the Month . Nominees will be requested to complete a nomination form to be judged to determine the organizations Youth of the Year . • Implement a Keystone Club for members 14 — 18 years that will meet a minimum of once a month . • Implement a Torch Club for 11 - 13 year olds that will meet a minimum of once a month . • Create a Passport to Manhood program for I 1 year old boys & up that will meet once a week for 8 weeks . • Implement the SMART Moves program for all age groups that will be offered on a weekly basis . • Implement a SMART Girls program the will be offered weekly , for girls ages 10 - 8 Bovs & Girls Club of Indian River County. Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee 15 . The program is designed to encourage healthy attitudes that will enable early adolescent girls to develop to their full potential . • Implement a Child Safety & Protection Program that will meet once a week for 8 weeks . • Implement a violence prevention program that meets once a week for 12 weeks in collaboration with Safe Space . • Implement an anger management and conflict resolution program that meets once a week for 8 weeks in collaboration with Safe Space . 3 . Increase/improve grade and skill levels of nc . Provide daily Homework Help, Reading & less than 20% of Club members Math skills enhancement activities, One- participating in its South County - Power On-One and Group Tutoring, POWER Hour program by grants end June 30 , 2004 . Pages and POWER Point activities during Baseline : I ' quarter school grades the school year . compared to 4`b quarter grades . . Establish good grades parties quarterly to celebrate improvements in school performance . • Meet with school officials to identify those members who are failing and provide additional homework and tutoring support . I • Implement a peer leader homework and tutoring program 5 days a week during the school year. • Establish a Goals for Graduation program that meets one a week for 12 weeks . • Establish a Goals for Growth program that meets once a week for 8 weeks . • Create a Job Ready program that will be offered during the summer. 4 . Establish Technology skills base line that . Create a Career Launch program that will measures member proficiency levels on the be offered year round to teenagers Computer at the beginning of the grant year . accessing the web at the Boys & Girls Outcome will be developed to show an Club . increase in skill level by end of grant term . Provide daily access to computers to June 30 , 2004 . Actual percentage of improve technology competency levels . increase will be determined after one . Provide daily access to the Advance funding cycle . Learning Systems software in order to im rove FCAT com etencies . 9 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee E. COLLABORATION (Entire Section E not to exceed one page) 1 . List your program ' s collaborative partners and the resources they are providing to the program bevond referrals and support. [NOTE : Collaborative agreement letters are not required by United Way of Indian River County. ] I Collaborative Agency Resources provided to the program Indian River County School District Transportation after school from Sebastian Elementary_ Pelican Island Elementary, Sebastian River Middle, SebastianCharter School and Sebastian River High School to the Boys & Girls Club . After school snacks and summer lunch program . Art instruction, supplies , place to host exhibits and Center for the Arts museum in the basket series . Co -ordinate mentoring opportunities , encourage Youth Youth Guidance Guidance participants to become members of the Boys & Girls Club and promote Mentor and Mentees to` mee: at the Boys & Girls Club . Provide instructors to conduct conflict resolution, Safe Space domestic violence and anger management sessions . Indian River County Sheriff' s Will match members with juvenile arrest to help us Department determine % of members participating in juvenile crime- Healthy Start Coalition Instructors to deliver a fatherhood preparation class - i Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children' s Services Advisory Committee F. PROGRAM EVALUATION (Entire Section F not to exceed two pages) 1 . DEMOGRAPHICS : What information (data elements) will you need to collect in order to accurately describe your target population including demographics (age, gender and ethnic background ) required by the funder in Section H? What are the pieces of information that qualify them for your target population ? How do you document their need for services or their "unacceptable condition requiring change" from Section B19 Each participant will be required to fill out a membership application that is manually entered into a computer software program called "Child Tracking" , which allows us to electronically maintain a database on each member that includes demographic, age, gender, race, family j economics, daily attendance, and activities participated in . Are target population is tracked by age . We are able to track our special interest in serving disadvantaged youth by asking and collecting the following : • Does your child receive free or reduced lunch ? (Asked to determine low economics) . • Who does your child live with ? (Asked to determine single parent family status) . • We collect report grades on a quarterly basis . • We submit our membership list to the Sheriff s Department to determine Juvenile arrest . i c) Limited access to affordable after school programs for school age children 6 — 18 years of j age, low economics, juvenile crime and below average academic achievement is the . condition requiring change . I 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 i 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 ? ! • Membership Applications are collected upon registering for the program . Membership renewal applications are updated continuously throughout the year, with the bulk registering j the beginning of the summer and the beginning of the school year. • Daily average attendance is collected by counting the number of members that attend daily divided by the numbers of days of service . Results are maintained and available on a j monthly basis . • Club Activities are collected daily to track members participation in the various activities that are offered throughout the day . • Pre and Post Surveys are distributed prior to all drug, alcohol and teen pregnancy prevention programs to measure the knowledge gained through participation in our SMART ! Moves programs . • Juvenile Crime Rates will be collected by providing the Indian River County Sheriff s 11 Boys & Girls Club of Indian River County. Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee Department with the names of all children enrolled in the program . The Sheriff' s Department will then notify us regarding the number of members arrested . Comparisons can be ran on an as need basis . • School Achievement will be measured by collecting report card data and providing a comparison of grades from quarter to quarter. A baseline will be established the 1St quarter of each year and compared to results at the end of the year. • Parent & Member Surveys will be distributed to each parent & member in April to evaluate services being delivered . • B & GCA Outcome Measurements Tool every member is encouraged to enter a baseline survey upon registering for the program . Ongoing surveys are administered each year . 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 ? All data collected will be compiled and presented to all funders and contributors in order to present our agencies positive impact on the community. 12 Boys & Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children ' s Services Advisory Committee G. TLMIETABLE (Section G not to exceed one page) 1 . List the major action steps, activities or cycles of events that will occur within the program year. New programs should include any start-up planning that may occur outside the funding year. In completing the timetable, review information detailed in prior sections . Action Steps Time Frame Develop Program Budget for February January 2003 Approval Write and Prepare United Way Grant March 2003 Distribute Parent & Members Surveys April 2003 Start Registering Summer Members May 12 , 2003 Develop Summer Program Schedule that May 2003 incorporates all the National Programs mentioned in section C3 . Write, prepare and submit Children ' s Services May 2003 Advisory Committee Grant . Summer Staff training & Building June 2 — 61 2003 Maintenance l 't Day of Summer Program for the Sebastian June 9 , 2003 Branch offer hours Monday — Friday 8 a. m . — 6 p . m . Start registering Members for School Year August 2003 before summer program Program . concludes . Develop School Year 2003 -2004 Program August 2003 Schedule that incorporates all the National Programs mentioned in section C3 . School Year Staff training and Building August 2003 Maintenance Upon securing funding, hire and train October 2003 Technology Center Director Evaluated Boys & Girls Club Program November, February, May , August . Utilizing Commitment to Quality_ 4 times a S year . 13 O O MM 1p . . . ' � ;�;i :55`i'iw?iiiii!w�ii tji :` � M r•+ .—i � O L Ul ' to i i i i i i kr) Qr 0 i i i N N • .. N r.+ O N IN It ) V '7 PIZ u �D IQO o C� "' N N \O :' " .':i :i yi' 5 ... ..Zz Za cJ Fa :Y�wc;: ;:: RS �': �•:''.t :: N O [� 6.4 42 o H o w o o04 ctj a vi a pa �C o �t 00 a\Quo Cd Vr a w a O `� O o o . , + H Boys Girls Club of Indian River Count/ .nc. — Sebastian Branch Grant Application to the Children Sereces Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET IMPORTANT: The Budget Narrafive 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 : Boys & Girls Clubs of Indian River County/Sebastian Branch FUNDER : Children Services Advisory Committee I CLQ /TION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should I Abe used for calculations and to write information only. GRAY AREAS FOR REi/ENUES � ERcrusEcecY Proposed Total Program Funder. 11 6.561 pecit:CAgency eu tui, ita s� Budget Budget &d et 1 Children 's Services Council-St. Lucie 66 2 Children 's Services Council-Martin 3 Children 's Services Council-Okeechobee 4 Advisory Committee-Indian River 60,000.00 60 ,000 .00 430 ,000. 00 5 United Way-St. Lucie County 6 United Way-Martin County 7 United Way-Okeechobee County 8 United Way-Indian River County60,000 .00 ' 74 , 000.00 9 Department of Children & Families 10 County Funds Individuals $1.55,000; Civic;' Groups - $13;000 Foundations $10;000; Corporations . 11 Contributions-Cash $451000 _23 ,000.00 12 Program Fees News Letter - $7;300, Golf Toumament .- $201000; Steakrr &'Stake - $30000, Outside Fundraisers $221000, Mail Apeals - 13 Fund Raising Events -Net $35$0001 , 400.00 30 , 700 .00 Vending 14 Sales to Public - Net Mael ienes 100. 00 400 .00 Membership - ($5:schooi Year, $30 Summer) , t 15 Membership Dues shirts - $5 ea . 51450 . 00 16 , 550. 00 16 Investment Income Exchange Club Rent - $300 per 17 Miscellaneous month 31600.00 18 Legacies & Bequests FLbOE - $44 000, JICSL $25,000, Jr. 719Funds from Other Sources League - 56,500 30 ,333 . 00 75, 500. 00 5/27/2003 f e s topay Team ::$98485G plus 11 c •� e - • � : 1 / . 1 I11 1 / I. I E I P�qppsed t 0 1 • I • CY FIC • • _ Budget ; Salaries - (must complete-chart on next page) IBM ' - Total salaries0.0765 1 . 1 / 1 1 - • 111 - • • ' - 111 • - 11 1 11 � / � 1 / I POSMON USING PO Specific > • • f f • • ee SalaryRequestr 1) - • - l ! ! li el I III II ! ! I ! ! Director of Operations/40 hrs / 111 11 MMMMMMMIone : Branch - • • 1 111111 111111 / 111 11 Wo : Program Di - • • 1 hrs / 111 111 ' . Technology - • • 1 hrsSummer Program • ' 1 hrs MOMMUM 11 Amencorp Team Leader/32 hrs iAmericorp Team Leader/32 hrs • ■ 1 • / 1 $ 107 , 618 . 00 111 11 -� � e s � � e • t • Boys Girls Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children Services Advisory Committee Example. CaseManagerl4o 5, OOQ00 382.50' 200.00 500. 00 . 300.40 200.00 1, 583.50 Director of Operations/40 hrs 0.00 0.00 0.00 Branch Director/40 hrs 309000.00 21295.00 400.00 21695.00 ogram Director/40 hrs 0.00 0.00 0.00 ethnology Director/40 hrs 25 ,000.00 1 ,912.50 400.00 2 , 312.50 Summer Program Specialist/40 hrs 0.00 0,00 0.00 Americorp Team Leader/32 hrs 0.00 0.00 0.00 Americorp Team Leader/32 hrs 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0 .00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 0 0 . 00 0.00 0.00 0 0.00 0.00 0. 00 0 0 .00 0 .00 0.00 0 0.00 0.00 0.00 0 0 .00 0.00 0.00 0 0.00 0.00 0.00 0 0.00 0.00 0.00 Total Funder Request Fringe Benefits $55 ,000.00 $4,207.50 $0.00 $800.00 $0 .00 $0.00 $5,007.50 Q 8 G D EXPENDITURES xnYeAEaeFoe ProposiednbtaiProgram Funder Specific: TatalAgency AGENCY usEaeLYTo sNavoeru Butlget : Butlget Budget - _ _ 28 Travel -Daily 700.00 11900.00 66 # of Staff x average # of miles/wk x 50 wks x $ 666 . 6 66 6 66 AftEstimated Daily Travel/Mileage Reimb. ZSamile. .. : . ravel/Conferences/Training Recommerttiatio 31000.00 11 , 500.00 National Conference (cost per staff) n from BGCA is • Training/Seminar (cost per staff) to,frvest 5% of art employee's • Other Trainings (cost of travel , lodging , salary towards registration , food) training. 30 Office Supplies 4, 897.00 14 , 267.00 Office supplies (monthly average x 12 months = estimated cost of office supplies based on $3$1 .33 month ly present history. avenge x1:2 31 Telephone 3 ,640.00 9,580 . 00 # Phone lines x average cost per month x 12 months = local phone cost 2 tines x , Long Average long distance calls x 12 months = Distance &- DSL Estimated cost of long distance Internet Lirte" 32 Postage/Shipping 370.00 61960.00 • Quarterly Mailing of Newsletter Mailings to • Parents - Art' Special events , etc. Mailed to Matti • Bulk mailings - appeals Office 33 Utilities 7,200.00 12 , 444.00 • Electricity ($ x 12 months) Electric, • Water/Sewer ($ x 12 months) Gargage & • Garbage ($ x 12 months) Water 34 Occupancy ( Building & Grounds ) $1960 43 , 535.00 68 , 838.00 • Mortgage/Rent ($ x 12 months) Month/Rent X • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) monthJJanitoriat x $50 BuildingANkRs eal Estate Taxes Maintenance; : rinting & Publications A shareofthe 1 ,600.00 16 ,500.00 5/27/2003 17 Bovs Girls Club of Indian River County, Inc. - =eeastian Brarcn Grant Application to the Children Services Advisory Cemmicee • Quarterly Newsletter ($ x 4) lorganizations • Letterheads . Envelopes , etc . printing is divided over ail • Fundraising materials• agency, Other programs. 1/4 - : 36 Subscri tion/Dues/Membershi s BGCA Dues - . 11 p p $3,326,<FL Area` 200.00 10. 115 .00 • Membership to National Organization Alliance Dues - • Dues $1 ,500; Rotary, • Subscriptions to Newspapers/maga2ines. etc. Mmnis, 37 insurance - 21733.00 14.763 .00 • Directors/Officers Liab. General'ILiability • Commercial/General Insurance PO4, Vehicles - > • Bond Ins . $1020, ' • Auto Insurance Members Accident - 38 Equipment: Rental & Maintenance 7. 200 .00 • Copier lease ($ x 12 months) Computer • Meter lease ($ x 12 months) Maintenance - • Copier Maintenance ($ x 12 months) Raiser's Edge • Computer Maintenance ( $ x 12 months) $3,70 .+ Copier Other Maintenance • $3,000. 39 Advertising 250.00 1 .200 .00 • Newspaper ads i • Recruitment for Fundraising ads/promotions vacancies - • Other (vacancies) $250 40 Equipment Purchases : Capital Expense 0.00 0 .00 • Computer/monitor (# x $) • Laser Printer 41 Professional Fees (Legal, Consutfing) 0.00 0. 00 • Legal advice ( estimated #hrs x $ ) • Consultant fees • Other 42 Books/Educational Materials 100.00 tt U .00 • Books/videos • Materials ($ x staff) BooksfVideoz 43 Food & Nutrition 3pp.00 600.00 • Meals ( # meals x clients x 5days x50 wks) Snacks from • Snacks Treasure :Coast Food Bank 44 Administrative Costs 0.001, 0. 00 • Admin . Cost (% of total budget) 45 Audit Expense 2 ,000. 00 9. 100. 00 • Independent Audit Review 46 Specific Assistance to individualsO .OD ) 0 . 00 • Medical assistance • Meals/Food • Rent Assistance • Other I 47 Other/Miscellaneous 1 . 170 . 001 10 . 389 . 00 Background check/drug test Back ground Other check/Drug test 1 48 Other/Contract • Sub-contract for program services 49 TOTAL EXPENSES $206, 680. 00 $609007 . 50 $681 . 940 . 00 5/27/2003 18 Boys Gids C or olden Artier Covey. hy: - Sebmw io o GraV PypMceom to tie CNWW 5"Ces n sorw C:mmlaes UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCYIPROGRAM NAME : FY 01102 FY 02103 FY 03104 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (col. Gco1. Bycol. e REVENUES BUDGETED BUDGETED 1 Children's Services CouncilSt Lucie 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 #DIV/O! 3 Children's Services Council-Okeechobee 0.00 #DIV/0! 4 Advisory Committee4ndian River 48 ,458.00 100.000.00 1307000.00 30.00% 5 United Way-St Lucie County 0.00 #DIV/O! 6 United Way-Martin County 0.00 #DIV/0! 7 United Way-Okeechobee County 0.00 #DIV/O! 6 United Way-Indian River County 80,000.00 136.000.00 174,000.00 27.94% 9 Department of Children 8e Families 0 .00 #DIV/0 ! 10 County Funds 0.00 #DIV/0! 11 Contributions -Cash 132.222.00 264.900.00 223,000.00 -15.82% 12 Program Fees 940.00 0.00 0.00 #DIV/O ! 13 Fund Raising Events-Net 56,799.00 69A94.00 807700.00 16.13% 14 Sales to Public-Net 710.00 300.00 400.00 33.33% 15 Membership Dues 91995.00 6.850.00 16,550.00 141 .61 % 16 Investment Income 27934.00 0.00 0.00 #DIV/0! 17 Miscellaneous 1 ,800.00 3.600.00 37600.00 0 .00% 18 Legacies & Bequests 0.00 0.00 #DIV/01 19 Funds from Other Sources 96.924.00 127.977.00 75.500.00 -41 .01 % 20a Reserve Funds Used for Operating 0.00 0.00 #DIV/01 201) In-Kind Donations (Not included in total) 1 .408.00 47.464.00 108.850.00 129.33% 21 TOTAL 430.782.00 709.121 .00 703.750.00 -0.76% ENRON EXPENDITURES 22 Salaries 183.135.00 394.936.00 393.527.00 -0 .36% • 23 FICA 27,773.00 26,130.00 5.92% 24 Retirement 6,992.00 19.025.00 22,750.00 19.58% 2s Life/Health 14.318.00 28.126.00 31 ,619.00 12.42% 26 Workers Compensation 2,524.00 9.730.00 97154.00 5.92% 27 Florida Unemployment 21788.00 2.379.00 2.404.00 1 .05% 28 Travel-Daily 897.00 748.00 19900.00 154.01 % 29 Travel/Conferences/Training 71169.00 22752.00 117500 .00 -49.45% 30 Office Supplies 12.863 .00 34.655.00 14,267.00 58.83% 31 Telephone 4.932.00 8.105.00 91580.00 18.20% 32 Posta e/S hipping 1 ."1 .00 1 .983.00 6.960.00 250.98% 33 Utilities 5,432.00 11 48.00 12.444.00 4.15% 34 Occupancy ( Building & Grounds 43,100.00 64.564.00 68,838.00 6.62% 35 Printing & Publications 18,863.00 10.215.00 16.500.00 61 .53% 36 Subscription/Dues/Memberships 4.626.00 3.573.00 10. 115.00 183. 10% 37 Insurance 8.235.00 11 .015.00 14,763 .00 34.03% 3e Equipment: Rental & Maintenance 115.00 0.00 7,200.00 #DIV/0 ! 39 Advertising 546 .00 1 .200.00 1 ,200.00 0.00% NNNNNNN 40 Equipment Purchases :Ca ital Expense 9 .048 .00 0.00 0.00 #DIV/0! 41 Professional Fees (Legal , Consulting ) 0.00 16.670.00 0 .00 -100.00% 42 Books/Educational Materials 2.883.00 2.000.00 1 .000 .00 50.00% 43 Food & Nutrition 497.00 600 .00 600 .00 0 .00% 44 Administrative Costs 0.00 #DIV/O ! NON 45 Audit Expense 4. 190.00 6.000.00 99100.00 51 .67% 46 Specific Assistance to Individuals 0.00 0 .00 0 .00 #DIV/0! 47 Other/Miscellaneous 21 , 962.00 14.327.00 10 .389 .00 -27 .49% IIIIII,4e Other/Contract 0.00 0.00 0.00 #DIV/O ! 4s TOTAL 356.556.00 692.324.00 681 . 940 .00 -1 .50% NUNN 5a REVENUES OVER/ UNDER EXPENDITURES 74.226.001 16.797.00 21 ,810.00 29.84% Itu?uue 'ays i.rs ate c' -om .Jl Count'. enc - :aoaseen Brwcn UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: FY 01102 FY 02103 FY 03/04 % INCREASE - FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (cot CKot. BycoL B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 #DIV/0! 2 Children's Services Council-Martin 0.00 #DIV/0! 3 Children's Services Council-Okeechobee 0.001 #DIV/0! a Advisory Committee-Indian River 12,685.00 30,000.00 607000.00 100.00% 5 United Wa St Lucie County 0.00 #DIV/0 ! 6 United Way-Martin County0.00 #DIV/01 7 United Way-Okeechobee County 0.00 #DIV/01 8 United Way-Indian River County 20,000.00 36,000.00 60,000.00 66.67% 9 Department of Children & Families 0.00 #DIV/01 10 County Funds 0 .00 #DIV/O! 11 Contributions-Cash 3 ,214.00 0.00 #DIV/0! 12 Program Fees 90 .00 0.00 #DIV/01 13 Fund Raising Events -Net 17400.00 #DIV/0! 14 Sales to Public-Net 100.00 #DIV/O! 15 Membership Dues 31813.00 21500.00 51450.00 118.00% 1s Investment Income 0.00 #DN/0! 17 Miscellaneous 0.00 #DIV10! 18 Legacies & Bequests 0.00 #DIV/0 ! 19 Funds from Other Sources 27,849 .00 307333 .00 30,333 .00 0.00% 20a Reserve Funds Used for O eratin9 0.00 #DIVlO! 20b In-Kind Donations (Not inckaded in total) 0.00 0.00 16 ,635.00 #DIV/0! 21 TOTAL 677651 .00 981833 .00 157,283.00 59.14% EXPENDITURES 22 Salaries 30 ,111 .00 7475000 107,618.00 43 .97% 23 HCA 29303.00 57718.00 71308.00 27.81 % 24 Retirement 21500 .00 47450.00 69150.00 38.20% 25 Life/Health 11912.00 77032.00 109525.00 49.67% 26 Workers Compensation 535.00 27003.00 21560.00 27.81 % 27 Florida Unemployment 630.00 824.00 30.79% 28 Travel-Dail 656.00 548.00 700.00 27.74% 29 Travel/Conferences/Training 47138.00 39852.00 31000.00 22.12% 30 Office Su ties4,409.00 61288.00 41897.00 -22.12% 31 Telephone 1 ,969 .00 21676 .00 37640.00 36.02% 32 Postage/Shipping 125.00 0.00 370.00 #DIV/0! 33 Utilities 988.00 27940.00 79200.00 144.90% 34 Occupancy (Building & Grounds 137686.00 3875600 439535.00 12.33% 35 Printing & Publications 37821 .00 17305.00 1 ,600.00 22.61 % 36 Subscription/Dues/Memberships 592.00 200.00 200 .00 0.00 % 37 Insurance 1 ,959 .00 27500.00 2.733 .00 9.32% 38 E ui ment:Rental & Maintenance 117.00 0 .00 0 .00 0.00% 39 Advertising 364.00 250.00 250.00 0 .00% 40 Equipment Purchases : Capital Expense 0.00 0.00 0.00 #DIV/0! 41 Professional Fees (Legal. Consulting ) 0 .00 0 .00 0 .00 #DIV/0 ! 42 Books/Educational Materials 617.00 1 ,000.00 100.00 -90.000 43 Food & Nutrition 143 .00 300.00 300.00 0 .000 44 Administrative Costs 0 .00 0 .00 0 .00 #DIV/0 ! 45 Audit Expense 0.00 1 ,700.00 21000.00 17.65% 46 Specific Assistance to Individuals 0.00 0.00 #DIV/0! 47 Other/Miscellaneous 947 .00 1 , 170 .00 #DIV/01 as Other/Contract 0 .00 #DIV/0! 49 TOTAL 71 ,892.00 156,898.00 206 ,680.00 31 .73 % 50 REVENUES OVER/ UNDER EXPENDITURES .4,241 .00 58,065.00 -49 ,397.00 -14.93 % :UUi Boys Girls Club of Indian River Cam, Inc. - Sebastian Branch Grant Application to the Children Savices Advisory Committee UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER : A B C FY 03104 FY 03/04 % INCREASE TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET (col. B/col. A) EXPENDITURES 22 Salaries 107, 618 . 00 559000 .00 51 . 11 % 23 FICA 79308 . 00 45207 . 50 57 .57% 24 Retirement 61150 . 00 0 .00 0 .00% 25 Life/Health 107525 .00 800 .00 7 .60% 26 Workers Compensation 29560 . 00 0100 0 .00% 27 Florida Unemployment 824. 00 0 . 00 0 . 00% 28 Travel-Daily 700 . 00 0 . 00 0 . 00% 29 Travel/Conferences/Training 37000 . 00 0 . 00 0 . 00% 30 Office Supplies 41897 . 00 0 . 00 0 . 00% 31 Telephone 37640 .00 0 . 00 0 . 00% 32 Postage/Shipping 370.00 0 . 00 0 . 00% 33 Utilities 71200 .00 0 . 00 0 . 00% 34 Occupancy ( Building & Grounds 437535 . 00 0 . 00 0 . 00% 35 Printing & Publications 17600 .00 0 . 00 0 . 00% 36 Subscription/Dues/Memberships 200 .00 0 . 00 0 . 00% 37 Insurance 2973300 0 .00 0 . 00% 38 Equi ment: Rental & Maintenance 0 . 00 0 . 00 #DIV/01 39Advertising 250 . 00 0 . 00 0 . 00% 40 Equipment Purchases : Capital Expense 0 . 00 0 .00 0 .00% 41 Professional Fees ( Legal , Consulting ) 0 . 00 0 . 00 0 .00% 42 Books/Educational Materials 100 .00 0 . 00 0 .00% 43 Food & Nutrition 300 .00 0 . 00 0 . 00% 44 Administrative Costs 0 . 00 0 . 00 0 . 00% 45 Audit Expense 2, 000 . 00 0 . 00 0 . 00% 46 Specific Assistance to Individuals 0 .00 0 . 00 0 . 00 % 47 Other/Miscellaneous 19170 . 00 0. 00 0 . 00% 48Other/Contract 0 .00 0. 00 0 . 00 % i 49 TOTAL $2069680 . 00 $ 609007 . 50 $ 0 .29 5/272003 21 Boys GMs Club or Indian Rrver County. mc. — Sebastian Brenn Grand AppMcatlon to line Children Serwces Advisory Committee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee W#DIV/O! Advisory Committee-Indian River A re uest in funding will be made to CSAC to ex and the program from 75 kids daily to 125 with hiring a Technol Director. #DIV/0! #DIV/0! #DIV/0! An increase infunding is being request to help us expand the program from 75 kids daily to 125 with hiring two Amencorps staff United Wa -Indian River nnitntv members. #DIV/0! #DIV/O! #DIV/0! #DIV/0! #DIV/O! #DIV/0! Membership Dues Due to the planned increase in dailyservice to youth we will raise more moneyin collected membership dues. 375 to 625) #DIV/0! #DIV10! #DIV/0! #DIV/0! #DIV/0! Salaries Additional staff w 11 be re aired to serve more oath. FICA Additional staff ex enses will be incured in order to serve more youth on a dailybasis. Retirement Additional staff ex enses will be incured in order to serve more oath on a dailybasis. Life/Health Additional staff ex enses will be incured in order to serve more youth on a daily basis. Workers Com ensation Additional staff a enses will be incured in order to serve more youth on a (jai basis. Florida Unem to ment Additional staff expenses will be incured in order to serve more youth on a daily basis. Travel Daily Additional staff expenses will be incured in order to serve more youth on a daily basis. Telephone #DIV/0! Utilities Printinq & Publications #DIV/0! #DIV/O! #DIV/O! Audit Ex ense Increase in audit expenses due to expansion in program. #DIV/0! #DIV/O! #DIV/0! t 5212003 22 Boys Gids Club of Indian Porer Cotady, atc. — Soman Bengt Grand Applimlon to the Chitran Sennces Aows Conar+ee UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET AGENCY/PROGRAM NAME: Boys St Girls Clubs of Indian River County/South County Branch FUNDER: Children Services Advisory Committee . ... . . r :<::z:>:::<zsr. . _ . . . . . . rte_.::. ::: :.: . . . . . . . . . . . . . . . . . :::...::::::..: :::: . . . . . . . . . . . . . . . . . . :. :::::::. ::::::::: . . . . . _ - . . . . . . Salaries FICA #DIV/0! srzzrzdda 23 /a Board Members Roster 2002 - 2003 M YS & GIRD Cams Of INDIAN RIVER COUNTY Name Role on Board Business Jay McNamara President National Brand Licensing — Chairman Ken Felten Immediate Past Arden & Felten Insurance — Owner President Ross Cotherman Vice -President, Harris , Cotherman & Assoc . — CPA Financial Development Wil Murphy Vice -President, Moss , Henderson, Blanton, Lanier, Kretschmen & Murphy, P . A . — Attorney Beverly O ' Neill Vice -President, Retired — Nurse Support Services Andrea Thum Treasurer Morgan , Jacoby , Thum, Boyle & Associates , P . A . — CPA • By Fauver Secretary Retired Fritz Blaicher Board Member CDC — Owner i Kay Brown Board Member Realtor Brian Fowler Board Member Indian River National Bank Lisa Giessert Board Member New Piper Aircraft Tom Hurley Board Member Becker Holding Company Dr . Bob Kelm Board Member Retired Educator France Kenyon Board Member Publisher ' s Alliance Corporation Joni Kinsley Board Member Comcast Wanda Lincoln Board Member Retired — Educator Gerald P . Lynch ! Board Member Retired Managing Director of Morgan j Stanley Edwin Mellett Board Member Retired President of Coca- Cola Daniel R . Richey Board Member Riverfront Groves j Lenora Ritchie Board Member Wahlstrom Foundation Bob Showfety Board Member Retired — Banker i l BOYS S GIRLS CLUB OF EI; DlAi` R-rVER COL ITY. INC. Financial Statements and Supplemental Iniortnation with Independent _auditors ' Report ]une 30. X002 • Table of Contents Page Independent Auditors ' Report . . . . . . . . . . . . . . , Financiai Statements : � tar=ne:a of Financial Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Matz -tent of AcLIVI les and Changes in Net Assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . state:neat of F ;inczional Expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , mr=eni of Cash ittows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 �• Otes tC : l; ;vp® man ' I O Haire, Kmetz, Nuttall, field _ - - 0®n®g ■® & Co . , chartered Mo _ l A 1 './ , If )' ■y Tax, Business ara Financia / Consultants ® MMM ' Independent .-auditors ' Report To the Board of Directors Boys Ir Girls Club of Indian River County , Inc . Vero Beach. Florida We nave audited the accompanying statement of financ :ai position of the Boys a Giris Crab or Indian Raver County, Inc . ( a nonprofit organization ) as of June 70 . 200 = . and the related statements of activities and C ::anges in net assets . functional eCDenses . and cash tows ror the vear then ended . T:rese financial statemfnts are the responsibiliiv of the Clubs = nageme- t . Our responsibllir : -- 0 express an opinion on :hese financial statements based on our audit . W'e conducted our audit in accordance with audicng stanc.:rcis generally accepred : n the Un: ed States of -�merica. Those standards require that we plat: and pe7 orm the audit to obtair. -easonabie assurance about whether the financial statements are free or mate ,i misstatement . An nuc : : inciudes examining . on a test basis . evidence supporting the amounts and disclosures in the financiai sta: ements . An audit aiso reiucies assessing the accounting principles usec and sic=ficant estimates made by manaQerient. as well as waivatine the overall financial statement presentation . •Ve believe that our audit arovides a reasonable I .-or our opinion . In our opinion , the financial statements referred to above present fairly , in ail nate-iai - spects . the tinanc : al position of the Boys S. Girls Club or _-idian R: ger County . Inc . as or _ ane = 0 . _ ) 02 , and : he C ..anges in its net assets and its Cash flows for rh, vear t en ended in coniormiry th (Yener_ ily accepted accounting principles in the United States of _ rnerica . � � r O ' Hai :e . Krnetz . Nuttall . Field L�: Co . . C :iartered Cr. ed P '.1blic .-accountants October _ . 2002 _ " " _.a � � ifJ .= L � F. ' iE • ;- car - _ - - - _ n _ _ _ _ . - _ - - - - - - - - - Bovs & Girls CIub of Indian River CiluntyInc. Statement or Financial Posirion June 30 , 2002 Assets Current Assets Cash S i 82 , 863 Grants receivable = 9 . 1 Contributions receivable , 75 Loan receivable 600 Prepaid expenses : 6 . 981 Total Current Assets , 78 Property and equipment, net 08 , 82 1 Other Assets Utility deposit x . 066 Security deposit 9 . 020 ; � 18 Liabilities and Net Assets Current Liabilities Accounts payable S 8 _ Pavroll taxes payable '. 56 i • Loan payable Total Liabilities 2, 6 _ vet Assets Unrestricted 6Q _ Temporarily restricted Total Net Assets : 00 . 830 Jre cc _ ompan %ins notes to tinanc: ai staterr.ent; . J i3uNs .% Girls Club of Indian River Counnr. Inc. Statement or _activities and Chanes in :vet :asset; Year evided June 30 , 2002 Temporan iv_ arestr: ;;ted Restricted Totai Revenues and other support Membership dues Contributions 10 & . 6 � " - 00 = 11 = . 6 = 0 Grants � O : , SS3 i9 . � 00 Fundraisin ,? eventsiproiects GOAL i - 90 . 31 Interest income c , ; Other Net assets released from resa-ic_:ions through " satisfaction of requirements Total revenues and other support 464 , : " 9 ( 15 . 606 ) Expenses Program services : Youth PTOa ams - South Counry Faciiiry Youth Programs - North County Faciiin' 108 . 011 - + 08 . 01 : Youth Volunteer Corp Program _ _ - 0 ; _ Total program services 30 .5 . 870 Supporting services : Mana�aement and general Fundraising - - - -` 00 _ , Iz z00 Total supporting services Total expenses = 6 : - 0 : Increase ( decrease j in net assets 9S . a - - j" 15 . 606 SG _ . oS Net assets . beginning of year Net assets . enc of _year j gee acco=am^, n2 rotes to tinancai scatem n 13oys & Girls ( ' lul , of Indian ( liver ( ' onnly , Inc . Slalentenl ul I , nnclional Expenses Ycar ended lune 111 21 ) 11 :., -- - -- - - I ' rogratn Services Supporting Services - -- `Total Youth Soullt North volunteer County conal 1 ' ro rants Programs I Y � CorP Management b ` rogrr, tn and General fundraising Salaries and ',vopes 100 , 781 $ 51 , 526 y; --- 3 qc► 5 I ' aytoll laic , and I , cnclil , � ' 1 , 26h $ 6 (177 2 715 $ 165 , 694 Protessional services - 12 , 4 ( 16 962 1 , 608 654 39 , 89 (1 Printing and adverlising - - ZI , 190 4 405 Su8 595 Supplies and ptslagc ` , 8 ( 11 3 , 379 1 , 697 2 238 10 , 463 8 , ) 54 I ( 1 315 20 , 578 . icenscs and docs 3 1 �I 817 6 , 150 31807 30 , 043 Real 1 , 388 - 925 20 , 286 9 , 120 - 4 , 627 Repairs and , nainlcn : tnce 521 6 050 - 5 - 4 , 234 3 , 456 37 , 096 I cicplu , rtc artd us lililic 5 I h2 3 1 10 _ - 9 , 576 u Insrance 4 , 1 1 7 2 , �I7 I 2 > 0 -13 - 10 , 365 I ' tol . tant a , fig ilt 1 - 1 , 647 8 , 235 lVlisccllanw „ tr' ) eprecial ion ' , 821 I , 254 83 327 2 465 - 7 , 1175 Slall ( raining and meetings - 2110 _ 10 , 9 ') 2 2 ) 276 4 , 845 93 ' 386 9 , 600 ' Iola , l expenses -- — �6 184 152 -- $ IOb , 01 1 $ 13 707 $ 33 , 835 $ 253500 $ 365 , 21) 5 see yilip notes tai financial stolen eels — - 1 . t 5 - Boys Sc Girls Club of Indian River County, inc. Statement of Cash Flows Year ended June 30 . = 002 Cash flows from operating activities : Increase in net assets S 30 . 368 Adjustments to reconcile increase in net assets to net cash provided by operating activities : Depreciarion i 0 , 992 Noncash contributions of fixed assets ( 19 , 046 ) Changes in assets and liabilities : Accounrs receivable ( 0 . J ; , ) Contributions receivable ( 299 ) Prepaid expenses 16 , 482 ) Loan receivable (600 ) Deposirs ( 8 . 090 ) Accounts payable Payroll taxes payable 1 . 608 Net cash provided by operatiniZ activities 48 . 84 Cash flows from investing activities : Purchase of property and equipment ( 39 . 958 ) Net cash used for invesrinQ activities ( 399 5 81 Net increase in cash 8 . 889 Cash . beainnine of vear 1719 " 1 Cash . end or- year S i5.85-) See accompatrnt: g -totes ,o tinanctai statements . Boys & Girls Club of Indian River Coun .i-, Inc. Notes to Financial Statements Note 1. — Summary of Significant Accounting Policies Organization The Boys & Girls Club orindian River County. Inc . (the Club ) was formed on February 4. 2000. to help �vouth of all backgrounds In Indian lZiver County, with special concern for those 37om I isadvantaged circumstances . develop he qualities needed to become responsible citizen and leaders . The Club ' s support comes primarily from individual donors ' contributions and nous ageacv rants . The Chub has two locations South County and Nor-[h County ' from which Lie; operate their prot_Tan,is . n Juiv . 00 = . tl: e Club or icially_ added the Youth Volunteer Co7D program that provides youths an oppor-sniry to improve the locai communing throuvjrrl suoe-7r1sed volunteerins . Basis of Accounting The financial statements of the Club have been prepared on the accrual basis of accounting and accordingly reflect all sigrliticant receivables , payables . and other liabiiiries . Basis of Presentation Financial statement presertanor, foilov - s he recommendations of the Financiai Standards 3oard in its S -iarement of Fina_ncmi Accounn= Standards ( SFAS ) No . i 17 . 'Manciai Statements .� * .Vot- for-Profir Or,ani.=ations . Unde- SFAS i17 . the Club is required to report inromlation re =- ding its financial position and activities according to three classes of net assets : unrestricted net asses , temporarily restncted net assets . and pev.7=enuy restricted net assets . Property and Equipment The Club follows the practice of capitanl=ng, at cost. all expenditures ror fixed assets ul excess of S5, 00 . Donations of property and Comment are recorded as contributions at their es:mated :air value . Such donation—ss are repot?ed as anrestricred contributions unless the donor has res`. , cLed the donated asset to a specific purpose . Depreciation is provided using the straig --it - line -:ethod over estimared userui rives ranc"ns mom to 29 vears . Revenue Recognition Contributions are recognized % hen he donor -Hakes a promise :o give to the Club tha: : s . 1, suostance . unconditional . l. ontriounors that are resTricted by the donor are reported as increases in unrestricted net assets if the -es Ll: L ils eytpire in the fiscal year in blob he Contribuncns recoolized . ^kll other donor-resu-icted corimbunons are reported as increases in temp_ or= iv or permanently restnctec net asses depe-ding on . he nanire of the rese= ctions . When a re =aTon expires . temporariiv restricted - et asset are reclassified .n unresv* cLed neL assets . Income Taxes The Club is a nonprofit orsani .=nor. aS :' escnotd in Sec . U i ( CH = i of Lhe internal Revcnu act and . s exempt from Fede-al anc Mate _nC ) nit :axes . Functional k-llocation of Expenses n` .: Ost OI pro %^ Qin the Var: ouc Dry hams .;nd Omer ac :rices - as Deep Sljmmar"IZC . ) n fllnCLlOnal baS1S in the staLem r OI IL` - nonai . xpenses . .3ccordin ? � y . Certain COSLs ha % : Jean -n among :he programs ai; Q Sut)T, .�ir. Z Se-vices 'Jenenred . j - S boys & Giris Club of Indian River County, Inc. votes to Financial Statements imnanued) Note 1 - Summary of Significant Accounting Policies =Effill�d ) Donated Services Tne Club received donated services from tmpaid volunteers for certain activities . No amounts have been recognized m the acconmaalang financial statements as the criteria for recognition under Financial Accounting Standards Board Statement No . 116 . "Accounting for Contributions Received arid Contributions Made " have not been satisfied. Use of Fstimates The preaarctlon of financial statemeyt_: in coniormlti, wish gtneralh% accet)ied aC : 011uting PnDcinles requires rnanaLremeni to rnaYe esri= tes and assummions that arTFct _he r" orted amounts of assets and liabilities and disclosure of contingent assets and liabilities at the dare or the financial statemer_ts and the reported amounts of revenues and expenses du^mQ the reporMinz period. Acral results could diuMer from those estimates . Note 2 — Property and Equipment, net Propern� and tompmert consists of the :olio %vinc at June . 0 : Vehicles L. 0 . '0l Leasehold improvements = ,M Office equipment and furnishings 36 . 641 Club equipment and furnishings S ,Oog 1 10 . ,94 Less accumulated depreciarion i , 1 3 ;; N S 98 . S _ 1 Note .3 — Loan Pavable 1n une 2003 , a board -nernbe , .=cans .= c a _unc development soft-ware paV :mgQ and iraining or, behalf of the Club for 1 = . The C: `: is obit ated to repay the board mzmbe, when :un L.: are available . No interest on the loan ba% arcf is beir2 Charged . The entire loan Baia ice ,vas forgiven in Senternber = 002 . Note 4 — Temporarily Restricted Net assets Temporariiv restricted net asses consi _ t .� f _he :oilowing : Vouth Voiunteer Corp program Sebastian owidins apiral : .= pajGT - Photograonv proaramn - 1 - � _ lt; Boys & Girls Club of Indian Diver County, Inc. Notes to Financial Statements cconnnueaj Note 5 — Contributed Rent The Club receives donated rental spare for its administrative offices from a private corporation on a month to month basis , beginning in June 2002 . The Club has estimated the fair value of this space to be 51 , 000 for the year ended J i^e 30 , 2002 . 'I1� is amount has been recognized in the accomoanving financial statements as an m-land contribution and as rental expense . Vote 6 — Employee Benefit Plan The Club participates in the Pension Trust of Boys & Giris Clubs of Arrtenca . Each employee is eligible to participate when they reach l years of age and have completed one year of service to the Club . Under the plan. the Club contributes 10°'0 of each eligible empiovee ' s salary on a calendar year basis . Plan expenses incurred by the Club for the year ended June 30, 2002 were 56 . 992 . Vote 7 — Lease izreements The Club : eases its South County and North County building acilities . The South Countv lease is from A=1 1 . 2001 through March 31 . = 003 with monthiv rent to the amount of S1 ,960 . The Club has the option to renew the lease for three additional term s of one vear each. The North Count~, Imre is from 1%lay 1 , = 002 through April 30 , 2006 with monthly rent ranging from 53 , 060 to S3 . 949 over the life of the Iease . • The future minimum rental payments are as JbIlows : June 30. 2003 S 64 . 808 June 30 . 2004 40 , 73 7 June 30 . 2006 39 . 187 \ ore 8 — Conditional Promise to Give ine Cab r-= eived a 550 . 000 conditional xomise :o give from the Johns Island Foundation . The donor : s '_^_oiling the money in escrow �.tnni surltcient funds are raised to construct a 32' . 000 square :oot :acliin, in northern Indian R ver Counrv . Because of the conditional name of this contribunon . the Cab has not recognized : his amount as revenue in the tinanc . ai statements . _ q _ Return at Orcanizabon �.emci From : nccme .an -! noes seClon ( c% =Z7. or 4947(a ; ( 11 of the : r:ts ai Revenue CZas iexc` nt blas: : ': no � ecartment cr -,ne re=sury 7ene7R =vat or =- zze FDunc=cni Q_Dentm ? lnjiC T. emai Revenue 3ervica Ir 'he CrGnt ,c n rev rave to tlse 2 CC;OV Cr =' r===77 TO ­Ta !v "r n.^. fE^ u:•'E!*1 ?!Tc_ lnsae�� un .� on or me 2001 Gienoar .`rear. or _ax vear uecinnina / / n — , iQ _ =nc emmnc 0 / J G 3 ec it aaoac.-me: -'easel C Varve ar arc=-r=-natt j3 =mmover M number use iR5 X �cdress mance BOYS cc G=S =UE OF I _=-N oI � ? — 3 62 = 2 9 8 lanei n _ Vame cnanoe print on R—' = CCUNTMY , :Nc 'eiepnone nursicer nni2i return type. INumner and 5•J2et (Cr P. O. =ox If mad is not netiven= = � to eet zrsi .^cCom/SuIIP % ^ ? — ? Q _(3 — 7A. d =mat recum See ? 0 . =0X ccountino method: asn scecifia - ..rm C. 900001 ) ci �_ T � L .. � �m - ^ WS ,�O -b vt ..YL -� = � w 7 .:, 622 98 -:!Ce = Fart:11 , Statement or all argan¢aaons must cometete cc:umn i :.). :um� : 3i. ; C;, zna ( 0 ) are recu,rea to sea:cn B01 ( c :: 3 ) ar4141 crca;,—„Cns ' unClonai '_ : lenses enc seccan A947(a !! 1 ) nonexernot �^,arrrc:e t US= : _ - con ! tor c ec= a o emers. . ..ee S - stn:.Ct:crs cn cac � o not mcIUae arnoums reaarred on line cmatam u C; danaoemem 3b . 3b . 9b . 40b . or ' 6 of c = rt ! a) �' �.a ung � setvtces ana cene rm Dl 2Z Giants ana adocmians isitz t scsteauiel cassn IZ2 - - JSoeanc .assmmnce r0 Inonnduais ^ti 7Z � 4 ° events said to or tar memoers 24 - --- - 25 c, moensaticn or omrers. ave=rs. etc . . . . . . . . . . . . . . 25 I - 26 Cthersamnesana wages 26 6 6a4 ! 2 � 0 . J021 0 , 6771 7 _ = 27 Pension oian contributions27 ' S , ta92 ! 6 , ^ a5 � 282 ! 28 Cther emmovee benents 28 1 17 , 4 d 9I 16 , d_ 6 01 7 0 I 296 29 Pavrall taxes 6231 ^ C G 30 P •oressionai fundratsing fees 3p .= c=unting fees 31 4 1901 ! 4 1901 32 Sucoiies 33 20 04 . ' 20 086i 6 X01 $ p - _ a -e: ecnane ;4 _ 0 6 = : 8 2921 ^ 0721 P^smce ana sni00inc ^ $ 36 CE: =1aancY . . . _ 36 - ; 09 64 29 AID 6i 4 = Al _ a 37 =^_utoment rental ana maintenanC.a 37 ! a = 76i 9 , E71 1 i 38 ^nano ana cuaiicamons 38 20 X781 7 8771 2 2381 . 0 1c ? 39 -rave! 39 a0 7, crnerences . :;nventions . ana meeunes 10 nteres: 41 = 2 �eerecauon . ceoleccn . er . , aa son. , a2 ^ X 02 0 02 ! 2 0 01 » : Curler expenses not cverea aeove ( itemize is a - a b SEE S ='A^' ^' . = . . . . mo=b = 6 '77 E ; 2c 9101 5 4671 10 = c uac .aid ref Iuneaonat exoenz" taod lines 4 - -M Organiatlans i comatetina columns 4Bh01. =try these totals to Tines ; 3- 1 14 I ? 6 = , ? 0 c ; 2 0 c 8 j 0 1 aint C asts_ Checc ► if you are following SOP 98, are anv 'Cint C=M -Cm a ccrnoinea ecu=cnai czmoaign ana funortsina soticitaecn remnea in 281 Fvocr .-r. servims? t as yo : t "'es. ' enter If] the aggreepte amount or these !otrtt costs j . ; (I1 the ametutt a!lotateo to Program services : iii) the amaunz atlCctea to Manaaemem ana oener2 J _na (Ivl the antourn allot atea to Funaraisina ? art fIF Statement or Procram Service Accomoiisilmenis Inszruc^ ons on ocase ' a . ; Nhat is "1e crcanizatien 's onmary exemot ourcose % = roarm Service P T S T == 2 =:.ceases . . . . . . . . . . I C -Ulrec = Ct0. 1 (C :j J i ar= All orcananucns must aesi:nce Me!r exemot ouroese acn !evements in a c: ear ana canese manner. Mate the numcer S1 C -IS47ra , . , � r caents servee . cuoii�rens :ssuea . etc. Discuss acnievements ;fiat are nct measumme . , Sewn =01 ( c ; ( 3 ) ana ( 4 ) , roan !z=ions ana -' 947(2j ( l ) ncnexemot cnaniaole !rusts mus: z!sc enter -.ne amou.^.t or cram _nc adorvvons ;o omer< - . - rr'BE BOYS AND C- 1 = S CLUB 3AS A *fafERSz _ ? = 60 SING TBL `. JVDS7 JARZ: CUS rDCC-RPIW . 3 V �cFI "S otic ai:C .�uan5 G ,aans ana ai=mns J e Other orccram services : attach scneou !e1 Giants ana aiic�uons S - or ! or 'Oeram Service c; senses knows eauai line . wmn serncec - - : l.' _ ^ V = .00 ' - . . �"7i. =N = c — 62. - , ? arz iv ? aianc : Snea� . � ee �zeecinc : r, s,;uc.ions ,. r. za . . = � . . Vale: A'i' ere recuirea . ttacnec Ecnenules aria amounts :athiri -�- e c2sc'c �n n ) mn znouid be ror eno -37-•ve2r 'amoun6 only. = B^_:nnino ct •-ear S Casn-non-interest-bearing . . . . . 4 - - - - - - - - - - - - - - - _ 4l -5 ;b Savinas ana temocrary trsn invezznentz . . . . . . . . . . . . . . . . . . . . . . . - , a Ao^unts rec..=rvaole - . . . . . . . . . . . . . 47a o Pss: allowance ror aotrntfui acc aunts 17b 4 , 0 ; 8 17c = 4 _ ^. c 43a ='ecges rec..=rvaoie :ga o e p1 c ass: ailowance for acuntful accounts sib -8c G c a =9 � i ants receivznie _ . . . . . . . . . . . . =9 . 0 meceivanies from officers . direc:ors . 7usees. aria key emoiove. a=cn scieauief _0 Fetes aria loans re eivaole taaacn s s .. eou! e ! . . . . SEE "wCRKIz ,, .,, b1a 5001 c _.ss : ailcwance rOr aouc[ful acccun[s 1b = 1c 500 cZ nventones far sate or use . . . . . - . _ - . . . . . . . . . . . s .3 ire_^^aid exoenses aria dererrea carges d nvestments-secunbes .,est X=a nves[ments-�ana. cuiidinas . aria - er:aomenc basis _ers: ac lmuiatea aeorecauon iattac-i =. eculei ;=b . — c i nves[merus-,other faazei su. eaule ! = 3 a -;,a . buiiainos. aria ecuioment basis 57a ' 10 , i 9 d _ess: ac='muiatea aeorecauon ( azzacti =eouie ! 57b . 3 � rIerassesiaescibe ► SEE SST 9oEi .3 E =9 -CrMi assets fzdd lines 15 throuan =3 ) (must ecual line -ci ^. = 7641 EG Ac=unm cavanie _ -=no aceo expenses d ? OZ ! d _ 51 ziants oavanie , a 52 De:nrrea revenue 52 03 s from amcers. oire=rs . :ruszees . aria key emmovees ( a=c. - i ` - s =eau!e ; - - =`b ax-exemot bona liaoiiities ia = i scriecuie ) ,yea '.1c„a2aes aria other notes oavanie ( z= cn sceauiei .:b � = . ". er ?la Giities ( aesGnbe )0 SES S TQM- T. 4 - - - - = o cai liabiilties iaod lines 50 threucn ^ 1 _ 0 ? i 7rcanizations that follow SFAS 4k ' 7 . -tecx here _ nc c—oie_ .:nes re5uIc-.=c 42 _ 43I . o I P3 = a'"tan B.^. I1v restnc:aa . ;i Canlzaiions that do not follow SFAS I 'a7 , cnecx here ► _ _ nc ' I - - - oiete lines 70 throucn cx . rus : cnnccai -. n cr oizal surclus . anc . = - vi ;cinc , 3nc ecG : cmer! : ;: r ;, - - _ =. <_ = inec eamines . -�nccNment . cv, .nuiateo : nc: rhe . r , - c :ai net assets orfuno balanCeS , acc sines 67 :n -cUon ' = _ = . , nes - raucn must eoual line - 9 . =iumn ic ) must e uai line = 1 llandities aria net assets r tuna balances • ac ❑ lines oc s:ic 4 ” S r _ L . - .rm is avallame ror ouoiic :nsce.on anc . 'Or <_cme ceco!e . serres as :.'le c-Tary vat _sale source or inrcrmancn accut a : 2M=' :ar :: .=2i. ^._9ucn . = eW the ouoiic oerrewes an crcaan =- ucn in su C, cz_scs TcY ce cetej7riineo ov the !nrCT;aacn oresent_atl : n s r= L: erercre , atease maKe sure ane re•nim ,s ccmeieie ane ana ::;iv cescces . . n Pan all . - e crt__ zniz= uon s : c-a - = a - c acecraiisnmens . , U = .ram X90 r20011 . 0 �= _Mc ^ ._4D7 :sLN = _ — = G � cc ? arriV-,A Reccnc: iiation of ievenue per Audited r'art: ; V ,pec: nc: iiatian OT = = ensas :: er .�=qwuaited - n2nciai Statement= with Revenue aer Fvnancoai Statements with = enses ger Revurn � ner.-nc . nsumuc^ ons . Oaoe 26 . i Return i otai revenue. -.stns. _no Cater suz= I a Gni excenses anc :ores Ger ;. er auaitea finana m statements > a 1 445 . E i Z ) suaimt: rinanczi s=ements nts incuaea an i111e a Out not cn j j - - Y _ b Amounts inauaea on line a out not , c :-arm 993: � � on tine ; 7, rarm — ! 11 ,Vet unreat¢ea cants a ( 1 ) 0onatr^t services ana use ; = nvestments S or ac iEes S 2 Oonatea service anc use (2) ?nor year amustmertts _ or faciities r _ 1 -enortea an line _0 . - ( 3) Recoveries of unor L_ year grants S - (3l Losses reoortea an tine =0. ( - r 4) Ctner ( snec:iy) : - —_ - =am (4) Wither Is 14 �eav ): - mad amounts cr ine_ ; 1 ) .-. rcuen 14) ► c - - - - .ac amounts on ines t1 ) r, rcucr _ne a minus ane b '> 445 5 7 _: I c ine a .^:mus ;ine c d ;;mounts incuaea on she ; _ i _--� �- .- a.. � g A.maunts ineuaea on line ' i. - =ann 994 but hat on ste =arm 8r-0 but not on line a: 1 ) Investment excenses nvesarent excenses s µ 'tat If7cuCea on ;JTe _ � 1 _ _ - ; '. at InC:t'aeg an line A. b . =arm 990 2 ) LIer scecnpr scec:y -_ - - ) . .aa amounts an ,{nes . 1 ) ana ( 2) > a ! ego amounts on lines ( 11 aha M o f - -atai revenue oer :ine : 7. Fcrrn 9C�0 a ,maid excenses ter •ine 7 . =arm 490 line c musme a) > a 445 , _c751 line c - us .ine a ) 1 e _ i7 = , � � _ Pa st or in i rustees , and Key Employees , L.st enc: one even! i nct =mceasatea : s� :. � nsm !=rns cn cane (8) 77ilfa aria average ( C :.:%.mcenso-nun I 01 :Znc.r. ; - = En A) Name aha ac..-es hours oerweac If hat =aid, tmert '2mctavee centra. .� =1 ether :ewtea to o==nse : ahs 3 c__. . _ VERO B "SCE . Fla 10 01 - BCSS V_ C✓ ?RES 'JERO BEC? . �• � 3EVERL � C ' _� V_ C_; . . . . . . . . . . . . . VERO BES CR 01 -_ VE;RO BEAC = Y r W�R 17ZC7m�=�'_' RC .. 10 any cmcer , n^ T_S�2E _ . .: a' _. . . _ ; OVE-e .receive aggregate ccmcensaucn cr ,mere than .4z I CO . LOC -cm .;cur -raanlZauO ^ anC ai; :�.3te2: C ,^, .'Car: ,"_,..-- �...�ns _ • '.Vn : G T. Cre roan 314 O - CO7 was CrOVlcea G `/ "" 2 .re: atea _ cr, f� t: Cr: S > ' 2= Z . 0 r. n .�' '(a ac-, < .:. e�e see Seec . rs— ^c ^c : ace _? — — �y = AA GF .STD _�NT Par[ ''A Other InfOrm2tion tS' ee . cec. 1c ; narucuanss :, n cace _ a b '.- e crcani7mLon encza_ e !n cflV z=,Viry !lot Drevicusiv renorr' to me ! RS 7 I ` � • ? � . � =trot= a rE_ IIe^_ CBS ;^,C :: Cn Gi Nere anv =,2nces .mce :n the crgan2lno Cr govemina ac=me!its rut not TeOCLE^_ IC u ie ! r. S 7 -T f ^'es.' atlaci a canrormea C==v of the ranges. 78a Did the arganirmdon nave unremma business cross inc. of SUM or more auhna me vear Clere^ by triis re'Sim ? - - b if `as.' `laza tea a rxx return cn Form ?a0- ,— far this yeaY? 78b i a' -� Was :here a iiauidation . cissoiLrbon . :ermtnation . or suostanual ccntrCcn ounna me Vear .2 " Fes. z== a statement . . . " . . . . . . . . . . . . . _ _ . . " " . . _ . . . . . . . . . . " . . . . . . . . . . . . - " . . . . . . I . . . . . . . . I . . " - ra All 30a Is le organization reiatea (=er ylari ov association with a starewide or nalionwiaE orcmntroni uirouan Common rtenaersnie , governing bogies_ :rusmes. -zffica . sic.. to any other exempt or ncnexemot cnm—nm=, on ? 80a i i . . . . . . . . . . . b if " /es. o enter Ile name of the c animucn ► BOYS a G=LS ClUE OF ASR_ t:._�. . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . . . . . . . . . . . . . . . . . " . . . . _ . " ana aleVNth c neer az- . . - " . -- -! e•not CR 'tonexemnL . . . . Xl =c _ 31 a =.:Ter eirec: or :ndire= ooidicaai eacoeriaitures_ See line 81 inns. b Did Lhe arcanr`don ,-7e Farm ' I20-AOL br this veal? 3. b - T . 2a Did ne Crgahr` oon reCe!ve acr.area services or :he use of materials. 3auiamenL .r .cGil[les ci ^ C -- 2r=e or at sucsmndaiiv less than fair rental value ? 32a b ;;cu may Incicate the vaSUe or these items nere. D0 nor inauee nis amCum as reveCCe n Pan i Cr as an excense !n Pa.—. all . , See ins7U=ons in Pan iii . ) 32b 33a Did me arcanrzadgn comom with the oubiic :rsae=on requirements far n?tums aria exemoacn aaclicatlons ? 8 a 7 b Did me orcaniZvon camaiv with the aiscasure requirements rembno to auid oro cap =ntnbt�"tns % 33b i q 3aa Did she crcant:ailon soiiai anv cnalbudcns or git'ts that were not tax ceauczbie ? 34a :3 f " 'es . ' pia me crganrmuon Ince with every saiimation an exeress statement :'at suan .. . McuricnsOr _ were net ax ceouc.-bie ? N 3Ab ilc ( S ", , _r • 6i crnanraacns . s .Ne.-n suostanriady ad cues nanceauc•ble ernners N � :_ gra O ' ia ne ^_roan=-=-Ilan MaKe gniv t.-,=louse '.c:bvma excencitures of 52 . 000 or less ' N / 3 35b - . . Na5 a' ncJVe!-e17 IO e!IhEr '.tea or ❑ o not camoler.e 85c :hrouan 85h becv unless -eo. nt�=.aan ' I . -Ewa!`/eq a 'NaNer CGr CraXV aX CNeq i-or -.roe C (i0f Year. _ moues. assessments. aria similar amounts :-rim memoers 85c -- , - e Sermon 462fei ioobyino aha eolibczi exne^ oitLres e �ocrerare :toncequcbie amount of se=en 602� ( e !( 1 ) (A) cues nouces 35e f -axagie arncurit of ionbvina aha coiitict expenditures One 85d less 8Ee ! g 'Does the organization eiea to cav the recon 6032 (e ) tax on the amount in 85F? 85g : f se^on 6002 (ei( i )(A) cues ngoces were sent. ones the organtmnon agree to ago me amc ,T !n C=t to Its reSsonaole esamate of cues adocaaoie to ncnaegucab:e iggovina aha orint rmi exioeriaitures t. ^ e fcilowvic :ax vear? N 3=h ; a6 =01 ( c : (7) ergs . =•lie! a Initiation fees ane =orioi mntnbuoans ;nauaeo on Iine 86e o .=ress recesms . "naucea en line - 2_ tr ❑uC7C Use CT aUO radities - ' ! � 37 z01, 1c : ( 14" eros. _, rer: a Gross :nc:me :rn n memoers or snarenoiders 37a y b ress incC:ne =cm Cmer scurczs_ 10a n = net amounts clue or Cala to cines _cure`s acalns, amounts cue cr reca!veo :;..m them . 37b i8 = tnv rime cucne une ' ear. cie �. e ^. roam-tion own a 50 % Or greater Merest In a =x we G 7C . c^uon zr = n c=vr c !sre^-a- ec as sp �arte 7mm me ^_ +'cantZaucn Linger Rec_ c:aocns s1•cns 301 . -01 - _ _no Z04, - .701 - ; 7 : f " es . ' =c,,.oiete P_r ( IX 38 7 _ _ _ _ _ . _ • . _ . - . _ _ . -, — cis - - - - - - - - - - - - - = fZ ar' g = _ c : : 4 ) ores . 'he crcaZ- =ricn enaaae !n anv se=n _ O ; C e`; r-..9ss Gene - — _ ur, nc :.'le :• err -r clic r be =me aware c , r excess oenerit � nsacen nom a ercr :e=_r7 " ' es . ' = ttic:, a SiZ ,2 .rlen. ; :xc : aininc eac-. Uc ,-. sac• on Bah _S ',2X :,T,OCEEC C' Me orioa- == uon manaeer< or o ;scuc !idea eersors cunno_ ':ear _ r=r 77 --_X cn Iine PiCc. Zoove , - e !.Ttourseo CV the Crcanrzzvcn - e, e. . . _ . cvees enaieve-z n :-, e ria-.- Genoa Tia [ ! nc::oes ..taro-. ' _ . : 001 _ _ _ Mb ' l -he _ .^.CKs are : n =- re ofe ! eonone riot at _1G ? 2 3e=Cn = c. - ( a : i ' 1 ncnexemat .-antooie -tss niina Farm =90 in neu c ' Form 1C41 - •: hecx - ere > — enc erirer ne amount v tax -exernot mteres: rece!vea or ac=uea ounnc !tie tax :•e=r 1 92 =am CC � I <CC11 _ -2"D 2001 ) _Cvc ^ F TZ Z. � SMLt✓IL Analvsis of Income-Produc.9na Ac:ivlIies ; E =- - `. Deane ns i ctOns Cn 'JcCe ] L . . "ime: _.^.ter cross amounts unless otnerwise _a-2e—zec Cu= ;e= incur =_ = ccs c•: � U, _ : _. _ ! �. . ,. .. tea. 7e'3tep cr E. .= e i -mount =xemct tunes, =tagram servica revenue: ,come a ��OG=cAZ� SrrRV= C^ RE`+TEI�7ffE � - cu 1 i NeaiuretMeai=d oavments . . . . . . . . . . . . . . . . . . . . . . . . . ? ce.c ana centres rem government aaenctes . . . . . . . . . . . . 34 :lemoersnic dues ana assessments 35 nterest on savincs ana temoorary =sn investments ; d 35 Zividenas ana interest Aam seurtiies . . . . . . . . . . . . . . . . . . - 1: _ - Net rental incme or (loss ) from real estate: - j - _ - ceat-inancec orcce.•ry ret cent-inancea orceerry ' : et rental in = me cr ' ICssi Tam cersonai orccerry . 4 : trier rnvescnent ;nur. .e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' 00 Gazin or ( loss ) from sates or assets other than inventary 101 Vet income or ( loss ) ftcm saeclai events 02 sass oretit or (less ) from sales of inventory 0� ' Lier revenue : a 1 ' 0» �uotatai (aaa =umns . E ) , i010 ana ( Ei ) ! 01 01 , _ fid 10! 7omi ( aad line 10=. =—'umns ( E ) , ; D ) , ana ( EI ) ► , _ a - . . . . . . . . . . . . . . . . . . . . . . . . . . . Naze : • , ,, e 10.9 oius line ' d . =dn 1 . snouid equal the amount on line ' 2. =.rr : . 3r 't II- Reiationsnie 07 AcziviLies to the Acccmolisnment of t—: eruct IIurt] oses + ° ze S ^ ec;=z : rs . .; cers cr. :; ace =xiain now ea= acdvnv for wni= income is recormc in =u:tat ( Ei of Par; VII cmnbutea imaon nmr o the _t.�mnii<nment • of u7e crcanization 's exemot ouroases ioMer tlian ov crovtdirc encs for <_t;= ouraosesi. � arr Information Recaraina 7ax2bie Subsidiaries ana Oisrec_ arden Entities ; See S- ce^c : ns =oris cr cane "ame . aodress . anc EN of cci-corabcn . Cf Nature Cf aatzvides cm; Tie _. e-_t-vezr :artnersnio . Cr ei<_reearaea enntv ?wnersnio interest : e_2.e N = . r Information Recaraina Transfers ,assac : atec wan taers ,: na ) Benefit Ccntracs a1 _ :p the arCanr=ccn. =Line the vear. .-eceive anv runes. _6"erdv er 'ncxe..- . _ - zv cremiurs cn a cermc:-z; Genes C1 . ie the c'—. an .^.. Bic:, . cunng the vear . : av " rermumns . 11re^: a : e'- Jn21 de .^. BT.it ' esX 'ip '; pte : " ' es ' 'c ibi . lie z= 8870 ana Farm 47070 Asea : nszruc_'cnsi . — — Jncer cz.^ -: = - - i_2e•iC.wce^—arh tna `ave exxrtinee ^;s a ::;.^._ :nc acca;" L �;.ar:^ sC Bcc:as a; s;H:ec e.= d _ _ ^. e ^_ -- , c . -•, ,rc.viecc = ;ra ,:se . J.;rr9C. andcarm z . _- ec.a<cen cr ^re^=ter — _ --an officer _ casea er. a . rro.^. .<•en r_ .�,- .- _ – _ _ = . a.. an . -cuea- = ., i c r7 77 = re ate vee ar c-rn name aAc oue. .; ate : `e= ' - . carers c5N c �T N rgte can. . nsr . : c lop o G o =,r^ sname icr vours � C 1 HARE . I�QM mu , -il.-"'mAT ,s.: Use*y .f sett—emcievecl. Z111 CARDINAL DR . 'ne - aoc.-eSS. ano VERO BEACH , FL " . Q63 -io . ► 7 SC ., >=AULH A j .. rcianizavan =.erncr .finder pec:ion Farm 990 or 390—=' MPrtvate Founaaitoni ana Section c091et , E0l ( ^ , 90ltkl , = S No, ; .: 0 Ifni , cr Sec.; on 49471a4l. :Jonexemar Charirzwe -rust � uomernentEry InTormaLton - .tee separate insuuCcions . ; = � Q : emnment or --.e 'reasury nremai Revenue :.emce > 'RUST ie cammeteo by the aoove oroanrz>ncrrs an❑ armcaea to their Form 990 or 9 !30 - :.ame or the argarttzaaan �^rployer identification num.^er 3C`TS &C GIRLS =UE OF =1MXAN ZTVER C^_,DN"_' Mwc ^ 623298 J Par -F Compensation of the Five Highest Paid E.nnicyees Other 7h2n Officers . Oirer=ars'. and Trustees ic., e= orae � of the inst uctons . List esch one . if there cre none. tinier " None . " gat Name am actress or earn emotovee can more : bl ttte ana z-ow.-ce nours ; dl ftntnnuoons to jei ==e se nan 550.000 mr imeex eevcmac to oosmon ict � rracer=vcn emoxryee oen. dans 3 i acataa am corer :ererrea cemoensation _w F= Cr 1 =7E D . 7E'RO 3ErC = LTJ E0 0 . 1 - 3001 � -tai numoer or Omer ernoiovees pato over — =0. 000 , 0 — _ Parol :- Comcensation or the Five Highest Paid Incecenaern Cantracmrs for Proiessionai Services Czen .7 ce = of -he insz. L: Si eac:J one iwne=her ncividuQiS Jr -irTTIs ; . ` f -dere cre none . enter " None - 7 ! at `Jame ano aeeress or earl inaeoenaent =Ira= each rncre than S 50 rCq ( bi - ?pe et sernce ( c; o_ -aon i "TCNE - CM1 r, uncer :: 7 ctr ers - ecewinc over = e J . CC = roresscnai sernc� s f :; rForr„ - 'Dr %1zoervycrx Recuc: : 0n Ac: .votica . _ e° ; ;. e nsrruc_ions -cr = c .. rr. d90 ano = _ r- . 9G -= . _ nec :: ie ; . 99C neouie A i F- ret kca cr acnes= _001 = C `_' 17 Y -_ RL . Part lli : Slaterne = Abour .Ac:"vities cace Of 7e ' ns �;L=clns . . ' es . o Junne the year. ..as ane arcan =ncn a=meree W intiuenca ranonai. Zmze. LA :c, r ; ecisiaaen . .ncuerne anv 3nemot to inruenca ouciic ccinion cn a :ecis;auve matter or remre.^.cum : ' f M / CC. 7 _.n. er wile =.i expenses caie or incrrreo in conne=cn with the :eoovinc acvrnes Y5 [ Must eauar amount on line " S. VI-A. or line i of Rairr VI-8. ) j anczations that mase an e!eaicn ureter se=cn .501 ( h ) by ming Farm �r 68 mus: =otete Part VI Other oraancmncns cte^tina "'es,' must .^rmniete Part VI-a AND attaat a statement grvmg a aemiea aIesatouan or :he iaobying acnviiies. 1 - _ During the year. .-tas the arc-.ninon . eft 'rer aire=y or incirer=y, enaagea in am o- the iaiiovnnc acs '.viih anv suostanaal contributors. msmes. Lirei s, CTnc=., =restors , :ey emolavees . .j mernoers of their famliies. Cr ' ,vith anv taxaale or>_anizz-tion with wnie: anv suci person is ata-liama as an officer. rreacr, nrstee. matoniv owner, ar pnncroai benericarv ? ( If the answer to anv question is 'fes. ' atracn a cetz-uea statement exciaininc The j ; - :ransac:ons . ; a Saie , excranae, cr :ersng or oracerty ? - ? a _ertaino of mcnev or =" er extens;cn cf snit? c =umisning gf acocs. Servir-�-s. cr :aciites ? d Pavmen( of cmoensadcn (or pavmem or n?uncursemem or ext). ;f more rrm-n 51 .000 )? =d e -rnsrer of anv par, of 5 ;n=me cr =.SsaeEs -- - , ces (Ise orc2n2 gc rraKe a:anis S.^_ , otarsnics . . eticwsn:cs , screen [ ! cans . ar ' :' See Note ce!ew . ; = o you nave a Se=on -02 ( bi annum . .2n rcr vcur emetovees ' vete : Attacn a statement :o exciain now ate crcanEmnion oerA.nnnes atat :ncivicuais c: crcznrzanens receiving aunts r ' cans from it in furtherance #&1t< =antaeie r =.rns " mai)fe to recewe cavments. Dart IV Reason for Nan ->' rrvam Foundation Situs i Sem Daces 3 throuan 6 of 'he ins:rucncns . i -n a nizauen is not a criva.e ietu(eanc ceruse a is: ( Rease cecc crny ONE _ cc::ceie Dox. , A cnure^i . convention ar aturces. = assoea-van ar cnurces. Se^on 170 (b )( 11 (A)(i). smoai . Se=on 170 (b )( 1 )(A)(ii). 4A1sa ccmeiete Part V. 1 7 _ .� hosoitzi or a cocceanve nolo= service crcaniztnon . Sec cn ' 70 (bI ( i `, (A. )( Foi. 3 _ 1 Feaerz( . ;,ate, cr :car eovernmerrt or ,overnmentai unit. Seron w 70 (b )( ' 1(A )(v i. — A meoicat researc< crcanE=ucn ace ateo in .^n#uncon with a nosormi. Se✓on , 70 (b )( 1 ) (A)(ii ). =nter :ne hosoitai's name. arty , and s .ute 0 — �n arcan ¢zncn coeramc for one cenetit Cf a cilece or universiry owner cr ccercteo by a covemmentai unrt Sac en . 701b )( 11 (A ) ( ivl . Also ccmoterM me SuDeort Sc- euuie in Psr, ' V crcanaaticn :hat nonAisily re"-erves a sucs—mmal can of its succcrtfrom a CCvernrrieniai unit or -om - e aerie.al ouclic. e=, on " 70 ( bt ( ' 1 (A )( vi ) . . Adso :ne Suoport Scneauie in P _r. : V -=- . 1b _ cc mmuniry tr".: st- Seton 1701bt ( w ' (A ) ( vl ) . , A;so ccrnciete ine Succor[ Scr. ecuie in r= an ; V - .- , T: Cr@ than ..- °u , . ' CS " tug . s =rn Z =..( res re:a:ec ' C : 6 .:a== re . 9rc. . :unc'Cns -dueie= :^ c.==.-:n ex.Bcccns . anc ( ^< ) no more than Z- -*,'Z ci is SuCcert -rail: Cress investment IrT =rne anc unretateo busness :axacie ==e ! less sc^Cil C :ax ! T: nt cus; messes ,: ccc . re❑ � v :.' e crcanr=cn miter une .- C . sec:ron Also =m : are ^le Suacort Scneouie : n = art 1n organization 7; at ; s not ==Uciiec ov anv c:scualirlee CerSgns iOmer :.'man -=—,caaucn managers) ono succC "S Crcanr:.._== Vons iescneec in : ; 1 ) lines d mrouan S,cve : C , , .2 ) s8 "on = O i1C : 1 � ) , , C . . � • - . . . . ..^. ev Tee! ^. e les ( z7 5a= n ^ ? "- e : :c'.vinc T. .—acG"1 cCCut :ne sucC •- e^ 'Carr,: :: :: 7S ` 89 CcCe - 'ne ^: s :T^ cns . al :cme! si Gi sur .... acZZC', e ' a -In arcani<ancr, cn=ntzea 'anc cce zuec to test for 7uelic SfetV . Se c-cn ( See pace 9 of ',he ' n -szriuc :Cns . , Scneduie A ( Farm 990 or 990 =', : 001 T ec e =cm czo ar 001 _ Cvc PardV-S•- Zur3oarr 4Scnef3Uie ! Czmoiete cniv Cvou cec:e= a cox cn tine 40 . " ' . Use casn meihoa or aacountino. 'late : 'cU =GV Use the `.vorKSreet :n Che !nS7.: C_`Cn5 :C.' Ve-Mr,= ,Cnl e = =J2! e '`._-.s - =**: ^ c' :❑ m IC itl , � f^ _ _ C _ aC::Ountln C . .a)ercarvesrtor5scnivearaeomnmoim a ) _ CO b1 ' Cc.hiiii� c ; oeg a ) oo7 E _otst zuts. _.ants. Ona c:.nmbutions ec�rvea. ; Do not incuae unusual .:ani See line 28. 1 42 321 � a2 16 'Aernt»�tsnio fees rec iveo 2 , I cz2f 2 � c2 7 :foss recera s from aam>ssmns. ,ner=2rrn se _oia c :ernces oerrortneo. or iumLsnino or itis in any a=vrry it= is remtea to -e Cr=am =n,s Cnarrtaole. etc. Zuraose 6 6 i . 60 i 8 =:nss rsc =am int. cividenas. amounts i -%cervea imm cymt an securities .;arts is i On 5t2(at(51). :ents. .waities. 7 clre=wa wusn. axaole inc. ; less s;r = . - tacesi from ousinesses acuirea -r me _�anmmon arter une :0 . ' 97s 9 'yeti: cine cram unre!atea business = r^ntes nct :ncuaea in tine ' 8 70 'a -Evn- :eviea for the orcanrzanon's .^.en 3 ara•)er aaia to if or exoenaea on its oer>ad 71 ne vaue or zero. or lac. ;umisnea to the I .•y. _e a governmento unit wdhota etsrge_ .0 no: wla. :^e value of sere. Or eG ^yen- '-ave ^xiniseo to the ouatic •.vnhout caarue 22 . c:er acme A=Cn a sc-.eauie" :Do not 1=lce Cain cr ilossl -:n :� OT Can. assets — r= 'ines " c throucn dp o I d — _� _ne ` „onus line 17 Z d 6 " a 71 d 6 — c = tee " oTane - =� jra:;r MZZtion5 aesc." ibea on lines 10 or 11 : t 25a a -_^.te. _" v. , or amaum in �:umn ( e ;, :fine .4 ► J =-eCuZ a Its-a .or `/our re^_.^.ros iC Slaw ne name of anc amount =1incuIPa by earm oe:Son lCmer Ilan a ;cve^tmentai unit or ouaiicfv suoeorrea organization ( wnose total grins for 1297 0lrougn 2000 exceeaea the :maum sna'rvn in line 26a. Do not fie this list with your nattim . Enter tie I= of all these -cess amounts 26b Z: -czar s. 000rt `or sewn 5J9(a )( 1 ) test =.ter tine =4 . =:umn ( ef '1 26c a 6 , 9 J =cc : .4irounts om column I e I for :fines: ? 8 i ac — - -cb ad 2 =-•otic succcrt ( line 25c minus line 2o6d 26e _ AA . = Sol •jbiic su000rt eercantaae dine 26e I numerator) dividea by line 26c ' denominator) ) 1 < 6f o 9 ? 6 ; C DrgoAiZations describes an line 12: a Far amounts incuaea in tines ' _` . - 6 . =na ' 7 ',vere rec..:vea :�� m a ' : iscua)inea Cafe a list tr your fe :cras :`, snow ,he name of. aro 9C— i amounts ret-..elves to ca ., vear `•om . e= — ' lisauatineo cerson . ' 0o not f•, ie this list with your return . :E ter .'ie _um c; _u = amcu !as zac ve_r. = OGi 999 ) • 9981 997 ) " - �.v 7e ^ ante Cr . = nc amount r eicarve� '_ .' ?3C:7 :'eaf . ' ci Xc5 Tc .^E '^ Cil i.^, e . araer c, f ! 1 :" - - cunt Cr) iine � E �c .' -.rie ' , ear ( 2 ) .`_: . JOO . n ^ e : iSrcani a ons aes . C =r : n ; fines , mxn i s ve!i as inc :wcluais . . Do nCt ;tie this tlsi wan your retum . .-. '=r — ut'nc eerween me amount re:e.:vea anc ale ta,-. =_ r Zimcunt cesccea n ill or i2'. , . . . e. -. e sum or tnese c rierences tL^ E excess cur. . ; for = acn vear V � _ - = OO : ac ° 1 ec81 cc - 1 - . . . . . _ C _ = � ► ' ' c _ - _ inE ? c _ _ uc _ crt , iine _ cl stat „ :nus . . ne = - c :om; i ► 70 _ J:al s:_•cccrt 'cr sewn 'J9( at ( 2 ) test =. ter amount cn gine ZI -.-:umn tel ► �f - - . = 'relic sueoort percentage illne <7e t numertor) aiviaeo by line :7 f ( oenommaton ) ► - 7a 1 nve_szmeni income cercentaae Cline - 5. column lel ( numer–mon aiviaeo bV '. ine 27f foencminaton ) ► .? h - 5 Inu5'�ni DrntS : �Cf an orCanlZ.ailCn C .� , bea in tine ' 0 . , . cr " 2 dial rec:Ivec anv unusca; crznrs Junng ' SS7 'tlrcuon 2-000 . ,Car= a tis! for your reveres to snow . 7.4, eacrl year. ne name or ' .. e =rImbutcr. Ile date anc amount or the ^_:ant ano a ener ' Esc:_ .on of the nature of the zrant- Do not Ile this lis-& with vour retum . -'o not incuae race c,2nrs in tine - E . _ �' Scrii A iForm 090 or 940 -c—'_ . 2001 L . — .. . . .. . _ CJOae _ . ie „ : ? ' :Gt= 490 , 1F O_ _ 4 ------------- Pz; rr*.V = rivare Zcaooi Cuestannaire iSee czne - or `. . _ ins .;.: .ons . -o ee = moletea CNL'.' :;v srnoois �.ar ane=ea the = =x on line 6 in P3rL 1V ! =° = oeE mie crgmn=cn nave a ,c.=div c.^.na '�iminatorV cmim- cavum =—z qrs aV 7=arnellt in - craner. --iaws • 1j / Yes `lo ctner an emina instrtsaent r in a resmuac:-r, ct is governing roav7 - - - - - - . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . _ . � 0 es z:,e anranrrauan me::ae a .s.atement c 9s rcaliy Wont=tr:mnnatery colic• tt�-a sa:ae.•rs .n ail its .=? ures. =iaiogues. ana aches writcr ten rmiummiions ' lina the public ceaw = sniaent ammssians . programs, ana sc o>armmnios? .:fl = � Has die arcaan=mn cunii=.=d its manly nc :nciselminatorr ::oiicr throucn newstzzmw or nroa=ast media eunne i . . . . -; he aenOe Ci seiic anon fLr srIaL-i25, c: auraia the registmtim oenoa if ii '.as no sr^---*on arc=.-m, n a way 111 mazes :.7e pcicv Knowrn to a7i cans of t7a general comrrarnity it served i f '.1es. ' piease cesc_ e: :; "Ia. ” =nesse e==n - 'If you nee= mare snag aiaCi a .')at'ate s�merit ; . . . . - . . . . . � '1 v 3 - - -- _ aes - e orcani.-_-_cn main ,ain m. =_ roiicHine_ ' = Ze=res mmcz ins me .ac•- ; c7n'.:osirdon of =:e smaent occ:. :ochry , anc aamunis zve soft':' > > E•,.;,ros aC .^_:me'innc =tat su Ofc��nics anc mer 7nancai aSism,-1CH a—c aWaraec _, a ,,oCnIN ^. onCSC:IL:nota^: oasis i . . . . - - - . . . . . . . . . . .2b C.:oies or ail mmic gues. zi-cmures. announcements, ano corer written =munic� =s c the =.:.-iic ceaiira nnth widen, aemissions, =rams. ana s=c=rsniasl .2c d Coeies or ail matenai tinea tv the craanrmza= or an its bena:'. to seiict =mburcr.: '72d i T� _ i- f ':eu answerec "Jal = anv Ot the accve . ,^. :ease exciain . i1* ,:ru neea rr.=e scaC =c: a se_a,aie s am.menL . 3�f . .. � aes -, e arczni=-aen ciscaiinam ay -ace :r: anv •.vay with rezceC :o : S Y y a Stucents ' rigors cr ".mideces ' o3a i z Oiss;ans caicsq -2b ^ionovment ai ;==itv c acrnin auvestaff? �3c ,7 zC==arEnics cr cmer �an Con assL=mnca % ' cnanal aciicas ' • �3e JSe OT taii tes : = u7ie^c grog.ems ' � a .. :her exuac n� ar a =vices ' yh " CU a :nswef-ec ` es • • ^. aMF, Cr .= cc,-, e . = -eZ E _Yaialn . -: Ou r^ eec. - : ." 5 '2c` _mac. H Vic_^ O :c1` � Ic : = .^ cn ` .:'Lt : ••. - 1 - s - = ciC ever _ ee ^ �evoKec csce.^. eec _ ab ' CJ ai7SLVEr? .. 9s • : -c C . _ . c ; F= e C . . Crain USir. c an a = c- E-= Src i=m E - - ° aces „'. e ercanl _:Cn 7nai . . , as ,:^. T�JEC NIt11 :nE aC : . : -:au^ IE rEOL ATE-^. :s _ _ v^ c ,'15 - '..^: rr, ;, _ _ ,. O - - . •, Y J F `. "No . ' .-c ar = _ :ananon g Sc ieeuie A iForm 990 or 900-E7. ZOOM. .:necule .Ik ,Form. ac0 or Part :`✓1 =-� Lzabving �= enditures by tiering Puoiic oaae ° or -he insiruc:ions . , _o oe CcmoieTea CNU! ov sn �. qiaibie 0rC2niz_ 1- ca ihci zieu 7- orm ^ i�] O ) N . , ecx > ] " A organ =Jan oe:onas to an a ,Tirlate^ =Muo. > 7 f VOLT C 7SCXe^ .. J :. -. no " imI[eo G ntrC; ' '-CVisian5J_ a1 ' mits an Lobbying J enditure5 t l 1 ;Kiiaeo c_. cun tc a cr AL' =-n rThe term O ?xoenaltures' means amorous paid or inctrrea. ) - 26 Total loobvina exoenoitures to influence puniic opinion (grzssnoots iooirnng) � s 7 7oral loobvina extienaitures to innuence a legislative bow cdire= lobbvina ! - 9 1 . 7 I 38 -oral lonbving exaenaitures iadd lines 26 ana 27) 28 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' ther exempt ouraose exoenoitures 10 Total exempt ouroose exaenaitures iaoa lines 28 ana 29)41 40 _oobylnc nontaxanie amount_ =.ater the amount from the �owino raoie- If the amount on line 40 is- The lobbying nontaxable amount s- I ' Ivor over 5500.000 =0% of the zncunr on line 10 . . . . . Over 5500.000 but not over 51 . 000. 000 5100.000 ors 15% of the excess c.-er 5500 .000 Iver 51 . 000 . 000 but not over 51 . 500 . 000 5175.000 on= ' 0' of the excess c•:er S1 . 00o.000 41 Over 51 . 500 . 000 but not over 517 . 000 . 000 _225.000 el= 5Z% of the excess over 51 . 5]0 .000 giver 517 . 000 . 000 51 . 000 .000 12 (assroats ncn[axanie amount ( enter 25 '.6 of line 411 11- ' - 43 SudtraG line 12 from line 26. =voter -4- ;f line 42 is more that line 26 -14 SUbtrzc. ;ine 11 from line 28 . =voter -3- if line 11 is more inatl line 28 14 i Caution : if there is an amount on either iine A3 or : ine 4LA . wu mus nie =arm 17"- A-Year Averaging Period Unaer Ses.-ion .Mlifh ) Seme orcant=rions tnat mace a se^cn 501 ( h ! e!ec­en cc ns ;ave to c=molete ail of the nve criumns ce!ow . See the ins-nuccons -cr : ines =5 chrcuon 5u on cace ' �Ule :nsauc ons . : _cbbvinc =:penaltures Ounna A-Year Avenging Penoa ' Ca! enaar vear ( or ;; at b i ( c : d ) e; 'asci year becinnina inl i> 7001 2000 45 '_cobvina nontax2nie amount 16 -aobvina cetiina arrcunt i1504c of i r.• - . - 47 -oral loobvina excericitures 48 ` rssrcots ncnraxaa!e amount 19r_s cors ceiiina amount ( 15040 of ine �81e ! ! - zrassroats icoovinc exoeneitures Par-. V.I'B Loobving Activity by Noneieo,ing Puoiic C ; ariiies cnr^ rti nniv - i1C ; crc _ t'r - _! 1 _ - C .=. c - - N , Svc i -' U (InC :;. e year . C'Canazuon anemot :C InTiuence nave—i . e Cr awl : °r':S is_Cn . . naumna an •; _ LkemOr to infuence ouciic carmen on a lealsiauve nrger Cr "e=ra.na ' : rn ;^; e _ < e ' es Vo Anc : r. : a 101unreers - J : TO staff Of --nanacerrient ( inc: uae =rricensation :n exc _'ses econec on ines _ - . .1mucn n . _ Mecia aevernserr. enrs ' akin ^_ c :c --. or. _ o .c . eq :s ;atCrs . 7r 71e ^. uCllc � 7 CIICa❑CnS . Uf U ,- CllSneC Cr oroaac - st s:a ce men cs = ianis CC OMer =zanI=1cns :Cr ' COCVIna aurz CSeS nrn �- ` zc:, ec; siaa crs . _neir S ora . _ Cvernmen; 7 Zailies . zemonsucaons . 3e•ninars . =nverinons . SoeeG' ; . . e=res . _ r any c _ . _. - eons - oral locoving exce.^.eitures iaad lines c cNrcuon n. W" es ' �o a—ny of *ne aooye . also armcn a s .cternent civ• a cemiie^- zesc. cc - ^ e zccyinc atmyir; es Scneauie A iForm Jan or ?9G : 001 : AA cneeciie A ir=orm 990 or -290- =) w0l Z=5 - - Pari "Vl � IfforrnaIlon ReaarQlnc ii rans;ers i C anc :r-ansae: Cns anc -elaIIonsnics With Ncrlcr::ritzz: le .. __: ernur `JroaniLations ; See oace Or -`ie ' nSirUC:: Z :1S . . = l :id the reooruna crcanizanon ciret yv or •naireri encaee :.^. anv c: -e *oliowinc ,vith any c—nc�a c_== in <_eV zDItc7 of the woe iotner Tian a^cn zD a ( c : (Si crean=v. si cr *. n se=n c=. :eiaung M= C=. a -rnsfers Tam elle reoornng oraaniz-nan to a nanc;antanse exetr.. It organCZ213ct Cr ' Yes � Uo Cash 51aU) Other assets _ All h OthertransacEons: ( i) Sales or exetanges or asses with a noncan—,ante exemar crca umnon ctil - . . . . . . . . . . - - - ( fit Purchases of asses from a nonctatrmole exenrot organn :) till I •' tjill Rentaj orfacuties, =ouioment or anter assay jivj 3eimoursement arrangements 'tryi . . . . . . . . . . . . . . . . . . - - - - - vj _cans or loan guarantees . . . . . . . . . . . . . bivi X (vi) PeArfarmance or services or memoersnio or 'unar-aisinc saucy. ens � tvil I c Shanng of faciities. eouioment_ mailing dszs, otner asses, c: aaic ernoicveas 1 ` :he answer to anv of the aoove is " es . ' .�mc:era Lie clicvtnc = ecuie. ;;,,._:.n ih l snc-; always s- Gv ^ e -:1 ;ceas. ctner assess. ar services riven cv ne re_aranc crcai:=n= . : f ate orga .-=non rew:-ec :ems ,�. :�tr -arae. ;aice : n arisacan or snannc arraneernent. sncv , n c=umn ic ! the •.Qiue =f :.tie aooas . _- er asses aer- ncss -=c=-:ec : ai ( b) c ( d1 ane no. amount imorvea Ik\ane ar nonetarrMcie exerr>:a era2n¢anon . as --=ten c �:_�jsms. sr=�. a a,enaeme �ss I i =Za s -Me crcanaanon eire=v or mcirecov a—:eater •.vrih , cr re:aw tc. cne or more =z�xernot ___ �niri�- -nens = escncea in secuon 5J1 ( c ; of the Coae + cuter ",an se=on cJ1 ( c :, 3 ) ) or in se=:, SZ?' ! _ 'fes :L .Vo "' as . ' =moiete the rcilowina sc; ecuie : ai l i c : Vame at crcon=Jon - .—a cr c.cn=-ucn Sc-. eaule i ==rm 920 cr 990-> : _701 =om, Ztfier Notes an ❑ Dans ,`(EC 1v2 "me ^ no -4 :ear _ r e= a^_:nn;nc � o ' 0 , 'lame =mmover :ae.^,tmcuor, ti ORM_ 990 4=ALR' _v -. - M _? - ?ADD I TZONPL 1"WCRMATION I Name or com-wer - e.@atronsnlo to aiscuaiinea oeMon 11 m� AIM SrAT,= SI�DD� 61 71 81 cl 101 Onoinai amount I uatunry ! I Interest borrowed i C ze or loan aarP ~<cecavm rt terns - a_ , 1 goo z ; _ E / 02 / _ = / o � s bo PER ue . FOR 11 .2 MONmsS 2 ) 7, al a , 101 Sec.;nty crovlcea by =artnwer =arouse ar loan it C^R^TIFI- Com`=T' OF '^ _ '*'._c. - . 987 = R 8P_I+r: OF DC'.�IP�'�JT VEH _ CLE �^' �7 - 31 41 OI 81 a;anca cue _[ = arnca cue at - air rarxec . z :ue _ nsee moon :imisaec '_ : enc = • ecinnlna or . e_r _r c or ear S 0 0 3 ) a ) i0 ) Ota is 000 oil i • 0 • Ili! ( 3 ' u ' u L ; S cu I 1 IBJ I n i1: 111 ' [l ; Cl I to O � .I c7 O t1 to I '1 rI I < I ) r � Irlhtnhlc h1 ci t , l t to ' I � to I ' I M I- I �) : u t „ ' Ql r, A10U .I r Irl n1jt„ ( �. , \4 [ 1 /1� Q � 1 :I ry r) I „ 1 -1 u n n Ml r 11 ' u U ✓r t ) 3 ( U 13 Q ] . CD 1 fI f7 (, l t + 3 ;, l1 I M V cl llll (� DiN I [ A m O ' 11 q O 0 , � l OznZ rl rq Tl ( n tTJ -' f r' 1 z, d I 1 I 1 -1 1p IlOC) 13 ' v Gl 1 I I ( ' 1 -u n (l 1 I • I , 1 , , , • u ul , 11 LJ raUljl � � m ( , c) 14 = ,, 04 30ru ( ) I O al [°o o� ro Q1 'I in rwil I ' I In Ill 1 . , . � � , u . � . , „ , I , t11 " • CT1 rrl Ill 1 I lj I , 1 In ( • 1 11 , 1 0 ill p l ' d cl ' Il fnq-Jill n ~Ul Oil :r m 4 1 1- 1 ;U - -u •1 r1 - '� I I C) � I-❑7 ('� qU In - 1 W 1' A ADD 0 CIA l :, tIl r . ) I ' ,1:- tb All Ail 7 n a �^ o , , , , • I , 1 • mt ° ro Ali d - r � ) In m , t . C , CO 111 l r 1 nl L: r 0 0 ( n ( n I ' I I `• , F 1 CJ ) � l � u , l Ij cL rJ C ) oo r ' I hl 0 yr Cl r ) C-, 1 Cl zi p M f :J . i CI 1 , U) a n CT by rD qJ O= QI m �� fl :3 r-4. - I -n f d 'Tl �. fZ . to tp m to oil TI a n W [IJ f QJ < ((n (D01 m (D fD toOl` O ' O ~l 0 rn i O w � r- •, dn _ - ul r n rD rrl to m 1 . , t . , (Il I � , � rl�l ❑ . m m I > I , (» M r r I rl B .O C 7__ rCj U (!) C O O O� O O A 1 f l' ul ,p O O E ' F m m C cu Q w - U) .� _ n . t riv r~. Lm .c U — i , L O ' 5 v cv E -1 ' c ccs n r f , ili rl I 11 If ) II 1111 IIAl1 -- - - - - - --- - - - t ) 0 - 36232WI Book Asset Detail 7 / 01 / 01 - 6 / 30 / 02 . 1 I / 12 / 2002 r; : n / IlNI 1= YE : 6 / 3O / 2 ( 1 ( 12 I ' �I � 1 � I I I , , Iu In Linttlt Houk Sur, Honk Sill Hm ) k I ' llur Hunk Currunl Hook End Hook Hill - Hunl , U , ul , � sscl Ihulu ; lly I It ; , , t11 , Uun Sutviru Cull 1711 kx 1 r, Vallln flu Jlcr, D ( � roclallnn Ilc ; ) roclalion Hnnlc Valud tvHook , l I uli „ 11 - - - I 1 _ , 1l , , , yli . f • I . rinr �. t111r1 ' nII . NI - - -_ _ - • - - • — • — . . 21 I ' l11 1111 ( 1 i I r\ Ill l : .l 11121101 " ' Il llllc ( 1 . 1111 100 7 111111 bb h6 731 . 2 (1 S / I . 28 A I S SI J1 ; 1 \V ;11t I : I I / ? ) /( l l S , bn6 97 bn 66 1 II 29 AI . S Sol , I \VAI ( I : , 11 not; 1 ) 18 n 00 1 , 1190 2 •f t , U90 24 1 , 516 . 73 S / I . 1 1 , _ / rot s , (, nr, 9R n . nnc 1) on 6 00 1 , 090 25 1 , 090 . 25 •1 , 516 . 73 S / I . 1 0 3 (I 1 ' 11111 ) 1IZA ( 1� 111 ( i5111 . 1 \VAItli 1 /11 ' 1 /(32 1 , 150 (In 0OOL; 00111 0011 31 ANII ! ItV IAN 1 ' 1 M N A f1 ( ) I I St W f 2 / 07 /62 son nil 0 06C boo 191 67 191 67 958 j3 S / I . 1 n 32 At, II ; ItI ( AI11 ? 1 ) 111 AIfullSill I 2 / u / /( 12 5 /) 111111 ( 1 Oil 691 .1 69 . 44 43056 S / I , 3Il 11 ON (1 no 0 no 69 • 1 -I 33 1 ' OOSIIA1 I Al ) IIIIIIN31 ' I : It I ' lltl • 1 / 12 /02 1 , 285 (10 0166 69 . 14 13 (156 S / I , 311 1 • I 6 IT • 141 ( ' l A111 i ' .`; ? ( 111(1 (I (► (1 30 60 3660 1025 -1 . 46 S / I , 7 11 i . 111 /02 710100 (1 (lntc 0, 00 0 011 35 S1II � IMMi11111 ' 1S S / 111 /(12 :! 9 ') 71 ) 0not; 01 . 60 0 0 1190 1190 697 . 116 S / I , ) 11 3 (, Ctll' llilt 6 / 1 1 /02 1 , ) 95 . 00 n 00C 100 I I ) (1 I I ) 0 487 . 80 S / I , ) O 37 COI ' ll ? ft 6 / 11 /02 2 , 995 00 0 . n(► c 0 00 29 92 29 . 92 11765 88 S / I , 5 11 38 I I lIt l ll ' f l lit 1 : 6 00 0 00 4 J 92 r. / 1 1 /112 999 82 1992 2 , 9 . 15 . 16 S / 1 . S 11 39 I1ItO1. 11 0 ) 1 '. 51; � Il (1(1c n 1111 11 no IG 66 10 fiG 983 , 16 S / 1 , S 11 6 / 20/02 689 . 95 n 00c n nn 0 no 46 POCOTOR At n : ( A nu n : 1 6 / 20/02 87992 11 (1 n nn 6139 . 95 S / I . 7 n 411 r ( , �) I . 1 A rll I 0 Ont n o0 0 nn 6111 ano 879 . 92 S / 1 , i n 6 ; u, 11) z 1 , 1913 nn 11a � 6 n1) •12 I ' ll 11' 111 ) 111 i r :\ I , I I 6 . 26 /1 ) 2 Rhe { z n al ► � 1) nn 6 . 61) n nn n 10 I , 195 . 1n S/ I , i n 013 I . t ) t : K l : lt i 6 / 215 /02 1 , 823 1 .1 0 (►Oc 11 . 1) 6 Il lin ( 1110 (1 (1(1 868 . 12 S/ I . 5 o f l r l IRl ( A l S (, / 27/02 0 0 ( 1 n no 0 nn 1 , 823 . 34 S / I . 7 11 1 , 113 23 n nnc 616 0 80 1-100 0 00 • 15 IM11TAf C :\ r. n 1 < ,\ I , c ) IIAII ! 1 6 / 1 /112 1 , 40000 n . 0nc 000 1 , 113 . 23 S / I . ) Il 46 rr , ( u r ;\ I11 r. 1-, n1IA " re1 ) I I / ) 11/111 2 , o0n 110 0 o1) n 1)11 010 I , 4n1 nn s / t . 5 11 47 CONlNII11M A I lim SyS ' II ; N1 1 / 2 � 1 . nnc (100 101 233 33 233 . 33 1 , 766 . 67 S / I . 5 0 I /1) S , fi4 (i ( 1 (► (1 . 00c 0 00 n 00 170 50 •IR InCI ) NII ' Ilflka t , l ' I '. RCOIIIII '. S � 2u /112 11 , (11111110 IINIc 470 . 51 5 , 175 . 50 S / I . 511 _ - . - .- 0, 001 ( 1 ( 111 166 67 166 67 9 , 813 . 33 S / I . 5 rl ( 1 . 11111 O1111 ' nII : N ' I ' ! 8 , 06795 ' (IIIOc 0 (11) . _ _ . _ .. �..-_-- �,•, U (111( 1 3 , 6 (1 . 1211 3 , 611 . 211 11 , 463 . 75 • .. Y I4 ,. .I , � Y . -. 1. l � ul laY LAY I ! : !_ I_: �1sl; : ll1 ) I I , In1r111 , \ ' o: nil �: Nl :i 111 1111111 ) Illtiltl : lltll' :\ Iit1115 4 ' 11 /111 1 , !111115 111111 1 CA14ITOI I , ( rl ,\ r1 � 1 ) .1 ; 19 /0 ( 1 , 780 no non a 011 11 . 20 - IIs 11311 61 . 011 1 , 742 15 s / 1 , , ! , n - 11) 6 90 nn 5 . 111 nn 61000 31150 nn S / t . 7 11 FAM1: I11 , 1 l ) 111116Iirt \ IFAIIIN ' IS 5 , 1583 . 15 (IQnc 0011 - 102 . 21 ) 5138 80 691 00 4 , 992 15 CANI1 : ItA I I / I 1 /1111 • 1V ' ) q9 2 ( • I ) NII ' ll ' II It 1 1 ' 0 / ( 01 ' 666 / 1111 333 . 32 S / I . 11 - I 1 /1111 N • 19 99 11111 11 ( I(1 111 ( 1 IIO Ib 1) 67 � u 3 1 NII , IIII I : t ' :\ 111111 I .`; ti ' 1ti /131 SIi9 97 1) (1 (1 111 11 17 ( 111 ( 1 283 . 33 566 66 S / I . 5 0 1 0 0 ) 0 ( ( ' 1111 : 11 Ill non n n6 81 • I2 81 42 488 55 S / I . 7 11 1 1 / 1 1 /111 ( 7111) 99 11 118 1) 60 100 On 1511 111 250 1 ► n S I ' ( A . 1A 111 1 : 12 " 415 /00 2 , 28 ') ( 111 Il III ► 11 11(1 •199 99 S / l , 5 11 6 I A11 41 OP ( ' r It\ 11 , 111 I v t I ) Ili ) IN, I 9 / I l /1111 190 75 327110 517 . 75 1 , 771 . 25 S/ I . 7 I1 1 , 551 60 0 (10 0 no 258 56 316 311 7 Nil :\ SO !, n r ) 111 : ) 1 6 / nl /O1 2 , 995 O0 1160 1 ) 00 9 567 . 70 982 . 30 S / t . ' S 0 ( ' t ) NIH I" 11 It , 1•. 11 ( 111 it tit , 1 ' It 111 f 2 , 1 5 /01 1 , 200 no 11 nn 19 I - 59 ) 00 648 . ) 2 2 , 3 . 16 68 S/ 1 . 5 ( 1 1 ' ) 21 1 INII ' 111 1 1t .1i , , , n 011 Inn nn 2 -10 nn 3 . 10 nn 868 nn S / 1 . 5 11 1 . . 1011 I , 5 ) n 11 ► 6 nn , ; 0 611 1 01 ) I59 110 159 , 60 1 , ,136 .16 S / I . 211 St ) 111' I .1 I ' 1 ( 11 ' \N t 1 ' It \V :\ It It 1 2 .' 28 /01 1 , 71. 1 96 0 6(► c 0 nor ( 1 0111 171 50 5 11 2I NI ' . I ) I I It rIt „ I2 . .! 8 / 01 549 99 1) 00 n 00 173 . 5 (1 1 , 5 (1 ( . •16 S / I . 5 0 22 2 C1 ) NII ' I111 : 11 51 ' I I : nIS 2iu7 /112 1 , 5 !) 6 f1O IL (11► c n Ill ( 0 fill !) 1 67 91 67 •158 32 S / I . i it J 21 I AI ' ' ( ( , I ' I / 1 ir112 1 . 61 !) 98 n 1) (Ic 11 ( I (1 131 611 133 O (1 1 , 463 . 66 S / 1 , 5 11 24 CI ) 1 ( , R 1 :\ :; I : Ic 111111 ( l I It I ; 15 / ( 12 > � 111 ) o 81 1111 _ , 161 ) 81 0 00C Il ( 16 0 1111 i 71 49 1 , 537 97 S / I 5 II 25 QI IIITl1 (lnl : 1' 111 , 6 > 6 / 112 549 95 111 ,: n 011 In _ a 102 . 49 1 , 9 -17 . 34 s / 1 . 5 I n nn n nn Ooh 549 05 S / 1 ) ( I / ( ► N BMS & UM I ] IJH OF 1INWIAH 11 / 12 / 2004", io ► 1i m/i k ) O - 360111 Book Asset. Dete 7101 / 0 - 1 - 6130 / 02 � I � �„ ► � ` 1 - Y1= : � / 3 �U111n � 11 , 1u In book Book Sec Book Sal Book Prior Book Cimmil Book End Book Nal Book Ansel hol , olly I1c :, c , il , 6on Solvice Cosi 170 Ex ) c Vallee Do llec De preclalion Ue reclallon Bool( Valle Melho , l plalo ( I G' , 'Mli . OFFICL: 1' Q1111 ' 1111 N1 ( � nnlliiiiul � --- - - • -- - -- ._ _ _ . . - - 26 CHIIICAlS 6121112 1 , 23 '1-) 22 01111c 000 11 . 110 1100 0 D 11239 . 22 8 / 1 . 111 119 I A (T IIA 16 , , ; , , I I WAN ! 6 / 25 /02 150666 66 - -- - 0 nn� 600 — -- o_ no 0 , 60 0 . 06 15 ,066 06 S1) , I o MITICE l : ( 111I1 ' nt I : N ' I ' 360 ,18 87 — _ 0 06c 0 . 00 879 . 17 20718 . 88 3 598 . 65 33 ,612 . 82 VILIII (TFS 8 1 ) 0061 : I ( Anl hOO VAH (, / 201111 2041102 , M ) _000 u . 6n _ -- 0000 •1 , 066 .40 .11080 . 40 161321 . 66 S/ I . n VEIII ( TES 21) 1 -162 06 6 one 0 . 06 6 . 06 4 , 080 40 40080A0 16 , 321 . 60 ; 1 ;11111 1 olal 1 10 , 793 97 0 One 0 . 60 981 . 37 8992 28 1 1 , 973 . 65 981820 . 32 v 12 : 19 PM Boys & Girls Club of Indian River Count 05/22/03 y y Accrual Basis Profit & Loss Budget vs . Actual July 1 , 2002 through May 22, 2003 TOTAL Jul 1 , '02 - Jul 02 Aug 02 Sop 02 Oct 02 Nov 02 Doc 02 Jan 03 Fob 03 Mar 03 Apr 03 May 1 - 22, 03 Budget May 220 03 Budget Ordinary Income/Expense Income Unrestricted Donations 7 ,850 .00 11660.00 270722 . 30 60487. 89 10, 100 .00 40, 171 .67 16 ,031 .51 190836.00 11000.00 34 ,980 .48 42,620 .38 40288.07 210 ,24 U . 17 28U, 1b6 . 0 / United Way Grant 11 ,333.34 11 ,333. 34 11 ,333.34 11 ,333.34 11 ,333 .34 11 ,333.34 11 ,333.34 11 ,333 .34 11 ,333.34 11 ,333.34 110333.34 0 .00 124 ,666.74 136 ,000 .00 CSAC Grants 0 .00 5,366.28 5,366.28 2,848.41 0 .00 12 , 186.48 80339 .89 9 ,225.66 0.00 18,451 .29 9 , 147 .34 0 .00 70 ,931 .63 100 ,000 .00 Florida Dept of Education Grant 0.00 0.00 0.00 0 .00 0 .00 16,747 .84 3,887 .36 3,506.52 0 .00 0 .00 7 ,242.20 0 .00 31 ,383.92 44 ,000 .00 Office of Justice Prog . Grant 0 .00 0 .00 0.00 0.00 0.00 0.00 7 ,850.00 2, 160.00 0 .00 0.00 0.00 0 .00 10 ,000 .00 10 ,000 .00 Dept. of Juvenile Justice Grant 0 .00 0 .00 0.00 0.00 0.00 0.00 0.00 0 .00 11306.33 0.00 2 , 181 .01 0.00 3 ,487 .34 39 ,477 .00 Other Restricted Grants 0. 00 0 .00 1 ,625.00 51 . 15 21500.00 0.00 25 ,000.00 41 .85 500 .00 0.00 0 .00 0.00 29,718.00 69 ,964 .00 Memberships 1 , 188.49 802.45 165.00 515.50 322.55 376.25 106.25 151 .50 265 .00 49.26 10882.00 0.00 5 ,823.24 4 ,850 .00 Program Service Fees 517.03 770.58 300.00 623 .55 59. 11 188.34 386. 18 300.00 760.02 1 ,662.90 168.70 17 .74 5 ,736.41 3 ,867 .74 Contributions In-Kind/Prog. 0 .00 0.00 0.00 0.00 0 .00 0.00 0.00 0 .00 0.00 0 .00 0.00 0 .00 0 .00 0 .00 Fund Raising Events/Projects 0.00 1 ,507.00 5,500 .00 40.00 15,516.53 50,310.67 7 ,278 .79 1 ,350.00 25,899.06 47,060.75 31059.70 0 .00 157 ,522 .40 69 ,494 .00 Investment Income 176 . 84 0.00 232.02 0.00 140.96 51 .99 47.81 42 .23 44 . 37 0.00 0.00 735 .22 Uncategorized Income 0 .00 0 .00 0 .00 0.00 0.00 312.06 0 .00 0.00 0.00 0.00 0 .00 0.00 312.06 0 .00 Total Income 21 ,064 .70 21 ,329 .65 52,244 .03 23 ,899.84 39,972.49 131 ,677.44 80 ,261 . 13 47 ,936. 10 41 , 108. 12 113,537.99 776534 .64 4 ,275.81 650 ,566 . 13 746 ,810 . 81 Expense Salary Benefits & Payroll Taxes 35,231 .54 30,866.94 28 ,943. 10 35,638.69 29 ,594 . 19 32,491 .29 37 ,702.05 399339.91 280965 . 81 38,268.61 18,319 .97 53026.98 355,362. 10 525,311 .33 Operating Expenses 19, 147 .87 16,595.63 14 ,709.29 19 ,282. 18 176481 .36 25,955.29 13,977. 28 16,432.41 18,445.20 22,755.68 126722.56 11 ,383.85 197 ,504 . 75 184 ,638 .97 Fundralsing Expenses 1 ,426.30 1 ,000.00 1 ,470.44 1 ,221 .23 9 ,066.80 13,803 .86 1 ,072.76 1 ,379.49 91028 .94 6 ,578.39 661 .90 0.00 46 ,600 . 11 15 ,000 .00 Total Expense 550805.71 480462.57 45, 122.83 56, 142. 10 566132.35 72,250.44 52,752.09 570151 .81 56,439.95 67 ,602.68 31 ,604.43 16,410 .83 599 ,466. 96 724 ,950 .30 Not Ordinary Income -34 ,741 01 -27 , 132 .92 7 , 121 . 20 -32 ,242 . 26 - 16, 160 .88 59 ,427 .00 27 ,609 .04 -9,216 .71 - 16,331 . 03 45 ,935 .31 45,930 . 21 - 12, 136. 02 61 ,090 . 11 21 .860 . bI Net Income -34,741 .01 -27,132.92 7 ,121 .20 •32,242 .28 •18,159.88 59,427.00 271509.04 •9,215.71 15,331 .83 45,935.31 46,930.21 -12,135.02 610099. 17 21 ,860 .51 I .,J `ago 1 of i 2003 =2004 Organizational Chart Director of ' Marketing Firfance Coordinator Id tl'I' s 2 r e Program Program Technology Director Director Director AmericQrp ' Team Leaders EJu1y4 2A0ii Ang :34 . �94331 :.::m +xu :.vxma•<y�+»�xt..y:•.v:, rn :mraeawwarnoe��ar•'aaw :::: Surilcfl�lM Frog �arrl $ti(# ET#E;# PTrETt .. Spe falls.. {Ju)yt ZpQ3 Augu$t: 1:5, 2 fD3j {Jpfi 20fT2— August I 2 0) •.:.• ,•. :•.. +v.•.•wxir„a+ rcoc,•.wvccw,,.,ww,c:;.:.w..Rcw�..a•": ' Airnerccnrp „ . �#7lprl£Orp Team Lean@r. . Ame lEcorp TeamLeaders EsePt t �QQ3 tune 3r+ zonal T@a1'� Lead@C tsei 4 1!003 Jun 30, 2004l . . a... . urir. ESePf i ?f103-.-.Ione 36.�:20fT4� ,::.•... Amen Team Leader Amereorp .16 (Sept # 2UQ3� June 3Q 20D41 TTa@aC� ✓E .� E�D� f 2Qtrd=-J�ne aa, 20Q4} O'AYiti\VOPJCN9YN1lA>'3.iatlA�"4:�s]tt.:,,.\'.:O' The Positive Place For A ds Brims & GIRLS C- Bs OF INDIAN RIVER COUNTY � 1 . u � �uival l.oJjvt L Page 1 of 21 ori i M B &GCA 2002 Club Annual Report Organization Information Name Boys & Girls Club of Indian Global ID 14438 River City / State Vero Beach , Florida Membership 12/ 7/ 2000 Date County Indian River Type Traditional Organization 561 . 299 . 3840 Phone 772 . 299 . 7449 Fax 772 . 299 . 3840 - Pending Approval Web Site Address A . Chief Professional Officer / Executive Director Name Leisa Smith - Fulton CPO Demographics Title Chief Professional Officer Gender r Male Female Personal Phone 561 . 299 . 7449 Age Group s' 18 - 29 772 . 299 . 7449 - Pending 30 - 45 Approval 46 - 55 56 + Personal Fax 561 . 299 . 3840 Ethnicity C African 772 . 299 . 3840 - Pending American Approval �` Asian Caucasian Hispanic Multi - racial t' Native American E- mail Address leisasmith@juno . com Years / Months Years . 2 In Position Months : 6 Primary Mailing P . O . Box 3068 Years / Months Years : 15 Address Vero Beach , FL 32964 In Movement Months : 10 USA Primary Shipping 683 27th Avenue S . W . Address Vero Beach , FL 32968 ( May Not Be A P . O . USA [Box ) B . Chief Volunteer Officer Name Jay McNamara httn : i/ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ? ASID =43105 & RptY . . . 214:2003 uAnnual eport rage .Z. or--./ Title Phone 772 . 299 . 7449 IMEN Fax 561 . 299 . 3840 772 . 299 . 3840 - Pending Approval E- mail Address ken@afins . com Jay07l728@aol . com - Pending Approval Business Affiliation Primary Mailing Address P . O . Box 3068 Vero Beach , FL 32964 USA Primary Shipping Address ( May Not Be A P . O . Box ) C . Area Council Liaison Room Name Jay McNamara Dr. Bob Keim - Pending Approval Title Phone 772 . 299 . 7449 772 . 569 . 6359 - Pending Approval Fax 561 . 299 . 3840 772 . 794 . 5345 - Pending Approval E- mail Address ken@afins . com Set data to nothing - Pending Approval . Primary Mailing Address P . O . Box 3068 Vero Beach , FL 32964 USA Pending Approval 810 Fax Trail SW Vero Beach , FL 32962 USA No Primary Shipping Pending Approval Address 810 Fox Trail SW ( May Not Be A P . O . Box ) Vero Beach , FL 32962 USA D . Organization Contact Person for any Questions about Submitted 2002 Annual Report Name Leisa Smith - Fulton Title Executive Director Phone 772 . 299 . 7449 E - mail Address LeisaSmith@juno . com . r - Club Name : Boys & Girls Club of Indian River County Club ID : 24103 http : //ars . beca. net/Orzo�r3nizationWizard/A-nnualReport FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 �, iuo Ynnuai txeport Page 3 of 21 L CLUB INFORMATION A . CLUB INFORMATION Chartered Club Boys & Girls Club of Indian Name River County Global ID 24103 City / State Vero Beach , Florida Membership 12/ 31/ 2001 Date County Indian River Type Unit Phone 772 . 299 . 7494 Fax WINNOW 561 . 299 . 3840 772 . 299 . 3840 - Pending Approval Primary Mailing P . O . Box 3068 Address Vero Beach , FL 32968 USA Shipping Address Pending Approval ( May Not Be A P.O. Box ) 683 27th Avenue SW Vero Beach , FL 32968 USA 1 . CLUB - DEMOGRAPHICS Please check all categories below that describe this Club . I— College/ University Campus F Detention Center Shopping Mall School F Church l— Salvation Army T Parks and Recreation F Synagogue f Teen Center f - Native American 1— Temple 1� Public Housfig Urban Community f� Suburban Community r Rural Community 2 . CLUB - TRANSPORTATION IN CALENDAR YEAR 2002 a . Does this club provide transportation to youth either to School Year Summer or from the Club ? Yes Yes r' No No b . If YES , is the transportation used by this Club owned or leased ? C Owned C Leased r No 3 . CLUB - TECHNOLOGY USE IN CALENDAR YEAR 2002 ( c. ) # ( a . ) # ( b . ) # computers computers computers in ( a ) or ( b ) TOTAL # Used by Used by that are COMPUTERS CLUB STAFF YOUTH SHARED by at this CLUB CLUB STAFF & YOUTH a . How many computers are available for use at this Club for Club Staff? b . How many for Youth ? 2 9 0 11 c . How many of these computers are SHARED by Club Staff and Youth ? d . Does this Club provide Internet Access to Club Staff? r Yes C No e . Does this Club provide Internet Access to Youth ? - 74 http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 & RptY . . . 2/ 14/2003 Club Annual Report Page 4 o II Ce Yes I C' No j 4 . CLUB - BOYS & GIRLS CLUB NATIONAL PROGRAMS CONDUCTED IN CALENDAR YEAR 2002 PROGRAM NAME Check here if # OF YOUTH Please check the B&GCA National Programs your Club conducted in 2002 . conducted PARTICIPATING Program in 2002 IN 2002 ( Unduplicated Count) MEMNON A. CHARACTER & LEADERSHIP DEVELOPMENT 1 . TEENSupreme Keystone Club 75 2 . Torch Club 35 3 . Youth of the Year r 1 B . EDUCATION AND CAREER DEVELOPMENT 1 . CareerLaunch 2 . Club Service l✓ 211 3 . Goals for Graduation F 41 4 . Goals for Growth [✓ 18 5 . JOB READY ! 24 6 . Jr . Staff Career Development I✓ 64 7 . Power Hour 216 8 . Project Learn (VO 238 • 9 . The Ultimate Journey F 72 C . HEALTH & LIFE SKILLS 1 . Act SMART 2 , Cavity - Free Zone 52 3 . Child Safety and Protection 64 4 . SMART Girls 10 5 , SMART Moves 74 6 . Street SMART [— D . THE ARTS 1 . Fine Arts Exhibit Program W 25 2 . ImageMakers National Photograhy Contest E . SPORTS, FITNESS AND RECREATION 1 . Fitness Authority 102 2 . Reviving Baseball in Inner Cities F . SPECIALIZED PROGRAM INITIATIVES 1 . Targeted Outreach Approaches for Reaching Out to At- Risk Youth 2 . The Diversity Initiative • 3 . Family Support (- 4 . Passport to Manhood 34 http : //ars . beca. net/OrganizationWizard/AnnualReport/'FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 k. iuu ruwuai rwport Page D of 21 G . TECHNOLOGY 1 . Club Tech ( Core Tech , Skill Tech , Web Tech ) I✓ 109 2 . How many Youth used your Technology Center at some time during 2002 ? 204 (e . g . used computers , intemet access , etc . ) (Unduplicated count) S . CLUB - REGISTERED MEMBERS FOR CALENDAR YEAR 2002 Number Number TOTAL Number Number TOTAL Age Of Of REGISTERED Age Of Of REGISTERED Males Females MEMBERS Males Females MEMBERS 5 year- olds & 0 0 0 13 year- olds 78 60 138 under 6 year- olds 5 5 10 14 year- olds 125 108 233 7 year- olds 16 9 25 15 year- olds 76 74 150 8 year- olds 20 14 34 16 year- olds 29 29 58 9 year- olds 23 22 45 17 year- olds 9 11 20 10 year- olds 25 18 43 18 year- olds 8 11 19 11 year- olds 73 64 137 19 year- olds 0 0 0 12 year- olds 73 66 139 20 year- olds 0 0 0 TOTAL 560 491 1051 6 . ETHNICITY - REGISTERED MEMBERS % African - 21 % American % Asian 1 % % Hispanic 8 % % Multi - Racial 2 % % Native American 1 % % Caucasian 67 % TOTAL ( Must TOTAL 100 100 % ) 7 . AVERAGE DUES PER CLUB MEMBER IN CALENDAR YEAR 2002 : $ 35 S . REGISTERED MEMBER AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 FOnaverage , how many Registered Members are served by this SchoolYear Summer lub house and off- site ) on a daily basis ? 171 190 9 . REGISTERED MEMBER FAMILY & HOUSEHOLD DEMOGRAPHICS A . What % of Registered Members are from single parent households ? 55 % B . What % of Other Youth Served are economically disadvantaged , based 80 % on the standards in your locality ? 10 . REGISTERED MEMBERS - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 During the School Year. a . On average, what % of Registered Members does this Club Serve . . . 3 or more times a week ? 270% Of Registered Members http : //ars . beca . net/OrganizationWizard/AnnualReport/FultReport . asp ?ASID=43105 & RptY . . . 21/ 14/2003 Club Annual Report Page 7o 2 times a week ? 24 % Of Registered Members 1 time a week ? 24 % Of Registered Members 1 time a Month ? 110/a Of Registered Members 5 or fewer times a year? 14% Of Registered Members Registered Members Served Seasonally - during the Summer, School Holidays, Sports Leagues . b . On average , what % of Registered Members does this Club serve seasonally ? ( i . e . during the summer, school 35 % Of Registered Members holidays , sports leagues ) 11 . CLUB - OTHER YOUTH SERVED FOR CALENDAR YEAR 2002 Number TOTAL Number TOTAL Age Number Of OTHER Age Number Of OTHER Of Males Females YOUTH g Of Males Females YOUTH SERVED SERVED 5 year- olds & under 0 0 0 13 year- olds 1 2 3 6 year- olds 4 3 7 14 year- olds 2 0 2 7 year- olds 4 4 8 15 year- olds 1 0 1 8 year- olds 1 1 2 16 year- olds 0 0 0 9 year-olds 3 2 5 17 year- olds 0 0 0 10 year-olds 2 0 2 18 year- olds 0 0 0 11 year- olds 0 0 0 19 year- olds 0 0 0 12 year- olds 0 0 0 20 year- olds 0 0 0 TOTAL 18 12 30 12 . ETHNICITY - OTHER YOUTH SERVED % African - 14 % American % Asian 0 % % Hispanic 11 % % Multi - Racial 4% Native American 0 % % Caucasian 71 % TOTAL ( Must TOTAL 100 100 % ) 13 . OTHER YOUTH SERVED AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 On average , how many Other Youth ( non - Members ) are served by School Year Summer this Club ( club house and off- site ) on a daily basis ? 0 0 14 . OTHER YOUTH SERVED FAMILY & HOUSEHOLD DEMOGRAPHICS A . What % of Other Youth are from single parent households ? 64 % B . What % of Other Youth Served are economically disadvantaged , based on the standards in your locality ? 73 % - > � http : //ars . beca . net/OrQanizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 7 of 21 15 . OTHER YOUTH SERVED - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 During the School Year. a . On average, what % of Other Youth does this Club Serve . . . 3 or more times a week? 0 % Of Other Youth Served 2 times a week? 55 % Of Other Youth Served 1 time a week? 45 % Of Other Youth Served 1 time a Month ? 0 % Of Other Youth Served 5 or fewer times a year? 0 % Of Other Youth Served Other Youth Served Seasonally - during the Summer, School Holidays, Sports Leagues . b . On average , what % of Other Youth ( non - Members ) does this Club serve seasonally ? ( i . e . during the 0 % Of Other Youth Served summer, school holidays , sports leagues ) Club Name : Sebastian Unit Club ID : 24463 CLUB INFORMATION A. CLUB INFORMATION Chartered Club Name Sebastian Unit Global ID 24463 City/ State Vero Beach , Membership 12/ 5/ 2001 Florida Date County Indian River Type Unit Phone 772 . 388 . 4944 Fax 561 . 299 . 3840 772 . 299 . 3840 - Pending Approval Primary Mailing P . O . Box 3068 Address Vero Beach , FL 32968 USA Shipping Address Pending Approval ( May Not Be A P .O . Box ) 250 Sebastian Blvd . Sebastian , FL 32958 USA 1 . CLUB - DEMOGRAPHICS Please check all categories below that describe this Club . 1-` College/ University Campus r Detention Center Shopping Mall School F Church r Salvation Army Parks and Recreation r Synagogue Teen Center r Native American 1—Temple Public Housing r Urban Community Ir Suburban Community r Rural Community 2 . CLUB - TRANSPORTATION IN CALENDAR YEAR 2002 http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 8 of 21 a . Does this club provide transportation to youth either to School Year Summer or from the Club ? (� Yes (' Yes C No (go No ._ b . If YES , is the transportation used by this Club owned or Owned Leased WINEWEN leased ? None 3 . CLUB - TECHNOLOGY USE IN CALENDAR YEAR 2002 MENEM ( c . ) # ( a . ) # ( b . ) # computers in (a ) or ( b ) TOTAL # computers computers that are COMPUTERS Used by Used by SHARED by at this CLUB CLUB STAFF YOUTH CLUB STAFF & YOUTH a . How many computers are available WENNEE for use at this Club for Club Staff? b . How many for Youth ? 3 11 0 14 c . How many of these computers are SHARED by Club Staff and Youth ? Me MEN d . Does this Club provide Internet Access to Club Staff? Yes No e . Does this Club provide Internet Access to Youth ? YesNo 4 . CLUB - BOYS & GIRLS CLUB NATIONAL PROGRAMS CONDUCTED IN CALENDAR YEAR 2002 PROGRAM NAME Check here if # OF YOUTH Please check the B&GCA National Programs your Club conducted in 2002. conducted PARTICIPATING Program in 2002 IN 2002 ( Unduplicated Count) A . CHARACTER & LEADERSHIP DEVELOPMENT 1 . TEENSupreme Keystone Club W✓ 45 2 . Torch Club 20 3 . Youth of the Year 1 Be EDUCATION AND CAREER DEVELOPMENT 1 , CareerLaunch W- 2 . Club Service 245 3 . Goals for Graduation F 50 4 . Goals for Growth r NEREN 5 . JOB READY ! 7 14 6 . Jr . Staff Career Development MENNEN 38 7 , Power Hour NEW IWO 308 8 . Project Learn MENNEN Wo 340 9 . The Ultimate Journey W✓ 55 C . HEALTH & LIFE SKILLS 1 . Act SMART 2 , Cavity - Free Zone W✓ 34 J � 1 http : //ars . baca. net/ OraanizationWizard/AnnualReporuFullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 � iu� < uuivai xepon ? ale 9 of ll 3 . Child Safety and Protection F 68 4 . SMART Girls 12 5 . SMART Moves 78 6 . Street SMART D . THE ARTS 1 . Fine Arts Exhibit Program62 2 . ImageMakers National Photograhy Contest E . SPORTS, FITNESS AND RECREATION 1 . Fitness Authority 148 2 . Reviving Baseball in Inner Cities 1— F . SPECIALIZED PROGRAM INITIATIVES 1 . Targeted Outreach Approaches for Reaching Out to At- r Risk Youth 2 . The Diversity Initiative r- 3 . Family Support �-- 4 . Passport to ManhoodrV020 G . TECHNOLOGY 1 . Club Tech ( Core Tech , Skill Tech , Web Tech ) [� 127 , 2 . How many Youth used your Technology Center at some time during 2002 ? 280 ( e . g . used computers , intemet access , etc. ) (Unduplicated count) S•. CLUB - REGISTERED MEMBERS FOR CALENDAR YEAR 2002 Number Number TOTAL Number Number TOTAL Age Of Of REGISTERED Age Of Of REGISTERED Males Females MEMBERS Males Females MEMBERS 5 year- olds r er und0 0 0 13 y ear-olds 5 7 12 6 year- olds 7 7 14 14 year- olds 6 4 10 7 year- olds 14 14 28 15 year- olds 2 4 6 8 year- olds 21 22 43 16 year- olds 5 3 8 9 year- olds 22 18 40 17 year- olds 3 3 6 10 year- olds 16 21 37 18 year- olds 0 0 0 11 year- olds 12 19 31 19 year- olds 0 0 0 12 year- olds 14 10 24 20 year- olds 0 0 0 TOTAL 127 132 259 6 . ETHNICITY - REGISTERED MEMBERS % African - American 6 % % Asian 0 % % Hispanic 3 % % Multi - Racial 26 % % Native American 0 % Caucasian 65 % http ://ars . beca . net/OrganizationWizard/AnnuaLReport/FullReport . asp ?ASID =43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 10512. 1 TOTALI ( Must TOTAL 100 100 % ) 7 . AVERAGE DUES PER CLUB MEMBER IN CALENDAR YEAR 2002 : $ 35 S . REGISTERED MEMBER AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 On average , how many Registered Members are served by this School Year Summer Club ( club house and off- site ) on a daily basis ? 1 75 65 9 . REGISTERED MEMBER FAMILY & HOUSEHOLD DEMOGRAPHICS A . What % of Registered Members are from single parent households ? 40 % B . What % of Other Youth Served are economically disadvantaged , based 60 % on the standards in your locality ? 10 . REGISTERED MEMBERS - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 During the School Year . a . On average, what % of Registered Members does this Club Serve . . . 3 or more times a week? 25 % Of Registered Members 2 times a week ? 21 % Of Registered Members 1 time a week ? 19 % Of Registered Members 1 time a Month ? 14% Of Registered Members 5 or fewer times a year? 21 % Of Registered Members iRegistered Members Served Seasonally - during the Summer, School Holidays, Sports Leagues . b . On average , what % of Registered Members does this Club serve seasonally ? ( i . e . during the summer, school 40 % Of Registered Members holidays , sports leagues ) 11 . CLUB - OTHER YOUTH SERVED FOR CALENDAR YEAR 2002 Number TOTAL Number TOTAL Number Of OTHER Number Of OTHER Age Of Males Females YOUTH Age Of Males Females YOUTH SERVED SERVED 5 year- olds & 0 0 0 13 year- olds 0 0 0 under 6 year- olds 0 0 0 14 year- olds 0 0 0 7 year- olds 0 0 0 15 year- olds 0 0 0 8 year- olds 0 0 0 16 year- olds 0 0 0 9 year- olds 0 0 0 17 year- olds 0 0 0 10 year- olds 0 4 4 18 year- olds 0 0 0 11 year- olds 0 6 6 19 year- olds 0 0 0 12 year- olds 0 8 8 20 year- olds 0 0 0 TOTAL 0 18 18 12 . ETHNICITY - OTHER YOUTH SERVED J � 1 http : //ars . beca. net/OrganizationWizard/AnnualReport/FultReport . asp ? ASID=43105 &RptY . . . 2/ 14/2003 Uub Amual Keport rage 1 1 of 21 % African - American 0 % % Asian 5 % % Hispanic 0 % % Multi - Racial 00/0 Native American 0 % % Caucasian 95 % TOTAL ( Must TOTAL 100 100 % ) 13 . OTHER YOUTH SERVED AVERAGE DAILY ATTENDANCE IN CALENDAR YEAR 2002 On average , how many Other Youth ( non - Members ) are served by School Year Summer this Club ( club house and off- site ) on a daily basis ? 0 0 14 . OTHER YOUTH SERVED FAMILY & HOUSEHOLD DEMOGRAPHICS A . What % of Other Youth are from single parent households ? 0 % B . What % of Other Youth Served are economically disadvantaged , based on the standards in your locality ? 0 % 15 . OTHER YOUTH SERVED - FREQUENCY OF ATTENDANCE IN CALENDAR YEAR 2002 During the School Year: a . On average, what % of Other Youth does this Club Serve . . . 3 or more times a week ? 0 % Of Other Youth Served 2 times a week ? 0 % Of Other Youth Served 1 time a week ? 100 % Of Other Youth Served 1time a Month ? 0% Of Other Youth Served 5 or fewer times a year? 0 % Of Other Youth Served Other Youth Served Seasonally - during the Summer, School Holidays, Sports Leagues . b . On average , what % of Other Youth ( non - Members ) does this Club serve seasonally ? ( i . e , during the 0 % Of Other Youth Served summer, school holidays , sports leagues ) ORGANIZATION - CHARTERED CLUBS COUNTS FOR CALENDAR YEAR 2002 NUMBER OF CLUBS ( Units and Extensions ) 1 . Number of B &GCA units and extensions CHARTERED between 2 1 / 1 / 2002 and 12 / 31 / 2002 2 . Number of B &GCA chartered units and extensions CLOSED between 0 1 / 1 / 2002 and 12 / 31 / 2002 3 . Number of B &GCA chartered units or extensions MERGED between 0 SI � L http : //ars . beca. net/Organization Wizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 11 of 21 1 / 1 / 2002 and 12 / 31 / 2002 4 . Number of B &GCA chartered units and extensions OPERATING on 12 / 31 / 2002 2 ORGANIZATION - STAFF TURNOVER AND RETENTION Please supply the number of employees in the indicated classifications for calendar year 2002 . Chief Full-time Full-time Part-time Professional Admin/ Mgmt Youth Development/ Admin/ Mgmt Officer Professionals and Staff Program Staff ( 37 . 5 Professionals and ( 37 . 5 hrs/wk or more ) hrs/wk or more) Youth Development/ Program Staff ( less than 37 . 5 hrs/wk) A . Number of Employees on Payroll on 1 0 4 1 1 / 1 / 2002 B . Number of Employees on 1 3 Payroll on 6 3 12 / 31 / 2002 C . Number of Terminations 1 / 1 / 2002 to 12 / 31 / 2002 ( both voluntary 0 2 3 14 and involuntary 1/ 01 / 2002 to 12/ 31 / 2002 ) D . How many of these Terminations were : Temporary Employees , Seasonal/Summer 0 1 0 12 Employees , or Terminations due to lack of funding , death or retirement? Eligible Terminations 0 1 ( C minus D ) 3 2 ORGANIZATION - ADULT STAFF FOR CALENDAR YEAR 2002 African - Multi - Native A . ADULT STAFF American Asian Hispanic Racial American Caucasian Total M F M F M F M F M F M F Administrative/ Management Staff Paid Full -Time 0 0 0 0 0 0 0 0 0 0 1 4 5 http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport. asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 13 of 21 Paid Part-Tim 0 0 0 0 0 0 0 0 0 0 0 Q Q Volunteers 0 0 0 F 0 0 0 0 0 0 0 0 0 0 Program Staff Paid Full -Time 1 0 0 0 1 0 0 0 0 0 1 6 9 Paid Part-Time 3 1 0 0 0 0 0 0 0 0 2 8 14 Volunteers 0 0 _0F 0NEIGUE 0 0 000012 - 3 . Other Staff ( e. g., office managers, secretarial staff, maintenance, etc. ) Paid Full -Time Q 1 0 0 0 0 0 0 0 0 0 0 1 1 Paid Part-Time 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 Voluntee 0 0 0 0 0 0 0 0 0 0 0 0 0 ORGANIZATION - YOUTH AND TECHNOLOGY STAFF FOR CALENDAR YEAR 2002 Be YOUTH STAFF African - Asian Hispanic Multi - Native American p Racial American Caucasian ( 17 and under) Total M F M F M F M F M F M F Program Staff Paid Part-Time 1 0 0 0 1 1 0 0 0 0 2 0 5 Volunteers 0 0 0 0 0 0 0 0 0 0 0 0` 0 C . TECHNOLOGY ADULT STAFF AT CLUBS Technology Staff are included in the Adult Staff numbers . Please proved the following detail : Paid Full-time Paid Part-time Volunteers Technical Support Staff: How many staff persons are dedicated to supporting technology at the Clubs? ( e . g . T of staff 2 0 3 supporting hardware , software, networks , etc . at the Clubs ) Technology Program Staff: How many staff persons are dedicated to Technology 0 0 0 Programs at the Clubs ? TOTAL 2 0 3 ORGANIZATION we ADULT GROUPS FOR CALENDAR YEAR 2002 ADULT GROUPS African - Asian Hispanic Multi - Native Caucasian Type Of Group American Racial American Total M FF M F M F M F M F M F Board Members 0 0 0 0 0 0 0 0 0 0 13 8 21 Unit Advisory Board Members 0 0 0 0 0 0 0 0 0 0 0 0 0 Auxiliary Group Members 00 0 0 0 0 GOO - 010 0 0 Alumni Association Members 0 0 0 0 0 0mm 0 0 0 0 1 0 0 0 Parent Group Members 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 _� klub Annual Keport Page 14 of 11 ORGANIZATION FINANCIALS FOR CALENDAR YEAR 2002 - ASSETS AND LIABILITIES ASSETS 2002 VALUE 1 . Cash & Cash Equivalents $ 182863 2 . Market Value Of Investments $ 0 3 . Pledges Receivable $ 2959 4 . Other Receivables $ 29775 5 . Prepaid Expenses $ 16981 6 . Market Value of Land , Building , & Equipment $ 98821 7 . Other Assets $ 11086 TOTAL ASSETS ( 1 through 7 ) $ 342 , 485 . 00 LIABILITIES 2002 VALUE 1 . Accounts Payable $ 14782 2 . Notes Payable / Loans $ 23312 3 . Other Liabilities $ 4561 TOTAL LIABILITIES ( 1 through 3 ) $42 , 655 . 00 2002 TOTAL NET ASSETS (Total Assets Minus Total Liabilities ) $ 299 , 830 . 00 2002 NET ASSETS 2002 VALUE Unrestricted $ 275693 Temporarily Restricted $ 24137 Permanently Restricted $ 0 ORGANIZATION FINANCIALS FOR CALENDAR YEAR 2002 = GOVERNMENT INCOMEIVALUES OF PROGRAMS 1 . U . S . Department of Agriculture Child & Adult Care Food Program $ 0 Community Facilities Grant $ 0 Summer Food Service Program $ 0 Other $ 0 TOTAL U . S . DEPARTMENT OF AGRICULTUREJ $ 0 . 00 2 . U . S . Department of Education Safe and Drug Free Schools and Communities Act $ 0 21st Century Community Learning Centers $ 0 Other $ 0 TOTAL U . S . DEPARTMENT OF EDUCATION $ 0 . 00 3 . U . S . Department of Defense - 9S� http : //ars . beca. net/OrganizationWizard/AnnualReporUFullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 k. iuo annual tceporn Page 1 J of 11 U . S . Department of Defense ( Including : Army, Navy, Air Force , Marines , National Guard , Army Reserve , and Coast Guard ) $ 0 Other $ 0 TOTAL U . S . DEPARTMENT OF DEFENSE $0 . 00 4 . U . S. Department of Health and Human Services Administration on Children , Youth , & Families $ 0 Center for Substance Abuse Prevention $ 0 Center for Substance Abuse Treatment $ 0 Child Care $ 0 Community Services Block Grants $ 0 Head Start $ 0 Neighborhood Initiative Grant $ 0 Prevention & Treatment of Substance Abuse Block Grants ( P . A . S . T. A . ) $ 0 Rehabilitation Programs (for the physically challenged ) $ 0 T. A . N . F . ( Welfare -To - Work Funds ) $ 0 Title XX - Social Service Block Grants $ 0 Other $ 0 TOTAL U . S . DEPARTMENT OF HEALTH AND HUMAN SERVICES1 $ 0 . 00 S . U . S . Department of Housing and Urban Development Community Development Block Grants ( CDBG ) - Administered Locally $ 0 Comprehensive Grant Program ( HUD - sponsored public housing program ) $ 0 Comprehensive Improvement Assistance Program ( HUD - sponsored public housing program ) $ 0 HOPE VI Program ( HUD - sponsored public housing $ 0 Drug Elimination Program $ 0 Native American Housing ( N . A . H . A . S . D . A . ) $ 0 Other $ 0 TOTAL U . S . DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT $ 0 . 00 6 . U . S . Department of Interior Bureau of Indian Affairs $ 0 Facilities Construction Grant $ 0 Other $ 0 TOTAL U . S . DEPARTMENT OF INTERIOR $ 0 . 00 7 . U . S . Department of Justice Bureau of Justice Assistance - BJA Pass Through From B &GCA $ 35000 Bureau of Justice Assistance - Violence Against Women Grants Office $ 0 Bureau of Justice Assistance - Weed & Seed $ 0 Byrne Foundation Grant Program (Administered at state level ) $ 0 Office of Juvenile Justice and Delinquency Prevention - Gang Prevention through Targeted Outreach ( B &GCA Pass Through ) $ 0 Office of Juvenile Justice and Delinquency Prevention - National Discretionary 7 - http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Keport age To 77 .71 Program $ 0 Office of Juvenile Justice and Delinquency Prevention - State Juvenile Justice Advisory Group Formula Grants $ 0 is Other $ 747 TOTAL U . S. DEPARTMENT OF JUSTICEI $ 35, 747 . 00 8 . U .S . Department of Labor Career Prep Pass Through From B&GCA $ 0 Summer Youth Employment Program ( S . Y . E . P . ) $ 0 Workforce Investment Act ( Including Youth Opportunities Grants ) $ 0 Job Corps Program $ 0 Other $ 0 TOTAL U . S . DEPARTMENT OF LABOR $ 0 . 00 EEEI 9 . All Other Federal Grants ACTION $ 0 Corporation for National Service (AmeriCorps , National Civilian Community Corp , VISTA ) $ 0 National Endowment for the Humanities $ 0 National Endowment for the Arts $ 0 Other $ 0 TOTAL ALL OTHER FEDERAL GRANTS $ 0 . 00 TOTAL FEDERAL INCOME $ 35 , 747 . 00 10 . State Government Grants [ Specify source of money - e . g . Department of Family Services ] State Alliance FL Area Alliance $ 1400 State Bonding Funds ( Capital funding through Legislature or Governor) $ 0 Other $ 34677 TOTAL STATE GOVERNMENT GRANTS $ 36 , 077 . 00 11 . Local Government Grants Other $48458 TOTAL LOCAL GOVERNMENT GRANTS $48 , 458 . 00 TOTAL GOVERNMENT INCOMEF $ 120 , 282 . 00 ORGANIZATION FINANCIALS FOR CALENDAR YEAR 2002 - INCOME INCOME 2002 VALUE 1 . Contributions from Individuals $ 57339 2 . Contributions from Corporations $ 19787 3 . Contributions from Foundations $ 11750 4 . Bequests Income $ 0 http ://ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/ ' 003 k. iuo Amuai tceport rage i / of ' 1 5 . Investment Income $ 2934 6 . Special Events ( net after expenses ) $ 76799 7 . Dues from Members $ 9991 8 . Camp Fees $ 0 9 . Income from United Way $ 80000 10a . Local Government Grant Income $48458 10b . State Government Grant Income $ 36077 10c . Federal Government Grant Income $ 35747 10 . Total Government Income ( 9a through 9c) 120282 11a Program Activity Fees $ 2053 12 . Rental Income $ 1800 13 . Day Care Fees $ 0 14 . Concessions ( net after expenses ) $ 710 15 . Value of Contributed Services $ 24754 16 . Total Other Income $ 26500 TOTAL INCOME ( 1 through is ) $433 , 589 . 00 ORGANIZATION FINANCIALS FOR CALENDAR YEAR 2002 - OPERATING EXPENSES 2002 VALUE 1 . Expenses for Program Services $ 305870 2 . Management and General Services Expenses $ 33835 3 . Fundraising Expenses $ 25500 4 . TOTAL OPERATING EXPENSES ( 1 + 2 + 3 ) $ 3651205 . 00 DETAILS OF CERTAIN EXPENSE CATEGORIES - CALENDAR YEAR 2002 1 . PERSONNEL EXPENSE CATEGORIES ( Personnel Expenses are included in Operating Expenses. Please provide the 2002 VALUE following detail . ) a . Salaries $ 169108 b . Benefits $ 22474 c . Payroll Taxes $ 14008 TOTAL PERSONNEL EXPENSES ( a through c ) $ 205 , 590 . 00 2 . TECHNOLOGY EXPENSE CATEGORIES 2002 VALUE ( Please provide the following detail . ) a . Technology Expense for Staff ( includes I . T . staff salaries , benefits and payroll $ 26545 taxes . ) b . Technology Expense for Club Technology Programs ( includes purchase of $ 1699 equipment, technical support, internet access and communication costs . ) DETAILS OF CERTAIN INCOME CATEGORIES = CALENDAR YEAR 2002 1 . ENDOWMENT a . Does your organization have an endowment or ' funds functioning as C Yes Ce' No 77s — y http : //ars . beca. net/OrganizationWizardl AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 L ub Annual eport Page 18 or an endowment? ' b . If YES , what was the current estimated value on 12/ 31 / 2002 ? $ 0 4. FOUNDATION a . Does your organization have a separate Foundation ? Yes r No b . What was the current estimated value of the Foundation 's Assets on $ 0 12/ 31/ 2002? c . Are the Assets of the Foundation reported under Section A (Value of r- Yes r No All Assets ) in this report? d . Does your Board of Directors control this Foundation ? Yes r No MINIMUM AND ESSENTIAL BENEFITS A . RETIREMENT PROGRAM 1 . What type of retirement plan does your r Defined Contribution Plan - B &GCA Plan organization provide ? � ` Defined Contribution Plan - Not B&GCA Check only one plan . Plan Defined Benefit Plan C Other ( 403b , IRA ) 2a . What is the % of salary contribution ? 10 % 2b . Of this % , what % does your Organization 100 % contribute ? 3 . What is the name of the Plan ? Plan Name : B&GCA Pension Plan B . BASIC HEALTH & SURGICAL COVERAGE - EMPLOYEE COVERAGE (— HMO 1 . What type of Major Medical Insurance does your xry PPO organization provide ? Check all that apply . F Indemnity 2 . What % of the Major Medical insurance premium is paid by your Organization for employee 100 % coverage ? 3 . What % of the Major Medical insurance premium is paid by your Organization for dependent 0 % coverage ? 4 . What is the name of the Insurance Carrier( s ) ? F Boys & Girls Clubs Workers ' Association ( B &GCWA ) ( Provider names that fail under B&GCWA include : Beech Street, Concentra , CTI , Health Payors Organization , Multiplan , Preferred Health Network ( PHN ) , Preferred Plan , QualCare , WPPN . ) r Aetna (W Blue Cross &/or Blue Shield (— Chesterfield Resources Kaiser I- Other : ( specify ) C . GROUP LIFE INSURANCE 1 . What % of the Group Life insurance premium is 100 % of GroupLife insurance premium paid by your Organization ? http : //ars . b Qca. net/OrganizationWizard/AnnuatReport/FullReport . asp ?ASID=43105 & RptY . . . 2/ 14/2003 l. iub annual Keport Page 19 of 21 2 . What level of life insurance coverage does your r 1 time employee salary Organization provide ? r 2 times employee salary C1 , 3 times employee salary Other : ( specify ) 10000 3 . What is the name of your Group Life insurance carrier? Carrier Name : B &GCWA D . SALARY CONTINUANCE/ DISABILITY COVERAGE Long Term Disability ( LTD ) 1 . What is the % of premium paid by your 100 % of LTD premium paid by Organization for employee Long Term Disability Organization ( LTD ) ? 2 . What is the name of the insurance carrier for LTD ? Carrier Name : B &GCWA Short Term Disability ( STD) 3 . What is the % of premium paid by your 100 % of STD premium paid by Organization for employee Short Term Disability Organization ( STD ) ? 4 . What is the name of the insurance carrier for STD ? Carrier Name : B&GCWA ORGANIZATION ROLL -UP : REGISTERED MEMBERS , OTHER YOUTH SERVED AND TOTAL YOUTH SERVED IN CALENDAR YEAR 2002 2002 Annual Report Data 2001 Annual Report Data TOTAL TOTAL TOTALTOTAL TOTAL TOTAL Age Registered Other Youth YOUTH Age Registered Other Youth YOUTH Members Served SERVED Members Served SERVED 5 year-olds & 0 0 0 5 year-olds &under 0 0 0 under 6 year-olds 24 7 31 6 year-olds 13 0 13 7 year- olds 53 8 61 7 year-olds 30 0 30 8 year-olds 77 2 79 8 year-olds 35 0 35 9 year- olds 85 5 90 9 year- olds 42 0 42 10 year-olds 80 6 86 10 year-olds 44 0 44 11 year-olds 168 6 174 11 year- olds 49 0 49 12 year- olds 163 8 171 12 year- olds 72 0 72 13 year- olds 150 3 153 13 year-olds 41 0 41 14 year- olds 243 2 245 14 year- olds 25 10 35 15 year-olds 156 1 157 15 year-olds 10 10 20 16 year-olds 66 0 66 16 year- olds 6 10 16 17 year- olds 26 0 26 17 year-olds 4 0 4 18 year- olds 19 0 19 18 year-olds 3 0 3 19 year- olds 0 0 0 19 year-olds 0 0 0 20 year- olds 0 0 0 20 year-olds 0 0 0 TOTAL 1310 48 1358 TOTAL 374 30 404 You Organization ' s 2002 Registered Member number is + / - 100/o of your 2001 S � http : //ars . beca. net/OrganizationWizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 Club Annual Report Page 20 of 21 number. What is the primary reason for the Registered Member Increase / Descrease from 2001 to 2002 ? r* On July 1 , 2002 we adopted the Youth Volunteer Corps (YVC) program which served 1 , 700 11 - 18 year olds in 2001 . We have been able to recruit 698 of those kids to be members of the B &G Club in the 2002 program year. The YVC program is an outreach service program for 11 - 18 year olds . The focus of the YVC program is to learn the importance of volunteering and how to give back to the community . You Organization ' s 2002 Other Youth Served number is + / - 10 % of your 2001 number. What is the primary reason for the Other Youth Served Increase / Descrease from 2001 to 2002? We have increased other youth served for two reasons : 1 ) We have increased other youth served by collaborating with a program title Value Visit , which is a program that provides mandated courted ordered supervised visitation to take place at our South County Branch . 2 ) We allow a Girl Scout troop to utilize our Sebastian Branch . MEMBERSHIP DUES A . 2003 DUES Total 2002 B &GCA dues owed $ 3 , 326 . 02 FISCAL YEAR • Indicate your Organization ' s fiscal year dates : July 1 to June 30 A- 133 AUDIT REQUIREMENT 1 . Did your organization expend federal funds totaling $ 300, 000 or more in its most recently completed fiscal year? r YES NO - If " NO " , please proceed to the next section . If YES to questionl , please answer questions 2 - 4 • 2 . Has your organization completed the necessary audit mandated by the federal government through the OMD Circular A- 133 ? YES NO - If " NO " , A - 133 Audit will be completed by 3 . Did any of the $ 300 , 000 or more expended by your organization consist of pass - through funding from Boys & Girls Clubs of America ? YES NO 4 . Has your organization submitted a copy of the A - 133 audit report to the appropriate grant manager ( s ) at Boys & Girls Clubs of America ? http : //ars . bec a. net/Orga.nization Wizard/AnnualReport/FullReport . asp ?ASID=43105 &RptY . . . 2/ 14/ 2 003 t. iun Hnnuai twporC rage L 1 012, 1 C YES {` NO SIGNATURES OF CHIEF VOLUNTEER OFFICER AND CHIEF PROFESSIONAL OFFICER ::] I, have examined the information entered on this re and, to the best of my knowledge it is true, correct, and complete . Signature Title Date I, have examined the information entered on this re and, to the best of my knowledge it is true, correct, and complete . Signature Title Date http : //ars . beca . net/OrganizationWizard/AnnualReport/FulfReport . asp ?ASID=43105 &RptY . . . 2/ 14/2003 M p I i ro a i V I V ) (� #- 1 Id 11 O) It ! : it 71 t•1 `1 . r- 1 ••1r �JIS (.rLl� � 1 ' U r-1 rl „ N 11 "[j { , I �� [� •• �M q �.! p CU j� L it ; j U 0 U 1 nt 11. ll N 1j )l } rl U 1 : V U i c > LI t 1 IJ VI 1 U N to O L(V1'f)1I Jxqq uU qUlVd >4 v a '1 U1 UU 11•r Mi 11 ulU U 11 , 9 0td11V 4111 Io 11� If Id 1 11 offu 1)'11vtn d o, Ir u u 0 Ira n 9 111 11 q > 1 r ) t7 U 1 0l H q •I rr lq6 IY Ri ► 1 V u U I ` U u r ) p U U L4 4j t1 UI U 7 F1 rl UaDO l�� � wq •� ►' r1 , U MNwrt11 '►Ntl7� �x114 0 � - U 'z u FA V it Biu 7 q N p : tt� , o b r .14 1171 u ? ri t1 ? W r l r1 t1 /7 N r 1 Y p d y U 3 , 1 / C� 11 U � 1 If I to '� 1 11 t7 q 1� M of > r U ro -- to U �r r� O 'n •-1 1' In Id b' v (7f rt •.1 fur•) `•' 3 �•• � 41 � � r! t� IJ (f r 1 ,d l � o. ll c� rn Lw In e u tI 11 1 10 F ' �, �. ,� . 11 If > 0 it u •I el * t of In to ct r � '{( r" 11'' ut IV1 r ,. rI1 u q V `' .p1 if p ? 1 , ►1 1 , e1 w u 11 1 � 1-4 u1 a IV r1 N m UI . 0 q i1 L` .i •p y ► q rt q tl ' 1i d el ii C Iti ( j1i wtj •u 0 11 If tV or R,. .] E • 14 U 0 1'* n: p U 0 r tt11 p n rl Its t o 11 a pf a 1 - u ti r ► r co h +/ ti1 " It �I n u, Q uI N .q J N [n 1 1 d o II " t 11 t ' N lv a 1 t1 N tr v In a u u .t1 q u d 'N 14 a N 'd •i > r. F v u u q o I t Ie �a ul I rN t set r 1• . n 7 w ( , 1 { {.� jl {� f� 1 jn U � I 'll a if I 1 SII i3 { . ► t iJ i � { . 1� I ' w 4j a u v ir} w r ll u • Ir r� u •�� ?U1 � I U N ( f ; oi �i f 1 �I t of R it J -. of '-1 .- 1 , 1 u the 04 to 0 up u pt off 0 1 •u . 1 a � pKI i tt 1 r, utl � �I + ' ' N iti+ e t U �' ;,. ►o u 10 II •� n o t ' i' 11 1?� ern !� .o 1 0 r, 4 a; f1 c>+ ea wtoIt , ► a� J u o • + rtl to d u W v ei d 1f A0 u 0 in Vl 4 0 IU N ``cq� -V p ,?i { •1 U ! 1 1 w U to v U { 14 � , ° I � 11 • 11 i �+ 17 i1 � o 1 ►i Y� ro r � � r1°� ;; >• r 11� 0 U 1 �d 14 �lrC°aii CJ l� c q � IIN� :))4 � .dq I � Od m •� dydi K ? � ut] y � U1 v1 uq U �1 1 UaJt� . MUUUd 0 � ' UII a ?• pIu o q g n i ! U u >, lqq , o e !� yy�� F� ►. n it !u1 't) ,RJ) 4 ' '.� q •tt nr u + `,c= Q' ► ' N ►1 U d 1� 11 U Irl Ott 44 1 N q1 '1 d Ll rl U to fl or 7, `a to rl •d I� Id oil J � 1 rt u bf U: � .� al 'I . �lD n l7 u0 1 I> It if e r / 1 N .l NNiw uD10 7 v 1 u 1. 9 ( M ' 1 1r r Ill t I,, 11 I 1 ► of o ry ' I • �� G if f it Iri I I ! i � I � Nu a n ^G j u 'O It 0 q I �. it lel iJ t6 tl tl 11 �) PI tY 1-• G 0 n P• � ) •k Y -3 A, !7 it n C i , ' , i v � ' lel A rt It, f: , 1' ►-• , '1n tl lel crt b nNo01 A Il 1 1 rt „ , ,, t7 n ro U n G tj It In C r ► n n p I 1 n K c X u x rt a II nil ►�• 1 � r1 11 :p n : ' !� n 1 n 1� a t� . t .. tq r leo A • < 1 -• ,f • r 1 ' 1 - ' 1 • n 0 'd ,. . . �t H h Pr IT h O tb t ►' Q . ' tl 0 0 fl 1 1 D . f C q A 11 11 'U O H : 11 Ir• < n I • I r. It 1 0Need ; N �J rt tl • q pp , t 11. n lo . DI ^ 1) f n 1 ti , • . p' O fn 4 tJ N 1 n p ► p N ti It 1 1► 0 I , Ig . r to 1 A r•, + p; �t ill {. 1 lei Ip { li 0 n f1 'i Lt H t, , T, f� C 611 n Or fl 1 '• 1 N n r{ O tl r . n' Q ' 1 , • 0 len p t1 v) n ' f7 0 ro rp �d n n r a 9 }[�' cul 1 t u • 1 I. (• ►1 11 CC`tti 11 1 • • t ,. A R, A n 1!1 I ' n• n r,' F lel 0 G c: rt .aro 1 � �'� h• 1 • K tt Ir �1 Ned it it o 1 , . ., 1, a d ul - p. I ' w r m 1 ,. C ' + '1 f 1 WW tr n a n r ' - b ii a Ito rc o ! ' tll ' � 0 0 � ,t 0 It 11 •C 10 � ' 1' � n ler 7 < ft le � C 11 O @ 1to r . n N l n t 1 �f � f -+ N 'd f i o► P/ �1. 1 � r� r-' I� �V1 �' • , Ei qar }� IA• �. lone, rl, � � , .y '� , � P1 � a � a � I1, I1 � rrq ►' I ' r • lo , u u f Ih G h f ' f m I- r F-• h , . 1 ' n i v , 1 0 p 1 • • G I tt m ; r a it . t n. fAo' Il of �r d f I • ro w t� n to n u p +rt rt w n +� n nnn p 4leri� Eprn 1 � 1r� Apf u r1 (1. 11 tlIt 1 / H . 1 J =) . nhW ' Uhu C � n 11 ►►tpnlea n 1 mf� nnll orr� � � o • n a u a. r. " q' 4a C v tie n aro �, n , 'D J0 1 " to ' '< ► .. v n , � � n lid, a, a to pa p h t1Frr � n rt i I v ' t1 r f 1 rt I I 1 >ti A n `o rf t . 1 t11 ld U 1, pf11 1 { fl trrrr 1 t �• '� N f�yl fj 1 n � 1 0 a n I� p n K „• p . • r in 11p1 'U � 1 , 11 a �' � �' Q IQ Er nab'. ° (i �9 . j1 . ,. rel'0 2 ►' G L , , , 1+ ,h tt�� Tt 1.� , o I -' to 11 I• • I J 111 }I n ."t r A �, n ) F 0 9 n L7 fl 'f I C t (j w t'1 ' Il F n: 'd I to '{ L 11• O apt „ i h L) W n 1� CL 1 � O n ` R len � ; ; ,� , . . d Ned- led n a 1- 0 e n leOilo h �f 1 • pT t t ,. 0 lA I . n n n tA 1 •. p ,U n c p. c, " It 11 ti ,., . n „ p' �. 1� n ni • " n p, G O O et f0i h O. 1-' n et tr it 1 w n O m e W ►1 In p M 1 ,I ' d r I�• jr n p 111 RI ,. . r l 0 I p 01 t • N n a p P . p tt n ({11 F• ri q1 It a �r n a tt' i3 ; n m '� F, ' fr i c rY ft tt t1+ 11-A a f1 1 . H Il ISI . Wn n tl , I n II opj � Nd: to t. . 1q ,d i�. 0 10 f I'. p 00 . cli / t rtd1 n I Uj ;y C M r` ' r ! ' O �`1 �1� r a p ` Il 1`• l0 6 r• Tnry /')to t� ' r r'7 A �1 • �' t p p. tti1. i ,` tl au 0 p . � Iu IJ r'' @ No Ilei• I A @ rt tp�1, �r 0 N n ,n ?� n n Ir p Id q q n ••` P, M O h, H n 1 • ti h yN� f, • n 11 � �- letp A l4 , ) I ,. ,q µ p t1 to i e�1 J Nj' O h tti U ` G tl U ' 'C► j�. s N , .. I! ;1 c7 •h i� ► tJ r In t, �• {1 O tr M n p 0 d IN, w • r p ,u n n U n Iq It .{ r[ IJ . rV Ir �< 4t � r. O d W I) n It I: : , 1 f] 1 • • d 11 p n , . th . n , q A It • ti IJ ; I rj • { io ► to n lei Inl h h D rt 11 , � If p 1 N 04 i a c} G (Y 1t t I h 44 0 f �t j) 'q*I (� 41 n ' tit ► .. 4 11 N • p1 t trj 0 ' • (, p . p. 4 T I� ► 1 la W. „ C H rel •-1 f. (�, C� C 0 U PI left O f: rrf q 11n [h� n T � f 1 nf1Dt �•1ft � pp � t'; ih �+ pf� nilt (i ° � ' It, rpiln � rolr� n 1 i1 !u1 13 Gt I � + fl r., h p tf (7 r��1 n �t f�?� ' M 1 11 1 (Qy1 {T 'tl f p TI I f L 41 14. 41 n , i in 11 (] . fit fA {i !1 ` IUI In t� 1�• Q ft '[ 1 n' { 7' W rh �j- Il n UI 1 • p , • I � . P, W @ Il. tL re h r kl 14 Il C O I-• Ci 1 • • �l 1 ) i If Ir len 0 1 1 t ► ID 11 0 1 • n H I •• f fl .4 � ItI: 1 tIn ~ 1, p { � •� tr " I � ( UgI1 mIt 1 �� tito �1• � 11 P p I ' • f I'� r 1 , � 4; ' a r rh r1 p 11 Vot n Ir t , n Ir , �{ �t len 1 , Ei t 1 1 ' 1" tt " 11 . 1 ,1 �e h if a n •� r ' Ei • ro 10 n I . 1 C1 I , � '� o � n ►t � • S pq I � � T, � 011 �1 n0 �lop lel , u l a p t o i• 0 I t i r 1 U' 1 i I l { j . p ,t r. It . 1 ) I • o D b 1 • n tl 1 0 C d o ` 1 . t••1 f i r N n t, N Tt 11 1 ti 1 ; w h p roan n 't E+ n, I ► n !1 t f� h D Ifs 11 • , 11 1 • n I} , - • a 1 ,. n 1 1� 1� h ' H ` n r . 0 I N itWW Vt rS t n T „ n a n IP 1 . n t, IP Pi • at tntlt k It . ii ler & a •d lel �! 1 u lel , r (T tl Iq 1r t; ,.,t •C K o t' ler ler N H IN-At rt C r1 f leu 11 if r N , • • C1 e1 1 . ' 1 x n p Tr 0 0 lel 11 U' IY n ler . •r �t n , to NO Il n t .l n n It, d tryP nt do 0 n4 ,.Ja iA It or 11V u nG too 17 pnNitrt0 Ideat1Q ' 11 ' •'. I n o It - It t W 11 1 ! n . t h n p 4 � � A i •• (� h 0 Id 0 !1 ler 'tJ , 1 -' 0 'r ry O n rt 'Ci U '' f r 11 1 -• n a n . 1 V r n. t, air : r a [y 11 . li A ., 1 0 M 111 1-, 10 ,F R t/ A •� It It `a U I(e M1 [If v1 tf IN) 1.) t . . a. t � n " a ' 1 N� tJ n . f , lel tl . 11 , I I: a O � `• m % t ► G a to n w p rP 7 i' 'n fi lel n �° p n n • 4 O , ft d .f t-1 H pt ,., U n D CT � • tJ' , I 11. role It ;t tr 1 n o 1 ' p P • u A Vi I ' '' }r r•-t Q U I � / 1 11 11 N I1 r4 1 , N pl It)' o c; .r m tr .e p m y c! pr t , o tt u s v ?, U V u an q o 11 v .J o a • u 11 t 'N b N A t6 v-1 tJ Ol , Ji .J ; K ► to ppp Nle �a , 1 c, ► , , , .m{ 44 v 13 p N q 1 w y 0 U • - 1 u U [� q t g U q 'H " cl �u1 41 h M o p l3 bt a . n °. " j o i� 14 1 a ti dd n I � u `r V O u ►1 '►1 V o Ir. U n '14 U tt 1 0• J 1 m H t t u m In 1 + of U to. a a o I1 11 to O U s [{ V ut v_I pu q NM (fir ,ro) u a f- r°i 91 t f •I° 1 day n i u Co.� Vi►i ail U i� 1 O -I " I r{ a ' 1 a r � U rpp�,, 1� �jSo t 11 pp 1 CIU t UUU r q A t� ► i� U 41 !{ U Ei � U`'I V .Mt l� 1.. o p Ib V q ,� U » t v t� t aut1 �{ a UII1 ) 1' ' 11n9uVI tVMSl � N +� � 'u' �t p� I�I 1 pt u m W to O { �rll 1 { 1 { 1 r 1 [1. u a U R , I P a d It SI J N x1 tl � � F �+ ,u U ii i � li ID 4-1 1-1ft %4 1 ,r.-{� V 0 t : u 0 0, n 1r >{ O r1 W .'1 .Il 1 >. , „ 19 tl ai N �7 U 1; d to u m1 U a ,d 1 it of u •d .il!l u to u V a r 1>. .1 v� °{ . 0 a n d ' • b ', t rJ O U tt � �� ll r y ll 1 •r Nr1 1 1 I O I a1 H ll j] (� q t+ }qrr 4� 1 (1 [� U 1 U, 44 1� 'd u a . It G iJ u u FI 0 s� 0 ! U •. t �1 n. Jf It I { � tlt • � 1 • ^11), rI 1 qyl � r ' PIP I a V rl N �• 11 i C1�1 t1 11 ti o u i � 1 i� f; N fd' A If ii a pf t • t y v .e1 o n to 41 i OJ la rt q � 1 ry� ' to 'd J3 4 ' d ti r � q t.t r1. r1 {� a �� .qW r -{ •-1 tl v Il rl u •ro w ro a N ' q 1, N !1 n �i p a� id D CL p Y u I. q ;i .�i b o iGl le Lot T1 n bt . o a 1 c, W 0 IT) h N I 1 on N U ?. u Um O q a t N 0 O u1 ,7r - r-1 4 J U 'd -11 " V b 11 C• IN r U .-t 1-0 O .Ir to q 1r q A p.1 N [; U 1 U M .�1 �i F1 1-1 a . t •rel r • ulp m aj a -7 q u o 1J .t } a n u O U of U �c � . pp -. 1 • r/ r° 11 Oi ii U V �I �i Il p' rl t1 If „ rl 11 t1 •1 'U ►J f1 n .x V4 J ;� s - Ilf U W 1! 1 s7 4 n a � ' 9 Iii a u t: 1 1, 11 In � I au to h o e o try N u U t l 1 Jj u p 0 U u U s1 N t�, p, d ° y 'L+ {) O O r S u `p 1 tp ti A ru`.) ro ro of t; (a LI ' 1 t n d p . t to tt q Il li K Hasp . 1 to at t u u q t d D v rd v u �1 ri p °0 N r d r� q ar A 0 ►J ► 1i rf 11 -t; It t bo E -) A ►+ to u o of p Iq t 1 a t1 rt fd u ur T.0 to t4 Pro to Ill V off } k i, H r { U rl rl >a [1. ri N a . 1 rt CI . •r1 NIto IP h O [o O v r' ' U r1 la > ' 'd �` r Il 1J p �d V L M l.i tp O d Q .P d �d u U �utl + 1 '1 MI [!� [� b to qbr llf [1 1 1 wi d hl - 1 t 0 0 I nl � ` 11 d t1 o[dr 1 U • r 1 •rt .1 1, C1 L Q 7 r v t� • •1 "' q u I,l I) u (� to to tl 1! •� �1 .f� L P 1 td C� V u SO r to of (j a r'I t+ rl 11 Tr r el y 1 It Of u► .-1 r [' t4 w I tl 11 . n d L ( l u x N t t0 a t1 tl •rl td 9� •. t n q tor,N r . N off . y p it u rD U u rrppiI t� p 14 tui U ll fill r.11 1111 L' r1 a/ u r� U to N p Lo p pp bt U V tr' VU L► C! II . gJJy �j ' ) 10UO �rUN U i� bj UU O 11 N 't� It11b1 [j1 IUJtj .1 11ld � • .t � Iq w �U L i/ qqu M N iS LUL ,4 �1 If q 1� If Nt�1 rl tN d 1) 4 i1 tf 1, V YI q . 1 r 1 • ri tl r1 t1 t! 11 V 1 bt rj 1J d rw1 A r� • 1 UU i J �1 tJ • . 1 11 to � Ivra °. 3 v U i{ , -r1 It 0tn u ( 0 14 I � U � � qd � � � :dft u JI t� u � Amo a mup. Va v ` u . � � d � • .0 if > r1 >, td 0 • 1 n X11 'd U p al o r 14 O 1/ 8 N N N n uu M > �`u `� a �' h a U u . 1 If d ' b to al u N �' V to '� y ' rf � it iN m o dl u H 1( M t 0 t9 a N U yJ id 11 0� to 0 '1 v rl tl Q ( ) fd W 11 u1 p d [� p� 11 i �I 0� d �r k '1 u t1 til u p • W u /! ► t 1t 1 >+ uy > rmgll utlbtl111 bt d uu v1 U r � it .d � o � a � E� � � �� � a to �� I` ! t • rt c' UP n 1 ?4 t (: U R UJ 1� 4J rl .g v u u t r q .1 O p u .tS N b1 fi r-r el •rt �•+ at fit 1 4� r��',' 1 1171 [L�1 ��j1' t� ( 11 L 'tl i% . 1 IJ vl O • -1 , L7 4t 4l n H pr O `1 t11 to 11 i11 CV1. [7�r 1-1 11 1- . i! la- I 'Jt '� 1n ri n 1 Y C 30YS L =R, If )•= hav= Z^_v quest=ars . please c=-z-ac= L_ persar. whco _ :Zl.^.0 arm tel�t;,ne sL':zs a� s:7cwa in t aezza of chis iecte= _ usure { 6i 0TiZ. . 25 w _ , FLORIDA DEPARTMENT OF STATE Katherine Harris Secretary of State February 4 , 2000 CAPITAL CONNECTION , INC . 417 E. VIRGINIA STREET, STE . 1 TALLAHASSEE , FL 32302 The Articles of Incorporation for BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY , INC . were filed on February 4 , 2000 and assigned document number N00000000764 . Please refer to this number whenever corresponding with this office regarding the above corporation . The certification you requested is enclosed . PLEASE NOTE: COMPLIANCE WITH THE FOLLOWING PROCEDURES IS ESSENTIAL TO MAINTAINING YOUR CORPORATE STATUS . FAILURE TO DO SO MAY RESULT IN DISSOLUTION OF YOUR CORPORATION . A CORPORATION ANNUAL REPORT/UNIFORM BUSINESS REPORT MUST BE FILED WITH THIS OFFICE BETWEEN JANUARY 1 AND MAY 1 OF EACH YEAR BEGINNING WITH THE CALENDAR YEAR FOLLOWING THE YEAR OF THE FILING DATE NOTED ABOVE AND EACH YEAR THEREAFTER . FAILURE TO FILE THE ANNUAL REPORT/UNIFORM BUSINESS REPORT ON TIME MAY RESULT IN ADMINISTRATIVE DISSOLUTION OF YOUR CORPORATION . A FEDERAL EMPLOYER IDENTIFICATION ( FEI ) NUMBER MUST BE SHOWN ON THE ANNUAL REPORT/UNIFORM BUSINESS REPORT FORM PRIOR TO ITS FILING WITH THIS OFFICE . CONTACT THE INTERNAL REVENUE SERVICE TO RECEIVE THE FE1 NUMBER IN TIME TO FILE THE ANNUAL REPORT/UNIFORM BUSINESS REPORT AT 1 -800-829 -3676 AND REQUEST FORM SS4 . SHOULD YOUR CORPORATE MAILING ADDRESS CHANGE , YOU MUST NOTIFY THIS OFFICE IN WRITING , TO INSURE IMPORTANT MAILINGS SUCH AS THE ANNUAL REPORT/UNIFORM BUSINESS REPORT NOTICES REACH YOU . Should you have any questions regarding corporations , please contact this office at the address given below . Carolyn Batten , Document Specialist New Filings Section Letter Number. 900A00005849 Division of Corporations - P . O . BOX 6327 - Tallahassee , Florida 32314 _ S� i •7f � NL • Mi• N • N • M1 .iHN. . •• M • • Nc14W # /i��•,�M M • N N •• N M • M M N M M M • NLsl • N •• •�/•�M� N • • • 1 • C'd • • C'JJ • iS7/ • • R'i/ • • • S.? • • h7/1 � a L J - • • N R L • a ti • L , y .0 t J . 7 • C ON C a s • Iwo �.� • • J C a s X 1 1 1 7 F a * fee so y = t a y a s s t •yam < S = L S L a / C S S : L ? F F S < y < �• . • + < S = am y t y L a C C S L L S L S � L ? C 7 S L L y L a C C s y L aats < fir a • • • y • L 1110 a 4 ? F F < • N N N • N N N N M N M • N • M N N M 4104,N Now N N N • N • N • N M • • • ARTICLES OF INCORPORATi ® jV OF rr F � il.f BOYS & GIRLS CLUB OF INDIAN RIVES COUNTY c e N I , the Incorporator , being a natural person of the age of twenty -one years or more and a citizen of the United States , for the purpose of forming a corporation under the provisions of Chapter 617 of the Florida Statutes , do hereby adopt the following Articles of Incorporation : ARTICLE I The name of this corporation shall be Boys & Girls Club of Indian River County , n and it shall be referred to as the " Corporation . " ARTICLE II Purposes and Limitations 1 . The Corporation is organized exclusively for charitable , religious , literary , scientific and educational purposes as set forth in Section 501 ( c ) ( 3 ) of the Internal Revenue Code . 2 . No part of the net earnings of the Corporation shall inure to the benefit of , or be distributable to its directors , officers , or other private persons , except that the corporation shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes set forth in these Articles of Incorporation . 3 . No part of the activities of the Corporation shall be the carrying on of propaganda , or otherwise attempting to influence legislation , and the Corporation shall not participate in , or intervene in ( including the publishing or distribution of statements ) any political campaign on behalf of any candidate for public office . 4 . Notwithstanding any other provision of these Articles , the Corporation shall not carry on any other activities not permitted to be carried on ( a ) by a Corperation exempt from federal income tax under Section 501 ( c ) ( 3 ) of the Internal Revenue Code , ( b ) by a Corporation , contributions to which are deductible under Section 170 ( c ; ( 2 ) of the Internal Revenue Code , or ( c ) by a nonprofit Corporation organized under the laws of the State of Florida , pursuant to the provisions of Chapter 617 of The = iorida Statutes . ARTICLE 111 Dissolution of the Corporation Upon the termination , dissolution or winding up of the Corporation , the Board of Directors shall , after paying or making provision for the payment of all liabilities of the Corporation ( as described in Chapter 617 . 1406 ( 3 ) ( a ) of the Florida Statues ) , distribute all assets of the Corporation ( including assets held by the Corporation under conditions requiring return , as described in Chapter 617 . 1406 ( 3 ) ( b ) of the Florida Statutes ) to such organization or organizations organized and operated exclusively for charitable , educational or scientific purposes as shall at the time qualify as an exempt organization or organizations under Section 501 ( c ) ( 3 ) of the Internal Revenue Code ( as described in Chapter 617 . 1406 ( 3 ) ( c ) of the Florida Statutes ) . In furtherance of the foregoing , any such plan of distribution shall be in accordance with the terms of Chapter 617 . 1406 of the Florida Statutes . Any such assets not so disposed of shall be disposed of by the Circuit Court to have jurisdiction over the matter occurring in the County in which the principal office of the Corporation is then located , exclusively for distribution to one or more domestic or foreign corporations , trusts , societies , or organizations engaged in activities substantially similar to those of the Corporation . ARTICLE IV Membership ; Directors and Election of Directors The Corporation shall be organized on a non - stock basis and shall have no members . The authority for all affairs of the Corporation shall be in a Board of Directors who shall have and may exercise all the powers of the Corporation as permitted by federal law , state law , these Articles of Incorporation , and the Bylaws of the Corporation as from time to time in effect . The Board of Directors will be elected under a method to be stated in the Bylaws of the Corporation . ARTICLE V Registered Agent The name and address of the initial registered agent and registered office are : Boys & Girls Club of Indian River County , Inc . C / o Lewis W . Murphy , Jr . , Esquire 817 Beachiand Boulevard Vero Beach , lorida 32963 i • ARTICLE VI Initial Principal Office The name and address of the initial principal office of the Corporation ( which is the same as the street address ) are : Boys & Girls Club of Indian River County, Inc . C / O Lewis W . Murphy , Jr . , Esquire 817 Beachland Boulevard Vero Beach , Florida 32963 ARTICLE VII Indemnification The Corporation shall have the power to indemnify its officers , directors , employees and agents to the fullest extent permitted by any applicable law , including , but not limited to the provisions of Chapter 617 . 0831 of the Florida Statues . ARTICLE VIII Amendment Any amendments to these Articles of Incorporation shall be made in accordance • with the provisions of the laws of the State of Florida . ARTICLE IX Incorporation of Definition of Terms All general or specific references herein made to the Internal Revenue Code shall be deemed to refer to the Internal Revenue Code of 1986 as now in force or later amended , or the corresponding provision of any future United States Internal Revenue law . Similarly , any general or specific references to the laws of the State of Florida shall be deemed to refer to the laws of the State of Florida as now in force or hereafter amended . I , the Incorporator , declare that I have examined the foregoing Articles of Incorporation and that the statements contained therein are , to the best of my knowledge and belief , true , correct and complete . i i i i i Executed this day of February 2000 . i j i Lewis W . ur y , Jr . , q Ire I Incorporator 817 Beachiand Boulevard Vero Beach , Florida 32963 j ( 561 ) 231 - 1900 STATE OF FLORIDA i COUNTY OF INDIAN RIVER I i The foregoing instrument was acknowledged before me this day of February j 2000 , by Lewis W . Murphy , Jr . , who is personally known to me or who has produced �� � „ c� L � . �,2 • as identification and who did not take an oath . / J Notary ' s Stamp i Name : Notary Public , State of Florida Commission No . i : ' ` = R:11 ARRIS Commission Expires : MY CCC 833161 i EXP20, 2000 y d ' 3aidW k Undrwri<ers r I i i i i i i r i i i j I i i i i i i i i I I CERTIFICATE OF DESIGNATION OF . REGISTERED AGENTIREGISTERED OFFICE PURSUANTTO THE PROVISIONS OF SECTION 617 . 0501 , FLORIDA STATUES , THE UNDERSIGNED CORPORATION , ORGANIZED UNDER THE LAWS OF THE STATE OF FLORIDA , SUBMITS THE FOLLOWING STATEMENT IN DESIGNATING THE REGISTERED OFFICE/REGISTERED AGENT, IN THE STATE OF FLORIDA . 1 . The name of the Corporation is : BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY . , Inc . 2 . The name and address of the registered agent and office are : Boys & Girls Club of Indian River County , Inc . C / o Lewis W . Murphy , Jr . , Esquire 817 Beachland Boulevard Vero Beach , Florida 32 .063 Having been named as registered agent and to accept service of process for the above stateld Corporation at the place designated in this certificate , 1 hereby accept the appointment as registered agent and agree to act in this capacity . I further agree to comply with the provisions of all statutes relating to the proper and complete performance of my duties , and I am familiar with and accept the obligations of my position as registered agent . Date : Lewis W . ur hy , r o o �F Registered Alent � , y •- � I 1 y I i I i i J - u3 BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC . CONSTITUTION We, the undersigned, being natural persons of the age of nineteen ( 19) years or more and citizens ofthe United States, for the purpose offorming a non-profit Corporation, under and pursuant to the laws of the State of Florida, do hereby adopt the following Articles of Incorporation . ARTICLE I - NAME The name of the corporation shall be Boys & Girls Club of Indian River County, Inc . ARTICLE II - PURPOSE Section 1 -- The purposes for which the corporation is organized are exclusively charitable within the meaning of Section 501 (c) (3 ) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States law . Section 2 -- Notwithstanding any other provision of these articles, this organization shall not carry on any activities not permitted to be carried on by an organization exempt from Federal income tax under Section 501 (c) (3 ) of the Internal Revenue Code of 1986 or the corresponding provision of any future United States Internal Revenue law. Section 3 -- In accordance with Section 1 and Section 2 , the mission of the corporation shall be to help youth of all backgrounds , with special concern for those from disadvantaged circumstances , develop the qualities needed to become responsible citizens and leaders irrespective of race, color, creed or national origin; to receive, invest and disburse funds ; and to hold property for the purpose of the corporation. Section 4 -- No part of the income or assets of this corporation shall inure to the benefit of any private individual or member . Section 5 -- This corporation shall have no capital stock, its object and purpose being solely of a benevolent character, and not for individual pecuniary gain or profit to its members . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. 0 CONSTITUTION and BYLAWS Page 2 ARTICLE III - MEMBERSHIP Section 1 - - Any adult resident of the United States may become a member of the corporation. Section 2 - - In the beginning, the membership of the corporation shall consist of those persons who have associated together to form the corporation. Section 3 -- At the first meeting of the corporation and at any annual meeting thereafter, the members may elect additional members by a two thirds vote of the members present and voting . Section 4 -- Membership shall be for a three year term or until a member is automatically dropped for nonattendance at meetings or removed for other cause . Section 5 -- Any member who is absent from three consecutive annual meetings of the corporation shall be dropped from membership unless reelected . At least thirty (30 ) days before the date of the next annual meeting, the secretary shall furnish to the nominating committee the names of persons who were dropped from membership subsequent to the last annual meeting. Section 6 -- Any member may be removed from membership on recommendation of the board of directors by a two thirds vote of the members present and voting at any special or annual meeting . ARTICLE IV - MEETINGS Section 1 - - The first meeting of the members of the corporation shall be held at a time and place to be fixed by those who have associated themselves together to form the corporation . Section 2 - - The annual meeting of the members of the corporation shall be held in January of each year, at a time and place to be fixed by the board of directors, for the purpose of receiving 7S � s BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 3 reports of officers , committees and the executive director; to elect members of the board of directors and members of the corporation; and to act on any other matters that may properly come before the annual meeting. Notices of such meeting shall be mailed by the secretary to the members of the corporation at least thirty (30) days before the date of the meeting . Section 4 -- 51 percent of the members of the corporation present in person shall constitute a quorum at any meeting of the corporation, but, in the absence of a quorum, a majority of those present at the time and place set for a meeting may take an adjournment from time to time until a quorum shall be present . ARTICLE V - NOMINATING CONMTTEE Section 1 -- At each annual meeting of the members of the corporation, they shall elect, or authorize the appointment by the president of, a nominating committee of at least three (3 ) members and not more than five ( 5 ) members, whose duty shall be to present at the next annual meeting of the members of the corporation nominations for membership in the corporation and nominations for members of the board of directors . If the appointment of a nominating committee by the president is authorized , the appointment shall be made at least ninety ( 90) days before the date of the next annual meeting . The nominating committee shall exercise its responsibilities under the auspices of the board development committee and adhering to the board development process approved by the corporate board of directors . Section ? -- Any member of the corporation may, at any annual meeting, nominate candidates for members of the corporation and members of the board of directors . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY , INC. CONSTITUTION and BYLAWS Page 4 ARTICLE VI - BOARD OF DIRECTORS Section 1 -- The business , property and affairs of the corporation shall be managed by a board of directors , which shall have the power to : initiate and approve plans and programs for the welfare of Boys & Girls Club members ; have custody and management of the land , buildings, equipment, securities and all other properties of the corporation. adopt the annual budget of the corporation; borrow money; raise and disburse funds ; invest and reinvest funds of the corporation; sell, buy and exchange properties and securities ofthe corporation. make contracts ; appoint the executive director and appoint, or delegate the power to appoint, other employees of the corporation; perform all other duties and have such other powers as may be necessary to carry out the purpose of the corporation. Section 2 -- The number of members of the board of directors, who shall be members of the corporation, shall be fixed by the members of the corporation at their first meeting, and this number may be changed at any annual meeting, provided, however, there shall not be less than ( 5 ) members of the board of directors, exclusive of any officers of the corporation who may be ex- officio members of the board of directors . Section .' -- At the first meeting of the members of the corporation, one third of the members of the board of directors shall be elected for one year. one third for two years and one third for three years, from among the members of the corporation . At each annual meeting thereafter, one third the number of directors shall be elected for three year terms . If the number of members of the board of directors is increased at any annual meeting, the additional members shall be elected in equal number for one, two and three year terms, and if the number of members is reduced at any annual meeting, • the terms of the remaining members shall be adjusted, as may be necessary to provide an equal j- � 7 BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 5 number serving one, two and three year terms . Section 4 -- All officers of the corporation shall be ex-officio members of the board of directors during their respective terms of office . Section 5 - - The board of directors shall have the power to fill vacancies in its own membership . Such new members shall have the power to fill vacancies in its own membership . Such new members shall hold office until the next annual meeting of the members of the corporation . Section 6 -- A majority of the members of the board of directors shall constitute a quorum at any regular or special meeting of the board of directors . Section 7 -- At least thirty (30) days before the date of the annual meeting, the secretary shall furnish the nominating committee with the names of the members of the board of directors whose terms will expire at such annual meeting. ARTICLE VII - OFFICERS Section 1 -- The officers of the corporation shall be a president, president -elect who will serve as one of the vice-presidents , three vice presidents, a treasurer and a secretary, who shall be elected annually by the board of directors . All officers shall serve for one year or until their successors are elected . Section 2 -- The board of directors shall have the power to fill vacancies among the officers at any time and officers so elected to fill such vacancies shall serve until the next annual meeting of the board of directors or until their successors are elected . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. 0 CONSTITUTION and BYLAWS Page 6 ARTICLE VIII - EXECUTIVE DIRECTOR The board of directors shall appoint an executive director of the corporation, fix his/her compensation, prescribe his/her duties and the terms of his/her employment, and supervise and evaluate his/her job duties . ARTICLE IX - BYLAWS The board of directors shall have the power to adopt bylaws regulating the affairs and prescribing the duties of the officers and executive director of the corporation, which bylaws shall not be inconsistent with this constitution. ARTICLE X - SEAL The seal of the corporation shall be a circular impression of the word and figures : Incorporation -- (date of incorporation) , surrounded by the name of the Boys and Girls Club -- (name of city and state) . ARTICLE XI - USE OF ASSETS ON DISSOLUTION AND USE OF INCOME Section 1 -- In the event of dissolution, the residual assets of the organization will be turned over to one or more organizations which themselves are exempt as organizations described in Sections 501 ( c) (3 ) and 170 (c) (2 ) of the Internal Revenue Code, or to the Federal , State, or local government for exclusive public purpose . Section 2 - - The corporation is one which does not contemplate pecuniary gain or profit to the members thereof and is organized for nonprofit purposes , and no part of any of the net earnings thereof shall inure to the benefit of any member or other individual . BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY INC * CONSTITUTION and BYLAWS Page 7 ARTICLE XII - AMENDMENTS The constitution may be amended upon a two thirds vote of the members present and voting at any meeting of the corporation, provided that a copy of the proposed amendment shall have been mailed to each member of the corporation at least thirty (30 ) days before the date of the meeting at which the proposed amendment is to be acted upon. ARTICLE XIII - EFFECTIVE DATE This constitution shall become effective immediately upon adoption by a two thirds vote of the members of the corporation present and voting . In witness whereof, the undersigned Incorporator has subscribed his name to the Articles of Incorporation on this /Td*ay of February, 2000 . Signature : 4114 .#00 —L W. Mu PVY, Jr. State of Florida County of Indian River Sworn to and subscribed before me this the �O day of February, 2000, by Lewis W . Murphy, Jr. , who is personally known to me . RESECCA D. HARRIS MY COMMISSION N CC 833161 ._ EXPIRES: August 20, 2000 Balled ifuu No4" Pudic Underwriters LZM Notary Public My commission expires � t^ BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY. INC. CONSTITUTION and BYLAWS Page 8 BYLAWS ARTICLE I - BOARD OF DIRECTORS Section 1 -- Regular meetings of the board of directors shall be held monthly at such places and times as the board of directors shall designate . Section 2 -- Special meetings may be held at the call of the president or of one third of the members of the board of directors providing notice of the time and purpose of the meeting is given to each member. ARTICLE I1 - COMNUTTEES Section -- There shall be an executive committee, board of development committee, financial development committee, human resources committee, program committee, property management committee, marketing committee, legal and insurance committee, planning committee, and planned giving committee . Section 2 -- The executive committee shall consist of the officers of the corporation, the chairperson of various standing committees and other such members as may be deemed advisable . The committee meets on call between regular meetings of the board of directors and assumes such duties and powers as are delegated to it by the board of directors . Section 3 - - The board development committee shall consist of at least three ( 3 ) members , exclusive of ex- officio members , of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the board development committee to report and make recommendations to the board of directors concerning all matters of board iseparation. The board development committee shall appoint a nominating committee which shall 7 - '? I BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 9 recommend to the board of directors a slate of candidates to fill vacancies on the board and a slate of officers for election. The board development and nominating committees shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 4 -- The financial development committee shall consist of at least three (3 ) members, exclusive of ex- officio members, of the corporation and board of directors and shall include the treasurer. The chairperson shall be a member of the board of directors . It shall be the duty of the financial development committee to report and make recommendations to the board of directors concerning all the financial affairs of the corporation, including charging subcommittees to plan, direct, and lead in the areas of resource development and budget & finance . The financial development committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 5 -- The human resource committee shall consist of at least three (3 ) members, exclusive of ex-officio members , of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the human resource committee to report and make recommendations to the board of directors concerning all matters of human resources . The human resources committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 6 -- The program committee shall consist of at least three (3 ) members , exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the program committee to report and make recommendations to the board of directors concerning the programs of the corporation, their relative BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 10 healthfulness, safety and adequacy of supervision. The program committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 7 -- The property management committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the property management committee to report and make recommendations to the board of directors concerning the maintenance of the building and other properties of the corporation including the retention of adequate limits of property and casualty insurance and the provision of safety and loss prevention programs for the guidance of staff. The property management committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 8 -- The marketing committee shall consist of at least three (3 ) members , exclusive of ex- officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the marketing committee to report and make recommendations to the board of directors concerning all matters of the development and execution of an annual marketing plan . The marketing committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 9 -- The legal and insurance committee, including the services of a competent insurance broker, reviews the insurance portfolio of the Boys & Girls Club annually to determine that adequate limits of coverage are kept in force . It develops and gives board leadership to a loss- prevention program to assure the safe and healthful operation of the Boys & Girls Club . The legal and insurance committee shall appoint a secretary from among its members who shall keep an BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 11 accurate record of its meetings . Section 10 - - The planning committee shall consist of at least three (3 ) members, exclusive of ex-officio members, of the corporation and board of directors . The chairperson shall be a member of the board of directors . It shall be the duty of the planning committee to report and make recommendations to the board of directors concerning all matters of planning, including the implementation of a strategic planning process . The planning committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . Section 11 -- The planned giving committee shall consist of at least three (3 ) members, exclusive of ex- officio members, of the corporation and board of directors . The committee shall include the services of competent legal and financial counsel. The chairperson shall be a member of the board of directors . It shall be the duty of the planned giving committee to report and make recommendations to the board of directors concerning all matters of the development and execution of a comprehensive planned giving program. The planned giving committee shall appoint a secretary from among its members who shall keep an accurate record of its meetings . ARTICLE III - PRESIDENT The president shall : preside at all meetings of the members of the corporation and of the board of directors ; appoint the members of all committees and be an ex- officio member of all such committees ; sign such papers as may be required by his/her office or as may be directed by the board of directors ; make such reports and recommendations to the board of directors and to the members of the corporation at any regular or special meetings concerning the work and affairs of the corporation, as his/her judgment may be necessary for their information and guidance ; request from 5 �74 BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 12 the treasurer, secretary and executive director such reports as in his/her judgment are necessary; and perform such other duties as may be incidental to the office . ARTICLE III - PRESIDENT The president shall : preside at all meetings of the members of the corporation and of the board of directors ; appoint the members of all committees and be an ex-officio member of all such committees ; sign such papers as may be required by his/her office or as may be directed by the board of directors ; make such reports and recommendations to the board of directors and to the members of the corporation at any regular or special meetings concerning the work and affairs of the corporation, as his/her judgment may be necessary for their information and guidance; request from . the treasurer, secretary and executive director such reports as in his/her judgment are necessary; and perform such other duties as may be incidental to the office . ARTICLE IV - VICE-PRESIDENTS The vice-presidents, in the order named by the board of directors, shall perform the duties of the president in case of his/her absence, resignation or inability to act . There shall be three ( 3 ) vice presidents, each responsible for one of the following general areas : operations, financial and support services . Each general area will be assigned committees and subcommittees related to the work of that area . The vice president of operations will oversee and facilitate the functions of the human resource, program, and property management committees . The vice- president of support services will oversee and facilitate the board development , marketing, planning, and the legal and insurance committees . The vice president of financial development will oversee and facilitate the budget and finance, resource development, and planned giving sub- committees . BOYS & GIRLS CLUB OF INDLAUN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 13 ARTICLE V - SECRETARY The secretary shall : issue in writing all notices of meetings of members of the corporation and board of directors ; notify individuals elected to office or to membership of the corporation or to the board of directors ; keep complete records of the meetings of the members of the corporation and of the board of directors ; keep complete records of the meetings of the members of the corporation and of the board of directors ; including an accurate record of attendance of members ; notify the nominating committee of persons dropped from membership in the corporation for nonattendance or other cause ; furnish the nominating committee with a list of officers and members of the board of directors whose terms shall expire at the next annual meeting; mail such other notices as may be directed by the board of directors ; be custodian of all records of the corporation, except such records and papers as shall be kept by the treasurer as herein provided ; sign such papers as may be required by his/her office or as directed by the board of directors ; and perform such other duties as may be incidental to the office . ARTICLE VI - TREASURER The treasurer shall : receive all monies of the corporation and have custody thereof, deposit the funds of the corporation in one or more banks selected by the board of directors, to be disbursed in accordance with the directions of, and upon the signatures of, persons designated by the board of directors ; keep a full account of all monies received and paid out and make such reports thereof to the president and board of directors as they may require ; receive and have custody of all deeds , securities, notes, contracts and other financial papers of the corporation and place them for safekeeping in the safe deposit vaults of a bank designated by the board of directors and under such BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC. CONSTITUTION and BYLAWS Page 14 rules of access as such board of directors shall determine; keep full account of all deeds, securities, notes and financial papers of the corporation and make such reports thereof to the president and board of directors as they may require, cause the books of account of the corporation to be audited at least once annually by a public accountant approved by the board of directors ; cause to be prepared and present at each annual meeting of the members of the corporation a comprehensive financial statement including the report of the accountant ; sign such papers as may be required by his/her office or as may be directed by the board of directors ; and perform such other duties as may be incidental to the office . He/She may be required by the board of directors to give such bonds as they shall determine for the faithful performance of his/her duties . The treasurer will serve as member of the financial development committee . ARTICLE VII - EXECUTIVE DIRECTOR Section 1 -- The executive director shall : manage the affairs and direct the work and employees of the corporation, subject to , and in accordance with, the directions of the board of directors ; prepare budgets of expense for the approval of the financial development committee; and be authorized to incur expenses in accordance with the approved budget, or as directed by the board of directors . Section 2 -- The executive director shall attend all meetings of the board of directors unless otherwise directed by the board of directors and shall be an ex-officio member of all committees . Section 3 - - The executive director shall from time to time make reports of the work and affairs of the organization to the president, board of directors and members of the corporation at their annual, monthly and special meetings . 3 - �-7 BOYS & GIRLS CLUB OF INDIAN RIVER COUNTY, INC . CONSTITUTION and BYLAWS Page 15 ARTICLE VIII - FISCAL YEAR The fiscal year of the corporation shall be the calendar year. ARTICLE IX - AMENDMENTS These bylaws may be amended by a majority vote of the members of the entire board of directors at any regular or special meeting called for that purpose, provided notice of the proposed change is given in the notice of the meeting at least ten ( 10) days prior to the meeting . ARTICLE X - SPECIAL AGENT The registered agent shall be and the registered office of said corporation shall be Lewis W. Murphy, Jr. , 817 Beachland Boulevard, Vero Beach, Florida 32964 . ARTICLE IX - INCORPORATOR Name Address Lewis W. Murphy, Jr. 817 Beachland Boulevard Vero Beach, FL 32964 IN WITNESS WHEREOF, the undersigned Incorporator has subscribed his name to the Articles of Incorporation on this the day of February, 200 . / t� Signatures : Lewis W. urp , Jr. STATE OF FLORIDA COUNTY OF INDIAN RIVER Sworn to and subscribed before me this the f day of February, 2000 , by Lewis W . Murphy, Jr . , who is personally known to me . ' My commission Expires : larf'4 Notary Public E - - REBECCA D. HARRIS MY COMMISSION f CC 833161 EXPIRES: August 20, 2000 Baided Ttru NotaryPLic U1&M ten ILA EmDIOVee Reiations The Club believes than the wont condidons, wages. and benefits it otters to its emniovees are competitive with those ozrered by other ®lovers in this area and m the non-prom youth serving industry. If employees nave concerns about work condiuoms or connpensanon. they are strongiv encouraged to voice these concerns openly and directly to heir supervisors_ Our experience pas shown that when employees deni openly and directiv with supervisors, the work environment can bee xceilenL communications can be clear, and attitudes can be positive. We believe than the 4. .ub ri iv demonstrates its c rriau menr to employees by responding et ecnveiv to enmjovee concerns. Equal Employment Opportunity/Affirmative Action Policy ine Club is an est opportunity employer. The Club is committed to the spirit and letter of au iede:ai_ state and ': ocai laws and re?uianons pertaining to equal opportuniry. To this end_ the Club does not disc:urinate against any individual with regard to race, coior, religion, sex, ase. nanonai origin. disabiiveteran status veterastatus or other prorectea status. This poiicr extends to all terms, conditions and pnvueges of empioyment . as wet as :he use of ail Club Taci][Ries. In order :o provide eat ai empioyment and advancement opportunities to ail individuais, emoiovment decisions at he Club will be based on merit, qualifications, and abuines to determine he most suitable applicant I fie C:ub wtil toilow American Disabilities Act ( ADA ) guidelines for emniovment and for emnioyee prac: cgs . i pis poi.icy governs ad aspects of e= iovment, inciudins seiecnon. Job assn=e^.t compensation. discipline, termination. and access to benefits and training. In addition to a commitment to provide equal employment onoornmiues to ail duaimed individuals, the Club has established an amrmative action program to promote opportunities for naividuais in certain protected classes throughout the orgmuZation. No form of uniawiui disc:-immanon, inciuding unlawful hamsmenL will be condoned Harassment It is the policy of the Club to provide. at ail times. an environment free of harassing conduct. getter enabling us :o focus on and mifiil the mission of the Club . The Club will not toierate any form of harassing zonduc: that is base anon an ittdividuai's race. coior. religion. sex, age. nanonai origin. disandity, maritai status. veterans status or other orotecred „ants_ For these purposes. the term " tiar-a sing conduct ;inv= rs " inciudes. but is not ited to . si . ; OKes . or other •:e b* _=hic, or physical conduct ;elating to an individual's race. coior. religion. se: age. national angin disaouiry or tparitrerm ai stares . The teharassing conduct aiso includes se.:uai advances . requests :or sexual favors and oche: conduct of a sexuai nature . env emoiovee vioiating this poiic-✓ will be subject to corrective action. up to and mcivains disCtiarse. So that -lou know . . . Harassment an he basis of race, color- religion. sex. age. aauonai onset. M" abuh y, maniai s:..tus . veteran s Status . =exuai Orientation. or other protected status is defined as conduct which has the purpose or eject or unreasonably nterierins :vim an individuai' s work performancz or creating an intimidating, hosnie . or offensive wor.: environment. =.:�a= ies of items . which could be construed as harassmear nciucie- but are not ' invited to : de2rading any amour) or crass of peopie : • assignment of less desimcie %work or working conditions to members or suc arotec :ea soups based soieiv on their group membership ; • a naividuais n a demeaning fashion. treatment of Drotecte Dratted 9/ 710l Employee Handbook u Juno e- mail for Lei saSmith@j uno . corn printed on Thursday , May 22 , 2003 , 11 : 08 AM From : "Marion Masterson " < mmasterson (cDircgov . com> To : " Boys & Girls Clubs " < LeisaSmith (aDjuno . com > , " Camp Manatee " < Michelle@irmh . ccm > , " CCCR" < cccrvero(cDaol . com> , " Children 's Home Society " < Kathy . rossini@chsfl . org > , " children 's home society " < maryellen . Maguirena chsfl . org> , " Children 's Home Society 2 " < Kathryn . quibeck . chsfl . org > , " Cultural Council" < mikelly(cDcultural-counci1 . org> , "Dasie Hope " < Vwright561 (cDaol . com> , " Exchange Club Castle " < dborrie@exchangecastle . orq> , " Four H of IRC " < Jawakefield (a) fas . ufl . edu > , " GROW Inc " < growinc2(abellsouth . net> , " GYAC" < bad (aDgyac. cc> , "GYAC Bobbie" < bohoda (a) aol . com> , " Healthy Start Coalition " < irchsc@aol . com> , "Help Me Behave Center" < Boohpy(cDaol . com > , "Hibiscus Children 's Center" < SshiPe0hccrkids . orq > , " Homeless Assistance Center HAC " < SLRHome(cDaol . com > , " HOPE " < Brotherpreach (cDaol . com > , " Kings Kids " < rayejlee bellsouth . net> , " Kings Kids 2" < mayamarion a .yahoo . com > , "Mental Health Association " < Krismha(cDearth link . net> , "Planned Parenthood " <triste . brooks(CDpppbtc . org > , " Red Cross" < hsycs(cDbellsouth . net> , "Samaritan Center" < SamaritanCenter1 (aa yahoo . com> , "Special Equestrians of the TC " < Heather. BuIkcr. wachovia . com> , "Substance Abuse Council" < sacirc bellsouth . net> , " Suncoast Mental Health Center" < scmh98 (cDbellsouth . net> Date : Tue , 13 May 2003 10 : 04 : 01 -0400 Subject: GOALS WORKSHOP May 19 1 -4 MANDATORY . . . . . . . . . . . . . . . . . . . . . .. . . . .. .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . ... .. . .. . . . . .. .... .. . . . .. . .. . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . .... .... . ... . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Dear Grant Applicant ( -zl Sc. � c,, ; L- AV4- One of the requirements for application for RFP is attendance at a goals workshop . A goals workshop is scheduled for May 19th at IPM at the Treasure Coast Homeless Center, 2525 St . Lucie Avenue, Vero Beach, Florida Please send a reply as soon as possible, stating qcr�• " 1 �. Y. m • I HAVE ATTENDED A GOALS WORKSHOP ON '—��„ ,r, _ a o a o03 GIVEN BY (agency) OR I HAVE NOT ATTENDED A GOALS WORKSHOP AND WILL BE ATTENDING. THERE WILL BE PEOPLE ATTENDING FOR (agency ) ON MAY 19TH Thanks Marion �- c 0 loft • NOT FOR PROFIT AGENCY CERTIFICATION The County of Indian River requires , as a matter of policy , that any Consultant or firm receiving a contract or award resulting from the Request for Qualifications issued by the County of Indian River, Florida , shall make certification as below. Receipt of such certification, under oath , shall be a prerequisite to the award of contract and payment thereof. I (we) hereby certify that if the contract is awarded to me , our firm , partnership, or corporation , that no members of the elected governing body of Indian River County, nor any professional management, administrative official or employee of the County , nor members of his or her immediate family, including spouse , parents , or children , nor any person representing or purporting to represent any member or members of the elected governing body or other official , has solicited , has received or has been promised , directly or indirectly , any financial benefit, including but not limited to a fee , commission , finder's fee , political contribution , goods or services in return for favorable review of any Proposal submitted in response to the Request for Qualifications or in return for execution of a contract for performance or provision of services for which Proposals are herein sought . The undersigned certifies that he/she is a principal or officer of the firm applying for consideration and is authorized to make the above acknowledgments and certifications for and on behalf of the applicant. The undersigned certifies that the Applicant has not been convicted of a public entity crime within the past 36 months , as set forth in Section 287 . 133 , Florida Statutes . • Failure to sign this form will result in disguali>Fcation Handwritten Si ature of Authorized Principal (s) : DATE : S - X'T - � OOS NAME : TITLE : LU " J e ` t p C \-jZIC NAME OF FIRM/PARTNERSHIP/CORPORATION : Sworn to and subscribed to FOR AND ON BEHALF OF THE APP ( CANT: me , a .Notary Pub ' , this o? '4*2ay of 2003 . BY: ., � 1fe p( � � e ELLEN Y. IAOHR stabs of Raida , �M �^ �. 6AApdI 18, (TYPE NAME & TITLE) X Indian River Board of County Commissioners 184025 th Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and oTA�tl ,ahk;gj (Agency/ Individual are in the process of negotiation of a contract for °' " �• Indian River County is authorized to make an investigation of the Agency/ Individual regarding its experience and qualifications . The Agency/Individual authorized the release of all relevant information concerning prior services furnished , contracts and background information of the Agency/ Individual . The Agency/ Individual authorizes any individual or organization that is in possession of relevant factual contract and background information , to release such data to Indian River County in response of the County' s request . When an individual employee of the Agency signs Authorization for Release= of Information , such individual authorizes the County to obtain relevant background information concerning such employee's criminal record , if any , and such other information that may be relevant to employee ' s good character and work experience . Authorization is given here by the Agency/Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/ Individual `Do*�( S -� C `va & o � ' �� � 12; �j -ey AU" Print name Name Employee Providing uthorization L-e. tirA Print me Signature ( in blue ink) - ` . �. _ Date X1 • Indian River Board of CountyCommissioners mmissioners 1840 25h Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and -T? m ,100ii) - \ inns #, (Agency/Individual are in the process of negotiation of a contract for 4% .e )0S -VW � � uWNL. Indian River County is authorized to make an investigation of the Agency/Individual regarding its experience and qualifications . The Agency/ Individual authorized the release of all relevant information conceming prior services furnished. contracts and background information of the Agency/individual . The Agency/Individual authorizes any individual or organization that is in possession of relevant factual contract and background information . to release such data to Indian River County in response of the County' s request_ When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee ' s criminal record , if any , and such other information that may be relevant to employee' s good character and work experience. Authorization is given here by the Agency/Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/ Individual Print name 0A � Name Employee Providing authorization UG . „ - Fuk �. ot� Print naqne Signature ( in blue ink) , A - _ Date X1 Indian River Board of County Commissioners 1840 25th Street Vero Beach , FL 32960 AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and Chbs o (Agency/ individual are in the process of negotiation of a contract for °� '^ • '"`' Indian River County is authorized to make an investigation of the Agency/ Individual regarding its experience and qualift2tions . The Agency/ Individual authorized the release of all relevant information concerning prior services furnished , contracts and background information of the Agency/ Individual . The Agency/Individual authorizes any individual or organization that is in possession of relevant factual contract and background information , to release such data to Indian River County in response of the County' s request . When an individual employee of the Agency signs Authorization for Release of Information , such individual authorizes the County to obtain relevant background information concerning such employee' s criminal record , if any , and such other information that may be relevant to employee' s good character and work experience. Authorization is given here by the Agency/Individual and such employees who execute this authorization with the understanding and limitation that Indian River County will utilize the information obtained for the purposes set forth herein and that such information shall not be disclosed to third parties except as provided by law. Name Agency/ Individual Y2!� y S , (� , Z y (°NI „� � Print name Name Employee Providing authorization W\Vo� _ Print nante Signature ( in blue ink) - Date S- a—? - r:� 80 SWORN STATEMENT UNDER SECTION 105. 08 INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 . This sworn statement is submitted with RFP No . 4046 for 2 . This sworn statement is submitted by : �y,a t ( Name of entity submitting Statement) whose business address is : , ( if applicable) and its Federal Employer Identification Number ( FEIN ) is—fit - q 4 ( If the entity has no FEIN , include the Social Security Number of the individual signing this sworn statement 3 . My name is ( Please print name of individual signing ) and my relationship to the entity named above is 4 . 1 understand that an " affiliate" as defined in Section 105 . 08 , Indian River County Code , means .- The eans :The term " affiliate" includes those officers , directors , executives , partners , • shareholders , employees . members and agents who are active in the management of the entity. XII u - 3 5 . 1 understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt, first cousin , nephew, niece , husband , wife , father-in-law, mother- in-law, daughter- in -law, son-in-law, brother-in -law, sister-in- law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild . 6 . Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement. [ Please indicate which statement applies . ] .s,,/Neither the entity submitting this sworn statement , nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity , have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement , or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate Name of County Commissioner Relationship or entity or employee XIII ( signature ) ( date ) STATE OF COUNTY OF iyai �r/ ,cam, yE,� The foregoing instrument was acknowledged before me this -�7 day of 20 03 , by 12lsIj Ste, //P/7 , who is personally known to me or who has produced as identification . NOTARY PUB1,1 • SIGN : G4L PRINT: State of Florida at Larg ELLMSUft �e MOHR My Commission Expire �h C n: oD r08898.12006 : Florida ( Seal ) XIV 11 - 5 SWORN STATEMENT UNDER SECTION 105 . 08 , INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 . This sworn statement is submitted with RFP No. 4046 for 2 . This sworn statement is submitted by: ( Name of entity submitting Statement ) whose business address is : 470�10 < %mac � �k �3 -Q 2c& Iq Lqq and ( if applicable ) its Federal Employer Identification Number ( FEIN ) ( If the entity has no FEIN , include the Social Security Number of the individual signing this sworn statement 3 . My name is i S G )vvx .- ( Please print name of individual signing ) and my relationship to thin entity named above is rN:e cAu�-Nkv f.- !; c' e r- 4 . I understand that an " affiliate " as defined in Sem ion 105 . 08 . Indian River County Code . means : The term ' affiliate " includes those officers , directors . executives ; partners . shareholders . employees , members . and agents wno are active in the management of the entity . YII 5 . I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt, first cousin , nephew, niece , husband , wife , father-in -law, mother-in-law, daughter- in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent , or grandchild . 6 . Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement . [ Please indicate which statement applies . ] V Neither the entity submitting this sworn statement, nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity , have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement , or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate _Name of County Commissioner Relationship or enti or employee _ XIII r (signature) OS ( date ) STATE OF •�/obi ofd COUNTY OF �ti� � • r/�� The foregoing instrument was acknowledged before me this �27 day of Ate2003 by 4e,- 3a 5141 -1- , amu-/4i, who is pgrsanally kno_ wnt4 me or who has produced as identification . NOTARY PUBO SIGN : PRINT: State of Florida at Large sE M M. MMOOHR My Commission Expires : cCommomn,; 000ease�FloridaM ( Seal ) i1 - S SWORN STATEMENT UNDER SECTION 105. 081, INDIAN RIVER COUNTY CODE, ON DISCLOSURE OF RELATIONSHIPS THIS FORM MUST BE SIGNED IN THE PRESENCE OF A NOTARY PUBLIC OR OTHER OFFICER AUTHORIZED TO ADMINISTER OATHS . 1 . This sworn statement is submitted with RFP No . 4046 for 2 . This sworn statement is submitted by : ( Name of entity submitting Statement ) whose business address is : el ) � \) . �vO)c 3QL S , � Qft) eakCl, P- and ( if applicable ) its Federal Employer Identification Number ( FEIN ) is Sq - Z Lo eLy�Ia a CR ( If the entity has no FEIN , include the Social Security Number of the individual signing this swom statement 3 . My name is L� sic, < � � - �- u ��-o ►•` _ _ ( Please print name of individual signing ) and my relationship to the entity named above is ta�xf C �.,.1r �v e � Y �1t7►� 4 . 1 understand that an " affiiiateas defined in Section 105 . 08 , Indian River County Code , means : The term " affiliate' includes those officers , directors , executives . partnerz . shareholders . employees . members . and agents who are active in the management of the entity . XII 5 . 1 understand that the relationship with a County Commissioner or County employee that must be disclosed as follows : Father, mother, son , daughter, brother, sister, uncle , aunt , first cousin , nephew, niece , husband , wife , father-in -law, mother-in -law, daughter- in-law, son -in-law, brother-in -law, sister-in-law, stepfather, stepmother, stepson , stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent , or grandchild . 6 . Based on information and belief, the statement which I have marked below is true in relation to the entity submitting this sworn statement . [ Please indicate which statement applies . ] .v� Neither the entity submitting this sworn statement , nor any officers , directors , executives , partners , shareholders , employees , members , or agents who are active in management of the entity , have any relationships as defined in section 105 . 08 , Indian River County Code , with any County Commissioner or County employee . The entity submitting this sworn statement, or one or more of the officers , directors , executives , partners , shareholders , employees , members , or agents , who are active in management of the entity have the following relationships with a County Commissioner or County employee : Name of Affiliate Name of County Commissioner Relationship or entity or employee XIII ( signature) ( date ) STATE OF COUNTY OF ,? e foregoing instrument was acknowledged before me this c>75 - day of �-/ 20 03 by ZeI5< Shri:!4Z2 X-�vc / who is personally known oto me or who has produced as identification . NOTARY PUBIC SIGN : c700 PRINT: State of Florida at Large ELLEN M. MOHR State of Florida My Commission Expires : My Camra. Exp. nprii 18, 2006 Comm. # DD 088983 ( Seal ) YID ' MAY-22- 2003 THU 12 ' 15 PM WM DAY FAX N0, 5615465772 P , 02 ACORDN CERTIFICATE OF LIABILITY INSURANCE 1 �DATE (MINDDIYYYY) 03102 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ND CONFERS NO RIGHTS UPON THE Day Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, CERTIFICATEEXTENDOR 11320 SE Federal Hwy. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. "ohe Sound FL 33455 772.5464767 INSURERS AFFORDING COVERAGE NAIC # INSURED Boys & Gins Club of Indian River County, Inc. INsuRERA; Markel Insurance Cc PO Box 3068 INSURER e: Vero Beach FL 32964 INSURER C. INSURER D: _ I�ISUREit E i vTHE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMCNr, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITII RCSPECT 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DPOLICY EFFECTNE POLICY EXPIRATION T . ,, POLICYNUMBER DATE IMMMIINYI LMTS GENERAL LIARIL" FACH OCCURRE114CE S 1,000.000 —' DAMAGE TO RENTED I A X COMMERCIAL GENERAL LM UTY 8502CY2201282 09113102 09113103 1100 000 CLAIMS MADE OCCUR MED EXP (Any n2 55,000 PS=R.SONAL & ADV INJURY S 10 .000 GENERALACGRIEGATE s3,0 000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COW/OP AGG S X POLICYr �j PITO LOC J AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 3 j j0001000 A X ANY AUTO 8502CY2201282 09113102 09113103 (F3 acddel0 X ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Pa r.,a pcn) S X HIRED AUTOS BODILY INJURY i X NON•OWNCDAUTOS (Perecdaent) PROPERTY DAMAGE 8 T& accident) GARAGE LIABILITY AUTO Ow Y • FA AMDENT i ANY AUTO OTHER THAN FA ACC S t AUTO ONLY: AcG S _ :'UWBRELLA LIABILITY EACH OCCURRENCE i I OCCUR EICLAIMS MADE AGGREGATE S S I DEDUCTIBLE S RETENTION I S WGSTATU- DTH- . WORKERS COMPENSATION AND �. EMPLOYERS' LIABILITY E.L. FACH ACCIOENT S AN'/ PROPRIFrORIPARTNCR/EXECUI NE OrFICEfUM>=MBER EXCLUOCW F f DISEASE - EA EMPLOYFF S 1 If de i7�� under 1 PROVISKO 5 Chow E.L. DISEASE - POLICY LIMIT S OTHER i =s;RATION OF OPERATIONS / LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT ! SPECIAL PROVISIONS CsniCztftjnoider is additional insured for General Liability & auto 30 Days notice applies except for nonpayment of premium CERTIFICATE HOLDER CANCELLATION Indian River County SHOULD ANY OF THE ABOVE D ESCRIBED POLICIES BE CANCELLED WWOR£ THE EXPIRATION Board of County Commissioners DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR To MAIL 10 GAYS WRrrTEN I 1840 25th 5t NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHA i Vero Beach, FL 329603365 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON THE INSURER ITS AGENTS On REPRESENTATIVES. i AUTHORIZED REPRESENTATIVE > ACORD 25 (2001108) CORD CORPORA41ON 1988 u - � MAY-22- 2003 THU 12 ' 15 PM WM DAY FAX We 5615465772 P , 03 IMPORTANT If the certificate holder is an ' ADDITIONAL INSURED, the poiicy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s ). If SUBROGATION IS WANED , subject to the terms and conditions of the policy, certain polides may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side - of this form does not constitute a contract between the issuing insurer(s) , authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend , extend or alter the coverage afforded by the policies listed thereon . i i AcORD 25 (2001108) Y —%2-2003 THU 12 ; 15 PM WH DAY FAX We 5615465772 P . 04 naafl ly, lZiu l, dudrat, Jr., a Chaumin• . U,f [ f'V C faf r {40 � A"MistcMd iy !tamnMSince ;1979 il .:n�te 4:ud�r, Vi.: CNIRm,n, tirldirle No \ivsKA , l.,+� rlvnd 3' 4 Jim x983 D l .a,krl�nd, l t. �3.'t4t-(1 )SB � sr�a'x�srrnuuptu;t�ti,l�t�'o,n n�>n,� s. p� wN, nr I,IgII4p� . _ 'Iclgilumc fRtS31 t4fii fiQlJl Ar l K(14-2Y?-715-b1L ► J'eR {Rbi} b6Cy- 1958 ( teles 1L Phnv, Air brm .ilrr Certificate of Insurance RE : 0520 -25864 ISSUED T0 : Indian River County Board of County Commissioners 1840 25th St Vero Beach , FL 32960-3365 This is to certify that Bays 8c Giris Club of Indian River CountyJnc P .O . Sox 3068 each , FL 52964, being subject to the provisions of the Florida Workers' Compensation Law, has secured the payment of any workers' compensation benefits due by insuring their risk with the Florida Retail Federation Self Insurers Fund . = CLiCY NUMBER: 0520_25864 Statutory Llmits—State of Florida Employers Liability EFFECTIVE DATE : Septf!mbeL13s__2=2 $ 500, 000 ( Each Accident) $ 500, 000 ( Disease- - Each Employee ) EXPIRATION DATE : 5eptember 13 , 2% $ 500 , 000 ( Disease-- Policy Limit) This certificate is not a policy and of itself does not afford any insurance . Nothing contained in this certificate shall be construed as extending coverage not afforded by the policy shown above or affording insurance to any insured not named above, The policy of insurance listed above has been issued to the named insured for the policy period indicated . Notwithstanding any requirement, tarn or condition of any contract or other document to which this certificate may pertain, the insurance made available by the described policy in this certificate Is subject to only the terms, exclusions and conditions of such policy, Paid claims may have reduced the shown limits , If the policy described above Is cancelled before the expiration date Indicated , the issuing company will attempt to mail 30 days' written notice to the certificate holder named above, However, the issuing company, Its agents or representatives accept no- obligation or liability of any kind for failure to mail such notice . Date 05/ 22/2003 contultirg , Inc,, Administrator rloriaa Retail Federatior: Self lnsusers F'und