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2007-308C
Indian River County Grant Contract This Grant Contract ("Contract") entered into effective this I day of October 2007 by and between Indian River County, a political subdivision of the State of Florida , 1801 27th Street, Vero Beach FL , 32960 ("County") and St. Peter's Human Services , Inc. , (Recipient); of: 4250 38th Avenue , Vero Beach , FL 32967 For: St. Peter's Boys Development &Training Program Background Recitals A. The County has determined that it is in the public interest to promote healthy children in a healthy community. B . The County adopted Ordinance 99- 1 on January 19 , 1999 ("Ordinance") and established the Children's Services Advisory Committee to promote healthy children in a healthy community and to provide a unified system of planning and delivery within which children 's needs can be identified , targeted , evaluated and addressed . C . The Children 's Services Advisory Committee has issued a request for proposals from individuals and entities that will assist the Children' s Services Advisory Committee in fulfilling its purpose . D . The proposals submitted to the Children's Services Advisory Committee and the recommendation of the Children 's Services Advisory Committee have been reviewed by the County. E . The Recipient, by submitting a proposal to the Children 's Services Advisory Committee , has applied for a grant of money ("Grant") for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . F. The County has agreed to provide such Grant funds to the Recipient for the Grant Period (as such term is hereinafter defined ) on the terms and conditions set forth herein . NOW THEREFORE , in consideration of the mutual covenants and promises herein contained , and other good and valuable consideration , the receipt and adequacy of which are hereby acknowledged , the parties agree as follows : 1 . Background Recitals . The background recitals are true and correct and form a material part of this Contract. 2 . Purpose of Grant. The Grant shall be used only for the purposes set forth in the complete proposal submitted by the Recipient attached hereto as Exhibit "A" and incorporated herein by this reference (such purposes hereinafter referenced as "Grant Purposes"). - 1 - 3 . Term . The Recipient acknowledges and agrees that the Grant is limited to the fiscal year 2007/2008 ("Grant Period ") . The Grant Period commences on October 1 , 2007 and ends on September 30 , 2008 . 4 . Grant Funds and Payment The approved Grant for the Grant Period is Eighteen Thousand Dollars ($18,000). The County agrees to reimburse the Recipient from such Grant funds for actual documented costs incurred for Grant Purposes provided in accordance with this Contract. Reimbursement requests may be made no more frequently than monthly. Each reimbursement request shall contain the information , at a minimum , that is set forth in Exhibit "B" attached hereto and incorporated herein by this reference . All reimbursement requests are subject to audit by the County. In addition , the County may require additional documentation of expenditures , as it deems appropriate . 5 . Additional Obligations of Recipient. 5 . 1 Records. The Recipient shall maintain adequate internal controls in order to safeguard the Grant. In addition , the Recipient shall maintain adequate records fully to document the use of the Grant funds for at least three (3 ) years after the expiration of the Grant Period . The County shall have access to all books , records , and documents as required in this Section for the purpose of inspection or audit during normal business hours at the County' s expense , upon five (5) days prior written notice. 5 . 2 Compliance with Laws . The Recipient shall comply at all times with all applicable federal , state , and local laws, rules , and regulations . 5 . 3 Quarterly Performance Reports . The Recipient shall submit quarterly, cumulative, Performance Reports to the Human Services Department of the County within fifteen ( 15 ) business days following : December 31 , March 31 , June 30 , and September 30 . The Recipient acknowledges and agrees that the County reserves the right to conduct random and unannounced monitoring of the program ' s performance throughout the Grant Period . 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. - 2 - 5.4 .2 The Indian River County Office of Management and Budget reserves the right at any time to send a letter to the Recipient requesting clarification if there are any questions regarding a part of the financial statements , audit comments , or notes . 5 . 5 Insurance Requirements . Recipient shall , no later than October 21 , 2006 , provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct business in Florida that is rated not less than category A-: VII by A. M . Best, subject to approval by Indian River County's risk manager, of the following types and amounts of insurance : ( i) Commercial General Liability Insurance in an amount not less than $ 1 ,000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations, products/completed operations , contractual liability, and independent contractors ; (ii ) Business Auto Liability Insurance in an amount not less than $ 1 ,000 ,000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and (iii) Workers' Compensation and Employer's Liability (current Florida statutory limit) 5 . 6 Insurance Administration . The insurance certificates , evidencing all required insurance coverages shall be fully acceptable to County in both form and content, and shall provide and specify that the related insurance coverage shall not be cancelled without at least thirty (30) calendar days prior written notice having been given to the County. In addition , the County may request such other proofs and assurances as it may reasonably require that the insurance is and at all times remains in full force and effect. Recipient agrees that it is the Recipient's sole responsibility to coordinate activities among itself, the County, and the Recipient's insurer(s) so that the insurance certificates are acceptable to and accepted by County within the time limits set forth in this Contract. The County shall be listed as an additional insured on all insurance coverage required by this Contract, except Workers' Compensation insurance. The Recipient shall , upon ten ( 10 ) days' prior written request from the County, deliver copies to the County, or make copies available for the County's inspection at Recipient's place of business , of any and all insurance policies that are required in this Contract. If the Recipient fails to deliver or make copies of the policies available to the County; fails to obtain replacement insurance or have previous insurance policies reinstated or renewed upon termination or cancellation of existing required coverages ; or fails in any other regard to obtain coverages sufficient to meet the terms and conditions of this Contract , then the County may, at its sole option , terminate this Contract. 5. 7 Indemnification . The Recipient shall indemnify and save harmless the County, its agents , officials , and employees from and against any and all claims, liabilities , losses , damage , or causes of action which may arise from any misconduct , negligent act , or - 3 - omissions of the Recipient, its agents , officers, or employees in connection with the performance of this Contract. 5 . 8 Public Records. The Recipient agrees to comply with the provisions of Chapter 119 , Florida Statutes (Public Records Law) in connection with this Contract. 6 . Termination . This Contract may be terminated by either party, without cause, upon thirty (30) days prior written notice to the other party. In addition , the County may terminate this Contract for convenience upon ten ( 10 ) days prior written notice to the Recipient if the County determines that such termination is in the public interest. 7 . Availability of Funds . The obligations of the County under this Contract are subject to the availability of funds lawfully appropriated for its purpose by the Board of County Commissioners of Indian River County. 8 . Standard Terms . This Contract is subject to the standard terms attached hereto as Exhibit C and incorporated herein in its entirety by this reference . IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date firsj•above written . INDIAN RIVER COUNTY Attest: J. K. Ba on ,' Clerk BOARD OF COUNTY COMMISSIONERS By Deputy Clerk By (c / Ga . Wheeler, Chairman BCC Approved : } Approved : touseph . Baird nty Administrator Zaprian d as to f d legal sufficiency: E . Fell , AS ist t County Attorney RECIPIENT: By: ST. PET ' S HUMAN SERVICES , INC . - 4 - EXHIBIT A [Copy of complete proposal/application] OrganiuHon: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council PROGRAM COVER PAGE 600 5 �� � Organization Name: St. Peter' s Boys Development and Training Institute t f Executive Director: Pastor Andrew Jefferson E-mail:stpetersschoolna,bellsouth net Address: 4250 38`' Avenue Telephone: 772-562-6863 Vero Beach, F132967 Fax: 772-562-8920 Program Director: Mr. Edward Coney E-mail: Same as above Address: Same as above Telephone: Fax : Program Title: Boy' s Developmental and. Training Institute Priority Need Area Addressed: To reduce juvenile delinquency and crime Brief Description of the Program: The program seeks to provide for school age children and teens access to a weekend training program that offers recreation academic supportself esteem character building and community services experience The program also provides positive role models through investors to equip the boys with knowledge about substance abuse violence and gang activity. SUMMARY REPORT — (Enter Information In The Black Cells Only) Aunt Requested Funder for 2007 /08: $ 61 ,386 71 Total Posed Prram Binet for 2007 /08 : $ 61 ,386 71 Percent of Total Program Budgeter 100 . 0 % 1 Current Pro-gram Funding, l2006 /07 ) : $ 36 , 106 t Dollar increase / decrease ) Percent increase / decrease in re quest * * 70. 0% Unduplicated Number of Children to be served Individually : 50 Unduplicated Number of Adults to be sely•. rved Individual Unduplicated Number to be served via Group settings : 50 f TotalPro ram Cost er Client : 613 . 87 = * *If request increased 5% or more, briefly explain why: The program is requesting an additional 16,094. 00 for food and $2, 600.00 for transportation as indicated in the variance section of the application. If these funds are being used to match another source, name the source and the $ amount: The Organization 's Board of Directors has approved this application o . (date) Andrew Jefferson Name of President/Chair of the Board igna ; Larry Tavlor Name of Executive Director/CEO ignature 3 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council PROPOSAL NARRATIVE Please respond to each question in the allotted space for each section. In responding to each section of the proposal narrative, please retain the section-label and/or question that you are addressing. Type using 12 pt. font on 8 %" X 11 " paper and number each page. These directions and the graphic boxes may be deleted if space is needed. A. ORGANIZATION CAPABILITY (Entire Section A not to exceed one page) 1 . Provide the mission statement and vision of your organization. Mission Statement: St. Peter' s Human Services, Inc. ' s mission is to increase the success rate of high risk students by providing educational support, drug awareness, and character education through operation of a public school of choice. The organization works cooperatively with established social programs to assist the targeted population of Indian River County to become self sufficient members of society. Vision: The St. Peter' s Human Services Corporation is a non religious, non denominational organization in operation since December 1996. The Agency' s vision is to address social problems and needs in targeted areas of Indian River County, Florida. The agency is designed to provide short and long term services in the areas of affordable quality child/daycare services, before and after school childcare, public school of choice for children with special needs who- may not be successful in the regular school system, youth intervention programs, and assisted living care for certain targeted groups. 2. Provide a brief summary of your organization including areas of expertise, accomplishments, and population served. Since is incorporation, the agency has provided quality daycare services for families with children ages zero to five years of age. The center also serves children who are Title 20 and ALPI Certified. The agency has a chartered public school of choice, serving 90 to 100 "at-risk" students of Indian River County. The Agency has also successfully implemented a Girl' s Development and Training Program for the targeted population, ages 7 to 16. The program' s highlights include organized drills, academic support, self esteem/character building, and exploration and exposure to educational and recreational activities through field trips and workshops. The Program is the only one of its kind in Indian River County. 4 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council 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. The unacceptable condition is juvenile delinquency that leads to further lives of crime, truancy, dropping out of school, low self esteem, etc. because the approach has been only to lockup the offenders without changing the behaviors. b. The children in need are the at-risk males between the ages of 7 and 16 who and discouraged learners, have low self-esteem, stressful family conditions, and have exhibited problem behaviors, such as school disciplinary referrals, chronic school truancy, repeated school suspensions, poor academic performance, a history of alcohol, tobacco and other drugs, rebellion, running away, mental and emotional health issues and those with a history of delinquent behavior. c. In Indian River County, 90% of the at-risk males involved in the program are from the surrounding community. d. DJJ Report indicates that the specific population of juvenile offenders are those who according to research are most likely to become chronic and serious offenders if they do not receive early help. They share certain high-risk factors, including the first offense at age 15 or younger, poor school performance and truancy, lack of parental supervision, substance abuse problems and gang affiliation. The profile of Florida Delinquency Report indicates that a total of 94,228 youth were referred to DJJ during FY 2005-06, presenting 150, 104 delinquency referrals (unduplicated). The majority of youth referred were males (70%), white (45 %), and were age 15 and under (49%) at the time of their most serious referral . Recent research indicates that two- thirds of male juvenile offenders have at least one psychiatric disorder (archives of general psychiatry 2002). DJJ reports indicate that 49% of the offenders surveyed have a diagnosed mental disorder. Fourteen percent demonstrated behavior which suggests mental disorder; 35% had a diagnosed substance-related disorder which suggested substance abuse. Nine percent are sex offenders and 5% have developmental disabilities. DJJ fact sheet indicates that during FY2004-05, 82 delinquency referrals were made per 1 ,000 juveniles. 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. There are two programs that serve the targeted population, however neither of the programs are structured to address the additional areas provided through the Boys Development Institute. 1 a. Gifford Youth Activity Center provides an after school day program for all youth, not just males. 1 b. The program does not provide many of the services rendered by our program i .e. mentoring, community services, Life Skills, Drug Awareness and Character Education, overnight stay on site, meals, recreational, and academic support and tracking the boys for six months after successful completion of the program through DJJ, schools and parents. 2a. Hope Academy provides an alternative day program for suspended students from public schools, while the Boys Institute seeks to serve the social, emotional and academic needs of the child, ensuring that all areas are addressed. 5 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council C. PROGRAM DESCRIPTION (Entire Section C, 1 — 6, not to exceed two pages) 1 . List Priority Needs area addressed. To reduce juvenile delinquency and crimes. 2. Briefly describe program activities including location of services. Activities Results and Program Requirements : The following services will be provided/required by the program: tutoring and academic instruction, counseling (rehabilitative, social, mental and emotional), drills for discipline training, character and self esteem building classes, conflict resolution and life skills classes, rap sessions to develop communication skills, recreational activities, field trips, mentoring, guest speakers, etc. Overall results : reduced juvenile delinquency and increased self esteem and responsibility. Process and Intended Outcomes — Client Involvement from start to finish: Referrals are made by schools, local churches, parents of . enrolled boys and from other partnering agencies. The boy is accepted into the program and must participate on every level while attending. The boy' s school attendance, records, etc. , are closely monitored and discussed during the duration of the program. Above is a list of those areas in which the boy will participate . Expected Outcomes and Changes : The outcomes generally include increased academic performance, decreased negative behavior, improved relationships among , peers, increased community awareness and increased awareness of substance abuse addiction and HIV risk factors. The outcomes that would benefit the community include reduced juvenile delinquency, reduced crimes, increased responsibility as a citizen of the community, etc. Follow- gR: After successful discharge, the boys are followed up on a monthly basis through DJJ for a total of six months. In addition, a concerned parent/school official is encouraged to contact the program director if there are any situations that arise that might be handled by the program director or counselors. The services are provided at St. Peter' s Missionary Baptist Church, 4250 38th Avenue, GiffordNero Beach, FL 32967 . The hours of operation are from Friday, 4: 30 p.m. through Saturday, 5 :00 p.m. 3. Briefly describe how your program addresses the stated need/problem. Describe, hoty your program follows a recognized "best practice" (see definition on page 12 of the Instructions) and provide evidence that indicates proposed strategies are effective with target population. The Boys Development and Training Program addresses the need to reduce juvenile delinquency by providing a program for at-risk males who are affected by chemical addictions, violence, poor family environment, and lack of social and academic skills, poor self esteem and other areas in need of improvement in a male youth' s life. The focus of this program centers on addressing these young male issues along the same lines as DJJ, as indicated in the editorial written by the Secretary of DJJ, Bill Bankhead, where he stated (concerning the DJJ programs), "Individualized resources that meet the needs of the particular juvenile and his or her family are provided. These can include mental health counseling, substance abuse treatment and tutoring . . . to get everyone working together positively on issues and to give the kids a way up and out of failure. " When looking at the Boy' s Institute, these areas have been addressed through a variety of mediums, discipline training, academic accountability, tutoring, parental involvement, community involvement (which increases ties to the community), mental health 6 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council assessment and counseling, substance abuse awareness and referral (if necessary), etc. The DJJ report on Community Involvement indicated that evidence show that communities can deter juvenile crime by targeting the key risk factors of truancy, school failure, access to weapons, not enough positive activities to keep kids busy. It indicated that " . . . some of the same strategies that can prevent delinquency from ever happening in a child' s life also can stop a juvenile offender from re-offending and recycling back into the delinquency system." The articles closes with this statement: "No matter how good an individual juvenile system program strives to be, a young person sooner or later returns to his home community." St. Peter' s Boys Development and Training Program assists in diverting the boys ' lives away from crime in their communities. It is a community program that develops community attachments for the youth while addressing the needs that placed the child at risk in the first place. According to DJJ Secretary, Bill Bankhead, " . . . outreach must be done in the neighborhoods where juvenile crime is high. " Governor Bush said of the successful outreaches, " . . . they focus on preserving the unity and integrity of family and emphasizing parental responsibility in dealing with troubled youth." (www.dii .state.fl.us/features/runaways.htW). Delinquency prevention is paramount to DJJ' s plan, which includes three elements: targeting the most at risk, cooperation between community- based programs working with the government to approach families, and accountability through data collection and measurement of program success. The Boys institute does all three and goes beyond in preventing or reversing the patterns and risk factors associated with delinquency. 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 — Administrator (PT, BA degree preferred, 2 yrs. Experience working with at-risks children). Oversees the overall operation of the program, including data collection, quarterly-reporting and financial management of the program. Supervise and oversee all staff, including book-keeping, clerical, operations; must also meet with parents, teachers and outside agency representatives regarding the program. 1 — Program Operations Manager (PT, Minimum HS diploma/equivalency, training in child development, at least 2 years experience in working with at-risk children) . Responsible for overnight supervision of program. Will monitor institute teachers and trainers in addressing the social and educational needs of the enrollees, ensuring a safe, nurturing environment conducive to learning. House parenting for the weekend, discipline, drills, activities and planning of activities . Also work with institute staff, mentors and volunteers. 2 — Institute Teachers (Part time. Must have educational experience in working with at-risk children.) Will teach appropriate information addressing educational needs of enrollees during program hours including computer instruction and reading clinic; will monitor progress and maintain records. 1 — Institute Prevention Coordinator (BA degree in related field and/or 2 years of experience in social setting working with youth. Knowledge of children and teaching basic skills.) Recruitment and new referrals, handle data, planning, parent training, discipline, counseling and assist with data collection from schools including school visits, on-site monitoring and coordination with teachers. 7 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council r How will the target population be made aware of the program? he program continues to provide awareness through word-of-mouth advertisement, flyers, local hurches, arents, and through collaboration with other partnering agencies. 6. How will the program be accessible to target population (i.e., location, transportation, hours of operation)? St. Peter' s Boys Development and Training Institute is located in the heart of 90% of the targeted population. The address is St. Peter' s Missionary Baptist Church, 4250 38th Avenue, Vero Beach, FL. Transportation is provided by the parents and Institute staff when needed. The program is open from Friday, 4 : 30 p.m. to Saturday, 5 :00 p.m. g Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council D, MEASURABLE OUTCOMES (Description of Intent) Use the Measurable Outcomesform. This descrt tion a e does not need to be inc1udd&L&gMgffd In order to show the impact that your program is having on the target population and the community, the funders are requiring measurable outcomes. Please review the examples and summaries below to insure your understanding of what is expected. OUTCOMES : Describes what you want to achieve with the target population. Indicates the results of the services you provide, not the services you provide. Outcomes utilize action words such as maintain, increase, decrease, reduce, improve, raise and lower. ACTIVITIES: Describes the tasks that will be accomplished in the program to achieve the results stated in the outcomes. Activities utilize action words such as complete, establish, create, provide, operate, and develop. The activities should reflect the services described in the PROGRAM DESCRIPTION (C2) . Use the following elements to develop your outcomes. All elements must be included: • Direction of change • Timeframe • Area of change • As measured by • Target population • Baseline: The number that you will be • Degree of chane measuring against Example 1 (Outcome) : To decrease (direction of change) number of unexcused absences (area of change) of enrolled boys and girls (target population) by 75% (degree of change) in one year (time frame) as reported by the 2003 School Board attendance records (as measured by). Baseline : 2003 School Board attendance records for enrolled boys and girls. Example I (Activity) : To provide anger management classes to enrolled boys and girls 2 times a week for 12 weeks. Example 2 (Outcome) : 75% (degree of change) of youth (target population) who have participated in the academic enrichment activities (as measured by) for 6 months or more (timeframe), will improve (direction of change) their scores in one or more subject area (area of change) . 25% of participants in academic enrichment activities will maintain the initial level of performance assessed at entry. Baseline : Pre-test scores from the academic enrichment test. Example 2 (Activity) : 1 ) Provide pre and post-test exercises on the Advanced Learning System software; 2) Participants will go through the one lesson per week and be graded for 10 weeks . IMPORTANT NOTE : Keep in mind when developing your PROGRAM OUTCOMES, that if funded, this will be what you are held accountable to accomplish. Also, the PROGRAM OUTCOMES should reflect the information described in the PROGRAM NEED STATEMENT (B 1 ) . All Program Need Statements should flow from the Mission & Vision. Measurable Outcomes should be based on and measure program needs. Activities are the tasks you do that are going to influence the outcome and impact the unacceptable condition in your Program Need Statement. 9 Organization: St Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council D, MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) OUTCOMES ACTIVITIES Add all o the elements or the Measurable Outcomes Add the tasks to accomplish the Outcomes OBJECTIVE #1 : Improved academic Provide tutoring each week to enrolled boys performance. Seventy-five percent (75%) of including a designated study hour each week. the program participants will increase their Provide classroom Instruction each Saturday GPA (grade point average) by a minimum of morning from 9 :00 a.m. — 12 : 00 p.m. in critical 25% by the end of the school term each year. core subjects. Measuring tools — Brigance Comprehensive Inventory of Basic Skills pre- post test, report cards and progress reports. OBJECTIVE #2 : Decreased negative/disruptive behavior. Sixty five percent (65%) of the participants will reduce the Provide rap sessions for enrolled boys weekly. number of school behavior referrals for Provide mentoring with positive role models disruptive behavior, including bullying and on a weekly basis. Provide character/self aggression toward peers and adults, as esteem training sessions, and conflict measured by school disciplinary records and resolution. Measuring tools : Entrance Behavior weekly parent behavior report forms . Description Report — reviewed beginning, mid and end of year-collect and monitor school OBJECTIVE #3 Raise Awareness level of behavior and discipline forms. chemical addictions, STD and HIV for enrolled boys. Eighty-five percent (85%) of the boys Invite guest speakers from the Substance will show increased knowledge of drug abuse Abuse Council, Indian River County Health addictions and effects, STD, and HIV by the Department, and other agencies . Training end of the program each year as indicated in sessions will be held by Substance Abuse pre and post surveys and questionnaires. Council, IRC Health Department, and other Agencies that will address alcohol, drug abuse, STD, HIV, abstinence, etc. Measuring tools: pre-post tests/questionnaire. The Institute will OBJECTIVE $W Increase community hold a minimum of four sessions per year. awareness and develop community attachments for youth through participation in community Program participants will take part in at least service projects. three major community service oriented projects each year, i.e. Habitat for Humanity, Faith Based projects and community clean-up events. 10 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council E. COLLABORATION (Entire Section E not to exceed one a e) 1 . List your program 's collaborative partners and the resources that they are providing to the program beyond referrals and support. (See individual funder requirements for inclusion of collaborative a reement letters. Collaborative Agency Resources provided to the program Substance Abuse Council Drug Awareness IRC Health Department Sexually Transmitted Diseases Gifford Youth Activity Center Seminar, "Raising Them Chaste" Black Faith-Based Organization, Inc. Basketball Tournament IRC Mental Health Center Referrals — Individual and Family Services 11 organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council 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 Bl ? The information to be collected includes: name, age, ethnic background, birth date and grade. To qualify for the target population, a prospective enrollee will be at-risk for at least two of the following conditions : At-risk males between the ages of 7 and 16 who have exhibited at least two of the problem behaviors as follows: school disciplinary referrals, chronic school truancy, repeated school suspensions, poor academic performance, a history of alcohol, tobacco and other drugs, rebellion, running away, mental and emotional health issues and those with a history of delinquent behavior. The unacceptable condition is juvenile delinquency and is documented through DJJ reports, school reports, parent reports, etc. This shall be documented and maintained through a database and spreadsheet proEarns. 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? Data will be collected from participants via progress reports/report cards on a nine week basis. Copies of schedules and activities listing the study hour, rap sessions and dates and times of guest speakers will be maintained on location. An entrance description of behaviors will be maintained and reviewed quarterly for improvement. Upon exiting a program, a summary of progress made while attending the program will be documented. Measurement items include grades, attendance sheets, progress reports, school conduct codes report, pre and post test reports, counselor reports, prevention activity attendance sheets, etc. The progress report/report cards will be collected every nine weeks and at the end of the semester. The schedule of activities will be collected every nine weeks and at the end of each semester. The schedule of activities will be collected on an ongoing basis. The entrance and exit behavior description will be collected upon entering and exiting the program. Progress notes on behavior improvement will be documented quarterly or as needed. After successful discharge, there will be a monthly follow-up for six months via parents, school and DJJ. 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? The data will be compiled in a notebook under each activity and also copies of the progress/report cards will be placed in each enrollee' s file. The information will be provided upon request to any requesting agency, collaborative partner and the Human Service Board of 12 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council Directors. In areas where the increase in a positive attribute is low or minimal, the program director and board will determine and research new ways to implement a more substantial increase in the positive attribute. It will also be utilized to determine what is working so that it can be continued. 13 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council 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. Month/Period Activities Weekly Tutoring — study hour and classes 9 : 00 a.m. — 12 :00 p.m. Saturdays. . Weekly Character/self esteem building sessions ; community activities; conflict resolution. As needed - ongoing Life Skills sessions; rap sessions Each nine weeks Academic improvement (progress reports and report cards) Weekly — ongoing Reducing negative behaviors — through rap sessions, field trips, seminars, training and mentoring. Weekly Recreational activities and drills Weekly Institute counseling and referrals. 14 Organization: St. Peter's Human Services, Inc. Program: St. Peter's Boys Development & Training Institute Founder: Children's Service Council H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Current Fiscal Yeararw Location tl Budget 2006/07 e �0 Unduplicated Clients Unduplicated Clients Unduplicated Clients N. Indian River County 45 50 50 S . Indian River County _ Indian River Co. Tota 45 50 50 Greater Stuart Hobe Sound Indiantown _ Jensen Beach Palm City Martin County Total Fort Pierce _ Port Saint Lucie St. Lucie Co. Total _ Other Locations _ TOTAL SERVED 45 501 50 Number of Unduplicated Clients by Age Current Fiscal Year Location Budget 2006/07 (ndividuali Group 0 to 4 - Pre-school 5 to 10 - (Elementary) - 22 - 24 24 1" 1 to 14 - (Middle) - 23 - 26 26 15 to 18 - (High School) Total Children - 45 50 - 50 19 to 59 - (Adults) 60 + (Seniors) Total Adults TOTAL SERVED - 45 - 50 - 50 15 Edit this Header. Tvue the organization and program name and the funder for whom it is being completed. The page N is already set at the bottom right of every page. I. BUDGET FORMS - To open the Budget Forms, please double-click on the icon below. meadjarmrt' • 16 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 disqualification. Handwritten Signature of Authorized Principal(s): DATE: May 4, 2007 NAME: Andrew Jefferson TITLE : President NAME OF FIRM/PARTNERSHIP/CORPORATION : St. Peter's Human Services , Inc. FOR AND ON BEH LF OF THE APPLICANT: Sworn to and s bscribed to IT Notary blic, this / day of 2007 . j3Y: Andrew Jefferson , President Lj (TYPE NAME & TITLE) 1 � t � L iFEf?30N MY I ION # ,0198000 XI AUTHORIZATION FOR RELEASE OF INFORMATION Indian River County and St Peters Human Services, Inc. (Agency/Individual are in the process of negotiation of a contract for St Peter's Boys Development &Training Institute. 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 St Peter's Human Services , Inc. Pririp me Name Employee Providing author Jefferson Pr name Signature (in blue ink) Date May 4 2007 XII 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 . 2007043 for St. Peter's Boys Development & Training Institute. 2. This sworn statement is submitted by: St. Peter's Human Services. (Name of entity submitting Statement) whose business address is: 4250 38'" Avenue, Vero Beach , FI 32967 and (if applicable) its Federal Employer Identification Number (FEIN) is 31 -1480633 (If the entity has no FEIN , include the Social Security Number of the individual signing this sworn s en 3. My a is ndrew Jefferson (Please pri name of individual signing) and my relationship to the entity named above is President . 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. 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 . ] Neither the entity submitting this sworn statement, nor any officers , directors , executives, partners, shareholders , employees, members , or agents who are XIII 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 . X 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 entit or employee St. Peter's Human Rosemary Teague Jefferson Sister-In-law Services , Inc. (County Employee) 4 Si latura�) �� May 4 2007 (Date) STATE OF FLORIDA COUNTY OF INDIAN RIVERY COUNTY The foregoing instiSw efore e thisday of 20 �IS6t 1 who is personally known to me or o h producedas identification . fferst Lar e My Commission Expires: (Seal) Hung uAFFIEasON �,�,-, MY COMMISS4.!N t DO iS90� $f EXPIRES: May 1, 2(X71 6xged IbM No" rtbc U4.rj. XIV AFFIRMATION ACTION PLAN It is the policy of St. Peter' s Human Services, Inc . , that no person shall on the basis of race, color, national origin, marital status or handicap, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity receiving state financial assistance, or be so treated on the basis of sex under educational programs or activities receiving state assistance . NEPOTISM STATEMENT The St. Peter' s Human Services Agency, in the interest of good practices and sound judgment, refrains from hiring family members as listed in the Indian River County' s Nepotism Policy. The Agency ' s Administrator and/or Board of Directors however, will as does the Indian River County Personnel Director, and as indicated in the Indian River County' s Nepotism Policy, at the discretion hire family members if it is determined in the best interest of the Agency. L A i ed Principal t0 1 Dat RUIHL JEFFERSON i s MY COMMISSION C DD 199000 EXPIRES. May 6, 2007 B=W lnm Notary PNim wkwawkem ST. PETER' S HUMAN SERVICES , INC . BOARD OF DIRECTORS BOYS TRAINING AND DEVELOPMENT INSTITUTE ADMINISTRATOR/ PROGRAM DIRECTOR .r PROGRAM MANAGER INSTITUTE PREVEN INSTITUTETRAI COORDINATOR & TEACHERS VOLUNTEERS egi MENTORS Attachment XX TAXONOMY OF HUMAN SERVICES PH-236.800 — Programs, often offered directly by schools, that develop collaborative partnerships with public and private community agencies to meet the mental health, juvenile justice, social service and academic need of school children whose struggles with multiple problems including poor physical or mental health, inadequate nutrition, substance abuse, family dysfunction or insufficient community support are affecting their educational performance. The purpose of these programs is to develop an integrated services delivery system through which existing resources are coordinated and made available to children and youth, their parents and family members at or near the school site. Attachment ZZ COMMUNITY AWARENESS OF CHILDREN' S ISSUES St. Peter' s Boys Development and Training Institute through its program sponsor the following activities and events to raise community awareness of children issues : 14 Community activities and projects 16 Fundraisers 4 Parent Meetings �6 Faith based organization programs 41 Tours and visits to community agencies 4 Advertisement 4 Door to Door recruiting 14 Brochures 46 Schools The public, businesses, parents, church, and community agencies are informed about the program, the youth involved, issues they face, and the efforts and services needed and provided to help serve the youth. Type the Organization and Program Name 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 Forms. AGENCY/PROGRAM NAME : Boys Development & Training Institute FUNDER: Children 's Services Council . . . . . . . . . _ _ _ _ _ _ _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . - _ . . _ . . _ . . _ . . _ . . _ . . _ . . _ . ._ . . _ . . — 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. "w Proposed Total Program Funder Specific Total Agency REVENUES" ' exoncucc. Budget ` Budget ' . Budget 1 Children's Services Council-St Lucie 7777777 2 Children's Services Council-Martin 3 Advisory Committee-Indian River 61 ,386.71 61 ,386.71 61 ,386.71 4 United Way-St Lucie County " 5 United Way-Martin County 6 United Way-Indian River County 7 Department of Children 8 Families 8Coun Funds 9 Contributions-Cash 10 Program Fees 11 Fund Raising Events-Net 12 Sales to Public - Net 13 Membership Dues 14 Investment Income - 15 Miscellaneous - 16 Le acies & Be uests 17 Funds from Other Sources 18 Reserve Funds Used for O eratin 19 In-Kind Donations INot Included in total) 20 TOTAL REVENUES Ido nl Include line 19 $61 ,386.71 $61 ,388.71 q$61 ,386 11 B C D; IXPENl31TUR1 S T ProposedTotal Program FonderSpecirf , Total Agency Sud et telaw CN.cutAlroe9 ' Budget ' g - Bu et 21 Salaries - (must complete chart on next page 32,192.001 32,192.01 32 192.0 Salary 22 FICA - Total salaries x 0.0765 7.650A 2,462.69 2,462.69 2,462.69 Retirement - Annual pension tor qualified 23 staff 0.00 I e eF- e Uena - arm0.0024 Disab. or eoyees x0.00 25 rate on a e 26 employees x $7,000 x UCT-6 rate 0.00 SALARIES A s c'= % of cross Annual - Gross Annual portion W Salary on Proposed POSITION' LISTING salary prograrrr Funder Specific Budget Salary Positron. Title / Total Hrs/wk -- (Agency) Requested(GA) Ezampfs: ExeeuWe Direcror/401am - :70,000.00 10,000.00 5,000.00 7.14% e- 5/e/2mn7 Type the Organizatlon and Program Name Program Director/Administration 10 hrs 7,800.00 7,800.00 7,800.00 100.00% Program Operations Manager 25 hrs. 15,500.00 15,500.00 15,500.00 100.00% Institute Prevention Coordinator - 12 Hrs. 41680.00 4,680.00 4,680.00 100.00% (2) Institute Trainers/Teachers - 6 hrs. 41212.00 4,212.00 4,212.00 100.00% #DIV/0! #DIV/01 #DIV/01 #DIV/0! #DIV101 #DIV/O! #DIV/0! #DIV/01 #DIV/01 #D!V/01 #DIV/0! #DIV/01 #DIV101 #DIV101 #DIV101 #DIV/0! Remaining positions throughout theagency Total Salaries $32,192.00 $32,192.00 $32,192.00 100.00% FRINGE BENEIT DETAIL a (Funder Specific Budget � Funder e _ � c tr � � F; c. Column C Offly� /rbm ling 12 f0 27 SpecHM FlCAT 8596 Pension ryNea/th fns. Workers Unemployme Total Fringes Funder } (Ax y�. Compens. nt compens. SpecHle PositionTWefTotalNra/wlt=` Bddget £xampHa CaselNsrtegerlMtuq` ,54000.00 - 38 .00 200.00 500.00 - 300.00 200.00 " f,582.50 Program Director/Administration 10 hrs 7,800.00 596.70 596.7 Program Operations Manager 25 hrs. 15,500.GC 1 , 185.75 1 ,185.751 Institute Prevention Coordinator - 12 Hrs. 4,680.00 358.02 358.02 (2) 1nstitute Trainersrreachers - 6 hrs. 4,212.00 322.22 322.22 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 O.Gc 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.00 0.0 0 0.00 0.60 0.0 a 0.00 0.00 0.0 0 0.00 0.00 0.0 0 1 0.001 0.00 0.0 0 1 0.001 0.001 1 0.0 0 1 0.001 0.001 1 0.0 Total Funder Request Fringe Benefits 1 $32,192.001 $2,462.691 $0.00 $0.00 $0.0 �$0-001 $2,462.6 A I IB I I I I c D EXPENDITURES w ro Proposed Total Program Funder Speck Total Agency .aawoe µ Budget Budget Budget - 27 Travel-Daily # of Staff x average # of miles/wk x 50 wks x $ = Estimated Daily TraveUMileage Reimb. 28 Travel/Conferences/Training srsnom e-1 Type the Organization and Program Name • National Conference (cost per staff) • Training/Seminar (cast per staff) • Other Trainings (cost of travel, lodging, registration, food) 29 Office Supplies • Office supplies (monthly average x 12 months = estimated cost of office supplies based on present history. 30 Telephone • # Phone lines x average cost per month x 12 months = local phone cost • Average long distance calls x 12 months = Estimated cost of long distance - 31 Postage/Shipping - • Quarterly Mailing of Newsletter • Special events, etc. • Bulk mailings - appeals 32 Utilities • Electricity ($ x 12 months) • Water/Sewer ($ x 12 months) - • Garbage ($ x 12 months) ,. - 33 Occupancy (Building & Grounds) • Mortgage/Rent ($ x 12 months) • Janitorial ($ x 12 months) • Grounds Maint. ($ x 12 months) • Real Estate Taxes ` 34 Printing & Publications ` • Quarterly Newsletter ($ x 4) • Letterheads, Envelopes, etc. • Fundraising materials • Other 35 Subscription/Dues/Memberships • Membership to National Organization • Dues • Subscriptions to Newspapers/magazines, r 3 etc. 36 Insurance • Directors/Officers Liab. • Commercial/General Insurance - • Bond Ins. - • Auto Insurance 37 Equipment Rental & Maintenance • Copier lease ($ x 12 months) _ • Meter lease ($ x 12 months) • Copier Maintenance ($ x 12 months) • Computer Maintenance ( $ x 12 months) • Other 38 Advertising 500.00 500.00 500.00 • Newspaper ads • Fundraising ads/promotions s • Other (vacancies) 39 Equipment Purchases:Capital Expense • Computer/monitor (# x $) • Laser Printer 40 Professional Fees (Legal, Consulting) • Legal advice ( estimated #hrs x $) • Consultant fees • Other 41 BookslEducational Materials 1 ,000.00 1 ,000.00 1 ,000.00 • Booksivideos - • Materials ($ x staff) 42 Food & Nutrition 16,094.00 16,094.00 - 16,094,00 5/812007 3-1 Type the Organirabon and Program Name • Meals ( # meals x clients x 5days x 50 wks) • Snacks 43 Administrative Costs • Admin. Cost (% of total budget) 44 Audit Expense 1 ,500.00 1 ,500.00 1 ,500.00 • Independent Audit Review 45 Specfic Assistance to Individuals • Medical assistance _ • Meals/Food • Rent Assistance • Other 46 0 ther/Miscellaneous2,600.00 2,600.0 2,600.00 • Background check/drug test • Other/rransportation 47 Other/Contract • Sub-contract for program services 48 TOTAL EXPENSES $56,348.69 $56,348.69 $56,348.69 5/8Y10W B-7 fro. x.aia.r�.eo^.ier� r�o.. . UNIFORM GRANT APPLICATION TOTALAGENCY BUDGET AGENCYIPROGRAM NAME: FY 04105 FY OblOB FY 06107 % INCREASE FYE FYE FYE CURRENTVS. NEXT FY BUDGET A 9 C D ACTUAL TOTAL PROPOSED Icor. C.wl. Bycol. a REVENUES BUDGETED BUDGETED 1 Children's Services Council-St Lucie 0.00 #DIVlO! z Children's Services Council-Martin 0.00 #DIVI01 3 Advisory Committee-Indian River 6138671 #DIV/01 4 United Way-St. Lucia Coun 0.00 #DIVIO! b United Way-Martin County 0.00 #DIVIDI s United Way-Indian River County 0.00 #DIVro! 7 De artment of Children S Families 0.00 #DIV101 0.00 #DIVI01 a Coun Funds D•DO #DNI01 9 Contributions-Cash 0.00 #DIVIO! 10Pro ram Fees 11 Fund Raisin Events-Net O.OD #DIV101 12 Sales to Public-Net 0.00 #ONTO! 0.00 #DNIOI 13 Membershi Dues 0.00 #DIVroI 14 Irrvestmerlt Income 0.00 #DMO! 15 Mlacellanaous 0.00 #DIVroI 16 Le acies 6 Be uests 17 Funds from Other Sources 0.00 #ONTO! 1EReserve Funds Used for Operating O.DO #DIVIOI 0.00 #DIVI01 is In-Kind Donations IWInaud*dmwml 20 TOTAL 0.00 0.00 6138671 #DIV101 EXPENDITURES 32192.00 #DIvro1 21 Salaries 22 FICA 2462.69 #DIVI01 0.00 #DIVro1 23 Retirement 0.00 #DN701 24 Life/Health p,p0 #DIVI01 25 WOrkera Com ensation 26 Florida Unem I ment 0.00 #DlVlol 0.00 #DIVI01 27 Travel-Dail 0.00 #DMO! 28 TmwaI1Conferences/Trainin 0.00 #DIVI01 29 Office Su lies 0.00 #DIV101 3o Tele hone 0.00 #DIVI01 31 Posta arbin ping 0.00 #DIVI01 32 Utilities 33 occupancy (Building & Grounds 0.00 #DIVIDI 34 Printing & Publications 0.00 #ONTO! 35 Subscri tionlDueslMembershl s 0.00 #DIVI01 0.00 #DIVro! 36 Insurance 37 E ui ment:Rental & Maintenance 0.00 #DIV101 500.00 #DN/01 3fi Advartisin 39 Equipment Purchases:Ca ital Expens 0.00 #DIVI01 m Professional Fees (Legal, Consulting) O.OD #DIVro! 41 BookslEducatlonal Materials 1 000.00 #DIVroI 42 Footl 8 Nutrition 16 094.00 #DIVI01 a, Administrative Costs 0.00 #DIVIDI 44 Audit Fx ense 1 .500.001 #DIVroI 45 S eciffc Assistance tO Individuals 0.00 #DIV101 46 Othadmiscellaneous 2600.00 #ONTO! 47 OtherlContract 0.00 #DIVI01 as TOTAL 0.00 0.00 56 348.69 #DIVIDI , 49 REVENUES OVERT UNDER EXPENDITURES 0.00 0.00 5,038.02 i1DIVro1 ex vsaoo7 TYPI� p�L{YAw1 Py�e lbm UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: St. Petels Human Service/SL Peter's Bos Development & Tral Ing Institute FY 04105 FY 05106 FY 06/07 % INCREASE FYE FYE FYE CURRENTV3. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED Icor Cool. sycl. a REVENUES BUDGETED BUDGETED I Children's Services CouncilSt Lucie 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 #DIVI01 3 Ativlsory Committee-Indian River 6138671 #DIVI01 4 Unibd Way-St Lucie County0.001 0DIV101 s United Way-Martin County0.00 f1DIV101 s United W -Indian River Coun 0.00 #DIVNII 7 De artmant of Children 6 Families 0.00 rIDIVI01 6 Coun Funds 0.00 #DIV10! s Contributions-Cash 0.00 /fDiV101 10 Pro ram Fees 0.00 #DIV/01 tt Fund Raisin Events-Net 0.00 tIDIV/01 iz Sales b Public•Net 0.00 #DIVI01 13 Membershi Dues 0.001 #DiV/01 14 Investment Income 0.00 #DIV/Ol is Miscellaneous 0.00 #DIV101 t6 Le aciea 8 Ba uesb 0.00 #DIVI01 17 Funds from Other Sources 0.00 #DIV101 19 Reserve Funds Used for Operating 0.00 #DiV101 I alo-Kind Donations ma Nmuded in t 11 0.00 #DIV/Dl 20 1 0.00 0.00 6138671 #DIV/01 EXPENDITURES 21 Sabrles 32192.00 #6I70I 22 FICA 2462.69 #DIV101 23 Retirement 0.00 #DIV/OI K LifelHeahh 0,00 #DIV10I 25 Workers Com nsation 0.00 #DIVIOI 26 Florida Unem to ment 11.00 #DIV101 27 Travel-Dell 0.00 #DIVI01 26 TraveVConferences/Trainin 0.00 #DIV/01 29 Oftica Su Iias D.00 #DIV101 3o Tele hone 0.00 #DIVl01 31 Posb alShi in O.DO #DIVI01 32 Utilitlea 0.00 #DIVro1 33 Oeeu enc (Building & Grounds) 0.00 A'DIV/01 u Printin 8 Publicetiona 0.00 #DIV/l)1 35 SubscA tlon/Duss/Membershi s 0.00 #DIVI01 381nsurenw 0.00 #DIVI01 37 E ui ment:Rental 8, Maintenance MOOMV101 DN/01 36 Advertfsin IMI is E ui ment Purchases:Capital Expense DIV/01 aoProfessionalFeea Le al Consulting) DIV/Ol 41 BookslEducational Materials DIV/01 42 Food 8 Nutrition DIV/01DIV/0144 Audi! Ex nse DIV/01 45 3 ciRc Assisbnce to Individuals 0.00 #DIV/01 48 OtherlMiacellaneous 2,600.0 tlOIVI01 47 OthedContrect 0.00 #DIV101 48 TOTAL 0.00 0.00 6634869 #DIVIOI 46 REVENUES OVER! UNDER EXPENDITURES 0.00 0.00 5$038.02 #DIV/01 vm 04 Type aro Organdabon and Program Name UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : FUNDER: A s c FY 06107 FY 06107 % OF TOTAL FUNDER TOTAL VS. PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B1col. A EXPENDITURES 21 Salaries 32,192.00 32, 192.00 100.00% 22 FICA 2,462 .69 2,462.69 100.00% 23 Retirement 0.00 0.00 #DIV/01 24 Life/Health 0.00 0.00 #DIV/01 25 Workers compensation 0.00 0.00 #DIVl01 26 Florida Unemployment 0.00 0.00 #DIV/01 27 Travel-Dailaaaa0.00 0.00 #DIVI01 28 Travel/Conferences/Training 0 .00 0.00 #DIV101 29 Office Su lies 0.00 0.00 #DIV/01 3o Telephone 0.00 0.00 #DIV/01 31 Postage/Shipping0.00 0 .00 #DIVIOI 32 Utilities 0.00 0.00 #DIV/01 33 occupancy (Building & Grounds 0.00 0.00 #DIV/01 34 Printing & Publications 0.00 0.00 #DIV101 35 Subscription/Dues/Memberships 0.00 0.00 #DIV/01 36 Insurance 0.00 0.00 #DIV/01 37 Equipment: Rental & Maintenance 0.00 0.00 #DIV/01 38 Advertising 500.00 500.00 . 100.00% 39 Equipment Purchases : Capital Expense 0.00 0.00 #1DIV/01 40 Professional Fees (Legal , Consulting) 0.00 0.00 #DIV/01 41 Books/Educational Materials 1 ,000.00 11000.00 100 .00% 42 Food & Nutrition 16,094.00 16,094.00 100.00% 43 Administrative Costs 0.001 0.001 #DIV/01 44 Audit Expense 1 ,500.00 1 ,500.00 100.00% 45 Specific Assistance to Individuals 0.00 0.00 #DIV/01 46 Other/Miscellaneous/Fuel Transportation 29600.00 21600.00 100.00% 47tTOTAL ontract 0.00 0 .00 #DIV/0l as $56,348.69 $56,348.69 100.00% 5102°07 TYp Me Ory,eeMn and Pip yYn Nang UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: St Peter's Human Services, IncJSt. Peter's Boys Development & Training Institute FUNDER: ",. w �f[ .v✓:.r.. Y' 4 ypp1; .J .'F4 § vt '.. J:-' bC. XDIVIOI < . . m #DIVIO #DN/Ol #DN/OI #DNroI #DNroI #DNIO #DNroI #DNroI #DN/OI #DI #DNroI #DNroI #DNro #DN/01 #DNroI #DNroI #DNIOI #DNroI #DNIDI #DNroI #DNroI #DNroI #DIVIOI #DIVIOI #DNroI #DNroI #DIV/01 #DNroI #DNIOI #DIVIDI Represents funtls par week needed tc provide meals for the children indutling, dinner, breakfast and lunch each week for 52 weeks @ #DNroI MAnI $8.00 er uth each week. #D rot #DNroI #DNroI #DNroI Represents fuel costs each week at $50. for 52 weeks. Pro #DNro ram now rovitlin 'ck u and drop o0 services for students. #DIV/01 #DN/OI #DNroI #Drvrol #DNro #DNI01 #avrol Nrol #DN/OI serzom e-6 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 1 " 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 30`") must be submitted on a timely basis . Each year, the Office of Management & Budget will send a agencies letter to all nonprofit advising of the deadline for reimbursement requests for the fiscal year. This deadline t typically year beyond that point. early to mid October, since the Finance Department does not process checks for the prior fiscal 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: Brad E . Bernauer, Indian River County Human Services Director 1801 27"' Street, Vero Beach , Florida 32960. Recipient: St. Peter's Human Services , Inc. , 4250 38"' Ave . , Vero Beach , FL 32967 2. Venue : Choice of Law: The validity, interpretation , construction , and effect of this Contract shall be in accordance with and governed by the laws of the State of Florida , only. The location for settlement of any and all claims, controversies, or disputes, arising out of or relating to any part of this Contract, or any breach hereof, as well as any litigation between the parties, shall be Indian River County, Florida for claims brought in state court, and the Southern District of Florida for those claims justifiable in federal court. 3 . Entirety of Agreement: This Contract incorporates and includes all prior and contemporaneous negotiations , correspondence, conversations , agreements , and understandings applicable to the matters contained herein and the parties agree that there are no commitments, agreements, or understandings concerning the subject matter of this Contract that are not contained herein. Accordingly, it is agreed that no deviation from the terms hereof shall be predicated upon any prior representations or agreements , whether oral or written . It is further agreed that no modification , amendment or alteration in the terms and conditions contained herein shall be effective unless contained in a written document signed by both parties. 4 . Severability: In the event any provision of this Contract is determined to be unenforceable or invalid , such unenforceability or invalidity shall not affect the remaining provisions of this Contract, and every other term and provision of this Contract shall be deemed valid and enforceable to the extent permitted by law. To that extent, this Contract is deemed severable. 5. Captions and Interpretations : Captions in this Contract are included for convenience only and are not to be considered in any construction or interpretation of this Contract or any of its provisions. Unless the context indicates otherwise , words importing the singular number include the plural number, and vice versa . Words of any gender include the correlative words of the other genders, unless the sense indicates otherwise. 6 . Independent Contractor. The Recipient is and shall be an independent contractor for all purposes under this Contract. The Recipient is not an agent or employee of the County, and any and all persons engaged in any of the services or activities funded in whole or in part performed pursuant to this Contract shall at all times and in all places be subject to the Recipient's sole direction , supervision , and control . 7. Assignment. This Contract may not be assigned by the Recipient without the prior written consent of the County. 1 ACORD CERTIFICATE OF LIABILITY INSURANCEGPID B DATE (MMATOMyy) PRODUCER STPETEA 08 / 34 / 07 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Hatcher Insurance , Inc . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P . O . Box 540689 HOLDER. THIS CERTIFICATE DOES AMEND, EXND OR ALTER THE OAFFORDED A 0 DED BOY THE POLIC ES Orlando FL 32854 -0689 BELOW. Phone : 407- 841 -2686 Fax : 407-841 -2688 INSURED - INSURERS AFFORDING COVERAGE NAIC I INSURERA: PhiladalPhla Insurance cos . St . Peters Academy Charter Sch INSURER B: Ccmerea and Induaty Company 4250p38thsAveenuue services , Inc INSURERC VerO Beach FL 32967 - 1711 INSURER D: COVERAGES INSURER E. THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IONS OF SUCH LTR NS TYPEOFINSURANCE POUCY NUMBER GENERAL WIBIUTY DATE MM/DO DATE MM/D LIMITS A X X COMMERCIAL GENERAL LIABILITY pHPK254326 EACH OCCURRENCE E 1000000 09/17/ 07 09/17 / 08 PREMISES (Eaoccureoce $ 100000 CLAIMS MADE � OCCUR X Educators Prof MED EXP (A`ry an a person) $ 5000 PERSONAL S ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000000 POLICY JECT LOC LOCPRODUCTS - COMP/OP ADD $ 2000000 AUTOMOBILE LIABILITY ANY AUTO COMBINED ISINGLE LIMIT I $ ALL OWNED AUTOS ) SCHEDULEDAUTOS I BODILY INJURY HIREDAUTOS I I (Per person) $ NON-DWNEDAUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE GARAGE LpBIUTY (Peracodenp I $ ANY AUTO I AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ EXCE351UMBRELL0. LIABILITY AUTO ONLY: AGO $ A X OCCUR CLAIMS MADE PHUB092599EACH OCCURRENCE $ 1000000 09/17/07 09/17/06 AGGREGATE $ 1000000 DEDUCTIBLE I S X RETENTION $ 10000 I $ WORKERS COMPENSATION AND $ B EMPLOYE RS' LIABILITY X TORY LIMITS ANY FFiCER EMBERJPARTNER/EXECUTIVE WC8967849 09 /17 / 06 09/ 17/07 E.L. EACH ACCIDENT ER OFFICERMEMBER EXCLUOEDT $ 100000 I( yn, descnhe Under 09/ 17/07 09/17/08 E.L. DISEASE - EA EMP.OYEE $ 100000 SPECIAL PROVISIONS below OTHER E.L. DISEASE - POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES I EXCLUSIONS ADOED BY ENDORSEMENT I SPECIAL PROW SIONS Certificate holder is included as additional insured regarding general liability . Liability is limited to loss or damage arising out of negligent acts Of the insured . *Except as required by Florida Statute . CERTIFICATE HOLDER CANCELLATION IHDIRIV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 • DAYS WRITTEN Indian River County , Florida NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TOW SO SHALL 1840 25th Street IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Vero Beach FL 32960-3365 REPRESENTATIVES. ACORD 25 © ACORD CORPORATION 1988