Loading...
HomeMy WebLinkAbout2004-229P ' 0q F� off. . ez-2c'ip Indian River County Grant Contract This Grant Contract ("Contract" ) entered into effective this 1st day of October 2004 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 Indian River County, Inc . , ( Recipient) , of: P . O . Box 3068 Vero Beach , Florida 32964 > . 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 2004/2005 ("Grant Period") . The Grant Period commences on October 1 , 2004 and ends on September 30 , 2005 . - l - 4 . Grant Funds and Payment The approved Grant for the Grant Period is Thirty Thousand Dollars ($30 , 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 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 21 , 2004 , provide to the Indian River County Risk Management Division a certificate or certificates issued by an insurer or insurers authorized to conduct business in Florida that is rated not less than category A- : VII by A. M . Best, subject to approval by Indian River County's risk manager, of the following types and amounts of insurance : 2 - (i ) Commercial General Liability Insurance in an amount not less than $ 1 , 000 , 000 combined single limit for bodily injury and property damage , including coverage for premises/operations , products/completed operations , contractual liability, and independent contractors ; ( ii) Business Auto Liability Insurance in an amount not less than $ 1 , 000 , 000 per occurrence combined single limit for bodily injury and property damage , including coverage for owned autos and other vehicles , hired autos and other vehicles , non -owned autos and other vehicles ; and ( iii ) Workers' Compensation and Employer's Liability (current Florida statutory limit) 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. 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 . 3 - IN WITNESS WHEREOF , County and Recipient have entered into this Contract on the date first above written . INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS � 7 r By: Caroline D . Ginn , Cha—Irmaff BCC Approved : Attearton , Clerk w 1 ra , ar W . Deputy Cf6i E111 Approved : dd Jo a A. Baird County Administrator pr ed as to form and legal sufficiency: ar' n E . Fell , Assista9161GY Aftarrf6y RECIPIENT : By: III o 6 & Girls Club of Indian River County, Inc 4 - EXHIBIT A [Copy of complete proposal/application] - 1 - 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: Jay McNamara (acting) Email : jU071728@hotmail . com Address : P . O . Box 3068 Telephone : (772) 299 -7449 Vero Beach, FL 32964 Fax : (772) 299-3840 Program Director: Christy McBurney Email : CMcBurney BGCAhotmail . com Address : P . O . Box 3068 Telephone : (772) 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 Programs that provide a wide range of supervised recreational activities and delinquency prevention services for children and youth of all ages and backgrounds, but particularly for disadvantaged youth, through membership in boys and/or girls clubs . Members are entitled to use recreational facilities and may have access to counseling, tutorial services, employment assistance, gang programs, drug abuse and alcoholism prevention and other activities and services that direct their energies toward positive social goals and facilitate healthy personality development. SUMMARY REPORT — nter Information In The Black Cells Only) Amount Requested from Funder for 2004 / 05 : $ 60 , 000 . 00 Total Proposed Program Budget for 2004 / 05 : $ 229 , 684 . 00 Percent of Total Program Budget : 26 . 1 % Current Funding ( 2003 / 04 ) : $ 30 , 000 Dollar increase / ( decrease ) in request : $ 30 , 000 Percent increase / ( decrease ) in request * * : 100 . 0 % Unduplicated Number of Children to be served Individually : 500 Unduplicated Number of Adults to be served Individually : 160 Unduplicated Number to be served via Group settings : 448 Total Program Cost per Client : 207 . 30 * * If request increased 5 % or more, briefly explain why : Increased funding is needed to reduce the Sebastian Branch waiting list increase participation of our target audience and improve the quality of our programs, such as the expansion of Club Tech to enhance the overall experience of our members . If these funds are being used to match another source , name the source and the $ amount : N/A The Organization 's Board of Directors has approved this applicati on (date). Wednesday, February 11 , 2004 Jay McNamara Name of President/Chair of the Board Sign ur Name of Executive Director/CEO ignature r ir- n4 tr It °mow r i �tT"Zsf �G;1�• a � a � ' a a d' -�Y . �J}r 4 �J" y` r r•.ir+"s`' +` , . . :i: N`aG`:°, y,• ; Boys & Girls Club of Indian River County, Inc. — Sebastian 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 circumstances, 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. Every day after school and all day during the summer, the Boys & Girls Clubs of Indian River County offer evidence-based programming that builds self-confidence and self- esteem, as well as fosters a sense of belonging, competence, usefulness and influence . The diverse activities at our clubs attract young people ages 6 through 18 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) . The low cost and convenient access make the clubs an unbeatable choice for working parents who need an affordable and safe place for their children to go after school and during the summer months . Club memberships combined with our teen outreach program, the Youth Volunteer Corps , allow us to serve 1200 children annually . While our method of delivery may change with season or school -related activities, our programs are consistent. Each day children are exposed to Five Core Service Areas that satisfy a variety of needs and interests including : • Education and Career Development . . . to facilitate the learning process, become proficient in basic educational subjects, apply learning to everyday situations and embrace technology to be successful in a career and life goals . • Character and Leadership Development . . . empowers youth to support and influence-their Club and community, sustain meaningful relationships , develop a positive self-image, participate in the democratic process and respect their own and others ' cultural identities . • Health and Life Skills . . . to help children learn and develop positive behaviors that will nurture their well being, teach the value of personal goals and the skills to mature into successful and self- sufficient adults . • The Arts . . . enables youth to develop creativity and cultural awareness through the visual and performing arts, crafts, 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 . j{ P4 n Y 'YS' ` ° rb' i h kw i q xf .a y ... x�L''�rV t i 4 4✓ ` ,c ^`' _ TTT ,A') ''!t.e�: "�, +x x't�" h '! } r . ➢ d 7 t: 19 qy , } w 1Z � L+, :E . :d' r + . ` ..+ r. , r + :K .- fT"�''Y' %cr s - 4 taF ,.s, ••.. .+ t 3' n'1 i .y +�:j p. Ott : ix 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) The condition requiring change includes limited access to affordable, quality after school programs for children ages 6 to 18 ; the average juvenile crime rate ; and below average academic achievement in economically disadvantaged youth. b) The population in need includes children between the ages of 6 years old that have completed kindergarten through 18 years old, with a special interest in disadvantaged youth from low economic backgrounds , single-parent families and/or latch key children. c) The children served live in close proximity to the Sebastian Branch, located at 250 Sebastian Boulevard, or attend Sebastian Elementary, Pelican Island Elementary, Sebastian River Middle, Sebastian Junior High and Sebastian River High School . d) According to the Indian River County School District 46% of children attending Sebastian Elementary, Pelican Island Elementary and Sebastian River Middle School qualify for free and reduced lunches and Sebastian Elementary and Sebastian River Middle School are all considered "B " rated schools based on the Florida Comprehensive Assessment Test (FCAT) standards . In addition, during 1999 and 2000 , Indian River County statistics from the Florida 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 . 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 for children ages 6 to 18 with year round drop in services every day after school until 8 p . m . and all day during the summer. No other program offers the same accessibility, affordability or daily programming specifically designed to help children 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 the future • Educational , employment, social , emotional and cultural competencies as well as the attitudes and skills necessary to succeed • Community and civic involvement ; a sense of belonging to community, family and/or group ; and a willingness to take civic responsibility • Healthy lifestyle, physical fitness and positive behaviors • Moral compass, values and positive relationships . b) Other programs under serve our target population for the following reasons : affordability, . accessibility and scope of services . it f gyp: �/ ✓ d .. f 'ti J 1 At. _ it At u* T kms x i r ?v , g r 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. Programs offered at the Boys & Girls Clubs are specifically designed to spark our members ' interests and offer positive alternatives to squandering time after school and getting into trouble. Our programs help children achieve educational success, learn tolerance of cultural difference and build good character and citizenship . All programs are carefully researched, designed and field-tested and are continually assessed and evaluated. Daily drop in hours are provided at our Sebastian Branch located at 250 Sebastian Boulevard, Monday through Friday after school until 8 p.m . and during winter, spring and summer breaks from 8 a.m. to 6 p .m. Specific programs include : • 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 F= • 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 children 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 positive effect on their lives, provided the skills necessary for leadership, improved their relationships with others and influenced success in later life. 6 } � .. � t: Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee • 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 Club Operations — with a Bachelor' s Degree and a minimum of three years experience in the nonprofit sector. The DCO dedicates 50 percent of his/her time to providing program support, evaluation and staff training in the Sebastian Branch. 1 full time Branch Director — with a Bachelor ' s Degree and a minimum of three years experience working with youth . The BD dedicates 100 percent of his/her time to planning, coordinating and directing the daily program at the Sebastian Branch . 1 full time Program Director — with an Associate ' s Degree or equivalent with a minimum of three years experience working with youth. The PD dedicates 100 percent of his/her time to planning, coordinating and implementing the daily program at the Sebastian Branch. 1 full time Technology Director— with a Bachelor ' s Degree, a minimum of three years experience working with youth and a demonstrated knowledge of and ability with computers . The TD dedicates 100 % of his/her time to planning, coordinating and implementing the technology program at the Sebastian Branch. 5 part-time ProgramSpecialists — with High School Diplomas , working towards college degrees , with demonstrated capability in working with youth . Each position dedicates 100 % of his/her time to onsite supervision of Club members . Volunteers - Demonstrated capability in working positively with youth . As many as possible and available . Each is dedicated to assisting with the specialized programs 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, Sebastian Junior High and Sebastian River High School . Word of mouth from members appears to be one of the most effective methods of informing our target audience about the Boys and Girls Clubs . 6 . How will the program be. accessible to target population (i . e. location , transportation , hours of operation) ? The location of the Sebastian Boys and Girls Club was purposely chosen to be within walking or bike riding distance from where our targeted youth live or attend school . In addition, the School District of Indian River County offers transportation from Sebastian area schools everyday after school . During the school year the Club is open to members Monday through Friday from 2 : 30 p . m . until 8 : 00 p .m. (on Wednesdays, during early dismissal , the Club opens at 1 : 30 p .m .) . During summer months and other days school is closed the Club is open from 8 a. m . until 6 p . m . r . . S {T i ( a4 � � �`�.ry ' r - � � +� b^'ub �'�? r'� a , . ' M�e€"zry 3 • .. - iY t ' l 7 r a ' . 9 . hgywV r t . 3 �•< "' `uRp'S i _ i 4 'tltt �Y�2'�, K c fY _ , R q M » Sri P Boys & Girls Club of Indian River County, Inc. — Sebastian Branch w Grant Application to the Children 's Services Advisory Committee D . MEASURABLE OUTCOMES (Entire Section D not to exceed two pages) FY04-05 OUTCOMES ACTIVITIES Add all the elements or the Measurable Outcomes Add the tasks to accomplish the Outcome(s) 1 . To increase average daily attendance of . Distribute Membership Recruitment Flyers Sebastian Branch club members by 64% in the schools to announce after school (from 80 - 125 ) as reported by the 2004-2005 program in the beginning of the school year year end average daily attendance totals . and summer programs at end. of the school Baseline : 2002-2003 average daily year, attendance totals . • Offer affordable 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 _T _ diversity among Club members ages 6- 18 . 2 . To decrease juvenile crime rates of enrolled • Provide daily diversion activities at the Club 10 - 17 year old Club Members to less than to channel the energy of our members into a 3 % compared to non-club members which is positive direction. To initially spark members ' 10 % as reported by the 2001 -2002 juvenile interests, game room tournaments and outdoor arrests . Baseline : 2001 -2002 Indian River playground activities will be offered. After a County statistics from the FL Department of rapport is established, staff will encourage Juvenile Justice Bureau Data. ( 10% of all participation in the five, core programs . 10 - 17 year olds) referred to the juvenile . Nominate eligible 14 year olds for Youth of the justice system . Month. Each nominee will be requested to complete a nomination form to be entered into judging for the Boys and Girls Clubs of Indian River County Youth of the Year Award. • Implement a Keystone Club for members age 14-18 that meets at least once a month. • Implement a Torch Club for members ages 11 - 13 that meets at least once a month. • Create a Passport to Manhood program for boys ages 11 - 18 that meets once a week for 8 weeks. • Implement the SMART Moves program for all age groups offered on a weekly basis. • Implement a SMART Girls program offered weekly for girls ages 10- 15 that encourages healthy attitudes that enable them to develop to their full potential. • Implement a Child Safety & Protection Program that meets once a week for 8 weeks. i • Implement a violence prevention program that n meets once a week for 12 `weeks in collaboration ry Q 8 Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee 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 • Provide daily Homework Help, Reading & no less than 45 % of Club members Math skills enhancement activities, One-On- participating in the Sebastian Branch One and Group Tutoring, POWER Pages and Power Hour program by June 30, 2005 . POWER Point activities during the school year. Baseline : 1St quarter school grades • Celebrate improvement in school performance compared to 4`h quarter grades , with quarterly parties. • Meet with school officials to identify members who are failing and provide additional homework and tutoring support. • Implement a peer led 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. 4 . Maintain 100% parent involvement of Club . Establish a Family Support program, designed members in the Sebastian Branch (209) as to provide seasonal activities, events and reported by the 2004 -2005 Parent attendance services to strengthen family relations through at Club events . Baseline : 2003 -2004 Parents informal social support. attendance at Club . • Implement a Family Advisory Network (FAN Club) that will meet 4 times a year. • Survey parents annually to evaluate program quality and identify new areas for service. 5 . Establish a baseline for computer • Create a Career Launch program offered year- proficiency at the beginning of the year and round to teenagers accessing the internet at the utilize it to establish an outcome that will Sebastian Branch. increase skill levels by the end of the grant . Provide daily access to computers to improve term , June 30 , 2005 . Actual percent increase technology competency levels. will be determined after one funding cycle . i , m»'...a't✓& r + S .w ar.� }yto <, r.. s s n = ! s I j1„ t :.'.. . � • � 'N a . pw { # , yy � vw & s^' a a. qq ]. ,., 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 beyond referrals and support. (See individual funder requirements for inclusion of collaborative agreement letters .) Collaborative Agency Resourcesprovided to the program Transportation after school from Sebastian Elementary, Pelican Island Elementary, Sebastian River Middle, Indian River County School District Sebastian Junior High and Sebastian River High School to the Boys & Girls Club. After school snacks and summer lunch program . Vero Beach Museum of Art Art instruction, supplies, place to host exhibits and museum in the basket series , y. Co-ordinate mentoring opportunities, encourage Youth Youth Guidance Guidance participants to become members of the Boys & Girls Club and promote mentors to meet with their assigned children at the Boys & Girls Club , Safe Space Provide instructors to conduct conflict resolution, domestic violence and anger management sessions , Substance Abuse Council Will match members with juvenile arrest to help us determine the percentage of members participating in juvenile crime , Girl Scouts Volunteers to conduct troops at the Boys & Girls Club once a week . F * S R v ilffiJ TNFt Z 10 66 13 9'i k .Wk' ms's*ry ' . =e - •',1�,, c ` +'i+'.i N.+ wM`r:6^iM . . � ;a4+:'rrar'e'd. . . 7F '�.5�- sn�F; ' 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 Bl ? 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. Our 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 Substance Abuse Council to determine Juvenile arrest. The condition requiring change includes limited access to affordable, quality after school programs for children ages 6 to 18 ; the average juvenile crime rate; and below average academic achievement in economically disadvantaged youth . 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 of registration at 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 member 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 Substance Abuse Council with the names of all children enrolled in the program. The Substance Abuse Council will then notify usrregarding the number of members arrested . Com arisons are made as needed . ; 1 '..AL. s r ,; " + v �.c y u'k� Jr• A' " f29,`�k . 2'r s k r t Y I P1. C � Tns � .tit tdS< Y `N�dq . 7 � � S .a y ''+ Y "4' 4 y„ ; SYr4 y Nt ��'` a r 4 w ¢'*�.` s - '' . . Y`'.f, .iCa'',a� int cr t.A"bN, , • } %Ti art "' ^kc . .. ski . p , ?"c k'.',� fF + 7" '" � er'. 't' ;: Boys & Girls Club of Indian River County, Inc. Sebastian Branch Grant Application to the Children 's Services Advisory Committee • School Achievement will be measured by collecting report cards and making quarterly grade comparisons . 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 demonstrate our agency ' s positive impact on the community . 6 . T F �<�..� TV role I , iIXNFI* r ny ti t - # +. }_ r} �T i a { � ? t Imo/ IN A 11 . . t .^haft : I -11 ti »°" ♦ .1 H �y, t Zi w�. t ° - ¢1 x IN IN t- .ti Boys & Girls Club of Indian River County, Inc. — Sebastian 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 2004 Approval Write and Prepare United Way Grant March 2004 Distribute Parent & Members Surveys May 2004 Start Registering Summer Members April 26 — 30 , 2004 Develop Summer Program Schedule that May 2004 incorporates all the National Programs mentioned in section C3 . Write, Prepare and Submit Children ' s Services May 2004 Advisory Committee Grant Summer Staff training & Building June 2 — 6 , 2004 Maintenance 1St Day of Summer Program for the Sebastian June 7 , 2004 Branch offer hours Monday — Friday 8 a. m . — 6 p . m . Start registering Members for. School Year August 2 — 6 , 2004 Program , Develop School Year 2003 -2004 Program August 2004 Schedule that incorporates all the National Programs mentioned in section C3 . School Year Staff training and Building August 16 — 20, 2004 Maintenance Evaluated Boys & Girls Club Program November, February, May, August . Utilizing Commitment to Quality 4 times a year. I Ell ell 5ics.,i3:�AI El irllE1a-r*d` e"�'Yt d t^ ,� t £'r'�"�'1 �" x > � rEll - 13 -E } Ell z s. + a 3 �;Qs�w+ Boys & Girls Club of Indian River County, Inc. — Sebastian Branch Grant Application to the Children 's Services Advisory Committee H. PROJECTIONS FOR UNDUPLICATED CLIENTS Number of Unduplicated Clients by Location Current Fiscal Year ' Location c r _ a' 0 Z A Budget 2002/03 acct 4 0 Unduplicated Clients Unduplicated Clients Unduplicated Clients N . Indian River County 582 880 880 S . Indian River County - - - Indian River Co . Total 582 880 880 Greater Stuart - - - Hobe Sound - - - Indiantown - - - Jensen Beach - - - Palm City - - - Martin County Total - - - Fort Pierce - - Port Saint Lucie - - St. Lucie Co . Total - - - Okeechobee County - - - v Palm Beach County - - - TOTAL SERVED 582 880 880 7 'cya ° a Current Fiscal Year Location " Budget 2003/04 I i i is , AWN u Individual Group It s , rau F 0 to 4 - (Pre -school) - - - - - - 5 to 10 - (Elementary) 136 - 218 - 219 - 11 to 14 - (Middle) 150 - 242 - 242 - 15 to 18 - (High School) 25 - 40 - 40 - 19 to 59 - (Adults) 62 209 100 280 100 280 60 + (Seniors) - - - - - - total adults 62 209 100 280 100 280 TOTALSERVED - 1 373 1 209 600 1 280 1 600 1 280 °' ,� fi x t >�`� ', . : K . , ,t . by •� �� � .w z , _ w+ w kr i +i1fct •i 14I r }, "W s s h f , f q � > v . . f s� � .nr• a ¢$ b � y ^ ��r�i �� i 7 - � y z� � f " yp t _- .*•8%.. _ .�sx . . . ,iia -n%�°fn`'. .!Y_;.9', � v '�la�$! i . . . . . 'z, y . g. . ; °ta Q `w Boys & Gids Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children's Services Advisory Committee UNIFORM GRANT APPLICATION BUDGET NARRATIVE WORKSHEET INr► RTANT: 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 : Boys & Girls Club of Indian River County, Inc ./Sebastian Branch FUNDER : Children 's Services Advisory Committee CA UTION : Do not enter any figures where a cell is colored in dark blue - Formulas and/or links are in place. Gray areas should Do be used for calculations and to write information only. A D a� B� dg���oseTo^ cNea► encaty . SO All Bdrtle +es o� u gum-------- OUR . .,. , . .m. ._ . . 1 Children's Services Council-St. Lucie * 2 Children 's Services Council-Martin " " ° 3 Advisory Committee-Indian River 60,000.00 600000.00 130,000. 00 4 United Way-St Lucie County , f 5 United Way-Martin County 6 United Way-Indian River County 60 ,000.00 1591000. 00 7 Department of Children & Families , -. 8 County Funds 9 Contributions -Cash `:, 2237000.00 10 Program Fees g 100.00 300. 00 11 ckknd Raising Events -Net 10200.00 1311692 . 00 1 s to Public - Net0.00 200 .00 13 wiembership Dues 4,850.00 10,050.00 14 Investment Income , * 15 Miscellaneous ? w 16 Legacies & Bequests a 17 Funds from Other Sources ,� f � -- ., ,�, 28 ,333.33 75 ,000 .00 18 Reserve Funds Used for Operating � w� ",: 19 In -Kind Donations (Not included In total) 16 ,635.00 780540 .00 20 TOTAL REVENUESfiY (doesn't Include line 19) N . $ 154 ,483 .33 $ 60 ,000 . 00 $729, 242.00 � �� ' ", .F. ON �� h-�+wrx"x EXPENDITURES �QRAYA3 r p se . a to fogr�am ,F = z TaitafAgencyr .: fi' x '�` '} '� 21 Salaries - (must complete chart on next page) 109,686.00 52,600 . 00 472 , 174.00 N 27 FICA - Total salaries x 0. 0765 6 % 7,467.00 30978 .00 26,872 .00 e Yemen - Annual pension torqua I le 3 M, t: 23 staff 91000.00 0 . 00 33,403 . 00 Life/Health - Medical/Dental/Short-term Ir' 24 Disab . - 10,938 .00 41022 . 00 32 , 574 .00 Workers Compensation - employees x 25 rate low 2 ,616.00 0.00 9 ,415 .00 eai*ts, Florida Unemployment - # pro)ec e, 26 employees x $7,000 x UCT-6 rate MU 961 .00 0 . 00 2 , 801 .00 BEtlt Iii / d t - � n a i P 15 J;, y fi i � � Lfif d� 4 f` s„ x'y { . ..�\ V r�bF r.N • s.�ait " 3. .X1,1? a v. Boys 8 Gids Club of Indian River County, Inc. - Sebastian Branch ' Grant plication to the Children's Services Advisory Committee Director of Operations/40 hrs 50 , 000.00 12 , 500.00 0.00 25 .00 % Branch Director/40 hrs 27, 000. 00 27 ,000.00 27, 000.00 100 . 00% Program Director/40 hrs 25,500.00 25 , 500.00 0.00 100.00% ch Director/40 hrs 25,000.00 25,000.00 25, 000.00 100.00% ericorps Team Leader/32 hrs 69042.00 6,042 .00 0 .00 100.00% Americorps Team Leader/32 hrs 61042.00 6,042.00 0.00 100.000/0 Program Specialist/40 hrs 21534.00 2 ,534.00 0 .00 100.00% Program Specialist/40 hrs 2 ,534.00 2 , 534.00 0.00 100. 00 % Program Specialist/40 hrs 2,534.00 2 , 534.00 0.00 100 . 00 % #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DI V/01 Remaining positions throughout the agency 324, 988.00 Tota! Salaries $472, 174. 00 $ 109 ,686.00 $52 ,000.00 23 .23% FRINGE BENEFITS= DETAILS d ,� m&.* m- �, �'•' '"` ' - s" s2 .few--: FunlerS 'e'ciflc P u et, .� fib_ ' . : 9 � ,; ¢ Pertslon �� ONE o Ei's t iem� to E 7ot2l nn eS funf�er.; q- r� _ !� pe l l t 7 �5 0: `-. a "`L.", .".": p, �"" R x. ., E r 'f: Golllfttrt oily f�0 ltrie�.2z7 �tx o , tom en nt �om en ecti"cf zBU eta - affi .arc` . =� a "` "`_- ' ' "4�� Position. Title . Total Hrs/wkMMAr a r ai & a p . _ . '. , w ,_ ' ,. s, 000.00 �szrso , " zoo oay ; 500. 00 zoo 00 l xam /e, - Casllianager/ �r� Mme„ ._ . , . � . w�30tl 00 � l 5,82, 50 x . ector of Operations/40 hrs 0.00 0.00 0. 00 )inch Director/40 hrs 27 ,000.00 2 ,065 .50 2;011 .00 4 ,076. 5 rogram Director/40 hrs 0.00 0 .00 0 .00 Tech Director/40 hrs 25 ,000.00 11912.50 2 ,011 .00 31923 . 50 Americorps Team Leader/32 hrs 0.00 0 . 00 0 .00 Americorps Team Leader/32 hrs 0.00 0.00 0 . 00 Program Specialist/40 hrs 0.00 0.00 0 . 0 Program Specialist/40 hrs 0.00 0. 00 0 . 0 Program Specialist/40 hrs 0. 00 0.00 0 . 0 0 0.00 0. 00 0 .00 0 0.00 0 .00 0. 0 0 0.00 0.00 0.00 0 0.00 0.00 0. 00 0 0. 00 0.00 0 . 00 0 0.00 0.001 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 0.001 0.00 0 .00 Total Funder Request Fringe Benefits $ 52pOOO-001 $ 31978 . 00 $ 0.00 $47022 .00 $0 . 001 $ 0.001 $ 80000 .00 w, • , s� T � ' x s ' ` v§ , F wi ' , 4y �FOR zpd d til: rot"�ffi � x = FTo �tfgericY .„% ., a4 3 .. y3r 3 "w .#' `/f�E�N ixISE• }JL1t0 'a s > _ - - .rider- eclfac trJget Fz'g*, . sx ''<„ i:.s•„ M. gB�aleit 27 T. evel-Daily 946.00 0. 00 5v938 .00 Staff x average # of miles/wk x 50 wks x v = Estimated Daily Travel/Mileage Reimb. t 28 TravellConferenceslTraintng . :r <' 00000 fix ' ' .` 4 , . 0.00 - 15,630.00 ` •F S � 1a1T " e A � k �. s a e � f w ex.• �� 'S` kt f' " 4 ' C az 4 a4iy Boys & Gins Club of Indian River County, Inc. - Sebastian Branch ' Grant Application to the Children's Services Advisory Committee ' rce�ommenaatlo _ � _ �`�� � National Conference (cost per staff) row }� Training/Seminar (cost per staff) �o t e� f o Other Trainings (cost of travel, lodging , a istration , food) 1�,�ry� fa tY�i►ij , k� .- �, � � �„ � _ . _� � < � ., + . +_ 6 •._; . dIce Supplies Z sr' 927.00 0.00 6t455.00 Office supplies (monthly average x 12VI x x months = estimated cost of office supplies r ` xa k � # aiib .m ai f '1 Y based on present history. ,_ � � s��< � . m 30 Telephone ' Y � 3,580 00 0.00 12 ,060 .00 # 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 0.00 0.00 1 , 169 00 • Quarterly Mailing of Newsletter • Special events , etc. • Bulk mailings - appeals 32 Utilities " 0 8,200.00 0. 00 16 ,500 00 Electricity ( $ x 12 months) Em P Water/Sewer ($ x 12 months) I IT .y rn°° y s ,. y @a � ry y y x ,f • x• Garbage ($ x 12 months) 33 Occupancy ( Building & Grounds) Refii k 55 , 083.00 0.00 93 , 028.00 Mortgage/Rent ($ x 12 months) * < T c�arlatbnal *fix z z • Janitorial ( $ x 12 months) ` k; � $20a�1 onth v • Grounds Maint. ($ x 12 months) BU (f� � aIN at r sx a Real Estate Taxes MaTrtnan�e 34 Printing & Publicationst � 1 750 00 0 00 14700.00 • Quarterly Newsletter ($ x 4) flr�aIIzatIQn5� • Letterheads , Envelopes, etc. rl ftr7 il • Fundraising materials d d d e itlt� fs •" then bscription/Dues/Memberships y1j200. 00 0 00 99835 .00 2 7fi � xffi' a -1 . , t * ' `.jos xh xy' 2 �x n fat e- • Membership to National Organization g � ' �3x 4 E 5 > I I • Dues BGC Due , - L- Zi g £ Subscriptions to Newspapers/magazines , ?x ` Parea �+Ihara�e� , � y �� � � .«�•` a ��, "� � I A etc. Dua � - 36 Insurance � ��� 4o824. 00 0.00 19 , 016 .00 • icers Liab. • Commercial/General Insurance x � _,,� y ", , d&0 CL B+Z;nd 4x ��� �� ,Y ? � 1 ..2E �' 1 R • Bond Ins . AUi3e; t� �� • Auto Insurancet1L �� 11175. 00 0 00 71525 .00 37 Equipment: Rental & Maintenance � � x�� �� � • Copier lease ($ x 12 months) x k • Meter lease ($ x 12 months) y� ' k m � � '� 0. • Copier Maintenance ($ x 12 months) • Computer Maintenance $ x 12 month 's • Other rnoti . NN ., 38 Advertising 250.00 0.00 11300.00 • Newspaper ads �� it • Fundraising ads/promotions � � • Other (vacancies) Rerlin � ; 39 Equipment Purchases : Capita l Expense ; 0 00 0 00 0 OQ Computer/monitor (# X $) � �its N,Al 10 � a el 11 az � a�tttnl4.4 11 C � " alIt - Laser Printer 40 Professional Fees ( Legal, Consulting ) -, F 0.00 0 .00 0.00 • Legal advice ( estimated #hrs x $) � �` _ • Consultant fees s KI K ME s ks/Educational Materials 4,328.00 0.00 12 ,345.00 ooks/videos y '4 Materials ($ z staff} a II 200.0 � j 42 Food & Nutrtttorr "` ` - fie = 100.00 o.on j_ 1T /25/2004 •? > •� Boys d Gids Club of Indian River County, Inc. - Sebastian Branch Grant Application to the Children's Services Advisory Committee Meals ( # meals x clients x 5days x 50 wks) x Snacks as: . IUR " . ,EM, 43 Administrative Costs 0.00 0.00 0 . 00 dmin . Cost % of total budget) - � ""` 9 ) . ,fig 4 �� ; 7 p 1 ,750.00 0.0 7,000.00 dit Expense SJt Independent Audit Review ora ` ��[� � $ a f 45 Specific Assistance to Individuals 0.00 0.00 0. 00 Medical assistance h . Meals/Food • Rent Assistance • Other �'��' ^. � "" � .� 'r- �' � � y; �� "S ,4 � 5�1 46 Other/Miscellaneous a/ 903 00 0 .00 71842 .00 B� rl Background check/drug test :a. xs a ,: -s+ c. --, i,,. .,.;� zS'az `3'`" � , z""'""& a,�"s. c .,` s• a-.,:. Yr<: .+"s z � � .+a3"3 *i�' oy -.4 z 9 9 g 5creepSlolF 3 � u ¢ E { , 3 k5 Ra � }� ' i l • Other ' '> S ' 'g ` § 47 Other/Contract 0 .00 0.00 0. 00 Sub-contract for program services a 48 TOTAL EXPENSES -��' > $229, 684 .00 $60 ,000.00 $807,782 . 00 _. x ' �v . Y, �J'"t .Rn '.t v�4 x i ���"��'�`v�y`� , s ��"`�hty+" v.F4. `'i �'.f su � '� "b' +y x• �+ _y + s.= v t V f kt.F 1 %0 5/201K a� , SAi a e k� 18 H a & _ RY�n� Yj r ♦ � Mti�"' 'CPy^i . p �A ow Y� Bep 6 GiU CFAs of Indan Mvw County, Wn �. SWMix) ennN r UNIFORM GRANT APPLICATION TOTAL AGENCY BUDGET AGENCY/PROGRAM NAME : Bos & Girls Clubs of Indian River County, Inc./Sebastian Branch '< FY 02/03 FY 03/04 FY 04/05 % INCREASE HE June 3Q HE June 30 HE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (ce C-col. Bpcol. B REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 0.00 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/01 3 Advisory Committee4ndian River 90 012.48 100 000.00 130 000.00 30.00% 4 United Way-St. Lucie County 0.00 0.00 0.00 #DIV/01 5 United Way-Martin County 0.00 0.00 0.00 #DIV/01 6 United Way-Indian River County 136 000.08 126 000,00 159 000.00 26. 19% 7 Department of Children & Families 0,00 0.00 0.00 #DIV/01 8 County Funds 0.00 0.00 0.00 #DIV/01 9 Contributions-Cash 193 488,31 223 000.00 223 000.00 0.00% to Program Fees 720,77 300.00 300.00 0.00% 11 Fund Raising Events-Net 116 345.20 85 500.00 131 692.00 54.03% 12 Sales to Public-Net 11193.51 400.00 200.00 -50.00% 13 Membership Dues 10142.00 16 050.00 10 050.00 -37.38% 14 Investment Income 876.69 0.00 0.00 #DIV/01 15 Miscellaneous 7t269. 161 0.00 0.00 #DIV/01 16 Legacies & Bequests 0.00 0.00 0.00 #DIV/01 17 Funds from Other Sources 97 523.32 122 396.00 75 000.00 -38.72% 18 Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/01 19 In -Kind Donations (Not Included In total) 35t382.73 12 000.00 78t540.00 554. 50% 20 TOTAL 688t954. 25 673 646 . 00 729242 8.25% eq Me. EXPENDITURES 21 Salaries 334 095.40 379 567.00 472 174.00 24.40% 22 FICA 23 880.04 28 720.00 26 872.00 -6.43% 23 Retirement 81998.921 21 500. 00 33 403.00 55. 36% 24 Life/Health 21 061 . 11 28 114.00 32 574.00 15.86% 25 Workers Compensation 10 693.84 1101323.00 91415.00 -8. 80% 26 Florida Unemployment 3j042.84 3t591 .00 21801 .00 -22.00% 27 Travel-Daily 21004.94 51000.00 5938.00 18.760/. 28 Travel/Conferences/Training 17 614.90 15 630.00 15 630.00 0.00% 29 Office Supplies 9,851 .32 8 172.00 6j455 . 00 -21 .010/0 3o Telephone 12 246.96 11 462.00 12 060.00 5.22% 31 Posta e/ShtpR:Lnq 3t462. 12 61960.00 19169 .00 -83.20% 32 Utilities 15 402.04 12 444.00 16 500.00 32.59% 33 Occupancy (Building & Grounds 78 710.59 83 616.00 93 028 .00 11 .26% 34 PrIntinq & Publications 31 055. 97 13 700. 00 14 700.00 7.30% 35 Subscri tion/Dues/Membershi s 15 866. 19 10 115.00 9t835 .00 -2.77% 36 Insurance 14 914.04 14 763.00 19 016 .00 28 . 81 % 37 E ui ment: Rental & Maintenance 2t495.45 6 900. 00 71525 .00 1 9.06% 38 Advertising 1t091 . 26 1 200. 00 130000 1 8. 33% 39 Equipment Purchases : Ca ital Expense 19449.77 0. 00 0.00 #DIV/01 40 Professional Fees (Legal, Consultin 275.00 0.00 0.00 #DIV/0l 41 Books/Educational Materials 61664.451 9 645.00 112P345.00 27.99% 42 Food & Nutrition 407,88 600.00 200.00 -66.67% 43 Administrative Costs 0.00 0.00 0.00 #DIV/01 44 Audit Expense 8t825.00 7v000.00 71000.00 0.00% 45 Specific Assistance to Individuals 0. 00 0.00 0.00 #DIV/01 46 Other/Miscellaneous 29 607.85 61624. 00 79842.00 18.397. 47 Other/Contract 0.00 #DIV/01 48 TOTAL 653 717. 88 685 646.00 807 782.00 17. 81 % IIIIIIIIIAsa { `a &Sc ^��..-.�«'.'���.. ,a �' � �`::�":' .�.'. ..�_�. `�e. "�s ". " � ... . v:ir .�4�*' �. .�' .�.`-,..r .�F"9. ';`�8 ^.c� '77 �'.: .��r.. ..�,.. 49 REVENUES OVER/ UNDER EXPENDITURES 35 236.37 -12,000.00 -78 , 540. 00 554. 50% r S % ell I , ell Fe tri ,at 1 S'4e g y le,vfM ..z�, S1 v �}� `f„ �,t � ,yi 3 _ k tis ...1 V "x N. a i .+w. .�y 1 ., e°r L an. G.E. MM+Aen RFwr Cwq, ak. • S*Wsftn tk.nea UNIFORM GRANT APPLICATION TOTAL PROGRAM BUDGET AGENCY/PROGRAM NAME: Bos & Girls Clubs of Indian River County, Inc Sebastian Branch FY 02/03 FY 03/04 FY 04/05 % INCREASE FYE June 30 FYE June 30 FYE June 30 CURRENT VS. NEXT FY BUDGET A B C D ACTUAL TOTAL PROPOSED (eol. C-eol. Byeol. e REVENUES BUDGETED BUDGETED 1 Children's Services Council-St. Lucie 0.00 0.00 0.00 #DIV/01 2 Children's Services Council-Martin 0.00 0.00 0.00 #DIV/01 3 Advisory Committee-Indian River 30 532.59 30 000 .00 60 000.00 100.00% 4 United Wa -St. Lucie County 0.00 0.00 0.00 #DIV/01 5 United Way-Martin County 0.00 0.00 0.00 #DIV/01 6 United Way-Indian River County36 000.00 40 000.00 60 000.00 50.00% 7 Department of Children & Families 0.00 0.00 0. 00 #DIV/01 e Coun Funds 0.00 0. 00 0.00 #DIV/01 9 Contributions-Cash 420. 10 0.00 0.00 #DIV/01 10 Program Fees 129.78 100.00 100.00 0.00% - 11 Fund Raising Events-Net 32r195.00 1400. 00 1 , 200.00 -14.29% 12 Sales to Public-Net 437. 94 100. 00 0.00 -100.00% 13 Membership Dues 41446.00 51350. 00 41850.00 -9. 35% 14 Investment Income 32.24 0 . 00 0.00 #DIV/01 15 Miscellaneous 0. 00 0.00 0.00 #DIV/01 16 Legacies & Bequests 0.00 0.00 0.00 #DIV/01 17 Funds from Other Sources 0.00 52 031 .00 28 333.33 -45.55% 18 Reserve Funds Used for Operating 0.00 0.00 0.00 #DIV/0l 19 In-Kind Donations (Not Included In total) 831 .25 0.00 16 635.00 #DIV/O ! 20 TOTAL 105 024.80 128 981. 00 154 483.33 19.77% EXPENDITURES 21 Salaries 65 266.46 90, 076 . 0010%686.00 686.00 21 .77% 22 FICA 4,98 6 .48 6 , 874.00 71467.00 8.63% 23 Retirement -190.34 4 9O0.001_ 91000.00 83.67% 24 Life/Health 5p118. 13 71020.00 10 938.00 55.81 % 25 Workers Compensation 0.00 2 563.00 2 616.00 2. 81 % 26 Florida Unemployment 0.00 11134.00 961 .00 -15.26% 27 Travel-Dail 778.02 700.00 946. 00 35. 14% 28 Travel/Conferences/Trainin 1 ,574.55 41000.00 400000 0.00% 29 Office Supplies 1 839. 10 21152. 00 927.00 -56. 92% 30 Tele hone 31273.04 364000 31580.00 -1 .65% 31 Postage/Shipping 185.00 0.00 0.00 #DIV/01 32 Utilities 91548 . 62 71200.00 81200600 13.89% 33 ! Occupancy (Building & Grounds 27 112.54 46 316 . 00 5508300 18.93% 34 Printing & Publications It 114. 25 1 600.00 11750.00 9. 38% 35 Subscription/Dues/Memberships 11645.421 200.00 19200.00 ' 500.00% 36 Insurance 4p576 .041 2 733. 00 41824.00 76 .51 % 37 Equipment: Renta I & Maintenance 525.00 525. 00 1 , 175.00 123.81 % 38 Advertising 317.19 250.00 250.00 0.00% 39 Equipment Purchases :Ca ital Expense 0.00 0.00 0.00 #DIV/01 40 Professional Fees (Legal, Consulting) 0.00 0.00 0.00 #DIV/OI 41 Books/Educational Materials 11653.661 31428.001 49328.00 26.25% 42 Food & Nutrition 61 .02 300.00 100.00 -66.67% 43 Administrative Costs 0.00 0.00 0.00 #DIV/01 44 Audit Expense 21206. 251 19750.00 1 750. 00 0.00% 45 S ecifle Assistance to Individuals 0.00 0.00 0.00 #DIV/01 46 Other/Miscellaneous 81298.52 295.00 903.00 206. 10% 47 Other/Contract 0.00 0. 00 0. 00 #DIV/01 48 TOTAL 139 888. 95 187 656.00 229 684.00 22.40% 49 REVENUES OVER/ UNDER EXPENDITURES -34 864. 15 -58 , 675 .00 -75,200.67 28 . 16% r' kk z k �� � �. Fr r b r 1. i rS . >t Z ) btAy Y.; V ✓ Fy S ' Boys 6 Gids Clubs of Indian River County, Inc. Sebastian Branch UNIFORM GRANT APPLICATION FUNDER SPECIFIC BUDGET PROGRAM EXPENSES AGENCY/PROGRAM NAME : Boys & Girls Clubs of Indian River County, Inc./Sebastian Branch FUNDER : CSAC A B C FY 04/05 FY 04/05 % OF TOTAL FUNDER TOTAL VS , PROGRAM SPECIFIC FUNDER REQUEST BUDGET BUDGET col. B/col . A EXPENDITURES 21 Salaries 109 , 686 . 00 529000 . 00 47 . 41 % 22 FICA 71467 . 00 31978 . 00 53 . 27 % 23 Retirement 91000 . 00 0 . 00 0 . 00 % 24 Life/Health 10 ,938 . 00 41022 . 00 36 . 77 % 25 Workers Compensation 2 , 616 . 00 0 .00 0 . 00 % 26 Florida Unemployment 961 . 00 0 .00 . 0 . 00 % 27 Travel -Dail 946 . 00 0 . 00 0 . 00% 28 Travel/Conferences/Training 41000 . 00 0 . 00 0 . 00% 29 Office Supplies 927 . 00 0 . 00 0 . 00 % 3o Telephone . 31580 . 00 0 . 00 0 . 00% 31 Postage/Shipping 0 . 00 0 . 00 #DIV/01 32 Utilities 81200 . 00 0 . 00 0 . 00 % 33 Occupancy ( Building & Grounds 55 , 083 . 00 0 . 00 0 . 00% 34 Printing & Publications 11750. 00 0 . 00 0 . 00 % 35 Subscription/Dues/Memberships 1 , 200 . 00 0 .00 0 . 00 % 36 Insurance 49824 . 00 0 . 00 0 . 00 % 37 Eg ui ment : Rental & Maintenance 11175 . 00 0 . 00 0 . 00 % 38 Advertising 250 . 00 0 . 00 0 . 00 % 39 Equipment Purchases : Ca ital Expense 0 . 00 0 . 00 #DIV/01 40 Professional Fees ( Legal , Consulting ) 0 . 00 0. 00 #DIV/01 41 Books/Educational Materials 41328 . 00 0 .00 0 . 00 % 42 Food & Nutrition 100 . 00 0 . 00 0 . 00 % 43 Administrative Costs 0 . 00 0 . 00 #DIV/01 44 Audit Expense 1 ,750 . 00 0 . 00 0 . 00 % 45 Specific Assistance to Individuals 0 .00 0800 #DIV/01 46 Other/Miscellaneous 903 . 00 0 . 00 0 . 00% 47 Other/Contract 0 . 00 0 . 00 #DIV/01 48 TOTAL " ' $229, 684.00 $60 , 000 .00 1 260' 12% :q 21a r wiy � ✓ z µ .At�`•x � tp . - � t < � 4 � 9tSii�. "{.f y ' x t s, •M.�y. r' d y � R� �31 ' . ♦ ys ' ,e y Boys a Gtk Ckft of Inden RKw County, Inc, SeDestlen Bmnch UNIFORM GRANT APPLICATION EXPLANATION FOR VARIANCES OF 15% OR MORE TOTAL PROGRAM BUDGET 'A4GENCYIPROGRAM NAME : Boys & Girls Clubs of Indian River County, IncJSebastian Branch FUNDER: Children's Services Advisory Committee :z - Lrry it dcF>vanra t� o u trtAJV #DIWOI #DIV/01 Advisory Committee-Indian River Applying for funding for the Branch and Technology Directors Positions. #DIV/0! #DIV/01 United Wa -Indian River County To increase quality program in Sebastian. #DIV/01 #DIV/01 #DIV/01 #DIVl01 #DIV/0t #DIV/01 #DIV/01 #DIV/01 Salaries Addition of a Technology Director Position and Continued funding of the Branch Director. Retirement We pay 10% of a full time employee's salary into a pension plan - with the addition of a new position this expense increases. Life/Health Addition of a Technology Director Position and Continued funding of the Branch Director. Travel-Daily Adjusted to account for more staff members turning in mileage reimbursements. Occu anc (Building & Grounds Our Sebastian lease was set up on a step up scale with an increase to the base rent every year. Subscri tion/Dues/Membershi s BGCA dues were not previously divided over the programs in the budget - they are now which accounts for the variance. Insurance Insurance was not previously divided over the programs in the budget - it is now which accounts for the variance. Equipment: Rental & Maintenance New leased copier and maintenance & child tracking software maintenance. #DIV/01 #DIV101 Books/Educational Materials Increased push for training of staff & need for program supplies. #DIV/01 #DIV/01 Other/Miscellaneous Increase in cost of background checks & drug screens. #DIV/01 i '1 . a• � G t 3 ♦ aAja�t y � .w ie�-K"+ 3a `r3 �y,�se ' i imp m - qtr t N1 Sr10U T Boys 6 GM6 CIuW of Indan Rhror Co". Inc. - Seoadan Branch UNIFORM GRANT APPLICATION EXPLANATION. FOR VARIANCES OF 15% OR MORE FUNDER SPECIFIC BUDGET := NCY/PROGRAM NAME: Boys & Girls Clubs of Indian River County, Inc./Sebastian Branch FUNDER : Children 's Services Advisory Committee Salaries Addition of a I emnoiogy Director Position and continued funding of the Branch Director. FICA Adamon of a Technology Director Position and continued funding of the Branch Director. Life/Health Addition of a Technology Director Position and continued funding of the Branch Director. #DIV/01 #DIV/01 #DIV/01 #DIV/01 #DIVI01 #DIV/01 �+• a L A 1 y -�,H ♦ _ �y t 4 �.Pa } hA?%j t x `' �tJ,� a - ¢v 11 71, 07 r 4 t ?w A �4"' /Y"^ ''aaXa r a Y's <t li. x n, 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 "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 Pa e # X TABLE OF CONTENTS (Check list) 1 X COVER PAGE (with signatures) . " , poll 3 A. ORGANIZATION CAPABILITY (one page maximum) X 1 . Mission and Vision of organizations . . . . . . , . . . . . . . a q a a 6 0 1 0 0 a a a a 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 0 1 0 1 1 1 1 X 2 . Summary of expertise , accomplishments, and population served . . , . . . . 4 B . PROGRAM NEED STATEMENT (one page maximum) X L . Program Need Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X 2 . Programs that address need and gaps in service . . . . . . . . . . Co PROGRAM DESCRIPTION (two pages maximum) ' X 1 . Funding priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 2 . Description of program activities . I I 1 0 1 1 1 1 1 1 0 0 0 1 0 0 . . . . I . . . . . . . . 11 " . . 0111 6 X 3 . Evidence that program strategy will work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 X 4 . Staffing . I a I 1 9 . . . . . . . . . . . . . . . . . . 7 X 5 . Awareness of program : . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 6 . Accessibility of program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . 7 X D . MEASURABLE OUTCOMES (two pages maximum) . . . . . . . . . . 1 . . . . . . . . 11 . . . 1 8 X E . COLLABORATION (one page maximum) . . . * , , . . . . . . . . . . . . . . :. . . . . . . . . . . . . . . . . . . 10 F. PROGRAM EVALUATION (two pages maximum) X 1 . Demographics . . . 11 X 2 . Measures . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 X3 . 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 •�'. ri�w43 e ' �- i .r.� + < . ,K . s 1. Jew `..n+�Y" '1v'a V rK i ' og 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 . . . . . . . . . . ell 15 X2 . Total Agency Budget . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 X 3 . Total Program Budget. . . . . . . " , , , , , * . . . . . . . . . logo " I 1 * 116 , 11010 10 , 611 , 20 X 4 . Funder Specific Budget. . . . . . . . . , " , , , , * * 111 . . . . . . , 1 * 00 * 009 * 00 . pop . . ogo , go * " * . . . . . . . . . 21 X 5 . Explanation for Variances — Total Program Budget . . . . . . . . . . 1 & , * , * 11 lot f l o o l l . . . . . 22 X 6 . Explanation for Variances - Funder Specific Budget . . . . . . . . . . . . . . . . . . . . . . . . . 9 6 0 0 . . . 23 J. FUNDER SPECIFIC/ADDITIONAL SHEETS (Copied once in White for all three programs submitted to CSAC for funding.) X 1 . List of current officers and directors J- 1 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-29 X Budget X 5 . Staff Organizational Chart J-31 X 6 . Cost Recent Annual Report (if available) J-32 X 7 , 501 (C) (3 ) IRS Exemption Letter J-58 X 8 . Articles of Incorporation J- 62 X 9 . Agency ' s Bylaws J-76 X 10 . Agency ' s written policy regarding Affirmative Action J- 84 X 11 . Proof of Goals and Outcomes Workshop Attendance J- 85 X 12 . Addendum No . 1 J- 86 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- 5 X 4 . Proof of Liability Insurance K- 14 r� -` FSG' i EXHIBIT B [From policy adopted by Indian River County Board Of County Commissioners on February 19 , 2002] " D . Nonprofit Agency Responsibilities After Award of Funding Indian River County provides funding to all nonprofit agencies on a reimbursement basis only. All reimbursable expenses must be documented by an invoice and/or a copy of the canceled check . Any expense not documented properly to the satisfaction of the Office of Management & Budget and/or the County Administrator may not be reimbursed . If an agency repeatedly fails to provide adequate documentation , this may be reported to the Board of Commissioners . In the event an agency provides inadequate documentation on a consistent basis , funding may be discontinued immediately. Additionally, this may adversely affect future funding requests . Expenditures may only be reimbursed from the fiscal year for which funding was awarded . For example , no expenditures prior to October 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 toils . 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 - r t e 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 25" Street Vero Beach , Florida 32960-3365 Recipient : Boys & Girls Club of Indian River County, Inc. P . O . Box 3068 Vero Beach , Florida 32964 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 - r s ACORD CERTIFICATEOF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1010812004 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Da Agency, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Y 9 enc Y 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 # INSURED Boys & Girls Club of Indian River County, Inc. INSURER A: Markel Insurance Co PO Box 3068 INSURER B: Vero Beach FL 32964 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'R ;R POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS PF OF INSURANCE DATE (MMIDDrArYl DATE IMMIDDIYYI GENERAL LIABILITY EACH OCCURRENCE $ 1 ,000, 000 A X COMMERCIAL GENERAL LIABILITY 8502CY2201284 09113104 09113105 DAMAGE TO RENTED $ 100,000 CLAIMS MADE FX ] OCCUR MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1 ,000, 000 GENERAL AGGREGATE $ 3, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 1 ,000, 000 MPOLICYF_j PRO I LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 000, 000 A X ANY AUTO 8502CY2201284 09113104 09113105 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY E. L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E . L. DISEASE - EA EMPLOYE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS certificateholder is additional insured for General Liability & auto 30 Days notice applies except for non-payment of premium CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Indian River County DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Board of County Commissioners NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 1840 25th St IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Vero Beach , FL 32960-3365 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE <AJD> CORD CORPORATION 1988 ACORD 25 (2001108) r r ` 16 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 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 . ACORD 25 (2001108) lli �12i 'Lt11S4 bb : 4b !Dbl 2yy: 640 bu'YS GIFLS i:LUb iRC PAGE 02 WED 05 ; ? 4 PM M AY , INC , FAX Na. 772 546 5772 r, U6 ei loridaMUM ftderad= ftmd . ,. Gurm 1 . . ll'. " fr . lt ' KutHt ai . l r , t 'I ,,Nt nun, S ,lr t'rtc <', N ' r i. , CimsrF : 5 .r►d, b4 �'nvliun , rw,. ( din, {. r •, • ^ :iLllrtHidf!<frT� kil 4�0Mrlrll fillet, 1979 Xn Njitwl, WrIlW4 0- , t 'J ` � i . lk 111 1, I 'l. 3,ir•gi •u �� a 1s'K'7Y..SI+ +VUrt )if iiru121. f17R1 71r>;na, $_ Rh . �, Ltlrinv, ' top 1 .( l li{>c tw + C n r { bal s K• Wtely . Jln ,l +r�ntlfr H> iCl `lu11617` ( 961 ) ax5awr>~ or Ivm[ 0•?.A2.7E�49 Rix ( XV) 66ev1 (6`i. . �. . �— . . . ... , c :: s:• c: r �*rr� ?.trancc RE : 0520- 25854 155LIeD TO : Indian River county Board of county commissioner3 1640 25th St Vero Beach, FL 32960 . 3365 ; L 329 - Is to ccrtify that Spys . Gir15 Cstl� t?L��!d11 . Rlver_C u��;Y. lt1�R• � - � Pu 505$.1lC�o. I . _ K Subjars t;� the provisions of the Florida Workers ' Compansatlon l,aw, has secured the payment of any 4~: cri; ers ` compensation benefits due by insuring their risk with the Florida Retail Federation Self InSufers Fund �,O JCy NUMBER 05z O." z5L Statutory Limits- - stab! of Florida Employers LlabilitY sTVt; DATE : SptGmUer 13 , .2004 $ 500 , 00G . ( Each Accident) $ 5001000 ( Disease- - 59ch Employee) '_X ' lit/ai1GN DATB : $ s00, 000 ( DI Seale - - Policy Limit) T ' w crtiflcate Is not a policy and of itself does not afford any insurance . Nothing container) In this i be construed as amending , extending, or altering coverage not afforded by the policy shown r "^ -dirg insurance to any insured not named above , :> ; cIicy of insurance listed above hag been issued to the named insured for the policy period indicated . ny contract or atNer document to Which this cerNf! cate any requirement, term or condition of a described policy in this - '� Berta n , the insurance made available by the bertificate Is subject to Only the .C; _ -• s, mxclus!ons and conditions of such policy. Paid claims may have redLced the shown limits , I ` r?,. ., eolicy described above Is cancelled before tho expiration date indicated , the issuing company will .T i ' 34 days' written notice to the cert holder named above , although if cancailauon is for w -: :nt of premium , then the isxulfig Company will attempt to mail 1?0 days' written notice #o the ^rr , 'icate holdor . In any event, the issuing company, its agents, and rep ► esentatives accept no obligation or ry of any kind for failure to mail such notica, 0 � t . - Date 11./ 03/ 2004 Ire . . r`, 11LplaCzdtCx A'uno xctail Tederarion Gelt ,tnkt, Xars 10 / 23 / 2004 11 : 23 5612993840 BOYS GIRLS CLUB IRC PAGE 02 • ul11bf ZD00 ti�ti) FV : s VAX HUJJ nt ,� ucx �. ,� ;. ca ., �, r ,1 Ic:, ., .. .. . INIZRIN) L REVENUE 5ERVIC£ DEVARTa(LN^ Op THE :'AEA.t Aki P . 0 , SOX 7508 CIAICTN2�ATI , �}; 45Zp1 Employer 13entifi.cation Nur - er ; Dates59 - ] 6329 ® A f OLN L705307i00bo30 BOYS 4 GIRLS ClWa or LZ%TIAN RIVER contact pervorn : COUNTY INC YVONNS LIGGETT 31296 917 2R ACXE. UM OLVV Contact Telephono Numjer : VERA BEACHt FL 32963 ( 877 ) 825 - 3500 . Accounting Pnridd Ending : December 31 ; 701WI3xtInn Stattt� Clao6ificsticn : 549 ( af ( 1 ) A4vance Ruling 'Period Begins , rebruarY 4 . : 2000 Advanco Ruling p . riod ends : oeccma er 31 , 2004 _ Mder.14s:m App3ice : Nc . Dear AppliGantt , Based an irtfo =nacion you auppiicd , and aumumi.ng your vparaticr.8 will be as statG4 in yo= applieatioh for rva:.ogT, ition of exnmptical ve haa,vaa deco -pined yo -1 are exenTt t =orn federal income taxi under flection Sol ( a ) of the Internal Revenue Cvdc as an p:ganlaaLion described in section 501 ( e ) ( 3 ) BcGauae you are a newly =4ated organization , wc , arc not new making a ZInal dztcrmination of youZ foundneien statue Lmdex flebeuion 509 ( a7 of tht Code . sovwcvcr , we have cacer,nined that you can renflo..sably curet to be a puhlicly supp = ted argajairatio4 049 =461" d in sections Sot ( a ) ( 1 ) and 2- % 0 ( t ) ( 1 ) (A ) ( vi ) . Arcordi. n3ly , dur7. ng au advYncp rul, irg period you will ise tz6ated ax d publicly supported orgaraizatian , and swot ar a privAta . foup. datiar: . Mit Advasyne ruling period begins and tnds on the doter, ghovA above . within 90 days 4fter they and of your advanca ruling period , You r4 $ t se -d us the iAfgzmaGion needed Lc ¢etarmint ahethar yvu neve mot tac requi-= C - nwnts: of the applicable aupporC Cees du :: ng the advance rulinu period . If you establluh that you have been a publialy 6upported organisation , we will elasa3 - fy you xx A ooctiou S0i ( ax ) ( 1 ) or 509 ( a ) ( 2 ) organj ;atior. pc lvsng as you cont : zue to rest the rcquirc=v=t % of the opplicablc s:uppart . met . If you do not n -Wct ; he Friblic support requir® ngnts during the aarance ruling period , we will clawaify you ae a privates towWation for futuro periodo . Alva ; if we claeeifv yoU ace a private foundation , we will treat you a * R pilvaate fou:.dation : rum fovr bepinninq date for purponer of oect : on 507 ( d ) sstcl 4940 . Grantors: and contriburars may ; • 3y on our determirsation that you szc nat a private foundation watil 90 dv# y8 atter the tnd of your edvhnce rullrg rer :: od , If you tend up the required intormat7on within the 3o daya , grancors and cotntributorg may continua . o rely on the edyance determination usztil we make (,eccer 1045 ' D3 / :Gr 10 / 23 / 2004 11 : 23 5612993840 BOYS GIRLS CLUE IRC FACE 03 e a 35 - deuelu t' cte tAd KUJS rit:111k:� . ) Wh ti nL PA JW 04K. 006 - f . `4� - i - EOYS L' GIRLS CLUB Or iNDIADt RSvsR a : incl rier. eurination at your foundation atatuo . Lf we publish a natio, in chit Internal Rtvenua Bulletin dtating that r,c wt, l no longer great you iLc -a publicly supported organization , a.rantors . And contributors may not rely yn° this dcterminacion attar tke dacc we publich th< rotIce , Lr. arit'. ition , if y' >u lose your statue as a publicly ■ upporced argnni - zation , and araAtor or C = Zt 4 hutor wag ?r tor , ?r was aware of , the act or , fxi2ure C6 act , that resulted n your lost of aucj : atatus , ttwt persor may not rely on thte dotcrmii7ation from the tiate cf the act or failure to act . D• lsc , i , a yrsrltor or caatribueor learvled that we had given nnt . ce tba r you would to removr:d from clersification : c a publ : c .y supported osga.nizatioa , then that persor, may not rely tan this deterzunatior, as of the dace he or the acquired such k=Vlodge , . f You change your sauzce3 of support , your purpoxes , character , or metk:od cf opasativn , please let as kncv an we can consider Che effact of the change an your ektmpe cta m% and foundation status , If you cn%and your organizational docLyaerit or bylaws , piear+ a tend uc a Copy of the amandbd doc%jtaent or trylawr . Also , let us know + 11 chknaes in your =me or addreru . . Res o ; JsnuYry 1 , •13td , }roe are liable for social beKurity taxes under the ieders .l Insur&ncu concribliti =r Act on amounts of $ loc or more you pay to eacy of your ctrplayean :. euring a ca ]. ertdar . year . rou kxie not lia.hle for the tax imposed un: c= tko Yedezv. l Vnerrploymant Tax Xct• lrwAI . orzranizations chart arc not private foundations are cot rubjec. Lto the pr:: - v :. te faundxtion excise t,',asrer : ir:_decr Chapter 4 : of the Iutezmx.l Revenue code _ xowever , you are not: automatically exempt £xam atter fiederal excise+ taxes , if you havr, any quaacioro :about ; excisa , employment , or other federal taxis , glea0a let us: kao:a . Dcncrr nay dedleGicon_ributious to yuu to pravided in section 170 of t1u Laternal xtvenuc Code . Zequests , legacies , deviaea , r:ranefurw , or gifts to you or for your use aro doe-ucti'ble for Federal estate and tilt tax pu_`Fosdu if they mccr tile a~Ppitcable pxaviafcrt7 or seetionp 2055 , 1106 , and 2522 of the Code . Concsrz may deduce contsibutio" to you only as chit a-xrent tha,C their contai,butioae :art gifts , vith no tonsideraticn received , T�ckct purchases and et . railar rayma its in . co::ijunction wit .a fundrxi,aing evencb may not neceserarily qualify at deduktibZa . <tontribut : ons , depending on the circumatancave novanue Ruling : 67 - 2460 publiahod is Cumulaceve Sullet :: 1367 - 3 , on pavre 104 , givtec guidoelires regarding wnrr. taxpayers may deduct pay*aaaeb fez- admission to , 0 other partic 4 v: 1on• in , fundraioing acaiviticv for charity . you are stet regaii:ed to file. Farm 990 , Return of organization Exempt rrom Income Tax , . t your gross :ecviptz ae.ch year arc nornally 4' 25 , 000 or lc= a . '. 1 you receivo a Form 990 paekxget in t `at mai '_ , 8irstply attcc2r the label provided . chock thn box in thv hradina to indicate that your annual grosrr raceipra arc ;Iar•nally * 2 ! . 000 or lac, v . and ai, ca the recurn . Heeaust you wi11 be trcated rte a public cL.azl cy for resurn filing puz-pvucr during f+ -ar enure advance "ruling perzo 4 # yot: should fila Four: 990 for cash ydez in your advance tali :g period Letter 1445 ; DO /CG ; a 10 / 23 / 2004 11 : 23 561299 '?840 1 :0YS GIRLS CLUB IRC PAGE 04 P . 0e - 3 - BOYS 4 GIRLS CLUB OF INDIAN RIVER th & C you erased the $ 25 . 000 eiling threshold even if youe sou :cex of avppoz• z do nct extisfy *,he public support re0t opccffied in the headinq of thio lctrer . IE a zeturn ix requirnd , i . must he filed by Cha Isch day e ! the £ iFth month after t : ,v end o £ your annual areounCing period . A penalty of 4 : 0 a day is char" d uh4n a return is filed mate . unless there it reasonable cause foe rhe delay . Howr. ver , tho maximum Danalty charged Cc=at exceed 110 , 000 or 5 percent of you.z grovo rtceipty for the year , w1itchever is leas - For oz'gariizatiaus reith group receipts exceedina $ 1 , 000 ' 000 in any year , the penalty is 1100 per day per recur:. , unless these ie retsonable cause for the delay The maxinum, penalty for Kr: organization with gzaro receipts exceeding v1 , 0000000 ehal :o. pot exceed $ 50 , 000 . Phis penalty may also be charged if i return ie not complete , Eo , please be sure your rstum : F Complete bnlore you file. it . You are nac required to file feieral incos, e tzx returns unless you are sub ; ect to the tax on vn-related business itcotre under section 51I. of the Code , xr you art subjarcr, to this tiu: , you ;suet file an income: tax return on Form 990 - T , Exempt 0 :-ganitatior. ©-asinevs zs% come Tax Return . Its trig letter we : re not dctrrmining whether any of yeti presf= or peogoaed aotiv'itlwrl e. :k un- ' o • lacer trade or :�usiveas ae definF.d . in section 513 of the code . You are required to make your anr> Lal ir:fozmation return , Ferro 990 or Form 990 - 82 . available for public inspection .or three yo3Rre tf :, cr the later of t1ie due date of the return or the date zhw return is Piled . You are also rei::uirCd to Makes availablo fwx public invpection your exe:Mgtldn applicscioa , any support -: ag docuMents , and Your oxsmption letter . Copies of these doGwncnt`v are also " quired to be provided to any indiviaurtl upon writte^ Cr fn parson request without charge vthor tlhan reasonable fnoa for copying and postage - Yau may fsiri. 11a tbloa raquLtemant by placinci thrahe documents on the Inrar:nec . Pene :lt { eaa rosy be iaapoaed for failure to conyly with there zAKu # raK.es�ts . Additional infoarmstton y. v availeble in Publication 5e7 , T&x • txempt statue far Your Qrga.nization , or you may call our tat„ free number shown abnve . You need Ott employer idcitifica.tien number oven if you have no employees . If an employuzr number was not entered or. your application , ve will acs : go s n%AMber to you and advsce }rou of it . Please use th4t number on all returns yoti: file and in all cozrezpardsncs with the IrtRrnal RevOttqq . Serv1C � . 19 we said, '00 tha heading of this * latter that &n addandum appl .ias , the addendum encloneti is. an inr. ecjrnl pare _! f this letter . Becauge Chia letter edald help us re5olv4 any questions e.bout your exempt otatva anti tou:dation oc4rus , you should keep it in your perm= en _ records . Letter 1045 10 / 23 / 2004 11 : 23 5612993840 BOYS GIRLS CLUB IRC PAGE 05 i ` • BOYS GZR14:3 =tB GP :27!? I :,N RLv$ q if )vu haves any qurstions , pluavc Connact the Persson whose norm and tt : cp tare nurroLer are rhcwm in tae heading a4 this : ercer . fiincc :e3y ycuz.a , never . ; . Miller Dirac � � z , Lx® rcpt prgani . xcidn� E_tc �u :� uSE ( cf �'r7tnt 8 ii ' O Lector 7onz. : 135